Food Becomes You

ADHD and Diet

by Wendy Gordon

In the early '70s, right around the time I graduated from high school, the Feingold Diet hit the national consciousness in a big way. The diet was developed by Dr. Ben Feingold, a pediatrician and allergist, to treat what was then known as hyperactivity. The diet banned artificial colors, thousands of artificial flavors, petroleum-based preservatives (BHA, BHT, and TBHQ), artificial sweeteners such as aspartame and (at least for the initial weeks of the diet) salicylates, a substance found in common foods like apples, almonds and grapes.

In the intervening thirty-plus years, hyperactivity has morphed into the officially designated disorder ADHD, diagnosed with astounding frequency among children and recently adults as well. The most common treatment for ADHD is stimulant drugs such as Ritalin or Adderall. According to an NIH "consensus statement" published in 1998, the core symptoms of ADHD include "developmentally inappropriate levels of attention, concentration, activity, distractibility and impulsivity." The statement estimates that 3-5% of children suffer from the disorder, yet in some communities over 10% of school children have been diagnosed with ADHD and are taking stimulant drugs.

My gut feeling is that ADHD is grossly over diagnosed. Many children slapped with this pathological diagnosis are just by nature more active, impulsive and "spirited" than the average. ADHD symptoms may be masking either giftedness or intense boredom, or else disorders such as dyslexia or hearing loss. Nevertheless, there's no denying that some individuals truly do have ADHD, exhibiting these symptoms to such a degree that they cannot learn, work or form lasting relationships.

Many parents gravitate towards nutritional treatments because they (understandably) dislike the idea of their child taking stimulant drugs. The drugs themselves, given their amphetamine-like nature, often cause poor appetite and delayed growth. Mainstream medicine remains dubious about nutritional treatments, but many nutritionists, alternative health practitioners and parents disagree. Despite numerous studies over the past thirty-five years, test results on the efficacy of dietary changes remain inconclusive. This lack of definitiveness is probably due to the inability to design a truly effective study. The diagnosis of ADHD is broad, and the suggested nutritional triggers extensive. One of the most common types of studies is the "challenge test," where children are placed on a strict elimination diet and various substances, such as BHT, are reintroduced. Any number of factors can go awry with this approach: the amount of the substances might not be enough to trigger a reaction; individual children might not be susceptible to that particular substance; or the substance may trigger a delayed reaction, too late to be picked up by the study.

The fact is, parents have nothing to lose by following most of the precepts of the Feingold Diet. No child should be eating artificial colors, flavors and petroleum-based additives, whether they have ADHD or not. These compounds are found only in processed foods. As a mother of four, I can state conclusively that serving your children whole, unprocessed, made from scratch food isn't impossible. It does require spending some time in the kitchen, though the advent of natural convenience foods (such as Annie's Mac and Cheese) makes life easier. As for the occasional bowl of Fruit Loops your child has at the neighbor's house, don't worry, intake at that occasional level will only disturb the most sensitive of children. There's not much evidence that salicylates provoke ADHD and since they are found in many nutritious and popular foods, I see no reason to eliminate them.

Other dietary links are worth considering. One in 133 people suffers from celiac disease, an inherited disorder where people are unable to absorb gluten (the protein in wheat, rye and barley) properly. Continuous irritation leads to flattening of the villi in the intestine, and usually diarrhea, weight loss and malnutrition. Sometimes, however, patients may develop isolated nutritional deficiencies without the related gastrointestinal distress. These deficiencies may produce neurological symptoms similar to those of ADHD. Children with ADHD should be routinely screened for celiac disease.

Similarly, casein allergies can also trigger behavioral symptoms. Casein is the main protein in cow's milk, but is also found in additives such as sodium caseinate and hydrolyzed casein. Again, there's no reason for all ADHD sufferers to eliminate dairy, but they should all be screened for casein allergy as part of an initial evaluation.

Omega 3 fatty acids are believed to aid memory and concentration, and preliminary studies indicate some promising results in the treatment of ADHD. There's no harm done, and probably some good, in giving children a daily Omega 3 fatty acid supplement as well as including omega rich foods such as tuna, salmon and vegetable oils in the diet.

Sugar has a bad reputation for causing children to bounce off the walls, but controlled studies have never borne out this reaction, and contrary to popular belief, sugar elimination was never part of the Feingold Diet. Refined sugar does cause an immediate rise in blood sugar levels, followed by an equally rapid drop (as anyone who's had a doughnut for breakfast can attest) so that probably accounts for some of the observed behavior changes. Also, many refined sugar foods, such as caffeine and soda, are chock full of artificial colors, flavors and preservatives, and are frequently served in situations where children get hyper regardless of what they eat, such as birthday parties. I would recommend limiting refined sugar in your child's diet, but not being obsessive about it. Small amounts of sugar in additive-free cakes, cookies and ice cream are fine for most children.

Good old caffeine benefits some children with ADHD. This is not surprising, since it is a stimulant. It's a natural one, though, and I'd rather give my child a cup of coffee in the morning rather than a prescription pill.

While diet definitely has a place in the treatment of ADHD, parents should be wary of overemphasizing diet to the detriment of other treatment modalities. Too much fixation on diet can make children feel like they are victims of an illness, without any accountability for their own behavior. Yet, the same can be said for medication. Behavioral therapies, with clear rewards and consequences, are just as important as diet and/or medication. While I think stimulants are vastly over prescribed, for a small percentage of children, the benefits far outweigh the risks and they should not be deprived of medication that can help them.