MONDAY, Jan. 9 (HealthDay News) — There’s limited evidence that
any particular diet or supplement helps kids with
attention-deficit/hyperactivity disorder (ADHD), but at least some
research suggests that omega-3 fatty acids may help while fatty
“Western-style” diets do these children no favors.
Researchers from Children’s Memorial Hospital in Chicago reviewed
previous studies on diets and supplements that have been tried in children
with ADHD. Among the diets tested: restricting sugar, which some parents
believe worsens hyperactivity; avoiding food containing additives and
preservatives, known as the “Feingold diet“; an “elimination diet” that
avoids foods most often implicated in food allergies; and supplementing
with omega-3 fatty acids, such as fish oil capsules.
Little research supports the idea that sugar or artificial sweeteners
affect children’s behavior, according to the review. Nor is there much
evidence from controlled trials to support the Feingold diet, which first
became popular in the 1970s and advocates avoiding food that contains red
and orange dyes and preservatives (including apples, grapes and lunch
meats).
Yet, some studies have suggested some kids with ADHD benefit from an
elimination, also known as a hypoallergenic, diet. But that typically
means forgoing cow’s milk, cheese, wheat cereal, eggs, chocolate, nuts and
citrus foods, which can be tough on the child and on the family, said
study author Dr. J. Gordon Millichap, a professor emeritus at Northwestern
University Medical School and neurologist at Children’s Memorial Hospital
in Chicago.
Moreover, the results of studies on hypoallergenic diets have been
mixed. “We find the hypoallergenic diet might be effective, but difficult
for families to manage them,” Millichap said.
One study by Australian researchers suggested that kids who ate a
typical “Western-style” diet that’s high in fat, salt and refined sugars
had a higher risk of ADHD than kids who had a healthier diet that was rich
in fish, vegetables, fruit and whole grains and that contained lots of
fiber, folate and omega-3 fatty acids.
Dr. Roberto Lopez-Alberola, an associate professor and chief of
pediatric neurology at University of Miami School of Medicine, said he
strongly advocates children with ADHD following such a healthier diet and
avoiding dyes, preservatives and other additives.
Though the precise biological mechanism hasn’t yet been uncovered,
Lopez-Alberola believes the increase in obesity rates and in ADHD are not
unrelated, and unhealthy modern diets may be contributing to the
problem.
“I am a firm believer that we ultimately are what we eat, and
unfortunately as a result of our poor Western diet, we see this in the
increase in the rate of obesity, particularly in the young population,”
Lopez-Alberola said. “The fast foods. The processed food. The
preservative-rich foods . . . In the same way we see an impact physically,
it’s going to have an impact from the neurodevelopmental standpoint. It’s
not surprising we see a parallel in the increase in obesity and in
ADHD.”
Another study, conducted by researchers in England in children who were
excessively clumsy — some of whom also had ADHD — found that omega-3
supplements didn’t help with motor skills, but did seem to help with
attention.
Other research has found that many kids with ADHD had unusually low
levels of iron in the blood. One Israeli study found that the parents of
kids given iron supplements reported less ADHD symptoms in their kids, but
teachers saw no such effect.
Therein lies much of the problem with research that looks at dietary
interventions for ADHD, said Dr. Andrew Adesman, chief of developmental
and behavioral pediatrics at Steven Alexandra Cohen Children’s
Medical Center of New York.
The placebo effect can be powerful. Much of the research on dietary
interventions compares dietary interventions to no treatment, while
there’s little research that compares a diet to stimulant medications such
as Ritalin (methylphenidate) or Adderall (dextroamphetamine and
amphetamine), which have decades of research showing that they’re
effective in kids with ADHD, Adesman said.
“For better or worse, medications are the single most effective
treatment available for ADHD,” Adesman said. “We don’t have data to
suggest dietary interventions are any more effective than medications, and
there is little, if any, data to suggest dietary interventions are
as effective as medications.”
The review is published in the February issue of Pediatrics.
ADHD affects an estimated 5 percent to 8 percent of school-aged
children. Symptoms, which often persist into adulthood, include
inattention, hyperactivity and impulsivity beyond what’s normally seen,
given a child’s age and development.
Understandably, many parents are reluctant to medicate their young
children, and so there’s lots of interest in alternative treatments,
experts said.
“We do find parents are becoming more interested in the possibility of
using diets rather than, or as a complement to, medication,” Millichap
said.
While the first line of treatment for ADHD is medication and behavioral
therapy, which uses positive reinforcement to help kids learn to control
impulsivity, parents who want to try dietary interventions should be
supported in their efforts, Millichap said.
“Diets can be used in the treatment of ADHD, but it’s usually not a
first choice with most parents,” he said. “But some parents prefer it and
don’t like medications at all. That’s one of the reasons for considering
the diets. Another is if there are side effects or adverse effects from
the medications. Then one might turn to dietary treatments.”
Added Adesman: “Families are welcome to explore and pursue alternative
approaches, but they need to recognize that oftentimes there is limited
research to support or justify their use and the benefits will likely be
less substantial than conventional treatment.”
More information
The U.S. National Institute of Mental Health has more on
ADHD.
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