The Diet Factor in Attention-Deficit/Hyperactivity Disorder - State-of-the-Art Review Article in Pediatrics

Diets that were tried in attempt to reduce symptoms associated with attention-deficit/hyperactivity disorder (ADHD) include:

- sugar-restricted
- additive/preservative-free
- oligoantigenic/elimination
- fatty acid supplements

Omega−3 supplement is the latest dietary treatment with positive reports of efficacy. Interest in the additive-free diet of the 1970s is occasionally revived.

Provocative reports have drawn attention to the ADHD-associated “Western-style” diet, high in fat and refined sugars, and the ADHD-free “healthy” diet, containing fiber, folate, and omega-3 fatty acids.

Indications for dietary therapy include:

- medication failure
- parental or patient preference
- iron deficiency
- change from an ADHD-linked Western diet to an ADHD-free healthy diet, when appropriate

In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients.

Iron and zinc are supplemented in patients with known deficiencies; they may also enhance the effectiveness of stimulant therapy.

In patients failing to respond or with parents opposed to medication, omega-3 supplements may warrant a trial.

References:

The Diet Factor in Attention-Deficit/Hyperactivity Disorder. J. Gordon Millichap, MD and Michelle M. Yee, CPNP. PEDIATRICS Vol. 129 No. 2 February 1, 2012, pp. 330 -337, (doi: 10.1542/peds.2011-2199)

Image source: Olive oil, Wikipedia

How to avoid hidden sodium - a Johns Hopkins dietitian walks through the aisles of a grocery store with you (video)

Join Johns Hopkins registered dietitian, Arielle Rosenberg, as she walks through the aisles and offers suggestions on how to lower salt intake -- but not compromise flavor.

Cutting U.S. salt intake by just half a teaspoon (3 grams) a day would prevent up to 92,000 deaths, 99,000 heart attacks, and 66,000 strokes -- a benefit as big as smoking cessation. A 3-gm per day reduction in salt (1,200 mg of sodium) will result in 6% fewer new cases of heart disease and 3% fewer deaths.

The average U.S. man gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.

77% of the salt in the American diet comes from processed food. Only 6% is shaken out at the table, and only 5% is sprinkled during cooking.

Once people cut back on salt -- whether or not they know they are doing it -- they begin to prefer less salt in their food. This happens in a matter of weeks.

References:

"Cutting Salt as Good as Quitting Smoking"

Chocolate consumption is inversely associated with coronary heart disease

Cocoa and dark chocolate are rich in flavonoids and may lower blood pressure.

5,000 people aged 25-93 years participated in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study.

Compared to subjects who did not report any chocolate intake, odds ratios for coronary heart disease (CHD) were:

- 1.0 for subjects consuming chocolate 1-3 times/month
- 0.74 for subjects consuming chocolate 1-4 times/week
- 0.43 for subjects consuming chocolate 5+ times/week

Consumption of non-chocolate candy was associated with a 49% higher prevalence of CHD comparing 5+/week vs. none per week [OR = 1.49].

Consumption of chocolate is inversely related with prevalent CHD in a general United States population.

References:

Chocolate consumption is inversely associated with prevalent coronary heart disease: the National Heart, Lung, and Blood Institute Family Heart Study. Djoussé L, Hopkins PN, North KE, Pankow JS, Arnett DK, Ellison RC. Clin Nutr. 2011 Apr;30(2):182-7. Epub 2010 Sep 19.
Image source: Wikipedia, public domain.

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

New U.S. Diet Guidelines: No more than 1.5 gm of sodium/day, get off your "SoFAS" - Solid Fats and Added Sugars

This is a summary of the Cleveland Clinic commentary on the new U.S. Diet Guidelines via their Twitter account, provided by the dietitian Kristin Kirkpatrick:

Decrease in salt consumption

The main recommendation is a decrease in salt consumption. New recommendation is below 1,500 mg/day for at-risk populations. At-risk populations include African-Americans, people with high blood pressure or kidney disease, and people over 51. Americans not at risk can consumer up to 2,300 mg of salt per day (for now, until the next update of the guidelines - commentary of the blog author). Kristin Kirkpatrick: I think the 1,500 mg/day recommendation should apply to the entire population for many reasons. There is strong scientific evidence that limiting salt can help prevent heart attacks and stroke. The problem with the current recommendations is that nearly everyone will enter the at-risk population at some point in their lives. In order to decrease your risk for a number of chronic diseases, it is advisable to consume as little salt as possible.

How to cut salt?

77% of sodium consumption in the US is obtained through processed foods.

Limit any food that can sit on your shelf for two years and still taste great when prepared. Try to only consume foods that will eventually rot if not eaten in 10 days or so.

Learn how to cook! Take a cooking class or experiment at home. Use spices, herbs for flavor instead of salt.

Investigate your eating-out choices beforehand. A typical restaurant meal averages 3,500 mg/salt.

Don't purchase canned soup - make your own! Most canned soup is very high in sodium.

Sea salt has more minerals and is less processed, but it contains the same level of sodium (or more) as iodized salt.

Get off your "SoFAS" - decrease Solid Fats and Added Sugars

Another recommendation is to replace solid fats with fats that are liquid at room temperature.

Read your labels and keep any foods with partially hydrogenated oils out of your shopping cart. Partially hydrogenated oils are linked to increased "bad" LDL cholesterol and decreased good "HDL" cholesterol

Focus more on consuming plant-based foods than animal-based foods to decrease saturated fat intake.

Don't forget that any kind of fat - good or bad - has, on average, 100 calories per teaspoon.

Good fats include avocado, seeds and nuts, olive and canola oil. Keep good fats to 20-25% of total caloric intake per day.

Vary protein sources in the diet - add seafood

Another recommendation is to vary protein sources in the diet.

It is recommended people consume 8-12 oz. of seafood per week. That's about 2 servings. Aim for seafood choices that provide omega-3 fatty acids like wild salmon, sardines, halibut, and trout. Pregnant women want to avoid higher mercury fishes like shark, swordfish, and king mackerel.

Eat a variety of fruits and vegetables

Another recommendation is to eat a variety of fruits and vegetables. Make sure to include dark green, red and orange vegetables in your diet. Kale, peppers and beets are good examples.

Food fact: The darker the color of the vegetable, the higher the antioxidant content.

Aim to consume five handfuls of fruit per day. When possible, keep the skins on for extra fiber.

Consume half of grains as whole grains

Another recommendation encourages Americans to consume half of their grains as whole grains. It is better to consume all of your grains as whole grains, however. Consume breads that contain 100% whole grain or whole wheat. Read the labels! Switch white rice to brown rice.

Check your pasta! The only ingredient should be 100% whole wheat. If "whole" or 100% isn't in front of "wheat", put it back. Pasta doesn't need to be wheat-based. You could also consume brown rice pasta. Brown rice pasta is gluten-free.

Practice healthy eating EVERY day

Most importantly, practice healthy eating patterns every day.

Eat together as a family, and turn off the TV and smartphone during meals. Distracted eating causes you to eat 40% more. Stay within your individual caloric needs. With all these recommendations, portion control is still key.

References:

Dietary Guidelines for Americans. USDA.

New U.S. Diet Guidelines tell you what NOT to eat - Get off your "SoFAS" - Avoid Solid Fats and Added Sugars. WebMD.
Primary takeaway from the new U.S. diet guidelines: Enjoy your food, but eat less. NYTimes.
How We Eat: Analyzing Half a Million Meals - 5 INFOGRAPHICS

Image source: Cleveland Clinic logo.