Nutrition and Attention-Deficit/Hyperactivity Disorder paper Complete

Joseph Albrecht

Advanced Nutrition

Dr. Gregoire

Nutrition and Attention Deficit/Hyperactivity Disorder

The recent rise in cognitive development and learning disorders has led to a broad platform of treatment modalities. Among these are the use of quality nutrition, herbs, vitamins, minerals, enzymes and other natural, non-invasive dietary factors. Current research implicates the incorporation of these factors as beneficial, specifically when it comes to attention-deficit/hyperactivity disorder (ADHD). By reviewing and building upon the existing scientific literature, useful discoveries can be made in this field and applied to help patients with this condition.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder involving the major traits of hyperactivity, inattentiveness and impulsivity. This condition often has a long-term impact on functioning, development and quality of life of patients (Sroubek, Kelly, Li; 2016). Healthcare professionals use the guidelines established in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) for diagnosing ADHD. The DSM-5 has an extensive list of symptoms for inattention, as well as hyperactivity/impulsivity. Six or more of these criteria must be present for both of these categories for children up to age 16, adolescents 17 and up and adults. In addition, these symptoms must be present for at least six months, shown to be inappropriate/disruptive for the person’s developmental level and are met along with four additional conditions related to age, symptoms and lifestyle factors (CDC, 2016).

Fortunately, there is a growing body of research which draws light on safe and effective ways to help some of the most-problematic symptoms of ADHD. A brief review of the PubMed database reveals hundreds of articles linking ADHD with various aspects of nutrition. One article in particular, from the peer-reviewed journal: Neuro Plasticity investigated herbal preparations and nutritional supplements assessed in clinical studies as potential ADHD treatments and considered their safety and efficacy. In particular, researchers looked into Pycnogenol, an extract from pine bark, and found it ample in catechin, procyanidins, phenolic acids and taxifolin. Each of these compounds has different biological effects (Ahn et al, 2016). The main benefits found were in episodic hyperactivity, inattentiveness and visual-motor coordination. Pycnogenol also helped decrease oxidative DNA damage and normalize antioxidant levels in ADHD patients after one month of treatment. Oxidative stress is hypothesized to be a contributing factor to ADHD (Ahn et al, 2016). Other herbs in the review included: Ginseng, Ginko biloba, Ningdong, Valerian, Bacopa, Passion flower, Oroxylin A, YY 162, Sideritis scardica and Rhodiola. These herbs have various anti-oxidant and anti-inflammatory compounds like polyphenols which help improve some of the most problematic ADHD conditions. Vitamins play crucial biological roles involving the many functions of the brain. Vitamin B6 was noted for its ability to influence the production of serotonin, a neurotransmitter responsible for transmitting impulses and has been associated with well-being and happiness. Vitamin C combined with alpha linolenic acid (ALA) showed promise due to strong antioxidant properties along with fats essential for healthy brain development (Ahn et al, 2016).

Minerals, in their role as cofactors, participate in the synthesis, uptake and breakdown of key neurotransmitters involved in ADHD. Furthermore, minerals such as calcium and magnesium are crucial for aerobic metabolism and cofactors in breaking down of blood glucose via glycolysis, the citric acid cycle and respiratory chain in the mitochondria (Ahn et al, 2016). Glucose is essential for adequate brain functioning because it is the brain’s primary fuel. Zinc also has been shown to provide benefits for those with ADHD. Akhondzadeh et al. performed a double-blind, placebo-controlled study in which Zinc was found as an effective complementary therapy cure for children with this condition. Another study conducted in Iran, compared three different therapies for 150 children (6-15 years) with ADHD, including a placebo-control group. All groups, including the control received Ritalin, a common ADHD medication; the two non-control groups received omega three fatty acids adjusted to body weight and a 22 mg zinc sulfate capsule, respectively. The results found significant decreases in ADHD symptoms, as reported by the Conner’s Parent and Teacher Rating Scales for both the zinc and the omega 3 group at 0, 2, 4 and 8 weeks. The group treated with the omega three fatty acids, however had a better clinical response than the zinc group (Salehi et al, 2016).

As stated above, essential fatty acids are crucial for healthy brain development. Within this category are the polyunsaturated fatty acids (PUFAs), including omega 3 and omega 6 fatty acids. To understand why PUFAs are important in ADHD, one must look into the biological of fatty acids and their constituent parts. Precursors for omega 3 and omega 6 fatty acids enter the body using the same enzyme pathway. Alpha-linolenic acid is a precursor for omega 3s and can enter the body when one consumes flax, soybeans, canola oil and green leafy vegetables (Königs et al, 2016). This precursor can be converted into docosahexaenoic acid (DHA), which helps produce the brain’s phospholipids and neural membranes. DHA is largely found in the synapses, or small gaps, between two nerve cells and is essential for the functioning of neurons. Eicosapentaenoic acid (EPA) is in charge of making anti-inflammatory eicosanoids for signaling. Both DHA and EPA are found in large amounts in fish and fish oil (Königs et al, 2016). Studies have shown lower blood and plasma levels of omega 3s in ADHD patients when compared to age-matching controls, including children, adolescents and adults. DHA levels in the brain continuously increase until the age of 18 years in healthy individuals. Additionally, the ratio of omega 3s to omega 6s has been shown to be lower in ADHD patients, with higher levels of omega 6 implicated in neuro-inflammation (Königs et al, 2016). It is therefore critical to monitor omega 3 and omega 6 levels and correct any imbalances through a healthy balanced diet. This diet should be rich in a wide-variety of nutrient-dense fruits, vegetables, whole grains, nuts/seeds, legumes, lean meats and fish, with additional supplementation if necessary.

Alongside a healthy diet, regular physical activity has shown tremendous promise in helping reduce symptoms of ADHD. Exercise has consistently shown to reduce stress and anxiety, increase alertness and improve overall health and well-being.  Specifically, physical activity increases the release of three crucial neurotransmitters: serotonin, dopamine and norepinephrine. These chemical messengers have been implicated in our ability to maintain attention in daily activities.  One study involving 66 participants, 28 of which had ADHD, assessed the effects of a 5 minute relay race without rest on computer game skills requiring attention.  The group with ADHD that performed the exercise before the game performed 30.52% better than those who did not (Silva et al, 2015). This research builds off previous studies showing that memory-regulating hormones (catecholamines) such as vasopressin, ACTH and B-endorphin are released during exercise.

The benefits of exercise on ADHD patients were also examined in a two-part study (Hung et al, 2016). This study highlighted the significance of P3, one of the most-researched components of event-related potentials. P3 occurs in response to a stimulus and shows the neural resources allocated towards that stimulus. Furthermore, researchers looked at global switch costs; a measure of working memory. Global switch costs refer to the difference in reaction time in mixed and pure conditions. In first part, 20 children with ADHD were examined in their task-switching potential alongside 20 controls without ADHD.  The control group exhibited better performance than the ADHD group, which had significantly longer response times, less accuracy, longer P3 latencies and larger global switch costs. The second study involved 34 participants with ADHD, performing a task-switching paradigm after a half hour of moderate exercise on a treadmill after control sessions (watching videos while seated). After exercise, the children had smaller global switch costs in response time compared with after control groups. Additionally, P3 amplitude only increased after exercised in the mixed condition and not the pure condition, compared to no effects found in the control session. The researchers concluded “…single bouts of moderate intensity aerobic exercise may have positive effects on the working memory of children with ADHD” (Hung et al, 2016). These studies provide the groundwork for more inclusive and in-depth investigations of the effects that exercise has on individuals with ADHD.

The current way of life in modern American society presents numerous obstacles to achieving quality health. Factors including: lack of physical activity, high stress and poor dietary choices can all contribute to weight problems and obesity. These conditions are significantly harder to treat for individuals with learning disorders such as ADHD. Fortunately, researchers and health professionals have developed effective, user-friendly weight-loss methods. In particular, a tool known as the Healthy Eating Plan (HEP) has shown to be helpful for losing weight and tracking food intake (Weems et al, 2016). This plan uses pictures to show daily serving sizes for dairy, fruit, vegetable, protein, grain, fat or sugar. The HEP provides relevant nutrition information based on an individual’s age, sex and energy needs. It also breaks down the different food groups into 2 general categories: “Always” and “Once in a While”. Healthier items like low fat dairy, fruits, vegetables, whole grains, lean protein meats and fish appear in the “Always” category and high fat, sugary and processed foods are in the “Once in a While” group.   By representing healthy foods and treats in clearly distinct categories, those using the HEP learn the importance of putting healthy food choices at the center of their diet. As a result, adolescents with ADHD can lose excess weight and consume nutrient-rich foods; both of which can improve cognitive function.

Although ADHD presents major challenges in modern society, advancements in scientific research and human health offer promising methods for managing this disorder. By evaluating current literature and applying it into everyday settings, new findings and treatments can emerge. Scientists and health professionals must work in cooperation with the public to enact meaningful progress in this area.

References

1.      Attention-Deficit/Hyperactivity Disorder: Symptoms and Diagnosis. Centers for Disease Control and Prevention Web Site. Published October, 2016. Updated October 5, 2016. Accessed October  20, 2016. http://www.cdc.gov/ncbddd/adhd/diagnosis.html

2.       James Ahn, Hyung Seok Ahn, Jae Hoon Cheong, and Ike dela Peña, “Natural product-     derived treatments for attention-deficit/hyperactivity disorder: safety, efficacy, and therapeutic potential of combination therapy,” Neural Plasticity, vol. 2016, Article ID 1320423, 18 pages, 2016. doi:10.1155/2016/1320423

3.       Hung C-L, Huang C-J, Tsai Y-J, Chang Y-K, Hung T-M. Neuroelectric and Behavioral   Effects of Acute Exercise on Task Switching in Children with Attention-Deficit/Hyperactivity Disorder. Frontiers in Psychology. 2016;7:1589. doi:10.3389/fpsyg.2016.01589.

4.       Königs A, Kiliaan AJ. Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment. Neuropsychiatric Disease and Treatment. 2016;12:1869-1882. doi:10.2147/NDT.S68652.

5.       Salehi B, Mohammadbeigi A, Sheykholeslam H, Moshiri E, Dorreh F. Omega-3 and zinc supplementation as complementary therapies in children with attention-deficit/hyperactivity disorder. Journal of Research in Pharmacy Practice. 2016;5(1):22-26. doi:10.4103/2279-042X.176561.

6.      Silva AP, Prado SOS, Scardovelli TA, Boschi SRMS, Campos LC, Frère AF. Measurement of the Effect of Physical Exercise on the Concentration of Individuals with ADHD. Lidzba K, ed. PLoS ONE. 2015;10(3):e0122119. doi:10.1371/journal.pone.0122119.

7.      Sroubek A, Kelly M, Li X. Inattentiveness in attention-deficit/hyperactivity disorder. Neurosci. Bull. (2013) 29: 103. doi:10.1007/s12264-012-1295-6 

8.      Maresa Weems et al. “A novel weight-loss tool designed for adolescents with intellectual disabilities. Journal of the Academy of Nutrition and Dietetics doi:http://dx.doi.org/10.1016/j.jand.2016.09.006