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There is no “ADHD diet” that could be used globally. There are, however, dietary tools that can be used to design an individual diet for ADHD therapy. Research on the relationship between diet and ADHD started in the 1970s. Dr Feingold tested the hypothesis that artificial food additives and salicylates are associated with hyperactivity and learning disabilities. (1)
This lead to the creation of the Feingold diet, which was followed by more research on the relationship between various elimination diets and ADHD.
These diets focused on the link between ADHD and food additives, salicylates, artificial food colorings (AFC), supplementation with omega 3 fatty acids, minerals and vitamins. (2)
Click here to learn about the association between ADHD and supplements.
Importance food in ADHD treatment
It is estimated that dietary treatment may improve ADHD symptoms in about 33% of children, 8% of whom are affected by food colors.
The chemicals responsible for those symptoms have not yet been identified. (3)
Diets used in ADHD therapy are mostly designed through an elimination process, where foods or food additives that cause worsening of symptoms are removed.
Research on an elimination diet and ADHD are divided into 3 categories:
- Artificial additives (colors, sweeteners, fragrances, preservatives) and naturally occurring salicylates.
The effects of other diets are not well-studied, except for the Ketogenic diet, which shows no benefits in ADHD therapy (4).
Another area of investigation is the effects of nutrient supplementation on ADHD.
- The purpose of the elimination diet in ADHD treatment is to identify and remove foods or food additives that worsen the symptoms.
- The elimination diet and nutrient supplementation are the most common natural therapy used in ADHD.
Feingold diet and ADHD – (artificial additives and salicylates)
The importance of food in ADHD treatment is not a new concept.
In 1934, food allergies were associated with the health of the nervous system. The elimination diet started to be implemented.
In 1976, the elimination diet started to be applied in the treatment of behavioral disturbances, such as headaches, learning difficulties, schizophrenia and depression.
In the 1970s, the allergist Dr. Feingold came up with the hypothesis that synthetic food additives and naturally occurring salicylates can trigger hypersensitivity, due to an immunological response.
- Artificial food colors (AFCs)
- Artificial flavors and fragrances
- Artificial sweeteners
- Synthetic flavors
- Preservatives such as sodium benzoate
- Salicylates (chemicals that occur naturally in some foods)
Dr Feingold started to apply the elimination diet, by removing some of these additives from a number of children’s diet.
He reported that the learning disabilities and hyperactivity improved by 30-50% on hyperactive children. (7)
Families of the children helped by this diet have formed the Feingold Association of the United States, where they continue promoting this method.
What do studies indicate?
The available, short term studies indicate that the Feingold method may be effective in a small percentage of the children.
It is still currently unclear, which chemicals and their dosage cause ADHD symptoms.
- Salicylates haven’t been shown to cause behavioral changes on their own in people with ADHD
- Artificial colors (AFCs) affect about 8% of the children with ADHD (3).
Studies show that up to 89% of children that are sensitive to AFCs, improve ADHD symptoms, when they are removed.
There are 6 artificial colors listed by the EU that ‘May have an adverse effect on activity and attention in children’. These colors are: sunset yellow FCF (E110), quinoline yellow (E104), carmoisine (E122), allura red (E129), tartrazine (E102) and ponceau 4R (E124). (12)
Many of the children sensitive to AFCs, are also sensitive to common food allergens, such as milk, chocolate, soy, eggs, wheat, corn and legumes and salicylate foods, such as grapes, tomatoes and oranges.
Those children react especially to the combination of AFCs and allergens or salicylates.
- Some other artificial additives may improve symptoms in 10-25% of hyperactive children, especially the younger ones.
- Artificial sweeteners
There are no studies that prove adverse effects of artificial sweeteners on ADHD and studies on aspartame have shown no effects. (16)
- Removing artificial food colorings (AFCs) and other additives result in significant improvement of symptoms, but only in a small percentage of children with ADHD.
- Children affected by AFCs are often affected by food allergens, salicylates or some preservatives.
- Artificial sweeteners do not worsen the symptoms of ADHD.
Sugar-free diet and ADHD
Sugar generally affects behavior, but can a sugar-free diet be considered an effective ADHD diet?
The consumption of simple sugars causes a sudden insulin secretion, leading to hypoglycemia. Hypoglycemia stimulates the production of epinephrine which, in turn, leads to nervous reactions and hyperactivity. (17)
Studies show that diets high in sugar are associated with symptoms common to ADHD, such as higher hyperactivity and inattention.
- Although high consumption of sugar increases hyperactive behavior and inattention in non-ADHD people, there is currently no evidence that it improves symptoms in ADHD.
Few foods diet and ADHD – (food allergens)
The “Few foods diet” (also called “oligoantigenic diet”) is a dietary tool used to identify problem causing foods, such as allergens.
In children with ADHD and allergic or sensitive to certain foods, this diet can be used as a method of identifying and eliminate those foods. This may reduce the symptoms of ADHD.
Once the problem causing foods are eliminated, a new personalized diet is compiled and then used as an ongoing treatment in ADHD.
This diet is more complex than the Feingold diet, since there are more foods involved and the diet starts with very basic foods known to be allergy safe. The reintroduction of foods phase may last up to 1.5 years. (22)
Steps of Few foods diet in ADHD treatment
“A few foods diet” is an elimination diet method.
The first step is to start only with foods that are known to be low allergenic and don’t cause food sensitivity symptoms.
Once the symptoms reduce or disappear, individual foods are re-introduced one at a time and symptoms are monitored.
Foods that worsen the symptoms are then eliminated from the diet.
The final selection of safe foods forms a diet that becomes part of the ongoing therapy.
Difficulty of the Few foods diet in ADHD therapy
The process of eliminating problem causing foods can unfortunately last a very long time, since there are many foods to be tested before the diet becomes nutritionally balanced.
This diet must be followed under the close supervision of a health professional to avoid nutrient deficiencies and requires long term, full commitment and motivation from the treated person or from both parents and children affected.
Due to its complexity, this diet is not recommended for most children with ADHD, but rather used in selected cases.
The scale of effects of eliminating foods through the FFD method is medium to large, but only in some children (usually younger) who can withstand a long term (up to 1.5 years) food elimination program. (23)
- The “Few-foods diet” is a long-lasting test that can be used to identify foods that worsen symptoms of ADHD.
- At the end, an individualized ADHD diet can be designed, based on the foods that don’t worsen the symptoms.
- This method is unfortunately lengthy, difficult and is only suitable for some children.