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Diet & ADHD

These are some of the studies and articles published in peer reviewed journals. The most recent are listed first. They are linked where available to their abstract in MedLine.

Most of these studies used an approximation of the Feingold Program and addressed only artificial colorings and preservatives. The Feingold Program also eliminates the thousands of artificial flavorings in the American diet, which have never been proven safe.

= Double blind controlled study

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Listed in date order, with the newest first:

McCann 2007 Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial.
Lien 2006 (Survey) Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway.
Husain 2006 (Evaluation) Estimates of dietary exposure of children to artificial food colours in Kuwait.
Murphy 2006 The ketogenic diet causes a reversible decrease in activity level in Long-Evans rats.
Lau 2006 (Neurotoxicology Study) Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test.
Bateman 2004 The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children.
Breakey 2004 (Review) Is food intolerance due to an inborn error of metabolism?
Schab 2004 (Meta Analysis) Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials./font>
Harding 2003 (Comparison Study) Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD.
Schnoll 2003 (Review) Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect.
Brue 2002 (Review) Alternative treatments for attention-deficit/hyperactivity disorder: does evidence support their use?
Dengate 2002 Controlled trial of cumulative behavioural effects of a common bread preservative.
Pelsser 2002 (Open Study) Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study.
Arnold 2001 (Review) Alternative treatments for adults ith attention-deficit hyperactivity disorder (ADHD).
Berdonces 2001 (Review) Attention deficit and infantile hyperactivity.
Kidd 2000 (Review) Attention Deficit/Hyperactivity disorder (ADHD) in children: rationale for its integrative management.
Anthony 1999 (Review) Attention Deficit Hyperactivity Disorder - letter to the editor.
Arnold 1999 (Review) Treatment alternatives for Attention-Deficit/Hyperactivity Disorder (ADHD).
Baumgaertel 1999 (Review) Alternative and controversial treatments for attention-deficit/hyperactivity disorder.
Beseler 1999 (Clinical Article/ Review) Effects on Behavior and Cognition: Diet and Artificial Colors, Flavors, and Preservatives.
Schnyder 1999 (Review) Food intolerance and food allergy.
Stubberfield 1999 (Review) Utilization of alternative therapies in attention-deficit hyperactivity disorder.
Bennett 1998 (Case Studies) The Shipley Project: Treating Food Allergy to Prevent Criminal Behaviour in Community Settings.
Breakey 1997 (Review) Review: The Role of Diet and Behaviour in Childhood.
Bennett 1997 (Questionnaire) The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders.
Schmidt 1997 Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.
Uhlig 1997 Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder.
Ward 1997 Assessment of chemical factors in relation to child hyperactivity.
McFadden 1996 (Review) Phenotypic Variation in Xenobiotic Metabolism and Adverse Environmental Response: Focus on Sulfur-Dependent Detoxification Pathways
Mothes 1996 Effects of prenatal ethanol exposure and early experience on home-cage and open-field activity in mice.
Reyes 1996 (Lab Study) Effect of organic synthetic food colours on mitochondrial respiration.
Weiss 1994 (Review) Low-level chemical sensitivity: a perspective from behavioral toxicology.
Boris 1994 Foods and Additives are Common Causes of the Attention Deficit Hyperactive Disorder in Children
Rowe 1994 Synthetic Food Coloring and Behavior:  A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study
Carter 1993 Effects of a Few Foods Diet in Attention Deficit Disorder
Egger 1992 Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior
Egger 1992 Controlled Trial of Hyposensitisation in Children with Food-Induced Hyperkinetic Syndrome
Novembre 1992 Unusual reactions to food additives
Schoenthaler 1991 (Retrospective
Study)
Applied Nutrition and Behavior
Pollock 1990 Effect of artificial food colours on childhood behaviour.
Ward 1990 The influence of the chemical additive tartrazine on the zinc status of hyperactive children: A double-blind placebo-controlled study.
Egger 1989 Oligoantigenic diet treatment of children with epilepsy and migraine
Kaplan 1989 Overall Nutrient Intake of Preschool Hyperactive and Normal Boys
Kaplan 1989 Dietary Replacement in Preschool-Aged Hyperactive Boys
Rowe 1988 Synthetic Food Colourings and "Hyperactivity": a Double-Blind Crossover Study
Arevalo 1987 Tyrosine administration to pregnant rats induces persistent behavioral modifications in the male offspring.
Gross 1987 The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders
Schoenthaler 1986 (Retrospective
Study)
The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools.
Weiss 1986 (Review) Food additives as a source of behavioral disturbances in children.
Zeisel 1986 (Review) Dietary influences on neurotransmission.
Collins 1985 (Review) Clinical spectrum of adverse reactions to tartrazine.
Egger 1985 Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome
Allen 1984 (Review) Adverse Reactions to Foods.
Menzies 1984 (Case Studies) Disturbed children: the role of food and chemical sensitivities.
Schauss 1984 Nutrition and behavior: complex interdisciplinary research.
Augustine 1983 (Neurotoxicology Study) Neurotransmitter release and nerve terminal morphology at the frog neuromuscular junction affected by the dye Erythrosin B.
Augustine 1983 (Neurotoxicology Study) Presynaptic effect of Erythrosin B at the frog neuromuscular junction: ion and photon sensitivity.
Egger 1983 Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment.
Rimland 1983 (Review) The Feingold diet: an assessment of the reviews by Mattes, by Kavale and Forness and others.
Rippere 1983 (Critique) Food additives and hyperactive children: a critique of Conners.
Feingold 1982 (Article) The role of diet in behavior.
Goldenring 1982 Sulfanilic acid: behavioral change related to azo food dyes in developing rats.
Salamy 1982 Physiological changes in hyperactive children following the ingestion of food additives.
Satterfield 1982 (Prospective
Study)
A Prospective Study of Delinquency in 110 Adolescent Boys with Attention Deficit Disorder and 88 Normal Adolescent Boys
Weiss 1982 (Review) Food additives and environmental chemicals as sources of childhood behavior disorders.
Yamawaki 1982 Effects of toluene inhalation on locomotor activity and brain catecholamine levels in rats.
Mattes 1981 Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study.
Augustine 1980 Neurotransmitter release from a vertebrate neuromuscular synapse affected by a food dye.
Dickerson 1980 (Review) Diet and hyperactivity.
Swanson 1980 Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test
Weiss 1980 Behavioral responses to artificial food colors.
Brenner 1979 Trace mineral levels in hyperactive children responding to the Feingold diet
Lafferman 1979 (Neurotoxicology Study) Erythrosin B inhibits dopamine transport in rat caudate synaptosomes.
Dumbrell 1978 (Comparison) Is the Australian version of the Feingold diet safe?
Fitzsimon 1978 Salicylate sensitivity in children reported to respond to salicylate exclusion.
Goyette 1978 Effects of artificial colors on hyperkinetic children: a double-blind challenge study.
Harley 1978 Hyperkinesis and food additives: testing the Feingold hypothesis.
Harper 1978 (Comparison) Nutrient intakes of children on the hyperkinesis diet.
Hindle 1978 The management of hyperkinetic children: a trial of dietary therapy.
Levy 1978 Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge.
Rose 1978 The functional relationship between artificial food colors and hyperactivity.
Williams 1978 Relative effects of drugs and diet on hyperactive behaviors: an experimental study.
Brenner 1977 (Case studies) A study of the efficacy of the Feingold diet on hyperkinetic children. Some favorable personal observations.
Conners 1976 Food additives and hyperkinesis: a controlled double-blind experiment.
Cook 1976 (Open diet study) The Feingold dietary treatment of the hyperkinetic syndrome.
Salzman 1976 (Case studies) Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome.




The following excerpts are in alphabetical order by first author.

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  1. Adverse reactions to foods. Allen DH, Van Nunen S, Loblay R, Clarke L, Swain A, Med J Aust 1984 Sep 1;141(5 Suppl):S37-42
    " ... In the majority of patients presenting with food intolerance, recognized or otherwise, symptoms are precipitated by various small, non-immunogenic organic molecules present in the food as natural or added ingredients. These reactions are pharmacological rather than immunological in nature, although in some situations they may share a final common pathway with true allergic reactions, resulting in similar symptoms. "

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  2. Attention deficit hyperactivity disorder , Anthony HM; Maberly DJ; Birtwistle S. Arch Dis Child 1999;81:189 (August)
    "... an elimination diet is effective in most cases. ... If they have had help with finding alternative foods, most parents find it surprisingly easy to keep the child to the diet most of the time after the first few weeks because the child usually prefers to feel well. ... If the diet is effective, behaviour often reverts to normal, to the great relief of all concerned. In view of the potential toxicity of medication in children and its limited effectiveness, all families with hyperactive children should be offered help in detecting offending foods. It is more appropriate to reserve medication for those who fail. "

    Text of Letter
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  3. Tyrosine administration to pregnant rats induces persistent behavioral modifications in the male offspring. Arevalo R, Castro R, Palarea MD, Rodriguez M, Physiol Behav 1987;39(4):477-81
    "... The offspring treated with large tyrosine doses showed a marked increase in both spontaneous locomotor activity and open field locomotion as adults. However, activity in the swim test decreased. ... The behavior of the rats treated with small doses of tyrosine was similar, in all tests performed, to that of rats treated with saline solution. These findings strongly suggest that a large increase in diet tyrosine during pregnancy modifies the behavior of male offspring"

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  4. Treatment alternatives for Attention-Deficit/Hyperactivity Disorder. (ADHD) Arnold, LE, Journal of Attention Disorders, Vol. 3, No. 1, April 1999, pp. 30-48
    " ...The oligoantigenic or few-foods diet [an extreme Feingold-type diet] has convincing double-blind evidence of efficacy in multiple trials for a properly selected subgroup. ... "

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  5. Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Arnold LE, Ann N Y Acad Sci 2001 Jun;931:310-41
    " ...Twenty-four alternative Tx were identified... Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. ... "

    Note: Dr. Arnold explained to us that his conclusion is based, not on a study showing lack of effect, but on the lack of any study on the effect of diet on adults --in other words, absence of evidence, not evidence of absence-- and the suggestion in some child studies that the effect is stronger in younger children. If any researcher reading this would like to do one, we hope that you will contact us at [email protected]

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  6. Neurotransmitter release from a vertebrate neuromuscular synapse affected by a food dye. Augustine GJ Jr, Levitan H, Science 1980 Mar 28;207(4438):1489-90
    " The food dye erythrosine (Erythrosin B; FD&C; No. 3) was applied to isolated neuromuscular synapses in the frog ... At concentrations of 10 muM or greater this anionic dye produced an irreversible, dose-dependent increase in neurotransmitter release.... These results suggest that erythrosine might prove a useful pharmacological tool for studying the process of transmitter release, but that its use as a food additive should be reexamined. "

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  7. Neurotransmitter release and nerve terminal morphology at the frog neuromuscular junction affected by the dye Erythrosin B. Augustine GJ, Levitan H, J Physiol 1983 Jan;334:47-63
    No abstract available

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  8. Presynaptic effect of Erythrosin B at the frog neuromuscular junction: ion and photon sensitivity. Augustine GJ, Levitan H, J Physiol 1983 Jan;334:65-77
    " . . . These results indicate that Erythrosin B is not acting solely by altering the ionic permeability of the presynaptic nerve terminal to calcium, magnesium, or sodium ions, or by altering the calcium metabolism of the terminal. The enhanced effect of the dye in calcium-free saline suggests that it may be competing with calcium at a common site, while the enhancement of its effect in elevated external calcium suggests that the dye may also increase the permeability of the nerve terminal to calcium ions. "

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  9. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Bateman B et al, Archives of Disease in Childhood. 2004 Jun;89(6):506-11.
    "AIMS: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. . . .RESULTS: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. . . .CONCLUSIONS: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children . . . "

    Note: The investigators suggest removing these from the diet of all children.  Just think about it -- only 20 mg per day of coloring was used as the "challenge." Imagine the results had they used the 150 mg of coloring present in one (1) Tb of green ketchup.

    Full Text of Study
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  10. Alternative and controversial treatments for attention-deficit/hyperactivity disorder. Baumgaertel A, Pediatr Clin North Am 1999 Oct;46(5):977-92
    Vanderbilt University School of Medicine
    "... Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. At this point, nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, ... The primary care provider, the alternative "specialist," and the family all should be willing to engage in "collaborative research," applying the same standards for treatment evaluation that one would apply in mainstream methods. Communication among all parties involved in a treatment strategy is the key to demystifying alternative approaches, creating strong therapeutic relationships, and optimizing management."

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  11. Attention deficit and infantile hyperactivity, Berdonces JL, Rev Enferm 2001 Jan;24(1):11-4
    "... psychiatric medication has major risks in children. From complementary medicine we can find several aids in changing diet patterns and supplementing with vitamins or minerals. Chocolate, sugar, sweeteners, additives, preservatives, dyes, can enhance the incidence of this syndrome; instead the supplementation with lipids rich in PUFA's can prevent it. B complex vitamins, magnesium, copper, manganese or calcium can be interesting and in herbal medicine, sedative plants like passion flower, valerian or lemon balm are useful aids. Also liquorice, fennel and berries can be used for different physiological actions."

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  12. Effects on Behavior and Cognition: Diet and Artificial Colors, Flavors, and Preservatives Beseler L, International Pediatrics, Volume 14, No. 1, 1999
    " This article explores the various controversies regarding nutrition and behavior. Reports have linked various foods, food dyes, and preservatives to behaviorónotably in children with Attention Deficit Hyperactivity Disorder. ..."

    Some interesting notes on this report: The Rowe study was mentioned, with the note that in the double-blind portion of the 1994 Rowe & Rowe study, behavioral changes were "associated with ingestion of tartrazine in some children." Perhaps it would have choked them to tell you that 19 of 23 "suspected reactors" (82.5%) were confirmed by the double blind test? - and that this was confirmed with quite a small dose of tartrazine. They do say that "higher doses of greater than 10 mg increased the duration of effect beyond 24 hours" ... 10 mg? That is about the amount in only half a cup of Koolaid, or the amount in less than 1/4 teaspoon of bright yellow cake frosting or equivalent size of solid-color candy.

    Surprisingly, the authors chose the 1987 David study to illustrate the "other side." In this small study, children were used who were not responding evenly to dietary intervention attempts, and parents had been referred to Dr. David for help. Tests were run on children already in the midst of reactions. Although large "doses" of coloring were used, they were already as "bad" as they could get apparently - so no effect was noted.

    The article encourages doctors that "if food sensitivity is demonstrated, an elimination diet can be utilized." This is a strange statement since the elimination diet itself is the only method to "demonstrate" food sensitivity. The article goes on to instruct doctors how to explain to parents that additives are impossible to avoid, and that a natural-foods diet is expensive and requires professional supervision to prevent nutritional deficits, and furthermore, that "while exploring nutrition interventions the families should be encouraged to pursue other forms of scientifically proven therapies."

    At no time is the Feingold Association recommended as a resource to make the diet easier to implement; but then it is clearly not the intent of the writer to do so.

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  13. Foods and Additives are Common Causes of the Attention Deficit Hyperactive Disorder in Children, Boris M; Mandel F, Annals of Allergy, May 1994, Vol. 72, pp. 462-8
    73% of 26 children with ADHD responded favorably to a diet eliminating reactive foods and artificial colors. 16 of the improved children were given a double blind challenge with 100 mg of mixed food dyes or a food chosen by the parent. ALL of them reacted to the challenge. Placebo effect was ruled out, as the children were as good on placebo days as at baseline (on the diet). "This study demonstrated a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD. Dietary factors may play a significant role in the etiology of the majority of children with ADHD."

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  14. Review: The Role of Diet and Behaviour in Childhood, J. Breakey, Journal of Paediatric Child Health, 1997, Jun;33(3) pp.190-194
    "The research has shown that diet definitely affects some children. ... and some non-food items are relevant. Symptoms which may change include those seen in attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), sleep problems and physical symptoms, with later research emphasizing particularly changes in mood."

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  15. Is food intolerance due to an inborn error of metabolism? Breakey J., Asia Pac J Clin Nutr. 2004;13(Suppl):S175.
    " Since Feingold hypothesised that chemicals in food caused hyperactivity in 1973 this issue has been controversial. ... As well as Attention Deficit Hyperactivity Disorder [ADHD] symptoms improving, mood and physical allergic symptoms improved on a low suspect chemical diet. ...

    To add to the confusion some of the symptoms which respond to diet include headaches, migraine, irritable bowel syndrome [IBS], mouth ulcers, and carsickness which are not allergic symptoms. The fact that symptoms responding were in many of the body's systems meant that several possible mechanisms have been proposed but none clarified.

    Yet another mechanism was proposed with the use of a gluten and casein free diet in autistic children. Peptides from these proteins are absorbed and thought to act as opiates affecting brain function. However those using this diet also exclude additives, chocolate, MSG and other small molecular weight compounds.

    An intriguing aspect of dietary response in the ADHD research was the finding of a reduction in halitosis [bad breath]. This author has also had patients report a reduction in breath and also in body and urine odour. Since most of the suspect chemicals are aromatic in structure the possibility of their poor metabolism arose. This was supported by the finding that similar enzymes are involved in the metabolism of both the suspect phenolic compounds [additive colours and flavours, salicylates and the benzoate preservative] and the amines. These are the sulpho transferases. Amines were reported to be degraded in the gut and phenolic compounds in the kidney.

    Work with diet-responding autistics in the UK has reported relevant findings that implicate sulphur metabolism. These autistic children have shown reduced levels of plasma sulphate, and increased levels of excretion of sulphate, sulphite and thiosulphate in their urine compared to controls. Sulphur oxidation appears to be abnormal in this group. The numbers of slow metabolisers or null metabolisers of cysteine dioxygenase in autistics is much higher than the normal population. A study of non-autistic food intolerant patients showed similar biochemical abnormalities.

    In clinical research it has been found that foods are better tolerated if flavour is mild, and more adverse reactions occur to foods which are highly flavoured, so a defect in management of aromatic compounds is indicated. The research implicating a defect in the metabolism of phenolic and amine metabolism provides evidence of a possible mechanism. "

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  16. A study of the efficacy of the Feingold diet on hyperkinetic children. Some favorable personal observations. Brenner A, Clinical Pediatrics (Phila) 1977 Jul;16(7):652-6
    "... the startling changes seen in patients who had been followed for years with other forms of therapy suggest strongly that this improvement was genuine. "

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  17. Trace mineral levels in hyperactive children responding to the Feingold diet, Brenner A, Journal of Pediatrics 1979 Jun;94(6):944-5
    Abstract [not included on MedLine]: "The Feingold hypothesis associating the hyperkinetic syndrome with ingestion of common food additives, artificial colors and flavors, and salicylate-containing foods has evoked considerable controversy. Since many children ingest these ubiquitous additives, and no differences in dietary habits have been noted between hyperkinetic and nonhyperkinetic children, it is possible that a biochemical difference may be present in children who appear to be affected by the additives."

    20 children who responded to the Feingold diet, and 14 who did not were tested for copper and zinc levels in their blood. There was a significantly higher level of copper in the children who did respond to the diet. Possible reasons are discussed.

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  18. Alternative treatments for attention-deficit/hyperactivity disorder: does evidence support their use? Brue AW, Oakland TD, Altern Ther Health Med 2002 Jan-Feb;8(1):68-70, 72-4
    " . . . Stimulant medication is one of the most common treatments for ADHD; however, adverse reactions from its use cause many parents to seek complementary or alternative treatments. . . . The success of CAM (complementary and alternative medicine) in treating children with ADHD varies, and parents typically use a trial-and-error method when evaluating CAM. Alternative treatments often include neurofeedback, homeopathy, herbal medicines, iron supplements, and dietary modifications or supplements. . . the use of more conventional treatments should be considered if alternative interventions prove unsuccessful. "

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  19. Effects of a Few Foods Diet in Attention Deficit Disorder, C.M. Carter, et al, Archives of Disease in Childhood, November 1993, Vol. 69 (5), pp.564-8
    59 of 78 children (75.6%) referred for "hyperactive behavior" improved on an open trial of an elimination diet.  19 of them were studied in a placebo-controlled double-blind challenge protocol.

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  20. Clinical spectrum of adverse reactions to tartrazine. Collins-Williams C, J Asthma 1985;22(3):139-43
    "Tartrazine, a common additive in foods and drugs, often causes adverse reactions such as recurrent urticaria, angioedema, and asthma and is frequently implicated in hyperkinesis. This paper summarizes the recent literature on the subject and outlines a practical approach for the practicing physician to diagnose and treat these patients in an optimal manner. "

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  21. Food additives and hyperkinesis: a controlled double-blind experiment. Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA, Pediatrics 1976 Aug;58(2):154-66
    "A double-blind crossover trial involving a control diet and a diet eliminating artificial flavors, colors, and natural salicylates as recommended by Feingold was conducted on 15 hyperkinetic children. ...Both parents and teachers reported fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline. ..."

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  22. The Feingold dietary treatment of the hyperkinetic syndrome., Cook PS, Woodhill JM., Med J Aust. 1976 Jul 17;2(3):85-8, 90.
    " ... Following Feingold's dietary prescription, an elimination diet relevant to the foods available in Sydney was developed. The treatment regime is described, and the results of its application to 15 hyperkinetic children are presented. The parents of 10 children are "quite certain" and those of three others "fairly certain" that their children's behaviour not only improved substantially with the diet, but also relapsed promptly when significant dietary infringements occurred. A possible ecological implication of these findings is briefly discussed. "

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  23. Controlled trial of cumulative behavioural effects of a common bread preservative. Dengate S, Ruben A., J Paediatr Child Health 2002 Aug;38(4):373-6
    " ...Twenty-seven children, whose behaviour improved significantly on the Royal Prince Alfred Hospital diet, which excludes food additives, natural salicylates, amines and glutamates, were challenged with calcium propionate (preservative code 282) or placebo through daily bread in a double-blind placebo-controlled crossover trial. ... CONCLUSIONS: Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative in healthy foods consumed daily. Minimizing the concentrations added to processed foods would reduce adverse reactions. Testing for behavioural toxicity should be included in food additive safety evaluation. "

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  24. Diet and hyperactivity. Dickerson JW, Pepler F., Journal of human nutrition 1980 Jun;34(3):167-74
    " Before the role of diet is considered a number of questions about the nature of hyperactivity are confronted. How common is the condition? What are the problems of diagnosis? How successful is drug treatment? The effectiveness of the Feingold diet in combatting hyperactivity and the importance of adverse reaction by children to items in the diet is emphasised. "

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  25. Is the Australian version of the Feingold diet safe? Dumbrell S, Woodhill JM, Mackie L, Leelarthaepin B, Med J Aust 1978 Dec 2;2(12):548, 569-70
    "... The nutritional quality, in terms of the level and balance of nutrients in the elimination test diet, was superior to that of the normal diet. With proper dietary counselling, the elimination test diet is safe for use in the treatment of children with hyperkinesis."

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  26. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment., Egger J et al., Lancet 1983 Oct 15;2(8355):865-9
    "93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; ... the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children. ... Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. In most of the patients in whom migraine was provoked by non-specific factors, such as blows to the head, exercise, and flashing lights, this provocation no longer occurred while they were on the diet."

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  27. Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome, J.Egger, P.J.Graham, J.F.Soothill, C.M.Carter, D.Gumley, The Lancet, March 9, 1985
    62 of 76 selected overactive children (81.6%) improved; other symptoms such as headaches, abdominal pain, and fits, also improved.

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  28. Oligoantigenic diet treatment of children with epilepsy and migraine, Egger J, Carter CM, Soothill JF, Wilson J, Journal of Pediatrics 1989 Jan;114(1):51-8
    Of 45 children with epilepsy and recurrent headaches, abdominal symptoms, or hyperkinetic behavior, 36 [80%] improved on an oligoantigenic diet; 25 [55%] ceased to have seizures and 11 had fewer seizures during diet therapy. "Headaches, abdominal pains, and hyperkinetic behavior ceased in all those whose seizures ceased, and in some of those whose seizures did not cease." ..."Of 24 children with generalized epilepsy, 18 [75%] recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 [85%] children with partial epilepsy. In double-blind, placebo-controlled provocation studies, symptoms recurred in 15 of 16 children, including seizures in eight; none recurred when placebo was given. Eighteen other children, who had epilepsy alone, were similarly treated with an oligoantigenic diet; none improved."

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  29. Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior, Egger J, Carter CH, Soothill JF, Wilson J, Clinical Pediatrics (Phila) 1992 May;31(5):302-7
    "Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. [daytime or nighttime bed wetting] On diet, the enuresis stopped in 12 of these children and improved in an additional four. [76%] ... Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods."

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  30. Controlled Trial of Hyposensitisation in Children with Food-Induced Hyperkinetic Syndrome, J.Egger, A.Stolla, L.McEwen, The Lancet, May 9, 1992, Vol. 339, pp. 1150
    A trial of enzyme-potentiated desensitisation, expected to be useful for those who have problems with foods that are difficult to avoid, or who cannot comply with dietary restrictions.

    Note: This is EPD, in use in England for 30 years. The FDA, responding to a ruling by the Medical Board of California, prevented new patients from being accepted under the then-existing national IRB treatment program. Although the doctor eventually won on appeal, EPD is now effectively illegal in the U.S. See www.treatmentchoice.org

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  31. The role of diet in behaviour. Feingold BF., Ecology of Disease 1982;1(2-3):153-65
    "The behavioural disorders, frequently labelled hyperkinesis, hyperkinetic impulse disorder, hyperactivity, Minimal Brain Dysfunction (MBD) and Attentional Deficit Disorder (ADD), are among the most critical problems of our contemporary culture.

    "Truancy, vandalism, violence and assault among school children coupled with a persistent drop in scholastic achievement is a universal problem affecting the school population of every so-called developed country. Every procedure for the control of behavioural disorders has not been successful; every technique for the improvement of learning has not been productive, while every modality for the rehabilitation of delinquents has failed us. Since all these procedures have been structured upon psychosocial concepts, it becomes necessary to look elsewhere for the answers, which is to the biosciences, including genetics, molecular genetics, pharmacogenetics, behavioural toxicology, behavioural teratology, immunochemistry, immunology, allergy and endocrinology, with a focus upon nutrition, which encompasses all these disciplines.
    ...
    The increase in behavioural disorders accompanied by a persistent drop in scholastic performance coupled with the continuing rise in the prevalence of delinquency is undoubtedly one of the most important expressions of the disruption of nature by the rising concentration of pollutants in the ecosystem. The prospect for controlling and eliminating the major contaninants of the environment is not too promising for the immediate future; however, an informed public, which should lead to greater commitment and involvement, would be followed by the containment and then reversal and resolution of this critical and important present-day situation involving the health and behaviour of both our contemporary population and also future generations. Public recognition and participation in the problem are mandatory to correct the insidious downgrading of the human race, which is already evident. "

    Dr. Feingold finalized this paper in the few days before his death. He had not had time to list his references, and the editors noted that they had decided to publish it without them.

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  32. Salicylate sensitivity in children reported to respond to salicylate exclusion. Fitzsimon M, Holborow P, Berry P, Latham S, Medical Journal of Australia 1978 Dec 2;2(12):570-2
    Twelve children, aged six to 13 years, whose parents reported an improvement in behavioural problems with use of the Feingold (K-P) diet for an average period of 12 months, were challenge-tested with 40 mg of acetylsalicylic acid in a double-blind, cross-over trial with ascorbic acid as a placebo. ... significance was reached in tests of general cognitive capacity, line walking and the "finger-to-nose" tests, as well as increased disturbance in sleep patterns in these children.

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  33. Sulfanilic acid: behavioral change related to azo food dyes in developing rats. Goldenring JR, Batter DK, Shaywitz BA., Neurobehavioral Toxicology and Teratology. 1982 Jan-Feb;4(1):43-9.
    " The effects of sulfanilic acid, a major azo food dye metabolite, were studied in normal developing rat pups and pups treated with 6-hydroxydopamine (60HDA). Chronic daily intraperitoneal injection of sulfanilic acid during the first postnatal month elicited hyperactivity and impaired shock escape performance in vehicle pups. ... These findings, which are similar to the results of our study of chronic administration of a food dye mix, suggest that sulfanilic acid may be one of the causative agents in food dye-induced behavioral changes in developing rats. ... "

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  34. Effects of artificial colors on hyperkinetic children: a double-blind challenge study. Goyette GH, Connors CK, Petti TA, Curtis LE, Psychopharmacol Bull 1978 Apr;14(2):39-40
    "Summary: ... In the first trial there was suggestive evidence that performance on a visual-motor tracking task may be impaired following ingestion of challenge material. Three "dye-sensitive" children retested in the laboratory gave results consistent with an impairment of attention and visual motor tracking 1 hour after cookie ingestion... A second study showed significant effects on parent ratings when these were limited to a 3-hour period immediately following ingestion of the cookies, suggesting that artificial food dyes do indeed impair and disrupt the behavior of the children..."

    Note: The "challenge" dose of food dyes is not specified, but implied to be 13 mg. This tiny amount still resulted in a trend of performance deficits on a visual motor tracking task after challenge but not after placebo. The deficits were more pronounced in younger children. This is not surprising because 13 mg is a larger "dose" per body weight for a smaller child.

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  35. The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders. Gross MD, Tofanelli RA, Butzirus SM, Snodgrass EW., J Am Acad Child Adolesc Psychiatry. 1987 Jan;26(1):53-5.
    " Thirty-nine children in a summer camp were given the Feingold Diet, which eliminates artificial additives and salicylate-containing foods, for 1 week, followed by administration for 1 week of food containing those ingredients. The behavior of all children was monitored by videotape for 4-minute intervals at mealtime. All children were classified by public school psychologists as having moderate to severe learning disorder; 18 were also hyperkinetic, and 17 were taking medication for the latter condition. Three raters blind to the respective diets the children were on rated the children's behavior for motor restlessness, disorganized behavior, and misbehavior. No significant differences were found in behaviors during weeks 1 and 2. The authors conclude that the Feingold Diet has no beneficial effect on most children with learning disorders, or on hyperkinetic children taking medication."

    Full Text of Study
    Note: Because this study has been cited occasionally as the "definitive" study on the Feingold diet, it deserves some extended comment:

    They were studying a diet recommended for children with ADHD, which usually takes more than one week to "show" an effect, and longer when a child is on medication. However,

    1. More than half the children in the study did not have ADHD.
    2. All but one of the children with ADHD were on medication the whole time.
      • If the medication worked well, how would they measure a diet effect?
      • The medication itself contained coloring - counteracting any diet effect.
    3. The one child not on medication was sent home because his behavior got worse when given the additives in Week 2
    4. One other child was sent home in Week 2 because his behavior got worse. It was concluded that his medication (Cylert) was "not strong enough."
    5. Notice that the video taping was done during mealtime to measure a reaction expected to occur only several hours after mealtime.
    6. Notice that the raters were "blind to the respective diets."
      • Dr. Gross - the primary investigator - was one of the three raters. Since he would be seeing the film, taken during meals, and could SEE whether or not there was ketchup on the tables, are we to truly believe that he was "blind" to the respective diets, as reported?
      • Alternatively, if the camera angle was so wide that all children were visible at once and details such as condiment bottles could not be seen, how well could the children themselves be seen for observation of their behavior?
    7. The children were not told that they were on a "diet" - they were told that the "good stuff" had not yet arrived. Is it very surprising that they were negative?
    8. Mustard was eliminated, for reasons unknown - appropriate brands of mustard are acceptable on the Feingold diet.
    9. Snacks and treats were eliminated, for reasons unknown - appropriate brands of candy and other treats are acceptable on the Feingold diet.
    10. Coloring, flavoring, and fragrances were apparently not eliminated, however, in personal toiletries, medications taken by the children, and cleaning supplies used by the camp, over which there was apparently no effort made at control.
    11. Nevertheless, the camp director and teachers were united in their observation that the children were noisier during the second (additive-rich) week. This was duly noted but discounted by the researchers.
    12. The researchers acknowledged that a one-week trial of the diet is short, but defended it by saying that people already using the Feingold diet say that eating something "off-diet" causes a reaction within a few hours.
      • This is only relevant AFTER a good response to the diet.
      • No initial response to the diet is expected, usually, until after one to several weeks.
      • Children on psychoactive medication or recently off it take longer to respond to the diet than do those who have never been on such medications. This has been reliably observed since the 1960's by Dr. Feingold, by other doctors using the diet, and by the Feingold Association.

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  36. Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD. Harding KL, Judah RD, Gant C. Altern Med Rev. 2003 Aug; 8(3): 319-30.
    " Twenty children with attention deficit/hyperactivity disorder (AD/HD) were treated with either Ritalin (10 children) or dietary supplements (10 children) . . . Subjects in both groups showed significant gains . . . . . .Numerous studies suggest that biochemical heterogeneous etiologies for AD/HD cluster around at least eight risk factors: food and additive allergies, heavy metal toxicity and other environmental toxins, low-protein/high-carbohydrate diets, mineral imbalances, essential fatty acid and phospholipid deficiencies, amino acid deficiencies, thyroid disorders, and B-vitamin deficiencies. . . . These findings support the effectiveness of food supplement treatment in improving attention and self-control in children with AD/HD and suggest food supplement treatment of AD/HD may be of equal efficacy to Ritalin treatment. "

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  37. Hyperkinesis and food additives: testing the Feingold hypothesis. Harley JP, Ray RS, Tomasi L, Eichman PL, Matthews CG, Chun R, Cleeland CS, Traisman E, Pediatrics 1978 Jun;61(6):818-28
    " Teacher ratings, objective classroom and laboratory observational data, attention-concentration, and other psychological measures obtained on 36 school-age, hyperactive boys under experimental and control diet conditions yielded no support for the Feingold hypothesis. Parental ratings revealed positive behavioral changes for the experimental diet; however, they seemed primarily attributable to one diet sequence. Parents' behavioral ratings on ten hyperactive, preschool boys indicated a positive response to the experimental diet; again, laboratory observations showed no diet effect. "

    Note: This study was funded by the "Nutrition Foundation," a food additive and chemical industry organization. Harley claimed he found "no support" for the diet. Nevertheless, 100% of preschoolers and 63% of the group of older children who had done the "control" diet first improved on the Feingold diet in this study. Harley discounted the 63%, claiming an "order effect."

    Upon reading the analysis of the Harley study by Dr. Bernard Weiss, Professor of Toxicology at University of Rochester School of Medicine and Dentistry, it becomes clear that there was no actual "order effect" for the older children.

    Without arguing the point, suffice it to say that the two groups of older children were not equal. The ones who were put on the Feingold diet after the control diet where off their medications several weeks longer than the ones put on the Feingold diet first. Since it was already known that stimulant medications increase the time necessary before an effect of diet is seen, we wonder why they were surprised to find this happening in this study (where those on the "control" diet first would have been off the meds several weeks more than the ones doing the Feingold diet first).

    You can see another detailed analysis of the Harley study (and others).

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  38. Nutrient intakes of children on the hyperkinesis diet. Harper PH, Goyette CH, Conners CK, J Am Diet Assoc 1978 Nov;73(5):515-9
    "The nutrient intakes of fifty-four hyperactive children during a baseline period and while following the hyperkinesis diet were calculated. During both periods, mean dietary intakes compared favorably with the Recommended Dietary Allowances. ..."

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  39. The management of hyperkinetic children: a trial of dietary therapy. Hindle RC, Priest J , N Z Med J 1978 Jul 26;88(616):43-5
    "... Ten hyperkinetic children have been treated with the diet, five of whom improved dramatically and are now off all other therapy. Their response to accidental and deliberate challenge supports the hypothesis that the dietary regime described has been responsible for their improvement."

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  40. Estimates of dietary exposure of children to artificial food colours in Kuwait. Husain A, Sawaya W, Al-Omair A, Al-Zenki S, Al-Amiri H, Ahmed N, Al-Sinan M., Food Additives & Contaminants 2006 Mar;23(3):245-51.
    "To assess the intake of artificial food colour additives by 5-14-year-old children in the State of Kuwait, a 24-h dietary recall was conducted twice on 3141 male and female Kuwaiti and non-Kuwaiti children from 58 schools. ... The results indicated that out of nine permitted colours, four exceeded their ADIs (acceptable daily intake) by factors of 2-8: tartrazine (E102/Yellow #5), sunset yellow (E110/Yellow #6), carmoisine (E122/not used in USA) and allura red (E129/Red #40). ... Further, follow-up studies to provide insight into potential adverse health effects associated with the high intakes of these artificial colour additives on the test population are warranted."

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  41. Overall Nutrient Intake of Preschool Hyperactive and Normal Boys, B.Kaplan et al, Journal of Abnormal Child Psychology, April 1989, Vol. 17(2), pp.127-32
    "...concluded that nutrition-behavior interactions are more likely a function of idiosyncratic sensitivities, rather than a general tendency for ADDH children to eat differently..."

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  42. Dietary Replacement in Preschool-Aged Hyperactive Boys, B.Kaplan, et al, Pediatrics, 1989, Vol. 83, pp. 7-17
    "More than half the subjects exhibited reliable improvement in behavior and negligible placebo effects.  In addition, several nonbehavioral variables tended to improve ... particularly halitosis, night awakenings, and latency to sleep onset."

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  43. Attention Deficit/Hyperactivity disorder (ADHD) in children: rationale for its integrative management. Kidd PM, Alternative Medicine Review 2000 Oct;5(5):402-28
    This is a review of treatments. " . . . major etiologic contributors also include adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins such as heavy metals and organohalide pollutants. Thyroid hypofunction may be a common denominator linking toxic insults with ADHD symptomatologies. Abnormalities in the frontostriatal brain circuitry and possible hypofunctioning of dopaminergic pathways are apparent in ADHD, and are consistent with the benefits obtained in some instances by the use of methylphenidate (Ritalin) . . . . Nutrient deficiencies are common in ADHD; supplementation with minerals, the B vitamins (added in singly), omega-3 and omega-6 essential fatty acids, flavonoids, and the essential phospholipid phosphatidylserine (PS) can ameliorate ADHD symptoms. When individually managed with supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and other features of a wholistic/integrative program of management, the ADHD subject can lead a normal and productive life."

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  44. Erythrosin B inhibits dopamine transport in rat caudate synaptosomes. Lafferman JA, Silbergeld EK, Science. 1979 Jul 27;205(4404):410-2.
    " . . . We found that erythrosin B inhibits dopamine uptake in rat caudate synaptosomes "uncompetitively" in the 10- to 800-micromolar range. . . . Erythrosin B also decreased nonsaturable binding of dopamine to the synaptosome membrane. The inhibitory action of erythrosin B on dopamine uptake is consistent with the hypothesis that erythrosin B can act as a central excitatory agent able to induce hyperkinetic behavior. "

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  45. Synergistic Interactions Between Commonly Used Food Additives in a Developmental Neurotoxicity Test. Lau K, McLean WG, Williams DP, Howard CV., Toxicol Sci. 2006 Mar;90(1):178-87, 2005 Dec 13; [Epub ahead of print]
    " Exposure to non-nutritional food additives during the critical development window has been implicated in the induction and severity of behavioural disorders such as attention deficit hyperactivity disorder (ADHD). . . We therefore examined the neurotoxic effects of four common food additives in combinations of two (Brilliant Blue and L-glutamic acid, Quinoline Yellow and aspartame) to assess potential interactions. . . Neurotoxicity was measured as an inhibition of neurite outgrowth. . . . Theoretical exposure to additives was calculated based on analysis of content in foodstuff, and estimated percentage absorption from the gut. Inhibition of neurite outgrowth was found at concentrations of additives theoretically achievable in plasma by ingestion of a typical snack and drink. . . both combinations had a straightforward additive effect on cytotoxicity. These data have implications for the cellular effects of common chemical entities ingested individually and in combination. "

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  46. Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Levy F, Dumbrell S, Hobbes G, Ryan M, Wilton N, Woodhill JM, Medical Journal of Australia 1978 Jan 28;1(2):61-4
    "...The rating scales and objective tests for the full sample did not show a statistically significant deterioration in the children's behaviour when they were challenged under double-blind test conditions with the Yellow Dye No. 5, tartrazine, and the tests were conducted the day after a two-week challenge period. ... a subgroup of the children... indicated a significant challenge effect, with mothers reporting more symptoms during the challenge period."

    NOTE: tests were conducted the day after challenge, not during challenge, and results of all children were averaged. Moreover, the "challenge" was 5 biscuits per day, each containing ONE mg of Tartrazine — a total per day of about ONE SWALLOW of Koolaid -- a very tiny dose indeed!

    Nevertheless, astonishingly, some of the children still reacted to this dye challenge!

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  47. Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E. American Journal of Public Health. 2006 Oct;96(10):1815-20
    " ... A cross-sectional population-based survey was conducted with 10th-grade students in Oslo, Norway (n = 5498). ... The relationship was linear for hyperactivity. ... the association between soft drink consumption and mental health problems remained significant after adjustment for behavioral, social, and food-related variables. The highest adjusted odds ratios were observed for conduct problems among boys and girls who consumed 4 or more glasses of sugar-containing soft drinks per day. CONCLUSIONS: High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders."

    Note: It has been concluded by some reporters that the cause of the behavioral deterioration is the high fructose corn syrup in these sodas, but there are many chemicals besides sugar or corn syrup included in sodas. Consider the combination of synthetic coloring, flavoring, and sodium benzoate, as suggested culprits.

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  48. Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study., Mattes JA, Gittelman R., Archives of General Psychiatry. 1981 Jun;38(6):714-8
    " ... We sought to maximize the likelihood of demonstrating behavioral effects of artificial food colorings by (1) studying only children who were already on the Feingold diet and who were reported by their parents to respond markedly to artificial food colorings, (2) attempting to exclude placebo responders, and (3) administering high dosages of coloring. ... Evaluations by parents, teachers, and psychiatrists and psychological testing yielded no evidence of a food coloring effect."

    See review by Bernard Rimland, PhD

    Notes:

    1. Their "high dose" of coloring did not even change the color of the cookies from identical cookies without coloring.
    2. Many of the children could not eat all the cookies, so they did not receive the expected dose of coloring.
    3. Evaluations were not always done 1 1/2 hours after eating a cookie - we have a report from one parent that she was unable to give her child the cookie and then drive to the meeting place.
    4. This same parent reports her child's reactions were so severe that the after-school dance teachers could not keep her in class, and she missed school because reactions included ear infections. You can read an excerpt of her letter here.
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  49. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Lancet, September 6, 2007 on line.
    "Artificial colours or a sodium benzoate preservative (or both) in the diet result in increased hyperactivity in 3-year-old and 8/9-year-old children in the general population."

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  50. Phenotypic Variation in Xenobiotic Metabolism and Adverse Environmental Response: Focus on Sulfur-Dependent Detoxification Pathways, S.A. McFadden, Toxicology, July 1996, Vol. 111(1-3), pp. 43-65
    "...a significant number of individuals with environmental intolerance or chronic disease have impaired sulfation of phenolic xenobiotics. This impairment is demonstrated with the probe drug acetaminophen and is presumably due to starvation of the sulfotransferases for sulfate substrate... In addition, impaired sulfation may be relevant to intolerance of phenol, tyramine, and phenylic food constituents, and it may be a factor in the success of the Feingold diet."

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  51. Disturbed children: the role of food and chemical sensitivities. Menzies IC. Nutr Health. 1984; 3(1-2): 39-54.
    " . . . A number of case studies are presented which suggest that the difficulties encountered by a significant number of these children have much to do with idiosyncratic responses to foods and additives. This hypothesis requires careful research study at an early date for if validated it will have far reaching implications for the assessment and management of disturbed, delinquent and learning disordered children. Perhaps not enough attention has been paid to the role of biological and environmental factors in the development of children's problems. Certainly recent research has begun to provide support for the concept of environmental (ecologic) illness. "

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  52. Effects of prenatal ethanol exposure and early experience on home-cage and open-field activity in mice. Mothes HK, Opitz B, Werner R, Clausing P, Neurotoxicol Teratol 1996 Jan-Feb;18(1):59-65
    "... Mice prenatally exposed to ethanol showed increased activity in their home cages, whereas open-field behavior was generally not different from that of control groups. Conversely, different preweaning rearing conditions had affected open-field behavior, but not home-cage activity. In conclusion, home-cage behavior was a sensitive paradigm for detecting hyperactivity subsequent to a relatively low dose of prenatal ethanol in mice..."

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  53. The ketogenic diet causes a reversible decrease in activity level in Long-Evans rats. Murphy P, Burnham WM., Experimental Neurology, 2006 Sep;201(1):84-9. Epub 2006 Jun 5.
    " Individuals with epilepsy also often exhibit symptoms of attention deficit hyperactivity disorder (ADHD). The ketogenic diet, which is a high fat, low protein, and low carbohydrate diet used in the treatment of intractable epilepsy, also appears to improve symptoms of ADHD in individuals with both disorders. Previous research suggests that the diet decreases the activity level of rats. ... adult male Long-Evans rats were placed on either a ketogenic diet or a control diet. The results of the first experiment show that the ketogenic diet can cause a decrease in activity level within 24 h and that the results are reversible. The results of Experiment 2 show that the decrease in activity level is not linked to a change in anxiety level. The ketogenic diet may be of use in the treatment of ADHD."

    Note: A word of caution is needed here. Every dietary manipulation which involves removing all or most "processed" foods approaches the Feingold diet by inadvertently eliminating all the many additives used in such products. We are therefore not surprised to see that removal of "only" milk, wheat, sugar, or protein/fats from the diet will "work," at least somewhat, in relieving hyperactive behavior.

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  54. Unusual reactions to food additives, Novembre E, Dini L, Bernardini R, Resti M, Vierucci A, Pediatria Medica e Chirurgica 1992 Jan-Feb;14(1):39-42
    "...In this study, we report two cases of unusual reactions to food additives (tartrazine and benzoates) involving mainly the central nervous system (headache, migraine, overactivity, concentration and learning difficulties, depression) and joints (arthralgias), confirmed with diet and double blind challenge. The possible pathogenetic mechanisms are also discussed."

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  55. Favourable effect of a standard elimination diet on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study Pelsser LM, Buitelaar JK, Ned Tijdschr Geneeskd 2002 Dec 28;146(52):2543-7
    " .. children, 36 boys and 4 girls, aged 3-7 (average 4.8 years), who met the DSM-IV-criteria for ADHD, followed their usual diet for two weeks and thereafter for two weeks an elimination diet, based on the few foods diet (rice, turkey, pear and lettuce). ... 25 children (62%) showed an improvement in behaviour of at least 50% on both the Conners list and the ADHD Rating Scale at the end of the elimination diet. Nine children (23%) withdrew from the study because the parents were unable to stick to the diet or because the child fell ill. Among the 15 children with both parent and teacher ratings, 10 [66%] responded both at home and in school. CONCLUSION: In young children with ADHD an elimination diet can lead to a statistically significant decrease in symptoms. "

    Note: This study was done in Holland where a Feingold Foodlist is not available. Their diet was very much more limited than the usual Feingold diet. Since 9 children dropped out, the number of children who completed the 2-weeks trial of the diet was only 31. Thus, 25 children improving would be 80.6% of them. This is in line with the results we see of those who try the Feingold diet, in spite of the fact that two weeks is a very short trial for any diet.

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  56. The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders, Bennett CPW, Brostoff J., Journal of Nutritional & Environmental Medicine, Vol.7, No.4 Dec 1997 pp.359-366
    " This questionnaire-based research addressed the young offender population in order to estimate the proportion likely to have food allergic and other nutritionally related disorders such as hyperactivity. A controlled health and dietary survey was conducted with 100 young offenders and 100 matched non-offenders. The offender group reported significantly higher rates of ill health than the non-offender group. It is suggested that the nutritional health of young offenders could be investigated as part of present statutory requirements to consider the physical and mental health of young criminals. There was no real difference between the diets of the two groups. Further research is justified into the association between nutrition, health and behaviour problems. From this study, the proportion of the persistent young offender population with maladaptive behaviours linked to food allergy, food intolerance and nutritional problems is cautiously estimated to be 75% whereas 18% of the young non-offender population is similarly affected. "TOP

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  57. The Shipley Project: Treating Food Allergy to Prevent Criminal Behaviour in Community Settings, Bennett CPW, McEwen LM, McEwen HC, Rose, EL, Journal of Nutritional & Environmental Medicine , Vol.8, No.1,Mar.1998, pp.77-83
    " Nine children with persistent anti-social, disruptive and/or criminal behaviours were assessed and treated for food intolerance and allergy. All were found to have a number of food allergies or intolerances and mineral imbalances, particularly in zinc. Three showed marginally raised cadmium while one had considerably raised cadmium. . . .The health and behaviour of all nine subjects improved both physically and psychologically. However, three children abandoned the dietary regime, two of whom re-offended and were placed in care while the third moved home and accepted enzyme-potentiated desensitization (EPD) treatment. He and the other six continued to improve in health, behaviour and school performance over 6 months. . . After 2 years, five of the nine had not re-offended. The feasibility of applying nutritional and biochemical assessment and treatment in the community to divert young offenders and disruptive schoolchildren from criminal behaviour was demonstrated. Criminal justice, education and health agencies could incorporate and develop this approach in furtherance of their statutory objectives.

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    Heart and Lung Institute, Brompton Hospital, London.
  58. Effect of artificial food colours on childhood behaviour. , Pollock I, Warner JO, Arch Dis Child 1990 Jan;65(1):74-7

    "... 19 children completed a double blind placebo controlled challenge study with artificial food colours. In these children food colours were shown to have an adverse effect on a daily Conners' rating of behaviour, but most parents could not detect these changes. A pharmacological mechanism of food additive intolerance is proposed to explain these effects."

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  60. Effect of organic synthetic food colours on mitochondrial respiration. Reyes FG, Valim MF, Vercesi AE. Food Additives and Contaminants. 1996 Jan;13(1):5-11
    " ... The compounds tested were: Erythrosine, Ponceau 4R, Allura Red, Sunset yellow, Tartrazine, Amaranth, Brilliant Blue, Blue, Fast Red E, Orange GGN and Scarlet GN. All food colours tested inhibited mitochondrial respiration ...This inhibition varied largely, e.g. from 100% to 16% for Erythrosine and Tartrazine respectively, ...This effect was dose related .... "

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  61. The Feingold diet: an assessment of the reviews by Mattes, by Kavale and Forness and others., Rimland B. Journal of Learning Disabilities 1983 Jun-Jul;16(6):331-3
    ". . . All of these reviews of research on the Feingold Diet come to essentially the same conclusion: The Feingold diet is of no value, or, at best, of marginal value for a few children, as a means of reducing hyperactivity. In my opinion, such a conclusion is certainly unwarranted, probably incorrect, and very likely damaging.

    Why do I come to this unkind and critical assessment of the diligent effort of so many colleagues? The answer can be expressed in one simple four letter word: "GIGO." GIGO, in computerese, stands for "garbage in, garbage out." That is, if the incoming data are of no value, no amount of massaging, analysis, or manipulation will increase its value.
    ...
    ...Suppose that thalidomide, rather than inducing structural deformities, had instead depressed IQ scores by 10%; would we ever have suspected it of adverse effects? The answer is all too obvious. We are all very much aware of a sharp decline in academic ability in our youngsters, including the 17 year drop in SAT scores. We are also aware of an enormous upsurge in youth crime during these decades. While there are a multitude of proposed alternative causes for these continuing disasters (e.g., Rimland and Larson, 1981), let us heed the insights and warnings of the prophetic Ben Feingold and remove the unnecessary pollutants from our food supply. Prudence demands no less. "

    See the rest of this review

    Note: Although this was published in 1983, the increase in violence and decrease in SAT scores (with periodic re-adjustments or "recentering" so that this drop is less obvious) has continued. How far will we let things go before we do something about it?

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  62. Food additives and hyperactive children: a critique of Conners. Rippere V, Br J Clin Psychol 1983 Feb;22 Pt 1:19-32
    " Food Additives and Hyperactive Children (Conners, 1980) is the first book-length attempt to evaluate Feingold's additive and salicylate-free Kaiser-Permenente diet for the treatment of hyperactive children, and as such it requires critical scrutiny. . .It is argued that the studies as reported do not constitute a methodologically adequate test of Feingold's hypothesis . . . and that it is thus premature to reject the hypothesis on the grounds presented here. . . "

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  63. The functional relationship between artificial food colors and hyperactivity.    Rose TL, J Appl Behav Anal 1978 Winter;11(4):439-46
    " . . .Two eight-year-old females, who had been on the Feingold K-P diet for a minimum of 11 months, were the subjects studied. The experimental design was a variation of the BAB design, with double-blind conditions. This design allowed an experimental analysis of the placebo phases as well as challenge phases. Data were obtained by trained observers on Out of Seat, On Task, and Physically Aggressive behaviors, as they occurred in the subjects' regular class setting. Results indicated (a) the existence of a functional relationship between the ingestion of artificial food colors and an increase in both the duration and frequency of hyperactive behaviors, (b) the absence of a placebo effect, and (c) differential sensitivity of the dependent variables to the challenge effects. "

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  64. Synthetic Food Colourings and "Hyperactivity": a Double-Blind Crossover Study, K.S.Rowe, Australia Paediatric Journal, April 1988, Vol. 24 (2), pp. 143-7
    40 of 55 children (72.7%) put on a 6-week trial of the Feingold Diet "... demonstrated improved behaviour."  26 of them (47.3%) remained improved following "liberalization" of the diet over a 3-6 month period.

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  65. Synthetic Food Coloring and Behavior:  A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study, K.S.Rowe, K.J.Rowe, Journal of Pediatrics, November 1994, Vol. 135, pp.691-8

    150 of 200 children [75%] improved on an open trial of a diet free of synthetic food coloring, and deteriorated upon introduction of foods containing synthetic colorings.

    34 other "clear" or "suspected" reactors plus 20 "controls" were studied in a separate double blind study. 82.5% of the "suspected reactors,", 27% of the "uncertain reactors," and 10% of the "controls" reacted to a mild single-item challenge of tartrazine (Yellow #5). Kind of reaction and length of time the children were affected depended on the dose. Rowe reported that a dose response effect was observed.

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  66. Physiological changes in hyperactive children following the ingestion of food additives. Salamy J, Shucard D, Alexander H, Peterson D, Braud L, International Journal of Neuroscience 1982 May;16(3-4):241-246
    "... The physiological measures [EEG and heart rate] were obtained prior to and following the ingestion of drinks containing food additives or placebos, which were administered in a double-blind, randomized, crossover procedure. ... the magnitude of physiological changes in the hyperactive children were greater in response to ingestion of the additives than to placebo. These physiological findings are consistent with behavioural data indicating that some hyperactive children are adversely affected by food additives.

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  67. Allergy testing, psychological assessment and dietary treatment of the hyperactive child syndrome. Salzman LK, Medical Journal of Australia 1976 Aug 14;2(7):248-51
    Thirty-one children with behavioural problems and learning difficulties were allergy tested ... 15 of these were given the Australian Version of the Feingold K.P. diet. Ninety-three per cent responded with improved behaviour in the areas of overactivity, distractability, impulsiveness and excitability. Sleep and enuresis problems were resolved partially or completely. This study demonstrates that the aforementioned elimination diet significantly affects behaviour.

    Note: Many people who don't "test positive" on such tests still respond well to the diet. Allergy testing may be useful if positive, but does not rule out response to diet management if negative.

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  68. A Prospective Study of Delinquency in 110 Adolescent Boys with Attention Deficit Disorder and 88 Normal Adolescent Boys, J.Satterfield et al, American Journal of Psychiatry, June 1982, Vol. 139, p.6
    "These findings suggest a strong relationship between childhood ADD and later arrests for delinquent behavior."  "...our study is consistent with other follow-up studies of drug-treated children that have found an absence of long-term beneficial effect ..."

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  69. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. Schab DW, Trinh NH, Journal of Developmental and Behavioral Pediatrics, 2004 Dec;25(6):423-34.
    " ... We searched ten electronic databases for double-blind placebo-controlled trials evaluating the effects of AFCs [artificial food colors]. ... Despite indications of publication bias and other limitations, this study is consistent with accumulating evidence that neurobehavioral toxicity may characterize a variety of widely distributed chemicals. "

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  70. Nutrition and behavior: complex interdisciplinary research. Schauss AG., Nutr Health 1984;3(1-2):9-37
    " . . . Discussions and findings from research presented include: refined carbohydrate consumption, maladaptive behavior, behavior disorders and learning; a history of the 'Feingold diet' and the basis for its controversy; an examination of recent critiques of research on artificial food dyes and hyperkinesis; indications for dietary intervention of hyperactive preschoolers; the role of iron in behavior disorders; effects of sub-clinical vitamin deficiencies on behavior; trace element analysis studies and violent behavior; and, suggested guidelines for further research into this complex and challenging field. . . "

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  71. Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial. , Schmidt MH, et al., Eur Child Adolesc Psychiatry, 1997 Jun;6(2):88-95.
    "Effects of diet were compared with those yielded by stimulant medication (methylphenidate). ... Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions ... The amount of positive changes in behavior in those who received both treatments was about the same... dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children ..."

    NOTE: These were children with conduct-disorder as well as ADHD. 44% responded to Ritalin while 24% responded equally well to a Feingold-type diet.

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  72. Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect, Schnoll R, Burshteyn D, Cea-Aravena J. Appl Psychophysiol Biofeedback. 2003 Mar;28(1):63-75
    " ... Nutritional factors such as food additives, refined sugars, food sensitivities/allergies, and fatty acid deficiencies have all been linked to ADHD. ...In general, diet modification plays a major role in the management of ADHD and should be considered as part of the treatment protocol. "

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  73. Food intolerance and food allergy, Schnyder B, Pichler WJ, Schweiz Med Wochenschr 1999 Jun 19;129(24):928-33
    "Confirmed adverse reactions to foods may be caused by toxic, enzymatic, pharmacological, "pseudoallergic" or allergic mechanisms. ... The most frequent differential diagnoses of true allergies are pseudoallergic reactions to food additives or pharmacological reactions to biogenic amines. The diagnosis of these reactions can usually be based on the history and course under a corresponding diet. In clinical practice additional investigations by double-blind placebo-controlled food challenges are rarely required. ... The therapy of food intolerance is a corresponding diet..."

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  74. Applied Nutrition and Behavior, S.Schoenthaler, J.Moody, L.Pankow, Journal of Applied Nutrition, November 1, 1991, Vol. 43
    Review of studies at California State University; implementation of "nutrient dense diets" in 813 state facilities "resulted in significantly improved conduct, intelligence, and/or academic performance..."

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  75. The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools, Schoenthaler SJ, Doraz WE, Wakefield JA, Int J Biosocial Res., 1986, 8(2); 185-195.

    " The introduction of a diet policy which lowered sucrose, synthetic food color/flavors, and two preservatives (BHA and BHT) over 4 years in 803 public schools was followed by a 15.7% increase in mean academic percentile ranking above the rest of the nation's schools who used the same standardized tests. Prior to the 15.7% gain, the standard deviation of the annual change in nation percentile rating had been less than 1% . . ., after the policy transitions, the percent of students who ate school lunches and breakfasts within each school became positively correlated with that school's rate of gain (r = .28, p < .0001)."

    FULL TEXT


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  76. Utilization of alternative therapies in attention-deficit hyperactivity disorder. Stubberfield T, Parry T, J Paediatr Child Health 1999 Oct;35(5):450-3
    "...A mailed questionnaire survey was undertaken in June 1993, of the use of various therapies by families of 381 children with ADHD. The respondent rate was 76%.... Diet therapies were the most commonly used alternative therapy (60%). ... Physicians were commonly involved in the suggestion to try a modified diet. ..."

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  77. Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test, J. Swanson, M.Kinsbourne, Science magazine, March 28, 1980, Vol. 207. pp.1485-7
    "The performance of the hyperactive children on paired-associate learning tests on the day they received the dye blend was impaired relative to their performance after they received the placebo, but the performance of the non-hyperactive group was not affected by the challenge..."

    Note: Dr. Swanson used 100 mg and 150 mg of mixed food dye in his study. In a phone conversation with this author, he said he had been told that his use of a "toxic dose" had devalued his study. When informed of the amount of food dye per tablespoon in solid bright-colored candies and frosting, green ketchup, and powdered drinks, as measured by students at an Atlanta college, he was astonished. According to his math, students at a birthday party can easily consume 500-600 mg of food dye. If 150 mg is really a "toxic dose," then we need to seriously reconsider what we are allowing in the food sold for children, and we also need to rethink the fact that manufacturers refuse to reveal just how much coloring is actually in any of their products.

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  78. Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder. Uhlig T, Merkenschlager A, Brandmaier R, Egger J, European Journal of Pediatrics 1997 Jul;156(7):557-61
    "... During consumption of provoking foods there was a significant increase in betal activity in the frontotemporal areas of the brain. This investigation is the first one to show an association between brain electrical activity and intake of provoking foods in children with food-induced attention deficit hyperactivity disorder. ..."

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  79. The influence of the chemical additive tartrazine on the zinc status of hyperactive children: A double-blind placebo-controlled study. Ward NI; Soulsbury KA; Zettel VH; Colquhoun ID; Bunday S; Barnes B, J Nutr Med; 1 (1). 1990. 51-58
    "...Tartrazine induces a reduction in serum and saliva zinc concentrations and an increase in urinary zinc content with a corresponding deterioration in behaviour/emotional responses of the hyperactive children but not the controls."

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  80. Assessment of chemical factors in relation to child hyperactivity. Ward NI, Journal of Nutritional & Environmental Medicine (Abingdon); 7 (4). 1997. 333-342.
    "...Only hyperactive children showed a significant reduction in blood serum zinc levels and an increase in urinary zinc output following the consumption of E102 [tartrazine] and E110 [sunset yellow]. . . For the 23 children who consumed a tartrazine beverage there were increased levels of overactivity (n = 18 children), aggressive (n = 16) and/or violent (n = 4) activity, poor speech (n = 2), poor coordination (n = 12), and the development of asthma and/or eczema (n = 8). Most of these were severe or moderate changes. Only one control child showed minor behavioural responses to tartrazine."

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  81. Behavioral responses to artificial food colors. Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, Cox C, McKibben J, Ogar D, Schultz S., Science 1980 Mar 28;207(4438):1487-9
    " Twenty-two young children, maintained on a diet that excluded certain foods, were challenged intermittently with a blend of seven artificial colors in a double-blind trial. Parents' observations provided the criteria of response. One child that responded mildly to the challenge and one that responded dramatically were detected. The latter, a 34-month-old female, showed a significant increase in aversive behaviors. These results further confirm previous controlled studies. "

    Note:

    • The children were not diagnosed as hyperkinetic (hyperactive).
    • Not all parents restricted the fruits and vegetables Dr. Weiss requested that they avoid.
    • 35.26 mg of mixed colors were used as the "challenge" in this study. Compare to 150 mg in one Tb green ketchup. Note also that when a challenge does not provoke worse behavior, it does not mean that the diet did not "work" but that the challenge did not "work."

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  82. Food additives and environmental chemicals as sources of childhood behavior disorders. Weiss, B, J Am Acad Child Psychiatry 1982 Mar;21(2):144-52
    " The Feingold hypothesis postulates that many children who exhibit disturbed behavior improve on a diet devoid of certain food additives. Its validity has been examined on the bassis of controlled trials. The total evidence, although not wholly consistent, nevertheless suggests that the hypothesis is, in principle, correct. Such a conclusion poses difficult problems and new issues for etiology, treatment, toxicology, and regulations."

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  83. Food additives as a source of behavioral disturbances in children. Weiss, B, Neurotoxicology 1986 Summer;7(2):197-208
    " The proposition that certain food additives, such as synthetic colors and flavors, might provoke behavioral disturbances in children surprised most of us. When Feingold (1975) advanced his thesis, he met a surge of scepticism and hostility leavened by large doses of indifference. Not much has changed in the intervening decade, but now the rejection of Feingold's hypothesis conflicts directly with a slowly growing body of data....

    We ought to heed what the late Philip Handler (1979) wrote about risk-benefit analysis: 'A sensible guide would surely be to reduce exposure to hazard whenever possible, to accept substantial hazard only for great benefit, minor hazard for modest benefit, and no hazard at all when the benefit seems relatively trivial.'" "

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  84. Low-level chemical sensitivity: a perspective from behavioral toxicology. Weiss B. Toxicol Ind Health 1994 Jul-Oct;10(4-5):605-17
    " ... The risk assessment process is designed explicitly to estimate the health threats posed by low exposure levels, typically by extrapolating from high experimental or environmental levels. The conventional risk assessment structure, however, was designed primarily around cancer. It is only awkwardly applicable to neurobehavioral toxicants because of the multiplicity of endpoints that have to be considered in evaluating neurotoxicity. ... Research on behavioral disorders evoked by food additives illustrates the importance of such questions. It also demonstrates that the methods currently used to assess the potential toxicity of many substances, including food additives, typically ignore subtle, and often sensitive, neurobehavioral measures. "

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  85. Relative effects of drugs and diet on hyperactive behaviors: an experimental study. Williams JI, Cram DM, Tausig FT, Webster E., Pediatrics. 1978 Jun;61(6):811-7.
    "In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additives. . . when the children were receiving placebos, their hyperactive behaviors in the classroom were greater when eating cookies with artificial colors than when eating cookies without artificial colors. According to the ratings, approximately seven children were no longer hyperactive. There is evidence to suggest that the behavior of three to eight children was diet-responsive, depending on the criteria used. There is evidence, particularly in teacher ratings, in support of Feingold's hypothesis if it is modified. . . . "

    Discussion
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  86. Effects of toluene inhalation on locomotor activity and brain catecholamine levels in rats. Yamawaki S, Sarai K, Yakubutsu Seishin Kodo 1982 Jul;2(1):57-9
    "...The inhaling of toluene vapor (0.7% in air, for 15 min) induced the increase in spontaneous locomotor activity. This locomotor accelerating effect lasted about 60 min after the end of toluene exposure. ... These results suggest that toluene may raise dopaminergic neuron activity."

    Note: Exposure of rats to neurotoxic substances commonly results in hyperactivity, as though the "brakes" are the neurons first suffering damage. Toluene is a solvent made from petroleum or coal tar. Its chemical formula is C6H5CH3

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  87. Dietary influences on neurotransmission. Zeisel SH, Advances in Pediatrics 1986;33:23-47
    "Diet clearly influences neurotransmission. ... Components of foods can also be used as drugs. ... Tryptophan, tyrosine, and choline may be useful in treatment of humans with sleep disorders, pain depression, mania, hypertension, shock, or dyskinesias. Other components of the diet that may affect behavior include food additives ... Given that there is little potential for harm and that there is a subpopulation that may respond, a trial of a diet that contains no food additives may be a valid diagnostic approach for children with attention deficit disorder who do not respond to stimulant therapy or for children for whom stimulant therapy is not desired...."

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