Diet and attention deficit hyperactivity disorder

There is insufficient evidence to support dietary changes in attention deficit hyperactivity disorder (ADHD) and thus they are not recommended by the American Academy of Pediatrics as of 2019.[1] For some children, diet is suspected of playing a role in the multiple behavioral and cognitive symptoms of ADHD.[2]

Food coloring and additives

Since the 1970s and the well-publicised advocacy of Benjamin Feingold, there has been public concern that food colorings may cause ADHD-like behavior in children.[2] These concerns have led the FDA and other food safety authorities to regularly review the scientific literature, and led the UK FSA to commission a study by researchers at Southampton University of the effect of a mixture of six food dyes (Tartrazine, Allura Red, Ponceau 4R, Quinoline Yellow WS, Sunset Yellow and Carmoisine (dubbed the "Southampton 6")) and sodium benzoate (a preservative) on children in the general population, who consumed them in beverages; the study published in 2007.[2][3] The study found "a possible link between the consumption of these artificial colours and a sodium benzoate preservative and increased hyperactivity" in the children;[2][3] the advisory committee to the FDA that evaluated the study also determined that "because of study limitations, the results could not be extrapolated to the general population, and further testing was recommended".[2]

The European regulatory community, with a stronger emphasis on the precautionary principle, required labelling and temporarily reduced the acceptable daily intake (ADI) for the food colorings; the UK FSA called for voluntary withdrawal of the colorings by food manufacturers.[2][3] However, in 2009 the EFSA re-evaluated the data at hand and determined that "the available scientific evidence does not substantiate a link between the color additives and behavioral effects" for any of the dyes.[2][4][5][6][7]

The US FDA did not make changes following the publication of the Southampton study, but following a citizen petition filed by the Center for Science in the Public Interest in 2008, requesting the FDA ban several food additives, the FDA commenced a review of the available evidence, and still made no changes.[2]

There is no evidence to support broad claims that food coloring causes food intolerance and ADHD-like behavior in children.[8]^:452 It is possible that certain food coloring may act as a trigger in those who are genetically predisposed, but the evidence is weak.[2][9]

Sugar regulation

A number of studies have found that sucrose (sugar) has no effect on behavior and in particular it does not exacerbate the symptoms of children diagnosed with ADHD.[10][11] One study demonstrated the impact of expectancy effects in parents' perceptions of their children's hyperactivity after consuming sugar. In this study, parents who were told their child had ingested a high concentration of sugar in drink form (even though the drink was actually flavored with aspartame), reported their child as being more active, inattentive and resistant to parental demands. This was in comparison to the group who were told (accurately) that their child had ingested no sugar.[12]

Omega-3 fatty acids

Some research suggests that children with ADHD may have low blood levels of essential omega-3 fatty acids.[13] However, it is unknown if decreased blood levels of omega-3 fatty acids can cause or exacerbate ADHD or whether lower blood levels of omega-3 fatty acids associated with ADHD are caused by an underlying mechanism.[13][14] Several other studies showed similar effects, especially of Omega 3 fatty acids with Zinc and Magnesium.[15]

References

1. Wolraich, ML; Hagan JF, Jr; Allan, C; Chan, E; Davison, D; Earls, M; Evans, SW; Flinn, SK; Froehlich, T; Frost, J; Holbrook, JR; Lehmann, CU; Lessin, HR; Okechukwu, K; Pierce, KL; Winner, JD; Zurhellen, W; SUBCOMMITTEE ON CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVE, DISORDER. (October 2019). "Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents". Pediatrics. 144 (4): e20192528. doi:10.1542/peds.2019-2528. PMC 7067282. PMID 31570648.
2. Center for Food Safety and Applied Nutrition (30 March 2011). Background Document for the Food Advisory Committee: Certified Color Additives in Food and Possible Association with Attention Deficit Hyperactivity Disorder in Children (PDF) (Report). Food and Drug Administration.
3. Chapman, Sarah (March 2011). Guidelines on approaches to the replacement of Tartrazine, Allura Red, Ponceau 4R, Quinoline Yellow, Sunset Yellow and Carmoisine in food and beverages (PDF) (Report). Aberdeen: Food Standards Agency in Scotland.
4. Boskou, D.; Charrondiere, R.; Dusemund, B.; Gott, D.; Hallas-Møller, T.; Hulshof, K.F.A.M.; König, J.; Parent-Massin, D.; Rietjens, I.M.C.M.; Speijers, G.J.A.; Tobback, P.; Verguieva, T.; Woutersen, R.A. (14 November 2009). "Scientific Opinion on the re-evaluation of Sunset Yellow FCF (E 110) as a food additive". EFSA Journal. 7 (11): 1330. doi:10.2903/j.efsa.2009.1330.
5. Boskou, D.; Charrondiere, R.; Dusemund, B.; Gott, D.; Hallas-Møller, T.; Hulshof, K.F.A.M.; König, J.; Parent-Massin, D.; Rietjens, I.M.C.M.; Speijers, G.J.A.; Tobback, P.; Verguieva, T.; Woutersen, R.A. (12 November 2009). "Scientific Opinion on the re-evaluation of Ponceau 4R (E 124) as a food additive". EFSA Journal. 7 (11): 1328. doi:10.2903/j.efsa.2009.1328.
6. Aguilar, F.; Bemrah, N; Galtier, P.; Gilbert, J.; Grilli, S.; Guertler, R.; Kass, G.E.N.; Lambré, C.; Larsen, J.C.; Leblanc, J-C.; Mortensen, A.; Pratt, I.; Stankovic, I.; Strobel, S. (12 September 2009). "Scientific Opinion on the re-evaluation of Quinoline Yellow (E 104) as a food additive". EFSA Journal. 7 (11): 1329. doi:10.2903/j.efsa.2009.1329.
7. Boskou, D.; Charrondiere, R.; Dusemund, B.; Gott, D.; Hallas-Møller, T.; Hulshof, K.F.A.M.; König, J.; Parent-Massin, D.; Rietjens, I.M.C.M.; Speijers, G.J.A.; Tobback, P.; Verguieva, T.; Woutersen, R.A. (12 November 2009). "Scientific Opinion on the re-evaluation Tartrazine (E 102)". EFSA Journal. 7 (11): 1331. doi:10.2903/j.efsa.2009.1331. The Panel concludes that the present dataset does not give reason to revise the ADI of 7.5 mg/kg bw/day.
8. Tomaska, LD; Brooke-Taylor, S. (2014). "Food Additives - General". In Motarjemi, Y; Moy, G; Todd, ECD (eds.). Hazards and Diseases. Encyclopedia of Food Safety. 2 (1st ed.). Amsterdam: Elsevier. pp. 449–454. ISBN 978-0-12-378613-5.
9. Millichap, JG; Yee, MM (February 2012). "The diet factor in attention-deficit/hyperactivity disorder". Pediatrics. 129 (2): 330–337. doi:10.1542/peds.2011-2199. PMID 22232312. S2CID 14925322.
10. Benton, D (May 2008). "Sucrose and behavioral problems". Critical Reviews in Food Science and Nutrition. 48 (5): 385–401. CiteSeerX 10.1.1.689.8566. doi:10.1080/10408390701407316. PMID 18464029. S2CID 35099819.
11. Staudenmayer, Herman (1999). "Diagnoses Incorrectly Attributed to EI". Environmental Illness: Myth and Reality. Boca Raton: Lewis Publishers. pp. 58–62. ISBN 978-1-56670-305-5.
12. Johnson, RJ; Gold, MS; Johnson, DR; Ishimoto, T; Lanaspa, MA; Zahniser, NR; Avena, NM (September 2011). "Attention-deficit/hyperactivity disorder: is it time to reappraise the role of sugar consumption?". Postgraduate Medicine. 123 (5): 39–49. doi:10.3810/pgm.2011.09.2458. PMC 3598008. PMID 21904085.
13. Young, G; Conquer, J (January 2005). "Omega-3 fatty acids and neuropsychiatric disorders". Reproduction, Nutrition, Development. 45 (1): 1–28. doi:10.1051/rnd:2005001. PMID 15865053.
14. Haag, M (April 2003). "Essential fatty acids and the brain". Canadian Journal of Psychiatry. 48 (3): 195–203. doi:10.1177/070674370304800308. PMID 12728744.
15. Frölich, J.; Döpfner, M. (March 2008). "Die Behandlung von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen mit mehrfach ungesättigten Fettsäuren – eine wirksame Behandlungsoption?" [The treatment of Attention-Deficit/Hyperactivity Disorders with polyunsaturated fatty acids - an effective treatment alternative?]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (in German). 36 (2): 109–116. doi:10.1024/1422-4917.36.2.109. PMID 18622940.