Natural Treatments for ADHD: What to Try After Medications Have Failed (2016 Edition)

The world of natural treatments for ADHD can be bewildering.  There are many treatments out there to choose from, but some are probably more likely to help than others.  What adds to the confusion is the large number of treatments that have been evaluated with one or two small trials, often generating more questions than answers about whether the treatment really worked and if it was really safe.  For most patients with ADHD, the research backing the treatments in this article is just not enough to justify a trial at home.  However, for some patients, especially those who have been unable to take medications, or have been unable to find a medication that works, these are worth consideration.

A note about this article:  I have reviewed many of these treatments in detail in separate articles on this blog.  The links to those articles (with their accompanying references) are in the heading to the corresponding paragraph in this article.

Neurofeedback.  Also known as EEG biofeedback, this therapy focuses on modifying brainwaves associated with ADHD.   While many studies have been done, the results are difficult to interpret, and it isn’t clear yet how to deliver neurofeedback to maximize its’ effects.  Despite many studies, no major side effects have been identified, so it’s likely to be quite safe.  Some insurance companies cover this treatment and some do not.

Restrictive Diet (Feingold/salicylate free/dairy free/gluten free).  The original research on the Feingold diet and similar diets is now decades old and outdated in today’s standards to the degree that it is difficult to conclude much.  A recent review of dietary treatments in ADHD suggested a 10-30 % response rate to all restrictive diets, with perhaps a 10% rate of full remission of symptoms.  On the other hand, one study of restrictive diets similar to the Feingold diet demonstrated a link to a high frequency of eating disorders in children.  With this in mind, it is important to remember to add back foods to achieve the least restrictive diet possible and to consult a dietician if multiple foods are eliminated at once.

Mineral supplements (magnesium, iron, zinc, calcium).  All of the minerals listed are linked to ADHD symptoms.  However, they can all have serious side effects if given in inappropriately high doses.  Patients should be tested for deficiency before treating with mineral supplements.

Caffeine.  While you can get caffeine without a prescription, it is a stimulant in the same class as other ADHD drugs, with all of the same side effects and a short half life.  It can be tricky to dose reliably and should not be used with other medications without a doctor’s guidance.  That being said, some people do find that a morning cup of coffee is all they need to help them get through the day, and some people do successfully use a caffeine containing drink in the afternoon as a booster to their long acting med.

Weighted vest.  Weighted vests, usually prescribed by an occupational therapist, have been shown in one medium sized trial, to reduce hyperactive behaviors in children with ADHD.  They were ineffective for impulsive and verbal behaviors (such as blurting or excessive talking).    Weighted vests are known to sometimes cause short term problems with posture and back pain (which is why they should be fit by an OT) , and some children take them off and use them as missiles, otherwise they seem to be harmless.  

Interactive Metronome.  This therapy usually involves 15 sessions of training involving timing movements to sounds.  It is unlikely to have significant side effects, but only two smaller studies demonstrate its effectiveness and due to the nature of the treatment, it can be quite expensive, even if it is covered by insurance.

Vayarin/phosphatidyl serine.  Vayarin is essentially omega 3 fatty acids plus phosphatidyl serine.  While omega 3 fatty acids have a great track record for safety and a pretty good one for effectiveness, there are only a few smaller studies which suggest that adding phosphatidyl serines adds anything to the effectiveness of omega 3s.  The main risk of phosphatidyl serine is that it can be sourced from cow’s brains, with a very tiny risk of acquiring Creutzfeld-Jacob disease, a progressive neurodegenerative disorder.  If you can find phosphatidyl serine sourced from plants, it definitely improves the safety of the product, but it clouds the research on effectiveness.

EMPower Plus.  This proprietary herbal therapy was the subject of a single, randomized controlled non-industry sponsored trial involving a modest number of patients (all adults), with improvements noticed only by patients, not by clinicians.  It isn’t possible to know what side effects this preparation might have due to the size of the trial, and the therapy is expensive, about $65-75/bottle for the baseline treatment.  Also, we don’t know what effect it might have on the developing brain of a child or adolescent. 

Essential oils.  The research done in the area of essential oils and ADHD has been hugely overblown, and their long term safety is unknown.  There is some potential for long term hormonal effects, as well as allergic reactions.   However, for short term use, say for break through symptoms, they may be worth looking at if other therapies have failed.

                                                               

Homeopathy.  The great thing about homeopathy is that it is unlikely to have side effects.  The bad thing about homeopathy is that clinical trials do not support the effectiveness of homeopathic treatments, especially those available as mass produced, over the counter remedies.   It is possible that researchers have not found the right way to study homeopathy, as practitioners often customize their treatments to the individual.

Pycnogenol.  There have been only two studies on this antioxidant extract of the maritime pine, so neither efficacy nor safety have been well demonstrated. 

Probiotics.  The evidence that probiotics could be a useful treatment for ADHD rests on a single trial done in infants and was more of a preventive type therapy.  Unfortunately, treating infants with live bacteria also carries a risk of active infection.  No studies of probiotics have been done in children and adults already diagnosed with ADHD.  There is little harm to trying probiotics, provided your immune system is normal and you are not allergic to any carrier, such as yogurt or gluten (present in many probiotic supplements).

As you can see, there is no shortage of natural treatments that have been tested in at least one clinical trial, which may be useful in treating ADHD, but not all of them have been extensively enough to say for certain that they are safe or to compare their effectiveness among other therapies.

Answers to FAQ's About Fish Oil for ADHD

Many people with ADHD take omega 3 fatty acids  or "omega 3's" for their symptoms, but a quick tour down the grocery aisle (or the internet) reveals a dizzying number of options all touting a number of characteristics which you probably have never considered.  Isn't fish oil, well... fish oil?  This article will help you understand the characteristics which are important in selecting an omega 3 supplement to fit your needs, as well as the basics of dosage and side effects.

Is the source of the omega 3 fatty acids important?   The major omega 3 fatty acids used by the brain are DHA and EPA.  The body can also make DHA and EPA from ALA (made by plants), but you must consume a much higher amount of ALA to get what you need in DHA and EPA.  Usually humans can only get the amounts of DHA and EPA needed to treat ADHD from algae or sea animals such as fatty fish, seals, and krill.  Other foods, like eggs, meat, and cereals may contain some omega 3’s but not enough to be important supplements.

Most omega 3’s are regulated as supplements and do not receive the same scrutiny for effectiveness that drugs do from the FDA.  There are some prescription omega 3 fatty acids that have been available as drugs but not for ADHD.  There is also a prescription medical food for ADHD containing omega 3 fatty acids which does not receive the same level of regulation as a drug would.

Why are mercury, PCBs, and dioxin critical?

Fatty fish accumulate toxins such as mercury, PCBs, and dioxins in their oil/fat.  Mercury poisons the nervous system.  PCBs and dioxins have been implicated in possibly causing diabetes, thyroid disorders, and cancer.  People taking fish oil should check the label to make sure their supplement is certified free of mercury, PCBs and dioxins because larger doses of fish oil over longer periods of time are needed to treat ADHD than other common disorders.

Is EPA or DHA more important?  The bottom line is that no one knows for sure right now. Different studies give conflicting answers and high quality studies haven’t been designed to answer this question.

Is omega 6 necessary?   Experts are divided because small trials of omega 3s combined with omega 6s have shown effectiveness in treating ADHD symptoms, which is not what one would expect since omega 6's opposite effects to omega 3's studies done investigating heart health.

What doses should be used?  Experts generally recommend a target dose of 300-600mg omega 3/30-60mg omega 6 daily for children, and 1-3 g of DHA for adults.    Most authorities recommend starting at a lower dose and increasing gradually to the target dose in order to avoid upset stomach and diarrhea.  The dose is high compared to the dose sizes available.  Be sure to take the number and size of pills into account when you purchase a fish oil supplement.

When will I see an effect?  Most clinical trials that have demonstrated an effect have run for 8-12 weeks or longer.  Experts recommend at least a 2 to 3 month trial at an adequate dose. If you haven’t seen an effect at that time and your diet isn’t deficient in omega 3 fatty acids, you can stop the supplement.

What are the side effects of omega 3 fatty acid supplements?  The vast majority of patients notice nothing. The most common side effects, especially at higher doses,  include a fishy aftertaste/burps and diarrhea/stomach upset.  Less common side effects include raising LDL (aka "bad") cholesterol (though without an increase in heart attacks), and prolonged bleeding.  The largest problem is that fish oil can taste fishy, a flavor not all patients find appetizing.

Are there any other things I should be aware of?   Some supplements may contain “inactive” ingredients which may worsen symptoms of ADHD.  For example, some may contain gluten, artificial flavoring, or glucose (sugar).  Check the label to be sure.

Gummies and soft gels can become stuck together in summer heat, leaving you with a blob of pills that have to picked apart.  If you are ordering online, this can be a particular issue and it is best to order a good supply before summer gets too warm, in order to avoid this inconvenience.

Why can’t I just eat more fish?  Some recent studies conclude that only people deficient in omega 3 fatty acids benefit from supplementation.  This may mean that getting omega 3’s from your diet may be equally beneficial, however it does mean that you eat a lot of fish.  It would probably be best to supplement if your diet contains less fish than 2 servings a week.

References:

Bloch, M. H., and A. Qawasmi. "Omega-3 Fatty Acid Supplementation for the Treatment of Children with Attention-deficit/hyperactivity Disorder Symptomatology: Systematic Review and Meta-analysis." Journal of the American Academy of Child and Adolescent Psychiatry 50.10 (2011): 991-1000. Print.

Cooper, R. E., C. Tye, J. Kuntsi, E. Vassos, and P. Asherson. "Omega-3 Polyunsaturated Fatty Acid Supplementation and Cognition: A Systematic Review and Meta-analysis." Journal of Psychopharmacology29.7 (2015): 753-63. Web.

Covington, Maggie B. "Omega-3 Fatty Acids." American Family Physician 70.1 (2004): 133-40. Print.

Millichap, J. G., and Michelle M. Yee. "The Diet Factor in Attention-Deficit/Hyperactivity Disorder." Pediatrics 129.2 (2012): 330-37. Print.

Sinn, Natalie, Catherine Milte, and Peter R. C. Howe. "Oiling the Brain: A Review of Randomized Controlled Trials of Omega-3 Fatty Acids in Psychopathology across the Lifespan." Nutrients 2.2 (2010): 128-70. Print.

Everything ADHD Medical Disclaimer

Everything ADHD Privacy Policy

Using Probiotics to Treat ADHD

It turns out the bacteria in your gut may have more to do with mental health than previously thought.   According to a recent article on the Psychology Today website, probiotics have recently been gaining traction as treatment in the world of psychiatry.   However, probiotics still have a long way to go before they become standard treatment for ADHD.

Studies Examining Plausability and Effectiveness

Two studies have been published regarding the role of probiotics in ADHD treatment.  In one study done by  functional medicine practitioner, Michael R. Lyon,  and  published in one of his books, 75 children with ADHD were examined and a majority were found to have high levels of yeast and pathogenic bacteria, with low levels of beneficial bacteria.  The author concluded that probiotics might play a role in healing ADHD, but did not do a clinical trial to document that it works. 

In a second study, done by in Finland and recently published in Pediatric Research, 75 children were randomized at birth to receive either placebo or Lactobacillus rhamnosus GG.  By the age of 13, 6 out of 75 were diagnosed with ADHD.  All of them were in the placebo group.  This data could be interpreted as meaning that the probiotic prevented development of ADHD in the treatment group.  However, if that were the case, one would also expect that the prevalence of ADHD in the entire group would be less than the  prevalence of ADHD in Finland, which it is not.   One would also expect that the prevalence of ADHD in the placebo group would be the same as the background prevalence of ADHD in Finland, which it also is not.  The other issue is that the probiotics were given to these children as infants as a preventive measure, not as treatment for ADHD once it was diagnosed, so the study cannot tell us whether later supplementation would be helpful or not.  

Studies Examining Harms of Probiotics

Most studies done on probiotics do not directly assess for harms, so we do not really know whether or how often side effects occur.  Clearly when you are treating someone with live bacteria, there is always a risk of active infection rather than harmless colonization.  This isn’t such a big risk in people with developed and healthy immune systems, but could be an issue if we are talking about treating infants preventatively.  There have been case reports of infants with normal intestines developing blood infections from probiotic supplements.  So, even though supplements are available for infants, there certainly are questions as to whether they are entirely safe for all infants, especially newborns.

Another issue to be aware of is that some probiotic supplements contain gluten, which can be a problem for some people with ADHD.

The cost of quality probiotics such as Culturelle is from $12-25 per month at the time this article is being written.  If you culture your own yogurt, the price might be closer to $5 per month.

Should You or Shouldn’t You?

There is little harm in trying probiotics in the form of yogurt or other fermented foods people normally eat, unless you have a known sensitivity to the food.   Similarly, taking a probiotic supplement likely will not result in harm as long as the person taking the supplement has no risk for lower than average immunity and isn’t taking a supplement containing inactive ingredients to which he or she is sensitive (ie gluten).  

However, in the face of known possibility for harm (infection) in infants, it is a good idea to avoid probiotic supplements in infancy until more is known about their safety.  Parents who want to be sure their child is colonized with the right bacteria should still do it the natural way—skin-to-skin contact with their infant and breastfeeding.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Implementing a Weight Gain Plan

You know the story.  You bring your child in after a great few weeks on a new medication for ADHD, only to find out--they're losing weight.  Maybe only a little, maybe lots!   What can you do?   Especially if you live in a house like ours where there's one person who is obese, and one who needs extra calories, just thinking about the extra meals is enough to be overwhelming!  It doesn't need to be.  Here is a step to step guide to making a plan that will work for your person who needs to keep on weight to stay on a medication that is working.

Plan 1.  Medication breaks
Skipping a dose of medication  on off days works best for people who have mild ADHD symptoms, who only need their stimulant medication for work or school work, and who only have mild weight loss.

Plan 2.  Beef up breakfast
This works best for people who like breakfast, or who like certain breakfast foods.   It is also helpful for people who have a household member who is obese, because many people do not eat breakfast together as a family.     Also, it is easy to serve one person cold cereal.  Healthy ways to increase calories at breakfast include adding a little extra to your milk (such as protein powder, powdered milk, instant breakfast mix), adding a piece of meat, or fruit.

Plan 3.  Keep them eating when they aren't interested.
Often a lack of appetite does not mean the stomach is full.  It could mean the child has lost patience with eating, though.  To combat this issue, try to serve larger portions.  If your child has to ask, prepare, or wait for more food, they may lose interest and just not bother eating, but if it is on their plate already they may be willing to eat more.   Sometimes kids with ADHD need a parent or responsible sibling to sit with them to keep them focused on eating when they'd rather be doing something else.  If your child says he or she is full, though, its best to not force them to continue to eat unless you are confident it is not possible they are truly full.

Plan 4.  Add-ons for dinner
For dinner, the strategy you will most likely want is to use add-ons to add calories to one person's meal without killing another person's weight loss diet.  You do this by doing things like adding spreads, dips, nuts, seeds, sauce to the meal of the person who needs to gain, while either leaving them out or using them more sparingly for what you are cooking for the family as a whole.

Plan 5.  A healthy, but hefty after-dinner snack
Also known as second dinner, but not really.  You and I are both too tired to cook another meal at the end of the day.  But you can try saving leftovers and serving them now.  Making a sandwich is another option.  If you want to avoid lunch meat, make extra pork chops, save chicken breasts or meatloaf, or boil some eggs for egg salad.  Tuna fish, hummus, or a quesadilla are other options. Other ideas for hefty after-dinner snacks include crackers with cheese and fruit or a bowl of granola cereal.

Plan 6.  Add to their liquids
Don't serve water to the person trying to keep on weight.  Add a scoop of powder (protein, milk powder, instant breakfast powder) to milk to add calories and protein without seeming to add to volume of food.  In our house, person who is obese gets water with enhancer, the person trying to gain weight gets instant breakfast, and the rest of us get skim milk.  For instant instant breakfast, individual premade servings are also available, and are especially handy for school lunch.

Whatever plan, or plans you choose, work with the person who is trying to keep/gain weight.  Accept honest feedback from them, and keep tabs on their weight according to your doctor's instructions.  If things aren't working out, it may be time for a different medication or medications for appetite.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Instant Breakfast Recipes

I did not know that you could make instant breakfast mix at home, though in retrospect it seems like most mixes have a knockoff home recipe.

What I like about this is that one of the big disadvantages to store bought instant meal replacers is that they can be very high in sugar or in artificial sweeteners.  While sugar doesn't cause ADHD, sugary drinks are associated with worse ADHD symptoms, so it would be great to find a way to make a calorie and protein booster that didn't have quite so much sugar.

The down side is that you have to add your own vitamin, but the upside is you can add fruit or whatever you want for fiber, plus you can add whatever flavoring you want and not suffer through the sickly vanilla or cheap chocolate or artificial strawberry in most commercial mixes.  

Here is my favorite (I am not on a weight gain diet, I just need more calcium) so far:
1 cup of skim milk
1 tsp of chocolate syrup
1Tbsp of dry milk powder


Everything ADHD Medical Disclaimer

Everything ADHD Privacy Policy

Western Style Diet and ADHD: Animal Research Strengthens Link

In a new study, researchers at Washington and Lee University in Virginia demonstrated that a Western style diet can cause ADHD like symptoms in rats.  Previous research has demonstrated that obesity and Western diet are both associated with development of ADHD in humans, however, no one had demonstrated that diet was actually the cause of these symptoms.  In this study, the researchers fed rats a Western style diet (red meat, high in sugar, fat and refined grains) or a control diet for 10 weeks.  They then tested the rats' performance in various behavioral tests.  They found that the rats fed the Western style diet showed impulsivity and hyperactivity compared to control rats.

What this means

• This study was done in rats, so it is possible that it does not apply to humans at all. 
• It is unlikely that the Western style diet is the only cause of ADHD in humans, due to the large amount of evidence that genetics plays a role.   However it could mean that ADHD symptoms could be worsened or triggered by the Western style diet.
• Since the Western style diet seems to be associated with or cause a number of other medical problems, including diabetes and obesity,  a more prudent diet including more fruits, vegetables, whole grains, chicken and fish would be unlikely to have significant risk.  The potential gain of avoiding ADHD symptoms might be well worth making this dietary change.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Caffeine for ADHD

Many patients wonder whether it wouldn't be safer and/or cheaper to take caffeine for their ADHD.  Caffeine, after all, is known for enhancing alertness and attention.  And it is easy to get--as easy as your nearest coffee pot or vending machine.

The reason caffeine sometimes works for ADHD symptoms is that it is a stimulant.  It is incredibly similar to amphetamines and methylphenidate.  It also shares many of the same side effects in terms of raising heart rate and blood pressure, decreasing the seizure threshold, increasing anxiety, causing insomnia, and being habit forming.

I personally do not recommend caffeine because of the following issues:

• It is a little difficult to know how much caffeine you are getting from say, a cup of coffee.  After all there is grandma's coffee flavored milk and there's black expresso and everything in between.  This makes it difficult to know how much is safe in combination with prescription medication and also to know if you've gotten an adequate dose to expect a response.
• It has the the same side effects as prescription medication.
• A recent study showed that use of energy drinks is associated with worse hyperactivity and inattention in middle schoolers with ADHD, so there may be a trade off  such as short term improvement of symptoms versus long term worsening.

That being said caffeine is cheap and it is short acting so it could be given potentially after your stimulant has worn off, and still allow you to sleep at night.  If you do decide to take caffeine remember the following health and safety tips:

1)  Consult with your doctor first.  Mixing caffeine and ADHD meds (even certain nonstimulants) can be really dangerous for your heart and could lead to things like seizures and hallucinations as well.  Be sure that the amount of caffeine and the timing of your dose is safe.
2)  Don't use it every day.  Daily use is sure to lead to caffeine withdrawal headaches and may possibly lead to tolerance--a need to use more to get the same effect.  Typical situations which might be appropriate would be the need to take caffeine for a weekly or twice weekly activity which requires attention--such as a team sport or evening class.
3)  Be aware of what you are taking with your caffeine.   For example, taking your caffeine as a soda may involve also adding a lot of sugar to your system and acid to your teeth.  As always, check labels for gluten, dyes, or other additives which may make things worse instead of better.


Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Sugary Drinks Worsen Hyperactivity and Inattention in ADHD

A study published in Academic Pediatrics demonstrated increased hyperactivity and inattention in middle schoolers consuming sugary drinks, especially energy drinks.   In a large study (n=1,649) of urban middle school students, the risk of self reported hyperactivity and inattention increased by 14% for each sugary drink consumed.  When drinks were broken down by energy drinks versus non-energy drinks, students who consumed energy drinks were a whopping 65% more likely to report symptoms of hyperactivity and inattention.

What can parents of children with ADHD take away from this study?
1)  Sugar and caffeine can cause and worsen symptoms of ADHD.  Before you allow your child to be diagnosed with ADHD, cut out the caffeine and minimize sugar to see if the behavior issues are due to diet.

2)  Children with ADHD should learn to avoid sugar.  This extends especially to sugary drinks such as juices, juice drinks, sodas, and other types of sweetened beverages.

3)  Parents need to be aware of what their children are drinking.  Energy drinks, sweetened coffee beverages, smoothies, soda, and even Pediasure, can be sources of extreme amounts of sugar which may be working against treatment for ADHD.

4)  Don't assume that caffeine will help your child with ADHD symptoms.  This is especially true if it is given in the form of a sweetened beverage.

Reference:
Schwartz, D. L., K. Gilstad-Hayden, A. Carroll-Scott, S. A. Grillo, C. McCaslin, M. Schwartz, and J. R. Ickovics. "Energy Drinks and Youth Self-Reported Hyperactivity/Inattention Symptoms." Academic Pediatrics (2015): n. pag. Web.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Appetite Problems and ADHD: 10 Healthy Ways to Pack in More Calories

Many people who have ADHD and take a stimulant also have problems with poor appetite.  Stimulants do suppress appetite, after all.   In this article, I will give you some concrete (without actual recipes) ideas about how to beef up a person's diet if they are not putting on adequate weight.

The main idea is to add healthy, nutrient-dense calories to the diet, without adding excessive amounts of sugar and unhealthy fats.  It is very easy to get most people to gain weight if we offer enough ice cream, but that it isn't very healthy.  Too much fat and sugar may also make ADHD symptoms worse.  The theme in these suggestions is to add calories in such a way that you don't think you are eating more.

1.  Spread it.  Peanut butter, freezer jam, and seasoned olive oil are the favorite spreads in our house.  You could also try hummus or bean dip, if the flavor appeals to you.  Or mayonnaise mixed with Greek yogurt and seasoning (like herbs or garlic).  Think outside of the breadbox, too.  You can spread on bread, bagels, and crackers, but you can also spread on fruit (apples, especially) and vegetables (celery and peanut butter).  But everytime you eat something that can have spread on it (don't forget sandwiches), try to make sure you use spread.

2.  Dip it.  You can dip things that normally need dip, like chicken nuggets, french fries , chips, and raw vegetables.  But try dipping other things too, like pieces of fruit (Greek yogurt, freezer jam) and nuts (well, I like chocolate sauce, but maybe sweetened yogurt would be ok too).

3.  Add nuts or seeds.  No salad, muffin, cookie, or bowl of cereal should be complete without nuts or seeds.   Certain nuts can be eaten with stir fries, or sprinkled on cooked vegetable dishes, too.

4.  Milk it.  Use full fat dairy, including cheeses, milk, and yogurt, if you have a choice.   Be sure not to drink too much before you eat. though.

5.  Scoop it.  If you don't like smoothies, you could still add something to your milk--protein powders, powdered milk, or even just a squirt of chocolate syrup (oops! I meant, a spoonful of sweetened condensed milk! :) ).  Ok, a little bit of chocolate syrup probably won't hurt you, unless you are also diabetic.

6.  Sauce it.  There's more to sauce than gravy, butter and cream of mushroom soup.  Also consider barbeque sauce, pasta sauces, ranch dressing, tartar sauce, and applesauce.  Sauces should be kept in the pantry for easy access during cooking.

7.  Dress it.  Full fat salad dressing is a versatile ingredient that can be added to many foods besides vegetable salad.   Vinagrette type dressings go well on pasta.  Ranch dressing can be added to many creamy casseroles or to some meats or fish.

8.  Switch it.  People with ADHD sometimes like novelty, so why not try dinner for breakfast?  Or lunch for afterschool snack?   Whenever you have an appetite to eat a substantial meal, you should try to do it and never mind the clock and what you "should" be eating.

9.  Cheese it.  Cheese is high in calories and can be added to virtually any food:  sandwiches, salads, soups (sometimes only as a sprinkle of Parmesan), vegetables.  Some fruits taste good with cheese on the side--apples and grapes especially.  Fruits are also tasty with cottage cheese and ricotta cheese.

10.  Read it.  Read food labels and choose those that have more calories.  For example, granola has a lot more calories than cornflakes.  Bagels have more than toast.  Avocados have more than tomatoes.  You get the idea.

Everything ADHD Medical Disclaimer

Everything ADHD Privacy Policy

ADHD and Handling Halloween Candy

Halloween is one of the worst holidays for kids with ADHD.  Too much sugar, too much dye, its just...too much!  What can you do for your child to help them limit their sugar intake, without going to the extreme step of forbidding trick or treat altogether?

1)  Decide whether eating the candy is an option at all.  For most kids, one day of candy is not going to be a problem in the grand scheme of things.  If you want, pick a weekend day when school won't be an issue, and let them eat some of what they collected.  Then get rid of the rest.  You may wish to be selective--say, only chocolate candies and no dye, depending on your child's sensitivities and how long their reactions last.

2)  Review the options with your child and the school.  Many schools have Halloween parties.  Be sure you have gone over the plan with your child.  With so many children to supervise, adult volunteer helpers may not understand the gravity of allowing your child to partake in the candy they have received.

3)  Bring the candy to the office.   You can put it in the break room or some other common area if it will be a temptation for you.  Explain to your child that giving something at the office is a good idea because it says "thank you" to the people who employ Mommy or Daddy (or who buy cookies or popcorn for fundraisers).

4)  Exchange the candy for something you do want. Some dentists will buy back the candy for cash or for prizes and donate it to troops overseas.  To find an office near you, try this website: Halloween Candy Buyback.  Some parents play a game where the Great Pumpkin (or some other imaginary being) comes and collects the candy a few days after Halloween and replaces it with a prize.

5)  Give it away yourself.   You may also donate your candy directly to an organization, such as Operation Gratitude,  that makes care packages for troops overseas, or to anyone else who might be encouraged by candy, such as missionaries working overseas.  Many kids with ADHD really love to help and to be helpful, and this is a great way for your child to use his or her disability to be an encouragement to others.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

ADHD, Obesity, and Eating Disorders

In a new article published in the International Journal of Eating Disorders, ADHD was found to be associated with obesity in 2 community pediatric mental health clinics.  When binge eating disorder was accounted for, the association was weaker.  In patients taking stimulants, the association was much stronger.  The average age of the patients in this study was 10.8 years old.

Some interesting points to take away from this study include the following:
1)  Binge eating is associated with ADHD, even in preteens, and even in those not taking medication.

2)  It isn't clear whether stimulants cause binge eating or whether people who need stimulants are also more likely to binge eat.  However, it is plausible that people who take stimulants are more likely to binge eat because they don't eat well during the day, and they are trying to make up for lost time.

Parents should be aware of this situation and be sensitive to their child's attitudes toward eating.  Some researchers believe that binge eating in ADHD is different from typical binge eating.  Typical binge eating disorder sometimes is related issues to feeling out of control, such as abuse or a perfectionist type of personality.   In ADHD related binge eating, researchers have noticed that some patients simply do not pay attention to the body's signals of fullness.  This may be why patients with ADHD suffer more from binge eating than from other eating disorders, such as anorexia.

There are some things parents can do to prevent obesity and binge eating disorder:

1)  Parents should teach their children to "listen to their body" and to avoid eating in situations where they may not be paying attention to how much they are eating, such as while watching TV, working/playing on the computer, or reading.    Unless your child is underweight, do not push him or her to eat when he or she is full.

2)  Parents can encourage children to eat at the table, with family or friends, and to eat a certain portion, rather than taking freely from a central plate or from a box, bag or other container.

3)  Finally, if a stimulant is causing symptoms of binge eating, parents should discuss their concerns with their prescribing physician and perhaps get a dietician involved to determine reasonable intakes for their child.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Review: Jif Omega 3 Peanut Butter

Ever thought of treating your ADHD with peanut butter?  Jif has a new product out--peanut butter made with omega 3 fatty acids.  I decided to give it a try when it was on sale at our local supermarket.

This peanut butter tastes like peanut butter.  You cannot tell the difference between it and regular Jif.  There is absolutely no fishy flavor or odor.

The type of omega 3 is DHA and EPA.   It does come from fish.  There is no statement about mercury or other toxins, but it does say the source is sardines, so it is not likely to contain large amounts of mercury.  

While the label says that the product is "an excellent source of omega 3s", the dose of omega 3 is 32 mg of DHA and EPA combined in 2 tablespoons of peanut butter.  While that isn't anything to sneeze at, it isn't a therapeutic dose for ADHD, either.  You might get a similar amount in a gummy vitamin.  If you tried to get a therapeutic dose of DHA/EPA from this peanut butter, you would consume more calories than you probably should in a day.

The cost of this peanut butter was the same as regular Jif during a recent sale at Kroger supermarket.    The shelf tag indicated that the regular price would also be the same.

Overall, I would consider this product as a boost to your regular dose of omega 3 fatty acids.  I would not give it alone, as the dose is too low.    If you eat peanut butter regularly, it might be more healthy than regular peanut butter, and like all peanut butter, it is an excellent source of protein.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Vayarin: Safe and Effective?

Vayarin is a food available by prescription only, for the purpose of treating ADHD. The principal ingredient of Vayarin is phosphatidylserine omega 3 enriched with EPA (an omega 3 fatty acid). It also contains a small amount of DHA (another omega 3 fatty acid). The nearest nonprescription source of these components is fish oil, which does not contain phosphatidylserine. Vayarin is registered with the FDA as a medical food, not a drug, which means that it does not have to undergo the same rigorous clinical trial process of approval that medications do to show that it is safe and effective for the treatment of ADHD.

Is it effective?

There is only one study supporting Vayarin's effectiveness. It included 200 children, which is a good sized trial for a nonmedicinal treatment, but it would not have been large enough to support FDA approval of Vayarin as a drug. Also, at least some of the study's authors were employees of the manufacturer, so it is possible the results of the trial are biased.

Is it more effective than fish oil?

No studies have been done directly comparing Vayarin with fish oil. On the one hand, Vayarin has a unique composition including phosphatidylserine, theoretically could make it more effective. However, it also has very low levels of DHA and EPA compared to most fish oil preparations used for ADHD. DHA and EPA are thought to be the omega3 fatty acids most important in treatment of ADHD.

Phosphatidylserine is also available over the counter, but no studies have been done to demonstrate its effectiveness or safety.

Is it safe?

The main study demonstrating Vayarin's safety was the same trial group as the one that demonstrated effectiveness. The study was continued for 30 weeks and did not demonstrate any major side effects compared to placebo. Although 30 weeks is a long time for a clinical trial, it is not a long time for a product that is meant to be taken daily for years.

On the basis of its ingredients alone, Vayarin should have the side effects of its active ingredients, at least in some patients.  It is possible that the number of patients studied was too small to reveal these side effects.

Importantly, Vayarin's capsules used to contain blue dye as one of its inactive ingredients.  The manufacturer has changed the coloring to a natural one in order to make the product usable by patients who are sensitive to blue dye.

Also, of theoretical concern is the fact that the source of the phosphatidylserine in Vayarin is bovine cortex.  Consuming cow's brains is linked with Creutzfeld-Jacob disease, a form of rapidly progressive dementia.  The problem is that while cow's brains may contain prions, the infectious agent that causes Creutzfeld-Jacob disease, they are difficult to detect and even more difficult to disinfect.   Cow's brains are strictly regulated in the United States because of this concern.  While it is unlikely that a person would contract CJD from  a single dose of Vayarin, it is a theoretical concern, particularly in a product meant to be taken over the lifespan of a chronic disease.   

Is it more safe than fish oil plus phosphatidylserine?

Fish oil has a number of well known side effects, including fishy tasting burps and possible effects on blood lipid levels.
Phosphatidylserine is not well studied but appears to have few adverse effects.

How does pricing compare with fish oil?

Vayarin is supposed to cost about $55 per month, more or less, depending on the pharmacy. However, this does not include the price of the doctor's visits needed to get the prescription. Fish oil preparations vary widely in cost, with some more and some less than $55 per month. The price of fish oil can be high because large amounts need to be taken in order to get the recommended dose of EPA and DHA.

Who should take Vayarin?

Vayarin is a reasonable choice for people with ADHD who have tried fish oil and experienced side effects or who did not see an effect. Fish oil is probably a better choice for people who only have suspected ADHD (because it does not require a doctor's prescription) or who have not tried an omega 3 supplement before (because fish oil has more clinical trial data to support its effectiveness).

Reference:

Vaya Pharma. "Pricing Information." Vayarin Pricing Information. Vaya Pharma, 2011. Web. 06 January,  2014.

Vaya Pharma. "Flip the Script." Vaya Pharma, 2015. Web. 24 January, 2015.

Brain Iron and ADHD

A newly published study in the journal Radiology showed a correlation between brain iron when patients with ADHD were compared to medicated patients with ADHD and when compared to neurotypical ("normal") patients.  Iron deficiency has long been thought a culprit when it comes to ADHD syptoms, but in this study, patients had comparable blood iron levels.  The only difference was in the levels of iron in the brain, as measured by MRI.

While on the surface, you would think that taking more iron should increase the brain iron level.  However, this study actually supports the idea that it doesn't matter how much iron you ingest.  Its the amount that the brain absorbs that is important.  Unfortunately, the only way that they demonstrated normalization of brain iron was stimulant medication.

If the study doesn't suggest a treatment for ADHD, at least it shows promise for a possible way to objectively diagnose ADHD.    The study was small, but if there is enough interest, perhaps a test based on this finding will be developed that will help the problems of over and under diagnosis.

This study is also important because it demostrates that the ADHD brain is different from the neurotypical brain, and that ADHD is not something that can simply be corrected by better parenting/school behavioral management.  This study is one of many brain function studies that demonstrate that these things may be important but are not the root cause of ADHD.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

How much fish is enough?

The FDA and EPA just issued a press release indicating that American women and children do not eat enough fish.  This may be due in part to previous guidelines suggesting that eating too much fish is harmful because of mercury, which is present in all fish.

However, the FDA has now released proposed changes to the guidelines stating that the optimum fish intake for pregnant women and young children is 2-3 servings of low mercury fish a week.

The interesting part of the guidelines is that they state that low mercury fish include most fish sold in grocery stores (with the exception of albacore tuna).    This includes canned light tuna, salmon, shrimp, haddock, cod, pollock, tilapia, and catfish.

So, eat your fish.  Yes, this is mom speaking.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

High Protein Snacks for ADHD Kids

Many people with ADHD struggle with getting enough protein into their diet.  Between medication sapping your appetite for lunch, and just having a higher demand for protein to make neurotransmitters, it can be hard to get enough.  Having enough protein also can help ADHD medication to work better.  Snacks can be challenging because they're often eaten on the go.  Here are some ideas for high protein, low sugar snacks.  (Please note, these are not all gluten free, dairy free, or low in salicylates, since many people with ADHD do not have these dietary sensitivities.)

Peanut butter
on crackers, graham crackers, or bread
on apples or stiff pears
on vegetables (like celery sticks)

Beans and nuts
Edamame (soy) beans  (kids like to pop these out of the pods)
Garbanzo beans (roasted or just boiled, consider organic for taste)
Any kind of nuts--go for unsalted if possible.

Bean dips (including hummus and refried beans)
with chips
spread on tortillas, crackers, or bread
as a dip for vegetables

Cheese
with crackers, pretzels, or bread
with apples, pears, or grapes
quesadillas

Leftovers
cold chicken, ham, pork, or steak
lunchmeat (can be high in salt and nitrites)
hard boiled eggs

Certain cereals
Kashi Go Lean (contains soy and a lot of sugar)
Oatmeal based cookies, bars, or muffins (most commercially premade ones have a lot of sugar, but you may be able to make something at home that has less)--especially with nuts.

What's your favorite high protein snack?   Leave a comment!

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Sugar and Dye

I have to admit that we do not follow a very strict diet, when it comes to ADHD.  At home, we try to avoid excess sugar and artificial colors, but when we're out with friends, we often don't stick to our guns.

The evidence out there says that sugar doesn't cause ADHD symptoms.   In our house, we only limit sweets because they can cause other problems, like sugar crashes, obesity and tooth decay.   We aren't so strict when it comes to class parties and such, so long as they aren't giving candy to go home with for a week.  (We confiscate excess candy and dole it out slowly or give it away to others.)

However, when it comes to artificial colors, we've seen problems for a day or more following cupcakes with supersaturated blue dye frosting, so we try to either scrape off the frosting, eat around it, or just not partake altogether.    However, since those occasions are rare, most of the time we just roll with it and realize that DD may be a little "off" for a day or so.  

Parents of children whose symptoms are more severe or long lasting may need to be more strict about teaching their kids to say no if there are party treats around.    If a child shows severe behavioral problems, such as physically hurting themselves or others, or if they cannot do school the next day, then clearly a parent has grounds for strictly enforcing an ADHD diet.  If that is the case, it is best to try to offer some kind of an alternative treat, while the rest of your child's friends are enjoying theirs.

For more about what to do with excess candy, please see my post on What to Do With Halloween Candy.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

More Fish For Dinner

Summer is coming.  As the days get hotter, I start to like the idea of turning on the oven less and less.  Which means that it gets harder to motivate myself to make my usual fish sticks and tuna casserole to get my family's ration of fish in.  I am a horrible cook when it comes to fish.  I admit that freely.  But, my family really likes this recipe, for tuna macaroni salad, from All You.    You do have to turn on the stove to cook the pasta, but you could do it earlier in the day.  This recipe is also dirt cheap--80c per serving!

Variations:
Vary the amounts of yogurt and mayonnaisse for less fat or less yogurt.
Use different types of pasta--I have used tricolor rotini and whole wheat rotini (well cooked, not al dente) with success.
We use only one small can of tuna, but the amount recommended would probably taste better.

Other dishes that are along the same vein use tuna and cold pasta with a dressing and various types of vegetables.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Compulsive overeating and ADHD

My mother in law (the mother of DH) is visiting us and we got on the topic of overeating.  She has classic undiagnosed adult ADHD.  She has struggled with eating too many sweets all her life.  She said that she has gotten herself sick eating sweets in the past.  She blames this on the fact that she never got much when she was growing up, which I feel is maybe partly true but not the whole story.

 Its interesting to me because I have been researching an article on obesity and ADHD.  In my travels through the literature, I found a few articles on eating disorders and ADHD.  What interested me was that the articles also discussed some ways that people with ADHD can avoid binge eating, which matched a lot of what my mother in law was telling me about sweets.

Here are some of the tips, a la my mother in law, which went along pretty well with my research so far:
1) " I can't stop eating if its in the house.   If its not in the house, I'm usually ok."
2) "I have to put the candy I make in little bags in the the freezer.  If I can't see it, I won't eat it all in one sitting."
3)  DH chipped in this one.  "Mom would always sit on the couch and watch TV while eating one candy after another."  (Some people find TV is a trigger for overeating, or at least for ignoring the fact that they are full.)

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Fish for Dinner

Omega 3 fatty acids are probably one of the only nutritional supplements with solid evidence for treating ADHD.  But no one really knows exactly how to give them or in what amounts.  Most research studies have focused on giving a supplement, but omega 3s can also be gotten through dietary means.  One of the best sources for omega 3s is marine life.   Fish is probably good for the whole family anyway, and the USDA currently recommends two servings of fish weekly for the average person.

We're not so good at eating fish because I'm always scared that it will be rotted.  That's what comes of growing up inland where there weren't a lot of fresh fish.  But I do have a few favorite recipes involving tuna.  This is what we had for dinner tonight.

Tuna with Broccoli and Shells
8 oz of small pasta shells
1 lb of broccoli, frozen or fresh
1 can of tuna
1 onion
2 tbsp oil
1/2 tsp oregano
1/2 tsp pepper

Cook pasta according to package directions.  When there are 3-5 minutes left in the cooking time, add the broccoli to the pot.  When pasta is done, drain.
While pasta is cooking, slice onion thinly, saute in oil until soft.  Remove from heat.  Add tuna, oregano, and pepper.  Add drained pasta and broccoli and stir.  Serve hot.  Serves 4.

If that doesn't sound good to you, or you want to take a supplement, you can read more about that in my article on Fish Oil for ADHD:  Tips and Answers to FAQ's

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy