ADHD and diet

FOOD INTOLERANCE NETWORK FACTSHEET

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ADHD and Diet

Introduction
The science
Which diet is best?
Which foods are most likely to cause problems?
Reader reports
Scientific references and notes
Further reading

Keywords: ADD, ADHD, ODD, attention deficit disorder, attention deficit hyperactivity disorder, oppositional defiance disorder, intolerance, elimination diet

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Introduction

Diet works for the majority of children with ADHD symptoms - if you get the diet right. ‘Experts’ who say otherwise do not know enough about it.

The diet we recommend is the RPAH (Royal Prince Alfred Hospital) Elimination Diet. This involves avoiding everything that can cause problems – additives, natural food chemicals, fragrances and even mint flavoured toothpaste - for 3-4 weeks then reintroducing foods and food chemicals one group at a time to find out exactly what is causing the problem. For best results, the diet and challenges should be supervised by a supportive dietitian who specialises in food intolerance. You can see our list of recommended dietitians.

The science

When highly processed additive-laden foods became widespread in the U.S. in the 1960s, paediatric allergist Dr Ben Feingold suggested that additives such as artificial colours, flavours and preservatives could be responsible for the growing epidemic of children’s behaviour and learning problems, variously called hyperkinesis, hyperactivity, ADD, ADHD, ODD and many more. Further, he suggested that natural chemicals called salicylates – in artificial flavours and natural foods – were also involved (1).

If Dr Feingold had been taken seriously then, it would have saved millions of families from anguish. Instead, a series of food industry funded studies ‘proved’ that he was wrong (2). Three decades on, it is now recognised that industry funding skews results and the FDA which should have been protecting our children is now accused of being a servant of industry (3,4,5).

It wasn’t until 2010 that the additive part of Feingold’s hypothesis was partly vindicated, at least in the EU (Europe) Based on research from the University of Southampton (6,7) from June 2010 foods containing certain artificial colours in Europe must carry the warning: ‘may have an adverse effect on activity and attention in children.’

Shortly afterwards, a well designed controlled study in the Netherlands that followed 100 children for a year showed that two thirds of children with ADHD can improve on a restricted diet (8).

The 2011 Dutch study is the tenth study to show that at least 60% of children with ADHD symptoms can be helped by diet (8 -17). In my bread preservative research, 100% of children who followed the RPAH elimination diet for at least two weeks improved significantly, with one out of 28 dropping out in the first week (11).

There is no doubt: diet works for the majority of children with ADHD symptoms if you get the diet right. ‘Experts’ who say otherwise do not know enough about it, for example those who say that diet trials should be RCT. As discussed by Kaplan and others, the most successful diets are too restricted to be used in an RCT protocol (18). The RCT phase is used during reintroduction.

Independent scientists recommend 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
  • the FDA should consider banning from foods consumed widely by children any dyes and other additives that affect behaviou
  • schools … should minimize the use of food additives that may contribute to behavioural disorders’ (19).

Which diet is best?

Researchers generally use:

  • a whole foods diet: excluding foods such as wheat, milk, tomatoes (8,9,12,14,16,20,21)
  • a low chemical diet: additive free, low salicylates etc (1,11,15, 22, 23)
  • a mixture: additive-free, avoiding certain whole foods (13, 18)
     

In general, the more restricted the diet, the more effective it is (18).

The diet best documented in the medical literature is the Few Foods diet pioneered by Dr Egger and used in the recent Dutch study (8). However, in the experience of the Food Intolerance Network, the Few Foods diet which starts with rice, turkey, lettuce, pears and a few vegetables, is extremely difficult for families to use. The diet recommended by the Food Intolerance Network is the RPAH Elimination Diet which avoids about 50 additives, salicylates, amines, glutamates and if symptoms are severe also dairy foods and gluten (25).

In our experience, the RPAH Elimination Diet when supervised by an experienced and supportive dietitian is doable and effective, see Reader reports below.

Which foods are most likely to cause problems?

For symptoms of ADHD such as overactivity or restlessness, the table below shows the approximate percentage of children likely to react to each food or food chemical.

Percentage

React to

Where found

75

salicylates

most fruit, mint, tomatoes, some vegetables; flavours

60-70

preservatives

processed foods e.g. bread, drinks, dried fruit, ham

55

colours

artificial colours; natural colour annatto 160b

40

amines

biogenic amines e.g. chocolate, cheese, processed meat

40

antioxidants

synthetic antioxidants e.g. TBHQ (319), BHA (320),BHT (321)

40

flavour enhancers

MSG, inosinates, guanylates, ribonucleotides 600-635, HVP, yeast extract, natural glutamates

20

dairy foods

milk, yoghurt, cheese, butter

Less than 1

gluten

although some people are affected by wholegrains e.g. wholegrain bread rather than white bread; figures are higher for other symptoms, up to 20% for irritable bowel

 

People rarely react to only one food chemical. Most react to between 3-6. (26)

Source: Loblay and Swain, 1986

Reader reports:

Inspiring collection of all stories about ADHD and diet, including those below

[956] Feedback after two years on failsafe (August 2010)

Our family have been following the Fed Up books for over 2 years now for a 5 year old daughter who was reacting severely with rashes on her face & body & a son whose doctor wanted to prescribe ADHD medication.

I can happily report that our daughter is rash-free and in fact after 7 years she doesn't even have eczema anymore. I believe her immune system has improved dramatically since being mostly failsafe. She is a healthy beautiful clear-skinned little girl with a good resistance to illnesses these days. My son is also progressing well with a mostly failsafe diet and fish oils to help with concentration. (our biggest problems - artificial colours & preservatives & in my daughter case - corn as well).

Just as an aside to this story - I put up with dreadful headaches every day for about 15 years, along with the headaches I got muscle cramps in my neck & shoulders. I was on a muscle relaxant for years until visiting a chiropractor. I went off the medication but after some weeks had a return of the problem after eating bacon & ham.....I am now convinced it was nitrates that were giving me the problem, and I have proven it a couple of times since. I have read about headaches & nitrates but can’t find anything on it affecting the muscles - for years I thought I was just being uptight!! - Julie by email

[926] Didn’t realise my daughter was affected by salicylates (June 2010)

I am a primary teacher with 3 children of my own. I first heard about your book 'Fed Up' when a student in my class was diagnosed with ADHD and his mother decided to try changing his diet rather than medicating him. The change in this boy was amazing. I wrote down the details of your book to recommend it to other parents in the future, but ironically I now use your book myself as my six year old has just been diagnosed with ADHD. We had been eating a diet low in artificial additives for years after discovering that my children were reacting to the preservative 282 in bread but have just recently begun failsafe eating after my son's diagnosis. In doing so we discovered that all 3 of our children were reacting to salicylates. Even my 7 year old daughter who had been irritable all the time and difficult to get along with has changed into a happy, co-operative child since changing her diet. We hadn't even realised that she was affected by the natural food chemicals. Our son who was diagnosed with ADHD has changed so much that at a recent doctor's visit the GP looked at him sitting quietly and said, "He doesn't have ADHD!" The doctor prescribed antibiotics to clear his cough and after one dose of antibiotics (with preservative and flavour) all his symptoms returned. We are now more sure than ever that food is the cause of his behavioural problems.- Cara, NSW

[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

preham  postham

[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

Scientific references

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

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

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.

The best of the industry-funded studies, this DBPC trial of a reduced salicylate diet was later heavily criticized by many due to the influence of industry. Mothers reported improvements in 100 per cent of 10 preschoolers and one third of 36 school aged boys, but researchers dismissed the diet as unsuccessful due to possible bias by mothers.

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

4. Moynihan R, Cassels A. Selling sickness: how drug companies are turning us all into patients. Sydney: Allen and Unwin, 2005.

Quote from Chapter 9, Taming the watchdogs, from former FDA senior consultant Paul Stolley: FDA officials are ‘confused and frightened’ because they are afraid to offend financial sponsors

5. Cover story. Who owns the FDA? The drug industry or the people? BMJ 2002;325: 555-6, 561, 592-595.

Quote: the opening editorial concludes the FDA ‘has failed in its mission to protect public health’.

6. McCann D and others, Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial Lancet. 2007 Nov 3;370(9598):1560-7.

In this first additive-hyperactivity study from the University of Southampton in the UK with a group of 277 three-year-olds from the Isle of Wight researchers 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.

7. 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.

A follow up of the study above, this is the study that led to artificial colours being phased out in the UK and the warning regarding artificial colours on food labels ‘may have an adverse effect on activity and attention in children.’

8. Pelsser LM and others Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. 2011;377(9764):494-503.

This repeat of the 2002 study involved 100 children aged four to eight. Fifty of them followed an elimination diet – removing all known problem foods until some of them consumed only rice, turkey, pear, vegetables and water. After five weeks, two-thirds of the children on the special diet no longer had any behavioural problems. There was no difference in the behaviour of the control group on a 'healthy' diet. The children were followed for a year, with foodstuffs being added back into their diet to determine what caused the hyperactive reaction. Researchers concluded that 'dietary intervention should be considered in all children with ADHD, provided parents are willing to follow a diagnostic restricted elimination diet for a five-week period, and provided expert supervision is available.' they wrote. This diet is not new, but it is the first time it has been trialled on so many children for such a long time. Full study at http://www.adhdenvoeding.nl/cms/wp-content/uploads/2011/02/Pelsser-The-Lancet-2011-Publication-INCA-study.pdf    http://www.ncbi.nlm.nih.gov/pubmed/?term=pelsser+lancet+2011+adhd   http://www.npr.org/2011/03/12/134456594/study-diet-may-help-adhd-kids-more-than-drugs 

9. 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.

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.

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

In an open trial of a low salicylate, low amine diet with 140 children, 86 (nearly two thirds, 61%) 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 (Full paper - PDF format)  

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

I used the RPAH Elimination Diet in the open trial first stage of an RCT study with 27 children with ADHD-type symptoms (irritability, restlessness, inattention, sleep disturbance). 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.

12. 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.

100% 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.

13. 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.

This study treated 26 children with symptoms of ADHD with a multiple item elimination diet. Of those, 19 children (73%) responded favourably. On open challenge, all 19 children reacted to many foods, dyes, and/or preservatives. A double-blind placebo controlled food challenge (DBPCFC) was completed in 16 children. There was a significant improvement on placebo days compared with challenge days (P = .003). The authors concluded: ‘This study demonstrates a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD. Dietary factors may play a significant role in the etiology of the majority of children with ADHD’.

14. 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.

In a repeat of the Egger et al 1985 study below, 73 per cent of 78 hyperactive children improved significantly on the Few Foods diet in an open trial followed by DBPC challenges.

15. 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.

In an open trial of a low salicylate, reduced amine diet, 80 per cent of 516 children with behaviour problems improved significantly.

16. 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.

More than 80 per cent of 76 hyperactive children improved significantly on the Few Foods diet in an open trial followed by DBPC challenges.

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

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.

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

19. 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.

20. 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. • An EEG (electroencephalogram) study with 45 children on the oligoantigenic diet found significant increases in brain activity in certain areas after children had eaten provoking foods.

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 reported in Jacobson and Schardt, 1999).

21 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.

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’

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

This analysis of salicylate contents in foods in the 1980s 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.

23. 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.

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.

24. 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.

25. 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.

26. Loblay RH, Swain AR. Food Intolerance. In: Recent Advances in Clinical Nutrition' Vol 2, 1986. Libbey, London. Eds: Wahlqvist ML and Truswell AS, pp169-177.

Other relevant studies

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.

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)

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.

In one of the earliest food colouring studies, 22 young children, maintained on a diet that excluded certain foods, were challenged intermittently with a blend of seven artificial colors in a double-blind trial. One child who responded mildly and another who responded dramatically to a challenge were detected. Now Professor of Environmental Medicine and Pediatrics at the University of Rochester, lead author Dr Bernard Weiss has since written many articles about behavioural toxicity of food and other chemicals.

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.

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).

Adams RF, Murray KE, Earl JW. High levels of faecal para-cresol in a group of hyperactive children. Lancet 1985;2(8467):1313.

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’.

Further reading

You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians 

Fed Up:  Understanding how food affects your child and what you can do about it by Sue Dengate is available from bookstores, libraries, as an ebook and through our website. Readers say:

  • If it had not been for your book we would still be living with an unhappy, difficult child and she would not have had the pleasure of knowing that she could achieve so much
  • Fed Up has been a lifesaver for us
  • The best of all your books
     

Our DVD "Fed Up with Children's Behaviour" is available in libraries and through our website. This is what one man wrote:

  • "I've watched your fantastic DVD three times since receiving it. It has made me go back to the drawing board, I think I missed salicylates earlier. You might want to reconsider the title "Fed up with Childrens behaviour", it is not just about children I feel, and it is not just about behaviour either. It goes much further. Many people who are not concerned about children's behaviour could still benefit in a big way from the DVD."
  • Mothers say it helps to convince kids and dads to do the diet, and makes teachers more supportive
     

The Failsafe Cookbook is available from bookstores, libraries, as an ebook and through our website. This book contains information about food intolerance with heaps of easy recipes and hints. It is especially useful if doing this diet in the long term. Readers say:

  • very easy to use and yummy results
  • everything we cook is out of your cookbook it has become like my bible - I even take it when I leave the house
  • when I found out that he had been lunch swapping at school I reviewed his lunch box and bought your cookbook - now he is getting enough interesting things and variety so he feels that he is not missing out!
 
The RPAH Elimination Diet Handbook with food and shopping guide and Friendly Food are available from www.allergy.net.au but in our experience, very few families succeed with Friendly Food alone. One failsafer wrote:
  • 'Thank you for writing your fantastic "Failsafe Cookbook". We have been using it for a while and have recently gotten "Friendly Foods" as well and as good as it is for a lot of stuff, I'm SO grateful for the simple, family friendly recipes in your book. 

 

Introduction to food intolerance

Dietary management of ADHD paper by Sue Dengate (1997)

Sue’s Blogs
Kids on Speed or Diet for ADHD?
ADHD increasing  
Attention deficits are not just for kids

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. You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians 

© Sue Dengate February 2014

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The pharmacist refused to fill my son's script for Ritalin.  He said 'for oppositional defiance, you need to read Fed Up and look at food'.  It changed our lives.

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