Can foods—particularly those containing citric acid—affect how well you absorb stimulants, such as Ritalin, Adderall, and Vyvanse?
I get that question a lot. So, let’s delve into answering it.
In a word, yes. Yes, food can interfere! Most specifically, an overly acid or alkaline system (ph) can affect some stimulants’ effectiveness.
For example, citric acid and antacids can mean the difference between a stimulant working—or not. This bears thinking about, because many Americans consume an extremely acid diet (e.g. soda, meat, cheese, chocolate, pasta, beer, wine, most grains, etc.).
Cautions Don’t Stop with Acid and Alkaline
But the cautions don’t stop with Ph—acid or alkaline.
Even calcium or ammonium chloride, a food additive to bread and certain types of licorice can reduce stimulant effectiveness.
Grapefruit juice can also create problematic interactions with stimulants and many other medications. Chemicals in grapefruit can interfere with the enzymes that break down (metabolize) the medication in your digestive system. That means the medication may stay in your body for too short or too long a time. When a medication breaks down too quickly, it has insufficient time to work. A medication that stays in the body too long may build up to potentially dangerous levels.
Unfortunately, many prescribing physicians remain unaware of these interfering factors.
By the way, did you find this page while searching for “hacks” to abuse stimulants? You’ll be disappointed. For example, maybe you read somewhere that downing an orange juice chaser with your Adderall pill will boost the effect? I cannot possibly say.
Stimulant Medication Response Depends on Many Factors
Please keep in mind: There are many other explanations to explain why a stimulant medication fails—or ceases to work—for an individual. They include genetic and physiologic.
Right now, though, let’s view this issue primarily through the narrow lens of ph (alkalinity and acidity). Merriam-Webster defines ph this way:
a measure of acidity and alkalinity of a solution that is a number on a scale on which a value of 7 represents neutrality and lower numbers indicate increasing acidity and higher numbers increasing alkalinity and on which each unit of change represents a tenfold change in acidity or alkalinity and that is the negative logarithm of the effective hydrogen-ion concentration or hydrogen-ion activity in gram equivalents per liter of the solution; also: the condition represented by a pH number.
Citric Acid and Stimulant Absorption
Many years ago, I learned that citric acid can reduce the stimulant’s absorption—because it changes the ph of the gut. So, if someone complained to me of reduced effect from the medication, I would ask about any new habits around citric acid consumption. This might include:
- Drinking orange juice
- Eating certain fruits
- Taking a vitamin C supplement
- Eating some other food product containing citric acid as a preservative. (Examples of the latter include soft drinks, fruit-flavor candies, and even some cooking stock/bouillon.)
The general rule, I’d heard: Do not consume citric acid an hour before or after taking the stimulant. I’ve heard the same of a high-fat meal—to avoid it around the time you take stimulant medication, as it can reduce absorption. But how true is all this?
This webpage (Citric Acid in Foods) contains a list of foods that contain citric acid naturally or to which it is added. The list is bigger than you might think, including berries, preserves and jams, and mayonnaise that is made with lemon juice. With children, think gummy bears, “fruit” chews, and all the other candy masquerading as fruit items.
Then again, I’d also heard that this acid/absorption issue applies more to the immediate-release medications. It’s less of a risk with the novel delivery systems for extended-release stimulants such as Vyvanse and Concerta.
One rumor is that citric acid actually improves absorption. As it turns out, that’s not the case.
Moreover, many middle-aged folks with late-diagnosis ADHD—their guts suffering from years of scattershot eating habits and stress—are also taking antacids. Can that affect stimulant effectiveness, too? You bet.
Let’s start solving this puzzle by examining medication label inserts, textbooks, and published literature. Read on.
Paper Inserts Shed Light
I checked the label insert for various stimulants. They offered some information.
Basically, yes, the gut ph (alkalinity/acidity) can reduce absorption. But it seems to vary by delivery method. That is, the way the medication travels from the pill (or other) to the bloodstream. For example, Adderall, Concerta, Vyvanse, and Daytrana (the patch) are all delivered via different mechanisms.
To read the product insert for each medication, click on the hyperlinked name.
Adderall:
- Acidifying agents:
- Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.
- Urinary acidifying agent (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion.
- Both groups of agents lower blood levels and efficacy of amphetamines.
- Alkalinizing agents
- Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase the absorption of amphetamines. Coadministration of Adderall and gastrointestinal alkalizing agents, such as antacids, should be avoided.
- Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion.
- Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.
Summary: A system that is too alkaline or acid will reduce medication effectiveness.
Adderall XR:
- Alkalinizing agents (GI antacids, including sodium bicarbonate, and urinary): These agents increase blood levels of amphetamine. (7.1)
- Acidifying agents (GI and urinary): These agents reduce blood levels of amphetamine. (7.2) One of these acidifying agents is ammonium chloride, also known as sal ammoniac; Wikipedia has this to say about ammonium chloride:
In several countries, ammonium chloride, known as sal ammoniac, is used as a food additive under the E number E510, commonly as a yeast nutrient in breadmaking. It is a feed supplement for cattle and an ingredient in nutritive media for yeasts and many microorganisms.
Ammonium chloride is used to spice up dark sweets called salty licorice (very popular in Nordic countries, especially in Finland), in baking to give cookies a very crisp texture, and in the vodka Salmiakki Koskenkorva for flavouring. In India and Pakistan, it is called “Noshader” and is used to improve the crispness of snacks such as samosas andjalebi
Vyvanse:
- Urinary acidifying agents may reduce blood levels of amphetamine. (7.1)
- Urinary alkalinizing agents may increase blood levels of amphetamine. (7.2)
Dexedrine:
Acidifying agents: Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.
- Urinary acidifying agents (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion.
- Both groups of agents lower blood levels and efficacy of amphetamines.
Daytrana:
[No ph interactions listed, perhaps because Daytrana is a methylphenidate patch worn on the skin and is not absorbed through the gut.]
Concerta:
- In patients, there were no differences in either the pharmacokinetics or the pharmacodynamic performance of CONCERTA® when administered after a high fat breakfast. There is no evidence of dose dumping in the presence or absence of food.
[The label makes no mention of ph interactions, perhaps due to Concerta’s novel delivery system.]
Ritalin LA:
- Especially tell your doctor if you or your child takes stomach acid medicines.
Focalin XR:
- Antacids or acid suppressants could alter the release of Focalin XR
- The effects of gastrointestinal pH alterations on the absorption of dexmethylphenidate from Focalin XR have not been
studied. Since the modified release characteristics of Focalin XR are pH dependent, the coadministration of antacids or
acid suppressants could alter the release of dexmethylphenidate.
The Literature Tells Us This
Next, I checked the literature (not an exhaustive search at this point) and found this information:
- The Medical Basis of Psychiatry: Both citric acid and calcium can affect stimulant absorption; offers no details on how the various delivery systems might differ.
- One paper (Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/Hyperactivity Disorder) offers information about Vyvanse that, if I’m reading this correctly, seems to contradict the official information:
In an in vitro study, the pH-solubility profile of LDX was determined in buffered aqueous solutions using an assay specific for LDX.
The environmental pH did not affect the solubility profile of LDX within the biological pH range (pH, 1–8), suggesting that gastric pH variation does not affect the absorption of LDX.
Due to the effect pH has on absorption, amphetamine also interacts with gastric acid reducers such as proton pump inhibitors and H2 antihistamines, which increase gastrointestinal pH (i.e., make it less acidic).
Grapefruit’s Particular Challenges
Now consider a very particular type of citrus: grapefruit. Beyond any considerations about acid and Ph, grapefruit—both the fruit and the juice—can create adverse outcomes when taken with certain medications, including some stimulants. What’s the culprit here? It seems to be flavonoids called furanocoumarins.
Wikipedia has a very clear entry on this topic, excerpted here:
These active materials inhibit a key enzyme (cytochrome P450 isoform CYP3A4) which is responsible (among other activities) for drug metabolism. The effect happens in two ways.
One is that grapefruit can block the hepatic CYP3A4 thereby affecting the medication metabolism. If the drug is not metabolized, then the level of the drug in the blood can become too high, leading to an adverse effect.
On the other hand, if the medication is provided as a pro-drug [Gina notes: Vyvanse is a pro-drug], compromising its metabolism may prevent the drug from being created, thereby reducing its therapeutic effect.
The other effect is that grapefruit can block the enterocyte CYP3A4 thereby affecting the medication absorption in the intestine. Absorbing the medication to a lesser extent means it may not reach a therapeutic level. Therefore, its effect may be compromised.
In other words, grapefruit juice can be a problem in two big ways:
1. Create a toxic too-high dose of the medication
2. Reduce the medication’s therapeutic effect.
The list of grapefruit’s potential drug interactions is long. Here is a sampling, again from the Wikipedia entry on Grapefruit-drug interactions:
- Benzodiazepines
- All the stimulant medications
- SSRI antidepressants
- Statins
- Anti-Erectile Dysfunction medications
- Acetaminophen
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Cytochrome P450
For more information on cytochrome P450, check this post from the series I wrote with my molecular-biologist husband: Part 4: Gene-Testing to Inform ADHD Drug Therapy.
The Bottom Line
It should be clear, from this brief examination, that ph can be a factor in stimulant efficacy. Grapefruit juice has its own particular effect on the absorption of stimulants and other medications. We also touched briefly upon the role of calcium, fat, and food additives such as ammonium chloride.
This is a reminder that stimulants do not act in a vacuum. They act in a highly individual human body. To be most effective, the stimulants require physiological support, including but not limited to:
- Adequate sleep: Stimulants cannot compensate for sleep deprivation
- Good nutrition: All medication targeting neurochemicals need “helpers”—B vitamins, potassium, magnesium, and other vitamins and minerals that help to fuel neural transmission (“moving messages around”).
- Adequate protein: Not “high protein” but rather adequate—because proteins are composed of amino acids. Amino acids are the building blocks of neurotransmitters such as dopamine, serotonin, and the like.
What’s Your Experience?
I’d love to hear your experiences on this topic. For example:
- Have you found that acidic foods affect your stimulant’s effectiveness?
- Have you noticed that taking an antacid creates problems with your stimulant being effective?
- Did your physician ever mention these factors? If so, what information did you receive?
- If you have particular knowledge in this area, please write a comment and I will incorporate it into this post for future readers to benefit. Thanks.
—Gina Pera
Why is it that it’s bad to take the meds with a high-fat meal? Because fat is always acidic, or?
The last 2-4 days I took my dexamphetamine after a small bowl of döner kebab and my medication failed immensely, I experienced hours of brainfog, dysfunction and abject misery, where I couldn’t get NOTHING done or do simple things, but it doesn’t make sense! It only has 27 grams of fat per 100, 5.6 carbs, 17 protein -and the ingredients are: 84% beef meat, water, beef fat, spices (pepper, cumin (“spidskommen”), garlic powder, chili (rosemary), salt, bamboo fiber, onion, stabilisators (E450, E451).
So this doesn’t look like that much fat and there doesn’t seem to be any citric acid (or ammonium chloride).
(I have tried taking it with MANY other types of meals and then have totally inconsistent effects but I’ll focus on this example. And most days if fails to work properly but SOME days it works wonderfully, so the medication itself isn’t wrong)
Hi Thomas,
I’m not sure where that idea originated, that it’s “bad to take the meds with a high-fat meal”? Is that really true? Seems like Internet rumor. 🙂
Maybe it’s true with some stimulants.
To start fact-gathering about Dexedrine specifically, I checked the FDA product insert for Dexedrine.
There’s nothing on the effects of consuming a high-fat meal.
You are probably taking a generic, so the FDA material wouldn’t wholly apply to that — there are probably different colorants and binders — but it would be the same insofar as the effective ingredient: dexedrine.
Here’s an excerpt from the product insert, listing acidifying agents (beyond citric acid):
Drug Interactions: Acidifying agents: Gastrointestinal acidifying agents (guanethidine, reserpine,
glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines. Urinary acidifying agents
(ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the
amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and
efficacy of amphetamines
NOTE: Glutamic Acid (Glutamate) is in many foods, naturally occurring or as additives.
Glutamic acid hydrochloride (C5H9NO4 · HCl) is the hydrochloride salt of the amino acid glutamic acid. Glutamic acid is usually obtained from gluten, casein, or other proteins by acid hydrolysis. Glutamic acid is commonly referred to as glutamate, and is an excitatory neurotransmitter in the brain.
The sodium salt of glutamic acid is monosodium glutamate (MSG). MSG is known to raise the histamine levels in people who are susceptible to that. While it might not directly reduce efficacy of the dex, the MSG might increase histamine levels to the point that they counteract the dex. In my follow-up response, I point out that many Doner products in Germany are found to have MSG, though not labeled as such.
Just a hunch!
The main thing is, you know that the Doner kebab has that effect (that brand, anyway). So you know to avoid it rather than avoiding fats.
As you experiment with other “offending” foods, maybe look for similarities to the doner kebab. Perhaps there are nitrates. Cured meats typically have them. Or MSG itself. It’s often added to prepared foods as a flavor enhancer.
Those stabilisers, E450 and E451, might be the culprits, too, or one of the culprits.
I hope this helps,
g
Hello Gina.
What? Internet rumor? It’s in your very own blog-post – to avoid high-fat meal around the time of taking the medication, that’s what made me think of it. Although I can see it’s not wholly confirmed, but still.
Is fat by itself acidic?
I’m taking a danish ‘variant’ called Attentin (5 mg), which is dexamphetamine or dexedrine.
And the ingredients I mentioned was listed in the kebab-product, not the medication. I am unsure if any of those fall under those many mentioned names (guanethidine, reserpine, glutamic acid HCl, ascorbic, etc.), just to make sure.
So MSG, stabilisers and nitrates might belong on the list of food items to avoid taking with medication as well?
Sounds like it might way simpler to just avoid all additives :-|. And I don’t avoid fat, just thought of limiting it in the first hours as per the ideas of this blog post.
Hi again, Thomas,
First, sorry to have confused you with poor wording — I emphasized my point in that paragraph (that avoiding fat and acid his is just what I’ve heard, not what I know to be a fact) by adding “But how true is all this?”
The general rule, I’d heard: Do not consume citric acid an hour before or after taking the stimulant. I’ve heard the same of a high-fat meal—to avoid it around the time you take stimulant medication, as it can reduce absorption. But how true is all this?
Then I transition to the next section with this – in other words, checking the oft-repeated rumors:
Let’s start solving this puzzle by examining medication label inserts, textbooks, and published literature. Read on.
Second, yes, I know you listed the kebab ingredients, not the medication. I shared the known interfering factors, as listed on the Dexedrine product insert.
The thing is, many prepared meat products will also have glutamic acid (MSG). Even if it’s not labeled.
I found evidence of this in Germany and Italy. No reason why it might not be true in other EU countries. This article references Döner kebab shops, not packaged kebabs (which I assume is the case with yours).
Excerpt:
According to regulations on the sale of food, kebabs that contain sausage meat, turkey or additives such as glutamate are not allowed to be sold as Döner. Legally they are only allowed to be called “spit meat”.
Although all additives should also be clearly stated, none of the Döner shops tested in the research followed the rules.
NDR also reports that these low quality Döner lookalikes are delivered from suppliers labelled simply as “spit meat” with instructions to be sold as such. But the Döner shops largely ignore this instruction.
In a separate study carried out by north German officials, 90 percent of meat sold as Döner did not meet the legal requirements.
https://www.thelocal.de/20161121/this-is-what-is-really-inside-your-dner-kebab
You might want to note each time this happens, and look for the common factors among those food products. Chances are, it’s not related to fat at all.
Sure, you can try to avoid additives but that means cooking everything from scratch. Great if you can manage it.
I hope this helps clarify.
Gina
Hello Gina and thanks for your response :).
No problem or need to apologize, I understand.
And yes you probably knew, it was just to make sure.
Yes, it is a packaged product in this case.
So the culprit might be glutamic acid or MSG? Or nitrates? Though these are not listed in the ingr.
I understand glutamic acid might be unlisted, but not nitrates? And these are not among or related to any of the mentioned kebab-ingredients, right? And I didn’t see nitrates listed in the blog-post.
Just had yet another case of brainfog now, so it’d be good to narrow this down. I’ve tried to chase causes for all sorts of food reactions for almost 4 years now. At least I didn’t experience exactly this when avoiding this in recent days, but there’s been a plethora of happenings. Can’t think or focus for 2 seconds, put items back in place or complete one step without…stalling completely.
Hi Thomas,
That sounds so frustrating!
“Being understanding of neurodivergence”. That too often the advice from therapists, etc. who have nothing better to offer. That kind of simplistic throwaway risks a lot, including for the adult with ADHD. Folks deserve better.
Do you cook? If not, can you try learning a few simple dishes or preparations? That way, you have more control, at least as you try to figure out the interfering ingredients.
I don’t know the laws in the country where the kebabs were produced. Maybe they are quite strict. As I mentioned, though, several news articles report on lack of MSG labeling on products in Germany and Italy.
I just mentioned nitrates as another item to watch for, potentially. Just an aside. If MSG isn’t listed (but present), perhaps the same could be true of nitrates. But nitrates in packaged foods, to my knowledge, are associated more with the “smoked” meats…bacon, ham, etc.. To make things even more fun, some vegetables contain nitrates (and are good for you!).
This is a huge and complex topic, one I am not qualified to address expertly. Just trying to point you in some useful directions.
g
Hi Gina.
I don’t cook much, only the simplest forms. When one is sick all the time like this, anything with more than 1-2 immediate steps just becomes too hard and aweful.
Okay, so the possible culprits here are MSG, nitrates and the E450-451 – got it :). I’ll watch out for those then.
That sounds…extra complicated. So nitrates are good when added together with certain nutrients?
Yes, and I thank you much for that – so far I’ve had a couple partially good days (without immense ‘brain crashes’ and unexplainable reactions) by resorting to chicken, salad, brazil nuts, fries, a.o.
Hi Thomas,
I understand. Sorry to know that’s your situation.
Yay for the partially good days.
I can’t comment on nitrates being good. It appears that there’s a difference between naturally occurring and added (to processed foods):
Not all forms of nitrates are bad. In general, the naturally occurring nitrates in many types of produce are safe to consume. But, added nitrates, like the ones often found in processed meats, are linked to health issues including cancer.
This article goes onto say that avoiding processed meats in general might be a good idea.
g
https://www.goodrx.com/well-being/diet-nutrition/are-nitrate-free-meats-bad
Time to do some experiments with bicarbonate of soda and my lisdexamfetamine hehehe
That’s a joke, right, Russ? 🙂
g
Thank you so much for this! I’ve been looking for Concerta specific information about grapefruit and couldn’t find any. I really appreciate it.
Thanks for letting me know. Happy to help!
Gina
I understood the official information to be quite clear and consistent on government websites and the official Vyvanse site – lisdexamfetamine is not affected by gastrointestinal pH levels. But maybe I’m a silly billy
Hi Ben,
I shared in the post the information from the Vyvanse product insert:
Vyvanse:
Urinary acidifying agents may reduce blood levels of amphetamine. (7.1)
Urinary alkalinizing agents may increase blood levels of amphetamine. (7.2)
g
“Did u find this trying to abuse stimulants” no i am obsessed with lemonade and want to know if the $5 Starbucks drink i just got is going to mess up my whole day with my new Rx and I don’t appreciate ur tone .
Can someone pls tell me if I can drink this lemonade or not </3 will eating a tums before i drink my lemonade cancel the lemonade out
Hi Paige,
The “someone” on this blog is me, Gina Pera.
I’ll assume you’re kidding about the “I don’t appreciate ur tone.” Because you are absolutely taking that sentence out of context.
You want to know if a Starbucks lemonade will interfere with your new Rx — and if eating a Tums before you drink the lemonade will cancel out the acid (presumbly).
1. What are the ingredients in the lemonade? I see lemon juice and lemon oil (https://www.starbucks.com/menu/product/873068639/iced/nutrition)
2. What is your Rx?
3. Read the post and see if your Rx is listed there, with information on what citric acid might do
4. I would not perform an uncontrolled experiment with lemonade and Tums.
Taking Tums with some stimulants can increase effect — and that’s not always a good thing.
https://www.drugs.com/drug-interactions/adderall-with-tums-freshers-190-1645-464-15611.html
https://www.reddit.com/r/ADHD/comments/mnhzw6/psa_do_not_mix_tums_with_adderall_holy_hell/
You’re welcome
g
Hi Gina, I saw your response below. I take adderral. I do not like the crash feeling, but also have trouble falling asleep. You mention that tums May increase the affect of the medication. If I want to take less medication, but find foods to help the effectiveness of the reduced amount, so you think taking tums in the morning would help?
Kindly,
Chelsie
hi Chelsie,
To be clear, I’m not recommending any type of medication “hacking.”
The links I offered explain the risks of mixing Tums produces with Adderall.
If you’re like most people with ADHD taking Adderall, you’ve tried no other stimulant. That is not recommended protocol,
If that’s the case, maybe it’s time to try something else instead of continuing to deal tolerate these adverse side effects?’
There are so many other options.
Good luck,
G
So can I drink Minute Maid Light Lemonade while taking Concerta?
Hi Jenn,
I can’t tell you for sure. You might want to check with your pharmacist.
If it’s brand Concerta, it might not be a problem. If it’s one of the inferior generics, maybe.
The best thing to do is stop drinking it for a while and see if you feel a change.
g
Thanks for the article! Very well explained and translated for those of us that aren’t in the medical field.
Is there any information about taking pro drugs (vyvanse) with alkaline water? Or any of the amphetamines with alkaline water?
Hi Lucy,
You’re welcome! I have to translate for ME, first, so I know understand what I’m sharing. 🙂
I don’t know that we can say what effect alkaline water might have. But here’s what the post says says for Vyvanse:
Vyvanse:
Urinary acidifying agents may reduce blood levels of amphetamine. (7.1)
Urinary alkalinizing agents may increase blood levels of amphetamine. (7.2)
I’d say you’d have to conduct your own experiments — try a day or two without the alkaline water and see.
cheers,
Gina
Hi Gina,
“One rumor is that citric acid actually improves absorption. As it turns out, that’s not the case.”
You are correct, citric acid doesn’t improve absorption of amphetamines, however the rumor is that it improves their retention in the body.
Though it is an acid, once citric acid is digested it breaks into citrate salts that increases the urine pH, hence reduces elimination of the medication from the body.
I’ve seen studies that says it does increase it and studies that say the effect is very mild. Maybe you are able to research this and verify it for us. However, what it seems universal is that citric acid salts; i.e. citrates do have an effect in increasing urine pH.
Folks who suffer from kidney stones seems to use citrates to do that in order to prevent the stones from re-occurring.
https://kidneystones.uchicago.edu/price-of-potassium-citrate/#:~:text=Potassium%20citrate%20lowers%20urine%20calcium,key%20kidney%20stone%20risk%20factor.
Thanks, Haidar.
I am neck-deep in course development, constantly re-jiggering my blog in order to appease the Google gods (which favor commercial “health” sites with short, simple articles on complex tpiocs). And I am entirely self-funded!
It’s an interesting question, and I welcome expertise. But just writing and researching this post took time I didn’t really have. 🙂
g
Back in the old days, when I was 35-40 or so, I discovered that my Gobstopper habit was affecting my Vyvanse. Now that I’m 55, nothing works well enough to make observations like that. I can no longer access Vyvanse because insurance doesn’t work, manufacturer coupon doesn’t work. So I’m on generic Adderall. The current generic is better than the previous, but in general it’s hard to fight the fog. I don’t feel I’m In a good enough treatment place to be able to assess citric acid impact, because I must have other factors going on too… menopause, thyroid, etc… I am curious about the vitamin water I’m addictive to from the fountain at QT. I get it to stay off soda, but I suspect it’s a player. Regarding this: was given an instruction sheet with tips about diet and citric acid only once, probably 20 years ago and I wish I still had that sheet. I have since told friends, and even my new providers.
Hi Jenn,
“vitamin water”? Probably has citric acid.
But yes, as perimenopause and menopause draws near and estrogen drops, it can affect cognition for many women, not just those who have ADHD. But for those who do, Patricia Quinn, MD, suggests looking into bioidentical hormones and a stimulant.
Also, ADHD neurobiology can affect thyroid function.
Also, Vyvanse might have a financial assistance program for you, beyond the coupons that work with insurance.
This blog post is probably more detailed than that instruction sheet.
good luck,
g
Your post sounds to me like someone who should read over the B-12 deficiency blog on this site. You could very well fall into that category. i did as well and had the same intense fog while on adderall.
Mystery solved then. My medication works great, except on Sundays. Guess what I have for breakfast on Sunday? Freshly squeezed orange juice.
Eureka!
Good sleuthing, Thalia! 🙂
g
First off: where is the main comment part on the web page? I have to reply to someone else’s comment to comment.
I never knew the amount of time for orange juice or vitamin c to interact with my Ritalin. I always thought it was 2 hours so I typically take my vitamin c before bed. Occasionally I’ll have strawberry lemonade but it’s at least an hour and a half after I take my meds.
Hi Mindy,
Scroll down past the comments and you’ll see the comment box.
I think a software update changed the previous position — before the comments.
tx
g
Hello,
Just going back to the acid reflux issue. Have you have a camera down your esophegus to check of any issues. A barrium is also suggested at the same time to cover all bases.
I’m confused by exactly how the difference in ph affects me because it’s seems that anything I eat results in symptoms consistent with “dose dumping”. At least while I was taking Vyvanse in combination with Wellbutrin. Because of problems with this I have stopped taking both. I have just switched to Adderall XR in the hopes that it would be less sensitive to food. I was off both of them for a week before starting Adderall XR. So far it’s been a few days taking it so I still have to see it through but it seems effected by it less intensely but it still happens. But maybe it will be better in time. I really need to find a medication that works for me but I need to also be able to eat normally. In that past I partially dealt with this by trying to manipulate when I ate and to eat less but it never fixed the problem and its non sustainable. I’m not really sure how to deal with this and my doctor doesn’t have many ideas. But they are open to changes in to medications or taking another ones if I suggest them.
There was a time where vyvanse and Wellbutrin worked really well but it would not last because of these problems and I can’t approach the doses that has been helpful in the past because the higher I go the more sensitive I seemed to become to food and too low made eating less of a problem but the medication was reduced to a level of efficacy much lower than what was helpful. Also no one talks about this and it needs more attention I’m glad to see what you’ve written about it:)
Hi Roberto,
It might be that ph has nothing to do with your reaction to Rx.
This is complex…..dialing in ADHD medications while also developing new habits that support Executive Functions…..and getting enough sleep and eating well, etc.
Lots of moving parts. I would not over-focus on the Ph issue until you’ve optimized other points.
I’m curious why you dropped Vyvanse and Wellbutrin and moved to Adderall XR…..instead of just trying the Vyvanse?
g
Dose dumping note
Hi sorry I didn’t realize you responded so quickly and it won’t let me reply to your
Comment so I’ll just reply to mine and hopefully It still shows you.
You’re right It could not be the ph issue I could not be accounting for something else and it could be many things. All I know is that I had consistent problems eating that seemed to fit the the description of dose dumping. I’m not sure what exactly the problem with eating is but I’m not sure sure what to do at this point.
As far as why I stopped taking vyvanse and Wellbutrin. I could not stay on therapeutic doses of Wellbutrin because it seemed to interact with the vyvanse and lowering it would help but eventually I got so low it didn’t make sense to take it all. I didn’t try vyvanse on its own for two reasons but I did consider it and it’s still option to go back to I guess. But basically while on vyvanse I had trouble eating foot because of the “dose dumping” like experience that I mentioned before. So I was hoping I could achieve the partial success from vyvanse all the time on adderall in the hopes that eating wasn’t as sensitive to me on it. I know adderall has a somewhat different mechanism of delivery and maybe it works better for me. Also adderall even xr version is supposed to start working more quickly where as vyvanse took roughly 3 hours for me to feel something significant. This was a pain to work around especially if say trying to make sure I have enough time to eat before hand and than wait for a little while then take it (one of the ways I tried to deal with this the eating problem. This lead to many hours before actually feeling any benefit. As a result delayed how long until I could function a much better level.
If there is someway to recreate how I would sometimes feel on vyvanse and Wellbutrin all the time and eat normally unaffected. It would actually be life changing.
It’s a puzzle, Roberto. But it’s best figured out if you change only one variable at a time.
Yes, Wellbutrin and Vyvanse is not a good pairing for many people with ADHD. It can really ramp up anxiety.
It truly might have been the Wellbutrin that was sending things in a negative direction.
Or the Vyvanse!
You won’t know until you try separately. This is why I am not a fan of prescribers starting with two (or more!) medications. You’ll never get a clear reading on what’s doing what!
good luck,
g
Now I’m confused about what I’m even supposed to eat. I don’t want to eat at all, this stuff makes it seem like I can’t eat anything. Can you give some real life examples?
I wanted to start doing smoothie bowls again now that the weather is warming up, is that too acidic?
Everything seems either too acidic, too sugary, or too fatty when I try to think of meals 🙁
Hi Anonymous Adderall user,
Now that’s a bit of “all or nothing” ADHD talking there…. :-). Aim for balance.
Sorry but this is something you’ll have to figure out yourself. I can’t predict what is in your smoothie bowl. Maybe re-read the details I provided about Adderall. Test it and see. Does your Adderall not seem to work after consuming certain foods?
As an aside, it’s generally better for glucose regulation to consumer fiber with fruit — that is, not pulverized fiber. It helps to slow sugar uptake.
I hope this helps.
g
There is far too little research on this topic and thank you for your work to summarize what we do know! Let me add my experience with magnesium supplements. If I have taken any amount of magnesium, any form of it, even just a regular adult multivitamin, within the previous 36 hours, it affects how I process IR adderall. I react with the exact same side effects as if I had taken a dose of adderall that is too high (significantly elevated heart rate, etc). However, foods containing magnesium, like bananas, do not cause those issues for me. This needs further research. Most studies assume that magnesium cannot affect absorption if it is taken several hours before. But for some people like me, it may have an affect for much longer. I would like to understand how and why my body reacts this way.
Hi Martha,
You’re welcome! thanks for your comment.
It just might be that you are magnesium-deficient. Taking a supplement might mean that you can take a lower dose of your stimulant medication, because it will work more efficiently.
When one is mag-defining, trying to address that with food can be difficult. The amount is much smaller.
I hope this helps
Gina
So I have GERD and I take pantoprazole. Since concomitant use of gastric ph modulators can change the release profile, shape of pharmacokinetic profile, and exposure to extended release medications like Adderall XR, I believe what is happening is what they refer to as “dose dumping” where the entire dose or a significant fraction thereof is being released too soon. I can’t go off of the PPIs, so I need to figure out what my best option is as far as an extended release medication which will stay in my system longer. I’ve tried Vyvanse, which gave me severe nausea (no other stimulant meds give me nausea so I’m not sure why it did). I’ve looked at Mydayis which contains 3 beads instead of 2 like Adderall XR. Mydayis is formulated to release some beads immediately, some at ph 5.5, and some at ph 7. I’m not sure if this would work any better for me vs Adderall XR, or if it would still result in dose dumping. I couldn’t find any info on what ph the Adderall XR extended release portion of the med releases at for comparison. I looked at Adzenys, which is formulated with a different release mechanism (Adzenys is a XR-ODT tablet not beads in a capsule) but is still ph dependent. However, Adzenys is amphetamine base instead of mixed amphetamine salts like Mydayis and Adderall XR. I don’t know if this would make any difference as far as if it would be more likely to release as intended in my stomach or if it would still result in dose dumping.
I think that pretty much exhausts the options for amphetamine based medications, but there are of course some options in the methylphenidate category with less ph dependent release mechanisms. It’s fairly easy to find information on the absorption of AMP being ph-dependent, but less info is available on the ph-dependent absorption of MPH. When I was first diagnosed, they tried a methylphenidate first and it helped some but not enough, and that’s why they switched me to Adderall. That was 14 years ago though so I don’t know if maybe the dose wasn’t right or if I would respond more optimally to a MPH based medication now. Concerta appears to be not influenced by stomach ph for its extended release delivery system, which is an osmotic pump in a pill instead of ph-released beads like Adderall XR. Daytrana is of course transdermal, but it is only approved for use in children and so I don’t know if my insurance would cover it, and it is really expensive without insurance. Concerta would be covered by my insurance.
With all of that said, I’m not sure what the best option would be. Looking for insight.
Hi Leo,
I think you owe it to yourself to try a MPH product. If you try Concerta, be sure to read my blog post on how to get the authorized generic (brand marketed as a generic).
It might be that, in the end, one of the “legally bioequivalent but we know otherwise” generics would work better for you. But the idea is controlling for all the variables you can first.
Sometimes, impatience toward seeing improvement and inability/reluctance to teach new skills mean Adderall. It seems to “work” better. But it also has a higher side effect profile, and many people burn out or develop physical symptoms.
good luck,
g
Hello Leo after reading your input I would highly suggest that you take your anti-acid medication at bedtime or late in the evening that seems to work very good for me and I take Concerta ER but if I take anti-acid medication during the day I get no effects whatsoever from my Concerta. I hope this helps you e a blessed day ❤️
Hello! I am a college student with ADHD and on 15mg of Adderall XR and 10mg IR in the afternoon. Sometimes the medicine works, but recently it has not been working at all. I am completely distracted and all over the place. I usually have greek yogurt with honey in the morning right before taking the medicine and about 10 minutes later have my first cup of coffee. What am I doing wrong? Is it the acidic coffee? I talked to my dr. about it and they didn’t seem to know much and weren’t much help other than upping my dose. I just want to be able to concentrate! Any help you have would be greatly appreciated.
Thank you!
Hi Michael,
I can only imagine how disorienting this is for you.
If that’s been your morning routine (yogurt, honey, coffee) while you’ve been taking the Adderall for a while, it’s probably something else, right?
Do the pills look different than ones in the past? Can you check your past receipts — or call the pharmacy and ask — to see if maybe your generic manufacturer has changed?
I assume you mean generic, but maybe you mean brand?
Nothing else has changed? Not less sleep? Not more demands on your focus/attention?
Did you ever try Vyvanse? At least you won’t have to deal with generics.
g
I’m also curious about if I am taking XR Aderral does it mean I can’t have anything with vitamin c all day long? Does malic acid do the same? What about Ritalin?
Should I take my meds an hour before coffee? So confused. Thank you!!
Hi Kriz,
First, I would not be taking Adderall XR with coffee or caffeine of any type.
As for what you can/can’t do with Adderall XR and Vitamin C, sorry, but I can’t advise you on that. I’ve provided all the available official information here. What happens with your particular neurophysiology might be up for grabs.
A good source for such info is typically pharmacists.
best,
Gina
So is Vyvanse made STRONGER or WEAKER by calcium carbonate and proton pump inhibitors? I take both and have recently upped my intake due to worsening GERD/gastritis pain after starting Vyvanse. This stuff must be caustic af because I’m dying. I’m getting an ulcer for sure–you know if you’ve ever had one. When I took couple days off, the pain eased up so it’s definitely the medication causing it. And I’m only on 10mg. I’m a substance user of many years and have (unfortunately) self-medicated with tons of stimulants, both legal and illegal, and NOTHING has burned my stomach like Vyvanse!
Mind you, I already have severe GERD due to a hiatal hernia so it doesn’t take much to tip over into ulcer territory. But jeez. Whatever’s in this pill must be pure fire. I’m hoping Adderall or Dexedrine doesn’t cause the same symptoms because I need these meds to function. They help so much, both with my ADD and sobriety from other substances 🙁
Awesome site, btw.
Hi Barbie,
I’m glad you like my blog, thank you! It’s the first website of any kind of Adult ADHD—with never any pharma support of any kind. (Pretty rare these days!)
Here’s what I wrote in the post, drawing from the FDA-mandated product insert:
Vyvanse:
Urinary alkalinizing agents may increase blood levels of amphetamine. (7.2)
So, the answer to your question (is Vyvanse made stronger or weaker) is……BOTH? 🙂
It’s impossible to say for any individual, but the general idea is: The medication will behave differently in the presence of these other factors (e.g. proton pump inhibitors, etc.).
It’s not that the Vyvanse itself contains “pure fire”. It’s that it changes your physiology, including gastric movement, etc..
If you haven’t tried a methylphenidate option, you might want to start there (e.g. Brand Concerta, Ritalin, etc.). Or maybe Strattera.
Definitely, if I were you, I wouldn’t stay on the Vyvanse. The sooner it’s out of your system, the sooner you can begin healing.
Good luck sorting this out.
g
Great article. I’ve had acid reflux on and off for a few years. A year ago I started on vyvanse for adhd and binge eating disorder, it did not work for adhd but worked well for bed. I had bad reflux but it seemed normal for me and so didn’t connect them. Had a break from vyvanse then went back to it where I then began huge relux worse than ever before, now believing its silent reflux going by symptoms but also a feeling of constant hunger which should be the opposite as it was when I took it before, I was eating but couldn’t get the feeling gone so upped my protein which didn’t help if anything was worse. Stopped vyvanse again 3 months ago but severe acid symptoms still here including severe hunger feelings, nothing is taking it away. Could it have been the vyvanse? What can I do? Thank you for any help
Hi Harry,
Apologies for the delay. Life has been extra busy this week.
That is a bit of a mystery.
Does your prescriber have a clue? (Silly question…. lol)
Are there any other variables? Have you changed your diet, supplements, sleep patterns, etc.?
Many people with ADHD will experience an uptick in anxiety from a stimulant, perhaps especially the amphetamines.
For some, this means that the anxiety merits medication treatment, too.
It can be a delicate balance, as stimulants boost certain neurotransmitter transmission at the price of back-suppressing others.
Have you tried a low dose of Strattera with the Vyvanse — or perhaps a methylphenidate stimulant?
The only reason that Vyvanse is used for BED over the other stimulants is because Shire paid for a study that showed effectiveness.
But really, the main thing is that ADHD itself is associated with obesity, including not “putting the brakes” on eating, in some cases due to not noticing being full.
It might be that another type of stimulant, along with a low dose of Strattera or an anti-depressant/anxiety medication might work better for you.
good luck,
g
Yeah extra protein prob wont help. try eating alkaline foods (fruits and vegetables) only for a week and see if that’s helps. Btw it should fix your overly acidic stomach. Take Care !
Hello Gina,
Sorry to resurrect an ancient thread. I just wanted to address something here in regards to LDX.
“…One paper (Lisdexamfetamine Dimesylate (Vyvanse), A Prodrug Stimulant for Attention-Deficit/Hyperactivity Disorder) offers information about Vyvanse that, if I’m reading this correctly, seems to contradict the official information”
This doesn’t contradict the official information that you quoted before. The above quote is in reference to gastric pH, while the other quote is in reference to urine pH. So LDX isn’t gastric pH-dependent like many other stims, but during the excretion stage, it is highly dependent on urinary pH which can result in dramatic differences in d-amphetamine exposure times—as it often does with other drugs. This is the reason why drug-dosages must be carefully considered among populations with impaired renal function.
Also, worth nothing that PPIs don’t affect urine pH, however Calcium Carbonate certainly does.
Dear Niels,
Thank you so much for supplying that info nugget!
I knew enough to hedge my statement (“if I’m reading this correctly”) but not enough to explain.
This might be an “ancient” thread but it’s one of my most popular blog posts.
g
Hello,
I am 24 years old, and I have been taking aderall for about 3 years now. About two years ago I started experiencing EXTREME acid reflux. I tried switching to extended release, which made it worse, so I moved to Vyvance, and that was also much worse. So I have been back on my regular 18mg Aderall. I have to sleep sitting up, and I have to eat oatmeal first thing in the morning, otherwise I am in excruciating discomfort. I mean I can’t bend over without feeling like I’m going to throw up acid. About six months ago I was prescribed 20mg of Famotidine to take every night before bed, and I haven’t noticed any change at all. I am plant based, I eat tons of veggies and clean foods, and I am in great shape. Please let me know what I can do to stop this terrible acid reflux!
Hi Sophia,
I am not a physician — but I sort of know more about this than most prescribers. 🙂
But that doesn’t mean I know a lot.
Here’s the thing: Stimulants target dopamine, a neurotransmitter. Dopamine affects more than brain functions such as focus, distractibility, etc.. It is involved with many physiological processes, including those of the respiratory and digestive systems.
Specifically, dopamine transmission (that is, dopamine molecules sending messages along neural pathways) can affect “gastric motility.” That is, the involuntary muscle movements that move food through our digestive system. That MIGHT be a factor in your “EXTREME acid reflux.”
More potential factors:
—Adderall might be acting as a vaso-constrictor — that is, contracting/narrowing the smooth muscle in blood vessels, which causes the vessels to constrict.
—Many people with ADHD have a co-existing condition, such as depression or anxiety. Stimulants can exacerbate those conditions by back-suppressing the neurotransmitter serotonin in parts of the brain.
—If you are taking generic, there might be problems you might not experience with the brand (different colorants, fillers, etc.).
I guess the main thing is to see how you might do off a stimulant or on the other class of stimulant, methylphenidate (e.g. Concerta, Ritalin, etc.).
If I was in your shoes, I’d try one of those or maybe even Strattera (with might help with anxiety, too) with a low dose of stimulant.
These acid-reflux-type problems can cause real damage, so I would not risk my good health by continuing the Adderall.
That’s great that you focus on a healthy diet and staying fit.
But just know that “tons of veggies” might be hard on your digestive system, too. And of course you’ll want to pay attention to vitamins and minerals that are not found sufficiently in a plant-based diet, such as zinc. We need those vitamins and minerals to metabolize medications and to support neurotransmitter function.
I hope this helps. Good luck!
g
Hello Sophia,
From what you shared it sounds like you might have LPR (laryngopharyngeal reflux) also known as silent reflux.
It’s very different from the more well known acid reflux. Alot of doctors aren’t well versed in it, prescribe medications that target the acid in the stomach which actually do little to nothing for LPR, hence no change in your symptoms.
I recently developed LPR and noticed an increase in symptoms when I was taking my daily Vyvanse.
I did a ton of research and found holistic ways to cope with the symptoms. I recently read a book by Jonathan Aviv called The Acid Watcher Book. I found it incredibly helpful as it explains so much about the issue plus ways to cope with the symptoms.
I hope this info is helpful to you, that you are able to find some relief soon.
J
Hi Jenn,
Thanks for sharing your discovery. It seems that LPR might sometimes have the gastric motility underpinnings that I explained in my response to Sophia.
https://www.uclahealth.org/esophageal-center/laryngopharyngeal-reflux
But none of these issues is simple, and it’s always great to have multi-faced information.
Dr. Aviv’s book sounds very useful!
Gina
Stay away from acid foods and eat alkaline !
Have you tried hot water with liberal amount of pieces of fresh ginger until the water is yellow? Drink it before eating, after eating, always abt 30min before going to bed, sip on it through out the day etc… Maybe you’ve already tried it, If you have not, you should go to the store and get the fresh ginger ASAP. So many of my American colleagues and friends who have suffered from extreme GERD don’t take my suggestion seriously, to the point that I have to go out and get the ginger and make the drink for them when I realize they just ignored my suggestion(probably sounds too simple, when they’ve already tried every advanced medication out there). I have never meet a person who it didn’t help and often times makes the symptoms go away completely over time.
But you must use fresh ginger, not one that’s already pre shopped, you must peel and chop it yourself, and NEVER add any other ingredient, it will be a bit bitter at first but you will get used to it and the relief will be worth it. Good luck, and if you’ve already tried it, ignore this message.
Thanks, Sarah.
I found this:
Ginger has been used worldwide as a natural cure-all for everything from malaria to baldness, but it is most commonly celebrated as a remedy for digestive problems. Because of the vast range of gastrointestinal issues, researchers continue to “dig deeper” to find more uses for this spicy, fragrant root (Source: Web MD).
Scientists are especially curious about whether ginger can relieve acid reflux and symptoms of heartburn. A 2011 study found that participants who took ginger supplements showed reduced levels of inflammation within one month. This could be due to the phenolic compounds in ginger, which can ease stomach irritation. Phenols are also known to reduce gastric contractions that might allow acid from the stomach to flow up into the esophagus (Source: Healthline).
Currently, most studies on ginger are limited to its nausea-reducing effects, so there is certainly room for more research on ginger’s effectiveness against acid reflux and heartburn. However, there is no denying that cultures worldwide have been using ginger to soothe digestive conditions for generations. According to Home Remedies for Life, ginger can also help:
https://westonoutpatient.com/news/the-power-of-gingertorelieveheartburn
Hi! What a fascinating article to read!
I have a question for you, as you seem to be quite an expert on the subject!
Is there anything that comes to mind or any reason at all why all types of stimulants have slim to no effect at all on someone? Adderall XR(60mg) ,Dextroamphetamine(Dexedrine spansule XR 60 mg)
methylphenidate (Ritalin) Modafinil(up to 400mg).
All of the above were prescribed to me for their wakefulness properties, because I have severe hypersomnia and also ADD.
Is there a protein, or anything, that could be “not binding” properly on something else in my brain and therefore, making all stimulants useless?
I’ve been tested for anti-lgi1, anti-ma2 and anti-nmda.
They did found elevated Beta-2 glycoprotein 1 IgG and I’ve tested positive for antinuclear antibodies. I am getting a full body PET-SCAN on Monday..
Could that explain why all stimulants don’t work on me? Caffeine and energy drinks are useless..
Thank you very much.
Have you’ve recieved any awnsers about your questions yet?.. I’m curious to know because I have pretty much the same symptoms you mentioned.
Hi Eric,
Thanks for bringing my attention to not replying to Patricia. It was a tough question, so I needed to think awhile. Then it got away from me. I just responded.
g
Dear Patricia,
Any revelations from your PET SCAN?
I am so sorry to have forgotten to attempt answering your question. I read it when you sent it, but then I needed time to ponder. 🙂
I could ask some questions, though.
1. Are you confident of your diagnoses — ADHD (inattentive presentation) and severe hypersomnia? Is it possible there is a mood disorder?
2. How long have you had these problems? Was there any time when you did not?
3. When you tried the stimulants, were you consuming citric acid, drinking caffeine, or on a restrictive diet?
4. Is your diet good, with enough (not too much) protein and you’re getting enough vitamins and minerals?
5. What is your age?
One tidbit: Generally speaking, the stimulants are not “wakefulness” medications. Especially not for people with ADHD. (ADD is the old term. Today all presentations are called ADHD.)
In fact, I’ve seen some folks with late-diagnosis ADHD and with lifelong sleep deficits actually become sleepy on the stimulants. That’s because, I presume, the stimulant is helping them to “focus” on sleep and relax — and pay off sleep debts. At least in some that’s how it’s turned out. With some patience. Does that sound like a possibility?
Gina
Hi,
This article was great! I have been taking adderall for about a year. I am a medical student and use it almost everyday. I take 20mg XR in the morning with breakfast, and take 10mg IR one to twice a day (depending on how long I work). I have been taking multi-vitamins much more regularly because I know I don’t always get key nutrients in my diet. I also have acid reflux that is not very consistent and I have random bouts of nausea like twice a week. I’m not prescribed anything for the acid reflux, but I do take some tums whenever I have an episode. I sometimes drink a sprite or ginger ale as well. I found that the therapeutic effects of the adderall are decreased, but the toxic effects, like nausea and headache, are increased when i take the antacids with it. So, I take the antacids because of nausea, which then causes me even more nausea, and on top of that, I don’t get any work done because there are no therapeutic effects. What do you think is the best way to avoid this issue?
Hi Aliyah,
If it were me, the best way to avoid this issue would be to try another stimulant, one with a sustained-delivery system. But that’s me. 🙂
Adderall could be causing your acid reflex. It could also be affecting your gut motility such that it speeds up to digest food, creating nausea. It might create nausea on an empty stomach, for the same reason — faster gut motility but nothing to digest.
But if you are also drinking coffee, that could be contributing as well.
You might want to keep a log, to see if the acid reflux and nausea are not so random.
Also maybe see if eating first and taking the Adderall 15-20 minutes later helps. (Though I realize that might be difficult.)
You probably know this but just in case: Taking vitamins/minerals on an empty stomach can create nausea. (Especially if it contains iron and/or zinc.)
Also, poor diet and sleep deprivation mean greater chance of side effects.
I hope this helps. Good luck!
g
I’m am having the most difficult time finding what I am allowed to eat while on adhd medication. I’ve scoured the Internet and it seems as though there are a gazillion articles on what NOT to eat but absolutely nothing on what you CAN eat or any ideas resources or guides on how to go about eating while on this medication. I am a law student and need the food for fuel and I’m finding that I have a lot of interactions with pretty much everything and this causes me to fall asleep while on the medication. I would greatly appreciate anyones assistance on the matter.
Warmest regards,
Alexia
Hi Alexia,
There is a lot of junk online. And it’s best ignored.
Taking ADHD medication (stimulants) does not require a special diet. You eat normally, making sure to get sufficient proteins, vegetables, fruits, grains, etc. — and take a daily multi-vitamin/mineral for good measure.
What do you mean by having “interactions with pretty much everything and this causes me to fall asleep while on medication”?
How do you know it’s the “interactions” between food and medication that’s causing you to fall asleep?
What are you taking exactly? What are you eating exactly? Maybe we can troubleshoot a bit.
g
I have read about how methylphenidate-classed drugs are not affected nearly as much as amphetamines. If you haven’t already tried them, it could be worth a shot.
I read somewhere that the pH of your stomach can reduce Adderall IR’s effects up to 65%, whereas Ritalin is only effected about 10%.
You may also want to give the stimulant, MYDAYIS, a try. It’s basically a triple release version of Adderall, so you would only need to be concerned about what you eat once a day.
Hi Scott,
Thanks for your comment.
It’s always a good idea to check the product insert for the medication in question. If there is an interaction, it should say it, as required by FDA.
I provided that information for a few stimulants in the post.
g
Thank you so much for this article. I have been taking adderall XR for 2 years for my adult adhd and was never informed of this. SO HELPFUL!!
Hi, This has turned out to be a really useful article! Thank you… I have been taking Elvanse for about 5 months now and overall, it has been very effective at 50mg. But one thing I have noticed recently is that my usually very regular menstrual cycle has started to become irregular. And despite being tired, I’m staying up so much later than I normally would. I usually have a glass of juice with breakfast and a probiotic tablet and a multivitamin (About 20-30 mins after taking my medication) and I am very fond of juice and carbonated drinks throughout the day… I’m starting to wonder if I’m messing up how the stimulant works, and by association Prolactin.
Hi Lamby,
Seems like a good operating theory — now time for an experiment?
I’m unfamiliar with Elvase’s mechanism of action. But if it’s like Vyvanse’s, consuming the citric acid 20-30 minutes after might not be a problem.
Still, it’s worth trying without the juice.
Also, remember that juice has a LOT of sugar. That can affect insulin levels, etc. which can also affect how a drug is metabolized ….and can also affect cognition.
good luck!
g
I have also been reading about the role histamine plays and how ADHD meds can affect that too. It’s a bit of a minefield…
Hi Vicki…absolutely, the complexity of our physiology is pretty much off the charts. 🙂
g
Hi.
I have recently started a Low dose vyvance (30mg). Every time i take it, by the time it kicks in, i get so fatigued I have to take a nap. I have insulin resistanse, low thyroid and diagnosed with pcos (What a fun mix) so I treat Both binge eating disorder and adhd. Is vyvance known to interact with blood sugar? Because when I track my blood glucose levels, This seem to be the only reason for my extreme fatigue.
Hi Elin,
Wow, that does sound like a juggling act.
When you say you are treating both, what does that mean? You’re taking another medication?
And you say that when you track your blood glucose levels…what? Am I mis-reading or did you leave off the next thought?
I don’t know about interactions with blood sugar. I suppose anything’s possible.
Is it possible that you are sleep deprived? Sometimes that happens when a person with ADHD starts stimulants; they are finally able to relax and the body wants sleep.
If you haven’t tried the methylphenidate class, that would be a logical step. You should be given trials of both classes.
Also, the dose might be too high.
I hope this helps.
g
I’ve been suspicious of my sugars also.
The reason I switched over to Vyvanse was because I found the short acting methylphenidates to be okay, but exceptionally short, which was not enough to get through a morning, nevermind a working day and homelife.
Since years of undx means that snacking my way through the day was one of my coping strategies, the Vyvanse for BED does seem to assist with that default behavior.
Is there an equivalent for methl the way Vyvanse is a precursor to dextro?
Or conversely something else that treats ADHD while having a negative impact on appetite that is not Vyvanse?
Hi Lora,
Yes, Vyvanse was approved for BED (Binge-eating disorder). But there is no reason to think that the other stimulant choices don’t have the same effect. It’s just that Vyvanse’s manufacturer paid to have those studies done.
You switched from methylphenidate (Ritalin) to amphetamine (Vyvanse). Those are the two very different classes of stimulants. One might work better for you than the other, so it’s important to try both classes.
I’m not sure what you mean,…that Vyvanse is a precursor to Dextroamheamine. Vyvanse IS dextroamphetamine — in a pro-drug formulation (meaning that the dex molecules aren’t activated until they get to a certain point in the gut).
So, yes, as I mentioned above, all the stimulants could work in a similar way, to help control impulsive eating — just as the stimulants help with all impulsive behaviors.
I hope that helps.,
g
Hi. A couple of questions.
Dr. Charles Parker and others, have provided suggestions and insights that IgG (food intolerances) wreck havock on the gut and also the absorption of ADHD medication and suggest this as some kind of main reason, that medication stops working or shifts effect.
Do you see any possible relation between this pH problem and IgG, that both revolve around the gut and metabolism of meds?
Should one adhere to both these aspects or what do you think?
And how can only elements like citric acid (or grape and the other handful of acidic foods) be the main culprit here, when there are many foods more acidic than the gut? And if citric acid isn’t more acidic than the stomach itself (where the medicine is broken down)?
If it’s because citric acid (a.o) has a very low pH, then wouldn’t it be all foods within a certain pH range (like below 3 or something) that has to be avoided around the time of taking the medication?
I’m still confused everytime I try to decide on specific foods.
And also, IF the medication have failed due to gut acidity, then I suppose it would make sense to take an antacid to COUNTER this derailing effect.
Regards, Thomas.
Hi Thomas,
Yes, that is indeed another potential factor when trying to figure out why a medication seems to have stopped working.
Those are good questions. I’ll try to answer them, grouped the following way.
1. IgG and the Gut
If you’re interested in theories about IgG, etc., Dr. Charles Parker’s videos are a good place to start. He knows much more than I do.
I’d offer only one observation about the food intolerances/sensitivities: We might sometimes have it a bit backward.
I’ll try to explain my thinking.
For some people with ADHD, untreated ADHD neurobiology itself might contribute to food intolerances and sensitivities.
Think of a “hyperactive” nervous system over-responding to food molecules. Normalize the nervous system and those intolerances and sensitivities (potentially also including pollen) might decline.
Anecdotal example: My husband, before ADHD diagnosis and treatment, had fairly strong reactions to onions, garlic, and sour cream. His face would break out. Quickly, too.
Gradually, with treatment, that improved to the point where I no longer had to curtail my cooking habits (no onions or garlic? seriously?). He didn’t even notice. No reactions.
Now, that’s my little theory, that treating ADHD might reduce sensitivities. I don’t know the mechanism by which this might work. Perhaps it is calming the nervous system. Perhaps it is improving the immune system through less stress. But I have also known people with ADHD who, once they started stimulant-medication treatment, were no longer bothered by grass-cutting, etc..
2. You ask: How can only elements like citric acid be the main culprit here?
I’m not sure that’s the case. My understanding is that different foods can affect different parts of the gut. If they affect the parts where drugs are metabolized, that might present the problem.
This article hints at the complexity: https://www.pharmacologyeducation.org/pharmacology/drug-absorption
It might be that because citric-acid foods and supplements are so ubiquitous in our diets, it merits a special caution. But it might be that their chemical structure and where they affect the gut is another factor.
If you check the post, you’ll see information specifically on grapefruit juice. Beyond it being an acidic food, the larger issue is that a certain chemical in grapefruit can affect drug metabolism.
3. All things in moderation
I’ve seen some folks with ADHD get a bit obsessive on these issues. If they’re not careful, they can go down a rabbit hole and never come out. 🙂
I’ve heard of a trend now involving alkalizing water, etc. It sounds like a merit-less fad to me.
Emphasize a varied diet and good health habits
Remember that protein provides the building blocks of neurotransmitters such as serotonin and dopamine, amino acids. We need sufficient protein but not “high protein.” Reducing dietary protein might also contribute to a medication being less effective—or not working at all.
That touches upon another factor: Getting a sufficient variety of amino acids. That’s another reason why eating a varied diet is important, to make sure you’re consuming all the amino acids.
https://www.medicalnewstoday.com/articles/324229
So yes, I urged not obsessing yet still trying to do all the things in that list. 🙂
Incorporate them one by one. If you’re in a dietary rut, hatch a strategy to add more variety.
I’ll be covering this topic in my online training. Meanwhile, I hope this helps!
g
Hello, sorry for budging back in so late.
1. Yes, I did see his videos. I was curious if there was some bigger picture involving the two (IgG v acidic foods), as they both revolve around derailing the medicinal effect. Maybe there was a connection.
Because when avoiding acidic foods, this might go against what’s good for gut health, and another thing will be adhering to one’s own IgG-index. Trying to adhere to several blacklists at once has brought a lot of confusion on my part, not least due to earlier attempts to figure out on my own what I couldn’t tolerate (before lab/blood test).
Interesting theory. I think my problem is ‘forwards’ though, as my experiences are more recent and post-treatment-oriented.
2. OK, so it might not be the pH *degree* (range/number) as such, but acidity combined with chemical structure.
3. Alkalizing water may be mostly a fad – BUT many mineral waters contain substances like sodium bicarbonate and I can add that this (let alone pH) really is a factor. I have many times countered the derailing effect of citric acid (i.e.) by taking water glasses with baking soda (under some circumstances – seems to depend on the amounts of both that and water + how full the stomach is). I’ve also sometimes succeeded in calming myself and ‘saving my mind’ after taking another antacid, when my ‘system’ has collapsed in ‘spastic’ unrest from having the wrong nutrients with my meds.
Paper inserts don’t say much about interactions, not on foods.
Why not high protein? Seems I gotta go ‘low carb’ after I got my microbiome result anyway.
Thanks for all the clues and response.
– Thomas.
Hi Thomas,
You ask, “Why not high protein”?
Because it’s generally considered unhealthy, being especially hard on the kidneys, etc.
“Low carb” doesn’t necessarily mean “high protein.” It also means lower-carb vegetables. Vegetables also tend toward the alkaline.
I don’t know what to tell you about your other comments. That’s above my pay grade. 🙂
I can offer one tidbit — which might or might not apply: I’ve seen some of the young men, in particular, in my local group, get a bit obsessed on this kind of tinkering. As if they can just figure it all out and “get it right.”
For many of them, it seems little more than a distraction, a delaying tactic toward getting on with ADHD-related strategies, improving sleep, etc..
Many of these tests are also over-sold, by people who don’t quite know what they are doing. It’s a problem in many places. Especially by vendors (I’m stopping short of calling them “medical professionals”) who are out of their debt vis a vis ADHD — but still want their tests and concoctions to “treat” it.
good luck sorting it!
g
Yes, I know everything can be overdone to the point of exaggeration. Just doubting how big of a risk it would be to down a massive amount of protein, when they’re the building blocks of neurotransmitters. Especially when being low on those.
I don’t think IgG tests are oversold or insignificiant though. And there’s a reason why the process includes both an elimination and a provocation phase – to see what foods TRULY have to be avoided in the longer run. Not all food intolerances have to be permanent, I’ve seen.
Thanks. I hope I’ll have better luck with this.
~ Th.
Hi again, Thomas,
Yes, I understand your perspective. But contrary to popular opinion, “more” does not always mean “better.”
Yes, protein supplies the building blocks of neurotransmitters. But a “normal” amount of protection should be adequate.
The big variable with neurotransmitter precursors from proteins is primarily uptake. Amino acids can compete for receptors. So, even if you are eating a sufficient or even “massive” amount of amino acids, that doesn’t mean your physiological will uptake them. It depends upon your receptors — and how they are funcioning.
You of course are free to think as you would like. But from my perspective (observing this field over 20 years and how it can snag people with ADHD, especially when overlying on naturopaths and others who are not qualified to understand neurogenic factors such as ADHD), IgG tests are definitely oversold and mostly misinterpreted.
We develop antibodies to the foods we eat most often. That doesn’t mean we are sensitive to or allergic to them.
Our bodies are complex. Many people with ADHD seem to have higher-than-average rates of celiac and other gluten sensitivities. Does that mean that gluten is causing their ADHD? No. It means that ADHD neurobiology can create an over-reactive nervous system that over-responds to everything.
Sometimes optimizing ADHD medication treatment resolves from hyper-sensitivity issues.
When I met him, and for the years during which he went without ADHD diagnosis or treatment, my husband would get headaches and his skin would break out when he’d eat onions, garlic, and sour cream. That does not happen anymore. Not at all. And hasn’t for a very long time.
We are complicated organisms. 🙂
good luck
g
Yes, I know that IgG antibodies often retrieve false positives in tests and they don’t always represent real/permanent sensitivities – and again, that’s why one has to do a provocation phase to reintroduce them and see if one (still) reacts to them.
Re-examining the foods is part of the program to find the *real* culprits over time. I’m surely not saying it’s a gold standard – that’s why those food items have to be ‘filtered’ and tried again.
And yes, I know gluten is not *causing* ADHD. I NEVER said that :).
You (and Charles) also wrote about the significance of IgG in here. And without that test, I would keep chasing my tail without a clue. I most surely have some hidden imbalances, as they usually result from food items, and experience treatment failure most days but not all.
And that sounds so good for you – I hope some of my sensitivies can go away too (avoiding 71 foods for life is too hard). That’s also in my picture.
Take care :).
-Thomas
Hi Thomas,
I know how frustrating it can be….so many moving parts. Especially at the beginning.
My husband is a molecular biologist. He took great issue with the testing (but did it anyway). When he heard that he would have to give up bananas and gluten — he hit the roof! 🙂
Appealing to his sense of scientific discovery, I said, “Let’s just view it as an experiment.”
Appealing to his ADHD-related poor sense of time, I said, “It won’t be for forever! Let’s try it for 3 weeks, one at a time.”
He agreed. And then I had to find all the gluten-substitutes because I do the cooking and shopping around here.
He professed to notice no difference, after omitting either, and I wasn’t sure I saw a positive difference, either.
But randomly, 4-5 weeks in (we stretched the deadline), he said, “I think that eliminating the gluten might help a bit.”
Who the heck knows.
My sense of it is that, in the beginning, it’s best to focus on pharmacological treatment and sleep (poor sleep affects the immune system, which can ramp up all kinds of allergies and sensitivities)— and improving diet overall.
That’s because the differences that the more subtle food sensitivities might make in the beginning just don’t stand out from the rest of the “noise.”
After cognitive functioning improves via medication, then try again with the food items. Keep fine-tuning, as it were.
I’m a pragmatic person, so that’s my take on it.
Good luck!
g
Hi, brilliant article and knowledge I must say. You don’t see many people/studies with the ability to properly integrate the knowledge of psychology with biology but yours is on point. I also agree with making sure to take supplements that we need to make up for due to food lacking because of GMO’s such as magnesium citrate, a nicely purified omega 3 and B vitamins if needed. I have found that B6 in the form of P5P makes a wonderful positive difference. I didn’t know how gut PH would affect stimulants but I suspected as much so your article helped make it clear for me. I’ve just been diagnosed with ADD and put on Elvanse, my question would be –
What do you think about doing a carnivore while taking this? (It’s been “shown” to have immense benefits on things like depression, diabetes type 1 and 2, cognitive ability, getting out of bed problems, arthritis, EDS and many more)
I know you advise not to take too much protein on it but since Elvanse also reduces your appetite I think it might balance it out that way? I’ve read you mentioned too much fat intake while on stimulants too, which on carnivore, one would have to consume. I guess I’ll just have to try it but wondered if you had experience/knowledge you can share
Apologies if this is something you have already mentioned, I have read more than half of your replies to others but find it hard to read everything. Like I have ADD or something (!) 🙂
Thanks for reading!
Hi Marcos,
Thanks for your comment and the kind words.
I try to be the “cross-disciplinary synthesizer”. 🙂
And good grief….I can barely keep up with all the comments on my blog…I can’t imagine readers will!
re: “carnivore”….is that like Atkins or low carb?
I really can’t speculate. But I can say that people with ADHD are individuals. ADHD is a highly complex and variable syndrome. So, what works for some people won’t work for others.
I remember one family telling me that when they went on the Atkins diet, their adolescent son’s behavior improved. Perhaps it stabilized sugar levels? Or prevented spikes and troughs?
Then again, a friend who is a psychiatrist and has lectured on “nutraceuticals” (basically, foods that can help improve health and thus mood, etc.)…tells me that low/no-carb diets can exacerbate depression and anxiety.
Given that many people with ADHD have co-existing, neurogenic depression and anxiety….low/no carb might be problematic.
I guess you are left to, as you say, treating yourself as a lab rat!
It might be helpful, though, to keep these possibilities in mind. That way, if you start feeling much worse, you can make a more informed decision about stopping or continuing.
I hope this helps. Good luck!
g
I take Omeprazole 20mg for heart burn and acid reflux, and I also take Vyvanse 30mg for ADHD. I had been taking both pills at the same time in the morning and found that the Vyvanse was not effective. When I take the Vyvanse by itself in the morning, I can feel the effects of it within a couple hours, as you normally would. I have tried waiting a couple hours in between taking the Vyvanse and Omeprazole, but within an hour of taking the Omeprazole, I can feel that I no longer have the effects of the Vyvanse. It’s like the omeprazole completely cancels out the vyvanse. I have been researching interactions between the two medications and cannot find anything about this, other than this article. So, in my experience, antacids can definitely impact your ADHD stimulant. Now, just trying to figure out the right time frame to be able to take both medications successfully.
Thanks for the data point, LD. I hope you figure out a solution.
g
Thank you so much! I am on 40g omeprazole and just started on 30g Vyvanse/Elvanse. I’ve been taking them at the same time them having bad headaches and panic. Maybe I was potentiating the Vyvanse with the Nexium! I’ll try taking Vyvanse after breakfast amd Nexium before bed. And maybe drink some juice with the Vyvanse to compensate for that lack of acidity!
Hi Anna, I’m glad you found my post.
I hope your experiment is useful.
You might want to try the Vyvanse WITHOUT the juice, too.
I’m not sure what you mean about compensating for that “lack of acidity” — you mean from taking the Nexium? But maybe the time-lapse will make that a non-issue.
good luck!
g
Hi, I live in Poland where knowledge about ADHD medications isn’t widespread in all doctors. I had some esophagus ulcers – I took once clindamycin without water, it said and made a burn, well… So I was on pantoprazole for 2 months, firstly 2 times 40 mg, then 1 time 40 mg.
But some time ago I had an ear infection and had to take antibiotic that work bad with protein pump inhibitors. I heard it’s also good time to not take them anymore.
What happened is, I guess, some rebound (adding to this red bull, caffeine, etc.), and I’ve got hyper acidic environment. I take Concerta in the morning and ritalin IR (other brand, but equivalent) in the afternoon. Maybe after PPI my body got used to higher concentration of the med or maybe my body was counter acting PPI so I had a normal PH when taking it but when I stopped it, I couldn’t study, I was so hyper and also my sensory issues started coming back. I also take Cymbalta. I’ve got a sore throat, doctor putted me on one week of “avoiding people” but I think it was a rebound from PPI. Now I’m taking them back and feel calm. It was like my meds were not acting or maybe acting too much, when my body started producing extra amount of acid? I don’t know. But I hadn’t such hard time earlier. I was so impulsive, so emotional, and couldn’t focus on studying for 20 minutes.
HI Jadwiga,
It’s good that you are thinking of all the possibilities.
It could be so many things, including the caffeine from those drinks. They are really a bad idea, with the caffeine amounts being unregulated, etc. And of course lots of acid.
take care,
g
Hi, im from Brazil. I start taking pantoprazole 40mg/day for 2 weeks and all side effects of ritalin have gone. It was so good! Now that i stoped pantoprazole, all side effects come back. Anyone knows how pantoprazole interacts with ritalin? Lower the absorbtion? Or make the concentration lower but extended? Any clues?
Thank you all!
Hi Bruno,
I see no known interactions between Ritalin and pantoprazole.
https://www.drugs.com/drug-interactions/omeprazole-with-ritalin-1750-0-1606-979.html
There are so many possibilities. Stimulants also affect the gut, so if the Ritalin is creating GI problems for you and the pantoprazole eliminates those problems…that would be my guess.
The main thing is, is the Ritalin still working.
g
So citric acid is what we need to avoid while taking adderall? Ascorbic acid is OK? If i take a multivitamin with 200% vitamin c (as ascorbic acid) at bedtime will it affect my 9am dose of adderall? I saw where you’re saying avoid acidy things an hour before and an hour after doses, but would the vitamin c sit in my stomach overnight and thus be acidic in the morning or should I be ok? Thanks for this awesome article and for replying to comments. This is exactly the information I’ve been searching for for literally the last 4 hours.
Hi Joshua,
I took this information from the product insert for Adderall — the little paper with the massive amount of tiny print, required by the FDA.
Note that it does mention ascorbic acid (in bold).
Adderall:
Acidifying agents:
Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines.
Urinary acidifying agent (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion.
Both groups of agents lower blood levels and efficacy of amphetamines.
Alkalinizing agents
Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase the absorption of amphetamines. Coadministration of Adderall and gastrointestinal alkalizing agents, such as antacids, should be avoided.
Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion.
Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.
Summary: A system that is too alkaline or acid will reduce medication effectiveness.
“You deserve better! What if you were prescribed eyeglasses but told you can wear them only 3-4 hours a day? Nonsense! ”
Thank you for this. That’s a really helpful perspective when thinking about adhd meds, especially when the mind goes to thoughts of “I should be able to control without meds”
You’re work is much appreciated.
Thanks for the kind words, Jill. They mean a lot.
I mean every word of it.
When it comes to medical care, people with ADHD are the clients — not beggars!
g
thanks for such an informative article about acidic foods Affect stimulants, which gave me clear understanding about the effects. thanks for sharing your information on this blog
Research I’ve seen indicated that methylphenidate absorption is enhanced by a high fat meal.
Hi Dan,
I’ve heard that and the opposite. 🙂
The most definitive information can be found on the product label. The FDA has strict guidelines on those.
Food Effects
Administration times relative to meals and meal composition may need to be individually titrated.
When Ritalin LA was administered with a high fat breakfast to adults, Ritalin LA had a longer lag time
until absorption began and variable delays in the time until the first peak concentration, the time until
the interpeak minimum, and the time until the second peak. The first peak concentration and the extent
of absorption were unchanged after food relative to the fasting state, although the second peak was
approximately 25% lower. The effect of a high fat lunch was not examined.
There were no differences in the pharmacokinetics of Ritalin LA when administered with applesauce,
compared to administration in the fasting condition. There is no evidence of dose dumping in the
presence or absence of food.
For patients unable to swallow the capsule, the contents may be sprinkled on applesauce and
administered (see DOSAGE AND ADMINISTRATION).
https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021284s020lbl.pdf
Hello,
I’m dumbstruck. Adderall – around here it’s dexamfetamine – stopped working one day. Just like that. Nothing. I haven’t been able to write (for a living) in three weeks. I’m starting to freak out.
I’m following a rather strict supplement regime. My guess is that it could have something to do with the regime. I won’t go into detail about why I follow the regime. But that’s how I came across this website.
It consists of …
2000 mg DLPA x 3
2000 mg Tyrosine X 2
2000 mg Glycine x 3
500 mg Leucine en methionine X 3
B complex, some minerals …
Could this be the reason? Upon first glance?
I’m desperate so anything that would make me understand what’s happening would be a godsend!
Hi Richard,
I’m sorry to learn of your distress.
Some thoughts:
1. Adderall is not dexamfetamine; it’s mixed amphetamine salts. So if you are taking dex now instead of Adderall, that could account for the difference.
2. I am very familiar with the idea of supplementing amino-acid precursors. I know it is widely touted.
The problem is, it is poorly studied.
The research I have found points to risks of actually down-regulating receptors — due to flooding the brain with those molecules.
The only way you can tell is if you stop taking them for a while and see.
At any rate, I’ve heard from many adults with ADHD who’ve tried this route that the effect goes away in a few weeks. More support for the down-regulation theory.
3. Also remember the importance of a good diet, with sufficient protein and vitamin/minerals. Your brain needs all that.
Good luck!
G
I’ve been taking adderall for 12 years. If you’re thinking that 12 years is a really long time, you’re right. I battle with the effectiveness of the drug everyday, but I imagine most of my issue is that I’ve been taking it way too long.
Anyway, as it pertains to this article (very well written, by the way), I figured out very early on that carbonated drinks and juice reduced the effectiveness. I gather everyone is different, and that may not be the case for everyone, but it was very obvious to me.
Thanks for sharing your experience, Brandon.
I’m not surprised at all about your taking Adderall for 12 years. I know many adults with ADHD who have taken medication for 10, 20, and even 30 years.
Taking brand might help, if you can get it. And, if you haven’t already tried it, Vyvanse works well for many people who respond well to Adderall (not all, but many).
Also, if you specifically need the mixed amphetamine salts (as in Adderall), you might want to check out Mydayis: https://www.mydayis.com/mas-formulations
thanks!
g
Hi Gina,
I appreciate the response. I agree about taking brand name but every time I have tried to get it they pharmacy is out. I’m not sure if that’s due to demand or because they stock generic over brand, but the result is the same either way.
In terms of generic, I have an ongoing battle with variations in formula. I tend to get one of two types, the round orange pills or the round white ones that crumble easy. If I take one of these for two consecutive months it becomes apparant that the formulation is different, and often times it means the medication is ineffective.
As for Vyvanse, I’ve tried it but found that it became less effective much faster than adderall. I think I managed 4-5 months on it before having to switch back.
I’ve never heard of Mydayis before, and I’m glad to see that more options are coming to market. I feel like I’ve gone about as far as I can with adderall. I’ll read through their website and see if it’s an option for me.
Again, thank you for responding.
Hi Brandon,
You’re most welcome. I wish I had more feedback on the newer Rx offerings. It’s slow in coming.
It looks like there are MANY Adderall generics (not sure if all are available):
https://www.drugs.com/availability/generic-adderall.html
I’ve yet to get a precise answer as to why Adderall tends to diminish in efficacy.
My guesses: sleep deprivation, insufficient vitamins/minerals, and protein building blocks for the neurotransmitters that Adderall acts upon.
good luck,
G
Hi Brandon,
I too have been taking Adderall for just about 12 years and then it just kind of stopped working. I was feeling lethargic all the time.
My doctor switched me to Mydayis, and I have been pleased with it. It is a delayed release drug, with 3 different times of release from one daily capsule, so the effects are more spread out and last even longer than Adderall ER, which is specifically what I was on. Hope this information helps someone, albeit a very late response. 🙂
Awesome article Gina! I came here looking for information about how stomach ph changes with different foods as the three releases of Mydayis are controlled by stomach ph. Keep up the good work!!! Very helpful.
Hi Diana,
Thanks for the kind words. I appreciate it!
Thanks also for providing a first-hand report on Mydayis.
There are so many new options, in both classes of stimulants. But such a trial to try changing.
I’m glad it works for you.
g
Hello and thanks for the article, it really set some important thoughts in motion – but unfortunately, this whole case seems so MASSIVEly complicated on so many levels, just from trying, testing, searching and reading.
1. I lapse into extreme, unconcetrated stressful rows of tics many of these, and I CAN’T figure out whether this is because of high blood pressure, too much body acid, or both.
2. MANY places on the net mention citric acid, oranges, lemons, fruit products AND yoghurts to be alkalinizing – in the *gut*. They’re naturally acidic to begin with (at ingestion, I guess), BUT they seem widely reported to de-acidifying agents in the stomach, or after digestion. I’ve just been checking back and forth. So how does that make sense, if they’re also to be thought of as gastro-intestinal acidifying agents?
3. The complications of (seemingly) needing to alkalinize my body, due to the stress, tics and total lack of concentration, makes for a need to avoid acid foods – but if I need to lower my blood pressure, I might need to take things with vitamin C or other ingredients, that are said to be acidifying (?!). And then, as a further complication – wanting to metabolize my Vyvanse (or Elvanse in DK) with protein, might mess me up, if the foods are acidic. But if things like yoghurt are alka/basic, maybe the sugar content of those mess up my heart and blood rate.
And no, the doctors just know nothing of this. Especially in Denmark, especially about foods in *relation to* ADHD-medicine absorption. It’s like all divided between either a pharmaceutical knowledge field about medicine, or general practical knowledge about foods and general health.
4. To add further confusion, I didn’t have any memorable, serious complications like this earlier in Spring, or Winter. The summer heat seems to escalate my anxiety many of the days and some of the stress, too. Maybe it relates to the possible high blood pressure.
It’s probably way too hard to talk solutions, but I can’t find a pattern to stick to, and I at least wanted to put this issue out there.
~ Regards, Thomas W.
Dear Thomas,
It sounds to me like Internet nonsense is stressing you out!
I don’t know where that comes from….this idea that citrus juice ends up being alkalinizing “in the gut.” I can find no evidence of that. I see only websites trying to make a buck peddling claptrap.
So, please
1. Forget about: “Alkalinizing” your body
2. Focus on: eating a healthy diet with plenty of fresh leafy greens and vegetables
3. Eat a breakfast that includes a normal serving of protein — an egg, turkey, protein drink, etc.
4. Stay hydrated; perhaps that’s why the summer is escalating anxiety; the brain is mostly water!
5. If you didn’t have hypertension before the Vyvanse, consider switching to a methylphenidate stimulant (e.g. Ritalin, Concerta, etc.)
6. Try to get good, regular sleep.
7. To be on the safe side, don’t consume citrus fruits or Vitamin C in the morning.
I hope this helps.
G
Hello Gina, and many thanks for responding!
I was primarily stressing because of my unexplainable physical reactions of constant tics (‘sniffs’), total inability to sit, work, relax, concentrate – and also trouble breathing! I found out it was caffeine jitters, which seem to come more easily and intensely while being on a higher stimulant dose. But I don’t think I’ve had caffine every time I experienced that in recent times.
And yes, that part was probably nonsense. I’ll show some of the links and articles I found on it here, just for clarity’s sake:
https://www.healthline.com/nutrition/orange-juice-benefits#section3
https://www.livestrong.com/article/494937-what-juice-raises-your-ph/
https://www.getgreenbewell.com/orange-juice-alkalizes-your-body-and-thats-a-very-good-thing/
1. Alright, it’s just difficult to avoid citric acid, when it’s both in fruits, yoghurt and various dairy, etc.
2. Difficult when most vegetables taste to bitter, but I’m searching a lot for healthy foods these days.
3. You mean protein foods that don’t contain a lotta sugar and saturated fats? Sometimes meat has been good to the mood.
4. Yep, I just never keep count on how much I drink, but I take water constantly.
5. I was on ritalin/methylphenidate last winter, and it mostly gave me anxiety (esp. when eating little) and not much effect.
6. Hitting about 6-8 hours everyday.
7. So citric acid and vitamin C are the ONLY kinds of acid that I should avoid, 1 hour before and after I take my Vyvanse/stimulant? I don’t have to worry about the acidic value of other food ingredients or the pH value of other types of acids? (Like vinegar, i.e.)
(weird btw., that I had such a good effect of it 2nd July, despite having a squeeze of orange juice during breakfast, even while sick)
-T
Hi Thomas,
I feel your pain. If only our bodies came with individualized operating manuals! 🙂
I believed you about the references. Those examples, however true in certain cases (orange juice somehow having an alkaline effect in the kidney, thus preventing kidney stones) we probably need to leave behind when it comes to considering stimulant medication efficacy.
Note the insert notes on this subject with Vyvanse, as I wrote in the article, indicate that citric acid can make the medication more effective OR less effective. Just depends on your neurochemistry.
1. Alright, it’s just difficult to avoid citric acid, when it’s both in fruits, yoghurt and various dairy, etc.
Right. So don’t try to avoid it. But try not to over-do it, either. Maybe monitor for a week, as part of a time-limited experiment.
2. Difficult when most vegetables taste to bitter, but I’m searching a lot for healthy foods these days.
There are ways to make vegetables taste better. But you don’t have to make it elaborate.
Pick 3-4 vegetables you DO like and start there; summertime makes that easier. Think red peppers, strawberies, cucumbers, green lettuce, etc.
3. You mean protein foods that don’t contain a lotta sugar and saturated fats? Sometimes meat has been good to the mood.
Right. Those kinds of protein foods. Lean turkey, ham, eggs, nuts, etc.
4. Yep, I just never keep count on how much I drink, but I take water constantly.
That’s great you’re drinking water. Some “health nuts” have over-done it, though.
We don’t want to drink so much water that we do this: 🙂
https://adhdrollercoaster.org/tools-and-strategies/chapter-14-denial-and-neurobiology/
5. I was on ritalin/methylphenidate last winter, and it mostly gave me anxiety (esp. when eating little) and not much effect.
You might also have co-existing anxiety, in which case your physician should be treating “the full range of symptoms.”
It can be tricky distinguishing “untreated ADHD anxiety” from a true “anxiety disorder,” though.
6. Hitting about 6-8 hours everyday.
Aim more for 8! 🙂
7. So citric acid and vitamin C are the ONLY kinds of acid that I should avoid, 1 hour before and after I take my Vyvanse/stimulant? I don’t have to worry about the acidic value of other food ingredients or the pH value of other types of acids? (Like vinegar, i.e.)
(weird btw., that I had such a good effect of it 2nd July, despite having a squeeze of orange juice during breakfast, even while sick)
As I mentioned above, who knows…maybe for your body Vyvanse is MORE effective the more citric acid.
But you don’t need to avoid Vitamin C if it is ascorbic acid. It is Vitamin C that is citric acid that we’re talking about.
For tics, you might want to investigate taking a B complex vitamin and magnesium citrate.
good luck!
g
So if I take Ritalin twice a day 20 mg, I feel like the first dose work really well for about 1.5 hrs. Then hour two comes and it’s time to take my next dose. But 1.5 hrs in when it starts to wear off It gets harder to breathe.. dose 2 doesn’t work as well for me it doesn’t help much. Should I incorporate another dose in the day? Should I take it sooner than 2 hrs?? I also feel like after dose 2 when it wears off 1 hr or so later i can’t breathe again. Help
Hi Renae,
That sounds awful….that you can’t breathe.
I’m not surprised, though. Dopamine plays an important role throughout the body in regulating processes such as breathing.
Are you eating a lunch that maybe interferes with the effectiveness? Are you drinking soda or coffee? Maybe try changing to something else and see how it goes.
In general, I’m not a fan of immediate-release stimulants. It’s like riding a roller coaster all day. If you are a fast metabolizer, it’s even worse.
If you’re taking medication for ADHD, you should be treating it as many hours of the day (and even into the night) as possible. At the very least, you should be taking another dose when the second wears off, and when the third, and….
You might try Ritalin LA. It’s basically taking two Ritalin at once, with one of them kicking in later.
But I encourage you to also try one of the longer-acting stimulant formulations. Now isn’t exactly a great time for Concerta, unless you can get brand. If you haven’t tried Vyvanse, it might be worth a trial. It is an amphetamine-class stimulant, though, not a methylphenidate (as is Ritalin).
You deserve better! What if you were prescribed eyeglasses but told you can wear them only 3-4 hours a day? Nonsense! 🙂
Good luck!
G
Hi Gina,
Thanks for your reply — I haven’t come across too many people who are also aware, as you are, of the unique experience women may have with stimulants due to hormone fluctuations. And yes, I believe you accurately summed up the findings to which I was referring.
I haven’t discussed it with my psychiatrist but don’t really feel it would be worth the time. I have an OK relationship with her and have been seeing her for six years, but one thing that frustrates me is that she’s not exactly the type to think outside the box when it comes to ADHD treatment.
A couple of years ago, when my work in my doctoral program started getting more intense, I broached the subject of raising my dose a little, given that there is just no way that 40 mg of Adderall is going to cover my busiest days, which can range from 12-16 hours of work. Her response ensured that I was never going to bring the topic up again.
She will pull the PDR online during a session to provide a rationale for decisions she makes, and she follows that thing to the letter. I don’t know if something has changed (I just checked the entry for Adderall and it said that “doses greater than 60 mg per day are not usually needed), but at that time she had said that it listed 40 mg per day as the upper limit, and she was absolutely unwilling to discuss it any further.
Obviously, I was not going to risk losing access to my medication altogether by being viewed as a “drug seeker”…which is the last thing I am…but it drives me nuts that she is SO rigid with her decisions. And in the same conversation, she remarked that she doesn’t see a lot of patients with ADHD, which doesn’t make me feel greater either.
The interesting thing is that I have plenty of clients of my own who also have ADHD, and many of them take higher doses of Adderall than I do, so evidently, there are psychiatrists out there who don’t agree with the rule she is going by.
Problem is, as many people know, it’s tough to switch docs…there is usually a long wait time and I don’t know of any in particular, in my area, who might be a better fit. The ones I do know of are colleagues, and therefore not psychiatrists I could see anyway. She and I did discuss Vyvanse at my last appointment, actually, but my insurance not cover it without a ridiculously long process of approval…and the last time I had to go through that it literally took months to sort out.
I recently heard about Mydayis, but with as new as it is, I don’t personally know anyone who has taken it; insurance-wise, that’s an even bigger reach than getting coverage for Vyvanse, but from what I have read it could be a good alternative to the ups and downs of Adderall and the nasty crash that comes along with it at the end of the day. Now that I have been free associating here, I can say I am a little less pleased with Adderall than I originally indicated, but don’t necessarily know how to go about changing things up. I just know it falls short for me lots of days.
Sorry this has gotten rather off-topic — not exactly related to the original post, go figure! Anyway, thank you again for all your great info.
If you have any thoughts or resources about ways of addressing these issues with a psychiatrist, I’d love to know about them. I feel pretty stuck with my provider and normally can advocate for myself just fine, but I already know the topic of my total daily dose raises her hackles instantly. And it’s not a great feeling, being afraid to bring something like that up.
Hi again,
It’s true that prescribers should be justifiably concerned about patients who seem to be using Adderall as a “performance drug.” ADHD medical treatment should help the person to become better organized and balanced—not to perform superhuman endurance tests. 🙂
Yet, there is also a danger of approaching ADHD treatment in a cookie-cutter manner. Some patients are fast metabolizers, for example, and some slow metabolizers, and that makes a difference in proper dosing.
There’s only so much you can do with MDs who compensate for their inexpertise by being overly rigid. But it seems that your insurance coverage presents the greater obstacle here.
I wonder if this savings program would speed things along (probably not as it’s not the insurance company saving money but the consumer). https://www.vyvanse.com/coupon-adult-adhd
And yes, Mydayis might be worth a trial but, like you, I know few people who have tried it and have only mixed reports from them. There is also a savings program: https://www.mydayis.com/prescription-support/copay-program
Perhaps you could draw a grid for your prescriber, showing your typical schedule. She’ll want to know that you are getting enough sleep, eating well, getting exercise, etc. Maybe seeing this in black and white will be more convincing than verbal explanations. (I always find that docs respond better to black-white data—short and bullet-pointed!—than talk.)
Meanwhile, 12-16 hours …that’s a long day. I’ve always worked long days, though, so I know they are the reality for many people. But do you think you could be more efficient with your time and priorities? If so, I would work on strategies to aid that.
OH! One more thing: You’re taking generic Adderall XR, I presume. Have you been taking the generic from the same manufacturer? Some are better than others, and some pharmacies have been horribly maximizing profit over efficacy. I’ve heard particularly unfavorable reports on the Aurobindo generic.
Good luck!
g
I apologize if this topic is already addressed somewhere here in the thread; as it is quite long, I skimmed much of it…anyway, I have been taking stimulants for ADHD for close to three decades and have no major complaints with my current regimen (Adderall XR 20mg 2 x daily), except that no matter how I time my doses, the effects generally fall short of what I need to accomplish in any given day and I spend the last few hours struggling to get by. I’ll grant, though, that it’s a whole lot better than it was with IR Ritalin or Concerta, the latter of which worked, literally, for about a week before having no effect whatsoever. Granted, the demands on my time are pretty extreme — I am about a year out from finishing my PhD in clinical psychology, which has been a long haul with ADHD, to say the least. Lots of days it is an uphill battle every step of the way, but I’m getting there.
Anyway, that brings me to my main point…I have spent a lot of my doctoral training focusing on ADHD treatment, and have amassed a small library of research studies on topics related to meds, counseling, etc. A couple of months ago, I came across a study by sheer chance that examined how the stages of women’s menstrual cycles have quite a significant effect on how well amphetamine salts (Adderall) are processed in the body. I can’t quite remember the specifics (I’m sure I have the study around here somewhere…but it goes without saying that my organizational skills are somewhat lacking!) but women reported distinctly different effects from their medication that were fairly predictable based on where they were in their cycle. At one phase, they were found to generally be less effective overall, where during another, the medications were associated with the more euphoric/energetic effects that many associated with stimulant medications.
I have yet to figure out what effects how well my medication works and when; I only know that it isn’t particularly consistent. Could be diet, hormones, or a combination of things…but, as so many have pointed out, this is a complex topic and there are tons of things that can impact medication effectiveness.
Thanks for this post, it’s nice to see some intelligent conversation about these medications by people who need them to live saner, more productive lives!
Hi Beanbean,
I’m wondering if you have tried Vyvanse. Many (not all) people who did well on Adderall do better on Vyvanse.
It’s not the same medication. Vyvanse is Dexedrine in a sustained release delivery system.
If Vyvanse does work well for you, you might find it lasts longer—or at least you don’t experience peaks and valleys throughout the day (if indeed that is the case).
TO YOUR QUESTION: Yes, it’s been commonly acknowledged (at least among the experts I trust on this topic, including Patricia Quinn, MD, and Kathleen Nadeau, PhD) that women might benefit from a little higher dose of stimulant during certain points in the cycle.
It’s thought this is due to fluctuating estrogen and progesterone levels. My understanding is that when estrogen levels are higher (typically during the first two weeks of a period), that promotes the release of serotonin and dopamine molecules. During the next two weeks, when progesterone levels rise, this can counter estrogen. That, presumably, might mean there are fewer targets for the stimulants.
Finally, absolutely, the human body is an incredibly intricate web!
Good luck sorting it out.
g
Recently, I’ve been feeling like my meds haven’t been working well and almost went back to doc to consider adjusting. I’ve also recently been diagnosed with lactose intolerance and started eating gummy bears by the truck load when I couldn’t have other sweets. (Yeah- I know I shouldn’t have all that sugar with an ADHD brain. I’m working on it. Lol) So THANK YOU for this awesome article. I’ll lay off the bears now.
Hi SpaceMom,
Wow! I’m interested to see if you start getting better results from your meds now.
Also: Could it be that you take a generic and the generic Mfr has changed?
Here’s the thing about the “ADHD brain”: studies have shown reduced glucose metabolism. So, a little sugar might not be a bad thing. Maybe fruit is better? I don’t know.
And of course what’s good for the brain isn’t always good for the rest of the body.
Good luck!
g
Let’s clear this up a little bit. The reason people take antacids with Adderall is to even out the PH in their stomach at the time of absorption, it’s not because it increases effectiveness by itself.
Since MOST people are far more likely to have pumped themselves full of acidic acids (soda, juice, juice flavorings, energy drinks, etc), taking the antacid helps to even out the PH and increase uptake.
If you want to get the most out of your Addy, take a single antacid tablet 60-90 minutes before taking it and then do NOT drink or eat anything an hour AFTER as well. I suggest a single tablet because it’s very unlikely to affect your PH to the point where it will hurt absorption, whereas acidity is a far bigger no no.
Hi CeeDub,
Thanks for your comment.
Are you basing this “Addy” tip on professional knowledge?
g
Hey Gina
Thanks for the reply!
I took a day off from meds today so no roller coaster today lol
How can I tell which amino acids compete and which ones don’t?
I don’t want to get “high” on Adderall or anything else for that matter
I’ve never taken an elicit drug. I used to drink hard in college but not recently
I just want a med (or anything) that works consistently. It should be simple but I’ve found it elusive
I want to be functional believe me!!
Technically I’m a genius. I qualify for Mensa based on a test
But it’s meaningless
I can’t hold a job. I’m still living at home with my parents
Hi R,
I do sympathize and I’m not judging. I simply have your best interests in mind, and I am all too aware of the sub-standard level of care in the U.S. and the world.
If that protein powder worked for you, I’d say stick with that rather than trying to figure out the scientific amino-acid wherefores and hows. 😉 Because that’s probably never going to happen, anyway! It’s too complex.
But I’d also encourage you to try a sustained-release RX. Such as Vyvanse. But if you haven’t tried the methylphenidate products (Concerta, etc.), I’d try those, too.
Above all, try not to judge if the medication is working by how it “feels” but by how it affects your functioning. Ask for feedback from people around you.
Maximize those “external supports” — wear a wristwatch and make yourself look at it often, use a calendar-planner, routinize your sleep schedule, get exercise…..no amount of medication will obviate the need for those habits.
Poor or insufficient sleep can greatly effect response to stimulants.
I hope this helps!
g
Hey
It’s 1:50 in the morning and I’m on an insane Adderall rush (we’ll get to that in a second…maybe)
Some people comment occasionally that they don’t know if thier meds are working
Gina suggested above that you can tell if the meds are working by seeing how long it takes to do a task with the meds and without. Objective and simple. I don’t disagree.
I’d like to suggest another way: look in the mirror and see if your eyes are dilated (or take a selfie). When amphetimes are working they dilate your eyes. A lot. Right now my eyes are VERY dilated but in this case I felt the medication kick in (which didn’t make sense because I took it more than FOURTEEN HOURS AGO) so I looked in the mirror to check; not the other way around.
One of the side effects of the Adderall going FULL BLAST is that I’m lonely. When I’m in a lower engergy state I don’t really want to interact with people. Not enough space in my mind or I’m focused on something else. But right now I’m in a high energy state. I NEED TO TALK TO SOMEONE SO BAD IT HURTS but there’s nobody around.
So I decided to post here instead.
I’m okay. No thoughts of self harm. I’m just going out of my box and I’m worried that I’ll be up all night and then crash 800am and be dysfunctional all day and then the rest of the week because my circordian symphony is out of sync.
But I digress.
It’s funny. The first time I took Adderall I probably had a manic/euphoric episode (no need for details here; but it was a little funny). Then it stopped working after about a month (the whole story is a little more nuanced but not for here). I tried a few other drugs with various but minimal effects and then just stopped the drugs altogether.
I lost my job four months ago and dropped out of life. Hardly left the house.
Found my leftover Adderall XR and decided to try it again. It worked a little bit but sometimes not but sometimes yes.
I’ve done some reading online and I’ve been experimenting with changing aspects of my diet and vitamins and antacids while taking the meds. These include a higher protein diet less sugar and carbs and also taking probiotics and magnesium and vitamin B supplements.
Sometimes the REALLY kicked in but sometimes it didn’t and sometimes a little bit.
So I took it this morning. 30mg of Adderall XR. And nothing. Okay. I make it through the day. Sort of. Situation normal
And quite by accident, I think I found out how to make it work.
I want to stress right now that there is a night and day difference when the meds work. It’s like someone with rotten vision puts on glasses.
The world literally looks different.
I’m not resistant to the drug.
I don’t need a higher dose (at least not now)
How did I get the meds to work?
FOURTEEN HOURS LATER
(By complete accident)
I googled what I thought it was but only found one hit (didn’t look too hard but still…)
I’m not joking
I’m not making this up
I got home at 12am
I had not eaten anything for about five hours
I was hungry but I didn’t want to eat too much because I thought I would go to sleep (Lol right now it’s 220am and I’m WIDE AWAKE)
So I took out some almond milk
And mixed it with
Ready?
Protein powder
My newfound elixir of life
A minute or two later I felt funny. It was like I was taking Adderall for the first time. It came on STRONG.
Which didn’t make sense because I hadn’t taken the pill for hours and hours.
So I checked my eyes
Dilated
I’m euphoric. I’m smiling while I’m pecking this out on my phone
I’m wide awake
And I’m convinced it’s the protein shake powder (it’s soy based if that makes a difference; or maybe it’s the Amino acids in there that set it off?)
I saw one other post about protein powder activating Adderall
Whatevs
Any thoughts?
Hi R.,
Yes, two thoughts:
1. If the Adderall makes your eyes dilate, you’re either on too high a dose or there’s some other reason that probably makes Adderall a poor choice for you.
2. Yes, neurochemicals such as dopamine, norepinephrine, serotonin, etc. are made from amino acids. That’s why we want to consume enough (but not too much) protein. Because the amino acids in protein are the building blocks of our brain chemicals.
In some cases, the proteins you consume contain amino acids that compete for receptors. The receptor “uptakes” the amino acid and takes it where it needs to go. Perhaps that protein powder has amino acids that don’t compete with each other?
Please do be careful. You don’t want to be euphoric. You want to be functioning. And remember: What goes way up can go way down. 🙂
g