Nutrition & Attention
When it comes to attention, not all foods are created equal. Although carbohydrates like cereals, chips, cookies, “granola” bars, gummies, candy, juices, and sodas can provide us with a boost of energy, the brain needs something different to help us pay attention and stay focused during the day.
Protein
Our brains need protein to make neurotransmitters, the chemicals that brain cells use to talk with each other. When you eat a food containing protein (like dairy products, eggs, nuts, meat, poultry, fish and beans) our body can make neurotransmitters like dopamine, noradrenalin, adrenalin, serotonin and GABA that help us concentrate, control our moods, and maintain a “calm, focused state”. Our body will tend to make “brain awakening” neurotransmitters from the foods that we eat in the morning and afternoon and then increase production of neurotransmitters that promote sleep in the early evening.
How do I know how much protein I’m getting?
Here’s a simple guide for how much protein your body gets from food. I call it the “Rule of Seven’s”. Your body gets approximately 7 grams of protein from…1 egg (the protein is in the whites), 1 oz. of cheese, 1 oz. of meat, chicken, turkey or fish, 7 oz. of milk, 15 nuts, or two tablespoons of peanut butter. A Greek-style yogurt typically has nearly twice that amount (12-14 grams).
What if I’m a Vegan or don’t eat much meat?
For my patients who prefer non-meat protein sources or are sensitive to dairy products, here’s my list of favorites:
Silk Protein Nut Milk
This product is so tasty, but is made from a combination of almonds, cashews and peas! Contains half of the sugar as a glass of dairy milk, but has more protein (10 grams per 8 ounces). Combine that with your favorite granola or breakfast “bar” and a little fruit and you’ve got a very quick, healthy and protein rich morning meal.
Beyond Meat
We’ve sampled a lot of “veggie” meat-replacement options and really like Beyond Meat Burger and Chicken Strip Substitutes. The
Beyond Meat Burger is soy free, gluten free, and obviously “meat” free. But the pea protein isolate that is the base for this is so good and provides 20 grams of protein in a 3 oz. burger. The chicken strip substitute comes in strips and we use them in stir fry’s, tacos, Fajita’s, salads, etc. The chicken strip version does have soy (in addition to the pea protein). However, 3 ounces of the chicken strips also have 20 grams of protein.
Beans/Pastas
Maybe you’re a lot smarter than us, but it took us a little while to realize that beans like lentils and chickpeas make a really good tasting pasta, without that gluten bloat. Two dry ounces of a green lentil pasta provides 13 grams of protein! Chickpea pasta provides even more (15-17 grams). Comes in pretty much every shape and size that you know and love.
What can I do if my child refuses to eat practically everything?
Protein Bars/Powder
Some of our patients are so picky that they’ll eat virtually nothing. This isn’t a good idea when it comes to attention. So as we gradually begin to “desensitize” them to other food textures, we’ll use protein bars or powders. Our favorite bars are the Special K Protein Bars and cereals, Belvita biscuits, and the Atkins Bars. If your child simply can’t tolerate any of these ideas, we’ve used a whey based protein powder, mixed in ice cream or puddings to start the day. A capful of a whey-powder contains approximately 20 grams of protein (as well as other vitamins and minerals) and makes a good soft serve when mixed with ice cream.
How about using a multivitamin or other kind of supplement?
Vitamin and Mineral Deficiencies
It is true that certain vitamin and mineral deficiencies can reduce your ability to sustain attention and can contribute to mood problems. Some of these deficiencies can be taken care of through food intake, others cannot.
The first step in deciding whether or not to use a vitamin or mineral supplement is getting tested to see if you have a deficiency in the first place. We’ve seen many, many patients at our clinic who take dozens of supplements on a daily basis, without any idea if they actually need them or are benefitting from them. At our clinic, we evaluate the many causes of our patient’s attention problems, including vitamin and mineral deficiencies.
| Group | Age (yrs.) | Protein (g) | Magnesium (mg) | Iron (mg) | Zinc (mg) |
|---|---|---|---|---|---|
| Children | 4-6 | 24/day | 120/day | 10/day | 10/day |
| Children | 7-10 | 28/day | 170/day | 10/day | 10/day |
| Males | 11-14 | 45/day | 2700/day | 12/day | 15/day |
| Males | 15-18 | 59/day | 400/day | 12/day | 15/day |
| Males | 19+ | 58/day | 350/day | 10/day | 15/day |
| Females | 11-14 | 46/day | 280/day | 15/day | 12/day |
| Females | 15-18 | 44/day | 300/day | 15/day | 12/day |
| Females | 19+ | 46/day | 280/day | 15/day | 12/day |
Vitamin D Deficiency
A far more common cause of our patient’s attention problems is Vitamin D deficiency. Vitamin D is a substance that binds with calcium and brings it to brain cells. It is the entry of calcium into the brain cell that triggers the release of neurotransmitters. Patients with Vitamin D deficiencies will have significant attention and mood problems and about 33% of our patients have Vitamin D deficiencies or insufficiencies. Unfortunately, Vitamin D is not found in high concentrations in the foods that we eat.
My child eats yogurt and drinks milk with Vitamin D. Isn’t that enough?
While many dairy products will be Vitamin D enriched, the amount found in most foods “pales in comparison” with the amount that is produced by 30 minutes of skin exposure to sunlight (about 10,000 iu’s). Although Vitamin D deficiency is more of an issue in regions where children and adults spend little time in the sun during the academic year (or are clothed from head to toe when they are outside), it is still wise to make sure that Vitamin D deficiency is not part of your attention and mood problem.
How much Vitamin D is needed?
If a supplemental Vitamin D is needed, you’ll need to be mindful that absorption of the Vitamin increases by about 50% if you take the Vitamin with a meal containing dietary fat. Dose of supplement will vary depending on the blood levels of Vitamin D. Insufficiencies (i.e. blood levels of 20-30 ng/nL) will typically respond to 2000 to 3000 iu’s of Vitamin D when you take them with a meal containing fat.
For deficiencies of Vitamin D (<20 ng/mL) dosages of at least 5,000 iu’s are commonly needed. It is important for you to realize that if you test positive for a Vitamin D deficiency, this will be a lifelong problem (unless you move to a sunnier region). Consequently, if you or your child has a Vitamin D deficiency this fall or winter, you’ll need to supplement every year. We typically recommend that supplementation continue from mid-October until May. We also advise that your physician re-evaluate Vitamin D levels in late January to make sure your dose is right for you.
Omega-3 Essential Fatty Acids
Believe it or not, people actually do need to eat fat. Well not just any kind of fat, but Omega-3 Essential Fatty Acids. There are three types of Omega-3’s: alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Our bodies seem to be able to use DHA and EPA more easily than ALA, so DHA and EPA are typically recommended. The primary role of DHA and EPA is to help develop and maintain the myelin sheath that covers brain cells and makes rapid communication between brain cells possible.
At our clinic, we examine the dietary habits of our patients to make sure that they are eating enough Omega-3’s. At minimum you should be eating at least 500-1000 mg of DHA and EPA per day. Here’s a chart that can give you an idea of how much Omega-3’s are found in foods like wild caught fish, nuts, seeds, egg yolks and grass fed beef.
| Food Type | Omega 3's |
|---|---|
| Alaskan Salmon (wild) | 1,716 mg in 3 ounces |
| Sardines | 1,363 mg in 3.75 ounces |
| Atlantic Mackerel | 6,982 mg in 8 ounces |
| Walnuts | 2,664 mg in 2 ounces |
| Flaxseeds (ground) | 1,597 mg in 1 tablespoon |
| Albacore Tuna | 1,414 mg in 3 ounces |
| White Fish | 1,363 mg in 3 ounces |
| Egg yolks | 240 mg in 4 ounces |
| Grass fed beef | 80 mg in 3.5 ounces |
Omega-3 Deficiencies and Attention Disorders
Even though it makes sense to consume Omega-3’s, there is a tendency for clinicians to minimize the importance of this type of food in patients with attention problems. Over the past decade there has been increased interest in studying the connection between Omega-3 deficiencies and attention and mood problems. One company investigated this problem extensively (Vaya Pharma) and demonstrated that use of an Omega-3 supplement (Vayarin) significantly reduced symptoms of inattention, impulsivity, restlessness and improved mood in studies of children, adolescents and adults. The degree of improvement noted in a double blind, placebo controlled clinical trial was sufficient for the FDA to indicate Vayarin for use in the treatment of ADHD. For children, teens and adults who do not eat sufficient Omega-3’s, use of Vayarin would be worth considering.
Food Allergies and ADHD
There has been a lot of conflicting reports about the importance of screening children for common food allergies before diagnosing them with ADHD. From our perspective, it is true that a relatively small percentage of our patients (about 3-5%) will have symptoms of inattention, impulsivity or hyperactivity that are caused by food allergies. That translates to about 1 in 25 children. While such a small number may not be a “significant” number statistically, at the FPI Attention Disorders Clinic, we want to make sure that we are treating the specific medical causes of our patient’s problems, and not simply beginning with medication for ADHD and seeing how that works first. At our clinic, we conduct blood screening for the following food allergies: corn, wheat, gluten, dairy, eggs, cocoa, nuts, and food dyes. When we discover a significant food allergy, we work with children and their parents to come up with a way to still enjoy eating, even though a child’s favorite food may be eliminated from their diet.