ADHD Diet - practical family meals

Practical ADHD diet for the family

ADHD Diet

A high-protein, low-sugar ADHD diet can help improve ADHD symptoms in children. Parents of children with ADHD are overwhelmed with dietary advice that is often time-consuming and disruptive to the household. However, this need not be so. Research shows it is feasible to incorporate an ADHD diet as part of an ongoing ADHD treatment program. Medication with behaviour modification is the backbone of ADHD treatment. A practical diet can be incorporated into the family routine to supplement ADHD treatment.

High Protein

Foods rich in protein - poultry, fish, eggs, beans, nuts, soy, mutton and low-fat dairy products (milk, paneer, cheese) - may have beneficial effects on ADHD symptoms.

Protein-rich foods are used by the brain to make neurotransmitters, the chemicals released by brain cells to communicate with each other. Protein can prevent surges in blood sugar, which increase hyperactivity. Giving your child protein for breakfast will help his body produce brain-awakening neurotransmitters. Combining protein with complex carbohydrates that are high in fibre and low in sugar will help your child manage ADHD symptoms better during the day.

Low Sugar

Eating simple processed carbohydrates, like white bread and jam, is almost the same as feeding your child sugar! Sugar surges are shown to increase inattention in children with ADHD. The body digests these processed carbohydrates into glucose (sugar) so quickly that the effect is virtually the same as eating sugar from a spoon.

For children with ADHD symptoms serve breakfasts and lunches high in protein, complex carbohydrates, and fibre — like cereals, dalia, upma with vegetables and nuts, and a glass of milk. Peanut butter on a slice of whole grain bread would also be good. The sugars from these carbohydrates are digested more slowly, because protein, fibre, and fat eaten together result in a more gradual and sustained blood sugar release. The result? A child can concentrate and learn better at school.

Supplements

Additive-free and oligoantigenic or elimination diets are time-consuming, disruptive to the household, and impractical. They have no proven role in ADHD treatment. Iron and zinc are best supplemented in children with known deficiencies. Omega-3 fatty acids supplements may be tried in some children with ADHD.

Greater attention to a healthy diet while omitting food that predisposes to ADHD symptoms, is perhaps the most effective and practical ADHD diet.

References

1. Millichap JG1, Yee MM. http://pediatrics.aappublications.org/content/129/2/330.long The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. 2012 Feb;129(2):330-7. doi: 10.1542/peds.2011-2199. Epub 2012 Jan 9.
2. Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. http://jad.sagepub.com/content/15/5/403.abstract?ijkey=d7ce9f17e13e896d1e6b00f2684ad29523c1c5a9&keytype2=tf_ipsecsha ADHD is associated with a “Western” dietary pattern in adolescents. J Atten Disord. 2011;15(5):403–411
3. Wender EH, Solanto MV. http://pediatrics.aappublications.org/cgi/ijlink?linkType=ABST&journalCode=pediatrics&resid=88/5/960 Effects of sugar on aggressive and inattentive behavior in children with attention deficit disorder with hyperactivity and normal children. Pediatrics. 1991;88(5):960–966.
4. Yehuda S. http://pediatrics.aappublications.org/external-ref?access_num=3305401&link_type=MED Nutrients, brain biochemistry, and behavior: a possible role for the neuronal membrane. Int J Neurosci. 1987;35(1–2):21–36

Corex cough syrup - no more OTC opioid dependence

Reducing codeine supply forces Corex users to the spiral of change

Corex Cough Syrup opioid dependence

Codeine cough syrup is no longer available over-the-counter (OTC) without a prescription. Record keeping by the dispensing pharmacist is now mandated by a new government notification. This one legislation will aid relapse prevention in abstinent Corex cough syrup addicts. Many former codeine addicts have relapsed after visiting their dispensary for another medication; the pharmacist casually offers opioid containing Corex cough syrup and provides a visual cue to trigger craving and retard their progress through the stages of change.

Codeine cough syrup addiction is fuelled by dispensaries that distribute litres of codeine in the form Corex Cough Syrup and other brands like Mits Linctus. The key ingredient in these ‘cough syrups’, Codeine, is derived from opium and is an addictive substance. Codeine containing cough syrup abuse made its entry to India in the 1990s and since then has contributed to the steadily increasing opioid dependence case-load.The estimated number of opium users in India is well over 5 million with codeine being a major oral source. Opioid dependence in a de-addiction centre increased significantly from 37 to 52% over the last three decades.

Relapse prevention at the pharmacy

Codeine dependent individuals are exposed to visual cues of Corex and other codeine containing cough syrups at every visit to the dispensary. Modification of addictive behaviours involves progression through five stages of change - precontemplation, contemplation, preparation, action, and maintenance. Individuals cycle through these stages many times before termination of the addiction. During relapse individuals regress to an earlier stage of codeine use. Stimulus control - avoiding or countering reminders of codeine use - is a key process for relapse prevention on the spiral of change. Cutting off easy access in the dispensary aids stimulus control and helps prevent relapse to codeine use. The common sight of multiple discarded codeine cough syrup bottle on stairwells would also disappear (see image).

Codeine cough syrup abuse prevention

1. Pharmacy-based approaches help in minimising the harm associated with OTC medicine abuse, and supporting and treating affected individuals.
• Removing products from sight
• Alerting or counselling customers to the abuse potential of products is effective.
• Refusing sales without a prescription
• Suggesting customers contact their doctor
• Supplying only limited amounts.
2. Raising awareness of the addiction potential of codeine cough syrup is necessary for both the public and the prescribers (many doctors are unaware of the ingredients that go into Corex and other cough syrups).
3. Preventing access is the domain of the government.  Regulating and monitoring codeine prescription and dispensing is a welcome step. The finance ministry is now attempting to enable tracing of batches of codeine containing cough syrups  to their suppliers in a bid to control smuggling of Corex and other codeine containing cough syrups.

Nature's vengeance

Unexpected help in relapse prevention by restricting supply has also come in the form of mother nature. Opium growers in Mandsaur, MP are ruing the increasing numbers of nilgai (Boselaphus tragocamelus) that have developed opioid dependence after chance grazing in farms that were once grassland. The nilgai now run amok and destroy swathes of poppy fields in search of their fix.

References

1. Debasish Basu, Munish Aggarwal, Partha Pratim Das, Surendra K. Mattoo, Parmanand Kulhara & Vijoy K. Varma. Changing pattern of substance abuse in patients attending a de-addiction centre in north India (1978-2008). Indian J Med Res 135, June 2012, pp 830-836
2. Richard J. Cooper. J Subst Use. Over-the-counter medicine abuse – a review of the literature. Published online Oct 3, 2011. doi: 10.3109/14659891.2011.615002. Apr 2013; 18(2): 82–107.
3. Gary Reid and Genevieve Costigan. Revisiting ‘The Hidden Epidemic’ A Situation Assessment of Drug Use in Asia in the context of HIV/AIDS. The Centre for Harm Reduction, The Burnet Institute, Australia. 2002. 
4. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992 Sep;47(9):1102-14.