~Stormi Niemann, author

Alright, let’s dive into the world of probiotics… it can be fairly daunting. Everything these days claims to have “added probiotics” or “stimulates gut health with probiotics” or “contains natural probiotics”. However, unlike many other nutrition fads, probiotic research is very promising and can play a role in the nutritional treatment of ADHD.
 
First, what in the world is a probiotic?
 
There are a lot of bacteria that naturally live in our body. Probiotics are the good bacteria/yeasts in the body. We also have bad bacteria that live in the body. Having more good bacteria in the body helps to eliminate bad bacteria, leading to less infections and better health. Having a higher proportion of probiotics in your microbiome can be beneficial for several reasons!
 
Now, what’s a microbiome?
 
Let’s think of your microbiome as your community. Lots of different types of microbes (people) live within your body (community). These microbes include bacteria, viruses, protozoa and fungi. Each person's microbiome is completely different.
 
What do probiotics do within my microbiome?
 
Probiotics help to maintain homeostasis (balance) within your body. Probiotics can slow or stop bad bacteria growth, help your body digest food, support the cells that prevent bad bacteria from making you sick and even help with the breakdown and absorption of medication!
 
Where can I get some probiotics?
 
While probiotic supplements are available, probiotics are also found in the food we eat!
 
Probiotics can survive in the intestine after being eaten and are safe to consume! Commonly eaten foods that contain probiotics include yogurt, sourdough bread, aged cheese, fresh sour dill pickles, kombucha and tempeh. However, be careful when choosing yogurt as not all yogurt contains probiotics- be sure to look for yogurt that “contains live and active cultures”.
 
So I understand probiotics? But I’ve also heard about prebiotics, what are those?
 
Prebiotics are basically fuel for your body's good bacteria (probiotics). Prebiotics are found in fiber, and are beneficial to the probiotic bacteria in your gut. Eating a high fiber diet that contains prebiotics can help promote probiotic growth and health. Prebiotics are found in many fruits and vegetables, and they are highest in the following: apples, bananas, berries, artichokes, barley, flaxseed, legumes, tomatoes, onions, wheat and soybeans.
 
And how can probiotics be beneficial to my child with ADHD? What does the research say?
To understand how probiotics may help with ADHD, we first need to understand how probiotics may influence brain health. The research in this area is still young, meaning that there are not a lot of large studies over a long time span. Nonetheless, researchers have found promising results to recommend the use of probiotics to promote brain development. A systematic review by Cerdo, et al. of probiotic, prebiotic and brain development research explored the impact of probiotics on the gut-brain microbiome and how it in turn affects brain development.  The key points are summarized below.

• The rapid colonization of the gut with beneficial bacteria that occurs during the first three years of life overlaps with the period of rapid development of the brain.
• Recent research has shown communication pathways between the brain and gut microbiota.
• An imbalance of the gut microbiota (such as having too much bad bacteria) can negatively affect development of the brain during childhood, leading to increased impulsivity, hyperactivity and inattention in children.
• Future research looks to be promising in determining which mechanisms of probiotics affect the brain development and the role of pre- and probiotics in ADHD.

 
While the reason and causes of ADHD are still widely unknown, many researchers seek to find factors that may play a role in the development and progression of neurological disorders. Gut dysbiosis in children and adults has been associated with ADHD. A systematic review of 208 articles published by Bull-Larsen, et al.  in 2019 indicates a potential influence of the gut microbiome on the progression of ADHD. The findings of the review are summarized below.

• In a study with mice, decreasing the numbers of bacteria in disease free mice resulted in neural (brain) cells that matured less rapidly. The conclusion was that the microbiome, gut and central nervous system may play a hand in the development of ADHD.
• Researchers also found that microbes in the gut can influence the inflammatory neural (brain) cells, which is important because neuroinflammation is often found in patients with ADHD.
• The study also found much variation when looking at environmental factors and the prevalence of ADHD, proving that the cause for ADHD is still widely disagreed upon.

 
A consistent finding in research is that the ADHD population has a different gut microbiota composition compared to the standard population. In a small study of 35 adults and children with ADHD, individuals who received a probiotic supplement reported higher health-related quality of life compared to the placebo group (Kumperscak, et al. 2020). However, more research is needed to determine the cause of this difference and if it is a contributing factor to ADHD symptoms. Most researchers agree there is a link between brain development and gut microbiome development and reiterate the need for further studies to determine the extent that the microbiome plays in ADHD and determine the benefit of probiotic use on symptoms of ADHD.
 
So should I give my child food with probiotics?
 
Research still needs developing to establish a solid foundation on the knowledge of how probiotics can affect ADHD. However, we know that good bacteria (probiotics) in the gut microbiome play a role in brain development. Aside from benefiting brain development, other benefits of probiotics include improved digestive processes, decreased risk of sickness/infection, and improved immune system health.
While research on the influence of probiotics upon ADHD symptoms is limited, use of probiotics in all populations has been proven to be safe and have health benefits. Future research is promising and in the meantime, probiotics have plenty of benefits aside from the reduction of symptoms related to ADHD. The use of probiotics in all populations, including those with ADHD, is safe and beneficial.
 
 
References
Cekici, Hande, and Nevin Sanlier. “Current Nutritional Approaches in Managing Autism Spectrum Disorder: A Review.” Nutritional Neuroscience 22, no. 3 (March 4, 2019): 145–55. https://doi.org/10.1080/1028415X.2017.1358481.

Cerdó, Tomás, Alicia Ruíz, Antonio Suárez, and Cristina Campoy. “Probiotic, Prebiotic, and Brain Development.” Nutrients 9, no. 11 (November 14, 2017): 1247.
 https://doi.org/10.3390/nu9111247.

Kumperscak, Gricar, Ulen and Micetic-Turk. | A Pilot Randomized Control Trial With the Probiotic Strain Lactobacillus Rhamnosus GG (LGG) in ADHD: Children and Adolescents Report Better Health-Related Quality of Life | Psychiatry.” (March 17, 2020): Accessed October 7, 2020. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00181/full.

Kechagia, Maria, Dimitrios Basoulis, Stavroula Konstantopoulou, Dimitra Dimitriadi, Konstantina Gyftopoulou, Nikoletta Skarmoutsou, and Eleni Maria Fakiri. “Health Benefits of Probiotics: A Review.” ISRN Nutrition 2013 (2013).  https://doi.org/10.5402/2013/481651.
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Bull-Larsen and Mohajeri. “The Potential Influence of the Bacterial Microbiome on the Development and Progression of ADHD.” (November, 17 2019): Accessed October 7, 2020.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893446/.

​Hi everyone! My name is Stormi and I am a current dietetic intern and graduate student!
 
I grew up in Las Vegas, Nevada. In 2016, I moved to Reno to pursue a college degree. I actually started college as a journalism major but quickly realized that I needed more structure and found myself OBSESSING over nutrition. As a member of Nevada Tri Delta, I was able to participate in raising over 60,000 dollars annually for St. Jude Children’s Research Hospital which really helped me recognize my interest and passion for pediatric nutrition.
 
I graduated from UNR in May 2020 (yep, right in the middle of this whole pandemic) and was matched to a MS/DI program. I’ll be completing graduate school and a dietetic internship in Boise, Idaho. Currently, I work at a yoga/pilates studio where I get to play a role in the mental and physical health of individuals! As of right now, my hope is to become a board-certified specialist in pediatric critical care nutrition, but we’ll see where my clinical rotations take me!
 
Aside from nutrition, I do have other hobbies and interests. I absolutely love travelling and I am constantly looking for an excuse to get out of the state (or country). I spent the past summer exploring the west coast and my newest goal is to visit 23 national parks before I turn 23. I have about 16 under my belt now, so wish me luck! I’m a total snow lover and you can find me skiing or boarding on the slopes anytime I get a couple hours of free time.
 
Thanks to Nevada’s mandatory stay-at-home order, I’ve realized how much I love cooking. If I’m not adventuring or working, then I’m typically cooking or crafting.
 
That’s just a little about me and I am so excited to be taking over the blog and reviewing more research on Nutrition and ADHD.

​Omega 3 fatty acids have been shown to decrease hyperactivity and improve attention in those with ADHD. Although Omega 3 fatty acids are not a replacement for medications, a lower dosage of ADHD medications may be sufficient if coupled with daily Omega 3 fatty acid intake.  Read my blog post from 9-3-17, https://wendyphillips.weebly.com/nutritionforadhd/do-omega-3-fatty-acid-supplements-really-improve-adhd, to learn more about this subject.
 
Omega 3 fatty acids are found in foods, but people with ADHD may not eat these foods very often. Fish oil supplements are popular and provide Omega 3 fatty acids, so I am often asked which supplement is the best or how to choose the right one.  To my knowledge, there are no supplements on the market that meet the minimum requirements in one pill to achieve the therapeutic benefit found in studies, so here are some tips to help you decide on which one might be best.
 
1.  There is more than one type of Omega 3 fatty acids. The goal is to get 500 mg EPA and 500 mg DHA each day.
2.  As you can see in the pictures, fish oil supplements usually list the content of fish oil itself, but you need to read further to see the actual content of the Omega 3 fatty acids.
3.  Some fish oils don’t list whether the Omega 3s are DHA, EPA, or ALA.  Don’t bother to buy those.
4.  You will likely need more than one pill to get at least 500 mg DHA and 500 mg EPA. This means you may go over 500 mg of one or the other.  That’s ok – at least 1,000 mg of each of those have been proven safe in adults and children, and probably higher levels are safe.
 
A more comprehensive review of Omega 3 fatty acids and their influence on ADHD symptoms can be found in chapter 6 of my book ‘Nutrition Management for Children with ADHD’, along with a list of foods high in Omega 3 fatty acids and a review of available supplements.  You can purchase the book on Amazon, Kindle, or here: https://www.createspace.com/7056720.

I often hear from adolescents with ADHD that they self-medicate with Mountain Dew or energy drinks like Red Bull or Jolt, even though they don’t know why.  They feel that these drinks improve their concentration and help them focus on their school work.  So is there any truth to this, or is it just an excuse to drink tasty but unhealthy beverages?
 
To examine this question, we need to first think about what causes ADHD.  Most scientists think that inadequate levels of brain chemicals, known as the neurotransmitters dopamine and serotonin, are to blame for ADHD…these chemicals don’t spend enough time between the brain cells to perform their work but instead get sucked back into the next brain cell too quickly. (For the dietitians and other healthcare professionals or scientists reading this, this means that dopamine and serotonin receptors on each neuron don’t allow those neurotransmitters to spend enough time in the pre-synaptic space.)  This altered brain metabolism leads to the hallmark signs of ADHD: inattention, hyperactivity, and impulsivity.  Although it seems counterintuitive to give a stimulant medications like methylphenidate (Ritalin) to a hyperactive person, these medications beneficially stimulate brain activity by increasing the dopamine and serotonin activity.
 
Therefore, anything that stimulates dopamine or serotonin can help improve the symptoms of ADHD, especially inattention.  Sugar is known to increase dopamine – this is our “feel good” chemical, which is why sugary foods and beverages are so appealing to us!  The problem with sugar intake is that the increase in dopamine activity is very short lived, so sugar is not an effective treatment for ADHD. It is unhealthy for many other reasons, so I don’t recommend consuming sugary foods or drinks on a regular basis.
 
Caffeine is known to increase mental alertness, so it is also not surprising that this would be linked to improvement in the ADHD symptom of inattention.  However, there have been very few studies in humans to confirm this hypothesis because most studies for ADHD are done with children – and it’s not very ethical to give children a lot of caffeine just for the purpose of studying its effects!
 
Here is a summary of two studies that have been done:
Study:  Barry, Christopher, & Sloman; 1981
Results:  6 children with ADHD treated as day hospital patients; Low dose caffeine with low dose methylphenidate had the better treatment effect compared with methylphenidate by itself or methylphenidate + high dose caffeine.

Study: Walker, Abraham, & Tercyak; 2010
Results: Adolescents with ADHD were two times more likely to drink caffeinated beverages.

 The 1981 study is (obviously) very old, and completed with a very small sample size. It did show that children should not consume excess caffeine if taking stimulant medications, but it did not study the effect of caffeine without medications.  The 2010 study confirmed what the teenagers I work with tell me: adolescents are likely to self-medicate with caffeine.  However, this does not tell us whether or not caffeine improves ADHD symptoms or reduces dependence on medications.
 
Bottom Line: Drinking sugar sweetened, high caffeine beverages is not likely to show sustained improvements in ADHD symptoms, and can lead to other health risks. It is best to work with a doctor and registered dietitian to determine a medication, behavioral, and nutrition plan that improves ADHD symptoms and promotes a healthy lifestyle.
 
References
1. Barry DG, Christopher DW, Sloman L. Responses to methylphenidate and varied doses of caffeine in children with ADHD. Canadian J Psychiatry. 1981;26:
2. Walker LR, Abraham AA, Tercyak KP. Adolescent caffeine use, ADHD, and cigarette smoking.  Children’s Health Care. 2010;39:73-90.

​As if on cue, the 1st day of Fall was yesterday and the temperature in southern Utah dropped 20 degrees!  My son and I decided to celebrate by finding the biggest apples around and making homemade cinnamon applesauce using my mom’s recipe with a significant modification.
 
This recipe is perfect for those with ADHD – it has only 2 ingredients, there is very little waiting (great for those with the need for immediate gratification), it is healthy, and snacking while cooking is encouraged! 
 
1st start with as many apples as your largest pot will hold.  It doesn’t matter what kind of apples or what size, and you can mix and match!  We used red delicious because they were the cheapest and crispiness doesn’t matter since we’re boiling them anyway.  
​
​Slice the apples – any kids who can use a knife safely can help with this step.  Have a little fun with slicing and dicing like my son did!  Sneaking apple slices into your mouth while putting the rest in the pot is perfectly acceptable.  

​Once they’re in the pot, sprinkle with cinnamon.  If you really like cinnamon, add more.  If you hate cinnamon, don’t add any.  If you have some people in the family who kind of like it, and others who love it, add a medium amount during cooking.  When the cinnamon-lovers dish theirs, they can sprinkle more cinnamon on top then.
 
Fill the pot with water just enough to barely cover the apples, then cover the pot.  Bring the water to boiling (be careful the cinnamon water doesn’t boil over!).  When the apples are soft and easy to cut through, turn the stove off and let it sit for 20 minutes if you have that much patience.  This will allow the cinnamon to soak even more into the apples.  Strain the water when you’re ready to process the apples.