June 20, 2021

New review investigates the impact of ketogenic diet in patients with obesity and type II diabetes

Ketogenic diets has become increasing more popular the past few years to support weight loss, neurological disorders and those with insulin resistance.

In a meta-analysis published this week in Nutrients, researchers investigated the impact of a ketogenic diet and its effects on specific metabolic biomarkers in patients with obesity and type II diabetes.  

Ketogenic diets reduce insulin levels which redirects lipid metabolism and utilizes ketones as an alternative energy source instead of glucose. Ketones are non-carbohydrate energy sources that are converted from fatty acids in the body. Ketones are generated in the body by limiting carbohydrate to 5% to 10% of total daily dietary requirements.

This review consisted of 14 randomized controlled trials including 734 patients whom were overweight or had obesity, 444 diabetic patients, and 290 non-diabetic patients. The primary laboratory assessment included fasting glucose, HA1c, fasting insulin, C-peptide, total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, C-reactive protein (CRP) and serum creatinine. Body weight, body mass index (BMI), waist circumference, systolic blood pressure and diastolic blood pressure were also collected. The effects of ketogenic diets on glycemic control over a 3 to 12-month period were greater in patients with diabetes compared to low-fat diets. This was demonstrated by a significant reduction in HA1c levels and homeostatic model assessment (HOMA) values for diabetic patients. Similar effects were seen with both diets in nondiabetic patients. In addition, ketogenic diets for 4 weeks to 12 months demonstrated a significant weight reduction in both diabetic and nondiabetic patients. Also, lipid profiles were improved including an increase in HDL cholesterol and lower triglyceride levels in diabetic patients.

As a result, this study showed that ketogenic diets are more effective in improving metabolic biomarkers associated with glycemic, weight, and lipid controls in patients whom are overweight, especially those with diabetes compared to low-fat diets.

This is the first study to perform a meta-analysis with randomized controlled trials to investigate the impact of ketogenic diets on glycemic control, weight loss, lipid control and cardiovascular and renal risk markers over varied low-fat diets.

Ketogenic diets are an effective strategy for weight loss, however, transitioning to a ketogenic diet can be challenge as the body is switching from burning glucose to fat for fuel. Many individuals often experience fatigue, nausea, dizziness, and irritability during this transition.

Perceived hunger is also a common barrier to weight loss. Based upon this recent research exogenous ketones are a great adjunct to a ketogenic diet, intermittent fasting, or for an individual transitioning to a ketogenic diet for weight loss. Exogenous ketone supplementation Increase blood ketone levels which may directly suppress appetite as they lower plasma ghrelin levels reduce cravings.

Source: Choi Y, Jeon S, and Shin S. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 6 July 2020, 12(7), 2005.

New study demonstrates the effect of resveratrol supplementation on bone mineral density in postmenopausal women

Resveratrol is a polyphenol with powerful antioxidant and anti-inflammatory properties.  It is naturally found in nuts, berries, and grapes skin but the concentration is low. Studies have been widely publicized for its cardiovascular, anti-carcinogenic, and anti-aging benefits.  Research has also shown significant benefits in several chronic inflammatory disorders.

According to a study published earlier this week in the Journal of Bone and Mineral Research, researchers investigated the effect of resveratrol supplementation on bone health in postmenopausal women.

Resveratrol is also a phytoestrogen and animal studies have shown that it promotes osteoblastic formation similar to genistein. There have only been a few human studies to investigate this, however, none of these studies were over 6 months in duration or in postmenopausal women.

This was a 24-month randomized, double-blind, placebo-controlled, two-period crossover study including 125 postmenopausal women between the ages of 45 and 85 years of age investigating the effects of resveratrol supplementation at 150 mg per day given in divided doses and its effects on cognition, cerebrovascular function, bone health, cardio-metabolic markers, and well-being in postmenopausal women.

As a result, after 12 months of resveratrol supplementation, there were beneficial effects on bone density in the lumbar spine and femur resulting in an improvement in T-score and a reduction in the 10-year probability of hip fracture risk. This improvement was higher in women with poor bone health biomarker status as expected. Interestingly, the improvement in T-score with resveratrol correlated with an improvement in perfusion. This is mediated by the activation of estrogen receptors on the endothelial cells by the resveratrol. In addition, there was a 7.24% decrease in C-terminal telopeptide type-1 collagen levels. This is a bone resorption marker that is useful to screen for excess bone loss as well as monitoring the effectiveness of osteoporosis treatment.  Furthermore, a sub-group analysis showed the benefit of resveratrol on bone health was also greater in individuals who were supplementing with vitamin D and calcium. This demonstrates the importance of a comprehensive approach compared to monotherapies.

In conclusion, this study showed that supplementation with 150 mg of resveratrol daily can reduce bone loss in postmenopausal women. Other nutrients to consider include tocotrienols, genistein, vitamin D, vitamin K, calcium, magnesium, DHEA, and specific collagen peptides.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Wong R, Zaw J, et al. Regular Supplementation with Resveratrol Improves Bone Mineral Density in Postmenopausal Women: A Randomised, Placebo-Controlled Trial. J Bone Miner Res. 2020 Jun 21.


New study investigates the impact of anti-inflammatory diet in patients on disease severity in patients with rheumatoid arthritis

There has been a significant increase in the incidence of autoimmune disorders over the past several decades. Most individuals have a less-than-perfect diet and over the years Americans have lost much of the diversity in their diet which plays an essential role in the gut microbiome and a contributing factor in the epidemic of autoimmune disorders. More and more research demonstrates that the food one eats affects what bacteria populations are in their gut.

A significant environmental trigger in autoimmune disease is the diet. Dietary approaches provide the most effective means to returning balance and dysfunction with the gastrointestinal system.

According to a new study published last week in The American Journal of Clinical Nutrition, researchers investigated the impact of an anti-inflammatory diet and disease severity in patients with rheumatoid arthritis.

This was a single-blinded crossover study including 47 patients with rheumatoid arthritis. Patients were randomly assigned to either an anti-inflammatory diet or control diet for a 10-week period. After a 4-month washout period, the patients switched diets. Food equivalent of approximately 50% of their energy requirements was delivered weekly to their homes. For the remaining meals, they were advised to consume the same type of foods as the ones provided during each diet. The primary outcome was the change in Disease Activity Score in 28 joints-Erythrocyte Sedimentation Rate (DAS28-ESR). Secondary outcomes were changes in the components of DAS28-ESR such as tender and swollen joints, ESR, C-reactive protein and visual analog scale.

The main meals of the diet included fish three to four times per week and vegetarian dishes with legumes once to twice a week. Potatoes, whole grain cereals, vegetables, spices, and other flavorings were also included. Snacks consisted of fruits and breakfasts included low-fat dairy, whole grain cereals, pomegranate, blueberries, nuts, and juice shots with probiotics. The probiotic shot included a strain of Lactobacillus plantarum and was consumed five days a week. For the meals not provided, patients were advised to limit their intake of meat to less than 3 times per week and to eat fiver or more servings daily of fruits and vegetables, to use oil or margarine for cooking, and to choose low-fat dairy and whole grain cereals.

The control diet provided contained meat or chicken and refined grains daily, a protein bar for snacks, and breakfasts consisted of white bread with a butter and cheese, or yogurt with corn flakes and orange juice. In addition, patients were instructed to consume meat more than five times a week, eat seafood no more than once a week, and to consume less than five serving of fruits and vegetables. Patients were also advised to use butter for cooking; and consume high-fat dairy products. They were also advised to avoid products with probiotics. Before each diet period, patients received a binder including weekly menus and recipes as well as instructions on for the meals not provided. Three weekly menus were repeated throughout the diet periods.

As a result, DAS28-ESR significantly decreased with the anti-inflammatory diet and was significantly lower after the intervention than after the control period in the patients that completed both periods. This study demonstrates positive effects of an anti-inflammatory diet on disease activity in patients with RA.

In addition to an anti-inflammatory diet, other nutrients to consider include vitamin D, fish oil, resveratrol, curcumin, and probiotics.

Autoimmunity can occur a few different ways. It is also important to look at any environmental triggers such as food sensitivities, nutrient status, toxins, and gut health. Each person’s biochemical individuality exerts a major influence on his or her health. The level of nutrient intake, lifestyle choices and environmental exposures filtered through genetic predisposition are major factors in the expression of disease, and a successful treatment approach must investigate these factors.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS Source: Vadell A, Barebring L, et al. Anti-inflammatory Diet in Rheumatoid Arthritis (ADIRA)- a Randomized, Controlled Crossover Trial Indicating Effects on Disease Activity. Am J Clin Nutr. 2020 Jun 1;111(6):1203-1213.

New study demonstrates the role of DHA in reducing the risk of type II diabetes and Alzheimer’s disease

Insulin resistance are a significant health care problem in the United States. Type 2 diabetes affects more than 300 million people.

Insulin resistance is preventable and reversible through lifestyle changes, proper nutrition, supplements, exercise and stress management. Weight loss and exercise are the best treatments for restoring the body’s ability to respond to insulin.

Previous research has shown omega-3 fatty acids mitigate insulin resistance linked to obesity, however, results have been inconsistent.

According to a new study published last week in Nutrients, researchers investigated the effect of DHA-rich fish oil on glycogen synthase kinase (GSK-30), which is linked to insulin resistance and Alzheimer’s disease. GSK-3 is involved in Aβ plaques, and Tau phosphorylation, which is elevated in patients with mild cognitive impairment and Alzheimer’s disease.

This was a double-blind randomized control trial including 58 individuals between the ages of 18 and 70 years of age with mild to moderate abdominal obesity. Participants were excluded if they have been diagnosed with diabetes or on blood sugar lowering medications that could affect insulin sensitivity such as Metformin. Each participant consumed 2 grams of fish oil consisting of 860 mg of DHA and 120 mg EPA or a placebo (corn oil) per day for a 12-week period. Anthropometric measurements were conducted using bio-electrical impedance scales. Height, weight, and waist circumference were measured and body mass index (BMI) was calculated). Laboratory assessment included fasting glucose, fasting insulin, hs-CRP, total cholesterol, RBC fatty acids, and GSK-3β. As a result, the DHA-rich fish oil significantly reduced GSK-3 and reduced insulin resistance compared to the placebo. Baseline CRP and fasting insulin levels were positively correlated, indicating the relationship between low-grade systemic inflammation and hyperinsulinemia.

This study demonstrates the effect of DHA-rich fish oil improving insulin sensitivity by reducing GSK-3 levels in individuals at a high risk of hyperinsulinemia and insulin resistance with high baseline CRP levels. DHA-rich fish oil should be considered as an early intervention to reduce the risk of developing metabolic disease and associated comorbidities as well as in reducing insulin resistance in individuals with higher inflammation levels.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Docosahexaenoic Acid-Rich Fish Oil Supplementation Reduces Kinase Associated with Insulin Resistance in Overweight and Obese Midlife Adults. Nutrients 30 May 2020, 12(6), 1612.



Low vitamin D levels predict mortality in ankylosing spondylitis patients

Vitamin D deficiency is a global epidemic and has been linked to many autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus, multiple sclerosis, and (inflammatory bowel disease) IBD, with studies finding a higher prevalence of these diseases in those who are deficient in vitamin D.

Previous studies in patients with ankylosing spondylitis have reported lower vitamin D levels compared to controls, however, the effect of vitamin D status on disease severity has been controversial. Some studies demonstrated that a vitamin D deficiency increased the disease severity while others did not show an association. Most of these studies were cross-sectional studies, had a small sample size, and none examined vitamin D levels on mortality in ankylosing spondylitis patients.

According to a study published two weeks ago in Nutrients, researchers investigated the effect of vitamin D deficiency on all-cause mortality in patients with ankylosing spondylitis and in the general population.

This was a retrospective cohort study including 919 patients with ankylosing spondylitis (AS) diagnosed between 2002 and 2007 and 4,519 controls. The average age at the start of the study was 52 years with 22% of them being women. The follow up continued until death or at the end of study in July 2019 with an average follow-up time of 14.3 years. Laboratory assessment included 25-hydroxyvitamin-D levels.

As seen with other autoimmune conditions, AS was associated with a higher proportion of vitamin D deficiency (< 20 ng/mL) and a vitamin D insufficiency (< 30 ng/mL) was significantly associated with increased incidence of all-cause mortality. This association was more prominent with a vitamin D deficiency and among male patients. On the other hand, inadequate levels of vitamin D among healthy controls were not associated with an increased all-cause mortality.

This study demonstrated that a vitamin D deficiency is more common in AS patients than healthy controls and is associated with an increased risk for all-cause mortality. This is most likely due to the role of vitamin D as an immunomodulator. Vitamin D inhibits the production of several cytokines including tumor necrosis factor alpha (TNF-α) which plays a role in joint inflammation and rheumatic diseases.

Most patients can obtain optimal levels of vitamin D in daily doses between 5,000 IU and 10,000 IUs/day. Research suggests daily dosing is more effective than weekly dosing. It is also essential to use a supplement that combines vitamin K or provide a separate vitamin K supplement. There are intricate relationships between fat-soluble vitamins and it is important take this into account with dosing vitamin D supraphysiologically.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Ben-Shabat N, Watad A, et al. Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study. Nutrients. 2020 May 13;12(5), 1400.


New study demonstrates the effect of collagen peptides on bone turnover in postmenopausal women with osteopenia

Collagen supplementation has increased exponentially and has gained increasing attention, however, not all collagen is considered equal. Collagen supplements can come from a variety of sources such as, porcine, bovine, or marine. In addition, there are variations in quality and molecular weight which limit absorption and efficacy.

Collagen is digested in the gastrointestinal tract and mainly broken down into single amino acids and di-peptides and enter the blood stream and accumulate in various tissues depending on the molecular weight.

According to new study published last month, researchers investigated the efficacy of specific collagen supplementation on body turnover in postmenopausal women with osteopenia.

Postmenopausal women have an increased risk of osteoporosis due to breaking down old bone tissue faster than it can be replaced. Type 1 collagen makes up about 95% of the collagen content of bone and previous research had shown its involvement on the properties of bone.

This was a randomized prospective study consisting of 51 postmenopausal women with osteopenia based upon bone mineral density measurements of the lumbar spine and femur using dual energy X-ray absorptiometry (DXA). These patients were divided into two groups. Supplementation in 24 individuals consisted of 5 grams of collagen peptides, 500 mg of calcium, and 400 IU of vitamin D. The other group consisting of 27 individuals supplemented with the same dosage of calcium and vitamin D only. Laboratory assessment included procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of collage 1 (CTX) levels. These samples were collected at baseline and at 3 months. Other laboratory testing was conducted to rule out secondary causes of osteoporosis such as serum calcium, parathyroid hormone, and vitamin D 25-OH.

As a result, there was a significant decrease in P1NP levels by 13.1 % and CTX levels by 11.4% in the collagen peptide supplementation group over a 3-month period. No changes were seen in the other group that only supplemented with calcium and vitamin D.

Collagen peptides affect the remodeling and mineralization of the bone matrix and enhance osteoblastic differentiation. These results demonstrate the positive effects collagen peptides on bone metabolism in postmenopausal women with osteopenia.

The body is not only composed of complete proteins, but is 25% to 30% collagen. Collagen protein is renewed at comparable rates as other proteins in the body, such as in bone. It is important to note that collagen also makes of a significant component of many tissues such as 65% to 80% in tendons, 70% in ligaments, 50% in cartilage, and 23% in cortical bone.

Other benefits of collagen supplementation include improving skin, sarcopenia, blood pressure, and insulin resistance. It important to use a quality collagen supplement that has research behind it and is a low molecular weight to optimize absorption and efficacy. Other nutrients to support osteopenia include vitamin D, vitamin K, magnesium, genistein, and delta and gamma tocotrienols.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Argyrou C, Karlafti E, et al. Effect of calcium and vitamin D supplementation with and without collagen peptides on bone turnover in postmenopausal women with osteopenia. J Musculoskelet Neuonal Interact. 2020; 20(1): 12-17.

New review investigates the effects of lutein and astaxanthin on the improvement cognitive function

A wide variety of research has shown the beneficial effects of diet on nearly every aspect of brain function and overall health. Lutein is selectively incorporated into the macula as well as the brain. Lutein levels in the macula and the brain have been associated with better cognition.

Previous research has demonstrated the benefits of lutein and astaxanthin on eye health and some research is emerging on their benefits on cognition, however, previous randomized controlled trials has shown inconsistent results.

According to a review published two weeks ago in Nutrients, researchers investigated the effects of lutein and astaxanthin on the improvement cognitive function.

This review included five studies with lutein and two studies with astaxanthin.  The inclusion criteria included randomized controlled trials using oral carotenoid supplementation in healthy individuals in which cognitive functions were assessed. These seven studies took place between 2008 and 2018 including 429 participants with a sample size ranging from 44 to 91 individuals. Four of the studies were conducted for 1 year, one study was 4 months in duration, another study took place over 12 weeks, and the final study was conducted over 8 weeks. Overall, 80 cognitive test outcomes were used in these studies divided among seven domains. Four of the studies measured macular pigment density and serum lutein. Macular pigment volume increased after supplementation as seen in previous studies. In addition, serum lutein was statically improved compared to the placebo group and there was a trend of increasing serum lutein in middle-aged and senior participants compared to younger individuals. As a result, 10 mg of lutein over a 12-month period has demonstrated selective improvement of visual episodic memory in young and middle-aged adults. One of the two studies with astaxanthin showed a significant improvement of verbal episodic memory performance in middle-aged adults. This was only seen in the higher doses of astaxanthin at 8 mg to 12 mg per day.

 Lutein is anti-inflammatory and an antioxidant. Recent research has shown it increasing total antioxidant capacity and brain-derived neurotrophic factor (BDNF) in young adults.

In addition to supplementation, avocados are a great bioavailable source of lutein, containing approximately 0.5 mg of lutein. Previous research demonstrated that avocado consumption increases macular pigment density.

Other brain supportive nutrients to consider are GPC, CDP-choline, gingko biloba, and phosphatidylserine, and fish oil. GPC and CDP-choline are water soluble forms of choline that supports brain health. These help make more acetylcholine, neurotransmitters, as well as phosphatidylcholine in the cell membranes. In addition, phosphatidylserine is an essential nutrient for brain function and is not found in the diet.

Source: Nouchi R, Suiko T, et al. Effects of Lutein and Astaxanthin Intake on the Improvements of Cognitive Functions among Healthy Adults: A Systemic Review of Randomized Controlled Trials. Nutrients. 2020 February 27; 12(3).

New study investigates the effect of high dose vitamin D on the gut microbiome

Vitamin D deficiency is a global epidemic and has been linked to many autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus, multiple sclerosis, and (inflammatory bowel disease) IBD, with studies finding a higher prevalence of these diseases in those who are deficient in vitamin D.

According to a study just published this month, researchers investigated the impact of high dose vitamin D supplementation on the composition of the gut microbiome adolescent girls.

Previous research has shown an interaction between the gut microbiome with vitamin D. Animal studies has shown vitamin D can change the composition of the gut microbiome. This data suggests vitamin D may play role in modulating the microbiome and a deficiency may lead to inflammation or dysbiosis. Some human data demonstrates vitamin D shifting the microbiome in IBD.

This was an intervention study including 50 healthy teenage females between the ages of 12 and 18. All fifty individuals received vitamin D supplementation at 50,000 IU once a week over a nine-week period. Fasting vitamin D levels were assessed at baseline and the end of the study as well as stool samples were taken. At the start of the study 86% of the participants had a vitamin D deficiency (20 ng/ml or less), 8% had an insuffiency (21-29 ng/ml), and only 6% had normal levels (30 ng/ml or higher). As a result, vitamin D supplementation significantly improved vitamin D status as well as increased levels of Firmicutes and Bifidobacterium. In addition, there was a reduction of Bacteroidetes after supplementation.

There are a few mechanisms in which vitamin D may have this effect. It’s impact on the gut microbiome is most likely from immune modulation and well as anti-inflammatory effects which change the microbiome composition.

Although this study used high weekly dosing of vitamin D, most patients will obtain optimal levels of vitamin D in daily doses between 5,000 IU and 10,000 IUs/day. Research suggests daily dosing is more effective than weekly dosing. It is also essential to use a supplement that combines vitamin K or provide a separate vitamin K supplement. There are intricate relationships between fat-soluble vitamins and it is important take this into account with dosing vitamin D supraphysiologically.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Tabatabaeozadeh SA, Fazeli M, et al. The effects of high doses of vitamin D on the composition of the gut microbiome of adolescent girls. Clin Nutr ESPEN. 2020 Feb;35:103-108.

New review investigates the effects of carnitine supplementation in nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) has become an increasing epidemic. It is the most common cause of elevated liver enzymes and is associated with diabetes and obesity with advanced liver disease.

There are few guidelines for diagnostic and follow up methods and limited proven treatment options. Previous research of pharmacological agents to treat nonalcoholic fatty liver disease were performed with poor results.

A few studies have shown a beneficial effects of carnitine supplementation in liver diseases, however, these results have been inconsistent. This may be due to study design, dosage, or form of carnitine administered.

According to a review published last week in Complementary Therapies in Medicine, researchers examined the effects of carnitine supplementation on clinical characteristics of nonalcoholic fatty liver disease.

This review included a total of 5 randomized placebo-controlled studies including 334 patients that investigated the effects of carnitine supplementation on liver function, body mass index (BMI), lipid profile, body weight, and HOMA-IR. These studies included a sample size between 48 and 80 individuals supplementing with a dosage of carnitine between 300 mg and 2000 mg per day over a 3 to 6-month period.

As a result, carnitine supplementation significantly decreased the HOMA-IR, AST, ALT, and triglyceride levels. On the other hand, it did not have an effect on BMI, body weight, HDL, LDL, or total cholesterol levels. Previous research has demonstrated carnitine supplementation provides a protective effect by preventing lipid peroxidation and can affect liver function by decreasing insulin resistance.

These individuals are in a chronic disease state and have increased demands then what could be obtained from the diet alone and therefore, dietary supplements should be considered to help prevent the progression as well as improve liver function. Other nutrients to consider include delta and gamma tocotrienols, phosphatidylcholine, fiber or resistant starch, n-acetylcysteine, fish oil, and probiotics.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Abolfathi M, Mohd-Yusof BN, et al. The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2020 Jan;48:102273.

New study investigates probiotic benefits on cognitive function in children and adolescents

According to a study published last month in Beneficial Microbes, researchers investigated the potential neurobehavioral benefits of probiotics through the gut-brain axis in children and adolescents.

This review included seven randomized controlled trials published between 1990 and 2018 that met inclusion criteria with an assessment of cognitive function. As a result, only one study demonstrated a positive result in patients with ADHD or Asperger syndrome. This was in a study supplementing with Lactobacillus rhamnosus at 1 billion CFUs per day. Supplementation was given to pregnant women for 4 weeks prior to delivery and was continued for 6 months after birth. ADHD or Asperger syndrome was diagnosed at the age of 13 in 17.1% of the children in the placebo group and none in the probiotic group. In addition, this study identified significant differences in commensal bacteria specifically related to Bifodobacterium between the children that later developed ADHD or Asperger syndrome and the children in the supplementation group. The 6 other studies included various strains, different lengths of duration, and the outcomes did not show a difference in cognition after probiotic supplementation.

This study demonstrates that probiotic supplementation during pregnancy and the first year of life may reduce the risk of developing ADHD or Asperger’s syndrome by its effects on the gut microbiome and commensal bacteria and via the gut-brain axis. This makes sense as the microbiome undergoes the most significant changes during infancy as well as old age and the immune system is also its weakest and most unstable during these two stages of life.

In addition, previous research suggests the presence of bacteria in the placenta, amniotic cavity, and umbilical cord suggesting the development of the microbiome may start in-utero. These factors may be influenced by type of delivery, diet, antibiotic exposure, maternal diet and microbiome as well as the environment.

It is also essential to optimize every child’s nutrient and essential fatty acid status. Previous research has demonstrated that a multivitamin can improve emotion, attention, and general functioning in children with ADHD. Addressing insufficiencies can optimize brain function as well as possibly prevent and alleviate some of the symptoms associated with ADHD without harmful side effects. Additional nutrients to consider include carnitine, choline, DHA, and phosphatidylserine. Optimal nutrition is important for brain health and this influences emotions and behavior which can impact ADHD symptoms. Gut dysfunction, food sensitivities, food dyes, processed foods, and low intake of fruits and vegetables can also play a role.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Rianda D, Agustina R, et al. Effect of probiotic supplementation on cognitive function in children and adolescents: a systemic review of randomized trials. Benef Microbes. 2019 Dec 9;10(8):873-882.