2. Minerals for ADHD
- 2.1. Zinc
- 2.2. Magnesium
- 2.3. Iron, ferritin
- 2.4. Niacin
- 2.5. Manganese
- 2.6. Copper
- 2.7. Cobalt
- 2.8. Silicon
- 2.9. Chrome
- 2.10. Vanadium
- 2.11. Bismuth
- 2.12. Germanium
- 2.13. Magnesium L-threonate
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
- Population-wide
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
Zinc oxide nanoparticles, as used in mouthwashes, cosmetics, sunscreens, toothpaste and root canal rinses, cause a significant increase in dopamine (almost doubled), noradrenaline (more than doubled) and serotonin (almost doubled) when introduced directly into the brain (not when used as intended) in animal experiments and, on the other hand, reduce the levels of K+, Ca2+ and Na+ ions.9
2.1.2. Zinc deficiency and ADHD
Zinc can possibly supplement and improve methylphenidate therapy.10 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.11
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.12
METASTUDY (3: zinc reduced, 1: zinc unchanged):
- A meta-analysis reported lower zinc levels in ADHD and a correlation between zinc levels and the severity of ADHD symptoms.13
- A Chinese meta-analysis of k = 17 studies with n = 5,077 children found decreased serum zinc levels in children with ADHD (SMD: 1.33).14
- A meta-analysis reports that zinc deficiency is primarily associated with ADHD-I.15
- A comprehensive meta-analysis of k = 11 studies on n = 1,311 subjects was unable to find any relevant differences in the zinc levels in the blood or hair of people with ADHD compared to those without. The results of the individual studies were very heterogeneous.16
Individual studies:
Various studies have found reduced zinc levels in ADHD:
- in the blood serum of children with ADHD:17
- Zinc: 7 % lower
- Chromium: 21 % reduced
- Magnesium: 4 % reduced
- Copper-zinc ratio: 11 % increased
- in hair in children with ADHD18
- Zinc: 19 % reduced. Low zinc hair levels could also be used as a predictor for ADHD.
- in the blood of children with ADHD (large study)19
- reduced zinc levels
- Magnesium, copper, iron and lead unchanged
- Zinc reduces20
- Zinc reduces21
- Zinc deficiency in 60 % of the test subjects (Egyptian children)22
One study found elevated zinc levels in ADHD:
- increased zinc levels in the blood and hair of children with hyperactivity and comorbid ODD or CD,23 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 ADHD symptoms.
Zinc administration for ADHD;
METASTUDY:
A meta-analysis found a positive effect of zinc on ADHD.24
Individual studies:
Zinc supplementation for people with ADHD with zinc deficiency without iron deficiency25
- 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 deficiency25
- Improved statistically significantly
- Verbal IQ
- Total IQ
- Hyperactivity
- Impulsiveness
- Mood stability
- Remained unchanged
- Performance IQ
- Attention
- Cognitive problems
- Oppositional problems
A randomized double-blind study found that zinc administration in addition to existing treatment with MPH (only) further improved inattention, but not hyperactivity, impulsivity or the ADHD total score.26
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.2728
A review of k = 45 meta-analyses found an increased risk of ADHD due to reduced magnesium blood levels.29
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.30
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.18
One study found average blood serum levels in children with ADHD compared to those not affected:17
- 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.3132
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,23 although the study apparently equated hyperactivity with ADHD.
A study of Egyptian children found a magnesium deficiency in 65% of them22
2.3. Iron, ferritin
Iron is an essential trace element and is required in particular for the formation of the red blood pigment (haemoglobin). Ferritin is a protein that stores the amount of iron present in the body. A low ferritin level is an indicator of reduced iron stores in the body.
Iron can cross the blood-brain barrier via the transferrin receptor.33 Severe iron deficiency can reduce dopamine, oxytocin, irisin, MAO-A, β-endorphin and α-MSH in the brain and increase synaptophysin.34 Rodents with iron deficiency show typical neuronal dopaminergic changes that are common in restless legs (RLS), such as reduced striatal D2 receptors. They also develop hyperarousal35
In ADHD, 10 (meta-)studies on iron found evidence of decreased iron levels in ADHD, 5 (meta-)studies found no correlation, and one study found evidence of increased brain iron levels in adults with ADHD.
Evidence of decreased peripheral iron levels in ADHD (10 sources):
-
significantly lower serum iron levels in children with ADHD36 This correlated with an increased intake of nutrient-poor foods such as high-sugar and high-fat foods and a reduced 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. -
a correlation of iron deficiency to ADHD and more severe ADHD symptoms (METASTUDY, k = 17, n = 6,251)37
-
significantly reduced iron levels in the brains of children with ADHD in
- Globus pallidus38
- Putamen38
- Caudate nucleus38
- Thalamus38
- Nucleus ruber38
- Bilateral limbic region of the striatum39
- Which correlated with higher severity of ADHD symptoms, while lower tissue iron levels in the left limbic striatum correlated only with the severity of anxious, depressive and affective symptoms.
-
Brain iron deficiency 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.38 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
-
a correlation between iron deficiency and ADHD40
-
a correlation with sleep problems in ADHD.41
- Iron deficiency also correlated with restless legs sleep problems.41
-
positive effect of iron on ADHD (meta-analysis)42 (meta-analysis)43
No clear correlation found between serum iron levels and ADHD 5 sources: (meta-analysis)44 (meta-analysis, k = 6, n = 986)45464748
Evidence of excessive brain iron levels in adults with ADHD found 1 Source:
- especially in the right precentral cortex49
In ADHD, 2 meta-analyses found decreased serum ferritin levels:
- Serum ferritin levels reduced in ADHD (meta-analysis, k = 10 , n = 3,387)50 (METASTUDY, k = 17, n = 6,251)37
- an association between ferritin levels as a peripheral marker of iron levels in ADHD and the risk of ADHD in children (meta-analysis, k = 5, n = 258)51
The prevalence of insufficient iron intake was stated as
- 20 % of pre-school children41
- between 0 % and 20 % in Europe 3
- for adults in Germany
- 7.1 % (men aged 19 to 64)
- 4.5 % (men aged 65 and over)
- 6.1 % (women aged 65 and over)
- about 10% of Europeans. Particularly frequently affected are
- Women
in particular:- of childbearing age
- after menstruation
- heavy menstrual bleeding in women correlated with ADHD symptoms52
- during pregnancy
- during breastfeeding
- Children
- Teenagers
- Dialysis patients
- for acute inflammation
- chronic intestinal diseases
- Gastritis
- Heart failure
- Cancer diseases
- Women
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:
- measure first (repeat annually)
- then just fill the deficit
During acute infections, iron supplementation can be detrimental.53
2.4. Niacin
Source: Bieger.5455 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 is an essential mineral and is absorbed with food. Important sources of manganese are tea, juices, cereals, rice, nuts, seafood, chocolate, fruit, vegetables, seeds and spices.
Manganese acts as a coenzyme. It is involved in and relevant for:5657
- Bone formation
- Macronutrient metabolism
- Defense against free radicals
- Manganese is a component of manganese superoxide dismutase (MnSOD), a primary antioxidant that eliminates reactive oxygen species during oxidative stress in the mitochondria
- Brain function and development58
- Activator of antioxidants
- required for insulin synthesis and secretion
Manganese deficiency can cause{Visternicu M, Rarinca V, Burlui V, Halitchi G, Ciobică A, Singeap AM, Dobrin R, Mavroudis I, Trifan A (2024): Investigating the Impact of Nutrition and Oxidative Stress on Attention Deficit Hyperactivity Disorder. Nutrients. 2024 Sep 15;16(18):3113. doi: 10.3390/nu16183113. PMID: 39339712; PMCID: PMC11435085. REVIEW}}
- Disorder of the carbohydrate metabolism
- Brain dysfunctions of the brain
Excess manganese can trigger:59
- cognitive deficits60
- Attention and learning problems6061
- Executive problems62
- Hyperactivity (meta-analysis)15
- emotional problem60
- 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 boys63
Manganese can affect the dopaminergic system.645961
A meta-analysis found increased manganese levels in the hair but not in the blood of children with ADHD.65 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.18
Another study reported that the administration of methylphenidate significantly reduced manganese levels.66
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.12
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.67
Several enzymes thought to play an essential role in the neurophysiology of ADHD are copper-dependent.68
Excess copper can promote the oxidation of dopamine and its metabolite salsolinol, which leads to the degeneration of dopaminergic neurons.69
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.18
One study found average blood serum levels of in children with ADHD compared to those not affected:17
- 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.70
One study found reduced levels in plasma, erythrocytes, urine and hair in children with increased hyperactivity of71
- Magnesium
- Zinc
- Copper
- Iron
- Calcium
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.72
One study found slight evidence of a role for copper in ADHD. No evidence of a connection was found for other micronutrients.73
A study of Egyptian children found a copper deficiency in 70% of them22
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.19
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.18
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.18
2.9. Chrome
One study found altered blood serum levels in children with ADHD compared to those not affected:17
- 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 of74
- 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.12
2.11. Bismuth
One study found altered levels in the hair of children with ADHD of74
- 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 of74
- 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.75 Magnesium L-threonate is a compound of magnesium and L-threonic acid. Magnesium L-threonate is a degradation product of vitamin C.
Lepping, Huber (2010): Role of zinc in the pathogenesis of attention-deficit hyperactivity disorder: implications for research and treatment. CNS Drugs. 2010 Sep;24(9):721-8. doi: 10.2165/11537610-000000000-00000. ↥
Scassellati, Bonvicini, Faraone, Gennarelli (2012): Biomarkers and Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analyses. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 51, Issue 10, 1003 – 1019.e20 ↥
Roman Viñas, Ribas Barba, Ngo, Gurinovic, Novakovic, Cavelaars, de Groot, van’t Veer, Matthys, Serra Majem (2011): Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab. 2011;59(2-4):84-95. doi: 10.1159/000332762. PMID: 22142665. ↥ ↥ ↥
Vreugdenhil, Akkermans, van der Merwe, van Elburg, van Goudoever, Brus (2021): Prevalence of Zinc Deficiency in Healthy 1-3-Year-Old Children from Three Western European Countries. Nutrients. 2021 Oct 22;13(11):3713. doi: 10.3390/nu13113713. PMID: 34835970; PMCID: PMC8621620. n = 278 ↥
Steinhausen, Rothenberger, Döpfner (2010): Handbuch ADHS, Seite 78 ↥
Sandyk (1990): Zinc Deficiency in Attention-Deficit Hyperactivity Disorder, International Journal of Neuroscience, 52:3-4, 239-241, DOI: 10.3109/00207459009000526 ↥
Coogan, McGowan (2017): A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders. September 2017, Volume 9, Issue 3, pp 129–147 ↥
Scassellati, Bonvicini, Faraone, Gennarelli (2012): Biomarkers and Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analyses. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 51, Issue 10, 1003 – 1019.e20 ↥
Dkhil, Diab, Aljawdah, Murshed, Hafiz, Al-Quraishy, Bauomy (2020): Neuro-biochemical changes induced by zinc oxide nanoparticles. Saudi J Biol Sci. 2020 Oct;27(10):2863-2867. doi: 10.1016/j.sjbs.2020.07.009. PMID: 32994747; PMCID: PMC7499291. ↥
Akhondzadeh, Mohammadi, Khademi (2004): Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial [ISRCTN64132371]. BMC Psychiatry. 2004 Apr 8;4:9., n = 44 ↥
Krause, Krause (2014): ADHS im Erwachsenenalter: Symptome – Differenzialdiagnose – Therapie, Schattauer, Seite 287 ↥
Austin, Curtin, Curtin, Gennings, Arora, Tammimies, Isaksson, Willfors, Bölte (2019): Dynamical properties of elemental metabolism distinguish attention deficit hyperactivity disorder from autism spectrum disorder. Transl Psychiatry. 2019 Sep 25;9(1):238. doi: 10.1038/s41398-019-0567-6. ↥ ↥ ↥
Scassellati, Bonvicini, Faraone, Gennarelli (2012): Biomarkers and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. J Am Acad Child Adolesc Psychiatry. 2012 Oct;51(10):1003-1019.e20. doi: 10.1016/j.jaac.2012.08.015. PMID: 23021477. METASTUDIE ↥
Sun GX, Wang BH, Zhang YF (2015): [Relationship between serum zinc levels and attention deficit hyperactivity disorder in children]. Zhongguo Dang Dai Er Ke Za Zhi. 2015 Sep;17(9):980-3. Chinese. PMID: 26412183. METASTUDY ↥
Scassellati, Bonvicini, Benussi, Ghidoni, Squitti (2020): Neurodevelopmental disorders: Metallomics studies for the identification of potential biomarkers associated to diagnosis and treatment. J Trace Elem Med Biol. 2020 Jul;60:126499. doi: 10.1016/j.jtemb.2020.126499. Epub 2020 Mar 16. PMID: 32203724. METASTUDIE ↥ ↥
Luo, Mo, Liu (2019): Blood and hair zinc levels in children with attention deficit hyperactivity disorder: A meta-analysis. Asian J Psychiatr. 2019 Sep 26;47:101805. doi: 10.1016/j.ajp.2019.09.023. ↥
Skalny, Mazaletskaya, Ajsuvakova, Bjørklund, Skalnaya, Chao, Chernova, Shakieva, Kopylov, Skalny, Tinkov (2019): Serum zinc, copper, zinc-to-copper ratio, and other essential elements and minerals in children with attention deficit/hyperactivity disorder (ADHD). J Trace Elem Med Biol. 2019 Dec 6;58:126445. doi: 10.1016/j.jtemb.2019.126445. n = 136 ↥ ↥ ↥ ↥
Tinkov, Mazaletskaya, Ajsuvakova, Bjørklund, Huang, Chernova, Skalny, Skalny (2019): ICP-MS Assessment of Hair Essential Trace Elements and Minerals in Russian Preschool and Primary School Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Biol Trace Elem Res. 2019 Nov 5. doi: 10.1007/s12011-019-01947-5. ↥ ↥ ↥ ↥ ↥ ↥
Yang, Zhang, Gao, Lin, Li, Zhao (2019): Blood Levels of Trace Elements in Children with Attention-Deficit Hyperactivity Disorder: Results from a Case-Control Study. Biol Trace Elem Res. 2019 Feb;187(2):376-382. doi: 10.1007/s12011-018-1408-9. PMID: 29909491. n = 814 ↥ ↥
Bekaroğlu, Aslan, Gedik, Değer, Mocan, Erduran, Karahan (1996): Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note. J Child Psychol Psychiatry. 1996 Feb;37(2):225-7. doi: 10.1111/j.1469-7610.1996.tb01395.x. PMID: 8682903. n = 93 ↥
Tabatadze, Kherkheulidze, Kandelaki, Kavlashvili, Ivanashvili (2018): ATTENTION DEFICIT HYPERACTIVITY DISORDER AND HAIR HEAVY METAL AND ESSENTIAL TRACE ELEMENT CONCENTRATIONS. IS THERE A LINK? Georgian Med News. 2018 Nov;(284):88-92. PMID: 30618396. n = 70 ↥
Elbaz F, Zahra S, Hanafy H (2017) Magnesium, zinc and copper estimation in children, The Egyptian Journal of Medical Human Genetics (2017) 18, 153–163 n = 40 ↥ ↥ ↥
Starobrat-Hermelin (1998): Wpływ niedoboru wybranych biopierwiastków na nadpobudliwość psychoruchowa u dzieci z określonymi zaburzeniami psychicznymi [The effect of deficiency of selected bioelements on hyperactivity in children with certain specified mental disorders]. Ann Acad Med Stetin. 1998;44:297-314. Polish. PMID: 9857546. n = 116 ↥ ↥
Granero, Pardo-Garrido, Carpio-Toro, Ramírez-Coronel, Martínez-Suárez, Reivan-Ortiz (2021): The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials. Nutrients. 2021 Nov 13;13(11):4059. doi: 10.3390/nu13114059. PMID: 34836314; PMCID: PMC8618748. METASTUDIE ↥
El-Baz, Youssef, Khairy, Ramadan, Youssef (2019): Association between circulating zinc/ferritin levels and parent Conner’s scores in children with attention deficit hyperactivity disorder. Eur Psychiatry. 2019 Sep 20;62:68-73. doi: 10.1016/j.eurpsy.2019.09.002. ↥ ↥
Noorazar, Malek, Aghaei, Yasamineh, Kalejahi (2020): The efficacy of zinc augmentation in children with attention deficit hyperactivity disorder under treatment with methylphenidate: A randomized controlled trial. Asian J Psychiatr. 2020 Feb;48:101868. doi: 10.1016/j.ajp.2019.101868. PMID: 31841818. n = 60 ↥
Effatpanah, Rezaei, Effatpanah, Effatpanah, Varkaneh, Mousavi, Fatahi, Rinaldi, Hashemi (2019): Magnesium status and attention deficit hyperactivity disorder (ADHD): A meta-analysis. Psychiatry Res. 2019 Feb 19;274:228-234. doi: 10.1016/j.psychres.2019.02.043. ↥
Hinghofer-Szalkay (physiologie.cc Abruf 2019): Humoral-neuronale Steuerung und Kontrolle von Organsystemen: Applikation, Transport, Metabolismus und Clearance ↥
Gao X, Zheng X, Wang X, Li Z, Yang L (2025): Environmental pollutant exposure and adverse neurodevelopmental outcomes: An umbrella review and evidence grading of meta-analyses. J Hazard Mater. 2025 Mar 5;491:137832. doi: 10.1016/j.jhazmat.2025.137832. PMID: 40068397. REVIEW ↥
Butler (2019): Magnesium Supplement and the 15q11.2 BP1-BP2 Microdeletion (Burnside-Butler) Syndrome: A Potential Treatment? Int J Mol Sci. 2019 Jun 14;20(12). pii: E2914. doi: 10.3390/ijms20122914. ↥
Hemamy, Heidari-Beni, Askari, Karahmadi, Maracy (2020): Effect of Vitamin D and Magnesium Supplementation on Behavior Problems in Children with Attention-Deficit Hyperactivity Disorder. Int J Prev Med. 2020 Jan 24;11:4. doi: 10.4103/ijpvm.IJPVM_546_17. PMID: 32089804; PMCID: PMC7011463. ↥
Hemamy, Pahlavani, Amanollahi, Islam, McVicar, Askari, Malekahmadi (2021): The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial. BMC Pediatr. 2021 Apr 17;21(1):178. doi: 10.1186/s12887-021-02631-1. PMID: 33865361; PMCID: PMC8052751. n = 66 ↥
Moos (2002): Brain iron homeostasis. Dan Med Bull. 2002 Nov;49(4):279-301. ↥
Moreno-Fernández, López-Aliaga, García-Burgos, Alférez, Díaz-Castro (2019): Fermented Goat Milk Consumption Enhances Brain Molecular Functions during Iron Deficiency Anemia Recovery. Nutrients. 2019 Oct 7;11(10):2394. doi: 10.3390/nu11102394. PMID: 31591353; PMCID: PMC6835798. ↥
Quiroz, Gulyani, Ruiqian, Bonaventura, Cutler, Pearson, Allen, Earley, Mattson, Ferré (2016): Adenosine receptors as markers of brain iron deficiency: Implications for Restless Legs Syndrome. Neuropharmacology. 2016 Dec;111:160-168. doi: 10.1016/j.neuropharm.2016.09.002. PMID: 27600688; PMCID: PMC5056844. ↥
Wang, Yu, Fu, Yeh, Hsu, Yang, Yang, Huang, Wei, Chen, Chiang, Pan (2019): Dietary Profiles, Nutritional Biochemistry Status, and Attention-Deficit/Hyperactivity Disorder: Path Analysis for a Case-Control Study. J Clin Med. 2019 May 18;8(5). pii: E709. doi: 10.3390/jcm8050709. n = 432 ↥
Tseng, Cheng, Yen, Chen, Stubbs, Whiteley, Carvalho, Li, Chen, Yang, Tang, Chu, Yang, Liang, Wu, Lin (2018): Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Sci Rep. 2018 Jan 15;8(1):788. doi: 10.1038/s41598-017-19096-x. PMID: 29335588; PMCID: PMC5768671. METASTUDY, k = 17, n = 6.251 ↥ ↥
Adisetiyo, Gray, Jensen, Helpern (2019): Brain iron levels in attention-deficit/hyperactivity disorder normalize as a function of psychostimulant treatment duration. Neuroimage Clin. 2019 Aug 26;24:101993. doi: 10.1016/j.nicl.2019.101993. ↥ ↥ ↥ ↥ ↥ ↥
Shvarzman R, Crocetti D, Rosch KS, Li X, Mostofsky SH (2022): Reduced basal ganglia tissue-iron concentration in school-age children with attention-deficit/hyperactivity disorder is localized to limbic circuitry. Exp Brain Res. 2022 Oct 27. doi: 10.1007/s00221-022-06484-7. Epub ahead of print. PMID: 36301336. ↥
Chmielewska A, Domellöf M (2025): Iron deficiency in infants and children - the current research challenges. Curr Opin Clin Nutr Metab Care. 2025 May 1;28(3):284-288. doi: 10.1097/MCO.0000000000001120. PMID: 40172128. REVIEW ↥
Leung, Singh, McWilliams, Stockler, Ipsiroglu (2020): Iron deficiency and sleep – A scoping review. Sleep Med Rev. 2020 Jun;51:101274. doi: 10.1016/j.smrv.2020.101274. PMID: 32224451. REVIEW ↥ ↥ ↥
Granero, Pardo-Garrido, Carpio-Toro, Ramírez-Coronel, Martínez-Suárez, Reivan-Ortiz (2021): The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials. Nutrients. 2021 Nov 13;13(11):4059. doi: 10.3390/nu13114059. PMID: 34836314; PMCID: PMC8618748. METASTUDY ↥
McWilliams, Singh, Leung, Stockler, Ipsiroglu (2022): Iron deficiency and common neurodevelopmental disorders-A scoping review. PLoS One. 2022 Sep 29;17(9):e0273819. doi: 10.1371/journal.pone.0273819. PMID: 36173945. METASTUDIE ↥
Scassellati, Bonvicini, Faraone, Gennarelli (2012): Biomarkers and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. J Am Acad Child Adolesc Psychiatry. 2012 Oct;51(10):1003-1019.e20. doi: 10.1016/j.jaac.2012.08.015. PMID: 23021477. METASTUDY ↥
Wang, Huang, Zhang, Qu, Mu (2017): Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PLoS One. 2017 Jan 3;12(1):e0169145. doi: 10.1371/journal.pone.0169145. PMID: 28046016; PMCID: PMC5207676. METASTUDY ↥
Magula, Moxley, Lachman (2019): Iron deficiency in South African children and adolescents with attention deficit hyperactivity disorder. J Child Adolesc Ment Health. 2019 Jul 24:1-8. doi: 10.2989/17280583.2019.1637345. ↥
Donfrancesco R, Parisi P, Vanacore N, Martines F, Sargentini V, Cortese S (2013): Iron and ADHD: time to move beyond serum ferritin levels. J Atten Disord. 2013 May;17(4):347-57. doi: 10.1177/1087054711430712. PMID: 22290693. ↥
Schulze M, Coghill D, Lux S, Philipsen A, Silk T (2024): Assessing brain iron and its relationship to cognition and comorbidity in children with ADHD with quantitative susceptibility mapping (QSM). Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Aug 30:S2451-9022(24)00250-7. doi: 10.1016/j.bpsc.2024.08.015. PMID: 39218036. ↥
Berberat J, Kagerer SM, Späni C, Hua J, Bavato F, Gruber P, van Zijl PC, Perroud N, Li X, Stämpfli P, Seifritz E, Lövblad KO, Quednow BB, Unschuld PG (2025): Brain iron load and neuroaxonal vulnerability in adult attention-deficit hyperactivity disorder. Psychiatry Clin Neurosci. 2025 Feb 27. doi: 10.1111/pcn.13806. PMID: 40013605. ↥
Wang, Huang, Zhang, Qu, Mu (2017): Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PLoS One. 2017 Jan 3;12(1):e0169145. doi: 10).1371/journal.pone.0169145. PMID: 28046016; PMCID: PMC5207676. METASTUDY ↥
Tan, Wei, Zhang, Lu, Li (2011): [Relationship between serum ferritin levels and susceptibility to attention deficit hyperactivity disorder in children: a Meta analysis]. Zhongguo Dang Dai Er Ke Za Zhi. 2011 Sep;13(9):722-4. Chinese. PMID: 21924020. 5 Studien, n = 258 METASTUDY ↥
MacLean B, Buissink P, Louw V, Chen W, Richards T (2025): Women with Symptoms Suggestive of ADHD Are More Likely to Report Symptoms of Iron Deficiency and Heavy Menstrual Bleeding. Nutrients. 2025 Feb 24;17(5):785. doi: 10.3390/nu17050785. PMID: 40077654; PMCID: PMC11902013. ↥
Metzgeroth, zitiert in Himmer (2022): Bleiern müde, Süddeutsche Zeitung 4./5./6. Juni 2022, Seite 33 ↥
Bieger (2006): Neuroscience Guide – Ein innovatives, diagnostisches und therapeutisches Stufenprogramm bei Neurotransmitter-Störungen, Seite 19 ↥
Visternicu M, Rarinca V, Burlui V, Halitchi G, Ciobică A, Singeap AM, Dobrin R, Mavroudis I, Trifan A (2024): Investigating the Impact of Nutrition and Oxidative Stress on Attention Deficit Hyperactivity Disorder. Nutrients. 2024 Sep 15;16(18):3113. doi: 10.3390/nu16183113. PMID: 39339712; PMCID: PMC11435085. REVIEW ↥
Erikson KM, Aschner M (2019): Manganese: Its Role in Disease and Health. Met Ions Life Sci. 2019 Jan 14;19:/books/9783110527872/9783110527872-016/9783110527872-016.xml. doi: 10.1515/9783110527872-016. PMID: 30855111. REVIEW ↥
Lucchini R, Placidi D, Cagna G, Fedrighi C, Oppini M, Peli M, Zoni S (2017): Manganese and Developmental Neurotoxicity. Adv Neurobiol. 2017;18:13-34. doi: 10.1007/978-3-319-60189-2_2. PMID: 28889261; PMCID: PMC6057616. REVIEW ↥
Farias AC, Cunha A, Benko CR, McCracken JT, Costa MT, Farias LG, Cordeiro ML (2010): Manganese in children with attention-deficit/hyperactivity disorder: relationship with methylphenidate exposure. J Child Adolesc Psychopharmacol. 2010 Apr;20(2):113-8. doi: 10.1089/cap.2009.0073. PMID: 20415606. ↥ ↥
Fernández-Olmo I, Mantecón P, Markiv B, Ruiz-Azcona L, Santibáñez M (2021): A Review on the Environmental Exposure to Airborne Manganese, Biomonitoring, and Neurological/Neuropsychological Outcomes. Rev Environ Contam Toxicol. 2021;254:85-130. doi: 10.1007/398_2020_46. PMID: 32474705. REVIEW ↥ ↥ ↥
Aschner M, Martins AC, Oliveira-Paula GH, Skalny AV, Zaitseva IP, Bowman AB, Kirichuk AA, Santamaria A, Tizabi Y, Tinkov AA (2024): Manganese in autism spectrum disorder and attention deficit hyperactivity disorder: The state of the art. Curr Res Toxicol. 2024 Apr 25;6:100170. doi: 10.1016/j.crtox.2024.100170. PMID: 38737010; PMCID: PMC11088232. REVIEW ↥ ↥
Carvalho CF, Menezes-Filho JA, de Matos VP, Bessa JR, Coelho-Santos J, Viana GF, Argollo N, Abreu N (2014): Elevated airborne manganese and low executive function in school-aged children in Brazil. Neurotoxicology. 2014 Dec;45:301-8. doi: 10.1016/j.neuro.2013.11.006. PMID: 24308913. ↥
Broberg, Taj, Guazzetti, Peli, Cagna, Pineda, Placidi, Wright, Smith, Lucchini, Wahlberg (2019): Manganese transporter genetics and sex modify the association between environmental manganese exposure and neurobehavioral outcomes in children. Environ Int. 2019 Sep;130:104908. doi: 10.1016/j.envint.2019.104908. n = 645 ↥
Shih JH, Zeng BY, Lin PY, Chen TY, Chen YW, Wu CK, Tseng PT, Wu MK. Association between peripheral manganese levels and attention-deficit/hyperactivity disorder: a preliminary meta-analysis. Neuropsychiatr Dis Treat. 2018 Jul 18;14:1831-1842. doi: 10.2147/NDT.S165378. PMID: 30140155; PMCID: PMC6054766. 4 Studien, n = 1.174 METASTUDIE ↥
Shih, Zeng, Lin, Chen, Chen, Wu, Tseng, Wu (2018): Association between peripheral manganese levels and attention-deficit/hyperactivity disorder: a preliminary meta-analysis. Neuropsychiatr Dis Treat. 2018 Jul 18;14:1831-1842. doi: 10.2147/NDT.S165378. PMID: 30140155; PMCID: PMC6054766. 4 Studien, n = 1.174 METASTUDIE ↥
Scassellati, Bonvicini, Faraone, Gennarelli (2012): Biomarkers and Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analyses. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 51, Issue 10, 1003 – 1019.e20 REVIEW ↥
Scassellati, Bonvicini, Faraone, Gennarelli (2012): Biomarkers and Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analyses. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 51, Issue 10, 1003 – 1019.e20 ↥
Llanos, Mercer (2004): The Molecular Basis of Copper Homeostasis Copper-Related Disorders. DNA and Cell BiologyVol. 21, No. 4. https://doi.org/10.1089/104454902753759681 ↥
Yu, Jiang, Wang, Xie (2008): Copper (Cu2+) induces degeneration of dopaminergic neurons in the nigrostriatal system of rats. Neuroscience Bulletin. April 2008, Volume 24, Issue 2, pp 73–78 ↥
Sakhr, Hassan, Desoky (2020): Possible Associations of Disturbed Neurometals and Ammonia with Glycaemic Control in Type 1 Diabetic Children with Attention Deficit Hyperactivity Disorder. Biol Trace Elem Res. 2020 Feb 5:10.1007/s12011-020-02063-5. doi: 10.1007/s12011-020-02063-5. PMID: 32020524. n = 60 ↥
Kozielec, Starobrat-Hermelin, Kotkowiak (1994): Wystepowanie niedoborów wybranych biopierwiastków u dzieci z nadpobudliwościa [Deficiency of certain trace elements in children with hyperactivity]. Psychiatr Pol. 1994 May-Jun;28(3):345-53. Polish. PMID: 8078966. n = 50 ↥
Yorbik, Mutlu, Özdağ, Olgun, Eryilmaz, Ayta (2016): Possible Effects of Copper and Ceruloplasmin Levels on Auditory Event Potentials in Boys with Attention Deficit Hyperactivity Disorder. Noro Psikiyatr Ars. 2016 Dec;53(4):321-327. doi: 10.5152/npa.2016.12659. PMID: 28360806; PMCID: PMC5353038. n = 65 ↥
Sui X, Liu T, Zou Z, Zhang B (2023): Appraising the role of circulating concentrations of micronutrients in attention deficit hyperactivity disorder: a Mendelian randomization study. Sci Rep. 2023 Dec 9;13(1):21850. doi: 10.1038/s41598-023-49283-y. PMID: 38071357; PMCID: PMC10710398. ↥
Perham, Shaikh, Lee, Darling, Rucklidge (2020): Toward ‘element balance’ in ADHD: an exploratory case control study employing hair analysis. Nutr Neurosci. 2020 Jan 3:1-11. doi: 10.1080/1028415X.2019.1707395. n = 107 ↥ ↥ ↥
Surman, Vaudreuil, Boland, Rhodewalt, DiSalvo, Biederman (2020): L-Threonic Acid Magnesium Salt Supplementation in ADHD: An Open-Label Pilot Study. J Diet Suppl. 2020 Mar 12:1-13. doi: 10.1080/19390211.2020.1731044. PMID: 32162987. n = 15 ↥