Thought this might be of interst too (adhd/add and diet)

[Guest guest]

ADHD & Diet: How Food Affects Mood

Issue 101, July/August 2000

By Michael Jacobson

for the Center for Science and the Public Interest

In the early 1970s, Dr. Benjamin Feingold, then chief emeritus of the

Department of Allergy at the Kaiser Foundation Hospital and

Permanente Medical Group in San Francisco, reported a link between

diet and several physical and allergic conditions. Thirty to 50

percent of Feingold's hyperactive patients said they benefited from

diets free of artificial colorings and flavorings, and certain

natural chemicals (salicylates, found in apricots, berries, tomatoes,

and other foods).

Although many parents eagerly embraced the Feingold diet, others--

such as the processed-food industry, many child-behavior experts, and

some pediatricians--were more skeptical. Perhaps, they reasoned, the

families were doing other things in addition to dietary modification,

or maybe they were simply reacting to wishful thinking. With time,

however, researchers began testing aspects of Feingold's claim. Over

the following decades, almost two dozen additional controlled trials

followed, mostly focusing on food dyes. In some cases, children were

put on a diet that lacked many food additives and

subsequently " challenged " with dyes. In other cases, the behavior of

children was monitored after they were switched to a diet free of

certain foods that might cause a reaction (dyes, wheat, egg,

chocolate, and others) and then challenged with those foods. Most--

but not all--of those studies found that some--but not all--children

were affected by diet, some slightly, others dramatically.

In 1982, the National Institutes of Health (NIH) convened

a " consensus development conference " on diets and hyperactivity to

review the early scientific research and advise health professionals

and the public. Their conclusion was that controlled studies " did

indicate a limited positive association between. . . [Feingold-type]

diets and a decrease in hyperactivity. " The panel recommended further

broad research on the diet-behavior connection--advice that generally

has not been heeded. This is in part why so little is known today

about the percentage of children who respond to dietary therapy, to

what degree they respond, which children are most likely to be

affected, the additives and foods that cause problems, and the best

ways to use diet therapy.

Nevertheless, in the face of ever-escalating Ritalin prescriptions,

some families are seeking out dietary therapy for their children. One

reason for their interest is that Ritalin and amphetamines (such as

Adderall and Dexedrine) may cause reduced appetite and weight loss,

stomachaches, and insomnia. More seriously, those drugs occasionally

may cause or exacerbate tics and Tourette's syndrome. Another drug,

Pemoline (Cylert), has been associated with fatal liver failure; the

Food and Drug Administration (FDA) urges doctors not to use it to

treat ADHD.

Furthermore, until long-term studies are done, it will not be known

whether years-long treatment in childhood (or, for that matter,

adulthood) with stimulant drugs has an effect on the nervous system

or other parts of the body later in life. Importantly, a study by the

federal government's National Toxicology Program (NTP) found that

doses of Ritalin that only modestly exceeded the maximum recommended

dose in humans caused liver tumors in mice. " Millions of young

children take Ritalin for years on end, and children may be

especially susceptible to a carcinogen's effects, " says Samuel

Epstein, a cancer expert at the School of Public Health at the

University of Illinois. Although the NTP study indicates " a weak

signal of carcinogenic potential, " the government still considers the

drug safe. Yet the lack of a long-range study of Ritalin's possible

carcinogenic effect is extremely troubling. Large numbers of children

have been consuming Ritalin for only the past one or two decades, and

cancer might not manifest itself for several decades later in life.

Trying a Dietary Modification Approach

Parents wishing to test their children's response to diet will seek

to identify and remove irritants in foods (and other products) that

cause behavioral symptoms. This is done by eliminating certain foods

(and vitamins and drugs) from the (unmedicated) child's diet for

several weeks to see if his or her behavior is improved. In some

cases, dietary changes by themselves may adequately reduce behavioral

problems. If not, amphetamines or another medication could be tried

in addition to, or instead of, a restricted diet. The goal is to

identify the specific foods or additives, if any, that affect your

child. What makes this challenging is that children's behavior

ordinarily is so variable.

Needless to say, controlling the diets of young children can be

difficult, especially once children go to school. Foods containing

dyes and other potentially provoking ingredients are advertised

aggressively and available everywhere: at supermarkets, restaurants,

schools, vending machines, parties, theaters, and the homes of

friends and relatives. Many young children are already " hooked " on

the very foods that may cause problems, though it is getting easier

to find acceptable alternatives. And children who don't eat what all

their friends eat may feel left out or stigmatized.

Some parents who've put their children on special diets, though, say

their children willingly cooperate in making dietary changes,

especially after they discover that those changes make them feel

better. Some older children avidly read labels to avoid certain

ingredients.

Although some studies suggest dietary therapy can be more effective

among young (preschool) children and those who suffer from asthma,

eczema, hives, hay fever, or similar symptoms, a diet could be worth

trying no matter how old your child is or how the behavioral problem

is manifested. It is certainly safer and cheaper than using stimulant

drugs, and, if your child has been eating a lot of artificially

colored foods, it may also be more nutritious.

Numerous studies have demonstrated that some children are sensitive

to dyes. Thus, you might start by eliminating only foods (and

vitamins, drugs, and toothpastes) that contain artificial colorings.

The Feingold diet eliminates additional additives, as well

as " salicylate-containing " foods. That diet eliminates:

& #61623; artificial colorings (look for names like " Red 40 " and " Yellow 5 "

on labels)

& #61623; artificial flavorings (including vanillin, used in synthetic

vanilla)

& #61623; artificial sweeteners (acesulfame-K, aspartame, saccharin,

sucralose)

& #61623; BHA, BHT, and TBHQ preservatives

One study suggests that sodium benzoate and benzoic acid should also

be on that list. The Feingold diet also excludes certain fruits and

vegetables, although studies have not demonstrated that they cause

problems. (See " Sidebar: Foods on the Feingold Diet " ). While that

diet excludes many common foods, you can later reintroduce any to

which your child is not sensitive.

Once you have decided which foods and additives you will eliminate,

check out all the foods in your refrigerator, pantry, and cupboards,

and remove or discard any that contain banned ingredients. Do not

forget restaurants: many fast-food chains offer lists of the

ingredients in their products; ask servers or call their consumer-

affairs offices. The Feingold Association publishes lists of selected

packaged and chain-restaurant foods that fit into the diet, but you

will have to become a careful label reader and inquisitive restaurant-

goer to learn the ingredients in your children's favorite foods. It

may be easier to stick to home-prepared meals during this test

period.

Once you are set to go, put your child (and the rest of the family,

if possible) on the modified diet for two or three weeks. If your

child mistakenly eats a prohibited food, do not get upset--just get

him or her back on the diet. Using a separate page for each day, keep

a score sheet (click here for sample score sheet) based on common

characteristics of ADHD, but modify that to include your own child's

most troubling behaviors. Note when behavior problems arise and which

foods your child had eaten recently. Engage your child's teacher in

monitoring your child's behavior, but unless the teacher provides

snacks for your child, there is no reason to risk drawing attention

to your young one by telling the teacher about the diet.

Next, you can try eliminating more of the additives or foods

suspected of affecting behavior. Likewise, if your child's behavior

did not improve on the initial diet, it could mean that he or she is

not affected by foods at all or is sensitive to other foods. It's

also possible that prohibited ingredients are sneaking into your

child's diet.

The " Few-Foods " Diet

If your child's behavior did not improve on the Feingold diet, you

could try a more restrictive " few-foods " diet. Studies indicate that

some children are sensitive not just to food additives but also to

such foods as the following:

& #61623; wheat

& #61623; eggs

& #61623; milk and other dairy foods

& #61623; chocolate

& #61623; soybeans/tofu

& #61623; corn products (including corn sugar and syrup)

On this diet, eliminate as many of those foods as you can, as well as

artificial colorings and other additives. Children can eat fresh meat

and poultry, any vegetable (except corn and soybeans), fruits and

fruit juices (but not citrus fruit juice and not beverages normally

consumed daily), rice, and oats. Work with an allergist if you

undertake an elimination diet, especially if your child has eczema or

other allergies. (Severe reactions might occur when a food is

reintroduced.) The more foods you eliminate, the more complicated it

will be to provide healthy meals and win your child's cooperation.

Fortunately, most of the restrictions will be temporary, because you

will be trying to identify the foods that do not cause problems, as

well as those that do.

Keep your child on the few-foods diet for two weeks, tracking his or

her behavior until you notice two consecutive days of significantly

improved behavior. Note that it can be difficult to distinguish an

effect of diet from your child's normal fluctuations in behavior. If

you don't notice any improvement, you can end your experiment.

If you have noted improved behavior, reintroduce one of the

eliminated foods or additives at a time. After your child has eaten

that food for several consecutive days, note in your diary any

symptoms that develop. If that food did not affect your child, then

consider it safe to eat. If your child's behavior deteriorated,

exclude that food from your child's diet, or retest it again later.

Every few days reintroduce another food and keep track of how your

child reacts. Gradually, you may be able to identify foods that do

and do not affect your child.

If your child stays on a very restricted diet for more than a few

weeks, you should work with a dietician to plan meals that provide

all the nutrients your child needs. Also, your child should take a

daily vitamin-and-mineral supplement, which may make sense regardless

of what diet he or she is on.

Another approach is to feed your child the few-foods diet until you

see an improvement. Then reintroduce everything--dyes, wheat, the

works--for several days to see if anything triggers a reaction. If

your child's behavior worsens, return your child to the special diet

and reintroduce foods one by one until you find the problems.

Finally, do not expect diet to bring about miraculous improvements in

behavior. Even in kids who are affected by food ingredients,

eliminating the culprits often yields only a partial improvement. But

even partial improvements could be most welcome. If your child does

not benefit significantly from a restricted diet, you should discuss

with your pediatrician other treatment options, including medications

and behavioral counseling.

Good Nutrition

Whether or not your child has behavioral problems, he or she should

eat a nutritious diet. Most children eat far too many fatty, salty,

and sugary foods-from burgers, fries, cheese, and ice cream to soft

drinks, potato chips, and candy. And few children get the vitamins,

minerals, fiber, and phytochemicals they need from fruits,

vegetables, and whole grains. It is important to your child's current

and future health to eat a really healthful diet (and that may mean

that you need to improve your diet to set a good example!).

First steps include getting rid of the junk foods in your home,

making fatty and sugary foods off-limits when eating out, and turning

off television shows riddled with junk-food ads. Also, give your

child a daily vitamin-and-mineral supplement.

FOR MORE INFORMATION

Center for Science in the Public Interest

1875 Connecticut Avenue NW, Suite 300, Washington, DC 20009

202-332-9110

www.cspinet.org

Center for Science in the Public Interest

Box 70373 Toronto Station A, Toronto, ON M5W 2X5

Feingold Association of the United States

PO Box 6550, Alexandria, VA 22306

800-321-3287

www.feingold.org

Michael Jacobson is executive director of the Center for Science in

the Public Interest (CSPI, a nonprofit health-advocacy organization).

The contents of this article are not intended to provide personal

medical advice, which should be obtained from a qualified health

professional.

 

 

Sidebar: Foods on the Feingold Diet

Foods Not Allowed on the Feingold Diet(partial list) *

almonds, apples, apricots, berries (all), cherries, cloves, coffee,

cucumbers and pickles, currants, grapes, raisins, nectarines,

oranges, peaches, peppers (bell, chili), plums, prunes, tangerines,

tea, tomatoes, aspirin (acetyl salicylate) and medications that

contain it, oil of wintergreen (menthyl salicylate, mint flavoring)

*reactions to these foods are based on unconfirmed reports, not

controlled studies

Foods Allowed on the Feingold Diet (partial list)

Fruits: bananas, cantaloupe, dates, grapefruit, honeydews, kiwis,

lemons, mangoes, papayas, pears, pineapple, watermelon

Vegetables: bean sprouts, beans (all types), beets, broccoli,

Brussels sprouts, cabbage, carrots, cauliflower, celery, kale,

lentils, lettuce, mushrooms, onions, peas, potatoes, spinach, squash,

sweet corn, sweet potatoes, zucchini

-- Michael Jacobson