ADHD DIET: The Feingold Diet Program for ADHD

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National Academy
of Sciences


A sensible guide to
risk-benefit analysis:

[] 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.

- Philip Handler (1979)
President of U.S. National Academy of Sciences 1969 to 1981


When it's
NOT ADHD

A boy in Germany was brought to a hospital and first diagnosed with asthma; he also was aggressive and hyperactive.

After ruling out a number of possible lung diseases, they tested him for parasites and found very elevated toxocara IgG antibodies - Toxocara is a parasitic worm usually found only in cats and dogs. Symptoms of the "covert" form can include coughing, fever, abdominal pain, headache, and changes in behavior and sleep.

If you have reason to suspect parasites, talk to your doctor.



Diet & ADHD:
Some of the Research



How Many Children Actually Get Better on an Elimination Diet?

In these studies, the children were put on a diet approximating the Feingold Diet. Sometimes it was only a Stage Two diet, and other times it was an oligoantigenic (few foods) diet you might call an "extreme" Feingold-type diet.

In many studies, the researchers put the children on the diet, and then gave those that got better a double-blind challenge using only very small amounts of one or a mix of food dyes. They had been told to use no more than 27 mg by the food additive industry organization calling itself the "Nutrition Foundation," and some used far less. If they didn't get results from their challenge, instead of concluding that the challenge didn't work, they strangely concluded that the diet didn't work.

Next, the results of the tests were reported in no particular order and results were claimed to be "all over the place," as you see in the picture below. Your doctor may tell you that today, because that is what he was taught. If you put the studies in appropriate order -- by amount of food dye used as the challenge -- you get a very different picture. See what happens when you hover your cursor over the picture below.





Below 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.


  • Anthony HM; Maberly DJ; Birtwistle S. Attention deficit hyperactivity disorder, 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. "

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  • Arnold LE, Lofthouse N, & Hurt E. Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics. 2012 Jul;9(3):599-609. doi: 10.1007/s13311-012-0133-x.
    "The effect of artificial food colors (AFCs) on child behavior has been studied for more than 35 years, with accumulating evidence from imperfect studies. This article summarizes the history of this controversial topic and testimony to the 2011 Food and Drug Administration Food Advisory Committee convened to evaluate the current status of evidence regarding attention-deficit/hyperactivity disorder (ADHD). Features of ADHD relevant to understanding the AFC literature are explained: ADHD is a quantitative diagnosis, like hypertension, and some individuals near the threshold may be pushed over it by a small symptom increment. The chronicity and pervasiveness make caregiver ratings the most valid measure, albeit subjective. Flaws in many studies include nonstandardized diagnosis, questionable sample selection, imperfect blinding, and nonstandardized outcome measures. Recent data suggest a small but significant deleterious effect of AFCs on children's behavior that is not confined to those with diagnosable ADHD. AFCs appear to be more of a public health problem than an ADHD problem. AFCs are not a major cause of ADHD per se, but seem to affect children regardless of whether or not they have ADHD, and they may have an aggregated effect on classroom climate if most children in the class suffer a small behavioral decrement with additive or synergistic effects. Possible biological mechanisms with published evidence include the effects on nutrient levels, genetic vulnerability, and changes in electroencephalographic beta-band power. A table clarifying the Food and Drug Administration and international naming systems for AFCs, with cross-referencing, is provided."

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  • Augustine GJ Jr, Levitan H, Neurotransmitter release from a vertebrate neuromuscular synapse affected by a food dye. Science 1980 Mar 28;207(4438):1489-90
    " The food dye erythrosine (Red No. 3) was applied to isolated neuromuscular synapses in the frog ... produced an irreversible, dose-dependent increase in neurotransmitter release.... its use as a food additive should be reexamined. "

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  • Augustine GJ, Levitan H, Neurotransmitter release and nerve terminal morphology at the frog neuromuscular junction affected by the dye Erythrosin B [Red #3]. J Physiol 1983 Jan;334:47-63
    Red #3 at concentrations of 10 micrograms or more, produced swollen mitochondria and increased transmitter release from presynaptic nerve terminals.

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  • Augustine GJ, Levitan H, Presynaptic effect of Erythrosin B at the frog neuromuscular junction: ion and photon sensitivity. J Physiol 1983 Jan;334:65-77
    " . . . Erythrosin B [Red 3] ... may also increase the permeability of the nerve terminal to calcium ions."

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  • Bateman B et al, The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood. 2004 Jun;89(6):506-11.
    "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 58 mg of coloring present in one (1) cupcake with red frosting.

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  • Bell, C. C. A comparison of daily consumption of artificial dye-containing foods by American children and adults, Eastern Michigan University Master's Theses. 2013.
    Counting number of exposures to food dye rather than actual amounts of dye consumed, she found that children encounter at least twice the number of exposures to food dyes as adults, and also that fruit and vegetable consumption was inversely correlated to the number of dye exposures per day in the children, who were found to "habitually consume more brightly colored foods with additives in lieu of nutrient dense foods."

    It appears we are training a generation of future adults to consume little more than easily-available and highly-advertised processed foods.

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  • Bennett CPW, Brostoff J., The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders, Journal of Nutritional & Environmental Medicine, Vol.7, No.4 Dec 1997 pp.359-366
    " ...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% "

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  • Bennett CPW, McEwen LM, McEwen HC, Rose, EL, The Shipley Project: Treating Food Allergy to Prevent Criminal Behaviour in Community Settings, 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 ... All were found to have a number of food allergies or intolerances and mineral imbalances, particularly in zinc. . . . .The health and behaviour of all nine subjects improved both physically and psychologically. . . . Criminal justice, education and health agencies could incorporate and develop this approach "

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  • Boris M; Mandel F, Foods and Additives are Common Causes of the Attention Deficit Hyperactive Disorder in Children, 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. "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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  • Brenner A, A study of the efficacy of the Feingold diet on hyperkinetic children. Some favorable personal observations. 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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  • Brenner A, Trace mineral levels in hyperactive children responding to the Feingold diet, Journal of Pediatrics 1979 Jun;94(6):944-5
    "... 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.

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  • Burlton-Bennett JA, Robinson VM, A Single Subject Evaluation of the K-P Diet for Hyperkinesis, Journal of Learning Disabilities, 1987 Jun-Jul;20(6):331-5, 346.
    A single subject ABAB design design was employed ... Diet effectiveness was measured by classroom observations and by teacher and foster-mother reports. It was concluded that the K-P diet was effective in controlling the subject's hyperkinesis.

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  • Carter, CM et al, Effects of a Few Foods Diet in Attention Deficit Disorder, Archives of Disease in Childhood, November 1993, Vol. 69 (5), pp.564-8
    59 of 78 children (75.6%) 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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  • Ceyhan, Gultekin, Doguc, & Kulac. Effects of maternally exposed coloring food additives on receptor expressions related to learning and memory in rats. Food and Chemical Toxicology, 2013 Jun;56:145-8. doi: 10.1016/j.fct.2013.02.016
    " Exposure to artificial food colors and additives (AFCAs) has been implicated in the induction and severity of some childhood behavioral and learning disabilities. N-methyl-D-aspartate receptors (NMDARs) and nicotinic acetylcholine receptors (nACHRs) are thought to be effective in the learning and memory-generating process. In this study, we investigated the effects of intrauterine exposure to AFCAs on subunit concentrations of NMDARs and nAChRs isoforms in rats. . . ... Our results indicate that exposure to AFCAs during the fetal period may lead to alterations in expressions of NMDARs and nAChRs in adulthood..."

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  • Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA, Food additives and hyperkinesis: a controlled double-blind experiment. 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 ...Both parents and teachers reported fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline. ..."

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  • Cook PS, Woodhill JM., The Feingold dietary treatment of the hyperkinetic syndrome., Med J Aust. 1976 Jul 17;2(3):85-8, 90.
    "... the results of its [the Feingold Diet's] 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. "

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  • Curtis LT, Patel K. Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review., J Altern Complement Med. 2008 Jan-Feb;14(1):79-85.
    " Autistic spectrum disorders and ADHD are complicated conditions in which nutritional and environmental factors play major roles. . . "

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  • David, TJ, Reactions to dietary tartrazine. Arch Dis Child. 1987 Feb;62(2):119-22.
    " Double blind challenges with tartrazine [Yellow 5] and benzoic acid were performed in hospital in 24 children . . . the parents of two children insisted on continuing the diet. . . "

    Note: David used a large dose of coloring -- 250 mg. However, he solicited children whose parents had come to him for help using the diet. He treated the parents like neurotics, judging by the tone of the article. The challenges were administered to children in the throes of reaction; furthermore, they were not evaluated by any sort of testing or questionnaire, but by asking busy nurses in the ward to "observe" them. This is a good example on how to do a really bad study.

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  • Dengate S, Ruben A., Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health 2002 Aug;38(4):373-6
    " ...Twenty-seven children, whose behaviour improved significantly on the Royal Prince Alfred Hospital [FAILSAFE] diet, were challenged with calcium propionate (preservative code 282) or placebo through daily bread ...Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative "

    Note: Calcium proprionate is used more heavily in bread in Australia than it is in the US. The Feingold Diet does not eliminate it, but products containing it are marked with "(CP)" in the Foodlist because some members must avoid it.

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  • Doguc et al., Effects of maternally exposed colouring food additives on cognitive performance in rats, Toxicology and Industrial Health, 2013 Aug;29(7):616-23. doi: 10.1177/0748233712436638
    " " Artificial food colourings and additives (AFCAs) have long been suggested to adversely affect the learning and behaviour in children. In this study, we aimed to provide additional data to clarify the possible side effects of colouring additives on behaviour and memory. We administered acceptable daily intake values of AFCAs as a mixture (Eritrosin, Ponceau 4R, Allura Red AC, Sunset Yellow FCF, Tartrazin, Amaranth, Brilliant Blue, Azorubin and Indigotin) to female rats before and during gestation and then tested their effects on behaviour and on spatial working memory in their offspring. ... Our results showed that commonly used artificial food colourings have no adverse effects on spatial working memory and did not create a depressive behaviour in offspring. But they showed a few significant effects on locomotor activity as AFCAs increased some parameters of locomotor activity. "

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  • Dumbrell S, Woodhill JM, Mackie L, Leelarthaepin B, Is the Australian version of the Feingold diet safe? 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. "

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  • Eagle, K. ADHD impacted by sulfotransferase (SULT1A) inhibition from artificial food colors and plant-based foods
    " SULT1A inhibitors in foods, including natural substances and artificial food colors, have a role in ADHD that can both worsen or improve symptoms. ... SULT1A inhibition can influence brain catecholamines through the intermediary of plasma tyrosine levels, which are influenced by dopamine inhibition of intestinal tyrosine hydroxylase."

    Note: SULT1A is the same enzyme group elsewhere called PST. This is a complicated study for those not well versed in organic chemistry, but it basically gives a clue why some children appear to get worse when first put on the diet.

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  • Egger J et al., Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment., 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. ... symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. . . ."

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  • Egger, Graham, Soothill, Carter, Gumley, Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome, 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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  • Egger J, Carter CM, Soothill JF, Wilson J, Oligoantigenic diet treatment of children with epilepsy and migraine, Journal of Pediatrics 1989 Jan;114(1):51-8
    Of 45 children with epilepsy and recurrent headaches, abdominal symptoms, or hyperkinetic behavior [old name for ADHD], 36 [80%] improved on an oligoantigenic diet . . . "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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  • Egger J, Carter CH, Soothill JF, Wilson J, Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior, Clinical Pediatrics (Phila) 1992 May;31(5):302-7
    "On diet, the enuresis [bed-wetting] stopped in 12 of these children and improved in an additional four. [76%] "

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  • Egger J, Hyperkinetic Syndrome, Journal of Nutritional & Environmental Medicine 1997, 7, 353-357.
    "Studies suggest that 5-10% of all schoolchildren suffer from hyperkinetic syndrome, and that children with hyperkinetic syndrome are at risk of developing conduct and other psychiatric disorders. Food intolerance seems to be an important cause of hyperkinetic syndrome and avoidance of provoking foods is the treatment of choice for most patients who have food-induced hyperkinetic syndrome."

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  • Feingold, BF., Hyperkinesis and learning disabilities linked to artificial food flavors and colors. 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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  • Feingold, BF., Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors. Journal of Learning Disabilities, 1976. Vol.9(9) pp.19-27
    The historical background of hyperkinesis and learning disabilities (ADHD) is reviewed briefly and followed by a discussion of food additives.

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  • Feingold, BF, Hyperkinesis and Learning Disabilities Linked to the Ingestion of Artificial Food Colors and Flavors, 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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  • Feingold, B.F., Food additives in dentistry., Journal of the American Society for Preventive Dentistry, 1977 Jan-Feb;7(1):13-5.
    " The presence of food additives in products used in dental procedures may have serious consequences for many patients. Hyperactivity and learning disabilities as well as buccal, gingival and oral cankers have occurred following the use of diagnostic aids. Furthermore, hyperkinetic patients, whose symptoms have been controlled by withdrawal of all artificial colors and flavors from their diets, have suffered relapses following a dental visit. These problems should be recognized by practitioners because only by the concerted efforts of professionals in the field will diagnostic aids free of artificial color and flavor become available."

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  • Feingold, BF. Dietary management of juvenile delinquency. 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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  • Feingold BF., The role of diet in behaviour. 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.

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  • Fitzsimon M, Holborow P, Berry P, Latham S, Salicylate sensitivity in children reported to respond to salicylate exclusion. 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.

    Note: He used only a half a baby aspirin to test them.

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  • Goldenring JR, Batter DK, Shaywitz BA., Sulfanilic acid: behavioral change related to azo food dyes in developing rats. Neurobehavioral Toxicology and Teratology. 1982 Jan-Feb;4(1):43-9.
    " ... sulfanilic acid may be one of the causative agents in food dye-induced behavioral changes in developing rats. ... "

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  • Goyette GH, Connors CK, Petti TA, Curtis LE, Effects of artificial colors on hyperkinetic children: a double-blind challenge study. Psychopharmacol Bull 1978 Apr;14(2):39-40
    "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 ... suggesting that artificial food dyes do indeed impair and disrupt the behavior of the children"

    Note: The "challenge" dose of food dyes is 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" for a smaller child.

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  • Gay et al., Salicylate elimination diets in children: Is food restriction supported by the evidence?
    Gray was treating patients who had previously been on the low-salicylate diet (or FAILSAFE diet) used in Australia, which is far more restrictive than the Feingold diet. He reported adverse effects in almost half the children, including weight loss, failure to thrive, nutritional deficiencies, food aversion, and hair loss. He did not, presumably, ever see those children who had been successfully treated via the FAILSAFE diet, and his conclusions provoked some interesting responses from other researchers (see links below).

    Full Text || Comment by Breakey || Comment by Heller || Comment by Loblay || Response by Gray || TOP


  • Gross MD, Tofanelli RA, Butzirus SM, Snodgrass EW., The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders. J Am Acad Child Adolesc Psychiatry. 1987 Jan;26(1):53-5.
    " Thirty-nine children in a summer camp were given the Feingold Diet... 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 ... 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."

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    Note: This study is Lesson One in How to Do a Really Bad Study


  • Harley et al., Hyperkinesis and food additives: testing the Feingold hypothesis. 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.' "

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    Note: This study was funded by the "Nutrition Foundation," a food additive and chemical industry organization. In this double-blind study, 100% of preschoolers improved on the Feingold diet, according to parents. 63% of the 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."

    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. It was already known that stimulant medications increase the time necessary before an effect of diet is seen.

    Dr. Bernard Weiss, Professor of Toxicology at University of Rochester School of Medicine and Dentistry, analyzed the study. See here.


  • Harper PH, Goyette CH, Conners CK, Nutrient intakes of children on the hyperkinesis diet. J Am Diet Assoc 1978 Nov;73(5):515-9
    "...mean dietary intakes compared favorably with the Recommended Dietary Allowances..."

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  • Hindle RC, Priest J, The management of hyperkinetic children: a trial of dietary therapy. 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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  • Holborow P, Elkins J, Berry P, The effect of the Feingold diet on 'normal' school children. J Learn Disabil March 1981 vol. 14 no. 3 143-147
    "Approximately 300 children in seven primary (elementary) schools used the Feingold diet for two weeks. Ratings were made by teachers before and after use of the diet on questionnaires developed from Conners' long teacher questionnaire. . . Of the total sample, 8.5% improved by five points or more. The mean before diet scores of children who improved were below the cut off value for hyperactivity, indicating hyperactivity itself is not a necessary condition for improvement. Item by item analysis of the response showed that the behavior problems mostly likely to show improvement were distractability, attention span, fiddling, and demands for attention."

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  • Howard et al, ADHD Is Associated With a 'Western' Dietary Pattern in Adolescents. Journal of Attention Disorders 2010 Jul 14. [Epub ahead of print]
    "... The Raine Study is a prospective study following 2,868 live births. At the 14-year follow-up, the authors collected detailed adolescent dietary data . . . Two major dietary patterns were identified: "Western" and "Healthy." A higher score for the "Western" dietary pattern was associated with ADHD diagnosis

    Note: The "Western" diet would be high in fats, which concerned the authors, but it would also be high in food additives.

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  • Husain A et al, Estimates of dietary exposure of children to artificial food colours in Kuwait. Food Additives & Contaminants 2006 Mar;23(3):245-51.
    "...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)..."

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  • Husarova V, & Ostatnikova D. Monosodium glutamate toxic effects and their implications for human intake: A review, JMED Research, Vol. 2013 (2013), doi: 10.5171/2013.60876
    This is a review of the "studies about MSG effects and its potential pathological influence on different systems in humans."

    Effects of injected MSG into rats included neuron damage, and prefrontal cerebral cortex changes, but such tests cannot be done on humans, who are not injected with MSG anyway (except in some vaccines which were not discussed in this article). Rats given MSG mixed with their food, however, also showed degenerative changes and inflammation in various brain areas.

    Mice born to mothers fed MSG had impaired maze learning although no neuronal damage was visible. Also, lower doses given orally to young rats led to learning problems in adulthood, indicating that "early-life MSG exposure could lead to subtle behavioral aberrations in adulthood." More research on doses approximating those used by humans are needed.

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  • Inomata N, Osuna H, Fujita H, Ogawa T, Ikezawa Z., Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl. Allergology International. 2006 Jun;55(2):203-5.
    "We present a 5-year-old girl who suffered from recurrent reactions accompanied by urticaria, angioedema, headaches, dyspnea, loss of consciousness, and abdominal pain that were not eradicated, but were instead exacerbated, by various treatments with antihistamines and intravenous corticosteroids. Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. . . . Open challenge tests with Tartrazine, aspirin and acetaminophen were positive . . . Consequently, intolerance to azo dyes and NSAIDs such as aspirin was diagnosed. However, she appeared to react to multiple chemical odors such as those of cigarette smoke, disinfectant, detergent, cleaning compounds, perfume, and hairdressing, all while avoiding additives and NSAIDs. On the basis of her history and the neuro-ophthalmological abnormalities, a diagnosis of severe MCS was made and she was prescribed multiple vitamins and glutathione.

    CONCLUSIONS:
    The present results suggest that in pediatric MCS, food and drug additives containing azo dyes might play important roles as elicitors."

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  • Kamel MM, El-lethey HS, The Potential Health Hazard of Tartrazine (Yellow 5)and Levels of Hyperactivity, Anxiety-Like Symptoms, Depression and Anti-social behaviour in Rats. (Scroll down to #183), Journal of American Science, 2011;7(6)
    "Tartrazine-treated rats showed hyperactivity in open field test presented by increased horizontal locomotion. . . Furthermore, tartrazine intake significantly promoted depression as expressed by prolonged immobilization during forced swim test. Impairment in social interaction test was also detected . . . This study provides sufficient scientific evidence that a causal link truly exists between tartrazine and inflection of hyperactivity, anxiety and depression-like behaviours in rats and points to the hazardous impact of tartrazine on public health."

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  • Kaplan et al, Overall Nutrient Intake of Preschool Hyperactive and Normal Boys, Journal of Abnormal Child Psychology, April 1989, Vol. 17(2), pp.127-32
    "... 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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  • Kaplan, et al, Dietary Replacement in Preschool-Aged Hyperactive Boys, 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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  • Kiddie JY, Weiss MD, Kitts DD, Levy-Milne R, Wasdell MB., Nutritional status of children with attention deficit hyperactivity disorder: a pilot study. International Journal of Pediatrics, 2010:767318. Epub 2010 Jun 28.
    "Nutritional assessment of 43 children aged 6-12 with ADHD was performed using a 3-day food record, 24-hour recall, and serum assessors. Results. Macronutrient intake and consumption of Low-Nutrient Foods were comparable to population norms; however, 66% were found to be deficient in zinc and 23% in copper... the food intake and nutrient status of children with ADHD and shows a predisposition for low zinc and copper status in ADHD. "

    Note: This means they are deficient in spite of adequate intake - not surprising in light of Ward's finding that kids with ADHD lose zinc when they eat things with Yellow 5 or 6.

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  • Lafferman JA, Silbergeld EK, Erythrosin B inhibits dopamine transport in rat caudate synaptosomes. Science. 1979 Jul 27;205(4404):410-2.
    " . . . We found that erythrosin B [Red 3] 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 [ADHD] behavior."

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  • Lau K, McLean WG, Williams DP, Howard CV., Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test. 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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  • Levy F et al, Hyperkinesis and diet: A double-blind crossover trial with a tartrazine challenge. 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."

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    NOTE: Tests were conducted the day AFTER challenge, and results of all children were averaged which may make any individual reactions invisible. 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!

    See also the Full Text of a second similar study by Levy, using only 8 children (the one who reacted strongly to the challenge was dropped from the study). In spite of again using only ONE mg Tartrazine per biscuit for the challenge, the results "just missed" significance statistically.

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  • Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E. Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. 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, such as a combination of synthetic coloring, flavoring, and sodium benzoate.

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    .
  • Biosocial bases of aggressive and violent behavior implications for nursing studies , Liu J; Wuerker A, Int J Nurs Stud, 2005 Feb;42(2):229-41
    " Although aggression and violence have been increasingly viewed as a major public health problem with a biological and health basis, it has been under-researched in the nursing and health context. This paper reviews early biological risk factors for violence. These factors include pregnancy/birth complications, fetal exposure to nicotine, alcohol, and drugs, low cholesterol, malnutrition, lead and manganese exposure, head injuries and brain dysfunction, low arousal, low serotonin, low cortisol, and high testosterone. A biopsychosocial violence mode is proposed. Finally, the paper argues that nursing is ideally placed to develop a new body of knowledge based on a biosocial perspective that can lead to more effective prevention programs for violence. "

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  • Malakar, S & Bhattacharya, S. (2014). Minding the greens: Role of dietary salicylates in common behavioural health conditions. Acta Alimentaria, 43(2), 344-359.
    "The role of artificial food additives and food chemicals in abetting certain behavioural conditions has been the subject of behavioural nutrition research over several decades. However, a few studies have also raised questions regarding a similar role possibly played by naturally occurring phytochemicals in general and salicylates in particular. ... The gap in the extant literature is even more prominent for salicylates present naturally in a number of fruits, vegetables, and plant-sourced food items the common core ingredients of what one would likely consider to be a healthy diet. Given that it is now well-known that autistic patients tend to be PST-deficient, causal link between a low-salicylate diet and the mitigation of symptom- severity seems a rather plausible hypothesis. However, while the literature is replete with dietary intervention studies that look at artificial food additives, peer-reviewed studies focusing exclusively on the role of a diet low in salicylates in general and natural salicylates in particular in treating autism spectrum disorders are conspicuously absent.

    ... It is quite apparent from the above discussions that Feingold hypothesis is still the central theoretical edifice when it comes to explaining the possible role of salicylates in several behavioural disorders.

    ... However, studies that have specifically tried to isolate the effect of salicylates (which is only one of the several elimination items in a typical Feingold diet) are few, and in those the effect of naturally occurring salicylates in common food items has not been studied. "

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  • Mattes JA, Gittelman R., Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study., Archives of General Psychiatry. 1981 Jun;38(6):714-8
    "Evaluations by parents, teachers, and psychiatrists and psychological testing yielded no evidence of a food coloring effect."

    MedLine || Full Text || Get Password || See review by Bernard Rimland, PhD

    Notes:

    1. They claimed to use a "high dose" of coloring, but it did not even change the color of the cookies from identical cookies without coloring.
    2. According to parents involved in the study, some children could not eat all the large cookies, so they did not receive even that small dose of coloring.
    3. 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.
    4. 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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  • Mattes JA, The Feingold diet: a current reappraisal. Journal of Learning Disabilities, 1983 Jun-Jul;16(6):319-23.
    "A review of all published, completed controlled studies, however, indicates that the Feingold diet is probably not effective, except perhaps in a very small percentage of children. The positive results in a few studies have been inconsistent between studies and greatly outnumbered by negative results. Even among children whose parents feel the diet has helped them greatly, the improvement seems more often a placebo effect, e.g., due to the increased attention the child is receiving, than a true effect of artificial colorings or flavorings."

    Note: This is the source of the often-heard mantra of "anecdotal evidence," "weight of the evidence," and "increased attention" ... These statements were not actually true at that time - but even had they been true, they were made back in 1983, and much double-blind ("gold standard") research has been done since then.

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  • McCann et al., Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial Lancet, 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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  • Menzies IC, Disturbed children: the role of food and chemical sensitivities. Nutr Health. 1984; 3(1-2): 39-54.
    " . . . the difficulties encountered by a significant number of these children have much to do with idiosyncratic responses to foods and additives. . . . 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. "

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  • Millichap JG & Yee MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics, 2012 Feb;129(2):330-7. doi: 10.1542/peds.2011-2199.
    " This article is intended to provide a comprehensive overview of the role of dietary methods for treatment of children with attention-deficit/hyperactivity disorder (ADHD) when pharmacotherapy has proven unsatisfactory or unacceptable. Results of recent research and controlled studies, based on a PubMed search, are emphasized and compared with earlier reports... In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients. ... "

    Note: He left out most of the studies on diet and behavior done over the past 20 years, in spite of his promise in his abstract (above) - but he had no problem claiming it would cause "household disruption" in spite of not one single study ever done on that.

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  • Niederhofer H, Pittschieler K., A preliminary investigation of ADHD symptoms in persons with celiac disease., Journal of Attention Disorders, 2006 Nov;10(2):200-4.
    "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:

    1. A gluten-free diet would eliminate many processed foods, thereby automatically reducing the ingestion of additives.
    2. 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 important to keep in mind.

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  • No Author Listed, Artificial food colouring and hyperactivity symptoms in children., Prescrire International, 2009 Oct;18(103):215.
    "A meta-analysis of 15 double-blind clinical trials that evaluated artificial food colouring in children already considered to be hyperactive showed an increase in their hyperactive behavior; In practice, even though the mechanism underlying this phenomenon has not been elucidated, these data suggest that it is best to avoid exposing children to artificial food coloring."
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  • Novembre et al., Unusual reactions to food additives, 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 [Yellow 5] 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."

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  • Pelsser et al., Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial., Lancet. 2011 Feb 5;377(9764):494-503.
    "A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food."

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    Several letters to the editor of Lancet, and author's reply
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  • Pelsser et al., Effects of food on physical and sleep complaints in children with ADHD: a randomised controlled pilot study., European Journal of Pediatrics, 2010 Apr 17.
    "The number of physical and sleep complaints was significantly decreased in the diet group compared to the control group . . . [also] headaches or bellyaches, unusual thirst or unusual perspiration, and sleep complaints. . . An elimination diet may be an effective instrument to reduce physical complaints in children with ADHD"

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  • Pelsser et al., A randomised controlled trial into the effects of food on ADHD. European Child & Adolescent Psychiatry. 2009 Jan;18(1):12-9.

    " . . the number of clinical responders in the intervention group was significantly larger than that in the control group [parent ratings 73% vs 0%; teacher ratings, 70% vs 0%]. . . symptoms of oppositional defiant disorder also showed a significantly greater decrease in the intervention group than it did in the control group . . ."

    Note: 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 usual Feingold diet.

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  • Pelsser LM, Buitelaar JK, Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study Ned Tijdschr Geneeskd 2002 Dec 28;146(52):2543-7
    " .. 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, even though two weeks is a very short trial for any diet.

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  • Pollock I, Warner JO, Effect of artificial food colours on childhood behaviour., 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... A pharmacological mechanism of food additive intolerance is proposed to explain these effects."

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  • Reyes FG, Valim MF, Vercesi AE. Effect of organic synthetic food colours on mitochondrial respiration. 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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  • Rippere V, Food additives and hyperactive children: a critique of Conners. 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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  • Rose TL, The functional relationship between artificial food colors and hyperactivity.    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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  • Rowe, KS, Synthetic Food Colourings and "Hyperactivity": a Double-Blind Crossover Study, 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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  • Rowe, KS & Rowe, KJ. Synthetic Food Coloring and Behavior:  A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study, 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 single-item challenge of tartrazine (Yellow #5). Rowe reported that a dose response effect was observed.

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  • Salamy J, et al., Physiological changes in hyperactive children following the ingestion of food additives. 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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  • Salzman LK, Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome. 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 (93%) 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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  • Sarantinos J, Rowe KS, Briggs DR, Synthetic Food Colouring and Behavioural Change in Children with Attention Deficit Disorder: A Double-Blind, Placebo Controlled, Repeated Measures Study. Proc. Nutr. Aust. 1990 pg. 233.
    "As part of their overall management, a diet excluding synthetic food colourings may be of benefit in modifying the behaviour of a small number of children with attention deficit disorder."

    Note: They used 10 mg Yellow 5 or Yellow 6. No matter how beautifully designed the study, when you use only a tiny amount of food dye as your "challenge" you won't get dramatic results.

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  • Schab DW, Trinh NH, Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. 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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  • Schmidt MH, et al., Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial. , 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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  • Schoenthaler, Moody, & Pankow, Applied Nutrition and Behavior, 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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  • Schoenthaler SJ, Doraz WE, Wakefield JA, The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools, Int J Biosocial Res., 1986, 8(2); 185-195.

    " 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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  • Shaywitz BA, Goldenring JR, Wool RS. Effects of chronic administration of food colorings on activity levels and cognitive performance in developing rat pups treated with 6-hydroxydopamine. Neurobehav Toxicol. , 1979 Spring;1(1):41-7.
    " ... At every age the highest dose of food dye (2.0 mg/kg) produced the greatest activity. This dose also resulted in significant effects on habituation of activity. Pups who did not receive food dye decreased their activity by 32.1% over the first 30 minutes of observation while in groups who received 2.0 mg/kg of food dye a reduction in activity of only 7.25% was noted over the same time period. ..."

    Note: 2.0 mg/kg is about the same as 60 mg food dye for a 30 kg child - about as much as in a single frosted cupcake.

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  • Sonuga-Barke et al., Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments, American Journal of Psychiatry, 2013 Mar;170(3):275-89. doi: 10.1176/appi.ajp.2012.12070991.
    "Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities."

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  • Spring C, Sandoval J, Food Additives and Hyperkinesia A Critical Evaluation of the Evidence. Journal of Learning Disabilities, November 1976 vol.9 no.9 p.560-569
    " ... A moratorium on further public advocacy is recommended until the efficacy of the diet for a defined population is firmly established by controlled research. "

    Note: This means that they wanted Dr. Feingold (and the parents) to shut up. Note the date: 1976. It is interesting that quite a few publications more than 10 years later are still citing this article as though it would be relevant, in spite of all the research done since that time.

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  • Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE., Dietary sensitivities and ADHD symptoms: thirty-five years of research., Clin Pediatr (Phila). 2011 Apr;50(4):279-93. Epub 2010 Dec 2.

    " . . .Of children with suspected sensitivities, 65% to 89% reacted when challenged with at least 100 mg of AFC. . . . A trial elimination diet is appropriate for children who have not responded satisfactorily to conventional treatment or whose parents wish to pursue a dietary investigation. "

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  • Stevens LJ, et al. Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children. Nutrition Review, 2013 May;71(5):268-81. doi: 10.1111/nure.12023
    " This review examines the research on mechanisms by which artificial food colors (AFCs) and common foods may cause behavioral changes in children with and without attention-deficit/hyperactivity disorder (ADHD). . . Studies have shown that a subgroup of children (with or without ADHD) react adversely to challenges with AFCs. . . Three types of potential mechanisms are explored: toxicological, antinutritional, and hypersensitivity. Suggestions for future studies in animals and/or children include dose studies as well as studies to determine the effects of AFCs on the immune system, the intestinal mucosa, and nutrient absorption. Given the potential negative behavioral effects of AFCs, it is important to determine why some children may be more sensitive to AFCs than others and to identify the tolerable upper limits of exposure for children in general and for children at high risk. "

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  • Stevens, L.J. et al., Amounts of artificial food colors in commonly consumed beverages and potential behavioral implications for consumption in children, Clinical Pediatrics, 2014 Feb;53(2):133-40. doi: 10.1177/0009922813502849.
    " Artificial food colors (AFCs) are widely used to color foods and beverages. The amount of AFCs the Food and Drug Administration has certified over the years has increased more than 5-fold since 1950 (12 mg/capita/day) to 2012 (68 mg/capita/day). In the past 38 years, there have been studies of adverse behavioral reactions such as hyperactivity in children to double-blind challenges with AFCs. Studies that used 50 mg or more of AFCs as the challenge showed a greater negative effect on more children than those which used less. The study reported here is the first to quantify the amounts of AFCs in foods (specifically in beverages) commonly consumed by children in the United States. ... "

    Winners in each category with the most dye in a single cup (8 ounces or 240 ml) were:

    • 34 mg - Faygo Redpop (a carbonated beverage)
    • 52.3 mg - Kool-Aid Burst Cherry (a fruit-flavored beverage)
    • 22.1 (Powerade Orange (a sports beverage)
    • 18.8 mg (Full Throttle Red Berry (an energy drink)

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  • Stevens, L.J. et al., Amounts of artificial food dyes and added sugars in foods and sweets commonly consumed by children, Clinical Pediatrics, 2014 Apr 24, 1-13.
    "Artificial food colors (AFCs) are used to color many beverages, foods, and sweets in the United States and throughout the world. ... Amounts of AFCs reported here along with the beverage data show that many children could be consuming far more dyes than previously thought. "

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  • Stevenson et al, The Role of Histamine Degradation Gene Polymorphisms in Moderating the Effects of Food Additives on Children's ADHD Symptoms., American Journal of Psychiatry. 2010 Jun 15.

    " Histamine may mediate the effects of food additives on ADHD symptoms, and variations in genes influencing the action of histamine may explain the inconsistency between previous studies. Genes influencing a range of neurotransmitter systems and their interplay with environmental factors, such as diet, need to be examined to understand genetic influences on ADHD symptoms."

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  • Stevenson et al, Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies. Journal of Child Psychology & Psychiatry, 2014 May;55(5):416-27. doi: 10.1111/jcpp.12215
    "The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). . . The aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed. ... The methodology of many of the trials on which the meta-analyses are based is weak. Nevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements. "

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  • Swanson J & Kinsbourne M, Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test, 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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  • Tomova et al., Gastrointestinal microbiota in children with autism in Slovakia. Physiology & Behavior 2015 Jan;138:179-87. doi: 10.1016/j.physbeh.2014.10.033
    " Development of Autism Spectrum Disorders (ASD), including autism, is based on a combination of genetic predisposition and environmental factors. ... The fecal microflora of 10 children with autism, 9 siblings and 10 healthy children was investigated by real-time PCR. The fecal microbiota of autistic children showed a significant decrease of the Bacteroidetes/Firmicutes ratio and elevation of the amount of Lactobacillus spp. ... The participants in our study demonstrated strong positive correlation of autism severity with the severity of GI dysfunction. Probiotic diet supplementation normalized the Bacteroidetes/Firmicutes ratio, Desulfovibrio spp. and the amount of Bifidobacterium spp. in feces of autistic children. ... This pilot study suggests the role of gut microbiota in autism as a part of the "gut-brain" axis and it is a basis for further investigation ..."

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  • Uhlig T, Merkenschlager A, Brandmaier R, & Egger J, Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder. European Journal of Pediatrics 1997 Jul;156(7):557-61
    "... 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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  • Verlaet AAJ, Noriega DB, Hermans N, & Savelkoul HFJ. Nutrition, immunological mechanisms and dietary immunomodulation in ADHD. European Child & Adolescent Psychiatry, 2014 Jul;23(7):519-29. doi: 10.1007/s00787-014-0522-2
    " Attention-deficit hyperactivity disorder (ADHD) etiology is not completely understood, but common comorbid dysfunction of the gastrointestinal and immune system suggests that these systems may be affected by a common genetic background and molecular mechanisms. For example, increased levels of specific cytokines were observed in ADHD. Moreover, ADHD has a high comorbidity with both Th1- and Th2-mediated disorders like ear infections, eczema and asthma. A common pathophysiological mechanism was suggested to underlie both asthma and ADHD, while several genes that are linked to ADHD have immune functions.

    Furthermore, immunological recognition of food provoking ADHD-like behavior was suggested. An immune imbalance, probably requiring a predisposing genetic background, is therefore suggested to contribute to ADHD etiology, with immune dysregulation being more likely than a single subcellular defect. However, next to allergic mechanisms, also pharmacological mechanisms (especially in case of food additives) might be involved. . . . As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation. If immune pathways contribute to ADHD, both its diagnosis and treatment should be reconsidered. Modulation of immune system activity might have potential in ADHD treatment, for example by nutritional approaches providing safe and low-cost ADHD therapy, but further research in these fields is implicated. "

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  • Vojdani & Vojdani, Immune reactivity to food coloring. Alternative Therapies in Health and Medicine, 2015;21 Suppl 1:52-62
    "Artificial food dyes are made from petroleum and have been approved by the US Food and Drug Administration (FDA) for the enhancement of the color of processed foods. .... However, since the use of artificial food coloring has become widespread, many allergic and other immune reactive disorders have increasingly been reported. During the past 50 y, the amount of synthetic dye used in foods has increased by 500%. Simultaneously, an alarming rise has occurred in behavioral problems in children, such as aggression, attention deficit disorder (ADD), and attention-deficit/hyperactivity disorder (ADHD). The ingestion of food delivers the greatest foreign antigenic load that challenges the immune system. Artificial colors can also be absorbed via the skin through cosmetic and pharmaceutical products. The molecules of synthetic colorants are small, and the immune system finds it difficult to defend the body against them. They can also bond to food or body proteins and, thus, are able to act in stealth mode to circumvent and disrupt the immune system. The consumption of synthetic food colors, and their ability to bind with body proteins, can have significant immunological consequences. This consumption can activate the inflammatory cascade, can result in the induction of intestinal permeability to large antigenic molecules, and could lead to cross-reactivities, autoimmunities, and even neurobehavioral disorders. The Centers for Disease Control (CDC) recently found a 41% increase in diagnoses of ADHD in boys of high-school age during the past decade. More shocking is the legal amount of artificial colorants allowed by the FDA in the foods, drugs, and cosmetics that we consume and use every day. The consuming public is largely unaware of the perilous truth behind the deceptive allure of artificial color. "

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  • Ward NI; Soulsbury KA; Zettel VH; Colquhoun ID; Bunday S; Barnes B, The influence of the chemical additive tartrazine on the zinc status of hyperactive children: A double-blind placebo-controlled study. 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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    Note: When we calculated the amount of food dye used, it was only a HALF a mg !! And yet there were measurable results!


  • Ward NI, Assessment of chemical factors in relation to child hyperactivity. 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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  • Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, Cox C, McKibben J, Ogar D, Schultz S., Behavioral responses to artificial food colors. Science 1980 Mar 28;207(4438):1487-9
    " 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."

    Note:

    • The children were not diagnosed as hyperkinetic (hyperactive).
    • Not all parents restricted the fruits and vegetables Dr. Weiss requested that they avoid.
    • 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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  • Weiss, B. Synthetic Food Colors and Neurobehavioral Hazards: The View from Environmental Health Research.
    Dr. Weiss examines " the basis of the FDA's position, the elements of the review that led to its decision and that of the Food Advisory Committee, and the reasons that this is an environmental health issue

    DISCUSSION: The FDA review confined itself, in essence, to the clinical diagnosis of hyperactivity, as did the charge to the committee, rather than asking the broader environmental question of behavioral effects in the general population; it failed to recognize the significance of vulnerable subpopulations; and it misinterpreted the meaning of effect size as a criterion of risk. The FDA's response would have benefited from adopting the viewpoints and perspectives common to environmental health research. At the same time, the food color debate offers a lesson to environmental health researchers; namely, too narrow a focus on a single outcome or criterion can be misleading."

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  • Whiteley et al., Gluten- and casein-free dietary intervention for autism spectrum conditions, Frontiers in Human Neuroscience, 2013 Jan 4;6:344. doi: 10.3389/fnhum.2012.00344. eCollection 201
    " ... We examine evidence suggestive that a gluten-free (GF), casein-free (CF), or gluten- and casein-free diet (GFCF) can ameliorate core and peripheral symptoms and improve developmental outcome in some cases of autism spectrum conditions. Although not wholly affirmative, the majority of published studies indicate statistically significant positive changes to symptom presentation following dietary intervention. In particular, changes to areas of communication, attention, and hyperactivity are detailed, despite the presence of various methodological shortcomings. ... the appearance of a possible diet-related autism phenotype seems to be emerging supportive of a positive dietary effect in some cases. Further debate on whether such dietary intervention should form part of best practice guidelines for autism spectrum conditions (ASCs) and onward representative of an autism dietary-sensitive enteropathy is warranted. "

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  • Williams JI, Cram DM, Tausig FT, Webster E., Relative effects of drugs and diet on hyperactive behaviors: an experimental study. 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 . . ."

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