How to navigate the potential pitfalls of taking ADHD medication

Has your child been prescribed ADHD stimulant medication such as methylphenidate? If so, you are not alone as a parent. Prescriptions for ADHD medications in England alone have risen by 18% a year recently.

Deciding to use medication is a personal choice and may not be suitable for every youngster living with ADHD. While many parents report a positive response to these medications, some find little effect, and there can fear around unwelcome side effects.

This blog is not about deciding whether to take it, but assuming you have… how to navigate the potential pitfalls of taking ADHD medication. You will learn that focusing on your child’s nutrition is a high priority if they take stimulant medications!

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Tell me about stimulant medications

A stimulant medication such as methylphenidate (including brand names such as Ritalin, Concerta, Medikinet, Delmosart and Equasym) is the usual first port of call when ADHD is diagnosed and must be prescribed by a consultant psychiatrist. This family of medications can help to varying degrees with executive function, daytime focus, hyperactivity, impulsivity, procrastination, academic achievement and productivity. It is vital to follow your child’s psychiatrist’s recommendations on when to take it and the correct dosage.

Your child will usually see the effects of this medication for only a 4-8 hour window shortly after taking their dose, and then the effect drops right off until the next dose is taken. It is not a medication that builds up in the system as such and does not need to be tapered off carefully like other psychiatric medication. This is why it is often only taken on school days and not during weekends and holidays.

It can also be tricky to land on the right medication and the most effective dosage. Even with the best psychiatrist it may take months to settle into the combination that works best for your child.

Many people report that these medications are not working as well as they hoped, and they are worried about both short-term and long-term side effects. So, what are these concerns and is there any evidence that nutrition can help to improve some of these negative effects and help the medication to work a bit better? This blog shares how your child can get the most out of their medication using some clever nutrition hacks.

ADHD medication supplement interactions

Before I do a deep dive into how to avoid the side effects from taking ADHD medications, the most frequent question I am asked is…. Can my child take supplements whilst they are taking ADHD medications?

The answer is YES, and according to numerous drug interaction databases there are no known supplement interactions with the methylphenidate family. So, it is possible and it can be beneficial to take supplements alongside ADHD medications.

The only potential interaction (which is cited only once on the internet and there is no published research to verify this, so this information is likely anecdotal at best) is that vitamin C can water down the effect of taking methylphenidate if given at the same time (or within a one-hour window either side of giving the medication). So, it might be prudent to avoid giving your child a big glass of orange juice to glug down their ADHD medication in the morning and also give any supplements containing vitamin C or ascorbic acid in the late afternoon or evening instead.

Conversely many research papers have found that ADHD children are often deficient in a wide range of nutrients. Papers have shown that kids living with ADHD are also commonly low in vitamin D, zinc, iron and magnesium and some studies have shown that giving supplements containing these nutrients help the medications to work better.

What symptoms should you look out for when taking ADHD medications?

Loss of daytime appetite

Kids taking ADHD medications often lose their appetite during the day. The loss of appetite is immediate after taking their stimulant in the morning and they have no hunger signals until it wears off mid-afternoon.

The downside of this is that they tend to miss out on lunch which should provide around a third of a child’s daily nutrition. Instead, a common pattern is they then binge on ultra processed and sweet foods wolfing down a packet of biscuits when they get back from school and during the evening to compensate. I have even heard of kids raiding the fridge in the middle of the night, as they have woken up starving having not eaten enough during the day.

If they binge on junk when they get back from school, then that can mean they are not that hungry for supper, and their nutrition overall takes a downward turn. These eating habits can negatively influence their growth and weight and can even worsen their ADHD symptoms if they develop nutrient deficiencies.

The high-risk times for developing vitamin and mineral deficiencies are when kids are going through growth spurts and during pre-puberty and puberty. If you child does more sport than their peers or siblings, again you need to watch their nutrition more closely.

How to help: Encourage a substantial breakfast before they take their medication in the morning, containing plenty of protein and healthy fats. This will give them the fuel to last their bodies until the afternoon.

Consider two suppers in the evening – one when they get back from school and another a couple of hours later. If they have missed out on lunch, then they will need to catch up with this extra meal after school. Make sure that you have a healthy nutritious snack available if there’s a risk they will otherwise reach for ultra processed snacks.

If morning appetite is very poor, they are not growing well, or they are a highly selective eater then supplement them with zinc to help encourage appetite and growth as well as to help expand their diet.

If they have a very small appetite, complain of a sore tummy or look very pale then they might be low in iron. If your daughter has heavy periods, then again iron may well be on the low end. If you suspect low iron levels then feed them plenty of red meat, liver, green veg and pulses like chickpeas, lentils and black beans. If you know they have low iron from a blood test, then supplementing is vital.

Feeling overstimulated

Some kids get side effects such as feeling overstimulated or jittery when they take stimulant medications. They can then feel more irritable and unsettled which is horrible.

How to help: Discuss these symptoms with your child’s psychiatrist as they may suggest reducing the dose or changing the mediation to a non-stimulant.

It is important for pre-teens and teens to avoid caffeine when starting out on stimulant medication, as the dual effect from the caffeine and ADHD medication together can be too overstimulating for some people.

Studies have found that many kids who live with ADHD also have a magnesium deficiency and from our clinical experience we have found that the effects of magnesium on calming the nervous system and enhancing the mellow GABA pathways can help reduce mild symptoms of feeling overstimulated.

Sleep problems

There have been studies to find that stimulant medications for ADHD can lead to problems getting to sleep, lighter sleep and less sleep overall. If your child sleeps well already, this might not be an issue for them, but if they have always found it difficult to get to sleep or stay asleep or are a light sleeper, then you might need to give them some extra help.

How to help: Sometimes sleep patterns can be affected by the timing of taking an ADHD medication, so this again is a conversation to have with your child’s psychiatrist.

Epsom salt baths and magnesium in the evening can help ADHDers feel sleepier and soporific, which in turn helps them to wind down and get to sleep.

There have also been studies on taking a supplement containing the spice saffron which can help improve sleep patterns in children who take methylphenidate.

More sports injuries

Even though ADHD medications can help with sports performance, due to their dopamine effects, in my clinical experience I have spoken to sporty kids who say they don’t perform well while they are taking them. It seems they struggle to notice the nuances of their sport, which typically give them their competitive advantage, particularly in fast-paced ball sports like hockey, netball, rugby, football and lacrosse.

Because of the suppression of appetite when taking these medications, the lack of good quality nutrition and lower calorific intake may influence sports performance. If they are undertaking a sporting activity on an empty stomach, and do not feed themselves well after the match or the race, then they may feel lightheaded and dizzy, or even nauseous. And in the longer term if this becomes a habit, they may experience unwanted weight loss or not enough muscle gain.

If they are not eating enough protein, this may weaken muscles and bones. Excessive use of stimulant medications can also cause irregular muscle contractions increasing the risk of injury and reducing exercise efficiency.

How to help: Focus in on a breakfast of champions, especially on match or race days and plan a filling and nutritious meal to give them afterwards. Fill their sports bag with protein-rich snacks.

Lots of colds and coughs

Taking methylphenidate has been associated with more upper respiratory infections such as colds, coughs and viruses. If your child is always sick, then this maybe a consideration if starting on this medication.

How to help: Since a very high proportion of kids with ADHD also have a vitamin D deficiency and have shortfalls in zinc, then also being ill all the time can be a flag to give them vitamin D and zinc rich foods and also add in other supplements such as probiotics, especially during the autumn and winter months.

Dry mouth and poor oral health

Stimulant medications can lead to a dry mouth and less saliva being produced. Over time, the lack of saliva can mean more oral plaque build-up, as well as bleeding gums and oral inflammation.

How to help: It is vital to ensure your child is brushing their teeth at least twice a day and to visit your child’s dentist regularly for check-ups.

Keep their oral microbiome healthy with xylitol-based mints and chewing gum, and ensure they are consuming enough calcium, magnesium and vitamin D.

Longer term heart problems

Many parents have heard about potential long-term cardiovascular complications if their child takes ADHD medications. Stimulant medication can increase both blood pressure and pulse and this is why your child’s psychiatrist and GP will monitor their blood pressure and pulse when prescribing ADHD medication or when changing their dose.

How to help: It is vital to keep your child’s cardiovascular system healthy which involves regular exercise and reducing your child’s intake of ultra processed foods. Encourage heart-friendly foods and nutrients such as omega-3 rich oily fish including salmon, sardines, mackerel and anchovies as well as polyphenol-rich berries, pomegranate and beetroot.

Round up

ADHD medications can be life-changing for some kids, but sometimes they do not work as well as they should, or they come alongside some unwelcome side effects. I hope that the tips in this blog help you to navigate things more easily for your darling ADHDer.

If you would like to run some tests to check them for any vitamin or mineral deficiencies or you are worried about their growth, sleep or immune system, then get in touch with our NatureDoc clinical team who can work with you and your child 1 to 1 to optimise their nutrition and to mitigate any side effects from taking their medication.

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