ADHD and Gut Health are More Connected Than You

Think
drruscio.com/adhd-and-gut-health

September 25, 2023

Articles
Evidence based
— Reviewed by Kellie Blake

Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct
professor at the University of Bridgeport. His work has been published in peer-reviewed medical
journals and he speaks at conferences around the globe.

Even Simple Gut Health Changes Can Go a Long Way for ADHD

Key Takeaways:
While attention deficit hyperactivity disorder (ADHD) has long been associated with
an imbalance of neurotransmitters in the brain, there’s a strong possibility that poor
gut health also affects symptoms in many individuals.
Some form of gut dysbiosis (candida overgrowth, viral infection, etc.) likely plays a
role in ADHD for both kids and adults.
Via the gut-brain connection, dysbiosis and inflammation in the gut can also
translate to neuroinflammation and disrupted communication in the brain.
An anti-inflammatory diet, probiotics and other gut-based treatments may be helpful
for treating ADHD and gut health symptoms.

For decades, attention deficit hyperactivity disorder (ADHD, formerly known as attention
deficit disorder, ADD) has been labeled primarily as a disorder of the brain, possibly
extending to the central nervous system. However, it’s becoming more and more clear
that the gut — especially the gut microbiome — has a say in many different neurological
and psychiatric disorders, including ADHD.

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ADHD may look like difficulty paying attention and maintaining concentration,
disorganization, poor emotional regulation, and forgetfulness, among other symptoms. All
of these issues can be influenced by a dysregulated gut.

So that begs the question about ADHD and gut health: can healing your gut improve or
even resolve ADHD symptoms? Let’s see what the research has to say and investigate
possible treatments, including diet, probiotics, and antimicrobials.

ADHD Overview

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Before we dig into the research on gut health and ADHD, let’s do a quick overview of the
basics. Attention deficit hyperactivity disorder is considered a neurodevelopmental
disorder or neuropsychiatric disorder, usually diagnosed in childhood before the age of
12. However, adults may be diagnosed with the condition too, often after having been
dismissed or unacknowledged in childhood when it first manifested. This is especially true
for girls, who are more likely to have the inattentive subtype rather than hyperactive, and
so may go relatively unnoticed until much later in life.

The most common presentations include [1]:

Poor attention and concentration

Constant need to move or fidget
Emotional dysregulation
Impulsivity
Disorganization
Difficulty making decisions
Trouble finishing tasks
Forgetfulness
Frequently losing things

ADHD has three different subtypes: predominantly hyperactive/impulsive, predominantly

inattentive, and combined hyperactive/impulsive and inattentive [1]. Among all ADHD
patients, about 8% are hyperactive/impulsive, about 18% fall under the inattentive
subtype, and about 70% demonstrate the combined subtype [1].

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ADHD is thought to arise from a combination of genes (it’s very common in siblings) and
triggers in the environment — including possible viral infections, smoking and/or drinking
during pregnancy, and nutritional deficiencies during pregnancy and after birth —
affecting certain receptors in the brain [1]. According to the CDC, about 6 million
(almost 10% of) children in the US received an ADHD diagnosis from 2016–2019
[2].

It has also been assumed for many years that most children with ADHD will “outgrow” the
condition as they grow into adulthood. While some symptoms, like hyperactivity and
inability to sit still, may diminish over time, it’s likely that certain ADHD symptoms will
persist into adulthood, such as a tendency toward disorganization, impulsive behavior,
inattention, and forgetfulness. Adults are much more likely to “mask” these symptoms to
be accepted socially, while children have not learned such behaviors yet.

The first-line conventional treatment for ADHD in children and adults is stimulant
medications, which can be very effective and safe when given properly, however perhaps
not sustainable. They are also at a high risk for side effects, including weight loss,
suppressed appetite, irritability, and more [1]. Non-stimulant ADHD medications are also
available if stimulants are not an option, but they tend not to be as effective as stimulants
[1]. Well-researched non-pharmacological treatments include psychosocial therapies like
psychoeducation for the family and patient and cognitive behavioral therapy (CBT) [1].

With that said, let’s move on to ADHD and gut health.

Not Just Neurotransmitters: How the Microbiome Affects ADHD

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As with anxiety and depression, the predominant thought on what causes ADHD is an
imbalance of neurotransmitters (such as dopamine, norepinephrine, and serotonin) in the
brain. And just like anxiety and depression, that isn’t the whole story.

While more research needs to be done, there seems to be at least a connection between
a disordered gut and ADHD, even if we can’t definitively say that one causes the other.
For example, research showing gut bacteria differences in children with ADHD
challenges the idea that the condition is solely related to neurotransmitters [3].

Another study showed that people of all ages with ADHD appeared to have a distinct gut
bacteria profile that overlapped with conditions like anorexia and bipolar disorder,
suggesting probiotics and a healthy diet could aid in treatment (by correcting the
microbiome) [4]. Indeed, gut dysbiosis may play a role in ADHD in kids and adults and
could be a useful target for therapy.

Along these lines, another recent study showed that fungal dysbiosis in the gut,
specifically levels of Candida albicans, were “significantly increased in ADHD
patients compared to the healthy controls” [5]. This suggests that curbing Candida
growth may improve symptoms of ADHD in certain individuals.

Other studies show that taking antibiotics during pregnancy may be linked to a
higher risk of ADHD in offspring (in both human clinical trials and lab studies on mice)
[6, 7], perhaps by impacting fetal development through the mother’s gut [7]. The
same risk of ADHD wasn’t found for infants who received antibiotics only out of the
womb, in their first years of life [7].

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Gut conditions, such as celiac disease [8] and excess gut permeability, aka leaky gut [9],
may also elevate ADHD risk. In fact, high levels of a leaky gut biomarker called zonulin
appeared to correlate with more severe ADHD symptoms in children [9].

One way to imagine the impact of leaky gut on the brain looks something like this:

Intestinal inflammation → increased permeability → bacterial metabolites

(lipopolysaccharides, aka LPS) travel to the brain → cause neuroinflammation → mental
health symptoms occur.

Clearly, there are many factors associated with the gut that may contribute to developing
ADHD. But what about how the gut impacts the brain itself?

The Gut-Brain Axis and ADHD

While the gut is considered your “second brain” and has a nervous system of its own
(another potential reason for its involvement in neurological disorders), the gut can also
send messages to your actual brain to either perform optimally or cause mixed signals
(and vice versa). This is called the gut-brain axis.

One major player in the gut-brain axis is the vagus nerve, the long wandering nerve that
connects the brain to the gastrointestinal system, among other essential organs, including
the heart and lungs. Dysbiosis and inflammation in the gut can negatively impact the
vagus nerve, which impairs communication with the brain and compounds inflammation.
There isn’t much direct research on this connection, but it’s not illogical to assume that an
inflamed gut causing an inflamed brain via the gut-brain axis could be contributing to
ADHD symptoms [3].

Does Gut Dysbiosis Cause ADHD?

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Based on current research, we can say that gut dysbiosis may play a role in ADHD
and could be a useful target for therapy [10]. This could look like an imbalanced
bacteria profile [4], fungal overgrowth [5], viral infections [1], and parasitic infections [11,
12]. These pathogens may cause immune system and nervous system dysregulation that
could show up as ADHD and other brain-related symptoms.

In fact, dysbiosis can cause intestinal inflammation, leading to leaky gut, food
sensitivities, vagus nerve disruption, and neuroinflammation, as we discussed above. On
another level, dysbiosis in the gut could also limit nutrient absorption which could
contribute to ADHD symptoms.

Can Gut Health Treatments Improve ADHD Symptoms?

Now that we know poor gut health may contribute to or cause ADHD, let’s see what we
can do to improve it with gut health treatments.

Diet

While there isn’t a specific diet tied to improving ADHD, we do have some broad research
on healthy, whole food-based diets improving ADHD symptoms in kids and teens. Two
large meta-analysis research reviews linked healthy diets (veggies, fruits, legumes, fish)
to lower ADHD risk in kids and teens, whereas Western and junk food diets raised the risk
[13, 14, 15]. Another study suggested that certain synthetic food colorings might affect
attention in kids with ADHD

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Based on these studies, a good diet strategy for ADHD seems to be eating as many
whole-food, antioxidant-rich, nutrient-rich foods as possible, and the least amount of
processed foods possible.

We also know that certain nutrients, including vitamin D and zinc, may help curb ADHD
symptoms, which can be acquired through a healthy diet (and sun exposure in the case
of vitamin D) [16, 17]. Multivitamin/multimineral supplements have also been shown to be
helpful for children with ADHD when taken consistently, again showing that a wide range
of nutrients found in a healthy diet are likely beneficial to counteract ADHD symptoms [18,
19].

Plus, an anti-inflammatory diet can help restore the microbiome, regulate the vagus
nerve, reduce neuroinflammation, decrease leaky gut, and help increase proper nutrient
absorption from foods through the gut lining. So we can approach ADHD from multiple
angles by implementing a healthy diet.

If you’re looking for a little more guidance and parameters to follow, I recommend most of
my patients start on the Paleo diet for optimal gut and brain health. You can find a full
breakdown and recommendations on how to start Paleo here.

Probiotics
Beyond a healthy diet, we do have some promising research on how probiotics
(beneficial bacteria) may benefit brain function for those with ADHD.

One RCT found that kids with ADHD who took synbiotics (prebiotic + probiotic
supplements) had less ADHD-associated inflammation, in part because the synbiotics
increased short-chain fatty acid production [20].

Another RCT found that kids whose mothers took probiotics during pregnancy and then
gave them probiotics for the first 6 months of life had a lower risk of developing ADHD
than kids and their moms who took a placebo [21].

Finally, a small nonrandomized trial showed that after kids and teens with ADHD took
probiotics for 8 weeks, their clinical symptoms improved and their gut microbes changed
[22].

If you want to try probiotics, I recommend a multi-species Lactobacillus and

Bifidobacterium blend starting with at least 1-10 billion CFUs. Or you can check out our
Probiotic Triple Therapy sticks, which combine all three types of probiotics (multi-species,
soil-based, and S. boulardii) in one. We typically find in our clinic that even those who
haven’t had success with other probiotics in the past respond well to our Triple Therapy
approach.

Short-Chain Fatty Acids

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Interestingly, the bulk of research shows that omega-3 essential fatty acids don’t seem to
improve outcomes of ADHD [23, 24]. However, short-chain fatty acids (SCFAs), like
butyrate, may have some merit. A study of Korean elementary school students found that
those with ADHD had significantly lower diversity in their gut microbiota and much lower
concentrations of short-chain fatty acids acetate and butyrate than the control group [25].
Similar low levels of SCFAs have also been found in adults with ADHD [26].

While low SCFAs may not necessarily cause ADHD, it’s likely some kind of dysbiosis is
leading to disrupted microorganisms in the gut, low SCFA levels such as butyrate, and
ADHD symptoms. Besides optimizing the diet and consuming resistant starches, which
your gut ferments to create butyrate, supplementing butyrate alongside probiotics may be
a therapeutic option for ADHD.

Antimicrobials
If gut infections are present, antimicrobials may also be used to help improve ADHD
symptoms. Which antimicrobial you need will depend on the type of infection and
individual tolerance. For example, oil of oregano is a powerful antimicrobial for just about
any pathogen, but for some, it may be too strong. Or you may need a combination of
antimicrobials such as berberine, artemisia, caprylic acid, and others.

In this case, it’s probably a good idea to work with a healthcare practitioner who can help
you determine what kind of dysbiosis is present in your gut and the best options to treat
it.

Heal Your Gut to Balance Your Brain

Whether poor gut health is a root cause for your ADHD symptoms or one factor of many,
supporting your gut health can only bring benefits to your brain and overall mental health.
You may be surprised by what even simple changes like following a Paleo diet or taking
daily probiotics can make!

You can learn more about gut-healing diets, protocols for dysbiosis, probiotics, and much
more for your overall health and wellness in my book Healthy Gut, Healthy You.

The Ruscio Institute has developed a range of high-quality formulations to help our
patients and audience. If you’re interested in learning more about these products, please
click here. Note that there are many other options available, and we encourage you to
research which products may be right for you.

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