The Consumer Guide to ADD
Attention deficit–hyperactivity disorder (ADD or ADHD) is defined as age-inappropriate impulsiveness, lack of concentration, and sometimes excessive physical activity. ADD has been associated with learning difficulties and lack of social skills. Obviously what constitutes “normal” in these areas covers a wide spectrum, and thus it is unclear which child suffers true ADD and which child is just more rambunctious or rebellious than another. No objective criteria exists to accurately confirm the presence of ADD.
The main drug treatment for ADD, Ritalin (methylphenidate), is very similar to the illegal drugs known as amphetamines. Paradoxically, these types of drugs can cause hyperactivity in adults but most often have a calming effect in those with ADD. Nevertheless, parents have expressed growing concern about treating their children with an amphetamine. A variety of natural approaches to this condition have been investigated as alternatives to drug therapy.
Lifestyle changes that may be helpful: Smoking during pregnancy should be strictly avoided, as it increases the risk of giving birth to a child who develops ADD.1
Lead2 and other heavy-metal exposures3 have both been linked to ADD. If other therapies do not seem to be helping a child with ADD, the possibility of heavy-metal exposure can be explored with a nutritionally oriented health practitioner.
Dietary changes that may be helpful: The two most studied dietary approaches to ADD are the Feingold diet and a hypoallergenic diet. The Feingold diet was developed by Benjamin Feingold, M.D., on the premise that salicylates (chemicals similar to aspirin, which are found in a wide variety of foods) are an underlying cause of hyperactivity. In some studies, however, it seemed this hypothesis did not hold up.4 But in studies where markedly different levels of intake of salicylates were investigated, a causative role for salicylates could be detected in some hyperactive children.5 It seems that about 10–25% of children may be sensitive to salicylates.6 Parents of ADD children can contact local Feingold Associations for more information about which foods and medicines contain salicylates.
The Feingold diet also eliminates synthetic additives, dyes, and chemicals, which are commonly added to processed foods. The yellow dye, tartrazine, has been specifically shown to provoke symptoms in controlled studies of ADD-affected children.7 Again, not every child reacts, but enough do so that a trial avoidance may be worthwhile. The Feingold diet in any form is complex and requires help from an experienced health care professional.
In another study, twenty-six children diagnosed with ADD were put on a hypoallergenic diet, and the nine children who improved were then challenged with food additives. All nine showed an exacerbation of symptoms when given these additives.8 Other studies have shown that eliminating individual allergenic foods and additives from the diet can help children with attention problems.9 10
Avoiding simple sugars has also benefited some children with ADD. One study found that avoiding sugar reduced aggressiveness and restlessness in hyperactive children.11 Girls with a diet restricting sugar may improve more than boys.12 However, a well-controlled study using large amounts of sugar and aspartame (Nutrasweet) found that negative effects were limited to just a few children.13 Most studies have not found sugar to stimulate hyperactivity except in rare cases.14
Nutritional supplements that may be helpful: A deficiency of several essential fatty acids has been observed in children with ADD compared to unaffected children.15 16 One study gave ADD patients evening primrose oil in an attempt to correct the problem.17 Although a degree of benefit was seen, results were not very promising.
B vitamins, particularly vitamin B6, have also been used for ADD. Low levels of vitamin B6 have been detected in some ADD patients.18 A study of six children with low vitamin B6 levels found that vitamin B6 and Ritalin were both effective at reducing symptoms, while only vitamin B6 corrected the vitamin deficiency.19 High doses of other B vitamins have shown mixed results in relieving ADD symptoms.20 21 A practitioner knowledgeable in nutrition must be consulted when using high doses of B vitamins.
Are there any side effects or interactions? (Refer to individual supplement for complete information.) Consistent, reproducible problems from taking evening primrose oil have not been reported. Although side effects from vitamin B6 supplements are rare, at very high levels this vitamin can damage sensory nerves, leading to numbness in the hands and feet as well as difficulty walking. Vitamin B6 supplementation should be stopped if these symptoms develop. Pregnant and lactating women should not take more than 100 mg of vitamin B6 per day. For other adults, vitamin B6 is usually safe in amounts of 200–500 mg per day,22 although occasional problems have been reported in this range.23 Any adult taking more than 100–200 mg of vitamin B6 per day for more than a few months should consult a doctor. Side effects from vitamin B6 become more common when intake exceeds 2,000 mg per day; consequently, this supplement level should be avoided.24
References:
1. Milberger S, Biederman J, Faraone SV, et al. Is maternal smoking during pregnancy a
risk factor for attention deficit hyperactivity disorder in children? Am J Psych
1996;153:1138–42.
2. Tuthill RW. Hair lead levels related to children’s classroom attention-deficit
behavior. Arch Environ Health 1996;51:214–20.
3. Krigman MR, Bouldin TW, Mushak P. Metal toxicity in the nervous system. Monogr
Pathol 1985;(26):58–100.
4. Harley JP, Ray RS, Tomasi L, et al. Hyperkinesis and food additives: Testing the
Feingold hypothesis. Pediatr 1978;61:818–21.
5. Levy F, Dumbrell S, Hobbes G, et al. Hyperkinesis and diet: A double-blind crossover
trial with a tartrazine challenge. Med J Aust 1978;1:61–64.
6. Williams JI, Cram DM. Diet in the management of hyperkinesis: A review of the tests of
Feingold’s hypotheses. Can Psychiatr Assoc J 1978;23:241–48 [review].
7. Rowe KS, Rowe KJ. Synthetic food coloring and behavior: A dose response effect in a
double-blind, placebo-controlled, repeated-measures study. J Pediatr
1994;125:691–98.
8. Boris M, Mandel FS. Foods and additives are common causes of the attention deficit
hyperactive disorder in children. Ann Allergy 1994;72:462–68.
9. Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in attention
deficit disorder. Arch Dis Child 1993;69:564–68.
10. Egger J, Stolla A, McEwen LM. Controlled trial of hyposensitisation in children with
food-induced hyperkinetic syndrome. Lancet 1992;339:1150–53.
11. Prinz RJ, Roberts WA, Hantman E. Dietary correlates of hyperactive behavior in
children. J Consult Clin Psychol 1980;48:760–69.
12. Rosen LA, Booth SR, Bender ME, et al. Effects of sugar (sucrose) on children’s
behavior. J Consult Clin Psychol 1988;56:583–89.
13. Wolraich ML, Lindgren SD, Stumbo PJ, et al. Effects of diets high in sucrose or
aspartame on the behavior and cognitive performance of children. N Engl J Med
1994;330:301–7.
14. Wolraich ML, Wilson DB, White JW. The effect of sugar on behavior or cognition in
children. A meta-analysis. JAMA 1995;274:1617–21.
15. Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum
essential fatty acid levels in hyperactive children. Clin Pediatr 1987;26:406–11
16. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid
metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr
1995;62:761–68.
17. Aman MG, Mitchell EA, Turbott SH. The effects of essential fatty acid supplementation
by Efamol in hyperactive children. J Abnorm Child Psychol 1987;15:75–90.
18. Bhagavan HN, Coleman M, Coursin DB. The effect of pyridoxine hydrochloride on blood
serotonin and pyridoxal phosphate contents in hyperactive children. Pediatrics
1975;55:437–41.
19. Coleman M, Steinberg G, Tippett J, et al. A preliminary study of the effect of
pyridoxine administration in a subgroup of hyperkinetic children: A double-blind crossover
comparison with methylphenidate. Biol Psych 1979;14:741–51.
20. Brenner A. The effects of megadoses of selected B complex vitamins on children with
hyperkinesis: Controlled studies with long term followup. J Learning Dis
1982;15:258–64.
21. Haslam RHA. Is there a role for megavitamin therapy in the treatment of attention
deficit hyperactivity disorder? Adv Neurol 1992;58:303–10.
22. Gaby AR. Literature review & commentary. Townsend Letter for Doctors and
Patients Jun 1990;338–39.
23. Parry G, Bredesen DE. Sensory neuropath with low-dose pyridoxine. Neurology
1985;35:1466–68.
24. Schaumburg H, Kaplan J, Windebank A, et al. Sensory neuropathy from pyridoxine abuse. N
Engl J Med 1983;309(8):445–48.