Reports on the Systemic and Nervous Reactions Caused by Foods (1984-1994):

Ian C. Menzies,  MB, CHB, FRC, Psyc.Ch.  In 1984, this Dundee, Scotland psychiatrist published an article entitled: "The role of food and chemical Sensitivities."  Here's the abstract of this article.

"a wide range of long-lasting patterns of symptoms may result from individual sensitivity to substances in the environment such as foods, chemicals, dusts and pollens."

"Behaviourally, disturbed and learning disordered children are common  .... their numbers may be increasing and certainly they make great demands on parental understanding and course, as well as on professional judgment and time.  A number of case studies are presented which suggest that the difficulties encountered by a significant number of these children have much to do with idiosyncratic responses to foods and additives." [emphasis added]

"This hypothesis requires careful research study at an early date for if validated it will have far reaching implications for the assessment and management of disturbed, delinquent and learning disordered children.  Perhaps not enough attention has been paid to the role of biological and environmental factors in the development of children's problems.  Certainly recent research has begun to provide support for the concept of environmental (ecologic) illness."

The following year, Joseph Egger, and four colleagues from the Departments of Immunology and child Psychologist, Institute of child Health and Hospital for sick Children in London, published an article in the March 9, 1985 issue of The Lancet which documented the role of diet in causing neurological and other symptoms in children.  here is a summary of their article:

"76 selected overactive children were treated with an oligoantigenic (few foods) diet.  62 improved, and a normal state of behavior was achieved in 21 of these ... Other symptoms, such as headache, abdominal pain and fits also improved.  28 of the children who improved completed a double-blind crossover, placebo-controlled trial in which foods thought to provoke symptoms were reintroduced."

"Symptoms returned or were exacerbated much more often when patients were on active material than on placebo.  48 foods were incriminated.  Artificial colorants and preservatives were the commonest provoking substances, but no child was sensitive to these alone."

In a report form the Departments of Pediatrics and Psychology from the University of Calgary, Bonnie J. Kaplan, Ph.D., and associates described their experiences using special diets in studying pre-school-aged hyperactive boys.  Here are excerpts from the abstract of their study:

"A ten-week study was conducted in which all food was provided for the families of 24 hyperactive preschool-age boys whose parents reported the existence of sleep problems or physical signs and symptoms.  A within-subject crossover design was used and the study was divided into three periods: a baseline period of three weeks, a placebo controlled period of three weeks, and an experimental diet of four weeks."

"The experimental diet was broader than those studied previously in that it not only eliminated artificial colors and flavors, but also chocolate, monosodium glutamate, preservatives, caffeine and any substance that families reported might affect their specific child.  The diet was also low in simple sugar and it was dairy-free if the family reported a history of possible problems with cow's milk."

"According to the parental report, more than half of the subjects exhibited a reliable, improvement in behavior and negligible placebo effects." [emphasis added]

In the concluding sentence of their 10-page article, the authors of this report stated:

"These results suggest that pediatricians and other practitioners might consider dietary modifications worth trying, particularly in younger children"

In 1989, Joseph Egger and colleagues published further studies on the role of diet in children with nervous symptoms in the Journal of Pediatrics.  Here's an excerpt from the abstract of their article, "Oligoantigenic (few foods) Diet Treatment of Children with Epilepsy and Migraine."

"We studied the role of oligoantigenic (few foods) diets in 63 children with epilepsy; 45 children had epilepsy with migraine, hyperkinetic behavior, or both, and 18 and epilepsy alone.  Of the 45 children who had epilepsy with recurrent headaches, abdominal pain or hyperkinetic behavior, 25 ceased to have seizures and 11 had fewer seizures during the diet therapy."

"Headaches, abdominal pain and hyperkinetic behavior ceased in all those whose seizures ceased and in some of those whose seizures did not cease.  Foods provoking symptoms were identified by systematic reintroduction of foods, one by one; symptoms recurred with 42 foods and most children reacted to several foods." [emphasis added]

Additional studies on the relationship of diet to attention deficit disorder were carried out by C. M. Carter and six colleagues from the Institute of child health, London Behavioural Sciences Unit which were published in the Archives of Disease in Childhood in 1993.  Here are excerpts from the abstract of their study:

"Seventy-eight children, referred to a diet clinic because of hyperactive behavior, were placed on a 'few food' elimination diet. Fifty-nine improved in behavior during the open trial period.  For the 19 of these children it was possible to disguise foods or additives, or both, that reliably provoked behavioural problems by mixing them with other tolerated foods and to test their effect in a placebo-controlled, double blind challenge protocol."

"The results of a crossover trial on these 19 children showed a significant effect for the provoking foods to worsen rating of behavior, and to impair psychological test performance.  This study shows that observations of change in behaviour associated with diet made by parents and other people with a role in the child's care can be reproduced using double-blind methodology and objective assessments. Clinicians should give weight to the accounts of parents and consider this treatment in selected children with a suggestive medical history." [emphasis added]

In 1994, Marvin Boris, M.D., and Francine S. Mandel, Ph.D. (Northshore Hospital, Cornell Medical Center, Manhassett, New York) published an article entitled "Foods and Additives are Common Causes of the Attention Deficit Hyperactivity Disorder"  In the introduction to their article published in the annals Of Allergy these professionals said:

"The attention deficit hyperactivity disorder (ADHD) is a neurophysiologic problem that is detrimental to children and their parents.  Despite previous studies on the role of foods, preservatives and artificial colorings in ADHD, this issue remains controversial."

"This investigation evaluated 26 children who meet the criteria for ADHD.  Treatment with a multiple item elimination diet showed 19 children (73%) responded favorably, P,.001.  On open challenge, all 19 children reacted to many foods, dyes and/or preservatives.  A double-blind, placebo controlled food challenge (DBPCFC) was completed tin 16 children.  There was a significant improvement on placebo days compared with challenge days (P=.003)"

"Atopic children with ADHD had a significantly higher response rate than the nonatopic group.  This study demonstrates the beneficial effect of eliminating reactive foods and artfiicial colors in children with ADHD.  Dietary factors may play a significant role in the etiology of the majority of children with ADHD."

Comments by William G. Crook: In spit of this report, and other reports, I've cited, several popular books published in the mid and late 90s term the relationship of diet to ADHD a myth.  And in these books, and a number of articles reviewing the diet/brain connection, the investigators say in effect:

"When a child improves following the removal of sugar or other dietary ingredients, the improvement occurs because the child is receiving more attention and the parent expect him/her to get better."

In responding to comments of this type, one of my colleagues said "What a physician isn't 'up on' he's 'down on'.

Another report published in the Journal of Pediatrics in 1994 came from Australia.  This scientific study carried out by two Australian researchers, Katherine S. Rowe, MBBS, MPH, DipEd (Lond) FRACP and Kenneth J. Rowe BA (Hons), MSc (Lond) was entitled "Synthetic Food Coloring and Behavior: A dose response effect in a double-blind, placebo-controlled, repeated-measure study."  Here is an excerpt from the abstract of their study:

"A 21-day, double-blind, placebo-controlled, repeated-measures study used each child as his or her own control.  Placebo, or one of six dose levels of tartrazine (1,2,5,10,20,50mg) was administered randomly each morning and behavioural reactions were recorded by parents at the end of ache 24 hours."

"The study identified 24 children as 'clear reactors' (19 of 23 'suspected reactors', 3 of 11 'uncertain reactors' and 2 of 20 'controlled subjects'). They were irritable and restless and had sleep disturbance.  Significant reactions were observed at all six dose levels.  A dose response effect was obtained. With a dose increase greater than 10 mg. the duration of the effect was prolonged."

"Conclusion: Behavioral changes and irritability, restlessness and sleep disturbances are associated with the ingestion of tartrazine in some children.  A dose response was observed."