Can poor diet cause ADHD, and can taking vitamin and mineral supplements help ADHD? As with most things ADHD’ish, the answer is complex.
This is a two-part post:
1. The original post from 2014, explaining results from a paper published that year on ADHD and nutrients. The research indicated that taking a combination of 36 vitamins and minerals was more effective than placebo in the adults studied.
2. The update: Wherein I went “behind the scenes” to examine the potential larger picture behind this study. To my knowledge, this study has not been replicated. That means, no other research team has conducted independent research using this study’s design. Replication is important, as it lends more authority to the findings.
For reasons involving Google search, I am leaving the original headline. The general statement is true enough. All humans need adequate nutrition in order to function well. That includes the human brain.
New Zealand researchers have found preliminary evidence: Vitamin and minerals improve the functioning of study subjects with adult ADHD and boost the mood of those who had moderate to severe depression at baseline.
The study was published this month in the British Journal of Psychiatry. Researchers used a broad array of 36 vitamins and minerals, not the customary single nutrient (e.g. zinc). That marks at least one distinction in this study. But additional distinctions make this research worth noticing.
Details of the Study
This double-blind, randomized, placebo-controlled trial showed that a vitamin/mineral product was significantly better
than placebo in reducing ADHD symptoms. The study subjects were 80 adults with untreated ADHD.
At baseline and trial completion, laboratory tests were performed to measure thyroid function, serum lipids, prolactin, fasting glucose, blood clotting, iron, zinc, vitamin D, vitamin B12 and copper levels, urinalysis and urine drug screen.
For 8 weeks, 42 took the supplement and 38 took matching placebo. This treatment resulted in “statistically robust improvements in several indices, from ADHD symptoms to global assessment of functioning, compared with placebo, with effect sizes ranging from 0.46 to 0.67,” according to the paper, published January 30, 2014.
Compared to the adults taking a placebo, adults who received the supplements reported greater improvement in both inattention and hyperactivity/impulsivity. Independent reports gathered from an observing friend, partner or partner also indicated improvement in hyperactivity/impulsivity.
When it comes to ADHD rating scales, however, clinicians did not observe differences between the placebo group and the group taking the supplement. Yet they did rate the individuals taking the micronutrients as functioning better in terms of work, relationships, and global psychological functioning. (In other words, while nutritional supplementation can help, it is unlikely to take you to the finish line.)
Additionally, study subjects with moderate to severe depression at baseline showed a greater improvement in mood if they were taking the micronutrients. The researchers reported no group differences in adverse events. The results, should they be replicated, would mark an important addition to informed ADHD treatment strategies.
We don’t need to wait for more studies, however, to understand that all of us need good nutrition for brain function and health.
Surprise: We Are Organic Beings!
For many years, ADHD experts and researchers have sometimes gone overboard in attempting to counter widespread skepticism about ADHD as a valid diagnosis by strenuously reassuring that it’s not caused by diet, that there is a highly neurogenetic link to ADHD. Of course, the picture is more complicated.
No one functions well when carrying around deficiencies in important nutrients. To put a finer point on it, people with ADHD generally carry around bigger-than-average deficiencies due to erratic eating habits. But gray area and nuance are not always easily expressed or understood in the mass media.
Then again, many treating psychiatrists are shockingly ignorant about basic biochemistry. Do they somehow imagine that neural pathways run on magic? Did they learn in school (and remember) that electro-chemical signals whose fuel is vitamins, minerals? Molecules of calcium, potassium, magnesium, and more. How about the various amino acids from different types of proteins? They are the building blocks of neurotransmitters such as dopamine and norepinephrine.
Sitting in a lecture hall once, I heard one psychiatric expert in pediatric ADHD, well known in the San Francisco Bay Area, refer to zinc as a “rare mineral.” I almost fell off my chair. No wonder so many people turn to “alternative” practitioners and shun medications if their physicians lack basic knowledge of biochemical requirements.
“But Gina, I Thought You Were Pro-Medication?”
Again, vitamins and minerals are the building blocks of our nervous system. When our bodies are deficient, nothing is going to work as well. This is why I always ask clients to detail their dietary habits.
Some will ask, “But Gina, I thought you were pro-medication.” Yes, I am for medication when it’s warranted and desired. I am especially interested in giving medication the best chance of working. Simply put: Medication will not work optimally when there are nutrient deficiencies.
It is the same with sleep deprivation: No stimulant will work as well as it could on someone lugging around a sleep debt. But anyone, ADHD or not, is vulnerable to various consequences when they lack key micronutrients.
It’s especially important that women of child-bearing age be well-nourished. The neurological system of the fetus is among the first systems formed, almost at conception. The area of science called epigenetics studies the factors that cause genes to turn on (“express”) or turn off. Some day, we might well learn certain epigenetic factors that dispose a fetus or person to ADHD or create more problematic genetic combinations.
To Learn More About the Study
The study’s lead investigator is Julia Rucklidge, a professor of clinical psychology in the department of psychology and part of a University of Canterbury group studying the effects of micronutrients on conditions such as ADHD, depression, sleep, and addictions.
Also, for more research involving the supplement used in the study, visit this page at TrueHope.com
Please note: This is not an endorsement of these supplements.
Update on This Research
Update : Since posting this article, I’ve learned that the lead researcher on this study, Julia Rucklidge, might not be as well-versed in the ADHD researcher as I thought her to be. Does this reflect on the integrity of her research, explained below? I don’t know. But at least it puts it in context.
Even though she is a clinical psychologist, I assumed that, given her area of focus, she must have expertise in biochemistry and that she knew quite a bit about ADHD and its evidence-based strategies.
Now I learn, from her comments on Twitter, that not only does she have little expertise in ADHD, but she is also perfectly willing to downgrade, in her TEDx talk, the effectiveness of psychiatric medications over time. (Perhaps you have also noticed that TEDx talks seem increasingly dominated by self-promoters with a very black-white agenda. I was hoping that one was different. Not so.)
She makes particular mention of the MTA study, which is the favorite “whipping boy” of the anti-psychiatry wingnuttery. They misinterpet this famous study that evaluated various types of treatment for ADHD in children to suit their agenda.
Called out on Twitter, Rucklidge also offers a study in Canada by an economist (not life scientists) showing lack of benefits over time for young people with ADHD.
read Currie’s study? Do stimulant medications improve educational and behavioral outcomes for ADHD? J Health Econ 37:58-69, 2014.
There are so many problems with that study, I don’t have time to recount them here. Suffice it to say, her offering that study as “proof” of her point absolutely diminished my confidence in her scholarly rigor vis a vis ADHD.
When I cast doubt on that study as evidence, Rucklidge responded:
I am starting to think you have an axe to grind because I am responding politely and providing research to back my position
Hmmm. What “axe” could I possibly want to grind? The failure of a grandstanding psychologist to acknowledge her limits, and the potential damage she is doing to people with ADHD being able to access medications without further stigma?
She also is a supporter of, and even a columnist for, Mad in America, a blog collection of anti-psychiatry extremists. They claim to have the interests of patients at heart. But read the columns. It is a collection of self-aggrandizing unknowns, especially on the topic of ADHD. Surely, no serious researcher fails to see what’s happening at that site. When I pointed out the problems with that site, however, she wrote:
“I think MIA have a mix of good and not so good articles, as does any website. I prefer not to dismiss things as black and white.”
Pretty hilarious, the subtle dig at me for thinking in “black and white” terms. But could she produce one reasonable piece on ADHD at MIA? No.
Instead, I find a piece by her mentor, Bonnie Kaplan, complaining of being not taken seriously by psychiatrists at a recent conference where they presented their findings. Of course they weren’t taken seriously. Just as we can’t take seriously Ms. Rucklidge’s research, when her biases are so transparent.
I am leaving this original post, below, just so readers can have the full story. I am sorry I didn’t realize what Ms. Rucklidge is about earlier.
It is so difficult, getting psychiatrists and even some neuroscience researchers to understand the importance of basic biochemistry. I thought Ms. Rucklidge was bridging the gap. But now I see that she holds views that are equally myopic. My apologies.
— Gina Pera
7 thoughts on “Research: Nutrients Improve ADHD Functioning”
Thank you for telling us about this research. Would be great if you could provide some more detailed info about nutrition rules for ADHD.
You’re most welcome. I’m glad you found the report useful.
As for “nutrition rules” for ADHD, there really are no rules. Everyone needs good nutrition, and that includes people who don’t have ADHD and people who do.
Sometimes people with ADHD, though, have difficulty eating a healthy diet, so they might need to make a particular effort.
Some physicians are smarter than others when it comes to nutritional deficiencies; there are some tests that can help determine how you stand. My physician ordered one for me from a testing lab called Spectracell. But I’m sure there are others.
Thanks for bringing this study to light. Unlike many studies of vitamins and micro-nutrients, this one was reasonably well-done. You have presented it in a thoughtful and well-balanced way.
There are two important caveats that I would ask you to highlight, though. First, the particular multi-vitamin, micro-nutrient mix used for this study is a bit expensive. It costs $160/month and on the company website or $100/month on Amazon.
Secondly, the company that manufactures it – Truehope – uses marketing practices that range from shady to highly unethical. Their website suggests that their vitamins will replace psychiatric medications, and they have a follow-up support system which involves unlicensed “counselors” who call vitamin users ostensibly to help them avoid “dangerous side effects”. Customers have reported medical advice given by these counselors in the form of recommendations to decrease or discontinue prescription medications.
There is a well-known case in Canada of a man with bipolar disorder whose parents – with Truehope counselor support – encouraged him to quit his medications and use their vitamins. Two weeks later, he murdered his father.
This is a caution for people who want to follow up on this story by reading the research and using the same multi-vitamin mixture that was used in the study. It does not cast any negative light on the story you are reporting which is a rather exciting bit of evidence that there are nutritional paths to better mental health yet to explore.
Oren Mason MD
Director Attention MD
Author Reaching For A New Potential
Thanks for providing those caveats. I thoroughly agree with you, which is why I didn’t mention the specific product. 🙂
I do wish that the researchers could have used a product that hadn’t been marketed so unfortunately and especially that they accepted the free product, along with the placebo manufactured by the company. But I am not a researcher and so don’t know all the thought processes behind the selection.
The study itself has this to say:
“This paper presents the first double-blind, parallel–group
RCT designed to assess the efficacy and safety of a broad-spectrum
micronutrient formula, EMPowerplus, compared with placebo in
medication-free adults with ADHD. This micronutrient formula
has been examined in over 20 published studies for treating
various mental conditions, has documented evidence of both
short- and long-term safety data (34) and has been more extensively
examined in psychiatric conditions than any other multivitamin/
multimineral formula; (35) however, as of yet, no masked trials have
been conducted on it. Efficacy measures included standardised
self-report, observer-rated and clinician-rated scales capturing
attention, hyperactivity/impulsivity, mood, quality of life and
overall psychiatric functioning.”
So, perhaps the authors felt it would be useful to substantiate or disprove some of the manufacturers’ claims.
Thanks for your comment!
P.S. Here are the two citations above (I’ve long been a fan of Bonnie Kaplan’s work and corresponded with her years ago upon discovering it):
(34) Simpson JSA, Crawford SG, Goldstein ET, Field C, Burgess E, Kaplan BJ.
Systematic review of safety and tolerability of a complex micronutrient
formula used in mental health. BMC Psychiatry 2011; 11: 62.
(35) Rucklidge JJ, Kaplan BJ. Broad spectrum micronutrient formulas for the
treatment of psychiatric symptoms: a systematic review. Expert Rev
Neurother 2013; 13: 49–73.
Thanks for ferreting out this interesting report. ADHD can prove, from a more global perspective, the tip of the iceberg – low hanging mind-fruit easily recognized as misunderstood, misdiagnosed, mistreated. Superficial ADHD labels based upon observable behavior deny mind complexity, and continue to provoke natural frustration with treatment failures and treatment imprecision.
The fact that trace elements and various supplements can help even when administered non-specifically, without precise measure, does encourage a deeper look into the value that real neuroscience evidence can bring to the entire psychiatric spectrum. Appreciation of these findings w ADHD do suggest the study of similar interventions for other psych conditions including anxiety, depression, mood disorder, and brain injury.
Thanks for your consistent reportage in these challenging times of increasing neuroscience awareness – well done!
As Galileo suggested about 1640: “Measure what is measurable, and make measurable what is not so.”
Author: New ADHD Medication Rules – Brain Science & Common Sense
Neuroscience evidence changes thinking.
Definitely, it will be best if each individual’s nutritional standing is tested instead of wholesale supplementation to entire populations. Still, the approach in this study seems better than the mono-supplementation of other studies.
Thanks for bringing this research to our attention. Yes, I agree re: nutrition and AD/HD; it is not one sole thing that makes a difference in improving functioning with AD/HD. Sometimes there are several streams feeding the river of change.
Holly Seerley, MA, MFT
Mill Valley, CA