ADHD is a complex neuro-behavioral disorder that affects about 6-8% of school aged children in the United States.[1] ADHD is characterized by inattention, distractibility, anxiety, and excessive motor activity.[2] Children with ADHD have decreased performance in school, impaired social relationships, and often have comorbid psychological disorders.[3] It is suspected that ADHD is influenced by a combination of factors including genetics, the environment, neurological issues, and psycho-social components.[4] The most common treatments for ADHD are stimulant medications, such as methylphenidate (Ritalin).[5] However, due to the negative side effects these medications can cause, more and more parents of children with ADHD have been searching for alternative therapies.[6]
The Feingold diet is one of the most well-known alternative treatments for ADHD in children. During the 1970’s Dr. Benjamin Feingold’s clinical observations led him to believe that some children are genetically predisposed to hyper active behavior which is triggered by allergic reactions to food additives and artificial dyes. Feingold reported that of his patients, 50% of children with hyperactivity improved after implementing a diet free of additives and artificial dyes.[7] Since the seventies, Feingold’s work has received a lot of attention and praise, as well as criticism in the scientific community, as his claims were based on observation rather than rigorous clinical studies. Is there evidence that avoiding allergens and food additives may actually benefit children suffering from ADHD?
In a double-blind placebo controlled study 15 hyperactive children who met the DSM-II criteria for ADHD were either given a Feingold diet or control diet for 4 weeks. Teachers reported significant reduction in hyperkinetic behavior of those children on the Feingold diet, but no improvement was observed by the parents of these children.[8]
One study in 1980 investigated the effects of food dye specifically on hyperactive behavior. A group of 20 hyperactive children and 20 children not considered to be hyperactive (according to the Conners Rating Scale) were admitted to the hospital in order to strictly monitor dietary intake. The children ate a diet free of food dyes and additives for 3 days and their behavior was monitored.[9] They were then administered a “challenge”, which consisted of either 100mg or 150mg of food dye (an amount within the average daily consumption as reported by FDA) to see how behavior was affected.[10] The researchers found that the food dye challenge negatively affected the hyperactive behaviors of all 20 hyperactive children in the study.[11]
Another factor that may explain some of the success of the Feingold diet is that children who follow it often consume less refined sugar. It is estimated that in the US, children consume about two pounds of sugar per week![12] The consumption of large quantities of refined sugar can produce hypoglycemia. Hypoglycemia can cause an increased production of epinephrine in order to maintain blood sugar control, and high levels of epinephrine may cause restless or hyperactive behaviors.[13] A study in 1980 showed that in hyperactive children, the amount of sugar they consumed was positively correlated with destructive aggressive behaviors (kicking, throwing of objects, etc.) and hyperactive behaviors.[14]
Other investigators have studied the effects of allergy elimination diets on the behavior of children with ADHD. Children not only avoided food additives and dyes, but foods such as wheat, dairy, eggs, citrus, corn, and nuts, which are common sources of allergies.[15] Several of these studies showed improvement in symptoms associated with ADHD after two or three weeks of following the allergen free diet. There seems to be a meaningful relationship between allergy and hyperactivity, as 70% of hyperactive patients experience allergies.[16]
A new and promising area of research in relation to the effect of diet on ADHD is focused on fatty acid metabolism. Recent studies show that children with ADHD have altered fatty acid metabolism.[17] In fact, one study compared 96 boys with and without ADHD to evaluate behavior and EPA concentrations. Boys who had lower EPA concentrations in their bodies actually had more impulsivity and hyperactivity issues as rated by the Conners scale.[18]
It is important to note that ADHD is a complex disorder and because of its strict limitations, the Feingold diet is often difficult to follow and evaluate. Although diet may not be the direct cause of ADHD, the food that we consume has a significant effect on our neurotransmitters and hormones. It affects the communication system of the body, and seems to, at the very least, have an aggravating effect on ADHD symptoms.
References
[1] Brue AW & Oakland TD. (2002). Alternative treatments for attention-deficit/hyperactivity disorder: Does evidence support their use? Alternative Therapies in Health and Medicine, 8, 1, 68-74.
[2] Schnoll R, Burshteyn D, & Cea-Aravena J. (2003). Nutrition in the Treatment of Attention-Deficit Hyperactivity Disorder: A Neglected but Important Aspect. Applied Psychophysiology and Biofeedback 28, 1, 63-75.
[3] Cruz NV & Bahna SL. (2006). Do Foods or Additives Cause Behavior Disorders? Pediatric Annnals, 35, 10, 744-754.
[4] Schnoll, Burshteyn, & Cea-Aravena op.cit., Brue & Oakland, op.cit., Cruz & Bahna op.cit.
[5] Brue & Oakland, op.cit.
[6] Cormier E & Elder JH. (2007). Diet and Child Behavior Problems: Fact or Fiction? Pediatric Nursing, 33, 2, 138-143.
[7] Schnoll, Burshteyn, & Cea-Aravena op.cit., Cruz & Bahna op.cit., Cormier & Elder op.cit.
[8] Schnoll, Burshteyn, & Cea-Aravena op.cit., Cruz & Bahna op.cit.
[9] Schnoll, Burshteyn, & Cea-Aravena op.cit., Cruz & Bahna op.cit, Cormier & Elder op.cit.
[10] Schnoll, Burshteyn, & Cea-Aravena op.cit.
[11] Schnoll, Burshteyn, & Cea-Aravena op.cit., Cruz & Bahna op.cit, Cormier & Elder op.cit.
[12] Schnoll, Burshteyn, & Cea-Aravena op.cit.
[13] Schnoll, Burshteyn, & Cea-Aravena op.cit.
[14] Schnoll, Burshteyn, & Cea-Aravena op.cit.
[15] Cormier & Elder op.cit.
[16] Schnoll, Burshteyn, & Cea-Aravena op.cit.
[17] Schnoll, Burshteyn, & Cea-Aravena op.cit., Brue & Oakland, op.cit.
[18] Brue & Oakland, op.cit.
Clinical Contributor
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