Notes and References
DVD “Fed Up with Children’s Behaviour” by Sue Dengate 2006
Most of the abstracts and some of the full texts of cited articles are available from www.pubmed.com
‘Children have changed in the last thirty years ..’ See: Stanley F, Richardson S, Prior M. Children of the Lucky Country? How Australian society has tuned its back on children and why children matter. Sydney: Pan Macmillan Australia, 2005; at Royal Children’s Hospital in Melbourne a quarter of all children who attended outpatient services for medical help in 2004 were diagnosed as having non-medical conditions such as learning difficulties and behaviour problems (Problem Learners Swamp Hospital by Caroline Milburn, Sydney Morning Herald, 6/12/2004) and Education Department figures showed that there were more than 23,000 Victorian students in school disability and language disorder programs in 2005, a rise of 74% since 2000, see Cmslive. Number of disabled students soars in Victoria. Curriculum Leadership. 2005;3(11): http://cmslive.curriculum.edu.au/leader/
‘Supermarkets now control about 80 per cent of our food, up from 20% in the 1950s’: see Blythman J. Shopped: the shocking powers of British supermarkets. London: Fourth Estate, 2004, and Lawrence F. Not on the label: what really goes into the food on your plate. Camberwell: Penguin, 2004.
‘As the levels of potentially harmful food chemicals have slowly increased in our foods… ‘ : from 1955, production of artificial food colours in the USA increased fourfold over four decades (in Jacobson MF, Schardt MS. Diet, ADHD and behaviour: a quarter-century review. Washington DC: Centre for Science in the Public Interest, 1999); between 1960-1970 there was a 30-70 per cent increase in the amounts of several sulphite preservatives used in the USA (Taylor SL, Higley NA, Bush RK. Sulfites in foods: uses, analytical methods, residues, fate, exposure assessment, metabolism, toxicity, and hypersensitivity. Adv Food Res 1986;30:1-76); MSG was introduced into western food in 1948 and its use has continued to increase since then (Samuels A. The toxicity/safety of processed free glutamic acid (MSG): a study in suppression of information. Account Res 1999;6(4):259-310); the nucleotide flavour enhancers including 635 were introduced to the world in the late 1990s (Sommer R. Yeast extracts: production, properties and components. 9th International Symposium on Yeasts, Sydney 1996); in 2001 Australian food regulators approved an increase in the maximum permitted level of the bread preservative calcium propionate 282 to the highest in the world despite knowing of consumer concerns (FSANZ. Food Standards Code. Food Standards Australia New Zealand, 2001. www.foodstandards.gov.au)
‘New disorders’, such as Restless Legs Syndrome (RLS), Gastroesophageal Reflux Disorder (GERD), Cough Variant Asthma (CVA), Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiance Disorder (ODD) and others. In our experience these are all associated with food intolerance, see below.
‘food additives are not tested for their effects on children’s learning and behaviour before approval nor monitored afterwards’: Weiss B. Environmental contaminants and behavior disorders. Dev Pharmacol Ther. 1987;10(5):346-53. Abstract: The discipline of behavioral toxicology is an acknowledgement that behavioral assessments should play a role in judging the safety of chemicals. Such a role is emphasized by the toxicological history of many different classes of substances. These include metals, insecticides, volatile organic solvents, and even food additives. For all of these, incipient toxicity often takes the form of subjective complaints that are later followed by overt impairments. The fetus and young child seem to be at special risk for substances such as methylmercury and synthetic food colors, a susceptibility not fully recognized.
‘Independent scientists recommend that schools should minimise use of artificial colours and other food additives that may contribute to behavioural disorders’: Jacobson MF, Schardt MS. Diet, ADHD and behaviour: a quarter-century review. Washington DC: Centre for Science in the Public Interest, 1999, www.cspinet.org (full report available for download)
Behavioural reactions to foods are food intolerance, not food allergy: for the best explanation of this, see Clarke and others, The dietary management of food allergy and food intolerance in children and adults, Aust J Nutr Diet, 1996.
‘Allergy can be life-threatening’: in a case that sent shockwaves through the education system, 13-year-old Hamidur Rahman died at a NSW school camp in 2002 after eating peanut butter in a competition run by the teachers. Even though his mother had told the school he was allergic to peanuts, the teachers at the competition didn’t know and an Epi-pen which could have saved his life wasn’t available. After his death the NSW coroner called for awareness campaigns to inform teachers, child care workers, parents and children of the risks of food allergy. The rate of allergies in Western countries has doubled in the past 25 years (figures from the Australasian Society of Clinical Immunology and Allergy), and in the US the incidence of peanut allergy doubled between 1997 and 2002 (Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003;112(6):1203-7). More information about true food allergy from Anaphylaxis Australia, www.allergyfacts.org.au
‘… the most scientific and effective in the world is the low chemical elimination diet introduced in the United States by Dr Ben Feingold in the 1970s and refined over many years by Australian researchers’. There are thousands of elimination diets and some are more effective than others. The disappointing results of elimination diets for behaviour in the 1970s was due to failure to exclude enough – or the correct – foods (Kaplan BJ, McNicol J, Conte RA, Moghadam HK. Dietary replacement in preschool-aged hyperactive boys. Pediatrics 1989;83(1):7-17. Diets that have been studied for effects on behaviour include wholefood diets in which certain foods are excluded (e.g. Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69(5):564-8 in which parents of 73 per cent of 78 children reported a worthwhile improvement on the Few Foods or oligoantigenic diet, and a worsening on certain test foods); low chemical diets in which certain food chemicals such as additives and salicylates are excluded (e.g.Harley JP, Ray RS, Tomasi L, Eichman PL, Matthews CG, Chun R, et al. Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 1978;61(6):818-28, in this study according to parents, about two thirds of 36 hyperactive school aged boys and one hundred per cent of 10 hyperactive preschoolers improved on the Feingold diet in this study although researchers who were funded by the food industry concluded there was no behavioural benefit of the diet - a much-criticised finding); Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2(8445):41-2, about sixty per cent of 140 children improved significantly on a low chemical diet of whom nearly three-quarters reacted to a salicylate challenge); or diets in which macronutrients such as carboyhydrates, fat or protein are reduced (e.g. Murphy P, Likhodii SS, Hatamian M, McIntyre Burnham W. Effect of the ketogenic diet on the activity level of Wistar rats. Pediatr Res 2005;57(3):353-7, free full text available at http://www.pedresearch.org/cgi/content/full/57/3/353, this study examined reports that behaviour, attention and cognition improve when epileptics are put on a ketogenic diet but can’t explain why. From my point of view, the low carb diet reduces sugar and fruit intake, which in turn reduces additive and salicylate intake); when obese asthmatics went on a very low fat diet using Nutrilett meal replacement products, as well as losing weight, they also lost their asthma - from my perspective, the weight loss products are additive-free. (Stenius-Aarniala B, Poussa T, Kvarnstrom J, Gronlund EL, Ylikahri M, Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. Bmj 2000;320(7238):827-32.) Asthmatics who ate only elemental formula for two weeks also improved; again, it was additive free and low in salicylates.(Hoj L, Osterballe O, Bundgaard A, Weeke B, Weiss M. A double-blind controlled trial of elemental diet in severe, perennial asthma. Allergy 1981;36(4):257-62.)
‘In the UK, police used a three week elimination diet with a group of chronic juvenile offenders’: see Bennett CPW, McEwen LM, Rose E. The Shipley Project: treating food allergy to prevent criminal behaviour in community settings. J Nutr Envir Med 1998;8:77-83. In this study, Superintendent Peter Bennett from the West Yorkshire police conducted a trial of the Few Foods diet with chronic juvenile offenders aged 8-16 and all improved. Those who remained on the diet did not re-offend.
‘The prevalence of migraines in both adults and children in developed countries has at least tripled since the 1970s with over 20 per cent of households now containing at least one migraine sufferer’: Centers for Disease Control (CDC). Prevalence of chronic migraine headaches--United States, 1980-1989. MMWR Morb Mortal Wkly Rep 1991;40(20):331, 337-8, see also ‘Study shows that migraine prevalence tripled in young children’, 17/9/1996, Doctors Guide to the Internet, www.docguide.com.
‘… headaches and migraines are most likely to be associated with MSG, preservatives, salicylates and amines’ : Loblay RH, Swain AR. 'Food intolerance'. In Wahlqvist ML, Truswell AS, Recent Advances in Clinical Nutrition. London: John Libbey, 1986, pages 169-177. 1986.
‘My head, my head’ … migraines manifest differently in children than in adults. They are more likely to occur in the middle of the head rather than one side, and are of shorter duration (1-2 hours) than in adults. The youngest recorded migraine patient was a 3 month old baby who cried, held his head and vomited. As he grew older it became clear that these episodes had been related to migraine, described by Professor James Lance on www.headacheaustralia.org.au
‘Australia has one of the highest incidences of eczema in the world’: Mar A, Marks R. The descriptive epidemiology of atopic dermatitis in the community. Australas J Dermatol 1999;40(2):73-8; Eczema Association of Australasia. Eczema backgrounder. www.eczema.org.au, 2005.
‘eczema and other itchy skin rashes … most likely culprits are preservatives, salicylates and other additives’ Juhlin L. Recurrent urticaria: clinical investigation of 330 patients. Br J Dermatol 1981;104(4):369-81; Loblay RH, Swain AR. 'Food intolerance'. In Wahlqvist ML, Truswell AS, Recent Advances in Clinical Nutrition. London: John Libbey, 1986, pages 169-177. For information about the new flavour enhancers ribonucleotides (flavour enhancer 635),disodium guanylate (flavour enhancer 627) and disodium inosinate (flavour enhancer 631), see Ribo Rash factsheet on website; and for a research report concerning the synergistic properties of nucleotide flavour enhancers, see Sommer R. Yeast extracts: production, properties and components. 9th International Symposium on Yeasts, Sydney 1996.
‘In England and the USA you can report adverse reactions to food additives, but in Australia there’s no government agency you can report any of this to’ – Tollefson L. Monitoring adverse reactions to food additives in the U.S. Food and Drug Administration. Regul Toxicol Pharmacol 1988;8(4):438-46.
‘Irritable bowel symptoms are now thought to affect about 20 percent of people in developed countries …’: Francis CY, Whorwell PJ. The irritable bowel syndrome. Postgrad Med J 1997;73(855):1-7.
‘Any food chemical can be a problem but some of the most likely suspects …’: Loblay RH, Swain AR. 'Food intolerance'. In Wahlqvist ML, Truswell AS, Recent Advances in Clinical Nutrition. London: John Libbey, 1986, pages 169-177.
Reflux in both babies and adults: according to an international breastfeeding association, in recent years there has been a dramatic increase in the number of babies who are being diagnosed with Gastroesophageal Reflux (GER). http://www.lalecheleague.org/FAQ/ger.html. Western doctors say this is simply due to better diagnostic methods but their non-Western counterparts – where regurgitation is a regarded as a common symptom in healthy infants that decreases spontaneously with age - report that the nature of gastroesophageal reflux differs from that in Western infants. Osatakul S, Sriplung H, Puetpaiboon A, Junjana CO, Chamnongpakdi S. Prevalence and natural course of gastroesophageal reflux symptoms: a 1-year cohort study in Thai infants. J Pediatr Gastroenterol Nutr 2002;34(1):63-7; Miyazawa R, Tomomasa T, Kaneko H, Tachibana A, Ogawa T, Morikawa A. Prevalence of gastro-esophageal reflux-related symptoms in Japanese infants. Pediatr Int 2002;44(5):513-6. Reflux in adults is common throughout the Western world. A review found the lowest prevalence in Italy (which from my perspective has one of the lowest intakes of food additives and westernized food in Europe, see website feature Food additives around the world): Delaney BC. Review article: prevalence and epidemiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2004;20 Suppl 8:2-4, extracts from the abstract: ‘.. gastro-oesophageal reflux disease (GERD) [is] a common condition that appears to be increasing in prevalence in the Western world … Heartburn is a common symptom in Europe ranging from a prevalence of 38% in Northern Europe to 9% in Italy. Comparable 6-month data from the USA suggest an even higher prevalence with a rate of 42%.
‘The sugar free sweeteners such as sorbitol …can cause bloating, gas, stomach cramps and diarrhoea’: Breitenbach RA, Simon J. Cases from the aerospace medicine resident teaching file. Case #59. A case of "unbearable" gremlinenteritis. Aviat Space Environ Med 1994;65(5):432-3 reported severe diarrhea in a flight surgeon due to sorbitol; Jain NK, Patel VP, Pitchumoni CS. Sorbitol intolerance in adults. Prevalence and pathogenesis on two continents. J Clin Gastroenterol 1987;9(3):317-9, this study found more than 30 per cent of healthy adults in India and the USA had sorbitol intolerance and children are thought to be more susceptible.Hill RE, Kamath KR. "Pink" diarrhoea: osmotic diarrhoea from a sorbitol-containing vitamin C supplement. Med J Aust 1982;1(9):387-9 reported months of serious diarrhoea in infants due to a pink coloured vitamin supplement sweetened with sorbitol. See also the Sugarfree Sweeteners Factsheet on the website, the Centre for Science in the Public Interest unsuccessfully petitioned the FDA for more realistic labelling.
Australia’s rate of childhood asthma has risen from about 10 per cent in the 1960s to about 30 per cent now. It’s one of the highest in the world: International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12(2):315-35.
‘Asthma is different from other food intolerance symptoms because most asthmatics react to only one or two food additives’: Allen DH, Van Nunen S, Loblay R, Clarke L, A. S. Adverse reactions to food. Med J Aust 1984;141 (Suppl):37-42; Hodge L, Yan KY, Loblay RL. Assessment of food chemical intolerance in adult asthmatic subjects. Thorax 1996;51(8):805-9
‘About 20 percent of asthmatics are affected by salicylates’: Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. Brit Med J 2004;328(7437):434. This review found that many more adult asthmatics are sensitive to salicylates than are aware of their sensitivity. While only 3% reported aspirin sensitivity, 21% of adult asthmatics reacted to oral challenges. Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7. This study of children with asthma also found 20% reacted to salicylates.
‘Most people don’t make the connection between what they eat and how they are affected unless they see a reaction within thirty minutes’: McDonald JR, Mathison DA, Stevenson DD. Aspirin intolerance in asthma. Detection by oral challenge. J Allergy Clin Immunol 1972;50(4):198-207. Asthmatics were given an aspirin tablet they were told was not aspirin. Those who reacted within 30 minutes blamed the aspirin. Those who reacted more than 30 minutes later (and up to hours later) didn't make the connection.
‘Sulphite preservatives are the additives most likely to affect asthmatics’: Fifty-first meeting of the Joint FAO/WHO Expert Committee on Food Additives. Safety Evaluation of Certain Food Additives: evaluation of national assessments of sulfur dioxide and sulfites and addendum. Geneva: World Health Organisation, 1999 (an upwards re-evaluation of the effects of sulphites from 4% of asthmatics to 20-30% of asthmatic children); Hodge and others as cited above; Steinman HA, Le Roux M, Potter PC. Sulphur dioxide sensitivity in South African asthmatic children. S Afr Med J 1993;83(6):387-90; Towns and Mellis as cited above - who found that nearly 70% of asthmatic children reacted to an oral sulphite challenge.
‘These are all foods eaten frequently by young children, who also have the highest rates of asthma’ …See Dangers of Dried Fruit, Sulphites in Foods factsheets on the website. It is not well known that sulphites in the body cleave to the thiamine molecule from either foods or supplements and thus can cause vitamin B1 deficiency despite vitamin supplementation – even causing death – which is why sulphites in meat were banned in the USA in 1959 and remain banned. Since signs of thiamine deficiency include irritability, insomnia and forgetfulness, this is a possible mechanism for behavioural effects of processed foods. Steel RJ. Thiamine deficiency in a cat associated with the preservation of 'pet meat' with sulphur dioxide. Aust Vet J 1997;75(10):719-21.
‘Other additives that can affect asthmatics include benzoate preservatives in drinks and medication’: Freedman BJ. Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clin Allergy 1977;7(5):407-15.
‘… including asthma medication … and this is something that some doctors are starting to complain about’: Balatsinou L, Di Gioacchino G, Sabatino G, Cavallucci E, Caruso R, E. G. Asthma worsened by benzoate contained in some antiasthmatic drugs. Int J Immunopathol Pharmacol 2004;17(2):225-6; Petrus M, Bonaz S, Causse E, Rhabbour M, Moulie N, Netter JC, et al. Asthmé et intolérance aux benzoates. Arch Pédiatr 1996;3(10):984-7 reports the case of a child who was diagnosed with asthma around her first birthday and medicated continuously for some years despite experiencing severe asthma attacks about once a month. Oral challenges revealed she was sensitive to benzoates in her asthma medication as well as some food and drinks. At follow up 12 months later she was found to be avoiding benzoates and asthma free.
‘Since the 1970s the number of children on stimulant drugs for behaviour or learning difficulties has increased 40-fold’: see http://www.wildestcolts.com/ for data showing that the number of children on psychiatric stimulant drugs today in the USA (7,000,000) is 40 times the number in 1970 (175,000). And it’s happening in Australia too: Berbatis CG, Sunderland VB, Bulsara M. Licit psychostimulant consumption in Australia, 1984-2000: international and jurisdictional comparison. Med J Aust 2002;177(10):539-43.
‘Anti-depressant drugs … including 3000 prescriptions for Prozac written for babies under the age of 12 months in 1994 in the USA’: in Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F. Trends in the prescribing of psychotropic medications to preschoolers. Jama 2000;283(8):1025-30.
The wildestcolts website above reported 735,000 children ages 6-18 on Prozac and related anti-depressants in 1996, up 80% since 1994, and the most recent figure available is 1,664,000 antidepressant prescriptions for children in 1998.
‘When I mention behaviour most people think of hyperactivity but there’s a huge range of symptoms’, see Feingold BF. Dietary management of nystagmus. J Neural Transm 1979;45:107-115.
When 800 New York schools introduced a low additive school lunch program over a period of four years, the number of students classified as learning disabled dropped from over 12 per cent to less than 5 per cent: Schoenthaler S, Doraz W, Wakefield JJ. The impact of a low food additive and sucrose diet on academic performance in 803 New York City public schools. International Journal of Biosocial Research 1986;8(2):185-195; see also Swanson JM, Kinsbourne M. Food dyes impair performance of hyperactive children on a laboratory learning test. Science 1980;207(4438):1485-7.
Since 1945 there has been a tenfold increase in major depression: Seligman M quoted in Buie J. ‘Me’ decades generate depression. APA Monitor 1988;19:18. It is fascinating to look at the work of Gerald Klerman, former Cornell Professor who spent his whole life investigating depression and was the author of many papers showing that the increases in rates of major depression in successive birth cohorts in the 20th century with both increased lifetime risks of depression and earlier ages of onset are not related to artifacts of recall or labelling or to increases in drug and alcohol abuse. Klerman GL, Weissman MM. Increasing rates of depression. Jama 1989;261(15):2229-35.
Depression can be associated with food chemicals: Parker G, Watkins T. Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance. Aust N Z J Psychiatry 2002;36(2):263-5; Murphy P, Likhodii S, Nylen K, Burnham WM. The antidepressant properties of the ketogenic diet. Biol Psychiatry 2004;56(12):981-3.
‘Everyone thinks that hyperactivity is the main behavioural effect of food chemicals but it isn’t, it’s irritability’: Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125(5 Pt 1):691-8.In this 21-day, double-blind, placebo-controlled, repeated-measures study 24 children were identified as clear reactors to tartrazine artificial food colouring (102). The authors concluded that tartrazine is associated with behavioral changes in irritability, restlessness, and sleep disturbance. The effects are related to dose and with doses greater than 10 mg, the effects last for longer and have reported the effects lasting for up to one month in an earlier study.
Although Restless legs syndrome (RLS) was first described in the 17th century and has been long been associated with Parkinsons Disease, it has only been regarded as a common disorder in the last ten years. It is thought to affect about 10 per cent of the population in Western countries, runs in families, and is commonly associated with other symptoms of food intolerance, from reflux to ADHD and depression. RLS is rarely recognised as a side effect of food chemicals although the relationship to medications is well understood. Phillips B, Hening W, Britz P, Mannino D. Prevalence and correlates of restless legs syndrome: results from the 2005 National Sleep Foundation Poll. Chest 2006;129(1):76-80; Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C. Epidemiology of restless legs symptoms in adults. Arch Intern Med 2000;160(14):2137-41.
Sleep disturbance: in 2005, 69 per cent of children in the US experienced significant sleep problems one or more times a night. Problems included snoring, getting up at night, refusing to go to bed, heavy or loud breathing while sleeping, or night terrors (US National Sleep Foundation survey, 2005).In the Rowe and Rowe study described above, sleep disturbance associated with tartrazine - and therefore other food chemicals in susceptible children and adults - included difficulty settling to sleep and frequent night waking.
‘… so if you only avoid colours, you’re not going to see a lot of difference’: The following successful studies used diets which avoided many more foods and food chemicals than artificial colours: Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2(8445):41-2; Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69(5):564-8; Breakey J, Hill M, Reilly C, Connell H. A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children. Aust J Nutr Diet 1991;48(3):89-94.
Children can be oppositional and defiant without having oppositional defiance disorder (ODD), see http://www.behavenet.com/capsules/disorders/odd.htm. They don’t have to be diagnosed with ODD to improve on diet.
‘Since the 1970s, rates of autism are thought to have increased tenfold in the USA’: Bertrand J, Mars A, Boyle C, Bove F, Yeargin-Allsopp M, Decoufle P. Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics 2001;108(5):1155-61; Lowy J. Autism reaching 'epidemic' levels. Scrips Howard News Service, 21/1/04, www.shns.com 2004.
‘The researcher concluded that a broad spectrum of severe autistic symptoms were “fully reversible”: Slimak K. Reduction of autistic traits following dietary intervention and elimination of exposure to environmental substances. Proceedings of 2003 International Symposium on Indoor Air Quality and Health Hazards, National Institute of Environmental Health Sciences, USA, and Architectural Institute of Japan, Tokyo, Japan 2003;2:206-216. Abstract: Effects of environmental exposure were isolated and studied in 49 autistic children. Elimination of food-related reactions entirely allowed effects of environmental chemicals to be thoroughly studied indefinitely in the absence of food-related symptoms. Initially unaffected by social contexts, the autistic subjects acted out the ways they were affected by their environment without the altering effects of societal influences; and severity of the adverse effects made observation and study easier. There was a strong correlation (P<.000) between environmental exposure levels and autistic symptoms and behaviors. There appeared to be nothing inherently wrong with autistic children studied. The children in the program (universal diet and clean room) returned to normal physically, in temperament, in awareness of surroundings and others, in emotions and empathy, and in ability to learn. Based on the results of the present study, a broad spectrum of severe and chronic autistic symptoms appear to be environmentally based, apparently caused by chronic exposure to volatile organic compounds, and appear to be fully reversible in the proper environment.
‘It’s not only autistic kids who are affected by VOCs’: a large-scale prospective study in England found depression and health problems in mothers and children related to VOCs such as cleaning products, and airfresheners: Farrow A, Taylor H, Northstone K, Golding J. Symptoms of mothers and infants related to total volatile organic compounds in household products. Arch Environ Health 2003;58(10):633-41.
Nasty additives: Hanssen M. Additive Code Breaker. Melbourne: Lothian, 2002; including annatto natural colour 160b: Mikkelsen H, Larsen J, Tarding F. Hypersensitivity reactions to food colours with special reference to the natural colour annatto extract (butter colour). Arch Toxicol Suppl 1978(1):141-3; Juhlin L. Recurrent urticaria: clinical investigation of 330 patients. Br J Dermatol 1981;104(4):369-81; 1. Clarke L, McQueen J, Samild A, Swain A. The dietary management of food allergy and food intolerance in children and adults. Australian Journal of Nutrition and Dietetics 1996;53(3):89-94.
The bread preservative: Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health 2002;38(4):373-6; Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2(8445):41-2.
The association between the very high levels of propionic acid seen in some metabolic diseases and severe neurological problems are well recognised in paediatric medicine. A number of studies in rats suggest that early administration of propionic acid - in doses only 4 times higher than could be expected from bread alone in the diet for a child in Australia - alters normal development and induces long-lasting behavioural deficits, and that administration of ascorbic acid can prevent the behavioural alterations provoked by propionic acid, yet food regulators continue to ignore the safety issues of this preservative: Brusque AM, Mello CF, Buchanan DN, Terracciano ST, Rocha MP, Vargas CR, et al. Effect of chemically induced propionic acidemia on neurobehavioral development of rats. Pharmacol Biochem Behav 1999;64(3):529-34; Brusque AM, Terracciano ST, Fontella FU, Vargas C, da Silva CG, Wyse AT, et al. Chronic administration of propionic acid reduces ganglioside N-acetylneuraminic acid concentration in cerebellum of young rats. J Neurol Sci 1998;158(2):121-4; Trindade VM, Brusque AM, Raasch JR, Pettenuzzo LE, Rocha HP, Wannmacher CM, et al. Ganglioside alterations in the central nervous system of rats chronically injected with methylmalonic and propionic acids. Metab Brain Dis 2002;17(2):93-102; Fontella FU, Pulrolnik V, Gassen E, Wannmacher CM, Klein AB, Wajner M, et al. Propionic and L-methylmalonic acids induce oxidative stress in brain of young rats. Neuroreport 2000;11(3):541-4; Wyse AT, Brusque AM, Silva CG, Streck EL, Wajner M, Wannmacher CM. Inhibition of Na+,K+-ATPase from rat brain cortex by propionic acid. Neuroreport 1998;9(8):1719-21; Pettenuzzo LF, Schuck PF, Fontella F, Wannmacher CM, Wyse AT, Dutra-Filho CS, et al. Ascorbic acid prevents cognitive deficits caused by chronic administration of propionic acid to rats in the water maze. Pharmacol Biochem Behav 2002;73(3):623-9; neurological presentation of propionic acidemia is not always associated with metabolic crises: Nyhan WL, Bay C, Beyer EW, Mazi M. Neurologic nonmetabolic presentation of propionic acidemia. Arch Neurol 1999;56(9):1143-7.
Salicylates: see salicylate section of advanced workshop, below.
Amines: see amine section of advanced workshop, below.
‘A2 milk contains a different kind of protein’: http://a2milk.com.au/
Synthetic antioxidants and the 5% labelling loophole: at the time of writing, Logan Farm frozen chips were free of BHA but we couldn’t find any at our local supermarkets.
A lot of people think that sugar causes children’s behaviour problems. It doesn’t: Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med 1994;330(5):301-7.
‘Most people aren’t aware that a craving for sugar can actually be salicylate reaction’. See salicylate section in advanced workshop below, especially salicylate-induced hypoglycaemia.
‘Some low perfume products’ see Shopping List on the website.
DIETITIANS LIST and RECIPE BOOKLET
See the free Failsafe Booklet (downloadable pdf file) as a companion to the DVD by Sue Dengate.
Salicylates are chemicals in plants that protect against pests and diseases and possibly function as plant hormones. Documented reactions to salicylates in oral or topical medications include skin rashes, asthma, gastric irritation, urinary and fecal incontinence, cardiac abnormalities and arrythmias and a wide range of central nervous system effects such as tinnitus, diminished short term memory and hearing, insomnia, agitation, aggression, irritability, coordination difficulties, rapid heart rate, anorexia (loss of appetite) and lethargy, as well as hypoglycaemia, which has been associated with ingestion of salicylate in subtoxic doses.
Effects can be different in children, and in 1966, a Dr Bywaters described the case of a young patient who attacked him with a knife while ‘under the influence of salicylates’ (reported in Schaller 1978, below). These reactions have been documented for nearly a hundred years, and reports in the medical literature frequently suggest that the effects of chronic salicylate toxicity are under-recognised. Arena FP, Dugowson C, Saudek CD. Salicylate-induced hypoglycemia and ketoacidosis in a nondiabetic adult. Arch Intern Med 1978;138(7):1153-4; Bailey RB, Jones SR. Chronic salicylate intoxication. A common cause of morbidity in the elderly. J Am Geriatr Soc 1989;37(6):556-61; Bell AJ, Duggin G. Acute methyl salicylate toxicity complicating herbal skin treatment for psoriasis. Emerg Med (Fremantle) 2002;14(2):188-90; Brubacher JR, Hoffman RS. Salicylism from topical salicylates: review of the literature. J Toxicol Clin Toxicol 1996;34(4):431-6; Courts NF. Salicylism in the elderly: "a little aspirin never hurt anybody"! Geriatr Nurs 1996;17(2):55-9; Lemesh RA. Accidental chronic salicylate intoxication in an elderly patient: major morbidity despite early recognition. Vet Hum Toxicol 1993;35(1):34-6; Limbeck GA, Ruvalcaba RH, Samols E, Kelley VC. Salicylates and Hypoglycemia. Am J Dis Child 1965;109:165-7; Mukerji V, Alpert MA, Flaker GC, Beach CL, Weber RD. Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity. Pharmacotherapy 1986;6(1):41-3.; Raschke R, Arnold-Capell PA, Richeson R, Curry SC. Refractory hypoglycemia secondary to topical salicylate intoxication. Arch Intern Med 1991;151(3):591-3; Schaller JG. Chronic salicylate administration in juvenile rheumatoid arthritis: aspirin "hepatitis" and its clinical significance. Pediatrics 1978;62(5 Pt 2 Suppl):916-25; Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7; Weiss B, Laties VG. Changes in pain tolerance and other behavior produced by salicylates. J Pharmacol Exp Ther 1961;131:120-9.
The same reactions and many others not listed can also be induced by salicylates in foods. Feingold suggested that a variety of ‘neurologic and neuromuscular disturbances (grand mal, petit mal, psychomotor seizures; La Tourette syndrome; autism; retardation; the behavioural component of Down's syndrome; and oculomotor disturbances)’ as well as the signs of the hyperkinetic syndrome could be induced by synthetic food colours, flavours and preservatives and foods containing the natural salicylate radical. Others have shown the success of diets which exclude salicylates. Breakey J, Hill M, Reilly C, Connell H. A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children. Aust J Nutr Diet 1991;48(3):89-94; Feingold BF. Dietary management of nystagmus. J Neural Transm 1979;45:107-115; Fitzsimon M, Holborow P, Berry P, Latham S. Salicylate sensitivity in children reported to respond to salicylate exclusion. Med J Aust 1978;2(12):570-2.; Noid HE, Schulze TW, Winkelmann RK. Diet plan for patients with salicylate-induced urticaria. Arch Dermatol 1974;109(6):866-9; Swain AR, Dutton SP, Truswell AS. Salicylates in foods. J Am Diet Assoc 1985;85(8):950-60; Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2(8445):41-2;Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7.
Biogenic amines such as tyramine and histamine are caused by the breakdown of protein products. They are normally broken down in the body by an enzyme called monoamine oxidase but people who are taking drugs which inhibit this reaction (called Monoamine Oxidase Inhibitors or MAOIs) can experience a range of unpleasant and even life-threatening symptoms from the build up of amines, so amine containing foods are documented in the medical literature in relationship to these drugs, see McCabe BJ. Dietary tyramine and other pressor amines in MAOI regimens: a review. J Am Diet Assoc 1986;86(8):1059-64. Any protein food can form amines through protein breakdown due to ageing, storage, handling, cooking, fermentation or ripening, so website lists are usually incomplete and there’s an interesting website at http://www.dr-bob.org/tips/maoi.html concluding that with amines, it’s better to err on the side of caution. The recent change in meat distribution in Australian supermarkets has caused major problems for amine sensitive consumers since vacuum packing has been shown to inhibit the growth of bacteria but not the development of amines in meat and other products: Nadon CA, Ismond MA, Holley R. Biogenic amines in vacuum-packaged and carbon dioxide-controlled atmosphere-packaged fresh pork stored at -1.50 degrees C. J Food Prot 2001;64(2):220-7; Emborg J, Laursen BG, Dalgaard P. Significant histamine formation in tuna (Thunnus albacares) at 2 degrees C--effect of vacuum- and modified atmosphere-packaging on psychrotolerant bacteria. Int J Food Microbiol 2005;101(3):263-79.
Tasty foods can contain natural glutamates in varying quantities and these glutamates will be concentrated by processing. Some of the highest naturally occurring glutamates are found in tomato juice, soy sauce, parmesan cheese and roquefort cheese. Even green peas contain small amounts, but we’re talking about the difference between 200 mg per serve compared with up to 5-10 grams per serve in a Chinese restaurant meal. (source: www.msgfacts.com, be warned, this is an industry-funded website. To restore your sense of balance after visiting it, you can see www.truthinlabeling.com)
There are thousands of permitted flavours but they are considered to be trade secrets so there are no names, they don’t have be declared on labels and consumers can’t find out what they are. One problem with this is that under the 5% labelling loophole, food manufactures can hide artificial colours and preservatives in the flavour additives without declaring them on the label, as revealed in a recent current affairs TV show. Natural flavours are made up of lots of different chemical compounds – for instance, about 50 in a strawberry flavour including some salicylates and benzoates - and they can be re-created in a laboratory. See Fast Food Nation: The Dark Side of the All-American Meal by Eric Schlosser (Houghton Mifflin, 2001) for a fascinating and highly recommended account on pages 122-129 of Schlosser’s tour of the vast International Flavours and Fragrances laboratories in New Jersey. As Schlosser says, ‘Natural and artificial flavors are now manufactured at the same chemical plants …calling any of these flavors “natural” requires a flexible attitude’. Do a google search to read the first chapter and selected pages.
A lot of families thinking of doing the diet now switch to a2 milk from the beginning because it is so easy. If you can’t get a2 milk in a nearby supermarket and have to travel, you can buy it in bulk and freeze it. In the UK you can buy buffalo milk which also contains the a2 protein.
Some people have a lifelong sensitivity to gluten called coeliac disease in which gluten damages the lining of the small intestine, although it often remains undiagnosed. Risk factors for coeliac disease include chronic low grade diarrhoea, iron deficient anemia, a relative with coeliac disease or type 1 diabetes; patchy baldness (alopecia areata) and male or female infertility. Since eating gluten during coeliac disease can lead to osteoporosis and/or bowel cancer, it’s worth having a blood test if you think you’re at risk. It is also possible to have gluten intolerance that isn’t coeliac disease, and this can cause the full range of food intolerance symptoms including behaviour and depression. Gluten intolerance is much less common than sensitivity to the other food chemicals we’ve talked about so it’s not necessary to avoid gluten during your elimination diet unless you think you have a very good reason to do it. One of the problems with gluten free diets is that many gluten free products such as corn and potato flours contain sulphite residues from processing, so if you develop asthma - or your symptoms get worse - after going gluten free, make sure you are avoiding sulphites as well. A recent survey in the USA reported an increase in the incidence of coeliac disease from 0.9 per 100,000 in 1950 to 9.1 per 100,000 in 2001, often with milder features than previously and possibly due to improved diagnosis. Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton LJ, 3rd. Trends in the identification and clinical features of celiac disease in a North American community, 1950-2001. Clin Gastroenterol Hepatol 2003;1(1):19-27. A gluten free diet is not recommended for people who suspect they may be coeliacs because it will interfere with the tests for coeliac disease, see Duggan JM. Coeliac disease: the great imitator. Med J Aust 2004;180(10):524-6. (free full text available at http://www.mja.com.au/public/issues/180_10_170504/dug10818_fm.html)
See Factsheet: School tuckshop help on www.fedup.com.au
Perfumed products and other environmental chemicals
See the free downloadable Failsafe Booklet for recommended fragrance free personal and cleaning products and see: Koger SM, Schettler T, Weiss B. Environmental toxicants and developmental disabilities: a challenge for psychologists. Am Psychol 2005;60(3):243-55. Abstract: Developmental, learning, and behavioral disabilities are a significant public health problem. Environmental chemicals can interfere with brain development during critical periods, thereby impacting sensory, motor, and cognitive function. Because regulation in the United States is based on limited testing protocols and essentially requires proof of harm rather than proof of lack of harm, some undefined fraction of these disabilities may reflect adverse impacts of this "vast toxicological experiment" (H. L. Needleman, as quoted in B. Weiss & P. J. Landrigan, 2000, p. 373). Yet the hazards of environmental pollutants are inherently preventable. Psychologists can help prevent developmental disabilities by mobilizing and affecting public policy, educating and informing consumers, contributing to interdisciplinary research efforts, and taking action within their own homes and communities to reduce the toxic threat to children.
1,2,3- Magic program available from www.parentmagic.com
In Australia from www.parentshop.com.au
RECIPES AND SUPPORT
The Failsafe Booklet by Sue Dengate contains some recipes and is available as a free downloadable pdf file to support the DVD.