Nutrition


ADHD, Food Dyes, and Additives

By Stephanie Watson
WebMD Feature

Reviewed by Patricia Quinn, MD

You might have read that artificial food colorings can worsen ADHD symptoms such as inattentiveness and hyperactivity. And if you have a child with ADHD, you may have considered cutting out dyes and other additives from their diet.

Before you make any dietary changes, here are a few things you should know about the link between food colorings and ADHD.

What Does the Research Show?

The possible connection between ADHD symptoms and food dyes started with San Francisco pediatrician and allergist Benjamin Feingold. In the early 1970s, Feingold noted that hyperactive kids became calmer when they ate a diet free from artificial colors, flavors, and preservatives.

Since then, several studies have tried to confirm the link. What they’ve found is that, although dyes don’t cause ADHD, a small percentage of kids with ADHD do seem to be sensitive to the effects of food dyes and other additives.

After looking at 34 different studies, “We concluded that there is a small association of food dyes with ADHD,” says Joel Nigg, PhD, a professor of psychiatry and behavioral neuroscience at Oregon Health & Science University and author of What Causes ADHD?

In Nigg’s review, about 8% of children showed symptoms related to food dyes, and about 30% responded well to a dye-free diet.

Yet Nigg says there are still some open questions. The studies that have been done so far have mostly included small numbers of children: in some cases, just 10 or 20 kids. Plus, many of the children ate foods that had both dyes and other additives, making it hard to pinpoint the exact cause of their behaviors.

Researchers also aren’t sure exactly how artificial food colorings might impact ADHD symptoms. It could be that these substances affect children’s brains. Or, it’s possible that some kids are hypersensitive: They have a kind of allergic reaction when exposed to dyes and additives, Nigg says. Many of the kids who are sensitive to dyes are also sensitive to other foods, like milk, wheat, and eggs.

Limiting Food Dyes

In 2007 study linked six different food dyes to increased hyperactivity in children. After the study’s release, the European Union started requiring warning labels on foods containing the dyes tested in the study:

  • quinoline yellow (yellow #10)
  • ponceau 4R (not available in the U.S.)
  • allura red (red #40)
  • azorubine (not approved for food in the U.S.)
  • tartrazine (yellow #5)
  • sunset yellow  (yellow #6)

The U.S. didn’t set similar requirements. In 2011, an FDA Food Advisory Committee concluded there isn’t enough evidence to prove food dyes cause hyperactivity in children.

Trying a Dye-Free Diet

Although the link between food dyes and ADHD symptoms is still not clear, some parents say they have seen an improvement after eliminating these and other additives from their children’s diet.

The eating plan Nigg found to have the greatest effect on ADHD symptoms is the one Feingold introduced decades ago, which removes all artificial colors, flavors, and preservatives (including BHA and BHT).

When Nigg looked at studies done on similar diets, “We saw a fairly large effect — about one-third to one-sixth the size of the medication effect,” he says. In other words, cutting out these additives worked one-third to one-sixth as well at curbing ADHD behaviors as taking medications.

Stripping your child’s diet of every processed food might be tough. “One of the challenges is getting kids to like the diet,” Nigg adds.

If you’re considering an elimination diet, he suggests enlisting the help of a nutritionist who understands ADHD. “Don’t try this on your own, because there are too many ways to miss key nutrients,” Nigg says.

Wait a few weeks to see if the diet has any effect. Then you can start adding foods back into your child’s diet, about one a week, to see which one restarts the symptoms. “In most cases, you could narrow it down to three or four things your child can’t eat,” Nigg says.

Colorings are added to many products, from coated candies to cough syrup. “What parents need to do is become label readers. They can start by looking at all the foods in their kitchen and not using the ones that contain any dye that has a number, like red #40 or yellow #5,” says Laura J. Stevens, research associate in Purdue University’s nutrition science department, and author of 12 Effective Ways to Help Your ADD/ADHD Child.

One benefit to avoiding artificial colors is that it can lift the overall health of your child’s diet. “Foods that contain artificial colors, it’s hard to find one that you would say has good nutrition,” Stevens says. Removing these colors should also limit excess sugar and other unhealthy ingredients.


The ADHD Food Fix: How to Fight ADHD Symptoms With Diet and Supplements

Studies show that a high-protein, low-sugar, no-additive diet combined with ADHD-friendly supplements like fish oil and zinc can drastically improve ADHD symptoms in children with no side effects. Here, an ADHD specialist tells you how to get started.

by Sandy Newmark, M.D.

Good nutrition can make a significant difference in the lives of children who have been diagnosed with attention deficit disorder (ADD/ADHD).

I have used nutritional interventions for hundreds of children with ADHD during the past 24 years. In many cases, dietary changes have not only improved the symptoms of hyperactivity, concentration, and impulsivity, but also have calmed oppositional behavior.

Many parents are eager to try foods and supplements to help their kids manage ADHD symptoms, but they often don’t know where to start. Below are several dietary changes — food to add to your child’s diet, things to eliminate — that, I have found, deliver the most symptom relief.

Stop Blood Sugar Spikes

Foods rich in protein — lean beef, pork, poultry, fish, eggs, beans, nuts, soy, and low-fat dairy products — may have beneficial effects on ADD symptoms.

Protein-rich foods are used by the brain to make neurotransmitters, the chemicals released by brain cells to communicate with each other. Protein can prevent surges in blood sugar, which increase hyperactivity. Giving your child protein for breakfast will help his body produce brain-awakening neurotransmitters.

Combining protein with complex carbs that are high in fiber and low in sugar will help your child manage ADHD symptoms better during the day, whether he’s taking medication or not. The single most important thing I recommend to parents is to decrease the amount of sugar in their ADHD child’s diet.

What many people don’t know is that eating simple processed carbohydrates, like white bread or waffles, is almost the same as feeding your child sugar! Your body digests these processed carbs into glucose (sugar) so quickly that the effect is virtually the same as eating sugar from a spoon.

A breakfast consisting of a Pop-Tart and a glass of juice, or a waffle with syrup, causes blood sugar to rise quickly. The body responds by producing insulin and other hormones that drive sugar down to too-low levels, causing the release of stress hormones. The result? By mid-morning, a child is hypoglycemic, irritable, and stressed out. This can worsen ADHD symptoms or make some non-ADHD children act like they have the condition. Having a simple-carb, low-protein lunch will cause the same symptoms in the afternoon.

Instead, try serving breakfasts and lunches high in protein, complex carbs, and fiber — like oatmeal and a glass of milk, or peanut butter on a piece of whole grain bread. The sugars from these carbohydrates are digested more slowly, because protein, fiber, and fat eaten together result in a more gradual and sustained blood sugar release. The result? A child can concentrate and behave better at school.

Go for the Fish Oil

Omega-3’s can improve several aspects of ADHD behavior: hyperactivity, impulsivity and concentration. As a result, I recommend that all children with ADHD take omega-3 fatty acids.

Omega-3s are essential fats important for normal brain function. They are called “essential” fats because the body must get them from diet; our bodies cannot make them. Research suggests that children with ADHD have lower blood levels of omega-3’s than kids without ADHD. So, unless your child is a dedicated fish eater, you’ll have to supplement, usually with fish oil, to achieve healthy levels.

A number of studies on omega-3s and ADHD have shown a positive effect. In a 2009 study, from Sweden, 25 percent of children who had daily doses of omega-3s had a significant decrease in symptoms after three months; by six months, almost 50 percent experienced better symptom management. This is an impressive result for a safe nutritional supplement with few side effects.

How much omega-3 should your child get and in what form? It’s a little complicated. The two main omega-3 fatty acids contained in supplements are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It appears that most benefits are derived from omega-3 products that contain more EPA than DHA. I recommend a total dose of 700 to 1,000 mg a day for younger children, and 1,500 to 2,000 mg for older children.

Omega-3s come in capsule, liquid, and chewable form. The gummies and chewables, unfortunately, don’t have much fish oil in them, so it is expensive and time-consuming to give your child the proper dose. Most kids who are too young to swallow capsules can take the liquid, although you’ll have to be creative about getting them to take it. It is OK to mix liquid omega-3s in just about anything. Orange juice and smoothies are a couple of favorites.

I’ve seen some children improve within a few days, while others didn’t show improvement for a few months. My advice to parents is always to be patient, and not to give up on an omega-3 regimen too soon.

Maintain Iron Levels

Many parents and professionals are unaware of the important role iron plays in controlling ADHD symptoms.

A study done in 2004 showed that the average iron level of children with ADHD (measured as ferritin) was 22, compared with 44 in non-ADHD children. Another study showed that increasing ADHD children’s iron levels improved their symptoms almost as much as taking a stimulant. The children in these studies were not anemic. The fact that your child has a normal “blood count” does not mean that his ferritin levels are normal. Because too much iron is dangerous, I do not recommend giving iron without first checking the ferritin level. Ask your pediatrician to test it.

If iron levels are low, below 35, say, talk with your doctor about starting your child on an iron supplement and/or increasing consumption of iron-rich foods, which include lean red meat, turkey and chicken, shellfish, and beans. The ferritin level should be rechecked in a few months.

Check Zinc and Magnesium Levels

Zinc and magnesium are two other minerals that may play an important role in controlling ADHD symptoms. Both are essential to normal health, and a surprising number of children, with and without ADHD, don’t get enough of them. Zinc regulates the neurotransmitter dopamine, and it may make methylphenidate more effective by improving the brain’s response to dopamine.

Magnesium is also used to make neurotransmitters involved in attention and concentration, and it has a calming effect on the brain. Have your doctor check your child’s magnesium and zinc levels when you test ferritin levels. I find that at least 25 percent of the children I see are low in zinc.

While studies have been done on both minerals’ effects on ADHD, the results are not as clear-cut as in studies done on omega-3’s and iron.

Cut Back on Chemicals

Several studies suggest that artificial additives make non-ADHD children more hyperactive, and make hyperactive children worse. The European Union requires a warning label on food packaging that contains additives: “This food may have an adverse effect on activity and attention in children.” Gatorade, cheese puffs, and candy are typical examples of foods containing artificial colors and preservatives, but additives and colors can be found in other foods.

The first step in avoiding additives is to read food ingredient labels until you’ve found a wide range of foods that are additive-free. In most cases, fresh, unprocessed foods are your best bet, as they contain few additives.

However, these days you can find bread, cereal, cookies, pizza, and just about anything else made without additives. Avoid colorful cereals, like Fruit Loops and Lucky Charms. Cheerios are better, and lower in sugar. Substitute 100-percent fruit juice for soft drinks and fruit punches, most of which are artificially colored and flavored.

Watch for Food Sensitivities

A number of research studies have shown that many children with ADHD are sensitive to certain common foods in the diet. These sensitivities make their ADHD symptoms significantly worse. In one recent study 50 children were placed on a restricted diet for five weeks, and 78 percent of them had significant improvements in ADHD symptoms!

In my practice, I have seen improvements in many children when they stopped eating foods they were sensitive to. The most common culprits are dairy, wheat, and soy.

It’s important to know that ADHD children do not necessarily have “food allergies” in the strict, medical sense. Results when testing for food allergies are usually negative in these kids. The only way to know whether food sensitivities affect your child is to remove certain foods from his diet and observe his reaction. A child might have food sensitivities if he displays allergy symptoms, like hayfever, asthma, eczema, or GI problems. But I have seen children with none of these problems respond well to a change in diet.

If there are one or two foods you suspect might be exacerbating your child’s ADHD symptoms, eliminate one for two or three weeks. Observe your child’s ADHD symptoms during that time. If you are thinking about starting a restrictive diet, find a professional to guide you. I know dietary changes are tough to engineer in a child with ADHD, but many families have done it successfully and are happy with the results.

Try Helpful Herbs

Several herbs have been recommended for managing ADHD symptoms, including ginkgo, St. John’s Wort, rhodiola, and ginseng. Most have been poorly researched, with two exceptions.

In a large European study on hyperactivity and sleep problems, a combination of valerian and lemon balm helped to relax children with ADHD by reducing anxiety. I use these herbs regularly for kids who deal with these problems. Consult a naturopathic doctor to find the appropriate dose for your child.

To improve attention, a new herbal product, called Nurture & Clarity, was developed, and carefully tested, by a team of practitioners in Israel. The children taking it demonstrated significant improvement, as measured by their performance on the Test of Variables Attention, a computerized measurement of attention. I would not make definitive recommendations based on one study, but this product is worth looking into. You can read about it at adhd-clarity.com.

Finally, pycnogenol, an extract made from French maritime pine bark, has been shown to improve ADHD symptoms in a limited amount of research. I have found that the herb helps improve concentration in some children.

One last thought: Herbal products vary greatly in quality, and some contain contaminants. You should find a knowledgeable professional to help you identify reliable sources of pure, standardized herbs.


Pesticides Linked to ADHD, Autism, IQ Scores Reduction

Tuesday, May 28, 2013 – Published in the Sun.Star Davao newspaper on May 29, 2013.

STUDIES have showed that pesticide exposure can increase the risk of neuro-behavioral disorders such as autism, ADHD, hearing loss, and intellectual impairment.

Over the past 30 years, autism rates have dramatically increased by 78 percent and ADHD rates are up three percent every year which have coincided with the rise in the use of pesticides in food.

“Fetuses and children are most vulnerable to pesticide exposure due to their less-developed immune system,” Professor Zwiauer, the head of the Department of Pediatrics at the Central Clinic in St. Polten, Austria warned.

“They have a far greater chance of exposure and absorption in relation to body mass. Pesticide exposure at such an early age can interfere with their development and may even cause lifelong damage,” he said.

This includes developmental delays, behavioral disorders, and even possible motor dysfunction.

In addition, Dr. Zwiauer also shared that pregnant women should also be careful because, along with their unborn child, they are very vulnerable to pesticide exposure.

Pesticides can be transferred from mother to child in the womb. Some exposures can cause delayed effects on the nervous system as the baby’s brain architecture establishes in the womb.

In fact, there are several possible complications and health problems in children that can arise from exposure to pesticides, including childhood obesity and even cancer.

Dr. Zwiauer explained that the best way to reduce the risk of pesticide exposure in infants and young children is to make sure they eat organic food.

Professor and doctor Karl Zwiauer, head of the Department of Pediatrics at the Central Clinic in St. Polten Austria, alongside Dr. Markus Bruengel of the German Society of Nutrition and Nutritional Medicine were guest speakers during a lunch symposium with members of the Philippine Pediatric Society at the Philippine International Convention Center last April 2013 Both pediatric experts from Austria and Germany presented studies on the importance of organic nutrition and why organic foods are a healthier choice, most especially for babies and toddlers when breast feeding is not possible.

Both experts reinforced that breast milk is the gold standard for infant feeding and should be the first choice for feeding infants and toddlers.

Choosing an alternative feeding from breast milk when breastfeeding is not possible should first be consulted with your pediatrician.

Organic milk comes from healthy cows that graze on organic farms, free from harmful pesticides, growth promoting hormones, and antibiotics. There is an increasing number of scientific and clinical evidence on the benefits of organic nutrition for everyone, especially babies and toddlers who absorb much more from their nutritional sources in terms of their body mass. It is important to protect our families from harmful pesticides and chemicals.


ADHD Diet: How Food Can Affect Your Child’s ADHD

By Wyatt Myers; Medically reviewed by Pat F. Bass III, MD, MPH

For years, doctors have speculated that certain foods may play a role in ADHD. Although much research has been done on the subject, it’s still not believed that food actually causes ADHD. What diet does seem do, however, is worsen ADHD symptoms or trigger symptoms that mimic the signs of ADHD in children. “Excessive caffeine and excessive use of fast foods and other foods of poor nutritional value can cause kids to display behavior that might be confused with ADHD,” says Frank Barnhill, MD, an expert on ADHD and the author of Mistaken for ADHD. The following foods in particular have been implicated in ADHD in one way or another.

Candy

Candy is loaded with sugar and artificial colours, which is a bad combination when it comes to children with ADHD who often need to follow an ADHD diet. Both of these components have been shown to promote ADHD symptoms in studies. “With the high content of sugar and artificial colouring, candy is a huge contributor to ADHD,” says Howard Peiper, author of The ADD and ADHD Diet.

Soda

If you have ADHD, consider eliminating soda. These sweet drinks often have many of the same sugars and sweeteners that make candy a bad idea for kids on the ADHD diet. Soda also has other ingredients that can help worsen ADHD symptoms, such as high-fructose corn syrup and caffeine. “Excessive sugar and caffeine intake both cause symptoms of hyperactivity and easy distractibility,” says Dr. Barnhill.

Cake Mixes And Frostings

Cake mix and frosting contain the high amounts of sugar and artificial colours that can lead to hyperactivity and other ADHD symptoms. Naheed Ali, MD, ADHD expert and the author of Diabetes and You: A Comprehensive, Holistic Approach, adds that these products are often also loaded with several artificial sweeteners. “When frosting and cake mix contain artificial sweeteners, they increase the risk of ADHD symptoms more than natural sweeteners would,” he says.

Energy Drinks

Energy drinks are becoming increasingly popular among kids, especially teens. Unfortunately, they also have a veritable treasure trove of ingredients that can worsen ADHD symptoms: sugar, artificial sweeteners, artificial colors, caffeine, and other stimulants. “Energy drinks are high on the list of things that cause teens to display behaviors mimicking ADHD,” says Barnhill. They have no place in a healthy ADHD diet.

Frozen Fruits And Vegetables

Most fruits and vegetables are healthy choices for an ADHD diet, but some frozen varieties can contain artificial colours, so check all labels carefully. Barnhill says these can cause ADHD symptoms for another reason as well. “Foods treated with organophosphates for insect control have been shown to cause neurologic-based behavioral problems that mimic ADHD and many other behavior problems,” he says.

Fish And Other Seafood

Dr. Ali says that eating fish and other seafood with trace amounts of mercury can cause ADHD symptoms in the long term. Some of the worst culprits are shark, king mackerel, swordfish, and tilefish. “Mercury, like cellulose, is extremely hard to digest and can accumulate in the brain over time,” explains Ali. “This can lead to hyperactivity.” Talk to your doctor or ADHD nutritionist about the best types of fish to include in your ADHD diet.

Other Food Sensitivities

According to a recent study, many children with food sensitivities can exhibit ADHD symptoms after they are exposed to certain foods. Based on the results of the research, some of the common foods that can cause ADHD reactions include milk, chocolate, soy, wheat, eggs, beans, corn, tomatoes, grapes, and oranges. If you suspect a food sensitivity may be contributing to your child’s ADHD symptoms, talk to your doctor about the possibility of trying an elimination diet.

‘Healthy’ Diet Best for ADHD Kids

But researchers still have yet to find link between refined sugar and hyperactivity in children.

By John Gever, Senior Editor, MedPage Today and Reviewed by Dori F. Zaleznik, MD and Dorothy Caputo, MA, RN, BC-ADM, CDE

MONDAY, Jan. 9, 20112 (MedPage Today) — Fast foods, sodas, and ice cream may be American kids’ favorite menu items, but they’re also probably the worst for those with attention deficit-hyperactivity disorder (ADHD), a new literature review suggests.

According to two researchers from Children’s Memorial Hospital in Chicago, a relatively simple diet low in fats and high in whole grains, fruits, and vegetables is one of the best alternatives to drug therapy for ADHD. Omega-3 and omega-6 fatty acid supplements have also been shown to help in some controlled studies, they noted.

Writing online in Pediatrics, J. Gordon Millichap, MD, and Michelle M. Yee, CPNP, reviewed nearly 70 publications on diet-based interventions in ADHD, emphasizing recent research and controlled trials.

They noted that diet is one established contributor to ADHD that parents can modify.

One of the most provocative findings in recent years came from the Australian Raine study, which was a prospective cohort study that followed children from birth to age 14, Millichap and Yee indicated.

It found that development of ADHD was significantly associated with so-called Western diets rich in saturated fats and sugar, compared with a “healthy” diet of proteins derived from low-fat fish and dairy products and with a high proportion of vegetables (including tomatoes), fruits, and whole grains.

However, their review indicated that controlled trials had failed to show significant benefits for such intensive modifications as oligoantigenic, elimination, or additive-free Feingold-type diets except in small subgroups. Such diets also “are complicated, disruptive to the household, and often impractical,” they wrote.

The Feingold diet and others are based on the idea that artificial colors and salicylates contribute to ADHD, which became popular in the 1970s. Federally funded trials showed that most ADHD children did not improve significantly on such diets, although some children with genuine sensitivities to additives and preservatives have been identified.

Such children, the researchers suggested, “might benefit from their elimination.” More recent research has also indicated that atopic children with ADHD responded to a highly restrictive diet lacking colorings, preservatives, and certain food types.

Millichap and Yee reached similar conclusions for so-called elimination diets that avoid common allergens such as nuts, dairy, and chocolate, as well as citrus fruits. “Studies have provided mixed opinions of efficacy,” they noted.

For both types of diet, the researchers pointed out, “a parent wishing to follow [them] needs patience, perseverance, and frequent evaluation by an understanding physician and dietitian.”

In another finding likely to raise eyebrows, if not hackles, Millichap and Yee concluded that only weak evidence supports the widespread belief that refined sugar promotes hyperactivity.

Some effects on brain electrical activity have been documented, and reactive hypoglycemia following big jolts of sugary foods may account for behavioral changes seen in some ADHD children.

But studies linking sugar consumption to ADHD have also been compromised by methodological problems. For example, one trial gave children sugar or placebo at breakfast with a high-carbohydrate cereal, which may have contributed to subsequent reactions to the sugar. Millichap and Yee cited a separate study that demonstrated when children ate a protein meal before or simultaneously with sugar, no hyperactivity reaction occurred.

Still, the researchers conceded, the notion that sugar exacerbates ADHD has become so entrenched it may not matter whether it’s true or not.

“No controlled study or physician counsel is likely to change this perception. Parents will continue to restrict the allowance of candy for their hyperactive child at Halloween in the belief that this will curb the level of exuberant activity, an example of the Hawthorne effect. The specific type of therapy or discipline may be less important than the attention provided by the treatment,” Millichap and Yee wrote.

They also reviewed studies exploring the potential roles of zinc and iron deficiency in ADHD. The upshot is that there is currently little indication that such deficiencies explain more than a small minority of ADHD cases. Children with confirmed deficiencies should receive supplements or appropriate dietary adjustments regardless of their ADHD status.

They were more impressed with the literature on polyunsaturated fatty acid supplements, especially the 2005 Oxford-Durham study.

In that trial, several ADHD symptoms were significantly improved in children receiving omega-3 and omega-6 fatty acid supplements, “an effect duplicated in other…supplement trials,” Millichap and Yee wrote.

They acknowledged that not all studies have confirmed the result, and recent studies have used too many different methodologies to yield firm conclusions. Nevertheless, they indicated that they now recommend it to parents of their patients, though not as the sole treatment approach.

“In almost all cases, for treatment to be managed effectively, medication is also required,” they wrote. “The beneficial effects of omega-3 and omega-6 supplements are not clearly demonstrated.”

“Supplemental diet therapy is simple, relatively inexpensive, and more acceptable to patient and parent,” Millichap and Yee concluded. “Public education regarding a healthy diet pattern and lifestyle to prevent or control ADHD may have greater long-term success.”

They suggested that diet-based interventions in ADHD are most appropriate when any of the following apply:

  • Children suffer medication reactions or treatment failure.
  • Parents or children want to try dietary modifications.
  • Mineral deficiencies are evident.