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home->Campaigns->Safeguard our students -> News
From Mothering website
Related Articles:
Does
ADHD Even Exist? The Ritalin Sham
ADHD & Diet
How Food Affects Mood
By Michael Jacobson In the early 1970s, Dr. Benjamin Feingold, then chief emeritus of the Department of Allergy at the Kaiser Foundation Hospital and Permanente
Medical Group in San Francisco, reported a link between diet and several
physical and allergic conditions. Thirty to 50 percent of Feingold's
hyperactive patients said they benefited from diets free of artificial
colorings and flavorings, and certain natural chemicals (salicylates, found
in apricots, berries, tomatoes, and other foods).
Although many parents eagerly embraced the Feingold diet, others--such as
the processed-food industry, many child-behavior experts, and some
pediatricians--were more skeptical. Perhaps, they reasoned, the families
were doing other things in addition to dietary modification, or maybe they
were simply reacting to wishful thinking. With time, however, researchers
began testing aspects of Feingold's claim. Over the following decades,
almost two dozen additional controlled trials followed, mostly focusing on
food dyes. In some cases, children were put on a diet that lacked many food
additives and subsequently "challenged" with dyes. In other cases, the
behavior of children was monitored after they were switched to a diet free
of certain foods that might cause a reaction (dyes, wheat, egg, chocolate,
and others) and then challenged with those foods. Most--but not all--of those
studies found that some--but not all--children were affected by diet, some
slightly, others dramatically.
In 1982, the National Institutes of Health (NIH) convened a "consensus
development conference" on diets and hyperactivity to review the early
scientific research and advise health professionals and the public. Their
conclusion was that controlled studies "did indicate a limited positive
association between. . . [Feingold-type] diets and a decrease in
hyperactivity." The panel recommended further broad research on the
diet-behavior connection--advice that generally has not been heeded. This is
in part why so little is known today about the percentage of children who
respond to dietary therapy, to what degree they respond, which children are
most likely to be affected, the additives and foods that cause problems, and
the best ways to use diet therapy.
Nevertheless, in the face of ever-escalating Ritalin prescriptions, some
families are seeking out dietary therapy for their children. One reason for
their interest is that Ritalin and amphetamines (such as Adderall and
Dexedrine) may cause reduced appetite and weight loss, stomachaches, and
insomnia. More seriously, those drugs occasionally may cause or exacerbate
tics and Tourette's syndrome. Another drug, Pemoline (Cylert), has been
associated with fatal liver failure; the Food and Drug Administration (FDA)
urges doctors not to use it to treat ADHD.
Furthermore, until long-term studies are done, it will not be known
whether years-long treatment in childhood (or, for that matter, adulthood)
with stimulant drugs has an effect on the nervous system or other parts of
the body later in life. Importantly, a study by the federal government's
National Toxicology Program (NTP) found that doses of Ritalin that only
modestly exceeded the maximum recommended dose in humans caused liver tumors in mice. "Millions of young children take Ritalin for years on end, and children may be especially susceptible to a
carcinogen's effects," says Samuel Epstein, a cancer expert at the School
of Public Health at the University of Illinois. Although the NTP study
indicates "a weak signal of carcinogenic potential," the government still
considers the drug safe. Yet the lack of a long-range study of Ritalin's
possible carcinogenic effect is extremely troubling. Large numbers of
children have been consuming Ritalin for only the past one or two decades,
and cancer might not manifest itself for several decades later in life.
for the Center for Science and the Public Interest
Trying a Dietary Modification Approach Needless to say, controlling the diets of young children can be difficult,
especially once children go to school. Foods containing dyes and other
potentially provoking ingredients are advertised aggressively and available
everywhere: at supermarkets, restaurants, schools, vending machines,
parties, theaters, and the homes of friends and relatives. Many young
children are already "hooked" on the very foods that may cause problems,
though it is getting easier to find acceptable alternatives. And children
who don't eat what all their friends eat may feel left out or stigmatized.
Some parents who've put their children on special diets, though, say their
children willingly cooperate in making dietary changes, especially after
they discover that those changes make them feel better. Some older children
avidly read labels to avoid certain ingredients.
Although some studies suggest dietary therapy can be more effective among
young (preschool) children and those who suffer from asthma, eczema, hives,
hay fever, or similar symptoms, a diet could be worth trying no matter how
old your child is or how the behavioral problem is manifested. It is
certainly safer and cheaper than using stimulant drugs, and, if your child
has been eating a lot of artificially colored foods, it may also be more
nutritious.
Numerous studies have demonstrated that some children are sensitive to
dyes. Thus, you might start by eliminating only foods (and vitamins, drugs,
and toothpastes) that contain artificial colorings. The Feingold diet
eliminates additional additives, as well as "salicylate-containing" foods. That diet eliminates:
One study suggests that sodium benzoate and benzoic acid should also be on
that list. The Feingold diet also excludes certain fruits and vegetables,
although studies have not demonstrated that they cause problems. (See Box 1). While that diet excludes many common foods, you can later reintroduce any to which your child is not sensitive.
Once you have decided which foods and additives you will eliminate, check
out all the foods in your refrigerator, pantry, and cupboards, and remove
or discard any that contain banned ingredients. Do not forget restaurants:
many fast-food chains offer lists of the ingredients in their products; ask
servers or call their consumer-affairs offices. The Feingold Association
publishes lists of selected packaged and chain-restaurant foods that fit
into the diet (see For More Information), but you will have to become a
careful label reader and inquisitive restaurant-goer to learn the
ingredients in your children's favorite foods. It may be easier to stick to
home-prepared meals during this test period.
Once you are set to go, put your child (and the rest of the family, if
possible) on the modified diet for two or three weeks. If your child
mistakenly eats a prohibited food, do not get upset--just get him or her
back on the diet. Using a separate page for each day, keep a score sheet (click here for sample score sheet) based on common characteristics of ADHD, but modify that to include your own child's most troubling behaviors. Note when behavior problems arise and which foods your child had eaten recently. Engage your
child's teacher in monitoring your child's behavior, but unless the teacher
provides snacks for your child, there is no reason to risk drawing
attention to your young one by telling the teacher about the diet.
Next, you can try eliminating more of the additives or foods suspected of
affecting behavior. Likewise, if your child's behavior did not improve on
the initial diet, it could mean that he or she is not affected by foods at
all or is sensitive to other foods. It's also possible that prohibited
ingredients are sneaking into your child's diet.
Parents wishing to test their children's response to diet will seek to identify and remove irritants in foods (and other products) that cause
behavioral symptoms. This is done by eliminating certain foods (and
vitamins and drugs) from the (unmedicated) child's diet for several weeks
to see if his or her behavior is improved. In some cases, dietary changes
by themselves may adequately reduce behavioral problems. If not,
amphetamines or another medication could be tried in addition to, or
instead of, a restricted diet. The goal is to identify the specific foods
or additives, if any, that affect your child. What makes this challenging
is that children's behavior ordinarily is so variable.
The "Few-Foods" Diet On this diet, eliminate as many of those foods as you can, as well as
artificial colorings and other additives. Children can eat fresh meat and
poultry, any vegetable (except corn and soybeans), fruits and fruit juices
(but not citrus fruit juice and not beverages normally consumed daily),
rice, and oats. Work with an allergist if you undertake an elimination
diet, especially if your child has eczema or other allergies. (Severe
reactions might occur when a food is reintroduced.) The more foods you
eliminate, the more complicated it will be to provide healthy meals and win
your child's cooperation. Fortunately, most of the restrictions will be
temporary, because you will be trying to identify the foods that do not
cause problems, as well as those that do.
Keep your child on the few-foods diet for two weeks, tracking his or her
behavior until you notice two consecutive days of significantly improved
behavior. Note that it can be difficult to distinguish an effect of diet
from your child's normal fluctuations in behavior. If you don't notice any
improvement, you can end your experiment.
If you have noted improved behavior, reintroduce one of the eliminated
foods or additives at a time. After your child has eaten that food for
several consecutive days, note in your diary any symptoms that develop. If
that food did not affect your child, then consider it safe to eat. If your
child's behavior deteriorated, exclude that food from your child's diet, or
retest it again later. Every few days reintroduce another food and keep
track of how your child reacts. Gradually, you may be able to identify
foods that do and do not affect your child.
If your child stays on a very restricted diet for more than a
few weeks, you should work with a dietician to plan meals that provide all
the nutrients your child needs. Also, your child should take a daily
vitamin-and-mineral supplement, which may make sense regardless of what
diet he or she is on.
Another approach is to feed your child the few-foods diet until you see an
improvement. Then reintroduce everything--dyes, wheat, the works--for several
days to see if anything triggers a reaction. If your child's behavior
worsens, return your child to the special diet and reintroduce foods one by
one until you find the problems.
Finally, do not expect diet to bring about miraculous improvements in
behavior. Even in kids who are affected by food ingredients, eliminating
the culprits often yields only a partial improvement. But even partial
improvements could be most welcome. If your child does not benefit
significantly from a restricted diet, you should discuss with your
pediatrician other treatment options, including medications and behavioral
counseling.
If your child's behavior did not improve on the Feingold diet, you could
try a more restrictive "few-foods" diet. Studies indicate that some
children are sensitive not just to food additives but also to such foods as
the following:
| Good Nutrition |
| Whether or not your child has behavioral problems, he or she should eat a
nutritious diet. Most children eat far too many fatty, salty, and sugary
foods-from burgers, fries, cheese, and ice cream to soft drinks, potato
chips, and candy. And few children get the vitamins, minerals, fiber, and
phytochemicals they need from fruits, vegetables, and whole grains. It is
important to your child's current and future health to eat a really
healthful diet (and that may mean that you need to improve your diet to set
a good example!).
First steps include getting rid of the junk foods in your home, making fatty and sugary foods off-limits when eating out, and turning off television shows riddled with junk-food ads. Also, give your child a daily vitamin-and-mineral supplement. |
FOR MORE INFORMATION Center for Science in the Public Interest Feingold Association of the United States Michael Jacobson is executive director of the Center for Science in the
Public Interest (CSPI, a nonprofit health-advocacy organization). The
contents of this article are not intended to provide personal medical
advice, which should be obtained from a qualified health professional.
Center for Science in the Public Interest
1875 Connecticut Avenue NW, Suite 300, Washington, DC 20009
202-332-9110
www.cspinet.org
Box 70373 Toronto Station A, Toronto, ON M5W 2X5
PO Box 6550, Alexandria, VA 22306
800-321-3287
www.feingold.org