ADHD and Nutritional Interventions: Part II

In part I of ADHD and Nutritional Interventions I examined the possible interactions, and benefits, of diet therapy for ADHD. In Part II, I will explore the potential benefits and risks associated with several herbs (St. John’s Wort, Ginkgo Biloba, Valerian and Kava, Pycogenol) and Nutritional Supplements (L-Carnitine, Melatonin, Magnesium, Iron and Zinc) often prescribed for ADHD.

  1. Herbs: Is there any benefit?a. St John’s Wort: St John’s Wort is referred to as a serotonergic/noradrenergic/dopaminergic agent, with antidepressant activity. In 2008 the Journal of the American Medical Association released a paper on the effects of St. Johns Wort on non-medicated children diagnosed with ADHD (54 Children, aged between 6 and 17 years). Children were administered either 300 mg of St. John’s Wort or Placebo. The findings of the randomised control trial, suggest no significant difference between the control and placebo groups.

    b. Gingko Biloba: In 2010, the Arak University of Medical Sciences, released a paper comparing the effectiveness of Ginkgo Biloba (promotes blood flow to the brain and inhibits platelet activation) against Methylphenidate (Concerta/Ritalin), for children diagnosed ADHD. In the foregoing study, Children with ADHD (61 children, aged between 6 and 14 years) were randomised to methylphenidate (20 mg to 30 mg) or Gingko Biloba (80 mg to 120 mg) for 6 weeks. Despite Methylphenidate yielding significantly better results, the study did show that Gingko Biloba had a mild effect on hyperactivity. In a safety comparison, methylphenidate resulted in more frequent headaches, appetite loss and insomnia compared to Gingko Biloba. It is important to note that based on Teacher’s Rating Scale for ADHD, Gingko had little to no effect.

    c. Pycnogenol: Pycnogenol is an extract of french maritime pine bark. In small randomised control trials, involving, on average, 61 children, pycnogenol was shown to improve attention and visual motor coordination and reduce hyperactivity compared to placebo. The most recent literature can be found in the Journal of European Child and Adolescent Psychiatry (2006).

    d. Valerian and Kava:The above herbs have no evidence supporting use for ADHD symptoms, but unfortunately, are still utilised despite risks (headaches, mydriasis, restlessness, potential liver and cardiac issues).

  2. Nutritional Supplements: Is there any benefita. L-Carnitine:

    In 2007 researchers from Ohio State University conducted a randomised control trial on the effects of L-Carnitine on children diagnosed with ADHD. 112 children (83 boys, 29 girls) were randomised to 500-1500 mg of L-carnitine or placebo, for 16 weeks. L-Carnitine was shown to have a beneficial effect on focus and attention in children diagnosed with inattentive ADHD. No effect was shown for children diagnosed with hyperactive-impulse ADHD.b. Melatonin: Melatonin is a natural hormone that regulates sleep. Three studies in ADHD youth, including a placebo controlled RCT, found significant improvement in sleep onset, but no improvement in ADHD symptoms. Given that the RCT’s were only 10 days to 4 weeks in duration, the possibility that cumulative sleep restoration itself might ameliorate ADHD symptoms in the long run cannot be ruled out.

    c. Zinc: inc is a co-factor for than 100 enzymes, including many in the brain. It is important in melatonin production, and helps regulate serotonin production. A recent Randomised Control Trial of 52 children, aged 6 to 14 years with ADHD (inattentive or combined type) demonstrated that a dose of zinc (glycinate) at 15 to 30 mg over 8 weeks was no more effective than placebo.

    d. Magnesium: Polish investigators have recently reported that 34 percent of a sample of ADHD children (116 children-94 boys and 20 girls) were deficient in magnesium. The children were aged between 9 and 12 years. Deficiency was determined by, hair, red blood cell and blood serum. The research, undertaken over 6 months, determined that on assessment at 6 months, children supplementing with 200 mg of magnesium daily, demonstrated improvements in both parent and teacher ratings (Conners Rating Scale) compared to untreated controls.

    e. Iron: Iron is the most common mineral deficiency among children. Iron is a necessary coenzyme to synthesize catecholamines (e.g. adrenaline, noradrenaline), which are considered deficient in ADHD. There have only been two small pilot trials of iron supplementation for ADHD symptoms in drug-free youth. For example, in a pilot placebo controlled randomised study, 23 non-anaemic children with ADHD and boarder-line deficient iron levels were given either ferrous sulphate (iron) (80 mg) or placebo for 12 weeks (RDI for iron is 8-15 mg daily). Researchers found a significant decrease in parent-reported ADHD symptoms.

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