No matter where you look, ADHD is everywhere. Can nutrition help? Kids as young as two years old receive stimulant medication for it. And according to CDC data, kids on Medicaid – that is, kids in lower income families – are more than twice as likely to get medication for ADHD than kids whose families have employer-sponsored insurance.

This may be no coincidence. Families in poverty eat poorly. They may live in food deserts, where fresh nutritious food is simply not available. Or, they may have no car (how do you get a week’s worth of food home without a car?), or no kitchen. Underfed kids, or kids who can’t tap into diverse nourishing diets, are at risk for more developmental injury and for learning deficits.

But what about families with means? With cars, kitchens, Whole Foods markets, and health insurance? Why are so many of their kids presenting with ADHD symptoms too?

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Because: Your child can be eating well, and even eating a lot, and still have one or more of these sure-fire nutrition fails that can trigger ADHD features. Leave any of these unaddressed, and it can be an uphill climb, whether you decide to medicate or not.

1 – Fungal body burden and gut dysbiosis – Especially for kids with big appetites for sweets, starchy processed foods, lots of bread, pasta, or dairy food.. but little else (hates veggies, hates proteins), this is a biggie. Optimize your child’s gut biome, and you will be amazed at the changes you will see in behavior, mood, attention, distractibility, and focus. “Fungal load” isn’t considered problematic in mainstream pediatrics, but it takes center stage in functional nutrition and functional medicine practice. Unless a child has visible thrush or patchy, itchy white material coming out of a body orifice, obvious ringworm style rashes, or other visible fungal skin manifestations, you’re probably not going to get traction on this one at the pediatrician’s office (but you will get an Adderall prescription). A functional stool culture to screen for fungal load and check levels of adequate beneficial flora is a start, and there are many other lab tests to define this piece. Depending on findings, I will choose a combination of herbal supports, probiotics, and foods to correct this. Correcting this piece can balance blood sugar swings your child may experience throughout the day, as well as eradicate irritating toxic by-products of a gut biome overburdened with fungal species. The result is a calmer, happier, more focused kid.

2 – Weak Iron Status – Iron is deal breaker for attention, focus, mood, sleep pattern, and appetite regulation. We need it to get oxygen to all tissues and the brain of course, but we also need it to create and balance neurotransmitters for learning. Kids don’t have to be anemic for marginal iron status to create or worsen ADHD features. Kids who do have anemia (more common than you might think) are easy to spot. They are tired, with pale skin or dark circles under their eyes. They sleep more and are visibly fatigued. They get sick more often, and stay sick longer. Your pediatrician is likely to pick up on this obvious problem with a simple finger prick blood test for hemoglobin and hematocrit. These only fall below normal levels when a child is well entrenched in iron-deficient anemia.

But there is a big grey zone between anemia and solid, healthy iron status.  It’s called pre-anemia. That’s where kids may not look anemic, but will have distractibility, irritable moods, impulsivity, insomnia or broken restless sleep, and poor school performance, especially for math tasks. Some have dark shiners under eyes. They may have bounds of energy part of the day, then get flat tires later on. More detailed testing than your pediatrician’s finger stick for hemoglobin and hematocrit are needed to sort this out. Learn more about the iron-ADHD connection here.

3 – Fish oils:  Get The Dose Right – Tomes have been written about what fish oils, and specifically omega three fatty acids, do for the brain, and about how our diets have changed over the last half century to deprive us of them. Fish oil supplements are widely available to help address this, but the trick is in the dosage and in the form. Many families I meet in my office use too low a dose, or use the wrong combination of oils for their child’s needs.

For kids with inattentive, incomplete, or jumbled effort when it comes to writing, reading, and visual tracking, emphasize DHA omega 3 fatty acids, and give 400 to 800 mg daily; more may benefit in some cases. Supplements that only give 50-200 mg DHA are of little value for ADHD or dyslexia. Therapeutic doses of DHA for these conditions are much higher – 800 mg to 2000 mg daily. For kids with impulsivity, emphasize EPA omega 3 fatty acids, and give 2000-4000 mg daily (two to four grams). You can join my practice nutrition dispensary here to get the products I depend on in practice. Set up your own account and get started with Barlean’s Seriously Delicious Key Lime Pie Fish Oil at a Tablespoon per day. Another liquid I love is Pharmax Finest Pure High DHA liquid at a teaspoon per day. If pills are your preference, Nordic Naturals ProOmega 2000 gives the highest potency available in 2 gel capsules. Search for these and get whichever best suits your child’s taste or ability – there are also other products available in flavors like lemon, orange or strawberry in my dispensary. Pro Tip: Skip the Nordic Berries from Nordic Naturals – the potency is far too low for school aged children with ADHD. Avoid the sugary dummies too if you can – they literally have more sugar than fish oil.

Note: Cod liver oil is a different animal altogether, and doesn’t have adequate DHA and EPA in itself to crack ADHD symptoms, unless you begin using doses of a tablespoon or more daily – and for some kids, this is too much because of the high vitamin A content in it. It is fine to combine cod liver oil with other fish oils and it is a great immune boost in itself.

4 – Weak protein – There are many ways protein can go wrong. When it does, it means the brain can’t get what it needs to build and balance things like dopamine – and what the brain needs is amino acids. Amino acids come from protein we eat. Whether it’s too little total protein eaten daily, too much of just one kind of protein (such as, your kid only eats dairy protein), eating inflammatory trigger proteins (undetected food sensitivities or allergies), or protein that is poorly digested or absorbed, kids who don’t get the right balance of amino acids into their brains are going to have “behavior” problems that can manifest as ADHD.

Amino acids are the building blocks of things like dopamine, GABA, serotonin, epinephrine, and all our neurotransmitters. Kids can look strong as an ox, grow well, and have more energy than you can handle – but may still have poor amino acid availability in the brain to build that focus chemistry. Or, they can eat a varied diet, but have chronic inflammation from low grade, undetected food protein sensitivities or allergies. Another problem is a pattern of constipation – always suspect for poor protein digestion and absorption.

There are many ways to sort out what your child’s protein story is, and many ways to fix it once you know what it is. A sure giveaway that your child isn’t getting enough protein is if they are slowing down for stature. That is are they growing? Pants getting shorter, need new shoes? If your kid’s progress for height has slowed down, and they’ve dropped more than fifteen points off their height percentile, there it is: They need more protein. Some kids just need diet changes; some need protein supplements; others need individual amino acids given as blends or as singles, such as tyrosine or carnosine. Still others may only need to improve a constipation pattern with gut biome balancing. Again, you may be astonished to see how easy it is to lessen ADHD features with targeted protein corrections.

5 – Too little food all day, every day – So simple, it’s exasperating. And many of you are probably saying, “…but my child can’t eat during the day at school, he’s too distracted / disorganized!” It is a catch-22, but once it is solved, kids do so much better. There are solutions that can get to the cause of this so that kids can pause and eat better, and they are worth the effort; there is no way a growing child can function smoothly from early in the morning to late afternoon, without eating.

While I work on helping kids’ appetites from the inside out, many of my clients work with school administrators on creating on a small lunch bunch so their kids can eat with a few peers in a quieter spot (a common accommodation in Individual Education Plans or IEPs); or, pack easy-to-swallow, high density liquid nutrition for lunch instead of a bento of items that require some disassembly, utensils, or organization. A formula called Neocate Splash has been helpful for many kids in my practice. Yes, it has some “ick” ingredients, but this product has permitted many of my kid clients to make it through a school year happier and more functional than if they had not had it at lunch – especially those with multiple food sensitivities. Another option is Orgain, an organic version of drinks like Pediasure which is available with or without dairy or soy protein. Orgain is in many supermarkets as well as Costco.

A simple finger food or two with a high-octane liquid lunch like this is better than zero food or a few raw vegetables and cheese. Consider deli meat wrapped around fruit; something to dip in hummus or pesto (crisp bell pepper wedges, crackers with seeds or sprouted grains); jerky or even bacon; or snack bars or bites rich in healthy carbs and fats, like Lara Bites or Lara Bars. Living here in Boulder, Colorado, it seems I see a new organic, kid friendly, hypoallergenic snack product every week in our local stores. If your local stores don’t stock healthy nutrient dense bars or snacks, shop on line – the options are endless, and impressive.

6 – Undiagnosed food sensitivities – These reactions, which are different from food allergy reactions, will definitely niggle your kids’ brain, and keep the distractibility flowing – along with dysgraphia, impulsivity, and slower processing speed. If you’ve done food allergy testing via skin prick or blood draw, you’re not done. Consider an ELISA IgG food antibody panel to find the full story. Cross-reactivity can occur between IgG food reactions and brain tissue – lab tests are also available to scrutinize this too, if helpful. Even if you’ve tried elimination trials, do the test to see what is really going on.

7 – Too few carb calories – We love to demonize carbohydrates these days, but truth is, kids really need them. A balance of healthy carbs in kids’ diets fuels progress on their weight-for-age growth pattern. It also protects protein from being used up for energy during the day – important, because we need that protein to get to the brain for functional focus chemistry. When there are enough carb energy sources around, protein is spared for growth and structure – so your kids can progress on their height-for-age growth pattern. Without carbs, even if your child eats a lot of protein, linear growth (height) can be stunted. Don’t limit your kids for reasonable carbs. Allow hefty ones during the school day with some good protein and fats – pumpkin breads, custard cups, sweet potato chips with guacamole, Paleo treats like Hail Merry Miracle Tarts or Merry Bites, Chia Pods, quinoa or cous cous salads with chopped cooked green or wax beans, olives, and hemp seeds – the options are plentiful!

8 – Not eating organic – Yup, it’s more expensive. But even the American Academy of Pediatrics is on board with this one. If you missed it, a clear association was found between ADHD and agricultural pesticides in urine in children. Per standard operating procedure, the AAP stated that more research is needed to see if this is causal. Wanna wait for that? Your kid will be 25 years old. Play it safe and smart, and splurge on organic when you can; grow your own; get some chickens or barter with neighbors who did; visit your local farmer’s market. Your kids really are what they eat!

9 – Untreated methylation impairments – You may have heard of nutrigenomics, the practice of integrating your genome with food and nutrients. Many things turn genes on and off, from toxins to nutrients. We have genes for everything, from what color eyes we have, to how vitamin D attaches to cells, to how efficiently we make dopamine, yes dopamine – the target neurotransmitter of many drugs for attention and focus. Dopamine depends on a process called methylation, and methylation gene mutations are quite common. They are easy to screen for (with a cheek swab or blood test for some of your DNA) and straightforward to support with methylated forms of certain nutrients. This can improve attention, focus, anxiety, and depression – drug and side effect free.

10 – Thinking any one of these things in itself will fix ADHD –  Your kid’s brain is like an engine – lots of moving parts, in terms of what is needed for functional focus biochemistry. Sure, you can change the oil, but what if the timing belt needs adjusting, or the fuel pump is failing? Don’t expect foods and supplements to work like drugs. If you tried just one nutrition approach and it was dismal, revisit the options mentioned here. Though it takes extra work to assess and coordinate all these components, the bonus is your kid will likely feel happier and healthier over all, without a drug dependency that can last well into young adulthood. Long term use of stimulant medications for ADHD has been shown to make no impact at all for academic improvement in boys or girls, and to increase depression in girls, according to this study. But building strong foundational nutrition will serve your kids for years to come.

Need help? Got questions? Set up an appointment via my calendar here. I can’t give treatment advice for your child in this forum, but would be happy to work with you in my pediatric nutrition practice. I look forward to hearing from you!