Dr Shawn M. Carney
Nutritional Supplements as Natural Treatments for ADHD
Updated: Nov 9, 2022
Natural and alternative treatment options for ADHD are often selected based on the outcomes of different tests, including nutrient testing. Treating with nutritional supplements has been shown to help in multiple clinical trials and is gentler than stimulant prescriptions.
Attention Deficit Hyperactivity Disorder (ADHD) has been increasing in recent years, so much so that the prevalence of children ever diagnosed with ADHD increased by 42% between 2003 (7.8%) and 2011 (11.0%).(1) Although researchers speculate on the reason for this rise, many factors likely contribute, including more accurate diagnosis and increased exposure to contaminants like BPA and phthalates, as discussed in a previous blog.(2) However, overwhelming evidence suggests that nutritional deficiencies are, in many cases, contributing factors as well.(3,4,5)
Omega-3 Fatty Acids
Our brain and nerves are composed mostly of fat. The most important of these are called omega-3 fatty acids and are found originally in algae, accumulating at higher usable amounts in fish or fish oil supplements.(6,7) Perhaps the two most notable omega-3s are called eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). they are absolutely necessary for human health, and their concentration in the brain makes them key players in neurological disorders such as ADHD. Brain and nerve growth throughout childhood is extraordinarily rapid, and the need for omega-3 fatty acids remains critical al the way through adolescence and into adulthood. Overwhelming evidence implicates deficiencies in omega-3 fatty acids for the rise of ADHD. (5,8,9) Some of this research even shows that children with low scores on behavioral assessment test consistently have lowers omega-3 fatty acids levels, and when supplemented with fish oils, the symptoms of ADHD improve.
Zinc is an important co-factor to several neurotransmitters, which directly affect mood and learning ability, including the production of dopamine, a feel-good chemical in our brains that is needed for learning.(10,11) In fact, studies show that zinc levels correlate with anxiety and behavioral problems, as well as have a significant effect on information processing in boys with ADHD. Since zinc levels can be much lower in individuals with ADHD, children with ADHD show positive behavioral and cognitive results after zinc supplementation.(11)
This element is a major cofactor of tyrosine hydroxylase, which is necessary for the synthesis of dopamine, which is one of the neurotransmitters supportive of concentration and mood.(12) Therefore, iron deficiency may lead to a lower dopamine production and enhanced ADHD symptoms. Not having an ample amount of well functioning dopamine-receptors in the brain, or a functional impairment in the dopamine-rich basal ganglia, can be important in the etiology of ADHD.(13, 14). Low levels of iron in the brain have even been shown to correlate with ADHD after being measured using magnetic resonance imaging (MRI).(15,11)
Oxidative stress is a term used to describe damage to our cells that occurs on a daily basis throughout our bodies. Fortunately, our bodies have built-in defenses against the onslaught of internal and external toxins causing oxidative stress in our tissues. Interestingly, several studies show patients with ADHD have normal levels of antioxidant production, but that their response to oxidative stress is insufficient, leading to oxidative damage.(16) Minerals such as selenium and cooper, antioxidants such as cysteine and vitamin E and several other nutrients ensure the body's powerful defense systems work optimally.
Many other nutrients should also be considered when assessing ADHD, including magnesium, copper, selenium and several amino acids which can influence neurotransmitter levels. Since so many nutrients are needed to keep our amazingly complex brain and nervous system functioning properly, a comprehensive assessment of nutritional status is very important. In disorders like ADHD, the potential improvement of symptoms when even a single deficiency is corrected can often be quite dramatic. And less invasive methods using constituents of the body should be considered well before turning to stimulant medications, given their potential side effects.(17)
Testing options may include blood-draws but may alternatively involve hair samples or urine collections, especially when pediatric patients are being considered.
Not all nutrient tests provide the same level quality of information. Whether a person is measuring nutrients or their related analytes in hair, urine, whole blood, serum, red blood cells, or white blood cells can give either more or less information and a knowledgeable clinician should be consulted to guide interpretation and treatment.
National Institute of Health, National Institute of Mental Health. Attention Deficit/Hyperactivity Disorder (ADHD). https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd#part_2550. Accessed 09-28-2022.
Johnstone, Jeanette M et al. “Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial.” Journal of the American Academy of Child and Adolescent Psychiatry vol. 61,5 (2022): 647-661. doi:10.1016/j.jaac.2021.07.005.
Rucklidge, Julia J et al. “Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial.” Journal of child psychology and psychiatry, and allied disciplines vol. 59,3 (2018): 232-246. doi:10.1111/jcpp.12817.
Bos, Dienke J et al. “Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder.” Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology vol. 40,10 (2015): 2298-306. doi:10.1038/npp.2015.73.
National Institute of Health, Office of Dietary Supplements. Omega-3 Fatty Acids Fact Sheet for Health Professionals. Accessed 09-30-22.
Harris WS. Omega-3 fatty acids. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:577-86.
Agostoni, Carlo et al. “The Role of Omega-3 Fatty Acids in Developmental Psychopathology: A Systematic Review on Early Psychosis, Autism, and ADHD.” International journal of molecular sciences vol. 18,12 2608. 4 Dec. 2017, doi:10.3390/ijms18122608.
Chang, Jane Pei-Chen et al. “Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder: a Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies.” Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology vol. 43,3 (2018): 534-545. doi:10.1038/npp.2017.160.
Lepping, Peter, and Markus Huber. “Role of zinc in the pathogenesis of attention-deficit hyperactivity disorder: implications for research and treatment.” CNS drugs vol. 24,9 (2010): 721-8. doi:10.2165/11537610-000000000-00000.
Robberecht, Harry et al. “Magnesium, Iron, Zinc, Copper and Selenium Status in Attention-Deficit/Hyperactivity Disorder (ADHD).” Molecules (Basel, Switzerland) vol. 25,19 4440. 27 Sep. 2020, doi:10.3390/molecules25194440.
Wigglesworth J., Baum H. Iron dependent enzymes in the brain. In: Youdim M., editor. Brain Iron: Neurochemical and Behavioral Aspects. Taylor and Francis; New York, NY, USA: 1988. pp. 25–66.
Youdim M.B., Ben-Shachar D., Yehuda S. Putative biological mechanisms of the effect of iron deficiency on brain biochemistry and behavior. Am. J. Clin. Nutr. 1989;50:607–617. doi: 10.1093/ajcn/50.3.607.
Castellanos, F X. “Toward a pathophysiology of attention-deficit/hyperactivity disorder.” Clinical pediatrics vol. 36,7 (1997): 381-93. doi:10.1177/000992289703600702.
Cortese, Samuele et al. “Brain iron levels in attention-deficit/hyperactivity disorder: a pilot MRI study.” The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry vol. 13,3 (2012): 223-31. doi:10.3109/15622975.2011.570376.
Joseph, Nidhin et al. “Oxidative Stress and ADHD: A Meta-Analysis.” Journal of attention disorders vol. 19,11 (2015): 915-24. doi:10.1177/1087054713510354.
Levy, F. “Side effects of stimulant use.” Journal of paediatrics and child health vol. 29,4 (1993): 250-4. doi:10.1111/j.1440-1754.1993.tb00504.x.
The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.