When I initially wrote this chapter, I was in central Oregon, lecturing to mental-health professionals about ADD. When I walked into the large lecture hall, my heart sank as I saw the food in the back of the room. On a table were boxes and boxes of muffins, donuts, bagels, and cinnamon rolls. I thought to myself, Oh no, Daniel, you have to be really good this morning or no one will be able to pay attention in about a half an hour. High-simple-carbohydrate foods are terrible for concentration. These foods are filled with sugar or substances that are easily broken down into sugar in the body. They cause a quick rise in blood sugar followed soon thereafter by an insulin release that lowers blood sugar below normal levels, making people feel tired, spacey, confused, and inattentive. Give people a lot of sugar (or high-carbohydrate substances like bread) in the morning, and they will act as if they have ADD. Did you know that if you chew bread long enough, it will actually begin to taste like sugar in your mouth? Your saliva has an enzyme called amylase that breaks down starches into glucose or sugar.
I started my lecture talking about the food in the back of the room. “The food in the back is a good example of what parents unknowingly do to make kids struggle in school. Most children start the day with muffins, donuts, Pop-Tarts, bagels, cinnamon rolls, and sugary cereals. They get virtually no protein in the morning. No wonder teachers complain that so many kids cannot concentrate. In order for children or adults to be able to concentrate, they need to have nutritious food that enhances energy and concentration. For most people with ADD, the right diet is a higher-protein, higher-healthy-fat, lower-simple-carbohydrate diet.” I was able to keep the group awake, but I wondered about all of the business meetings that start with muffins or donuts and become unproductive halfway through. A better breakfast for the group would have been hard-boiled eggs, nuts, chopped veggies, and fruit (but not fruit juice—too much sugar). I finished my introduction about food by saying, “If you want to concentrate this afternoon and have good energy until dinnertime, have no simple carbohydrates at lunch. No bread, no pasta, no potatoes, no rice, and no sugar. Have something like a stir-fry without the rice, a salmon salad, or a piece of meat and grilled veggies.” Many people who took my suggestions about lunch came up to me at the end of the day saying how amazed they were that they felt so good. They said that their energy and concentration were much better than they usually were.
Dietary interventions are very important in treating all types of ADD. Food can be used as brain medicine. It can have a powerfully positive effect on cognition, feelings, and behavior. It can have a very negative effect on these as well. The right diet can actually decrease the amount of medication needed. However, the wrong diet will do the opposite. Joseph Egger reported in the British medical journal The Lancet that 116 of 185 hyperactive children had a positive response to a low-allergen diet (higher in protein and lower in simple carbohydrates) supplemented by calcium, zinc, magnesium, and vitamins. Over and over in my clinical practice, I have found that diet matters for treatment and prevention.
When I can convince my patients to eat this way, they notice better mood stability, focus, and stamina, as well as less distractibility, tiredness in the late morning and midafternoon, and less craving for sugary substances. Here are the Amen Clinics Nine Rules for Brain-Healthy Eating. Using these strategies will enhance your brain for better focus and energy, and in some cases can be the primary treatment for ADD.
If you are going to eat right to think right, it is critical to make sure your food is loaded with proper nutrients that your body is able to properly digest and absorb.
The quality of your food matters. Always opt for high-quality food. Also, be careful with calories. Likely due to impulsivity, ADD is often associated with obesity, which has been demonstrated to be bad for the brain. Think of eating only high-quality calories. One cinnamon roll can cost you 720 calories; a small quiche can be more than 1,000 calories. Both will drain your brain. Swap those for a 400-calorie salad made of spinach, salmon, blueberries, apples, walnuts, and red bell peppers, which will supercharge your energy and make you smarter.
If you eat more calories than you need, you will be fatter, sicker, and less productive. In one study, researchers followed a large group of rhesus monkeys for twenty years. One group ate all the food they wanted, the other group ate 30 percent less. The monkeys who ate anything they wanted were three times more likely to suffer from cancer, heart disease, and diabetes, plus researchers saw significant shrinkage in the important decision-making areas of their brains. In addition, the calorie-restricted monkeys had smoother skin and healthier hair.
Your brain is 80 percent water. Anything that dehydrates it, such as too much caffeine or alcohol, decreases your thinking and impairs your judgment. Make sure you get plenty of water every day. To know you are drinking enough water for your brain, a good general rule is to consume half your weight in ounces per day, unless there is significant obesity, and then usually not more than 120 ounces a day.
Protein helps balance your blood sugar, helps you focus, and provides the necessary building blocks for brain health. Great sources of protein include fish, skinless turkey or chicken, beans, raw nuts, and high-protein vegetables such as broccoli and spinach. I use spinach instead of lettuce in my salads for a huge nutrition boost. Protein powders can also be a good source, but read the labels. Many companies put a lot of sugar and other unhealthful ingredients in their powders. It is important to start each day with protein to boost your focus and concentration skills.
This means eat carbohydrates that do not spike your blood sugar (low-glycemic index), that are also high in fiber, such as vegetables, and fruits like blueberries and apples. Carbohydrates per se are not the enemy; they are essential to your life. But bad carbohydrates are the enemy, substances that have been stripped of any nutritional value, such as simple sugars and refined carbohydrates.
Sugar is NOT your friend. Sugar increases inflammation in your body, increases erratic brain cell firing, is addictive, and has been implicated in aggression. In a new study, children who were given sugar every day had a significantly higher risk for violence later in life. I don’t agree with the people who say everything in moderation: Cocaine or arsenic in moderation is not a good idea. The less sugar in your life, the better your life will be. Inflammation in the body increases inflammation in the brain.
Get to know the glycemic index (GI). The glycemic index rates carbohydrates according to their effects on blood sugar. It is based on a scale of one to 100+ (glucose is 100), with the low-glycemic foods having a lower number (which means they do not spike your blood sugar, so they are generally healthier for you) and the high-glycemic foods having a higher number (which means they quickly elevate your blood sugar, so they are generally not as healthy for you). In general, I like to stay under 60.
Eating a diet that is filled with low-glycemic foods will lower your blood glucose levels, decrease cravings, and help you focus.
Choose high-fiber carbohydrates. Experts recommend eating 25 to 35 grams of fiber a day, but research shows that most people fall far short of that. Boost your fiber by eating fruits, vegetables, and legumes. When reading a label, look for >5g of fiber and <5g of sugar per serving.
Fat is not the enemy. Good fats are essential to your health. The solid weight of your brain is 60 percent fat (after all the water is removed). When the medical establishment recommended we remove fat from our diets, we got fat. However, bad fats, such as trans fats, are the enemy, and should be eliminated. Did you know that certain fats found in pizza, ice cream, and cheeseburgers fool the brain into ignoring the signals that you should be full? No wonder I used to always eat two bowls of ice cream and eight slices of pizza. Focus your diet on healthy fats, especially those that contain omega-3 fatty acids, found in foods like salmon, sardines, avocados, walnuts, flaxseed, chia seed, and dark green leafy vegetables.
This means put natural foods of many different colors into your diet; include blueberries, pomegranates, yellow squash, and red bell peppers. This will boost the antioxidant levels in your body and help keep your brain young.
Here is a little food for thought, literally.
As much as possible, eat organically grown or raised foods, as pesticides used in commercial farming can accumulate in your brain and body, even though the levels in each food may be low. Also, eat meat that is hormone free, antibiotic free, and that is free-range and grass-fed. It is critical to know and understand what the things you eat, ate. You are not only what you eat, you are also what the animals you eat, ate. In addition, eliminate food additives, preservatives, and artificial dyes and sweeteners. This means you must start reading the labels. If you do not know what is in something, do not eat it. Now is the time to really get thoughtful and serious about the food you put in your body.
Fish is a great source of healthy protein and fat, but it is important to consider the toxicity in some fish. Here are a couple of general rules to guide you: 1) The larger the fish, the more mercury it may contain, so go for the smaller varieties. 2) From the safe fish choices, eat a fairly wide variety of fish, preferably those highest in omega-3s, like wild Alaskan salmon, sardines, anchovies, and Pacific halibut.
Did you know that gluten can literally make some people crazy? There are scientific reports of people having psychotic episodes when they’re exposed to gluten, and when they eliminate wheat and other gluten sources (such as barley, rye, spelt, imitation meats, soy sauce) from their diets, their stomachs and their brains are better. One of my patients lost thirty pounds and her moodiness, eczema, and irritable bowel symptoms completely went away when she got wheat out of her diet. Another one of my patients would become violent whenever he ate MSG. When we scanned him on MSG, his brain changed into a pattern more consistent with our aggressive patients.
ADHD-affected and autistic children often do better when we put them on elimination diets that get rid of wheat, dairy, all the processed foods, all forms of sugar and sugar alternatives, food dyes, and additives.
There are blood tests you can take to learn more about your sensitivities to food.
To help you get started on the right path, here is my list of the fifty-two best brain-healthy superfoods. Make sure these foods are organic and, when appropriate, hormone free, antibiotic free, free-range, and grass-fed.
Most people don’t know that they can use food to manipulate their minds. Food can help you feel relaxed, happy, and focused, or downright dumb. The way we feed ourselves and our children in this country is backward.
Generally, simple carbohydrates such as those found in pancakes, waffles, muffins, bagels, or cereal boost serotonin levels that help us feel relaxed, calm, and less worried and motivated. Protein, found in meat, nuts, or eggs, boosts dopamine levels and helps us feel more driven, motivated, and focused. Yet, many people eat simple carbohydrates in the morning and have more protein-based meals at night.
For example, it is very common to feed ourselves or our children a breakfast of donuts, pancakes, sugary cereals, or bagels, along with fruit juices (concentrated sugar). Then we ask ourselves and our children to focus. These simple-carbohydrate-based meals spike insulin, which can often cause low blood-sugar levels in a short period of time, causing brain fog. In addition, simple carbohydrates spike serotonin levels in the brain, so we feel happier after the meal. The problem is that serotonin can also decrease our ability to get things done, and for many people can give them a more “don’t worry, be happy” attitude. Not exactly the best mindset for school or work. Protein-based meals tend to do the opposite. They can boost dopamine levels in the brain, give us energy, and help us focus. Therefore, it makes sense to eat a protein-rich meal earlier in the day to get started, or at dinner if you still need to get work finished in the evening. If you want to relax in the evening and go to bed early, I recommend decreasing the protein and eating more healthy, fiber-rich, complex-carbohydrate foods such as vegetables.
Often, when kids come home from school, parents give them a few cookies and a soda (a high-simple-carbohydrate-based snack). Then they tell them to do their homework. Unfortunately, the parents have unwittingly diminished their children’s ability to get their homework finished, and it causes a night of stress for everyone. Give them an apple and some peanut butter and watch them improve.
As a reminder, serotonin is a neurotransmitter that helps soothe the brain. It is intimately involved in sleep, mood regulation, appetite, and social engagement. It helps decrease our worries and concerns. Based on research at MIT, foods rich in simple carbohydrates have been found to quickly boost serotonin. They cause a spike in insulin, which lowers most large amino acids with the exception of tryptophan, the amino acid building block for serotonin, thereby decreasing the competition for tryptophan to get into the brain. This is why many people can become dependent on or even addicted to bread, pasta, potatoes, rice, and sugar. They use these as “mood foods” and feel more relaxed and less worried after they eat them. Unfortunately, because they boost serotonin, they can also lower prefrontal cortex function and diminish a person’s internal braking ability. I think this is precisely why restaurants serve bread and alcohol before a meal. If you consume them, you are much more likely to order dessert.
Brain-healthy foods that help to boost serotonin include smart carbohydrates such as sweet potatoes, apples, blueberries, carrots, gluten-free steel-cut oatmeal, quinoa, and chickpeas. These cause a more gradual increase in serotonin. It is a myth that foods that contain high levels of tryptophan, such as turkey, actually raise serotonin in the brain. This is because tryptophan is transported into the brain by a system that is geared toward larger protein molecules, and tryptophan, being smaller and less abundant, doesn’t compete well against the other proteins to get in the brain. This is one of the main reasons why exercise helps people feel better. Exercise pushes the larger amino acids into your muscles and thereby decreases the competition for tryptophan to get into the brain. If you want to feel happier, grab an apple and go for a walk.
Dopamine is the neurotransmitter involved in motivation, emotional significance, relevance, focus, and pleasure. It helps you get things done. Foods that tend to increase dopamine include beef, poultry, fish, eggs, seeds (pumpkin and sesame), nuts (almonds and walnuts), cheese, protein powders, and green tea. In addition, avocados and lima beans can help. Simple carbohydrates tend to deplete dopamine.
Acetylcholine is the neurotransmitter involved with learning and memory. Liver, eggs, salmon, and shrimp tend to boost these levels.
The gut is often called the second brain. It is loaded with nervous tissue and is in direct communication with our big brain, which is why we get butterflies when we get excited, or have loose bowels when upset. Anxiety, depression, stress, and grief all express themselves with emotional pain (the brain) and quite often, gastrointestinal (GI) distress.
Your gut is one of the most important organs for the health of your brain. It is estimated that the GI tract is loaded with about one hundred trillion microorganisms (bacteria, yeast, and others), about ten times the total number of cells in the human body. To be healthy, the relationship of good bugs to bad bugs needs to be lopsided in the positive direction, around 85 percent good guys to 15 percent bad guys. When it goes the other way and the bad bugs get a foothold, all sorts of physical and mental problems can arise. Keeping the good and bad bugs in proper balance is essential to your mental health.
There is new evidence that friendly gut bacteria actually deter invading troublemakers, such as E. coli, and help us withstand stress. If the friendly bugs are deficient, either from a poor diet that feeds yeast overgrowth (think sugar), or the excessive use of antibiotics (even as far back as childhood) that killed the good bacteria, we are more likely to feel stressed. Disorders ranging from ADD to autism in children, and depression to mental fogginess in adults, have been connected to intestinal bacteria imbalances that cause increased gut permeability.
The intestines provide an important barrier to bad bugs from the outside world. If they become too permeable, often called “leaky gut,” inflammation and illness can be created throughout the body. Optimizing the “gut-brain axis” is critical to your mental health.
Factors that decrease healthy gut bacteria:
The greatest danger from antibiotics does not come from those prescribed by your doctor, but rather from the foods you eat. The prevalence of antibiotics found in conventionally raised meats and vegetables has the potential to throw off the balance of good to bad bacteria. It is estimated that 70 percent of the total antibiotic use in the U.S. is for livestock. It is critical to focus on eating antibiotic free, hormone free, grass-fed, free-range meats.
We all need the good bugs in our intestinal tract to boost our immune system, so be careful not to go overboard in keeping your children away from the dirt. Animals raised in a germ-free environment show exaggerated responses to psychological stress. When researchers gave the animals probiotics (healthy bugs), their stress levels normalized.
Stress, all by itself, decreases healthy gut flora. Early abandonment issues can cause increased stress, decreased healthy bacteria, and increased gut permeability. When young rats were separated from their mothers, the layer of cells that line the gut became more permeable, allowing bacteria from the intestine to pass through the bowel walls and stimulate immune cells to start attacking other organs. “In rats, it’s an adaptive response,” reports Dr. Emeran Mayer of the UCLA Collaborative Centers for Integrative Medicine. “If they’re born into a stressful, hostile environment, nature programs them to be more vigilant and stress responsive in their future life.” Dr. Mayer says that up to 70 percent of the patients he treats for chronic gut disorders had experienced early childhood traumas like parents’ divorces or deaths, or chronic illnesses. “I think that what happens in early life, along with an individual’s genetic background, programs how a person will respond to stress for the rest of his or her life.”
What does this mean for you? Follow the brain-healthy food guidelines in this chapter carefully, especially by eliminating most of the simple sugars from your diet that feed the bad bugs. Focus on eating smart carbohydrates (low glycemic, high fiber), which enhance healthy flora. Also, consider taking a daily probiotic to give the good bugs a head start. Be careful with antibiotics, and if you had a lot of them in the past, a probiotic and healthy diet becomes even more important to the health of your brain.
As we have seen, Type 3 (Overfocused) ADD is associated with low serotonin and dopamine levels. It is often associated with worrying, moodiness, emotional rigidity, and irritability. A higher-protein, higher-healthy-fat, lower-carbohydrate diet (that enhances focus) may cause people with Overfocused ADD to focus even more on the things that bother them. Remember, the problem in this type is not that they can’t pay attention, it is that they can’t stop paying attention and they tend to get stuck in negative thoughts or behaviors. Dietary interventions need to be geared toward naturally increasing serotonin and dopamine.
Diet matters. Pay attention to it.