Dietary sensitivities and ADHD symptoms: thirty-five years of research

Stevens LJ, Kuczek T, Burgess JR, Hurt E, L Arnold, LE (2011) Clin Pediatr (Phila). 50(4) 279-93. doi: 10.1177/0009922810384728. Epub 2010 Dec 2.

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Abstract:

Artificial food colors (AFCs) have not been established as the main cause of attention-deficit hyperactivity disorder (ADHD), but accumulated evidence suggests that a subgroup shows significant symptom improvement when consuming an AFC-free diet and reacts with ADHD-type symptoms on challenge with AFCs.

Of children with suspected sensitivities, 65% to 89% reacted when challenged with at least 100 mg of AFC.

Oligoantigenic diet studies suggested that some children in addition to being sensitive to AFCs are also sensitive to common nonsalicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes) as well as salicylate-containing grapes, tomatoes, and orange.

Some studies found "cosensitivity" to be more the rule than the exception.

Recently, 2 large studies demonstrated behavioral sensitivity to AFCs and benzoate in children both with and without ADHD.

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.

FAB RESEARCH COMMENT:

As this review shows, substantial evidence from controlled trials clearly shows that many children with ADHD or related behavioural conditions show adverse behavioural reactions to some common foods and food additives.

This evidence has now been accumulating for over 30 years - and provides a sound rationale for all health professionals involved in the care of children with ADHD to at least consider the possibility that dietary interventions could help in the management of some behaviour and learning difficulties.

Instead, many parents and carers - even if they themselves suspect that food intolerances may be contributing to their child's problems - are nonetheless still told that 'there's no evidence' that diet has any impact on ADHD-type symptoms.

This is simply not true, as this review makes clear.

However, better education and training of both professionals and polcymakers on the potential impact of nutrition and diet on behaviour is still urgently needed to improve clinical and educational practice in this area.

For all children, avoiding artificial food colourings (AFC) as far as possible is a sensible strategy, as controlled trials have shown these to have adverse behavioural effects not only for children with ADHD and related behaviour problems, but also in children from general population samples. What's more, these and other artifical additives are only found in ultra-processed foods and drinks, and excluding these in favour of fresh, whole or minimally processed foods is also likely to improve the overall nutritional quality of the diet in any case.

In children with ADHD-type difficulties, research also shows that adverse behavioural reactions - as well as physical symptoms - can be reduced by identifying and eliminating various foods - including some common ones such as milk and dairy products, chocolate, soy, eggs, wheat, corn, legumes - as well as other vegetables and some fruits. These kinds of intolerance intolerance reactions are highly individual, and specialist help may be needed both to identify these and to make sure the diet still provides all essential nutrients.

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