The Feingold Diet Program for ADHD

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Diet & ADHD:
Some of the Research


In some of these studies, the researchers followed up implementation of the Feingold-type diet with a double-blind challenge using only very small amounts of one or a mix of food dyes. They had been told to use no more than 27 mg by the food additive industry organization calling itself the "Nutrition Foundation," and some used far less. If they didn't get results from their challenge, instead of concluding that the challenge didn't work, they strangely concluded that the diet didn't work.

Next, the results of the tests were reported in no particular order and results were claimed to be "all over the place," as you see in the picture below. Your doctor may tell you that today, because that is what he was taught. If you put the studies in appropriate order -- by amount of food dye used as the challenge -- you get a very different picture. See what happens when you hover your cursor over the picture below.

Below are some of the studies and articles published in peer reviewed journals. The most recent are listed first. They are linked where available to their abstract in MedLine.

Most of these studies used an approximation of the Feingold Program and addressed only artificial colorings and preservatives. The Feingold Program also eliminates the thousands of artificial flavorings in the American diet, which have never been proven safe.

= Double blind controlled study
Some of the studies below have links to their full text which require a password.
Email us to request the password.

Back to Research Menu Page
Updated 11/18/13

Listed in date order, with the newest first:

Kamel 2011      The Potential Health Hazard of Tartrazine and Levels of Hyperactivity, Anxiety-Like Symptoms, Depression and Anti-social behaviour in Rats.
Stevens 2011      (Review) Dietary Sensitivities and ADHD Symptoms: Thirty-five Years of Research. .
Pelsser 2011      (Randomized study) Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial.
Howard 2010      (prospective study) ADHD is Associated with a 'Western' Dietary Pattern in Adolescents.
Kiddie 2010      (Clinical study) Nutritional status of children with attention deficit hyperactivity disorder: a pilot study.
Pelsser 2010      (Randomized
controlled study)
Effects of food on physical and sleep complaints in children with ADHD: a randomised controlled pilot study.
Stevenson 2010      The Role of Histamine Degradation Gene Polymorphisms in Moderating the Effects of Food Additives on Children's ADHD Symptoms.
Dodig-Curkovic
2009
(Review) The role of zinc in the treatment of hyperactivity disorder in children.
No Author 2009 (Health Assessment) Artificial food colouring and hyperactivity symptoms in children.
Pelsser 2009 (Randomized
controlled study)
A randomised controlled trial into the effects of food on ADHD.
Curtis 2008 (Review) Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review.
McCann 2007 Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial.
Grandjean 2006     (Review) Developmental neurotoxicity of industrial chemicals.
Husain 2006 (Evaluation) Estimates of dietary exposure of children to artificial food colours in Kuwait.
Inomata 2006 (Case Study) Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl.
Lien 2006 (Survey) Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway.
Niederhofer 2006 (Clinical Study)A preliminary investigation of ADHD symptoms in persons with celiac disease.
Lau 2006 (Neurotoxicology Study) Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test.
Bateman 2004 The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children.
Schab 2004 (Meta Analysis) Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials.
Dengate 2002 Controlled trial of cumulative behavioural effects of a common bread preservative.
Pelsser 2002 (Open Study) Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study.
Stubberfield 1999 (Survey) Utilization of alternative therapies in attention-deficit hyperactivity disorder.
Bennett 1998 (Case Studies) The Shipley Project: Treating Food Allergy to Prevent Criminal Behaviour in Community Settings.
Bennett 1997 (Survey) The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders.
Schmidt 1997 Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.
Uhlig 1997 Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder.
Ward 1997 Assessment of chemical factors in relation to child hyperactivity.
Reyes 1996 (Lab Study) Effect of organic synthetic food colours on mitochondrial respiration.
Boris 1994 Foods and Additives are Common Causes of the Attention Deficit Hyperactive Disorder in Children
Rowe 1994 Synthetic Food Coloring and Behavior:  A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study
Carter 1993 Effects of a Few Foods Diet in Attention Deficit Disorder
Egger 1992 Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior
Novembre 1992 Unusual reactions to food additives
Schoenthaler 1991     (Retrospective
Study)
Applied Nutrition and Behavior
Pollock 1990 Effect of artificial food colours on childhood behaviour.
Sarantinos 1990 Synthetic Food Colouring and Behavioural Change in Children with Attention Deficit Disorder: A Double-Blind, Placebo Controlled, Repeated Measured Study.
Ward 1990 The influence of the chemical additive tartrazine on the zinc status of hyperactive children: A double-blind placebo-controlled study.
Egger 1989 Oligoantigenic diet treatment of children with epilepsy and migraine
Kaplan 1989 Overall Nutrient Intake of Preschool Hyperactive and Normal Boys
Kaplan 1989 Dietary Replacement in Preschool-Aged Hyperactive Boys
Rowe 1988 Synthetic Food Colourings and "Hyperactivity": a Double-Blind Crossover Study
Burlton-Bennet 1987 (ABAB study) A Single Subject Evaluation of the K-P Diet for Hyperkinesis.
David 1987 Reactions to dietary tartrazine
Gross 1987 The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders
Schoenthaler 1986 (Retrospective
Study)
The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools.
Egger 1985 Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome
Menzies 1984 (Case Studies) Disturbed children: the role of food and chemical sensitivities.
Augustine 1983 (Neurotoxicology Study) Neurotransmitter release and nerve terminal morphology at the frog neuromuscular junction affected by the dye Erythrosin B (Red 3).
Augustine 1983 (Neurotoxicology Study) Presynaptic effect of Erythrosin B at the frog neuromuscular junction: ion and photon sensitivity.
Egger 1983 Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment.
Rippere 1983 (Critique) Food additives and hyperactive children: a critique of Conners.
Mattes 1983 (opinion) The Feingold Diet: A current reappraisal.
Feingold 1982 (Article) The role of diet in behavior.
Goldenring 1982 Sulfanilic acid: behavioral change related to azo food dyes in developing rats.
Salamy 1982 Physiological changes in hyperactive children following the ingestion of food additives.
Mattes 1981 Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study.
Holborow 1981 (Observational study) The effect of the Feingold diet on 'normal' school children.
Augustine 1980 (Neurotoxicology Study) Neurotransmitter release from a vertebrate neuromuscular synapse affected by a food dye.
Swanson 1980 Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test
Weiss 1980 Behavioral responses to artificial food colors.
Brenner 1979 Trace mineral levels in hyperactive children responding to the Feingold diet
Feingold 1979 (Article) Dietary management of juvenile delinquents.
Lafferman 1979 (Neurotoxicology Study) Erythrosin B inhibits dopamine transport in rat caudate synaptosomes.
Shaywitz 1979 Effects of Chronic Administration of Food Coloringts on Activity Levels and Cognitive Performance in Developing Rat Pups Treated with 6-Hyroxydopamine
Dumbrell 1978 (Comparison) Is the Australian version of the Feingold diet safe?
Fitzsimon 1978 Salicylate sensitivity in children reported to respond to salicylate exclusion.
Goyette 1978 Effects of artificial colors on hyperkinetic children: a double-blind challenge study.
Harley 1978 Hyperkinesis and food additives: testing the Feingold hypothesis.
Harper 1978 (Comparison) Nutrient intakes of children on the hyperkinesis diet.
Hindle 1978 The management of hyperkinetic children: a trial of dietary therapy.
Levy 1978 Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge.
Rose 1978 The functional relationship between artificial food colors and hyperactivity.
Williams 1978 Relative effects of drugs and diet on hyperactive behaviors: an experimental study.
Brenner 1977 (Case studies) A study of the efficacy of the Feingold diet on hyperkinetic children. Some favorable personal observations.
Feingold 1977 (Speech) Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors .
Feingold 1977 (article) Food Additives in Dentistry.
Conners 1976 Food additives and hyperkinesis: a controlled double-blind experiment.
Cook 1976 (Open diet study) The Feingold dietary treatment of the hyperkinetic syndrome.
Feingold 1976 (article) Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors.
Salzman 1976 (Case studies) Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome.
Spring 1976 (Negative review) Food Additives and Hyperkinesia A Critical Evaluation of the Evidence
Feingold 1975 (article) Hyperkinesis and learning disabilities linked to artificial food flavors and colors.




National Academy
of Sciences


A sensible guide to
risk-benefit analysis:
  • to reduce exposure to hazard
    whenever possible;

  • to accept substantial hazard
    only for great benefit;

  • to accept minor hazard for
    modest benefit; and

  • to accept no hazard at all
    when the benefit seems
    relatively trivial.
- Philip Handler (1979)
President of U.S. National Academy of Sciences 1969 to 1981

When it's
NOT ADHD

A boy in Germany was brought to a hospital and first diagnosed with asthma; he also was aggressive and hyperactive.

After ruling out a number of possible lung diseases, they tested him for parasites and found very elevated toxocara IgG antibodies - Toxocara is a parasitic worm usually found only in cats and dogs. Symptoms of the "covert" form can include coughing, fever, abdominal pain, headache, and changes in behavior and sleep.

If you have reason to suspect parasites, talk to your doctor.






The following excerpts are in alphabetical order by first author.

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  1. Attention deficit hyperactivity disorder , Anthony HM; Maberly DJ; Birtwistle S. Arch Dis Child 1999;81:189 (August)
    "... an elimination diet is effective in most cases. ... If they have had help with finding alternative foods, most parents find it surprisingly easy to keep the child to the diet most of the time after the first few weeks because the child usually prefers to feel well. ... If the diet is effective, behaviour often reverts to normal, to the great relief of all concerned. In view of the potential toxicity of medication in children and its limited effectiveness, all families with hyperactive children should be offered help in detecting offending foods. It is more appropriate to reserve medication for those who fail. "

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  2. Neurotransmitter release from a vertebrate neuromuscular synapse affected by a food dye. Augustine GJ Jr, Levitan H, Science 1980 Mar 28;207(4438):1489-90
    " The food dye erythrosine (Red No. 3) was applied to isolated neuromuscular synapses in the frog ... this anionic dye produced an irreversible, dose-dependent increase in neurotransmitter release.... These results suggest that erythrosine might prove a useful pharmacological tool for studying the process of transmitter release, but that its use as a food additive should be reexamined. "

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  3. Neurotransmitter release and nerve terminal morphology at the frog neuromuscular junction affected by the dye Erythrosin B [Red #3]. Augustine GJ, Levitan H, J Physiol 1983 Jan;334:47-63
    Red #3 at concentrations of 10 micrograms or more, produced time and dose dependent increases in transmitter release from presynaptic nerve terminals and swollen mitochondria.

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  4. Presynaptic effect of Erythrosin B at the frog neuromuscular junction: ion and photon sensitivity. Augustine GJ, Levitan H, J Physiol 1983 Jan;334:65-77
    " . . . These results indicate that Erythrosin B [Red 3] is not acting solely by altering the ionic permeability of the presynaptic nerve terminal to calcium, magnesium, or sodium ions, or by altering the calcium metabolism of the terminal. The enhanced effect of the dye in calcium-free saline suggests that it may be competing with calcium at a common site, while the enhancement of its effect in elevated external calcium suggests that the dye may also increase the permeability of the nerve terminal to calcium ions. "

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  5. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Bateman B et al, Archives of Disease in Childhood. 2004 Jun;89(6):506-11.
    "AIMS: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. . . .RESULTS: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. . . .CONCLUSIONS: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children . . . "

    Note: The investigators suggest removing these from the diet of all children.  Just think about it -- only 20 mg per day of coloring was used as the "challenge." Imagine the results had they used the 58 mg of coloring present in one (1) cupcake with red frosting.

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  6. The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders, Bennett CPW, Brostoff J., Journal of Nutritional & Environmental Medicine, Vol.7, No.4 Dec 1997 pp.359-366
    " ...From this study, the proportion of the persistent young offender population with maladaptive behaviours linked to food allergy, food intolerance and nutritional problems is cautiously estimated to be 75% whereas 18% of the young non-offender population is similarly affected."

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  7. The Shipley Project: Treating Food Allergy to Prevent Criminal Behaviour in Community Settings, Bennett CPW, McEwen LM, McEwen HC, Rose, EL, Journal of Nutritional & Environmental Medicine , Vol.8, No.1,Mar.1998, pp.77-83
    " Nine children with persistent anti-social, disruptive and/or criminal behaviours were assessed and treated for food intolerance and allergy. All were found to have a number of food allergies or intolerances and mineral imbalances, particularly in zinc. Three showed marginally raised cadmium while one had considerably raised cadmium. . . .The health and behaviour of all nine subjects improved both physically and psychologically. . . . The feasibility of applying nutritional and biochemical assessment and treatment in the community to divert young offenders and disruptive schoolchildren from criminal behaviour was demonstrated. Criminal justice, education and health agencies could incorporate and develop this approach in furtherance of their statutory objectives. "

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  8. Foods and Additives are Common Causes of the Attention Deficit Hyperactive Disorder in Children, Boris M; Mandel F, Annals of Allergy, May 1994, Vol. 72, pp. 462-8
    73% of 26 children with ADHD responded favorably to a diet eliminating reactive foods and artificial colors. 16 of the improved children were given a double blind challenge with 100 mg of mixed food dyes or a food chosen by the parent. ALL of them reacted to the challenge. Placebo effect was ruled out. "This study demonstrated a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD. Dietary factors may play a significant role in the etiology of the majority of children with ADHD."

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  9. A study of the efficacy of the Feingold diet on hyperkinetic children. Some favorable personal observations. Brenner A, Clinical Pediatrics (Phila) 1977 Jul;16(7):652-6
    "... the startling changes seen in patients who had been followed for years with other forms of therapy suggest strongly that this improvement was genuine. "

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  10. Trace mineral levels in hyperactive children responding to the Feingold diet, Brenner A, Journal of Pediatrics 1979 Jun;94(6):944-5
    Abstract [not included on MedLine]: "The Feingold hypothesis associating the hyperkinetic syndrome with ingestion of common food additives, artificial colors and flavors, and salicylate-containing foods has evoked considerable controversy. Since many children ingest these ubiquitous additives, and no differences in dietary habits have been noted between hyperkinetic and nonhyperkinetic children, it is possible that a biochemical difference may be present in children who appear to be affected by the additives."

    20 children who responded to the Feingold diet, and 14 who did not were tested for copper and zinc levels in their blood. There was a significantly higher level of copper in the children who did respond to the diet. Possible reasons are discussed.

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  11. A Single Subject Evaluation of the K-P Diet for Hyperkinesis, Burlton-Bennett JA, Robinson VM, Journal of Learning Disabilities, 1987 Jun-Jul;20(6):331-5, 346.
    A single subject ABAB design design was employed to determine the effectiveness of the Feingold Kaiser Permanente (K-P) diet in the treatment of a 6-year-old hyperkinetic male hypothesized to be diet-responsive. ... Diet effectiveness was measured by classroom observations and by teacher and foster-mother reports. It was concluded that the K-P diet was effective in controlling the subject's hyperkinesis.

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  12. Effects of a Few Foods Diet in Attention Deficit Disorder, Carter, CM et al, Archives of Disease in Childhood, November 1993, Vol. 69 (5), pp.564-8
    59 of 78 children (75.6%) referred for "hyperactive behavior" improved on an open trial of an elimination diet.  19 of them were studied in a placebo-controlled double-blind challenge protocol.

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  13. Food additives and hyperkinesis: a controlled double-blind experiment. Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA, Pediatrics 1976 Aug;58(2):154-66
    "A double-blind crossover trial involving a control diet and a diet eliminating artificial flavors, colors, and natural salicylates as recommended by Feingold was conducted on 15 hyperkinetic children. ...Both parents and teachers reported fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline. ..."

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  14. The Feingold dietary treatment of the hyperkinetic syndrome., Cook PS, Woodhill JM., Med J Aust. 1976 Jul 17;2(3):85-8, 90.
    " ... Following Feingold's dietary prescription, an elimination diet relevant to the foods available in Sydney was developed. The treatment regime is described, and the results of its application to 15 hyperkinetic children are presented. The parents of 10 children are "quite certain" and those of three others "fairly certain" that their children's behaviour not only improved substantially with the diet, but also relapsed promptly when significant dietary infringements occurred. A possible ecological implication of these findings is briefly discussed. "

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  15. Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review., Curtis LT, Patel K. J Altern Complement Med. 2008 Jan-Feb;14(1):79-85.
    " The purpose of this study was to concisely review the available literature of nutritional and environmental factors on autistic spectrum and attention deficit hyperactivity disorder (ADHD). . . . Many, but not all, studies link exposure to toxins such as mercury, lead, pesticides, and in utero smoking exposure to higher levels of autism and/or ADHD . . . Autistic spectrum disorders and ADHD are complicated conditions in which nutritional and environmental factors play major roles. . . "

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  16. Reactions to dietary tartrazine., David, TJ Arch Dis Child. 1987 Feb;62(2):119-22.
    " Double blind challenges with tartrazine [Yellow 5] and benzoic acid were performed in hospital in 24 children . . . Twenty two patients returned to a normal diet without problems, but the parents of two children insisted on continuing the diet. . . "

    Note: David used a large dose of coloring -- 250 mg. However, he solicited children whose parents had come to him for help with their efforts at implementing a diet for their children; he treated the parents like neurotics, judging by the tone of the article. The challenges were administered to children in the throes of reaction; furthermore, they were not evaluated by any sort of testing or questionnaire, but by asking busy nurses in the ward to "observe" them. This study is included for your information, but should not be considered a valid test of either the Feingold diet or food dyes. Rather, it is a good example on how to do a really bad study.

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  17. Controlled trial of cumulative behavioural effects of a common bread preservative. Dengate S, Ruben A., J Paediatr Child Health 2002 Aug;38(4):373-6
    " ...Twenty-seven children, whose behaviour improved significantly on the Royal Prince Alfred Hospital diet, [FAILSAFE] which excludes food additives, natural salicylates, amines and glutamates, were challenged with calcium propionate (preservative code 282) or placebo through daily bread in a double-blind placebo-controlled crossover trial. ... CONCLUSIONS: Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative in healthy foods consumed daily. Minimizing the concentrations added to processed foods would reduce adverse reactions. "

    Note: Calcium proprionate is used more heavily in bread in Australia than it is in the US. The Feingold Diet does not eliminate it, but products containing it are marked with "(CP)" in the Foodlist because some members must avoid it.

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  18. The role of zinc in the treatment of hyperactivity disorder in children. Dodig-Curkovic K, Dovhanj J, Curkovic M, Dodig-Radic J, Degmecic D, Acta Medica Croatica, 2009 Oct;63(4):307-13. [Article in Croatian]
    "Zinc is an essential cofactor of more than 100 enzymes ... Dopamine is one of the most important factors in the pathophysiology of hyperactivity disorder, and the hormone melatonin has an important role in the regulation of dopamine. Because zinc is necessary in the metabolism of melatonin, it can be assumed that zinc is a very important factor in the treatment of attention deficit and hyperactivity disorder (ADHD). ... Preliminary investigations in humans show that many children with ADHD have lower zinc concentration in relation to healthy children. ... A study of ADHD treatment with zinc sulfate as a supplement to methylphenidate [Ritalin] showed beneficial effects of zinc supplementation in the treatment of children with ADHD. The dose of zinc sulfate used was 55 mg/day, which is equivalent to 15 mg zinc. The improvement achieved in ADHD children with the use of zinc sulfate appears to confirm the role of zinc deficiency in the etiopathogenesis of ADHD. ..."

    Note: See Ward studies re children with ADHD who are exposed to synthetic food coloring lose zinc.
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  19. Is the Australian version of the Feingold diet safe? Dumbrell S, Woodhill JM, Mackie L, Leelarthaepin B, Med J Aust 1978 Dec 2;2(12):548, 569-70
    "... The nutritional quality, in terms of the level and balance of nutrients in the elimination test diet, was superior to that of the normal diet. With proper dietary counselling, the elimination test diet is safe for use in the treatment of children with hyperkinesis."

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  20. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment., Egger J et al., Lancet 1983 Oct 15;2(8355):865-9
    "93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; ... the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children. ... Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. . . ."

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  21. Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome, J.Egger, P.J.Graham, J.F.Soothill, C.M.Carter, D.Gumley, The Lancet, March 9, 1985
    62 of 76 selected overactive children (81.6%) improved; other symptoms such as headaches, abdominal pain, and fits, also improved.

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  22. Oligoantigenic diet treatment of children with epilepsy and migraine, Egger J, Carter CM, Soothill JF, Wilson J, Journal of Pediatrics 1989 Jan;114(1):51-8
    Of 45 children with epilepsy and recurrent headaches, abdominal symptoms, or hyperkinetic behavior [old name for ADHD], 36 [80%] improved on an oligoantigenic diet . . . "Headaches, abdominal pains, and hyperkinetic behavior ceased in all those whose seizures ceased, and in some of those whose seizures did not cease." . . . "Of 24 children with generalized epilepsy, 18 [75%] recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 [85%] children with partial epilepsy. In double-blind, placebo-controlled provocation studies, symptoms recurred in 15 of 16 children, including seizures in eight; none recurred when placebo was given. Eighteen other children, who had epilepsy alone, were similarly treated with an oligoantigenic diet; none improved."

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  23. Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior, Egger J, Carter CH, Soothill JF, Wilson J, Clinical Pediatrics (Phila) 1992 May;31(5):302-7
    "Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. [daytime or nighttime bed wetting] On diet, the enuresis stopped in 12 of these children and improved in an additional four. [76%] ... Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods."

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  24. Hyperkinesis and learning disabilities linked to artificial food flavors and colors. Feingold, BF. The American Journal of Nursing, 1975 May;75(5):797-803.
    "... It is important to recognize that this entire behavioral pattern is beyond the child's voluntary control. He does not choose to be a failure nor does he want to be bad. It is as though something within is driving him. He is like a revved up motor with the throttle stuck. Discipline achieves nothing but invites rebellion and further frustration, precipitating displays of temper and tantrums."

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  25. Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors. Feingold, BF. Journal of Learning Disabilities, 1976. Vol.9(9) pp.19-27
    " The historical background of hyperkinesis and learning disabilities is reviewed briefly and followed by a discussion of food additives. Focus on artificial food colors and flavors as important etiologic agents is explained and supported ..."

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  26. Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors, Feingold, BF. Speech to American Academy of Pediatrics, New York Hilton Hotel, November 8, 1977.
    " Recognizing that any compound under the appropriate conditions can induce adverse reactions, including behavioral disturbances, it becomes necessary to evaluate each compound or class of compounds on the basis of benefit compared with risk. ... colors and flavors have no nutritional value whatsoever. If they were removed from our food supply, nothing nutritionally would be lost. Therefore, on balance, the risk outweighs the benefit."

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  27. Food additives in dentistry., Feingold, BF. Journal of the American Society for Preventive Dentistry, 1977 Jan-Feb;7(1):13-5.
    " The presence of food additives in products used in dental procedures may have serious consequences for many patients. Hyperactivity and learning disabilities as well as buccal, gingival and oral cankers have occurred following the use of diagnostic aids. Furthermore, hyperkinetic patients, whose symptoms have been controlled by withdrawal of all artificial colors and flavors from their diets, have suffered relapses following a dental visit. These problems should be recognized by practitioners because only by the concerted efforts of professionals in the field will diagnostic aids free of artificial color and flavor become available."

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  28. Dietary management of juvenile delinquency. Feingold, BF. International Journal of Offender Therapy and Comparative Criminology, Vol 23(1) 1979.
    " This disenchantment with present-day rehabilitation techniques prompted the Ford Foundation in its annual report for 1977 to recommend that the role in delinquency of biochemical and organic factors, with a focus on nutrition be investigated.
    . . .
    We have now managed approximately 600 children with the diet. Initially, our successes for control of observed behavior ranged between 30 and 50 percent; however, since we are emphasizing the elimination of BHT (butylated hydroxtoluene) and BHA (butylated hydroxyanisole) our successes for control of behavior average between 60 to 70 percent of our samples."

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  29. The role of diet in behaviour. Feingold BF., Ecology of Disease 1982;1(2-3):153-65
    "The behavioural disorders, frequently labelled hyperkinesis, hyperkinetic impulse disorder, hyperactivity, Minimal Brain Dysfunction (MBD) and Attentional Deficit Disorder (ADD), are among the most critical problems of our contemporary culture.

    "Truancy, vandalism, violence and assault among school children coupled with a persistent drop in scholastic achievement is a universal problem affecting the school population of every so-called developed country. Every procedure for the control of behavioural disorders has not been successful; every technique for the improvement of learning has not been productive, while every modality for the rehabilitation of delinquents has failed us. Since all these procedures have been structured upon psychosocial concepts, it becomes necessary to look elsewhere for the answers, which is to the biosciences, including genetics, molecular genetics, pharmacogenetics, behavioural toxicology, behavioural teratology, immunochemistry, immunology, allergy and endocrinology, with a focus upon nutrition, which encompasses all these disciplines.
    ...
    The increase in behavioural disorders accompanied by a persistent drop in scholastic performance coupled with the continuing rise in the prevalence of delinquency is undoubtedly one of the most important expressions of the disruption of nature by the rising concentration of pollutants in the ecosystem. The prospect for controlling and eliminating the major contaninants of the environment is not too promising for the immediate future; however, an informed public, which should lead to greater commitment and involvement, would be followed by the containment and then reversal and resolution of this critical and important present-day situation involving the health and behaviour of both our contemporary population and also future generations. Public recognition and participation in the problem are mandatory to correct the insidious downgrading of the human race, which is already evident. "

    Dr. Feingold finalized this paper in the few days before his death. He had not had time to list his references, and the editors noted that they had decided to publish it without them.

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  30. Salicylate sensitivity in children reported to respond to salicylate exclusion. Fitzsimon M, Holborow P, Berry P, Latham S, Medical Journal of Australia 1978 Dec 2;2(12):570-2
    Twelve children, aged six to 13 years, whose parents reported an improvement in behavioural problems with use of the Feingold (K-P) diet for an average period of 12 months, were challenge-tested with 40 mg of acetylsalicylic acid in a double-blind, cross-over trial with ascorbic acid as a placebo. ... significance was reached in tests of general cognitive capacity, line walking and the "finger-to-nose" tests, as well as increased disturbance in sleep patterns in these children.

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  31. Sulfanilic acid: behavioral change related to azo food dyes in developing rats. Goldenring JR, Batter DK, Shaywitz BA., Neurobehavioral Toxicology and Teratology. 1982 Jan-Feb;4(1):43-9.
    " The effects of sulfanilic acid, a major azo food dye metabolite, were studied in normal developing rat pups and pups treated with 6-hydroxydopamine (60HDA). Chronic daily intraperitoneal injection of sulfanilic acid during the first postnatal month elicited hyperactivity and impaired shock escape performance in vehicle pups. ... These findings, which are similar to the results of our study of chronic administration of a food dye mix, suggest that sulfanilic acid may be one of the causative agents in food dye-induced behavioral changes in developing rats. ... "

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  32. Effects of artificial colors on hyperkinetic children: a double-blind challenge study. Goyette GH, Connors CK, Petti TA, Curtis LE, Psychopharmacol Bull 1978 Apr;14(2):39-40
    "Summary: ... In the first trial there was suggestive evidence that performance on a visual-motor tracking task may be impaired following ingestion of challenge material. Three "dye-sensitive" children retested in the laboratory gave results consistent with an impairment of attention and visual motor tracking 1 hour after cookie ingestion... A second study showed significant effects on parent ratings when these were limited to a 3-hour period immediately following ingestion of the cookies, suggesting that artificial food dyes do indeed impair and disrupt the behavior of the children..."

    Note: The "challenge" dose of food dyes is not specified, but implied to be 13 mg. This tiny amount still resulted in a trend of performance deficits on a visual motor tracking task after challenge but not after placebo. The deficits were more pronounced in younger children. This is not surprising because 13 mg is a larger "dose" per body weight for a smaller child.

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  33. Developmental neurotoxicity of industrial chemicals, Grandjean P, Landrigan PJ., Lancet 2006 Dec 16;368(9553):2167-78
    ". . . A few industrial chemicals (eg, lead, methylmercury, polychlorinated biphenyls [PCBs], arsenic, and toluene) are recognised causes of neurodevelopmental disorders and subclinical brain dysfunction. Exposure to these chemicals during early fetal development can cause brain injury at doses much lower than those affecting adult brain function. . . . Despite an absence of systematic testing, many additional chemicals have been shown to be neurotoxic in laboratory models. The toxic effects of such chemicals in the developing human brain are not known and they are not regulated to protect children. The two main impediments to prevention of neurodevelopmental deficits of chemical origin are the great gaps in testing chemicals for developmental neurotoxicity and the high level of proof required for regulation. New, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals."

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  34. The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders. Gross MD, Tofanelli RA, Butzirus SM, Snodgrass EW., J Am Acad Child Adolesc Psychiatry. 1987 Jan;26(1):53-5.
    " Thirty-nine children in a summer camp were given the Feingold Diet, which eliminates artificial additives and salicylate-containing foods, for 1 week, followed by administration for 1 week of food containing those ingredients. The behavior of all children was monitored by videotape for 4-minute intervals at mealtime. All children were classified by public school psychologists as having moderate to severe learning disorder; 18 were also hyperkinetic, and 17 were taking medication for the latter condition. Three raters blind to the respective diets the children were on rated the children's behavior for motor restlessness, disorganized behavior, and misbehavior. No significant differences were found in behaviors during weeks 1 and 2. The authors conclude that the Feingold Diet has no beneficial effect on most children with learning disorders, or on hyperkinetic children taking medication."

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    Note: Because this study has been cited occasionally as the "definitive" study on the Feingold diet, it deserves some extended comment:

    They were studying a diet recommended for children with ADHD, which usually takes more than one week to "show" an effect, and longer when a child is on medication.

    However,

    1. More than half the children in the study did not have ADHD.
    2. All but one of the children with ADHD were on medication the whole time.
      • If the medication worked well, how would they measure a diet effect?
      • The medication itself contained coloring - counteracting any diet effect.
    3. The one child not on medication was sent home because his behavior got worse when given the additives in Week 2
    4. One other child was sent home in Week 2 because his behavior got worse. It was concluded that his medication (Cylert) was "not strong enough" in Week 2 (when additives were used).
    5. Notice that the video taping was done during mealtime to measure a reaction expected to occur only several hours after mealtime.
    6. Notice that the raters were "blind to the respective diets."
      • Dr. Gross - the primary investigator - was one of the three raters. Since he would be seeing the film, taken during meals, and could SEE whether or not there was ketchup on the tables, are we to truly believe that he was "blind" to the respective diets, as reported?
      • Alternatively, if the camera angle was so wide that all children were visible at once and details such as condiment bottles could not be seen, how well could the children themselves be seen for observation of their behavior?
    7. The children were not told that they were on a "diet" - they were told that the "good stuff" had not yet arrived. Is it very surprising that they were negative?
    8. Mustard was eliminated, for reasons unknown - appropriate brands of mustard are acceptable on the Feingold diet.
    9. Snacks and treats were eliminated, for reasons unknown - appropriate brands of candy and other treats are acceptable on the Feingold diet.
    10. Coloring, flavoring, and fragrances were apparently not eliminated, however, in personal toiletries, medications taken by the children, and cleaning supplies used by the camp, over which there was apparently no effort made at control.
    11. Nevertheless, the camp director and teachers were united in their observation that the children were noisier during the second (additive-rich) week. This was duly noted but discounted by the researchers.
    12. The researchers acknowledged that a one-week trial of the diet is short, but defended it by saying that people already using the Feingold diet say that eating something "off-diet" causes a reaction within a few hours.
      • This is only relevant AFTER a good response to the diet.
      • No initial response to the diet is expected, usually, until after one to several weeks.
      • Children on psychoactive medication or recently off it take longer to respond to the diet than do those who have never been on such medications. This has been reliably observed since the 1960's by Dr. Feingold, by other doctors using the diet, and by the Feingold Association.

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  35. Hyperkinesis and food additives: testing the Feingold hypothesis. Harley JP, Ray RS, Tomasi L, Eichman PL, Matthews CG, Chun R, Cleeland CS, Traisman E, Pediatrics 1978 Jun;61(6):818-28
    " Teacher ratings, objective classroom and laboratory observational data, attention-concentration, and other psychological measures obtained on 36 school-age, hyperactive boys under experimental and control diet conditions yielded no support for the Feingold hypothesis. Parental ratings revealed positive behavioral changes for the experimental diet; however, they seemed primarily attributable to one diet sequence. Parents' behavioral ratings on ten hyperactive, preschool boys indicated a positive response to the experimental diet; again, laboratory observations showed no diet effect. "

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    Note: This study was funded by the "Nutrition Foundation," a food additive and chemical industry organization. Harley claimed he found "no support" for the diet. Nevertheless, 100% of preschoolers and 63% of the group of older children who had done the "control" diet first improved on the Feingold diet in this study. Harley discounted the 63%, claiming an "order effect."

    Upon reading the analysis of the Harley study by Dr. Bernard Weiss, Professor of Toxicology at University of Rochester School of Medicine and Dentistry, it becomes clear that there was no actual "order effect" for the older children.

    Without arguing the point, suffice it to say that the two groups of older children were not equal. The ones who were put on the Feingold diet after the control diet where off their medications several weeks longer than the ones put on the Feingold diet first. Since it was already known that stimulant medications increase the time necessary before an effect of diet is seen, we wonder why they were surprised to find this happening in this study (where those on the "control" diet first would have been off the meds several weeks more than the ones doing the Feingold diet first).

    You can see another detailed analysis of the Harley study (and others).

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  36. Nutrient intakes of children on the hyperkinesis diet. Harper PH, Goyette CH, Conners CK, J Am Diet Assoc 1978 Nov;73(5):515-9
    "The nutrient intakes of fifty-four hyperactive children during a baseline period and while following the hyperkinesis diet were calculated. During both periods, mean dietary intakes compared favorably with the Recommended Dietary Allowances. ..."

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  37. The management of hyperkinetic children: a trial of dietary therapy. Hindle RC, Priest J , N Z Med J 1978 Jul 26;88(616):43-5
    "... Ten hyperkinetic children have been treated with the diet, five of whom improved dramatically and are now off all other therapy. Their response to accidental and deliberate challenge supports the hypothesis that the dietary regime described has been responsible for their improvement."

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  38. The effect of the Feingold diet on 'normal' school children. Holborow P, Elkins J, Berry P, J Learn Disabil March 1981 vol. 14 no. 3 143-147
    "Approximately 300 children in seven primary (elementary) schools used the Feingold diet for two weeks. Ratings were made by teachers before and after use of the diet on questionnaires developed from Conners' long teacher questionnaire. . . Of the total sample, 8.5% improved by five points or more. The mean before diet scores of children who improved were below the cut off value for hyperactivity, indicating hyperactivity itself is not a necessary condition for improvement. Item by item analysis of the response showed that the behavior problems mostly likely to show improvement were distractability, attention span, fiddling, and demands for attention. Parents provided information on the additive foods being ingested by their children. Those children who were reported to be taking a great deal of additive were found to rate significantly higher in behavioral problems compared with children receiving little additive."

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  39. ADHD Is Associated With a 'Western' Dietary Pattern in Adolescents. Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. Journal of Attention Disorders 2010 Jul 14. [Epub ahead of print]
    "... The Raine Study is a prospective study following 2,868 live births. At the 14-year follow-up, the authors collected detailed adolescent dietary data . . . Results: Data were available for 1,799 adolescents, and a total of 115 adolescents had an ADHD diagnosis. Two major dietary patterns were identified: "Western" and "Healthy." A higher score for the "Western" dietary pattern was associated with ADHD diagnosis . . . ADHD diagnosis was not associated with the "Healthy" dietary pattern.

    Note: The "Western" diet would be high in fats, true - but it would also be high in food additives.

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  40. Estimates of dietary exposure of children to artificial food colours in Kuwait. Husain A, Sawaya W, Al-Omair A, Al-Zenki S, Al-Amiri H, Ahmed N, Al-Sinan M., Food Additives & Contaminants 2006 Mar;23(3):245-51.
    "To assess the intake of artificial food colour additives by 5-14-year-old children in the State of Kuwait, a 24-h dietary recall was conducted twice on 3141 male and female Kuwaiti and non-Kuwaiti children from 58 schools. ... The results indicated that out of nine permitted colours, four exceeded their ADIs (acceptable daily intake) by factors of 2-8: tartrazine (E102/Yellow #5), sunset yellow (E110/Yellow #6), carmoisine (E122/not used in USA) and allura red (E129/Red #40). ... Further, follow-up studies to provide insight into potential adverse health effects associated with the high intakes of these artificial colour additives on the test population are warranted."

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  41. Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl. Inomata N, Osuna H, Fujita H, Ogawa T, Ikezawa Z., Allergology International. 2006 Jun;55(2):203-5.
    "We present a 5-year-old girl who suffered from recurrent reactions accompanied by urticaria, angioedema, headaches, dyspnea, loss of consciousness, and abdominal pain that were not eradicated, but were instead exacerbated, by various treatments with antihistamines and intravenous corticosteroids. Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. . . .

    RESULTS:
    Open challenge tests with Tartrazine, aspirin and acetaminophen were positive . . . Consequently, intolerance to azo dyes and NSAIDs such as aspirin was diagnosed. However, she appeared to react to multiple chemical odors such as those of cigarette smoke, disinfectant, detergent, cleaning compounds, perfume, and hairdressing, all while avoiding additives and NSAIDs. On the basis of her history and the neuro-ophthalmological abnormalities, a diagnosis of severe MCS was made and she was prescribed multiple vitamins and glutathione.

    CONCLUSIONS:
    The present results suggest that in pediatric MCS, food and drug additives containing azo dyes might play important roles as elicitors."

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  42. The Potential Health Hazard of Tartrazine and Levels of Hyperactivity, Anxiety-Like Symptoms, Depression and Anti-social behaviour in Rats. (Scroll down to #183), Kamel MM, El-lethey HS, Journal of American Science, 2011;7(6)
    " The current research aimed to determine the influence of different doses of exposure to tartrazine [Yellow 5] on levels of hyperactivity, anxiety, depression and anti-social behaviours in rats. . . Tartrazine-treated rats showed hyperactivity in open field test presented by increased horizontal locomotion. . . Furthermore, tartrazine intake significantly promoted depression as expressed by prolonged immobilization during forced swim test. Impairment in social interaction test was also detected . . . This study provides sufficient scientific evidence that a causal link truly exists between tartrazine and inflection of hyperactivity, anxiety and depression-like behaviours in rats and points to the hazardous impact of tartrazine on public health. "

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  43. Overall Nutrient Intake of Preschool Hyperactive and Normal Boys, B.Kaplan et al, Journal of Abnormal Child Psychology, April 1989, Vol. 17(2), pp.127-32
    "...concluded that nutrition-behavior interactions are more likely a function of idiosyncratic sensitivities, rather than a general tendency for ADDH children to eat differently..."

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  44. Dietary Replacement in Preschool-Aged Hyperactive Boys, B.Kaplan, et al, Pediatrics, 1989, Vol. 83, pp. 7-17
    "More than half the subjects exhibited reliable improvement in behavior and negligible placebo effects.  In addition, several nonbehavioral variables tended to improve ... particularly halitosis, night awakenings, and latency to sleep onset."

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  45. Nutritional status of children with attention deficit hyperactivity disorder: a pilot study. Kiddie JY, Weiss MD, Kitts DD, Levy-Milne R, Wasdell MB., International Journal of Pediatrics, 2010:767318. Epub 2010 Jun 28.
    " Objective. This is a pilot study of the dietary intake and nutrient status of children with Attention Deficit Hyperactivity Disorder (ADHD). Method. Nutritional assessment of 43 children aged 6-12 with ADHD was performed using a 3-day food record, 24-hour recall, and serum assessors. Results. Macronutrient intake and consumption of Low-Nutrient Foods were comparable to population norms; however, 66% were found to be deficient in zinc and 23% in copper. Conclusions. This pilot study reports the food intake and nutrient status of children with ADHD and shows a predisposition for low zinc and copper status in ADHD. "

    Note: This means they are deficient in spite of adequate intake - not surprising in light of Ward's finding that kids with ADHD lose zinc when they eat things with Yellow 5 or 6.

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  46. Erythrosin B inhibits dopamine transport in rat caudate synaptosomes. Lafferman JA, Silbergeld EK, Science. 1979 Jul 27;205(4404):410-2.
    " . . . We found that erythrosin B [Red 3] inhibits dopamine uptake in rat caudate synaptosomes "uncompetitively" in the 10- to 800-micromolar range. . . . Erythrosin B also decreased nonsaturable binding of dopamine to the synaptosome membrane. The inhibitory action of erythrosin B on dopamine uptake is consistent with the hypothesis that erythrosin B can act as a central excitatory agent able to induce hyperkinetic [ADHD] behavior. "

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  47. Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test. Lau K, McLean WG, Williams DP, Howard CV., Toxicol Sci. 2006 Mar;90(1):178-87, 2005 Dec 13; [Epub ahead of print]
    " Exposure to non-nutritional food additives during the critical development window has been implicated in the induction and severity of behavioural disorders such as attention deficit hyperactivity disorder (ADHD). . . We therefore examined the neurotoxic effects of four common food additives in combinations of two (Brilliant Blue and L-glutamic acid, Quinoline Yellow and aspartame) to assess potential interactions. . . Neurotoxicity was measured as an inhibition of neurite outgrowth. . . . Theoretical exposure to additives was calculated based on analysis of content in foodstuff, and estimated percentage absorption from the gut. Inhibition of neurite outgrowth was found at concentrations of additives theoretically achievable in plasma by ingestion of a typical snack and drink. . . both combinations had a straightforward additive effect on cytotoxicity. These data have implications for the cellular effects of common chemical entities ingested individually and in combination. "

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  48. Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Levy F, Dumbrell S, Hobbes G, Ryan M, Wilton N, Woodhill JM, Medical Journal of Australia 1978 Jan 28;1(2):61-4
    "...The rating scales and objective tests for the full sample did not show a statistically significant deterioration in the children's behaviour when they were challenged under double-blind test conditions with the Yellow Dye No. 5, tartrazine, and the tests were conducted the day after a two-week challenge period. ... a subgroup of the children... indicated a significant challenge effect, with mothers reporting more symptoms during the challenge period."

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    NOTE: Tests were conducted the day AFTER challenge, and results of all children were averaged which may make any individual reactions invisible. Moreover, the "challenge" was 5 biscuits per day, each containing ONE mg of Tartrazine — a total per day of about ONE SWALLOW of Koolaid -- a very tiny dose indeed!

    Nevertheless, astonishingly, some of the children still reacted to this dye challenge!

    See also the Full Text of a second similar study by Levy, using only 8 children (one, who reacted strongly to the challenge was dropped from the study). In spite of again using only ONE mg Tartrazine per biscuit for the challenge, the results "just missed" significance statistically.

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  49. Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E. American Journal of Public Health. 2006 Oct;96(10):1815-20
    " ... A cross-sectional population-based survey was conducted with 10th-grade students in Oslo, Norway (n = 5498). ... The relationship was linear for hyperactivity. ... the association between soft drink consumption and mental health problems remained significant after adjustment for behavioral, social, and food-related variables. The highest adjusted odds ratios were observed for conduct problems among boys and girls who consumed 4 or more glasses of sugar-containing soft drinks per day. CONCLUSIONS: High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders."

    Note: It has been concluded by some reporters that the cause of the behavioral deterioration is the high fructose corn syrup in these sodas, but there are many chemicals besides sugar or corn syrup included in sodas. Consider the combination of synthetic coloring, flavoring, and sodium benzoate, as suggested culprits.

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  50. Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study., Mattes JA, Gittelman R., Archives of General Psychiatry. 1981 Jun;38(6):714-8
    " ... We sought to maximize the likelihood of demonstrating behavioral effects of artificial food colorings by (1) studying only children who were already on the Feingold diet and who were reported by their parents to respond markedly to artificial food colorings, (2) attempting to exclude placebo responders, and (3) administering high dosages of coloring. ... Evaluations by parents, teachers, and psychiatrists and psychological testing yielded no evidence of a food coloring effect."

    Full Text || Get Password || See review by Bernard Rimland, PhD

    Notes:

    1. Their "high dose" of coloring did not even change the color of the cookies from identical cookies without coloring.
    2. According to parents involved in the study, some children could not eat all the cookies, so they did not receive even that small dose of coloring.
    3. Evaluations were not always done 1 1/2 hours after eating a cookie - we have a report from one parent that she was unable to give her child the cookie and then drive to the meeting place.
    4. This same parent reports her child's reactions were so severe that the after-school dance teachers could not keep her in class, and she missed school because reactions included ear infections. You can read an excerpt of her letter here.
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  51. The Feingold diet: a current reappraisal. Mattes JA, Journal of Learning Disabilities, 1983 Jun-Jul;16(6):319-23.
    "The Feingold diet, eliminating artificial colorings, artificial flavorings, and salicylates, has been claimed, based on anecdotal evidence, to improve the learning and behavior of hyperactive children. A review of all published, completed controlled studies, however, indicates that the Feingold diet is probably not effective, except perhaps in a very small percentage of children. The positive results in a few studies have been inconsistent between studies and greatly outnumbered by negative results. Even among children whose parents feel the diet has helped them greatly, the improvement seems more often a placebo effect, e.g., due to the increased attention the child is receiving, than a true effect of artificial colorings or flavorings."

    Note: This is the source of the often-heard mantra of "anecdotal evidence," "weight of the evidence," and "increased attention" ... These statements were not actually true at that time - but even had they been true, they were made back in 1983, and much double-blind ("gold standard") research has been done since then.

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  52. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Lancet, September 6, 2007 on line.
    "Artificial colours or a sodium benzoate preservative (or both) in the diet result in increased hyperactivity in 3-year-old and 8/9-year-old children in the general population."

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  53. Disturbed children: the role of food and chemical sensitivities. Menzies IC. Nutr Health. 1984; 3(1-2): 39-54.
    " . . . A number of case studies are presented which suggest that the difficulties encountered by a significant number of these children have much to do with idiosyncratic responses to foods and additives. . . . if validated it will have far reaching implications for the assessment and management of disturbed, delinquent and learning disordered children. Perhaps not enough attention has been paid to the role of biological and environmental factors in the development of children's problems. "

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  54. A preliminary investigation of ADHD symptoms in persons with celiac disease., Niederhofer H, Pittschieler K., Journal of Attention Disorders, 2006 Nov;10(2):200-4.
    "Several studies report a possible association of celiac disease (CD) with psychiatric and psychological disturbances, such as ADHD. METHOD: The authors assess 132 participants from 3 to 57 years of age ... affected by CD for the possibility of an associated ADHD-like symptomatology ... before their gluten-free diet was started and 6 months later. RESULTS: The overall score improves significantly as well as most of the ADHD-like symptomatology ... CONCLUSION: The data indicate that ADHD-like symptomatology is markedly overrepresented among untreated CD patients and that a gluten-free diet may improve symptoms significantly within a short period of time. "

    Notes:

    1. A gluten-free diet would eliminate many processed foods, thereby automatically reducing the ingestion of additives.
    2. Some people with ADHD, even on the Feingold Program, do better when they eliminate gluten and/or casein. Since Celiac Disease can also be present without frank symptoms of GI disturbance, this connection is very interesting.

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  55. Artificial food colouring and hyperactivity symptoms in children., No Author Listed, Prescrire International, 2009 Oct;18(103):215.
    Abstract:
    1. A hypothesis has been proposed that artificial food colourings have a role in exacerbating hyperactive behavior in children;

    2. A placebo-controlled, double-blind, crossover clinical study in 297 children representative of the general population showed higher hyperactivity scores during the periods when they were ingesting food colourings;

    3. A meta-analysis of 15 double-blind clinical trials that evaluated artificial food colouring in children already considered to be hyperactive showed an increase in their hyperactive behavior;

    4. In practice, even though the mechanism underlying this phenomenon has not been elucidated, these data suggest that it is best to avoid exposing children to artificial food coloring.

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  56. Unusual reactions to food additives, Novembre E, Dini L, Bernardini R, Resti M, Vierucci A, Pediatria Medica e Chirurgica 1992 Jan-Feb;14(1):39-42
    "...In this study, we report two cases of unusual reactions to food additives (tartrazine [Yellow 5] and benzoates) involving mainly the central nervous system (headache, migraine, overactivity, concentration and learning difficulties, depression) and joints (arthralgias), confirmed with diet and double blind challenge."

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  57. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial., Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK. Lancet. 2011 Feb 5;377(9764):494-503.
    "... 100 children were enrolled and randomly assigned to the control group (n=50) or the diet group (n=50). Between baseline and the end of the first phase, the difference between the diet group and the control group in the mean ARS [ADHD Rating Scale] total score was 23·7 according to the masked ratings. ... In the challenge phase, after challenges with either high-IgG or low-IgG foods, relapse of ADHD symptoms occurred in 19 of 30 (63%) children, independent of the IgG blood levels...INTERPRETATION: A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged."

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    Several letters to the editor of Lancet, and author's reply
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  58. Effects of food on physical and sleep complaints in children with ADHD: a randomised controlled pilot study., Pelsser LM, Frankena K, Buitelaar JK, Rommelse NN. European Journal of Pediatrics, 2010 Apr 17. [Epub ahead of print]
    "... Dietary intervention studies have shown convincing evidence of efficacy in reducing ADHD symptoms in children. In this pilot study, we investigated the effects of an elimination diet on physical and sleep complaints in children with ADHD. . . The number of physical and sleep complaints was significantly decreased in the diet group compared to the control group . . . headaches or bellyaches, unusual thirst or unusual perspiration, and sleep complaints. . . An elimination diet may be an effective instrument to reduce physical complaints in children with ADHD"

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  59. A randomised controlled trial into the effects of food on ADHD. Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Pereira RR, Buitelaar JK. European Child & Adolescent Psychiatry. 2009 Jan;18(1):12-9. Epub 2008 Apr 21.

    "The aim of this study is to assess the efficacy of a restricted elimination diet in reducing symptoms in an unselected group of children with Attention deficit/hyperactivity disorder (ADHD). . . the number of clinical responders in the intervention group was significantly larger than that in the control group [parent ratings 73% vs 0%; teacher ratings, 70% vs 0%]. . . symptoms of oppositional defiant disorder also showed a significantly greater decrease in the intervention group than it did in the control group . . ."

    Note: They used a diet which eliminates milk, wheat, eggs, chicken, and beef as well as additives. This would pick up allergies or intolerance to any of these items. Otherwise, the diet is basically an extreme version of the standard Feingold diet.

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  60. Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study Pelsser LM, Buitelaar JK, Ned Tijdschr Geneeskd 2002 Dec 28;146(52):2543-7
    " .. 36 boys and 4 girls, aged 3-7 (average 4.8 years), who met the DSM-IV-criteria for ADHD, followed their usual diet for two weeks and thereafter for two weeks an elimination diet, based on the few foods diet (rice, turkey, pear and lettuce). ... 25 children (62%) showed an improvement in behaviour of at least 50% on both the Conners list and the ADHD Rating Scale at the end of the elimination diet. Nine children (23%) withdrew from the study because the parents were unable to stick to the diet or because the child fell ill. Among the 15 children with both parent and teacher ratings, 10 [66%] responded both at home and in school. CONCLUSION: In young children with ADHD an elimination diet can lead to a statistically significant decrease in symptoms. "

    Note: This study was done in Holland where a Feingold Foodlist is not available. Their diet was very much more limited than the usual Feingold diet. Since 9 children dropped out, the number of children who completed the 2-weeks trial of the diet was only 31. Thus, 25 children improving would be 80.6% of them. This is in line with the results we see of those who try the Feingold diet, in spite of the fact that two weeks is a very short trial for any diet.

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  61. Effect of artificial food colours on childhood behaviour. , Pollock I, Warner JO, Arch Dis Child 1990 Jan;65(1):74-7, Heart and Lung Institute, Brompton Hospital, London.

    "... 19 children completed a double blind placebo controlled challenge study with artificial food colours. In these children food colours were shown to have an adverse effect on a daily Conners' rating of behaviour, but most parents could not detect these changes. A pharmacological mechanism of food additive intolerance is proposed to explain these effects."

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  62. Effect of organic synthetic food colours on mitochondrial respiration. Reyes FG, Valim MF, Vercesi AE. Food Additives and Contaminants. 1996 Jan;13(1):5-11
    " ... The compounds tested were: Erythrosine, Ponceau 4R, Allura Red, Sunset yellow, Tartrazine, Amaranth, Brilliant Blue, Blue, Fast Red E, Orange GGN and Scarlet GN. All food colours tested inhibited mitochondrial respiration ...This inhibition varied largely, e.g. from 100% to 16% for Erythrosine and Tartrazine respectively, ...This effect was dose related .... "

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  63. Food additives and hyperactive children: a critique of Conners. Rippere V, Br J Clin Psychol 1983 Feb;22 Pt 1:19-32
    " Food Additives and Hyperactive Children (Conners, 1980) is the first book-length attempt to evaluate Feingold's additive and salicylate-free Kaiser-Permenente diet for the treatment of hyperactive children, and as such it requires critical scrutiny. . .It is argued that the studies as reported do not constitute a methodologically adequate test of Feingold's hypothesis . . . and that it is thus premature to reject the hypothesis on the grounds presented here. . . "

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  64. The functional relationship between artificial food colors and hyperactivity.    Rose TL, J Appl Behav Anal 1978 Winter;11(4):439-46
    " . . .Two eight-year-old females, who had been on the Feingold K-P diet for a minimum of 11 months, were the subjects studied. The experimental design was a variation of the BAB design, with double-blind conditions. This design allowed an experimental analysis of the placebo phases as well as challenge phases. Data were obtained by trained observers on Out of Seat, On Task, and Physically Aggressive behaviors, as they occurred in the subjects' regular class setting. Results indicated (a) the existence of a functional relationship between the ingestion of artificial food colors and an increase in both the duration and frequency of hyperactive behaviors, (b) the absence of a placebo effect, and (c) differential sensitivity of the dependent variables to the challenge effects. "

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  65. Synthetic Food Colourings and "Hyperactivity": a Double-Blind Crossover Study, K.S.Rowe, Australia Paediatric Journal, April 1988, Vol. 24 (2), pp. 143-7
    40 of 55 children (72.7%) put on a 6-week trial of the Feingold Diet "... demonstrated improved behaviour."  26 of them (47.3%) remained improved following "liberalization" of the diet over a 3-6 month period.

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  66. Synthetic Food Coloring and Behavior:  A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study, K.S.Rowe, K.J.Rowe, Journal of Pediatrics, November 1994, Vol. 135, pp.691-8

    150 of 200 children [75%] improved on an open trial of a diet free of synthetic food coloring, and deteriorated upon introduction of foods containing synthetic colorings.

    34 other "clear" or "suspected" reactors plus 20 "controls" were studied in a separate double blind study. 82.5% of the "suspected reactors,", 27% of the "uncertain reactors," and 10% of the "controls" reacted to a mild single-item challenge of tartrazine (Yellow #5). Kind of reaction and length of time the children were affected depended on the dose. Rowe reported that a dose response effect was observed.

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  67. Physiological changes in hyperactive children following the ingestion of food additives. Salamy J, Shucard D, Alexander H, Peterson D, Braud L, International Journal of Neuroscience 1982 May;16(3-4):241-246
    "... The physiological measures [EEG and heart rate] were obtained prior to and following the ingestion of drinks containing food additives or placebos, which were administered in a double-blind, randomized, crossover procedure. ... the magnitude of physiological changes in the hyperactive children were greater in response to ingestion of the additives than to placebo. These physiological findings are consistent with behavioural data indicating that some hyperactive children are adversely affected by food additives.

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  68. Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome. Salzman LK, Medical Journal of Australia 1976 Aug 14;2(7):248-51
    Thirty-one children with behavioural problems and learning difficulties were allergy tested ... 15 of these were given the Australian Version of the Feingold K.P. diet. Ninety-three per cent (93%) responded with improved behaviour in the areas of overactivity, distractability, impulsiveness and excitability. Sleep and enuresis problems were resolved partially or completely. This study demonstrates that the aforementioned elimination diet significantly affects behaviour.

    Note: Many people who don't "test positive" on such tests still respond well to the diet. Allergy testing may be useful if positive, but does not rule out response to diet management if negative.

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  69. Synthetic Food Colouring and Behavioural Change in Children with Attention Deficit Disorder: A Double-Blind, Placebo Controlled, Repeated Measures Study.Sarantinos J, Rowe KS, Briggs DR, Proc. Nutr. Aust. 1990 pg. 233.
    "As part of their overall management, a diet excluding synthetic food colourings may be of benefit in modifying the behaviour of a small number of children with attention deficit disorder."

    Note: They used 10 mg Yellow 5 or Yellow 6. No matter how beautifully designed the study, when you use only a tiny amount of food dye as your "challenge" you won't get dramatic results.

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  70. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. Schab DW, Trinh NH, Journal of Developmental and Behavioral Pediatrics, 2004 Dec;25(6):423-34.
    " ... We searched ten electronic databases for double-blind placebo-controlled trials evaluating the effects of AFCs [artificial food colors]. ... Despite indications of publication bias and other limitations, this study is consistent with accumulating evidence that neurobehavioral toxicity may characterize a variety of widely distributed chemicals. "

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  71. Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial. , Schmidt MH, et al., Eur Child Adolesc Psychiatry, 1997 Jun;6(2):88-95.
    "Effects of diet were compared with those yielded by stimulant medication (methylphenidate). ... Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions ... The amount of positive changes in behavior in those who received both treatments was about the same... dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children ..."

    NOTE: These were children with conduct-disorder as well as ADHD. 44% responded to Ritalin while 24% responded equally well to a Feingold-type diet.

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  72. Applied Nutrition and Behavior, S.Schoenthaler, J.Moody, L.Pankow, Journal of Applied Nutrition, November 1, 1991, Vol. 43
    Review of studies at California State University; implementation of "nutrient dense diets" in 813 state facilities "resulted in significantly improved conduct, intelligence, and/or academic performance..."

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  73. The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools, Schoenthaler SJ, Doraz WE, Wakefield JA, Int J Biosocial Res., 1986, 8(2); 185-195.

    " The introduction of a diet policy which lowered sucrose, synthetic food color/flavors, and two preservatives (BHA and BHT) over 4 years in 803 public schools was followed by a 15.7% increase in mean academic percentile ranking above the rest of the nation's schools who used the same standardized tests. Prior to the 15.7% gain, the standard deviation of the annual change in nation percentile rating had been less than 1% . . ., after the policy transitions, the percent of students who ate school lunches and breakfasts within each school became positively correlated with that school's rate of gain (r = .28, p < .0001)."

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  74. Effects of chronic administration of food colorings on activity levels and cognitive performance in developing rat pups treated with 6-hydroxydopamine. Shaywitz BA, Goldenring JR, Wool RS. Neurobehav Toxicol. , 1979 Spring;1(1):41-7.
    " ... At every age the highest dose of food dye (2.0 mg/kg) produced the greatest activity. This dose also resulted in significant effects on habituation of activity. Pups who did not receive food dye decreased their activity by 32.1% over the first 30 minutes of observation while in groups who received 2.0 mg/kg of food dye a reduction in activity of only 7.25% was noted over the same time period. ..."

    Note: 2.0 mg/kg is about the same as 60 mg food dye for a 30 kg child - or the same as a single red-frosted cupcake.
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  75. Food Additives and Hyperkinesia A Critical Evaluation of the Evidence. Spring C, Sandoval J, Journal of Learning Disabilities, November 1976 vol.9 no.9 p.560-569
    " This article evaluates evidence relevant to Feingold's hypothesis that synthetic food colors and flavors cause hyperactivity. Feingold's opinion that a recent “epidemic” of hyperkinesis is due to an increase in the use of synthetic colors and flavors is examined. The authors conclude that there are no reliable data to support the belief that there has been an epidemic of hyperkinesis. Results from clinical tests and uncontrolled studies of an elimination diet are reviewed, and the contaminating effect of placebo responses is discussed. Finally, results from two recent controlled studies of the diet are examined. The authors agree with the investigators that these controlled studies show equivocal results which should be interpreted with caution. A moratorium on further public advocacy is recommended until the efficacy of the diet for a defined population is firmly established by controlled research. "

    Note: They want a "moratorium on further public advocacy" ... this means that they wanted Dr. Feingold to shut up. Note the date: 1976. It is interesting that quite a few publications more than 10 years later are still citing this article as though it would be relevant, in spite of all the research done since that time.

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  76. Dietary sensitivities and ADHD symptoms: thirty-five years of research., Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE., Clin Pediatr (Phila). 2011 Apr;50(4):279-93. Epub 2010 Dec 2.

    " . . .accumulated evidence suggests that a subgroup shows significant symptom improvement when consuming an AFC-free diet and reacts with ADHD-type symptoms on challenge with AFCs [artificial food colors]. Of children with suspected sensitivities, 65% to 89% reacted when challenged with at least 100 mg of AFC. . . . A trial elimination diet is appropriate for children who have not responded satisfactorily to conventional treatment or whose parents wish to pursue a dietary investigation. "

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  77. The Role of Histamine Degradation Gene Polymorphisms in Moderating the Effects of Food Additives on Children's ADHD Symptoms., Stevenson J, Sonuga-Barke E, McCann D, Grimshaw K, Parker KM, Rose-Zerilli MJ, Holloway JW, Warner JO., American Journal of Psychiatry. 2010 Jun 15. [Epub ahead of print]

    " Objective: Food additives can exacerbate ADHD symptoms and cause non-immunoglobulin E-dependent histamine release from circulating basophils. However, children vary in the extent to which their ADHD symptoms are exacerbated by the ingestion of food additives. The authors hypothesized that genetic polymorphisms affecting histamine degradation would explain the diversity of responses to additives. Method: In a double-blind, placebo-controlled crossover trial, challenges involving two food color additive and sodium benzoate (preservative) mixtures in a fruit drink were administered to a general community sample of 3-year-old children (N=153) and 8/9-year-old children (N=144). ... Results: The adverse effect of food additives on ADHD symptoms was moderated by histamine degradation gene polymorphisms HNMT T939C and HNMT Thr105Ile in 3- and 8/9-year-old children and by a DAT1 polymorphism (short versus long) in 8/9-year-old children only. ... Conclusions: Histamine may mediate the effects of food additives on ADHD symptoms, and variations in genes influencing the action of histamine may explain the inconsistency between previous studies. Genes influencing a range of neurotransmitter systems and their interplay with environmental factors, such as diet, need to be examined to understand genetic influences on ADHD symptoms."

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  78. Utilization of alternative therapies in attention-deficit hyperactivity disorder. Stubberfield T, Parry T, J Paediatr Child Health 1999 Oct;35(5):450-3
    "...A mailed questionnaire survey was undertaken in June 1993, of the use of various therapies by families of 381 children with ADHD. The respondent rate was 76%.... Diet therapies were the most commonly used alternative therapy (60%). ... Physicians were commonly involved in the suggestion to try a modified diet. ..."

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  79. Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test, J. Swanson, M.Kinsbourne, Science magazine, March 28, 1980, Vol. 207. pp.1485-7
    "The performance of the hyperactive children on paired-associate learning tests on the day they received the dye blend was impaired relative to their performance after they received the placebo, but the performance of the non-hyperactive group was not affected by the challenge..."

    Note: Dr. Swanson used 100 mg and 150 mg of mixed food dye in his study. In a phone conversation with this author, he said he had been told that his use of a "toxic dose" had devalued his study. When informed of the amount of food dye per tablespoon in solid bright-colored candies and frosting, green ketchup, and powdered drinks, as measured by students at an Atlanta college, he was astonished. According to his math, students at a birthday party can easily consume 500-600 mg of food dye. If 150 mg is really a "toxic dose," then we need to seriously reconsider what we are allowing in the food sold for children, and we also need to rethink the fact that manufacturers refuse to reveal just how much coloring is actually in any of their products.

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  80. Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder. Uhlig T, Merkenschlager A, Brandmaier R, Egger J, European Journal of Pediatrics 1997 Jul;156(7):557-61
    "... During consumption of provoking foods there was a significant increase in betal activity in the frontotemporal areas of the brain. This investigation is the first one to show an association between brain electrical activity and intake of provoking foods in children with food-induced attention deficit hyperactivity disorder. ..."
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  81. The influence of the chemical additive tartrazine on the zinc status of hyperactive children: A double-blind placebo-controlled study. Ward NI; Soulsbury KA; Zettel VH; Colquhoun ID; Bunday S; Barnes B, J Nutr Med; 1 (1). 1990. 51-58
    "...Tartrazine induces a reduction in serum and saliva zinc concentrations and an increase in urinary zinc content with a corresponding deterioration in behaviour/emotional responses of the hyperactive children but not the controls."

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  82. Assessment of chemical factors in relation to child hyperactivity. Ward NI, Journal of Nutritional & Environmental Medicine (Abingdon); 7 (4). 1997. 333-342.
    "...Only hyperactive children showed a significant reduction in blood serum zinc levels and an increase in urinary zinc output following the consumption of E102 [tartrazine] and E110 [sunset yellow]. . . For the 23 children who consumed a tartrazine beverage there were increased levels of overactivity (n = 18 children), aggressive (n = 16) and/or violent (n = 4) activity, poor speech (n = 2), poor coordination (n = 12), and the development of asthma and/or eczema (n = 8). Most of these were severe or moderate changes. Only one control child showed minor behavioural responses to tartrazine."

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  83. Behavioral responses to artificial food colors. Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, Cox C, McKibben J, Ogar D, Schultz S., Science 1980 Mar 28;207(4438):1487-9
    " Twenty-two young children, maintained on a diet that excluded certain foods, were challenged intermittently with a blend of seven artificial colors in a double-blind trial. Parents' observations provided the criteria of response. One child that responded mildly to the challenge and one that responded dramatically were detected. The latter, a 34-month-old female, showed a significant increase in aversive behaviors. These results further confirm previous controlled studies. "

    Note:

    • The children were not diagnosed as hyperkinetic (hyperactive).
    • Not all parents restricted the fruits and vegetables Dr. Weiss requested that they avoid.
    • 35.26 mg of mixed colors were used as the "challenge" in this study. Compare to 150 mg in one Tb green ketchup. Note also that when a challenge does not provoke worse behavior, it does not mean that the diet did not "work" but that the challenge did not "work."

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  84. Relative effects of drugs and diet on hyperactive behaviors: an experimental study. Williams JI, Cram DM, Tausig FT, Webster E., Pediatrics. 1978 Jun;61(6):811-7.
    "In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additives. . . when the children were receiving placebos, their hyperactive behaviors in the classroom were greater when eating cookies with artificial colors than when eating cookies without artificial colors. According to the ratings, approximately seven children were no longer hyperactive. There is evidence to suggest that the behavior of three to eight children was diet-responsive, depending on the criteria used. There is evidence, particularly in teacher ratings, in support of Feingold's hypothesis if it is modified. . . . "

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Last Update 04/21/2014