Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, disorganization, and/or hyperactivity-impulsivity, significantly impacting daily life. It can be classified by severity (mild, moderate, severe) and presentation (inattentive, hyperactive/impulsive, or combined).
ADHD is one of the most searched neurodivergent conditions, with Google Trends showing a 576% increase in searches for “ADHD” in 2024 compared to five years ago. In the U.S., videos with the hashtag #ADHD have accumulated 35 billion views in three years.
This surge in interest has led to misinformation and the rise of self-proclaimed "gurus."
A study in The Canadian Journal of Psychiatry investigated the quality of medical information in the most popular ADHD TikTok videos, searching TikTok using the hashtag #ADHD with the platform's algorithm returning the most popular videos based on views and likes.
The analysis, performed by a psychiatry and psychiatry resident with clinical experience with ADHD, considered 100 videos that
- Specifically described or educated viewers on ADHD symptoms and diagnosis
- Described the lived experiences with neurodivergence
- Described strategies for managing ADHD.
They found:
- Total views: Over 283 million (average 2.8 million per video)
- Average duration: 36.7 seconds per video.
- Shares: 31,000 shares.
- Non-healthcare professionals created 89%
- 52% were misleading, containing information unsupported by scientific evidence. These videos accumulated 2.5 million views, 549,000 likes, and 24,000 shares.
- 27% were personal experiences sharing a patient’s anecdotal experiences. These videos had 3.9 million views, 839,000 likes, and 46,000 shares.
- 21% were useful, presenting scientifically accurate information, and involved 2.3 million views, 566,000 likes, and 28,000 shares.
- The comprehensibility of the videos was rated as very high, although the quality of the sources was deemed low.
While non-professional videos were more popular, this was not statistically significant; compared to healthcare professionals, these videos produced significantly more misleading content. The research quantifies what we already know: the internet—particularly social networks- is a powerful disseminator of misinformation. Complex topics are oversimplified, vague statements are generalized, and appeals to authority and cherry-picking data are prevalent.
The field of nutrition is not immune to this trend, with some individuals promoting unsubstantiated claims about diet’s ability to cure or treat ADHD—an idea lacking solid scientific backing.
The origin of a belief
Pediatrician and allergist Benjamin Feingold was one of the first to suggest a link between nutrients, food chemicals, and ADHD. Although I could not access his original research, this information is based on the "Feingold Diet" chapter by Dr. Hyman S. in the Encyclopedia of Autism Spectrum Disorders and the Feingold Association website. This organization advocates for an “elimination diet,” removing harmful chemical additives from the diet to improve conditions like ADHD.
In the 1940s, preliminary studies suggested that foods rich in salicylates [1] and the dye tartrazine (FD&C Yellow No. 5) could trigger allergic reactions in some individuals. In the 1960s, Feingold explored the link between diet and ADHD, noting improvements in both allergic and psychiatric symptoms in a patient on a low-salicylate diet.
He expanded the diet to exclude foods high in salicylates, artificial colors, and sweeteners. Clinical records showed that 30% to 50% of ADHD patients reported improvements in hyperactivity, impulsivity, and inattention. In 1979, Feingold added the exclusion of artificial preservatives, with improvement rates rising from 60% to 70%. A meta-analysis done at that time concluded:
“The findings of this meta-analysis do not offer support for the Feingold hypothesis. … the Feingold K-P diet produces a small treatment effect [so that] children placed in the Feingold K-P diet were better off than only 55% of control subjects at the end of treatment. …Consequently, a child placed on the Feingold K-P diet may exhibit slight improvement in behavioral functioning but not much else.”
While slight improvement may be worthwhile, it is important to review current evidence to determine whether this approach has robust scientific support.
Nutrition and ADHD Today
A more recent systematic review of dietary interventions for ADHD was published in PLoS One. These trials, all double-blinded placebo-controlled, aimed to evaluate the effectiveness of dietary interventions, including both food elimination and the use of supplements, in managing ADHD.
Based on the evaluation of six meta-analyses—selected from approximately a hundred that met the inclusion criteria—the authors concluded that neither dietary supplements nor the exclusion of specific chemical compounds (such as dyes) had a significant effect on ADHD.
The authors suggest that a single supplement, like omega-3 or omega-6, is unlikely to address all the complexities of ADHD, indicating that isolated nutrient interventions may be less effective than a comprehensive nutritional approach.
However, the so-called low or few-food diets (FFD), which exclude large groups of foods and additives, showed a positive impact. These studies show that certain foods can trigger behavioral issues, which are alleviated by their elimination. It is important to note that FFD is intended as a short-term diagnostic tool, not a long-term solution like ADHD medications. While some children demonstrate behavioral improvements with FFD, this approach is costly and only feasible for highly motivated, well-structured families, making large-scale implementation unrealistic.
Finally, one of the study’s authors has a significant conflict of interest: he franchises the Restricted Elimination Diet (RED) protocol and receives fees for its application in the Netherlands. While conflicts of interest do not automatically invalidate the data, caution is warranted.
Another noteworthy study published in Clinical Nutrition ESPEN explored the association between dietary patterns and the occurrence of ADHD.
The initial search yielded 4,894 articles; however, after applying the inclusion criteria and reviewing the abstracts, only 12 articles were included in the systematic review, and 6 were used in the meta-analysis.
They found:
- A balanced diet with regular meals rich in dairy and vegetables was linked to a reduction in ADHD symptoms.
- The "healthy eating pattern" (characterized by a high intake of fruits, vegetables, grains, and fish) was associated with a 37% lower likelihood of developing ADHD compared to others.
- The "junk food eating pattern" (with a high intake of sweets, sugary drinks, snacks, and fast food) was linked to a 1.51 times greater risk of developing ADHD.
- The "Western dietary pattern" ( with high consumption of red meat, processed meat, animal fat, and salt) showed a 1.92 times higher risk of developing ADHD. Excluding one study from the meta-analysis removed the statistical association.
The authors note that the findings may have been influenced by varying study designs and measurement errors in the assessment tools. Data collection mainly relied on food frequency questionnaires and a non-consecutive 24-hour recall, which are prone to biases such as memory inaccuracies.
Moreover, the studies do not clarify whether a poor diet contributes to ADHD, or ADHD leads to poor dietary choices, or whether both are influenced by a third factor not addressed in the studies. Furthermore, it is important to emphasize that all other available evidence in the literature suggests that ADHD is not caused by diet or food coloring. As is always the case, these associations only suggest, not confirm, a cause-and-effect relationship.
Given the complexity of ADHD and the absence of biomarkers, defining the exact role of nutrients and diet in the disorder remains challenging. While the Few-Foods Diet (FFD) may benefit specific diet-sensitive subgroups, it should be considered an exception rather than a standard approach. Personalized nutrition shows promising potential, but there is no one-size-fits-all solution for every case of ADHD.
[1] a group of chemical compounds found in various plant-based foods, as well as the active ingredient in aspirin
Sources: TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. The Canadian Journal of Psychiatry. DOI:10.1177/07067437221082854
Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLoS One. DOI:10.1371/journal.pone.0169277
Empirically derived dietary patterns and food groups intake in relation with Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review and meta-analysis. Clin Nutr ESPEN. DOI: 10.1016/j.clnesp.2019.10.013
