Tics are sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations that involve discrete muscle groups. Common motor tics include eye blinking, shoulder shrugging, head jerking, mouth movements, or foot tapping. Common vocal tics include throat clearing, sniffing, grunting, or repeating words or phrases. Tics can range from being relatively mild to quite severe and debilitating.
Tics are the defining symptom of a group of childhood-onset neurodevelopmental disorders collectively known as tic disorders. The most common tic disorder is Tourette syndrome, which is characterized by multiple motor tics and at least one vocal tic over the period of more than one year. Other tic disorders include persistent (chronic) motor or vocal tic disorder, which involve either motor tics or vocal tics but not both.
The exact causes of tic disorders are not fully understood. However, it is believed that abnormalities in certain brain regions and chemical imbalances in the brain involving the neurotransmitters dopamine and serotonin play a role. There are also likely genetic factors, as tic disorders tend to run in families.
The symptoms of tic disorders tend to worsen during periods of stress or excitement. Certain environmental factors can trigger or exacerbate tics, and things like fatigue, illness, emotions, and anxiety are known to increase tics. This has led to interest in whether diet and nutrition could potentially have an impact on tics as well. Could dietary changes help manage tic severity and frequency? Let’s explore what the current research says.
Can diet affect tics?
So far, there is limited research investigating how nutrition and diet may influence tic disorders. Most studies have focused specifically on how diet affects Tourette syndrome. Here is a summary of what the research has found so far:
– **Elimination diets** – Some small studies have looked at the effect of elimination diets, such as gluten-free or dairy-free diets, on tic symptoms. The results have been mixed, with some people showing improvements in tics but others showing no change. Larger, more rigorous studies are still needed.
– **Omega-3 fatty acids** – Omega-3s are healthy fats that have anti-inflammatory effects in the body. A few small studies have suggested supplemental omega-3s may help reduce tics, while omega-6 fatty acids may worsen tics. More research is needed to confirm this.
– **Iron** – There is some emerging evidence that low iron levels may exacerbate tics. One study found iron supplementation improved tics in children with low iron. More research is underway.
– **Eating trigger foods** – For some individuals with Tourette’s, certain foods seem to trigger their tics to temporarily worsen. Common trigger foods include caffeine, sugar, artificial colorings/preservatives, and MSG. Avoiding trigger foods may help reduce tics.
– **Ketogenic diet** – The high-fat, low-carb ketogenic diet has been studied in a few small trials for Tourette’s. Some promise has been shown in reducing tic severity, but larger controlled studies are needed.
– **Probiotics and gut health** – There is speculation that probiotics and improving gut health may impact brain functioning in ways that could potentially improve tics, but no quality research yet.
So in summary, while preliminary research provides some clues, there is not yet enough evidence to make conclusive recommendations about specific diets, supplements, or nutritional approaches to manage tic disorders. The relationship between diet and tics needs much more high-quality research.
Nutritional considerations for people with tic disorders
Although definitive dietary recommendations cannot be made yet, there are some general healthy eating principles to keep in mind if you or a loved one has a tic disorder:
– **Avoid trigger foods** – Keeping a food journal can help identify specific foods that seem to worsen tics for that individual. Avoiding those trigger foods may help.
– **Limit caffeine** – Caffeine seems to exacerbate tics for many people. Limiting coffee, tea, soda, chocolate and other caffeinated foods may be beneficial.
– **Get enough iron** – Iron deficiency appears to be common in those with chronic tic disorders. Eating iron-rich foods may help; talk to your doctor about testing iron levels. Good dietary sources of iron include red meat, poultry, eggs, spinach and iron-fortified cereal.
– **Try a vitamin B12 supplement** – Vitamin B12 deficiency has also been associated with worsening of tics. Food sources include meat, eggs, dairy, fish and fortified cereals. A daily B12 supplement may help.
– **Aim for regular meals and snacks** – Keeping blood sugar stable throughout the day by eating regularly scheduled meals and snacks may help minimize tic fluctuations throughout the day.
– **Stay hydrated** – Dehydration can exacerbate tics for some, so drink plenty of water and limit caffeinated beverages like coffee and soda that have a diuretic effect.
– **Consider a food journal** – Tracking the timing of tics and correlating it to foods eaten throughout the day in a journal can help identify personal food triggers that can then be eliminated.
– **Manage stress** – Higher stress is a common tic trigger. Make sure diet includes foods rich in stress-fighting nutrients like magnesium, B vitamins and zinc.
– **Get adequate sleep** – Lack of sleep is a common tic trigger, so allowing time for winding down before bedtime is important. Limiting caffeine intake close to bedtime can also improve sleep.
The potential role of inflammation
One way diet may influence tics is through inflammation. Many experts believe inflammation in certain regions of the brain plays a role in the development and worsening of tic disorders like Tourette’s.
Markers of inflammation have been found to be higher in children with Tourette’s compared to healthy children in some preliminary studies. Factors like stress, poor diet, gut issues, food sensitivities, obesity, and lack of exercise can all contribute to increased inflammation.
Eating a nutrient-dense anti-inflammatory diet and controlling potential food intolerances and allergies may help lower inflammation. Key aspects of an anti-inflammatory diet include:
– Increasing fruits, vegetables, whole grains, nuts, seeds, fatty fish, olive oil
– Avoiding refined grains, fried foods, processed foods, sugary foods
– Eliminating suspected food triggers
– Staying hydrated and getting adequate fiber
– Getting enough omega-3s from fish or supplements
– Limiting saturated fat, omega-6 oils, trans fats, red and processed meats
Lowering inflammation through diet and lifestyle may be one way nutrition can play a supportive role in tic management, but much more research is still needed in this area.
The gut-brain connection
There has also been some speculation that gut health could influence tic disorders like Tourette’s through the gut-brain connection. This is the communication that takes place between the gastrointestinal system and the central nervous system.
Some preliminary theories suggest:
– Food sensitivities, gut inflammation, and leaky gut syndrome could trigger neuroinflammatory responses that impact the brain regions implicated in tic disorders.
– Disruptions in the gut microbiome could affect neurotransmitter levels thought to play a role in Tourette’s, especially dopamine.
– Poor gut health could contribute to nutritional deficiencies that exacerbate tics, like deficiencies in iron, zinc, magnesium, and B vitamins.
Currently these ideas are theoretical, as there is very little quality research specifically looking at the gut microbiome and diet patterns in people with tic disorders. More study is needed to determine if strategies like probiotics, improving gut health, and healing leaky gut could have an impact on tics.
The potential impact of the ketogenic diet
One specific diet that has shown some early promise in small studies for reducing tic severity is the ketogenic diet. This is a very high-fat, low-carbohydrate diet that promotes the production of ketones.
The ketogenic diet has been proven effective for difficult-to-control epilepsy, and researchers are now interested in studying its impact on other neurological disorders like Tourette’s.
A few small studies using the ketogenic diet for Tourette’s have shown:
– In one randomized controlled trial with 31 children, tic scores were reduced by over 30% in the group following a ketogenic diet, compared to no change in the control group.
– In another small 2-month study, 9 out of the 18 children on the ketogenic diet had >50% fewer tics, with 45% of children having >35% improvement in tic scores.
– In case reports, starting the ketogenic diet has resulted in dramatic reductions in tics, sometimes as quickly as 3 days after initiating the diet.
Researchers hypothesize the ketogenic diet may positively impact brain cell metabolism or function of neurotransmitters implicated in Tourette’s. Larger controlled studies are still needed to confirm the diet’s effectiveness.
The classic ketogenic diet has a ratio of 3-4 grams of fat for every 1 gram of carbohydrate and protein combined. This stringent ratio is hard to adhere to long-term. Less restrictive versions like the modified Atkins diet may be easier to follow while still providing benefit.
Complementary and integrative approaches
Some complementary approaches like supplements, herbs, acupuncture, and stress reduction techniques may also help support the management of tic disorders. While large, rigorous studies are generally lacking in these areas, some parents have reported benefits from incorporating complementary strategies:
– **Probiotics** – Improving gut health with daily probiotic supplements may potentially support the gut-brain connection. Small studies looking specifically at probiotics for Tourette’s are needed.
– **Omega-3 fatty acids** – Omega-3 supplements may help reduce inflammation implicated in tic disorders. DHA and EPA omega-3s are best. Typical doses used in small studies range from 600-1000 mg EPA/DHA daily.
– **Magnesium** – Magnesium deficiency exacerbates tics for some people. Supplements or increased dietary intake may help reduce tic severity.
– **Ginkgo biloba** – This herbal supplement may help regulate dopamine levels in the brain. Small studies using ginkgo extracts in children with Tourette’s have shown reductions in tic frequency and severity.
– **Massage** – Therapeutic massage to reduce muscle tension and stress has been subjectively reported by parents to reduce tic severity in some children with Tourette’s. Larger controlled studies are needed.
– **Acupuncture** – Small preliminary studies suggest acupuncture may reduce premotor brain activity associated with tics. More research is underway on acupuncture for Tourette’s.
– **Cognitive behavioral therapy (CBT)** – CBT has proven benefits for better managing the emotional and cognitive aspects of living with a chronic tic disorder. CBT does not reduce tics directly but can improve overall well-being.
Should specific foods be avoided?
Some online sources claim that people with Tourette’s or other tic disorders should avoid specific foods like sugar, gluten, dairy, soy, artificial colors, or processed foods. However, there is currently no solid scientific evidence to support completely eliminating any of these foods universally.
The best approach is to individually assess whether eliminating a particular food reduces tics and symptoms. Possible steps include:
– Having the person keep a detailed food and symptom journal for 2-4 weeks, tracking everything eaten and any changes in tics hourly and daily. Look for symptom patterns related to specific foods.
– Trying a hypoallergenic elimination diet that removes all major allergens for 2-4 weeks, then systematically reintroducing them. This can help identify personal tic triggers. Work with an experienced dietitian or nutritionist to ensure nutritional adequacy.
– Getting testing for IgG food sensitivities through a functional medicine practitioner, which can detect delayed immunological reactions to foods. However, this testing remains controversial.
– Removing one suspect food completely for 3-4 weeks to see if tic frequency or severity improves. Reintroduce it to check for any effects.
– Exercising caution with broad elimination diets like strict gluten-free or dairy-free diets, which can impair nutrition intake and are difficult to sustain long-term unless absolutely needed.
Identifying specific tic triggers based on an individual’s unique physiology and metabolism is more beneficial than universally avoiding or recommending certain foods for people with Tourette’s or other tic disorders. The level of research evidence does not support universal dietary restrictions at this time.
Takeaway on diet and tic disorders
While research investigating the link between nutrition and tic disorders like Tourette’s syndrome is still emerging, the current evidence suggests:
– There are no clear dietary approaches proven effective yet for substantially improving tics. More research is still greatly needed.
– However, there are some promising areas that warrant further study, including anti-inflammatory diets, the ketogenic diet, iron, vitamin B12, eliminating trigger foods, and probiotics/gut health.
– Keeping a detailed food journal can help identify individual food triggers that may exacerbate tics so these can be eliminated. Common culprits include caffeine, sugar, food dyes, preservatives, and MSG.
– A healthy diet focused on whole, nutrient-dense foods is encouraged, along with daily exercise, good sleep, stress management and social support, which can all help overall wellness and tic management.
– Work with your healthcare provider before making any significant dietary changes. Registered dietitians knowledgeable about tic disorders can also provide personalized guidance.
While we still have a ways to go in understanding the diet-tic connection, paying attention to nutrition and lifestyle factors can be an empowering part of a comprehensive treatment approach. With more research, we will hopefully better elucidate how diet and gut health may impact these challenging neurodevelopmental disorders.