Role of Food Intolerance in ADHD

Role of Food Intolerance in ADHD

Reference: Boris M & Mandel FS: Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 72: 462-8, 1994.

Summary:. The role of foods, preservatives and artificial colorings in attention deficit hyperactive disorder (ADHD) remains controversial. 26 children meeting the diagnostic criteria for ADHD were treated with a multiple item elimination diet. 19 children (73%) responded favorably. On open challenge, all of the 19 children reacted to many foods, dyes, and/or preservatives. A double-blind placebo-controlled food challenge was completed with 16 children. There was significant improvement on placebo days when compared to challenge days. Atopic children with ADHD had a significantly higher response rate than the nonatopic children in this group. The authors conclude that eliminating reactive foods and artificial colors in children with ADHD is beneficial and that dietary factors may play a significant role in the etiology of children with ADHD.

Comments/Opinions: I sympathize with parents of ADHD children who continue to be "screened" from this information. Instead they are pressured into accepting drug therapy and advised to ignore dietary measures as unproven. A case in point are the recent studies claiming that sugar has no effect on ADHD children (even though the study was with "normal" children) and that aspartame is safe in this population. Of course, these "controlled" studies are a complete contradiction to the common sense observations of parents.

It is interesting to note that in 1982 NIH came out with a consensus paper regarding the three major areas that needed more research and clarification in ADHD. Besides further epidemiological studies and a closer look at psychosocial issues, the other major issue was diet.(1) As most readers are aware, the theory of diet contributing to ADHD has been around since the turn of the century. In 1922, Dr. Shannon and colleagues postulated that learning and behavior could be influenced by diet.(2) Of course, the most outspoken proponent of a role for diet came form the food additive and salicylates theory of Dr. Feingold in the mid-70's. His work, which must be considered groundbreaking, was somewhat anecdotal and poorly controlled.

The real champion of dietary contributions to ADHD in the last decade has been Dr. Joseph Egger of London. In 1985, Dr. Egger provided what is considered the "breakthrough" study connecting food intolerance and ADHD. 76 children with ADHD were placed on a oligoantigenic diet with 62 improving markedly (21 achieved "normal behavior"). 28 of the group showing improvement during the oligoantigenic diet trial were then placed in a double-blind rechallenge phase. Although 48 foods were incriminated, the most common provoking substances were artificial colorants and preservatives. It was interesting to note that physical symptoms of food allergy such as headaches and abdominal pain also improved during the elimination phase.(3) In 1992, he showed that a oligoantigenic diet was extremely successful in the management children with enuresis and concomitant migraine headaches and/or ADHD.(4) Recently, he has developed an enzyme-potentiated desensitization program that can be used as a substitute for the difficult oligoantigentic diet in children.(5)

The study summarized above serves to reinforce Egger and colleagues' findings regarding food intolerance and ADHD. It also serves to reinforce the need to rule out atopy in ADHD children. Atopic children in this study were far more likely to manifest food sensitivities and to respond favorably to the elimination diet. It is also interesting to note that the Conners hyperactivity index score was at its lowest in the group of "responders" while they were on the multiple elimination diet. This is a fairly typical finding in other food intolerance related conditions like atopic dermatitis and migraine headaches.

One other area of note with ADHD is the role of adrenal function. Dr. Tintera, in his brilliant work with hypoadrenocorticism, postulated that children born to mothers with low adrenal function ran a greater risk of hyperkinetic behavior. I frequently place my ADHD patients on a modified hypoglycemic diet (keeping complex carbohydrates in the mix), use daily chromium supplementation, and also support adrenal function with phytomedicines like Eleutherococcus senticous (Siberian ginseng).

(1) NIH Position Paper: Defined diets and childhood hyperactivity, JAMA 248: 290-2, 1982.

(2) Shannon WR: Neuropathic manifestations in infants and children as a result of anaphylactic reactions to foods contained in their diet. Am J Dis Child 24: 89-94, 1922.

(3) Egger J, Carter CM, et al: Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet March 9, 1985, pp. 540-5.

(4) Egger J, Carter CH, et al: Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior. Clin Ped May 1992, pp. 302-7.

(5) Egger J, Stolla A & McEwen LM: Controlled trial of hyposensitization in children with food-induced hyperkinetic syndrome. Lancet 339:1150-3, 1992.

Natural Product Research Consultants, Inc.


By D. Brown

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