Reports on the Systemic and Nervous Reactions Caused by Food (1950-1984):
by Dr. William Crook
In 1954, Susan C., Dees, a pediatric allergist at Duke University published an article describing allergic reactions affecting the nervous system. In this article, Dees presented the history and the EEG studies of a child whose convulsions were caused by milk. Here's an excerpt from her article.
"As experience with allergic conditions increases, we recognize more frequently allergic reactions may affect the nervous system. No part of the central nervous system is immune from such response given the proper situation and stimulus [emphasis added].... Children are less articulate in describing sensations and situations which vary from their usual state. Furthermore, a neurologic examination is more difficult and more cursory in children than in older people..."
"Our studies of the electorencephalograms of allergic children have shown a high percentage of one type of abnormality, namely occipital dysrhythmia, or irregularity, in children with allergy alone and with neither a past history of, nor present convulsions."
In 1954, Frederic Speer, the University of Kansas, published the first of his many observations on the relationship of food allergies to symptoms which affect many chidlren. Here's an excerpt from a report published in the Pediatric Clinics of North America.
"Among the many somatic factors which may be manifested in behavior disturbances is allergy, and it is the purpose of this paper to discuss the behavior pattern characteristic of certain allergic children...."
"Hyperkinesis is often noted early in life, the mother remarking that the child was always restless and inclined to 'fight sleep'... As the child grows older hyperirritability becomes increasingly manifest. The emotional balance is precarious, the child is easily upset, characteristically crying readily and for long periods. These youngsters are almost universally regarded as 'spoiled' even by their parents who wonder where their methods of child care have been faulty."
In the summary of his article, "Speer said,
"One source of disturbed behavior and vague illness is allergy and the classic allergic behavior state constitutes a distinct syndrome which is marked by tension and fatigue with more or less evidence of constitutional allergy. [emphasis added]. although the allergic-tension-fatigue picture commonly occurs in combination with other allergic disease, it often occurs alone and may properly be considered a primary allergic syndrome."
My observations (Dr. Crook): I opened my office to practice general pediatrics in my hometown in 1949. I saw sick children and well children and some in between. Although I helped most of my patients, there were some I was unable to help.
In 1955, the mother of one of my regular patients convinced me (against my will!) that following the removal of cow's milk from her 12-year-old son's diet he was a "different child." His headache, fatigue and irritability vanished. His ability to concentrate in school improved.
This mother's observations impressed me and played an important part in changing my life. A short time later, I read the above cited articles by Rowe, Randolph, Dees and Speer and I said to myself "Many of my tired, irritable, complaining patients may be sensitive to foods they're eating every day."
So I began using elimination/challenge diets in studying these patients. I was both excited and delighted to find I could help many of these youngsters. I reported my observations at a meeting of the Allergy Sections, American Academy of Pediatrics in Chicago in 1958 and published them in a major pediatric journal in 1961. Here's an excerpt from this article:
"There's a kind of allergy that is met with in children of all ages yet is easily overlooked if the physician is not aware that it exists. Signs of this disorder may be noted in the child's facies as he walks fully clothen into the physician's office. He appears pale or sallow, although the blood may later be found to be normal; his eyes have dark circles under them and often here's an associated puffiness of the periorbital areas...."
"As the child's examination proceeds, other characteristics, symptoms and signs are uncovered. Almost without exception he tends to have a stuffy nose, although this symptom is rarely the presenting one. (Parents) are concerned about his sluggishness, on his general irritability, peevishness and unpredictable behavior. They're apt to say, 'Jimmy just isn't like himself'."
"Sometimes a child shows more severe neurological and psycholigical signs and symptoms including - facial tics, severed personality disturbances, even psychotic behavior..."
A diagnosis of food sensitivity was made in the following manner: Symptoms and signs were relieved by eliminating the suspect food from the diet for five to twelve days and then reproduced by giving the food back to the child.
Mental and emotional symptoms were present in 49 of the 50 patients in this series. In 26 of these patients, nervous symptoms were major complaints. They included irritability, restlessness, inability to concentrate, anxiety, tearfulness, peevishness, perversities, paranoid ideas and compulsiveness. The cause of these symptoms: foods alone (38), inhalants alone (4), foods and inhalants (8), milk (28), chocolate (21), egg (11) ragweed (6), wheat, corn and peanuts (6), other substances (5).
In my article I reviewed the medical literature and included references to Rowe, Randolph, Speer and other observers, including a comment by Davison who said that character problems in children must be considered the direct result of allergic reactions in the nervous system. He further commented that certain children without allergic foods in their diet are like Dr. Jekyll; when those foods are entered back into the diet they're almost demons like Mr. Hyde.
More about my observations (Dr. Crook): During a visit with my pediatric chief at Vanderbilt, Amos Christie, in 1956, I learned that he was a good friend of William C. Deamer, Professor of Pediatrics at the University of California (San Francisco). Because I was impressed by the observations of Dr. Albert Rowe, I went to California to visit him and to learn more about his work. When I told Dr. Christie of my plans, he said "By all means go by and see my good friend Bill Deamer."
Following an introduction by Dr. Christie, I had a cordial visit with Dr. Deamer and told him how and why I had come to California. He said, "Although Dr. Rowe is a wonderful man, I feel his patients improve because of his enthusiasm and not because of his diets."
Then, a couple of years later, Dr. Deamer learned that his own fatigue, headache and other symptoms vanished following dietary changes. So he began to include a discussion of the tension-fatigue syndrome in training his residents and medical students. Here is an excerpt from his 1971 article published in Pediatrics:
"I'd about made up my mind that I would ask to be relieved of my supervision of Pediatric Allergy Clinic and seek satisfaction in some other pediatric filed. Our patients were not doing well, some were actually getting worse on injection therapy.... Without question I was at fault .. I finally learned to recognize allergy, especially food allergy, when it presents itself as the tension-fatigue syndrome..." [emphasis added]
"Despite an extensive bibliography, it may be one of the most under-diagnosed syndromes in practice. Dr. William Crook finds such patients to be numerous in the general pediatric practice. I agree, but it took me a long time to become fully aware of the fact. I cannot help but feel that all physicians caring for children will do well to become acquainted with the allergic tension-fatigue syndrome and the frequency with which foods, especially milk and chocolate, are responsible."
My interest in food allergies continued during the 1960s and following the suggestion of Dr. Christie, on January 1, 1973, I began a clinical study on the relationship of nervous symptoms in my patients. I started the study by keeping a roster of every new patient who came to me with the chief complaints of "hyperactivity and associated emotional and behavior and learning problems." Most of these patients were self-referred by other physicians.
During the five ensuing years, I saw 182 children with these complaints and I reported my findings in an article in the Journal of Learning Disabilities in 1980. Here's an excerpt from this article:
"Seventy percent (128) parents reported that their child's hyperactivity was definitely related to specific foods in the diet ... An additional 8 parents (4.7%) noted clear cut improvements in their child on an elimination diet. However, cause and effect relationship to specific foods was not clearly defined. In 17 additional patients (9.3%) hyperactivity appeared to be "probably related to the diet" However, in this group of patients, the relationship was not as clear-cut or convincing."
"The foods causing hyperactivity in 136 children included sugar (77), colors, additives and flavors, especially red color (48), milk (38), corn (30), chocolate (28), egg (20), wheat (15). However, many other foods were reported as causing trouble."
"Forty-one parents reported an excellent response to dietary elimination; 60 parents reported a good response; 18 parents reported a fair response and 16 reported a poor response. Seventeen reported, "Don't know."
Here are representative comments made by parents,
Children Clinic Chart No. 43676: "Charles was expelled from nursery school at 18 months for aggressive behavior. His worst food troublemakers were red dye, peanuts, wheat, sugar and milk. Today, at 4 1/2, Charlie continues to be an extraordinary contrast of what he was two and a half year ago. His mental capacities are to say in the least, astounding. He sleeps well, rarely awakens at night. Instead of being the most trouble of four children, he is by far now the least."
Children's Clinic Chart No. 31848: "DDC, age 12, Sugar, milk , chocolate and prepared foods containing preservatives cause him to be nervous and irritable. He says these foods make his 'points foul out'."
Children's Clinic Cart No. 47179: "SH, age 4. the food that caused the most trouble was corn. One small piece of cornbread or a small amount of popcorn will cause screaming, hitting and problems with behavior."
My interest in food allergies continued and in an article published in Pediatric Annals in 1974 I reviewed the observations of Shannon, Rowe, Randolph, Deamer and Speer and my own observations in practice, and I quoted Dr. Speer who said:
"If pediatricians and allergists are going to insist that an antigen antibody reaction must always be demonstrable, a vast amount of childhood suffering will go unrelieved."
I also described my use of the elimination/challenge diet.
"Careful instruction is essential if the diet is going to be worthwhile. this requires some 20 to 45 minutes (or more) or someone's time. Moreover, the person giving the instructions should be interested, enthusiastic and knowledgeable in order to motivate the parents to carry out the diet accurately and thoroughly."
A couple of years later I was invited to write an article on food allergy to be included in the Pediatric Clinics of North America. The author who invited me said, Dr. Charles May of the University of Colorado will be disagreeing with your point of view.
My article, "Food Allergy, the Great Masquerader." I said many of the things I had said before. And in discussing learning problems I said:
"Certainly the sluggish, stuffy, drowsy child with a headache or stomachache simply cannot perform well in school. Neither can an irritable, hyperactive child with a nervous system allergy ... To make a diagnosis of (this type) food allergy you must first think of it. You next take a good history ... then put the child on an elimination diet... If your patient was colicky, stuffy and irritable during the first year of life, you should suspect milk as a probable troublemaker..."
"On the other hand if a child exhibited irritability and restlessness during the first year of life in spite of the elimination of cow's milk, I've found that such a child is often allergic to corn or cane, common hidden dietary ingredients ... Another way to get a clue in children with syttemic and nervous system allergies is to ask the mother, "What's Johnny's favorite foods?"
"...Carrying out an elimination diet is amazingly simple ... if you compare it to such complicated medical studies as gastrointestinal or genital or urinary x-rays or electroencephalograms and other in-hospital diagnostic procedures."
Observations of others: Mayo Clinic internist, Walter C. Alvarez, in the Foreword of Dr. Frederic Speer's book, Allergy of the Nervous System, said:
"For years .... I suffered from what I call 'dumb Monday' when I was too dull to do much constructive work like writing. Then I discovered that the bad Mondays were due to the Alvarez family's habit of having chicken for Sunday dinner. When I stopped eating chicken, that was the end of my troubles on Monday ..."
"I happened to tell my dear friend, Dr. Clifford Sweet, a pediatrician about 'dumb Monday." He told me that a study had shown that the 'dumb Monday' children were suffering from food allergy and it came most often on Monday because on Sunday the child usually ate something not eaten during the rest of the week. Cliff said "I now have a big dumb Monday club."
An Arkansas physician, Frederick H. Kittler, in an article in Speer's 1970 book, presented a number of reports in his patients including EEG studies. In describing the response of one of his patients he said:
"GL was seen because of temper tantrums. He was too uncontrollable to do initial IQ testing. He was placed on a diet free of milk, chocolate and cola drinks. He was learning better and his behavior was much improved. He was challenged again with the suspected foods for one week.... His behavior became quite uncontrollable and his EEG tests became abnormal." [emphasis added]
In describing a second patient, Kittler said:
"CK was a destructive, impulsive child who did poorly in school. He could not get along with his peers and his reading ability was poor. Following testing and treatment for allergies to house dust and grass and elimination of foods causing allergic reactions, the child showed significant improvement and his EEG improved."
In early 1970, I learned that two academicians from the Upstate Medical Center of New York, Syracuse were interested in the relationship of diet to nervous symptoms which affected many children. In his 1977 book, Don't Drink Your Milk, Dr. Frank C. Oski said:
"There's a growing body of evidence ... to suggest that certain allergies may manifest themselves primarily as changes in personality, emotions or in one's general sense of well-being .. Tension is a major manifestation of food allergy. These children will appear restless and in a constant state of activity. They fidget, grimace, twist, turn, jump and never seem to sit still. Many of these children are also excessively irritable and can never be pleased."
"Although the 'tension fatigue' syndrome is a the most common manifestation of food allergy, it is by no means the only one. Vague recurrent abdominal pain, repeated headaches, aching muscles and joints and even bedwetting have been observed as symptoms of food allergy."
Walter W. Tunnessen, Jr. Oski's colleague in New York and subsequently at Johns Hopkins, published an article about food allergies in 1979. Here are excerpts:
".. the manifestations of food allergy are legion. Motor symptoms may include overactivity, restlessness and clumsiness; sensory tension may be reflected in irritability, insomnia, hypersensitivity to pain or noise. The proof of the pudding is in simple dietary elimination .. the culprits I find most often are milk, chocolate and eggs, although can sugar, corn and wheat should also be considered."
In the 1970s, Doris Rapp, a Buffalo, New York physician, began to write and talk about the relationship of diet to hyperactivity and other health problems which affected many children. She has also carried out scientific studies and made movies to document her observations. Here are excerpts from Dr. Rapp's article published in the Journal of Learning Disabilities in 1978:
"Twenty four hyperactive children were tested with sublingual foods and dyes followed by a seven-day diet omitting milk, wheat, egg, cocoa, corn, sugar and food coloring and by subsequent individual ingestion challenges with these same food items ... Twelve children improved to a moderate or marked degree during the seven-day diet ... Improvement persisted in children who avoided foods or dyes for at least 12 weeks .. Parents repeatedly volunteered that the ingestion of food coloring, sugar and/or milk in particular, continued to be followed by hyperactivity."
In the mid 1960s, I learned that John W. Gerrard, Professor of Pediatrics, University of Saskatchewan, was interested in food allergies and sensitivities. In his 1973 book, Understanding Allergies, he gave a detailed report about his patient, Charles, who had been placed on a milk-free diet. He then asked the mother to allow Charles to drink milk again and see if his symptoms returned.
"She decided not to place him back on milk because milk had such a disturbing effect on his personality... Charles 'used to be a restless, inattentive lad who was so fidgety in the classroom that he infuriated his teacher and upset most of the other children.' After milk was eliminated from his diet, his teacher said 'He now concentrates on his work. He sits still as a statue and is a model to everyone else."
"At first I found it hard to believe that harmless foods could so change a child's personality; but many parents have made confirmatory, unsolicited observations. I'm now convinced that in ways we do not yet understand, the allergic child's and adults too, behavior can be altered and modified as dramatically by foods as it can be altered by drugs."
Observations of Dr. Benjamin Feingold: In the early 1970s (and even before) this California allergist, noted that a number of adults and children developed symptoms because of food colors, flavors and preservatives.
Here are excerpts from his presentation at the annual meeting of the American Academy of pediatrics, November 8, 1977.
"The colors and flavors are the most pervasive additives in our food supply, involving about 80% of our foods. By virtue of this widespread distribution, colors and flavors are the commonest cause of adverse reactions attributed to additives, affecting practically every system of the body."
"The Kaiswer Permanete diet consists of two parts: 1. The elimination of all foods with artificial colors and flavors and the antioxidant preservatives ... BHT and BHA. We've observed over the last few years that BHA and BHT have equal importance to the colors in behavioral disturbance. 2. The elimination of selected groups of foods containing a natural salicylate radical ...."
"The initial group of 25 patients reported at the June 1973 meeting of the AMA ... represented failures to respond to the conventional procedures in pediatrics, psychology and psychiatry ... The first case history in my presentation at the AMA in June 1973, which was rejected for publication, can perhaps very objectively answer some of the questions raised:"
"A seven year old boy presented with a history of hyperkinesis of several years duration. When at home he stomped around, slamming the doors and kicking the walls and even charging oncoming cars with his bicycle. At school his hyperactive behavior was diruptive, resulting in his inability to learn.
Numerous pediatricians were consulted, as well as neurologists, psychiatrists and psychologist. Nothing succeeded until the child was placed on the KP diet. After a few weeks of dietary control, the child became well adjusted both at home and at school. Infractions of the dietary program led almost immediately to a recurrence of hyperkinetic behavioral problems."
"Since the initial case report, we have now observed about 458 of these children, most of them representing failure to respond to the conventional management recommended by various professionals.
Additionally, our favorable response for improved behavior were 30 - 50%, depending on the sample and age of the child. Today, with emphasis upon the elimination of BHT and BHA, our success to control the behavior is between 60 - 70% ... Fortunately, the diet, unlike therapy with behavior modifying drugs, is a benign modality which carries no risk, since it introduces no harmful substances."
although the great majority of physicians ignored Dr. Feingold's observations, a loyal band of his supporters established a national organization with chapters in many parts of the country. They've also provided members with helpful lists of foods and beverages which enable parents to follow Dr. Feingold's recommendations.
More of My Comments: In spite of my observations and those of many physicians I've cited, the great majority of physicians remained skeptical and demanded "specific proof". To respond I published a commentary in Pediatrics in March 1980, "What Is Scientific Proof?" Here's an excerpt:
"In my opinion, the detection of hypersensitivity reactions to foods as a cause for a wide variety of chronic symptoms in both children and adults is so apparent that we could not wait for an explanation of the mechanisms involved before putting our patients on carefully designed and executed elimination diets. I believe there are millions of other Americans, both children and adults, who suffer from similar food-induced reactions. In over 30 years of pediatric practice and allergy, I've found that adverse or allergic reaction to foods have been the commonest apparent cause of chronic symptoms in my patients."
Some of the the supposedly "scientific studies" in the 80s which concluded that food colors and dyes played little or no role in causing hyperactivity, I'm told, were funded by companies that manufacture dietary products containing these ingredients. In my efforts to encourage additional research studies, I sent a letter to Pediatrics, which was published in January 1982. Here are excerpts:
"Although investigating the effects of sugar (or any dietary ingredient) on the behavior of children is difficult and complex .. the time has come for carefully designed studies to be undertaken to throw more light on this controversial subject of However, before such studies are done ... the following prerequisites should be met:
"What a child eats can make him hyperactive. And truly impartial, carefully designed scientific studies are urgently needed to document this relationship for the benefit of parents, children, physicians, teachers and everyone concerned with the health and welfare of children."
"Then when this 'scientific proof' is established, leaders in the American Food Industry can produce, advertise and distribute better foods which will contribute to the good health of American children."
Reports on the Systemic and Nervous Reactions Caused by Foods (1984-1994)