Running Head: CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS

Can a Paleolithic Diet Reduce Symptoms in Attention Deficit Hyperactivity Disorder? A Grant Proposal Lindsay Allwood, Jamie Husain, and Brian Umali University of California, Merced

Authors Note This paper was prepared for Writing 101, Section 3, taught by Professor Moberly.

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

Introduction In the modern day supermarket, shelves are lined with processed and packaged foods. There is a small section dedicated to fresh produce, though, most of this fresh-produce is actually a week old and decreasing in nutritional value. The typical grocery cart fills up with too much processed foods and not enough fresh produce. Processed foods are products made to look and taste better. The long shelf life and convenience of processed food is attractive to the average supermarket customer. Our bodies are programmed to seek calorie sources from fats and sugars for survival (Abbott, 1997). We have an abundance of food to suffice these needs, but all the wrong kinds. The Standard American Diet (SAD) has become problematic because the foods going into our bodies lack vital nutrients necessary and leads to a decline in cognitive health (Grotto & Zied, 2010). The SAD could be the cause for the explosion of ADHD, Autism, Depression, and many other ailments of the 21st century. By reverting to the diet consumed by people for the majority of evolutionary history, could we reverse the effects of the SAD? Thomas Edison said the doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease and Hippocrates said Let thy food be thy medicine. We propose an experiment that will explore how consuming a Paleolithic diet, which is the most robust health-promoting dietary regimen (Lindeberg et al., 2003) can improve the symptoms of ADHD. Throughout this proposal we will discuss current research within the field, how our research can add to it, and our plans for our experiment.

Literature Review There has been considerable research published showing the effects of ADHD medication; however, there is little research about ADHD in adults and how diet can help improve ADHD symptoms. Our proposed research will fill this gap in the literature. In our literature review, we will discuss what ADHD is, the current treatments used, the side-effects of these treatments, how diet affects the brain, and the benefits of the Paleolithic diet. Overview of ADHD Attention Deficit Hyperactivity Disorder, otherwise known as ADHD, is the most common neurobiological disorder among children, but also is common in adulthood. ADHD continues into adulthood for an estimated two-thirds of the children who suffered from it and about 4.5% of adults meet the criteria for ADHD (Advokat et al., 2008). The DSM-V characterizes ADHD as a pattern of behavior, presented in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings which symptoms include failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an inability to remain seated in appropriate situations. ADHD is problematic among adults because it decreases educational achievement, socioeconomic status, and occupational status (Advokat et al., 2008). Also, people with ADHD are at an increased risk for developing anti-social disorders and drug abuse (Mannuzza et al., 1997). College students that are managing their ADHD symptoms can find it exceptionally difficult because it is the first time they are on their own. There is no cure for ADHD, though there are treatment methods for people managing their symptoms. The most common treatment method is prescription medications, though diverse side-effects often follow.

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

Current Treatment Methods and Side Effects Prescription medications are the most common treatment method for ADHD, though unfortunately varying side-effects often follow. Current evidence shows using immediate-release Methylphenidate (MPH) as a first-line treatment is the most effective treatment method for adults with ADHD (Peterson et al., 2008). Dexamphetamine ( DEX) is another medication used to treat ADHD. The side-effects of MPH and DEX, which are stimulants, include insomnia, appetite suppression, irritability, proneness to crying, anxiousness, sadness/unhappiness, and nightmares (Efron et al., 1997). Other research shows that MPH and other stimulants also cause jitteriness, abdominal pain, and anorexia, and in rare cases Paranoia and psychosis can result from the ADHD medication (Hall et al., 2005). There are also many ADHD medications which are selective serotonin reuptake inhibitors, or SSRIs. These types of medications have sideeffects that include mild nausea, headaches, odd dreams, sleep disturbance, decreased libido, and delayed orgasm, and more seriously anxiety, agitation, and increased obsessive thinking about suicide (Hall et al., 2005). Are these side-effects worth it to decrease symptoms in ADHD sufferers? Many ADHD sufferers decide to handle their symptoms on their own rather than experience these unpleasant side-effects, though research is pointing towards diet as an alternative method to beat these symptoms. How Diet Affects the Brain Research shows that diet affects the brain in various ways. One study shows that healthy children perform better on tests than overweight children (Datar et al., 2004). It can be indicated that overweight children consume a less nutritional balanced diet than non-overweight children. Another study looked at the effects of breakfast on childrens cognition. The children were given various performance tests including addition, multiplication, grammatical reasoning, number checking, vocabulary, and creativity. They also gave endurance tests to the children. This study showed that the amount of energy intake at breakfast correlated with childrens cognitive functioning and academic performance (Wyon et al., 1997). These studies show the importance of nutrition on the brains cognitive functioning. Another study showed that the eliminations of trigger foods in children with ADHD, such as sugar and additives, caused them to not be considered to have ADHD anymore based on the DSM-IV-criteria (Toorman et al., 2009). There is an abundance of research that shows the effects of diet on the brain and on ADHD symptoms. While this research is mostly focused on children, our research will target college students. The Paleolithic Diet The typical diet of industrialized western societies is known as the Standard American Diet (SAD). The SAD has undergone considerable changes since in the 1950s by making calorie-dense and nutrient-poor food and beverages more readily available (Grotto & Zied, 2010). Although the SAD has undergone recent chance with the newly mass marketed processed food, the western diet is rooted in the agricultural revolution. Roughly 3,000 years ago when agriculture became widely adopted the health of many Europeans began to plummet (Gibbons, 2009). These changes were seen as revolutions, but the long-term consequences were not foreseen. The typical diet of industrialized western societies can contribute to the decline in cognitive function (Grotto & Zied, 2010). It has been suggested that a diet eaten by humans

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

during the Paleolithic Era starting 10,000 years ago could reverse the negative effects of the SAD by providing the necessary nutrients for optimal functioning. This is known as the Paleolithic diet. The Paleolithic diet is a modern dietary regimen based on foods presumably eaten regularly during the Paleolithic era, which includes lean meat, fish, shellfish, fruits, vegetables, roots, eggs and nuts, but not grains, dairy products, salt or refined fats and sugar (Jnsson et al., 2009). The Paleolithic diet is rich in polyunsaturated fatty acids (PUFAs), which have been shown to reduce ADHD symptoms (Sinn & Bryan, 2007). Freshly caught fish and grass fed beef is commonly eaten in the Paleolithic diet. Research shows that wild game has over five times more PUFAs per gram than domestic livestock (Crawford 1968). Strong evidence supports PUFAs reduce ADHD symptoms, which are plentiful within the Paleolithic diet. Our research plans to directly examine how well the Paleolithic diet can help reduce ADHD symptoms, which has not yet been researched. Changes in our diets have had detrimental effects. ADHD is on the rise, in which there is no cure. Medications can help manage symptoms, though there are often side-effects. Many people with ADHD have decided to opt out of medical treatment. Research has strongly pointed to the Paleolithic diet having benefits to people with ADHD. Though, research has focused little on ADHD in adults and mostly on children. Also, there is little discussion of diet as a treatment method for ADHD in current research. Our project proposal fills these gaps by studying how diet can be used as a healthier and natural alternative to help manage ADHD symptoms among college students.

Project Plan Project Overview In this experiment, we plan to utilize the benefits of the Paleolithic diet in the treatment of ADHD symptoms among college students. Medications that are used to treat ADHD are usually accompanied by a long list of harmful side-effects. It is our goal to discover a healthier, more natural treatment method that is just as effective as medication, but without the harmful side-effects. We will be discussing how we plan to recruit participants, our plans for executing the study, estimated costs, limitations of the study, and a projected timeline of the entire study.

Methodology Participants We plan to recruit a minimum of 200 college students from the Merced area who have been diagnosed with ADHD and who have opted out of medical treatment. Our participants will be recruited from the University of California, Merced, Merced College, and California State University, Stanislaus. Our participants will be between 18 and 23 years of age, which is the average age of undergraduate college students. We chose to use college students as our population because we would not need parental consent and they are easily accessible to contact for our research. To recruit our participants we will send out an email to the entire student

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

population. This email will include a brief overview of the study and a link to our experiment website. Using email to recruit participants will allow for more confidentiality to those students who feel embarrassed, than other common recruiting techniques would allow for. Also, to appeal to the college population, each participant who completes the study will receive a hundred dollar incentive. An incentive will motivate participants to continue the study. Participants, though, could opt out of the experiment at any time, for any reason. Also, more males are reported to be sufferers of ADHD, though we expect to include an equal number of female and male participants. Materials If a person is interested in our study, they will be guided to our experiment website. This website will be where we communicate with our participants. On this website a description will be included of the purpose of this study. We will not tell participants any details about the experiment because it could cause bias. If participants are further interested after reading the studys purpose, they can take a short initial survey of 10 questions, which can be seen in Appendix A. This surveys purpose is to gather basic information about the participant such as age, gender, and ethnicity. It also asks the participant if they have been diagnosed with ADHD, if they are on medications, and if they have been on medications before. For our study, we want people who have been diagnosed with ADHD and who have opted out medications. In addition, the survey asks the person if they have any other disorders, such as depression or anxiety. Having co-occurring disorder could skew our data. The survey will also ask how willing the participants are to follow a strict diet and keep a food journal. Lastly, contact information will be asked. This survey will also help weed out the people trying to participant in the study for the wrong reasons, because they will not know how to correctly answer questions. By reviewing these surveys we can select our participants that meet our criteria. Procedures We plan to use the Connors Adult Rating Scale (CAARS), a scale used to assess and diagnose ADHD in people 18 and over. We picked this scale because current literature suggests use of the CAARS and the majority of researchers using this scale. Refer to Appendix B for more details. It serves as a scale to identify the presence and severity of ADHD. The CAARS measures inattention, memory problems, hyperactivity, impulsivity, emotional lability, and problems with self-concept (Connors et al., 1999). It also measures symptoms based on the DSM-IV such as inattentive symptoms, hyperactive-impulsive symptoms, and total ADHD symptoms (Connors et al., 1999). We choose this scale because it is only 10 to 30 minutes in length. It is important not to give an assessment that is too lengthy to an individual already struggling with paying attention. To start our experiment, we plan to administer the CAARS to each participant in order to establish a baseline measurement for the severity and presence of ADHD. If the results from a participant do not show the presence of symptoms of ADHD, they will be disregard from our research. Following the study, each participant will be administered the CAARS test again. Both CAARS will be taken by participants on our website. Comparing the results of the test will show how the different variables impacted the participants ADHD symptoms.

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

Groups: Following the first CAARS assessment, we would then begin the main procedure of our study. The 200 test participants would be assigned to one of the four groups: Paleolithic diet and food journaling (PDFJ), Paleolithic diet with modified food journaling (PD), food journaling without the Paleolithic diet (FJ), and the control group that will only be exposed to the modified food journaling and not exposed to the Paleolithic diet (CTRL). Our 200 participants will be randomly assigned to one of four groups, with 50 people in each. The organization of the groups within the study is illustrated below Table 1. A larger sample size of 200 participants creates a buffer against the possibility that participants will drop out of the study. Having a larger sample size reduces the number of outliers, which will generate more accurate results. Table 1. Group PDFJ (50 people) Group PD (50 people) Group FJ (50 people) Group CTRL (50 people) Paleolithic Diet The Paleolithic diet is a modern diet in which only foods and resources that were available during the Paleolithic era are eaten. This diet fulfills the adequate omega 3 fatty acid intake that is necessary for ADHD college students. We will be using a local Paleolithic food service delivery, Kettlebell Kitchen, to provide fresh cooked meals to the PDFJ and PD groups. Each participant will be able to communicate with the food delivery service and choose what they want to eat for each meal. On our experiment website, our PDFJ and PD groups will be able to access the Kettlebell Kitchens website and view the multiple food options they can choose from. There are 24 different meals, along with a customized list in which the participants can customized their preferred foods. Along with full meals, there are also snacks, sides, and desserts. Some of the options can be viewed in the Appendix C. The PDFJ and PD groups are discouraged to eat foods that are not within the Paleolithic diet. It is important it give the participants freedom to choose their own meals because it will allow our participants to feel more comfortable and feel as if they are making their own decisions. We choose to have food delivered to our participants in the PDFJ and PD groups because it is difficult to ask a college student to completely change their diet because it is expensive, time consuming, and a huge commitment. Our participants would be more likely to adhere to the diet and not opt out if the meals were delivered to their homes. Detailed Food Journaling: In our study, participants in the PDFJ and FJ group will be doing detailed food journaling for four weeks. We have compiled a food journaling template for these groups. On our website, participants are to fill out one food journal template at the end of each day. The template asks the Paleolithic Diet Paleolithic Diet No Change in Diet No Change in Diet Detailed Food Journaling Modified Food Journaling Detailed Food Journaling Modified Food Journaling

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

participants to fill in a table of all foods and beverages consumed, what time, how much, and their mood and energy before and after. Also, there is an area for participants to check off how many glasses of water they drank. The food journal will ask the participants their overall mood during the day, which includes a list of options. Also, the food journal asks how their symptoms were and which behaviors required their attention that day. What times, situations, and moods that are likely to cause cravings and what types of food are they most likely to crave is also asked. This detailed food journaling template can be seen in Appendix D. Since people who suffer from ADHD struggle with staying focused, giving them a writing template will hopefully guide them in their writing and allow them to organize their thoughts more efficiently. All these questions are asked to help the participants identify their own individual patterns in their diet along with their symptoms. The detailed food journals can also be further analyzed to perhaps discover connections between foods to symptoms and moods, which can prompt further research. The detailed food journals will be used as a way to measure if the participants self-assessment of their symptoms is consistent with their score on the CAARS. Modified Food Journaling The PD and CTRL groups in our study will participate in modified food journaling for four weeks. This modified food journal will have participants only list what foods and beverages they consumed, which will be done once a day on our experimenter website. The detailed food journals and the modified food journals will measure what the participants are consuming each day, and if they are adhering to the Paleolithic diet in the PDFJ and PD groups. Research shows that writing down everything you consumed in a food journal maximizes memory and helps bring forth attention to meals (Krall & Dwyer, 1987) in people without ADHD. People with ADHD have memory and attention difficulties, so perhaps any form of food journaling can be beneficial to college students with ADHD. Further research would need to be conducted if results were found to be significant. Costs To administer the CAARS test each of the 200 participants twice, we will need to purchase 8 kits which include 25 manuals and scoring forms, which will cost 379.00 dollars.1 This total comes out to be $3,032. After calculating the costs of Kettlebell Kitchens food preparation and delivery, the total comes out to $83,935.00. It is possible that the costs of meals delivered would be less than our estimated about, but it is important we have the funds to cover all the costs in case our participants all chose the costly options. Our inducement is $100 for each of the 200 participants. This comes out to a total of $20,000.00. Below in Table 2 all of these costs can be seen.

These CAARS prices are calculated based on the website, Pearson Assessments, which is where we plan to purchase the tests.

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

Table 2. Product Connors Adult Rating Scale Food Delivery Inducement Amount 400 tests 100 participants 200 participants $100 Costs $3,032 $83,935.00 $20,000.00 Total Cost: $106,967.00
Note. These costs do not include participants who opt out of the experiment before it is over.

Limitations Focusing on participants within a small area can be seen as a limitation, but it would be difficult, costly, and timely to expand our participant focus. If the results of our study are significant, further research could be performed. The CAARS is created based on symptoms listed in the DSM-IV, which can be seen as another limitation to our study because there is a newer version, the DSM-V. The DSM-V criteria has not changed from the DSM-IV, only examples have been added to illustrate behavior, therefore this will not have an effect on the results of the study. Another limitation is there is no way to control if the participants within the PD and PDFJ groups eat foods outside of the diet. By giving these participants various customizable choices, which will be delivered to them, the probability of them eating foods outside the diet will be minimized. The food journals, for both groups, serves to collect data of what the participants ate and if they followed the Paleolithic diet regime. Within the food journals and the CAARS there is no way to control honesty, but comparing the two to one another should be a good indicator of a discrepancy. Timeline We will send out an email to the three schools on January 1, 2014, which will include a link to our experiment website. On the website, the purpose of our study will be explained. If they are interested, they will be directed to an initial survey on our website. Two weeks later, on January 14th, 2014, we will go through the surveys and select the people, and randomly assign each of the participants to one of the four groups. On January 21, 2014, we will send each of the four groups a detailed email explaining the next steps of the study. Participants will be unaware of the other groups. We will give the participants an additional week to ask any questions they may have pertaining to the study before we begin. Each participant will have two days to take the CAARS, which will be located on our experiment website. Two days will allow sufficient time for participants to complete the assessment. Between February 1, 2014 and February 28, 2014 we will be conducting our experiment. We chose this month because there are no major holidays such as Thanksgiving, Christmas, or Easter. Avoiding anything that can tempt the participants into consuming non-Paleolithic foods or beverages is best. Valentines Day falls in the month of February, but the food service delivery can provide celebratory desserts to satisfy participants. Also, the month of February does not include any large breaks, such as, Thanksgiving, Winter,

CAN A PALEOLITHIC DIET REDUCE ADHD SYMPTOMS?

Spring, or Summer break. Similarly, it would be difficult to stay with a strict diet while on a break. Following the study, we will administer the second CAARS to each of the participants. Participants will be given two days, March 1, 2014 and March 2, 2014 to complete the assessment. The rest of March will allow us time to analyze our data. Below, Table 3 shows an outline of our projected timeline. Table 3. January 1, 2014 January 14, 2014 Email participants Participants take initial survey Select people who meet criteria Randomly select participants to 1 of 4 groups Email each of the 4 groups explaining the studys next step Allow time for questions Administer the first CAARS to each participant online Administer the different controls to the groups (Paleolithic diet and food journaling) Administer the second CAARS to each participant online Analyze the data

January 21, 2014 January 30, 2014 - January 2014 February 1, 2014 - February 28, 2014 March 1, 2014 - March 2, 2014 March 2, 2014 - March 31, 2014

Conclusion The undergoing changes of the SAD have decreased the health of people; consequently, ADHD has been on the rise. Currently, the use of stimulant medications is the most effective treatment method helping adults manage their symptoms. Due to the many unpleasant sideeffects associated with these medications, many people have opted out of medical treatment. Many college students are suffering from their symptoms and struggle with managing them, which interferes with their success in school. Our research can help these college students by offering a healthier alternative treatment for treating ADHD symptoms with the Paleolithic diet. Seeking a safer, healthier alternative could provide a better life for these students, allowing them to achieve their full potential in school and elsewhere. Further on, a new insight could be generated regarding the association between diet and behavioral disorders. Your contribution can help benefit ADHD sufferers, and make new discoveries. Thank you for taking the time to read our proposal; we look forward to potentially working with you. Contact Information Lindsay Allwood, Jamie Husain, Brian Umali 5200 N. Lake Rd, Merced, CA 95340 USA

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Phone: (408) 429-4742 Email: paleofightsadhd@ucmerced.edu

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References Abbott, M. (1997). Taste: the neglected nutritional factor. Journal of the American Dietetic Association, 97(10), S205-S207. Advokat, C. D., Guidry, D., & Martino, L. (2008). Licit and illicit use of medications for attention-deficit hyperactivity disorder in undergraduate college students. Journal of American College Health, 56(6), 601-606. Conners, C. K., Erhardt, D., & Sparrow, E. (1999). Conners' Adult ADHD Rating Scales: (CAARS). Toronto: MHS. Datar, A., Sturm, R., & Magnabosco, J. L. (2004). Childhood Overweight and Academic Performance: National Study of Kindergartners and FirstGraders. Obesity research, 12(1), 58-68. Efron, D., Jarman, F., & Barker, M. (1997). Side effects of methylphenidate dexamphetamine in children with attention deficit hyperactivity disorder: a double-blind, crossover trial. Pediatrics, 100(4), 662-666. Gibbons, A. (2009). Civilization's Cost: The Decline and Fall of Human Health.Science, 324(5927), 588-588. Grotto, D., & Zied, E. (2010). The standard American diet and its relationship to the health status of Americans. Nutrition in Clinical Practice, 25(6), 603-612. Hall, K. M., Irwin, M. M., Bowman, K. A., Frankenberger, W., & Jewett, D. C. (2005). Illicit use of prescribed stimulant medication among college students. Journal of American College Health, 53(4), 167-174. Jnsson, T., Granfeldt, Y., Ahrn, B., Branell, U. C., Plsson, G., Hansson, A., ... & Lindeberg, S. (2009). Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol, 8(35), 1-14.

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Krall, E. A., & Dwyer, J. T. (1987). Validity of a food frequency questionaire and a food diary in a short-term recall situations. Journal of the American Dietetic Association, 73(2). Lindeberg, S., Cordain, L., & Eaton, S. B. (2003). Biological and clinical potential of a palaeolithic diet. Journal of Nutritional and Environmental Medicine, 13(3), 149-160. Mannuzza S, Klein R G, Bessler A, Malloy P, Hynes M E (1997) Am Acad Child Adolesc Psychiatry 36: 12221227. Peterson, K., McDonagh, M. S., & Fu, R. (2008). Comparative benefits and harms of competing medications for adults with attention-deficit hyperactivity disorder: a systematic review and indirect comparison meta-analysis.Psychopharmacology, 197(1), 1-11. Sinn, N., & Bryan, J. (2007). Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental & Behavioral Pediatrics, 28(2), 82-91. Toorman, J., Pereira, R. R., & Buitelaar, J. K. (2009). A randomised controlled trial into the effects of food on ADHD. European child & adolescent psychiatry, 18(1), 12-19. Wyon, D. P., Abrahamsson, L., Jrtelius, M., & Fletcher, R. J. (1997). An experimental study of the effects of energy intake at breakfast on the test performance of 10-year-old children in school. International journal of food sciences and nutrition, 48(1), 5-12.

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Appendix A Initial Survey

1. What is your gender? Male Female Which of the following best represents your ethnicity? (check all that apply) Non-Hispanic White or Euro-American Black, Afro-Caribbean, or African American Latino or Hispanic American East Asian or Asian American South Asian or Indian American Middle Eastern or Arab American Native American or Alaskan Native Other How old are you? _______ Have you been diagnosed with ADHD? Yes No Are you currently on medications to help reduce your ADHD symptoms? Yes No Have you been on medications before? Yes No Do you have any other disorders? (ex. anxiety, depression) Yes No Would you be willing to follow a strict diet regime? Yes No Unsure Would you be willing to keep a food journal? Yes No

2.

3. 4.

5.

6.

7.

8.

9.

10. What is your contact information? (all your personal information will be kept confidential) Email: Phone Number: Address:

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Appendix B Alternative Measures of ADHD Symptoms Table B1 Overview of suggested scales found in literature reviews. Researcher Kooji et al., 2008 Retz et al., 2006 Scales suggested for use in literature reviews Brown Attention-Deficit Disorder Scale Conners Adult ADHD Rating Scale Wender-Reimherr Interview (WRAADDS) Conners Adult ADHD Diagnostic Interview for DSM-IV CAADID Adult Interview Brown ADD Scale Diagnostic Form Brown ADD-DF Adult ADHD Investigator Symptom Rating Scale (AAISRS) The Conners' Adult ADHD Rating Scale Brown Attention-Deficit Disorder Scale Wender Utah Rating Scale ADHD Rating Scale and ADHD Rating Scale-IV The Current Symptoms Scale Adult ADHD Self-Report Scale-v 1.1 Symptom Checklist

Murphy & Adler 2004.

Table B2 Overview of scales used in recently published ADHD studies. Researcher Scales used in published studies

Johnson et al., 2009 Sinn & Bryan 2007 Richardson & Montgomery 2005 Richardson & Puri 2002 Michelson et al., 2003

Investigator-rated ADHD Rating ScaleIV and Clinical Global Impression (CGI) Conners Teacher Rating Scale Conners Teacher Rating Scale Conners' Parent Rating Scale Conners Adult ADHD Rating Scale

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Appendix C Samples of the Paleolithic Menu

Figure C1 Various meals offered from Kettlebell Kitchen.

Figure C2 A detailed meal that includes ingredients and nutrition facts

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Appendix D

Food Journal
Name: ______________________ Sun Mon Date: _____________ Tues Wed Thurs Fri Sat

Check # of 8 once glasses of water:

Time

Place

Food/Beverage

How much?

Mood/Energy Before

Mood/Energy After

Whats your mood today?: angry, sad, overwhelmed, happy, anxious, exhausted, lonely, jealous, bored, hopeful, thrilled, excited, relaxed, chipper, mad, frustrated, confused, energetic Your Day: (Times/situations/moods likely to cause cravings, types of food most likely to crave, etc.) ______________________________________________________________________________ ______________________________________________________________________________ Behaviors that require your attention: ______________________________________________________________________________ ______________________________________________________________________________ How are your symptoms today?: ______________________________________________________________________________ ______________________________________________________________________________