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 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,
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
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
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
