ADHD and diet

ADHD, Sugar, and Thiamine

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Attention-deficit hyperactivity disorder (ADHD) is a prevalent and debilitating disorder diagnosed on the basis of persistent and developmentally-inappropriate levels of overactivity, inattention and impulsivity. In this post we describe our use of Orthomolecular Medicine in the treatment of this condition, a term derived from a paper written in 1949 by Linus Pauling describing the discovery that sickle cell anemia was the first molecular disease to be discovered.

The word Orthomolecular is probably not well understood by most people and the phrase Orthomolecular Medicine would be meaningless to them. The prefix ortho means “the same as” and the prefix hetero means “different from”.  This means that Orthomolecular Medicine is the sole administration of substances that are recognized by the body as compatible with its normal function.  There is only one way of doing this and it is by the use of nutrients. Obviously, that means that prevention is obtained by the use of a diet that contains a complete list of the ingredients required by each cell for maintenance of its normal function. Mother Nature knows the precise number of the necessary substances: we do not. We have discovered many of them and called them vitamins. However, many of us strongly suspect that there are still nutrients to be discovered, thus demanding that naturally occurring food is the only food that we should be using to preserve a complete state of health.

Metabolic Disease and Disturbances

In the seventies, I was working in a multidisciplinary clinic as a consultant pediatrician. Pediatricians in private practice would refer patients where they considered that they needed some help. A common referral was a child with emotional problems and I was frequently confronted with the problem of ADHD and children with similar problems. At that time, emotional problems were considered to be caused by bad parenting and I would sit down with the parents, only to find that most of them had a completely healthy approach to this important discipline. However, when I asked about “diet”, I found that in nearly every case, this was appalling. These children were showered with “goodies” that gave them an enormous increase in empty calories, most of which were sugar containing.

My special professional interest was in a group of rare disorders known as “inborn errors of metabolism”. Each one of these diseases was inherited by a gene from both parents, resulting in biochemical changes in the child’s physiology. Most of them caused mental retardation if not recognized at birth and in some of them, mental retardation could be prevented by giving a highly specialized diet. That is why a biochemical “screening program” has been set up in a state-controlled laboratory in each of the states in the United States. The infant is subjected to a pin prick and a drop of blood is absorbed on a little piece of filter paper and mailed to the laboratory.

The missing genes in these diseases code for a specific metabolic reaction essential to normal function of the whole person and I began to think about why the brain was inevitably affected, no matter where the metabolic breakdown occurred. Although the cause of mental retardation is unknown, I began to think that the sole responsibility of food to generate cellular energy was the core issue of disease. I began to assume that energy deficiency may be the underlying cause of the mental retardation, although the mechanism was unknown. Could energy deficiency be the cause of some, If not all, disease?

The Importance of Brain Energy in ADHD

This kind of disease is extremely common, is not an “inborn error of metabolism” and since my clinical experience suggested diet as the underlying cause, it seemed to be necessary to study the details of how food generates energy. I wondered if dietary sugar had anything to do with the behavioral changes in the brains of these children. It seemed highly unlikely to be genetically determined because of its common appearance. Well, I found that glucose sugar was the primary fuel of the brain, so this seemed to deny that sugar could possibly be blamed. I began to study the details and found an enormously complex chemistry. I had learned some of this in medical school but had been told that I did not need to remember the details. All I needed for practice was to understand the general physiology of the body and which of the many medicines I would to apply when something went wrong. The emphasis was on making a diagnosis: with which of the many diseases was each patient confronting me? Then I could look up the disease in a medical textbook to see what was known about it. In each disease, the symptoms and signs were described in detail and ended with what was known about treatment. I can still remember how horrified I was to see in nearly every described disease that there was no treatment known. Of course, many changes have occurred since I graduated, but the success rate, particularly for chronic disease, is appallingly low.

It occurred to me that the complexity of how food is turned into energy presented the key to understanding why taking sugar caused brain dysfunction, in spite of the fact that a form of sugar called glucose is the prime fuel. The analogy of a car engine enabled me to see the answer. Some people will remember that cars had a gadget called a choke. It introduced a surge of gasoline to the engine, a so-called “rich mixture”. It was used to start a cold engine and had to be turned off when the engine warmed. Sometimes the choke stuck, thus permitting a “rich mixture” to the engine which promptly began to cough and splutter. The car slowed down and thick black smoke issued from the exhaust pipe. It is an example of fuel combustion efficiency. The rich mixture is too concentrated and overwhelms the ability to mix with oxygen and allow the spark plug to ignite the gasoline.

In the human body, glucose has to be ignited, but although the principles are identical to the car engine, the details are much more sophisticated. Thiamine and magnesium act as “spark plugs” by uniting the glucose with oxygen. If the food consists of too many calories, the mix with oxygen is overwhelmed: thiamine and magnesium are then insufficient to “ignite” the glucose. The brain is the most oxygen consuming tissue and it becomes compromised, resulting in changes in function that are expressed as symptoms such as ADHD. It would be fair to say that the engines of the brain cells, known as mitochondria, have been choked. Often times, in these and other cases, the measure of thiamine and magnesium are be found to be in the normal range, giving a false message that the ADHD is not due to thiamine/magnesium deficiency. The reality is calorie excess, relative to thiamine and magnesium, but the symptoms would be the same as true thiamine/magnesium deficiency in a person taking a healthy concentration of calories. It is the balance between essential vitamins and minerals and caloric intake, particularly of sugary foods, that is at the root of many diseases, including those ascribed to the category of ADHD. Perhaps before progressing down the medication rabbit hole with these children, a closer look at dietary contributors is warranted.

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Derrick Lonsdale M.D., is a Fellow of the American College of Nutrition (FACN), Fellow of the American College for Advancement in Medicine (FACAM). Though now retired, Dr. Lonsdale was a practitioner in pediatrics at the Cleveland Clinic for 20 years and was Head of the Section of Biochemical Genetics at the Clinic. In 1982, Lonsdale joined the Preventive Medicine Group to specialize in nutrient-based therapy. Dr. Lonsdale has written over 100 published papers and the conclusions support the idea that healing comes from the body itself rather than from external medical interventions.


  1. ADHD medications are not just a rabbit hole. They are useful medicines if they are used intelligently. As a person whose life has been destroyed by Lupron inducing myriad forms of misery and life threatening circumstances ie compromised functioning behind the wheel of a car plus other things, that progressed to dysautonomia. According to mainstream science it is a life sentence now, no known cure. I do get some benefit from TTFD + thiamine. Some only. Its a life sentence. ADHD medications allowed me to stumble through a degraded quality of life inflicted by Lupron. With holding medications from people who need them

    Dr. Lonsdale I have spoken to many people about your work in glowing terms. I could not speak highly of dismissing this medication. People need these medications. Are you dismissing them, and the people who benefit from them? Children may be a different matter. Thiamine is great but I am profoundly disabled with it alone. ADHD meds allow me to stumble thru a reasonable life as they do people with ADHD. Thiamine alone: no way.

    Very smart people who know the research findings on dysautonomia recommend them since 90% of patients with dysautonomia diagnosis say the crushing fatigue and brain fog are the worst of the many nasty symptoms, and find that they relieve those life degrading symptoms.

    • maybe you need to take very high doses for years to replenish the supply?
      I saw another guy with beriberi and he has to take thiamine for 3-5 years to heal himself.

      it’s hard for people with adhd to stick to something for so long, i know, therein lies the paradox.

      maybe we just need to tough it out, while getting some other help (caffeine, meditation, running) in the meantime. like a dual strategy (give something that will help today, while fixing underlying deficiency)

      but maybe we can’t heal if we keep taking adderall/stimulants since they try and force the energy in a stressful non-sustainable way.

      adhd meds burnt me out and left me in a waaaay worse spot than when i started. imho they aren’t sustainable long term. (not even long enough to get you to retirement)

  2. A quick comment about sugar and thiamine—I was recently reading about a study that, as I remember it, showed that thiamine deficient cells functioned normally until glucose was added—and then the classic signs of thiamine deficiency appeared. I am almost sure it was in an article or comment by Dr. Lonsdale somewhere here on Hormones Matter. I will try to find the reference, but this is a good reason to avoid refined sugar.

  3. Hi Dr. Lonsdale,
    Thank you for all your work on this subject! I have several questions:
    1. Do people who have trouble detoxing mycotoxins actually have thiamine deficiency, rather than the HLA gene theory proposed by Dr. Ritchie Shoemaker? (HLA not recognizing antigens and body stores them instead of detoxing)
    2. Do people with eczema often have thiamine deficiency?
    3. What company do you recommend to get thiamine from?
    4. Do people need to stay on megadoses for life if they don’t have any familial beriberi or rare genetic thiamine disorders?
    5. Could mutations that show up on genetic tests really be mitochondrial dysfunction, and once that is corrected, you would have different genetic test results? (I ask specifically about keap1 and nrf2 genes)

    Thank you very much! Any answers or advice would be greatly, greatly appreciated!

  4. Dr
    Truly, enjoy your insights and the articles!
    I’m retired MD myself, and love your viewpoints.
    Question on thiamine: have three young sons with borderline ADD type behavior. I already have them on B2, B6 and magnesium with good response, but want to add thiamine as well. Cannot seem to locate a recommended dosing regimen for age, or weight. Any recommendations?

  5. Dr. Lonsdale,
    I always appreciate your writings and intellect over the years.
    Do you think, that since as humans we do not synthesize our own ascorbic acid, that our propensity for sugar may be a hold over from a time, when we used to utilize it for that manufacturing process and that it has morphed into an addiction?
    And therefore thiamine was elevated to an even more important place in the metabolic scheme?
    Thank you.

  6. Dr. Lonsdale – thank you for your work – have you ever treated anyone with MTHFR A1298C gene mutation? Our child is diagnosed with type 1 diabetes and we have done extensive testing – for the purpose here – he has the MTHFR A1298C mutation, blood tests show high folate & high b12. I’ve read a similar case in your book somewhere. Would that respond to thiamine? What would you do? Any advice? In our country doctors seem to not care (we did the testing ourselves and basically seek information ourselves since years…). Thank you very much.

    • Autism has been correlated with low cerebral folate…normal blood folate levels may be misleading. Take him off dairy, that seems to worsen folate deficiency.

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