Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...Tell Me More
A few months back, I put together an article on alternative therapies for depression. Many readers showed a lot of interest in some of the emerging non-drug treatments in that field, and, more importantly, many began to relay their own stories about how they overcame or successfully managed their depression through various strategies. That’s what I love the most about this community—sharing experience and expertise in the interest of broadening available solutions beyond what conventional thought tells us.
I’ve received frequent requests over the years to do the same for the convoluted world of ADD and ADHD treatment. There’s a lot to this picture and (if there’s interest) probably fodder for a follow-up post. For today I’ll delve into some of the lifestyle strategies and alternative therapies that offer the most promise.
I understand that ADD and ADHD treatment—and even diagnoses—are sensitive topics. Debates continue to rage within the medical, caregiver, and even Primal communities as to what actually constitutes the conditions, whether they’re simply modern constructs, and what the best forms of treatment are. Despite the increasing numbers of diagnoses, there’s still a lot we don’t know about the issue and even less people can agree on.
In the U.S., it’s estimated that between 3 and 10% of children and 1-6% of adults have been diagnosed with attention deficit hyperactivity disorder (ADHD). As the stats imply, both ADD and ADHD are more prevalent in children but there’s a very strong possibility that the symptoms will continue into adulthood.
Under the conventional model of diagnosis, those difficulties typically manifest as “an inability to organize complex sequences of behavior, to persist in the face of distracting stimuli, and to respond appropriately to the consequences of past behavior.” Resulting academic impairments, social dysfunction and poor self-esteem can in more serious cases morph into alcohol and substance abuse, criminal tendencies, and antisocial behaviors as a person slides into adulthood (although other family, social and educational factors come into play here).
The difference between ADD and ADHD, in case you’re wondering, is the additional symptom of hyperactivity in the latter condition. In much of the literature, the focus is now almost exclusively geared towards ADHD as the more inclusive of the two disorders, and that’s what I’ll largely be focusing on too.
Clearly, through the black and white lenses of the conventional practitioner, there’s a lot to be said for prescribing a heady dose of Ritalin at the first signs of inattentiveness or hyperactivity. Doing so has been shown to improve ADHD symptoms in around 60% of patients. But there’s often no corresponding improvement in school performance, and the rather alarming fact that 40% of those taking side effect-laden stimulants like Ritalin still aren’t seeing any measurable improvement in their symptoms. What’s more, a daily dose of Ritalin, for example, acts in a similar way to cocaine in the brain, while other common ADHD drugs have in some studies been associated with earlier onset of bipolar disorder and growth suppression.
In the U.S. and elsewhere, Ritalin and associated stimulant prescriptions are rapidly on the rise, but even in conventional circles many are beginning to question whether the symptoms that comprise the “disorder” might simply be an innate response to living conditions or even foods that we’re not well adapted to. Are we then prescribing potentially harmful drugs to our kids (and ourselves) when all we should be doing is eating better, revising our educational system, and making key lifestyle changes?
In 2008, a Northwestern University study suggested that ADHD may be an evolutionary adaptation suited to the hunter gather lifestyle that’s comprised most of humanity’s history. Researchers compared two tribal groups in Kenya—one which was still nomadic, and one who had settled into villages. Within both tribes, researchers located individuals exhibiting ADHD traits, finding that those within the nomadic tribe were better suited to the hunter-gatherer lifestyle and in fact were thriving compared to their non-ADHD peers.
Those ADHD individuals in the settled tribe showed the inevitable difficulty in the classroom and in the more structured drudgery of everyday life in a village—a common element linking today’s ADHD children.
The results suggest that rather than ADHD being a “disorder,” it may be an adaptation giving the individual an advantage in certain types of learning and activities—namely those centered around nomadic subsistence. This raises the question of whether we should be approaching ADHD as a disorder in the first place, or as a variation of constitution that thrives on a different way of life—one which doesn’t force children to learn by sitting in hard chairs listening to the drone of a teacher’s voice (or even where adults are expected to sit still for 8 hours a day and stare at an artificially lit screen).
That’s a topic for discussion (and maybe further research), but it’s interesting food for thought in the meantime.
Faced with the dilemma of potential misdiagnosis, conventional drug side effects, and a high rate of conventional treatment failure, I’m going to venture that it’s logical to seek out alternative ADHD therapies and basic lifestyle strategies that can either complement or, in some cases, replace those prescribed by the doctor. Let’s look at a few of the more popular or emerging recommendations.
This is arguably where the notion of dietary influence on ADD/ADHD first emerged. Back in the 70s, San Francisco-based allergist Ben Feingold developed an elimination diet that had thousands of parents claiming their children with ADHD showed marked improvement in their symptoms. The foundation of that diet? Elimination of food colorings and preservatives.
There was plenty of industry pushback at the time, but in recent years there’s been a resurgence of interest in artificial food colorings and other synthetic compounds in foods and the impact they might be have on ADD and ADHD symptoms. In 2004, a study published in the Journal of Developmental & Behavioral Pediatrics revealed that artificial food colors had significant negative effects on focus and concentration, therein promoting hyperactive behaviors in children and teens.
A spate of research linking artificial food colors and ADHD followed suit, culminating in a 2007 study in which researchers unequivocally placed hyperactive behavior firmly on the doorstep of four synthetic colors and a sodium benzoate preservative…regardless of whether the children eating or drinking them had actually been diagnosed with ADHD.
While it’s hard to control everything kids eat, cutting food coloring and additives is a good first-line strategy—for anyone with ADD/ADHD or not.
Stimulants like Ritalin work by temporarily restoring reward signaling in the brain. Children and adults with ADHD tend to exhibit haywire patterns in certain neurotransmitters, particularly in the case of dopamine—which just so happens to influence a person’s ability to make rational choices or delay gratification.
Reward signaling in the brain of someone with ADHD is often very similar to people prone to binge eating. Let’s be honest and admit that a diet rich in junk food is partly to blame for certain behaviors inherent in ADHD patients. The continual flood of dietary sugar, along with heady combinations of refined sodium and hydrogenated fats, is enough to invoke chaos in anyone’s reward system and general health. (This could be a post in an of itself.) Ditch the junk food, feed the body the micronutrients it requires, and at least some of the ADHD symptoms will improve.
Seeing as we’ve got the elimination ball rolling, why not single out a few more likely culprits? In functional medicine circles, elimination diets have been used decades to manage symptoms of ADHD and other forms of neural dysfunction. In particular, these diets have focused on eliminating both gluten and casein to good effect.
A 2011 study published in The Lancet placed 50 ADHD children on a hypoallergenic diet of rice, turkey, lamb, lettuce, carrots, pears, and other pre-approved whole foods known for the non-allergic palatability. Close to two-thirds of the children experienced a significant improvement in their symptoms on the diet, with most of them regressing to former symptoms shortly after stopping the diet.
A 2013 Danish study involving 72 children with autism spectrum disorder, which can include many symptoms similar to those of ADHD, found that introducing a diet free from both gluten and casein produced significant results. Certainly, research linking celiac disease to ADHD-like symptoms goes a long way towards verifying this hunch.
As the concept of nutritional ADHD therapy has taken hold, there’s been a particular focus on omega-3 essential fatty acid deficiency. As most Primal folks know, omega-3s play a critical role in the structure and function of membranes enclosing brain cells, and are similarly important for regulating transmission of impulses between nerve cells.
If a developing brain isn’t receiving enough omega-3 fatty acids through dietary or supplementary sources, the likelihood of developing ADHD and other behavioral issues increases. In particular, a lack of the long-chain fatty acid DHA has repeatedly been linked to a higher risk of ADHD.
But it might not be as simple as eating a more omega 3-rich diet. Studies examining dietary patterns and blood fatty acid composition in children note that kids with ADHD seem to have lower serum fatty acid content, regardless of how many omega-3s they get in their diet. It’s thought that this might be due to increased fatty acid oxidation in these children, suggesting a significant increase in omega-3 fatty acid consumption is needed to offset the jumped-up fatty acid metabolism.
The consensus? While the jury is still officially out on omega-3s and ADHD, high quality omega-3 supplementation from the likes of fermented cod liver oil is probably a good idea for most people with ADHD. Several studies recommend in the range of 300-600 mg/day of supplemental omega-3, but I wouldn’t be afraid to go over 1000 mg in those who really need that boost (just run it by your doctor first).
Supplementing with certain vitamins to fill dietary gaps may be a good strategy for some ADHD patients as they play a critical cofactor role in facilitating energy metabolism and neurotransmitter synthesis. B-vitamins are at the top of the chart in this respect, playing a key role in carbohydrate metabolism along with supporting healthy myelin sheath maintenance.
Vitamin B6 in particular can help to boost low levels of serotonin in hyperactive kids and alleviate aggression, especially when combined with magnesium. And of course, more vitamin D, whether from the sun or supplementary sources, is also likely to improve ADHD symptoms in those who are lacking.
As investigations continue into the links between diet and behavioral issues in both children and adults, it’s becoming increasingly apparent that ADHD patients are often deficient in zinc, iron and magnesium.
In children with ADHD, low serum zinc levels are associated with decreased concentrations of circulating fatty acids, which can lead to a negative feedback loop. To illustrate this point, researchers showed that supplementing with evening primrose oil, which is rich in gamma-linolenic acid, improved the behavior of ADHD kids in school, but that this positive effect was only apparent in those who were deficient in zinc.
Iron, as it happens, also plays a pivotal role in dopamine neurotransmission. In a 2004 study, 84% of children with ADHD tested were deficient in blood ferritin, compared to just 18% in health controls. Perhaps unsurprisingly, low serum ferritin levels were associated with more severe ADHD symptoms across the board. But supplementing with iron can be a fickle beast, and one which should be accompanied by regular blood measures with physician supervision.
Then there’s magnesium. I’ve already linked to a study that showed decent improvements from a combined approach of vitamin B6 and magnesium, and magnesium supplementation alone may provide almost as much efficacy in taking the H out of ADHD.
Choline is an essential micronutrient which plays an important role in brain development, liver function, muscular maintenance, nerve function, and plenty more besides. Suffice it to say that a deficiency in choline is not a good thing. In this study, 1H-MRS analysis indicated that children with poor memory had lower concentrations of choline-containing compounds, suggesting that increasing choline consumption may at least target the memory symptoms associated with ADHD.
The average Primal diet should already provide a decent dose of choline, but if in doubt don’t be afraid to offer a few more pastured eggs, and maybe throw in a serving of grass-fed liverwurst while you’re at it.
Acetyl-L-carnitine (ALC) facilitates the transport of fatty acids into the mitochondria, thereby boosting energy production via efficient metabolism of fatty acids. In a 2002 study, 13 out of 24 boys with ADHD showed a significant improvement in attention problems and aggressive behavior at both home and school.
More recent research into the effect of ALC on ADD/ADHD has been mixed, with several studies concluding no significant positive effect, while another trial that examined the effect of ALC on 56 fragile X syndrome boys with ADHD found that there were notable improvements in social behavior and significant reductions in hyperactivity from ALC treatment.
Another approach might simply be to invest in a high quality multivitamin (and fish oil) that ticks off all the likely bases in one fell swoop.
Certain clinical micronutrient formulations have often shown impressive results in small trials, with this study, for example, finding a 30% decrease in ADHD symptoms after 8 weeks of micronutrient supplementation in 70% of participants and a marked overall improvement in almost 80% of the participants. A follow-up from the same team with a larger number of subjects found similarly promising results. And these findings are nothing out of the ordinary, suggesting that micronutrients may be a good starting point for both children and adults who are in the process of exploring “alternative” means of treating their ADHD.
Exercise is one are where there’s no shortage of research—the challenge is sorting out the facts from the almost-fiction. A 2013 study showed that a single bout of moderate-intensity aerobic exercise improved reading accuracy and processing in both children with and without ADHD compared to those who didn’t exercise. The researchers concluded that “single bouts of moderately intense aerobic exercise may have positive implications for aspects of neurocognitive function and inhibitory control in children with ADHD.” Another trial found that attention deficit symptoms in ADHD children could be minimized through physical activity whether they were taking Ritalin or not.
Yoga, which straddles both the exercise and meditation realms, has been a bit of a mixed bag in the ADHD research arena. While some studies have found no measurable effects on ADHD at all, others have found yoga to provide a good complementary treatment for children with ADHD.
I venture the power of both exercise and meditation have a lot to offer kids and adults with ADHD. It would be great to see larger studies delving into the subject, but I don’t think it’s worth waiting on when both activities are known to enhance well-being anyway.
Given more time today (or another post), we could explore the possibilities contained within other burgeoning alternative ADD and ADHD treatments, like neurofeedback strategies, acupuncture, vestibular stimulation…even massage. There’s a lot going on in the world of alternative therapies, and many of the findings are very promising indeed.
I’d love to see more forays like this one into the world of comprehensive treatments—what finely tuned combinations of nutrition, lifestyle, supplements and, in appropriate situations, medications provide the most benefit for those suffering from ADD or ADHD (or at least the symptoms we’ve come to associate with these disorders).
And, as is so often the case, I think we’re called to examine the environment and expectations of modern living. Where can we simplify, naturalize our lives and the lives of our children? What’s possible, for the sake of our kids’ well-being, to change in our home life or educational choices? Sometimes big issues call for big questions—questions, not to mention answers, for which conventional wisdom isn’t likely to take the lead.
Thanks for reading everyone. I’m interested in your thoughts and questions—and certainly your experiences. What opinions and recommendations would you add?