“A restricted diet should be part of standard of care for all children with ADHD”

Whaaaaaat?  This was my response as I read this summary article in BlackBag, a free medical app that has dozens of medical news articles delivered daily to your smartphone or ipod.  The title of the summary article was exactly as I typed it above, and the author’s conclusions were based on a study recently published in the Lancet, an excellent randomized controlled trial now known as the INCA trial (“The Impact of Nutrition on Children with ADHD”). 

For years naturopathic physicians have been huge proponents of the allergy (or, more accurately, the “intolerance”) elimination diet.  In fact, elimination diets have become such a mainstay in naturopathic medicine that it has become a bit of a running joke in school - when in doubt, the answer to a test question is always “eliminate gluten” (worth 1/2 credit, at the very least). 

ND’s have used the elimination diet to treat everything from IBS to hypertension, often with astounding results.  In pediatric practices elimination diets are routinely prescribed for recurrent otitis media, constipation and a variety of behavioral problems, including ADHD.  I’ve heard my professors tell stories of children who had dramatic changes on restricted diets to the point where the children were nearly unrecognizable - bouncing off the walls and breaking furniture on one occasion, and playing quietly the next. 

This summary was published just as I was finishing my preceptorship with a pediatrician in Seattle, an MD with an excellent reputation and known for being alternatively minded.  I learned a great deal about the medical management of children in that preceptorship, and I am very thankful for that opportunity.  It was striking to me, however, to see the large number of children on stimulant medications for ADHD.  These medications carry significant risks, from anorexia and weight loss to addiction, abuse and diversion, not to mention the black-box warning for increased likelihood of sudden cardiac death.  I give credit to the pediatrician - he never took this lightly, and always made the prescription only after a lengthy discussion of risks and benefits with the parents. 

I sent the original article to him; I sincerely hope that medical doctors like him see the scientific validity of elimination diets and the huge benefit this intervention could have in terms of risk reduction. 

And, for my medical doctor readers out there who have no idea how to counsel their patients through an elimination diet: please feel free to contact a naturopathic physician near you.  The American Association of Naturopathic Physicians has an excellent website: www.naturopathic.org, click on the link that says “Find a Doctor,” and search for an ND in your area. 

Reference:
Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet 2011; 377: 494-503