Feingold diet

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The Feingold diet is a food elimination program developed by Ben F. Feingold, MD to treat hyperactivity. It eliminates a number of artificial colors and artificial flavors, aspartame, three petroleum-based preservatives, and (at least initially) certain salicylates. There has been much debate about the efficacy of this program. Some mainstream medical practitioners deny that it is of any value, while other medical practitioners, as well as many people living with ADHD and parents of children with ADHD, claim that it is effective in the management of ADHD as well as a number of other behavioral, physical and neurological conditions. The debate has continued for more than 30 years, involving not only consumers and physicians, but scientists, politicians, and the pharmaceutical and food industries.

Contents

[edit] The Feingold Program

The Feingold Program eliminates three groups of synthetic food additives and one class of synthetic sweeteners:

Most of these additives are synthetic compounds made from by-products of the petroleum refining process.[citation needed] The word "synthetic" is used instead of "artificial" because not all artificial colorings, such as titanium dioxide, are eliminated by the program. Only FD&C and D&C colorings are eliminated. Aspartame and its related chemicals have recently been eliminated from the Feingold Program because of evidence that they may be harmful to the nervous system. [1]

During the initial weeks of the Program, certain foods containing salicylates are removed and may later be reintroduced and tested for tolerance, one at a time. Most of the problematic salicylate-rich foods are common temperate-zone fruits, as well as a few vegetables, spices, and one tree nut. During this early period, foods like pears, cashews and bananas are used instead of foods like apples, almonds and grapes.

Contrary to popular misconception, soft drinks, chocolate and sugar have never been eliminated on the Feingold Program, although moderation is encouraged when consuming such items. Families can often continue to eat the types of food to which they are accustomed, including desserts. It is a matter of picking brands free of the unwanted additives. Most of the acceptable foods are easily available at supermarkets.

[edit] History

Dr. Feingold was a pediatrician and allergist, and was considered a pioneer in the fields of allergy and immunology.[citation needed] He served as Chief of Pediatrics, Cedars of Lebanon Hospital, Los Angeles, CA; later he established a number of allergy centers for Kaiser Permanente of Northern California, and served as Chief of Allergy at the Kaiser Permanente Medical Center in San Francisco.

[edit] First Recorded Case

Since the 1940s, researchers world-wide had discussed cross-reactions of aspirin (a common salicylate) and Tartrazine (FD&C Yellow #5).[citation needed] Dr. Stephen Lockey at the Mayo Clinic and later Dr. Feingold at Kaiser, found that eliminating both salicylates and synthetic food additives from patients' diets eliminated not only allergic-type reactions, but also behavioral changes in some of his patients.

The first clear case was a patient referred to him for treatment of her severe hives in 1965. [2] Typical treatments had not worked for her. Dr. Feingold placed her on a low-salicylate diet with no synthetic coloring or flavoring. Soon her hives were gone, and the patient was happy.

Ten days later, however, her psychiatrist called Dr. Feingold to ask, "What did you do to my patient?" She had been receiving treatment for a personality disorder for years, but in less than two weeks on the diet, her behavior had noticably improved. Both doctors were puzzled. Dr. Feingold asked his staff to watch for other patients who did not respond to standard treatments. He suggested the diet regimen to them, and sometimes it worked. As more reports of behavioral improvement came in, he began to use the diet for people - especially children - with behavioral problems as well as allergy, and eventually found the diet often worked for children with behavioral problems but without allergy symptoms.

He named the diet the K-P Diet for Kaiser-Permanente (and he liked the pun of "K-P" as Kitchen Police).[citation needed] Later, as this diet became more well-known for helping hyperactive and learning disabled children, the media dubbed it the "Feingold diet."

[edit] Early Use of the K-P / Feingold Diet

As he began to form a hypothesis around the connection between food additives and hyperkinesis, Dr. Feingold began to look for children that had not responded to typical treatments such as Ritalin, Dexedrine, Talk Therapy or other available treatments. He offered them the K-P diet. He reported the following response to the diet in children for whom other typical approaches had failed[citation needed]:

  • 1/3 significantly helped
  • 1/3 partially helped
  • 1/3 not helped

Since these families had already tried a variety of other medications and treatments without improvement, they were not likely to be placebo-responders.[citation needed]

In the beginning, Dr. Feingold did not eliminate the preservatives BHA or BHT. After food additive expert and author Beatrice Trum Hunter convinced him to do so, positive results increased to over 70%.[citation needed] At that time TBHQ and aspartame, which are eliminated today, did not yet exist.

[edit] Initial Controversy

In 1973, Dr. Feingold presented his findings at the annual conference of the American Medical Association [1]. By that time he had 8 years of clinical experience with the diet: he had treated hundreds of children, and was beginning to use this experience to develop a more user-friendly diet.

Within a few months, the Nutrition Foundation, an organization whose members included Dow Chemical, Coca Cola, and several companies who make, use, and distribute the food additives removed from the K-P diet[2][citation needed], published statements claiming that there was "no valid scientific support"[cite this quote] for the K-P diet. These statements are still quoted today, more than 30 years later[citation needed]. Over the next few years, the Nutrition Foundation funded and designed several small studies carefully crafted to show that the diet produced little effect.[citation needed]

A review of these studies published in 1983 [3] concluded that possibly 2% of children respond adversely to food additives, but that even 2% was "questionable," and that there was no need for further research on additives or for any improvement in product labeling. However, when toxicologist Bernard Weiss [4] and autism expert Bernard Rimland [5] analyzed these same studies, they found that they actually did support the positive effects of the Feingold diet.

Because of the confusion with weight-loss diets, and because more than just diet is involved in the management of ADHD suggested by the Feingold Association, the "Feingold Diet" was renamed the "Feingold Program."

[edit] Research findings

This article or section may contain original research or unverified claims.
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Many studies show that 70% or more of hyperactive children respond positively to the removal of synthetic additives, especially when salicylates or allergens are removed. There is controversy, however, over what happens when researchers take children whose behavior has improved on a diet that eliminates several thousand additives, and then challenge them with one or a few additives, usually synthetic colors.

Especially in the early studies, if such a challenge did not produce a change in behavior, researchers often concluded that the diet had not directly caused the initial improvement in behavior. Rather, the assumption was that the improvement had been due to a placebo effect.

There are other possible reasons for the failure of a challenge to evoke a response, however. For example, the amount of additive used as a challenge might have been too small to cause an effect[citation needed]. A comparison of studies using food dyes as the challenge [6] [7] [8] [9] [10] [11] [12] [13] [14] indicates that there is likely a dose-related response: when a larger dose of the challenge is used, more children react to it. [citation needed] In addition, the effect of a challenge additive might only be seen in synergy with other additives or foods [1], or the additive used for the challenge may simply not be among those causing the original effect.[citation needed]

[edit] Early studies

Like most new developments, the first reports of improvement of behavior via diet were anecdotal. This was followed by clinical trials and eventually by larger, double-blind placebo-controlled studies.

In 1976, a double-blind crossover diet trial found that both parents and teachers saw fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline.[15] A 1978 double-blind crossover study using cookies with 13 mg food dye each combined with either medication or placebo found, "The results of this study offer data that a diet free of artificial flavors and colors results in a reduction of symptoms in some hyperactive children."[16] In 1980, forty children were put on a diet free of artificial food dyes and other additives for five days. They then performed the usual double-blind placebo-controlled test but used 100 mg or 150 mg of the food dye mix. They found that the food dyes impaired the performance of the 20 hyperactive children on paired-associate learning tests. The dyes did not hurt the performance of the 20 non-hyperactive children. The study states: "Our data suggest that a large dose of food dye blend decreases attention span in hyperactive children as reflected by performance on the learning test."[17]

Seven small studies adding up to a total of 190 children were published starting in the late 1970's. Some of them were elaborate double-blind diet studies using a Feingold-type diet. In some of these studies, the children were taken off their medication, while in others, they continued on stimulant medications including artificial colorants, in spite of the interference that this would create with the diet.

One of the studies in 1978 [18] , for example, used 36 children between 6 and 12, and 10 children between 3 and 5. The teachers of the school-aged children did not record any improvement, but 63% of the mothers reported improved behavior, as well as 100% of the mothers of the preschoolers; however, since the improvement was reported by the parents of the children rather than teachers, and locomotor activity tests were unaffected, it was reported that there was "no diet effect."

In 1980 the Nutrition Foundation set up a review team to review studies related to the Feingold diet. [19] They published a report that stated that there was no response at all to the diet. In 1983, the review team's co-chairman and a colleague reviewed a variety of studies and concluded that no more than 2% of children respond adversely to dye additives.

An influential comparative diet studies was conducted in 1987. [20] This was a study of 39 children, of whom 18 were hyperactive, and the balance had other learning disorders. Of those 18, all but one were on behavior-modifying medications during the entire study. The researchers provided a Feingold-type diet for a single week that was, by their own description, unpalatable. They particularly noted that the children missed mustard and ketchup; however, mustard is not eliminated by the Feingold diet, and no reason was given for its exclusion.

This diet week was followed by an additive-rich diet the next week. Although the study reported that the camp director and all teachers felt that the children were noisier and more active during the second, additive-rich week, they discounted these observations in favor of filmed 4-minute sequences made during meals. These films were intended to measure reaction to additives in the meals in spite of the fact that any such reaction would not be expected to occur for some time after eating.

During the course of the study, three children were dropped: one who was not on stimulant medication, whose behavior became worse during the second week; one who refused to behave altogether; and one whose dose of Cylert became "inadequate" and whose behavior worsened when additives were allowed during the second week.

They concluded that the "Feingold diet has no beneficial effect on most children with learning disorders" and moreover that the diet was "distasteful to the typical American child."

[edit] Later studies

Recent studies show that between 50% to 85% of children placed on an additive-restricted diet show improvement. For example, in a 1994 study of 200 children, 75% of the children improved on a Feingold-type diet; more than 82% of them got worse in a double-blind challenge using small-to-modest amounts of the single food dye Tartrazine (Yellow #5), and a dose-response effect was observed.[14]

In the biggest such study ever performed, in 1986, the performance of over a million children in 803 New York City public schools was studied for seven years. The children's average standardized test scores rose 15.7% during the years that additives were removed from their breakfast and lunch menus.[21]

In 1997, an association between brain electrical activity and intake of provoking foods was shown in children with food-induced ADHD. (Picture) [22] Another study showed that an oligoantigenic diet (a diet with the least possible risk of allergic reaction) can work as well as Ritalin for conduct-disordered children. [23] Other research demonstrated the positive effect of treating young criminals with dietary intervention and correction of mineral imbalances, [24] [25] and that toddlers show both significant reductions in hyperactive behaviour when additives are removed from their diet, as well as increased hyperactivity when exposed to a very small (20 mg) amount of food coloring and a benzoate preservative. This effect was observed by parents whether or not the child was hyperactive or atopic. [26]

A number of studies conducted since 1980 using diets similar to the Feingold Program report greater than 70% of children responding positively to the diets. Others that eliminated synthetic colors and flavors, but included salicylates still reported greater than 50% positive response. [27] [10] [28] [11] [29] [30] [31] [14] [13]

[edit] Criticism of Feingold Diet

Over the years, a number of criticisms of the Feingold Program have been presented. Many of these center on the difficulty in avoiding synthetic additives, especially in processed or fast food or while eating out, or with social or emotional side-effects the diet may cause. Others center on the range of symptoms claimed to be improved by the Feingold Program.

[edit] Food- and Diet-Related Issues

Some critics say that the Feingold Program requires a significant change in family lifestyle and eating patterns because families are limited to a narrow selection of foods, and that such foods are often expensive, and must be prepared "from scratch", greatly increasing the amount of time and effort a family must put into preparing a meal [citation needed].

Like any change in diet, the Feingold Program does require that patients make changes in the food that they eat. However, these changes do not usually require significant changes in the types or cost of food a family may choose or the way a family chooses to prepare them. It does require making careful selections between similar alternatives, rather than wholesale changes.[citation needed]

Such choices can be more difficult to make in circumstances where little is known about the exact ingredients used in a product, such as at a restaurant or when purchasing food from a vending machine. This requires that a family identify restaurants or products that are not likely to create a problem. Questionable choices can also be avoided by bringing appropriate food when necessary, such as bringing a lunch to school. Parents are encouraged to keep treats available at home and school, so that the children never need feel deprived or left out.[citation needed]

Nutritionally, the the Feingold Program is little different from what the child would experience without it. While some fruits and a few vegetables are eliminated in the first weeks of the Program, they are replaced by others. Often, some or all of these items can be returned to the diet, once the level of tolerance is determined. Studies have found that children on the Feingold Program actually ate better than those eating a "usual" diet, and were more likely to achieve the Recommended Dietary Allowance (RDA) of various nutrients.[32] [33]

[edit] Psychological or Behavioral Issues

Other critics express concerns about social or emotional side-effects that putting children on a specific diet may have. These include that their self esteem may be undermined by implanting notions that they are unhealthy and fragile, or that children may experience situations in which the children's eating behavior or "fear of chemicals" are regarded as peculiar by other children. [19] Some have even gone so far as to speculate the Feingold Program could contribute to a child developing an eating disorder in later life.[34]

No clinical evidence whatsoever supports these speculations. While it is possible to use any therapy abusively, this is obviously not the intention of the Feingold Program. Children can continue to enjoy the same circumstances and experiences any other child would, and at the same time avoid the additives that trigger their symptoms.

The issues that a child on the Feingold Program faces are very similar to the issues that a child with an allergy to a common product such as lactose or peanut butter must deal with, or a condition such as diabetes. With that perspective, a child on the Feingold Program would hardly stand out as "different." In fact, the Feingold Program could be seen as relatively liberal, as it includes sugary foods, junk foods and even fast food.

[edit] Issues Surrounding Treatment of Multiple Symptoms

Some feel that it is absurd to think that one intervention could improve symptoms as diverse as asthma, allergies, bedwetting, chronic ear infections, headaches, and insomnia all at once. Critics point to the fact that effectiveness against a wide range of unrelated symptoms is frequently a hallmark of treatments that work via the placebo effect.

The diet was originally designed as a diagnostic elimination diet to improve food-related asthma and allergic reactions. It is therefore not surprising that it influences these problems. Only later was it found to also be effective in treating behavioral issues. In addition, many children with ADHD suffer from multiple comorbid symptoms. It has been found that there is a profile of the child most likely to benefit from the diet. [35] The child may not have all of these symptoms: some may have few symptoms and others seem to have all of them. While the underlying physiological reason is not understood, when a patient eliminates the additives to which they are sensitive, many or even most of the symptoms contained within the profile are improved. Research supports dietary intervention for each of the symptoms in turn.[citation needed]

[edit] Support for Parents

Dr. Feingold wrote a book directed to parents, entitled Why Your Child is Hyperactive. [36], as well as The Feingold Cookbook, [37] written in collaboration with his wife, Helene. In addition, more up-to-date books have also been published.

As parents began using this diet for their children, many saw dramatic success and formed grass roots support groups. When they gathered in 1976 to form a non-profit national organization, they chose the name "Feingold Association" to honor Dr. Feingold. As time passed, due to the increasing number of double-income families, fewer mothers were available to run these local "kitchen table" support groups, and today the Feingold Association of the United States provides member support services. Recently, some support has been added for Canadian members, and there is some information on the website suitable for people in other countries, as well.

The Feingold Association provides information and support for those starting the Program. Members receive comprehensive materials [38] including a book listing thousands of brand name foods that have been researched by the Association and are free of the eliminated additives. Newsletters, updates, and phone and email support are also provided. Acceptable products — food, toiletries, cleaning supplies — are included in the Foodlist and Shopping Guide, the Mail Order Guide, the Supplements Guide and the Fast Food Guide.

A good introduction to the Feingold Program, as well as 400 pages of compiled wisdom from over 30 years of working with families using the diet, is provided by the book "Why Can't My Child Behave?" [39]

[edit] Links & References

[edit] External links

[edit] References

  1. ^ a b Lau, K. and McLean, W.G. and Williams, D.P. and Howard, C.V. (March 2006). "Synergistic interactions between commonly used food additives in a developmental neurotoxicity test". Toxocological Sciences 90 (1): 178-187. PMID 16352620.
  2. ^ Feingold, B.F. (1985). Why Your Child is Hyperactive (pp.1-2). Random House. ISBN 0-394-73426-2.
  3. ^ (1983) "Diet and hyperkinesis--an update.". Journal of the American Dietetic Association. Aug;83(2): 132-4. PMID 6875141.
  4. ^ Weiss, Bernard (1982). "Food additives and environmental chemicals as sources of childhood behavior disorders". J Am Acad Child Psychiatry. 21 (2): 144-152.
  5. ^ Rimland, Bernard (1983). "The Feingold diet: an assessment of the reviews by Mattes, by Kavale and Forness and others". Journal of Learning Disabilities 16 (6): 331-333.
  6. ^ Mattes J, Gittelman-Klein R (1978). "A crossover study of artificial food colorings in a hyperkinetic child". Am J Psychiatry 135 (8): 987-8. PMID 665853&.
  7. ^ Williams, J.I. and Cram, D.M. and Tausig, F.T. and Webster, E. (June 1978). "Relative effects of drugs and diet on hyperactive behaviors: an experimental study". Pediatrics 61 (6): 811-817. PMID 353680.
  8. ^ Goyette, G.H. and Connors, C.K. and Petti, T.A. and Curtis, L.E. (April 1978). "Effects of artificial colors on hyperkinetic children: a double-blind challenge study". Psychopharmacol Bull 14 (2): 39-40.
  9. ^ Weiss, B. and Williams, J.H. and Margen, S. and Abrams, B. and Caan, B. and Citron, L.J. and Cox, C. and McKibben, J. and Ogar, D. and Schultz, S (March 1980). "Behavioral responses to artificial food colors". Science 207 (4438): 1487-1489. PMID 7361103.
  10. ^ a b Swanson, J. and Kinsbourne, M. (March 1980). "Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test". Science 207: 1485-1487. PMID 7361102.
  11. ^ a b Egger, J. and Carter, C.M. and Soothill, J.F. and Wilson, J. (January 1989). "Oligoantigenic diet treatment of children with epilepsy and migraine". Journal of Pediatrics 114 (1): 51-58. PMID 1582098.
  12. ^ Pollock, I. and Warner, J.O. (January 1990). "Effect of artificial food colours on childhood behaviour". Arch Dis Child 65 (1): 74-77. PMID 2301986.
  13. ^ a b Boris M., Mandel F.S. (1994). "Foods and additives are common causes of the attention deficit hyperactive disorder in children". Annals of Allergy 72: 462–468. 8179235.
  14. ^ a b c Rowe KS, Rowe KJ (1994). "Synthetic food coloring and behavior: A dose response effect in a double-blind, placebo-controlled, repeated-measures study". Journal of Pediatrics 125: 691–698. 7965420.
  15. ^ Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA. (August 1976). "Food additives and hyperkinesis: a controlled double-blind experiment.". Pediatrics 58(2): 154-66. PMID 781610.
  16. ^ Williams JI, Cram DM, Tausig FT, Webster E. (June 1978). "Relative effects of drugs and diet on hyperactive behaviors: an experimental study.". Pediatrics Jun;61(6): 811-7. PMID 353680.
  17. ^ Swanson JM, Kinsbourne M. (March 1980). "Food dyes impair performance of hyperactive children on a laboratory learning test.". Science 28;207(4438): 1485-7. PMID 7361102.
  18. ^ Harley, J.P. and Ray, R.S. and Tomasi, L. and Eichman, P.L. and Matthews, C.G. and Chun, R. and Cleeland, C.S. and Traisman, E. (June 1978). "Hyperkinesis and food additives: testing the Feingold hypothesis". Pediatrics 61 (6): 818-828. PMID 353681.
  19. ^ a b [[Stephen Barrett|Barrett, Stephen]] (15 March 2004). The Feingold Diet: Dubious Benefits, Subtle Risks. Quackwatch website. Retrieved on 22 October 2006.
  20. ^ Gross, M.D. and Tofanelli, R.A. and Butzirus, S.M. and Snodgrass, E.W. (January 1987). "The effect of diets rich in and free from additives on the behavior of children with hyperkinetic and learning disorders". Journal of the American Academy of Child and Adolescent Psychiatry 26: 53–55.
  21. ^ Schoenthaler SJ, Doraz WE, Wakefield JA. (1986). "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 8(2): 185-195.
  22. ^ Uhlig T, Merkenschlager A, Brandmaier R, Egger J. (1997). "Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder.". European Journal of Pediatrics. Jul;156(7): 557-61. PMID 9243241.
  23. ^ Schmidt MH, Mocks P, Lay B, Eisert HG, Fojkar R, Fritz-Sigmund D, Marcus A, Musaeus B. (1997). "Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.". European Child & Adolescent Psychiatry. Jun;6(2): 88-95. PMID 9257090.
  24. ^ Peter C, Bennett W, Brostoff J. (1997). "The Health of Criminals Related to Behaviour, Food, Allergy and Nutrition: A Controlled Study of 100 Persistent Young Offenders". Journal of Nutritional & Environmental Medicine. Vol.7, No.4 Dec 1997: 359-366.
  25. ^ Peter C, Bennett W, McEwen, LM, McEwen HC, ROSE, EL. (1997). "The Shipley project: Treating food allergy to prevent criminal behavior in community settings". Journal of Nutritional & Environmental Medicine. Vol.8, No.1,Mar.1998: 77-8.
  26. ^ Bateman B, Warner JO, Hutchinson E, Dean T, Rowlandson P, Gant C, Grundy J, Fitzgerald C, Stevenson J. (2004). "The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children". Archives of Disease in Childhood. Jun;89(6): 506-11. PMID 15155391.
  27. ^ Egger J, Carter CM, Graham PJ, Gumley D, Soothill JF (1985). "Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome". Lancet Mar 9;1(8428): 540-5. PMID 2857900.
  28. ^ Rowe KS (1988). "Synthetic food colourings and 'hyperactivity': A. double-blind crossover study". Aust Paediatric Journal 24: 143¿147. PMID 3395307.
  29. ^ Kaplan BJ, McNicol J, Conte RA, Moghadam HK (1989). "Dietary replacement in preschool-aged hyperactive boys". Pediatrics 83:1: 7-17. PMID 2909977.
  30. ^ Egger J, Carter CH, Soothill JF, Wilson J. (1992). "Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior.". Clinical Pediatrics. May;31(5): 302-7. PMID 1582098.
  31. ^ Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, Taylor E. (1993). "Effects of a few food diet in attention deficit disorder.". Archives of Disease in Childhood. Nov;69(5): 564-8.. PMID 8257176.
  32. ^ Dumbrell, S. and Woodhill, J.M. and Mackie, L. and Leelarthaepin, B. (December 1978). "Is the Australian version of the Feingold diet safe?". The Medical Journal of Australia 2 (12): 569-570. PMID 364258.
  33. ^ Harper, P.H. and Goyette, C.H. and Conners, C.K. (November 1978). "Nutrient intakes of children on the hyperkinesis diet.". Journal of the American Dietetic Association 73 (5): 515-519. PMID 701681.
  34. ^ Minirth, Frank (1991). Love Hunger. Ballantine Books. ISBN 0-449-90613-2.
  35. ^ The Feingold Association of the United States (2006). Feingold Program - Symptoms. The Feingold Association website. The Feingold Association of the United States. Retrieved on 21 August 2006.
  36. ^ Feingold, B.F. (1985). Why Your Child is Hyperactive. Random House. ISBN 0-394-73426-2.
  37. ^ Feingold, B.F. (1979). The Feingold Cookbook for Hyperactive Children. Random House. ISBN 0-394-73664-8.
  38. ^ The Feingold Association of the United States (2006). The Feingold Program. The Feingold Association website. The Feingold Association of the United States. Retrieved on 29 April 2006.
  39. ^ Hersey, Jane, Robert C. Lawlor (2006). Why Can't My Child Behave?, 4th printing, Williamsburg, VA: Pear Tree Press. ISBN 0-9651105-0-8.
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