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What Role Does Nutrition Play in ADHD?

Food

There's no evidence that the behavioral disorder ADHD is caused by diet.

However, research suggests that for some people, dietary changes can improve symptoms.

In fact, a substantial amount of research has examined how nutrition affects ADHD.

This article is an overview of these findings, discussing the foods, diets and supplements involved.

ADHD is a complicated behavioral disorder and common treatments include therapy and medication.

What Is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a behavioral condition involving inattention, hyperactivity and impulsiveness (1, 2).

It's one of the most common disorders children can have, but also affects many adults (3, 4).

The exact cause of ADHD is unclear, but research shows that genetics play a major role. Other factors, such as environmental toxicity and poor nutrition during infancy, have also been implicated (5, 6, 7, 8).

ADHD is believed to originate from low levels of dopamine and noradrenaline in the region of the brain responsible for self-regulation (9, 10, 11).

When these functions are impaired, people struggle to complete tasks, perceive time, stay focused and curb inappropriate behavior (12, 13, 14).

This, in turn, affects the ability to work, do well in school and maintain appropriate relationships, which can decrease quality of life (15, 16, 17, 18, 19).

ADHD is not considered to be a curable disorder and treatment instead aims to reduce symptoms. Behavioral therapy and medication are mostly used (20, 21).

However, dietary changes may also help manage symptoms (1, 22).

Bottom Line: ADHD is a complicated behavioral disorder and common treatments include therapy and medication. Dietary changes may also be useful.

Nutrition and Behavior

The science behind food's effects on behavior is still quite new and controversial. However, everyone can agree that certain foods do affect behavior.

For example, caffeine can increase alertness, chocolate can affect mood and alcohol can totally change behavior (23).

Nutritional deficiencies can also affect behavior. One study concluded that taking a supplement of essential fatty acids, vitamins and minerals led to a significant reduction in antisocial behavior, compared to a placebo (24).

Vitamin and mineral supplements can also reduce antisocial behavior in children and poly-unsaturated fatty acids have been shown to decrease violence (25, 26).

Since foods and supplements have been shown to influence behavior, it seems plausible that they could also affect ADHD symptoms, which are largely behavioral.

For this reason, a good amount of nutrition research has looked into the effects of foods and supplements on ADHD.

Mostly, two types of studies have been performed:

  • Supplement studies: Supplementing with one or several nutrients.
  • Elimination studies: Eliminating one or several ingredients from the diet.

Bottom Line: Studies show that certain foods and supplements do affect behavior. For these reasons, quite a few studies have looked into how nutrition affects ADHD symptoms, which are mostly behavioral.

Supplement Studies: A Research Review

Many studies have shown that children with ADHD often have unhealthy eating habits or nutrient deficiencies (27, 28, 29, 30).

This caused researchers to speculate that supplements might help improve symptoms.

Nutrition studies have looked into the effects of several supplements on ADHD symptoms, including amino acids, vitamins, minerals and omega-3 fatty acids.

Amino Acid Supplements

Every cell in your body needs amino acids to function. Among other things, amino acids are used to make neurotransmitters or signaling molecules in the brain.

In particular, the amino acids phenylalanine, tyrosine and tryptophan are used to make the neurotransmitters dopamine, serotonin and norepinephrine.

People with ADHD have been shown to have problems with these neurotransmitters, as well as low blood and urine levels of these amino acids (31, 32).

For this reason, a few trials have examined how amino acid supplements affect ADHD symptoms in children.

Tyrosine and s-adenosylmethionine supplements have provided mixed results, with some studies showing no effects and others showing modest benefits (33, 34, 35).

Bottom Line: Amino acid supplements for ADHD show some promise, but more studies need to be done. For now, the results are mixed.

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Vitamin and Mineral Supplements

Iron and zinc deficiencies can cause cognitive impairment in all children, whether or not they have ADHD (36, 37, 38).

However, lower levels of zinc, magnesium, calcium and phosphorous have repeatedly been reported in children with ADHD (39, 40, 41).

Several trials have looked into the effects of zinc supplements and all of them reported improvements in symptoms (42, 43, 44).

Another two trials assessed the effects of iron supplements on children with ADHD. They also found improvements, but again, more research is needed (45, 46).

The effects of mega-doses of vitamins B6, B5, B3 and C have also been examined, but no improvements to ADHD symptoms were reported (47, 48).

Nevertheless, a 2014 trial of a multivitamin and mineral supplement did find an effect. The adults taking the supplement showed a convincing improvement on ADHD rating scales after 8 weeks, compared to the placebo group (49, 50).

Bottom Line: The results from vitamin and mineral supplement studies have been mixed, but several show promise.

Omega-3 Fatty Acid Supplements

Omega-3 fatty acids play important roles in the brain.

Children with ADHD generally have lower levels of omega-3 fatty acids than children who don't have ADHD (51, 52).

What's more, the lower their omega-3 levels, the more learning and behavioral problems the ADHD children seem to have (53).

Therefore, it's not surprising that many studies have found omega-3 supplements to cause modest improvements to ADHD symptoms (54, 55, 56, 57, 58).

In studies, omega-3 fatty acids appear to help improve task completion and inattention. Additionally, they decreased aggression, restlessness, impulsiveness and hyperactivity (59, 60, 61, 62, 63, 64, 65).

Bottom Line: Numerous trials have found that omega-3 supplements can bring about modest improvements in ADHD symptoms.

Elimination Studies: A Research Review

People with ADHD are more likely to have adverse reactions to food, which caused speculation that eliminating problematic foods might help improve symptoms (30, 66).

Studies have examined the effects of eliminating many ingredients, including food additives, preservatives, sweeteners and allergenic foods.

Eliminating Salicylates and Food Additives

By accident, an allergist named Dr. Feingold discovered that food could affect behavior.

In the 1970s, he prescribed a diet for his patients that eliminated certain ingredients that produced a reaction for them.

The diet was free of salicylates, which are compounds found in many foods, medications and food additives.

While on the diet, some of Feingold's patients noted an improvement in their behavioral problems.

Soon after, Feingold started recruiting children diagnosed with hyperactivity for dietary experiments. He claimed that 30–50 percent of them improved on the diet (67).

His work was celebrated by many parents, who formed the still-existent Feingold Association of the U.S. (68).

Although reviews concluded the Feingold diet was not an effective intervention for hyperactivity, it stimulated further research into the effects of food and additive elimination on ADHD (69, 70, 71).

Bottom Line: The Feingold diet pioneered elimination diet research for ADHD. It improved symptoms in children with ADHD, although recent evidence is mixed.

Eliminating Artificial Colors and Preservatives

After the Feingold diet was no longer considered effective, researchers narrowed their focus to look at artificial food colors (AFCs) and preservatives.

This is because these substances seem to affect the behavior of children, regardless of whether or not they have ADHD (72, 73).

One study followed 800 children suspected of hyperactivity. 75 percent of them improved while on an AFC-free diet, but relapsed once given AFCs again (74).

Another study found that hyperactivity was increased when 1,873 children consumed AFCs and sodium benzoate, a preservative (75).

Yet even though these studies indicate that AFCs can increase hyperactivity, many people claim the evidence is not strong enough (1, 54, 76, 77, 78, 79).

Nonetheless, the Food and Drug Administration (FDA) requires certain AFCs to be listed on food packages. The EU, on the other hand, requires foods containing AFCs to have a label warning of adverse effects to children's attention and behavior (80, 81, 82, 83).

Bottom Line: AFCs may affect behavior in children, although some say the evidence is not strong enough. However, the FDA and the EU require food labels to list additives.

Eliminating Sugar and Artificial Sweeteners

Soft drinks have been linked to increased hyperactivity and low blood sugar is also common in those with ADHD (84, 85).

Furthermore, some observational studies have found sugar intake to be related to ADHD symptoms in children and adolescents (86, 87).

However, one review looking into sugar and behavior found no effects. Two trials studying the artificial sweetener aspartame also found no effects (88, 89, 90).

Theoretically, it's more likely that sugar causes inattention, rather than hyperactivity, as blood sugar imbalances can cause attention levels to drop.

Bottom Line: Sugar and artificial sweeteners have not been shown to directly affect ADHD. However, they may have indirect effects.

The Few Foods Elimination Diet

The Few Foods Elimination Diet is a method that tests how people with ADHD respond to foods. Here's how it works:

  • Elimination: Follow a very restricted diet of low-allergen foods that are unlikely to cause adverse effects. If symptoms get better, enter the next phase.
  • Reintroduction: Foods suspected of causing adverse effects are reintroduced every 3–7 days. If symptoms return, the food is identified as “sensitizing."
  • Treatment: A personal dietary protocol is prescribed. It avoids sensitizing foods as much as possible, in order to minimize symptoms.

Twelve different studies have tested this diet, each of which lasted 1–5 weeks and included 21–50 children.

Eleven of the studies found a statistically significant decrease in ADHD symptoms in 50–80 percent of the participants, while the other one found improvements in 24 percent of the children (91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102).

Of the children who responded to the diet, most reacted to more than one food. While this reaction varied by individual, cow's milk and wheat were the most common offenders (92, 94, 100).

The reason why this diet works for some children and not others is unknown.

Bottom Line: The Few Foods Elimination Diet is a diagnostic tool to rule out problems with food. All studies have found a favorable effect in a subgroup of children, usually more than half.

Take Home Message

Research about how food affects ADHD symptoms is far from conclusive.

Yet the studies mentioned here suggest that diet can definitely have powerful effects on behavior.

This article was reposted from our media associate Authority Nutrition.

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New research shows that there's actually a larger quantity of plastic in the ocean than previously thought. Susan White / USFWS / Flickr / CC by 2.0

By Elizabeth Claire Alberts

In 1997, Charles Moore was sailing a catamaran from Hawaii to California when he and his crew got stuck in windless waters in the North Pacific Ocean. As they motored along, searching for a breeze to fill their sails, Moore noticed that the ocean was speckled with "odd bits and flakes," as he describes it in his book, Plastic Ocean. It was plastic: drinking bottles, fishing nets, and countless pieces of broken-down objects.

"It wasn't an eureka moment … I didn't come across a mountain of trash," Moore told Mongabay. "But there was this feeling of unease that this material had got [as] far from human civilization as it possibly could."

Captain Charles Moore looking at a piece of floating plastic in the ocean. Algalita Marine Research and Education

Moore, credited as the person who discovered what's now known as the Great Pacific Garbage Patch, returned to the same spot two years later on a citizen science mission. When he and his crew collected water samples, they found that, along with larger "macroplastics," the seawater was swirling with tiny plastic particles: microplastics, which are defined as anything smaller than 5 millimeters but bigger than 1 micron, which is 1/1000th of a millimeter. Microplastics can form when larger pieces of plastics break down into small particles, or when tiny, microscopic fibers detach from polyester clothing or synthetic fishing gear. Other microplastics are deliberately manufactured, such as the tiny plastic beads in exfoliating cleaners.

"That's when we really had the eureka moment," Moore said. "When we pulled in that first trawl, which was outside of what we thought was going to be the center [of the gyre], and found it was full of plastic. Then we realized, 'Wow, this is a serious situation.'"

Captain Charles Moore holding up a jar of plastic-filled seawater from a research expedition in 2009. Algalita Marine Research and Education

Since Moore's discovery of the plastic-swirling gyres, there's been a growing amount of research to try and understand the scale of the plastic pollution issue, including several studies from 2020. This new research shows that there's actually a larger quantity of plastic in the ocean than previously thought, and that the plastic even enters the atmosphere and blows back onto land with the sea breeze. Recent studies also indicate that plastic is infiltrating our bodies through food and drinking water. The upshot is that plastic is ubiquitous in the ocean, air, food supply, and even in our own bodies. The new picture that is emerging, scientists say, is of a biosphere permeated with plastic particles right down to the very tissues of humans and other living things, with consequences both known and unknown for the lifeforms on our planet.

How Much Is Really in the Ocean?

In the past 70 years, virgin plastic production has increased 200-fold, and has grown at a rate of 4% each year since 2000, according to a 2017 study in Science Advances. Only a small portion of plastics are recycled, and about a third of all plastic waste ends up in nature, another study suggests.

While new research indicates that plastic is leaking into every part of the natural world, the ocean has long been a focal point of the plastic pollution issue. But how much is actually in the sea?

Moore says it's "virtually impossible" to get an accurate estimate because of the ongoing production of plastic, and the tendency for plastic to break down into microplastics.

"This count is constantly increasing, and it's increasing at a very rapid rate," he said. "It's a moving target."

One commonly cited study, for which Moore acted as a co-author, estimated that there are more than 5.25 trillion plastic pieces floating in the ocean, weighing more than 250,000 tons, based on water samples and visual surveys conducted on 24 expeditions in five subtropical gyres. But even at the time of publication in 2014, Moore said he knew "that was an underestimate."

A more recent study published this year, led by researchers at Plymouth Marine Laboratory, indicates that there's a lot more microplastic in the ocean than we previously thought. When taking samples from the ocean, most researchers use nets with a mesh size of 333 microns, which is small enough to catch microplastics, but big enough to avoid clogging. But the team from Plymouth Marine Laboratory used much finer 100-micron nets to sample the surface waters in the Gulf of Mexico and the English Channel.

"Our nets clogged too, so we used shorter trawls and a specialized technique for removing all the plankton — microscopic plants and biota — from the sample to reveal the microplastics," Matthew Cole, a marine ecologist at Plymouth Marine Laboratory and author of the study, told Mongabay in an email. "This process is quite time-consuming, so it'd be challenging for all samples collected to be treated this way."

The research team at Plymouth Marine Laboratory collecting water samples. Matthew Cole

The researchers found there were 2.5 to 10 times more microplastics in their samples compared to samples that used 333-micron nets.

"If this relationship held true throughout the global ocean, we can multiply existing global microplastic concentrations ascertained using 333-micron nets, to predict that globally there are 125 trillion plastics floating in the ocean," Cole said. "However, we know these plastics keep on degrading, and these smaller plastics would be missed by our smaller 100 micron net — so the true number will be far greater."

Another team of researchers delved down to the seafloor in the Tyrrhenian Sea in the Mediterranean to take sediment samples. They found that microplastic accumulated at depths of 600 to 900 meters (about 2,000 to 3,000 feet), and that certain spots in the ocean, termed "microplastic hotspots," could hold up to 1.9 million pieces per square meter — the highest level ever to be recorded on the seafloor. The results of this study were published in Science in June 2020.

"We were shocked by the sheer number of [microplastics]," Ian Kane, the study's lead author, told Mongabay in May. "1.9 million is enormous. Previous studies have documented much smaller numbers, and … just talked about plastic fragments, but it's fibers that are really the more insidious of the microplastics. These are the things that are more readily consumed and absorbed into organisms' flesh."

A water sample containing plastic. Algalita Marine Research and Education

While these studies shine light on the fact that there's definitely more plastic in the ocean than we think, it still doesn't complete the picture, says Steve Allen, a microplastic expert and doctoral candidate at the University of Strathclyde in the U.K. Large quantities of microplastics still appear to be "missing" from the ocean, he said. For instance, one study suggested that 99.8% of oceanic plastic sinks below the ocean surface layer, making it difficult to detect, but Allen says this doesn't fully explain what's happening to all of the plastic that enters the ocean.

"We're finding some of it," Allen told Mongabay. "But we're … trying to explain where the rest of it went."

Allen and his wife, fellow scientist Deonie Allen, also from the University of Strathclyde, have been working to find their answer, or at least part of it, in an unlikely place: up in the sky.

‘Microplastics Are in Our Air’

As the ocean churns and breaks waves, air is trapped in tiny bubbles. When those bubbles break at the sea's surface, water rushes to fill the void, and this causes tiny, micro-sized particles, like flecks of sea salt or bacteria, to burst into the atmosphere. A new study, published in PLOS ONE, suggests that microplastics are entering the air in the same way.

"[Bubbles] act a little bit like velcro," Deonie Allen told Mongabay. "Rather than the bubble going through the plastic soup and coming to the surface and not bringing any of the plastics with it, it actually collects [the plastic] and hangs on to it as it comes up. And when it bursts, the energy from the creation of the jet to fill the hole that's left in the sea … is what gives it the force to eject the plastic up into the atmosphere."

A lot of previous research on plastic pollution in the ocean has assumed that plastic remains in the seawater and sediment, or gets washed ashore. But this study takes a pioneering step to suggest that ocean plastic is entering the atmosphere through the sea breeze.

"This was just the next logical step to see whether what we're putting into the ocean was actually going to stay there, or whether it would come back," Steve Allen said.

A device used to collect air and mist samples to test for microplastics. Steve Allen

To obtain the necessary data for this study, the research team collected air and sea spray samples on the French Atlantic coast, both onshore and offshore. They found that there was a high potential for ocean microplastics to be released into the air, and suggested that each year, 136,000 tons of microplastics were blowing ashore across the world, although Steve Allen said this number was "extremely conservative."

This study specifically looked at microplastics, but the much smaller nanoplastics are likely going into air by the same means, according to the Allens. But detecting nanoplastics in the water or air can be challenging.

While this is the first study to look at the ocean as a source of atmospheric plastics, other research has examined the capacity of land-based plastics to leach into the air. One study, authored by the Allens and other researchers, found that microplastics were present in the air in the Pyrenees Mountains between France and Spain, even though the testing site was at least 90 kilometers (56 miles) from any land-based source of plastic, such as a landfill. This suggests that the wind can carry microplastics over long distances.

"We know that microplastics are in our air everywhere, from the looks of it," Deonie Allen said.

More research needs to be done to understand the implications of atmospheric microplastics on human health, but according to the Allens, it can't be good for us.

A "cloud catcher" used to collect data for research on microplastics in the atmosphere. Steve Allen

"Microplastics are really good at picking up the contaminants in the surrounding environment — phthalates, flame retardants, heavy metals," Deonie Allen said. "That will get released into the body, relatively effectively."

Enrique Ortiz, a Washington, D.C.-based ecologist and journalist who writes on the plastic pollution issue, says that this evidence should be a "wake up" call to humanity.

"The oceans are picking up the plastic that we throw in it, and that's what we're breathing," Ortiz told Mongabay "And that's the part that really … amazes me."

"But it's not just happening in coastal cities," he added. "No matter where you go, [even] in the middle of the Arctic … the human imprint is already there."

We're not just inhaling microplastics through the air we breathe — we're also getting it through the water we drink and the food we eat.

‘Our Life Is Plasticized’

Plastic waste isn't just leaking into the ocean; it's also polluting freshwater systems and even raining or snowing down from the sky after getting absorbed into the atmosphere, according to another study led by Steve and Deonie Allen. With microplastics being so ubiquitous, it should come as no surprise that they are also present in the food and water we drink.

Drinking water, including tap and bottled water, is the largest source of plastic in our diet, with the average person consuming about 1,769 tiny microplastic particles each week, according to a 2019 report supported by WWF. Other primary sources of microplastics include shellfish, beer and salt.

A new study published this year in Environmental Research found that microplastics were even present in common fruits and vegetables. Apples had one of the highest microplastic counts, with an average of 195,500 plastic particles per gram, while broccoli and carrots averaged more than 100,000 particles per gram.

"The possibility of plastics in our fruit and vegetables is extremely alarming," John Hocevar, ocean campaign director for Greenpeace USA, said in a statement. "This should prompt additional studies to assess how much plastic we are consuming through our produce each day and examine how it is impacting our health."

"Decades of plastic use have contaminated our air, water, and soil," Hocevar added. "Eating just a bite of an apple could now mean eating hundreds of thousands of bits of plastic at the same time."

Through normal water and food consumption, it's estimated that the average person consumes about 5 grams of plastic each week, equivalent to the size of a credit card, according to the WWF report.

"Plastic is everywhere," Thava Palanisami, a microplastics researcher at the University of Newcastle, Australia, and contributor to the WWF report, told Mongabay. "We live with plastic and our life is plasticized — that we know. But we don't know what it does to human health. That's the biggest question mark."

While it's not entirely clear how plastic affects human health, research suggests that the inhalation of fibrous microplastics can lead to respiratory tract inflammation. And another study, referenced in the WWF report, shows that fish and other marine animals with high concentrations of microplastics in their respiratory and digestive tracts have much higher mortality rates. Another study, published in 2020, indicates that plastic accumulates in the muscle tissue of fish.

"If you look at what happens, for example, in fish — it [plastic] stays in their muscles," Ortiz said. "It's scary. If you look at the numbers, you're eating something in the order of one kilo of plastic every three years. I wonder, in our lifetime … if a percentage of our weight will be plastic that is still in our muscles."

"The problem is serious," Palanisami said. "We've got to stop using unwanted plastic and manage plastic waste properly, and … work on new plastic alternates."

Stemming the Tide  

Erin Simon, head of plastic waste and business at WWF, and leader of the organization's packaging and material science program, says the key to curbing the plastic pollution issue is making sure that plastic doesn't leak into nature in the first place.

"If you had a leaky faucet, would you bring out the mop first, or would you turn off the water?" Simon told Mongabay. "We're trying to stem that tide of plastic flowing into the ocean and into nature in general … but at the same time, trying to identify the different root causes of that leakage."

While Simon says there are various ways to try and stop plastic from entering the natural world, such as well-managed recycling and composting programs, she also said that large companies can play a critical role in helping to reduce plastic waste. WWF is currently spearheading a new program called ReSource, launched in 2019, that helps analyze companies' plastic footprints in order to work toward sustainable solutions. The program's website says 100 companies could prevent 50 million tons of plastic waste.

"We have three targets that we're looking at when we're partnering with companies," Simon said. "One, get rid of what you don't need. At the end of the day, we do need to reduce our demand for virgin nonrenewable plastic. Once you get rid of that, you think about the stuff that you do need — the things [for which] plastic is the right material choice. Where am I sourcing that from? Am I getting it from recycled content? Am I getting it from a sustainably-sourced bio base, or is it virgin non-renewable [plastic]? And then finally … how are you, as a company … making sure it comes back? Are you designing it in a way that it's technically recyclable into the places that it's ending up?"

Marine debris litters a beach on Laysan Island in the Hawaiian Islands National Wildlife Refuge, where it washed ashore. Susan White / USFWS

While recycled plastic may seem like a satisfactory alternative to virgin plastic, a new study, published in July 2020, showed that children's toys made out of recycled plastic contained high levels of toxic chemicals, comparable to levels found in hazardous waste.

Moore, who has been studying plastic pollution since his discovery of the floating debris in the North Pacific Ocean, says he doesn't believe there's an easy fix to this issue, especially when it comes to the businesses that are producing large amounts of plastic.

"There's no change that corporations can make under the current system that will successfully combat plastic pollution," Moore said. "There is no technical fix to the plastic problem. It's not in the corporate portfolio to reduce sales of your products — the corporate portfolio is about increasing sales. The idea that [corporations] can be convinced to reduce their production and sale of the products that they make is a fantasy."

However, Moore says a solution could be found in "radical change," and that this moment of time, with the Black Lives Matter movement spreading across the world, could provide the opportunity for that change.

"Now is the time when a world historical revolution would be possible, when the people of the world could unite to change the system as a whole," Moore said.

"There won't be a techno fix and science won't develop … a new product that will get us out of the problem of plastic pollution," he said. "It will only come with the world as a whole agreeing to charter a new course towards a non-polluting future."

Reposted with permission from Mongabay.

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