Finally Focused: Mineral Imbalances &

ADHD Part I
Zinc Deficiency & Copper Excess in ADHD Patients
What if there was a safe, effective, inexpensive, and simple way to
help treat one of the most common neurodevelopmental disorders of
childhood?
Health care professionals often overlook nutrients; yet imbalances in
many minerals are frequently seen in medical disorders including
ADHD. Fortunately, replenishing nutrients with an integrative
treatment plan has proven to be an effective treatment for the
symptoms of ADHD.
In this two-part series, we will evaluate mineral deficiencies in zinc and
magnesium, excess copper, and their relationship with
neuropsychiatric symptoms.

Minerals Essential for Health

Minerals are inorganic substances essential for cell metabolism,
neurotransmitter synthesis, growth, and development. Major minerals, such
as magnesium, need to be consumed in higher amounts than trace
minerals, such as copper and zinc, although both types are crucial for many
bodily functions. Our bodies cannot synthesize minerals so they must be
obtained through food or supplementation.
Mineral deficiencies are commonly seen in patients suffering from
psychiatric disorders. Due to modern agricultural practices such as
fertilizers and erosion, our soil is tragically depleted in minerals. In addition,
when food is processed, it is stripped of essential minerals. Minerals are also
depleted from the body with stress and through sweat from exercise or hot
yoga practices.

A Toxic Mineral – Lead

In April 2014, the city of Flint, Michigan changed its water supply from Lake
Huron to the Flint River. The corrosive water from the Flint River caused
lead from old pipes to leach into the water supply, putting up to 12,000
children at risk of consuming dangerous levels of lead. One year after the
water supply switch, 5% of children tested in Flint had elevated blood lead
levels, prompting President Obama to declare a state of emergency in
January 2016.
Overall, blood lead levels in children have plummeted since the US phased
out the use of leaded gas and paint in the 1970s. Still, 24 million homes in
the US contain deteriorated lead paint and elevated levels of lead-
contaminated dust. The reduction in children’s blood lead levels has not
been uniform across all areas of the US. Recently, Reuters found nearly
3,000 areas across the US with lead poisoning rates doubling those in Flint.
More than 1,000 of these areas had at least a four times higher rate of
elevated blood tests than those seen in Flint. The health effects of
neurotoxins such as lead are most severe in children, as it can cause
irreversible brain damage. Even at low levels, lead has been associated with
lower IQ scores, inability to pay attention, impaired motor function skills,
and poor academic performance among children.

Lead Exposure and Brain Health

Since lead poisoning causes cognitive, motor, and behavioral changes, it is
not surprising that it also plays a role in the pathophysiology of ADHD. Lead
exposure is estimated to account for 290,000 excess cases of ADHD in US
children (Braun et al., 2006) . A study on almost 5,000 US children aged 4 to
15 years found children with the highest blood lead levels were over four
times as likely to have ADHD compared to children with the lowest blood
lead levels (Braun et al., 2006) . A 2016 study exploring the link between
lead exposure and hyperactivity and impulsivity in children found that these
children had a mutation of a gene that regulates iron uptake and modulates
lead metabolism. The researchers concluded, “The findings of our study are
difficult to explain unless lead is, in fact, part of the cause of ADHD, not just
an association” (Nigg et al., 2016) .
Brain scans from participants of the Cincinnati Lead Study revealed that
childhood lead exposure was associated with brain volume loss in
adulthood. Individuals with higher blood lead levels as children had less
gray matter in certain brain regions. Of the regions affected, a significant
loss was observed in the prefrontal cortex, which is responsible for
executive function, behavioral regulation, and fine motor control (Cecil et
al., 2008).
The CDC has set a blood lead level of 5 µg/dL as the reference value to
identify children who require case management. However, numerous
studies have shown lead levels <5 μg/dL are still associated with inattentive
and hyperactivity symptoms and learning difficulties. The risk of ADHD
symptoms increases with elevated blood lead levels, even in low
concentrations. In one study, 2,200 children aged 7 to 9 years who did not
have ADHD at baseline were followed for two years. About 5% (107 cases)
developed suspected ADHD. Children with blood lead levels >2.17 μg/dL
had a 55% greater risk of developing ADHD compared with those with blood
lead levels <2.17 μg/dL (Choi et al., 2016) .

Neurotoxic Effects of Excess Copper in Drinking Water

One of copper’s roles in the body is in the synthesis of
dopamine, the neurotransmitter that supports alertness and
motivations.
Our bodies require a delicate balance of copper levels. One of copper’s roles
in the body is in the synthesis of dopamine, the neurotransmitter that
supports alertness and motivations. However, too much copper creates an
excess of dopamine leading to an excess of the neurotransmitter
norepinephrine. High levels of these neurotransmitters lead to symptoms
similar to ADHD symptoms: hyperactivity, impulsivity, agitation, irritability,
and aggressiveness. Like lead, copper can leach into the water supply when
copper pipes corrode.Following the water crisis in Flint, Michigan,
environmental toxins present in food and water sources raised serious
concerns among public health officials. This prompted several states to
begin rigorously testing their own water supply. In November 2016, The
Boston Globe reported that of the 300 public schools tested in
Massachusetts, 227 schools had elevated levels of either copper or lead, or
a combination of both, in their drinking water supply. Copper is an essential
mineral that is needed in trace amounts; however, excess copper can cause
oxidative cell damage and trigger neurobehavioral symptoms such as
hyperactivity and irritability.
In children with excess copper, stimulant medications are ineffective and
can cause side effects such as agitation, anxiousness, and changes in sleep
and appetite. Most ADHD medications work by increasing levels of
dopamine, intensifying the effects of excess copper. Excess copper also
blocks the production of serotonin, which is responsible for regulating mood.
The imbalance of copper and neurotransmitter levels triggers emotional,
mental, and behavioral problems such as depression and anxiety.
Some studies have assessed the neurotoxic effects of excess copper and its
role in ADHD symptoms. High copper levels are correlated with an ADHD
diagnosis and with attention and short-term memory difficulties in children
and adolescents (Viktorinova et al., 2016; Kicinski et al., 2015) . In a
randomized controlled trial with 80 adults with ADHD, those with lower
baseline copper levels had better response to treatment with a vitamin-
mineral supplement. Among those in the highest copper tertile, only 35%
responded to treatment. In comparison, 77% of adults in the middle copper
tertile responded to treatment (Rucklidge et al., 2014) .

Zinc Deficiency and Brain Health

Excess copper in the presence of a zinc deficiency can be particularly
harmful in individuals with ADHD. Zinc is another essential trace mineral
that is a vital component of the central nervous system
and neurotransmitter synthesis. Zinc is involved with over 300 enzymatic
reactions within the body to support normal growth and development.
Researchers have linked zinc deficiencies in the pathophysiology of several
neuropsychiatric illnesses including ADHD. Multiple studies have
demonstrated that children and adults with ADHD have been consistently
deficient in zinc.
Zinc is required in the synthesis of several neurotransmitters, including
dopamine, norepinephrine, and serotonin and enhances GABA, one of our
main inhibitory/relaxation neurotransmitters. Daily zinc intake is required to
maintain a constant supply as the human body has no zinc storage system.
Environmental toxins, such as Bisphenol A (BPA) and phthalates found in
everyday plastic products, bind to zinc and deplete zinc levels in the body.
Multiple studies have confirmed that not only are zinc levels lower in
children with ADHD, but the extent of zinc deficiency is inversely correlated
with symptom severity in those with ADHD. In a recent study case-control
study, 70% of the 20 ADHD cases aged 6 to 16 were zinc deficient. Those
with lower hair zinc levels had the worst hyperactivity, inattention,
oppositional, and impulsivity scores on the Conners’ parent rating
scale (Elbaz et al., 2016) . In a larger group of 118 children with ADHD, those
with the lowest blood levels of zinc had the most severe conduct problems,
anxiety, and hyperactivity as rated by their parents (Oner et al., 2010) .
Not only are zinc levels lower in children with ADHD, but the
extent of zinc deficiency is inversely correlated with symptom
severity in those with ADHD.
Zinc Supplementation to Improve ADHD and Counteract Excess
CopperElectromyogram (EMG) tests, which reflect brain activity, have
objectively shown that low plasma zinc levels negatively affect information
processing. 28 medication-free boys with ADHD, aged 7 to 12, were
compared to 24 control children. Event-related potential indices from
parietal and frontal brain regions showed that ADHD children had worse
working memory (lower amplitudes of P3) and slower information
processing (longer latency of P3) compared to control children. Individuals
with ADHD and zinc levels <80 μg/dL showed worse information processing
and inhibition (shorter latencies of N2). Plasma zinc levels were significantly
lower in ADHD individuals than in controls, but brain waves began to
normalize with increasing plasma zinc levels (Yorbik et al., 2008) .
Zinc supplements improve symptoms more than placebo and enhance the
effectiveness of stimulant medications. When 400 ADHD children aged 6 to
14 were randomized to zinc sulfate 150 mg/day or placebo for 12 weeks,
those taking zinc had significantly reduced symptoms of hyperactivity,
impulsivity, and impaired socialization (Bilici et al., 2004) . Similarly, when
over 200 children were randomized to zinc 15 mg/day or to placebo for 10
weeks, those taking zinc saw significant improvement in attention,
hyperactivity, oppositional behavior, and conduct disorder (Üçkardeş et al.,
2009).
Studies also support zinc supplementation as an effective augmentation
strategy, as it can help children achieve a therapeutic effect from their
 stimulant medications at lower dosages. In one study, children received zinc
glycinate 15-30 mg/day or placebo. For two weeks, all children were given
amphetamine 5-15 mg/day. Over the course of the next three weeks, the
children continued the zinc or placebo while amphetamine was titrated. The
children receiving zinc had better scores on neuropsychological tests,
especially tests of impulsivity. The optimal weight-adjusted mg/kg/day
amphetamine dose with zinc was 37% lower than with placebo. Likewise,
the optimal absolute mg/day amphetamine dose with zinc was 43% lower
than with placebo (Arnold et al., 2011) .
The Hair Tissue Mineral Analysis test can be used to measure zinc and
copper levels in the body. If these minerals are out of balance,
supplementation is a simple correction. Children aged 12 and older should
take 30 mg of zinc picolinate, twice daily, with meals. Children aged 6 to 11
years can take 15 mg, twice daily, with meals. It can take three to four
months for zinc supplementation to restore a normal copper-zinc balance.
Once zinc-copper ratios have been balanced, medication is less likely to
cause side effects.
Correcting a child’s unique nutritional imbalances is integral to effectively
treating his or her ADHD symptoms. Minerals are essential substances
needed for physical and mental health. Zinc and copper are required to
create neurotransmitters and are part of our antioxidant defense system
protecting cells from free radical damage. Although minerals are crucial for
growth and development, they must be maintained in an appropriate
balance. Children with ADHD often present with low zinc, high copper,
and/or high lead levels. Since zinc, copper, and lead directly affect the
brain, these children suffer from inattention, aggression, hyperactivity, and
learning problems. Correcting nutrient imbalances through supplementation
is a safe and effective strategy to reverse attentional and behavioral
symptoms.

Ready to learn breakthrough nutritional and functional

strategies to help your ADHD patients? Enroll in the upcoming
ADHD Intensive with Dr. James Greenblatt!
Learn More & Enroll Today!

References
1. Arnold et al. (2011). Zinc for attention-deficit/hyperactivity disorder: Placebo-
controlled double-blind pilot trial alone and combined with
amphetamine. Journal of Child and Adolescent Psychopharmacology, 21(1), 1-
19.
2. Bilici et al. (2004). Double-blind, placebo-controlled study of zinc sulfate in the
treatment of attention deficit hyperactivity disorder. Progress in
Neuropsychopharmacology & Biological Psychiatry, 28(1), 181-190.
3. Braun, J., Kahn, R., Froehlich, T., Auinger, P., & Lanphear, B. (2006). Exposures
to Environmental Toxicants and Attention Deficit Hyperactivity Disorder in U.S.
Children. Environmental Health Perspectives, 114(12), 1904.
4. Cecil et al. (2008). Decreased Brain Volume in Adults with Childhood Lead
Exposure. PLoS Medicine, 5(5), PLoS Medicine, 2008, Vol.5(5).
5. Choi, W., Kwon, H., Lim, M. H., Lim, J., & Ha, M. (2016). Blood lead, parental
marital status and the risk of attention-deficit/hyperactivity disorder in
elementary school children: A longitudinal study. Psychiatry Research, 236, 42-
6.
6. Elbaz et al. (2016). Magnesium, zinc and copper estimation in children with
attention deficit hyperactivity disorder (ADHD). Egyptian Journal of Medical
Human Genetics, Egyptian Journal of Medical Human Genetics, in press.
7. Kicinski et al. (2015). Neurobehavioral function and low-level metal exposure in
adolescents. International Journal of Hygiene and Environmental Health, 218(1),
139-146
8. Nigg, J., Natarajan, N., Elmore, A., Friderici, K., & Nikolas, M. (2016). Variation in
an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels
and Attention-Deficit/Hyperactivity Disorder in Children. Psychological Science,
27(2), 257-269.
9. Oner et al. (2010). Effects of Zinc and Ferritin Levels on Parent and Teacher
Reported Symptom Scores in Attention Deficit Hyperactivity Disorder. Child
Psychiatry and Human Development, 41(4), 441-447.
10. Rucklidge et al. (2014). Moderators of treatment response in adults with
ADHD treated with a vitamin–mineral supplement. Progress in
Neuropsychopharmacology & Biological Psychiatry, 50, 163-171.
11. Russo, A. (2010). Decreased Serum Cu/Zn SOD Associated with High Copper
in Children with Attention Deficit Hyperactivity Disorder (ADHD). Journal of
Central Nervous System Disease, 2, 9-14.
12. Üçkardeş et al. (2009). Effects of zinc supplementation on parent and
teacher behaviour rating scores in low socioeconomic level Turkish primary
school children. Acta Paediatrica, 98(4), 731-736.
13. Viktorinova et al. (2016). Changed Plasma Levels of Zinc and Copper to Zinc
Ratio and Their Possible Associations with Parent- and Teacher-Rated Symptoms
in Children with Attention-Deficit Hyperactivity Disorder. Biological Trace
Element Research, 169(1), 1-7.
14. Yorbik et al. (2008). Potential effects of zinc on information processing in
boys with attention deficit hyperactivity disorder. Progress in
Neuropsychopharmacology & Biological Psychiatry, 32(3), 662-667.

Finally Focused: Mineral Imbalances &

ADHD Part II
Magnesium Deficiency
In part 1 of this series, we discussed the importance of correcting trace
mineral imbalances of copper and zinc to reduce behavioral symptoms
and improve medication efficiency in children with ADHD. There is
another nutrient that should be considered by all healthcare
professionals, parents, and those struggling with ADHD: magnesium.
Magnesium is a macromineral required for hundreds of the body’s
biochemical reactions including protein synthesis, muscle and nerve
function, blood glucose control, bone development, DNA synthesis, and
glutathione synthesis.

Magnesium and Brain Health

Magnesium is an inorganic substance essential for brain function. The
bioavailability of magnesium affects the function and binding
of neurotransmitters to their receptors, such as serotonin and dopamine.
For example, magnesium can increase neurotransmission by endogenous
serotonin receptors (5-HT1A). Magnesium also keeps the excitatory
neurotransmitter glutamate within appropriate limits by inhibiting NMDA
receptors. Magnesium also supports the calming actions of GABA interacting
with its receptor.

The Rise of Modern-Day Magnesium Deficiency

Over the last century, magnesium has been progressively declining in our
food supply due to the emergence of highly processed foods, modern
fertilizers, and soil depletion. Refining grains removes up to 80% of the
magnesium originally present. Consumption of refined sugars, soft drinks,
and caffeine also depletes magnesium. It is estimated that approximately
50% of Americans of all ages have an inadequate intake of
magnesium (Mosfegh et al., 2009). Symptoms of magnesium deficiency
include irritability, difficulty with concentration, insomnia, depression, and
anxiety. Because up to 95% of those with ADHD are deficient in magnesium,
almost all ADHD children can benefit from magnesium
supplementation (Kozielec & Starobrat-Hermelin, 1997).
In a recent study on patients with ADHD aged 6 to 16 years, 72% of the
children were found to be deficient in magnesium and there was a
significant correlation between hair magnesium, total IQ, and hyperactivity.
The magnesium deficient children were randomized to magnesium
supplementation 200 mg/day plus standard medical treatment or standard
medical therapy alone for 8 weeks. Those taking magnesium experienced a
significant improvement in hyperactivity, impulsivity, inattention,
opposition, and conceptual level compared to those taking medication
alone (El Baza et al., 2016).

Magnesium Supplementation Improves ADHD Symptoms

Magnesium supplements with vitamin B , which increases magnesium
6

absorption, have shown promise for reducing ADHD symptoms. One study
found that 58% of participants with ADHD had low serum magnesium levels.
All of the children were given preparations of magnesium plus vitamin
B 100 mg/day for a period of 1 to 6 months. In all of the children, physical
6

aggression, instability, attention at school, muscle rigidity, spasms, and

twitching improved.
One of the children treated was a six-year-old referred to as “J.” Initially he
suffered from aggressiveness, anxiety, inattention, and lack of self-control.
After taking the magnesium plus vitamin B supplements for 6 months, he
6

experienced better sleep and concentration—and no methylphenidate was

needed (Mousain-Bosc et al., 2004). A later study also replicated similar
results, as researchers found that a magnesium-vitamin B regimen for at
6

least 2 months significantly improved hyperactivity, aggressiveness, and

attention at school (Mousain-Bosc et al., 2006). The researchers concluded,
“As chronic magnesium deficiency was shown to be associated to
hyperactivity, irritability, sleep disturbances, and poor attention at school,
magnesium supplementation as well as other traditional therapeutic
treatments, could be required in children with ADHD”. In a larger study
evaluating children with ADHD, 30 days of magnesium-vitamin
B supplementation led to improved anxiety, attention, and hyperactivity.
6

Magnesium treatment increased attention, work productivity, task

performance, and decreased the proportion of errors. The EEG’s of children
treated with magnesium showed positive changes as well, with brain waves
significantly normalizing (Nogovitsina & Levitina, 2007).
Children with ADHD should be encouraged to increase their
consumption of magnesium-rich foods such as bananas,
avocados, beans, and green leafy vegetables.
Assessing Magnesium StatusChildren with ADHD should be encouraged to
increase their consumption of magnesium-rich foods such as bananas,
avocados, beans, and green leafy vegetables. A prospective population-
based cohort of over 600 adolescents at the 14- and 17-year follow-ups
found that higher dietary intake of magnesium was significantly associated
with reduced attention problems, aggressiveness, delinquency (Black et al.,
2015). However, since only 30% to 40% of dietary magnesium is absorbed
by the body, supplementation is the most reliable way to increase
magnesium levels in children and adults with ADHD.
It is often difficult to assess magnesium status because magnesium is
predominantly stored inside cells or bone. Serum levels have little
correlation with total body magnesium levels or concentrations in specific
tissues. Tests are usually inaccurate and often unnecessary because most
patients with ADHD can benefit from magnesium supplementation. Clinical
symptoms of constipation, anxiety, insomnia and irritability are often better
assessments of magnesium deficiencies than laboratory testing.

Forms of Magnesium in Supplements

There are several forms of magnesium supplementation, including
magnesium glycinate, magnesium oxide, magnesium citrate, and
magnesium gluconate. They are equally effective, with one exception:
magnesium oxide, which is poorly absorbed and can cause laxative effects.
A common side effect from magnesium supplementation is loose stools, but
this symptom is usually self-limiting and self-resolving.
 Sufficient magnesium is required to adequately support neurotransmitter
systems. Although only 1% of magnesium in the body is found in the blood,
this 1% is critical because free-circulating magnesium is involved in over
300 vital metabolic reactions. Studies consistently show ADHD children who
suffer from greater nutrient imbalances endure more severe symptoms.
Fortunately, with appropriate integrative treatments that restore nutrient
deficiencies, children can achieve relief from behavioral symptoms including
inattention, hyperactivity, impulsivity, and oppositional behavior.

Mineral Balance and ADHD – Conclusions

Thus, correcting copper/zinc imbalances and addressing magnesium
deficiencies can yield significant reductions in ADHD symptomology and
improve cognitive performance. The available literature suggests that the
use of targeted nutritional therapies can be particularly useful in ADHD
treatment and maximize treatment outcomes, by minimizing medication
side effects while also enhancing the therapeutic effect of medications at
lower doses. By incorporating nutritional strategies into modern-day
psychiatry, we can effectively provide relief to the millions of children and
adults struggling with ADHD.

Ready to learn breakthrough nutritional and functional

strategies to help your ADHD patients? Enroll in the upcoming
ADHD Intensive with Dr. James Greenblatt!
Learn More & Enroll Today!

References
1. Black et al. (2015). Low dietary intake of magnesium is associated with
increased externalising behaviours in adolescents. Public Health Nutrition,
18(10), 1824-30.
2. El Baza et al. (2016). Magnesium supplementation in children with attention
deficit hyperactivity disorder. Egyptian Journal of Medical Human Genetics,
17(1), 63-70.
3. Kozielec & Starobrat-Hermelin. (1997). Assessment of magnesium levels in
children with attention deficit hyperactivity disorder (ADHD). Magnesium
Research: Official Organ Of The International Society For The Development Of
Research On Magnesium, 10(2), 143-148.
4. Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. (2009). What We Eat in
America, NHANES 2005–2006: Usual Nutrient Intakes from Food and Water
Compared to 1997 Dietary Reference Intakes for Vitamin D, Calcium,
Phosphorus, and Magnesium. U.S. Department of Agriculture, Agricultural
Research Service: Washington, DC, USA.
5. Mousain-Bosc et al. (2004). Magnesium VitB6 intake reduces central nervous
system hyperexcitability in children. Journal Of The American College Of
Nutrition, 23(5), 545S-548S.
6. Mousain-Bosc et al. (2006). Improvement of neurobehavioral disorders in
children supplemented with magnesium-vitamin B6. I. Attention deficit
 hyperactivity disorders. Magnesium Research: Official Organ Of The
International Society For The Development Of Research On Magnesium, 19(1),
46-52.
7. Nogovitsina & Levitina. (2007). Neurological aspects of the clinical features,
pathophysiology, and corrections of impairments in attention deficit
hyperactivity disorder. Neuroscience and Behavioral Physiology, 37(3), 199-202.