Does a gluten-free diet help improve symptoms of ADHD?
In my practice, I often recommend a gluten-free diet for individuals with ADHD. ADHD is a disorder of increased inflammation, and one contributing factor becoming more apparent in research is Leaky Gut. What contributes to Leaky Gut?….GLUTEN.
Leaky Gut is a condition of increased permeability in the gut lining. You may ask - what in the world is that?!
Our digestive system is meant to be a protective fortress from the outside world, protecting us from harmful bacteria, fungi, viruses, allergens, and anything else we’ve ingested that could be harmful. It is very selective, determining what will and will not enter the bloodstream. Ideally, supportive, necessary nutrients, bacteria, and molecules are let in, and harmful substances are excreted out.
The gut is lined with tight junctions, which function as gatekeepers. These tight junctions play a crucial role in maintaining the integrity and function of the digestive system. Zonulin, a protein, opens these tight junctions.
Several studies have revealed that gluten triggers the activation of Zonulin, resulting in increased intestinal permeability. More Zonulin increases Leaky Gut. With Leaky Gut, harmful substances can enter the bloodstream that would have been blocked and trigger an immune response. When we trigger an immune response over and over, this may result in an auto-immune reaction and/or chronic inflammation over time.
When immune cells respond to a foreign invader, some stay in the intestine or gut, resulting in localized damage in conditions like celiac disease. Other immune cells will exit the intestine and venture into other regions, including the nervous system, where they incite neuroinflammation. Clinical consequences will vary depending on an individual's genetic makeup. Notably, elevated levels of Zonulin have also been observed in individuals with Autism Spectrum Disorder (ASD) and ADHD.
Removing gluten 100% from the diet can feel overwhelming, but it’s not as hard as you think. It starts with asking the question when eating out. Most restaurants are accommodating with gluten intolerances and allergies.
There are amazing brands on the market, like Siete, Simple Mills, Purely Elizabeth, Hu Kitchen, and Primal Kitchen, that use gluten-free ingredients exclusively. Knowing these brands makes grocery shopping super easy. Check out my Amazon Storefront for numerous gluten-free recommendations. None of the foods I have posted have gluten in them.
Finally, when we eat foods from the perimeter of the grocery store, like the produce, meat, and dairy sections, we don’t find gluten! Eating nutrient-dense foods is the best way to optimize health and simplify shopping as well!
If you have an immune response to gluten, it takes a while to reduce the inflammation it has caused. One bite of gluten can cause an immune response for up to 6 weeks. If you’re attempting an elimination trial, I recommend going 100% gluten-free for a minimum of 6 weeks and honestly 2-3 months to experience the best results.
The breakdown of intestinal barrier integrity, triggered by environmental factors originating from food or alterations in gut microbiota, appears to be fundamental in the development of inflammation and mental health disorders like ADHD. If this is something you or a loved one struggles with, it is worth eliminating gluten. When my family removed gluten, my son commented how much more energy he had!
References:
Asbjornsdottir, B., Snorradottir, H., Andresdottir, E., Fasano, A., Lauth, B., Gudmundsson, L. S., Gottfredsson, M., Halldorsson, T. I., & Birgisdottir, B. E. (2020). Zonulin-Dependent Intestinal Permeability in Children Diagnosed with Mental Disorders: A Systematic Review and Meta-Analysis. Nutrients, 12(7), 1982. https://doi.org/10.3390/nu12071982
Bennett, P. (2022). Q&A with Celiac Expert Dr. Alessio Fasano. Allergic Living. https://www.allergicliving.com/2014/04/16/qa-with-celiac-expert-dr-alessio-fasano/
Esnafoglu, E., Cirrik, S., Ayyildiz, S. N., & Ertürk, E. Y. (2017). Increased Serum Zonulin Levels as an Intestinal Permeability Marker in Autistic Subjects. https://doi.org/10.1016/j.jpeds.2017.04.004
Fasano A. (2020). All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Research, 9, F1000 Faculty Rev-69. https://doi.org/10.12688/f1000research.20510.1
Özyurt, G., Öztürk, Y., Appak, Y. Ç., Arslan, F. D., Baran, M., Karakoyun, İ., Tufan, A. E., & Pekcanlar, A. A. (2018). Increased zonulin is associated with hyperactivity and social dysfunctions in children with attention deficit hyperactivity disorder. Comprehensive psychiatry, 87, 138–142. https://doi.org/10.1016/j.comppsych.2018.10.006