By Bernie Mertens, Nutrition and Behaviour MSc, Registered Nurse BSc (Hons)

Key points:

–Sleep is crucial for proper restoration and recovery and is needed for the body to be able to function at its best.

-Our nervous system regulates sleep and the body relies on the production of hormones/neurotransmitters to help it maintain a healthy sleeping pattern/good quality sleep which can be difficult to maintain for those with ADHD/ADD.

-Additives/preservatives have the potential to reduce functionality of the nervous system and inhibit essential neuro-transmitters from working in both neurotypical and neurodivergent individuals.

-Individuals with ADD/ADHD are more susceptible to sleep disorders due to brain over-activity and/or an unfavourable environment for the production of hormones that could aid sleep and therefore should pay more attention to the impact of lifestyle factors such as nutrition.

-Additives effect behavioural symptoms in both children and adults with ADD/ADHD which can impact sleep.

-Common foods are often pumped full of food additives in order to preserve them during production. This can also manipulate the way they taste or look but also the way in which they are metabolised and impact overall health. Often these foods are also lacking in other essential nutrients and can poorly affect mental and physical health.

-Common foods that contain additives are:

• Bread
• Energy/sugary drinks
• Caffeinated drinks
• Ready Meals
• Processed meat (eg. Sausages, ham, bacon, friend chicken etc)
• Cheese
• Cereals
• Snacks (eg. Sweets/chocolate/crisps/baked goods)
• Fast-food/takeaways

Introduction

As with all routine behaviours, sleep plays a critical role in keeping our bodies balanced and working at their best (homeostasis). It is essential for recovery of almost all bodily functions, allowing us to recharge so we can continue to do all the important stuff we need to do in our daily lives. Sleep is regulated by the nervous system, and it’s the quality and duration can dictate changes in both our physical and mental health [1]-so it’s fairly important. As part of a natural sleep cycle, hormones are activated by messages sent to the brain (neurotransmitters), which determine when it’s time to rest and rise, known as our internal body clock, or circadian rhythm [2].

Just like most trigger-response systems that manage our bodies ongoing homeostatic equilibrium, the circadian rhythm relies on our nervous system’s ability to regulate neurotransmitter activity to stimulate natural sleep [3]. Problems with sleep duration and quality, can often be a result of insufficiencies instigated by environment or lifestyle factors (such as nutrition), which can either promote or reduce sleep activation and regulation initiated by brain activity.

Characteristically, ADHD/ADD (Attention Deficit and Hyperactivity Disorder/Attention Deficit Disorder), is associated with dysregulation of brain activity, which can inspire poor sleep behaviours such as high amounts of stimuli, lack of routine, or poor dietary intake all of which pose a threat to our circadian rhythms. It is ever more necessary then, in a world that is learning to recognise the scale of neurodiverse individuals, to understand the ways in which we can promote functionality of fundamental behaviours that effect every day life, such as sleep.

The importance of sleep and its impact on physical and mental health

There are different types of sleep which include REM sleep and NREM sleep (Rapid Eye Movement and Non-Rapid Eye Movement). Now this may not mean a great deal, but in this context the difference between the two outlines the quality of sleep someone has (which symptomatically results in eye movement) and the duration of which determines quality of brain recovery[4].

During our sleep cycles, we drift in and out of these phases but how much rest and restoration your body receives is dependent on activation and duration of these cycles[5]. Not only that but there are multiple ways in which our bodies respond to this that are only stimulated whilst we sleep, so without it, we prevent ideal rest that creates a foreground for optimal physical and mental health[6].

Some research suggests we developed our individual “chronotypes”, which establish whether or not we’re an “early bird” or a “night owl”, from our hunter-gatherer ancestors. Other research, highlights that regardless of genetics, sleep regulation is self-sustained, and therefore is heavily dependent on a variety of lifestyle factors that can affect the synchronisation of specific hormones (such as melatonin), triggered through messages sent to our brain to allow us to fall into a natural sleep which relies heavily on routine to thrive[7].

How much or how well we sleep can be a result of age, gender, environment, the amount of physical activity be undergo, quality of nutrition, presence of health conditions, and the list goes on. But what has been noted in recent research is that we are sleeping less[8]

The effects of nutrition on sleep quality

In a large number of cases, insomnia/poor sleep quality, or dysregulated sleep, is caused by brain over-activity such as hyper-activity, anxiety, excitement and stress. Brain over-activity is just one side-effect for individuals with ADHD/ADD. Not only that but, the bursts of energy and hyperactivity that often accompany the condition, actually inhibit hormonal production of melatonin and cortisol-hormones which help the reduction of stress and help to promote natural sleep.[9][10] As a result, this can often lead to periods of fatigue or in some cases episodes of inattentiveness to combat overuse of energy in times of over-exertion.  In order to prevent this, a lot of people tend to turn to holistic coping mechanisms, which can come in the form of calorific, low-nutrient foods to provide a supply of energy when sources are low. Unfortunately, there is new evidence emerging which suggests that a great deal of our melatonin receptors reside in our digestive tract.[10]

It’s no secret that low nutritious foods, especially those full of caffeine and sugar, prevent our sleep hormones from working effectively [8][11]; after all, keeping us alert and/or energised is what is what they were designed to do. but what you may not be aware of is that poor quality sleep can impact how effectively our bodies digest food (especially sugar)[12][13]. This can lead to leading to dysregulation of metabolism and even weight gain[14]. Often, these foods are full of additives and preservatives which instigate further brain activity and sleep disruption leading, heightened fatigue,  and with the aforementioned reduction of dopamine receptors, makes those with ADHD/ADD evermore susceptible to negative mental and physical health outcomes [15][1][16].

Recent evidence has shown that higher symptoms of ADHD is correlated with a higher consumption of ultra-processed foods containing high amounts of additives[17]. Often, cereals, sweets, snacks and energy drinks with high sugar contents, bright colours and catchy adverts are widely targeted at children, and parents. Because of the content of these foods they offer very limited nutritional value and can also be addictive [18]. But what’s more concerning, is that some evidence has demonstrated that the lack of nutrients provided by ultra-processed/energy dense foods actually inhibits the growth and productivity of brain function in children and enables flourishing of mental health conditions in both children and adults combined[19] (which I will go into more detail in my next article). This may be reflective of rise of mental health conditions and sleep disturbance at a time that consumption of ultra-processed foods is at it’s all-time highest.

But what can we do about it? We’ve already mentioned that a lot of the time people look for nutrition as a source of aid in times of stress, but often fuel our bodies with short-term antidotes to satisfy energy cravings prompted by lack of sleep. But what if we considered we’re fuelling our bodies with and how it can impact our health.

Understand more about how diet and nutrition can affect sleep in our blog post:  Feeding better sleep in children with ADHD, ASD and related conditions

For further help and advice, book an appointment with a registered nutritionist:

What are food additives?

When we think of additives, the implication is that something potentially not-so-natural has been added to (usually) food, and that’s basically right. But more specifically (and looking at the dictionary definition of google), additives are defined as something that has been added to preserve or improve food.[20]

The World Health Organisation (WHO) describes additives as “modify[ing] the sensory properties of foods including taste, smell, texture and appearance.”[21] The ongoing societal pressure for food production and competitive demand for enhanced taste profiles of fast-foods, has made room for an invasion of food pumped full of additives and preservatives used to meet popular requirements.

Common examples of popular food additives/preservatives are [22]:

• Calcium Propionate[23]
• MSG
• Artificial Food Colouring
• Sodium Nitrate
• Guar Gum
• High-Fructose Corn Syrup
• Artificial Sweeteners
• Trans Fats
• Carrageenan
• Sodium Benzoate
• Xanthan Gum
• Yeast Extract

These have become staples in our diets as a way of ensuring longevity and in most cases, prioritising taste over nutritional value, more commonly found in the food we label ultra-processed.

Examples of these types of foods are:

• Bread
• Processed meats such as ham, sausages, fried chicken, bacon etc
• Chips
• Cereals
• Snacks (such as sweets, chocolate, crisps, baked goods etc)
• Fast-food or takeaway
• Sugary drinks
• Caffeinated drinks

However, there is some evidence to suggest that certain foods can actually nurture a natural sleep cycle and maintain good quality sleep.

As reflected by the work of FeinGold and others[24], it has been suggested that additives and preservatives found in food might actually impact neurotransmitters responsible for the uptake of essential hormones to provide a health environment for brain function[9], aggravating the behavioural symptoms in both adults and children with ADHD/ADD [25]. In research where foods containing additives were limited or restricted, showed positive effects on behaviour and sleep outcomes in children[23]. It has been noted that 1/3 of children with ADHD saw a reduction of symptoms when consuming a diet that contains restricted amounts of artificial colours and preservatives[26][17], and later noted a similar response in adults[27].

So, if we are saying that sleep is impacted by symptoms of ADHD/ADD and nutrition further impacts these symptoms, surely we need to be looking at our diets?

In nutrition-based clinical trials that observed positive behavioural outcomes in children, permitted foods were found in the form of fruit and veg, protein, eggs and fish[23], and some even permitted certain snacks. Previous research signifies that this is likely due to increased omega 3 consumption which specifically promotes healthy brain activity, and by doing so helps to regulate the nervous system, in both neurodiverse and neurotypical individuals.[28]

With the limited amount of research into how neurodiverse individuals regulate sleeping patterns and nutrition, and as with most scientific research surrounding the human body, there’s not a one-size fits all answer[8], typical (or not-so typical)… However, what we can ascertain is that energy-dense, low nutritious foods pumped full of additives and preservatives have the potential to impact not just our sleep but also our brain activity which can affect our mood and behaviour which can be worse for neurodiverse individuals [29]. This is an important factor surrounding sleep deprivation but also navigates the way in which we negotiate our everyday lives. For this reason I will be going into more detail about the ways in which additives effect mental health and behaviour in my next article, as well as the ways in which nutrient-dense food can help to promote positive mood and behaviour change in both children and adults with ADHD/ADD.

You may also be interested in the following blog articles:

• Feeding better sleep in children with ADHD, ASD, and related conditions

• Understanding and managing ADHD: The importance of nutrition and diet

For one to one assistance in reducing additives or preservatives in your or your child’s diet,  you may benefit from the support of a registered nutritionist:

Additionally, you may want to view a list of supplements that may support sleep issues:

References

[1] Justyna Godos, Giuseppe Grosso, Sabrina Castellano, Fabio Galvano, Filippo Caraci, Raffaele Ferri,

Association between diet and sleep quality: A systematic review, Sleep Medicine Reviews, Volume 57, 2021, 101430, ISSN 1087-0792, https://doi.org/10.1016/j.smrv.2021.101430.

[2] https://www.healthline.com/health/cortisol-and-sleep#bottom-line

[3] Riganello F, Prada V, Soddu A, di Perri C, Sannita WG. Circadian Rhythms and Measures of CNS/Autonomic Interaction. Int J Environ Res Public Health. 2019 Jul 2;16(13):2336. doi: 10.3390/ijerph16132336. PMID: 31269700; PMCID: PMC6651187.

[4]Eugene AR, Masiak J. The Neuroprotective Aspects of Sleep. MEDtube Sci. 2015 Mar;3(1):35-40. PMID: 26594659; PMCID: PMC4651462

[5]Theertham P. Rao , Motoko Ozeki & Lekh R. Juneja (2015) In Search of a Safe Natural Sleep Aid, Journal of the American College of Nutrition, 34:5, 436-447, DOI: 10.1080/07315724.2014.926153

[6]Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017 May 19;9:151-161. doi: 10.2147/NSS.S134864. PMID: 28579842; PMCID: PMC5449130.

[7] Czeisler CA, Gooley JJ. Sleep and circadian rhythms in humans. Cold Spring Harb Symp Quant Biol. 2007;72:579-97. doi: 10.1101/sqb.2007.72.064. PMID: 18419318.

[8] Jean-Philippe^a ;Dutil, Caroline^a, c;Sampasa-Kanyinga, Hugues^a, d Sleeping hours: What is the ideal number and how doesNature and Science of SleepVolume 10, Pages 421 – 4302018 ISSN 11791608 DOI10.2147/NSS.S163071 age impact this?

[9]https://www.healthline.com/health/cortisol-and-sleep#bottom-line

[10]Tordjman S, Chokron S, Delorme R, Charrier A, Bellissant E, Jaafari N, Fougerou C. Melatonin: Pharmacology, Functions and Therapeutic Benefits. Curr Neuropharmacol. 2017 Apr;15(3):434-443. doi: 10.2174/1570159X14666161228122115. PMID: 28503116; PMCID: PMC5405617.

[11] https://www.healthline.com/nutrition/foods-that-keep-you-awake

[12] Westerterp-Plantenga MS. Sleep, circadian rhythm and body weight: parallel developments. Proc Nutr Soc. 2016 Nov;75(4):431-439. doi: 10.1017/S0029665116000227. Epub 2016 Apr 27. PMID: 27117840.

[13 ]Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007 Jun;11(3):163-78. doi: 10.1016/j.smrv.2007.01.002. Epub 2007 Apr 17. PMID: 17442599; PMCID: PMC1991337.

[14]Lundahl A, Nelson TD. Sleep and food intake: A multisystem review of mechanisms in children and adults. Journal of Health Psychology. 2015;20(6):794-805. doi:10.1177/1359105315573427

[15]Wang L, Sun M, Guo Y, Yan S, Li X, Wang X, Hu W, Yang Y, Li J, Li B. The Role of Dietary Inflammatory Index on the Association Between Sleep Quality and Long-Term Cardiovascular Risk: A Mediation Analysis Based on NHANES (2005–2008). Nat Sci Sleep. 2022;14:483-492
https://doi.org/10.2147/NSS.S357848

[16] Shanshan Wang, Matthew E. Rossheim, Rajesh R. Nandy, Uyen-Sa Nguyen,

Interaction between sleep duration and trouble sleeping on depressive symptoms among U.S. adults, NHANES 2015-2018, Journal of Affective Disorders, Volume 351, 2024, Pages 285-292, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2024.01.260

[17] Feingold, B., 1985. Why Your Child Is Hyperactive: The bestselling book on how ADHD is caused by artificial food flavours and colours. Random House.

[18]Lustig RH. Ultraprocessed Food: Addictive, Toxic, and Ready for Regulation. Nutrients. 2020 Nov 5;12(11):3401. doi: 10.3390/nu12113401. PMID: 33167515; PMCID: PMC7694501.

[19]Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Ruusunen A, Jacka FN. Dietary recommendations for the prevention of depression. Nutr Neurosci. 2017 Apr;20(3):161-171. doi: 10.1179/1476830515Y.0000000043. Epub 2016 Mar 2. PMID: 26317148.

[20]https://www.google.com/search?q=additives+definition&sca_esv=df000c20b485358f&sxsrf=ACQVn08bhmyRjMUFo51xf-avW8_yzqrEyw%3A1708769993411&ei=ycLZZeLLGNulhbIP1sugYA&ved=0ahUKEwii1Naj4MOEAxXbUkEAHdYlCAwQ4dUDCBE&uact=5&oq=additives+definition&gs_lp=Egxnd3Mtd2l6LXNlcnAiFGFkZGl0aXZlcyBkZWZpbml0aW9uMgoQABiABBhGGPkBMgUQABiABDIFEAAYgAQyBRAAGIAEMgUQABiABDIGEAAYFhgeMgYQABgWGB4yBhAAGBYYHjIIEAAYFhgeGA8yCBAAGBYYHhgPMiQQABiABBhGGPkBGJcFGIwFGN0EGEYY-QEY9AMY9QMY9gPYAQFIrBRQ4ANYmxJwAXgBkAEAmAHJAqABow6qAQczLjMuMi4yuAEDyAEA-AEBmAILoAKOD8ICChAAGEcY1gQYsAPCAg0QABiABBiKBRhDGLADwgINEC4YgAQYigUYQxiwA8ICChAAGIAEGIoFGEPCAgoQLhiABBiKBRhDwgIkEAAYgAQYRhj5ARiXBRiMBRjdBBhGGPkBGPQDGPUDGPYD2AEBmAMAiAYBkAYKugYGCAEQARgTkgcHNC4zLjEuMw&sclient=gws-wiz-serp

[21]https://www.who.int/news-room/fact-sheets/detail/food-additives#:~:text=Additives%20are%20added%20to%20ensure,%2C%20smell%2C%20texture%20and%20appearance.

[22] https://www.healthline.com/nutrition/common-food-additives#TOC_TITLE_HDR_12

[23]Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health. 2002 Aug;38(4):373-6. doi: 10.1046/j.1440-1754.2002.00009.x. PMID: 12173999.

[24] Nigg JT, Holton K. Restriction and elimination diets in ADHD treatment. Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):937-53. doi: 10.1016/j.chc.2014.05.010. Epub 2014 Aug 10. PMID: 25220094; PMCID: PMC4322780.

[25] https://www.hsmh.co.uk/blog-posts/adhd-management-understanding-the-role-of-diet-and-nutritional-supplements#:~:text=investigation%20is%20required.-,3.,needed%20to%20confirm%20these%20findings.

[26] Buka I, Osornio-Vargas A, Clark B., 2011. Food additives, essential nutrients and neurodevelopmental behavioural disorders in children: A brief review. Paediatr Child Health. (7):e54-6. doi: 10.1093/pch/16.7.e54. PMID: 22851902; PMCID: PMC3200397.

[27]Hyperactivity Gerald H. Block Journal of Learning Disabilities 1977 10:4, 236-240

[28] Rucklidge JJ, Harrison R, Johnstone J. Can micronutrients improve neurocognitive functioning in adults with ADHD and severe mood dysregulation? A pilot study. J Altern Complement Med. 2011 Dec;17(12):1125-31. doi: 10.1089/acm.2010.0499. Epub 2011 Nov 23. PMID: 22112202.

[29] https://www.hsmh.co.uk/blog-posts/adhd-management-understanding-the-role-of-diet-and-nutritional-supplements#:~:text=investigation%20is%20required.-,3.,needed%20to%20confirm%20these%20findings.