Sun January 8, 2012
For Kids With ADHD, The Elimination Diet Falls Short Of Success
Originally published on Mon January 9, 2012 2:55 pm
You may remember the controversial studies linking food coloring and additives to hyperactivity in kids. Or you may know parents who have pinned their hopes on an elimination diet to improve their kids' rowdy behavior.
"When [elimination] diets fail, parents can feel they've failed," says Linda Brauer, coordinator of the Grand Rapids chapter of the advocacy group Children and Adults with Attention Deficit/Hyperactivity Disorder. She remembers feeling guilty when her son's symptoms did not improve. But now she says the science is on her side.
A review paper published today in the journal Pediatrics evaluated the evidence from many studies on this topic. And it concludes that changing a child's diet is usually not enough to effectively treat attention deficit hyperactivity disorder.
"Elimination diets may help in a very small percentage of patients," whereas stimulant medications are generally very effective, writes J. Gordon Millichap, a neurologist at Children's Memorial Hospital in Chicago who authored the paper.
Now, before all of the we-are-what-we-eat believers among us dismiss this, you should know that experts don't deny the importance of diet. Far from it.
"[Diet's] main role in my clinical practice is as a complementary treatment," Benjamin Prince, a psychiatrist at Massachusetts General Hospital tells us. That means kids with ADHD usually need medicine and good diets.
But what makes a good diet? Here are three tips for kids on the ADHD spectrum from the experts:
- Eat a protein-rich breakfast. Kids with ADHD tend to burn lots of calories and can often be too overstimulated to sit down to eat. In addition, medication often suppresses their appetites. Put all of these factors together, and kids with ADHD are prone to feeling "hangry," Prince says. (The term — a cross between angry and hungry — was coined by Prince's friend.) The solution? Keep the calories coming. Complex carbohydrates, like whole grains, and foods rich in protein can help kids feel full longer. "So if you can have a glass of milk and a peanut butter sandwich, that's going to help carry you through the day," says Prince.
- Cut back on sugary treats and processed foods. Australian researchers tracked patterns of eating among children with ADHD. They found that diets rich in sugary snacks, processed foods, red meat and high-fat dairy correlate with higher levels of ADHD. "Try to cut down on those foods," recommends lead author Wendy Oddy of the University of Western Australia. (Note: She didn't say eliminate.) And Millichap agrees. "We conclude that adherence to a 'healthy' diet (fish, vegetables, fruit, whole wheat and low-fat dairy) should be advised," Millichap wrote to us.
- Fish oil and omega-3 supplements. There has been a lot of interest and research on the value of omega-3s from fish oil — or long-chain, polyunsaturated fatty acids. "We think there's some link between having low amounts of long-chain, polyunsaturated fatty acids and ADD," says Prince. So he says adding healthy amounts of fish to the family diet — or taking fish oil supplements — are both fine. But he stresses that clinical trials on this subject have not been consistent. "The evidence is mixed" on whether omega-3s can help kids with ADHD, he says. But given the heart benefits for all of us (not just those with ADHD), Prince says, it can't hurt.
DAVID GREENE, HOST:
It's MORNING EDITION from NPR News. I'm David Greene. Steve Inskeep is up in New Hampshire ahead of tomorrow's primary there. In Your Health today, we'll talk about how to properly take care of contact lenses. But first we turn to Attention Deficit Disorder and diet. Families struggling with ADD often pin their hopes on changes in diet, whether it's adding fish oil supplements or eliminating sugar and food coloring. NPR's Allison Aubrey looks at whether these strategies really work.
ALLISON AUBREY, BYLINE: If you cross the hungry with the word angry what do you get? Hangry. A hangry kid is one who steps off the bus ravenous, irritable, and fidgety. This can happen to anyone, but for kids with Attention Deficit Disorder the effect is even more dramatic. Mother Linda Brauer says with her son, she realized it had little to do with what he was eating. It was that he hadn't eaten enough.
LINDA BRAUER: He's always gotten hangry. You know, when he is wanting something to eat and he can't even articulate it, it was really hard to stave him off until we had something to eat.
AUBREY: Kids with ADD burn lots of calories. They're moving their bodies all the time and often won't sit still long enough to eat. So Brauer says she realized that managing her son's diet was very important, but not in the way she'd been led to believe. She says back in the 1980s when her son was diagnosed, lots of parents were experimenting with elimination diets - removing sugar, food colorings, preservatives, certain kinds of fruits and meats. And she did try this.
BRAUER: I really tried hard to control his diet when he was little, just because that was what good mothers were supposed to do.
AUBREY: But she says it finally dawned on her that the diet made no difference. She recalls reports from her son's preschool.
BRAUER: He was grabbing toys from other children. He wouldn't wait his turn. He was interrupting.
AUBREY: And home wasn't any easier. Brauer says her son's behavior was so impulsive she couldn't leave him alone for a moment. Feeling very worn down, she took the advice of doctor and put her son on the stimulant medication Ritalin.
BRAUER: It was so amazing to me. I could really see night and day. So, yes, it was very helpful.
AUBREY: Unlike diet, the medicine clearly worked. Brauer's story turns out to be pretty typical. For most kids diagnosed with ADD, stimulant medication is very effective, whereas diet changes alone are usually not enough. This is the conclusion of a paper published in the journal Pediatrics. It evaluates lots of studies over three decades. And psychiatrist Jefferson Prince of the Massachusetts General Hospital, who was not involved in the study, says the author's findings certainly fit with his own experience in treating children.
JEFFERSON PRINCE: There may be a small percentage of people for whom changing diet will have enough of an effect to be used alone.
AUBREY: Probably fewer than 10 percent of kids, he says. The rest will need medication. But Prince says this is not to say that diet is irrelevant.
PRINCE: Its main role in my practice, is as a complimentary treatment.
AUBREY: Lots of research suggests that diets rich in refined sugars and processed carbohydrates - think sodas and chips - are bad for all of us, not just kids with ADD. So Prince's nutrition advice is simple. Eat as much fresh whole food and healthy fats as possible.
PRINCE: I think if we have more processed stuff we don't feel as good as if we have less processed stuff.
AUBREY: And in terms of specific advice for ADD kids, Prince says there's been a fair amount of research on the value of omega 3s from fish oil - also known as long-chain, polyunsaturated fatty acids.
PRINCE: We think that there's some link between having low amounts of long-chain, polyunsaturated fatty acids and ADD.
AUBREY: So go ahead and get some fish in your diet or even take fish oil supplements. Prince says, even though the evidence isn't conclusive that this will help kids with ADD, given the heart benefits, he says it can't hurt. And his other bit of specific advice, eat lots of protein.
PRINCE: Having protein is really, really important.
AUBREY: Why? Well, he says lots of kids with ADHD aren't good eaters to begin with, and the medicine can suppress their appetites, so they still go long stretches without eating.
PRINCE: And they get hangry.
AUBREY: And need food quick. Prince says one way to keep this in check is to start the day with a high protein breakfast that sticks.
PRINCE: So if you can have a glass of milk and peanut butter sandwich, that's going to help carry you through the day.
AUBREY: Linda Brauer says she swears by the breakfast tip. She opted for egg sandwiches for her son. And she says it's made a big difference.
Allison Aubrey, NPR News. Transcript provided by NPR, Copyright NPR.