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
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
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
[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
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.
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,
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.
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.
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.
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
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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,
Swain AR, Dutton SP,
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
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Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, et al.
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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
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. You can find a supportive dietitian through the Dietitians
Association of
© Sue Dengate Update August 2006
