Broad-Spectrum Micronutrient Treatment for Attention-Deficit/Hyperactivity Disorder: Rationale and Evidence to Date

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a chronic psychiatric illness, which often co-occurs with other common psychiatric problems. Although empirical evidence supports the short-term efficacy of pharmacological and behavioural treatments, families often search for alternative treatment methods because of concerns about side effects and safety, cost and access, as well as fears about long-term exposure to psychotropic medications. This review presents the published evidence on use of broad-spectrum micronutrients to treat ADHD symptoms. This approach makes physiological sense in that nutrients are required for many critical biochemical reactions to occur, ranging from manufacturing neurotransmitters, to providing the mitochondria with essential nutrients for energy production, to assisting the gut to heal from inflammation. Multi-nutrient treatment approaches are an intriguing yet under-researched area; all but one of the trials conducted in the last decade have shown benefit for the treatment of ADHD symptoms, and the one negative trial likely used doses too low to effect change. However, the methodologies have varied widely from case-controlled studies to open-label trials to one randomized controlled trial. Sample sizes have typically been modest, although the effect sizes have tended to be medium to large. What is required now is replication, as well as investigation into the optimal ingredient range and optimal doses of nutrients. We discuss the proven and potential benefits of the broad-spectrum nutrient approach, considering the heterogeneous nature of ADHD.

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

“…It is recognized that people with mental disorders commonly take nutritional supplements in combinations. In some instances, research has supported this approach, most commonly in the form of multivitamin/mineral combinations. However, recent research in the area of depression has revealed that “more is not necessarily better” when it comes to complex formulations.…”

The Mediterranean Diet and ADHD in Children and Adolescents

“…This kind of approach makes physiologic sense, considering that nutrients are required for many critical biochemical reactions and because it is unlikely that 1 nutrient by itself would resolve all vulnerabilities present in a complex disorder such as ADHD. 38 We cannot overlook that the relationship found between diet and ADHD could represent reverse causation. 6 Individuals with ADHD are often characterized by impulsivity traits and emotional distress 39 that may lead to poor dietary choices (ie, fat-rich or sugar-rich snack foods) to balance their emotions as a form of selfmedication.…”

Pre-conceptual and prenatal supplementary folic acid and multivitamin intake, behavioral problems, and hyperkinetic disorders: A study based on the Danish National Birth Cohort (DNBC)

“…Recently, higher levels of maternal plasma concentrations of 25-hydroxyvitamin D3 in pregnancy have been shown to be associated with lower risk of ADHD symptoms in childhood (37). Though it has also been suggested that inconsistent results from a single micronutrient could be due to an imbalance in other nutrients, and that a combination or broader spectrum of micronutrients is required for optimal brain function and development (26). To the best of our knowledge this is the first study to assess the association between early maternal multivitamin intake and report an inverse association with HKD diagnosis and prescription use of ADHD medication.…”

“…Previous reports on folic acid supplementation starting a month before until two-months after conception suggested potential benefits in terms of behavioral outcomes associated with ADHD (23–25). Furthermore, there is growing theoretical and empirical evidence suggesting effective treatment of ADHD with broad spectrum micronutrients (26). Given the recent interest in research on early folic acid supplementation and neurodevelopmental deficits, we aim to assess whether dietary folic acid and multivitamin supplementation during a 12-week period, beginning 4-weeks prior from to the last menstrual period (LMP) through to 8-weeks after the LMP affects the diagnosis of HKD in the off-spring in the Danish National Birth Cohort (DNBC), treatment with ADHD medication, and/or parental reports of a child’s ADHD-like behaviors as documented in the Strength and Difficulties Questionnaire (SDQ) at age 7.…”