ADHD and Diet

(Letter to ‘The Schafer Report’
in response to ‘Ivanhoe Broadcast News Transcript with Thomas Spencer, M.D., Child Psychiatrist,
Massachusetts General Hospital, Boston, Massachusetts

The transcript included:
Question: ‘Does a child's diet have anything to do with ADHD?
Dr. Spencer: Your question about diet was actually formally studied. Everybody had the impression that diet was closely related. If diet was to be a cause of the problem, then if you changed diet, then people would get better, and it hasn’t been shown to be  true. Kids with ADHD tend to crave junk food and sugar. They eat poorly. If you eat a lot of sugar, you’re a little more hyper, but even if you exclude sugar and all these additives and eat a very bland, difficult-to-enforce diet, you don’t improve that much. That was actually tested. There were lots of double-blind controlled studies of that. The American Academy of Pediatrics wrote a position statement saying that there may be a few sensitive individuals, but by and large, diet isn’t a good treatment for ADHD, and it's not usually part of the cause.’
Food dyes impair performance of hyperactive children on a laboratory learning test.
‘Forty children were given a diet free of artificial food dyes and other additives for 5 days. Twenty of the children had been classified as hyperactive by scores on the Conners Rating Scale and were reported to have favorable responses to stimulant medication. A diagnosis of hyperactivity had been rejected in the other 20 children. Oral challenges with large doses (100 or 150 milligrams) of a blend of FD & C approved food dyes or placebo were administered on days 4 and 5 of the experiment. 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 nonhyperactive group was not affected by the challenge with the food dye blend.’
 [Swanson J.M., Kinsbourne M., Science. 1980 Mar 28;207(4438):1485-7]
Synthetic food colourings and 'hyperactivity': a double-blind crossover study.
‘Of 220 children referred for suspected 'hyperactivity', 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3-6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double-blind crossover study, employing a single-subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead-in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with 'hyperactivity' based on 'attention deficit disorder' may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.’
[Rowe KS. Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia. Aust Paediatr J. 1988 Apr;24(2):143-7]
Synthetic food colouring and behaviour: a dose response effect in a double-blind, placebo-controlled, repeated-measures study.
‘Sensitivity to food colors and flavors:
This study demonstrated a functional relation between the ingestion of a synthetic food color (tartrazine) and behavioral change in 24 atopic (allergic) children, with marked reactions being observed at all six dosage levels of dye challenge. When they reacted to the (food) dye, the younger children had constant crying, tantrums, irritability, restlessness, severe sleep disturbance, and were described as 'out-of-control, easily distracted and excited, and high as a kite.’
[Rowe, K.S. and Rowe K.L. (1994) Journal of Pediatrics (125),691-8]
Oligo-antigenic diet treatment of children with epilepsy and migraine
’We studied the role of oligo-antigenic diets in 63 children with epilepsy; 45 children had epilepsy with migraine, hyperkinetic behavior, or both, and 18 had epilepsy alone. Of the 45 children who had epilepsy with recurrent headaches, abdominal symptoms, or hyperkinetic behavior, 25 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. Foods provoking symptoms were identified by systematic reintroduction of foods, one by one; symptoms recurred with 42 foods, and seizures recurred with 31; most children reacted to several foods. Of 24 children with generalized epilepsy, 18 recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 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.’
[J Pediatr. 1990 Sep;117(3):509-10.. Egger J, Carter CM, Soothill JF, Wilson J. Department of Neurology, Hospital for Sick Children, London.]
The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders
‘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.’
[C. Peter, W. Bennett ; Jonathan Brostoff ; Journal of Nutritional & Environmental Medicine 7:4:359 – 366]
Can treating food allergies prevent antisocial behavior?
‘Poor health and nutritional problems are common among young criminals. New research indicates that the link is more than coincidental, and that treating health and diet problems may be one key to preventing behavioral problems and even criminality.
‘Sick’ offenders
Several years ago, C. Peter Bennett and Jonathan Brostoff surveyed 100 young offenders and 100 matched non-offenders, and found that ‘the offender group reported significantly higher rates of ill health than the non-offender group.’ For instance, offenders were far more likely than controls to report stomach-aches, lethargy, eye and nose problems, poor sleep, abnormal thirst, poor concentration, and poor memory, and to be hyperactive. Noting that many symptoms exhibited by the offenders could be linked to food allergies or food intolerance, Bennett et al. recently tested the effects of nutritional interventions on young criminals. Their research involved nine children, between the ages of 7 and 16, with histories of ‘persistent anti-social, disruptive and/or criminal behaviors.’ Bennett et al. say their nine subjects had collectively committed 67 crimes, and note that ‘all the subjects regularly displayed irrational aggression and violence.’
  Physicians identified nutrient deficiencies and food allergies in all nine of the subjects, and elevated levels of cadmium - a neuro-toxic heavy metal - in four. The researchers provided treatment for all subjects, including dietary restriction and allergy desensitization therapy.
  Videos shot by an independent BBC film crew before the intervention, the researchers say, ‘showed uncontrolled, violent, competitive and anti-social behavior.’ Afterward, in contrast, participants were ‘controlled, cooperative and sociable.’
  Bennett et al. say that the health and behavior of all nine subjects improved during treatment. Three children later discontinued the dietary intervention, and two re-offended. Of the six other subjects, two re-offended, ‘but with much reduced frequency and violence than before the project.’ In all, of nine subjects, five did not re-offend during the two years following the intervention.
  The researchers conclude that dietary intervention ‘appears to work within an ethical, efficient, effective, economical and preventive paradigm without harm.’
Color me hyper
Research by Neil Ward links hyperactivity - a strong risk factor for criminality - to nutritional deficiencies and food intolerance. Ward surveyed the parents of 486 hyperactive children and 172 non-hyperactive controls. The parents of the hyperactive children reported that more than 60% exhibited increased behavior problems when exposed to synthetic colorings and flavorings, preservatives, cow's milk, and certain chemicals. In contrast only 12% of parents of the controls reported a connection between food additives or colorings and worsened behavior.
Ward identified a subgroup of hyperactive children with known sensitivities to synthetic food colors, and exposed the children to these chemicals. Of 23 exposed to the food coloring tartrazine, 18 responded by becoming overactive, 16 became aggressive, 4 became violent, and several developed eczema, asthma, poor speech, or poor coordination. In contrast, only one control subject showed minor behavioral changes after drinking tartrazine. Two other colorings, ‘sunset yellow’ and amaranth, also caused significant behavioral effects in hyperactive subjects.
Ward uncovered one possible explanation for the food colorings’ effects. The hyperactive children in the study had statistically lower zinc and iron levels than controls - and when hyperactive children known to be sensitive to the colorings tartrazine and ‘sunset yellow’ were exposed to these chemicals, their blood serum zinc levels dropped markedly. ‘Several studies,’ Ward notes, ‘have shown that zinc-deficient animals are more prone to stress and are aggressive when compared with normal cases.’ Previous research also has strongly linked tartrazine to hyperactivity.
(see related article, Crime Times, 1995, Vol. 1, No. 3, Page 5).
Dr. Christie C. Yerby, Doctor of Naturopathic Medicine writes in her article ‘To Die For’: ‘It is amazing the amount of toxins that are in some nutritional supplements these days. Perhaps it was by the example of the food industry that originally sanctioned it as being OK, that other industries feel that they can follow. Now, even some of our nutritional supplements, the sacred resource we have trusted as being “good for us”, is causing concern. What we eat as food, swallow as supplement and drug pill coatings or medicinal syrups, or rub on ourselves as cosmetics often contain toxic coal-tar based dyes. According to several resources on the subject, four of these dyes, Red 3, Yellow 5, Yellow 6, and Blue 2 have been shown to cause cancer, as have other dyes which are not used in food, but are used in drugs or cosmetics. Fortunately, the history of food dyes in the U.S. is one of “decreasing” rather than “increasing.” Of the 24 food dyes previously allowed in the American food supply, 17 are now banned, de-listed, or no longer produced. We are, however, still waiting for the other seven to be removed from consumer products by the FDA. Until then, we continue to consume them. Toxicity of three dyes (Red 3, Yellow 5, and Yellow 6) is the subject of a Public Citizen Health Research Group petition to the FDA, calling for a ban. The group is now also reviewing the safety studies on the other four dyes (Green 3, Red 40, Blue 1, and Blue 2), because of previous toxic findings. FD and C Blue No. 2 was shown to produce malignant tumors at the site of injection when introduced under the skin of rats. The World Health Organization gives it a toxicology rating of B, meaning that data was not sufficient to make it acceptable for food use. FD and C Yellow No. 6 is used in food, alcohol, supplements, cosmetics, and hair rinses. In 1986, the FDA passed a ruling that it had to be listed on the labels because of its ability to cause allergic reactions. Don’t be fooled, though. Check your one-a-day “A to Zs” and you will note that the dyes are listed only on the throw-away box, and not on the inside bottle itself. Tests conducted on FD and C Red No. 40 were all conducted by its manufacturer, (name withheld). Consequently, many American scientists feel that the safety of Red No. 40 is far from established. The National Cancer Institute reported that p-cresidine, a chemical used in preparation of Red. No. 40, was carcinogenic in animals. In rats, a high dose caused adverse reproductive effects. Aspirin-sensitive patients have been reported to develop life-threatening asthmatic symptoms when ingesting Yellow No. 5. By law, it too is supposed to be on the label when added to a product. But, again, many products do not reflect these additives if the lists of ingredients are not labeled directly on the bottle itself. Watch for this. Of particular interest, these toxic dyes are not only being read from the labels of junk foods, candies, and fertilizers, they are coming right off the outside boxes of a popular multivitamin for kids. Oh, and one more interesting thing, it adds near the bottom: “Keep out of reach of children.”’
New England Journal of Medicine October 5, 2000; 343; 1047-1048:
‘A common blue food dye seems to have caused the deaths of 2 patients after it was used to color the liquid food pumped into their stomachs, according to a new report in the New England Journal of Medicine. The patients had been given food with FD&C blue dye No. 1, after which their skin and blood turned a bluish-green. Several hours later the patients, a 12 month old with Down's Syndrome and a 54 year old with kidney failure, were dead. The blue dye, made of coal tar, is routinely added to the liquid food to help doctors see whether any of the food is escaping from the stomach. In healthy people, the food and the dye are not thought to leave the digestive tract.  The three cases involved patients who had digestive track tissues being destroyed by sepsis, a serious infectious condition. The condition apparently allowed the dye to enter the bloodstream, causing a deadly drop in blood pressure (hypotension) and an increase in acid levels in the body's fluids and tissues (acidosis). According to the researchers: “During sepsis, gastrointestinal permeability increases because of enterocyte death and loss of barrier function at intercellular gaps. Thus, substances that are otherwise nonabsorbable may be absorbed during sepsis.”
  The researchers note that Blue dye #1 was approved by the FDA in 1982 after experiments in healthy animals indicated that the dye was nontoxic and not absorbed. Concerning the potential health dangers of the dye, the authors state:
  “Blue dye no. 1, a triphenylmethane dye, is a potent inhibitor of mitochondrial respiration in vitro and reduces oxygen consumption by a factor of eight in mitochondrial preparations in vitro. It appears to inhibit energy transformation by blocking the adenine nucleotide translocator (as is the case with atractyloside).”
  The researchers note that although both patients were hospitalized with serious illnesses, their condition was improving before they received the dye. Although researchers say the dye is not dangerous to the vast majority of people, they are recommending “judicious use” in patients with possible increased gastrointestinal permeability.’
Lost study links food additives to tantrums.
By Robert Uhlig Food Correspondent (Filed: 25/10/2002):
‘Lost study links food additives to tantrums: Parents were left confused last night after a Government-sponsored study appeared to show that food colourings and additives used in some 200 popular foods caused temper tantrums and hyperactivity up to a quarter of young children. The study, commissioned three years ago by the former Ministry of Agriculture and completed last year, was discovered by food campaigners in the library of the Food Standards Agency. It appeared to be the first time that a Government-sponsored study had corroborated anecdotal evidence of a link between food additivies and changes in children’s mood and behaviour. The Food Standards Agency said the study was “in line with previous reports by other organisations” but had been dismissed by experts on its scientific and medical panel as “scientifically inconclusive”. Having been rejected by several peer-reviewed journals, the report by scientists at the Asthma and Allergy Research Centre lacks the science world's stamp of approval.
  Nevertheless the Food Commission, which unearthed the study, said parents should take close notice because the study concluded that “significant changes in children's hyperactive behaviour could be produced by the removal of colourings and additives from their diet”.
The food additives were tested on 277 three-year-olds from the Isle of Wight using scientifically valid double blind tests. However, the research was deemed by the Food Standards Agency not to be scientifically objective because it relied on parents recording significant changes in their children's behaviour. The artificial food colourings Tartrazine (E102), Sunset Yellow (E110), Carmoisine (E122), and Ponceau 4R (E124) and the preservative Sodium Benzoate (E211) were given in a single drink. The test dose of colourings in the trial was well below levels permitted in children's foods and drinks. For the preservative, the test dose was equal to the permitted level. Parents described behaviour such as “interrupting”, “fiddling with objects”, “disturbing others”, “difficulty settling down to sleep”, “no concentration” and “temper tantrums”.
  Following the study, the Food Commission found more than 200 children's foods and drinks containing one or more of the additives. The products included well-known fizzy drinks, sweets, canned vegetables, cakes, biscuits, puddings, sauces, crisps and ice lollies.
Annie Seeley, a nutritionist at the Food Commission, said nearly 40 per cent of children’s food and drinks contained additives. Kath Dalmeny, research officer at the commission, which publishes the findings in Food Magazine today, said it was “concerned to find it has been rejected by several peer-reviewed journals”. She said: “Any study involving children often relies on parental observation. Taking children out of their home environment or having them observed by strangers can itself affect the results.” Dr Hasan Arshad, director of the David Hide Asthma and Allergy Research Centre, which undertook the study, defended its findings. He said it provided the first results from a large-scale trial.’

References and other relevant literature:
The Shipley Project: treating food allergy to prevent criminal behaviour in community settings; C. Peter, W. Bennett et al; Journal of Nutritional and Environmental Medicine, Vol. 8, 1998, pp. 77-83.
The health of criminals related to behaviour, food, allergy and nutrition: a controlled study of 100 persistent young offenders; C. Peter, W. Bennett and Jonathan Brostoff;, Journal of Nutritional and Environmental Medicine, Vol. 7, 1997, pp. 359- 366.

Assessment of chemical factors in relation to child hyperactivity; Neil Ward, Journal of Nutritional and Environmental Medicine, Vol. 7, 1997, pp. 333-342.
The Failsafe Cookbook: reducing food chemicals for calm and happy families, Random House, 2001
Fed Up: understanding how food affects your child and what you can do about it, Random House, 1998
Different Kids: growing up with ADD, Random House, 1994
Fed Up with Asthma: how food affects asthma and what you can do about it; Random House, 2003
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Dengate S, Restless babies. Nursing Mothers Association of Australia Newsletter, 2001;37(1); 4-6.
Dengate S and Ruben A, Controlled trial of cumulative behavioural effects of a common bread preservative. J Paed Child Health, in press.
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www.mcspotlight.org, about McDonalds
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