A Nutritionist’s Approach to ADHD
All kids (and adults) have trouble paying attention sometimes and act impulsively now and again. But for people diagnosed with ADHD and ADD, these tendencies can overwhelm—and make everyday life extraordinarily difficult. As a parent, it’s troubling to see a child struggle, particularly when neither the cause nor the solution is apparent. Which is why we appreciate Kelly Dorfman‘s approach: A licensed nutrition dietitian (with a masters of science in nutrition and biology), Dorfman is known for her ability to pinpoint the underlying factors behind a diagnosis and to find ways to help resolve them through diet. Below, she shares her take on ADHD/ADD and the solutions that work for many of the clients she sees in her D.C.-based private practice. (We also highly recommend her book, Cure Your Child with Food: The Hidden Connection Between Nutrition and Childhood Ailments, which ranges far beyond ADHD/ADD, examining nearly every common kid ailment and issue.) And for a different take on ADD, see this goop piece with Dr. Edward Hallowell.
A Q&A with Kelly Dorfman
Q
What have you found to be the major symptoms surrounding ADHD and ADD, and what are their causes?
A
The symptoms of ADHD/ADD break down into two areas: distractibility and hyperactivity/impulsivity. Distractibility symptoms include losing homework, refusing to do homework, frustration with learning activities, and not following directions.
Impulsivity/hyperactivity symptoms include a lot of classroom distractions, like talking out of turn, not staying seated, invading the personal space of others, and doing stupid stuff without thinking (like throwing a pencil).
There are many, many known causes for these behaviors plus many we probably have not discovered yet. Some of the causes I know that can lead to these behaviors include:
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Immature pre-frontal cortex development
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Not sleeping enough
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Picky eating and weak breakfast
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Food reactions
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Auditory processing problems
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Sensory processing disorders
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Visual development issues
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Anxiety
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Reactions to medications
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Allergies
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Stomach problems such as chronic constipation
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Home trauma such as parent drug use, divorce, abuse
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Magnesium or other nutrient deficiency
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Reaction to food dyes and artificial flavors in food
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Thyroid problems
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Undiagnosed learning challenges. *
* This is a huge one! Many kids cannot pay attention because information is taught in a way they cannot process—learning disabilities or learning differences such as slow processing speed can play a huge role. A thorough neuropsych evaluation can find these hidden attention saboteurs.
Q
How do you believe diet plays into ADHD/ADD?
A
Either something is irritating the child that he/she is eating, or the child is missing something he/she needs. Your body cannot run on a deficit, so if you do not consume something you need to learn/attend, you budget-cut learning/attending. Everything you do has a chemistry to it, including attention and learning. For instance, there’s one little-known nutrient called choline: The deficiency symptom for it (what happens if you do not get enough) is a reduced capacity to learn—and it’s estimated that ninety percent of American kids have low intake of choline.
Q
Part of your practice focuses on nutritional support for kids with ADHD/ADD—particularly for those who also have a history of allergies, are picky eaters, or are often sick. What are the key nutritional tips that parents in this camp should know?
A
Allergic reactions make it very hard to pay attention. Imagine how well you would do learning a complex math principle if your throat were itching all day, or if your stomach hurt.
If you think your children are eating poorly, they are. In one study, forty percent of people who thought they ate well were actually poor eaters—so if you suspect your children are eating poorly, they probably are not getting what they need for optimal learning. It is worth the trouble to fix this, because it will eventually affect their mood, too (if it has not already). Parents do not hesitate to hire a tutor for math but are less likely to consider an eating tutor, which could help in much broader ways—so get help.
One thing you can do for picky eaters is to close the gap between what they are willing to eat and what they need for optimum development with nutritional supplements. There are excellent whole-food supplements as well as traditional vitamins/minerals, plus fish oil for brain development. This is not a long-term solution, but can be very effective while you work on developing new habits. [Parents of picky eaters will likely find Dorfman’s E.A.T. program helpful, which she explains here.]
Whatever you do, do it as a family. Do not expect your kids to do what you do not. If they are taking vitamins, you take vitamins. If you want them to eat vegetables, you eat vegetables.
Q
Are there other overarching nutritional principles, or unexpected foods to avoid, or especially important vitamins and minerals that all parents should know about?
A
Studies have found that kids diagnosed with ADD/ADHD tend to have lower levels of the long-chain fats found in fish compared to the general population. Your brain is twenty-five percent DHA (one of the fats found in fish), so this is an important structural nutrient for the brain. I think every child labeled with ADD/ADHD could use some fish oil. (Unless they are allergic or have other medical reasons not to take it.) Fish is truly a brain food—a good source not just of fish oil, but choline. Ironically and sadly, it is safer to take fish oil that has been processed to remove mercury and PCBs than it is to eat some fish. Avoid tilapia: it is the one fish that is not a good source of the DHA/EPA oil.
Eat a strong breakfast. When in doubt, eat dinner for breakfast—many American breakfast foods are sugary and many people don’t want to eat eggs every day. There are several reasons why breakfast is so important, but the one most parents do not consider is that it may be the only meal the child gets all day. Yes, lunch is provided at school or you pack it, but the lunchroom can be a very distracting place, and kids on ADD medicine often are not hungry at lunch. Many kids in my practice eat a weak breakfast and little or no lunch. By the time they are picked up, they are loaded for bear. Guess who gets the brunt of that?
Q
How important is physical activity for kids who struggle with sitting still?
A
Critical. I call it vitamin M (for movement). Exercise/movement increases BDNF (brain derived neurotrophic factor), which is sort of a growth hormone for the brain. There is good research on the importance of physical activity for people with ADHD/ADD (here’s one study on children, and another on adults). And it’s especially important for boys, who have a stronger tendency to use movement to drive learning. If they do not get enough, they move themselves so they can pay attention. It is no accident that more boys than girls are diagnosed with ADD/ADHD.
Q
Are there other lifestyle changes that make a difference?
A
Getting enough sleep is also important: At least eight and a half to nine hours for teenagers. That can be difficult but can make a huge difference.
Q
Are most of your clients with ADHD/ADD also taking Ritalin or other drugs? Have you found medicine to be effective when used in combination with other treatments?
A
Almost everybody tries medicine at some point. The last government data that has been collated and published was from 2011, which estimated that 6.4 million kids (4-17 years old) had been diagnosed with ADD/ADHD, and that about two-thirds of diagnosed children had prescriptions for stimulants. It looks like the number has gone up in the last five years, though there is not quotable data yet.
Though I talk to people all over the country, my practice is in the Washington, D.C. area, which has some of the highest medication use for ADD in the country, so many of my clients are on medication.
Research has found medication is best for controlling classroom behavior. Parents also benefit if the child is impulsive and has difficult behaviors at home. Medicine can be used effectively with nutritional intervention, but I think it is best used to buy time while you sort out the real cause of the symptoms. On rare occasion, it is necessary for long periods because of extreme behaviors or developmental issues.
Q
Do you offer different solutions for adults with ADHD/ADD—i.e. what are the important differences between having ADHD/ADD as a child and as an adult?
A
The difference is the adult usually has much more control over their environment so they can find creative ways to exercise around their schedules, and buy the food they need. Kids are completely dependent and controlled by the adults in their environment.
Also, in adults the pre-frontal cortex is fully developed. The pre-frontal cortex is the last part of the brain to develop—it lets you do the hard thing and plan ahead for the long haul, do things today that will not benefit you until next month. This is very helpful in planning strategies that can help in the long run.
Q
Why do you describe ADHD and ADD as a set of symptoms as opposed to a disease or a disorder?
A
What is a disease or illness? A disease is an illness or condition caused by germs, inflammation, or other dysfunctional process. The National Institutes of Health define ADHD/ADD as a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity. Scientists do not know what causes it. Calling ADHD/ADD a disease is like saying your rash is a disease characterized by a rash—it makes no sense.
Attention problems are a symptom of an unknown condition. Inattention is a symptom we all have under certain circumstances. The questions are: Are these symptoms interfering with my life, and what is causing them? We call the symptoms of ADD/ADHD a disease because we have drugs that treat the symptoms. Because the drugs don’t address the root cause, you’re no better when you stop taking them than before you started. Stimulants, the main class of drugs used to treat ADD/ADHD, have come with black-box warnings, because a number of children have died taking this form of medicine. Plus, they are abused widely by teenagers and young adults.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
