Nutritional Therapies for ADHD & Autism
Key Nutrients for Brain HealthWelcome to our dedicated section for those seeking information regarding key nutrients to support ADHD and Autism type symptoms.
By Bernie Mertens
Registered Associate Nutritionist: Nutrition and Behaviour MSc
Introduction to Nutritional Therapy
The level and quality of our nutrition can affect us in many different ways and food plays a complex and integral role in daily activities and in our lives as whole. It starts with what we decide to eat. In a ‘throwaway’ culture, although an increasingly wide variety of food is accessible, nutritional quality can often be compromised in favour of competitive taste profiles, ease of preparation and reduced costs, often reinforced by relentless advertising in the media. Psychological factors that surround food choice are becoming increasingly influential, with confusing labelling and targeting advertising making more and more of the population unaware of exactly what they are putting into their bodies to fuel them.
According to the World Health Organisation, there is a general trend towards deficits in the consumption of the recommended daily allowances (RADs) of essential nutrients[1], as well as an increase in the use of additives or preservatives that promote a longer shelf life but reduce the nutritional quality of food. As a result, the diagnosis of long-term health conditions is increasing, and with it, over-prescribing of pharmaceutical medications to compensate for poor dietary choices, treating the resulting clinical effects but not the underlying causes. As the NHS begins to see irreversible strain, more and more people are turning to ‘nutritional therapy’, in a hope to understand ways in which they can live healthier lives and reduce their clinical symptoms, to achieve optimal functionality and promote longevity, to create and maintain a better quality of life[2].
How Diet Affects Behaviour and Cognition
Optimal neurotransmission is supported by an array of vitamins and minerals that are found in ‘whole’ foods that help to create a well-nourished diet, supporting positive mental wellbeing and neurological regulation. Diet and nutrition have direct impacts on homeostasis and response systems that maintain and control basic bodily functions, and the increased behavioural and emotional dysregulation that we are now seeing within the general population as a whole, may be influenced by dietary factors[3][4][5].
The growing incidence of neurological disease and escalation of mental health conditions in recent years, has inspired a surge in research surrounding nutritional influences on brain health[6]. The importance of the ‘gut-brain axis’ (the relationship between the brain and the gut) and it’s influence on both physical and emotional wellbeing, is not yet fully understood[7]. However, what we do know is that neurological development, plasticity and transmission are all impacted by the availability of essential nutrients, which are absorbed through the gut and have multiple effects throughout our lifetime on our overall physical and psychological functionality[8].
How Nutrition Impacts Autism and ADHD
Overview
Neurodevelopmental disorders include Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Behavioural features of ASD include restrictive or repetitive patterns, and features of ADHD include impaired levels of attention and/or hyperactivity, both of which pose complications toward daily functioning[9]
Optimal functionality, particularly cognitive performance, is unique to each individual. It is based on a cocktail of genetics, environmental factors and metabolism, that are heavily influenced by age, gender and health status, as well as lifestyle factors such as physical activity, diet and habitual behaviours. These different factors not only influence but are also affected by the availability of different nutrients within the body. As a consequence, different individuals are likely to require different amounts of specific nutrients to not only achieve optimal performance, but also to meet their environmental demands, and decrease any symptomatic impacts of a distorted or imbalanced internal equilibrium. For those with Autism or ADHD, their neurological network could predispose them to interference with cognitive functioning, as well as behaviours that could reduce their nutritional uptake, which may affect basic operational and homeostatic interactions[10][11]. Research suggests that appropriate nutritional consumption, aided by supplementation is likely to improve uptake of nutrients needed to reduce deficits, regulate symptoms, and improve overall wellbeing and quality of life[12].
Common Nutritional Deficiencies and Dietary Issues
It has been noted that those with Autism and ADHD are more likely to have nutritional deficiencies than neurotypical individuals, as a result of unhealthy eating habits[13]. This is because these individuals are more susceptible to irregular eating behaviours as a result of neurological dysregulation that predisposes them to avoidant/restrictive or emotional/binge eating behaviours. Often associated with texture, smell or taste, these behaviours make them less inclined to consume a wide variety of ‘whole’ foods and more inclined to consume processed foods, that are also damaging to health.[14]
Without a balanced diet, and uptake of certain dietary components, there is risk of pathophysiological dysregulation that could trigger behavioural and emotional disturbances and increased symptomatic stress.[15][16] There has been links made to poor nutritional intake and worsening of attention-deficit, hyperactivity, low mood, anxiety, stress and aggression in both children and adults.[17][18][19]
Foods to Avoid or to Incorporate for Optimal Brain Health
Research has highlighted associations with poor diet and worsening behavioural symptoms/emotional regulation in individuals with ADHD and ASD. [20][21]. Not only can restrictive or picky eating determine a reduction of essential nutrients, ultra-processed food can cause malabsorption,[22] resulting in damage to physical and emotional wellbeing that lingers long after consumption.
Some research has shown positive effects of restricting diets for individuals with neurological disorders. Research indicates that avoiding foods high in saturated fats, sugar and salt is beneficial for general health and wellbeing.[23][24] Ultra-processed foods such as sweets, chocolates, snacks and confectionary, baked goods, fast food and takeaways all contain large amounts of these components and should swapped for whole-foods such as fruit and vegetables, as well as oily fish and water over sugary drinks.[25][26] Those who consume large amounts of this type of food have a higher occurrence of both physical and mental health conditions long-term and increased mortality rates in general; and can also be a catalyst for hyperactive or inattentive behaviours, that are often paired in children that have spectrum disorders, and can be detrimental to basic emotional and social functionality.[27] [28] Restricting the consumption has seen positive effects in symptoms related to ASD/ADHD, and also biochemical changes to gut profiles that could benefit physical health and impact the ‘gut-brain axis’.[29][30].
Key Nutrients for Brain Health
Primary role in the body:
Omega-3s are a family of poly unsaturated fatty acids (PUFAs) that are essential for brain and physiological health. They are used by the body to produce eicosanoids which play an important role in immune, pulmonary, cardiovascular, and endocrine health. Studies have drawn attention to the benefits of an appropriate diet, related to prevention of cardiovascular disease, cancer, insulin resistance, mental health conditions, inflammation and child development[31][32].
Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) are PUFAs associated with brain function and processing[33].They are important for functioning of the heart, blood vessels, lungs, immune and hormone systems. Unfortunately, the human body is unable to synthesise these molecules from scratch and relies on the dietary consumption of Alpha-linolenic acid (ALA), which is a dietary fat essential for their production. DHA is also critical for the development of the eyes and brain[34] especially during foetal development and the early stages of infancy when the brain is undergoing swift development[35]. Partly due to these effects they significantly affect cognition and emotional regulation throughout the individuals lifespan, as well as helping to prevent age-related cognitive decline[36].
Unfortunately, the human body is unable to synthesise EPA and DHA from scratch and relies on the dietary consumption of Alpha-linolenic acid (ALA), which is a dietary fat essential for their production. However, this requires a relatively large amounts of ALA sourced from ALA-rich foods and this process can be inefficient for some people. Therefore, for those who do not like, or eat, fish, Omega-3 supplements containing both EPA and DHA are usually recommended.
Omega 3 – Impact on Mental Wellbeing and Behaviour
Omega-3s are essential for brain function and the biochemical mechanisms responsible for regulation and maintenance of our nervous system. These systems help to control and stimulate sleep, emotional processing and responses, that can all have major impacts our physical and mental health.
Omega 3 – Signs of Deficiencies
The biological conversion of DHA and EPA is a slow and limited process, which requires a large dietary uptake of suggested foods (see below) and therefore deficiencies can occur. Health conditions or lifestyle factors that restrict nutrient uptake, including restrictive diets, can affect the uptake of Omega-3. Vegan/vegetarian diets may be influenced by the greater abundance of shorter-chain fatty acids in plant sources, impacting the efficiency of absorption of Omega-3. Some studies have shown a decline of absorption in older people and post-menopausal women, making these groups of people at higher risk of deficiencies[37].
Omega- 3 deficiency can present in multiple ways, causing increased skin dryness, reduced skin and hair integrity[38][39], increased risk of inflammation and dry or irritable eyes.[40] What we know about the neuroprotective effects of omega-3, suggests that symptoms could present as low mood, impaired memory[41] and a higher risk of mental health concerns, especially for those with existing neurological conditions.
Omega 3 – Dietary Sources
Although there are vegetables that contain omega 3, fish (especially oily fish) is often promoted as a reliable and abundant source of omega-3, specifically of EPA and DHA. Animal sources of omega-3 are often favoured over plant sources due to the latter’s less efficiently metabolizable short-chains (Hall-2017)[42].
Nuts and seeds, and their oils, contain ALA (good sources include: walnuts, flaxseeds and rapeseed), and other veg sources include seaweed and some fortified foods. Animal sources such as mackerel, salmon, sardines, trout and kippers are high omega 3 sources. However, white fish (cod, haddock, plaice, pollack, coley, dover sole, dab, flounder, red mullet and gurnard) and shellfish also contain some, but at lower levels.
Omega 3 – Supplementation and RDAs
There is no official RDA for Omega-3 but most healthcare professionals recommend a minimum of 250–500 mg combined EPA and DHA each day for healthy adults.
Alpha-linolenic acid RDAs are:
- Adult men: 1.6g
- Adult Women: 1.1g[43]
The most common source of Omega-3 supplementation is fish oil. Some supplements contain only algae so are suitable for vegetarians and vegans, but typically animal sourced omega-3 is more sufficient than vegetable sources[44].
Always check labels for DHA and EPA content and choose an age-appropriate supplement (children will need less than adults), but a good reference is a supplement that provides the same daily amount provided by eating one to two portions of fish per week (about 450mg EPA and DHA per daily adult dose). Generally, studies have found that the most effective supplementation is 1,000–1,500 mg of combined EPA and DHA.[45]
Primary role in the body:
Zinc is necessary for the functioning and regulation of the enzymes that aid metabolism, digestion, nerve function, blood glucose control, immune system function and many other processes[46]. It is also evident that adequate levels of zinc contributes to homeostatic balance and good overall health.
Crucial for the metabolization of fat, carbohydrate and protein ,[47], Zinc plays an active role in general growth and development[48]. Zinc is essential protein folding, enzyme formation, regulating oxidative dress and inflammation, and contributes heavily to cell repair, tissue re-epithelialization, scar formation and coagulation, making it vital for skin health and wound healing. [49]
Zinc – Impact on Mental Wellbeing and Behaviour
Its regulatory impact on the central nervous system may provide a positive influence for mood, memory, behaviour, and overall mental health[50]. Similar to Iron, Zinc contributes to monoamine synthesis (neurotransmitters which manage memory and mood), more specifically serotonin metabolism, which plays a huge role in regulation of psychiatric health[51].
More evidence is needed surrounding Zinc intake and sleep quality but some research has demonstrated Zinc-assisted sleep quality has been linked to improvements in memory and mental health[52][53]. There is evidence to suggest that the bidirectional neurotransmission between Zinc and melatonin, which could mean that deficits in Zinc could obstruct melatonin secretion and effect natural sleep progression.[54]
Zinc – Signs of Deficiencies
You should be able to get RDAs of Zinc from a balanced diet, however those with restrictive lifestyles or health status’ that hinder nutritional uptake (such as those who are pregnant or aging, or vegans/vegetarians, gastrointestinal conditions[55]) could require supplementation [56]. Adequate Zinc absorption can also be affected by absorption of other nutrients, such as phytates (organic acids that protect some plant-based foods from germinating too early) which can create digestive issues and hinder Zinc bioavailability. Phytates can be found in some grains, legumes, nuts and seeds. [57] However, there is also evidence to show that protein can benefit the bioavailability of Zinc.[58]
Symptoms of Zinc deficiency differs with age, and can affect functionality of epidermal, gastrointestinal, central nervous, immune, skeletal, and reproductive systems[59]. There is also some evidence to suggest increased Insulin resistance[60], which could lead to increased risk of obesity. Delayed wound healing, and increased risk of infection, impaired taste or loss of appetite, hair loss, diarrhoea and fertility issues[61] are some other manifestations of Zinc deficiency[62].
Symptoms can also include reduced cognitive function including impaired memory and behavioural/mood changes especially in vulnerable age groups (such as infants who are developing, the elderly who experience cognitive decline or those with neurological conditions).[63]
Zinc – Dietary Sources
The bioavailability of zinc from foods of animal origin is generally higher than from plant-based foods. Good sources of zinc include: meat, shellfish, dairy (such as cheese), bread, fortified cereals.
Zinc – Supplementation and RDAs
-Children 1-3 yrs: 5mg[64]
-Children 4-6yrs: 6.5mg
-Children 7-10yrs: 7mg
-Children 11-14yrs: 9mg
-Adolescents 15-18 yrs: 7mg females), 9.5mg (males)
-Men aged 19-64: 9.5mg
-Women aged 19-64: 7mg[65]
Zinc Sulphate, zinc gluconate or zinc acetate due to their ability to be absorbed more effectively by the body[66].
Recommendations generally suggest not exceeding 20 mg per day, as high doses of zinc prevent efficient absorption of copper and iron, as a consequence of which can cause anaemia and weakening of the bones, and changes in cholesterol and immune status[67] and therefore consultation from a medical professional is important before supplementation.
Iron is an essential mineral required by the circulatory system for the formation of red blood cells, or more specifically haemoglobin. Iron is crucial for the transportation of oxygen and other essential nutrients around the body and is required for immune function and DNA synthesis, making it a requirement for basic physical health.[68]
It is vital for the psychological wellbeing of children and adults alike[69] with cognitive function relying on sufficient Iron levels to manage the amalgamation of neurotransmitters responsible for central nervous system control and development. Glutamate and GABA homeostasis is also manipulated by iron status, and can impact learning capacity and motor skills in developing children, which they will later rely on as adults.
Iron – Impact on mental wellbeing and behaviour
The significant role of Iron surrounding neurotransmission, suggests that deficiencies could be detrimental to neurological function and wellbeing. Like Zinc, the production and secretion monoamines (which include neurotransmitters such as serotonin, dopamine, and norepinephrine) all rely on sufficient iron bioavailability to maintain a positive neurological environment. Moreover, the hormonal metabolism of melatonin also relies on iron, which is vital for natural sleep progression. There has been some evidence to suggest that Iron deficiencies can hinger sleep/wake cycles in infants which means that iron could impact sleep duration and quality but more research is needed.[70]
Iron – Signs of Deficiencies
The significant role of Iron surrounding neurotransmission, suggests that deficiencies could be detrimental to neurological function and wellbeing. Like Zinc, the production and secretion monoamines (which include neurotransmitters such as serotonin, dopamine, and norepinephrine) all rely on sufficient iron bioavailability to maintain a positive neurological environment. Moreover, the hormonal metabolism of melatonin also relies on iron, which is vital for natural sleep progression. There has been some evidence to suggest that Iron deficiencies can hinger sleep/wake cycles in infants which means that iron could impact sleep duration and quality but more research is needed.[70].
Deficits can impact the body as a whole but a reduction in energy levels and neurotransmission metabolism could heavily impact mood and behaviour[71]
You should be able to consume Iron RDAs through diet, but some individuals may be of a higher risk to deficiencies than others. Individuals with inadequate dietary intake (such as restrictive diets including veganism, or those who consume diets of low nutritional quantity), increased body needs (such as athletes, developing children or pregnant women), reduced absorption (because of health conditions), chronic inflammation (especially in the small bowel where the majority of iron is absorbed) and chronic blood loss (including menstruating women)[72].
Iron – Dietary Sources
Good sources of iron include: liver (avoid during pregnancy), spinach, red meat, beans (such as red kidney beans, edamame beans, legumes and chickpeas), nuts, dried fruit – such as dried apricots, fortified breakfast cereals
Vitamin C is a catalyst for Iron absorption, and so consuming foods with high Vit C (such as oranges, tomatoes and red peppers) and foods with vit c and Iron content makes them beneficial (such as spinach, broccoli, Brussels sprouts, green peas and beans[73]).
Iron – Supplementation and RDAs
-Children 1-3yrs: 6.9mg
-Children 4-6 yrs: 6.1mg
-Children 7-10yrs: 8.7mg
-Children 11-18yrs: 14.8 (females), 11.3 (males)[75]
-Men 19+: 8.7mg
-Menstruating women aged 19-50: 14.8mg
-Post-menopausal women (and non-menstruating women): 8.7mg
Types of supplements:
-Ferrous sulfate (20% elemental iron)
-Ferrous gluconate (12% elemental iron)
-Ferrous fumarate (33% elemental iron)
Available in tablet, liquid, or capsule form[76]
Always consult a healthcare professional before taking as high levels can be harmful[77]
Vitamin C improves the uptake of iron, whereas caffeine can hinder absorption.
Consuming high amounts of iron for a long period can be harmful and symptoms include nausea, constipation and stomach pain. Breast fed babies and those receiving fortified formula as well as children over a year don’t normally require supplementation. It is important to consult a healthcare professional before supplementing minerals such as these.
Primary role in the body:
Vitamin D is a vitamin that is essential for skeletal health (bone and teeth) and muscle health through the regulation of calcium and phosphate, and plays a crucial role in the prevention of extraskeletal and musculoskeletal health.[78]
Some research highlights that vitamin D deficiency has been linked to some autoimmune diseases, cancer, cardiovascular disease, diabetes, cognitive conditions such as depression, and dementia.[79][80][81]
Vitamin D – Impact on Mental Wellbeing and Behaviour
The inflammatory response triggered with depression could be reduced with the antioxidant and anti-inflammatory effects caused by vitamin D, especially in the central nervous system[82]. This is supported by reports of Vit D and seasonal affective disorder (SAD) where the reduction of seasonal sunlight creates inadequate levels of D3 which can negatively impact emotional wellbeing intensified by the hindered the uptake of serotonin[83].
With more focus on the positive effects of Vitamin D surrounding mood disorders and behaviour, there has been some research observing the impact of Vit D on sleep disorders (with mixed results). Some suggestions about the insufficient uptake of melatonin have been linked to Vit D deficiencies[84], however more emphasis is placed on sleep quality associated with phycological improvements as a result of Vit D uptake.
One study showed that when combined with magnesium, and another with omega 3, that vit D could improve behavioural symptoms for those with neurological conditions such as ADHD, although more research is needed.[85][86].
Vitamin D – Signs of Deficiencies
The main intake of Vit D is from diet and sun exposure and paired with nutritional intake, is enough to reach RDAs. Those in colder countries where there is a lack of sunlight (autumn/winter months in the UK), could be at risk of deficiency, and supplementation is recommended.
A lack of Vit D can lead of bone deformities such as rickets in children and osteomalacia, osteoperosis and arthritis in adults.[87] [88].
In recent years there has been more research to suggest Vit D deficiencies are linked to cognitive and mental health decline and disease which could impact mood/behaviour and sleep quality[89].
Vitamin D – Dietary Sources
Good dietary sources of D3 include oily fish – such as salmon, sardines, herring and mackerel, red meat, liver (avoid liver if you are pregnant), egg yolks, fortified foods – such as some fat spreads and breakfast cereals[90]. Good dietary sources of D2 include mushrooms and yeast.
Vitamin D – Supplementation and RDAs
-1-70 yrs: 10mcg/400IU[91]
-71+ yrs: 20mcg/800IU[92]
Types of vitamin D
-Vitamin D2 (ergocalciferol)
-Vitamin D3 (cholecalciferol)[93]
Vitamin D2 and 3 are available as dietary supplement capsules, sublingual (beneath the tongue) tablets, and liquid forms.
There is variable understanding of the biology and clinical implications of vitamin D, and therefore knowledge is limited. RADs differ with age, gender, health status, and country so always consult a healthcare professional, however, in the UK supplementation (10mcg) is recommended, especially in the autumn and winter months where there is less sunlight for everyone including breastfeeding women[94].
Taking high doses of Vit D over a long period can cause hypercalcaemia, which could negatively affect your bones, kidneys and heart[95]
Iodine – Impact on Mental Wellbeing and Behaviour
Due to the compounding research documenting the significance of Iodine in neurological foetal development and cognitive function in infants, links have been made between this, and Iodine’s impact on neurological conditions in later life. There has been evidence to suggest that those who maintain healthy levels of Iodine, optimise intellectual and behavioural function.[98]
Iodine – Signs of Deficiencies
Iodine deficiency is common and increases by 50% during pregnancy. It helps with neurological development of the foetus and because of this, pregnant women are of higher iodine deficiency risk[99]. Those who consume low animal products such as vegans/vegetarians are also of higher risk than other individuals.
Iodine deficiency could impair cognition and growth in developing children and can cause thyroid and cognitive disorders in adults and could present themselves as changes in mood and behaviour[100]. If left untreated, disruption to thyroid function can cause hormonal and metabolic malfunction and eventually, severe iodine deficiency may lead to hypothyroidism.[101][102]
Iodine – Dietary Sources
Rich sources include: Fish (such as cod and tuna), seaweed, shellfish, dairy products (such as milk, yogurt, and cheese) and eggs, which are also good sources of iodine as well as fortified products such as salt, plant-based drinks and some cereal products[103].
Iodine – Supplementation and RDAs
-Adults 18+: 140mcg[104]
-Children 1–3 yrs: 70mcg
-Children 4-6yrs: 100mcg
-Children 7-10 yrs: 110mcg
-Children 11-14yrs: 130mcg
-Adolescents: 15–18 yrs: 140mcg[105]
-Pregnant women may require more
There are plenty of supplements form available including tablets, capsules and gummies.
Dosage is important for these and recommendations suggest that taking 0.5mg or less a day is safe, but taking too much could cause harmful side-effects[106].
Other forms of supplementation can be found in the aforementioned fortified foods such as salt which is a good way to add Iodine to your diet, although dosage is more difficult to establish.
Seaweed supplements are not advisable for pregnant women.
Primary role in the body:
Vitamin B12 is a water-soluble vitamin that is naturally present in some foods. Vitamin B12 is involved in red blood cell and folate production, as well as the metabolic processes involved in protein synthesis and nucleic acid[107], assisting the conversion of food to energy (ATP) and DNA/RNA synthesis which could impact both mental and physical health[108]
B12 catalyses the conversion of homocysteine to the essential amino acid methionine and aids the metabolism of propionate, a short-chain fatty acid which is beneficial for brain health.[109]
Vitamin B12 – Impact on Mental Wellbeing and Behaviour
B12 has a notable role in the development and function of the central nervous system and neurotransmission synthesis which can heavily impact psychological status and behaviour associated with some mental health conditions.
Just as with other B vitamins (see below) B12 is required in the synthesis of monoamines (neurological transmitters important for psychological wellbeing) and is required to maintain neurological health[110]. Therefore, adequate uptake could improve mood and behavioural dysregulation, especially in individuals with neurological conditions.[111]
Vitamin B12 – Signs of Deficiencies
Those with reduced meat intake such as vegetarians/vegans, and the elderly are at higher risk of vitamin B12 deficiency[112].
Deficiencies can present in a variety of ways including both physical and emotional concerns: extreme fatigue or lack of energy, pins and needles, a sore tongue and/or mouth ulcers, muscle weakness, problems with your vision.
Psychological problems range from impaired memory, understanding and/or judgement which could stimulate further behavioural concerns[113] such as mild depression or anxiety to confusion.
Some neurological conditions such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) have been highlighted as occurring in children with B12 deficiencies[114][115].
Vitamin B12 – Dietary Sources
Its main sources include animal products: fish, meat, poultry, eggs, and dairy products[116]. Some plant foods have been fortified to contain B12 to compensate for vegan/vegetarian diets where individuals are at risk of deficiencies.
Vitamin B12 – Supplementation and RDAs
-Children 1–3 yrs: 0.5 mcg
-Children 4–6 yrs: 0.8 mcg
-Children 7-10 yrs: 1.0 mcg
-Children 11-14yrs: 1.0 mcg (females) 1.2mcg (males)
-Adolescents 15-18yrs: 1.5mcg
-Adults 19+ yrs: 1.5mcg[117]
B12 isavailable as a dietary supplement (including tablets, capsules and gummies) and requirements can vary with gender, ages and health. More sever supplementation can be prescribed and given as an injection, but a healthcare professional should always be consulted as high uptake of B12 could be harmful.
Seaweed supplements are not generally advisable for pregnant women[118].
B6 (Pyridoxine)
Primary role in the body:
Vitamin B6 assists the body with the reservation and metabolism of protein and carbohydrates for energy, as well as the production of haemoglobin, vital for the transportation of oxygen and vital nutrients around the body[119]. Just like folate (see below) and B12 (see above), B6 also contributes to neurotransmitter synthesis and foetal brain development which continues throughout infancy.
Vitamin B6 – Impact on Mental Wellbeing and Behaviour
Due to it’s role in neurotransmission synthesis, B6 helps to regulate neurological functionality and psychological health. Deficiencies have been documented as being associated with behavioural dysregulation, especially concerning individuals with neurological conditions,[120] and some studies have shown improvements after adequate supplementation[121]
Vitamin B6 – Signs of Deficiencies
Daily uptake is required due to insufficient storage in the body, and animal sourced are more efficient. A balanced diet should sufficiently supply B6 recommendations, therefore, deficiencies are associated those who have reduced or restricted nutritional uptake, (including those who practice a vegan/vegetarian diet)as well as those with chronic alcohol dependence, obesity and some gut-related and auto-immune diseases such as inflammatory bowel diseases, coeliac disease and rheumatoid arthritis.[122] Just as with other B vitamins, pregnancy predisposes women to deficiencies due to increased requirements.
Documented B6 deficiencies include behavioural dysregulation, new presentation of dermiological conditions, weakness and fatigue, diarrhoea, and if left untreated anaemia and cognitive decline.
In pregnant women, B6 deficiency has been linked to pregnancy complications and premature birth and in infancy could present as seizures.[123]
Vitamin B6 – Supplementation and RDAs
-Children 1-3 yrs: 0.7mg[125]
-Children 4-6yrs: 0.9mg
-Children 7-10: 1mg
-Children 11-14: 1mg (females), 1.2mg (males)
-Adolescents 14-18yrs: 1.2 mg (females), 1.5 mg (males)
-Adult men: 1.4mg
-Adult women: 1.2mg[126]
-1.9-2mg for pregnant/breastfeeding women[127]
Pyridoxine is the main form of supplementation and is available as a vitamin or multivitamin (tablet).
Over-supplementation (200mg or more daily) of B6 can be harmful and symptoms include loss of sensation in peripheries (peripheral neuropathy). Research suggests that no more than 10mg daily is advisable (unless prescribed by a doctor).[128]
Vitamin B9 (Folate)
Primary role in the body:
Folate (or vitamin B9), is closely linked to B12 (see above) and could impact the uptake of B12 and B6[129] vitamins. Like B12 and B6, folate is also fundamental for the formation red blood cells (haemoglobin), which in turn, are used for the transportation of oxygen and essential nutrients around the body. Folate has also been documented as assisting the regulation of vascular health, and prevention of some cancers[130] and plays a vital role in DNA synthesis and production. Supplementation is often advised during pregnancy as it could help to prevent birth defects in unborn foetus’, through its contribution to cell production, specifically surrounding the spinal cord and nerve cell development[131].
Vitamin B9 – Impact on Mental Wellbeing and Behaviour
Folate’s significance in the production of DNA and the spinal cord in foetal development, enables optimal neurotransmission to take place, establishing a safe environment for a lifetime of internal communication. Without it, functionality of this kind could compromise psychiatric health. It has also been linked with the synthesis of monoamines (such as serotonin, epinephrine, and norepinephrine) suggesting that it plays a large role in regulation of mood and behavioural[132]. Some studies have demonstrated improvement of diagnosed psychological disorders[133][134], especially when paired with ongoing pharmaceutical treatment[135].
Vitamin B9 – Signs of Deficiencies
Folate deficiencies are similar to as those related to B12 deficiencies (see above).
Folate isn’t stored long-term in the body, and sufficient uptake reduces with age, so needs to be consumed regularly to avoid deficits, especially for aging individuals or/and those with reduced nutritional intake. Folate is absorbed through the bowel so for those with bowel-related diseases such as Chrone’s, absorption could also be impacted[136].
Low folate levels can present with symptoms such as headaches, heart palpitations and behavioural dysregulation[137]. Long-term deficiency, can result in extreme fatigue, diarrhoea, loss of appetite and/or weight loss, and if left untreated, individuals could develop folate deficient anaemia.[138]
Vitamin B9 – Dietary Sources
Vitamin B9 – Supplementation and RDAs
-Children 1-3yrs: 70mcg[141]
-Children 4-6yrs: 100mcg
-Children 7-10yrs: 150mcg
-Children 11-14yrs: 200mcg
-Adolescents 15-18 yrs: 200mcg
-Adults: 200 mcg
-Pregnant or breastfeeding women: 100/200mcg more than normal RDA[142].
Folate supplements are available in tablet form, but taking more than one 1mg of nonprescribed folate daily could cause harmful side-effects and if left untreated, damage the nervous system.[143]
Primary role in the body:
Vitamin A is a fat-soluble vitamin that plays a vital role in immune system functionality and inflammatory responses in the body[144]. It is essential for normal vision, reproduction, and growth and development. Vitamin A is also involved in the regulation of some vital organs[145], and well as playing an important role in the integrity of the respiratory urinary and gastro-intestinal tracts, as well as bone marrow production[146].
Vitamin A – Impact on Mental Wellbeing and Behaviour
Vitamin A is involved in neuroplasticity: maintaining a safe environment for growth and development of cognition. It effects surrounding neurological functionality are life-long, changing throughout age and health status. It aids learning and memory, and helps to prevent age associated cognitive decline[147][148].
Its active role in neurological processing and development can be associated with the regulation of phycological health and wellbeing. Some studies highlight the role of Retinol in the prevention of mental health disorders such as depression[149]
Vitamin A – Signs of deficiencies
The most common sign of vitamin A deficiency is an eye conditions, specifically xerophthalmia (the inability to see low light), which can lead to blindness if it isn’t treated [150]. Long-term deficiency can also lead to a higher risk of respiratory and infectious diseases[151], and some skin conditions anaemia.
Vitamin A – Dietary Sources
There are two different sources for vitamin A:
Preformed vitamin A: found in fish, organ meats (such as liver), dairy products, and eggs.
Provitamin A carotenoids: The body is able to convert some carotenoids into vitamin A. Carotenoids are pigments that give yellow, orange, and red fruits and vegetables their colour (Green leafy vegetables and other green, orange, and yellow vegetables such as spinach, sweet potatoes, carrots, broccoli, and winter squash. Fruits, including cantaloupe, mangos, and apricots). The most common provitamin A carotenoid in foods and dietary supplements is beta-carotene.
Vitamin A – Supplementation and RDAs
-Children 1-6yrs: 400mcg[152]
-Children 7-10yrs 500mcg
-Children 11-14yrs: 600mcg
-Adolescents 14-18rs 600mcg (females), 700mcg (males)
-Adult men: 700mcg
-Adult women 600mcg[153]
The most common form of dietary supplement is beta-carotene and a lot of multi-vitamins and other supplements (such as fish lover oil) contain Vit A.
You should not have more than a total of 1.5mg Vit A (1500mcg) a day as it can cause harmful side effects such as age-associated weakening of bones, liver cirrhosis and the development of high blood pressure.[154] [155] Pregnant women should avoid taking Vit A supplements unless prescribed by a doctor.
Primary role in the body:
Choline is important for multiple bodily functions at a cellular level, including cell structure, transmission and communication which significantly impacts DNA synthesis.
It assists with the metabolism and transportation of fat, (including the removal of cholesterol from the liver which consequently impacts liver function), and is crucial for brain and central nervous system development, as a result of its role in the formation of neurotransmitter acetylcholine. Acetylcholine is a neurotransmitter that is involved in a range of basic functions such as muscle movement, memory, breathing heartbeat regulation etc. a deficiency of which could promote neurotoxicity[156][157]. There has also been evidence to suggest that Choline helps with cardiovascular health including vasodilation and cerebral blood flow that effects neurotransmission in the hippocampus and regions in the brain involved in learning and memory[158]
Choline – Impact on Mental Wellbeing and Behaviour
Due to the metabolism of Acetylcholine, as well as assisting blood circulation in the brain, Choline has been linked to improvements in neurological environment and function. Documented benefits include improved mood, memory, cognition and behaviour.[159]
Choline – Signs of Deficiencies
Choline deficiency has been associated with various disorders that surround metabolic function and gastrointestinal sufficiency, including obesity, microbiome dysfunction, celiac disease and inflammation. It has also been highlighted in some neurological disorders, cardiovascular, kidney and liver diseases and muscle decline[160].
Choline deficiency is rare, but could increase risk of pregnancy complications including preeclampsia, premature birth, and poor foetal neurological development[161].
Choline – Dietary Sources
Good sources include: beef liver, chicken liver, egg yolk, cod, cauliflower, broccoli, Bananas, oranges, spinach, tomato, potato[162], soybean products (oats, flaxseed, barely).
Soy lecithin is a widely used food additive that contains choline. Therefore, it is likely that extra choline is consumed through the diet via food additives.
Choline – Supplementation and RDAs
-Children 1–3 years: 200 mg
-Children 4–8 years: 250 mg
-Children 9–13 years: 375 mg
-Adolescents 14–19 years: 400 mg females), 550 mg (males)
-Adult women: 425 mg
– Adult men: 550 mg
Breastfeeding women: 550 mg
Pregnant women: 930 mg
Supplements include Choline chloride, CDP-choline, alpha-GPC and betaine. CDP-choline and alpha-GPC tend to be higher in choline content per unit weight. They are also more easily absorbed than others.
High Choline consumption can cause harmful effects such as sweating, increased salivation, gastrointestinal pain, diarrhoea/nausea, fainting/dizziness, low blood pressure, depression[163]
Selenium
Primary role in the body:
Selenium is an essential mineral that plays an important role in metabolic health and mortality. It impacts reproduction, thyroid function, DNA production, reducing damaging effects of free radicals and activating immune response for the prevention of infection.[164] It involved in the synthesis of selenoproteins and antioxidative effects which could benefit immune response and neurological functionality[165].
Selenium – Impact on Mental Wellbeing and Behaviour
Due to its role surrounding selenoprotein synthesis, and the reduction of oxidative stress and inflammation, there has been some discussion regarding the benefits of selenium on mood disorders and neurological function[166]. Discussions surrounding the benefits of selenium on the central nervous system include neurotransmission, motor performance, cognition, memory and co-ordination, and deficiencies have been linked to neurological conditions such as dementia and Parkinson’s disease.[167]
Some animal studies have shown the preservation pf dopamine in some cases[168] which could heavily improve behavioural symptoms in individuals with neurological conditions such as ADHD, who often struggle with dopamine uptake; though more research is needed.
Selenium – Signs of Deficiencies
Studies suggest that women are specifically vulnerable to thyroid insufficiencies as a result of selenium deficiencies and if left untreated could result in hyper/hypothyroidism[169].
Other associated symptoms of selenium deficiencies include poor immune health, reduced fertitly, increased risk of some cancers and type 2 diabetes[170].
Some research has linked long term deficiencies to mood disorders, cognitive decline and dementia and Parkinsons disease[171].
Selenium – Dietary Sources
Seafood, Meat, poultry, eggs, and dairy products, breads, cereals, and other grain products.
Selenium – Supplementation and RDAs
Children 1–3 yrs: 15 mcg[172]
-Children 4–6 yrs: 20 mcg
-Children 7–10 yrs: 30 mcg
-Children 11-14 yrs: 45mcg
-Adolescents 15-18 yrs: 60mcg (females), 70 mcg (males)
-Adult women: 60 mcg
-Adult men: 75mcg
Supplements include: Selenium sulfide, Sodium selenite, Selenium-enriched yeast, Selenomethionine (this has been linked to better absorption) and come in tablet, capsule and powdered form.
Taking more than 900 micrograms of a non-prescribed selenium daily can have harmful effects. Some studies document that high exposure to selenium is associated with uncontrolled blood sugar levels and therefore an increased risks of type 2 diabetes and non-alcoholic fatty liver disease.[173]
Magnesium (Mg)
Primary role in the body:
Magnesium is a mineral that is metabolised by the body and plays a fundamental role in continuous reactionary and mechanical processes at a cellular level. It plays a crucial role in energy production and the synthesis of protein and RNA/DNA and is required for the metabolism of other nutrients (such as calcium and potassium), which are imperative for nerve impulse, muscle contraction, and normal heart rhythm. It’s also fundamental for biochemical responses such as blood glucose control, blood pressure and hormonal regulation, and neurological transmission.
Magnesium – Impact on Mental Wellbeing and Behaviour
Magnesium’s assistance in the navigation of neurological pathways[174], means that it plays an important role in maintaining hormonal regulation and nerve impulse conduction, which could ultimately impact our decision making, mood and behaviours. If utilised correctly, adequate levels of Mg has the potential help with anxiety and/or stress that could be effecting sleep and other health concerns.
There is a fair amount of research documenting the interaction of magnesium and cortisol[175], and evidence suggests that conditions associated with psychological stress could be reduced through regular uptake. This could positively impact disorders such as anxiety, depression, as well as sleep regulation and muscle tension[176].
Magnesium – Signs of Deficiencies
Whilst overt hypomagnesaemia is rare, absorption decreases with age, which means older adults are higher risk of magnesium deficiencies. Moreover, some of the earlier signs and symptoms can present as signs of normal aging, such as weakness and fatigue. It is excreted renally, and therefore, anyone with renal-associated health conditions or those that take certain medications (e.g., diuretics, antibiotics etc), are more likely to have Mg deficiencies.
Should deficiencies continue, it may present with more severe symptoms of loss of appetite and nausea, numbness, tingling, muscle contractions/cramps, seizures, abnormal heart rhythms and arterial changes as a result of result in hypocalcemia or hypokalemia (low serum calcium or potassium levels) .
Ongoing deficiencies could be a catalyst for mental health concerns, especially in those individuals who are high risk, such as those with health conditions like diabetes, heart conditions and/or neurological conditions like ADHD, and may require supplementation to help to control symptoms.
Magnesium – Dietary Sources
The richest sources are : green leafy vegetables (spinach, kale, avocado broccoli), wholegrain bread, wholegrain cereals, brown rice, nuts (almonds, peanuts cashews), legumes (black beans/edamame).
Smaller amounts are also found in: fish, meat, dairy products.
Magnesium – Supplementation and RDAs
-Children 1-3 yrs: 85mg
-Children 4-6 yrs: 120mg
– Children 7-10 yrs: 200mg
– Children 11-14 yrs: 280mg
-Adolescents 15-18yrs: 300mg
-Men 18+: 300mg
-Women 18+: 270mg
Supplements include: Magnesium glycinate, Magnesium aspartate, Magnesium lactate, Magnesium lactate, Magnesium sulphate, Magnesium oxide, Magnesium glycinate (for more information on these see my other article: Magnesium and its Brain Health Benefits
The above information demonstrates the benefits of multiple nutrients which are essential for developing and maintaining optimal cognition. Whether it be assisting neuroplasticity, and influencing environmental conditions for appropriate learning and development, or regulating sufficient neurotransmission and preventing cognitive decline, nutritional uptake is important for neurological health and physiological wellbeing.
For those with cognitive impairments, the affects can be tenacious, severely affect the quality of life, and further increase the risk of mental health conditions associated with poor cognitive regulation, emphasising the requirement for effective treatments[177].
Although it is frequently stated that a healthy and fully balanced diet, can provide all of the nutrients essential for a healthy life, many different environmental, behavioural and health factors contribute to deficits, which make it reasonable to assume that safe supplementation with a variety of vitamins could positively benefit certain individuals improving symptoms, and quality of life,[178] e.g. those with ASD/ADHD.
Conclusion
Brain development is dictated by sufficient nutritional uptake, which in childhood relies on an optimal internal environment and neuroplasticity, to facilitate growth of the systems responsible for learning and homeostatic operation. In adulthood, homeostatic sustainability and neurological performance is shaped by a number of lifestyle factors, including hormonal impact, aging, sleep, stress, and nutrition; insufficiency of which can cause psychological disturbance. As we age, we rely on integration of the neurological arrangements defined in infancy, to maintain optimal cognition and neurological responses in times of physiological pressures including age-related alteration and decline[179].
Unfortunately, irregular eating behaviours means that individuals with ADHD/ASD are more vulnerable to poor nutritional uptake defined by restrictive or binge eating, with a preference to ultra-processed foods over whole, nutritionally sound foods. Not only can this impact gut chemistry, but the link between physical and emotional well-being means this may also impact behavioural symptoms that could impact psychological health.
With the inclination of those with neurological conditions towards reduced nutritional quality, it is unsurprising that emerging studies have demonstrated beneficial effects of sufficient supplementation. These outcomes have showing both psychological and physical benefits, showing changes withing gut biology that could also impact mood and behavioural outcomes.[180][181]
However, a clearer understanding of the impact of nutrition specifically surrounding those with cognitive impairment is needed to explore how consumption of nutrient-deficient, ultra-processed foods, which currently dominate western eating patterns, can influence both human physical / psychological health and behaviour.
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Disclaimer: The views and opinions expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of any professional organization or guidelines. The information provided is for educational and informational purposes only and is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your therapist or other qualified health provider with any questions you may have regarding a medical or mental health condition.
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Important – This information is for insight and educational purposes. Identifying with any symptoms or experiences mentioned should not be taken as a substitute for a formal or clinical diagnosis of these complex conditions, nor the specific support required to support a particular individual. Please talk to a qualified health professional or GP for specific support. If you are thinking about ending your life, please call 999 (UK) or go to A&E and ask for the contact of the nearest crisis resolution team.