Multivitamins & Fish Oil for Pediatric ADHD Treatment
Sub-optimal nutrition not only affects a child’s physical health, but also predisposes them to neurocognitive deficits like attention deficit hyperactivity disorder (ADHD).[1],[2],[3]
ADHD is a common, early-onset, and enduring neurodevelopmental condition characterized by developmentally inappropriate attention deficits, hyperactivity, increased impulsivity, and/or emotional deregulation. Needless to say, ADHD can significantly impair many facets of a child’s life[4] and place great strain on caregivers, teachers, and family members.
As is the case with many neuropsychiatric disorders, the causes of ADHD are multifactorial. Nevertheless, it is clear that nutrition plays a major role in both prevention and treatment, as the levels of several nutrients – including iron, zinc, magnesium,[5],[6] vitamin D,[7] iodine,[8] vitamin B12,[9],[10] and omega-3 polyunsaturated fatty acids[11],[12] – have been shown to be lower in ADHD-affected children than in healthy controls.
High quality daily multivitamins and fish oil supplements may therefore easy-to-implement strategies of great value in the treatment of pediatric ADHD.
How did we get here?
Studies suggest that only about 20% of children nowadays eat the recommended daily amounts of fruits and vegetables.[13] Neuro-atypical children, such as those with ADHD, are at particular risk for inadequate nutritional intake. Due to the manifestations of ADHD, children with the condition may exhibit greater degrees of stubbornness, cravings, and aversions around food than other children; they may further lack the attention necessary to sit still through meals.[14],[15],[16] The prescription medications commonly used to manage ADHD symptoms typically cause appetite suppression, further undermining efforts to promote adequate nutritional intake in these children.[17]
The nutritional power of our food supply has further been compromised by a loss of nutrient density in the soil and increased environmental toxin exposures.[18],[19]
In a study exploring the connections between nutrition, cognition, and behavior,[20] 1,795 children with signs of malnutrition were followed over time and assessed at ages 3, 8, 11, and 17 years. The authors found that in relation to the 1,206 comparison “adequately nourished” subjects, “the children with malnutrition signs at age 3 years… were more aggressive or hyperactive at age 8 years, had more externalizing problems at age 11, and had greater conduct disorder and excessive motor activity at age 17.” The researchers observed a similar connection between poor nutritional status and low intelligence quotient (IQ) in the children.
Children with malnutrition signs at age 3 were more aggressive or hyperactive at age 8.
These findings connect early childhood nutritional deficiencies with cognitive and behavioral disturbances later in childhood and adolescence.
How multivitamins can help ADHD
When we consider the nutrients typically found in a high quality multivitamins, it becomes clear that these daily supplements have the potential to mitigate ADHD symptoms and support a child’s overall health with minimal risk of harm. A multiple vitamin/mineral product is an easy place to start.
While many (if not all) of the nutrients of a multivitamin may support a child’s nervous system, some nutrients in particular have demonstrated their relevance in the treatment of ADHD:
Vitamin D
Vitamin D has been shown to be anti-inflammatory, antioxidant, neuroprotective (protecting the nerves), and neurotrophic (supporting nerve growth) – actions that may directly oppose the pathogenesis of ADHD. This fat-soluble nutrient also supports the neurotransmitters dopamine and serotonin, making it a further valuable player in pediatric (and adult) mental health.[21]
Children with ADHD tend to have lower vitamin D levels than children who don’t have the condition.
Unfortunately, 4 out of every 10 toddlers and children are deficient in vitamin D, according to the American Academy of Pediatrics (AAP),[22] and children with ADHD tend to have lower vitamin D levels than children who don’t have the condition,[23] making supplementation crucial.
Magnesium
While it is often (rightfully) appreciated for its effects on cardiovascular health, musculoskeletal health, and metabolic function,[24],[25] magnesium also facilitates nervous system communication and exerts a calming effect on the central nervous system (CNS).[26]
The manifestations of magnesium deficiency include reduced attention span, irritability, fatigue, poor concentration, nervousness, and increased aggression[27] – many of the same symptoms seen in ADHD.
Magnesium is also an important component in serotonin production,[28] and further interacts with norepinephrine and dopamine – the same neurotransmitters that have been implicated in ADHD.[29],[30]
Magnesium deficiency was observed in a whopping 95% of children with ADHD.
Children with ADHD are more likely to be magnesium deficient than unaffected children.[31],[32] In fact, magnesium deficiency was observed in a whopping 95% of children with ADHD in one study.[33] In another trial, 72% of (or 18 of 25) children with ADHD were found to be magnesium deficient,[34] and supplementation with 200 mg of magnesium daily improved cognitive function by multiple scoring systems. Other studies have demonstrated the value of magnesium in alleviating ADHD-related inattention and hyperactivity.[35],[36],[37],[38]
Iodine
The rate of iodine deficiency is on the rise in the Americas.[39],[40] A 2016 study of 89 children with ADHD found a shocking 71.9% to be iodine deficient, and further revealed a significant association between low iodine levels and hyperactivity.[41] Iodine is important for normal thyroid function and inadequate intake in childhood and adolescence can also lead to impaired cognitive function.[42]
B vitamins
The vitamins B6 (pyridoxine), B9 (folate), and B12 (cobalamin) are key players in the production of the neurotransmitters essential for brain health and neurological function.[43]
Vitamin B12 levels have been found to be lower in the brains of children with ADHD than in healthy kids,[44],[45] which is truly unfortunate, as “the B’s” are critical for detoxification.
B vitamin deficiencies place undue strain on a child’s nervous system[46] and can manifest as fatigue, difficulty learning/focusing, and mood disturbances – many of the same symptoms found in ADHD.[47],[48],[49] Vegans are also at risk of B12 deficiency, as red meat is the primary source of dietary B12.[50]
B vitamins are water-soluble nutrients and therefore cannot be stored within the body: regular intake from the diet and/or supplements is necessary to ensure optimal health.[51]
How fish oil can help ADHD
As essential fats, the omega-3 polyunsaturated fatty acids (ω-3’s) cannot be synthesized by the human body and thus must be consumed in the diet (ideally from oily fish, like sardines and anchovies) and/or in the form of fish oil supplements.
Low levels of ω-3’s have been causally related to ADHD[52],[53] and other CNS-linked disorders, including poor cognition, depression, anxiety, and poor anger control.[54] Many developmental disorders – including ADHD, dyslexia, and autism spectrum disorder (ASD) – are associated with decreased levels of docosahexaenoic acid (DHA),[55] a type of ω-3 associated with learning and memory.
The conclusion of a meta-analysis reviewing the studies on ω-3’s published between 2000 and 2015 is that ω-3’s are a “successful treatment of ADHD symptoms,” and that the dosage of stimulant ADHD medications can be reduced when taken concurrently with ω-3’s.[56]
The dosage of stimulant ADHD medications can be reduced when taken concurrently with ω-3’s.
The authors of another meta-analysis[57] found that children and youth with ADHD have elevated ratios of ω-6 to ω-3 fatty acids as compared those who don’t have ADHD. This is problematic, as high blood levels of omega-6 fatty acids (ω-6) relative to ω-3’s can lead to inflammation[58] – including brain inflammation. Unlike the Mediterranean Diet, which is rich in ω-3’s,[59] the Standard American Diet (appropriately abbreviated as “SAD”) is high in ω-6’s and relatively low in ω-3’s,[60] thus increasing the need for ω-3 supplementation in children.[61]
SECS vs. RUDE test
According to the guidelines suggested by researchers at Ohio State University, treatments that are Safe, Easy, Cheap, and Sensible (SECS) require less evidence than those that are Risky, Unrealistic, Difficult, or Expensive (RUDE).
Per the “SECS vs. RUDE” rule, the researchers conclude: “Two nutritional treatments appear worth general consideration: Recommended Daily Allowance/Reference Daily Intake multivitamin/mineral supplements as a pediatric health intervention not specific to ADHD and essential fatty acids… as an ADHD-specific intervention.”[62]
In other words: multivitamins and essential-fatty acids are two of the safest, easiest, cost effective, and sensible tools in ADHD management.
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