Connecting Food Additives & ADD/ADHD

We've all at some point fallen prey to the colorful and artificially-flavored cereal aisle or utilized colorings in home baking to make the end result more visually appealing, but what is the health impact of these seemingly harmless additives? The answer is that they aren't as benign as you may think, with negative links to several disorders and illnesses. However, the focus today will specifically be on Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD) and the connection between consumption of artificial colors, flavors and preservatives.

Implementation of artificial additives in the food industry have a long history, with more widespread use in the 20th century. This is despite many decades of research and clinical experience proposing that neurodevelopment disorders may be linked to consumption, especially in children who are unfortunately a huge target audience and more sensitive to their effects. Artificial additives exist in so many places and not just in food products. They can be found in supplements, medications, beverages, makeup and so much more so they can be challenging to avoid.

One of the pioneers in this realm was Dr. Ben Feingold who practiced medicine in the mid 1900's, a time when ADD/ADHD was known as Hyperkinesis and Learning Disorder (H-LD) and Minimal Brain Dysfunction (MBD). Dr. Feingold worked with pediatrics and was the chairman of a research committee later in his career. He spent decades researching and studying potential etiologies of H-LD and MBD and focused extensively on the long- and short-term health effects of exposure to artificial colors, flavors and preservatives. Throughout the decades he treated many individuals who suffered from H-LD/MBD and had great success using his treatment methods which were cutting edge. Over 40 years of clinical research and experience lead to the Feingold Diet, which was a staple for his patients with a variety of neurodevelopment disorders. Then, in 1985 he released the book "Why Your Child Is Hyperactive" in an effort to educate the public (4).

The basis for the Feingold Diet is simple, yet results were profound and effective for some of his patients. Strict avoidance of all artificial colors (Red #40, Yellow #5, Blue #1 etc.), sweeteners, flavors, salicylates, and preservatives (specifically butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and tert-Butylhydroquinone (TBHQ)) was the premise of the diet. The thinking behind the avoidance of these specific chemicals lies in the idea that they are haptens, which are defined as small molecules bound to proteins that can illicit an immune response. In other words, while these chemicals do not directly cause ADD/ADHD, they can have a profound effect and potentiate the symptoms experienced by the individual (4).

Modern Day Relevance

If you are even remotely motivated and informed on the importance of reading labels, the Feingold diet may not come as a huge surprise since there is a strong argument for all humans to eat in a way that is minimally processed, not just those who suffer from ADD/ADHD. However, you can only imagine the backlash and push back Dr. Feingold received for his findings. Even now, the Feingold diet is heavily criticized despite some research and a lot of anecdotal evidence of success and reduction of symptoms.

The unfortunate truth is that the diagnosis for ADD and ADHD has skyrocketed in the last few decades. Historically, it was treated primarily using Ritalin (stimulant), Dexedrine (stimulant), Stelazine (antipsychotic), Tofranil (antidepressant), and Dilantin (anticonvulsant). These drugs carry both minor and the potential for major side effects, most of which include heart problems such as palpitations, insomnia, headache, reduced appetite, abdominal pain, high blood pressure, anxiety, mania, and circulatory problems (just to name a few). Even in modern medicine, Ritalin is still one of the most commonly prescribed drugs for the treatment of ADD/ADHD, despite its well-documented side effects that can potentially be experienced.

While dietary changes can undoubtedly be challenging, the risk to benefit ratio is undeniable as eating a more pure and un-adulterated diet poses little "risk" or negative side effects when compared with choosing a medication that will not address the root cause and introduces an established side effect profile that may or may not be experienced.

What does research have to say about artificial food additives and ADD/ADHD?

To this day, opinions on whether artificial food additives play a role in ADD/ADHD is mixed within the medical field as studies have produced mixed results. Artificial colors have been linked in some studies to hyperactive behavior in children (1, 5) and an inflammatory cascade that can result in neurobehavioral disorders (8). Certain colors (Blue #1 and Red #3 if not complexed to a protein) have the ability to cross the blood brain barrier (7). While the focus here is on artificial food additives and the connection to ADD/ADHD, it's important to know that these chemicals are linked to other health concerns, including cancer (3, 6).

However, according to research effects seen by ingestion are "small" and it is considered unclear whether effects are specific to ADHD (6). A study in 2013 utilizing both food coloring and a placebo showed that when 50mg of artificial food coloring was given, children with and without ADHD displayed behavioral reactions (irritability, inattention, impulsivity, and hyperactivity) that were not present in the placebo group (7).

Takeaway

If there is anything to take away from this, it is that you have the power to make changes for yourself and your family and behavioral solutions don't always have to be complicated. Being more intentional about removing or at least reducing food additives could change the health of everyone around you and prevent both misdiagnosis, and the subsequent medications that often go along with it.

References:

1. Bakthavachalu, P., Kannan, S. M., & Qoronfleh, M. W. (2020). Food Color and Autism: A Meta-Analysis. Advances in neurobiology, 24, 481–504.

2. Batada, A., & Jacobson, M. F. (2016). Prevalence of Artificial Food Colors in Grocery Store Products Marketed to Children. Clinical pediatrics, 55(12), 1113–1119.

3. Debras, Charlotte et al. “Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study.” PLoS medicine vol. 19,3 e1003950. 24 Mar. 2022, doi:10.1371/journal.pmed.1003950

4. Feingold, B. F. (1985). Why your child is hyperactive. Random House.

5. Ly V, Bottelier M, Hoekstra PJ, Arias Vasquez A, Buitelaar JK, Rommelse NN. Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017 Sep;26(9):1067-1079.

6. Kobylewski, S., & Jacobson, M. F. (2012). Toxicology of food dyes. International journal of occupational and environmental health, 18(3), 220–246.

7. Stevens LJ, Kuczek T, Burgess JR, Stochelski MA, Arnold LE, Galland L. Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children. Nutr Rev. 2013 May;71(5):268-81. doi: 10.1111/nure.12023. Epub 2013 Mar 13. PMID: 23590704.

8. Vojdani, Aristo, and Charlene Vojdani. “Immune reactivity to food coloring.” Alternative therapies in health and medicine vol. 21 Suppl 1 (2015): 52-62.