ADHD and Nutrition: What We Know and What We Don't

In the first months after the diagnosis this is the area where I got lost most. I would watch a video, and the next day I would cut something out. Then another video, another cut. When weeks had passed, I had a restricted list in my hands and the same attention as before.

Nutrition is the area where the most wrong information about ADHD circulates. The reason is understandable too: food is one of the rare things over which we feel we have control. I cannot fix my attention directly, but I can fix my breakfast, and that gives me the feeling that I am doing something.

The aim of this article is to separate clearly where each claim stands. Because what really harmed me was not the wrong information; it was giving every claim the same weight.

Those with weak evidence

Sugar causes ADHD. This is one of the most widespread beliefs and it is not supported by controlled studies. In studies where children were given sugar under blinded conditions, no difference in behavior is found; the difference shows up in the parents' assessment. In the glossary: the sugar myth.

This does not mean sugar is healthy. It means it is not a cause of ADHD.

Elimination diets. The comprehensive meta-analysis by Sonuga-Barke and colleagues (2013) evaluates the effect of restrictive diets, and the result is this: in blinded assessments the effect size shrinks markedly. So part of the effect comes from expectation.

The single most talked-about study in this area is the INCA study by Pelsser and colleagues (2011). In a five-week restricted elimination diet carried out with 100 children aged 4-8, significant improvement was reported in 32 of the 50 children in the diet group. The figure is impressive, and that is why it circulates so much.

The study's own limits are also out in the open: the outcome assessments were not blinded, a small part of the sample was made up of girls, and the proportion of children of the inattentive type was very low. So the finding is interesting but does not stand where it can be presented as "here is the evidence."

Restrictive diets also carry nutritional risks, especially in children. Applying them without a doctor's supervision is not recommended. I opened up this whole discussion separately in the article on whether diets work in ADHD.

Food dyes. Here the picture is a little more mixed. The meta-analysis by Nigg and colleagues (2012) points out that synthetic food dyes may have a small effect on behavior in a subgroup of children. This does not produce a recommendation for the general population; it may be meaningful for a small number of people with a specific sensitivity. In the glossary: the food dye debate.

There is no evidence that nutrition treats ADHD. Saying this does not mean saying that nutrition is unimportant.

Those with evidence, and their limits

Omega-3. The meta-analysis by Bloch and Qawasmi (2011) reports that omega-3 supplementation has a small but statistically significant effect on ADHD symptoms. The effect size is markedly lower than that of medication.

The practical meaning: it may be a support, not a treatment. In the glossary omega 3; the details are in the article on whether omega-3 is good for ADHD.

Iron. The relation of iron deficiency to attention and attention symptoms is a researched subject. If there is a deficiency, correcting it is meaningful. But there is a critical warning here: an iron supplement taken without a deficiency can be harmful. This requires a blood test and a doctor's decision. In the glossary iron and ferritin.

The decision on supplements is the doctor's. Whether supplements such as omega-3, iron, magnesium, zinc and vitamin D are necessary varies from person to person, and some can interact with medications. Instead of starting a supplement on your own, you need to talk to your doctor. Be sure to tell them the medications you are taking, too.

What really makes the difference: regularity

The most concrete effect of nutrition on ADHD comes from its regularity rather than its content.

Not skipping meals. Going hungry for a long time has a direct effect on attention, emotion regulation and energy. The irritability that appears when a meal is skipped is often mistaken for an ADHD symptom.

Protein in the morning. It is widely reported that eating something with protein in the morning reduces the swings during the day. The crash that comes after a high-sugar breakfast makes the rest of the morning harder. In the glossary protein priority.

Water. Simple but its effect is visible. In the glossary forgetting to drink water.

Track caffeine. Caffeine affects both sleep and anxiety and is often used in ADHD. The details are in the article on caffeine and self-medication.

Not eating heavily in the evening. It directly affects sleep, and in ADHD sleep is already fragile.

For me the item on this list that made by far the most difference was the first. The evening of a day on which I did not skip meals does not resemble the evening of a day on which I did; the difference is bigger than any supplement could give. It took me a long time to notice this, because skipping a meal does not look like a choice for me. When I get absorbed in a job I do not notice hunger, that is all. I wrote about this side separately in the article on body signal blindness in ADHD.

Making food doable

Most nutrition advice says what should be eaten and does not say how to do it. In ADHD the place that gets stuck is usually the second.

What determines what I eat in the evening is not how healthy I know it to be, but how many decisions I need to make in the kitchen at that moment. Even fifteen minutes of preparation can be a job that cannot be started on a tired evening.

Three things have worked for me: making the same few meals in rotation, always keeping a ready-made or half-prepared option on hand, and moving the work of deciding to the shopping list. Whatever is at home is what gets eaten; so the real decision is made not in the evening but at the market. I gathered the kitchen side in the article on food and kitchen order in ADHD.

If you take medication

It is a known fact that stimulant medications suppress appetite. This can lead to not eating at all through the day and making up for it in the evening.

Commonly reported adjustments: eating breakfast before the medication, putting a meal in the hours when the effect is wearing off, and keeping small high-calorie snacks at hand. All of these are things that can be discussed with your doctor.

The common mistake

The most common mistake is putting nutrition in place of treatment. The sentence "I'll sort this out with diet" gives hope for a while, and then when it does not work the person both returns to where she started and feels guilty.

The second is cutting many things at the same time. When you give up five things at once, even if there is a change, you cannot know which one it came from. If you want to try something, you need to try it one at a time and for a defined period.

The third, and in my opinion the most expensive: skipping regularity entirely while busy with content. Skipping a meal while researching which oil is better gives the same result as not eating a meal made with the best ingredients.

What remains

Nutrition does not treat ADHD, but it noticeably affects the day. The part with evidence is modest: regular meals, enough water and, where there is one, correcting deficiencies. You need to be cautious about content that promises a miracle diet.

Where I arrived was this. I set aside all the excited claims about nutrition and was left with a very boring sentence: do not go hungry. Its being boring bothered me for a long time, because I was looking for something bigger. Now I think that looking for something bigger was also the real reason for the time I lost in this area.