by Nancy Clark, MS, RD, CSSD
As a sports nutritionist, I commonly counsel runners and other athletes who have Attention Deficit Hyperactivity Disorder—generally referred to as ADHD (or ADD). ADHD is characterized by hyperactivity, impulsivity, and/or inattention. It affects 4-10% of all American children and an estimated 4.4% of adults (ages 18-44 years). ADHD usually peaks when kids are 7 or 8 years old. Some of the ADHD symptoms diminish with maturation but 65-85% of the kids with AHDH go on to become adults with ADHD.
Ideally, runners with ADHD get the help they need to learn how to manage their time and impulsiveness. Unfortunately, many youth athletes with ADHD just receive a lot of negative feedback because they have difficulty learning rules and strategies. This frustrates teammates and coaches. Older athletes with ADHD often run to reduce their excess energy, calm their anxiety, and help them focus on the task at hand. This article offers nutrition suggestions that might help coaches, friends, and parents, as well as runners with ADHD, learn how to calm the annoying ADHD behaviors.
• To date, no clear scientific evidence indicates ADHD is caused by diet, and no specific dietary regime has been identified that resolves ADHD. High quality ADHD research is hard to do because the added attention given to research subjects with ADHD (as opposed to the special diet) can encourage positive behavior changes. But we do know that when & what a person eats plays a significant role in ADHD management and is an important complimentary treatment in combination with medication.
• ADHD treatment commonly includes medications such as Concerta, Ritalin & Adderall. These medications may enhance sports performance by improving concentration, creating a sense of euphoria, and decreasing pain. These meds are banned by the World Anti-Doping Agency (WADA) and the International Olympic Committee (IOC). Hence, runners who hope to compete at a high level are discouraged from taking ADHD medications
• To the detriment of ADHD runners, their meds quickly blunt the appetite. Hence, they (like all athletes) should eat a good breakfast before taking the medication.
• The medication-induced lack of appetite can thwart the scrawny teen runner who wants to gain weight and add muscle. Teens should be followed by their pediatricians, to be sure they stay on their expected growth path. If they fall behind, they could meet with a registered dietitian (RD) with knowledge of sports nutritionist (CSSD) to help them reach their weight goals.
• An easy way for “too thin” runners to boost calories is to swap water for milk (apart from during exercise). The ADHD athlete who does not feel hungry might find it easier to drink a beverage with calories than eat solid food. Milk (or milk-based protein shake or fruit smoothie) provides the fluid the athlete needs for hydration and simultaneously offers protein to help build muscles and stabilize blood glucose.
• A well-balanced diet is important for all runners, including those with ADHD. Everyone’s brain and body need nutrients to function well. No amount of vitamin pills can compensate for a lousy diet. Minimizing excess sugar, food additives, and artificial food dyes is good for everyone.
• Eating on a regular schedule is very important. All too often, high school runners with ADHD fall into the trap of eating too little at breakfast and lunch (due to meds), and then try to perform well during afterschool sports. An underfed brain gets restless, inattentive, and is less able to make good decisions. This can really undermine an athlete’s sports career
• Adults with ADHD can also fall into the same pattern of under-fueling by day, “forgetting” to eat lunch, then by late afternoon are hangry and in starvation mode. We all know what happens when any runner gets too hungry – impulsiveness, sugar cravings, too many treats, and fewer quality calories. This is a bad cycle for anyone and everyone.
• All runners should eat at least every four hours. The body needs fuel, even if the ADHD meds curb the desire to eat. ADHD runners can set a timer: breakfast at 7:00, first lunch at 11:00, second lunch at 3:00 (renaming snack as second lunch leads to higher-quality food), dinner at 7:00.
•For high school runners with ADHD, the second lunch can be split into fueling up pre-practice and refueling afterwards. This reduces the risk of arriving home starving and looking for (ultra-processed) foods that are crunchy, salty, and/or sweet.
• Fiber-rich fruits, vegetables, and whole grains can be lacking on an ADHD runner’s food list. Their low fiber diet can lead to constipation. Fiber also feeds the zillions of microbes in their digestive tract that produce chemicals that can positively impact brain function and behavior. Everyone with ADHD should eat more fiber-rich foods like beans (hummus, refried beans in a burrito), seeds (chia, pumpkin, sunflower, sesame), and whole grains (oatmeal, brown rice, popcorn). They offer not only fiber but also magnesium, known to calm nerves.
• With more research, we’ll learn if omega-3 fish oil supplements help manage the symptoms of ADHD. At least, eat salmon, tuna, and oily fish as often as possible, preferably twice a week, if not more.
• Picky eaters who do not eat red meats, beans, or dark leafy greens can easily become iron deficient. Iron deficiency symptoms include interrupted sleep, fatigue, inattention, and poor learning and can aggravate ADHD. Iron deficiency is common among runners, especially females, and needs to be corrected with iron supplements
• While sugar has the reputation of “ramping kids up”, the research is not conclusive about whether sugar itself triggers hyperactivity. The current thinking is the excitement of a party ramps kids up, more so than the sugary frosted cake. Yes, some runners are sugar-sensitive and know that sugar causes highs and crashes in their bodies. They should choose to limit their sugar intake and at least enjoy protein along with sweets, such as a glass of milk with the cookie, or eggs with a glazed donut. Moderation of sugar intake is likely more sustainable than elimination of all sugar-containing foods.
For more information about ADHD in kids, teens, and adults, please use these resources:
— Feeding the Child with ADHD—a -podcast with Jill Castle RD
— Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) – a national resource center
Sports Nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes in Newton MA (617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop and books. For more information visit www.NancyClarkRD.com.