Give Me the Data

A few months ago as I was doing some research online I stumbled across this article on research done in the UK in 2007 with children ages 3 and 8-9.  They gave some children a drink with artificial dyes, some with sodium benzoate, and some a placebo.  They found that both kids with ADHD and kids without ADHD both showed significantly more ADHD like symptoms when given the artificial dyes/preservatives vs the placebo.  It doesn’t appear to affect every kid but there is clearly a subset of children that are very sensitive to the artificial food dyes and preservatives.

The amount of artificial food dyes in our diet have gone up the last couple years.  This study released in 2014 was the first to actually show how much food dye (mg per serving) are in various foods we consume.

After reading these articles we completely cut out artificial food dye two months ago.  I don’t think it made much of a difference for our family (though we only cut out the artificial dyes and not the artificial preservatives) but it is a really easy first step.  I was shocked how many foods have dye in them!  Even these seemingly innocuous things have artificial food dyes:

What things have you found containing artificial dye that has surprised you?

So SOME kids are sensitive to artificial food dyes and preservatives according to research in the UK.  But what about all the other foods my doctor was asking us to temporarily cut out?  When I started researching I was pretty sure I was just going to find a handful of weak anecdotal evidence but instead I found this amazing article by Stephens et al., 2010.  The article written by a number of doctors at Purdue University summarizes most of the food/children/behavior research that has been done to date.  What they found was:

“The research reviewed in this article suggests some points that are described below. (1) There is a subpopulation of children with ADHD who improve significantly on an AFC-free diet and react with ADHD-type symptoms on challenge with AFCs. (2) The size of this subpopulation is not known. In the cited studies it has varied from 65% to 89% of the children tested when at least 100 mg of dye was used for the challenge, so the proportion of the whole ADHD population is undoubtedly smaller.  However, the children in these studies were often selected because they were suspected of sensitivities to AFCs, so the proportion of the whole ADHD population is undoubtedly smaller. (3) A search of the literature did not find any challenge studies of the specific effects of artificial flavors or natural salicylates alone. (4) Instead, oligoantigenic studies have indicated that some children with ADHD, in addition to being sensitive to artificial food dyes, are also sensitive to common, nonsalicylate containing foods (milk, chocolate, soy, eggs, wheat, corn, legumes) and to grapes, tomatoes, and orange, which do contain salicylates. This may explain why some studies that used challenge cookies made of chocolate and wheat with and without AFCs did not show more of an effect. (5) According to the Egger and Carter studies, no child reacted to just the dyes alone; all with sensitivity were sensitive to at least 2 foods. The Bateman et al27 and McCann et al28 studies suggest that sensitivity to AFCs and benzoate is not confined to the ADHD population but is instead a general public health problem and probably accounts for a small proportion of ADHD symptoms.”

As far as how long a child is likely to react to AFCs:

“Specifically, hyperactive children’s performance impairment in response to AFCs occurred about half an hour after ingestion, peaked at about 1 1⁄2 hours, and lasted at least 3 1⁄2 hours “

Elimination diet success for a group of ADHD children:

“In the initial study, investigators recruited 16 children (ages 4-11), who were placed on an elimination diet; authors reported that parents and teachers reported children’s behavior problems were reduced by 57% and 34%, respectively, while on the diet. “

“Initial sample sizes ranged from 45 to 78 unmedicated children with hyperactivity. All participants participated in an open trial of the oligoantigenic diet for 3 to 4 weeks. For example, 2 meats (lamb and chicken), 2 carbohydrate sources (potatoes and rice), 2 fruits (bananas and apples), vegetables, and water (with calcium and vitamin supplementation) were allowed in the Egger et al36 study. Positive response rates to the diet were fairly consistent (71%-82%) “

“All these studies reported high response rates to the various elimination diets (>70%); however, it is again unclear whether diets without offending foods can be maintained to support long-term improvement. All studies containing a double-blind challenge phase found that parents reported more hyperactivity when children were challenged with offending foods and/or AFCs than placebo. Children’s performance on learning tasks and blinded psychologists’ ratings of children’s hyperactivity were consistent with parent ratings, although daycare staff did not report a difference in children’s behavior between active and placebo challenges. “

Which foods caused reactions:

“Artificial colors and preservatives were the most common culprits, causing reactions in 70% to 79% of the children, but no child reacted only to these. Common foods that triggered behavior reactions included milk, chocolate, soy, egg, wheat, corn, and legumes. A small proportion of the initial samples (24%-37%) completed a double-blind crossover challenge of offending foods or placebo. In all 3 studies, parents reported significantly higher levels of hyperactive behavior when their children had received an active challenge (offending food or AFC) than placebo. Carter et al37 also reported that when children were challenged with provoking foods, they had worse latency and made more errors on a matching figures test (P < .01) and were rated more hyperactive by blinded psychologists (P < .01) “

This article answered some of my questions like:

Couldn’t I just make the “diet” easier by removing each possible offending food item out of our diet one at a time?  According to the article virtually all the children that were sensitive to one food were sensitive to at least two or three different foods.  This could be why we haven’t seen any benefit to removing just artificial food dyes from our diet.  If Mr Rockstar has food sensitivities it is probably more than just food dye so maybe if we cut out the all the offending foods the magnitude of difference it makes in his behavior will be more noticeable.

Do we really need to eliminate caseins, gluten, eggs, etc?  Yes. To discover all the food interactions it appears the list of foods to avoid is a lot longer than just artificial colors and preservatives.

So what food does that leave us with?

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