Although Dr. Amen and most other psychiatrists are quite comfortable using pharmaceutical meds to assist those who suffer from ADD or ADHA, and obviously they have been very helpful for many individuals, with relatively minor side effects.
Nevertheless, there are those who do not like the effects of drugs, and even the thought of using or giving their child a drug makes them uncomfortable.
Moreover, as noted in the prior segment, there is a growing body of research that suggests certain nutrients may be lacking in individuals with ADD or ADHD, and therefore, it just makes good sense, to try a nutritional approach, supplementing, when possible, with the nutrients lacking, to fill those deficits.
Also, as you will see below, that the effectiveness of several medications used to treat ADHD, like Ritalin®, may be significantly improved with the addition of one or more of the following food supplements.
First, as we consider the various possible causes of these disorders, it’s clear that there are biological, or biochemical deficits in most individuals diagnosed with ADD or ADHD.
Nutritional supplementation offers a much broader and safer approach to addressing those deficits. The growing brain requires a tremendous amount of nutrition to support its structure and function. Supplements can provide components that are used in brain cell membranes and as building blocks or co-factors for neurotransmitter production.
For example, it has been noted that most individuals with ADHD appear to be low in a neurotransmitter called Dopamine, which is primarily derived from the protein L-Tyrosine. Moreover, many have found that by simply increasing their intake of tyrosine, they feel better, and can focus and think clearer. According to AI:
L-tyrosine is believed to help with attention deficit hyperactivity disorder (ADHD) symptoms by boosting dopamine which can improve cognitive performance during times of stress and improving working memory. Here are some ways that taking a supplement of L-tyrosine may be beneficial for those with ADHD:
The assertions above are supported, with additional considerations, by the articles in the links below.
B-Vitamins are a family of water-soluble nutrients that play a vital role in metabolism. Levels of B vitamins, namely vitamin B6 (pyridoxine) and B9 (folate), and vitamin B12 (cobalamin have been found to be reduced in children and adults with ADHD.
A deficiency of B vitamins may contribute to ADHD because of their essential role in the production of serotonin, and dopamine. For example,
vitamin B6 (pyridoxine) is involved in the production of serotonin and early research found that B6 supplementation increased serotonin levels and improved hyperactivity in ADHD.
Magnesium deficiency is common among individuals with ADHD. In a placebo-controlled trial, supplemental magnesium at a dose of about 200 mg per day for six months showed a significant decrease of hyperactivity in 7–12 year old children with ADHD.
An 8-week study on 40 children with ADHD found that supplementation with magnesium (6 mg/kg/day) and vitamin B6 (0.6 mg/kg/day) led to improvements in hyperactivity and school attention. Interestingly, when the treatment regimen was discontinued, the children’s symptoms reappeared in a few weeks.32 A similar regimen of vitamin B6 and magnesium supplements improved hyperexcitability symptoms in a previous study by the same researchers. In this study, the magnesium-B6 supplement combination was given to 52 hyperexcitable children for six months; symptoms such as physical aggressiveness and attention in school improved in all subjects during treatment.(*)
While the studies above used just magnesium and B-6, because the B-vitamins often work in tandem with various proteins and other vitamins, so too much of one may reduce levels of another. Therefore, it’s generally considered preferable to provide all of the “complex” of B-vitamins together. And these B-complex vitamins are generally quite inexpensive, or often in good multivitamins. Moreover, if a person happens to get more than needed any extra will generally be excreted in the urine.
Best forms of magnesium for the brain include Magnesium Glycinate, Magnesium Malate or Citrate, Magnesium L-Threonate, or Magnesium Acetyl-Taurate.
Acetyl-L-carnitine (ALC), a natural derivative of the amino acid L-carnitine, serves a key role in the metabolism of fatty acids and cellular energy production and is a precursor to acetylcholine which plays a role in memory. In a placebo-controlled trial with 112 subjects, 500–1,500 mg ALC twice daily (based on weight) improved symptoms in children with the inattentive ADHD subtype. This makes sense in the context of Dr. Bergs’s comment in his YouTube video that ADHD is actually a problem with a lack of energy in the brain, even though children are often seen a being hyper – with too much energy. And…
In a separate randomized double-blind trial, ALC had a beneficial effect on hyperactivity and social behavior in 51 young boys with fragile X syndrome and ADHD. However, a 2011 study of boys and girls with ADHD found that 500–1,500 mg ALC daily did not have an effect when combined with methylphenidate (Ritalin).
Zinc. Zinc is involved in dopaminergic signaling and has been shown to be a common nutrient deficiency in individuals with ADHD. Children with ADHD treated with Ritalin for six weeks received better behavioral ratings from teachers and parents when they also took zinc supplements (55 mg zinc sulfate per day, providing 15 mg of elemental zinc) than children who received Ritalin and a placebo.37 As a monotherapy, 150 mg zinc sulfate daily for 12 weeks was shown to significantly improve hyperactive, impulsive, and impaired socialization symptoms versus placebo in a large study of 400 children with ADHD.(*)
Iron. Iron is an essential trace element in the body that is important for growth, development, oxygen transport by red blood cells, and dopamine signaling. Iron is stored in the body by the protein ferritin, which can subsequently release iron in a controlled fashion as required by the body. Low ferritin levels have been observed in patients with ADHD, suggesting an important role of iron/ferritin in ADHD. Many children with ADHD are iron deficient, and the severity of iron deficiency correlates with symptom severity.59 Low iron levels have also been observed in children who have ADHD plus sleep disorders (eg, restless leg syndrome).
A randomized placebo-controlled study in 23 children (aged 5–8 years) with ADHD as well as iron deficiency (defined by ferritin levels less than 30 ng/mL) showed that 80 mg of ferrous sulfate supplementation daily (providing 16 mg of elemental iron) for 12 weeks resulted in a significant decrease in symptoms. Another trial with 14 subjects (7–11 years old) showed that 5mg/kg (about 2.3 mg per pound of bodyweight) iron per day for 30 days significantly reduced parent ratings of ADHD symptoms.61
In a trial of 52 iron-deficient children on Ritalin® randomized to receive iron supplementation (ferrous sulfate 300 mg capsule containing 80 mg of elemental iron) or placebo for 12 weeks, parents reported significant improvement in ADHD symptoms for those receiving iron but not for those receiving placebo.(*)
Caution, high doses of iron (such as those used in these trials) exceeding the RDA should only be used under the guidance of a healthcare practitioner, as accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years of age.
Vitamin D. Vitamin D is a fat-soluble vitamin obtained through the diet and through our skin from sun exposure. Vitamin D deficiency has been suggested as a possible contributor to several neuropsychiatric disorders and may be a risk factor for ADHD. A meta-analysis of eight studies totaling 11,324 children (2,655 with ADHD) found that vitamin D serum levels were significantly lower in patients diagnosed with ADHD compared with healthy controls.63 In a separate meta-analysis of five studies, lower vitamin D status was significantly associated with a higher risk of developing ADHD.64 Vitamin D deficiency may also contribute to mood disorders, which commonly coexist with ADHD.
Vitamin D supplementation has been examined in various clinical trials as a therapy to reduce ADHD symptoms. A double-blind trial randomized 54 children (5‒12 years) to receive 2,000 IU (50 mcg) vitamin D or placebo for eight weeks as adjunctive therapy to Ritalin®. While ADHD symptoms decreased significantly in both groups, evening symptoms were improved at both four and eight weeks with vitamin D.66
In a separate trial including 96 children with ADHD randomized to receive 1,250 mcg (50,000 IU) vitamin D weekly or placebo for six weeks (along with a stable daily dose of Ritalin®), the vitamin D group saw an improvement in ADHD symptoms with a particular effect on symptoms of inattention.(*)
As you may have noticed, most of the nutrients noted above, found to be helpful in reducing ADHD, can be commonly found in most multi-vitamin and mineral formulas – namely the B-vitamins, Vitamin D, Magnesium, zinc, and iron. Therefore, various researchers have reasoned that a combination of these in a multi-vitamin mineral formulation, as well as other healthful nutrients, should be significantly more potent than just taking one, two or a few of these nutrients on their own.
Not surprisingly several studies have been conducted to test the validity of that hypothesis, with a variety of formulations. One of the best and most recent of these was a 2018 fully blinded controlled trial of 93 children (ages 7‒12) with ADHD not taking any medication, subjects were randomized to receive a nutritional supplement providing (13 vitamins, 17 minerals, and 4 amino acids) or placebo for 10 weeks. Most of the nutrients in the formula were at doses between the recommended daily allowance (RDA) and the traditionally tolerable upper intake level (UL).
The results showed a significant improvement on CGI-I scale, a measure of a clinician’s view of the patient’s global function, in which 47% of those given the micronutrients were identified as improved versus 28% given placebo. Clinician, parent, and teacher reports also identified that those on micronutrients showed greater improvements in emotional regulation, aggression, and general function compared with placebo. (Go here for a link to the full report, and here for a complete list of all ingredients and quantities, which included vitamins A, C, D, E, K, B-complex, Alpha-lipoic acid, iron, magnesium chelate, zinc, selenium, potassium, choline bitartrate, Alpha-Lipoic Acid, inositol, ALC, NAC, Grape seed, Ginkgo, boron, and lithium orotate – this was no regular off the shelf concoction.)
Moreover, In a 1-year follow up of this trial, children who benefitted from micronutrients in the short-term maintained these improvements at follow up without side effects. A whopping, 84% of participants who remained on micronutrients were identified as having “Much” or “Very Much” improved overall functioning relative to baseline, compared to 50% of participants who switched to psychiatric medications and 21% who discontinued treatment, strongly supporting a role for combined micronutrient supplementation in improving ADHD symptoms.
“Nutritional supplementation offers a much
broader and safer approach.”
Dr. Julias Goepp, M.D.
Omega-3 & Omega-6 Fatty Acids
Children with ADHD may have lower levels of omega-3 fatty acids in their blood. While the typical Western diet often contains excessive levels of certain omega-6 fatty acids, it is lacking in omega-3 fatty acids, which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Considering that dopamine-producing nerve endings are composed of up to 80% of the omega-3 fatty acid DHA, these fat molecules have an important role in the central nervous system and its functions. In children, the severity of ADHD symptoms is linked to lower levels of omega-3 and higher levels of omega-6 fatty acids.
Hyperactivity and inattention in general are also linked to omega-3 fatty acid deficiency. A UK-based study in 493 school children aged 7–9 years found omega-3 fatty acid insufficiency was very common and associated with ADHD-related symptoms (eg, oppositional behavior and emotional instability). Research from another group found that low blood levels of omega-3 fatty acids correlated with callous-unemotional behavior, antisocial traits, and impaired emotional processing.
Swedish scientists studied the effects of fish oil supplements containing polyunsaturated omega-3 fatty acids (558 mg EPA, 174 mg DHA daily) and the beneficial omega-6 fatty acid gamma linolenic acid (GLA) (60 mg daily) in 75 children and adolescents with ADHD over a six-month period. They found that after six months, nearly half of subjects responded to the omega-3 and omega-6 supplements with a reduction in ADHD symptoms.
An analysis of several published studies also found that supplementation with free fatty acids and exclusion of artificial food coloring from the diet had statistically significant effects on reducing ADHD symptoms.84
Flax oil, which provides high levels of the omega-3 fatty acid alpha-linolenic acid (ALA), a precursor to EPA and DHA, also may be of benefit. A study examining the benefit of supplementation with an emulsion of flax oil (providing 200 mg ALA) and vitamin C (25 mg) given twice daily to children with ADHD found a significant improvement in symptoms of ADHD, including impulsivity, restlessness, inattention and self-control, as reflected by a reduction in total hyperactivity scores.(*)
The balance of fatty acid levels can be measured with blood tests, and people taking fatty acid supplements can have repeat blood tests to measure their effect.
Phosphatidylserine (PS) is a major component of cell membranes and is considered one of the most important brain nutrients. PS has a variety of functions within the brain including supporting cell membrane fluidity and beneficially influencing neurotransmitter systems (eg, acetylcholine, dopamine, and serotonin). A 2021 meta-analysis found that at a dose of 200–300 mg daily, PS had a significant effect on symptoms of inattention compared with placebo.
In a 2013 randomized controlled trial, 36 children diagnosed with ADHD were given either 200 mg PS daily or placebo for two months. PS supplementation resulted in significant improvement in ADHD symptoms including inattention, impulsivity, and short-term memory. No adverse effects were reported and the supplement was well tolerated.(*)
So what if you combined these two?
Another randomized controlled trial of 15 weeks duration studied the effects of PS combined with omega-3 fatty acids. In this study, 200 children with ADHD were given either 300 mg PS plus 120 mg EPA and DHA or placebo. The treatment resulted in significant improvement in ADHD symptoms. A subgroup analysis revealed this treatment may be especially effective in children with ADHD with more pronounced hyperactive and impulsive behavior.(*)
5-HTP is a metabolite of the amino acid L-Tryptophan, which converts in the body into serotonin, one of the primary calming chemical messengers or anti-depressants in our body. Serotonin in turn is converted at night time into melatonin, which enables us to go to sleep, and hopefully stay asleep.
Dr. Amen likes to use 5-HTP to help decrease aggressiveness and improve concentration and mood during the day, and to facilitate sleep at night. According to Dr. Amen, “A number of double blind studies have shown 5-HTP to be as effective as antidepressant medication in treating depression.” (p. 258) These, along with other serotonin enhancers like St John’s Wart and saffron, have a long history of use in helping individuals with ADD or ADHD to calm down, relax and focus. And although it’s a bonafede antidepressant it does not have any adverse side effects, when taken as directed, except for an occasional upset stomach when taken on an empty stomach.
According to Dr. Amen the usual recommended dose of 5-HTP for adults is 50 to 300 mg per day. Children should start with a half dose. Ideally he suggests taking it independent of other proteins to facilitate it’s uptake into the brain to make serotonin.
5-HTP might also help to reduce any cravings for sugar.
L-Theanine, is a naturally occurring amino acid found in tea, that has been shown to help ease anxiety, reduce stress, and improve focus and attention. L-theanine is structurally similar to L-glutamate (a neuro excitor) and its effects are attributed to its ability to bind glutamate receptors, inhibit glutamate and glutamine reuptake, and elevate levels of the inhibitory neurotransmitter gamma-Aminobutyric acid (GABA)
Sleep disorders, a common comorbidity in ADHD that also can be a factor in its etiology, have been shown to be improved with L-theanine. In boys (aged 8‒12 years) diagnosed with ADHD, 400 mg L-theanine daily was shown to improve sleep.72
5-HTP and Theanine work very well together to increase both Serotonin and GABA, the two primary messengers of calm, which can also work in concert to effect a significant improvement in sleep.
Conversely, studies suggest L-theanine alone and in combination with caffeine, another compound naturally found in tea, can also improve attention and focus in patients with ADHD.73
A study including five male children (ages 8‒17) administered L-theanine (2.5 mg/kg), caffeine (2 mg/kg), L-theanine plus caffeine, or placebo found L-theanine and the combination improved cognitive function and decreased mind-wandering activity during functional magnetic resonance imaging (fMRI).74 These results were corroborated in a separate small trial involving five boys (age 8‒15 years) with ADHD; administration of a drink containing L-theanine and caffeine (2.5 mg/kg and 2 mg/kg, respectively) improved cognitive function, inhibitory control, and reduced mind-wandering (“daydreaming”) compared with placebo, whereas L-theanine alone only improved cognition.(*)
In conclusion, the research noted above, suggests once again that a combined synergistic approach, combining medications with supporting nutritional supplements, or just taking various nutrients together, will likely be the most effective biological approach for the most people to reduce their symptoms, improve their cognitive and social functioning and quality of life.
