Behavioral Issues in Kids: Could Diet or Nutrient Deficiency Be To Blame?
"I had no idea, until I eliminated this food group, how much of an impact it would have on our son's behavior. He is truly fun to be around now. This was not a problem with discipline, but with diet."
This statement is from a dear friend of mine, who had, months prior, tearfully told me that parenting was no longer fun because of the constant tantrums her 3 year old was throwing. Within about 1 month of some dietary changes that they implemented for him, though, my friend made the above statement.
As a Pediatric RN, especially in the context of the clinic I work in, I hear parents constantly expressing concern about their children's behavior. In fact, I would say these concerns have steadily gone up in the last 8 years since I've worked in the Outpatient Pediatric setting.
My own experience with poor gut health and toxicity sent me on a journey of intensive research, and along the way, I came across tons of research regarding how issues similar to mine can affect a child's health and behavior. Now, whether I like it or not, I rarely take things at face value.
What types of behavior concerns are parents coming to us with? ADHD is a big one. Also on the list, to name a few, would be anxiety, depression, sensory issues, difficulty coping in new or stressful situations, and temper tantrums.
Now, I'm NOT talking about an active young boy who gets restless or sometimes silly in the classroom after being in the classroom for 6 hours, but for the most part behaves and tries his best in school. And I'm not talking about a 2 year old who is just learning to share, and screams for a few minutes when another kid takes her toy. These can be very normal behaviors.
I'm talking my previously mentioned dear friend's 3 year old (let's call him Ethan), who, during every transition or mealtime, had a temper tantrum which involved a minimum of 45 minutes of crying and defiant behavior. This was happening multiple times per day! My friend described setting limits and handling Ethan with love and logic; she was literally doing everything right, but nothing she did helped.
I'm also talking about 8 year old girl who can't focus for more than 5 minutes in the classroom, and, no matter how hard she tries, just cannot seem to get her homework done without massive frustration and difficulty.
Or maybe that 4 year old boy, who, no matter how hard the parents work with him, and how hard he even tries, cannot control his impulses and hits, shoves, or even jumps off of furniture. The boy is a good kid, but just cannot stop himself.
And, what about the 12 year old girl who, despite not having access to social media, who does well in a great school, has nice friends, and is involved in a reasonable amount of extracurricular activities without going overboard, deals with chest crushing anxiety when she tries to go to bed at night?
Is It Ever a Parenting Problem?
Well, sometimes yes. Of course poor parenting, difficult family situations, and possibly traumas that happen that can absolutely cause poorly behaved children. These issues should be addressed, first and foremost!
But this article is for those people who have already received counseling for themselves and maybe their child too. They are implementing everything the counselor recommends, they are doing everything they can to be a great parent. Not a perfect parent, but a parent who is present and cares. Finally, a traumatic event has been ruled out, or at least dealt with. Still, nothing seems to be helping.
That's the situation that I would start to wonder if there might be more going on. And that's what I suspected for Ethan.
We've Ruled Out a Parenting Problem or a Childhood Trauma. Now What?
I will first say that, even though I'm a Pediatric RN, in general, I do not believe starting with medicating children for behavioral problems, or mood issues like anxiety and depression. That doesn't mean I don't think medication can't ever be useful in a handful situations, and for a very limited timeframe, but my goal is to help people address the root cause of an issue. And I do truly believe there are root causes to behavioral problems.
If you've been following me for awhile, you are likely not going to be surprised when I say, the first thing to look at is diet.
The Gut-Brain Connection
It is no secret that there is a very strong Gut-Brain connection in our bodies. There are literally more neurotransmitters in the gut than in the brain! So it only makes sense that if gut health is compromised, it can affect the brain, and in turn, our behavior and our mood.
There are some factors that that put our children at especially high risk for gut health being compromised:
History of Being on Reflux Medication
This is is a very personal one for me. My son was on a reflux medication, and there has since been some research that has shown a correlation between reflux medications (either acid neutralizing, or acid blockers/proton-pump inhibitors) and asthma, as well as allergies.
First of all, stomach acid is our body's first line of defense against pathogens that enter our bodies. When you reduce the acidity in our stomach, it leaves us wide open to these pathogens! It is well known by GI doctors that long term use of acid blocking medications causes Small Intestinal Bacterial Overgrowth, or SIBO. This is a difficult to treat condition that causes a myriad of digestive complaints, and often mood concerns.
Secondly, acid blocking medications have been shown to make children sensitive, over time, to foods they eat regularly. Dairy is a great example, because we start giving kids whole milk at 12 months of age. They tend to drink it daily, and if they are taking a reflux medication at the same time, there is a high likelihood they will have developed an allergy to milk.
This was absolutely true for my son. He did, indeed, go on to develop asthma and allergies, and it has required us to completely remove dairy from his diet. I also do look back and recognize that when my son turned 1 year old, we added whole milk into his diet, as I weaned him from breastfeeding. This is exactly when his tantrums started! Yes, sometimes tantrums can be a normal part of child development. But there is a point that they go beyond what's normal. While my son's tantrums were not as significant as Ethan's, it is quite an interesting connection.
History of Antibiotics
Kids who were prone to ear infections or sinus infections as babies, for example, have likely been on antibiotics multiple times. Antibiotics themselves are abrasive to the gut lining, and even more, it is well known that they have a negative effect our gut flora. A child can then have gut dysbiosis, or, a decreased amount of good bacteria, along with an increased amount of pathogenic bacteria.
This gut flora change can have a HUGE effect on mood. The right bacteria in our guts is associated with brain health and mood regulation. Remove that good bacteria, and you've got a direct correlation between gut dysbiosis its effect on brain health and mood.
Processed Foods and Food Allergies
Processed foods are damaging to the gut lining, and also cause blood sugar problems, since they have the tendency to spike blood sugar. Blood sugar instability is directly associated with mood issues, as many parents can tell you when it is their kids' mealtimes.
Processed foods in themselves can cause food allergies, because of the damage they cause to the gut lining. In addition, processed foods feed pathogenic bacteria, further contributing to gut dysbiosis.
Processed foods also tend to contain artificial coloring and flavoring (this includes artificial sweeteners). These components are known to affect the brain, and in turn, a child's behavior. I have witnessed children acting completely normal, then consuming an artificial coloring, and immediately get incredibly hyperactive and irritable. To put it quite simply, artificial coloring and flavors are chemicals that our bodies were never meant to be exposed to. Some of these artificial additives are known to be toxic to the brain!
What Should I Do If My Child Has One (Or More) of These Risk Factors?
Elimination Diet, or Food Allergy Testing
A parent can often determine obvious food sensitivities by doing an elimination diet with their child. The first place to start is to remove gluten, dairy, soy, sugar, artificial coloring and artificial flavoring. You can also consider eggs. I know this list can sound overwhelming, but consider doing it for 30 days. Against All Grain is a great resource for great substitutions for some of your kids favorite foods, without making them feel deprived.
Focus on foods that are unprocessed; meaning, just because the package says Gluten Free, does not mean it is a healthy food. Processed Gluten Free foods are just as unhealthy as any other processed food!
After the 30 day elimination, add each food you eliminated back into your child's diet one by one. I would recommend only one new food per week. I do not recommend EVER adding artificial coloring and flavoring back in, and hopefully after being off processed foods for 30 days, you'll see the benefit of committing to staying away from these as much as possible.
When you add each new food back in, monitor your child closely for a reaction. These can happen even days after adding the new food! Watch for a change in behavior, skin concerns, abdominal complaints; basically any change for the worse. If you see a reaction, you'll be able to identify it as being caused by the food you recently added back in.
You could consider IgG food allergy testing, done through a naturopath or functional medicine practitioner, if you'd rather know ahead of time exactly which foods your child is reacting to. Allergists typically test for IgE allergies, which are important to know about, but only address hives and anaphylactic types of reactions. Foods that cause IgE reactions should absolutely be avoided, but if the IgE testing is negative, this does not mean your child is in the clear. IgG reactions are less obvious, but tend to cause increasing inflammation over time. These are the types of reactions that are more likely to be related to behavioral problems.
Probiotics and Fermented Foods
When gut health is compromised, there is almost always some form of gut dysbiosis involved. Giving your child a high quality probiotic and encouraging fermented foods can help to address gut dysbiosis, and you might be surprised at how this in itself can help with your child's behavior!
Check my Gut Health section of my blog posts for more information on healing the gut!
Consider Nutrient Deficiencies
So, we've addressed gut health. There are other things still to consider, though! Vitamin and mineral deficiencies have a direct link to behavior AND to gut health. Depletion of our soil over recent decades means that it is more and more difficult to get the nutrients we need from food alone. In addition, poor gut health will make a child more likely to have these types of deficiencies.
Consider having your child tested for the following deficiencies. Just doing one set of labs can help identify any obvious nutritional issues.
Magnesium. Magnesium deficiency is known to be a cause of anxiety, and can also cause issues with hyperactivity and focus. Magnesium is essential for the production of fatty acids, and is directly involved in energy production and muscle relaxation. It is also involved in neurotransmitter function.
I know of direct cases of children who were being identified as having ADHD, and correcting magnesium deficiency in these children was enough to completely turn around this diagnosis! Testing for magnesium deficiency should be not be done just by testing plasma levels, but red blood cell (RBC) levels.
Clearly, correcting magnesium deficiency is powerful. There is some question as to whether it is necessary to take magnesium with calcium. There are such supplements available, but the problem is, the calcium source is often one that is difficult to absorb, and can actually cause more harm than good. I prefer to ensure my kids get enough calcium through diet. It is not difficult to do this, even when you've eliminated dairy, as greens are an excellent source of calcium! I still use magnesium citrate without calcium, and it has been very effective in keeping our magnesium levels in the correct range.
Checking Vitamin D levels is truly essential for any condition. Behavioral problems are no exception. Vitamin D is critical for every body and brain function, including the immune system, neurotransmitter function, brain development, and bone health.
Have your child's Vitamin D levels checked via a 25-hydroxy-vitamin D level test, and supplement with Vitamin D3 accordingly.
Omega-3 Fatty Acids
Omega-3's are well known to support brain health and lower inflammation. The DHA component in particular supports brain health, and the EPA component is anti-inflammatory. Wild salmon and sardines are excellent sources of Omega-3's, but it is difficult for many children to eat enough of these foods to make a difference in Omega-3 levels, so supplementation can be helpful.
Look for a wild caught fish oil that is 3rd party tested for contamination, including heavy metals. Krill Oil is being looked at more and more for supplementation, as it is very bioavailable, and is also less susceptible to oxidation and rancidity.
Healthy iron levels are associated with supporting physical and cognitive growth. In children who are very picky eaters, combined with the physical demands required in the basic growth process they are undergoing, iron deficiency is something to consider. Low iron levels can affect attention span and cause sensory problems, as well as issues with regulating emotions and behavior.
Most pediatricians are very willing to check iron levels. This can be done by checking a basic CBC (Complete Blood Count), Iron, Total Iron Binding Capacity, and Serum Ferritin levels.
This mineral is also highly involved in neurotransmitter production, cognitive function, immune function, bone health, and wound healing. Zinc helps to turn Vitamin B6 into the active form the body can utilize, and also supports the body's ability to use Omega 3 fatty acids! Keeping zinc at the proper levels can greatly help with behavioral concerns. Pay attention to copper levels as well, as zinc and copper levels are very tied together.
B Vitamins (Especially B6, folate, B12)
Vitamin B6 is directly involved in serotonin production, and Vitamin B12 is critical in myelin sheath neuron regeneration. Folate (or B9) is directly involved in regulating mood, cognitive function, and behavior, and is again, vital in the production of neurotransmitters in the brain. Clearly, these B vitamins are directly related to brain health and behavior. It is important to note, also, that if your child has low B6, folate, and/or low levels of B12, it is possible there is a methylation issue involved. More discussion on this issue is to come in this article.
When testing B12 levels in particular, keep in mind that it is possible to show a HIGH B12 level in the blood, when in reality, your child might have low levels. This happens when the cells are unable to convert B12 into the active, or methylated, form, that the body can actually utilize. So, the B12 is floating around "free" in the blood, but is not actually being utilized in the cells. Dig deeper if your child has a high B12 level.
Definitely give your child foods that are high in B vitamins, but if your child does have a methylation issue, it may be helpful to supplement with methylated B vitamins. Methyl B12 should be in a sublingual form for optimal absorption.
I do feel that it is preferable to have the guidance of a naturopath or functional medicine provider who is well versed in this type of supplementation.
Methylation Issues/MTHFR Gene Mutation
Methylation and MTHFR is becoming more and more of a hot topic. It is often "blown off" by mainstream providers, but people who have some of these genetic issues addressed, like myself, will tell you they are definitely worth paying attention to.
It is true that in a perfect world with no environmental stressors, and nothing but the most nutrient dense, unprocessed diet, a person can live with methylation issues and experience no health issues. But most of us are affected negatively, in some way, by environment and diet. Once our bodies become stressed in these ways, the study of epigenetics confirms that these genes can start to "act up" and cause a myriad of problems (Dr. Ben Lynch's book, Dirty Genes, provides an excellent explanation of how this happens, and how to address it).
People with autism, autoimmunity, ADHD, chronic pain, repeated miscarriages, and many other disorders tend to have higher rates of MTHFR gene mutation, and/or other methylation issues.
As previously mentioned, low levels of B6, folate, and B12 can be a clue that a person is affected by this. Folate (or Vitamin B9) is affected by the MTHFR gene mutation, in particular.
If you suspect this to be an issue for your child, I strongly recommend you consult a naturopath or functional medicine provider who is well versed in these concerns. 23andMe can provide the raw data that shows whether these issue are present or not, but they are difficult to read and make sense of without qualified help.
Make sure not to supplement with folic acid, as this is the synthetic form of folate. Folic acid is received by our cell's folate receptors, but does not provide the benefits that folate itself does. Further more, the cell's receptors are now blocked by the folic acid, and are not able to receive the folate that the body actually needs.
A Brief Note on Heavy Metal Toxicity
Because I mentioned the MTHFR and methylation issues, it's important to also bring up the concern of heavy metal toxicity. Those genetic issues make people more likely to have difficulty ridding themselves of heavy metals that we are all exposed to, such as aluminum and mercury. Furthermore, kids' brains are more likely to be affected because they are still developing. If there is, indeed, a methylation issue in your child, check with his or her provider on the concern of heavy metals, and consider testing for these.
What Was it For Ethan?
I've given you a lot to consider, regarding the root cause of behavioral issues in kids! Before you start feeling overwhelmed, I want to give you the outcome of Ethan's case, which was actually quite simple in the end!
You read the testimonial about what happened when Ethan's diet was addressed. My friend found that within days of giving Ethan a paleo type of diet, this very picky eater was eating MORE, and healthier, foods! This was a totally unexpected outcome, as Ethan's parents expected to run into worsening temper tantrums when they changed his diet.
Ethan even told his his parents, about 2 or 3 days into his new diet, "my tummy doesn't hurt anymore!". His mom told me that he had never even complained of abdominal pain, but clearly had been suffering from it all along!
Within weeks, Ethan was spontaneously giving his parents hugs, and telling them he loved them. His temper tantrums decreased significantly, and now they are few and far between. Ethan's parents were able to identify dairy, and artificial flavors and colors as the main culprits.
Ethan's diet is now much broader than it was during his elimination diet, and he also receives probiotics, as well as my favorite children's multivitamin. Ethan's mom carries around organic lollipops with natural food coloring and flavorings, in case he is offered a treat that will affect him badly when they are out and about. His parents find that a dairy free diet is incredibly easy, and is well worth the benefits.
While identifying root causes can sometimes feel overwhelming, you'd be surprised as to how simple it can actually be for many kids, once you make the right changes. Kids heal more quickly than adults, and often the root causes can be somewhat easier to identify, because they've had less time to develop complex problems like adults.
This is, of course, not the case for every child, and some children have serious health problems that are, indeed, more complex. It can also be the case that a simple change might solve the majority of the issue, but some fine tuning might be required afterward.
The main message is, parenting does not have to be, and should not be, awful. And your child's behavioral problems most often do not reflect poor parenting! What a relief this could be to hear, for so many parents who are at the end of their rope!