adhd: attention deficit (hyperactivity) disorder
Research on the dietary connection
The studies listed below are organized by date, with the most recent date first. Some of the full texts will need a password because they are kept in a locked file to protect their copyright. For educational purposes only, we are allowed to share the password with you if you write to us.
If you are trying to find a particular author, see the Index below which lists all the primary authors alphabetically with their publication dates.
- Arnold 2012
- Bateman 2004
- Bell 2013
- Bennett 1997
- Bennett 1998
- Boris 1994
- Brenner 1977
- Brenner 1979
- Burlton-Bennett 1987
- Carter 1993
- Ceyhan 2013
- Conners 1976
- Cook 1976
- Curtis 2008
- David 1987
- Dengate 2002
- Doguc 2013
- Dumbrell 1978
- Eagle 2014
- Egger 1983
- Egger 1985
- Egger 1989
- Egger 1992
- Feingold 1975
- Feingold 1976
- Feingold 1977
- Feingold 1979
- Feingold 1982
- Fitzsimon 1978
- Goldenring 1982
- Goyette 1978
- Gray 2013
- Gross 1987
- Harley 1978
- Harper 1978
- Hindle 1978
- Hoekstra 2011
- Husain 2006
- Husarova 2013
- Inomata 2006
- Kamel 2011
- Kaplan 1989
- Lafferman 1979
- Lau 2006
- Levy 1978
- Lien 2006
- Malakar 2014
- Mattes 1981
- Mattes 1983
- McCann 2007
- Menzies 1984
- Millichap 2012
- Niederhofer 2006
- Novembre 1992
- Pelsser 2002
- Pelsser 2009
- Pelsser 2010
- Pelsser 2011
- Pollock 1990
- Prescrire 2009
- Reyes 1996
- Rose 1978
- Rowe 1988
- Rowe 1994
- Saab 2012
- Salamy 1982
- Salzman 1976
- Sarantinos 1990
- Schab 2004
- Schmidt 1997
- Schoenthaler 1986
- Schoenthaler 1991
- Shaywitz 1979
- Sonuga-Barke 2013
- Spring 1976
- Starobrat-Hermelin 1998
- Stevens 2011
- Stevens 2013
- Stevens 2014
- Stevens 2014a
- Stevenson 2010
- Stevenson 2014
- Swanson 1980
- Tomova 2015
- Uhlig 1997
- Verlaet 2o14
- Vojdani 2015
- Ward 1990
- Weiss 1980
- Weiss 2012
- Whiteley 2013
- Williams 1978
Tomova 2015: Study on GI microbes & autism in Slovakia
Tomova et al., Gastrointestinal microbiota in children with autism in Slovakia.Physiology & Behavior 2015 Jan;138:179-87. doi: 10.1016/j.physbeh.2014.10.033
” Development of Autism Spectrum Disorders (ASD), including autism, is based on a combination of genetic predisposition and environmental factors. … The fecal microflora of 10 children with autism, 9 siblings and 10 healthy children was investigated by real-time PCR. The fecal microbiota of autistic children showed a significant decrease of the Bacteroidetes/Firmicutes ratio and elevation of the amount of Lactobacillus spp. … The participants in our study demonstrated strong positive correlation of autism severity with the severity of GI dysfunction. Probiotic diet supplementation normalized the Bacteroidetes/Firmicutes ratio, Desulfovibrio spp. and the amount of Bifidobacterium spp. in feces of autistic children. … This pilot study suggests the role of gut microbiota in autism as a part of the “gut-brain” axis and it is a basis for further investigation …”MedLine
Vojdani 2015: Immune reactivity to food coloring
Vojdani & Vojdani, Immune reactivity to food coloring. Alternative Therapies in Health and Medicine, 2015;21 Suppl 1:52-62
“Artificial food dyes are made from petroleum and have been approved by the US Food and Drug Administration (FDA) for the enhancement of the color of processed foods. …. However, since the use of artificial food coloring has become widespread, many allergic and other immune reactive disorders have increasingly been reported. During the past 50 y, the amount of synthetic dye used in foods has increased by 500%. Simultaneously, an alarming rise has occurred in behavioral problems in children, such as aggression, attention deficit disorder (ADD), and attention-deficit/hyperactivity disorder (ADHD). The ingestion of food delivers the greatest foreign antigenic load that challenges the immune system. Artificial colors can also be absorbed via the skin through cosmetic and pharmaceutical products. The molecules of synthetic colorants are small, and the immune system finds it difficult to defend the body against them. They can also bond to food or body proteins and, thus, are able to act in stealth mode to circumvent and disrupt the immune system. The consumption of synthetic food colors, and their ability to bind with body proteins, can have significant immunological consequences.This consumption can activate the inflammatory cascade, can result in the induction of intestinal permeability to large antigenic molecules, and could lead to cross-reactivities, autoimmunities, and even neurobehavioral disorders. The Centers for Disease Control (CDC) recently found a 41% increase in diagnoses of ADHD in boys of high-school age during the past decade. More shocking is the legal amount of artificial colorants allowed by the FDA in the foods, drugs, and cosmetics that we consume and use every day. The consuming public is largely unaware of the perilous truth behind the deceptive allure of artificial color. “MedLine
Eagle 2014: ADHD, sulfotransferase & food colors (SULT1A = PST)
Eagle, K. ADHD impacted by sulfotransferase (SULT1A) inhibition from artificial food colors and plant-based foods Physiology & Behavior, 135 (2014), 174-179.
” SULT1A inhibitors in foods, including natural substances and artificial food colors, have a role in ADHD that can both worsen or improve symptoms. … SULT1A inhibition can influence brain catecholamines through the intermediary of plasma tyrosine levels, which are influenced by dopamine inhibition of intestinal tyrosine hydroxylase.”Note: SULT1A is the same enzyme group elsewhere called PST. This is a complicated study for those not well versed in organic chemistry, but it basically gives a clue why some children appear to get worse when first put on the diet.
Malakar 2014: Role of salicylates in behavior
Malakar, S & Bhattacharya, S. (2014). Minding the greens: Role of dietary salicylates in common behavioural health conditions. Acta Alimentaria, 43(2), 344-359.
“The role of artificial food additives and food chemicals in abetting certain behavioural conditions has been the subject of behavioural nutrition research over several decades. However, a few studies have also raised questions regarding a similar role possibly played by naturally occurring phytochemicals in general and salicylates in particular. … The gap in the extant literature is even more prominent for salicylates present naturally in a number of fruits, vegetables, and plant-sourced food items – the common core ingredients of what one would likely consider to be a healthy diet. Given that it is now well-known that autistic patients tend to be PST-deficient, causal link between a low-salicylate diet and the mitigation of symptom- severity seems a rather plausible hypothesis. However, while the literature is replete with dietary intervention studies that look at artificial food additives, peer-reviewed studies focusing exclusively on the role of a diet low in salicylates in general and natural salicylates in particular in treating autism spectrum disorders are conspicuously absent…. It is quite apparent from the above discussions that Feingold hypothesis is still the central theoretical edifice when it comes to explaining the possible role of salicylates in several behavioural disorders.
… However, studies that have specifically tried to isolate the effect of salicylates (which is only one of the several elimination items in a typical Feingold diet) are few, and in those the effect of naturally occurring salicylates in common food items has not been studied. ”
Stevens 2014: Amounts of food colors in beverages consumed by children in US
Stevens, L.J. et al., Amounts of artificial food colors in commonly consumed beverages and potential behavioral implications for consumption in children,Clinical Pediatrics, 2014 Feb;53(2):133-40. doi: 10.1177/0009922813502849.
” Artificial food colors (AFCs) are widely used to color foods and beverages. The amount of AFCs the Food and Drug Administration has certified over the years has increased more than 5-fold since 1950 (12 mg/capita/day) to 2012 (68 mg/capita/day). In the past 38 years, there have been studies of adverse behavioral reactions such as hyperactivity in children to double-blind challenges with AFCs. Studies that used 50 mg or more of AFCs as the challenge showed a greater negative effect on more children than those which used less. The study reported here is the first to quantify the amounts of AFCs in foods (specifically in beverages) commonly consumed by children in the United States. … “Winners in each category with the most dye in a single cup (8 ounces or 240 ml) were:
- 34 mg – Faygo Redpop (a carbonated beverage)
- 52.3 mg – Kool-Aid Burst Cherry (a fruit-flavored beverage)
- 22.1 (Powerade Orange (a sports beverage)
- 18.8 mg (Full Throttle Red Berry (an energy drink)
Stevens 2014: Amount of food dye children eat in foods in US
Stevens, L.J. et al., Amounts of artificial food dyes and added sugars in foods and sweets commonly consumed by children, Clinical Pediatrics, 2014 Apr 24, 1-13.
“Artificial food colors (AFCs) are used to color many beverages, foods, and sweets in the United States and throughout the world. … Amounts of AFCs reported here along with the beverage data show that many children could be consuming far more dyes than previously thought. ”
Stevenson 2014: Review of research on diet & ADHD, & recommendations for future studies
Stevenson et al, Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder–an appraisal of the evidence on efficacy and recommendations on the design of future studies. Journal of Child Psychology & Psychiatry, 2014 May;55(5):416-27. doi: 10.1111/jcpp.12215
“The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). . . The aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed. … The methodology of many of the trials on which the meta-analyses are based is weak. Nevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements. ”
Verlaet 2014: Nutrition, immune system & diet in ADHD
Verlaet AAJ, Noriega DB, Hermans N, & Savelkoul HFJ. Nutrition, immunological mechanisms and dietary immunomodulation in ADHD. European Child & Adolescent Psychiatry, 2014 Jul;23(7):519-29. doi: 10.1007/s00787-014-0522-2
” Attention-deficit hyperactivity disorder (ADHD) etiology is not completely understood, but common comorbid dysfunction of the gastrointestinal and immune system suggests that these systems may be affected by a common genetic background and molecular mechanisms. For example, increased levels of specific cytokines were observed in ADHD. Moreover, ADHD has a high comorbidity with both Th1- and Th2-mediated disorders like ear infections, eczema and asthma. A common pathophysiological mechanism was suggested to underlie both asthma and ADHD, while several genes that are linked to ADHD have immune functions.Furthermore, immunological recognition of food provoking ADHD-like behavior was suggested. An immune imbalance, probably requiring a predisposing genetic background, is therefore suggested to contribute to ADHD etiology, with immune dysregulation being more likely than a single subcellular defect. However, next to allergic mechanisms, also pharmacological mechanisms (especially in case of food additives) might be involved. . . . As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation. If immune pathways contribute to ADHD, both its diagnosis and treatment should be reconsidered.Modulation of immune system activity might have potential in ADHD treatment, for example by nutritional approaches providing safe and low-cost ADHD therapy, but further research in these fields is implicated. ”
Bell 2013: Amount of food dye eaten by adults & children in US
Bell, C. C. A comparison of daily consumption of artificial dye-containing foods by American children and adults, Eastern Michigan University Master’s Theses. 2013.
Counting number of exposures to food dye rather than actual amounts of dye consumed, she found that children encounter at least twice the number of exposures to food dyes as adults, and also that fruit and vegetable consumption was inversely correlated to the number of dye exposures per day in the children, who were found to “habitually consume more brightly colored foods with additives in lieu of nutrient dense foods.“It appears we are training a generation of future adults to consume little more than easily-available and highly-advertised processed foods.
Ceyhan 2013: Rat study on food coloring effect on learning & memory
Ceyhan, Gultekin, Doguc, & Kulac. Effects of maternally exposed coloring food additives on receptor expressions related to learning and memory in rats. Food and Chemical Toxicology, 2013 Jun;56:145-8. doi: 10.1016/j.fct.2013.02.016
” Exposure to artificial food colors and additives (AFCAs) has been implicated in the induction and severity of some childhood behavioral and learning disabilities. N-methyl-D-aspartate receptors (NMDARs) and nicotinic acetylcholine receptors (nACHRs) are thought to be effective in the learning and memory-generating process. In this study, we investigated the effects of intrauterine exposure to AFCAs on subunit concentrations of NMDARs and nAChRs isoforms in rats. . . … Our results indicate that exposure to AFCAs during the fetal period may lead to alterations in expressions of NMDARs and nAChRs in adulthood…”MedLine
Doguc 2013: Study on rat babies whose moms ate food dyes
Doguc et al., Effects of maternally exposed colouring food additives on cognitive performance in rats, Toxicology and Industrial Health, 2013 Aug;29(7):616-23. doi: 10.1177/0748233712436638
” ” Artificial food colourings and additives (AFCAs) have long been suggested to adversely affect the learning and behaviour in children. In this study, we aimed to provide additional data to clarify the possible side effects of colouring additives on behaviour and memory. We administered acceptable daily intake values of AFCAs as a mixture (Eritrosin, Ponceau 4R, Allura Red AC, Sunset Yellow FCF, Tartrazin, Amaranth, Brilliant Blue, Azorubin and Indigotin) to female rats before and during gestation and then tested their effects on behaviour and on spatial working memory in their offspring. … Our results showed that commonly used artificial food colourings have no adverse effects on spatial working memory and did not create a depressive behaviour in offspring. But they showed a few significant effects on locomotor activity as AFCAs increased some parameters of locomotor activity. “MedLine
Gray 2013: Salicylate eliminate diets, criticism
Gray et al., Salicylate elimination diets in children: Is food restriction supported by the evidence?
Gray was treating patients who had previously been on the low-salicylate diet (or FAILSAFE diet) used in Australia, which is far more restrictive than the Feingold diet. He reported adverse effects in almost half the children, including weight loss, failure to thrive, nutritional deficiencies, food aversion, and hair loss. He did not, presumably, ever see those children who had been successfully treated via the FAILSAFE diet, and his conclusions provoked some interesting responses from other researchers (see links below).
Husarova 2013: Review of MSG & brain damage
Husarova V, & Ostatnikova D. Monosodium glutamate toxic effects and their implications for human intake: A review, JMED Research, Vol. 2013 (2013), doi: 10.5171/2013.60876
This is a review of the “studies about MSG effects and its potential pathological influence on different systems in humans.”Effects of injected MSG into rats included neuron damage, and prefrontal cerebral cortex changes, but such tests cannot be done on humans, who are not injected with MSG anyway (except in some vaccines which were not discussed in this article). Rats given MSG mixed with their food, however, also showed degenerative changes and inflammation in various brain areas.
Mice born to mothers fed MSG had impaired maze learning although no neuronal damage was visible. Also, lower doses given orally to young rats led to learning problems in adulthood, indicating that “early-life MSG exposure could lead to subtle behavioral aberrations in adulthood.” More research on doses approximating those used by humans are needed.
Sonuga-Barke 2013: Review of dietary & psychological treatments for ADHD
Sonuga-Barke et al., Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments, American Journal of Psychiatry, 2013 Mar;170(3):275-89. doi: 10.1176/appi.ajp.2012.12070991.
“Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities.”
Stevens 2013: How reactions to food dyes work
Stevens LJ, et al. Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children. Nutrition Review, 2013 May;71(5):268-81. doi: 10.1111/nure.12023
” This review examines the research on mechanisms by which artificial food colors (AFCs) and common foods may cause behavioral changes in children with and without attention-deficit/hyperactivity disorder (ADHD). . . Studies have shown that a subgroup of children (with or without ADHD) react adversely to challenges with AFCs. . . Three types of potential mechanisms are explored: toxicological, antinutritional, and hypersensitivity. Suggestions for future studies in animals and/or children include dose studies as well as studies to determine the effects of AFCs on the immune system, the intestinal mucosa, and nutrient absorption. Given the potential negative behavioral effects of AFCs, it is important to determine why some children may be more sensitive to AFCs than others and to identify the tolerable upper limits of exposure for children in general and for children at high risk. ”
Whiteley 2013: study on Gluten/Casein free diet for autism
Whiteley et al., Gluten- and casein-free dietary intervention for autism spectrum conditions, Frontiers in Human Neuroscience, 2013 Jan 4;6:344. doi: 10.3389/fnhum.2012.00344. eCollection 201
” … We examine evidence suggestive that a gluten-free (GF), casein-free (CF), or gluten- and casein-free diet (GFCF) can ameliorate core and peripheral symptoms and improve developmental outcome in some cases of autism spectrum conditions. Although not wholly affirmative, the majority of published studies indicate statistically significant positive changes to symptom presentation following dietary intervention. In particular, changes to areas of communication, attention, and hyperactivity are detailed, despite the presence of various methodological shortcomings. … the appearance of a possible diet-related autism phenotype seems to be emerging supportive of a positive dietary effect in some cases. Further debate on whether such dietary intervention should form part of best practice guidelines for autism spectrum conditions (ASCs) and onward representative of an autism dietary-sensitive enteropathy is warranted. ”
Arnold 2012: Review -'conclusions to dye for'
Arnold LE, Lofthouse N, & Hurt E. Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics. 2012 Jul;9(3):599-609. doi: 10.1007/s13311-012-0133-x.
“The effect of artificial food colors (AFCs) on child behavior has been studied for more than 35 years, with accumulating evidence from imperfect studies. This article summarizes the history of this controversial topic and testimony to the 2011 Food and Drug Administration Food Advisory Committee convened to evaluate the current status of evidence regarding attention-deficit/hyperactivity disorder (ADHD). Features of ADHD relevant to understanding the AFC literature are explained: ADHD is a quantitative diagnosis, like hypertension, and some individuals near the threshold may be pushed over it by a small symptom increment. The chronicity and pervasiveness make caregiver ratings the most valid measure, albeit subjective. Flaws in many studies include nonstandardized diagnosis, questionable sample selection, imperfect blinding, and nonstandardized outcome measures. Recent data suggest a small but significant deleterious effect of AFCs on children’s behavior that is not confined to those with diagnosable ADHD. AFCs appear to be more of a public health problem than an ADHD problem. AFCs are not a major cause of ADHD per se, but seem to affect children regardless of whether or not they have ADHD, and they may have an aggregated effect on classroom climate if most children in the class suffer a small behavioral decrement with additive or synergistic effects. Possible biological mechanisms with published evidence include the effects on nutrient levels, genetic vulnerability, and changes in electroencephalographic beta-band power. A table clarifying the Food and Drug Administration and international naming systems for AFCs, with cross-referencing, is provided.”
Millichap 2012: Review (mostly old studies)
Millichap JG & Yee MM. The diet factor in attention-deficit/hyperactivity disorder.Pediatrics, 2012 Feb;129(2):330-7. doi: 10.1542/peds.2011-2199.
” This article is intended to provide a comprehensive overview of the role of dietary methods for treatment of children with attention-deficit/hyperactivity disorder (ADHD) when pharmacotherapy has proven unsatisfactory or unacceptable. Results of recent research and controlled studies, based on a PubMed search, are emphasized and compared with earlier reports… In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients. … “Note: He left out most of the studies on diet and behavior done over the past 20 years, in spite of his promise in his abstract (above) – but he had no problem claiming it would cause “household disruption” in spite of not one single study ever done on that.
Saab 2012: Case study on 9 year old boy with ADHD
Saab, L., The effect of diet supplementation on children with ADHD, Lebanese American University, Masters Thesis 2012
A case study was conducted on a 9 year old boy attending in a private school in Beirut who was diagnosed with ADHD. The participant had food additives, refined sugars, casein, gluten, and foods with salicylates removed from his diet and an increased intake of essential fatty acids (omega 3 and omega 6). The study that lasted 5 weeks aimed to observe the effects of this special diet on the boy’s hyperactivity, impulsivity and inattention. The diet proved effective in that diet modification played an effective role in the management of ADHD and hence should be recommended to students with similar conditions.
Weiss 2012: Food colors & environmental health
Weiss, B. Synthetic Food Colors and Neurobehavioral Hazards: The View from Environmental Health Research.
Dr. Weiss examines ” the basis of the FDA’s position, the elements of the review that led to its decision and that of the Food Advisory Committee, and the reasons that this is an environmental health issueDISCUSSION: The FDA review confined itself, in essence, to the clinical diagnosis of hyperactivity, as did the charge to the committee, rather than asking the broader environmental question of behavioral effects in the general population; it failed to recognize the significance of vulnerable subpopulations; and it misinterpreted the meaning of effect size as a criterion of risk. The FDA’s response would have benefited from adopting the viewpoints and perspectives common to environmental health research. At the same time, the food color debate offers a lesson to environmental health researchers; namely, too narrow a focus on a single outcome or criterion can be misleading.”
Hoekstra 2011: Treatments beyond stimulants
Hoekstra PJ. Is there potential for the treatment of children with ADHD beyond psychostimulants? European Child & Adolescent Psychiatry 2011, 20 (9), 431-2. doi: 10.1007/s00787-011-0212-2.
… What promise may alternative treatments offer for children with ADHD? Food-based interventions may be one option. In 2009, this Journal had published promising effects of a restricted elimination diet in reducing symptoms of ADHD versus a waiting list control group. Results were recently confirmed in a larger scale Lancet study by the same group of investigators …
Kamel 2011: Double-blind controlled study on rats & Yellow 5 (Tartrazine)
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. ”
Pelsser 2011: Randomized Controlled Trial on Children with ADHD
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.”
Several letters to the editor of Lancet, and author’s reply
Stevens 2011: Review
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. ”
Pelsser 2010: Double blind study on kids with ADHD & physical problems
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“
Stevenson 2010: Genes & sensitivity to food additives
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.”MedLine || Full Text || Get Password
Pelsser 2009: Controlled study of effect of food on ADHD in children
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.
Prescrire International 2009: Health assessment of artificial food dyes
Artificial food colouring and hyperactivity symptoms in children., No Author Listed, Prescrire International, 2009 Oct;18(103):215.
- A hypothesis has been proposed that artificial food colourings have a role in exacerbating hyperactive behavior in children;
- 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;
- 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;
- 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.
Curtis 2008: Review
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. . . ” MedLine
McCann 2007: Double-blind study on children and food dyes
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.”
Husain 2006: Kuwait children's exposure to food dyes
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.”
Inomata 2006: Case study of child and azo dye
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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Lau 2006: interactions between food additives
Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test. Lau K, McLean WG, Williams DP, Howard CV., Toxicological Sciemces. 2006 Mar;90(1):178-87.
” 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. “
Lien 2006: Soft drinks & behavior
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.
Niederhofer 2006: Gluten-free diet & ADHD
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. ”
- A gluten-free diet would eliminate many processed foods, thereby automatically reducing the ingestion of additives.
- 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.
Bateman 2004: double-blind study on preschool children
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.
Schab 2004: Review
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. ”
Dengate 2002: double-blind test of calcium propionate in bread
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.
Pelsser 2002: elimination diet trial for ADHD
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.
Bennett 1998: Case studies on diet for criminal behavior
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. ”
Starobrat-Hermelin 1998: Magnesium needed for ADHD
The effect of deficiency of selected bioelements on hyperactivity in children with certain specified mental disorders, Starobrat-Hermelin B, Annales Academiae Medicae Stetinensis, 1998;44:297-314
“… shortage [of magnesium, copper, zinc, calcium, iron] occurs more often among hyperactive children than among those being healthy, and deficiency of magnesium is the most frequent in this respect. Further, I have divided the group of 110 children with magnesium deficiency into two groups according to the other mental disorders that coexist with ADHD: 1) the group where hyperactivity coexists with disorders typical for developmental age such as enuresis, tics, separation anxiety, stuttering, selective mutism (63 children); 2) the group where hyperactivity coexists with disruptive behaviour disorders: conduct disorder and oppositional defiant disorder (47 children). … The obtained results have clearly disclosed significant increase of magnesium, zinc, calcium content … and … decrease of hyperactivity in the group of children treated with magnesium. At the same time, however, among the children given standard treatment without magnesium, hyperactivity has intensified … The findings herein presented indicate that it is necessary to take into consideration a possible bioelements deficiency among children with ADHD. Consequently, the accomplished study proves that there is a need of magnesium supplementation in ADHD children irrespectively of other mental disorders.”
MedLine (article in Polish)
Bennett 1997: Controlled study of diet and 100 young offenders
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.”
Schmidt 1997: Double-blind few-foods diet and behavior
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.
Uhlig 1997: EEG brain mapping for diet and ADHD
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. …”
Reyes 1996: Lab study on food dye & mitochondria
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 …. ” MedLine
Boris 1994: Double-blind study on diet and ADHD in children
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.”MedLine
Rowe 1994: Double-blind study on Yellow 5 and ADHD in children
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.
Carter 1993: Double-blind study on few-foods diet & ADHD in children
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. Clinicians should give weight to the accounts of parents …
Egger 1992: Diet & double-blind test on children with ADHD / migraine & enuresis
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.”
Novembre 1992: Double-blind study on CNS & joint reactions to food dye & benzoates
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.”
Schoenthaler 1991: Review of diet studies in 813 prisons
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…” Full Text
Pollock 1990: Double-blind study on diet and food dyes in children
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.”
Sarantinos 1990: Double-blind study on ADHD & food dye
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.
Ward 1990: Double-blind study on Yellow 5 & zinc in children
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.”
Egger 1989: Double-blind study on children with ADHD/ migraine/ GI pain & seizures
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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Kaplan 1989: Food diary comparison in children with & without ADHD
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…”
Rowe 1988: Double-blind study of ADHD & food dye
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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Burlton-Bennett 1987: Single-subject ABAB study on Feingold Diet
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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David 1987: Double-blind challenges of food dye on children not successful on diet
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.
Gross 1987: Diet study in summer camp
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 is so unusually bad, and yet is sometimes described as the “definitive study” on the Feingold diet, it deserves special treatment. It has been elected to Lesson One in How to Design a Really Bad Study
Schoenthaler 1986: Study of 803 New York City schools
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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Egger 1985: Controlled trial diet in ADHD (& headache, Gi pain, seizures)
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
Menzies 1984: Case studies reviewed
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. ”
Egger 1983: Double-blind study of diet & migraine (& GI pain, behavior, seizures, asthma, eczema)
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. . . .” MedLine
Mattes 1983: opinion on Feingold Diet
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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Feingold 1982: Final paper
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. ”
Note: 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.
Goldenring 1982: Azo food dyes and behavior change in rats
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. … ”
Salamy 1982: EEG & heart rate after food additives
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.
Mattes 1981: Double-blind study of children & critical review
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.”
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- Their “high dose” of coloring did not even change the color of the cookies from identical cookies without coloring.
- 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.
- 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.
- 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.
Swanson 1980: Double-blind study on children
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.
Weiss 1980: Double-blind study on children using less than 36 mg dye
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. ”
- 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.”
Brenner 1979: Double-blind study on copper & zinc in children on Feingold Diet
Trace mineral levels in hyperactive children responding to the Feingold diet, Brenner A, Journal of Pediatrics1979 Jun;94(6):944-5
“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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Feingold 1979: Article on diet & juvenile delinquency
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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Lafferman 1979: Red 3 and dopamine
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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Shaywitz 1979: Food dye makes rat pups hyper
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.Neurobehavior Toxicology, 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. …”
Dumbrell 1978: Feingold diet nutritionally superior to normal diet
Is the Australian version of the Feingold diet safe? Dumbrell S, Woodhill JM, Mackie L, Leelarthaepin B, Medical Journal of Australia, 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.”
Fitzsimon 1978: Double-blind study on salicylate-sensitivity
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.
Goyette 1978: Double-blind study on hyper children
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, in a cookie eaten after a meal twice a day. 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.
Harley 1978: Double-blind diet study
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 the 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.
Nevertheless, 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).
It should be noted that the “control” diet was itself free of most junk food, restricting soft drinks, aspirin (salicylate) compounds, cough drops, toothpaste and medications. Also, they modified the Feingold diet by including oranges, tangelos, strawberries, and almonds since their own analysis for salicylic acid and methyl salicylate was negative for these items.
You can see another detailed analysis of the Harley study (and others).
Harper 1978: Nutrient intake of kids on Feingold Diet
Nutrient intakes of children on the hyperkinesis diet, Harper PH, Goyette CH, Conners CK, Journal of the American Dietetics Association, 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. …”
Hindle 1978: Study of Feingold-type diet on 10 children
The management of hyperkinetic children: a trial of dietary therapy. Hindle RC, Priest J , New Zealand Medical Journal, 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.”
Levy 1978: Double-blind study of Yellow 5 on children
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.
Rose 1978: Double-blind study of food dye on 2 girls
The functional relationship between artificial food colors and hyperactivity. Rose TL, Journal of Applied Behavior Analysis 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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Williams 1978: Double-blind comparison study of drugs & diet
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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Brenner 1977: Case studies on Feingold Diet
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
Feingold 1977: Food additives in dentistry
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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Feingold 1977: Speech to American Academy of Pediatrics
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.”
Conners 1976: Double-blind study of diet on 15 children
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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Cook 1976: Open diet study on 15 children
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. ”
Feingold 1976: Article in Journal of Learning Disabilities
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
Salzman 1976: Clinical study on diet and ADHD, sleep, enuresis
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 allergy tests still respond well to the diet. Sensitivity to additives is not usually an allergy.
Spring 1976: Old negative review, wants
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.
Feingold 1975: Article in Am. Journal of Nursing
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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The Diet Connection
When Dr. Feingold first began to use diet (then called the K-P diet) to treat children with ADHD (then called hyperkinesis), he said that 30% to 50% of them got better. Later, after he also eliminated the petrochemical preservatives BHA and BHT (TBHQ didn’t exist yet), he found that over 70% of the children got better. We still see that same – or better – result today.
About 50% of children (or adults) don’t need any other intervention. The others still need more help, which may be educational adjustments, tutoring, supplements, further restrictions due to identified allergies, behavior modification or counseling, or some sort of medication including stimulants. While some people do use both the diet and stimulant medication, in almost all cases they can use less medication than expected
The TOVA reports 4 parameters, two of which are called “cognitive” and the other two are called “behavioral.” All four must be in the normal range for the child or adult to behave and learn normally. When used to monitor the effects of Ritalin on a child, the “cognitive” parameters rise to normal first, according to the TOVA company. Under increased medication, the other two rise.
However, Shula noticed that when put on the Feingold diet, the “behavioral” parameters of each child rose to normal first, followed by the “cognitive” ones. If using both diet and Ritalin, theoretically, the diet would raise the “behavioral” parameters while the medication would raise the “cognitive” ones at the same time. Therefore, it makes perfect sense that less medication would be needed for the best effect.
Some of our members find that during high pollen seasons, their allergic children need more than the diet alone – some benefit from a very tiny dose of medication during that time. Unfortunately, no studies have been done on the relation of allergy to the need for medication, or why medication would be needed only during those times, but if this seems to be a problem in your family, work with your doctor to achieve the best possible results for yourself or your child.