In the Stephens et al., 2010 article summarizing the food/behavior/children to date they recommend for parents with ADHD children to try:
“For 2 weeks, the child should follow a careful elimination that excludes dairy, wheat, corn, yeast, soy, citrus, egg, chocolate, and peanuts (Table 6) or perhaps use the few-foods diet described earlier. They should avoid all AFCs, artificial flavors, and preservatives. “
The handout the doctor had given us was written by Doris Rapp, M.D, who is also the author of Is This Your Child?. In her book she recommends eliminating artificial color, artificial preservatives, sugar (cane or beet), milk, corn, cocoa, wheat, grains, egg, apples/juice, Grapes/juice, peanut, peanut butter, tomato, banana, orange, and yeast.
There is a lot of overlap in these two lists. Some of the original studies compiled in the Stephens et al., 2010 article recommended eliminating all legumes but the thought of no beans along with everything else just seemed crazy. Since the authors only suggested eliminating peanuts in their conclusions I decided to leave beans in the “OK” food group. Dr Rapp recommended eliminating sugar and a number of the foods that were not suggested in the Stephens et al., 2010 article. Most of the the foods Dr Rapp adds to the list that aren’t included in the Stephens et al, 2010 article are foods high in salicylates. In the 1970’s Dr Feingold was one of the first doctors to recognize that artificial food colors and preservatives could exacerbate/cause hyperactivity in children. He also claimed that some children are sensitive to salicylic acid. Salicylates are found in aspirin but also in many fruits, oils, spices, honey, etc. In the Stephens et al, 2010 article they did mention that the studies that limited the diets the most, which they noted were also low salicylate diets, had the best results.
So I took these two lists and came up with what foods we would eliminate:
- Salicylates, natural and artificial
- Sugar (all forms of sweetener except maple syrup)
- Peanut Butter
- Artificial Colors
- Artificial Preservatives
The trickiest part of the diet will be avoiding salicylates. Initially I wasn’t going to include salicylates because the data is more inconclusive than for the other foods; however, as I started making my menus for the first couple weeks I realized they were packed with salicylates. We were going to be switching from a medium salicylate diet to high by doing the elimination diet if we ignored salicylates.
Most lists of salicylate foods have foods ranked as none, low, medium, high and very high. I was distraught when I realized ALL spices except garlic were on the VERY HIGH list! We might be eating chicken and rice for a few weeks but I was hoping it wouldn’t be completely bland. I did some more digging and found the 1980’s research that actually lists the mg of salicylates per 100 g of each food tested. In this list they note that:
“Quantities are in milligrams per 100 grams. Please, when using this, note how much of the food you’re likely to eat: an average helping of watermelon will have far more salicylate than one of loganberry, even though the loganberry has a higher concentration.”
Also under spices they noted:
“Some spices can be extraordinarily high in salicylate, but are eaten in such small quantities this is not often relevant.”
Clearly people had taken this list through the years and based on this mg per 100 g list divided the foods into Salicylate levels WITHOUT TAKING INTO ACCOUNT REASONABLE SERVING SIZES. (Can you tell I am ticked off?!?) It was easy enough to fix though. I uploaded the ingredients with mg of salicylates per 100g into Excel and added a serving size ratio. For example I can easily eat 100 g of apple in a sitting (roughly one apple) but I would NEVER eat 100 g of vanilla in one setting. Once I added this serving size adjustment to the data a handful of spices and other foods made it back onto the OK list. Here is the master list of Salicylates adjusted for serving size and the master list of acceptable foods for the diet.
Maybe we will survive this crazy experiment.