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2. Minerals for ADHD

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2. Minerals for ADHD

2.1. Zinc

2.1.1. Zinc deficiency affects dopamine transporters and melatonin

Zinc can increase dopamine levels by reducing the activity of the DAT.12

  • Prevalence of zinc deficiency:
    • Population-wide
      • Europe: 11 % (0.8 to 28.8 %)3
      • In Germany, 9.8 % (women) and 10.3 % (men) of adults (aged 19 to 64) and 13.4 % (women) and 8 % (men) of older people (aged 65 and over) stated that their intake was too low.
    • Healthy children from 1 to 3 years:
      • Western Europe: 31.3 %4
    • in children under five years of age (Disease Control Priorities in Developing Countries 2006).
      • East Asia/Pacific: 7 %
      • Eastern Europe and Central Asia: 10%
      • Latin America and the Caribbean: 33 %
      • Middle East and North Africa: 46 %
      • Sub-Saharan Africa: 50 %
      • South Asia: 79 %
    • Zinc deficiency manifests itself in a lack of T and B lymphocytes, among other things
    • Zinc deficiency often goes hand in hand with vitamin A deficiency

ADHD medication, nicotine and zinc block the dopamine transporters (DAT) (too frequently present in the brain in ADHD) and thus reduce their overactivity.5. Zinc therefore acts as a dopamine reuptake inhibitor.

Zinc deficiency can influence the modulation of melatonin. Melatonin regulates dopamine function.6 Melatonin deficiency can cause sleep disorders.7

Dysregulation of zinc or copper can increase susceptibility to oxidative damage to tissues or oxidative stress to the brain by damaging antioxidant defenses, which may be a possible ADHD cause.8

2.1.2. Zinc deficiency and ADHD

Zinc can possibly supplement and improve methylphenidate therapy.9 However, the dosage of zinc used in the aforementioned study requires medical supervision to avoid iron or copper deficiency as well as gastrointestinal complaints or zinc flu. However, the reported improvements were impressive.
Whether the effect exists independently of MPH therapy is unknown. Differentiating Krause.10

It is possible that the metabolism of cobalt, copper, lead, zinc and vanadium is altered in ADHD. Reduced cycle stability (determinism), duration (mean diagonal length) and complexity (entropy) of the exposure profiles were found.11

One study found 19% less zinc in the hair of children with ADHD. Low zinc hair levels could also be used as a predictor for ADHD 12
In contrast, a comprehensive meta-analysis of 11 studies involving 1,311 subjects was unable to find any relevant differences in zinc levels in the blood or hair of people with ADHD compared to those without. The results of the individual studies are very heterogeneous.13

One study found average blood serum levels in children with ADHD compared to those not affected:14

  • Zinc: 7 % lower
  • Chromium: 21 % reduced
  • Magnesium: 4 % reduced
  • Copper-zinc ratio: 11 % increased

Zinc supplementation for people with ADHD with zinc deficiency without iron deficiency15

  • Improved statistically significantly
    • Hyperactivity
    • Attention
    • Impulsiveness
    • Mood stability
  • Remained unchanged
    • Intelligence
    • Cognitive problems
    • Oppositional problems

Zinc and iron supplementation for people with ADHD with zinc deficiency and iron deficiency15

  • Improved statistically significantly
    • Verbal IQ
    • Total IQ
    • Hyperactivity
    • Impulsiveness
    • Mood stability
  • Remained unchanged
    • Performance IQ
    • Attention
    • Cognitive problems
    • Oppositional problems

One study found elevated levels of zinc in the blood and hair of children with hyperactivity and comorbid ODD or CD,16 whereby the study apparently equated hyperactivity with ADHD. The study also found a frequent deficiency of magnesium. In the children with magnesium deficiency, the administration of magnesium also improved the ADHD symptoms.

One large study found decreased zinc levels in the blood of children with ADHD, while levels of magnesium, copper, iron and lead were unchanged.17 Several other studies1819 and a meta-analysis20 also reported lower zinc levels in ADHD and an association between zinc levels and the severity of ADHD symptoms,
A meta-analysis reports that zinc deficiency is primarily associated with ADHD-I.21 A randomized double-blind study also found that zinc supplementation in addition to existing treatment with MPH (only) further improved inattention, but not hyperactivity, impulsivity or the overall ADHD score.22
A meta-analysis found a positive effect of zinc on ADHD.23

As a result, it can be concluded that zinc levels are not generally altered in ADHD. However, the results of zinc supplementation in individual people with ADHD indicate that an existing zinc deficiency can contribute to the intensification of ADHD symptoms in some persons with ADHD. Therefore, the zinc level and the functionality of the zinc receptors should be checked individually during diagnostics. If deficits are found here, zinc supplementation should be able to reduce ADHD symptoms in these people with ADHD.

Even in the case of an existing deficiency, the administration of zinc or other vitamins or minerals should not be expected to achieve anywhere near the Effect size of medication. However, correcting any deficiencies in vitamins or minerals can be helpful for ADHD.

2.2. Magnesium

Seven studies consistently found reduced magnesium blood levels in people with ADHD.2425

In 15q11.2 BP1-BP2 microdeletion syndrome (Burnside-Butler syndrome), the following symptoms were found among 200 people with ADHD:

  • Developmental disorders (73 %)
  • Speech disorders (67 %)
  • Memory difficulties (60 %)
  • Writing problems (60 %)
  • Reading problems (57%)
  • Verbal IQ below 76 (50 %)
  • Behavioral problems (55 %)
  • Dysmorphic ears (46 %)
  • Anomalies on the front palate (46 %)
  • Motor slowdown (42 %)
  • Abnormalities in brain imaging (43%)
  • ADHD (35 %)
  • Autism spectrum disorders (27%)
  • Epilepsy (26 %)
  • Schizophrenia / paranoid psychoses (20 %)

It is assumed that magnesium administration can be helpful here.26

In children with ADHD, magnesium was found to be 29% lower in the hair. However, low hair magnesium levels could not be used as a diagnostic tool for ADHD.12

One study found average blood serum levels in children with ADHD compared to those not affected:14

  • Zinc: 7 % lower
  • Chromium: 21 % reduced
  • Magnesium: 4 % reduced
  • Copper-zinc ratio: 11 % increased

In children with ADHD aged 6 to 12 years, a double-blind placebo-controlled study found that 50,000 IU D3 per week and 6 mg/kg/day of magnesium significantly improved symptoms in the areas of conduct disorder, social behavior and anxiety, but not psychosomatic symptoms.2728

One study found a frequent lack of magnesium in the blood and hair of children with hyperactivity. In the children with magnesium deficiency, magnesium administration also improved ADHD symptoms,16 although the study apparently equated hyperactivity with ADHD.

2.3. Iron, ferritin

The prevalence of insufficient iron intake in Europe is between 0% and 20%.3 In Germany, 7.1% of adults (aged 19 to 64) were reported to have an insufficient intake of iron (men), and 6.1% (women) and 4.5% (men) for older people (aged 65 and over).

A meta-analysis found a correlation between ferritin levels as a peripheral marker of iron levels in ADHD and the risk of ADHD in children.29 Another meta-analysis found a positive effect of iron in ADHD.23 A third meta-analysis also found a significant association between iron deficiency and ADHD.30 A further meta-analysis does not appear to have found a clear correlation between iron and ADHD 20
Another meta-analysis concluded that serum ferritin levels were lower in ADHD (10 studies, n = 3,387), while there was no correlation between serum iron levels and ADHD (6 studies, n = 986).31
Another meta-analysis found lower serum ferritin levels in children with ADHD and a correlation of iron deficiency to ADHD as well as to more severe ADHD symptoms.32

A large study of 432 children found significantly lower serum levels of iron in children with ADHD.33 This correlated with an increased intake of nutrient-poor foods such as foods high in sugar and fat and a lower intake of vegetables, fruit and protein-rich foods than in healthy children.
It remains to be seen whether the change in diet is the cause, consequence or vicious circle of ADHD.

In contrast, two other studies found no correlation between iron deficiency and ADHD.3435

Another study found significantly reduced levels of iron in the brains of people with ADHD in

  • Globus pallidus
  • Putamen
  • Caudate nucleus
  • Thalamus
  • Nucleus ruber

This iron deficiency in the brain in ADHD is eliminated by stimulant medication. The increase in iron in the brain correlated with the duration of stimulant administration and was greater in older children than in younger children.36 Iron deficiency may therefore be a consequence and not a cause of ADHD, which is consistent with the very manageable Effect size of treatment of iron deficiency in ADHD on ADHD symptoms

One study found lower iron levels in the bilateral limbic region of the striatum in children with ADHD. Lower tissue iron levels in the bilateral limbic striatum correlated with higher severity of ADHD symptoms, while lower tissue iron levels in the left limbic striatum only correlated with severity of anxious, depressive and affective symptoms.37

Iron can cross the blood-brain barrier by means of the transferrin receptor.38

One study found that severe iron deficiency could reduce oxytocin, dopamine, irisin, MAO-A, β-endorphin and α-MSH in the brain and increase synaptophysin.39

One review found clear evidence of a correlation between iron deficiency and restless legs sleep problems, as well as possible evidence of correlations with sleep problems in ADHD.40

Iron-deficient rodents develop the major neurochemical dopaminergic changes common in restless legs (RLS), such as decreased striatal D2 receptors. They also develop hyperarousal41

Around 10% of Europeans suffer from an iron deficiency. Particularly frequently affected are

  • Women
    in particular:
    • of childbearing age
    • after menstruation
    • during pregnancy
    • during breastfeeding
  • Children
  • Teenagers
  • Dialysis patients
  • for acute inflammation
    • chronic intestinal diseases
    • Gastritis
  • Heart failure
  • Cancer diseases

Symptoms of iron deficiency can be

  • Brittle, dull, fragile hair
  • Hair loss
  • Rough, cracked skin
  • Cracked corners of the mouth
  • Brittle nails
  • Hollow nails (nails that bend inwards)
  • Burning tongue with pain when swallowing
  • Abnormal cravings, for example for lime, soil or ice cubes (picacism)
  • Impaired (athletic) performance
  • Depression
  • Headache
  • Tiredness
  • Concentration problems
  • Restless legs (restless legs)
  • Sleep disorders

Excess iron is just as harmful as iron deficiency. As with all vitamins and minerals:

  1. measure first (repeat annually)
  2. then just fill the deficit

During acute infections, iron supplementation can be detrimental.42

2.4. Niacin

Source: Bieger.4344 Bieger operates a laboratory and sells food supplements. Its own products were recommended in laboratory analyses without the conflict of interest being disclosed.

2.5. Manganese

Manganese can affect the dopaminergic system.45

A meta-analysis found increased manganese levels in the hair but not in the blood of children with ADHD.46 Another study found 27% less manganese in the hair of children with ADHD. However, low hair manganese levels could not be used as a diagnostic tool for ADHD.12

Manganese exposure is occasionally discussed as a possible cause of ADHD. One study found that this depends on the genotype of the manganese transporter and that girls are more sensitive to ADHD reactions to manganese than boys.47 A meta-analysis also reported a link between manganese exposure and hyperactive behavior.21

Another study reported that the administration of methylphenidate significantly reduced manganese levels.48

2.6. Copper

It is possible that the metabolism of cobalt, copper, lead, zinc and vanadium is altered in ADHD. Reduced cycle stability (determinism), duration (mean diagonal length) and complexity (entropy) of the exposure profiles were found.11

The prevalence of insufficient iron intake in Europe is between 8% and 24%.3

Dysregulation of copper or zinc can increase susceptibility to oxidative damage to tissues or oxidative stress to the brain by damaging antioxidant defenses, which may be a possible ADHD cause.49

Several enzymes thought to play an essential role in the neurophysiology of ADHD are copper-dependent.50

Excess copper can promote the oxidation of dopamine and its metabolite salsolinol, which leads to the degeneration of dopaminergic neurons.51

Children with ADHD were found to have 10% less copper in their hair. However, low hair copper levels could not be used as a diagnostic tool for ADHD.12

One study found average blood serum levels of in children with ADHD compared to those not affected:14

  • Zinc: 7 % lower
  • Chromium: 21 % reduced
  • Magnesium: 4 % reduced
  • Copper-zinc ratio: 11 % increased
    • Copper therefore increases

Another study on children with diabetes 1 and ADHD also found an increased copper-to-zinc ratio.52

One study found reduced levels in plasma, erythrocytes, urine and hair in children with increased hyperactivity of53

  • Magnesium
  • Zinc
  • Copper
  • Iron
  • Calcium

A large study found decreased levels of zinc in the blood of children with ADHD, while levels of magnesium, copper, iron and lead were unchanged.17

One study found no change in copper blood levels in children with ADHD. Changes in copper blood levels or ceruloplasmin blood levels also did not correlate with ADHD symptoms within the group of ADHD subjects.54
One study found slight evidence of a role for copper in ADHD. No evidence of a connection was found for other micronutrients.55

2.7. Cobalt

Children with ADHD were found to have 18% less cobalt in their hair. However, low hair cobalt levels could not be used as a diagnostic tool for ADHD.12

2.8. Silicon

Children with ADHD were found to have 16% less silicon in their hair. However, low hair silicon levels could not be used as a diagnostic tool for ADHD.12

2.9. Chrome

One study found altered blood serum levels in children with ADHD compared to those not affected:14

  • Zinc: 7 % lower
  • Chromium: 21 % reduced
  • Magnesium: 4 % reduced
  • Copper-zinc ratio: 11 % increased

Another study found altered levels in the hair of children with ADHD of56

  • Bismuth: 8-fold increased
  • Chromium: 15 % reduced (and strongest predictor of ADHD symptoms)
  • Germanium: 11 % reduced

2.10. Vanadium

It is possible that the metabolism of cobalt, copper, lead, zinc and vanadium is altered in ADHD. Reduced cycle stability (determinism), duration (mean diagonal length) and complexity (entropy) of the exposure profiles were found.11

2.11. Bismuth

One study found altered levels in the hair of children with ADHD of56

  • Bismuth: 8-fold increased
  • Chromium: 15 % reduced (and strongest predictor of ADHD symptoms)
  • Germanium: 11 % reduced

2.12. Germanium

One study found altered levels in the hair of children with ADHD of56

  • Bismuth: 8-fold increased
  • Chromium: 15 % reduced (and strongest predictor of ADHD symptoms)
  • Germanium: 11 % reduced

2.13. Magnesium L-threonate

A very small study claims to have found benefits from the administration of magnesium L-threonate.57 Magnesium L-threonate is a compound of magnesium and L-threonic acid. Magnesium L-threonate is a degradation product of vitamin C.


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