10 Supplements and Vitamins for Brain Health
Can supplements — vitamins, minerals, and herbs — augment ADHD medication to help relieve symptoms like inattention, memory, mood, and cognitive function? Find out what the research says here.
Research shows that medication does a good job of managing ADHD symptoms in many children and adults. Still, the thought of starting your eight-year-old son or daughter on a drug, no matter how effective it might be, causes lots of hand-wringing and soul-searching in parents before they agree to do it. So some parents look for ways to improve overall brain health and emotional regulation through nutrition, exercise, and supplements.
It is important to understand what a supplement is. A nutritional supplement provides basic nutrients for optimal health and function that you may not be getting from your food. Supplements include vitamins, minerals, proteins, and fats. I don’t include herbal or botanical ingredients, such as ginkgo or St. John’s wort, in the supplement category. Botanicals are plant-based products that are not necessarily nutrients, but which may have positive effects on health and function.
Now let’s look at the individual supplements I recommend for brain health. Every supplement mentioned here has some research to support its effectiveness in improving some symptoms.
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If possible, I’d consult a physician to help you incorporate supplements into your treatment plan. Managing supplements and other integrative treatments requires expertise. It is difficult for a family to do this on their own.
Omega-3 Fatty Acids
Usually given in the form of fish oil, omega-3s are a popular supplement in the ADHD community. Numerous studies, including two meta-analyses, have found benefit in the area of hyperactivity, attention, or impulsivity.
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Finding the best omega 3 supplement is a different story. Despite all the studies on omega-3s, questions remain about the optimal dose and how to give it. The important omega-3 fatty acids are EPA and DHA, which are listed on most product labels. I recommend a total of 1,000 mg. of EPA plus DHA (add the two together) for smaller children, 2,000 mg. for adolescents, and 1,500 mg. for those in between. There should be 1.5 to 2 times as much EPA as DHA. Most omega-3 gummies don’t provide these higher levels, so your best option is to give your child capsules or a liquid. For children who are vegetarian, algae oil is available, but it requires large doses to get enough EPA and DHA.
A related supplement is phosphatidylserine. This is a type of molecule derived from fatty acids that plays an important role in cell signaling. A couple of small studies indicate it might be helpful for ADHD. My clinical experience is that the benefits have not been impressive. It can be taken on its own or in conjunction with a fish oil supplement.
Zinc
I recommend zinc because, though the mineral is not as well researched as omega-3s and iron, there is some positive research. One study showed that taking zinc with a psychostimulant caused a nearly 40 percent reduction in the amount of the stimulant required to function at optimal levels. Other studies have shown benefits for ADHD symptoms in general. Zinc levels can be measured in the blood, but it is safe to give 20-25 mg. of zinc daily to your child without first doing a blood test.
Vitamin D
Many American children have abnormally low levels of vitamin D. Newer research shows that children with ADHD have lower vitamin D levels than children without the condition. One study showed that expectant mothers with low vitamin D levels had a higher likelihood of their children having ADHD. There are no studies showing that giving vitamin D to children with ADHD improves their symptoms. Nevertheless, I would check vitamin D levels and supplement if the levels are low or even borderline low.
Iron
Low levels of the mineral iron can be a significant problem in children with ADHD. Studies have shown that iron is crucial for normal brain function, and that treating with supplemental iron can improve ADHD symptoms.
Before giving an iron supplement to your child, it is important to measure the iron levels in your child’s blood. When doctors measure these in children, they test for hemoglobin and hematocrit — the level of iron in red blood cells. These readings are usually normal in children with ADHD. I recommend that doctors also check the ferritin level, which measures circulating iron. This is often low, or borderline low, in kids with ADHD. One study showed that the average ferritin level in ADHD children was 22 compared with 44 in non-ADHD children.
I recommend supplementing with iron if a child has a ferritin level under 30. It is important to use a chelated iron product, which reduces the problem of constipation or stomachaches. I usually begin with 30-40 mg. of elemental iron a day, and measure ferritin levels again in three to six months.
Multivitamin/Multimineral
It is important that children with ADHD have adequate amounts of a wide range of vitamins and minerals, but until recently, there has been little research suggesting that taking a multivitamin/multimineral was helpful for ADHD. Research indicates that a specific multivitamin/multimineral combination is effective for kids who have ADHD and emotional dysregulation, often displayed by oppositional children.
Daily Essential Nutrients (DEN) is made by Hardy Nutritionals. In three double-blind randomized placebo-controlled trials, the micronutrients in this formulation reduced impairment and improved inattention, emotional and mood regulation, aggression and overall functioning. DEN did not improve hyperactive/impulsive symptoms. The downside is that it is expensive, and for optimal efficacy, a child has to take 12 pills a day (the vitamins are also available in flavored powder form for children who have difficulty taking pills). It’s possible that other multivitamins have similar effects, but they have not been well-studied.
Magnesium
This mineral won’t directly improve attention, but it can calm hyperactivity and agitation, which compromise attention. I find magnesium helpful for children who have a “rebound effect” after their stimulant medication wears off. A child can safely take 100-300 mg. of elemental magnesium twice daily in the form of magnesium glycinate, citrate, or chelate. The citrate form tends to lead to loose stools.
Inositol
Inositol is found in very small amounts in many foods. In concentrated doses, it helps to counter agitation and anxiety. I recommend 12-18 grams a day divided into two or three doses for adults. The dose for kids would be calculated based on their mass.
Ginkgo Biloba
This herb has been used to improve cognitive function for thousands of years. A couple of small studies have shown that it may be helpful in children with ADHD. A recent double-blind randomized study looked at adding ginkgo to a stimulant that children were already taking. Some children took ginkgo plus a stimulant, while others took a placebo and a stimulant. Those who took the ginkgo had a 35 percent better response rate in terms of improving attention. It had no effect on hyperactivity or impulsivity. I use 60 mg., twice a day, for children.
Other Herbs
Bacopa and gotu kola, which are part of Ayurvedic medicine (the traditional medicine of India), have both been used to treat ADHD, but western medicine has done little research on them.
One herb, St. John’s wort, is often recommended for children with ADHD, but research shows that it helps with mood disorders, not ADHD. A study on using St. John’s wort to treat ADHD reached the same conclusion: It did not help. This study was discussed in the June 2008 issue of the Journal of the American Medical Association. View the study abstract.
The ABCs of Supplements
Among the many questions parents ask me when thinking about natural supplements are: How can supplements help? Are they a substitute for ADHD medication, or can they be used together? How long do they take to work? Can they have side effects?
- How do supplements improve attention, impulsivity, or hyperactivity? It is helpful to understand how supplements are researched. The most common method is to give either the supplement being studied or a placebo to a person, and see if ADHD symptoms improve. Researchers measure this by looking at ADHD surveys or checklists, filled out by teachers and parents. In most cases, the research shows improvements in attention and focus, hyperactivity, or impulsivity, or all of them. It is hard to predict the effect any single supplement will have on a child.
- Will supplements improve symptoms as much as ADHD medication? For the most part, no. ADHD-friendly supplements are helpful, but they do not have the immediate and powerful effect on ADHD symptoms that medication does. It is hard to quantify the effectiveness of these supplements compared to medication. It is worth noting that supplements in general have far fewer side effects than medication, and less potential for severe side effects. I use supplements as part of an integrative treatment plan that includes interventions related to school, parenting, sleep, and exercise.
- How long will it take to see results after starting a supplement? This varies, depending on the supplement and the child. Some families have told me that they saw improvement within days of starting fish oil; other families didn’t see any improvement after a month. I recommend waiting a few months before deciding whether or not supplements are helpful.
- Do supplements have side effects? Some supplements have side effects, but they are milder and less common than the side effects of ADHD stimulants. Iron, for instance, may cause constipation or abdominal pain. It is important to notice any symptoms that occur after starting one or more supplements and consult with your physician.
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Sandy Newmark, M.D., is a member of the ADDitude ADHD Medical Review Panel.
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