FOOD INTOLERANCE NETWORK FACTSHEET

Diet and ADHD

Despite ample evidence, the connection between children’s behaviour and what they eat is considered to be controversial.

On one side of the debate, the influential US Food and Drug Administration (FDA) denies that artificial colours affect children’s behaviour, in a booklet co-sponsored by the food industry. Major criticism of industry influence in recent years include the charges that the FDA:

• has become ‘a servant of industry’ (Horton, Lancet editorial 2001)

• ‘has failed in its mission to protect public health’ (BMJ editorial, 2002)

officials are ‘confused and frightened’ because they are afraid to offend financial sponsors (former FDA senior consultant Dr Paul Stolley, in Moynihan, 2005)

On the other side of the debate, independent scientists from the Centre for Science in the Public Interest carried out a review of 25 years worth of diet and behaviour studies (Jacobson and Schardt, 1999). Their recommendations included:

  ‘that parents should consider dietary changes (along with behaviour therapy) as the first course of treatment for children with behavioural problems before turning to stimulant drugs’

• ‘that ’the FDA should consider banning from foods consumed widely by children any dyes and other additives that affect behaviour’

• ‘that schools … should minimize the use of food additives that may contribute to behavioural disorders’.

Objective measurement of the effects of diet

Three studies have shown physical markers of dietary effects:

• An EEG (electroencephalograms) study with 45 children on the oligoantigenic diet found significant increases in brain activity in certain areas after children had eaten provoking foods (Uhlig and others, 1997).

• In a similar study reported in German, EEGs showed increased beneficial sleep and reduced wakening when food sensitive hyperactive children were on diet (Kiefer and others, 1991 in Jacobson and Schardt, 1999).

• A study with nine uncontrollable children in 1985 found that average levels of para-cresol in faeces were five times higher than for a control group. Para-cresol is a breakdown product of tyramine, a biogenic amine. Although the source of para-cresol was never identified, the researchers commented that ‘the results point to dietary involvement’ (Adams and others, 1985).

Effects of additives

• Researchers found that 17 out of 20 hyperactive children taking realistic doses of artificial colours in double blind placebo controlled (DBPC) challenges suffered decreased attention spans on a laboratory learning test (Swanson and others, 1980).

• A repeated measures DBPC study of tartrazine (102) with 34 children showed that reactions to artificial colours were dose-related and the main behavioural effects were irritability, restlessness, inattention and sleep disturbance (Rowe and Rowe, 1994)

• In a group of 27 children whose behaviour problems improved on an elimination diet, 14 reacted significantly to the bread preservative (282) in DBPC challenges with irritability, restlessness, inattention and sleep disturbance (Dengate and Ruben, 2002). 

• A study with a group of 277 three-year-olds from the Isle of Wight found during DBPC challenges that artificial colourings (E102, E110, E122, E124), and benzoate preservative (E211) caused significant behavioural effects detectable by parents including 'interrupting', 'fiddling with objects', 'disturbing others', 'difficulty settling down to sleep'  and 'temper tantrums' whether there was a history of hyperactivity or not (Bateman and others, 2004).

• Researchers at the University of Liverpool found that when mouse nerve cells were exposed to combinations of additives (MSG and brilliant blue or aspartame and quinoline yellow at concentrations theoretically achievable by ingestion of a typical snack and drink), the additives stopped the nerve cells growing and interfered with proper signalling systems. Additives in combination had a much more potent neurotoxic effect than each additive on its own (Lau and others, 2006).

The Few Foods diet

Elimination diets generally avoid either whole foods or food chemicals. In general, the more restricted the diet, the more effective it is. As discussed by Kaplan and others, the most successful diets are too restricted to be used in a DBPC protocol (Kaplan and others, 1989). The most effective of the whole foods diets is the Few Foods or oligoantigenic diet, although it is extremely difficult to follow.

• More than 80 per cent of 76 hyperactive children improved significantly on the Few Foods diet in an open trial followed by DBPC challenges (Egger and others, 1992).

• In a repeat of the study above, 73 per cent of 78 hyperactive children improved significantly on the Few Foods diet in an open trial followed by DBPC challenges (Carter et al, 1993).

• One hundred per cent of  9 chronic juvenile offenders aged 8-16 improved significantly on a three week open trial of the Few Foods diet. Those who remained on the diet did not re-offend (Bennett and others, 1998).

• A German trial of the Few Foods diet with 21 children found significant improvements according to questionnaires and interviews but not on attention tests and actometer. Researchers commented ‘it may be that the oligoantigenic diet influences only certain dimensions of hyperactivity’ (Schulte-Korne and others, 1996).

• A Dutch trial of the Few Foods diet (rice, turkey, pear and lettuce) with 40 ADHD children found 62 per cent improved significantly after two weeks on the diet. Nine children withdrew because the diet was too difficult or the child fell ill (Pelsser and others 2002).

Low salicylate diets

In the 1970s, American pediatrician Dr Ben Feingold found that hyperactive children who are affected by artificial colours and preservatives can also be affected by natural salicylates in foods.

• In a DBPC trial of a reduced salicylate diet study that was later criticized for the influence of industry funding, mothers reported improvements in 100 per cent of 10 preschoolers and one third of 36 school aged boys. Rresearchers dismissed the diet as unsuccessful due to possible bias by mothers (Harley and others, 1978).

In the mid-80s a new analysis of salicylate contents in foods was published by Australian researchers showing that there were salicylates in many more foods than previously thought and than had been excluded by the Feingold diet (Swain and others, 1985).

• In an open trial of a low salicylate, low amine diet with 140 children, 86 per cent improved significantly. DBPC challenges showed reactions to salicylates, preservatives including benzoates, nitrate, metabisulphite and propionic acid, azo dyes, synthetic antioxidants, brewers’ yeast, tyramine and phenylethylamine and MSG (Swain and others, Lancet 1985).

• In an open trial of a low salicylate, reduced amine diet, 80 per cent of 516 children with behaviour problems improved significantly (Breakey and others, 1991).

• I used the low salicylate, low amine, low glutamate diet developed by Swain and others (1985) for the open trial first stage of a DBPC study with 27 children. One hundred per cent of the children who completed two to three weeks of the elimination diet improved significantly. One child left the study in the first week due to the difficulty of sticking to the diet. I noticed that the number of children improving on the diet will depend on the amount of support given to the family, as even the smallest mistakes could prevent improvement. For example, during the study, two children failed to improve until it was found that they were mistakenly eating unlisted antioxidant 320 in common plain cracker (Dengate and Ruben, 2002).

• A 27 year old university graduate had a history of ADHD without hyperactivity and obsessive-compulsive disorder since childhood, and anxiety and depression since late teenage. Although his symptoms did not respond to a range of psychotropic drugs, he improved significantly during a 4-week trial of the diet mentioned above.  DBPC and open challenges showed that salicylates and many other food chemicals were associated with his symptoms (Parker and Watson, 2002).

• Preliminary results from a Melbourne study of diet and behaviour currently underway using the diet mentioned above are encouraging. Enrolments for this study will be closing soon.

Reader Stories:

[039] "They said we would be wasting our time" using diet for ADHD and ODD (May 2000)

My eight year old son was recently diagnosed ADHD and ODD by three different doctors. All three doctors said we would be wasting our time altering his diet and that the only thing to do was to prescribe drugs.

We didn't want to put him on drugs but my wife and I were at our wits end, our son was becoming more and more of a handful, I must admit I was about to give up and take the doctors' advice.

We bought your book "Fed Up" and started the diet. My God, the improvement was almost instant. He changed from an aggressive and argumentative little creep to a loving and caring little boy almost immediately. My wife, myself, our other two children and most of all our son's teacher are amazed. We have stuck to the diet and there have been no hassles in the home or the classroom for several weeks. Although last weekend we took the kids out for the day and bought them each a bottle of Schweppes lemonade. Within half an hour our son was back to his aggressive old self ... learned a lesson there. He now realises that some things make him cranky and steers away from them, after all, he says he doesn't like being his angry self.

Sue, we don't know how to thank you. You have changed the lives of not only our family, but the other kids in our son's classroom, who I'm sure are as grateful as we are - concerned father, ACT

[040] The preham and postham sandwich pictures (May 2000)

On Day 2 of the elimination diet, which I forgot about in a moment of sheer flustering, I gave my daughter Laura (aged 4) a ham sandwich on normal bread. Before the ill-fated sandwich she had drawn a picture which we have named "preham sandwich". Then later that afternoon she drew another picture (after spending a horrible bad tempered afternoon together) which we named "postham sandwich". Quite a difference wouldn't you say! and I just thought it was my son who needed the help! - Lynda Smith, NSW

[139] 282: Bread preservative-induced ADHD (December 2001) 

I have felt compelled to write to you for some time now to let you know how successful Failsafe foods have been in our home. Our daughter, Courtney, now aged 7, was diagnosed with ADHD at the age of 5. I was not convinced that the process of this diagnosis was exactly scientific so I decided to do some reading.

I read "Different Kids" and embarked on the elimination diet with the help of a dietician. We had tremendous results. Courtney's teachers were openly amazed at the change in her behaviour. With their support we started the challenges - no noticeable reaction to salicylates or amines, but a very strong reaction to the bread preservative (282) which gradually built up over a 5 day period. Once the challenge was stopped, it took 2 weeks for withdrawal. Courtney's behaviour was extremely aggressive and impulsive and withdrawal resulted in lethargy and stomach aches. We have not been able to do any further challenges as Courtney was jeopardising the very fragile friendships she had begun to make. We will need to wait for the Christmas holidays before proceeding any further.

I have only recently read "Fed Up" and I was amazed to learn just how many children react to 282. Our dietician was surprised at our results. I am now a bit of a campaigner against food additives and recommend your books to anyone willing to listen! Our heartfelt thanks to you for helping us rediscover the lovely little girl we knew as a baby without the need for medication. - Heather - by email

[133] On medication if not on diet (December 2001)

"My husband and I follow the diet with our four children, aged 9 months to 7 years. We started the diet after we saw the difference it made in my sister's three children (two with ADHD). We and our paediatrician believe our two oldest children would, in the long run, be on medication like their cousins if we had not started the diet when we did almost two years ago ... it's both easy and hard, but so very worth it!" - reader, NSW

[110] Cut his Ritalin dose in half (August 2001)

"My son is 11 years old, diagnosed with ADHD, and has been on Ritalin for about 6-7 years … we have had him on a Failsafe diet for almost two months now. By the end of the first month he showed remarkable improvement, being able to finish homework more quickly and having a more thoughtful disposition. We were also able to cut his Ritalin dose by half, giving him the medication mainly for school, but not at home." – from the USA

[066] "I was wondering about coping with school next year" (September 2000)

Although my child had never been diagnosed as ADD or ADHD, he was just a very active little boy who did not sleep much or very well. He wasn't interest in reading, writing or drawing and I was becoming very concerned about how he was going to cope with going to school next year. After two weeks of eliminating all fruit (except pears) and preservatives from his and our diets he is a changed person. He writes his own name and started to write other letters and is very happy to sit and draw for at least an hour! (he couldn't sit still for at least 5 mins before the diet). His new favourite word is "preservatives".

[270] A 21-year-old looks back on diet (June 2003)

When I was around 4 years old I had quite severe behavioural problems, so my mum went from doctor to doctor looking for a possible solution. Eventually one doctor suggested the Feingold diet. I started the elimination diet in 1986, and my parents found an immediate improvement. One day my grandparents gave me red cordial which pretty much confirmed the effects of food additives. My parents and I found that I reacted to salicylates, and lots of artificial colours and flavours.

I went from a kid who everyone said would grow up to be a juvenile delinquent, to a better behaved kid who is now 21, studying for an Information Technology Bachelors degree. I also finished a 12-month employment contract not long ago and started a new job.

I'm surprised that it's only recently that people have been talking about the link between food and behaviour. - Danny Frencham, student

[267] Borderline ADHD and additive-free diet (June 2003)

My son was diagnosed with borderline ADHD and we have him on a colour and preservative free diet. It has made such a difference. It is nice to have other people comment on his behaviour in a positive way now. Before he couldn't sit still in church for the first part of the service before going out for Sunday School but now he happily sits still. - Jennie Breach, NSW

[408] Hyperactivity, bad mood swings, violent behaviour (March 2006)

My 9 year old nephew 'suffered' from super hyperactivity and very bad mood swings for most of his life which was very stressful for all his 3.5 school years. His violent behaviour, which only ever occurred at school, included pushing over desks, tearing up paper, pulling phone connections out of walls, pulling plants out of the garden and hurting a teacher when being restrained. They would ring his Dad to come and take him home. He visited many medical specialists, was finally diagnosed ADHD and prescribed adult doses of drugs with no improvement.

Over the last six months he has been failsafe while being homeschooled and there was an incredible difference within two weeks. In four months he covered nearly 12 months school work and is improving rapidly. He has always been quick to lose his temper at home with his brother and sister but since he started on the diet we have not seen him angry.  He actually had his head slammed in a car door recently by his sister's friend.  It must have really hurt and his eyes watered but his response was "It wasn't your fault, Poppy". We were all amazed. He is now a healthy, happy little boy with a great sense of humour. It is frustrating to say the least that so much of the trauma this little boy and his family went through was to do with food additives.  by email, Qld

[407] My children were on an extremely healthy diet (March 2006)

After failsafeing my children we have seen a great improvement in their behaviour. My eldest daughter (nearly 5yrs) was diagnosed with ODD. She is so much happier and easier to live with since being on the diet. My youngest daughter had dry eczema on her arms that has all but disappeared. Both of my children were on what would have been considered an extremely healthy diet (fit for life) with very little junk food and loads of fruit and vegetables. They have both improved considerably over the four or five months on the diet. Thanks for the work you have done in making us aware of what really is in our food. We have tried many things to help our eldest daughter with little success and were at our wits end. Food has turned out to be a big key. Now some of the other methods we had previously tried (eg. reward charts) actually work. If we have a slip on the diet it's like a wall goes up in her mind and she can't listen anymore. – Belinda, by email

[324] Autism and diet at school (2) (April 2004)

About 18 months ago you helped us put our son Ryan (now nearly 5 years old) on the elimination diet, after we had been to RPA for Ryan's hyperactivity, ADHD and autism. Three months later you helped us find a problem with wholegrain wheat and antioxidants that had pulled us undone. Salicylates turned out to be our main problem although antioxidants are a close second, with amines and other additives a problem too. Our son is now in his second year at special school, where he has made great leaps and bounds. When Ryan started school he was already on the diet. Months later when we'd allowed bananas to become more frequent than one half every second day, his teachers actually came to me and asked was Ryan eating something he shouldn't be. It took us three weeks to figure it out, and cut back on the bananas. Through this incident, they really came to see what we were talking about. Interestingly the school has strongly supported us, always keeping us up to date with what's coming up for 'tasting' in cooking classes, and seeking alternatives for Ryan. I'm very grateful for this! - reader, NSW.

[335] I thought my child was not a "foodie" (July 2004)

When my 8-year-old daughter was diagnosed with ADHD late last year the doctor suggested I read Dr Green’s book, which I did, and she also suggested that I cut out some artificial colours, flavours and salicylates. She told me that salicylates are in cheese. I did this for about a week. Most of the food I had in my home was "no artificial colours" etc and avoiding cheese made no difference. The doctor didn’t tell me that salicylates are mainly in fruit, she didn’t tell me about 282, and she didn’t give me any reference to your work or that of the RPAH diet. Therefore, I thought my child was not a "foodie" (as I call her!) and gave it no further thought. My husband is dead against ADHD medication and basically my daughter got worse over the next six months until I was at breaking point with her behaviour at home, socially, and at school.

About 3 months ago, I went into a bookstore in desperation one day just looking for anything that would help me. I had been in tears for a week not knowing what else to do with her. I bought a copy of "Fed Up With ADHD" and I admit I didn’t place much hope in it because of my previous experience. I read your book in a day and a half. The third page got my attention when you mentioned all the things food intolerance can be responsible for - handwriting, co-ordination, bowel control etc which are all things my daughter has been struggling with for years. She has never finished a task at school and she is in year 3. She is currently having occupational therapy for her co-ordination and she has always had bowel problems which are ongoing.

That week I took all my children off commercial bread and bought Bakers Delight which is the only bread I have bought since. I thought about two days later that my home was slightly calmer, but told myself that I was just looking for something. After three days I started my children on the diet, much to their total disgust! Within another three days I could see a difference in my daughter.

Since then, I have been having daily communication with her teachers and frequently the Principal, and although she is still quite slow and disorganised, her attitude is much better and she is not anywhere near as emotional as she was. She has gone from crying hysterically ten times a day to only having hysterics if she has eaten something wrong. I’ve established, unfortunately, that she is severely sensitive to salicylates, and even pears seem to make her a bit vague. While I am still struggling with this (I mean after all, how can a child not eat any fruit!!), I am learning what I can give her and when.

Basically, it is very hard work (which I realise you of all people know!), and a very big learning curve, but we’re getting there. Everywhere I go now and mention it someone says something along the lines of "Oh yes, my friend has a sister who’s done that and apparently the kid is like a different person". Sue, the word is spreading! I just wanted to say thank you for all the work and time and effort you have put in to this. Without your advice I would probably be on antidepressants by now. - Tracy, NSW

[017] ADHD success from New Zealand (June 1999)

We purchased your book 'Fed Up' and started to use some of your foods mentioned and in a matter of two days we noticed a difference with our two children who are ADHD.

Our six year old was diagnosed ADHD 12 months ago. He was in the top 3% for hyperactivity. Ritalin has never been our answer but seemed to be the better of the two evils. He still finds it hard to fit in with children in his class and is often left standing alone when it comes time for the children to pick a partner. He however interacts very well with older children and all his friends at school are two or three years ahead of him. When you strip away the ADHD he is the most gentle intuitive animal-crazy kid you'd ever meet.

I had felt up until a day or two into the diet we had been robbed of the normal loving caring relationship shared by mother and son and it makes me sick to the stomach that all the so-called top paediatricians and psychiatrists have never mentioned diet, only increasing the amount of Ritalin and disregarding my theory on diet. Our son loves school, even if it comes with a few knocks. He's bright and he wants to learn so I want to do everything in my power to help him succeed and your diet works better and more consistently than Ritalin.

Our younger son is 15 months old and what a handful he is, exactly like his brother but with a temper, again the diet has helped him slow down and become more focused and much calmer to be around. Thank you so much as it has brought our family closer.- Leesa & Stephen King, NZ

REFERENCES Abstracts for most of the papers mentioned below can be found at www.pubmed.com

Bateman B, Warner JO, Hutchinson E, Dean T, Rowlandson P, Gant C, et al. 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. Arch Dis Child 2004;89(6):506-11.

Bennett CPW, McEwen LM, Rose E. The Shipley Project: treating food allergy to prevent criminal behaviour in community settings. J Nutr Envir Med 1998;8:77-83.

Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994;72(5):462-8.

Breakey J, Hill M, Reilly C, Connell H. A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children. . Aust J Nutr Diet 1991;48(3):89-94.

Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69(5):564-8.

Clarke L, McQueen J, Samild A, Swain A. The dietary management of food allergy and food intolerance in children and adults. Australian Journal of Nutrition and Dietetics 1996;53(3):89-94.

Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health 2002;38(4):373-6.

Egger J, Carter CM, Graham PJ, Gumley D, Soothill JF. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet 1985;1(8428):540-5.

Feingold BF. Why your child is hyperactive. New York: Random House, 1974.

Fitzsimon M, Holborow P, Berry P, Latham S. Salicylate sensitivity in children reported to respond to salicylate exclusion. Med J Aust 1978;2(12):570-2.

Harley JP, Ray RS, Tomasi L, Eichman PL, Matthews CG, Chun R, et al. Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 1978;61(6):818-28.

Horton R. Lotronex and the FDA: a fatal erosion of integrity. Lancet 2001;357(9268):1544-5. (has become ‘a servant of industry’)

Jacobson MF, Schardt MS. Diet, ADHD and behaviour: a quarter-century review. Washington DC: Centre for Science in the Public Interest, 1999. Download the report from www.cspinet.org under Reports, 1999

Kaplan BJ, McNicol J, Conte RA, Moghadam HK. Dietary replacement in preschool-aged hyperactive boys. Pediatrics 1989;83(1):7-17.

Lau K, McLean WG, Williams DP, Howard CV. Synergistic interactions between commonly used food additives in a developmental neurotoxicity test. Toxicol Sci 2006;90(1):178-87.

Moynihan R, Cassels A. Selling sickness: how drug companies are turning us all into patients. Sydney: Allen and Unwin, 2005, chapter 9, Taming the watchdogs includes the story about former FDA senior consultant Paul Stolley’s quote about ‘confused and frightened’.

Parker G, Watkins T. Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance. Aust N Z J Psychiatry 2002;36(2):263-5.

Pelsser LM, Buitelaar JK. [Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study]. Ned Tijdschr Geneeskd 2002;146(52):2543-7.

Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125(5 Pt 1):691-8.

Schulte-Korne G, Deimel W, Gutenbrunner C, Hennighausen K, Blank R, Rieger C, et al. [Effect of an oligo-antigen diet on the behavior of hyperkinetic children]. Z Kinder Jugendpsychiatr Psychother 1996;24(3):176-83.

Cover story. Who owns the FDA? The drug industry or the people? BMJ 2002;325: 555-6, 561, 592-595, the opening editorial concludes the FDA ‘has failed in its mission to protect public health’

Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2(8445):41-2.

Swain AR, Dutton SP, Truswell AS. Salicylates in foods. J Am Diet Assoc 1985;85(8):950-60.

Swanson JM, Kinsbourne M. Food dyes impair performance of hyperactive children on a laboratory learning test. Science 1980;207(4438):1485-7.

Uhlig T, Merkenschlager A, Brandmaier R, Egger J. Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder. Eur J Pediatr 1997;156(7):557-61.

Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, et al. Behavioral responses to artificial food colors. Science 1980;207(4438):1487-9.

More information

Children have different reactions to various food chemicals so any or all of the following food chemicals can cause problems: artificial colours, natural colour annatto 160b, sorbate, benzoate, sulphite, nitrate, nitrite and propionate preservatives, synthetic antioxidants, flavour enhancers, natural salicylates, amines and glutamate as well as, for some people, dairy foods, wheat or gluten. See the Failsafe booklet on the website www.fedup.com.au under Failsafe Eating.  If reducing your intake of nasty additives doesn’t help, you might want to do a full elimination diet to find the cause of the problem. You can email for our list of supportive dietitians: confoodnet@ozemail.com.au

www.fedup.com.au

The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance.

© Sue Dengate Update August 2006