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Diet and children's behavior: are food dyes the missing link?

There has been a dramatic rise in the number of American children with attention deficit hyperactivity disorder (ADHD). The Centers for Disease Control recently found that 1 in 5 high-school-aged boys and 11% of children overall have been diagnosed with ADHD, which represents a 41% increase over the past decade.

Some analysts believe that this increase is partly due to the vague criteria used for diagnosing ADHD, which has no definitive test. Others have suggested that parents, concerned with their children's inability to concentrate on schoolwork, may be pressuring doctors to diagnose them as having ADHD and prescribe medications that help them perform better at school.

Most of these analysts are overlooking an important factor in determining children's behavior: what they eat.

While recent attention on children's diet has largely revolved around the increased consumption of junk food and its effect on childhood obesity, empty calories are not the only unhealthful ingredients lurking in a highly processed diet.

It has been known for decades that certain food additives, such as petroleum-based synthetic dyes, can have a negative impact on children's behavior, and recent studies have confirmed this link.

One such study is a 2011 Australian trial conducted at the Royal Melbourne Institute of Technology, which was sponsored by the nonprofit Feingold Association. This study, which involved children ages 4 through 12, found that a diet eliminating synthetic additives, including food dyes, and other factors led to clinically significant improvements in behavioral problems such as oppositional behavior, ADHD, and inattentiveness.

A major reevaluation of previous studies on synthetic food dyes and ADHD, published in the May 2013 issue of the American Journal of Psychiatry, has provided more evidence of the harmful nature of these additives. The authors of this meta-analysis concluded that " ... artificial food color exclusions appear to have beneficial effects on ADHD symptoms...."

Some experts believe that many studies on food dyes underestimate their negative effects, because the amounts tested on children are usually much lower than the quantities of these chemicals that children actually consume on a daily basis.

A case in point is a 2013 study that was published in the journal Food and Chemical Toxicology. It was found that the dye Blue #1, which is widely used in hard candies such as lollipops, can be absorbed directly into the bloodstream through the mucous membranes of the tongue. Ordinarily when Blue #1 is consumed, most of it is broken down in the stomach and liver before it can enter the bloodstream. But when children lick lollipops or suck on hard candies, they are exposed to much more of the dye, which is absorbed through their tongues.

Blue #1 is a particularly troublesome chemical, because it can interfere with mitochondrial respiration (the basic process by which cells generate energy) and thus cause cell damage. The dangers of this dye were highlighted in 2003, when the Food and Drug Administration (FDA) issued a public health advisory concerning its use in foods administered via feeding tubes to patients with gut permeability issues. Among the possible side effects listed by the FDA were hypotension and death.

Recognition of the harmful effects of synthetic food dyes has resulted in the British Food Standards Agency's advising parents to consider eliminating these additives from their children's diet. The European Union has also issued rules requiring labels on foods containing these dyes to state that the colorings "may have an adverse effect on activity and attention in children."

In the US, a 2011 FDA advisory panel narrowly rejected requiring warning labels on artificially dyed foods. Perhaps the recent accumulation of research highlighting the effects of these chemicals on children's behavior will result in the FDA's reconsidering this decision.

Dealing with the behavioral problems of our children will require a holistic approach. Parents and physicians need to recognize that a healthful diet free of synthetic dyes will play a critical role in the solution to this important problem.

Individual dietary needs vary, and no one diet will meet everyone's daily requirements. Before starting any new diet, check with your doctor or nutritionist.

References

FDA Public Health Advisory: Subject: Reports of Blue Discoloration and Death in Patients Receiving Enteral Feedings Tinted with the Dye, FD&C Blue No. 1 [Web page]. September 29, 2003. http://www.fda.gov/ForIndustry/ColorAdditives/ColorAdditivesinSpecificProducts/InMedicalDevices/ucm142395.htm

Harris G. F.D.A. panel to consider warnings for artificial food colorings. New York Times. March 29, 2011.

Lucova et al. Absorption of triphenylmethane dyes Brilliant Blue and Patent Blue through intact skin, shaven skin and lingual mucosa from daily life products. Food Chem Toxicol. 2013;52:19-27.

Modernising the rules on food additives and labelling of azo dyes [Web page]. European Parliament. July 8, 2008. http://www.europarl.europa.eu/sides/getDoc.do?language=en&type-IM-PRESS&reference-20080707IPR33563.

Sonuga-Barke et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. Am J Psychiatry, March, 2013;170(3): 275-289.

Schelleman MJ. The impact of diet on children's behavior problems: The relative and combined impact of the Simplified Elimination Diet and a Behaviour Parent Training program. PhD thesis. RMIT University, School of Health Sciences, Division of Psychology. December 2011.

Schwartz A, Cohen S. A.D.H.D. seen in 11% of U.S. children as diagnoses rise. New York Times. March 31, 2013.

Jane Hersey is national director of the nonprofit Feingold Association (www.feingold.org/800321-3287), which helps families implement the low-additive Feingold diet developed by pediatrician/allergist Dr. Benjamin Feingold. A former teacher and Head Start consultant, she is author of Why Can't My Child Behave? and Healthier Food for Busy People. Hersey has testified before the National Institutes of Health, the U.S. Department of Agriculture, and Congress about diet and behavior problems. She frequently lectures at education associations, hospitals, medical groups, universities, and schools.
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Author:Hersey, Jane
Publication:Townsend Letter
Geographic Code:1USA
Date:Nov 1, 2013
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