Research on the dietary connection
Irritable Bowel Syndrome, Crohn's Disease, Celiac Disease
Intestinal symptoms seem to go along with symptoms of both ADHD and autism. For some, their ADHD symptoms could be due to undiagnosed celiac disease even when there are no intestinal symptoms. For others there is an overgrowth of yeast which can cause intestinal distress. Yet others may have lactose intolerance which can cause painful gas, flatulence, and bloating (lactose intolerance is the inability to digest lactose, or milk sugar, not to be confused with sensitivity to casein, which is a milk protein).
Crohn’s disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932.
Crohn’s disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Together, Crohn’s disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD)
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.
- Antico 1989
- Boutilier 2000
- Corvaglia 1999
- Egger 1983
- Egger 1985
- Egger 1989
- Faulkner-Hogg 1999
- FDA 2003
- Granville 2001
- Ignys 1995
- Inomata 2006
- Jakobsson 1985
- Kristjansson 2007
- Niec 1998
- Niederhofer 2006
- Niederhofer 2011
- Pelsser 2010
- Petitpierre 1985
- Sasaki 2002
- Van Bever 1989
- Zelnik 2004
Niederhofer 2011: ADHD & celiac disease
Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Niederhofer H., (2011) The Primary Care Companion for CNS Disorders, 13(3), pii: PCC.10br01104
A possible association of celiac disease with psychiatric and psychological disturbances such as attention-deficit/hyperactivity disorder(ADHD) has been reported repeatedly. The objective of this study was to observe whether a gluten-free diet could alleviate the behavioral symptoms in patients with celiac disease and ADHD.
Sixty-seven subjects aged 7 to 42 years (mean = 11.4 years) with ADHD were enrolled in the study in South Tyrol, Italy, from 2004 to 2008. Hypescheme, an operational criteria checklist that incorporates DSM-IV and ICD-10 criteria, was used to assess ADHD-like symptomatology. Additionally, blood serum levels of all subjects were assessed for possible celiac disease by examining antigliadine and antiendomysium antibodies. A gluten-free diet was initiated for at least 6 months in celiac disease-positive patients with ADHD.
Of the 67 patients with ADHD, 10 were positive for celiac disease. After initiation of the gluten-free diet, patients or their parents reported a significant improvement in their behavior and functioning compared to the period before celiac diagnosis and treatment, which was evident in the overall mean score on the Hypescheme questionnaire (t = 4.22, P = .023).
Celiac disease is markedly overrepresented among patients presenting with ADHD. A gluten-free diet significantly improved ADHDsymptoms in patients with celiac disease in this study. The results further suggest that celiac disease should be included in the ADHD symptom checklist.
Pelsser 2010: Diet for sleep & physical complaints
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]
“Attention deficit/hyperactivity disorder (ADHD), a common behavioural disorder in children, may be associated with comorbid physical and sleep complaints. 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. A group of 27 children . . . were assigned randomly to either a diet group (15/27) or a control group (12/27).The diet group followed a 5-week elimination diet; the control group adhered to their normal diet. Parents of both groups had to keep an extended diary and had to monitor the behaviour and the physical and sleep complaints of their child conscientiously. . . The number of physical and sleep complaints was significantly decreased in the diet group compared to the control group . . . Specific complaints that were significantly reduced were in three domains: 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, but more research is needed to determine the effects of food on (functional) somatic symptoms in children with and without ADHD.”
Kristjansson 2007: Casein like gluten
Mucosal reactivity to cow’s milk protein in coeliac disease. Kristjánsson G, Venge P, Hällgren R.,Clinical & Experimental Immunology. 2007 Mar;147(3):449-55.
” Patients with coeliac disease (CD) on a gluten-free diet may still have gastrointestinal symptoms. On clinical grounds cow’s milk (CM) protein sensitivity may be suspected. Here, using rectal protein challenge, we investigated the local inflammatory reaction to gluten and CM protein in adult patients with CD in remission. Rectal challenges with wheat gluten and dried CM powder were performed in 20 patients with CD and 15 healthy controls. … In 18 of 20 patients gluten challenge induced neutrophil activation defined as increased MPO release and increased NO synthesis. Ten of these 20 patients showed a similarly strong inflammatory reaction to CM challenge. … A mucosal inflammatory response similar to that elicited by gluten was produced by CM protein in about 50% of the patients with coeliac disease.Casein, in particular, seems to be involved in this reaction.”
Niederhofer 2006: ADHD & celiac disease
.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.” MedLine || Full Text || Get password
- 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.
Inomata 2006: Case study - food dyes & abdominal pain
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 … Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. Open challenge tests with food additives and nonsteroidal anti-inflammatory drugs (NSAIDs) were performed after elimination of these items. … 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. ”
Zelnik 2004: ADHD & more in celiac disease
Range of neurologic disorders in patients with celiac disease. Zelnik N, Pacht A, Obeid R, Lerner A.,Pediatrics. 2004 Jun;113(6):1672-6.
Patients with CD were more prone to develop neurologic disorders (51.4%) in comparison with control subjects (19.9%). These disorders include hypotonia, developmental delay, learning disorders and ADHD, headache, and cerebellar ataxia. Epileptic disorders were only marginally more common in CD.
FDA 2003: Public Health Advisory re blue in tube feedings
Dear Health Care Professional:
The Food and Drug Administration (FDA) would like you to be aware of several reports of toxicity, including death, temporally associated with the use of FD&C Blue No. 1 (Blue 1) in enteral feeding solutions. . . in vitro evidence that Blue 1 can be a mitochondrial toxin lends plausibility to the idea …
Sasaki 2002: Mouse study on 39 additives
The comet assay with 8 mouse organs: results with 39 currently used food additives., Sasaki YF, Kawaguchi S, Kamaya A, Ohshita M, Kabasawa K, Iwama K, Taniguchi K, Tsuda S, Mutation Research 2002 Aug 26;519(1-2):103-19
We determined the genotoxicity of 39 chemicals currently in use as food additives. . . Of all the additives, dyes were the most genotoxic. Amaranth, Allura Red, New Coccine, Tartrazine, Erythrosine, Phloxine, and Rose Bengal induced dose-related DNA damage in the glandular stomach, colon, and/or urinary bladder. All seven dyes induced DNA damage in the gastrointestinal organs at a low dose (10 or 100mg/kg). Among them, Amaranth, Allura Red, New Coccine, and Tartrazine induced DNA damage in the colon at close to the acceptable daily intakes (ADIs). Two antioxidants (butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT)), three fungicides (biphenyl, sodium o-phenylphenol, and thiabendazole), and four sweeteners (sodium cyclamate, saccharin, sodium saccharin, and sucralose) also induced DNA damage in gastrointestinal organs. Based on these results, we believe that more extensive assessment of food additives in current use is warranted.MedLine || Full Text || Get Password
Granville 2001: Blue colon from Blue 1
Blue colon at autopsy. Granville LA, Finch C., Archives of Pathology & Laboratory Medicine. 2001 May;125(5):599.
Letter to the Editor, Comment on Boutilier 2000, (Green colon: an unusual appearance at autopsy)
Recently we encountered a blue colon at autopsy (Figure). The recently published article by Boutilier et al1 and their photograph illustrating a green colon were instrumental in determining the probable origin of the unusual finding of this bright blue colon …
Boutilier 2000: Green colon at autopsy from Blue 1
Green colon: an unusual appearance at autopsy. Boutilier RG, Murray SK, Walley VM. Arch Pathol Lab Med. 2000 Sep;124(9):1397-8.
One of the authors has occasionally noticed patients with unusual and vivid green discoloration of their colons at autopsy. Two cases described here illustrate this phenomenon. . . Discussion with the intensive care unit nursing staff disclosed a common local practice of coloring the enteral feeding solutions with a blue liquid food coloring (Blue 1) … the nursing staff indicated a highly variable practice with respect to the amount of food coloring employed, in some cases using as much as a 1:10 food coloring : feed ratio. … Following ingestion of the water-soluble dye, it is apparently concentrated in the colon, the site of water reabsorption in the gastrointestinal tract.
Faulkner-Hogg 1999: Celiac disease & trace amounts gluten
Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Faulkner-Hogg KB, Selby WS, Loblay RH, Scand J Gastroenterol 1999 Aug;34(8):784-9
. . . Thirty-nine adult members of The Coeliac Society of New South Wales, all of whom had persistent gastrointestinal symptoms despite adhering to a GFD, were evaluated. . . All subjects were required to follow a NDG-GFD [no detectable gluten diet] during the study. . . . Of 22 patients who switched to a NDG-GFD [from an almost-gluten-free diet] symptoms resolved in 5 (23%) and were reduced in 10 others (45%). . . . Symptomatic improvement was experienced in 24 (77%). . . Diarrhoea was the most commonly provoked symptom, followed by headache, nausea, and flatulence. Symptoms were especially provoked by amine, salicylate and soy.. .
Corvaglia 1999: Untreated celiac and behavioral disorders
Depression in adult untreated celiac subjects: diagnosis by the pediatrician, Corvaglia L, Catamo R, Pepe G, Lazzari R, Corvaglia E., American Journal of Gastroenteroly. 1999 Mar;94(3):839-43.
Untreated celiac disease can lead to serious behavioral disorders. We describe three adult patients with undiagnosed or untreated celiac disease without particular intestinal signs, causing persistent depressive symptoms in three of the parents of our pediatric patients. . . .In all three patients, the depressive symptoms improved quickly with a gluten-free diet. In conclusion, celiac disease should be taken into consideration in the presence of behavioral and depressive disorders, particularly if they are not responsive to the usual antidepressive therapy.
Niec 1998: Diet and irritable bowel disease
Are adverse food reactions linked to irritable bowel syndrome? Niec AM, Frankum B, Talley NJ, Am J Gastroenterol 1998 Nov;93(11):2184-90
. . . Of the seven studies included, the positive response to an elimination diet ranged from 15% to 71%; double-blind placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to cause symptom exacerbation; of the foods identified the most common trait was a high salicylate content. Foods high in amines were also identified. Studies of diarrhea-predominant IBS identified a higher percentage of adverse food reactions. . . . Carefully designed controlled clinical trials are now needed to specifically test the potential role of adverse food reactions in diarrhea-predominant IBS.
Ignys 1995: Most children improved on elimination diet for abdominal pain
Food allergy in pathogenesis of chronic abdominal pain in children, Ignys I et al., Pediatria Polska 1995 Apr;70(4):307-11
The aim of the study was to analyse the cause-and-effect relationship between chronic abdominal pain in children, endoscopic and histopatological picture, and food allergy, as well as to evaluate the applied elimination diet and/or antiallergic treatment on the improvement of both the clinical status and endoscopic picture. In 71 children gastrofiberoscopic examinations, food skin tests, and specific and total IgE allergen serum tests were performed. In the majority of examined children one could observe an improvement of clinical status and of the endoscopic-histopatological picture of the stomach mucous membrane after application an elimination diet and/or treatment with sodium cromoglycate.
MedLine (article in Polish)
Van Bever 1989: Double-blind study on food additives & reactions
Food and food additives in severe atopic dermatitis. Van Bever HP, Docx M, Stevens WJ, Allergy 1989 Nov;44(8):588-94
“In this study the role of food additives, tyramine and acetylsalicylic acid, was investigated by double-blind placebo-controlled challenges (DBPCC) in 25 children with severe atopic dermatitis (AD). All children challenged with foods (n = 24), except one, showed one or more positive reactions to the DBPCC with foods. Positive reactions presented as different combinations of flares of skin symptoms, intestinal symptoms and respiratory symptoms... Six children underwent DBPCC with food additives, tyramine and acetylsalicylic acid. All were found to demonstrate positive skin and/or intestinal reactions to at least one of the food additives. Two children reacted to tartrazine, three to sodium benzoate, two to sodium glutamate, two to sodium metabisulfite, four to acetylsalicylic acid and one to tyramine. It is concluded that some foods, food additives, tyramine and acetylsalicylic acid, can cause positive DBPCC in children with severe AD.”
MedLine || Full Text || Get Password
Egger 1989: 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.”
MedLine || Full Text || Get Password
Antico 1989: Food additives and Irritable Bowel Syndrome
Irritable colon syndrome in intolerance to food additives., Antico A, Soana R, Clivio L, Baioni R., Minerva Dietol Gastroenterol 1989 Oct-Dec;35(4):219-24
. . . Following our observation, we can draw the conclusion that food additives intolerance may be a major factor in the pathogenesis of IBS.
MedLine (article in Italian)
Petitpierre 1985: IBS & food sensitivity
Irritable bowel syndrome and hypersensitivity to food. Petitpierre M, Gumowski P, Girard JP, Ann Allergy1985 Jun;54(6):538-40
Food hypersensitivity as a cause of irritable bowel syndrome was investigated by means of exclusion diet and blind provocation… In 14 patients one or several food or additives were shown to induce the typical symptoms of IBS… Among other potential pathogenetic mechanisms, the presence in the intestinal tract of yeast (Candida albicans, Geotrichum candidum) seems to be of major importance. Yeast apparently favor the development of allergic as well as pseudo-allergic reactions, at least in some patients…. Dramatic clinical improvements can result from the introduction of an adequate exclusion diet.
Jakobsson 1985: Case study on milk causing cerebral symptoms & bedwetting
Unusual presentation of adverse reactions to cow’s milk proteins. , Jakobsson I., Klinische Padiatrie1985 Jul-Aug;197(4):360-2
Allergy to cow’s milk most commonly give symptoms from the gastrointestinal tract, the skin or the respiratory tract. Here two patients are described, with symptoms not so common. One with cerebral symptoms and the other with enuresis. Infantile colic occurs more or less in about 20% of all infants. We have found that in about 1/3 of breastfed infants with infantile colic the symptoms disappeared when the mothers had a cow’s milk free diet. We have also managed to analyse the content of the cow’s milk protein beta-lactoglobulin in the human milk.
Egger 1985: Diet study 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
Egger 1983: 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. . . .”
The Diet Connection
Some of our members report that in addition to ADHD, their children had either chronic diarrhea or chronic constipation – or a mixture of both – and that on the Feingold diet these symptoms resolved.
In 2003, the FDA issued a warning that Blue #1 should no longer be used in the mix for tube feedings given to patients in hospitals. Although the coloring was used in an effort to see the food in case the tube was misplaced, what they found is that the patients were dying – but not from their diseases. They were dying from the Blue #1 which was passing through the gut membranes and causing bright blue colons to be found on autopsy. The FDA admitted in their warning that Blue #1 is known to be toxic to mitochondria (the little energy-factories inside cells of the body).
Blue Colon at Autoopsy,
Back in 1989, Antico reported that according to his observations, he could “draw the conclusion that food additives intolerance may be a major factor in the pathogenesis of IBS (Irritable Bowel Syndrome).”
In 2002, Sasaki et al showed that all seven of the food dyes he studied “induced DNA damage in the gastrointestinal organs at a low dose.”