Exam Room Nutrition: Where Busy Clinicians Learn About Nutrition

12 | Boost Your Focus: Nutrition Strategies for ADHD

September 19, 2023 Colleen Sloan, PA-C, RDN Episode 12
Exam Room Nutrition: Where Busy Clinicians Learn About Nutrition
12 | Boost Your Focus: Nutrition Strategies for ADHD
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Show Notes Transcript

Colleen Sloan explores the complicated world of ADHD management with Becca King, a Registered Dietitian and certified intuitive eating counselor. They delve into the role of nutrition in managing ADHD and debunk common misconceptions about food's impact on ADHD symptoms.

Key Points:

  • One-size-fits-all ADHD diets do not work.  Encourage flexibility and adaptability in dietary choices. 
  • Learn strategies to manage appetite while on stimulants 
  • Listening to patients, respecting their autonomy, and providing
    tailored recommendations is of utmost importance

Don't miss the Nutrition Notes at the end for extremely useful tips for addressing patients who "don't feel hungry for breakfast."

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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.


Welcome back to the Exam Room Nutrition Podcast. I'm your host, Colleen Sloan. I'm a registered dietician and pediatric PA. Has your patient ever asked you if there are any foods that they can eat that might help with their focus, memory, or nervous energy? Then this episode is for you. Join us as we dive deep into the world of ADHD management and discover how nutrition can be a game changer.

With over 11 million adults in the U. S. affected by ADHD, we've got the expert here herself, Becca King. She's here to guide us through the path to better focus and well being. Becca King is a registered dietitian and certified intuitive eating counselor from Charlotte, North Carolina.

She's dedicated to supporting adults with ADHD in their journey to heal their relationship with food. Combining her personal experience with ADHD and disordered eating, Becca offers a weight inclusive approach And utilizes the principles of intuitive eating in her virtual private practice.

You can connect with her on Instagram at ADHD nutritionist, and I highly recommend you do. I follow her and find her content super helpful. So Becca, thank you so much for being here.

Welcome to the show.

Thanks for having me, Colleen. I'm so excited to chat with you.

So I want to start with a really common question that I get a lot of times, but especially from pediatrics. And I know we're talking about adult management, but this is kind of like a general, maybe misconception, but maybe it's true. So I'd love for you to give us the facts on this. do the foods people eat really play a role in their ADHD symptoms, 

Like we've heard that sugar makes people hyper and that kind of stuff. So is this really true?

I would say yes and no, in a sense. there really aren't any studies showing that like a diet. Causes ADHD, like in the sense of like sugar causes ADHD, you know, that's a common myth that's out there. the research is a little bit mixed in terms of whether or not sugar exacerbates ADHD symptoms.

I find with my clients, a lot of times it's more so like blood sugar fluctuations and inconsistent eating patterns that will make, , they're. ADHD symptoms be a little bit worse. 

Makes sense. And. I hate when literature is inconclusive because that makes our recommendations inconsistent. So then a lot of patients are hearing a lot of different conflicting information, even from clinicians. So what foods can we as clinicians be recommending to our patients to help manage their ADHD?

 So honestly, the, the guidelines aren't very like, like sexy or exciting. they're kind of the general guidelines for healthy eating, but because I think often too, people with ADHD aren't doing those things of, you know, getting in enough fruits and vegetables, getting in protein at their meals and things like that.

So I think. Just encouraging healthful eating patterns can be a really helpful place to start, because for a lot of my clients, like, eating very inconsistently, so they're going really long periods of time and then when they do eat, they're like, what's the quickest, fastest thing I can get? And oftentimes they're not going to be the most nutritious options that we're going towards in those moments.

but some of the nutrients in particular, that can be helpful. Omega 3s are probably the most widely studied for ADHD again. A little bit inconclusive as to how helpful they can be, but cold water fish in particular, so tuna, salmon, mackerel, even shellfish can be some, good sources 

 So encouraging, you know, getting in a couple servings of fish throughout the week can be something. Protein often is something a lot of ADHDers don't consume enough of. so emphasizing or encouraging that at meals and snacks might not be very different from what we would recommend to someone who doesn't have ADHD.

Making sure people are actually doing that can be very helpful. and then fruits and vegetables, you know, getting those in to get our micronutrients in and things like that. can be a little bit more challenging sometimes too. So encouraging that, you know, can be helpful.

Awesome. So it sounds like there's not really a certain ADHD specific diet, but just following the general healthy guidelines for Americans. Is that

Yeah. Yes, exactly. Yeah. There's, there's a few elimination style diets that have been studied in kids. There's no studies with adults yet. and a lot of those diets, they're extremely restrictive. and they can take up to a year to work through like the elimination and reintroduction phase, which is a very long time to be doing that.

And it's cutting out like a lot of major . Foods and food groups. So it's something that's not really recommended even for kids and clinical practice yet because it's so restrictive. 

 if someone's curious about those, it's an option, but it seems to be for a small subset of folks who don't respond to medication or maybe for kids who are too young to take medication that might benefit from that diet. but for people who have ADHD, like myself having issues with executive functioning, these diets require you to be able to cook everything from home and from scratch and like a lot of effort and energy to be able to keep up with that for a whole entire year would be.

For some people, extremely challenging and may not actually be feasible. Yeah, I can imagine that's extremely challenging. And also, as you're explaining that, I'm thinking that, you know, with your own personal struggle with ADHD and an eating disorder, these diets, quote unquote, might either bring out an eating disorder or worsen, possibly, an undiagnosed eating disorder. So I think it is super important to recommend general, healthful eating.

my whole goal with this podcast is so our clinicians stop saying just blanket statements like eat healthy.

So what things could you tell us as clinicians to say that would help our patients eat healthy or follow a general healthy diet?

What are some, you know, two or three bullet points of what does that healthy diet look like and how do we say that to our patients?

 I think in terms of fruits and vegetables, a common one is like, you know, try and make your plate have fruits and vegetables, or just like, how can I add in vegetables to what I'm eating? Even if it doesn't quite make sense with your meal, like if it just means you're like microwaving, you know, some frozen veggies to add to your dish.

So there's some sort of vegetables, like go for it. the other thing I think about too, is like protein would be, you know, just including that at your meals. and making sure you're getting in your protein. and the other piece, I would say, just trying to consume fish twice, twice a week would be, a decent guideline to follow

Yeah, that's excellent. So, super helpful. Are there certain foods that we should tell our ADHD patients to avoid altogether?

I would say no, there isn't any specific foods across the board like that research is like, Hey, every person with ADHD should not be eating these foods. Obviously, if you have certain sensitivities, or have things like celiac, you know, you probably should not eat gluten. If you have celiac, that's probably a smart idea in there.

There's a little bit of a correlation between celiac and ADHD. So some people who are celiac might have ADHD. there really isn't strong research to say, like, everyone needs to cut out a certain food. If you think there's things like food dyes or additives that might be.

Making your symptoms worse. You can always try eliminating those foods and seeing if it helps. but I'm always really cautious again, because of the link with ADHD and binge eating disorder and bulimia I would be focusing more on what nutritious foods we can add than what we can take away to limit the likelihood that someone is going to potentially develop one of those eating disorders.

And. We know how much restriction can play into that. So, you know, yes, we should be mindful of our sugar intake and those sorts of things, but it's. It's not realistic to be like, never eat sugar. Cause that's just, that's pretty unrealistic for most people. So I think just being cautious there with, with how we talk to patients.

I'm like, yeah, we should all be cutting out all of these foods. It might make things worse. And especially like things with sugar saying everyone needs to cut it out. We're going to breathe. so much guilt and shame there for people. If they're like, oops, I had a cookie and now I'm so bad, but I shouldn't have done that.

And then it's like, well, I had one cookie. So screw it. I'm going to have, especially if you have impulse control issues, screw it. I'm going to have six cookies and then you're obviously not going to feel good. and just make things worse. That's great. That's an excellent point. You touched a little bit on if the patient feels like food dyes affect them or, you know, even sugary foods affect them. I'm thinking about, maybe them keeping a little log of symptoms in the foods that they eat and eliminating maybe those food dyes to see if it helps.

I'm curious in your opinion, how long should they eliminate those foods to truly see an impact on their symptoms?

So there isn't necessarily a guideline with food dyes. Gluten is one where people say like at least two weeks, remove gluten to see if you. Like notice any changes so you could probably follow like a similar time frame there with With food dyes and the research, even with them is pretty mixed. It appears.

It's just more of like a subset of children They're just a little bit more sensitive to dies and we don't unfortunately have a lot of data yet with adults that have to like, say, if it makes it worse or not.

 Yeah, but I think that's really helpful, especially in listening to the patient, because that's another thing I'm really trying to get my clinicians who are listening to the podcast to learn to listen to what the patient is saying, and to respect their autonomy. So if they feel like, Hey, I think red dye number 40 worsens my impulse control.

to just say, Hey, you know what? Let's remove it from your diet and let's see you back in two weeks. I think that's a really helpful practical thing that clinicians can start to doing to walk alongside their patients. So that was really, really helpful. all right. So I also like how you had mentioned to.

See where they can add in foods than be removing foods because even for me I like to hear hey You can have more of this this this and this as opposed to hey You can't have this this this and this because that's really frustrating When all you hear is things that you can't be eating right for anybody 


I see that on social media so, so often and people will be underneath like doctor's comments like, so what do I eat? Cause they're just like, you can't, you shouldn't eat X, Y, Z. And they're like, cool, then what's left to eat? So I think showing people what they can eat or what they can eat more of and helping them with maybe to do that or or having them talk to.

A dietitian or someone to help with actually being able to do that. Because for a lot of my clients, I find it's not a knowledge deficit when it comes to like, what healthy eating is. It's not like they don't know what it is. It's just how to do it and how to be consistent with it. there's a famous psychologist, Dr.

Hollowell, and he says, ADHD years are consistently inconsistent. And so I think knowing that about people with ADHD is super helpful about like. Despite sometimes we could have all of the, you know, the want and the drive to achieve certain things, but that inconsistency can come in and, it can be frustrating because you can be like, I'm doing so great and doing all the things and then something will happen and throw your routine off or whatever.

And then it's really hard to get back to it again. and I think just acknowledging that with patients to can be really helpful about, like, helping them actually do those things, whether it's like, hey, you can buy frozen vegetables or buy pre cut. Fruit, if that means you're actually going to eat it or buy individual serving sizes of Greek yogurt or like high protein things so that they're really accessible and you can just grab them and eat them just like you can a bag of potato chips or cookies, you know, from your pantry, make those nutrient dense foods just as accessible as all of the fun foods we like to consume too.

yes, I love those shortcuts. I'm the queen of the frozen veggies and the little snack packs of nuts. It just makes life easier, right? And it is true that if it's accessible and kind of in your face and easy to grab and go, you're going to eat it. That's why junk food is so easy because they're cute little crunchy packets that you literally just grab and go.

So I love that you suggested that those little, you know, snack hacks are totally fine to be doing.

You know, with you being on social media and kind of in the ADHD world and just being a registered dietitian, I'm curious to hear what are some of the craziest fads or foods that maybe have been recommended or that you've seen?

 I don't see a ton with ADHD it's more so like super restrictive or like overly clean diets, which like, if you want to do that, great, that's awesome for you. But like recommending it to everyone is often not helpful because it might not be within people's means like eating everything organic and like minimally processed and all that can be.

Very expensive to do those things. And that might not be accessible to eat grass fed and all of this stuff. Like not everyone can afford those things, or have the ability to cook everything from scratch. like just telling patients with ADHD to like spend their whole Sunday meal prepping.

Like it's never, never going to happen. I love cooking and I don't like eating the same exact thing every single day, 

And I love that. It's not a one size fits all right again. We need to listen to our patients, get to know them, get to know what works for them. You know, being a busy mom myself, I also can't, cook everything from scratch and everything's organic because that's not reality, right?

Sometimes it is mac and cheese for dinner and I'm lucky if I also put a broccoli on the side

of it and that's okay. 

So it's not a one size fits all, you know, guidelines for one thing that works for one person's going to work for the other. All right, so let's shift gears a little bit here, and talk about managing people's appetites while on stimulants, because I know a lot of people struggle with feeling hungry, so they're probably skipping meals.

what can we recommend to help our patients with this?

Yeah, I would say if you find a patient's really struggling with this please refer them to a dietitian 

Things that I find helpful is like something is better than nothing. It might sound a little counterintuitive to like healthy eating guidelines, but when you're not eating on your medication, like if, if it means that like, Hey, all I can tolerate is like a PB and J like old school, like that is better than not eating anything.

so I think reminding people, especially because for adults, I find. if you're not eating on your medication, when you, where's the off, I call it the hunger monster that comes out, 

It's a lot harder to be mindful and make decisions around food. And so it's a lot easier to overeat or binge if they're not eating. So I think really encouraging eating regularly, like that's kind of the foundation I talk about with my clients is like eating every three to four hours is.

really important for keeping your blood sugar stable, making sure you don't get overly hungry by the time your medication wears off. And then like exploring other foods too, like liquids, like protein shakes, smoothies, even like the little fruit squeeze pouches, drinkable yogurt, soups, those sorts of things.

Sometimes kids foods, which we might be like, why would an adult want that? That might be what people can tolerate on their meds. And that's okay. if you have a patient that's on like a short acting medication. Sometimes my clients have found it helpful. Like, I do this because I take short acting Adderall.

My breakfast and lunch is when I take my, my meds because, you know, by the time my morning dose is starting to wear off, my appetite's a little bit better. So it's easier to eat lunch. And then I take my meds and I know I've actually taken them that way. Like. I check those two things off together so I don't forget, um, to do them.

So some of my clients have found that helpful or anchoring their meals. So having like, I'm going to plan that breakfast and lunch are going to be maybe larger meals, ideally high protein, and then like some smaller frequent like mini meals or snacks throughout the day. Eating a large volume of food like is really unappealing.

Sometimes like you'll sit down when you're medicated it's like, oh, I can't finish all of this. And now I don't even want to take like two bites of it. 

What would you, suggest for those people who say, I'm not hungry in the morning, and so they totally, completely skip breakfast? What could be some simple things that we can suggest that they do in clinic?

adjust a little bit with those a lot of my clients find super helpful because it's just something you can get down and like. they have coffee ones now too, but have caffeine in it, which is nice. or I have clients who will mix their, like, make a nice coffee and mix in like a scoop of protein powder into their coffee.

So they're like, at least I'm getting something in, or even switch up your pattern a little bit and like, Hey, maybe I have a small, like a snack instead of a breakfast sort of thing. And then, maybe something a little bit larger later on in the morning. ideally something with protein would be what I would recommend.

and then, I'd even just ask them like what are some Like easier things that you think you could eat or tolerate and someone's just getting them to think about it can open the door Oh, I could do a greek yogurt in the morning or I could have a protein bar and like those just little things Like again, something's better than nothing especially because if they're not eating breakfast There's a good chance if they're not hungry when they wake up.

They're probably eating A good bit of food in the evening or could be binging in the evening and that's just going to keep them stuck in that cycle. 

 Yeah, no, that's great. And I'll educate my patients and talk to them about that. They don't have to have quote unquote breakfast foods for breakfast. I'm not really a breakfast food lover and I'll sometimes have a ham and cheese sandwich or if I'm busy, a cheese stick, you know?

So I think, like you said, thinking outside the box. And letting them know, hey, you don't have to sit there and gag down eggs and toast if you don't want that. So, I think that's been helpful in the past too.

Yeah. I've had some clients who are like, leftovers are great for breakfast. it just have a very like westernized view. Like it has to be breakfast foods. And it's like, no, it can be any foods you like can be a breakfast food. We just always kind of have that one idea of what it looks like.

yep, exactly. All right. So I would love for you to leave us with a, I call it the clinician what not to do a segment. And what would be the worst thing that clinicians could say to those struggling with ADHD?

So I asked my followers this because I was like, I would love to know what they think. I got a lot of different answers. which I think is, is very helpful. one thing I think. For people who are maybe exploring a diagnosis or bringing it up to you as as their provider of you can't have ADHD because you did well in school or Like you don't struggle with your job like those sorts of like assumptions.

I think I got a lot of those. It's like, you can't have ADHD because of X, Y, or Z. so I think not just discounting people if they are exploring a diagnosis, because especially for women, we can be very quote, unquote, high achieving people and there, but there might be other areas of her life. We're really struggling, or we're working 10 times harder 

To show up to work and do our job just like somebody else. And so it might not look like it on the outside, but inside it looks like I'm really struggling though. So I'd say that's one for like people who maybe aren't formally diagnosed that are looking for that. and the other one I got a lot was like, just saying, just do X, Y, or Z.

Like you said, I'm like, just, just eat healthy. I was like, just do this. It's not that hard. for people with ADHD, we get that a lot in a lot of areas of our lives of like, You know, it's not that hard. Just do the dishes and it's like Actually, that's for me way harder than showing up to a call with a client and doing my like actual job.

That is a lot harder for me to do for my clients, it's really figuring out the how piece of things. So just saying, just do this. That was like, cool. I've definitely thought of that. I'm like, just get a planner or just be more organized. It's like, I've tried that a lot of times.

It hasn't worked. 

I love that. And I love that you asked your community because what better recommendation than from those who are living, walking, breathing with ADHD. I know sometimes as clinicians, it's so easy to just say, Hey, just do this, eat healthier, eat more fruits and vegetables. But when you're not living that person's life and you're not inside their brain and you're not inside their day to day of all the other stressors 

 It makes it feel very just dry and insensitive to just be saying, you know, blanket recommendations. So I think the things that you had suggested today are going to be super helpful. So if you work with. People who have ADHD or you yourself have ADHD. I would highly recommend you follow Becca at ADHD nutritionist on Instagram And if you have any questions for her if you would like to have her back on the show You can also send me a message at exam room nutrition on Instagram as well Becca Thank you so much for the gift of your time I can't give that back to you and I'm so appreciative that you were here with us today.

Well, thank you so much for having me and creating space for this 

. All right, guys, now it's time for my nutrition notes. In this section, I will provide you a nutrition tip, an interesting quote, or an interesting case that I think might add value to your day.

And in keeping with the theme of ADHD, I actually wanted to discuss an interesting case that I had

where I had a teenager who refused to have breakfast because they just didn't feel hungry. And I hear that a lot.

We all know breakfast is the most important meal of the day, so skipping it can be very detrimental. Their blood sugars are going to tank later on and that can lead to binge eating or just choosing really unhealthful things for lunch or things for snacks.

So I asked the patient why they don't feel like eating in the morning. And of course, their answer is, well, I just don't feel hungry. And while that may be true, we have to find out, well, why don't you feel hungry? So a few things that you can ask your patients when they tell you, I don't feel hungry in the morning.

Number one is, what time is the last time that you eat? the night before. For some patients, if they are eating late or having a late night, midnight snack, they truly might not be hungry because if they're waking up at five or six o'clock in the morning, there might only be four or five hours in between the last time that they ate and they really might not be hungry.

The other question I like to ask is, Are you rushed in the morning, especially for kids if they are rushed and they have that kind of anxiety and that panic to that rush out and get to the bus or mom is rushing them to put their clothes on and they really don't have time to sit down and eat something Their appetite will decrease Because they're kind of in a fight or flight mode, and they need to get out the door. So if either of those are true, they're eating really late or having midnight snacks, or they're waking up and having to rush, I recommend these things. Number one, go to bed a little bit earlier so you can wake up at least 10 minutes early to have time to sit and eat something.

And number two, let's stop snacking or eating dinner so late so that you can be hungry in the morning. Now, the other thing I touched on during my discussion with Becca was that we don't have to have breakfast foods for breakfast. I think it is a Western thing that, you know, an omelet or oatmeal is the only thing that you can have for breakfast.

But for my teenager patients who say they don't want to eat breakfast or they don't like breakfast or they're rushing to go to the bus, I always recommend things that they can pack and eat while they're walking or while they're traveling, things that are really easy. And it doesn't have to be breakfast foods.

So like we had talked about, it could be leftovers. It could be something as simple as a ham and cheese sandwich, a peanut butter and jelly sandwich. you could pack a yogurt tube or yogurt drink that they can sip on while they're walking to the bus.

Even a baggie of nuts. Like Becca had said, something is better than nothing, but if we can guide them to choosing something a little bit healthier, that has a little bit of carb and a little bit of protein to help balance their blood sugar, so they can make it to lunch. That would be very beneficial to them.

Well, guys, thank you so much for joining me today. I hope you found value in the content that I provided. And if so, I would really appreciate if you could leave me a five star rating or a review in your favorite podcast, or even leave a comment on YouTube. 

That would just greatly help other people to discover and find this podcast.

If you have a question that you would like me to feature with one of our expert guests, I would love to hear from you. You can send me a message at exam room nutrition at Instagram. Well, that's all for today, guys. So thank you so much for joining me. And as always, let's continue to make our patients healthier one exam room at a time.

I'll see you next time.