The Studies

Adorable little girl sleeping in the bed with her toy

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.

Author Index
  1. Blunden 2011
  2. Breakey 1997
  3. Fitzsimon 1978
  4. Kaplan 1989
  5. Mahajan 2010
  6. Pelsser 2010
  7. Rowe 1988
  8. Rowe 1994
  9. Salzman 1978
  10. Stevens 2014
Stevens 2014: Problems with food dyes

Amounts of artificial food colors in commonly consumed beverages and potential behavioral implications for consumption in children, Stevens LJ1, Burgess JR, Stochelski MA, Kuczek T., Clinical Pediatrics, 2014 Feb;53(2):133-40.

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. Consumption data for all foods would be helpful in the design of more challenge studies. The data summarized here should help clinicians advise parents about AFCs and beverage consumption.

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Blunden 2011: Diet and sleep related in children with ADHD

Diet and sleep in children with attention deficit hyperactivity disorder: preliminary data in Australian children, Blunden SL1, Milte CM, Sinn N., Journal of Child Health Care,  2011 Mar;15(1):14-24

Sleep disturbances are common and consequential in children with attention deficit hyperactivity disorder (ADHD). Diet also influences ADHDsymptoms. Interrelationships between diet, sleep and behaviour in children diagnosed with ADHD are little studied. We investigated, via parental report, the relationships between sleep and diet in 88 Australian children aged 6-13 years old (M = 8.94, SD = 1.78). This pilot data shows that 30 per cent of the children had sleep disturbance (≥ 2 standard deviations above the mean) with significant relationships between ADHD symptoms, sleep disturbance and diet. Parents who reported more sleep disturbance also reported a higher intake of carbohydrate, fats, and, most particularly, sugar which was also a significant predictor of night time sweating. These findings suggest an interrelationship between diet and sleep in children withADHD. Given that both sleep and dietary intake are potentially modifiable behaviours within treatment regimes of children with ADHD, further investigation is needed.

Note: The children with worse ADHD and sleep symptoms ate more carbohydrate, fats, and sugar …. this translates to more processed junk food containing food dyes, artificial flavorings, and preserved shortenings.

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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.”

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Mahajan 2010: Sleep problems and ADHD in adults

Hyperactive-impulsive symptoms associated with self-reported sleep quality in nonmedicated adults with ADHD, Mahajan N, Hong N, Wigal TL, Gehricke JG.,  Journal of Attention Disorders. 2010 Sep;14(2):132-7. Epub 2009 Sep 18.

OBJECTIVE: Individuals with ADHD often report sleep problems. Though most studies on ADHD and sleep examined children or nonclinically diagnosed adults, the present study specifically examines nonmedicated adults with ADHD to determine whether inattentive and hyperactive-impulsive symptoms are associated with sleep problems. …CONCLUSION: The results show that sleep problems are associated with hyperactive and impulsive symptoms in nonmedicated adults with ADHD. These findings provide information on the nature of sleep problems without the confounding effects of medication associated with ADHD. Treatment of sleep problems, especially in those with hyperactive-impulsive symptoms, may help ameliorate ADHD symptomatology.”

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Breakey 1997: Diet and sleep problems

Review: The Role of Diet and Behaviour in Childhood, J. Breakey, Journal of Paediatric Child Health, 1997, Jun;33(3) pp.190-194

The research has shown that diet definitely affects some children. … and some non-food items are relevant. Symptoms which may change include those seen in attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), sleep problems and physical symptoms, with later research emphasizing particularly changes in mood.

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Rowe 1994: Study of Yellow 5, caused sleep disturbance

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 63% of them responded to a single-item challenge of tartrazine. In the double-blind portion, the study identified 24 children as clear reactors, including 19 of the 23 “suspected reactors” [82.5%] . “They were irritable and restless and had sleep disturbance. Significant reactions were observed at all six dose levels. A dose response effect was obtained.”

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Kaplan 1989: Sleep problems were among the improvements on diet

Dietary Replacement in Preschool-Aged Hyperactive Boys, B.Kaplan, et al, Pediatrics, 1989, Vol. 83, pp. 7-17

More than half the subjects exhibited reliable improvement in behavior and negligible placebo effects.  In addition, several nonbehavioral variables tended to improve … particularly halitosis, night awakenings, and latency to sleep onset.

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Rowe 1988: Food dye reactions include sleep disturbance

Synthetic food colourings and ‘hyperactivity’: a double-blind crossover study, Rowe KS, Australian Paediatric Journal, 1988 Apr;24(2):143-7.

Of 220 children referred for suspected ‘hyperactivity‘, 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3-6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double-blind crossover study, employing a single-subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead-in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with ‘hyperactivity‘ based on ‘attention deficit disorder‘ may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.

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Fitzsimon 1978: Salicylate challenge caused sleep problems

Salicylate sensitivity in children reported to respond to salicylate exclusion. Fitzsimon M, Holborow P, Berry P, Latham S, Medical Journal of Australia 1978 Dec 2;2(12):570-2

Twelve children, aged six to 13 years, whose parents reported an improvement in behavioural problems with use of the Feingold (K-P) diet for an average period of 12 months, were challenge-tested with 40 mg of acetylsalicylic acid in a double-blind, cross-over trial with ascorbic acid as a placebo. … significance was reached in tests of general cognitive capacity, line walking and the “finger-to-nose” tests, as well as increased disturbance in sleep patterns in these children.

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Salzman 1976: Case studies 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.

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The Diet Connection

It’s hard to understand why something as innocent as a piece of fruit or a bag of candy can result in sleep problems, some of which can be extreme. Most people can enjoy healthy food like fruits with no harmful effects, and most do not notice any change when they eat candy, even if it contains artificial colors and flavors. But the Feingold Association has received many reports of disturbed sleep from people who are very sensitive to salicylates and/or additives. For some, the reaction is simply difficulty in settling down to sleep; others suffer night terrors or even hallucinations.

A month’s trial of eliminating salicylates and artificial colors, flavorings, and petrochemical preservatives could make a lifetime of difference.

Gloria's story: Sleep disorders & salicylates

Sleep is supposed to be a restful experience, but for Gloria of Austin, Texas, sleep was exhausting. Shortly after falling asleep, her heart would begin to beat irregularly. “I would suddenly awaken and find myself sitting bolt upright, or even standing beside the bed, feeling short of breath and wondering what had hit me.”

Gloria began to notice a pattern, with severe sleep attacks occurring after she had eaten tomato sauce, an apple, strawberries, or pineapple (although the canned pineapple is generally well tolerated, fresh pineapple is often a problem for salicylate-sensitive people). Stripping furniture with chemical solvents also caused an attack. Gloria tells her story below:

I had been painting the house, and the following morning the right side of my face went numb. I experienced slurred speech, dizziness, blurred vision, and fatigue. I felt like I had been hit in the head with a rubber mallet.

I visited many doctors in search for relief, but none of the medications helped.

The hospital nutritionist put me on a diet with fruit three time a day.  My attacks became worse than ever. I had difficulty breathing and felt like I was coming apart at the seams. My doctor said I was suffering from anxiety depression.

I ended up in church on Sunday asking God for a clue. On Tuesday I made an appointment with an allergist because I knew the attacks were connected to foods.

The allergist told me he didn’t deal with food allergies as he had his hands full with pollen (we live in the pollen capital of the world).

But as I was walking out the door he pondered, “Maybe you are intolerant to salicylates in foods.” The word struck like an arrow piercing my brain . . . I can still feel the sensation. My first clue. (I later went back and thanked him for that word.)

But at the time I felt like I was at another blind spot in the road. I was in tears by the time I returned home and found my sister on the phone waiting to talk with me.

I told her what I had learned so far and mentioned the foods I had identified as causes. When the conversation, and my crying, had ended, I learned that my niece and her friend were in the next room and heard my phone conversation.

They came into the kitchen and my niece’s friend said, “You know you sound as if you have the same problem as the hyperactive children I teach. Some of them can’t tolerate salicylates.”

Voila! My second clue. SALICYLATES! That wonderful word spoken twice in one hour.

She told me about Dr. Feingold’s book, and I was at the bookstore an hour before it opened.

Within three days there were no more irregular heartbeat attacks when I slept. That was August of 1984 and I’ve been able to see a correlation between the attacks and heavy use of household cleaners, oil based paint, and natural gas.

That explains why I would become so irritable or have an extreme exhaustion spell after cooking.  I have not felt that way since I turned the gas off and began using my electric skillet and microwave oven.

Much love and my thanks to everyone at FAUS.

Alice's story: When babies don't sleep

Most parents of 3 year olds would be very upset if their child woke up several times each night. For Alice’s mom, this represented a dramatic improvement in her child’s sleep pattern. Her mom wrote the following letter to the Feingold Association of Indiana, in 1985.

Every night when our daughter sleeps 3 to 8 hours without waking up screaming, I thank you and all other Feingolders. For the first twenty months of life, Alice woke up every five minutes to 2 hours all night long.

My first indication that the cause might be artificial coloring came when she had a cold and I gave her Novahistine. The medication didn’t make her sleepy, as it would my other two children. In fact, she was so wound up, it was 2 days before her arms and legs stopped moving.

When she accidentally got some of my diet “grape” drink, and had the same reaction, I was sure it was the coloring. I took everything out of her diet which listed coloring. But I actually changed her diet very little, and her behavior changed very little as well.

I read everything I could on diet and hyperactivity, and followed the suggestions, but still without results. Then a friend gave me your address and I received the Foodlist, newsletter, and instructions. Now Alice sleeps more soundly than ever, and for a longer time. She doesn’t sleep “like a log” as do some children, but she and I sleep most of the night.

Note: Through their Feingold literature, the family learned that the 2% milk they had been giving Alice contained hidden preservatives. They switched to vitamin D whole milk for their daughter, and now report that Alice sleeps soundly through the entire night.