Traitement nutritionnel du TDA/H

• Diminuer le plus possible les sucres +++ (bonbons, sodas, gâteaux, biscuits, céréales de petit-déjeuner, fruits au sirop, pain blanc,…)

• Manger des protéines le matin et le midi (pour avoir des acides aminés disponibles dès le matin) ; Manger 0,8g de protéines / kg / jour. (Enfants 10g/j de 0 à 2ans, 12g/j entre 2 et 3 ans ; garçons et filles de 4 à 18 ans : 1,4g/kg/jr ; à partir de 18 ans 1,3g/kg/jr pour les G ; 1,25 pour les F) (anses)

 

• Supplémenter si besoin, en Fer, Zinc , Iode, Vitamine D, Vitamine B6 selon les résultas d’un bilan sanguin et urinaire.

• Supplémentation systématique en Magnésium 100 à 150mg par jour, avec de la vitamine B6 (le dosage sanguin est peu utile car peu informatif sur le stock réel de magnésium (osseux et musculaire)

• Supplémentation systématique en Omégas 3

• Si prédominance troubles de l’attention : L-Tyrosine 500mg le matin, en dehors des repas

• Si prédominance d’impulsivité et hyperactivité : L-Tryptophane 220mgau coucher

• Si mixte : L-Tyrosine + L-Tryptophane

• Supprimer les colorants et additifs, le plus possible, notamment l’acide benzoïque, le salycilate

• Si troubles digestifs : traitement de la perméabilité intestinale et de la dysbiose + éventuellement, si besoin, enquête sur des allergies alimentaires

 

 

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La bibliographie quant aux impacts de la nutrition sur le TDAH est très abondante. En voici un large échantillon pour souligner l’importance de ce facteur.

Synthèses générales :

Bloch MH, Mulqueen J, Nutritional Supplements for the Treatment of Attention-Deficit Hyperactivity Disorder, Child Adolesc Psychiatr Clin N Am. 2014 Oct; 23(4): 883–897.

Synthèse complète et critique donnant le niveau de preuve et des recommandations

Coudron O, Déficit de l’attention et micronutrition, Santé Intégrative, mai/juin 2010, p.21-27 ;http://www.sebastienvaumoron.com/data/documents/SANTE_INTEGRATIVE_No15.pdf

Konokowska K, Regulska-Ilow B, Rozanska D, The influence of components of diet on the symptoms of ADHD in children,Rocz Panstw Zakl Hig.2012;63(2):127-34.

Millichap JG, Yee MM, The diet factor in Attention-Deficit/Hyperactivity disorder, Pediatrics, feb 2012, vol 129

Protéines le matin :

Yehuda S. Nutrients, brain biochemistry, and behavior: a possible role for the neuronal membrane. Int J Neurosci. 1987;35(1–2):21–36pmid:3305401The hyperactive response is blocked if a protein meal is ingested before or with the sugar

Fer :

Calarge C, Farmer C, DiSilvestro R, Arnold LE. Serum ferritin and amphetamine response in youth with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2010;20(6):495–502pmid:21186968

Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001;107(6):1381–1386pmid:11389261

Konofal E, Lecendreux M, Arnulf I, Mouren M-C. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2004;158(12):1113–1115pmid:15583094

Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol. 2008;38(1):20–26pmid:18054688

Millichap JG, Yee MM, Davidson SI. Serum ferritin in children with attention-deficit hyperactivity disorder. Pediatr Neurol. 2006;34(3):200–203pmid:16504789

Sever Y, Ashkenazi A, Tyano S, Weizman A. Iron treatment in children with attention deficit hyperactivity disorder. A preliminary report.Neuropsychobiology. 1997;35(4):178–180pmid:9246217

Zinc :

Akhondzadeh S, Mohammadi MR, Khademi M. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial. BMC Psychiatry. 2004;4:9pmid:15070418

Arnold LE, Pinkham SM, Votolato N. Does zinc moderate essential fatty acid and amphetamine treatment of attention-deficit/hyperactivity disorder? J Child Adolesc Psychopharmacol. 2000;10(2):111–117pmid:10933121

Arnold LE, DiSilvestro RA. Zinc in attention-deficit/hyperactivity disorder.J Child Adolesc Psychopharmacol. 2005;15(4):619–627pmid:16190793

Arnold LE, Bozzolo H, Hollway J, et al. Serum zinc correlates with parent- and teacher- rated inattention in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2005;15(4):628–636pmid:16190794

Arnold LE, Disilvestro RA, Bozzolo D, et al. Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine. J Child Adolesc Psychopharmacol. 2011;21(1):1–19pmid:21309695

Bilici M, Yildirim F, Kandil S, et al. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(1):181–190pmid:14687872

Fankun Zhou, Fengyun Wu, Shipu Zou, Ying Chen, Chang Feng, Guangqin Fan, Dietary, Nutrient Patterns and Blood Essential Elements in Chinese Children with ADHD, Nutrients2016, 8(6), 352

Iode :

Kanık Yüksek S1, Aycan Z, Öner Ö, Evaluation of Iodine Deficiency in Children with Attention Deficit/Hyperactivity Disorder.J Clin Res Pediatr Endocrinol.2016 Mar 5;8(1):61-6

Vermiglio F1, Lo Presti VP, Moleti M, Sidoti M, Tortorella G, Scaffidi G, Castagna MG, Mattina F, Violi MA, Crisà A, Artemisia A, Trimarchi F, Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries, J Clin Endocrinol Metab.2004 Dec;89(12):6054-60.

Vitamine B6

Dolina S, Margalit D, Malitsky S, Rabinkov A, Attention-deficit hyperactivity disorder (ADHD) as a pyridoxine-dependent condition: urinary diagnostic biomarkers, Med Hypotheses.2014 Jan;82(1):111-6

Med Hypotheses. 2014 Jan;82(1):111-6. doi: 10.1016/j.mehy.2013.11.018. Epub 2013 Nov 21.

Attention-deficit hyperactivity disorder (ADHD) as a pyridoxine-dependent condition: urinary diagnostic biomarkers.

Dolina S, Margalit D, Malitsky S, Rabinkov A.

Author information

Abstract

The data obtained in children with different forms of epilepsy allowed us to consider epilepsy as an inborn error of pyridoxine (vitamin B6) metabolism (Dolina et al., 2012). Mutual interconnections between ADHD and epilepsy indicate that such an approach is reasonable for ADHD. To check such an assumption we analyzed in ADHD patients the same parameters of pyridoxal phosphate (PLP)-dependent tryptophan (TRP) degradation, which were analyzed in epileptic children. The level of TRP and concentrations of compounds formed or metabolized by TRP degradation, the ratios between some of them, and the level of 4-pyridoxic acid were HPLC detected in ADHD children and healthy controls. The data obtained, including low values of 4PA/TRP, IND/TRP and IND/KYN ratios, have evidenced dramatically impaired activity of pyridoxine-dependent enzymes in ADHD patients. Ritalin treatment did not change the general pattern of TRP degradation, but still created a kind of balance between some of detected metabolites. However, the 4PA/TRP, IND/TRP and IND/KYN ratios remained as low as in untreated patients, keeping the importance of diagnostic markers. Almost identical parameters of TRP degradation in untreated ADHD and epileptic patients allow to assume that inborn disorders of vitamin B6 metabolism are the common biochemical background of both diseases. The disturbed activity of PLP dependent enzymes apparently forms those profound disturbances of neurotransmitter systems, which are inherent in ADHD: low concentrations of monoamines and disordered amino acid metabolism. If vitamin B6 disorders are the core biochemical disturbances inherent in ADHD, then the long-term pyridoxine treatment is pathogenetically based replacement therapy of the disease. According to our data, multi-year pyridoxine treatment normalizes completely the pattern of ADHD behavior, without causing any serious side effects.

Copyright © 2013 Elsevier Ltd. All rights reserved.

Magnésium + Vitamine B6

Black LJ, Allen KL, Jacoby P, Trapp GS, Gallagher CM, Byrne SM, Oddy WH,Low dietary intake of magnesium is associated with increased externalising behaviours in adolescents, Public Health Nutr. 2015 Jul;18(10):1824-30

Nogovitsina O.R., Levitina E.V.: Neurological aspects of the clinical features, pathophysiology, and corrections of impairments in attention deficit hyperactivity disorder. Neurosci. Behav. Physiol. 2007, 37, 199-202.

Omégas 3 :

Bélanger SA, Vanasse M, Spahis S, Sylvestre MP, Lippé S, L’heureux F, Ghadirian P, Vanasse CM, Levy E.  Omega-3 fatty acid treatment of children with attention-deficit hyperactivity disorder: A randomized, double-blind, placebo controlled study. Paediatr Child Health. 2009;14:89-98

Germano M, Domenico M, Montorfano G, Adorni L, Negroni M, Berra B, Rizzo AM.  Plasma, red blood cells phospholipids and clinical evaluation after long chain omega-3 supplementation in children with attention deficit hyperactivity disorder (ADHD). Nutritional Neuroscience. 2007;10: 1–9

Gustafsson PA, Birberg-Thornberg U, Duchén K, Landgren M, Malmberg K, Pelling H, Strandvik B, Karlsson T. EPA supplementation improves teacher rated behaviour and oppositional symptoms in children with ADHD. Acta Paediatr. 2010 May 19. [Epub ahead of print]

Hirayama S, Hamazaki T, Terasawa K.  Effect of docosahexaenoic acid-containing food administration on symptoms of attention-deficit/hyperactivity disorder – a placebo-controlled double-blind study. Eur J Clin Nutr. 2004 Mar;58(3):467-73

Johnson M, Ostlund S, Fransson G, Kadesjö B, Gillberg C. Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents.  J Atten Disord. 2009;12:394-401

Kirby A, Woodward A, Jackson S, Wang Y, Crawford MA. Childrens’ learning and behaviour and the association with cheek cell polyunsaturated fatty acid levels. Res Dev Disabil. 2010 May-Jun;31(3):731-42

Richardson AJ, Puri BK: The potential role of fatty acids in attention-deficit/hyperactivity.  Essent Fatty Acids 2000, 63:79-87

Stevens LJ, Zentall SS, Abate ML, Kuczek  T AND Burgess JR. Omega-3 Fatty Acids in Boys With Behavior, Learning, and Health Problems Physiology & Behavior. 1996; 59:915-920

Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, Zentall SS, Arnold LE, Burgess JR.  EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors.  Lipids. 2003;38:1007-21

Sorgi PJ, Hallowell EM, Hutchins HL, Sears B.  Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutr J. 2007 J;6:16

Transler C, Eilander A, Mitchell S, van de Meer N. The Impact of Polyunsaturated Fatty Acids in Reducing Child Attention Deficit and Hyperactivity Disorders. J Atten Disord. 2010 Apr 27. [Epub ahead of print]

Vaisman N, Kaysar N, Zaruk-Adasha Y, Pelled D, Brichon G, Zwingelstein G, Bodennec JCorrelation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of dietary n-3 fatty acids containing phospholipids.  Am J Clin Nutr. 2008;87:1170-80

Voigt, R.G., Llorente, A.M., Jensen, C.L., Fraley, J.K., Berretta, M.C., and Heird, W.C. A Randomized, Double-Blind, Placebo-Controlled Trial of Docosahexaenoic Acid Supplementation in Children with Attention Deficit /Hyperactivity Disorder, J. Pediatr. 2001;139: 189–196

Vitamine D : Les insuffisances en vitamine D étant fréquentes et la vitamine D ayant, notamment, un rôle anti-inflammatoire, il convient d’assurer un bon statut en vitamine D.

Voir p. ex :

Schäfer TK, Herrmann-Lingen C, Meyer T, Association of circulating 25-hydroxyvitamin D with mental well-being in a population-based, nationally representative sample of German adolescents, Qual Life Res.2016 Jun 24.

1 Points de repère : Apports Nutritionels Conseillés (ANC) :Fer : 9 mg/j (homme (H)), 16 mg/j (femme (F) non ménopausée) ; Zinc : 12mg/j (H), 10 mg/j (F) ; Iode : 150mcg/j ; Magnésium : 420mg/j (H), 330 (F) ; Vitamine D : 5mcg ; Vitamine B6 :1,4mg/j (H), 2mg/j(F enceinte et allaitante) ; DHA : 250mg /j ; EPA 250mg/j