Food additives and hyperactivity: Feingold was right.

One hundred fifty-three three-year-old children and 144 children aged eight or nine years consumed a diet free of food colorings and sodium benzoate for six weeks. During weeks 2, 4, and 6, they were randomly assigned to receive, in double-blind fashion, a daily drink containing 1) placebo or 2) sodium benzoate plus one of two mixtures of artificial food colors and additives. Mix A contained sunset yellow, carmoisine, tartrazine, and ponceau 4R. Mix B contained sunset yellow, carmoisine, quinoline yellow, and allura red AC. Doses for mixes A and B for three-year-old children were roughly the same as the amount of food coloring in two 56 g bags of sweets. For eight-year-old and nine-year-old children, the dose for mix A was equal to about two bags of sweets per day and for mix B about four bags of sweets per day. In three-year-old children, compared with placebo, Mix A had a significant adverse effect on the main outcome measure (a global hyperactivity score; p < 0.05), whereas Mix B had a nonsignificant adverse effect (p = 0.09). In eight- and nine-year-old children, a significant adverse effect was seen for Mix A (p < 0.03) and Mix B (p = 0.001) when the analysis was restricted to children who consumed at least 85% of the study drinks.

Comment: More then 30 years ago, Dr. Ben Feingold reported that ingestion of artificial colors or large amounts of naturally occurring salicylates was an important contributing factor to hyperactive behavior. Feingold's initial report stimulated a great deal of research, some of which supported his observations, but much of which did not. Most of the negative studies had important flaws. In one study, for example, the effect of a chocolate cookie containing artificial colorings was compared with that of a placebo chocolate cookie. Since many of the children were presumably sensitive to sugar or chocolate, a chocolate cookie was not an appropriate placebo. The results of the present study confirm Feingold's original observations by demonstrating that consumption of artificial colors or sodium benzoate (or both) resulted in increased hyperactivity in three-year-old and eight- and nine-year-old children in the general population.

McCann D, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007;370:1560-1567.

by Alan R. Gaby, MD

[e-mail]

[ILLUSTRATION OMITTED]