What nutrients should be supplemented during Adderall (amphetamine and dextroamphetamine) and Vyvanse (lisdexamfetamine) use?

Nutrient Supplementation for Adderall and Vyvanse Use

For individuals taking Adderall (amphetamine-dextroamphetamine) or Vyvanse (lisdexamfetamine), a daily multivitamin-mineral supplement containing zinc, B vitamins (especially B12), iron, and magnesium is recommended to address potential nutrient deficiencies caused by these medications.

Key Nutrient Recommendations

Primary Supplements

1. Zinc

   • Best evidence among all supplements for ADHD symptoms 1
   • Recommended dosage: 15 mg daily
   • Two positive randomized controlled trials support its use 1

2. B Vitamins

   • Particularly B12: 250-350 μg daily or 1000 μg weekly (sublingual) 2
   • Thiamin should be included in the multivitamin supplement 2

3. Iron

   • 45-60 mg elemental iron daily 2
   • Particularly important as stimulants may affect appetite and dietary iron intake

4. Protein

   • 60-80 g/day or 1.1-1.5 g/kg of ideal body weight 2
   • High-quality protein sources rich in leucine (eggs, meat, lentils, soy products)
   • Whey protein supplements may be beneficial if dietary intake is insufficient 2

Secondary Supplements (Mixed Evidence)

1. Omega-3 Fatty Acids

   • Mixed evidence for ADHD symptoms 1, 3
   • May support brain function but not recommended specifically for cognitive improvement 2

2. Magnesium

   • Limited evidence but may help with medication side effects 1
   • Often included in comprehensive multivitamin formulations

3. Vitamin D

   • 3000 IU daily (cholecalciferol) 2
   • Important for overall health, though specific ADHD benefits are not well-established

Mechanism of Action and Rationale

Stimulant medications like Adderall and Vyvanse work by blocking the reuptake of norepinephrine and dopamine, increasing their release into the extraneuronal space 4. This mechanism can affect:

1. Appetite suppression: Leading to reduced nutrient intake 5
2. Increased metabolic rate: Potentially increasing nutrient requirements
3. Altered neurotransmitter function: Requiring specific nutrient cofactors

Long-term use of prescription medications can induce subclinical and clinically relevant micronutrient deficiencies that develop gradually over months or years 6. Stimulants may particularly affect nutritional status through:

• Reduced food intake
• Changes in gastrointestinal function
• Altered metabolism of certain nutrients

Practical Supplementation Approach

Daily Regimen

1. Morning (with breakfast):

   • Multivitamin-mineral supplement containing zinc, B vitamins, and other essential nutrients
   • Protein-rich breakfast to support neurotransmitter production

2. Afternoon/Evening:

   • Additional protein source if daily requirements not met
   • Calcium citrate: 600 mg daily (if dietary intake is insufficient) 2

3. Before bed:

   • Magnesium supplement (if not included in multivitamin)
   • Omega-3 supplement (if using)

Dietary Recommendations

• Prioritize protein-rich foods: Eggs, lean meats, fish, legumes, dairy
• Include complex carbohydrates: Whole grains, vegetables, fruits
• Avoid simple sugars: May exacerbate medication side effects 2
• Stay well-hydrated: Stimulants can cause dry mouth and increased fluid needs

Monitoring and Adjustments

• Monitor for signs of nutrient deficiencies: fatigue, poor concentration, hair loss, etc.
• Adjust supplementation based on dietary intake and medication dosage
• Consider periodic blood tests to check levels of key nutrients (iron, vitamin D, B12)

Important Cautions

• Avoid mega-doses of supplements, which can have toxic effects 2
• Supplements should complement, not replace, a balanced diet 5
• Herbal supplements like Ma Huang/ephedra, St. John's wort, and yohimbine should be avoided due to potential interactions with stimulant medications 5
• No evidence supports the use of St. John's wort, tyrosine, or phenylalanine for ADHD symptoms 1

By addressing potential nutrient deficiencies through targeted supplementation, individuals taking Adderall or Vyvanse may experience improved medication efficacy and reduced side effects, ultimately supporting better management of ADHD symptoms and overall health.