ADHD and Vitamin D Deficiency

ADHD children had 21 ng of vitamin D (control = 35 ng) – Jan 2014

Vitamin D Status in Children with Attention Deficit Hyperactivity Disorder
Pediatr Int. 2014 Jan 13. doi: 10.1111/ped.12286.
Goksugur SB, Tufan AE, Semiz M, Gunes C, Bekdas M, Tosun M, Demircioglu F.
Department of Pediatrics, Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders of the childhood is an early onset, affecting 2-18 % of the children worldwide. Etiopathogenesis of ADHD is obscure. In recent studies, low levels of vitamin D are found in association with many disorders as well as in neuropsychiatric diseases. In this study, we aimed to investigate serum vitamin D levels in pediatric ADHD patients.

METHODS: A total of 60 ADHD patients and 30 healthy controls were included in the study. Ages of the both groups were in 7 and 18 years old range. Serum levels of 25-OH-Vitamin D, calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) were investigated.

RESULTS: Serum levels of 25-OH-vitamin D were found to be significantly lower in children and adolescents with ADHD compared to healthy controls and no significant differences were found between the groups in terms of other variables. 25-OH-vitamin D level in ADHD group and control group was respectively; 20.9±19.4 ng/mL and 34.9±15.4 ng/mL (p=0.001).

CONCLUSION: Our results suggest that there is an association between lower 25-OH-vitamin D concentrations and ADHD in childhood and adolescence. Up to our knowledge this is the first study that investigate the relationship between vitamin D and ADHD in children.

PMID: 24417979 patients/caregivers can buy a copy of the study from the publisher for just $3.50

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See also VitaminDWiki

• ADHD decreased by 11% for each 10 ng increase in vitamin D in early pregnancy – April 2015
• Psych meds used by 1 in 13 U.S. schoolkids (wonder about interaction with vitamin D) – April 2014
• Psychiatric problems such as ADHD treated with vitamin D – March 2010
• VitaminDWiki Category Magnesium 124 items
• Search VitaminDWiki for hyperactivity OR "attention deficit" 87 items as of April 2015
     (Note: Did not search for ADHD, as ADHD is on the left of every page in VitaminDWiki)
• Autism and Vitamin D studies 57 items
• Autism and vitamin D many articles on and off VitaminDWiki
• Deficiencies of Vitamin D, Iron, Magnesium, and Zinc all associated with ADHD – Sept 2014
• ADHD in Arab countries – vitamin D is the only changeable risk factor – review April 2015

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Less sun ==> more ADHD (March 2013)

Geographic Variation in the Prevalence of Attention-Deficit/Hyperactivity Disorder: The Sunny Perspective
Biological Psychiatry, doi:10.1016/j.biopsych.2013.02.010
Martijn Arns email address; Kristiaan B. van der Heijden, L. Eugene Arnold. J. Leon Kenemans
Received 6 December 2012; received in revised form 19 February 2013; accepted 19 February 2013. published online 25 March 2013.

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood, with average worldwide prevalence of 5.3%, varying by region.

Methods: We assessed the relationship between the prevalence of ADHD and solar intensity (SI) (kilowatt hours/square meters/day) on the basis of multinational and cross-state studies. Prevalence data for the U.S. were based on self-report of professional diagnoses; prevalence data for the other countries were based on diagnostic assessment. The SI data were obtained from national institutes.

Results: In three datasets (across 49 U.S. states for 2003 and 2007, and across 9 non-U.S. countries) a relationship between SI and the prevalence of ADHD was found, explaining 34%–57% of the variance in ADHD prevalence, with high SI having an apparent preventative effect. Controlling for low birth weight, infant mortality, average income (socioeconomic status), latitude, and other relevant factors did not change these findings. Furthermore, these findings were specific to ADHD, not found for the prevalence of autism spectrum disorders or major depressive disorder.

Conclusions: In this study we found a lower prevalence of ADHD in areas with high SI for both U.S. and non-U.S. data. This association has not been reported before in the literature.
The preventative effect of high SI might be related to an improvement of circadian clock disturbances, which have recently been associated with ADHD. These findings likely apply to a substantial subgroup of ADHD patients and have major implications in our understanding of the etiology and possibly prevention of ADHD by medical professionals, schools, parents, and manufacturers of mobile devices.

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ADHD and Vitamin D Deficiency: Any Evidence?

http://adhd-treatment-options.blogspot.com/2010/03/adhd-and-vitamin-d-deficiency-any.html March 12, 2010
Is there any link between vitamin D levels and ADHD? A review of the current evidence:

We have spent a lot of time looking at correlations between vitamins, minerals, omega-3 fatty acids and amino acids (and their deficiencies) and ADHD. However, it is important to note that just because low levels of a particular nutrient are seen alongside the disorder, it does not necessarily mean that this deficiency is the cause of ADHD (i.e. correlation does not imply causation). In other words, the nutrient deficiency and ADHD symptoms might both be secondary effects of a larger primary cause, such as an enzyme deficiency or metabolic dysfunction.

In the case of vitamin D, the association with ADHD is a lot more muddled than with some of the other nutrients which have a relatively strong connection with the disorder (iron, zinc, magnesium, and omega-3 fatty acids to name a few). The amount of information in the literature is relatively scarce, as well. A search in the journal database Pubmed (where this blogger gets most of his articles and information) for "ADHD" and "vitamin D" turns up only a small handful of search results, the majority of which focus on other disorders and only mention ADHD peripherally.

However, given the fact that vitamin D is such a "hot" vitamin and has been a popular supplement as of late, we should investigate some of its potential benefits with regard to ADHD and related disorders. Please keep in mind that many of these points below are more theoretical or speculative, because most of the hard, concrete evidence in well-documented clinical controlled studies simply does not exist at the moment. Nevertheless, here are some possible ways in which vitamin D may help in cases of ADHD or related disorders:

• Vitamin D can boost levels of the antioxidant glutathione in the brain. One way that vitamin D does this is by regulating an enzyme called gamma-glutamyl transpeptidase, which plays a role in both the metabolism and recycling of glutathione. We have spoken at length about how antioxidant deficits can worsen ADHD symptoms, and how fatty acids (namely omega-3's) are frequently administered for ADHD and related disorders. Given the high makeup of these omega-3 fatty acids in the brain, and their susceptibility to oxidation and damage in the central nervous system, protecting them by boosting antioxidant levels (either directly or indirectly) is a good bet.
• One of the current theories surrounding ADHD is that it is (at least partially) an energy deficiency syndrome, or is the result of impaired metabolic abilities in key regions of the central nervous system. While highly debatable, this theory holds that impaired glucose metabolism in various parts of the brain may be a major contributing factor to the presence or severity of this disorder.

While this blogger is currently neutral on this deficiency theory, it is interesting to note that vitamin D can help regulate glucose tranport into the brain, which would (at least in theory) improve this possible cause of the disorder. It is believed that vitamin D works by targeting multiple enzymes involved in glucose transport and metabolism. Much more study needs to be done to confirm this assertion, but this may be another potential benefit of boosting vitamin D levels in the ADHD patient.

• Vitamin D may play a role in catecholamine synthesis. Catecholamines include the neurotransmitters dopamine and norepinephrine, both of which are believed to be tightly regulated and highly involved in the treatment of ADHD (deficiencies of both dopamine and norepinephrine in the "gaps" between neuronal cells are often seen in cases of ADHD).
• Vitamin D boosts the effects of an enzyme called choline acetyltransferase in the mammalian brain. This enzyme is used in the manufacture of another neurotransmitting agent called acetylcholine. Acetylcholine is thought to play a major role in maintaining a state of sustained attention, a critical shortcoming in those with ADHD. In other words, keeping adequate levels of vitamin D could potentially help prop up lower levels of this attention-sustaining neurochemical.
• Learning and memory deficits, both of which are heavily present in the ADHD population, have been tied to prenatal vitamin D deficiencies in the rat model. This involves a process called synaptic plasticity, which relates to memory formation in an individual. If this finding extends to humans, it could have serious implications on maintaining adequate vitamin D intake in pregnant women.
• Problems with fine motor control are sometimes seen as a secondary characteristic in a fraction of the ADHD population. These problems may be exacerbated in a vitamin D deficient state.
• Perhaps the strongest correlation, however, may be between vitamin D and depressive-like symptoms, particularly those associated with seasonal affective disorders (SAD). Please keep in mind, however, that studies on vitamin D levels and depression are highly variable; a number of studies have been done on the topic and found no such linkage between the two. We have previously investigated possible connections between ADHD and SAD in an earlier post.

This may make intuitive sense, since vitamin D production is triggered by sunlight, so in the dark winter months, the levels of this vitamin are often much lower (this may also be a major contributing factor as to why illnesses run so much more rampant during the winter months). In other words, vitamin D supplementation may be particularly useful in individuals with ADHD who also have co-occuring depressive or anxiety-ridden symptoms.

To summarize: Vitamin D does not have as many pronounced direct effects on ADHD as do some of the other vitamins, minerals, fatty acids and amino acids we have previously discussed. Nevertheless, the vitamin does seem to have multiple neurodevelopmental and neuroregulatory properties, and may go well with comorbid disorders such as schizophrenia, speech difficulties, memory problems, and (perhaps most strongly) depressive symptoms. Please keep in mind, however, that it may not be possible to simply "supplement these problems away" with extra vitamin D. This blogger just wants to point out that a deficiency in this vitamin often manifests itself in many ways, some of which closely parallel ADHD or related disorders. Nevertheless, supplementing may not be a bad idea, especially if you live in an area that gets minimal sunlight for part of (or all of) the year. Some rough guidelines for vitamin D intake can be found here.
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PDF from http://www.additudemag.com which may be from 2010, is attached at the bottom of this page

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See web

• ADHD associated with both low vitamin D and low iron Sept 2014
  full free text online. Note: iron deficiency is associated with low vitamin D in many other diseases
• ADHD and Vitamin D Deficiency June 2014
  ADHD = 17 ng of vitamin D, controls = 26 ng
• Might be able to predict ADHD based on Low vitamin D levels Nov 2013
   Download the PDF from VitaminDWiki.
• Predict attention deficit hyperactivity disorder? Evidence -based medicine Nov 2013
  household income, poor relationship between parents, mothers' occupation, consanguinity, BMI in percentiles, low duration of time under sun light, physical activity, low serum calcium level and low vitamin D level were considered as the main risk factors associated with the ADHD
• Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature. 2012
• More Sunshine Tied to Fewer Cases of ADHD Psych Central review of the study
  The study ruled out several other possible explanations for the geographic variability including low birth weight, infant mortality levels, socioeconomic differences and latitude.
  Arns said that vitamin D levels are an unlikely explanation for the results, since another recent large study showed no relationship between the vitamin and behavioral problems in children.
• Sunlight exposure correlates to a reduced risk of ADHD Sunlight Institute discussion of this study - Oct 2013
• More Diagnoses of A.D.H.D. in New C.D.C. Data NY Times March 2013
  6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives
  a 53 % rise in the past decade
• Significant Increase in ADHD Over Last 9 Years Psych Central on Kaiser Report, 2013
  24 % between 2001 and 2010. Black children had a 70% relative increase in ADHD incidence
• ADHD linked with 2 Vitamin & Mineral Deficiencies July 2010
  ADHD linked to low level of Magnesium AND low vitamin D
• Vitamin D and other deficiencies can be mistaken for ADHD short article which refers to book
• Psychiatric insanity: Over 20% of young boys labeled 'ADHD' Natural News Dec 2013
  20% labeled ADHD sometime in their life, which is an increase of 42% from 2003 to 2011
• Wide Global Variation in ADHD Diagnosis and Treatment Medscape May 2011 - A global increase in ADHD, not just US
  . . the prevalence of ADHD varies across nations but that most of this difference is due to disparate diagnostic practices and algorithms.
  . . a meta-analysis indicated that differences in prevalence are largely attributable to methodologic differences in the studies themselves rather than cultural or national factors.
  China . . . use of methylphenidate medication is difficult because the government-run health system mandates that any prescriptions be given for a maximum of only 2 weeks
  CLICK HERE for full study
• Is It Alzheimer’s, or A.D.H.D.? New York Times Sept 2015
  3 % of Dutch over 60 have A.D.H. D. It overlaps with age-related cognitive decline
  Note by VitaminDWiki - both are associated with and probably prevented and treated with low vitamin D
• The Selling of Attention Deficit Disorder NY Times Dec 2013, show adult ADHD increasing faster than child

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ADHD prescriptions in US

ADHD prescription by young adults up 220% in a decade

88% in 4 years by those in age range 26-34 NY Times March 2014

Ritalin in UK

ADHD Chart of possible reasons (vitamin D not mentioned)

Magnesium and mental illness chart

Which is in Overview Magnesium and vitamin D