Maximizing Nutrients for Healthy Brain Function - A Focus on ADHD in Adults and Children

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treat adhd naturallyTo say our brains are overwhelmed is an understatement.

From the moment we wake up, we’re in front of a screen, driving, listening to the radio, or downing caffeine or alcohol to bring us up and calm us down.

Add parenting stress, school stress, work stress, relationship stress, pandemic stress, and more and it’s no wonder that many Americans have turned to prescription drugs for ADHD, depression, anxiety, energy, pain, and sleep.

The good news is that there are natural approaches to help offer help for brain fatigue and wellness and it starts with getting the right macro and micronutrients in your diet - and supplementing the difference when necessary.

Here are some of the most important nutrition principles to keep in mind when it comes to maintaining focus and brain function.

Nutrition Strategies to Boost Brain Function and Support ADHD Naturally

Essential Fatty Acids and Brain Health:

The brain is made out of fat and healthy fat is necessary for proper cell structure and messages between cells. It’s estimated that 60-70% of the brain is fat by volume.

When evaluating the nutrient status and the brain, it’s important to start with healthy fats, especially essential fatty acids (EFA’s). EFA’s include omega-3 and omega-6 fats that the body cannot make on its own and depend on outside dietary or supplemental intake to meet its levels.

The body can make some interconversions between fats on its own to help support brain function and inflammation, but genetics, nutrient status, and other factors can all slow these conversions.

For instance, vegetarians receive omega 3’s only from alpha-linolenic acid found in flax, chia, and walnuts.

Some individuals have a hard time converting alpha-linolenic acid to the DHA and ultimately EPA that we hear most about when it comes to omega 3’s (1). Fish oil also contains DPA, “the forgotten” omega-3 that offers additional anti-inflammatory and gut benefits for the body. 

MegaOmega by Microbiome Labs for instance contains EPA, DHA, and DPA, while also adding specialized pro-resolving mediators (SPMs) which work to finish the inflammatory response so that inflammation does not become chronic.

Some compromise by taking an algae source of omega-3’s such as Krill oil.

Nutrition profiles of children with ADHD reflect low omega-3 fatty acids (2).

Clinical trials support the use of essential fatty acids for ADHD in children - especially when in a specific ratio of 9:3:1 corresponding to eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma-linolenic acid (GLA).

I recommend the essential-fat-containing medical food EquazenPRO to support children with ADHD - while also supporting normal essential fatty acid balance and inflammation.

One doesn’t have to have ADHD to benefit from essential fats - everyone should look to optimize their levels of essential fatty acids.

I like to incorporate some combination of fish oil with either borage oil or evening primrose oil to add the benefits of gamma-linolenic acid, an anti-inflammatory omega-6, along with the anti-inflammatory benefits of omega-3’s.

I like MegaOmega for general support with GLA-containing borage oil or evening primrose oil (EPO) to help complete the essential fatty acid picture.

For focus, I’ll use EPA Ultimate in combination with one or both of the borage or EPO products that contain GLA. For more specific details, check out What’s Missing in Your Fish Oil?.

Gut Health and Brain Optimization:

Any time I discuss micronutrients, I have to bring attention to how well one might be absorbing nutrients in the first place.

Many minerals require strong acidity in the stomach to be absorbed. Many Americans, including children at an increasing level, are on acid-blocking remedies such as H2 blockers (ex/ Tagamet, Zantac, Pepcid) that may also be slowly depleting away key minerals that overlap with many mentioned in this article.

Because of the disgusting effects of the Standard American Diet on American adults and youth, many of us produce low digestive secretions, are stressed out, and are inflamed.

Take apple cider vinegar (1oz liquid diluted with 1oz water or capsules), betaine HCL with pepsin, as well as adequate magnesium and zinc levels will support acid production. Lowering stress of course is associated with the better release of digestive secretions.

Eating an anti-inflammatory and hypoallergenic diet will reduce overwork on the gut and support strong acidity too.

When the acid production is low it promotes changes in bacteria down the rest of the GI tract. We also like Megaguard by Microbiome Labs if one suspects H. pylori, and we add MotilPro if gastric motility seems to be a concern.

I’ve discussed The Domino Effect of Low Stomach Acid previously with some more comprehensive discussion.

The absorption issue depends on a healthy mucosal layer which helps protect the lining - but also serves as the home for billions of healthy gut bacteria. In return, the bacteria also help promote the lining in beautiful synergy.

Disruptions in the balance of the microbiome have been implicated with ADHD (3). The best analysis we’re aware of currently for microbiome health is BiomeFx and we’ve discussed Personalized Microbiome Analysis previously.

Take probiotics like Megasporebiotic, TrubifidoPRO, or TheralacPRO, prebiotics like MegaPre or Sunfiber, and mucosal support like MegaMucosa, Whole Body Collagen, L-glutamine, zinc carnosine, and others to support a healthy gut lining. The mucosa is a thin, snot-like layer that separates the inner gut from the sensitive lining of the gut - and protects what is allowed to enter the bloodstream.

Controlling inflammation naturally with compounds like curcumin, omega-3’s, and of course eating a healthy diet in the first place will support normal levels of inflammation.

Inflammation control is important, as the mucosal barrier cannot be healing and inflamed at the same time.

Check out our most visited article for full details on what a plan may look like for you or your child: The 7 Core Strategies to Health the Gut Lining and Manage Leaky Gut Naturally. One of my favorite products here is MegaIgG2000 which helps bind toxins that help reduce inflammation so the mucosa is given time to heal.

For guidance on probiotics and prebiotics, check out Dr. Rinehart’s Probiotic Blueprint.

Gluten/Dairy Free Diet:

Gluten and dairy are two of the most common food allergens, sensitivities, and intolerances. Let’s first consider gluten.

Humans do not make the DPP-IV (“DPP-four”) enzyme needed to break down the gluten molecule completely. The incomplete digestion causes the proteins to create microtears in the intestinal lining of ALL who consume gluten. Whether it causes symptoms in the context of your diet and lifestyle is another consideration.

Additionally, both gluten and dairy derive into opioid-like compounds that will disrupt the conversion of essential fats into the active messengers the body needs for a healthy brain and immune system.

The opioid effect is also addictive, and may mask the discomfort that otherwise would be triggered by gluten's irritation to the gut lining!

To consider dairy specifically, it contains whey, casein, and lactose - all of which can create digestive problems for humans. Humans drastically reduce the amount of lactase we naturally produce after the age of two - so most people are intolerant of lacrosse and dairy whether it’s causing an immune reaction or not.

Eventually, your body may start making antibodies to dairy (as well as wheat) and those reactions can start to cross-react with other tissues, other foods, and more, creating a slippery slope of gastrointestinal, immune, and BRAIN dysfunction.

When we eat out, I carry a bottle of Wheat Rescue with me to help mitigate unwanted exposures to gluten. I also use Gluten/Dairy Digest by Pure Encapsulations, Intolerance Complex by Enzyme Science, or DairyAssist by Enzymedica depending on what I have available to support unwanted exposures when eating outside of the home or to take with me on trips or dinner parties with friends and family.

Magnesium and Attention Deficit and Hyperactivity Disorder:

Magnesium promotes healthy brain function and spurs hundreds of reactions in the body. 

It’s widely depleted in Americans, and stress also exhausts the body of its magnesium status.

There are many ways to support magnesium status. For brain function, I specifically like MagPure Brain Boost by Jigsaw Health as it uses magnesium threonate - a specific form of magnesium that can cross the blood-brain barrier and target magnesium status in the brain.

Magnesium and magnesium threonate have been evaluated for their roles in ADHD (4).

Zinc and specifically, the  Zinc: Copper ratio:

Zinc and copper are sister minerals. As a parent to these sisters, you want to make sure that you do not favor one over the other!

If you take too much of one - it depletes the status of the other.

While many are deficient in zinc levels, when supplementing with zinc for its many benefits for immunity, mucosal health, brain health, and more, be sure to supplement with copper too.

How might you know one is getting too much zinc?

One might feel nauseous, upset stomach, diarrhea, or a metallic taste in your mouth. I take generally 1mcg of copper for every 15mg of zinc, and I generally try not to exceed 30mg of zinc per day unless taking it for immune support and/or am ensuring adequate copper intake too.

I use Zinc Carnosine by Integrative Therapeutics (which provides elemental zinc) commonly to support mucosal health and stress balance - with the added benefit of supporting zinc levels.

When recommending zinc on its own, I’ll use different variations of Zinc Liquid by Pure Encapsulations, Zinc Plus by Klaire Labs (which contains 15mg zinc: 1mg copper), or Zinc Chelate by Integrative Therapeutics. I’ll add Copper Glycinate by Pure Encapsulations to keep my ratios happy. 

The copper glycinate contains 2mg of copper per serving. If I am only taking 15mg or so of zinc, I may take that supplement every other day to support my increased copper needs. The goal is to mix and match to promote a 15mg:1mg zinc to copper ratio.

Remember to check multi-vitamins, immune supplements, and more for zinc content to make sure you’re not taking too much and supplying enough copper to balance your intake!

Your functional medicine practitioner can do a Zinc tally test with you where you taste two teaspoons of a liquid zinc solution and if you don’t taste it, it means you’re deficient in zinc. If the liquid tastes metallic to you, it means that your zinc levels are likely normal.

Vitamin D Benefits for the Brain

Of many of the vitamins, D3 has mainstream recognition of its importance.

Despite its popularity, many Americans are routinely deficient in vitamin D (measured as 25-OH vitamin D). I like it to fall in the 50-70mg/dL range.

Yet, many of my clients fall in the 19-30mg/dL range! - Even in Arizona where it is sunny most of the year and outdoor lifestyles are common.

Learn more about vitamin D3 rangers and how it interacts with Vitamin K, specifically K2-7) here: The D3 and K2 Connection

Vitamin D is one of the biggest misnomers in nutrition because D3 is not even a vitamin at all - it’s an anti-inflammatory hormone.

As a hormone, it helps control calcium absorption in the intestines, yet it plays vastly important roles in immune health, inflammation, and the integrity of the gut and brain barrier systems.

Vitamin D plays important roles as to what is allowed to pass into the blood from the gut - as well as what’s able to pass from the blood to the brain.

It seems simple, but it is critical to know your vitamin D3 levels and to maintain a healthy level in the 50-70mg/dL range.

Manganese, Selenium, and Glutathione Support of Detoxification

Manganese, selenium, and glutathione also play critical roles in the protection of body tissues from free radical damage. 

Nuts and leafy greens are good dietary sources of manganese. Supplemental magnesium can be taken as well.

Selenium levels are also easy to maintain - the problem is that many minerals are increasingly deficient in soils - so we may be more dependent on extra intake than we think.

Brazil nuts are the best natural source of selenium - found in just 2 brazil nuts a day. Aside from that, one can take selenium supplementally and my choice is Reacted Selenium by OrthoMolecular.

Selenium helps compete with mercury for absorption into the body. It also serves as the backbone for key detoxification processes in the body and energy creation.

We are born with toxicity at birth - traces of tens of thousands of chemicals can be found in umbilical cord blood. As sickening as that is to hear, our detoxification systems are at a deficit from the very beginning - before we even have a choice in the matter.

Chemicals are added to our environments daily that are untested - and if so, it would be impossible to account for the infinite exposure combinations.

In many ways, we are living in one large guinea pig experiment when it comes to toxic exposures. I choose to be proactive in minimizing exposures that I can control and boosting the natural systems that protect me.

Protecting our detoxification systems is more important as each day passes - selenium is one aspect of that conversation, others may include glutathione support such as NAC or liposomal glutathione.

I also like curcumin, specifically Theracurmin as it supports detoxification and is also known to support brain and gut integrity.

Guessing which minerals are needed by the body can be difficult - so some use a general multi-mineral to support their needs. I like Multi-Mineral Complex w/o Iron by Klaire Labs.

Note on multi-mineral supplements:

I do not like including iron as it is not something you want to supplement if you're not deficient. Iron in excess or in the wrong form can contribute to nausea or stomach discomfort - I only supplement with iron if I see supporting bloodwork.

B-Vitamins for Focus and Attention:

B-Vitamins and Homocysteine Metabolism for Brain Health

Children with ADHD have demonstrated a deficiency in B-vitamins, particularly B6, B9, and B12 (5).

These vitamins are important with homocysteine metabolism - an important pathway of the body that can disturb the health of blood vessels. B2 known as riboflavin is also deficient in individuals with ADHD (6), and plays an important role in homocysteine metabolism (7).

Because the brain is full of numerous tiny blood vessels, insult from high homocysteine can lead to suboptimal brain function.

When I supplement with B-vitamins, I like to start with a complete B-vitamin such as Pure Genomics B-Complex by Pure Encapsulations.

B-vitamins work together. If you supplement with B-vitamins independently you can start to drive deficiencies in the others - start with a good B-complex vitamin and branch off from there unless otherwise directed by bloodwork, urinary analysis, and genetic tendencies!

Vitamin B6 / Pyridoxine and the Brain: 

B6 deficiency has been implicated to play important roles in ADHD (8). When B6 was combined with magnesium in a small trial in children, ADHD symptoms improved after 2 months of treatment, when the supplementation was removed, symptoms reappeared (9).

When I use B6, I look for it in its "activated" form - known as pyridoxal-5-phosphate or P5P. I use P-5-P by Pure Encapsulations most commonly.

B6 also plays a direct role in adrenal health, often combined with pantothenic acid (known as vitamin B5).

The adrenal glands are the battery system behind your stress response - and get depleted with overwork, inflammation, and chronic stress. B5 and B6 help to grease the gears of adrenal function, and as a result, brain function is optimized.

With lots of mental overwork, supplemental B-vitamins can help keep the gears churning smoothly.

Vitamin B9 / Folate:

Children with ADHD had folate levels lower than controls (10). Folate can play important roles in the development of the nervous system during early childhood (11). The B-vitamin is also important for detoxification pathways.

At a baseline, look for folate on supplement labels instead of “folic acid”. Folic acid is synthetic, while folate is natural. Some individuals have trouble converting the man-made "folic acid" version to the active form used by the body.

Supplement and food companies often use the folic acid form because it is cheaper and helps maximize margins. Cereal companies and others can be mandated to use the folic acid form as well. This is because grains and processed foods are often stripped of their vitamin content during processing - and vitamins need to be added back. 

Our solution is to eat whole and unprocessed foods in the first place!

A blood test can help you determine if you’re not utilizing folic acid optimally and whether you should generally avoid foods fortified with folic acid or folic acid-containing supplements (12).

Commonly, folate is found alongside B12 discussed next such as in a product like B12 Folate by Pure Encapsulations

I like Pure Encapsulations when it comes to many B-vitamin products as they pay attention most consistently to using the best forms for absorption and utilization by the body.

Vitamin B12 / Cobalamin Links to the Brain: 

Vitamin B12 plays roles in healthy nerve structure and function (13) and neurological deficits can exist in the absence of clinical anemia symptoms (14). It was shown to be deficient in children with ADHD when compared to control (15) and is also involved in homocysteine metabolism - a predictor of vessel health and therefore brain function (16)

If stomach and gut function is compromised, sometimes injections or intravenous delivery of B12 may be necessary to prop up levels until absorption issues are addressed. Adequate stomach acid production is important for absorption. The acid activates intrinsic factors - critical for proper absorption of B12.

Dietary B12 comes from animal products. As such, B12 deficiency is common in individuals following vegan/vegetarian diets. Monitoring B12 status is critical for these individuals.

Serum B12 can be unreliable and less sensitive than urinary or serum methylmalonic acid (MMA). I use MMA and, in part, serum homocysteine to evaluate B12 status - with high levels of MMA indicating a need for B12, and high homocysteine a potential need.

Genetic analysis through services like GeneByGene.com and running the raw data through Livewello.com and/or Promethease.com can help you and your functional provider to decipher exactly which form of B12 and other vitamins to take for optimal effect.

Iron's Role in Brain Health:

Iron deficiency has been associated with individuals with ADHD.

Iron deficiency is a cause of anemia. Anemia is when the red blood cells are having difficulty carrying oxygen throughout the body. Iron is a component of hemoglobin in blood cells - low iron will disrupt the ability of red blood cells to carry oxygen.

The brain has more oxygen needs than anywhere else in the body - those who are anemic will have difficulty bringing oxygen to their brain.

Anemia comes in many forms - with iron deficiency being a common cause. Some basic blood work with your doctor can help you determine if you or your child is showing signs of anemia. 

You can express that iron deficiency is associated with issues with focus and attention, and ask for an anemia panel to be ordered alongside the complete blood count and metabolic panels typically ordered.

A functional medicine provider can help analyze the results further to optimize oxygen delivery to the body and brain - and help diagnose borderline anemia before it becomes a clinical disease state. 

Medical doctors look at whether your measurements fall outside of the accepted medical ranges - but functional medicine doctors will look to optimize function within tighter ranges associated with healthy individuals, not just average measurements.

Oxygen is necessary for life and healing. Anemia is a deal-breaker that needs to be addressed for all healing approaches to work their best.

Iron can be found in red meat, beans, and dark green vegetables, but also can be taken supplementally. I like Reacted Iron by Orthomolecular.

You can boost the absorption of iron by taking vitamin C alongside it - and by optimizing stomach acidity in the course of your normal diet via supplements like betaine HCl / Pepsin, and/or apple cider vinegar capsules.

L-Tyrosine and L-Carnitine - Support Neurotransmitters Behind Focus and Attention

Amino acids are the building blocks of proteins and enzymes. These structures perform the many functions of the body.

L-tyrosine is a direct precursor to the neurotransmitter dopamine (as well as stress hormones epinephrine and norepinephrine known more widely as "adrenaline"). L-tyrosine is carried by a number of brands, I tend to use L-tyrosine by Pure Encapsulations.

Dopamine is involved in motivation and attention - so L-tyrosine supplementation has been recommended as a safe way for individuals to support ADHD-related symptoms and general focus issues - before turning to more aggressive means via medication.

Stress will use up the L-tyrosine raw material to produce stress hormones - stealing away production from dopamine and increasing your needs of the amino acid.

L-carnitine - specifically acetyl-l-carnitine helps support acetyl groups used in acetylcholine - another focus neurotransmitter.

The carnitine helps to shuttle energy into cells of the brain - fueling brain activities. It's often combined with a choline supplement such as phosphatidylcholine or CDP-choline. The acetyl portion of the former combines with the choline portion of the latter - to create acetylcholine.

Acetylcholine is a neurotransmitter not only involved with focus, but also gut motility!

I like adding coenzyme Q10 in the ubiquinol form to help absorb oxidative stress any time I'm boosting metabolic activity in the body - and I recommend consuming levels near 300mg although as little as 60mg may be supportive.

It's interesting that those with brain issues often suffer from constipation and motility issues too!

Supplements to Support Brain Circulation and Antioxidant Protection

Someone with ADHD may not be getting adequate blood flow to the focus centers of the brain - whether due to stress, inflammation, or head trauma. 

At 2-3% of body weight, the brain demands  20-25% of total oxygen-rich blood flow.

Small changes in blood availability of the brain have dramatic effects on total brain function - especially when it comes to less necessary areas devoted to focusing, attention, and deep planning.

Ginkgo biloba is an herb that is known to support circulation, especially to the brain. I love the combination of brain supportive nutrients in NeurO2 by Apex Energetics - yet it is also found in Mycobotanicals Brain by Host Defense or by itself such as in Gingko by Genestra.

Pycnogenol or pine bark extract, and resveratrol may also help target antioxidant protections in the brain and nervous system. These nutrients are also regarded to support anti-aging mechanisms throughout the body - what can be more important but to protect the health of your nervous system that controls every function in your body.

For pine bark extract, I turn to Pycnogenol by Klaire Labs. For resveratrol support, I like Resveratrol Ultra High Potency by Integrative Therapeutics. Anti-aging experts often include similar formulas in their everyday supplements.

NAD+ Support for Healthy Brain Function and Recovery

I also like TruNiagen - a nicotinamide riboside (NR) supplement that comes in 300mg and 500mg capsules.

NR is a new form of vitamin B3 that is regarded to support the production of “NAD+” - which has been referred to as the central regulator of metabolism.  NMN can be taken supplementally too and is also regarded to support NAD+ production and activation - and researchers go back and forth as to whether nicotinamide riboside or NMN is better. We currently use NAD Gold by Quicksilver Scientific.

Nevertheless, both sides absolutely agree that NAD+ support is critical to warding off the effects of cellular aging - and many also take resveratrol products simultaneously.

Levels of NAD+ may help support healthy brain function, reduce antioxidant load, support efficient breakdown and utilization of nutrients, and may ward off feelings of depression and anxiety.

Needs for NAD+ support increase after inflammation, stress, overeating, or overconsumption of alcohol. NAD+ also supports skin health, especially after a bout of sun damage - and is one of the most powerful ways to support a healthy complexion.

Live and Age Confidently: Bringing a Brain-Boosting Plan Together that Makes Sense

While many more nutrients could be linked to brain health - and have correlations with improvements in focus and cognition - the options listed above are the most commonly discussed in the literature.

When it comes to evaluating supplements, don’t overlook the powerful benefits of exercise, stress reduction, a clean diet, gut health and microbiome diversity, and good habits like sun exposure and sleep! 

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Dr Alex Rinehart

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