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Running Header: POSSIBLE EFFECTS OF A PALEOLITHIC DIET ON ADHD SYMPTOMS

Possible effects of a Paleolithic diet on Symptoms of the Attention Deficit Hyperactivity Disorder Lindsay Allwood, Jamie Husain, and Brian Umali

Authors Note: Literature Review WRI 101- 03 Professor Matt Moberly

POSSIBLE EFFECTS OF A PALEOLITHIC DIET ON ADHD SYMPTOMS An Overview of Attention Deficit Hyperactivity Disorder (ADHD) The DSM-V characterizes Attention Deficit Hyperactivity Disorder, or ADHD, as a pattern of behavior, presented in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings. More young children are being diagnosed with attention deficit and being placed on stimulant medication. Current best evidence supports using immediate release methylphenidate as first-line treatment for most adults with ADHD (Peterson et al., 2008). According to data from the Federal Centers for Disease Control and Prevention, nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of Attention Deficit Hyperactivity Disorder (New York Times, 2013). ADHD patients are characterized by inappropriate risk-taking and disadvantageous decision-making (Drechsler et al., 2008). Some studies have been conducted using the Iowa Gambling task which largely focus on risk taking in ADHD patients. Another recent study adopted the Game of Dice Task, a test procedure in which risks are made explicit (Drechsler et al., 2008). Is risk taking the same as decision making? There is also evidence to suggest that risk-taking behavior and impaired decision making are not synonymous (Bechara et al., 2000). There is concern that risk and decision making tasks may show deficits in laboratory settings, but not in real life situations. An ADHD group performed well on a simple driving simulator, but obtained low scores on a test containing driving rules and decision-making (Barkley et al., 2002). ADHD may be a more efficient use of attention and that imaging studies showing deficiency in certain brain regions may be a more optimal efficient use of those areas. Though ADHD cannot be treated, its symptoms can be minimized through many treatments. These various types of treatments include medications and therapy. Diet is not often thought about as a treatment method for ADHD patients. Studies show that eliminating certain foods and replacing them with alternative healthy options may reduce ADHD symptoms, this will be further discussed later in this review.

ADHD Neuroimaging Literature Findings in neuroimaging literature of ADHD report there are decits in neural activity within fronto-striatal and fronto-parietal circuits (Dickstein et al., 2006). Laboratory measures, such as computerized tests of attention, EEG, SPECT, and positron emission tomography, have potential as research tools, but there is no evidence to support their routine clinical use in the diagnosis of ADHD (McGough et al., 2004). Although laboratory measures should not be relied upon for routine clinical use in diagnosis of ADHD, there are still interesting findings. A study shows children with ADHD manifest reduced blood ow to frontal lobes and basal ganglia but increased blood ow to occipital lobes (Lou et al., 1990). Another PET study shows lower glucose metabolism in the frontal lobes of the ADHD group when performing an auditory attention task (Zametkin et al., 1990). Many studies have found less activation of brain areas in ADHD patients. It is exciting to consider the idea that these deficiencies may be a sign of

POSSIBLE EFFECTS OF A PALEOLITHIC DIET ON ADHD SYMPTOMS efficiency. A recent study has shown that physical activity during childhood can lead to more adult-like recruitment of anterior prefrontal brain areas important for maintenance and goaloriented cognitive control (Chaddock-Heyman et al., 2013). Adult-like recruitment of these areas actually means mature, optimal and efficient. Many studies showing deficits in ADHD patients through less activation of brain regions in lab tasks may actually be showing brains that are simply more efficient. Many people diagnosed with ADHD may not have a deficit of attention but rather a more efficient use of attention. It is possible that ADHD has been over diagnosed and that many patients suffering from impaired judgment and decision making could benefit from alternatives to stimulant medication. This leads to a discussion of diet.

The Paleolithic Diet as an Alternative Treatment Option for ADHD The effects of nutrition on brain plasticity and neurogenesis are important areas for future research. Nutrition is also said to be very connected to genetics, age and lifestyle (Dauncey, 2009). A balanced diet is very important for the development and regulation of a healthy brain. More specifically, there is evidence that a bad diet or undernourishment can increase the negative symptoms of Attention Deficit Hyperactivity Disorder. Research shows that the typical diet of industrialized western societies can contribute to declined cognitive functioning ( Knopman et al., 2001). This has been confirmed a study conducted on rats where a high-fat, refined sugar diet reduced brain-derived neurotrophic factor, neuronal plasticity, and learning (Molteni et al., 2002). The human brain has developed to be a complex organ, which has given our species astonishing abilities. These abilities have led to societal advancements leading toward industrialization. Has this movement toward industrialization actually been detrimental to us? What if people transformed their diets to reflect how their ancestors ate thousands of years ago? This is known as the Paleolithic diet. A Paleolithic diet is a modern dietary reg-imen based on foods presumably eaten regularly during the Paleolithic, which includes lean meat, fish, shellfish, fruits, vegetables, roots, eggs and nuts, but not grains, dairy products, salt or refined fats and sugar, which became staple foods long after the appearance of fully modern humans (Jnsson et al., 2009).

Distinguishing the Paleolithic Diet from the Mediterranean Diet There has already been considerable research conducted showing improvements in cognition as a result of a Mediterranean diet. Adherence to a Mediterranean diet has been shown to reduce the risk of Alzheimers and Parkinsons disease by 13% (Sofi et al., 2008). While there has been discussion of the Mediterranean diet and its effects on cognition there is room for discussion. It is important to differentiate between Paleolithic diet and a Mediterranean diet. The few articles discussing the Paleolithic diet have called for further investigation, especially in human subjects. It has been discussed that the theoretical underpinning of a Paleolithic nutrition is more robust than that of any other proposed health-promoting dietary regimen (Lindeberg et al., 2003). A

POSSIBLE EFFECTS OF A PALEOLITHIC DIET ON ADHD SYMPTOMS recent study shows that a Paleolithic diet improved glucose tolerance and was lower in glycemic compared to a Mediterranean-like diet (Lindeberg et al., 2007).

Polyunsaturated Fats found in the Paleolithic Diet and Time Frame for Effects Advocates of the Paleolithic diet call for the consumption of grass feed beef and wild caught fish, both of which are said to be high in omega 3/omega 6 fatty acids. The Paleolithic diet is not characterized by the absence of omega 6 and omega 3 acids but rather by the ratio of omega 6 to omega 3 (Lindeberg et al., 2003). A popular trend in nutrition articles is also the discussion of DHA/EPA also known as polyunsaturated fatty acids or omega 3/omega 6 (Dauncey, 2009). By including omega 3 and omega 6 fatty acids and in their correct ratio, the Paleolithic diet shows promise for ameliorating core symptoms of ADHD. A study has shown the significant positive treatment effects of polyunsaturated fatty acids (PUFAS) on parent ratings of core ADHD symptoms on the Conners Parent Rating Scale (CPRS) (Sinn & Bryan, 2007). The same study states that supplementation can take 8-12 weeks before there is an improvement of symptoms and that symptoms can be dramatically reduced after 30 weeks. (Sinn & Bryan, 2007). There was initial concern that children given the PUFAS supplements may suffer from withdrawal from stimulant medication. However the study took place over 30 weeks total and showed positive results for EPA/DHA supplementation.

Improvement in Cognition with Caloric Restriction Characteristic of Paleolithic Diet Advocates of the Paleolithic diet say our ancestors would routinely have to go for periods of time without food when food was scarce. They believe that this created a genetic disposition for cognitive improvement when subject to intermittent fasting. A study conducted supports the idea that intermittent fasting leads to increased cognition, specifically spatial navigation abilities in rats (Halagappa et al., 2007).Whether these abilities are translated directly to humans is still in question. The study reports that Alzheimers disease can be slowed down by using dietary energy restriction. Caloric restriction and intermittent fasting were tested using mice in a water maze and open apparatus. The study shows that mice on the caloric restriction diet and intermittent fasting diet exhibit higher levels of exploratory behavior and performed better in the water maze task. The study suggests that caloric restriction and intermittent fasting can ameliorate agerelated deficits in cognition function (Halagappa et al., 2007).

Food Journaling Effects

POSSIBLE EFFECTS OF A PALEOLITHIC DIET ON ADHD SYMPTOMS A empirical research study found that the act of writing foods into a diary maximized memory of participants and brought forth their attention to meal (Krall & Dwyer, 1987). ADHD patients already have difficulties paying attention and often forget things. Research has shown that food journaling is beneficial to the overall populations, which can suggests that people diagnosed with ADHD could also benefit by their abilities to pay attention and remember more improving.

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POSSIBLE EFFECTS OF A PALEOLITHIC DIET ON ADHD SYMPTOMS

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