Nutrition and Behaviour
6th / 8th February 2017
Lecture 2: Food Hypersensitivity and Food Intolerance
Hyperactivity and psychotic symptoms
Feingold
Benjamin F Feingold
Some develop intolerance to aspirin (acetylsalicylic acid)
Those sensitive to aspirin react to foods containing natural salicylates, similar substances.
Aspirin sensitive patients react to the yellow colouring tartrazine (E102)
Those sensitive to tartrazine react to aspirin
A yellow synthetic azo dye
Typical products include fizzy drinks, fruit squash, puddings, cakes, sauces, soups, sweets, jelly, ice cream, jams,
honey products etc.
Aspirin and tartrazine produce either hives or a rash in those who respond to those compounds.
While ill he became aware of a marked increase in hyperactivity among children
Estimated half to 5 million children affected of which half taking Ritalin (used to treat ADHD and ADD).
25 years before when he was a paediatrician, hyperactivity was rare among children.
Noted that if the use of additives and the increase in hyperactivity was plotted, the lines were parallel.
The Feingold diet was then developed on the premise that salicylates may trigger hyperactivity.
In 1965, a woman in her early forties came with a swollen face and giant hives.
Placed on a diet avoiding artificial colours and flavours
Within 3 days her condition improved
Additionally, unknown to Feingold she had a long history of aggressive behaviour which also diminished.
,Most herbs, spices, fruits and vegetables are within the category of high-salicylate foods.
Johnny’s Dietary Diary
Chocolate bar at 11:30am, very noticeable behaviour change at 2:30pm
Teaspoon of anti-histamine cough syrup at bedtime produced a raving maniac
Hamburger with relish and juice punch, super-charged behaviour that lasts the next day.
No controls, no placebo, not double-blind, no objective measure, not falsifiable, correlation does not mean
causation.
Feingold submitted work to medical journals but was rejected.
Press became interested.
Wrote a popular book where it is claimed that 40-70% of children respond
, By 1978, 20,000 families were using the Feingold diet and there were 100 Feingold associations in dozens of
countries.
Kavale and Forness (1983): Looked at the findings from 23 studies and found that diet produced a small but non-
significant effect on activity. There was no sign of any influence on cognitive dimensions. “Diet modification is not
an effective intervention for hyperactivity”.
Gray et al. (2013): Review of case notes which identified 74 children who had been prescribed diets that eliminated
foods containing natural salicylates (Feingold diet). The most common indications for starting the diets were eczema
(34 children) and behavioural disturbances such as ADHD (17 children). Found no evidence to support efficacy of
elimination in managing both diseases. As a result of the diet, a high proportion of the children suffered adverse
outcomes such as nutritional deficiencies, food aversion, eating disorders.
However, there is evidence that food exclusion can ameliorate the hyperkinesis symptoms of ADHD.
Carter et al. (1993): 78 children referred to a diet clinic because of hyperactive behaviour were placed on an
elimination diet. The majority of children improved in behaviour. For 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 ratings of behaviour and to impair
psychological test performance.
However, a recent randomised controlled trial suggests that much of this effect is caused by artificial food additives,
and that natural salicylates were not found to increase hyperactivity (unlike Feingold’s suggestion).
McCann et al. (2007): Randomised, double-blinded, placebo-controlled, crossover trial to test whether intake of
artificial food colour and additives affected childhood behaviour. Found that artificial colours and/or sodium
benzoate preservative in the diet resulted in increased hyperactivity in 3- and 8-year old children in the general
population.
The Hyperactive Children’s Support Group (HACSG) was formed in 1977 to promote Feingold’s work in the UK.
However, not all suspected ingredients are man-made. There are a number of naturally occurring substances to
which many children react adversely. One such chemical is salicylate, an aspirin-like substance, which occurs in many
fruits and some vegetables.
Food Aversion (psychological)
Psychological food intolerance
Food avoidance
Food Hypersensitivity (biological)
Enzyme defects
Pharmacological
Allergic
Fermentation of food
Other
6th / 8th February 2017
Lecture 2: Food Hypersensitivity and Food Intolerance
Hyperactivity and psychotic symptoms
Feingold
Benjamin F Feingold
Some develop intolerance to aspirin (acetylsalicylic acid)
Those sensitive to aspirin react to foods containing natural salicylates, similar substances.
Aspirin sensitive patients react to the yellow colouring tartrazine (E102)
Those sensitive to tartrazine react to aspirin
A yellow synthetic azo dye
Typical products include fizzy drinks, fruit squash, puddings, cakes, sauces, soups, sweets, jelly, ice cream, jams,
honey products etc.
Aspirin and tartrazine produce either hives or a rash in those who respond to those compounds.
While ill he became aware of a marked increase in hyperactivity among children
Estimated half to 5 million children affected of which half taking Ritalin (used to treat ADHD and ADD).
25 years before when he was a paediatrician, hyperactivity was rare among children.
Noted that if the use of additives and the increase in hyperactivity was plotted, the lines were parallel.
The Feingold diet was then developed on the premise that salicylates may trigger hyperactivity.
In 1965, a woman in her early forties came with a swollen face and giant hives.
Placed on a diet avoiding artificial colours and flavours
Within 3 days her condition improved
Additionally, unknown to Feingold she had a long history of aggressive behaviour which also diminished.
,Most herbs, spices, fruits and vegetables are within the category of high-salicylate foods.
Johnny’s Dietary Diary
Chocolate bar at 11:30am, very noticeable behaviour change at 2:30pm
Teaspoon of anti-histamine cough syrup at bedtime produced a raving maniac
Hamburger with relish and juice punch, super-charged behaviour that lasts the next day.
No controls, no placebo, not double-blind, no objective measure, not falsifiable, correlation does not mean
causation.
Feingold submitted work to medical journals but was rejected.
Press became interested.
Wrote a popular book where it is claimed that 40-70% of children respond
, By 1978, 20,000 families were using the Feingold diet and there were 100 Feingold associations in dozens of
countries.
Kavale and Forness (1983): Looked at the findings from 23 studies and found that diet produced a small but non-
significant effect on activity. There was no sign of any influence on cognitive dimensions. “Diet modification is not
an effective intervention for hyperactivity”.
Gray et al. (2013): Review of case notes which identified 74 children who had been prescribed diets that eliminated
foods containing natural salicylates (Feingold diet). The most common indications for starting the diets were eczema
(34 children) and behavioural disturbances such as ADHD (17 children). Found no evidence to support efficacy of
elimination in managing both diseases. As a result of the diet, a high proportion of the children suffered adverse
outcomes such as nutritional deficiencies, food aversion, eating disorders.
However, there is evidence that food exclusion can ameliorate the hyperkinesis symptoms of ADHD.
Carter et al. (1993): 78 children referred to a diet clinic because of hyperactive behaviour were placed on an
elimination diet. The majority of children improved in behaviour. For 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 ratings of behaviour and to impair
psychological test performance.
However, a recent randomised controlled trial suggests that much of this effect is caused by artificial food additives,
and that natural salicylates were not found to increase hyperactivity (unlike Feingold’s suggestion).
McCann et al. (2007): Randomised, double-blinded, placebo-controlled, crossover trial to test whether intake of
artificial food colour and additives affected childhood behaviour. Found that artificial colours and/or sodium
benzoate preservative in the diet resulted in increased hyperactivity in 3- and 8-year old children in the general
population.
The Hyperactive Children’s Support Group (HACSG) was formed in 1977 to promote Feingold’s work in the UK.
However, not all suspected ingredients are man-made. There are a number of naturally occurring substances to
which many children react adversely. One such chemical is salicylate, an aspirin-like substance, which occurs in many
fruits and some vegetables.
Food Aversion (psychological)
Psychological food intolerance
Food avoidance
Food Hypersensitivity (biological)
Enzyme defects
Pharmacological
Allergic
Fermentation of food
Other
