Nootropics, Nutrition, and Lifestyle Hacks for ADHD

Since the 1960s, adult attention-deficit/hyperactivity disorder (ADHD) has been labeled a mental health disorder by the American Psychiatric Association (APA). While the title is specific to adults, the condition is thought to begin in early childhood and extend into adulthood. Currently, it is estimated that about 3.5% of Americans have ADHD, and it is significantly more prevalent in males.

Diagnosing and treating ADHD

Recent studies show there may be genetic and hormonal components involved. For example, researchers believe that higher testosterone levels may be why males are three times more likely to be diagnosed with the condition. Studies are also looking into other possible causes and risk factors like brain injury and exposure to environmental toxins like lead during pregnancy or at a young age.

The most common symptoms of ADHD are:

• An inability to maintain focus, or a short attention span
• Impulsivity - Examples include interrupting others before they have finished speaking or being unable to wait for one’s turn in line
• Hyperactivity - Examples include an inability to sit still without fidgeting or being generally disruptive in social settings

People with inattentive ADHD (aka ADD) do not experience hyperactivity or impulsivity. Rather, they find it challenging to maintain focus and attention for extended periods of time.

To reach a diagnosis, a psychologist, psychiatrist, or neurologist may administer standardized assessments that look for characteristics like hyperactivity, inattention, and lack of behavioral regulation. Doctors may also conduct physical exams and interviews with the adult patient or the child patient and parent.

The standard first-line treatment for ADHD is medication, and the two most commonly prescribed drugs are Adderall (an amphetamine) and Ritalin. Additionally, doctors might recommend psychotherapy and treatment for any other mental health conditions that may accompany ADHD. Stimulants work by increasing levels of the neurotransmitters dopamine and norepinephrine in the brain, both of which are important neuromodulators that help us stay alert,  focused, and motivated. Since each person’s chemical makeup varies, finding an effective medication sweet spot without undesirable side effects can be tricky sometimes. Some known side effects of ADHD medications include anxiety, reduced appetite, weight loss, and insomnia. In addition, the withdrawal symptoms that come with using these drugs make it more likely that a person could become addicted.

Nootropics as an alternative to standard ADHD drugs

Nootropics (aka smart drugs) are a class of natural or artificial substances that support healthy cognitive function. They may come in the form of a dietary supplement, a nutraceutical, or an energy drink — some are available over the counter, while others can be accessed by prescription only (1).

One example of a common nootropic that we are all familiar with is coffee. Unlike conventional ADHD drugs, most nootropics do not directly trigger the brain to release neurotransmitters, though there are some exceptions (2). Nootropics work as vasodilators, widening the blood vessels, usually near the surface of our skin. This promotes the flow of blood, nutrients, and oxygen to the brain while improving its supply of glucose (the brain’s preferred source of fuel).

According to the Romanian psychologist and chemist Corneliu E. Giurgea, who first coined the term, nootropics are substances that should convey the following benefits:

• Enhanced learning and memory
• A strengthened ability to resist developing learned behaviors/memories to traumatic conditions, which tend to disrupt them
• Increased efficacy of the brain systems that influence decision-making, language, and processing of emotions
• Little to no side effects and toxicity, unlike standard drugs that have overtly sedative or stimulating effects

Best nootropics for ADHD

Some of the best nootropics for people with ADHD are listed below. Combining two or more of these substances is called “stacking” and can have synergistic effects — sometimes positive, other times not so much. Since most nootropics are stimulating (excitatory), the general rule of thumb is to balance them with a substance that has a more calming (inhibitory) effect. Make sure to do your own research, or check with a health professional to prevent any undesirable interactions:

By prescription:

• Modafinil - A milder alternative to Adderall, this synthetic drug enhances our ability to focus even when we are distracted or interrupted. Modafinil works by increasing our availability of excitatory neurotransmitters like dopamine that control sleep and wakefulness and has a very low risk of addiction.\ This drug is available by prescription for people seventeen and older and works best when taken in a single dose first thing in the morning (3).
• Vyvanse - A stimulant used in people ages six and older to increase attention and decrease impulsiveness and hyperactivity. This medication has the potential to be too stimulating. Common side effects can include anxiety, panic attacks, appetite, and weight loss.\ Stacking this drug with other calming nootropics like L-Theanine can help balance its sometimes more energizing effects.

 Over the counter:

• Piracetam - Synthesized in the 1960s by the same guy who coined the term nootropic, Piracetam has been used safely for decades to treat a variety of cognitive disorders. An offshoot of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), this supplement is known for promoting concentration, calmness, and self-control by balancing the excitatory neurotransmitter called glutamate. Together, GABA and glutamate support normal neurological development and help nerve cells communicate better — improving our ability to learn and remember (4).

Dosages typically used in studies range from 50-75 mg/kg for children ages 6+ and 2.4-4.8g for adults (5).

Check out this article on why Piracetam is often stacked with cholinergic substances (i.e., citicoline, alpha GPC) to enhance focus, mental acuity, and memory while preventing the headaches some people experience with this drug.

• Noopept - This supplement works very similarly to Piracetam but is much more potent. It helps balance GABA and increases dopamine levels in the brain with little to no side effects (6).

 Noopept can be stacked with a calming cholinergic substance like Alpha GPC or citicoline to harmonize its energizing effects and prevent headaches. The recommended dosage for adults is between 10-30 mg and varies depending on a person’s weight.

• Alpha GPC - This supplement is a choline compound that has shown great promise in treating a variety of cognitive dysfunctions. Choline is naturally found in the brain and is also supplied by foods like meat, fish, poultry, dairy, and eggs. Both animal and human studies have emphasized the importance of an adequate choline intake by expectant mothers for the healthy brain development and lifelong cognitive function of their babies (7), (8). On its own, Alpha GPC enhances focus and memory (9). It can also be stacked with fish oil supplements containing the omega-3 fatty acids EPA and DHA. In a review of seven clinical trials that included more than 500 children, those taking a combination of EPA and DHA supplements showed improvements in their symptoms, as well as parent-reported attention scores (10). When taken together, these two can have an even greater impact. The recommended dosages of alpha GPC products generally range between 200-600mg daily and could go as high as 1,200mg for serious cognitive disorders like Alzheimer’s. Try starting with the lowest recommended amount, and work your way up slowly from there, as needed.
• Rhodiola rosea (RR) - Used for millennia in TCM, this herb is especially treasured for its ability to build energy and increase circulation. As one of the most scientifically studied herbs, we now understand that RR contains hundreds of bioactive compounds. A known adaptogen, RR has the unique ability to bring the body and mind back to a balanced state. RR has many benefits specific to ADHD, including supporting healthy dopamine, serotonin, and norepinephrine levels, protecting nerve cells from damage, and making us more resilient to stress (11). Try stacking RR with a high-quality B-complex supplement that contains healthy amounts of vitamin B6. Check out this article on the benefits of vitamin B6 for ADHD.
• Citicoline - When consumed as a supplement, this naturally occurring brain chemical gets converted to the neurotransmitter acetylcholine plus uridine. We need healthy levels of acetylcholine for learning and memory and uridine to help repair and maintain our brain cells. Stacking citicoline with Rhodiola Rosea is known to supply steady mental energy without the eventual crash often experienced with synthetic stimulants. In one study of 75 healthy adolescent males, the group receiving dosages between 250 and 500 milligrams (instead of placebo) showed improved attention span, reduced impulsivity, and an improved ability to identify and respond to rapid changes in their environment (12).
• L-theanine - This amino acid promotes focused attention, alertness, plus an energetic and relaxed mind. L-theanine is a component naturally found in green tea, which is why the beverage gives us a balanced lift without the jitters that may accompany a cup of coffee. The best dietary sources of L-theanine are matcha tea, shade-grown green teas, and first-flush green and black teas. When combined with B vitamins, L-theanine can support behavioral regulation/self-control and quality sleep. One clinical trial of ninety-eight boys aged 8-12 showed that the group receiving 400mg of L-theanine in divided doses twice daily had significantly improved sleep markers — being able to fall asleep faster and stay asleep longer (13).
• Phosphatidylserine (PS) - This fatty substance lubricates and protects our brain cells and helps us move messages between them — like a well-oiled machine. In two double-blind studies of kids aged 1-6 and 7-12, a daily dose of 200mg of this phospholipid was shown to improve ADHD symptoms. While there are currently no adult studies specific to ADHD, other studies have shown that this supplement can improve cognitive function, short-term memory, mood, and concentration (14). Listen to this short clip of neuroscientist Andrew Huberman discussing how stacking PS with omega-3 fatty acids greatly enhances its effects.
• Red Ginseng (Asian/Panax) - Prized for its ingenious ability to both calm and stimulate the nervous system, this herbal supplement has a long history of use in Traditional Chinese Medicine (TCM), mainly for its ability to boost brain health and energy levels. Among ginseng root’s many notable active ingredients, numerous clinical studies show that its ginsenosides stand out for their ability to impart resilience in times of physical and emotional stress. In one 12-week study of 40 children aged 6-12 years old with ADHD, ginseng, taken in combination with omega-3 fatty acids, was shown to significantly improve test scores on sustained attention, short-term memory, and executive function (15). The dosages used were 3mg of Korean red ginseng extract and 500mg of omega-3 (EPA, 294 mg; DHA, 206 mg). For optimal results, seek out a chemically balanced product made from mature ginseng root (six years or older).
• Bacopa monnieri - Also known as Brahmi in Ayurvedic medicine, this perennial herb has been shown to enhance communication between our nerve cells. Its wide-ranging benefits include improved focus, self-control, and calmness. One study found that a dosage of 225mg per day was well tolerated in children 6-12 years old and improved symptoms such as restlessness, self-control, and attentiveness (16). Adult doses typically range between 300-600mg daily. Try starting at the low end and bumping up in small amounts as needed to find your optimal dosage.

Improving ADHD symptoms with lifestyle changes

While nootropic supplements can be a great alternative or add-on to the standard stimulants used for treating ADHD, modifying certain lifestyle habits to improve brain function should also be seriously explored.

The US has seen a significant increase in ADHD diagnoses since the 1990s. This could be partially due to improved diagnostic methods, but could it also be true that some of our habits contribute to the prevalence of decreased attention spans and increased impulsivity and hyperactivity?

Interestingly, ADHD in children has been linked with obesity, and children who are diagnosed with ADHD are more likely to have sedentary habits, such as eating at bedtime in front of a computer screen (17). Research also strongly suggests that exposure to excessive screen time in children can be associated with emotional, social, and attention problems. Most experts agree that screen time in both adults and children should be limited to less than two hours per day, but kids today are averaging 7.5 hours.

Exercise is one of the lifestyle habits with robust scientific support behind its ability to promote neural growth and development and boost brain and behavioral function in both kids and adults — and it is perfectly free. Experts recommend sixty minutes of physical activity per day for kids and thirty minutes of exercise per day, plus some strength training each week for adults.

Additionally, eating a consistently well-balanced whole foods diet rich in healthy fats and antioxidants can go a long way towards improving brain function. For example, children with ADHD have been routinely shown to be deficient in vitamin D (the sunshine vitamin), zinc, magnesium, calcium, and phosphorous. Iron deficiency anemia can also cause developmental delays and behavioral disturbances in attentiveness, socialization, and motor activity. Adults with ADHD tend to have lower levels of vitamins B2, B6, and B9 (18).

If you suspect you or your child may have nutrient deficiencies, ask your doctor to order tests to determine which nutrients may be lacking.

In short, while our medical system’s go-to strategy in dealing with ADHD is to prescribe medications that encourage long-term dependence, there is some very solid science to show that nootropics, exercise, and diet have the potential to powerfully improve brain function either in combination with standard treatments or on their own. Nootropics may help manage ADHD symptoms, but a healthy lifestyle also plays a significant role, so both should be considered. 

References

1. Malík, Matěj, and Pavel Tlustoš. 2022. “Nootropics as Cognitive Enhancers: Types, Dosage and Side Effects of Smart Drugs.” Nutrients 14 (16): 3367. https://doi.org/10.3390/nu14163367.
2. Suliman, Noor Azuin, Che Norma Mat Taib, Mohamad Aris Mohd Moklas, Mohd Ilham Adenan, Mohamad Taufik Hidayat Baharuldin, and Rusliza Basir. 2016. “Establishing Natural Nootropics: Recent Molecular Enhancement Influenced by Natural Nootropics.” Evidence-Based Complementary and Alternative Medicine 2016: 1–12. https://doi.org/10.1155/2016/4391375.
3. Biederman, Joseph, James M. Swanson, Sharon B. Wigal, Samuel W. Boellner, Craig Q. Earl, and Frank A. Lopez. 2006. “A Comparison of Once-Daily and Divided Doses of Modafinil in Children with Attention-Deficit/Hyperactivity Disorder.” The Journal of Clinical Psychiatry 67 (05): 727–35. https://doi.org/10.4088/jcp.v67n0506.
4. Edden, Richard A. E., Deana Crocetti, He Zhu, Donald L. Gilbert, and Stewart H. Mostofsky. 2012. “Reduced GABA Concentration in Attention-Deficit/Hyperactivity Disorder.” Archives of General Psychiatry 69 (7): 750–53. https://doi.org/10.1001/archgenpsychiatry.2011.2280.
5. Zavadenko, N. N., and N. Iu Suvorinova. 2008. “[Atomoxetine and Piracetam in the Treatment of Attention Deficit Hyperactivity Disorder in Children].” Zhurnal Nevrologii I Psikhiatrii Imeni S.S. Korsakova 108 (7): 43–47. https://pubmed.ncbi.nlm.nih.gov/18833117/.
6. Kolesnikov, A. V., A. V. Shchul’kin, O. I. Barenina, E. N. Yakusheva, V. S. Kudrin, R. U. Ostrovskaya, M. G. Uzbekov, and M. M. Shishkin. 2019. “The Effect of Noopept on Neurochemical Changes in the Retina during the Experimental Thrombosis of Its Vessels.” Neurochemical Journal 13 (1): 62–67. https://doi.org/10.1134/s1819712419010112.
7. Korsmo, Hunter W., Xinyin Jiang, and Marie A. Caudill. 2019. “Choline: Exploring the Growing Science on Its Benefits for Moms and Babies.” Nutrients 11 (8): 1823. https://doi.org/10.3390/nu11081823.
8. Zeisel, Steven H. 2006. “Choline: Critical Role during Fetal Development and Dietary Requirements in Adults.” Annual Review of Nutrition 26: 229–50. https://doi.org/10.1146/annurev.nutr.26.061505.111156.
9. Parker, Adam G, Allyn Byars, Martin Purpura, and Ralf Jäger. 2015. “The Effects of Alpha-Glycerylphosphorylcholine, Caffeine or Placebo on Markers of Mood, Cognitive Function, Power, Speed, and Agility.” Journal of the International Society of Sports Nutrition 12 (S1). https://doi.org/10.1186/1550-2783-12-s1-p41.
10. Chang, Jane Pei-Chen, Kuan-Pin Su, Valeria Mondelli, and Carmine M Pariante. 2018. “Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies.” Neuropsychopharmacology 43 (3): 534–45. https://doi.org/10.1038/npp.2017.160.
11. Sharma, Anup, Patricia Gerbarg, and Richard Brown. 2015. “Non-Pharmacological Treatments for ADHD in Youth.” Adolescent Psychiatry 5 (2): 84–95. https://doi.org/10.2174/221067660502150430154937.
12. McGlade, Erin, Anna Monica Agoston, Jennifer DiMuzio, Miho Kizaki, Eri Nakazaki, Toshikazu Kamiya, and Deborah Yurgelun-Todd. 2015. “The Effect of Citicoline Supplementation on Motor Speed and Attention in Adolescent Males.” Journal of Attention Disorders 23 (2): 121–34. https://doi.org/10.1177/1087054715593633.
13. Lyon, Michael R., Mahendra P. Kapoor, and Lekh R. Juneja. 2011. “The Effects of L-Theanine (Suntheanine®) on Objective Sleep Quality in Boys with Attention Deficit Hyperactivity Disorder (ADHD): A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” Alternative Medicine Review: A Journal of Clinical Therapeutic 16 (4): 348–54. https://pubmed.ncbi.nlm.nih.gov/22214254/.
14. Hirayama, S., K. Terasawa, R. Rabeler, T. Hirayama, T. Inoue, Y. Tatsumi, M. Purpura, and R. Jäger. 2013. “The Effect of Phosphatidylserine Administration on Memory and Symptoms of Attention-Deficit Hyperactivity Disorder: A Randomised, Double-Blind, Placebo-Controlled Clinical Trial.” Journal of Human Nutrition and Dietetics 27 (March): 284–91. https://doi.org/10.1111/jhn.12090.
15. Lee, Jeewon, Areum Lee, Ji-Hoon Kim, Yun Mi Shin, Seong-Ju Kim, Woo Dong Cho, and Soyoung Irene Lee. 2020. “Effect of Omega-3 and Korean Red Ginseng on Children with Attention Deficit Hyperactivity Disorder: An Open-Label Pilot Study.” Clinical Psychopharmacology and Neuroscience 18 (1): 75–80. https://doi.org/10.9758/cpn.2020.18.1.75.
16. Dave, Usha Pinakin, Sunila Rajeev Dingankar, Vinod Swaroop Saxena, Joshua Allan Joseph, Bharathi Bethapudi, Amit Agarwal, and Venkateshwarlu Kudiganti. 2014. “An Open-Label Study to Elucidate the Effects of Standardized Bacopa Monnieri Extract in the Management of Symptoms of Attention-Deficit Hyperactivity Disorder in Children.” Advances in Mind-Body Medicine 28 (2): 10–15. https://pubmed.ncbi.nlm.nih.gov/24682000/.
17. Tong, Lian, Xu Xiong, and Hui Tan. 2016. “Attention-Deficit/Hyperactivity Disorder and Lifestyle-Related Behaviors in Children.” Edited by Manuel Portolés. PLOS ONE 11 (9): e0163434. https://doi.org/10.1371/journal.pone.0163434.
18. Landaas, Elisabeth Toverud, Tore Ivar Malmei Aarsland, Arve Ulvik, Anne Halmøy, Per Magne Ueland, and Jan Haavik. 2016. “Vitamin Levels in Adults with ADHD.” BJPsych Open 2 (6): 377–84. https://doi.org/10.1192/bjpo.bp.116.003491.