The Dietary Connection
Bobby Masterson, 8, of Gibsonia, Penn., has always struggled academically. He has problems paying attention and acts out frequently. His second grade teacher thinks he has ADHD, but testing has been inconclusive. His mother, Sandy, thinks Bobby's problems are related to red food dyes and has tried to be rigorous about monitoring his food intake. Complicating matters are the school lunches that feature Jell-O and fruit punch and the colored candies his teacher offers as rewards for good behavior.
After he was diagnosed with ADHD at age 6 and prescribed Ritalin, Michael Weathers, of Poughkeepsie, N.Y., started to have problems as a result of negative reactions to the medication. Finally, at the end of third grade, his mother, Patricia, flew him to the Block Center in Hurst, Texas, for an evaluation. At the Block Center, founded by Dr. Mary Ann Block, they believe in a natural, multidisciplinary approach to ADHD that includes a diet as close to the natural state of foods as possible, in other words, very little "junk" food. There, Michael was put on a strict diet that severely cut back on sugar, wheat products and any foods with additives. In addition, he began taking nutritional supplements such as vitamin B6 and other vitamins and minerals that some people believe children diagnosed with ADHD are lacking.
ADHD and Additives
Is there a connection between ADD/ADHD and food additives? In 1973, Dr. Benjamin Feingold, who was then chief emeritus in the Department of Allergy for the Kaiser Foundation Hospital and Permanente Medical Group, presented research linking food additives to learning and behavior disorders.
Feingold developed a two-stage diet that quickly became popular with parents of children with learning and behavioral problems. Stage one eliminates synthetic coloring, artificial flavorings and the artificial preservatives BHA, BHT and TBHQ, as well as natural salicylates found in items such as apples, grapes, oranges and aspirin products. After four to six weeks, the foods with natural salicylates are slowly added back to the child's diet and any reactions are noted. If there is no reaction, these foods are considered acceptable to eat. The artificial flavors, colorings and preservatives are permanently eliminated.
There was no doubt that some children showed improvements on the Feingold diet. According to consumer advocate Dr. Stephen Barrett, founder of Quackwatch.com, a nonprofit organization designed to protect consumers from health-related scams, however, the diet may have been the reason in only some of the cases. While he acknowledges that there definitely are people who are sensitive to these substances, he says they have been blamed far beyond proportion to what studies show are reasonable numbers. His theory is that most of these children are finally receiving something they weren't getting enough of: attention.
"Adherence to the Feingold diet requires a change in family lifestyle and eating patterns, because Feingold recommended that the hyperactive child help prepare the special foods and encouraged the entire family to participate in the dietary program," says Dr. Barrett. "The parents are now paying more attention to the children and actively engaging in productive activities with them. This is probably as good a reason for behavioral improvement as the diet."
Furthermore, Dr. Barrett worries about the message kids get when we blame behavior on diet, thus removing the element of personal responsibility. He notes that the benefits of the diet need to be weighed against potentially harmful results, such as teaching children that their behavior and school performance are related to what they eat rather than what they feel. This could implant notions that they are unhealthy and fragile, creating situations in which their eating behavior is regarded as peculiar by other children and ignoring the fact that they may need appropriate professional help such as medication or psychotherapy.
Sugar and Hyperactivity
It's a pretty common joke: Someone gives your child a cookie and says, "Now that I've got him all sugared up, you can take him home and try to put him to bed." The implication is that the sugar will make the child so hyperactive that the parent won't be able to get him to settle down. But is this true?
According to Dr. Barrett, the answer is no, and he has some solid research behind his claims. In February 1994, results of a study examining this issue, funded by the National Institutes of Health, were published in the New England Journal of Medicine. Two groups of children, one group considered sensitive to sugar and the other a control group, were fed a variety of carefully calibrated diets, including one high in sugar. The results showed that the higher-than-normal sugar regimen had no significant effect on either group of children.
Later research conducted by Judith Wurtman, Ph.D., research scientist in the Department of Brain and Cognitive Sciences at the Massachusetts Institute of Technology, has shown that sugar actually has a calming effect on both children and adults. This may be why a person who is stressed out often reaches for a cookie rather than a carrot.
So what causes this perception many adults have that sugar causes kids to go wild? The answer, according to Wurtman, Dr. Barrett and most other experts is simple: Take a look at the situations in which kids get sugary treats. Usually, it's at a celebration or special occasion. Giving a child a couple of cookies and a glass of milk before bed isn't likely to rile her up, but taking her out to an exciting family gathering or party where there are other children running around and people having unstructured fun and give her those two cookies. She's likely to be wound up afterward. But don't blame the cookies; blame the excitement. The same holds true with classroom parties or social gatherings with peers. It's the situation, not the food.
Finding a Balance
Eileen Bailey, of Pottstown, Penn., and her husband, George, founded the ADD Helpline to answer questions about ADD/ADHD after their oldest son was diagnosed with the disorder. While Bailey has found that foods with certain additives do make her son more angry and depressed (he also has clinical depression and bipolar disorder), she also recognizes that they are not the "cause" of his problems – in spite of what some people would like her to believe.
"It's just like any other food – you can have a sensitivity," says Bailey. "However, if I cut all red dyes out of his diet, his ADD and other problems certainly wouldn't go away. It would not be in his best interests if I were to use diet as a cure-all and be blind to the reality of his condition."
Bailey's advice to parents: Don't be afraid to try alternatives, as long as they are proven safe, to help your children. However, approach any claim with a healthy dose of skepticism.