Mythbusters: artificial food colours and ADHD

When I was a kid, there was a boy in my class called Jeroen. At times I found him friendly and funny, but other times he would drive me insane with his hyperactive behaviour, jumping around and pulling my hair. Then one day, he told us that we wasn’t aloud to eat anything with artificial food colours anymore. This was supposed to reduce his hyperactivity. I was hopeful, but also sceptical if this would work.

Now that I’m involved in an international consortium investigating food and behaviour, I finally had the chance to learn about food colours and ADHD. Turns out, there is some truth to the claim, although it may only be true for some children, and it may not be specific to ADHD.

A shitty story

To better understand the effects of food on behaviour, we need to start at the end. Your poo can actually tell us a lot about the billions of microbes that live in your gut and help to digest the food you eat. For a long time, we didn’t know much about this micro-wildlife, until scientists developed techniques to analyse large amounts of DNA very quickly and cheaply. As every species has unique DNA, researchers can identify all the different species that live in your gut by analysing their DNA from poo. This helps us to better understand the many important roles that the gut bacteria play in your body, including your brain. For instance, certain bacteria produce neurotransmitters from digesting fibres. These neurotransmitters are important for the communication between brain cells.

ADHD

What does this have to do with ADHD? ADHD is a neurodevelopmental condition, which means that the brain develops differently compared to typically developing children. This influences the functioning of the brain and hence people with ADHD have problems focussing their attention, controlling their impulses and regulating their activity. A disruption in the neurotransmitter system is thought to play a key role in this. While the main cause of ADHD is genetic, environmental factors are also known to increase the risk of the condition, such as smoking during pregnancy, toxins in the environment, and food allergies. Since recently, researchers are investigating the gut bacteria (aka the poo) to better understand how food allergies may trigger ADHD [1].

Food allergies

The microbes in the gut interact closely with the immune system. During development the immune system has to learn that many foreign substances in the intestines (i.e. food and bacteria) are good and should not be attacked. In a way, it has to learn not to overreact. And this is what happens with food allergies. The over-reaction of the immune system is harmful for both the gut environment and for the brain, especially if it happens very often. Hence, an allergic reaction to food colourings may trigger small changes in the brain that in turn may trigger behaviour such as hyperactivity. How this works exactly is still unknown.

Based on this theory, clinicians and nutritionists are now investigating if special diets can reduce ADHD symptoms [2]. In such a diet, a child is put on a very restrictive diet that eliminates any potentially allergenic substances. To see which food types trigger the symptoms, specific foods are introduced one by one. For some children, this really seems to work well and they can manage their symptoms by not eating certain foods the rest of their lives. The elegance of this method is that it is based on the individual. While one person may need to eliminate food colourings, for another it could be certain fruits, or cow’s milk.

Myth busted?

Do artificial food colours cause ADHD? This may be the case for some children. In others, other types of food may trigger ADHD symptoms. And in yet another group of children, their ADHD has nothing to do with food allergies. At the moment, the only way to find out is through trial and error. But only try this under supervision of trained nutritionists and clinicians!

Back to Jeroen. I don’t remember him getting less annoying. Perhaps he was not allergic to food colourings at all, and he should have tried the complete elimination diet or different medication. Or perhaps I was just an eight-year old girl allergic to all boys.

References

  1. Dam, S. et al. (2019) The Role of the Gut-Brain Axis in Attention-Deficit/Hyperactivity Disorder. Gastroenterol Clin N Am, 48, 407–431
  2. Ly, V. et al. (2017) Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. European Child and Adolescent Psychiatry, 26, 1067-1079.

This blog was written by dr. Jeanette Mostert. She is a neuroscientist and science communicator. She is involved in the CoCA-project and Eat2beNICE project. In the latter she is learning all about the links between food and mental health. 

Food & mental health: the Eat2beNICE project

We all know that a healthy lifestyle is beneficial for our health. But many of us forget that eating healthy, exercising regularly and getting enough sleep is also important for good mental health. In the Eat2beNICE research project a large team of researchers is investigating the link between food and mental health, specifically impulsivity, compulsivity and aggression. To share this knowledge with the rest of the world, they work together with food consultant Sebastian Lege.

The Eat2beNICE project just released a video to explain what the research is about and why it’s important. In this video Sebastian Lege visits the project coordinator Alejandro Arias-Vasquez, en several other researchers in the consortium.

More information about the Eat2beNICE project can be found at http://www.newbrainnutrition.com

 

 

 

 

 

Busting ADHD myths

This year’s ADHD Awareness Month was themed “ADHD myths and facts, know the difference”. As scientists, we feel that it is our role to spread the facts about ADHD. But what myths are there about ADHD? To get a better idea of this, we chose to interview people and just ask them what they know about ADHD. What are the symptoms? How do you get ADHD? Can adults have ADHD?

The people that we interviewed actually were quite well informed about ADHD. Most know that people with ADHD have problems with controlling their attention, with sitting still and that they often have a lot of energy.  And about half the people that we interviewed suspect that also adults can have ADHD. But we also noticed some myths.

Myth 1: People with ADHD are always active and have a lot of energy

ADHD is not just characterised by hyperactivity and restlessness. Many people with ADHD are actually quite capable of sitting still, but suffer more from a kind of inner restlessness and mindwandering. Also problems with focussing attention are very typical for ADHD, and there are people who only have this inattentive ADHD subtype, without the hyperactivity. What many people also don’t know is that people with ADHD often suffer from emotional dysregulation such as regalting your emotions and easily getting irritable or angry.

Myth 2: Only children can have ADHD

Although ADHD is wellknown in children, adults can also have ADHD. It is estimated that around 15% of the children with ADHD will continue to have the full diagnosis in adulthood. But about 60 – 80% of children with ADHD will still have symptoms of ADHD when they are adults. Often, the hyperactivity symptoms of ADHD reduce when children get older, but the inattention symptoms often remain.

These videos were created with help of early career scientists of the CoCA project (www.CoCAproject.eu)

 

Do you want to learn more about ADHD myths and facts? Have a look here:https://adhdawarenessmonth.org/myths-and-facts-about-adhd/

And keep watching this site, because more mythbusting videos will be coming!

Do you have an ADHD myth that you want to have busted? Or are you unsure about whether something is a myth or fact? Let us know in the comments and we’ll answer you!

 

It’s ADHD Awareness Month – know the facts and bust the myths!

It’s October, and that means that it’s ADHD Awareness Month again. Throughout this month people all across the globe will be raising awareness about Attention Deficit Hyperactivity Disorder (ADHD). As ADHD researchers, we of course contribute to this by sharing with you what we know – and what we yet don’t know – about ADHD.

To start off, let’s re-watch the beautiful mini-documentary that was created last year: Shine a light – understanding ADHD. In this video we see several people with ADHD as well as ADHD researchers, who all explain how they see, experience and investigate ADHD.

This year’s ADHD Awareness Month is about myths and facts. On this website you can find some very nice articles that clearly explain the facts: for instance why ADHD is not an excuse for laziness, and why about half of the children with ADHD do not grow out of it when they reach adolescence and adulthood. For this last reason, many of us are studying ADHD in adulthood. For instance in the IMpACT research consortium.

In a few weeks we will be releasing a series of videos in which some more myths about ADHD are being debunked. These videos are being created by researchers from the CoCA-consortium. The research done in this consortium is aimed to stop the spiral from ADHD into depression and obesity, as was written in this nice article by the European Commission.

Another intersting new research theme is whether lifestyle choices such as diet and exercise can influence how we behave and feel. If you want to learn more about this, I refer you the website New Brain Nutrition, which has several very interesting learning modules, as well as a nice blog.

We hope that through these websites we inspire you to learn more about ADHD. Know the facts, and bust the myths!

 

More information:

http://www.adhdeurope.eu

http://www.adhdawarenessmonth.org

http://www.coca-project.eu

http://www.newbrainnutrition.com

http://www.impactadhdgenomics.com

https://ec.europa.eu/research/infocentre/article_en.cfm?artid=50905

 

Pay Attention to ADHD – Podcast with prof. Stephen Faraone

Professor Stephen Faraone – professor in Psychiatry at SUNY Upstate University and expert on ADHD – was interviewed by dr. Therese Markow for the podcast series ‘Critically Speaking’. In this podcast they discuss myths about ADHD and the scientific evidence that debunks these myths. Stephen Faraone explains why it is so important to diagnose and treat ADHD early. He also explains why ADHD is often undiagnosed in girls, and why sometimes adults are diagnosed with ADHD who have not sought treatment earlier in their life.

Critically Speaking is a podcasts series hosted by dr. Therese Markow who interviews experts to discuss in plain language complex issues that concern our health, society and planet.

You can listen to the podcast here: http://criticallyspeaking.libsyn.com/002-pay-attention-adhd-with-dr-stephen-faraone

 

German study first to show direct medical costs of ADHD and its comorbid conditions across the lifespan

Having ADHD is expensive. A study of German insurance data has shown that the medical costs of a person with ADHD are 1500 euro higher per year, compared to a person without ADHD. But that’s not all; individuals with ADHD are far more likely to suffer from additional conditions such as mood and anxiety problems, substance abuse or obesity. Treatment of these conditions can cost up to an additional 2800 euro per year. As ADHD – especially in adults – is still poorly recognised and diagnosed, these numbers may not reflect the complete picture of ADHD medical costs. Improving diagnosis and adult mental healthcare may prevent mental health problems later in life and actually reduce costs, argue Berit Libutzki and her co-authors.

ADHD (Attention Deficit / Hyperactivity Disorder) is a developmental condition. Symptoms arise before the age of 12 and are characterised by age-inappropriate and impairing behaviour in terms of problems with attention, impulsivity and hyperactivity. World-wide prevalence of children with ADHD is estimated around 5%, while in adults this is around 2.5%. This means that in about half of the children problems do not subside with age. For these people, ADHD is a lifelong condition that often impairs health, career and social life.

To estimate the economical costs of ADHD, Berit Libutzki and her colleagues from HGC Healthcare Consultants GmbH analysed the (anonymised) health insurance data of almost four million Germans. They compared the medical costs of people with an ADHD diagnosis to those of a well-matched group without ADHD.

medical costs per person_figure

The results showed that the medical costs of a person with ADHD are on average 1508 euro higher than those of a person without ADHD. These costs are mainly due to treatments in hospitals and by psychiatrists. ADHD medication itself (such as Methylphenidate) are in third place, contributing to only 11% of the additional costs. Other interesting findings from the study are that medical costs are a bit higher in women compared to men, and that costs are much higher in individuals over 30 years old compared to younger age groups. After the age of 18, the costs of for example ADHD medication drop, while psychiatrist costs and costs for other (non-ADHD) medications increase notably. Also sick payment is high in adult ADHD patients, leading to a significant increase in costs. One of the explanations for these cost increases could be a gap in care after leaving the regular care of a paediatrician at age 18, and the development of disorders that arise in addition to ADHD.

medical costs increase_figure

ADHD plus additional (mental) health problems

It has been shown before that having ADHD puts you at a much higher risk of developing additional (comorbid) disorders. Mood disorders – such as depression – and anxiety are most frequent; in the German data two-thirds of ADHD individuals over 30 had such an additional diagnosis (compared to only a fifth of adults without ADHD). Substance abuse and obesity are more common in people with ADHD as well. These comorbidities should not be underestimated as they add strongly to the burden of disease. The study shows that substance abuse and morbid obesity are even the most costly, especially in adulthood. In total, the surplus costs associated with these conditions are 1420-2715 euro higher for ADHD individuals, compared to individuals who suffer from mood or anxiety disorder, substance abuse, or obesity alone.

comorbid disorders_figure

Scientists think that certain genetic factors that play a role in ADHD also make a person more vulnerable for these comorbid health conditions. Libutzki and her team are part of the European research consortium Comorbid Conditions of ADHD (CoCA) that investigates the shared biological mechanisms of ADHD and these additional disorders. “Through this research we hope to find leads to prevent these disorders from developing, and improve mental health care.”, says the leader of the CoCA consortium Prof. Dr. Andreas Reif of the University Hospital Frankfurt.

“It is intriguing to speculate that these comorbidities, which were shown to be the important cost drivers in adulthood, could be prevented if mental healthcare were provided more constantly over the lifespan” write the authors. “The prevention of the development of comorbidities with age should be the focus of mental health care. Early treatment starting in childhood and continued treatment of adolescents into adulthood seem therefore advisable.”

Improving diagnosis and adult mental health care

There is one caveat in the study by Libutzki, that is also acknowledged by the authors: many people, especially adults, are not diagnosed with ADHD, even though they experience the symptoms. “Our knowledge gap is especially large in adulthood”, says Dr. Catharina Hartman from the University Medical Centre Groningen, The Netherlands. “The prevalence of adult ADHD in the health insurance data was very low (0.2 %). Given that the population prevalence for adult ADHD is 2,5 %, this indicates that many adults with ADHD are currently not diagnosed or treated. They may nonetheless make high direct costs since their ADHD may not be recognised, or they make indirect costs through unemployment or criminality.” This would indicate that the costs reported by the study are underestimated. On the other hand, adults often find out about their ADHD only after consulting a psychiatrist for other mental health problems. This would indicate that estimated costs and prevalence of comorbid disorders with ADHD in adulthood are overestimated, compared to when you were to include also all undiagnosed people with ADHD, and diagnosed persons who do not make costs (i.e. milder cases of ADHD).

The study thus provides a partial view on the costs of ADHD during the lifespan. That said, it is among the first to show in detail the lifespan medical costs of ADHD and comorbid disorders in Germany. These findings are likely to be representative of other western-European countries. Policy makers in these countries are strongly advised to investigate ways to improve the transition from child to adult mental healthcare and increase awareness about adult ADHD. This will not only improve the quality of life of many adults but may also save money.

Further reading

Libutzki, Ludwig, May, Jacobsen, Reif and Hartman (2019). Direct medical costs of ADHD and its comorbid conditions on basis of claims data analysis.  European Psychiatry, 58: 38-44. https://www.europsy-journal.com/article/S0924-9338(19)30019-7/abstract

The findings from this study are also summarised in an infographic: https://my.visme.co/projects/1jok0qg8-medical-costs-adhd

Mini-documentary: “Shine a light – understanding ADHD”

On the last day of the international ADHD Awareness Month, we are releasing a mini-documentary about ADHD. The hope is that this video will help young people and adults diagnosed with ADHD, or who suspect they have ADHD, as well as their family and friends, to understand the condition better.

“I feel like a universe, stuffed within a shoebox” – this is how Bryn Travers describes what it’s like to have Attention Deficit / Hyperactivity Disorder (ADHD). In this short film we have asked people with ADHD and their relatives about living with ADHD: what are the challenges and what are the things they like about ADHD? We have also asked clinicians and researchers working with ADHD to explain more about the origins of the disorder, what they have learnt from their experience working with patients, but also what are the main questions that research is trying to answer about ADHD.

Many children, adolescents and adults suffer from ADHD. ADHD is a complex disorder that affects people differently. Generally people experience problems in daily life, especially with respect to controlling attention, impulses and emotions. At the same time, people with ADHD enjoy their creativity and positive energy. Medication is effective for many people with ADHD, but not for all. That is why many people are interested in other types of (additional) treatment, such as meditation or diets. These types of treatment should therefore be better investigated. Knowing more about ADHD and spreading awareness will help people to understand what causes their behaviour. This will reduce stigma and (self)blame.

The video features four of the most well-known researchers in the field of ADHD: dr. Eric Taylor is emeritus professor of Child and Adolescent Psychiatry at King’s College London, dr. Philip Asherson is professor of Molecular Psychiatry at King’s College London, dr. Barbara Franke is professor of Molecular Psychiatry at Radboud university medical center Nijmegen (The Netherlands), and dr. Corina Greven is psychologist and behavioural geneticist at Radboud university medical center Nijmegen. Next to these scientists and psychiatrists, we see three people with ADHD (Bryn Travers, Evie Travers and Aziz), Andrea Bilbow, president of patient organisation ‘ADHD Europe’ and mother of two children with ADHD, and dr. Kai Syng Tan, researcher and artist at King’s College London, who also has an ADHD diagnosis.

This film was created through the MiND research consortium, in collaboration with the consortia Aggressotype, CoCA and Eat2beNICE. These consortia are all funded by the European Commission through the FP-7 and horizon2020 programs. Young researchers dr. Nicoletta Adamo and Laura Ghirardi are the brains behind this film, with the help of the MiND training program and 4QuarterFilms.

Do you want to help us spreading awareness about ADHD? Then share this video with everyone you know! The video also contains subtitles in English, Dutch, German, Spanish, Italian, Swedish and Hungarian (and more languages may follow).

You can watch the video here: