A sensible guide to a risk-benefit analysis would surely be
- to reduce exposure to hazard whenever possible;
- to accept substantial hazard only for great benefit;
- to accept minor hazard for modest benefit; and
- to accept no hazard at all when the benefit seems relatively trivial.
|
These are some of the studies and articles published in peer reviewed journals. The most recent are listed first. They are linked where available to their abstract in MedLine.
Most of these studies used an approximation of the Feingold Program and addressed only artificial colorings and preservatives. The Feingold Program also eliminates the
thousands of artificial flavorings in the American diet, which have never been proven safe.
= Double blind controlled study
Some of the studies below have links to their full text which require a password.
Email us to request the password.
Listed in date order, with the newest first:
| Pelsser 2008 |
(Randomized
controlled study) |
A randomised controlled trial into the effects of food on ADHD. |
| McCann 2007 |
|
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. |
|
Grandjean 2006 |
(Review)
| Developmental neurotoxicity of industrial chemicals. |
| Husain 2006 |
(Evaluation) |
Estimates of dietary exposure of children to artificial food
colours in Kuwait. |
| Lien 2006 |
(Survey) |
Consumption of soft drinks and hyperactivity, mental distress, and
conduct problems among adolescents in Oslo, Norway. |
| Liu 2006 |
(Review) |
The effect of childhood malnutrition on externalizing behavior. |
| Murphy 2006 |
|
The ketogenic diet causes a reversible decrease in activity
level in Long-Evans rats. |
| Niederhofer 2006 |
(Clinical Study) | A preliminary investigation of ADHD symptoms in persons with celiac disease. |
| Lau 2006 |
(Neurotoxicology Study) |
Synergistic Interactions Between Commonly
Used Food Additives in a Developmental Neurotoxicity Test. |
| Bateman 2004 |
|
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. |
| Liu 2004 |
(Longitudinal Study) |
Malnutrition at Age 3 Years and Externalizing Behavior
Problems at Ages 8, 11, and 17 Years. |
| Schab 2004 |
(Meta Analysis) |
Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. |
| Harding 2003 |
(Comparison Study) |
Outcome-based comparison of Ritalin versus
food-supplement treated children with AD/HD. |
| Raine 2003 |
(Comparison Study) |
Effects of Environmental Enrichment at Ages 3–5 Years
on Schizotypal Personality and Antisocial Behavior
at Ages 17 and 23 Years. |
| Dengate 2002 |
|
Controlled trial of cumulative
behavioural effects of a common bread preservative. |
| Pelsser 2002 |
(Open Study) |
Favourable effect of a standard
elimination diet on the behavior of young children with attention deficit hyperactivity
disorder (ADHD): a pilot study. |
|
Stubberfield 1999 |
(Survey) |
Utilization of alternative therapies in
attention-deficit hyperactivity disorder. |
| Bennett 1998 |
(Case Studies) |
The Shipley Project: Treating Food Allergy to
Prevent Criminal Behaviour in Community Settings. |
| Bennett 1997 |
(Survey) |
The Health of Criminals Related to Behaviour, Food,
Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders. |
| Schmidt 1997 |
|
Does oligoantigenic diet influence
hyperactive/conduct-disordered children--a controlled trial. |
| Uhlig 1997 |
|
Topographic mapping of brain electrical
activity in children with food-induced attention deficit hyperkinetic disorder. |
| Ward 1997 |
|
Assessment of chemical factors in relation to
child hyperactivity.
|
| Mothes 1996 |
|
Effects of prenatal ethanol exposure and early
experience on home-cage and open-field activity in mice.
|
| Reyes 1996 |
(Lab Study) |
Effect of organic synthetic food
colours on mitochondrial respiration. |
| Boris 1994 |
|
Foods and Additives are Common Causes
of the Attention Deficit Hyperactive Disorder in Children
|
| Rowe 1994 |
|
Synthetic Food Coloring and
Behavior: A Dose Response Effect in a Double-Blind, Placebo-Controlled,
Repeated-Measures Study
|
| Carter 1993 |
|
Effects of a Few Foods Diet in Attention
Deficit Disorder
|
| Egger 1992 |
|
Effect of diet treatment on enuresis in
children with migraine or hyperkinetic behavior
|
| Egger 1992 |
|
Controlled Trial of Hyposensitisation in
Children with Food-Induced Hyperkinetic Syndrome
|
| Novembre 1992 |
|
Unusual reactions to food additives
|
|
Schoenthaler 1991 |
(Retrospective
Study) |
Applied Nutrition and Behavior
|
| Pollock 1990 |
|
Effect of artificial food colours on childhood
behaviour. |
| Ward 1990 |
|
The influence of the chemical
additive tartrazine on the zinc status of hyperactive children: A double-blind
placebo-controlled study.
|
| Egger 1989 |
|
Oligoantigenic diet treatment of children with
epilepsy and migraine
|
| Kaplan 1989 |
| Overall Nutrient Intake of Preschool
Hyperactive and Normal Boys
|
| Kaplan 1989 |
|
Dietary Replacement in Preschool-Aged
Hyperactive Boys
|
| Rowe 1988 |
|
Synthetic Food Colourings and "Hyperactivity":
a Double-Blind Crossover Study
|
| Burlton-Bennet 1987 |
(ABAB study) |
A Single Subject Evaluation of the K-P Diet for Hyperkinesis.
|
| Arevalo 1987 |
|
Tyrosine administration to pregnant rats
induces persistent behavioral modifications in the male offspring.
|
| Gross 1987 |
|
The effect of diets rich in and free
from additives on the behavior of children with hyperkinetic and learning disorders
|
| Schoenthaler 1986 |
(Retrospective
Study) |
The Impact of a Low Food Additive and Sucrose
Diet on Academic Performance in 803 New York City Public Schools. |
| Egger 1985 |
|
Controlled Trial of Oligoantigenic Treatment
in the Hyperkinetic Syndrome
|
| Menzies 1984 |
(Case Studies) |
Disturbed children: the role of food
and chemical sensitivities. |
|
Augustine 1983 |
(Neurotoxicology Study) |
Neurotransmitter release and nerve terminal morphology
at the frog neuromuscular junction affected by the dye Erythrosin B. |
|
Augustine 1983 |
(Neurotoxicology Study) |
Presynaptic effect of Erythrosin B at the
frog neuromuscular junction: ion and photon sensitivity. |
| Egger 1983 |
|
Is migraine food allergy? A double-blind controlled
trial of oligoantigenic diet treatment.
|
| Rippere 1983 |
(Critique) |
Food additives and hyperactive children: a
critique of Conners. |
| Feingold 1982 |
(Article) |
The role of diet in behavior.
|
| Goldenring 1982 |
|
Sulfanilic acid: behavioral change related
to azo food dyes in developing rats.
|
| Salamy 1982 |
|
Physiological changes in hyperactive
children following the ingestion of food additives.
|
|
Satterfield 1982 |
(Prospective
Study) |
A Prospective Study of Delinquency in 110
Adolescent Boys with Attention Deficit Disorder and 88 Normal Adolescent Boys
|
| Yamawaki 1982 |
|
Effects of toluene inhalation on
locomotor activity and brain catecholamine levels in rats.
|
| Mattes 1981 |
|
Effects of artificial food colorings in
children with hyperactive symptoms. A critical review and results of a controlled study. |
| Augustine 1980 |
(Neurotoxicology Study) |
Neurotransmitter release from a
vertebrate neuromuscular synapse affected by a food dye. |
| Swanson 1980 |
|
Food Dyes Impair Performance of Hyperactive
Children on a Laboratory Learning Test
|
| Weiss 1980 |
|
Behavioral responses to artificial food colors.
|
| Brenner 1979 |
|
Trace mineral levels in hyperactive children
responding to the Feingold diet
|
| Feingold 1979 |
(Article) |
Dietary management of juvenile delinquents.
|
| Lafferman 1979 |
(Neurotoxicology Study) |
Erythrosin B inhibits
dopamine transport in rat caudate synaptosomes. |
| Dumbrell 1978 |
(Comparison) |
Is the Australian version of the Feingold diet safe?
|
| Fitzsimon 1978 |
|
Salicylate sensitivity in children reported to
respond to salicylate exclusion.
|
| Goyette 1978 |
|
Effects of artificial colors on
hyperkinetic children: a double-blind challenge study.
|
| Harley 1978 |
|
Hyperkinesis and food additives: testing the
Feingold hypothesis.
|
| Harper 1978 |
(Comparison) |
Nutrient intakes of children on the
hyperkinesis diet.
|
| Hindle 1978 |
|
The management of hyperkinetic children:
a trial of dietary therapy.
|
| Levy 1978 |
|
Hyperkinesis and diet: a double-blind
crossover trial with a tartrazine challenge.
|
| Rose 1978 |
|
The functional relationship between artificial
food colors and hyperactivity.
|
| Williams 1978 |
|
Relative effects of drugs and diet on hyperactive
behaviors: an experimental study.
|
| Brenner 1977 |
(Case studies) |
A study of the efficacy of the Feingold diet
on hyperkinetic children. Some favorable personal observations.
|
| Feingold 1977 |
(Speech) |
Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors .
|
| Conners 1976 |
|
Food additives and hyperkinesis: a controlled
double-blind experiment.
|
| Cook 1976 |
(Open diet study) |
The Feingold dietary treatment of the
hyperkinetic syndrome.
|
| Feingold 1976 |
(article) |
Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors.
|
| Salzman 1976 |
(Case studies) |
Allergy testing, psychological assessment
and dietary treatment of the hyperactive child syndrome.
|
| Feingold 1975 |
(article) |
Hyperkinesis and learning disabilities linked to artificial food flavors and colors.
|
The following excerpts are in alphabetical order by first author.
.
-
Attention deficit hyperactivity disorder , Anthony HM; Maberly DJ; Birtwistle S. Arch Dis Child 1999;81:189 (August)
"... an elimination diet is effective in most cases. ... If they have had help with finding alternative foods, most parents find it surprisingly easy to keep the child to the diet most of the time after the first few weeks because the child usually prefers to feel well.
... If the diet is effective, behaviour often reverts to normal, to the great relief of all concerned. In view of the potential toxicity of medication in children and its limited effectiveness, all families with hyperactive children should be offered help in detecting offending foods. It is more appropriate to reserve medication for those who fail. "
Text of Letter
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.
-
Tyrosine administration to pregnant rats induces persistent
behavioral modifications in the male offspring. Arevalo R, Castro R, Palarea MD, Rodriguez M, Physiol Behav 1987;39(4):477-81
"... The offspring treated with large tyrosine doses showed a marked increase in both spontaneous
locomotor activity and open field locomotion as adults. However, activity in the swim test decreased. ... The behavior
of the rats treated with small doses of tyrosine was similar, in all tests performed, to that of rats treated with saline
solution. These findings strongly suggest that a large increase in diet tyrosine during pregnancy modifies the behavior of
male offspring"
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.
-
Neurotransmitter release from a vertebrate neuromuscular synapse affected by a food dye.
Augustine GJ Jr, Levitan H,
Science 1980 Mar 28;207(4438):1489-90
"
The food dye erythrosine (Erythrosin B; FD&C No. 3) was applied to isolated neuromuscular synapses in the frog ... At concentrations of 10 muM or greater this anionic dye produced an irreversible, dose-dependent increase in neurotransmitter release.... These results suggest that erythrosine might prove a useful pharmacological tool for studying the process of transmitter release, but that its use as a food additive should be reexamined.
"
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.
- Neurotransmitter release and nerve terminal morphology at the frog neuromuscular junction affected by the dye Erythrosin B.
Augustine GJ, Levitan H,
J Physiol 1983 Jan;334:47-63
No abstract available
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.
- Presynaptic effect of Erythrosin B at the frog neuromuscular junction: ion and photon sensitivity.
Augustine GJ, Levitan H,
J Physiol 1983 Jan;334:65-77
"
. . . These results indicate that Erythrosin B is not acting solely by altering the ionic permeability of the presynaptic nerve terminal to calcium, magnesium, or sodium ions, or by altering the calcium metabolism of the terminal. The enhanced effect of the dye in calcium-free saline suggests that it may be competing with calcium at a common site, while the enhancement of its effect in elevated external calcium suggests that the dye may also increase the permeability of the nerve terminal to calcium ions.
"
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.
- 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.
Bateman B et al, Archives of Disease in Childhood. 2004 Jun;89(6):506-11.
"AIMS: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. . . .RESULTS: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. . . .CONCLUSIONS: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children . . . "
Note: The investigators suggest removing these from the diet of all children. Just think about it -- only 20 mg per day of coloring was used as the "challenge." Imagine the results had they used the 150 mg of coloring present in one (1) Tb of green ketchup.
Full Text of Study
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The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders,
Bennett CPW, Brostoff J., Journal of Nutritional & Environmental Medicine, Vol.7, No.4 Dec 1997 pp.359-366
"
This questionnaire-based research addressed the young offender population in order to estimate the proportion likely to have food allergic and other nutritionally related disorders such as hyperactivity. A controlled health and dietary survey was conducted with 100 young offenders and 100 matched non-offenders. The offender group reported significantly higher rates of ill health than the non-offender group. It is suggested that the nutritional health of young offenders could be investigated as part of present statutory requirements to consider the physical and mental health of young criminals. There was no real difference between the diets of the two groups. Further research is justified into the association between nutrition, health and behaviour problems. From this study, the proportion of the persistent young offender population with maladaptive behaviours linked to food allergy, food intolerance and nutritional problems is cautiously estimated to be 75% whereas 18% of the young non-offender population is similarly affected.
"TOP
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The Shipley Project: Treating Food Allergy to Prevent Criminal Behaviour in Community Settings, Bennett CPW, McEwen LM, McEwen HC, Rose, EL,
Journal of Nutritional & Environmental Medicine ,
Vol.8, No.1,Mar.1998, pp.77-83
"
Nine children with persistent anti-social, disruptive and/or criminal behaviours were assessed and treated for food intolerance and allergy. All were found to have a number of food allergies or intolerances and mineral imbalances, particularly in zinc. Three showed marginally raised cadmium while one had considerably raised cadmium. . . .The health and behaviour of all nine subjects improved both physically and psychologically. However, three children abandoned the dietary regime, two of whom re-offended and were placed in care while the third moved home and accepted enzyme-potentiated desensitization (EPD) treatment. He and the other six continued to improve in health, behaviour and school performance over 6 months. . . After 2 years, five of the nine had not re-offended. The feasibility of applying nutritional and biochemical assessment and treatment in the community to divert young offenders and disruptive schoolchildren from criminal behaviour was demonstrated. Criminal justice, education and health agencies could incorporate and develop this approach in furtherance of their statutory objectives.
"TOP
.
Foods
and Additives are Common Causes of the Attention Deficit Hyperactive Disorder
in Children, Boris M; Mandel F, Annals of Allergy,
May 1994, Vol. 72, pp. 462-8
73% of 26 children with ADHD responded favorably to a diet eliminating reactive foods and artificial colors. 16 of the improved children were given a double blind challenge with 100 mg of mixed food dyes or a food chosen by the parent. ALL of them reacted to the challenge. Placebo effect was ruled out, as the children were as good on placebo days as at baseline (on the diet). "This study demonstrated 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."
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A study of the efficacy of the Feingold diet on hyperkinetic children.
Some favorable personal observations.
Brenner A, Clinical Pediatrics (Phila) 1977 Jul;16(7):652-6
"... the startling
changes seen in patients who had been followed for years with other forms of therapy suggest strongly that this
improvement was genuine. "
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Trace mineral levels in hyperactive children responding to
the Feingold diet, Brenner A, Journal of Pediatrics 1979 Jun;94(6):944-5
Abstract [not included on MedLine]: "The Feingold hypothesis associating the hyperkinetic syndrome with ingestion of common food additives, artificial colors and flavors, and salicylate-containing foods has evoked considerable controversy. Since many children ingest these ubiquitous additives, and no differences in dietary habits have been noted between hyperkinetic and nonhyperkinetic children, it is possible that a biochemical difference may be present in children who appear to be affected by the additives."
20 children who responded to the Feingold diet, and 14 who did not were tested for copper and zinc levels in their blood. There was a significantly higher level of copper in the children who did respond to the diet. Possible reasons are discussed.
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A Single Subject Evaluation of the K-P Diet for Hyperkinesis, Burlton-Bennett JA, Robinson VM, Journal of Learning Disabilities, 1987 Jun-Jul;20(6):331-5, 346.
A single subject ABAB design design was employed to determine the effectiveness of the Feingold Kaiser Permanente (K-P) diet in the treatment of a 6-year-old hyperkinetic male hypothesized to be diet-responsive. Secondary aims were to assess both the nutritional adequacy of the diet and the problems involved in implementing it. Diet effectiveness was measured by classroomobservations of attending-to-task, out-of-seat, and movement behaviors; and by teacher and foster-mother reports. It was concluded that the K-P diet was effective in controlling the subject's hyperkinesis. The diet was also shown to be nutritionally adequate and moderately difficult to implement.
Full Text
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Effects
of a Few Foods Diet in Attention Deficit Disorder, Carter, CM et
al, Archives of Disease in Childhood, November 1993, Vol. 69 (5), pp.564-8
59 of 78 children (75.6%) referred for "hyperactive
behavior" improved on an open trial of an elimination diet. 19
of them were studied in a placebo-controlled double-blind challenge protocol.
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Food additives and hyperkinesis: a controlled double-blind
experiment. Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA,
Pediatrics 1976 Aug;58(2):154-66
"A double-blind crossover trial involving a control diet and a diet eliminating artificial flavors, colors, and natural salicylates
as recommended by Feingold was conducted on 15 hyperkinetic children. ...Both parents and teachers reported fewer hyperkinetic
symptoms on the K-P diet as compared to the pretreatment baseline. ..."
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The Feingold dietary treatment of the hyperkinetic syndrome.,
Cook PS, Woodhill JM.,
Med J Aust. 1976 Jul 17;2(3):85-8, 90.
"
... Following Feingold's dietary prescription, an elimination diet relevant to the foods available in Sydney was developed. The treatment regime is described, and the results of its application to 15 hyperkinetic children are presented. The parents of 10 children are "quite certain" and those of three others "fairly certain" that their children's behaviour not only improved substantially with the diet, but also relapsed promptly when significant dietary infringements occurred. A possible ecological implication of these findings is briefly discussed.
"
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.
Controlled trial of cumulative behavioural effects of a common bread preservative.
Dengate S, Ruben A.,
J Paediatr Child Health 2002 Aug;38(4):373-6
"
...Twenty-seven children, whose behaviour improved significantly on the Royal Prince Alfred Hospital diet, which excludes food additives, natural salicylates, amines and glutamates, were challenged with calcium propionate (preservative code 282) or placebo through daily bread in a double-blind placebo-controlled crossover trial. ... CONCLUSIONS: Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative in healthy foods consumed daily. Minimizing the concentrations added to processed foods would reduce adverse reactions. Testing for behavioural toxicity should be included in food additive safety evaluation.
"
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Is the Australian version of the Feingold diet safe? Dumbrell S, Woodhill JM, Mackie L, Leelarthaepin B,
Med J Aust 1978 Dec 2;2(12):548, 569-70
"... The nutritional quality, in terms of the level and
balance of nutrients in the elimination test diet, was superior to that of the normal diet. With proper dietary counselling,
the elimination test diet is safe for use in the treatment of children with hyperkinesis."
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Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment., Egger J et al., Lancet 1983 Oct 15;2(8355):865-9
"93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; ... the role of the foods provoking migraine was
established by a double-blind controlled trial in 40 of the children. ... Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. In most of the patients in whom migraine was provoked by non-specific factors, such as blows to the head, exercise, and flashing lights, this provocation no longer occurred while they were on the diet."
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Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome, J.Egger, P.J.Graham, J.F.Soothill, C.M.Carter, D.Gumley, The Lancet, March 9, 1985
62 of 76 selected overactive children (81.6%) improved;
other symptoms such as headaches, abdominal pain, and fits, also improved.
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Oligoantigenic diet treatment of children with epilepsy and
migraine, Egger J, Carter CM, Soothill JF, Wilson J, Journal of Pediatrics 1989 Jan;114(1):51-8
Of 45 children with epilepsy and recurrent headaches, abdominal symptoms, or hyperkinetic behavior, 36 [80%] improved on an oligoantigenic diet; 25 [55%] ceased to have seizures and 11 had fewer seizures during diet therapy. "Headaches, abdominal pains, and hyperkinetic behavior ceased in all those whose seizures ceased, and in some of those whose seizures did not cease." ..."Of 24 children with generalized epilepsy, 18 [75%] recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 [85%] children with partial epilepsy. In double-blind, placebo-controlled provocation studies, symptoms recurred in 15 of 16 children, including seizures in eight; none recurred when placebo was given. Eighteen other children, who had epilepsy alone, were similarly treated with an oligoantigenic diet; none improved."
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Effect of diet treatment on enuresis in children with migraine
or hyperkinetic behavior, Egger J, Carter CH, Soothill JF, Wilson J, Clinical Pediatrics (Phila) 1992 May;31(5):302-7
"Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully
treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. [daytime or nighttime bed wetting]
On diet, the enuresis stopped in 12 of these children and improved in an additional four. [76%] ... Enuresis in
food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of
provoking foods."
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Controlled
Trial of Hyposensitisation in Children with Food-Induced Hyperkinetic
Syndrome,
J.Egger, A.Stolla, L.McEwen, The Lancet, May 9, 1992, Vol. 339,
pp. 1150
A trial of enzyme-potentiated desensitisation, expected
to be useful for those who have problems with foods that are difficult
to avoid, or who cannot comply with dietary restrictions.
Note: This is EPD, in use in England for 30 years. The FDA, responding to a ruling by the Medical Board of California, prevented new patients from being accepted under the then-existing national IRB treatment program. EPD is now effectively illegal in the U.S. See more information.
See News for the Practitioner about this study.
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Full text: Hyperkinesis and learning disabilities linked to artificial food flavors and colors. Feingold, BF. The American Journal of Nursing, 1975 May;75(5):797-803.
"...
It is important to recognize that this entire behavioral pattern is beyond the child's voluntary control. He does not choose to be a failure nor does he want to be bad. It is as though something within is driving him. He is like a revved up motor with the throttle stuck. Discipline achieves nothing but invites rebellion and further frustration, precipitating displays of temper and tantrums."
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Full text: Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors. Feingold, BF. Journal of Learning Disabilities, 1976. Vol.9(9) pp.19-27
"
The historical background of hyperkinesis and learning disabilities is reviewed briefly and followed by a discussion of food additives. Focus on artificial food colors and flavors as important etiologic agents is explained and supported ..."
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Full text: Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors, Feingold, BF. Speech to American Academy of Pediatrics, New York Hilton Hotel, November 8, 1977.
"
Recognizing that any compound under the appropriate conditions can induce adverse reactions, including behavioral disturbances, it becomes necessary to evaluate each compound or class of compounds on the basis of benefit compared with risk. ... colors and flavors have no nutritional value whatsoever. If they were removed from our food supply, nothing nutritionally would be lost. Therefore, on balance, the risk outweighs the benefit."
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Full text: Dietary management of juvenile delinquency. Feingold, BF. International Journal of Offender Therapy and Comparative Criminology, Vol 23(1) 1979.
"
This disenchantment with present-day rehabilitation techniques prompted the Ford Foundation in its annual report for 1977 to recommend that the role in delinquency of biochemical and organic factors, with a focus on nutrition be investigated.
. . .
We have now managed approximately 600 children with the diet. Initially, our successes for control of observed behavior ranged between 30 and 50 percent; however, since we are emphasizing the elimination of BHT (butylated hydroxtoluene) and BHA (butylated hydroxyanisole) our successes for control of behavior average between 60 to 70 percent of our samples."
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.
The role of diet in behaviour.
Feingold BF.,
Ecology of Disease 1982;1(2-3):153-65
"The behavioural disorders, frequently labelled hyperkinesis, hyperkinetic impulse disorder, hyperactivity, Minimal Brain Dysfunction (MBD) and Attentional Deficit Disorder (ADD), are among the most critical problems of our contemporary culture.
"Truancy, vandalism, violence and assault among school children coupled with a persistent drop in scholastic achievement is a universal problem affecting the school population of every so-called developed country. Every procedure for the control of behavioural disorders has not been successful; every technique for the improvement of learning has not been productive, while every modality for the rehabilitation of delinquents has failed us. Since all these procedures have been structured upon psychosocial concepts, it becomes necessary to look elsewhere for the answers, which is to the biosciences, including genetics, molecular genetics, pharmacogenetics, behavioural toxicology, behavioural teratology, immunochemistry, immunology, allergy and endocrinology, with a focus upon nutrition, which encompasses all these disciplines.
...
The increase in behavioural disorders accompanied by a persistent drop in scholastic performance coupled with the continuing rise in the prevalence of delinquency is undoubtedly one of the most important expressions of the disruption of nature by the rising concentration of pollutants in the ecosystem. The prospect for controlling and eliminating the major contaninants of the environment is not too promising for the immediate future; however, an informed public, which should lead to greater commitment and involvement, would be followed by the containment and then reversal and resolution of this critical and important present-day situation involving the health and behaviour of both our contemporary population and also future generations. Public recognition and participation in the problem are mandatory to correct the insidious downgrading of the human race, which is already evident.
"
Dr. Feingold finalized this paper in the few days before his death. He had not had time to list his references, and the editors noted that they had decided to publish it without them.
Full Text |||
OBITUARY
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Salicylate sensitivity in children reported to respond to salicylate exclusion. Fitzsimon M, Holborow P, Berry P, Latham S, Medical Journal of Australia 1978 Dec 2;2(12):570-2
Twelve children, aged six to 13 years, whose parents reported an improvement in behavioural problems with use of the
Feingold (K-P) diet for an average period of 12 months, were challenge-tested with 40 mg of acetylsalicylic acid in a
double-blind, cross-over trial with ascorbic acid as a placebo. ... significance was reached in tests of general cognitive capacity, line walking and the "finger-to-nose" tests, as well as
increased disturbance in sleep patterns in these children.
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Sulfanilic acid: behavioral change related to azo food dyes in developing rats.
Goldenring JR, Batter DK, Shaywitz BA., Neurobehavioral Toxicology and Teratology. 1982 Jan-Feb;4(1):43-9.
"
The effects of sulfanilic acid, a major azo food dye metabolite, were studied in normal developing rat pups and pups treated with 6-hydroxydopamine (60HDA). Chronic daily intraperitoneal injection of sulfanilic acid during the first postnatal month elicited hyperactivity and impaired shock escape performance in vehicle pups. ... These findings, which are similar to the results of our study of chronic administration of a food dye mix, suggest that sulfanilic acid may be one of the causative agents in food dye-induced behavioral changes in developing rats. ... "
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.
Effects of artificial colors on hyperkinetic children: a double-blind
challenge study. Goyette GH, Connors CK, Petti TA, Curtis LE,
Psychopharmacol Bull 1978 Apr;14(2):39-40
"Summary: ... In the first trial there was suggestive evidence that performance on a visual-motor tracking task may be impaired following ingestion of challenge material. Three "dye-sensitive" children retested in the laboratory gave results consistent with an impairment of attention and visual motor tracking 1 hour after cookie ingestion... A second study showed significant effects on parent ratings when these were limited to a 3-hour period immediately following ingestion of the cookies, suggesting that artificial food dyes do indeed impair and disrupt the behavior of the children..."
Note: The "challenge" dose of food dyes is not specified, but implied to be 13 mg. This tiny amount still resulted in a trend of performance deficits on a visual motor tracking task after challenge but not after placebo. The deficits were more pronounced in younger children. This is not surprising because 13 mg is a larger "dose" per body weight for a smaller child.
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Developmental neurotoxicity of industrial chemicals, Grandjean P, Landrigan PJ., Lancet 2006 Dec 16;368(9553):2167-78
". . . A few industrial chemicals (eg, lead, methylmercury, polychlorinated biphenyls [PCBs], arsenic, and toluene) are recognised causes of neurodevelopmental disorders and subclinical brain dysfunction. Exposure to these chemicals during early fetal development can cause brain injury at doses much lower than those affecting adult brain function. . . . Despite an absence of systematic testing, many additional chemicals have been shown to be neurotoxic in laboratory models. The toxic effects of such chemicals in the developing human brain are not known and they are not regulated to protect children. The two main impediments to prevention of neurodevelopmental deficits of chemical origin are the great gaps in testing chemicals for developmental neurotoxicity and the high level of proof required for regulation. New, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals."
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The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders.
Gross MD, Tofanelli RA, Butzirus SM, Snodgrass EW.,
J Am Acad Child Adolesc Psychiatry. 1987 Jan;26(1):53-5.
"
Thirty-nine children in a summer camp were given the Feingold Diet, which eliminates artificial additives and salicylate-containing foods, for 1 week, followed by administration for 1 week of food containing those ingredients. The behavior of all children was monitored by videotape for 4-minute intervals at mealtime. All children were classified by public school psychologists as having moderate to severe learning disorder; 18 were also hyperkinetic, and 17 were taking medication for the latter condition. Three raters blind to the respective diets the children were on rated the children's behavior for motor restlessness, disorganized behavior, and misbehavior. No significant differences were found in behaviors during weeks 1 and 2. The authors conclude that the Feingold Diet has no beneficial effect on most children with learning disorders, or on hyperkinetic children taking medication."
Full Text of Study - (Get Password
Note: Because this study has been cited occasionally as the "definitive" study on the Feingold diet, it deserves some extended comment:
They were studying a diet recommended for children with ADHD, which usually takes more than one week to "show" an effect, and longer when a child is on medication. However,
- More than half the children in the study did not have ADHD.
- All but one of the children with ADHD were on medication the whole time.
- If the medication worked well, how would they measure a diet effect?
- The medication itself contained coloring - counteracting any diet effect.
- The one child not on medication was sent home because his behavior got worse when given the additives in Week 2
- One other child was sent home in Week 2 because his behavior got worse. It was concluded that his medication (Cylert) was "not strong enough."
- Notice that the video taping was done during mealtime to measure a reaction expected to occur only several hours after mealtime.
- Notice that the raters were "blind to the respective diets."
- Dr. Gross - the primary investigator - was one of the three raters. Since he would be seeing the film, taken during meals, and could SEE whether or not there was ketchup on the tables, are we to truly believe that he was "blind" to the respective diets, as reported?
- Alternatively, if the camera angle was so wide that all children were visible at once and details such as condiment bottles could not be seen, how well could the children themselves be seen for observation of their behavior?
- The children were not told that they were on a "diet" - they were told that the "good stuff" had not yet arrived. Is it very surprising that they were negative?
- Mustard was eliminated, for reasons unknown - appropriate brands of mustard are acceptable on the Feingold diet.
- Snacks and treats were eliminated, for reasons unknown - appropriate brands of candy and other treats are acceptable on the Feingold diet.
- Coloring, flavoring, and fragrances were apparently not eliminated, however, in personal toiletries, medications taken by the children, and cleaning supplies used by the camp, over which there was apparently no effort made at control.
- Nevertheless, the camp director and teachers were united in their observation that the children were noisier during the second (additive-rich) week. This was duly noted but discounted by the researchers.
- The researchers acknowledged that a one-week trial of the diet is short, but defended it by saying that people already using the Feingold diet say that eating something "off-diet" causes a reaction within a few hours.
- This is only relevant AFTER a good response to the diet.
- No initial response to the diet is expected, usually, until after one to several weeks.
- Children on psychoactive medication or recently off it take longer to respond to the diet than do those who have never been on such medications. This has been reliably observed since the 1960's by Dr. Feingold, by other doctors using the diet, and by the Feingold Association.
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Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD.
Harding KL, Judah RD, Gant C.
Altern Med Rev. 2003 Aug; 8(3): 319-30.
"
Twenty children with attention deficit/hyperactivity disorder (AD/HD) were treated with either Ritalin (10 children) or dietary supplements (10 children) . . . Subjects in both groups showed significant gains . . . . . .Numerous studies suggest that biochemical heterogeneous etiologies for AD/HD cluster around at least eight risk factors: food and additive allergies, heavy metal toxicity and other environmental toxins, low-protein/high-carbohydrate diets, mineral imbalances, essential fatty acid and phospholipid deficiencies, amino acid deficiencies, thyroid disorders, and B-vitamin deficiencies. . . . These findings support the effectiveness of food supplement treatment in improving attention and self-control in children with AD/HD and suggest food supplement treatment of AD/HD may be of equal efficacy to Ritalin treatment.
"
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Hyperkinesis and food additives: testing the Feingold hypothesis.
Harley JP, Ray RS, Tomasi L, Eichman PL, Matthews CG, Chun R, Cleeland CS, Traisman E,
Pediatrics 1978 Jun;61(6):818-28
"
Teacher ratings, objective classroom and laboratory observational data, attention-concentration, and other psychological measures obtained on 36 school-age, hyperactive boys under experimental and control diet conditions yielded no support for the Feingold hypothesis. Parental ratings revealed positive behavioral changes for the experimental diet; however, they seemed primarily attributable to one diet sequence. Parents' behavioral ratings on ten hyperactive, preschool boys indicated a positive response to the experimental diet; again, laboratory observations showed no diet effect.
"
Note: This study was funded by the "Nutrition Foundation," a food additive and chemical industry organization. Harley claimed he found "no support" for the diet. Nevertheless, 100% of preschoolers and 63% of the group of older children who had done the "control" diet first improved on the Feingold diet in this study. Harley discounted the 63%, claiming an "order effect."
Upon reading the analysis of the Harley study by Dr. Bernard Weiss, Professor of Toxicology at University of Rochester School of Medicine and Dentistry, it becomes clear that there was no actual "order effect" for the older children.
Without arguing the point, suffice it to say that the two groups of older children were not equal. The ones who were put on the Feingold diet after the control diet where off their medications several weeks longer than the ones put on the Feingold diet first. Since it was already known that stimulant medications increase the time necessary before an effect of diet is seen, we wonder why they were surprised to find this happening in this study (where those on the "control" diet first would have been off the meds several weeks more than the ones doing the Feingold diet first).
You can see another detailed analysis of the Harley study (and others).
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Nutrient intakes of children on the hyperkinesis diet. Harper PH, Goyette CH, Conners CK,
J Am Diet Assoc 1978 Nov;73(5):515-9
"The nutrient intakes of fifty-four hyperactive children during a baseline period and while following the hyperkinesis diet
were calculated. During both periods, mean dietary intakes compared favorably with the Recommended Dietary
Allowances. ..."
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The management of hyperkinetic children: a trial of dietary therapy.
Hindle RC, Priest J , N Z Med J 1978 Jul 26;88(616):43-5
"... Ten hyperkinetic children have been treated with the diet, five of whom improved dramatically and are now off all other therapy. Their response to accidental and deliberate challenge supports the hypothesis that the dietary regime described has been responsible for their improvement."
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Estimates of dietary exposure of children to artificial food colours in Kuwait.
Husain A, Sawaya W, Al-Omair A, Al-Zenki S, Al-Amiri H, Ahmed N, Al-Sinan M.,
Food Additives & Contaminants 2006 Mar;23(3):245-51.
"To assess the intake of artificial food colour additives by 5-14-year-old children in the State of Kuwait, a 24-h dietary recall was conducted twice on 3141 male and female Kuwaiti and non-Kuwaiti children from 58 schools. ... The results indicated that out of nine permitted colours, four exceeded their ADIs (acceptable daily intake) by factors of 2-8: tartrazine (E102/Yellow #5), sunset yellow (E110/Yellow #6), carmoisine (E122/not used in USA) and allura red (E129/Red #40). ... Further, follow-up studies to provide insight into potential adverse health effects associated with the high intakes of these artificial colour additives on the test population are warranted."
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Overall
Nutrient Intake of Preschool Hyperactive and Normal Boys, B.Kaplan
et al, Journal of Abnormal Child Psychology, April 1989, Vol. 17(2),
pp.127-32
"...concluded that nutrition-behavior interactions
are more likely a function of idiosyncratic sensitivities, rather than
a general tendency for ADDH children to eat differently..."
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Dietary
Replacement in Preschool-Aged Hyperactive Boys, B.Kaplan, et al, Pediatrics, 1989, Vol. 83, pp. 7-17
"More than half the subjects exhibited reliable improvement
in behavior and negligible placebo effects. In addition, several
nonbehavioral variables tended to improve ... particularly halitosis, night
awakenings, and latency to sleep onset."
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Erythrosin B inhibits dopamine transport in rat caudate synaptosomes.
Lafferman JA, Silbergeld EK,
Science. 1979 Jul 27;205(4404):410-2.
"
. . . We found that erythrosin B inhibits dopamine uptake in rat caudate synaptosomes "uncompetitively" in the 10- to 800-micromolar range. . . . Erythrosin B also decreased nonsaturable binding of dopamine to the synaptosome membrane. The inhibitory action of erythrosin B on dopamine uptake is consistent with the hypothesis that erythrosin B can act as a central excitatory agent able to induce hyperkinetic behavior.
"
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Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test.
Lau K, McLean WG, Williams DP, Howard CV., Toxicol Sci. 2006 Mar;90(1):178-87, 2005 Dec 13; [Epub ahead of print]
"
Exposure to non-nutritional food additives during the critical development window has been implicated in the induction and severity of behavioural disorders such as attention deficit hyperactivity disorder (ADHD). . . We therefore examined the neurotoxic effects of four common food additives in combinations of two (Brilliant Blue and L-glutamic acid, Quinoline Yellow and aspartame) to assess potential interactions. . . Neurotoxicity was measured as an inhibition of neurite outgrowth. . . . Theoretical exposure to additives was calculated based on analysis of content in foodstuff, and estimated percentage absorption from the gut. Inhibition of neurite outgrowth was found at concentrations of additives theoretically achievable in plasma by ingestion of a typical snack and drink. . . both combinations had a straightforward additive effect on cytotoxicity. These data have implications for the cellular effects of common chemical entities ingested individually and in combination.
"
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Hyperkinesis and diet:
a double-blind crossover trial with a tartrazine
challenge.
Levy F, Dumbrell S, Hobbes G, Ryan M, Wilton N, Woodhill JM,
Medical Journal of Australia 1978 Jan 28;1(2):61-4
"...The rating scales and
objective tests for the full sample did not show a statistically significant deterioration in the children's behaviour when they
were challenged under double-blind test conditions with the Yellow Dye No. 5, tartrazine, and the tests were conducted
the day after a two-week challenge period. ... a subgroup of the children... indicated a significant challenge effect, with mothers reporting more symptoms during the challenge period."
NOTE: tests were conducted the day after challenge, not during challenge, and results of all children were averaged. Moreover, the "challenge" was 5 biscuits per day, each containing ONE mg of Tartrazine — a total per day of about ONE SWALLOW of Koolaid -- a very tiny dose indeed!
Nevertheless, astonishingly, some of the children still reacted to this dye challenge!
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Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway.
Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E.
American Journal of Public Health. 2006 Oct;96(10):1815-20
"
... A cross-sectional population-based survey was conducted with 10th-grade students in Oslo, Norway (n = 5498). ...
The relationship was linear for hyperactivity. ... the association between soft drink consumption and mental health problems remained significant after adjustment for behavioral, social, and food-related variables. The highest adjusted odds ratios were observed for conduct problems among boys and girls who consumed 4 or more glasses of sugar-containing soft drinks per day. CONCLUSIONS: High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders."
Note: It has been concluded by some reporters that the cause of the behavioral deterioration is the high fructose corn syrup in these sodas, but there are many chemicals besides sugar or corn syrup included in sodas. Consider the combination of synthetic coloring, flavoring, and sodium benzoate, as suggested culprits.
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Malnutrition at Age 3 Years and Externalizing Behavior
Problems at Ages 8, 11, and 17 Years.
Liu J, Raine A, Venables PH, Mednick SA.
The American Journal of Psychiatry. 2004 Nov;161(11):2005-13
"
... the children with malnutrition signs at age 3 years (N=353) were more aggressive or hyperactive at age 8 years, had more externalizing problems at age 11, and had greater conduct disorder and excessive motor activity at age 17. . . . The findings suggest that reducing early malnutrition may help reduce later antisocial and aggressive behavior."
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The effect of childhood malnutrition on externalizing behavior.
Liu J, Raine A.
Current Opinion in Pediatrics, 2006 Oct;18(5):565-70.
"
... Externalizing behavior (aggression, hyperactivity, and conduct disorder) is associated with both macromalnutrition (e.g. protein) and micromalnutrition (e.g. iron and zinc). Both prenatal and postnatal malnutrition is implicated. . . . The effects of docosahexaenoic acid/omega-3 long-chain essential fatty acid on externalizing behavior are more mixed. From animal and human findings, it is hypothesized that malnutrition impairs neurocognitive functioning by reducing neurons, alternating neurotransmitter functioning, and increasing neurotoxicity, and that such neurocognitive impairments predispose to externalizing behavior. "
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Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study.,
Mattes JA, Gittelman R., Archives of General Psychiatry. 1981 Jun;38(6):714-8
"
... We sought to maximize the likelihood of demonstrating behavioral effects of artificial food colorings by (1) studying only children who were already on the Feingold diet and who were reported by their parents to respond markedly to artificial food colorings, (2) attempting to exclude placebo responders, and (3) administering high dosages of coloring. ... Evaluations by parents, teachers, and psychiatrists and psychological testing yielded no evidence of a food coloring effect."
See review by Bernard Rimland, PhD
Notes:
-
Their "high dose" of coloring did not even change the color of the cookies from identical cookies without coloring.
-
Many of the children could not eat all the cookies, so they did not receive the expected dose of coloring.
-
Evaluations were not always done 1 1/2 hours after eating a cookie - we have a report from one parent that she was unable to give her child the cookie and then drive to the meeting place.
- This same parent reports her child's reactions were so severe that the after-school dance teachers could not keep her in class, and she missed school because reactions included ear infections. You can read an excerpt of her letter here.
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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
McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Lancet, September 6, 2007 on line.
"Artificial colours or a sodium benzoate preservative (or both) in the diet result in increased hyperactivity in 3-year-old and 8/9-year-old children in the general population."
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Disturbed children: the role of food and chemical sensitivities.
Menzies IC.
Nutr Health. 1984; 3(1-2): 39-54.
"
. . . A number of case studies are presented which suggest that the difficulties encountered by a significant number of these children have much to do with idiosyncratic responses to foods and additives. This hypothesis requires careful research study at an early date for if validated it will have far reaching implications for the assessment and management of disturbed, delinquent and learning disordered children. Perhaps not enough attention has been paid to the role of biological and environmental factors in the development of children's problems. Certainly recent research has begun to provide support for the concept of environmental (ecologic) illness.
"
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Effects of prenatal ethanol exposure and early experience on
home-cage and open-field activity in mice. Mothes HK, Opitz B, Werner R, Clausing P, Neurotoxicol Teratol 1996 Jan-Feb;18(1):59-65
"... Mice prenatally exposed to ethanol showed increased activity in their home cages, whereas open-field behavior
was generally not different from that of control groups. Conversely, different preweaning rearing conditions had affected
open-field behavior, but not home-cage activity. In conclusion, home-cage behavior was a sensitive paradigm for
detecting hyperactivity subsequent to a relatively low dose of prenatal ethanol in mice..."
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The ketogenic diet causes a reversible decrease in activity level in Long-Evans rats. Murphy P, Burnham WM.,
Experimental Neurology, 2006 Sep;201(1):84-9. Epub 2006 Jun 5.
"
Individuals with epilepsy also often exhibit symptoms of attention deficit hyperactivity disorder (ADHD). The ketogenic diet, which is a high fat, low protein, and low carbohydrate diet used in the treatment of intractable epilepsy, also appears to improve symptoms of ADHD in individuals with both disorders. Previous research suggests that the diet decreases the activity level of rats. ... adult male Long-Evans rats were placed on either a ketogenic diet or a control diet. The results of the first experiment show that the ketogenic diet can cause a decrease in activity level within 24 h and that the results are reversible. The results of Experiment 2 show that the decrease in activity level is not linked to a change in anxiety level. The ketogenic diet may be of use in the treatment of ADHD."
Note: A word of caution is needed here. Every dietary manipulation which involves removing all or most "processed" foods approaches the Feingold diet by inadvertently eliminating all the many additives used in such products. We are therefore not surprised to see that removal of "only" milk, wheat, sugar, or protein/fats from the diet will "work," at least somewhat, in relieving hyperactive behavior.
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A preliminary investigation of ADHD symptoms in persons with celiac disease., Niederhofer H, Pittschieler K., Journal of Attention Disorders, 2006 Nov;10(2):200-4.
"Several studies report a possible association of celiac disease (CD) with psychiatric and psychological disturbances, such as ADHD. METHOD: The authors assess 132 participants from 3 to 57 years of age ... affected by CD for the possibility of an associated ADHD-like symptomatology ... before their gluten-free diet was started and 6 months later. RESULTS: The overall score improves significantly as well as most of the ADHD-like symptomatology ...
CONCLUSION: The data indicate that ADHD-like symptomatology is markedly overrepresented among untreated CD patients and that a gluten-free diet may improve symptoms significantly within a short period of time.
"
Notes:
- A gluten-free diet would eliminate many processed foods, thereby automatically reducing the ingestion of additives.
- Some people with ADHD, even on the Feingold Program, do better when they eliminate gluten and/or casein. Since Celiac Disease can also be present without frank symptoms of GI disturbance, this connection is very interesting.
- See full text of study - Get Password
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Unusual reactions to food additives, Novembre E, Dini L, Bernardini R, Resti M, Vierucci A, Pediatria Medica e Chirurgica 1992 Jan-Feb;14(1):39-42
"...In this study, we report two cases of unusual reactions to food additives (tartrazine and benzoates) involving mainly the central nervous system (headache, migraine, overactivity, concentration and learning difficulties, depression) and joints (arthralgias), confirmed with diet and
double blind challenge. The possible pathogenetic mechanisms are also discussed."
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A randomised controlled trial into the effects of food on ADHD.
Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Pereira RR, Buitelaar JK.
ADHD Research Centre, Liviuslaan 49, 5624 JE, Eindhoven, The Netherlands, lmjpelsser@worldmail.nl.
"The aim of this study is to assess the efficacy of a restricted elimination diet in reducing symptoms in an unselected group of children with Attention deficit/hyperactivity disorder (ADHD). Dietary studies have already shown evidence of efficacy in selected subgroups. Twenty-seven children (mean age 6.2) who all met the DSM-IV criteria for ADHD, were assigned randomly to either an intervention group (15/27) or a waiting-list control group (12/27). Primary endpoint was the clinical response, i.e. a decrease in the symptom scores by 50% or more, at week 9 based on parent and teacher ratings on the abbreviated ten-item Conners Scale and the ADHD-DSM-IV Rating Scale. The intention-to-treat analysis showed that the number of clinical responders in the intervention group was significantly larger than that in the control group [parent ratings 11/15 (73%) versus 0/12 (0%); teacher ratings, 7/10 (70%) versus 0/7 (0%)]. The Number of ADHD criteria on the ADHD Rating Scale showed an effect size of 2.1 (cohen's d) and a scale reduction of 69.4%. Comorbid symptoms of oppositional defiant disorder also showed a significantly greater decrease in the intervention group than it did in the control group (cohens's d 1.1, scale reduction 45.3%). A strictly supervised elimination diet may be a valuable instrument in testing young children with ADHD on whether dietary factors may contribute to the manifestation of the disorder and may have a beneficial effect on the children's behaviour."
They used a diet which eliminates milk, wheat, eggs, chicken, and beef as well as additives. This would pick up allergies or intolerance to any of these items. Otherwise, the diet is basically an extreme version of the standard Feingold diet.
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Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study
Pelsser LM, Buitelaar JK,
Ned Tijdschr Geneeskd 2002 Dec 28;146(52):2543-7
"
.. children, 36 boys and 4 girls, aged 3-7 (average 4.8 years), who met the DSM-IV-criteria for ADHD, followed their usual diet for two weeks and thereafter for two weeks an elimination diet, based on the few foods diet (rice, turkey, pear and lettuce). ... 25 children (62%) showed an improvement in behaviour of at least 50% on both the Conners list and the ADHD Rating Scale at the end of the elimination diet. Nine children (23%) withdrew from the study because the parents were unable to stick to the diet or because the child fell ill. Among the 15 children with both parent and teacher ratings, 10 [66%] responded both at home and in school. CONCLUSION: In young children with ADHD an elimination diet can lead to a statistically significant decrease in symptoms.
"
Note: This study was done in Holland where a Feingold Foodlist is not available. Their diet was very much more limited than the usual Feingold diet. Since 9 children dropped out, the number of children who completed the 2-weeks trial of the diet was only 31. Thus, 25 children improving would be 80.6% of them. This is in line with the results we see of those who try the Feingold diet, in spite of the fact that two weeks is a very short trial for any diet.
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Effect of artificial food colours on childhood behaviour.
, Pollock I, Warner JO, Arch Dis Child 1990 Jan;65(1):74-7, Heart and Lung Institute, Brompton Hospital, London.
"... 19 children completed a double blind placebo controlled challenge study with artificial food colours. In these children food colours were shown to have an adverse effect on a daily Conners' rating of behaviour, but most parents could not detect these changes. A pharmacological mechanism of food additive intolerance is proposed to explain these effects."
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Effects of environmental enrichment at ages 3-5 years on schizotypal personality and antisocial behavior at ages 17 and 23 years., Raine A, Mellingen K, Liu J, Venables P, Mednick SA, The American Journal of Psychiatry. 2003 Sep;160(9):1627-35
"... This study assessed the effects of an early nutritional, educational, and physical exercise enrichment program on adult outcome for schizotypal personality, conduct disorder, and criminal behavior. . .Subjects who participated in the
enrichment program at ages 3–5 years
had lower scores for schizotypal personality
and antisocial behavior at age 17 years
and for criminal behavior at age 23 years,
compared with the control subjects."
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Effect of organic synthetic food colours on mitochondrial respiration.
Reyes FG, Valim MF, Vercesi AE.
Food Additives and Contaminants. 1996 Jan;13(1):5-11
"
... The compounds tested were: Erythrosine, Ponceau 4R, Allura Red, Sunset yellow, Tartrazine, Amaranth, Brilliant Blue, Blue, Fast Red E, Orange GGN and Scarlet GN. All food colours tested inhibited mitochondrial respiration ...This inhibition varied largely, e.g. from 100% to 16% for Erythrosine and Tartrazine respectively, ...This effect was dose related ....
"
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Food additives and hyperactive children: a critique of Conners.
Rippere V,
Br J Clin Psychol 1983 Feb;22 Pt 1:19-32
"
Food Additives and Hyperactive Children (Conners, 1980) is the first book-length attempt to evaluate Feingold's additive and salicylate-free Kaiser-Permenente diet for the treatment of hyperactive children, and as such it requires critical scrutiny. . .It is argued that the studies as
reported do not constitute a methodologically adequate test of Feingold's hypothesis . . . and that it is thus premature to reject the hypothesis on the grounds presented here. . . "
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The functional relationship between artificial food colors and
hyperactivity.
Rose TL,
J Appl Behav Anal 1978 Winter;11(4):439-46
"
. . .Two eight-year-old females, who had been on the Feingold K-P diet for a minimum of 11 months, were the subjects studied. The experimental design was a variation of the BAB design, with double-blind conditions. This design allowed an experimental analysis of the placebo phases as well as challenge phases. Data were obtained by trained observers on Out of Seat, On Task, and Physically Aggressive behaviors, as they occurred in the subjects' regular class setting. Results indicated (a) the existence of a functional relationship between the ingestion of artificial food colors and an increase in both the duration and frequency of hyperactive behaviors, (b) the absence of a placebo effect, and (c) differential sensitivity of the dependent variables to the challenge effects.
"
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Synthetic Food Colourings
and "Hyperactivity": a Double-Blind Crossover Study, K.S.Rowe, Australia Paediatric Journal, April 1988, Vol. 24 (2), pp. 143-7
40 of 55 children (72.7%) put on a 6-week trial of the
Feingold Diet "... demonstrated improved behaviour." 26
of them (47.3%) remained improved following "liberalization"
of the diet over a 3-6 month period.
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Synthetic Food Coloring and
Behavior: A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study, K.S.Rowe, K.J.Rowe, Journal of Pediatrics, November 1994, Vol. 135, pp.691-8
150 of 200 children [75%] improved on an open trial of a diet free of synthetic food coloring, and deteriorated upon introduction of foods containing synthetic colorings.
34 other "clear" or "suspected" reactors plus 20 "controls" were studied in a separate double blind study. 82.5% of the "suspected reactors,", 27% of the "uncertain reactors," and 10% of the "controls" reacted to a mild single-item challenge of tartrazine (Yellow #5). Kind of reaction and length of time the children were affected depended on the dose. Rowe reported that a dose response effect was observed.
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Physiological
changes in hyperactive children following the ingestion of food additives. Salamy J, Shucard D, Alexander H, Peterson D, Braud L, International Journal of Neuroscience 1982 May;16(3-4):241-246
"... The physiological measures [EEG and heart rate] were obtained prior to and following the ingestion of drinks containing food additives or placebos, which were administered in a double-blind, randomized, crossover procedure. ... the magnitude of physiological changes in the hyperactive children were greater in response to ingestion of the additives than to placebo. These physiological findings are consistent with behavioural data indicating that some hyperactive children are adversely affected by food additives.
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Allergy testing, psychological
assessment and dietary treatment of the hyperactive child syndrome. Salzman LK, Medical Journal of Australia 1976 Aug 14;2(7):248-51
Thirty-one children with behavioural problems and learning difficulties were allergy tested ... 15 of these were given the Australian Version
of the Feingold K.P. diet. Ninety-three per cent responded with improved behaviour in the areas of overactivity,
distractability, impulsiveness and excitability. Sleep and enuresis problems were resolved partially or completely. This
study demonstrates that the aforementioned elimination diet significantly affects behaviour.
Note: Many people who don't "test positive" on such tests still respond well to the diet. Allergy testing may be useful if positive, but does not rule out response to diet management if negative.
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A Prospective Study of Delinquency
in 110 Adolescent Boys with Attention Deficit Disorder and 88 Normal Adolescent Boys, J.Satterfield et al, American Journal of Psychiatry, June 1982, Vol. 139, p.6
"These findings suggest a strong relationship between
childhood ADD and later arrests for delinquent behavior." "...our study is consistent with other follow-up studies of drug-treated children that have found an absence of long-term beneficial effect ..."
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Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. Schab DW, Trinh NH, Journal of Developmental and Behavioral Pediatrics, 2004 Dec;25(6):423-34.
"
... We searched ten electronic databases for double-blind placebo-controlled trials evaluating the effects of AFCs [artificial food colors]. ... Despite indications of publication bias and other limitations, this study is consistent with accumulating evidence that neurobehavioral toxicity may characterize a variety of widely distributed chemicals.
"
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Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial. , Schmidt MH, et al., Eur Child Adolesc Psychiatry, 1997 Jun;6(2):88-95.
"Effects of diet were compared with those yielded by stimulant medication (methylphenidate). ... Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions ... The amount of positive changes in behavior in those who received both treatments was about the same... dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children ..."
NOTE: These were children with conduct-disorder as well as ADHD. 44% responded to Ritalin while 24% responded equally well to a Feingold-type diet.
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Applied Nutrition and Behavior, S.Schoenthaler, J.Moody, L.Pankow, Journal of Applied Nutrition, November 1, 1991, Vol. 43
Review of studies at California State University; implementation of "nutrient dense diets" in 813 state facilities "resulted in significantly improved conduct, intelligence, and/or academic performance..."
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The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools,
Schoenthaler SJ, Doraz WE, Wakefield JA,
Int J Biosocial Res., 1986, 8(2); 185-195.
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The introduction of a diet policy which lowered sucrose, synthetic food color/flavors, and two preservatives (BHA and BHT) over 4 years in 803 public schools was followed by a 15.7% increase in mean academic percentile ranking above the rest of the nation's schools who used the same standardized tests. Prior to the 15.7% gain, the standard deviation of the annual change in nation percentile rating had been less than 1% . . ., after the policy transitions, the percent of students who ate school lunches and breakfasts within each school became positively correlated with that school's rate of gain (r = .28, p < .0001)."
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Utilization of alternative therapies in attention-deficit hyperactivity disorder. Stubberfield T, Parry T,
J Paediatr Child Health 1999 Oct;35(5):450-3
"...A mailed questionnaire survey was undertaken in June 1993, of the use of
various therapies by families of 381 children with ADHD. The respondent rate was 76%.... Diet therapies were the most commonly used alternative
therapy (60%). ... Physicians were commonly involved in the suggestion to try a modified diet. ..."
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Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test, J. Swanson, M.Kinsbourne, Science magazine, March 28, 1980, Vol. 207. pp.1485-7
"The performance of the hyperactive children on paired-associate
learning tests on the day they received the dye blend was impaired relative
to their performance after they received the placebo, but the performance
of the non-hyperactive group was not affected by the challenge..."
Note: Dr. Swanson used 100 mg and 150 mg of mixed food dye in his study. In a phone conversation with this author, he said he had been told that his use of a "toxic dose" had devalued his study. When informed of the amount of food dye per tablespoon in solid bright-colored candies and frosting, green ketchup, and powdered drinks, as measured by students at an Atlanta college, he was astonished. According to his math, students at a birthday party can easily consume 500-600 mg of food dye. If 150 mg is really a "toxic dose," then we need to seriously reconsider what we are allowing in the food sold for children, and we also need to rethink the fact that manufacturers refuse to reveal just how much coloring is actually in any of their products.
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Topographic mapping of brain electrical activity in children with
food-induced attention deficit hyperkinetic disorder.
Uhlig T, Merkenschlager A, Brandmaier R, Egger J, European Journal of Pediatrics 1997 Jul;156(7):557-61
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"... During consumption of provoking foods there was a significant increase in betal activity in the frontotemporal
areas of the brain. This investigation is the first one to show an association between brain electrical activity and intake of
provoking foods in children with food-induced attention deficit hyperactivity disorder. ..."
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The influence of the chemical additive tartrazine on the zinc status of hyperactive children: A double-blind placebo-controlled study. Ward NI; Soulsbury KA; Zettel VH; Colquhoun ID; Bunday S; Barnes B, J Nutr Med; 1 (1). 1990. 51-58
"...Tartrazine induces a reduction in serum and saliva zinc
concentrations and an increase in urinary zinc content with a corresponding deterioration in behaviour/emotional responses of the hyperactive children but not the controls."
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Assessment of chemical factors in relation to child hyperactivity. Ward NI, Journal of Nutritional & Environmental Medicine (Abingdon); 7 (4). 1997. 333-342.
"...Only hyperactive children showed a significant reduction in blood
serum zinc levels and an increase in urinary zinc output following the
consumption of E102 [tartrazine] and E110 [sunset yellow]. . . For the 23 children who consumed a tartrazine beverage there were increased levels of overactivity (n = 18 children), aggressive (n = 16) and/or violent (n = 4) activity, poor speech (n = 2), poor coordination (n = 12), and the development of asthma and/or eczema (n = 8). Most of these were severe or moderate changes. Only one control child showed minor behavioural responses to tartrazine."
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Behavioral responses to artificial food colors.
Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, Cox C, McKibben J, Ogar D, Schultz S.,
Science 1980 Mar 28;207(4438):1487-9
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Twenty-two 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. Parents' observations provided the criteria of response. One child that responded mildly to the challenge and one that responded dramatically were detected. The latter, a 34-month-old female, showed a significant increase in aversive behaviors. These results further confirm previous controlled studies.
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Note:
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The children were not diagnosed as hyperkinetic (hyperactive).
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Not all parents restricted the fruits and vegetables Dr. Weiss requested that they avoid.
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35.26 mg of mixed colors were used as the "challenge" in this study. Compare to 150 mg in one Tb green ketchup. Note also that when a challenge does not provoke worse behavior, it does not mean that the diet did not "work" but that the challenge did not "work."
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Relative effects of drugs and diet on hyperactive behaviors: an experimental study.
Williams JI, Cram DM, Tausig FT, Webster E.,
Pediatrics. 1978 Jun;61(6):811-7.
"In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additives. . . when the children were receiving placebos, their hyperactive behaviors in the classroom were greater when eating cookies with artificial colors than when eating cookies without artificial colors. According to the ratings, approximately seven children were no longer hyperactive. There is evidence to suggest that the behavior of three to eight children was diet-responsive, depending on the criteria used. There is evidence, particularly in teacher ratings, in support of Feingold's hypothesis if it is modified. . . .
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Discussion
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Effects of toluene inhalation on locomotor activity and brain
catecholamine levels in rats. Yamawaki S, Sarai K,
Yakubutsu Seishin Kodo 1982 Jul;2(1):57-9
"...The inhaling of toluene vapor (0.7% in air, for 15 min) induced the increase in spontaneous locomotor activity.
This locomotor accelerating effect lasted about 60 min after the end of toluene exposure. ... These results suggest that toluene may raise dopaminergic neuron activity."
Note: Exposure of rats to neurotoxic substances commonly results in hyperactivity, as though the "brakes" are the neurons first suffering damage. Toluene is a solvent made from petroleum or coal tar. Its chemical formula is C6H5CH3
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