(Part 2 of 3 blogs focussing on ADHD and diet for both children and adults)

 See the Few Foods (Oligoantigenic) Diet working (Youtube 5mins)

Multiple studies published in the last three years around the world - in China (1), Turkey (2), Iran (3), Italy (4) and USA (5) - show that a diet high in processed food can increase ADHD symptoms. 

Elimination diets to manage ADHD symptoms

USA - Feingold Diet

1976: Allergist Dr Ben Feingold was the first traditionally trained physician to recognise that the rise in childhood behaviour problems was associated with the increasing use of artificial food additives. His diet avoided additives and natural food chemicals called salicylates, and he claimed a 50% success rate (6).

Australia - RPAH Elimination Diet

1985: 61% of 140 children improved significantly in an open trial of the Royal Prince Alfred Hospital Elimination Diet that avoids food additives and a wider range of salicylates and other natural chemicals than the Feingold diet (7). A report from an ex-Feingolder:

“My daughter… has improved immensely since we started the (RPAH) diet. When I looked over her old diet (Dr Feingold's), I realise that it is really only halfway there, which explains why sometimes she reacted and sometimes she didn't” - from [263]

England and Europe – Few Foods (Oligoantigenic) Diet

1985:  82% of 76 hyperactive children improved and 29% achieved normal behaviour on a trial of the Few Foods (oligoantigenic ) diet in Great Ormond Street, Hospital, London (8).

2011: 64% of children diagnosed with ADHD showed significant improvement after 5 weeks on the Few Foods diet at the ADHD Research Centre in Einhoven, Netherland, and in 2021, behavioural changes after diet were associated with changes in brain function, seen in before-and-after  functional MRIs (9).

2022: Over 30% of ADHD children were still doing well on diet alone, approximately 3.5 years after doing a 4 week Few Foods diet at Freiberg University in Germany (10).

Diet training for doctors?

According to Dr Lidy Pelsser, a senior researcher at the ADHD Research Centre in Eindhoven, Netherlands (12), changing a child’s diet should be done with a doctor's supervision:

"We have got good news - that food is the main cause of ADHD.   We've got bad news - that we have to train physicians to monitor this procedure because it cannot be done by a physician who is not trained."

Despite evidence from all over the world showing that ADHD symptoms are related to diet, last year’s Australian Evidence-based Clinical Guidelines for ADHD (13), prepared by doctors and psychiatrists, barely mentions diet, presumably because they have no training in diet. See more in blog Doctors and food intolerance

As Dr Feingold explained, the reason why he ignored the connection between diet and behaviour for 10 years :

“I was an allergist, not a behaviourist… such activity was not within the scope of the Allergy Department” (14) .

Another possibility is that early industry-funded studies showed that diet didn’t work, although it is now recognised that BigFood and BigPharma - funded studies are likely to be heavily biased in favour of the products they sell (15) and in 1989, Dr C Keith Conners who has been described as “the founding father of ADHD” wrote in in his book Feeding the Brain (16): 

“I believe that the failure of some experiments to validate parent observations about food and behaviour is the fault of the studies, not the parents” .

Health professionals who don’t “believe…”

Award-winning dietitian Joy Anderson wrote in the June 2013 issue of the Medical Journal of Australia Insight (17):

“As a dietitian who uses the RPAH Allergy Unit Elimination Diet in my everyday practice, I can assure you that it does work brilliantly in the majority of cases…  it needs to be done properly ... The diet should be supervised by an Accredited Practising Dietitian with experience in food-chemical intolerances … I have many, many satisfied clients who were fobbed off by other health professionals in the past, because they didn't 'believe' in food-chemical intolerance.”

Evidence of effects on the brain

Two of the most recent studies have noted food effects on the brains of ADHD children (10) and young adults (5) which may provide plausible mechanisms. Other researchers suggest that the effects of petroleum-based artificial colours and other processed foods on the brain are important and should not be ignored (18).

The diet we support

The diet regarded as “the gold standard” in the European studies above is the Few Foods (Oligoantigenic) diet pioneered by Dr John Egger in England (8). However, in the experience of the Food Intolerance Network, the Few Foods diet that starts with rice, turkey, lettuce, pears and a few vegetables, is extremely difficult for families to use.

We support the RPAH Elimination Diet that achieves the same results and is easier to use.

Reader reports

Children

“Did Diet work for ADHD? - Yes, had huge results after first 2 weeks of going baseline. Concentration, focus, calmness. The boys dad thought I had sedated him. Strict elimination…” - Tracy [1503]

“My eldest son aged 8 is now excelling in school due to failsafe - he previously had all the symptoms of inattentive ADHD - head in the clouds, extremely forgetful, vague … The biggest culprit … is salicylates. When we did the RPAH diet and salicylate challenge he fell asleep in the classroom at school and had to be taken home. – Lindy [708]

"Ten years ago the teachers and doctors wanted to medicate our daughter for ADHD ... Last year she graduated high school with one of the highest scores which guaranteed her entry into top universities. Everyone comments on how polite and engaging she is as a teenager. My advice to those starting the failsafe journey ... hang in there ... the rewards are well worth the effort." – D [1179]

“I am a primary school teacher … we have just recently begun failsafe eating after my six year old son's diagnosis (of ADHD … at a recent doctor's visit the GP looked at him sitting quietly and said, "He doesn't have ADHD!" – Cara from story [926]

Adults

“As a young girl, I grew up … struggling with the difficulties of ADHD and food intolerances…. (Since doing the diet as an adult) … I have grown so much as a person in the last year, most people wouldn't recognise me …" [1414]

“I have had extremely severe ADHD and Aspergers diagnosed from when I was six … I can honestly say that since I first started this diet (one month ago), my life has been unrecognisably changed for the better ... Before this diet I was surviving, and now I am genuinely, for the first time in my whole life, living life to the full” – Ffion [1395]

READ ADHD diagnoses increasing (blog 1 of 3)

READ How to do diet for ADHD (blog 3 of 3)

References

Diets high in processed foods a risk for ADHD

1. China

A case-control study with 102 ADHD children and 102 healthy children using a food frequency questionnaire (FFQ) found of five dietary patterns, the most processed pattern consisting of processed meat, fried food, puffed food, sugared beverages, and candies was associated with a risk of ADHD. Yan W, Lin S, Wu D, Shi Y, Dou L, Li X. Processed Food-Sweets Patterns and Related Behaviors with Attention Deficit Hyperactivity Disorder among Children: A Case-Control Study. Nutrients. 2023 Mar 2;15(5):1254. doi: 10.3390/nu15051254. PMID: 36904252; PMCID: PMC10005288. https://pubmed.ncbi.nlm.nih.gov/36904252/

2. Turkey

A study with 169 ADHD children aged 6-17 and 221 healthy controls used a FFQ Food consumption including 18 food containing processed meat products and snacks. Consumption amount of all snacks were positively correlated with ADHD symptom scores. Akin S, Gultekin F, Ekinci O, Kanik A, Ustundag B, Tunali BD, Al-Bayati MBA, Yasoz C. Processed meat products and snacks consumption in ADHD: A case-control study. North Clin Istanb. 2022 Jul 8;9(3):266-274. doi: 10.14744/nci.2021.64497. PMID: 36199857; PMCID: PMC9464840. https://pubmed.ncbi.nlm.nih.gov/36199857/ 

3. Iran

A case control study with 500 pre-school and school age children, identified 2 major dietary patterns The healthy dietary pattern was rich in fruits, vegetables, vegetable oils, whole grains, legumes, and dairy products. The Western pattern was rich in processed meat, red meat, pizza, eggs, snacks, animal fat, hydrogenated fat, and salt. Children in the top quintile of the Western dietary pattern score had greater odds having ADHD. Abbasi K, Beigrezai S, Ghiasvand R, Pourmasoumi M, Mahaki B. Dietary Patterns and Attention Deficit Hyperactivity Disorder Among Iranian Children: A Case-Control Study. J Am Coll Nutr. 2019 Jan;38(1):76-83. doi: 10.1080/07315724.2018.1473819. Epub 2018 Oct 11. PMID: 30307794. https://pubmed.ncbi.nlm.nih.gov/30307794/  AND

A case-control study with 120 newly diagnosed ADHD children and 240 controls, age 7-13 years. found that higher adherence to Mediterranean diet containing vegetables, legumes, fruits and nuts, grains, and fish could decrease the odds of ADHD in primary school children. Darabi Z, Vasmehjani AA, Darand M, Sangouni AA, Hosseinzadeh M. Adherence to Mediterranean diet and attention-deficit/hyperactivity disorder in children: A case control study. Clin Nutr ESPEN. 2022 Feb;47:346-350. doi: 10.1016/j.clnesp.2021.11.014. Epub 2021 Nov 15. PMID: 35063225. https://pubmed.ncbi.nlm.nih.gov/35063225/

4. Italy

Zupo R, Castellana F, Boero G, Matera E, Colacicco G, Piscitelli P, Clodoveo ML, Rondanelli M, Panza F, Lozupone M, Sardone R. Processed foods and diet quality in pregnancy may affect child neurodevelopment disorders: a narrative review. Nutr Neurosci. 2023 Apr 11:1-21. doi: 10.1080/1028415X.2023.2197709. Epub ahead of print. PMID: 37039128. https://pubmed.ncbi.nlm.nih.gov/37039128/

5. USA

The first ever study of the effects of artificial food colours on young adults found effects of food colours on brainwave activity and ADHD symptoms in ADHD college students but not the control group. Kirkland AE, Langan MT, Holton KF. Artificial food coloring affects EEG power and ADHD symptoms in college students with ADHD: a pilot study. Nutr Neurosci. 2022 Jan;25(1):159-168. doi: 10.1080/1028415X.2020.1730614. Epub 2020 Mar 1. PMID: 32116139. https://pubmed.ncbi.nlm.nih.gov/32116139/

Elimination diets

6. Feingold diet

50% success rate: Feingold BF. Hyperkinesis and learning difficulties linked to artificial food flavours and colors. Am J Nurs 1976:797-803. In Glaisher IL. Feingold diet. Can Fam Physician. 1980 Jan;26:22. PMID: 21297836; PMCID: PMC2383520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2383520/pdf/canfamphys00262-0024b.pdf

Industry-funded studies didn’t agree: Lisa Bero, Industry influence on research: A cycle of bias, 2022, Oxford University Press https://academic.oup.com/book/44473/chapter-abstract/376462402?redirectedFrom=fulltext found at www.Feingold.org

7. RPAH elimination diet
Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet. 1985 Jul 6;2(8445):41-2. doi: 10.1016/s0140-6736(85)90089-3. PMID: 2861485. https://www.fedup.com.au/images/stories/Swainetal1985.pdf

Few Foods (Oligoantigenic) diet

England

8. 1985 “Artificial colorants and preservatives were the commonest provoking substances, but no child was sensitive to these alone”. Egger J, Carter CM, Graham PJ, Gumley D, Soothill JF. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet. 1985 Mar 9;1(8428):540-5. doi: 10.1016/s0140-6736(85)91206-1. PMID: 2857900.  https://pubmed.ncbi.nlm.nih.gov/2857900/

Netherlands

9. 2011 Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. 2011 Feb 5;377(9764):494-503. doi: 10.1016/S0140-6736(10)62227-1. PMID: 21296237. https://pubmed.ncbi.nlm.nih.gov/21296237/

10. 2021 "Behavioural changes after diet were associated with changes in brain function, seen in before-and-after functional MRIs" Hontelez S, Stobernack T, Pelsser LM, van Baarlen P, Frankena K, Groefsema MM, Kleerebezem M, Rodrigues Pereira R, Postma EM, Smeets PAM, Stopyra MA, Zwiers MP, Aarts E. Correlation between brain function and ADHD symptom changes in children with ADHD following a few-foods diet: an open-label intervention trial. Sci Rep. 2021 Nov 12;11(1):22205. doi: 10.1038/s41598-021-01684-7. PMID: 34772996; PMCID: PMC8589974. https://pubmed.ncbi.nlm.nih.gov/34772996/

Germany

11. 2022 "… ADHD symptoms and other clinical abnormalities can be improved by an oligoantigenic diet. It can be a treatment option for ADHD not only in the short term but also in the long term. Food intolerances are individual and the oligoantigenic diet is currently the gold standard to identify them. Personalized nutrition could be a valid tool for the personalized treatment of ADHD". Walz G, Blazynski N, Frey L, Schneider-Momm K, Clement HW, Rauh R, Schulz E, Biscaldi M, Clement C, Fleischhaker C. Long-Term Effects of an Oligoantigenic Diet in Children with Attention-Deficit/Hyperactivity Disorder (ADHD) on Core Symptomatology. Nutrients. 2022 Dec 1;14(23):5111. doi: 10.3390/nu14235111. PMID: 36501141; PMCID: PMC9737158. https://pubmed.ncbi.nlm.nih.gov/36501141/

12. Dr Pelsser’s quotes from NPR Research News Study: Diet may help ADHD kids more than drugs http://www.npr.org/2011/03/12/134456594/study-diet-may-help-adhd-kids-more-than-drugs

13. “Tiniest mention of diet”: Among 111 recommendations, under 4.1.1 Lifestyle changes in this $500,000 government-funded guideline : “Clinicians should offer guidance on lifestyle factors to help people with ADHD, including …  asking about diet and physical activity levels, and offering strategies and/or referral to assist with any challenges, if needed”  Australian Evidence-Based Clinical Practice Guideline for ADHD by Australian ADHD Professionals Association, 2022. https://adhdguideline.aadpa.com.au/   https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-Summary-of-Recommendations-031022.pdf

14. BF Feingold, Why your child is hyperactive, 1985 (chapter 2), https://www.amazon.com/Why-Your-Child-Hyperactive-bestselling/dp/0394734262

15. Industry-funded studies didn’t agree, Lisa Bero, Industry influence on research: A cycle of bias, 2022, Oxford University Press https://academic.oup.com/book/44473/chapter-abstract/376462402?redirectedFrom=fulltext

16. Dr C Keith Conners, Feeding the Brain, 1989 https://www.amazon.com/Feeding-Brain-Foods-Affect-Children/dp/0738206202

17. Joy Anderson, Medical Journal of Australia Insight , 2013, reference in Why see a dietitian

18. Effects on the brain

The following USA research suggests that “allowable heavy metal residues” in petroleum-based artificial colours and other ultra-processed foods may be contributing to the increasing rates of ADHD and autism in American children and should be further investigated. Lead author Dr Renee Dufault is a former food investigator for the FDA (Food and Drug Administration) and author of the book Unsafe at Any Meal, 2107, https://www.amazon.com/Unsafe-Any-Meal-About-Foods/dp/0757004369

Dufault RJ, Crider RA, Deth RC, Schnoll R, Gilbert SG, Lukiw WJ, Hitt AL. Higher rates of autism and attention deficit/hyperactivity disorder in American children: Are food quality issues impacting epigenetic inheritance? World J Clin Pediatr. 2023 Mar 9;12(2):25-37. doi: 10.5409/wjcp.v12.i2.25. PMID: 37034430; PMCID: PMC10075020. https://pubmed.ncbi.nlm.nih.gov/37034430/