Do diet changes help ADHD children?

by Nara Schoenberg, Chicago Tribune

Dylan Jerrell was having a tough time in kindergarten. The energetic, outgoing Bigfoot fan was easily frustrated, and he responded to challenges with disruptive meltdowns. He wouldn't hit anyone, but he'd break down and cry or yell at his teachers. For a week in mid-September, he was in the principal's office every single day. His mom, Jacqueline Fellows, considered home schooling. His pediatrician offered medication for attention deficit hyperactivity disorder.

But then Fellows, a health writer in McKinney, Texas, put Dylan on the Feingold diet, which eliminates artificial colors and and some preservatives.

"I started the Feingold diet on a Saturday, the weekend after he'd been in the principal's office every day, and he's only been back to the principal's office once, and that was when (someone) fed him a hot dog," Fellows says.

"It was amazing. It's not a silver bullet, but it's the most powerful tool that I have for him."

Parents of children with (ADHD) have been reporting marked behavioral improvements due to diets eliminating artificial food coloring and other additives for decades now, but those reports have gained traction in the past decade, with recent studies suggesting that scientists may have been too quick to dismiss dietary triggers for ADHD in the 1980s and '90s.

In 2007, a landmark British study published in The Lancet medical journal found that artificial food colors and preservatives increase hyperactivity in children, leading the European Union to require on foods containing any of six specific food colors. This set off renewed debate in the U.S., but the declined to take regulatory action.

Now, scientists are getting intriguing results from sophisticated analysis techniques that allow them to pool findings from multiple studies. A of 34 studies that appeared in the Journal of the American Academy of Child and Adolescent Psychiatry in 2012 found that artificial food colors had a small but significant effect on ADHD symptoms. The overall effect was equivalent to about one-fifteenth to one-thirtieth the effect of medication, according to study co-author Joel Nigg, a professor of psychiatry at Oregon Health & Science University in Portland.

And when patients followed broader elimination diets - excluding not just artificial colors and preservatives, but other suspected triggers such as eggs - the effect was larger: about one-third to one-sixth the effect of medication, Nigg says.

The authors of the 2012 study estimated that as many as 8 percent of kids with ADHD may have symptoms related to artificial food colors and 30 percent of kids with ADHD may have symptoms that improve when they follow more comprehensive diets that eliminate suspected allergens as well.

"The take-away is, it's not a waste of time," Nigg says of dietary restrictions for kids with ADHD.

"It has a chance of working - a less than 50-50 chance, but it's a chance. It's going to take some effort, so (if you want to try it) get a good nutritionist to advise you and talk to your child and give it a couple of months of effort."

L. Eugene Arnold, a professor emeritus of psychiatry at Ohio State University, points out that the British study found that artificial food dyes and preservatives increase hyperactivity in the general population of children, not just kids with ADHD.

"It makes sense for all kids to reduce the amount of dye they take in," says Arnold, who says that per capita consumption of artificial food dyes has quadrupled in the last 50 years.

But in 2011 an advisory panel for the FDA concluded that although artificial food dyes may trigger hyperactivity in a small percentage of children with behavioral problems such as ADHD, there isn't enough evidence to claim that food dyes cause hyperactivity in the general population. The panel voted against recommending warning labels on foods with artificial dyes and called for more research.

According to a recent statement released by the FDA, "the agency continues to study the matter in various populations, including children, and will report its findings." The FDA did not say when those findings would be reported.

Popularized in Benjamin Feingold's best-selling 1974 book, "Why Your Child Is Hyperactive," the Feingold diet eliminates artificial colors and flavors and three preservatives, and it temporarily removes foods containing natural salicylates, such as oranges and apples. The foods with natural salicylates may later be reintroduced. The diet fell out of favor with scientists after a 1983 meta-analysis concluding that the overall effect was too small to be important, according to a 2012 article in Neurotherapeutics.

Fellows says that before she put her son on the diet, she was your typical suburban mom, treating her son to cherry limeades and never really questioning the chemical additives in foods.

But she had a friend whose son had seen a marked improvement in a behavioral tick - involuntarily sniffing - on the Feingold diet, and, with Dylan's pediatrician saying her son was a candidate for medication, Fellows figured she had nothing to lose.

Seven months later, she says, Dylan can still be a handful - he's 6, after all - but his behavior is much better. Before the dietary changes, Fellows volunteered regularly in his school cafeteria and saw Dylan popping up and down, spinning in his seat, yelling and not really eating his lunch. She dropped by during lunch time a few months after the dietary change, and he was sitting down, eating his lunch and talking quietly to the little girl next to him.

"He didn't go from 'wild man' to calm," Fellows says. "He was just able to really listen and comprehend what you said. He could learn. Before he would get really agitated if he couldn't do it the first time or you asked him to do something he really didn't want to do. When he started doing Feingold, he was a reasonable child to parent. He was an easier child to parent."

Accounts such as Fellows' are plausible, says Nigg, particularly when the effect lasts over a period of months and it's observed by teachers as well as parents.

Nigg's analysis applies to the entire group studied; both kids who responded to dietary restrictions and the ones who didn't. He says the data don't really lend themselves to analyzing the range of effects on individual kids, but it appears that some kids were getting something close to full recovery from ADHD symptoms from dietary restrictions alone.

"I think it is possible that, for some kids, you would get a dramatic effect," he said. "And probably for a lot of kids, you'll get some effect."

WHAT'S AN ADHD DIET?

ADHD diets are basically elimination diets; you remove the foods or ingredients most likely to trigger or heighten symptoms, and if you see an improvement, you try adding back foods one by one, nixing the ones that bring back symptoms.

The chief suspects are artificial food colorings and preservatives, but the authors of a recent research analysis in the Journal of the American Academy of Child and Adolescent Psychiatry found diets are more effective when they restrict other foods as well. The authors estimated that 30 percent of kids with ADHD experienced a reduction in symptoms when they initially eliminated foods such as wheat, rye, barley, eggs, dairy, corn, yeast, soy, citrus, eggs, chocolate and peanuts. Study co-author Joel Nigg recommends consulting with a nutritionist before embarking on this type of diet.

Journal reference: The Lancet search and more info website

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