Aidan:
Hello and welcome to the ideal nutrition podcast. My name is Ed Muir and I’m here with my co -host Leah Higl and this is episode 127 where we will be talking about nutrition for ADHD. This is probably one of the most requested topics we’ve had. Have we had anything more than this do reckon?
Leah:
I think this is probably a top one, top contender.
Aidan:
I’ve kind of shied away from the topic because I knew it was going to be a very deep rabbit hole and a lot to go through and it’s taken up a lot of my time which is…
I don’t know, time’s pretty valuable to me right now, but I’ve been really looking forward to this and I’ve done a massive deep dive, so I want to put out a bunch of content on this. So I’m looking forward to this. One of the other reasons why I had shied away from this though, is because it’s a tricky space to navigate in terms of how much does nutrition help with this? That’s something that we probably want to add heaps of context to as we go. But one of the clear things is nutrition won’t quote unquote cure ADHD, but it can play a role.
I really just want to focus on the areas where it can play a role, the things that we can do and everything like that, and put out a bunch of info where you can kind of take what you want from this in terms of using things that would be helpful for you. In terms of this, for this specific podcast, we’re going to be splitting things up into five subcategories.
We’re going to be talking about nutrients of interest, logistical challenges, elimination diets, thoughts on food colours, thoughts on sugar. We’ll see how long this ends up going. Maybe split into two parts. We’ll try and get done in one. If we split it up to two, it is what it is. But those are going to be the five categories we’ll go through.
Leah:
So we’ll start off with the nutrients of interest. We’ll go over them briefly one by one. But there are a lot of nutrients that are common deficiency in those with ADHD. This does create a scenario where we’re like, it like the chicken or the egg?
Does the deficiency come first and then make like the ADHD symptoms worse or is it a symptom of the ADHD itself or is it kind of like this two -way street? And it probably depends on the specific nutrient we’re talking about. But going through them one by one, we will start with iron. So looking at the research, addressing iron deficiency if you have ADHD can pretty drastically help with symptom management.
For example, one small study found that 84 % of children with ADHD were low in ferritin versus 18 % in a control group. So we know there is some link between having ADHD and there’s more risk of having iron deficiency, but we also know that addressing this iron deficiency can improve symptoms. So again, can go both ways.
Aidan:
At minimum, it’s probably worth getting a blood test just to see. That would be the same for a lot of these things as well. But it’s hard to say whether that 84 % number is a bit of over -representation or not, but it’s so clear that there is a big difference and it’s worth checking for.
Leah:
Definitely worth checking for.
Aidan:
The next one we’ll talk through is Omega 3s. So a systematic review looking at pretty much all of the research on this topic found that 13 out of 16 studies on Omega 3 and Omega 6 supplementation found improvements in symptoms.
I think this is a bit of a simple one. If dietary omega -3 intake is not overly high, increasing that makes sense, whether that’s through food or supplements. There are some mechanisms as to how this could help. The proposed mechanism mainly is that it helps with transmission of chemical messages in the brain and it also reduces oxidative stress. But at a minimum, if you have a low intake, it probably makes sense to increase that.
Leah:
Yeah, moving on to zinc. Supplementing zinc, if there is a deficiency, again, can help. So very similar to iron. If there is a deficiency, it can be helpful to look at rectifying that. Again, another decent thing to be screening for. Every study that has been done on zinc supplementation, ADHD has found a benefit in symptoms. So I don’t know, when you were looking through the zinc stuff, was there a higher prevalence of zinc deficiency in ADHD like iron or it’s like a bit? I
Aidan:
t’s harder because it’s not as commonly screened for. Like if you’ve got a blood test looking stuff, don’t really get the zinc on there as often. that’s kind of why.
It’s worth noting that all of the studies that have been done on zinc supplementation did find improvements as well.
Leah:
Yeah, 100%. So again, we’re screening for and if there is a deficiency, rectifying it.
Aidan:
And for anyone listening as well, all of these studies are mentioned in the show notes as well. So if you did want to check any of this stuff out, it is in there as well. Vitamin D supplementation, if addressing a deficiency, likely helps. The research is way weaker in this area. I don’t want to hype this up too much, but the research that’s on the topic has shown improvements.
At least one study comes to mind where they were doing it alongside medication and it improved the effectiveness of the medication. So I’m always begun addressing vitamin D deficiency anyway. It’s something that’s relatively common just in general. So once again, testing that makes sense.
Leah:
Yeah. Talking about another deficiency though, that is more common in people with ADHD, that is magnesium. So people with ADHD do tend to have lower magnesium levels at least compared to those that don’t have ADHD.
Therefore again, supplementation of magnesium is going to be perhaps like very beneficial in this scenario and may help improve symptoms like inattention, hyperactivity and impulsivity in those with magnesium deficiency. So once again, screening for it is a good idea.
Aidan:
One of the things that sucks about magnesium deficiency is it’s harder to screen for, like you can’t just get a blood test. 100%. Like I would wager that if we looked at just blood tests like magnesium deficiency would still be quite rare. if we’re looking at like a cellular level so to speak, it’s quite common just in the general public as well.
Leah:
Yeah, I guess if the only way to really for us to screen for it is really looking through someone’s diet and looking at dietary quality would be easiest.
Aidan:
B vitamins is an interesting space and I think it’s just a space where more research would be relevant like all of these spaces, right?There’s very clear research that people with ADHD have lower levels and lower intakes of certain B vitamins, particularly B2, B6, B9, and B12 as well. But there’s not much research supporting that addressing that has actually shown improved symptoms, which brings you back to the chicken or the egg scenario. Everything we’ve mentioned so far, we have evidence that if you do increase your intake of those, it does lead to improvements in symptoms. With B vitamins, it’s not as clear cut.
Leah:
And the final one from a micronutrient point of view that we want to touch on is just multivitamins. As a clear sign that micronutrients definitely do matter in this space, there are two studies that have been done on multivitamins that both have found benefits in taking a multivitamin with ADHD and symptom management. So I think that just gives us an overall idea of like this stuff does matter for the management of ADHD. And overall having good dietary quality, rectifying deficiencies is going to be important.
Aidan:
I want to start with all the micronutrients because I personally found that very fascinating. Like some of the stuff I knew obviously before going into this, I’m not going to say I didn’t know anything, like, like the iron stuff, like that’s crazy. Like 84 % of children in that study. wasn’t a massive study, but like there’s so many things that are worth looking at. How much will this move the needle? Like it’s hard to say, like it’s not going to be an absolute game changer, but even a little bit of help for something as simple as for example, taking multivitamin is an easy win as well.
Leah:
The next thing we want to touch on is the logistical challenges that can come with nutrition and ADHD. And this is a pretty long list. Look, not all of these are going to be relevant to everyone. Obviously, it depends on how ADHD presents in a person. This can differ whether you’re male, female, what age you are, and just individual circumstances. again, may not all be relevant, but things that we would think about or
As someone, I work with lot of ADHD clients, a lot of neurodivergent clients, and a lot of these come up super frequently in our things that we do have to work through. So the first one is poor appetite. I find that this can present in many ways. The first is having like a poor appetite during the start of the day, or maybe the fact that someone’s more hyper -focused on work or a particular task during the day and are not aware of the appetite signals and then potentially having a higher appetite of a night time.
There’s also the logistical challenge of stimulant medication like dexamphetamine that can suppress your appetite and then once it wears off, appetite increases. A lot of these issues around appetite management and medications have been linked with things like binge eating disorder and emotional eating that can be present in people with ADHD. And again, this is something that I have seen in a lot of my clients and things we’ve had to work through, particularly kind of that Venn diagram between binge eating disorder and having ADHD, particularly when there are these medications involved. So that in itself can be a really hard logistical challenge when you do have ADHD potentially.
Talking a little bit back to the hyper focus is just generally forgetting to eat during the day. So even if there’s not this lack of appetite, it’s this total lack of awareness of appetite and even satiety signals that can make nutrition very challenging and appetite management very challenging. And this can result in both under eating and over eating depending on how it presents in the person.
Another one that is again quite common with ADHD is different kinds of digestive problems and food sensitivities. So this does tend to be more likely in people with ADHD or just neurodivergence in general it seems. And if you do have food sensitivities, if you have these digestive problems that can create a barrier to optimal nutrition and maybe something that you want to to manage working with a dietitian or someone to help you have an optimal intake, meeting all those micronutrient needs, whilst managing these particular sensitivities, or even food aversions.
So food aversions, whilst not in everyone with ADHD, it can absolutely be a symptom of ADHD, especially when you have the mix of ADHD and autism diagnosis. So you may want to work with someone to ensure that you do have a proper range of nutrients coming in through your diet. Whilst working through all these, again, logistical challenges that you may come across.
And potentially, like when it comes to those micronutrient deficiencies, these are some of the reasons why these deficiencies may occur on a more broad level in ADHD. Impulsive decision-making can also be an issue when we have someone with ADHD, particularly that kind of dopamine -seeking behaviour when that is tightly associated with food, some people really seek out food as their dopamine seeking behaviour and eating for just a general stimulation when they’re under stimulated. So we find that sometimes it can lead to unintentional weight gain and issues around chronic disease management, etc. So that’s something that we would like to look at from a logistical challenges point of view at times.
And I know this is getting long, but the final thing that I want to briefly touch on is general poor planning. When you have ADHD, you may have issues with executive dysfunction. So planning ahead can be quite a challenging thing to do. And there may be strategies you need to put in place from a food perspective to get from point A to point B in regards to your goals.
Aidan:
So we’re going to talk through some tips on how to potentially help with this. One huge caveat to go with this is like not everything in this will be useful to each individual. We’re basically gonna chuck a bunch of things out there. If there’s anything in here that’s useful for you, that’s incredible. That’s the goal. you can just take one or two things away. Hey, that’s awesome. And if you get nothing out of it, that sucks and I apologise, but we’re just trying to help where we can. I think it’s important for us to go through some of these tips in case they’re helpful. That’s kind of the goal. Some of the things might work for some of them might not or a lot of them might not, but we’re just going to do the best we can.
Leah:
Yeah, absolutely. So a huge one going on from that poor planning and preparation that might be involved in ADHD is making an effort to plan and prep everything ahead of time if possible. This strategy is going to look different for everyone, depending on so many things, your lifestyle, how the ADHD presents, and essentially even things that you may have worked through with your psychologist is being good strategies for your specific ADHD issues and utilising that for a nutrition planning strategy.
Some examples of what I guess I’ve used with people in the past is having visual reminders everywhere. So whilst we will take a specific time to plan once a week or once a fortnight is there’s no point for them having that in their phone or somewhere where it’s just completely out of sight, out of mind.
So we might have something on the fridge, we might have something on their vanity. We’ve got different queues everywhere for that kind of planning preparation point of things.
Aidan:
One that I’m big on is obviously finding what works for you, but some form of tool like checklists, reminders, alarms, maybe calendars, anything like that. the classic one of like say hyper -focusing and forgetting to like if you say you want to eat lunch at 12 p .m. if you have an alarm that goes off at 12 p .m. and it kind of pulls you out of that hyper focus like will that work for everybody? No, but I always think it’s worth trialing and just seeing if it helps.
Leah:
Yeah, and not making the assumption that it won’t work for you. Trying things is definitely important. And even one of my ADHD clients, like we actually have a session every single week where we do this planning in sessions. They have to turn up to this session every single week and we plan out their week ahead. And we’re just, work in very small snippets of time. Cause something that is beneficial for ADHD at times is what’s called body doubling in just like you need someone else there while you’re doing a task just to keep you on track. So whether it’s your dietitian or a friend or a family member, having that body double can be super helpful.
Aidan:
Something that can be hard to do, is worth always trying where possible in relation to either binge eating or potentially just going long periods of time without eating and then potentially unintentionally overeating later on is small frequent meals and snacks, prioritising breakfast. If your appetite is suppressed by medication, potentially having breakfast before the medication could be a starting point as well. Really prioritising this where possible, huge emphasis where possible, but that is something that can help with everything too.
Leah:
Yeah, and having those set small frequent meals and snacks, maybe with reminders throughout the day can be absolutely super helpful for the appetite management, especially when there’s binge eating involved. I feel like this is the first place we start is just like finding some way to get in regular meals across the day.
Aidan:
Taking nutrient supplements if relevant, like we just touched on so many nutrient deficiencies. If it’s unlikely that you’re going to get, you’re going to meet these targets through food then maybe having a soft loan could help.
Leah:
On top of that, getting enough sleep and staying well hydrated as well as reducing stress can help a lot too. When we’re managing those things effectively, executive dysfunction and those other symptoms of ADHD do tend to be less. So this kind of planning, preparation, managing nutrition, all that can be a whole lot easier.
Aidan:
And then I reckon the final thing we’ll just talk about is like just time -saving stuff where it’s like pre -cut vegetables, frozen fruit, frozen vegetables, microwavable rice even some pre -made meals and stuff like that could help too.
Leah:
Yeah, definitely a huge win.
Aidan:
Cool. Let’s talk elimination diets. This could potentially be a big one. Yeah, so we’ll see. I think we’ve got time. get through it. elimination diets have been consistently effective in research, which I think is something that a lot of people find interesting. Clearly diet does play a role in some way, or form. In fact, 10 out of 12 studies on the topic found consistent improvements when participants were on an elimination diet. For context, in 10 of those studies, 50 to 80% of participants experienced noticeable improvements and symptoms and in the 11th one, there was a 24% improvement. And then in the top, there’s like pretty much nothing, right? Those numbers are interesting because like firstly, even at the top end of that, that therefore means there are people who did not experience any benefit, but 50 to 80% is a huge number.
Leah:
It’s still a huge number of people that did help.
Aidan:
Yeah. The most effective approach so far has been what is known as an oligoantigenic diet which is basically a low food allergen diet. So diets that are low in common food allergies. For example, avoiding things like cow’s milk, cheese, eggs, chocolate, nuts, so on and so forth. There are varying levels of strictness. There’s varied forms of this dietary approach as well. But the most common one is called the few foods diet, which as the name implies, it is quite restrictive.
It involves an elimination process, reintroduction phase and personalisation phase. And depending on how you go about doing it, it can take as long as 18 months, which is insane. So we’re going to talk about this in a bit of depth because like whether you choose to pursue an elimination diet is an individual decision that I kind of want to look at from as unbiased of a perspective as I can. The first thing to factor in, the research actually looks way more promising than it actually is. What I mean by that is a lot of the studies aren’t done in a blinded fashion, as in all the participants kind of know what they’re doing. In the studies where blinding had occurred, the effect size dropped to about one third of what it was without blinding. That’s worth paying attention to because it’s like, hey, the benefit was still there. It’s just far less. We could talk about blinded versus unblinded stuff a lot, but let’s simplify just down to the placebo effect of knowing that you’re doing something will change how you report symptoms, everything like that.
The research also has only ever looked at the elimination phase, or mostly has looked at the elimination phase. We would assume that if you went through the reintroduction phase and then personalisation, you would theoretically have similar symptoms to what you had at the end of the elimination phase. But really, would you? Like, if you think about this in other areas, I would wager in most cases have slightly more symptoms in the personalisation phase than what they have at end of the elimination phase.
If we did like FODMAPS and stuff like that in IBS, like once people personalise and everything like that, their symptoms that they would report would probably be tiny bit higher than what they were at the end of the elimination phase. I could be wrong, that’s my own interpretation. But then suddenly the effect size is getting a little bit smaller as well. Now onto the important stuff. It’s restrictive and tough.
What if binge eating was a factor? I don’t know how deeply we’re talking about binge eating on the podcast, but an obvious thing that is very clear with binge eating is restriction is a bad thing for trying to overcome binge eating. Adding a layer of restriction on top of the challenges that ADHD already presents with could make things really tough. Even without binge eating being a factor, ADHD and nutrition is already tough based on all the stuff we’ve just spoken about. It would be tough to make it tougher.
There’s also levels to this in terms of like, who is the person that we are talking about? Is it an adult with ADHD looking after all of their nutrition? Is it a child with their parents looking after their nutrition? Both of them have very separate challenges and both of them experienced pretty significant challenges. And that would factor into this decision as well. And then the other thing that I think makes it tough to assess is that the best case scenario found in research was that 50 to 80% success rate in those 10 studies.
Which therefore means 20 to 50 % of people didn’t experience any benefit even after going through that tough kind of elimination phase.
Leah:
When we’re talking symptoms, is this symptoms in regards to ADHD or food sensitivities related to ADHD?
Aidan:
So ADHD in terms of like hyperactivity and stuff like that as well and attention is what they were looking at. So this wasn’t digestive stuff, this was specific to ADHD. And where like, you can kind of hear me talk through those challenges and kind hear that maybe I’m leaning a little bit away from elimination diets while also presenting the facts being like, oh, this has been beneficial for a large sample size as well, is the tough thing is it really depends on your personal situation.
In the systematic review that found like the 10 out of 12, their conclusion was that it probably doesn’t make sense to go down the route of an elimination diet, but does make sense to pay attention to your own symptoms and identify if there’s anything that is relevant for you. I don’t fully know where I stand on this, but it’s like if somebody went through an elimination diet and they had a huge improvement in symptoms, was probably the right choice for them, right? I wouldn’t have a strong opinion on that. But it’s just hard being like, if I had somebody in front of me and they asked me if it was a good idea for them, that’s where it gets really complex.
Leah:
Yeah, really, really tricky. Because I personally have never tried an elimination diet with any of my ADHD clients. We’re usually focusing more on those logistical challenge reducing overall symptoms of ADHD. So it is an interesting approach that if it works for you, amazing, but it may not work for everybody. And whether it’s worth the process is another question. All in itself.
Aidan:
I reckon we’ll wrap this up and we’ll do a part two. Part of the thing that’s prompted me is, while I was going through this process, I was looking at everything, right? So was watching Huberman, I was watching his podcast. It’s one of my like many, many, many things I was doing and he did like a two hour long podcast and all the comments are like come on, man. Like. We have ADHD. So we’re going to get this short. We’re going to wrap this up and we’ll do a part two next week.
Leah:
This has been episode 127 of the Ideal Nutrition Podcast on nutrition for ADHD. Part two coming next week. Thank you for tuning in for this week.