“That’s because of ADHD too?!”  The links between ADHD and disordered eating, explained.

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

Attention deficit hyperactivity disorder (ADHD) is a highly heritable, neurodevelopmental spectrum of traits that research has shown to be connected to inconsistent availability of important neurotransmitters, like dopamine and norepinephrine.  These neurotransmitters are responsible for regulating our daily functioning and health; they mediate functions like focus and concentration, impulse control, the ability to sustain attention (regardless of whether we are interested in the topic at hand), managing boredom and distractibility and our level of fidgetiness (which can be internal or external).

Part of ADHD treatment is the implementation of lifestyle changes that support our overall health. The other part of treatment, acknowledges the reality of the physiology of ADHD – the impossibility of manifesting consistent and appropriate levels of dopamine and norepinephrine. 

Our brains don’t make or access consistent levels of neurotransmitters, like a pancreas that doesn’t make insulin for a type 1 diabetic patient, or how eyeballs that are myopic do not see 20/20, no matter how much we’d like them too.  

Why does understanding these processes matter?

1. Mortality data.

A large study published in The Lancet showed (over 32 years of follow-up of almost 2 million people) people with ADHD (versus no ADHD) have more than double relative risk of premature death (accidents, the most common cause). The relative risk increase is higher for females than for males, and also higher if late-diagnosed (about 70% of people with ADHD are not diagnosed until adulthood).  In that publication issue, Dr. Stephen Faraone, director of child and adolescent psychiatry research at SUNY Upstate Medical University in New York also shared, the risks are relative (not absolute) and that,

“mortality risk is greatly reduced with evidenced-based treatments. For clinicians, early identification and treatment should become the rule rather than the exception.”

2. ADHD is one of the most treatable conditions in all of medicine.

We can DO something about it!

​Treatment of ADHD, is never just about medicine. ‘Treatment’ is medicine, therapy and coaching interventions, tailored to an individual and family. An important part of that work, is properly assessing ALL of the ways that dopamine-seeking behaviours have both worked for AND against us, in our very human drives for survival, acceptance and belonging.Our mammalian brains are adept at homeostasis – seeking to balance our internal systems in an effort to function optimally (for example, when we feel cold, our bodies involuntarily shiver to warm up).

In this quest to right the wrongs, our brains drive our behaviour – in the case of ADHD, toward things that will light up the dopaminergic reward ‘do-it-again’ pathway, (these are broad principles) which reassures us we are with others (safety), we have food (survival), we pursue romantic partners (continuation of the DNA), we experience pleasure (good for mammals).


The problem that unfolds for people who remain undiagnosed and therefore untreated, is brain-driven behaviours can seem like conscious choices to others, while remaining a mystery to the ADHD-brained person. The invisibility of brain function in the moment, lays the groundwork for a lifetime of internalized blame and shame, living at the whim of dopamine-seeking life, which can be rather anxiety inducing, amoung other things. 

It’s like starting each day, with an empty tank of gas in your car, yet being expected to drive the same distance. The wily ADHD brain then will seek to find shortcuts, or route alternatives, but might eventually feel so defeated, never quite knowing why it’s so much harder for them, than it seems to be for others, that they might give up. All the while, no one has questioned the gas tank.

One of the most efficient sources of a dopamine ‘hit’ in our modern Western world, is food. To our prehistoric brains, it represents security, safety and sustained survival.  Often, high caloric food is so readily available in our modern Western culture, providing fast reward in a moment when our dopamine-seeking brains are scanning for the most efficient source in our proximity.  People with ADHD are known for eating in reaction to environmental cues – something external that might alert them that it’s been several hours since they have eaten (its suddenly dark outside and therefore must be dinner time), rather than a habit of regularly spaced, balanced meals throughout the day. 

ADHD & disordered eating

It might come as no surprise then to learn, people with ADHD brains have potentially high overlapping symptoms with disordered eating behaviours, using food as a way to unconsciously deal with boredom, stress and intense feelings. 

Those with ADHD may be particularly likely to forget to eat (inattentive ADHD) and to binge later. 

​They may have trouble planning and shopping ahead (executive function deficits), which can result in spur-of-the-moment and uncontrolled eating (impulse control).


What does recent research tell us? 

​New data is emerging about the prevalence of undiagnosed ADHD within eating disorder patient populations.

  • About 50% of patients with bulimia nervosa (BN) or binge eating disorder (BED) feature symptoms of ADHD, and around 15% of those people also struggle with other impulsive behaviours, including substance use, impulse or compulsive shopping, and multiple sexual relationships/infidelity.
  • Obesity and ADHD share common brain pathways (hypothalamic, executive, and reward centers) with pathophysiology in these areas manifesting in partial or complete expression of these diseases. Sleep dysfunction, loss of control/binge eating disorder and anxiety also all share similar pathways and are associated with this diagnostic combo.
  • Newer research points to an involvement of both the immune and the metabolic systems in the pathophysiology of EDs and highlights the importance of the microbiome.
  • A recent study conducted in eating disorder patients found a third (31.3 %) of patients had possible ADHD. The highest prevalence rates (35-37 %) were in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, followed by Eating Disorder Not Otherwise Specified and Binge Eating Disorder. Anorexia Nervosa patients had the least amount of overlapping symptoms, but still present at 18%.
    1. The most common symptoms associated with ADHD included presence of binge eating, purging and a loss of control over eating.
    2. The study also noted the heritability of BED estimated to range from 41.0 to 57.0%. It should be noted obesity (in the context of a medical definition and study variable), exists in the absence of BED and vice versa, reveals that the genetic and environmental factors which contribute to both pathologies are not exactly the same ones.

  • A high degree of ADHD symptoms may have a negative impact on recovery in ED (ability to consistently stick to recovery maintenance plans for example, requires executive function skills).  Screening/diagnostic evaluation of ADHD in all loss of control over eating/bingeing/purging ED patients and studies of the effect of implementing ADHD-treatment strategies in this patient group are recommended.
Image of a lab and vegetables, depicting food science.

As a registered psychotherapist with a sub-specialty in ADHD, I have the basic training in nutrition and the effect of nutrition, eating and feeding behaviours in mental health, but even I know the nutrition data can be confusing.  While there is much buzz about ‘nutritional psychiatry’ and tweaking diets in ADHD, the data is usually conflicting, contradictory and ultimately, we come back to common sense nutrition basics. 

Recently, I have been delighted to find dietitians and nutritionists who share specialized information about ADHD and eating (unicorns of the nutrition world in my opinion!). MeetJulie Bereczki, who is a clinical Holistic Nutritionist from Vancouver Island, in beautiful British Columbia, Canada.  Julie caught my eye on social media (find her on Instagram tiktok), when I saw she was sharing the real deal for people with ADHD, struggling with overeating, binge-eating or irregular eating.  

​Here is are Julie’s answers to 4 questions I had for her about ADHD and eating.


1. What’s the typical cycle you see in untreated ADHD brains when it comes to managing eating?

Given that I only discovered my ADHD in September of 2020 at age 32, I am going to answer this from my own personal experience versus generalizing for all ADHDers.  When I was undiagnosed, I did a lot of overeating and binge eating, predominantly in the evenings. This makes sense because this is when my executive function was depleted and my desire for dopamine would be highest. What I have learned since my diagnosis is that binge eating and eating disorders are disturbingly common with ADHD. 
 
Eating is a source of dopamine. Especially when the foods consumed are high in sugar, fat, or are highly processed.  Highly processed foods are specifically engineered to impact dopamine because getting people hooked on your product is good for sales obviously.  This is especially troublesome for ADHD brains that seek and crave dopamine more than neurotypical brains. When ADHD is undiagnosed and untreated you are subconsciously seeking out excess dopamine wherever you can find it, making it much more difficult to make the healthier choice.  Willpower really can’t stand up to a dopamine craving.
 
As far as how managing eating goes, it is important to note that staying on top of grocery shopping, meal planning, cooking, etc. can be very challenging for those with ADHD, never mind undiagnosed ADHD, where you don’t understand why you are so bad at keeping up with this responsibility.  This can then lead to feelings of shame and frustration with yourself, followed by emotional eating.

2. What exactly does ‘intuitive eating’ mean for ADHDers?

Intuitive eating is a tricky one for ADHDers.  I believe it can most certainly be achieved, but it will take some dedicated mindfulness practices and meal consistency to teach an ADHDer how to be in tune with themselves.  We tend to be quite scattered, distracted and ungrounded.  This makes it quite challenging to be intuitive with our hunger signals.  And for the many ADHDers using stimulant medication for treatment, they may not experience any hunger all day until their medication has worn off. So intuition around eating is fairly ineffective here.

It is more effective for ADHDers to use external reminders to eat consistently.  Phone reminders/alarms work great for this.  Set a timer for every 3-4 hours to remind yourself to take a break from what you’re doing and eat a snack or meal. A combination of complex carbs, protein, and healthy fats is the most beneficial way to fuel the brain, keep blood sugar stabilized, and stay satiated.  Having snacks/meals prepared in advance that are easy to grab will make it much easier to achieve this.  Energy balls are perfect for this and there are loads of recipes online.  You don’t need any real cooking skills to pull it off, just a blender or food processor!

By fueling the body and brain more consistently it will prevent overeating later due to extreme hunger from not eating enough during the day. It will also better support executive function so that more can be accomplished more easily throughout the day as well. I provide many free recipes and meal plans on my social media accounts to assist with this.

3. How should people bring up concerns about eating to their doctors or therapists? 

I think it’s imperative that more awareness is created around the many ways in which ADHD impacts dietary choices.  Unfortunately, this may mean having to inform your doctor and therapist about why you are struggling with eating so that they don’t continue to give advice that isn’t effective for your struggles. Medication can be a useful tool here, and that may be part of the discussion as to why you would like to try medication.  For me, it was being medicated that made me feel in control of my eating habits.  It is important to note that stimulant medication can greatly suppress appetite and the strategy for setting alarms to eat is highly beneficial to avoid undereating as well.

4. What do you know now that you wish you knew much earlier?

I wish I would have had more knowledge about ADHD in general! I probably wouldn’t have made it to my 30’s not even considering the possibility that ADHD may be part of my story. I feel hopeful that this is changing. The amount of awareness around ADHD happening on social media channels is very promising. The more people that get proper support, earlier in their lives, the better.  When you know better, you can do better. Ideally, avoiding years of unnecessary shame and self-doubt. I plan to be a part of the awareness movement!

I’m happy to have Julie’s perspective as someone who knows what it’s like from the inside out! Check her out on her social media channels (linked above) to get some of her great tips (on both platforms @adhd.health.hacks). 


I do want to provide 2 last opinions, based both on available research (linked throughout this article) and my clinical experience:1. When you are looking for a professional to get advice or support from, its reallyreally important to look for, or ask about, the training that person has specifically in ADHD. There perhaps is no more misunderstood area of health than ADHD, and a general credential is a necessary minimum, but certainly not sufficient.

2. On the role of stimulant medication in ADHD as it relates to eating.  The purpose of stimulant medication in ADHD is to take an incredibly effective medicine that increases executive function skills, and manages difficult symptoms. In the absence of medication, humans ‘self-medicate’, sometimes in adaptive healthy ways, but more often in maladaptive and ultimately, unhealthy ways. 

​When it comes to over-eating, stimulants help people avoid the temptation to regulate their dopamine levels with food. By boosting the brain’s access & use of dopamine and norepinephrine, stimulants help individuals with ADHD become better at observing and regulating their behaviors and avoid impulsive eating.  Stimulants also make it easier for people with ADHD to follow through with their eating and exercise plans — to be consistent. 

I have seen blogs or social media posts filled with harmful misinformation positioning the use of a prescription stimulant as a manipulation from a ‘fat/obesity-shaming’ medical/pharma community … I can tell you from the hundreds of people with ADHD I have personally supported, nothing could be further from the truth.

Always be wary of extremes, correlations without causation claims and stuff that just intuitively doesn’t make sense.


INTERESTED IN MORE EDUCATION?

​Check out episode 10 from The Christina Crowe Podcast, featuring Registered Psychotherapist and Dietitian Josée Sovinsky.


RESOURCES

At Dig A Little Deeper, we’ve posted some reputable and evidenced-based articles on our ADHD Resource Page in a new subsection, ADHD and eating.

Start with ADHD Coaching article #1:
Christina’s Pro Tips: Mastering your beautiful brain.

Another evidenced-based resource is the Dietitians of Canada site and directory.


If you prefer talking to a human to help find the right therapist for you,Call 

905-584-8963,or email 

admin@digalittledeeper.ca
You can expect a reply within 24-48 hours, Mon-Fri, during regular business hours.


REFERENCES

Agüera, Z., et al. (2020). A review of binge eating disorder and obesity. Neuropsychiatrie 10.1007/s40211-020-00346-w. https://doi.org/10.1007/s40211-020-00346-w
Bull-Larsen, S., & Mohajeri, M. H. (2019). The Potential Influence of the Bacterial Microbiome on the Development and Progression of ADHD. Nutrients11(11), 2805. https://doi.org/10.3390/nu11112805.

Fliers, Ellen A. et al. “ADHD Is a Risk Factor for Overweight and Obesity in Children.” Journal of Developmental and Behavioral Pediatrics, vol. 34, no. 8, 2013. 10.1097/ DBP.0b013e3182a50a67.

Goodman, D. (Feb 24, 2021). The Science Behind Diagnosing and Treating ADHD in Older Adults [podcast episode]. ADHD Experts Podcast. https://podcasts.apple.com/ca/podcast/adhd-experts-podcast/id668174671?i=1000510453562

Heilskov Rytter, M. J., et al., (2015). Diet in the treatment of ADHD in children – a systematic review of the literature. Nordic journal of psychiatry69(1), 1–18. https://doi.org/10.3109/08039488.2014.921933

Svedlund NE, et al. Treatment of eating disorders with concurrent ADHD symptoms: knowledge, knowledge gaps and clinical implications. Lakartidningen. 2019 Sep 17; Swedish. PMID: 31529419.

Svedlund, N. E., Norring, C., Ginsberg, Y., & von Hausswolff-Juhlin, Y. (2018). Are treatment results for eating disorders affected by ADHD symptoms? A one-year follow-up of adult females. European eating disorders review: the journal of the Eating Disorders Association26(4), 337–345. https://doi.org/10.1002/erv.2598

Himmerich H, Treasure J. Psychopharmacological advances in eating disorders. Expert Rev Clin Pharmacol. 2018 Jan;11(1):95-108. doi: 10.1080/17512433.2018.1383895. Epub 2017 Oct 5. PMID: 28933969.

Svedlund NE, Norring C, Ginsberg Y, von Hausswolff-Juhlin Y. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients. BMC Psychiatry. 2017 Jan 17;17(1):19. doi: 10.1186/s12888-016-1093-1. PMID: 28095885; PMCID: PMC5240294.

Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet. 2020 Mar 14;395(10227):899-911. doi: 10.1016/S0140-6736(20)30059-3. PMID: 32171414.

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Picture of ​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

Registered Psychotherapist, Validated Clinical Supervisor, ADHD Therapist & Coach Podcast Host The Christina Crowe Podcast Christina is a Canadian Registered Psychotherapist, a member of CADDRA's Advocacy Committee and relentless mental health advocate. Christina believes great mental health information should be available to everyone, loves creating content that makes invisible things VISIBLE and finding new ways to bring healing experiences to as many people as possible.

2 thoughts on ““That’s because of ADHD too?!”  The links between ADHD and disordered eating, explained.”

  1. What a wonderful post, you have put quite a lot of effort into this one, I can tell. Love everything about this, great post. Hope to see more such posts from you soon.

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