Is There A Role for Supplements in Managing ADHD?
Attention Deficit Hyperactivity Disorder. Officially classified as a brain disorder,1this condition can be a blessing for some and a curse for others.
The U.S. National Institute of Mental Health (NIMH) explains that the condition is characterized by a pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Usually just called “ADHD” (because who has the attention span to say all of those other words?), its primary defining behaviors include:
Inattention: A person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized.1
Hyperactivity: A person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks.1
Impulsivity: A person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification.1
ADHD can be a curse for children who don’t fit into the mold in settings like traditional educational institutions.
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Interestingly, ADHD has proven to be a blessing for Olympic champions like snowboarder Shaun White, downhill skier Bode Miller, and superstar swimmer Michael Phelps. Writing about the exploits of these Team USA Olympians, Garret LoPorto asks, “Why does it seem like the unique qualities of Olympic superstars are also the very symptoms of ADHD? Hyperactivity, thrill-seeking, recklessness, hyper-focus, rebelliousness and impulsiveness, all primary ‘symptoms’ of ADHD, are proving to provide the winning edge that gives an athlete supernormal abilities in competition.”2
While White, Miller, and Phelps were lucky enough to grow up in settings where their families helped channel their gifts in unconventional ways, many children and adults with ADHD are simply trying to survive as they navigate the constraints within our traditional, buttoned-up society.
According to NIMH, ADHD treatments include medication, psychotherapy, education or training, or a combination of treatments. Many people—frustrated by continuing struggles to stay organized and just fit in—search for additional solutions, including nutritional supplements.
Researchers have looked into the potential role of several supplements in helping to manage symptoms of ADHD. Based on the knowledge that patients with ADHD have been found to have reduced levels of vitamin D, zinc, ferritin, and magnesium, a team from the University of Arizona and Mercy Children’s Hospital in St. Louis reviewed the published literatureon nutritional deficiencies of these vitamin and mineral levels and their association with ADHD. Their larger goal was to be able to guide clinicians on possible appropriate laboratory screening measures for children presenting with symptoms consistent with ADHD.3
What did they conclude? Here are the summaries for each of the vitamins and minerals studied:
ZINC:“Zinc plays an important role in neurologic functioning. ADHD has been associated with lower levels of hair, plasma, serum, and urinary zinc. Although the efficacy of supplementation with zinc is not definitively clear, there is evidence to support that many children even in developed countries have sub-optimal levels of zinc intake… Checking plasma/serum levels of zinc (suggestive of short term zinc status) and/or hair zinc (suggestive of long term zinc status) may be appropriate for individuals not responding to conventional treatments for ADHD and populations at higher risk of zinc deficiency (e.g., vegetarians). It has been recommended that zinc in RDA/RDI dosages as part of a balanced vitamin/mineral supplement is a safe and cost effective intervention.”3
For guidance on recommended zinc intakes and potential food sources, click here.4
MAGNESIUM:“There is preliminary evidence to suggest that a subgroup of patients presenting with hyperactivity, impulsivity, and inattention may be deficient in magnesium. It is unclear if this is true for only certain regions of the world. Some individuals may be at higher risk for magnesium deficiency (e.g. those with appetite suppression or proton pump inhibitors). In individuals presenting with symptoms of ADHD, where there is clinical suspicion for magnesium deficiency, clinicians may consider measuring RBC-mag levels.”3
For guidance on recommended magnesium intakes and potential food sources, click here.5
VITAMIN D:“There are no current studies in children using vitamin D as a treatment for ADHD, but two studies show lower levels of vitamin D in individuals with ADHD. There are vitamin D receptors in key areas of the brain implicated in ADHD, and increasing research showing the importance of this vitamin in brain development. Clinicians may consider measuring 25-OH vitamin D levels in some individuals with symptoms of ADHD, especially in those with other risk factors.”3
For guidance on recommended vitamin D intakes and potential food sources, click here.6
IRON:“Although some studies have shown lower levels of ferritin in children with ADHD, other studies have not found this correlation; therefore, current results are mixed… [However,] studies have estimated the prevalence of Restless Leg Symptoms (RLS)/RLS symptoms in patients with ADHD to be up to 44%…In children with RLS and low ferritin (less than 40 ng/mL), iron supplementation was found to be effective for improving symptoms of ADHD in a small open-label study. Given the high comorbidity, children with symptoms of ADHD should be screened for RLS, and in those with RLS, measuring serum ferritin should be considered.”3
For guidance on recommended iron intakes and potential food sources, click here.7
So, as might be expected, the team did not find evidence to support supplementation of just one vitamin or mineral as a sole treatment for ADHD. However, they did state that“supplementation may improve medication response and overall well-being, especially in those with deficiencies. Although it is not definitively clear the percentage of children presenting with symptoms of ADHD who have nutrient deficiencies, the existing literature suggests that a subgroup of children with ADHD are at risk for nutrient deficiencies which may play a role in symptomology. In children presenting symptoms of ADHD, clinicians are encouraged to review the dietary history, consider risk factors for zinc, iron, magnesium, and vitamin D deficiency and order tests measuring RBC-magnesium, 25-OH vitamin D, ferritin, and serum zinc when appropriate.”3
The bottom line is to talk with your health care provider about screening for potential nutrient deficiencies and whether it makes sense to add supplements to the picture. NIMH also recommends the following tips for helping children and adults to stay organized in a world that may not appreciate their unique gifts.
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:1
- Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
- Organizing everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
- Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
- Keeping clear and consistent. Children with ADHD need consistent rules they can understand and follow.
- Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:1
- Keeping routines
- Making lists for different tasks and activities
- Using a calendar for scheduling events
- Using reminder notes
- Assigning a special place for keys, bills, and paperwork
- Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.
Editor’s Note: The original article was published on September 10, 2018 and was updated on September 20, 2018 to reflect a more comprehensive review of the role supplements can play in managing ADHD and the science that supports that.
- National Institute of Mental Health. Mental Health Information, Health Topics: Attention Deficit Hyperactivity Disorder. Last Revised March 2016. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml2
- LoPorto G. Secret to U.S. Olympic Gold = ADHD? HuffingtonPost. Updated November 17, 2011. https://www.huffingtonpost.com/garret-loporto/secret-to-us-olympic-gold_b_471670.html
- Villagomez A, Ramtekkar U. Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder. Children. 2014;1(3):261-279. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928738/
- National Institutes of Health. Office of Dietary Supplements. Zinc Fact Sheet for Health Professionals. Updated March 2, 2018. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
- National Institutes of Health. Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. Updated March 2, 2018. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
- National Institutes of Health. Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. Updated March 2, 2018. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
- National Institutes of Health. Office of Dietary Supplements. Iron Fact Sheet for Health Professionals. Updated March 2, 2018. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
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