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r. Rebecca Carey admits to being a little embarrassed about what her son, Mark, eats every day. Hamburger patties for breakfast, or bacon. A pack of raisins and a cookie for lunch; a turkey and cheese sandwich “if I’m lucky,” says Carey, but it usually comes back home. His favorite dinner is fish cakes and pasta, but all vegetables remain firmly untouched.

It’s the kind of diet — low in fruits and vegetables, high in carbs — that a doctor like herself might caution against. But it’s also low in milk, sugar, and artificial food additives — all things Carey believes worsen 10-year-old Mark’s attention deficit hyperactivity disorder, or ADHD, symptoms. Twice a day, in the morning at their home in Newburgh, Ind., and from the school nurse at lunch, he takes a vitamin and mineral supplement, which helps make up for the lack of veggies.

It’s been six months on this diet, which Carey researched herself and tested out on Mark, and in that time he has transitioned off his ADHD medication. It wasn’t all smooth sailing; there were fights in the candy section of the grocery store, and Carey struggled to find quick, high-protein breakfasts. “But honestly, I would never go back,” she said.

Carey is not the only one who’s trying this approach. Medication and therapy remain the most effective treatments for ADHD. But driven by concerns about the short- and long-term side effects of psychiatric medications on children, some parents are looking for ways to keep their kids on lower doses of the drugs, or to quit the drugs entirely.

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But addressing ADHD symptoms by changing diet can be a minefield. For one thing, while some diet interventions have scientific evidence to back them up, others don’t — and even the ones that do only seem effective for a subset of kids. Diet tweaks are oftentimes pretty harmless to try, but not universally so. And most pediatricians aren’t nearly as familiar with these approaches as they are with conventional medication.

So amid a lot of confusing and contradictory information on the internet, and a big nutrition knowledge gap in the medical system, parents at their wits’ end are mapping out their own treatment plans through trial and error over the dinner table.

ADHD Nutrition
Mark, 10, takes a vitamin and mineral supplement twice a day.

Medication and side effects

As of 2011, the latest data from the Centers for Disease Control and Prevention show, at least 6.4 million children in the US had been diagnosed with ADHD. Only about 6 percent are taking medication for the condition. The vast majority, then, are doing something else — perhaps counseling, or other forms of treatment, or nothing at all.

The most common types of drug used for ADHD are methylphenidate and amphetamine, both stimulants that work on the central nervous system, sold under brand names Ritalin and Adderall. These drugs are considered the most effective ADHD treatment. Less is known, however, about the drugs’ long-term effects. Common side effects include loss of appetite, trouble sleeping, and anxiousness.

Those side effects became a problem for Mark soon after he was first diagnosed with ADHD in kindergarten. At home, he’d always been a sensitive, irritable child, but in the classroom he started having “freakouts,” said Carey: throwing things, hiding under his desk, biting other students. Carey’s pediatrician put Mark through a behavioral test, found he measured high on the ADHD spectrum, and prescribed him behavioral therapy and Concerta, another common brand of methylphenidate.

Carey was uncomfortable with the medication from the beginning. It became a constant fight to get Mark to eat; he shedded weight, and couldn’t fall asleep at night. Carey had a “gnawing feeling” that he’d have to always be on the drug. And it wasn’t helping his symptoms — instead, he seemed to be getting worse. After a year, his psychiatrist thought he was showing signs of bipolar disorder, and prescribed medication for that.

“I just felt in my heart of hearts there had to be a better way,” said Carey. As a physician specializing in gastrointestinal disease, Carey had seen diet do tremendous things for her own patients. Mark’s diagnoses got her thinking about nutrition’s role in the brain, and she started to chart her own course of research and experimentation.

Weighing pros and cons

Dietary interventions tend to be relatively low-risk — but the evidence base for most of them, in terms of improving ADHD symptoms, is still small.

To try to balance those factors against one another, a group of specialists in child and adolescent psychiatry at Ohio State University in 2011 devised what they call the SECS vs. RUDE test. Looking at the scientific literature surrounding 15 different dietary or nutritional interventions, they asked: Are they Safe, Easy, Cheap, and Sensible; or Risky, Unrealistic, Difficult, and Expensive?

“SECS doesn’t need as much evidence for someone to try it on an individual basis,” said Dr. L. Eugene Arnold, a physician at Ohio State’s medical center who specializes in childhood ADHD and autism and who coauthored the 2011 study. “You want more evidence before you invest a lot of money or undertake something risky.”

Delaying “standard treatment” — medication and behavioral therapy — in favor of alternative approaches can be risky if it means symptoms go untreated, wrote Arnold and coauthors in their review. If a treatment doesn’t work, there is also the loss of family resources, including time and money, to consider.

Some of the things their analysis found that fall under the SECS category are fatty acid supplements, specifically omega-3 supplements, which seem to improve ADHD symptoms.

“I just felt in my heart of hearts there had to be a better way.”

Dr. Rebecca Carey, parent of child with ADHD

Arnold and coauthors looked at five randomized, placebo-controlled, double-blind trials (the gold standard of clinical research) that tested combinations of fatty acids on ADHD symptoms, in both children and adults. Four had a statistically significant positive effect on symptoms.

Omega-3 fatty acids, said Arnold, show “small but significant benefits,” and as long as these supplements are low in mercury, it makes sense to try.

Other interventions, however — like homeopathic and herbal treatments — were both uncertain and potentially risky, the analysis found.

A supplement with less evidence, but which still passes the SECS test, is the one that Mark Carey takes. Called EMPowerplus, the supplement contains 36 different vitamins and minerals, and is marketed to help with psychiatric disorders, including bipolar disorder, ADHD, and depression.

But only one of the studies done on the pill was placebo-controlled and double-blinded. It showed a reduction in ADHD symptoms in adults. More research is needed on EMPowerplus and similar broad-spectrum micronutrient supplements before conclusions about their effectiveness can be made, Arnold said.

ADHD nutrition
Rebecca and Paul Carey help their twin sons Mark (right) and William with their homework.

Eliminating additives, foods

More difficult interventions tend to be the ones that eliminate whole classes of foods. Elimination diets involve taking foods out of the diet — one of the first iterations of which, for hyperactivity, was the Feingold Diet.

Developed back in the 1970s, the Feingold Diet focused on the link between artificial colors and flavorings and ADHD. Research since then has supported a link. A 2004 meta-analysis of only the gold standard of studies — double-blind and placebo controlled — concluded that artificial food colorings increase hyperactivity in kids with ADHD. And another 2004 study found that kids even without a hyperactive disorder experience behavioral effects of colorings. Preschoolers given a drink with artificial coloring were rated as more hyperactive by their parents than those given a naturally colored placebo. (The study was blinded, so parents didn’t know which their kids received.)

Lidy Pelsser, a researcher at the Netherlands ADHD research center, led a trial in 2009 in which 100 families of children with ADHD were recruited to take part in a five-week “few-foods” experiment. Half were instructed to keep their kids on a healthy diet, and half were instructed to give their children only “turkey, rice, some vegetables, and water — and that’s it,” said Pelsser. Of the 41 families who completed the few-foods diet, 32 responded positively, with 60 to 70 percent improvements on ADHD tests compared to when they’d started.

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Pelsser described this approach not as a cure, but as a “diagnostic tool” that is going to have different results depending on the child. If there’s no improvement in behavior after five weeks, “the child is allowed to eat everything again and medication would be appropriate,” she said. If the child improves significantly, then the parents can start adding foods back in slowly and one at a time to figure out which may be triggers.

She warned that this approach is “aggravating.” It is low-risk, but also difficult for families.

When it works, it seems to work really well, said Pelsser, and families are increasingly willing to try. “What I see is more awareness in parents that they do not want to give their medication and they are desperately looking for other ways to help their child.”

A 2014 review estimated that a strict elimination diet may have a 10 to 30 percent chance of showing symptom improvements for ADHD.

Arnold also pointed out that these approaches don’t have to replace medication.

“We know that behavioral treatments tend to enhance the effects of medication, so that the patient can respond to a lower dose,” said Arnold. “There’s no reason to believe that wouldn’t work the same way with diet and nutrition.”

ADHD nutrition
Mark works to solve a Rubik’s Cube in his bedroom.

Parents helping parents

Although diet is widely promoted by doctors as an important lifestyle factor in managing ADHD, along with exercise, routine, and good sleep habits, the acceptance of diet and nutrition as an effective primary treatment is still very “grassroots” within the medical community, according to Dr. Anna Esparham, a Kansas-based pediatrician and member of the American Academy of Pediatrics’s integrative health unit.

Carey recalls a feeling of isolation. “I was so despondent about where Mark was and despondent about the treatment options for him that I felt like I couldn’t be the only one,” she said.

So in September 2016, she started a support group for other parents like her who felt like they were struggling outside the mainstream. The first meetings were held at her church — “I didn’t want it affiliated with anything, I just wanted to start it in the local community,” she said — but after six months the group had grown large enough and was taking up enough of Carey’s time that she needed help. She brought it to the medical director at St. Mary’s hospital, in Evansville, Ind., where Carey works, and now the hospital hosts the group, which draws about 30 people to its meetings.

Each week a different speaker comes to talk about topics that the parents indicated they were interested in in a poll at the beginning — things like vision therapy, curbing screen time, and a behavioral therapy called the “nurtured heart” approach.

Carey acknowledges that these things “might not be mainstream or have lots of randomized control trials behind them,” but she figured parents — including herself — deserved to have a place could openly discuss alternatives to the status quo.

Ideally, someday, that place could also be the doctor’s office. Esparham thinks a big part of the reason parents and providers don’t discuss diet interventions for ADHD is a general ignorance of nutrition in the medical field. “A lot of doctors do not know how to give nutritional advice because they didn’t get in school, in residency, in training,” said Esparham.

Pelsser, the Dutch researcher, thinks it might take more than just education — it might take a perspective shift as well. “In the Netherlands as well as the United States there is a lot of skepticism about the effect of food on ADHD, despite the research,” she said. “I think it’s difficult to accept that things could be different from what we have been thinking all the time. It takes courage to say, well, after all, we may be wrong.”

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  • ““I just felt in my heart of hearts there had to be a better way.””

    That’s pathetic. This is a doctor? Demonstrate this through a controlled study, with hard evidence. Aren’t you practicing evidence-based medicine? Don’t you realize it’s 2017 and superstition is now known to be superstition?

    • Controlled studies have shown that a) long-term use of stimulants does NOT improve long-term outcomes on the average – “ADHD” kids who take stimulants for the long term don’t do better overall than “ADHD” kids who never take stimulants or take them for a short period of time, and b) putting “ADHD” kids in open classrooms (where kids get more control over what they do and when they start and stop their activities) are essentially indistinguishable from “normal” kids, while they stand out like a sore thumb in a standard classroom setting.

      So if we were REALLY practicing evidence-based evidence, we’d be giving stimulants only in the short term and we’d be routing every ADHD kid we could into an open classroom setting.

      Have you ever heard of these hard-evidence studies? Why do you think you haven’t?

      We can just as easily accuse the mainstream of medicine of failing to practice evidence-based medicine, because they routinely ignore inconvenient findings like the ones I have highlighted above in favor of more convenient or socially acceptable or financially remunerative options, even when these options are demonstrably false. This is true in many other areas besides ADHD as well. The idea that doctors practice or recommend “evidence-based practices,” as common as this belief is, is actually pretty naive.

  • I agree complementary therapies and treatment can work or help many symptoms. However when the author mentioned in a comment that even autism can be “recovered” from diet changes and biomedical treatment, her credibility was immediately called into question.

    • Jennifer, I made two comments in this section, in response to other comments, and neither mentioned autism or recovery. Are you referencing something in the article?

    • I see that comment was from Holly, who was not the author. My apologies to the author.

  • Sure – eating healthy makes people feel better – no sh*t Sherlock. But if a diet change cured your son’s ADHD, he never had ADHD.

    Why does it seem that parents try to treat ADHD so differently from every other neurological disorder? Imagine if we tried to cure Autism with fruits, vegetables, and Paleo. People (kids and adults) who truly have ADHD have a neurotransmition problem. Parents need to get over the fact that their kid might need to take a pill every day. Treating ADHD with amphetamine improves brain development and nerve growth. And long term it has been proven to “decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain”. Long term treatment with amphetamine/lisdexamfetamine also decreases the risk of substance abuse.

    Parents get caught up in the “not my child” cycle. It’s selfish and harmful to the child.

    • Dan, I am not anti-medication but what about those who these medications don’t work for? What if they fall into the “do not take if” list for these medications? I used to be in denial, and when a “so called healthy diet” didn’t work, we conceded to do treatment using meds for some time. Some did work somewhat (others were nightmares) but what we got was a child who lost all his muscle, zest for life, obtained ticks and so much more that are painful to discuss. He was so personally disgusted with what was happening to his body and mind that he spit the medications out. Luckily our psychiatrist didn’t say, “well, meds are the only way, too bad for him.” He referred us to other practitioners who could help. Our son improved more significantly with other complementary therapies. Before we began, he had pretty much all the right tendencies to get a diagnosis on the spectrum. The tipping point of his recovery was somewhat accidental when his diet shifted after being inspired by his brother’s changes. There is so much research in the area of how the gut affects the brain and I am quite certain that was a huge piece in my son’s recovery. As someone who advocates for other families in the same situation, I see improvements and even recovery from autism using nutritional therapy and biomedical interventions when their regular doctors had pretty much given up on these kids (check out Julie Matthew’s work and the work of her professional colleagues). When doctors give up, should parents also? No. If you haven’t walked in a parent’s shoes of the nightmares they go through with their child, you really don’t know (maybe you have, I don’t know but we all have a different experiences/paths). I don’t think it’s productive to shame parents or to discourage parents who seek out nutritional therapy. Does it matter if the diagnosis is correct? ADHD and Autism are subjective based on a list of symptoms so you have no right to say that they never had it if you yourself cannot prove that. There is research being done and has been done all over the world that supports the fact that dietary intervention and nutritional therapy can work. There are physicians, real MDs, who have 2 year waiting lists and more because they are helping families when medications don’t work. I would never judge a parent who chooses medication. Why not both or for those who the medication does not work for? Those parents don’t want to give up and there are other ways that can help. It takes 17 years for research to make it into practice. That’s too late for children. There is nothing wrong with eliminating as many stressors on the body as possible to support a child’s healing. I get that you are passionate about your medication but there is more than one way to healing for these kids. I’m forever grateful for researchers and MDs who decided to think outside the box. Usually it’s the ones who don’t respond to traditional therapies. Peace be with you.

    • While it is generally believed by the public that “ADHD” is a neurological problem (due to massive propaganda to that end), there is no neurological test to distinguish “genuine ADHD” from “difficult to manage in a standard classroom setting for some other reason.”

      Hence, saying “ADHD” is neurological is not scientifically supportable, nor is saying that recovery from “ADHD” through diet means the child didn’t have ADHD. ADHD is diagnosed through a checklist, and there is no way to distinguish between ADHD caused by neurology vs. ADHD caused by low iron vs. ADHD caused by poor classroom management vs. ADHD caused by boredom vs. ADHD caused by lack of sleep vs. ADHD caused by lack of structure and discipline in the home vs. ADHD caused by trauma and/or neglect. Every one of the circumstances above can cause “ADHD” symptoms. There are even a number of studies showing that starting school one year later leads to a 30% drop in ADHD diagnoses!

      With such a subjective way of “diagnosing,” suggesting that EVERY case of “ADHD” is a neurological problem is a scientific impossibility. With such a heterogeneous group being diagnosed with the same “disorder,” it should hardly be surprising that different kids respond to different approaches, and it’s quite believable (and even supported by science) that SOME cases of “ADHD” resolve with dietary changes, even if the majority do not.

      Just like all rashes don’t require the same kind of treatment, not all cases of ADHD require the same kind of treatment. It would be unreasonable to expect anything different, given the haphazard way it is diagnosed.

    • “Let food by thy medicine, and let medicine by thy food”. Hmmm, who said that? Maybe the father of f&*king medicine… Hippocrates!

      But you just go ahead and keep drinking the (artificially colored) kool-aid that they would have you ingest.

      Nobody said that a diet change was an out and out cure. But then again there is so little research into diet intervention, because after Reagan slashed the NIH budget back in the 80’s, basic research like that was left to die. Now that tRump is again slashing their budget, evidenced based medicine will finally be put to death once and for all. Although this saves a little money now, it will cost us much more money decades from now. Penny wise, dollar foolish.

      Being that both ADHD and autism are neurological diseases, essential fatty acids would be a smart place to start. Adding omega 3 fish oil is a smart and easy choice. Removing the omega 6 industrially processed seed oils (chock full of nasty things like trans-fats & hexane) would be even smarter, but much harder to do (as they are in EVERYTHING). You basically have to make everything from scratch (NO processed foods), but that does makes it much easier to get the O6 to O3 ratios closer to 1:1 (or at least around 4:1, instead of most peoples 25:1), which is probably the ratio that the human species evolved on.

      30% of the human brain (dry weight) is made up of PUFAs at a 1:1 ratio of O3 to O6, and that those same PUFAs are essential in proper synaptic function. And there has been some recent anecdotal evidence that autism patients can also be helped by ridding their diets of the unhealthy industrial O6 PUFAs currently in our SAD (Standard American Diet).

      NO, I am not saying O6 PUFAs are inherently bad (they’re essential, they can’t be bad). Just the ones that are oxidized, and have had their anti-oxidants stripped from them, because their extraction is done by using high pressures, high heat, hexane solvent, and oxidizers (to deodorize them). You know, the cheap sh1t in the stores that the AMA/AHA says is “heart healthy”. There was a good reason why Dr. Atkins said not to eat that sh1t.

      It’s well known that a ketogenic diet can tamp down, and sometimes even CURE epilepsy. This therapy dates back over 100 years, but many “doctors” are clueless to this, as they get most of their medical treatment information via pharmaceutical companies (instead of the NIH). There is also evidence that it also works for some migraine sufferers too (same area of the brain as epilepsy).

  • I think the author made an error when she wrote that only 6% of children diagnosed with ADHD were receiving medication. Actually (as of 2011) 3.5 million out of 6.4 million children diagnosed with ADHD were being treated with drugs. The 6% figure is for the total population of children (including those not diagnosed with ADHD).

    • Actually, recent figures showed as much as 11% of the child population in the USA is taking stimulants or some other drug treatment for ADHD, far more than the total prevelance estimates of ADHD in the general population (6%). There is a real problem here!

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