The N.D.D. Book

How Nutrition Deficit Disorder Affects Your Child's Learning, Behavior, and Health, and What You Can Do About It--Without Drugs


By William Sears, MD, FRCP

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The Sears Parenting Library’s latest addition is an exploration of how nutrition affects the brains and behavior of youngsters. N.D.D., or Nutrition Deficit Disorder, as coined by Dr. Bill Sears, is based on the idea that if “you put junk food into a child’s brain, you get back junk behavior and learning.”

Dr. Sears will explore the latest scientific research on the effects of nutrition on the brain. He will present case studies of his own patients who were diagnosed as “N.D.D.” and showed major improvement in learning and behavior with diet change. Instead of simply medicating his patients, Dr. Sears looked for a better solution — in fact, with better nutrition, many of his patients were able to greatly reduce or even stop their medication. The book will also provide parents with a prescription, shopping and meal tips, and recipes to make implementing a healthier lifestyle that much easier.

The N.D.D. Book will be a must-have for all parents who want to help their children become healthier, happier, and better prepared to learn.


Copyright © 2009 by William Sears, M.D.

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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First eBook Edition: April 2009

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ISBN: 978-0-316-05298-6

Sears Parenting Library

The Vaccine Book

The Healthiest Kid in the Neighborhood

The Baby Sleep Book

The Premature Baby Book

The Pregnancy Book

The Baby Book

The Birth Book

The Attachment Parenting Book

The Breastfeeding Book

The Fussy Baby Book

The Discipline Book

The Family Nutrition Book

The A.D.D. Book

The Successful Child FAQ Books

The First Three Months

How to Get Your Baby to Sleep

Keeping Your Baby Healthy

Feeding the Picky Eater

Sears Children's Library

Baby on the Way

What Baby Needs

Eat Healthy, Feel Great

You Can Go to the Potty


Parents, We Have a Problem. It's NDD!

The story begins on a typical day in the office of Sears Family Pediatrics, where I have the privilege of practicing medicine with my three sons. What happened that day changed the way I practice pediatrics forever and influenced the health of hundreds of my patients. That was the day this book was born.

"Welcome to our office. How can I help you?" I greeted my first patient.

"Johnny's school thinks that he has ADD," his mother began.

"Attention deficit disorder. Hmm… . Tell me, what does Johnny have for breakfast?" I inquired.

"Hi-C and a Pop-Tart," Johnny's mother confessed.

"What does he have for midmorning snack?"

"Usually nothing, but sometimes he has some chips."

"What does he have for school lunch?"

"Oh, the usual pizza and stuff that kids eat."

"Johnny does not have ADD, he has NDD!" I said spontaneously, straight from my heart.

I'll never forget the surprised look on this mother's face. She had no idea what on earth NDD was, but it sounded like something she didn't want her child to have.

"Nutrition deficit disorder," I interpreted.

I went on to explain to this puzzled parent that the brain, above all other organs, is affected, for better or worse, by what we eat. "You put junk food into a child's brain, you get back junk behavior, junk learning, and junk mood. It's as simple as that!" The mother's look of amazement immediately changed to one of comprehension. "Oh! That makes sense. I get it! NDD." Relieved, she said, "So he doesn't need drugs?"

"No, not the prescription kind. He just needs to eat real food, because real food is real medicine."

It was then that I realized that this mother, and many other moms like her, didn't understand that food can affect how her child learns, behaves, and feels.


Here are the main signs we look for when diagnosing a child with NDD:

frequent mood swings

unrelenting temper tantrums

restless sleep

poor attention span

impulsive outbursts

labeled with a D: ADD, ADHD, BPD, OCD, etc.

behavior problems at school, home, and day care

learning difficulties


frequent infections

dry, flaky, bumpy skin

intestinal problems: reflux, abdominal discomforts, constipation, diarrhea

vision problems

frequent allergies

dry, brittle hair

brittle, thin nails

very pale skin, especially on the earlobes


To fully understand how fake food affects a child, let's spend a day in the body and brain of a typical seven-year-old junk-food eater. Let's call him Johnny Junk-Food Eater.

Johnny awakens from a restless night's sleep. Because he went to bed with his body full of junk food, he got junk sleep. He wolfs down a junk-food breakfast and rushes off to school. Because of junk sleep and a junk breakfast, he starts his day with a big D, for being disadvantaged. Because he missed the head start that real food gives the brain, and the biochemical balance that real food gives the body, he enters the classroom feeling tired and with a bit of a brain fog. Johnny begins his school day with his body and brain in biochemical imbalance, so he can't keep his mind on what he is reading and what the teacher is saying.

Around nine thirty or ten, Johnny gets hungry because the fake food wasn't filling. His blood sugar drops because the junk carbs that rushed into his bloodstream at breakfast are all used up. Now he has an even harder time concentrating. Meanwhile, his brain is telling his body, "I need more fuel." So it sends a signal to his adrenal glands to pump out stress hormones, which squeeze some of the stored fuel out of his liver to feed his hungry brain. These stress hormones get Johnny hyped up, so he starts to fidget. He looks out the window because he's bored, and his stress hormones–filled body tells him, "Gotta move!" But the teacher says, "Gotta sit!" While Johnny's body sits in the classroom, his mind is already at recess. Because his brain is out of biochemical balance, so is his behavior, and he pokes the kid sitting next to him.

Around noon Johnny goes through the school lunch line for his next junk-food fix—the junk carbs and fake fats are there for the choosing. After lunch he's calmer but way too sluggish to play, which is what his body really should be doing right now. So, back to the classroom Johnny goes, with a case of double TB, tired body and tired brain. He experiences more mind wandering, more fidgeting, and more distractibility. Johnny goes home, gets a snack, and runs around outside. He feels much better for a short time. But then comes a high-carb dinner, and, naturally, both Johnny's body and brain get turned off from doing homework.

Johnny not only eats polluted food, he breathes polluted air, since his school is located near an intersection of freeways.

Because Johnny wasn't fed real food, his immune system is also out of balance. Johnny gets sick often and misses school, and this puts him further behind. His allergies flare up, too, causing him to wheeze and cough so much that his brain and body can't rest at night. The cycle continues.

Johnny gets more Ds. Of course the teacher notices that Johnny is having difficulty. To a child, being labeled difficult or different means he is less somehow—no one's fooling him—and his self-esteem goes downhill. "He's another one of those kids with ADD," the teacher concludes. "He needs medication," she tells his parents, so off to the doctor they go. What his parents don't realize is that the doctor often suffers from her own D, distraction, from having to see too many patients in too little time. Since the distracted doctor doesn't have enough time to take a full nutritional history, Johnny gets another D, drugs.

Now he starts the day with a double D, the D caused by his junk food and the D of biochemical disarray caused by the drugs. Now his body and brain are really in a metabolic mess.

Because his brain and body are out of balance, Johnny's food cravings are as well. He craves more junk food because that's what his body is used to, and this leads to overeating, which leads to weight gain. This cycle causes an even greater imbalance in body and brain and leads to more drugs.

Johnny has NDD. The rest of this book covers the changes that the parents of Johnny, who is especially junk-food-sensitive, and many other parents can make to dramatically improve their children's behavior and learning.


Kids with one D are more likely to get other Ds because the cause is the same—nutrition deficit disorder. Children with disorders of the brain are also more likely to get diseases of the body.

The D epidemic. Parents, we have an epidemic of Ds: attention deficit disorder (ADD), obsessive compulsive disorder (OCD), autism spectrum disorder (ASD), bipolar disorder (BPD), oppositional defiant disorder (ODD), depression, and the biggest D of the decade, diabetes. To treat these Ds, children are taking more prescription drugs than ever before. While these disorders do exist and drugs are often necessary, they can be made worse and even triggered by nutrition deficit disorder. In my almost forty years as a pediatrician I have never before seen so many children get so many drugs for so many Ds. The good news is, your child does not have to be one of them. Throughout this book you will learn how to help your child dodge the Ds.


Children are getting sicker, sadder, and fatter, and NDD is responsible. Think about these alarming statistics from the past decade:

• Recently the U.S. Centers for Disease Control (CDC) issued a prediction: "Type 2 diabetes, once believed to affect only adults, is being increasingly diagnosed among young people. Unless American families change the way they eat and live, 1 in 3 children will eventually get diabetes."

• The front page of USA Today, November 3, 2008, reported on a study published in the medical journal Pediatrics that showed an alarming increase from 2002 to 2005 in the percentage of children on medications for chronic illnesses. The increase in children on medications for diabetes rose 103 percent; for asthma, 47 percent; for ADD and ADHD, 41 percent; and for high cholesterol, 15 percent. The study also showed a gender difference. The number of boys taking medications for diabetes increased by 39 percent, while the number of girls taking these medications skyrocketed 147 percent.

• Rather than "life expectancy," the WHO (World Health Organization) uses the more meaningful term "health expectancy"—the number of years one is expected to live in good health. The United States ranks twenty-fourth in health expectancy. I have heard many doctors at medical meetings say that this may be the first generation in history in which the children have a shorter "health span" (or health expectancy) than their parents.

• The number of preschool children who are receiving mood-altering drugs, either to perk them up or calm them down, has tripled.

• The number of Ritalin prescriptions for two-to four-year-olds has tripled.

• The number of prescriptions for mood-altering psychotropic medicines (SSRIs, like Prozac) for children younger than five years old has increased tenfold.

• Allergies serious enough to be debilitating and require drug treatment have increased an average of 5 percent per year.

• The Bogalusa Heart Study revealed that 60 percent of overweight five-to ten-year-olds already showed signs of car diovascular disease. In July 2008 the American Academy of Pediatrics issued a historic recommendation that some children as young as eight years old be prescribed cholesterol-fighting drugs to prevent future heart problems, stating, "The advice is based on mounting evidence showing that damage leading to heart disease, the nation's leading killer, begins early in life." (My concern with this recommendation is that cholesterol is a vital structural component of brain tissue. When we tinker with the body's natural cholesterol-making mechanism, we run the risk of causing more NDD.)

• Obesity extreme enough to disable a child has increased 40 percent.

• GERD (gastroesophageal reflux disease) is now one of the most frequent diagnoses in children. Drugs previously reserved for heartburn in older folks are now frequently prescribed for children. Twenty years ago, GERD didn't even exist in the list of typical childhood diseases.


The biggest D of the decade—ASD—or autism spectrum disorder, has reached epidemic proportions. Autism now affects one in 150 children. Nearly every day in our pediatric practice a parent asks, "Why are so many kids getting autism, and what can we do about it?" While there are many theories about what causes this neurological disorder, I believe that it is exacerbated by the polluted food that children eat and the polluted air that they breathe.

In the past year, an increasing number of studies have focused on the large number of schools throughout the United States that are located near polluted air. A 2008 study of 127,000 schools found that 20,000 of them are within half a mile of a major industrial plant. This is especially troubling because, as toxicologists have long known, a child's immature immune system makes him or her particularly vulnerable to the harmful effects of environmental pollutants, dubbed the "smokestack effect."


Once upon a time, the causes of ADHD and many mood, behavioral, and learning disorders were unknown. New insights into neurochemistry have shown that most of these Ds are due to neurochemical imbalances in the brain. In fact, psychiatrists often justify the use of drugs by telling patients that their Ds are due to a "chemical imbalance" that drugs will help correct. But balancing one bit of chemistry causes lots of imbalances in other bits. The typical child has the right balance of exciting and calming neurohormones. The child with ADHD, for example, is out of balance—too many exciting and not enough calming neurohormones. Why not balance the body and brain with food?

My Harvard Healthy Food Experience

Recently I was invited to a nutrition conference at Harvard Medical School to share the success stories of our LEAN Start Program (the health program we teach our patients, and the seven simple steps you will learn in this book). My presentation was near the end of the conference, and it followed talks given by professors of nutrition and experts in the field of nutritional biochemistry. Realizing that the audience was already overfed with statistics of the epidemic of Ds but underfed with real solutions to fixing the Ds, I decided to get real. So after my lecture I invited questions from the confused audience. "What about kids eating too much?" was the first question. "Just serve real foods. It's hard to overeat them," I answered. "Don't kids need a low-fat diet?" one audience member wondered. "No, they need a right-fat diet," I replied. "American families need an oil change!" I reminded them that mother's milk, the nutritional gold standard for optimal growth, is 40 to 50 percent fat. "Shouldn't kids be on a low-carb diet?" someone asked. "No, they should be on a right-carb diet," I corrected. To emphasize my point, I reminded this esteemed audience that the growing brain is 60 percent fat and that it utilizes carbs as the only source of fuel. "Shouldn't we have more nutrition education programs for parents?" someone suggested. "Yes, just tell them to serve real foods," I said. After the conference, a young medical student thanked me for simplifying the solution for the epidemic of Ds: Eat real foods.


While the effects of NDD are most noticeable in children's brains, nutritional deficit disorder also bothers growing bodies.

Mental DsPhysical Ds
ADD (attention deficit disorder)Allergic diseases
ADHD (attention deficit/hyperactivity disorder)CVD (cardiovascular disease)
BPD (bipolar disorder)Diabetes
DD (developmental delay)GERD (gastroesophageal reflux disease)
DepressionIBD (inflammatory bowel disease)
LD (learning disability)Infectious diseases (weak immune system)
OCD (obsessive compulsive disorder)Inflammatory diseases ("-itis" illnesses: e.g., dermatitis, colitis, bronchitis)
ODD (oppositional defiant disorder)Vision deficiencies
SPD (sensory processing disorder) 

Neither the food industry nor the government is going to cause the Ds to drop. Parents must be the change agents. They are at the top of the food supply chain: Farmers grow it, the food industry packages it, supermarkets stock it, and parents buy it.


Years ago in my pediatric practice, I noticed that more and more mothers were feeding their children healthfully. Initially, I reacted like the typical nutritionally misinformed doctor and dubbed them health nuts. Later I called them "pure moms." As I finally began to get the message that food was medicine and that NDD was at the root of many of the Ds, I started using my medical practice as a nutritional laboratory. I decided to study what these moms did and how their children turned out, and to offer some nutritional tips of my own.

They served real food. After starting life with real food from Mom's body, these "pure kids" continued to get real food from Mom's kitchen. Instead of food from jars or cans, these children got real veggies prepared fresh, and cookies made from scratch. Yum! With a kid-friendly nibble tray full of nutritious "grow foods," they grazed their way through toddlerhood, eating when hungry, stopping when full.

They practiced the "we principle." They taught their children, "This is what we believe, this is how we dress, this is how we talk, and this is what we eat." Pure and simple! When their kids fussed for junk food, these motivated moms lovingly but uncompromisingly said, "We don't eat that in our house." They not only made food pure, they made food fun. Realizing that kids are more likely to eat the foods they grow, they planted gardens together. They called the produce "grow foods." Kids like that term. These moms seldom used the term "healthy," because some children equate healthy with icky.

They made feeding fun. They understood that they were bucking the trend and that their pure children would soon enter the polluted world, so they realized they had to serve quality food in a creative way. For example, they made fresh pizzas with funny faces. Eating was fun! They also went out of their way to help food taste better so that their children developed a taste for real food (see our recipes, chapter 12). Their children had normal sweet tooths (mother's milk is one of the sweetest of all foods), so they wanted their children to develop a taste for real sweetness from fruits. These kids learned, for example, that plain yogurt sweetened and colored with blueberries was a better grow food than yogurt diluted with fake colors and sweeteners.

They did "traffic-light" eating and shopping. These mothers regarded the supermarket as a giant nutritional classroom and taught their children how to have fun shopping. They played nutritional games when approaching the produce section, saying things like "Go pick out three reds, two blues, and four yellows," to teach their kids that the more colorful a food, the better a grow food it is likely to be. They taught them to shop the perimeter of the supermarket "because that's where the grow foods are." At my suggestion, they taught their children the concept of "traffic-light" eating: green-light, yellow-light, and red-light foods. Children loved the green-light foods ("eat them anytime and eat them as much as you want" foods). They learned that green-light foods helped them grow stronger and run faster. Yellow-light foods were "eat sometimes" treats. They learned there was an aisle in the supermarket that "we just don't go down," where the red-light foods were. These pure children learned very quickly that red-light foods kept them from growing strong and caused them to miss school and games and to have dry skin and less pretty hair and to just not feel well. (For more information about traffic-light eating, see page 77.)

They taught the three bad words. When their kids learned to read, these moms taught them how to read labels: "Look for good words on the label, like whole grains. Beware of the three bad words on the label: high fructose corn syrup, hydrogenated, and anything with a number," or what they called the "yucky stuff."

They shared with pure families. Realizing that peer pressure influenced eating habits, these pure parents went out of their way to dine with other pure families so that their kids would understand that real foods are normally eaten in other houses too.


Metabolic programming is a new and exciting field of research that relates early feeding experiences to later adult diseases. Studies have revealed that breastfed infants, compared with formula-fed infants, tend to have lower cholesterol as adults. The theory goes that, since breast milk contains cholesterol, and infant formula doesn't, adults who were breastfed are able to metabolize cholesterol better because these mechanisms were turned on early.

The term imprinting is sometimes preferred over metabolic programming because it suggests something that cannot be forgotten. Parents try to imprint many habits, such as their faith and values, on their children when they're young in the hope that even if their children should later deviate from these early habits, they will eventually return to them because they have been so deeply imprinted on them. Yet parents often forget about nutritional imprinting. One of the most heavily researched areas of nutritional imprinting is the link between early obesity (children who are overfed but malnourished) and later diabetes.

Metabolic programming researchers believe that during childhood, there is a window of nutritional opportunity to imprint lifelong nutritional habits that will program children at the cellular level to grow up to be healthy adults. I call this a "programming window." It seems that the genetic code of the cells "memorizes" feeding patterns and encodes them into lasting "this is the way we're supposed to behave" actions.

At this writing, metabolic, or nutritional, imprinting research is in its infancy. So, parents, let's use the science of common sense. Let your children's rapidly growing genetic codes memorize the effects of eating real foods. As a result, when your children become adults, they are more likely to enjoy good health.

From one mother: "All my friends comment about how eventempered and easygoing my children are. I know that temperaments are partially inherited, but I really do think that diet has a lot to do with behavior. When my kids get too much junk food, they become whiny and have extremely short attention spans. They even complain of headaches."

They prepared their kids for the real world.


On Sale
Apr 29, 2009
Page Count
224 pages
Little Brown Spark

William Sears, MD, FRCP

About the Author

William Sears, M.D., and Martha Sears, R.N. are the parents of eight children, eleven grandchildren, and two great grandchildren, and the authors of 45 best-selling books on parenting and family health.  They are the pediatric experts on whom American parents increasingly rely for advice and information on all aspects of pregnancy, birth, child care, and family nutrition.  Dr. Bill received his pediatric training at Harvard Medical School’s Boston Children’s Hospital and Toronto’s Hospital for Sick Children, the largest children’s hospital in the world, where he was Associate Ward Chief of the pediatric intensive care unit.  He was also the Chief of Pediatrics at Toronto Western Hospital, a teaching hospital of the University of Toronto.   He has practiced pediatrics for more than fifty years, and is the founder of and the Dr. Sears Wellness Institute, which has certified over 12,000 health coaches around the world.  He has served as voluntary professor at the University of Toronto, the University of South Carolina, the University of Southern California’s Keck School of Medicine, and the University of California, Irvine.  Dr. Sears’ contribution to family health was featured on the cover of Time magazine in 2012.  Martha Sears is a registered nurse, former certified lactation consultant of IBCLC, and childbirth educator.  
Robert W. Sears, MD, is also a pediatrician in private practice in  Southern California. Dr. Bob received his medical degree from Georgetown University and completed his pediatric training at Children’s Hospital Los Angeles. He has coauthored six books in the Sears Parenting Library, including The Baby Book and The Allergy Book. He is also the author of The Vaccine Book and The Autism Book. He frequently speaks to parents and doctors about children’s health. He has three grown sons, two grandchildren, and lives with his wife in Dana Point, California.
James Sears, MD, is a pediatrician and former cohost of the popular TV show The Doctors, a spin-off of Dr. Phil. Dr. Jim received his medical degree from Saint Louis University School of Medicine and did his pediatric residency at Tod Children’s Hospital in Youngstown, Ohio. He frequently speaks to parenting groups around the country about children’s nutrition. He is the proud father of two children and resides and practices in Southern California.


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