Psychiatrists and other mental health professionals are often asked about the role that diet and nutrition play in ADHD etiology and symptom management. This article examines the contributory role of diet on ADHD symptoms, including how the elimination of certain foods and additives, as well as the consumption of other foods or nutrients, may impact symptoms. The role of nutrient supplementation will be reviewed as well, including the potential mechanisms behind why nutrient supplementation may alleviate some symptoms of the disorder.
The role of elimination diets
Elimination diets have been a consideration in managing ADHD symptoms since the 1970s, beginning with the work of Feingold,1 a pediatric allergist, who recommended eliminating food additives such as dyes and preservatives alongside other foods. Feingold theorized that highly antigenic foods (those often associated with allergies and intolerance) negatively influenced the behavior of children with ADHD (hyperkinesis). Despite anecdotal reporting from many families that the elimination of these foods, based on Feingold’s diet, significantly improved their children’s behavior, initial results from effectiveness studies were inconclusive. In the decade that followed these mixed results, stimulant medication came to the fore as a primary treatment for ADHD, which likely contributed to diminished scientific interest in dietary interventions for ADHD.
Over the past two decades there has been renewed scientific interest in dietary interventions for ADHD. In randomized, double-blind, placebo-controlled studies from the University of Southampton, the consumption of food coloring and preservatives was found to be associated with hyperactive behavior in community samples of 3 year olds and 8 and/or 9 year olds.2,3 Although the study comprises a community rather than a clinical sample, the findings led to a reconsideration of the theoretical underpinnings of Feingold’s diet, at least for some hyperactive children.
Further investigation into the genotypes of the Southampton study participants highlighted possible mechanisms that may contribute to individual responses to food additives. Stevenson and colleagues4 suggest that in children with ADHD, histamine gene polymorphisms associated with alterations in the histaminergic system, explain differential responses to certain food additives.
Meta-analyses have shown that for about 8% of children, elimination of certain foods, additives, and food colors resulted in significant improvement in ADHD symptoms.
Dr Rucklidge is Professor of Clinical Psychology, Department of Psychology, University of Canterbury, Christchurch, New Zealand. Dr Taylor is a Research Specialist, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan. Dr Johnstone is a Research Investigator, National University of Natural Medicine, Helfgott Research Institute, and Psychologist and Clinical Researcher, Department of Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, OR.
The authors report no conflicts of interest concerning the subject matter of this article.
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