Additives (Feingold diet)

ADD, ADHD, antioxidants, artificial colors, artificial flavors, aspirin-containing products, attention deficit disorder, attention deficit hyperactivity disorder, BHA, BHT, Benjamin Feingold, elimination diet, FAUS, hyperactivity, KP diet, salicylates, synthetic food additives, TBHQ.

The Feingold diet involves the elimination of artificial colors and flavors as well as other food additives as a potential way to resolve a number of behavioral and cognitive difficulties. This diet is based on the premise that allergic reactions or sensitivities to certain components of foods may contribute to the symptoms of certain medical conditions.

Dr. Benjamin Feingold, the founder of the Feingold diet, was a pediatrician and allergist in San Francisco, California in the United States. While working with patients who were allergic to aspirin, he found that some of them reacted both physically and behaviorally to certain foods and food additives. In 1973, Feingold proposed that salicylates, artificial colors, and artificial flavors may cause hyperactivity in children. He suggested a diet free of these chemicals, and named it the KP diet. The media then changed this name to the Feingold diet.

This diet may help children diagnosed with hyperkinesis or hyperactivity. When present with other symptoms, hyperactivity is a symptom of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). Many parents of children with ADD or ADHD adopt this diet for their children.

Advocates of this diet also claim that asthma, bedwetting, ear infections, eye-muscle disorders, seizures, sleep disorders, stomach aches, and other conditions may respond to the Feingold program. Sensitivity to synthetic additives and/or salicylates may be a factor in antisocial traits, compulsive aggression, self-mutilation, difficulty in reasoning, stuttering, and excessive clumsiness. There is currently conflicting evidence regarding the effectiveness of the Feingold diet in treating these conditions. The etiology (origin) of disorders that the Feingold diet claims to benefit, such as ADD and ADHD, are also the subject of vigorous debate in the scientific community.

There is currently conflicting evidence regarding the effectiveness of the Feingold diet in treating a variety of conditions. The etiology (origin) of disorders that the Feingold diet claims to benefit, such as ADD and ADHD, are also subject of vigorous debate in the scientific community.

Proponents claim that this diet can treat a wide variety of conditions including marked hyperactivity, which is characterized by constant motion, running instead of walking, inability to sit still, and inappropriate wiggling of legs/hands. It is also claimed to treat impulsive actions seen as disruptive behavior, unresponsiveness to discipline, unkindness to pets, and poor self-control. Destructive behaviors, such as throwing and breaking things, little or no recognition of danger to self, inappropriate noises, excessive or loud talking, and abusive behavior have also been targeted as intentions of therapy for the Feingold diet. Proponents also claim that compulsive actions including aggression, perseveration/repeating of an activity, touching things or people excessively, workaholic habits, chewing on clothing, other objects, scratching, biting and picking at the skin, can be treated by the Feingold diet, along with emotional concerns such as low frustration tolerance, depression, frequent crying, irritability, nervousness, low self-esteem, mood swings, and suicidal thoughts. It has also been claimed to treat short attention spans, characterized by impatience and distraction. Other proposed conditions treated include neuro-muscular involvement such as poor coordination, dyslexia, speech delays, tics, some seizures, and cognitive and perceptual disturbances including auditory memory deficits (difficulty remembering what is heard), visual memory deficits (difficulty remembering what is seen), difficulty in comprehension and short term memory and reasoning.

Many parents who have followed Feingold's recommendations have reported improvement in their children's behavior. FAUS, which has local chapters throughout the United States along with international chapters, claims that fidgetiness, poor sleeping habits, short attention span, self-mutilation, antisocial traits, poor muscle coordination, memory deficits, asthma, bedwetting, headaches, hives, seizures, and many other problems may respond to the Feingold program. However, some experiments fail to support the idea that additives are responsible for such symptoms in the vast majority of children.

Through the 1970s, Feingold published a series of studies in which a diet free of salicylates, artificial flavors and colors resulted in a remission of symptoms in 30-50% of children diagnosed as hyperactive. In the following years, further experimental studies resulted in tests of the original diet and a modified diet with salicylates included but artificial additives excluded. None of the studies gave unqualified support for the hypothesized diet effects, and there were also reports that may disprove the theory. Findings suggested that some hyperactive children (10-25%), mostly younger ones, respond favorably to a diet free of artificial additives. The lack of conclusive evidence dictated the need for additional research.

A study conducted by Brenner in 1977 involved 59 children, ages 6 to 14 years, diagnosed as hyperkinetic. Of 32 who were able to tolerate the Feingold low-salicylate and additive-free diet, 11 were markedly improved. A placebo effect could not definitely be ruled out, but the changes seen in patients who had been followed for years with other forms of therapy suggested that this improvement was genuine.

In 1980, a review team assembled by the Nutrition Foundation concluded that double-blind studies have not shown consistent deterioration in behavior of hyperactive children when challenged with artificial food colorings. The results of this study contrast those reported by Feingold and others, which claimed that 32-60% of children improved dramatically with the elimination of additives under non-blind conditions without placebo controls. This suggests that the method of testing may play a role in the results, and should be noted when interpreting the results of a study.

A 1983 study by Lipton and Mayo examined Feingold's proposition that hyperactivity and learning disabilities in children are commonly caused by the ingestion of food additives and claimed that elimination of foods with additives from the diet resulted in major improvements in three-quarters of hyperactive children. This study compiled the results of multiple controlled double-blind studies over a period of 5 years, and concluded that 2% (contrasted with Feingold's claims of 75%) of hyperactive children respond adversely to dye additives, and even the 2% were questionable. According to the authors, there is no need for high-priority research or for changes in public policy regarding the use and labeling of foods containing additives. Sugar and aspartame (an artificial sweetener) have also been blamed for hyperactivity, but available well-designed studies have found no evidence supporting such claims. Hyperkinesis has multiple etiologies, which require other types of biological and psychological research.

A study done in 1988 by Rowe included 220 children with suspected hyperactivity. Fifty-five children were chosen to participate in a 6-week trial of the Feingold diet. Of these 55 participants, 40 (72.7%) demonstrated improved behavior and 26 (47.3%) remained improved following liberalization of the diet over a period of 3 to 6 months. Also in this study, 8 children were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo or 50mg of either tartrazine or carmoisine (synthetic colorings) each for 2 separate weeks. Two of these 8 children were classified as having significant reactions to these additives, characterized as extreme irritability, restlessness, and sleep disturbance. One of these children had inattention as a feature while the other did not.

Attention deficit hyperactive disorder (ADHD) is considered a neurophysiologic problem that is detrimental to children and their parents. Despite previous studies on the role of foods, preservatives and artificial colorings in ADHD, this issue remains controversial. An investigation conducted by Boris in 1994 evaluated 26 children who met the criteria for ADHD. Treatment with a multiple item elimination diet showed 19 children (73%) responded favorably. On open challenge, all 19 children reacted to many foods, dyes, and/or preservatives. A double-blind placebo controlled food challenge was completed in 16 children. There was a significant improvement on placebo days compared with challenge days. Atopic (genetically susceptible to allergies) children with ADHD had a significantly higher response rate than the non-atopic group. This study demonstrates a beneficial effect of eliminating reactive foods and artificial colors in atopic children with ADHD and claims that dietary factors may play a significant role in the etiology of the majority of children with ADHD.

Overall, the evidence on the Feingold diet (including additive free diets) is mixed. Nonetheless, this diet may have benefits in select groups of patients, such as allergy-prone individuals.

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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The Feingold Association of the United States (FAUS) is a non-profit membership based program, which guides dieters in the use of the Feingold diet. Adherence to this diet may require lifestyle and eating pattern changes. Both children and adults may follow the Feingold diet, although current available evidence has not evaluated the long-term safety and efficacy in these groups. The Feingold diet has varied and inconsistent support by medical doctors and naturopathic physicians.

The recommendations of this diet advise a two-stage plan. The first stage involves eliminating artificial colors and flavors, certain antioxidants, aspirin-containing products, and foods containing natural salicylates. After 4 to 6 weeks in this first stage, if an improvement occurs, certain foods may be reintroduced. The reintroduction of foods typically occurs one at time, and in moderation, during the second stage of this diet. This stage lasts until it is determined which, if any, of the eliminated products can be reintroduced.

Salicylate-containing foods that are eliminated may include cherries, cloves, tangerines, berries, coffee, plums, apricots, cucumbers, tea, apples, currants, tomatoes, peaches, oranges, almonds, pears, nectarines, grapes, raisins, grapefruit, green peppers, and prunes. Because most vitamin C containing fruits and vegetables are eliminated, this diet may require supplementation. A qualified healthcare provider should be consulted before making decisions about diets and/or health conditions.

Additives and other ingredients that are typically avoided include adipic acid, antioxidants, BHA (bishydroxyanisoile), BHT (bishydroxytoluene), benzoates, carminic acid, cochineal, colorings, concentrates, corn syrup, nitrites, sulfur dioxide, and sulfites.

This diet does not eliminate sugar or junk food specifically, but does encourage moderation of these food types. However, elimination of junk food that contains multiple synthetic additives is recommended.

Certain over the counter and prescription drugs, as well as mouthwash, toothpaste, cough drops, and various non-food products may have to be avoided to adhere to the elimination of certain additives.

The majority of foods included in this diet can be purchased at a neighborhood supermarket. However, it may be necessary to shop at a health food store in order to buy items such as natural toothpastes or lollipops that are free of artificial colors or flavors. There are also mail-order suppliers and websites that cater to individuals using the Feingold diet.

A sample day on the Feingold diet may include:

Breakfast: One cup whole grain cereal, ? cup 2% milk, two slices whole grain toast, two teaspoons butter.

Lunch: One cup vegetable soup with barley (without tomato), one jack cheese sandwich on whole wheat bread, one cup milk (2% fat), two oatmeal cookies.

Dinner: Three oz. chicken breast, one baked apple, one dinner roll, two teaspoons butter, one cup low-fat milk, 1/2 cup pudding.