Feed Your Child’s Focus

Diet is especially important for children and adults with ADHD. Learn more about the role artificial food dyes, sugar, and food sensitivities play in exacerbating symptoms of attention deficit.

Your body is an amazing chemical factory. It transforms the raw materials in the foods you eat — amino acids, fatty acids, vitamins, minerals, oxygen, glucose, and water — and produces more than 100,000 chemicals that wind up as brain cells, neurotransmitters and so much more. In other words, diet is especially important for kids and adults with ADHD, for whom the wrong chemicals and additives can spell system failure.

Artificial Food Coloring

As Susan served breakfast for her six-year-old son with attention deficit disorder (ADHD), little did she know the tasty blueberry muffin, bowl of Fruit Loops, and glass of Sunny D Citrus Punch would worsen his ADHD symptoms all day long, making him more inattentive and fidgety. With some probing, she found the problem wasn’t a food allergy, or even the foods’ too-high sugar content, but rather a common sensitivity to their rainbow of artificial colors that was to blame for her son’s distracted mind.

Studies published in The Lancet, Pediatrics, and Journal of Pediatrics suggest that Food Additives adversely affect a population of children with ADHD (see “Study Up,” below). And more studies indicate that artificial coloring and flavors, as well as the preservative sodium benzoate, can make even some kids without ADHD hyperactive.

Two studies from the United Kingdom (The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children and 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) are good examples. In 2004, one studied healthy preschoolers after giving them either a placebo or 20 milligrams of artificial dye mix plus sodium benzoate. They found that, when the children received the actual dye and sodium benzoate, they had a significant increase in hyperactivity.

In 2007, a research team Lead by UK researcher Donna McCann studied a group of 3 year olds and 8 or 9 year olds. It found that both hyperactive children and non-hyperactive children experienced increased hyperactivity scores when given artificial food colors and additives, suggesting that the dyes are a general public health concern. Starting in 2010, the European Union required the following warning label for all food that contains artificial dye: “May have adverse effect on activity and attention in children.”

The Center for Science and the Public Interest petitioned the Food and Drug Administration (FDA) to hold a hearing on whether the U.S. should require a similar warning label — or ban artificial colors altogether. In the end, the vote established that labels should not be added, and the food dye was deemed safe.

However, the FDA did admit that a population of children does react adversely to these dyes. The Center for Science and Public Interest has an informative website with more information: Food Dyes: A Rainbow of Risks.

If you consume orange soda in the U.S., you’re consuming red #40 and yellow #5. But in Britain, you’re drinking pumpkin and carrot extract. Strawberry Nutragrain bars have artificial food dyes in the U.S., but natural dyes in Britain. McDonald’s strawberry sundaes are colored with red #40 in the U.S.; British consumers get real strawberries instead.

Things are changing with U.S. food manufacturers. In early 2015, Nestle announced that it will remove all artificial food dyes from its candies. A couple days later, Hershey said its labels would have “simpler ingredients that are easy to understand.” Kraft has committed to removing all yellow dyes from its macaroni and cheese. Taco Bell and Panera have committed to stop using artificial colors or high fructose corn syrup. And General Mills is already removing dyes from some of its cereals.

How do you know if food additives are compromising your child’s focus? Conduct a quick test at home. For one week, avoid foods and drinks that contain U.S. certified colors Red #40, Blue #2, Yellow #5 (Tartrazine), Yellow #6 (Sunset Yellow), as well as sodium benzoate. Do you find your child less fidgety? Less prone to meltdowns? Less impulsive and hyperactive?

After seven days, reintroduce food additives into his diet by squeezing a few drops of artificial food coloring — you know, the McCormick brand in the little plastic bottles — into a glass of water, and have your child drink it. Observe his behavior for two or three hours. If you don’t see a change, have him drink a second glass. Does he become more hyperactive?

Elimination Diets

When British researchers tested food dyes and preservatives, 79% of the children tested had a reaction to the food dyes, 73% reacted to soy, 64% reacted to MILK, and 59% reacted to chocolate. Additional foods caused problems as well.

When placed on a special elimination diet excluding foods that trigger unwanted behavior, as many as 30% of toddlers and preschoolers benefit, says Eugene Arnold (link to .edu page), M.D., author of A Family’s Guide to Attention-Deficit Hyperactivity Disorder and professor emeritus of psychiatry at Ohio State University. The benefits for adults with ADHD are less clear.

On an elimination diet, you start by eliminating dairy, chocolate and cocoa, wheat, rye, barley, eggs, processed meats, nuts, and citrus. Instead, you eat only foods unlikely to cause reactions, including:

Lamb

Chicken

Potatoes

Rice

Bananas

Apples

Cucumbers

Celery

Carrots

Parsnips

Cabbage

Cauliflower

Broccoli

Salt

Pepper

Vitamin supplements

Then you restore other foods, one at a time, to see whether they cause a reaction.

If nothing happens within two weeks — if you see no difference in your child’s behavior even when he’s eating the restricted diet — stop the experiment. If you notice an improvement, reintroduce one excluded food each day and watch what happens. If the child has a bad response to the food — if he becomes more fidgety or has trouble sleeping, for example — eliminate it again. If it’s a food your child really likes, try reintroducing it again a year or so later. When not repeatedly exposed to a trigger food, children often outgrow sensitivities.

In the 1970s, Benjamin Feingold, M.D., a pediatrician and allergist at Kaiser Permanente Medical Center in San Francisco, introduced an eating plan that he said could help alleviate symptoms of ADHD. The Feingold Diet forbids artificial food colors, flavorings, sweeteners, and preservatives, as well as salicylates, naturally occurring compounds found in some fruits and vegetables.

Studies failed to uphold Feingold’s claims when he first made them, and most ADHD experts still dismiss the Feingold diet as ineffective. Yet some recent research suggests that the Feingold diet may, indeed, benefit the 5 percent of children with ADHD who seem sensitive to chemicals in food.

Any elimination diet is not easy, but it is doable. The results could be very important. It does require careful meal planning, grocery shopping, label reading, and the cooperation of your whole family. Remember, what you don’t look for will probably not be found.

The Sugar Debate

Most parents of children with ADHD — 84 percent of 302 parents in one 2003 study — believe that sugar has a negative effect on their kids’ behavior. And many adults with ADHD are convinced that sugar worsens their symptoms as well.

But medical experts still tend to discount any link between behavior and sugar or artificial sweeteners. As evidence, they point to a pair of decades-old studies that appeared in the New England Journal of Medicine. “Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children” (February 3, 1994) found that “even when intake exceeds typical dietary levels, neither dietary sucrose nor aspartame affects children’s behavior or cognitive function.” A similar study, “The Effect of Sugar on Behavior or Cognition in Children” (November 22, 1995), reached much the same conclusion — though the possibility that sugar may have a mild effect on certain children “cannot be ruled out,” according to the study’s authors.

In any case, sugar carries loads of calories and has no real nutritional value. People who eat lots of sweets may be missing out on essential nutrients that might keep them calm and focused. Since ADHD medications tend to blunt the appetite, it’s important to make every calorie healthy and nutritious. Sugar is neither of those things.

The most recent review of all the studies on diet and ADHD, concluded and published in 2014, found mixed outcomes. The science is still shaky in this area. The studies found that parents often reported behavior changes with consumption of artificial food colorants and additives, but teachers and clinical tests didn’t report the same level of change. The conclusion? Artificial colors do react adversely with ADHD symptoms in some children. The studies on sugar and artificial colors had negligible results as well, thwarting the theory that sugar and artificial sweeteners cause ADHD symptoms. However, all studies on the effect of elimination diets on ADHD symptoms found statistically significant ADHD symptom reduction when children were given a narrow diet of foods unlikely to cause reactions.

It is now known that any sweetener, including artificial sweeteners, disrupts dopamine and dopamine receptors in the brain. This can lead to alterations in behavior, binge eating, and ADHD symptoms.

Every credible agency recommends that we reduce the amount of sugar in our diets, including the American Heart Association because sugar has been associated with diabetes and heart disease. It’s recommended that preschoolers have no more than four teaspoons of sugar a day. For ages four to eight, three teaspoons, and for pre-teens and teens, five to eight teaspoons.

For context, 12-ounce can of soda contains almost 10 teaspoons of sugar; that is a bad idea for a child of any age. When reading your food labels, remember that four grams of sugar is equal to 1 teaspoon.

Most health-care practitioners recommend greatly reducing sugar for better health and behavior. Try to satisfy sugar cravings with fruits, and avoid all high fructose corn syrup. You can use small amounts of alternative sweeteners like xylitol, monk fruit, and stevia. To test your child for sugar sensitivities, follow the test for the food dyes, above, and substitute sugar as the test material.

What to Do

If you find that your child exhibits food sensitivities, wean him or her off of foods that are artificially dyed or flavored, or that contain sodium benzoate. Here are some helpful tips about what foods to avoid and what to serve instead:

Substitute 100 percent fruit juice for soft drinks, fruit drinks, and fruit punches, all of which are typically artificially colored and flavored. If your child must have a soft drink, try 7-Up, Squirt, or Sprite. These brands are naturally flavored and free of dyes — though they all contain sodium benzoate, except Sierra Mist NATURAL. Even better, buy natural sodas or fruit spritzers sold at health food stores.