ADHD Food Link

ADHD and a link to food has been a hot topic for nearly 40 years now. The FDA has been keeping a close watch on this topic and in March of 2011 published its findings after an extensive review of all available published clinical studies and literature. This page summarizes this report and the background surrounding their action. In addition, below are several additional resource web pages for further review.

ADHD's link to food or food additives or food colorings has been a source of controversy for over 40 years. In the late 60's and 70's a pediatrician released his "Remove Additives" diet claiming that these additives can be linked to children's behavior. At the time the FDA reviewed all available literature and concluded that while there was some indication that some children may be adversely affected by artificial colors, more research was needed before the FDA could make any final statement regarding specific effects of these additives.

Background: ADHD Food Link

In 1982 the National Institutes of Health convened a panel of experts to review the data. They reviewed all available published studies and literature. They identified a number of significant gaps in investigative techniques used to prove an ADHD- food link. They stated that these gaps needed to be filled in before any conclusion could be made regarding the dietary management of hyperactivity. These gaps included a lack of standard diagnostic criteria, not including any genetic parameters, and not taking into account developmental or environmental factors.

In 1986 the FDA's committee on Hypersensitivity to Food Constituents reviewed all currently available data relating to an ADHD food link, including data with FD&C Yellow No. 5. The committee reported there was not evidence of behavioral disorders associated with the food ingredients studied.

More recently in 2007, a study conducted by the Univ. of Southampton in the UK again brought the the use of synthetic color additives under scrutiny. The study was published in the British medical journal – Lancet. At first this appeared it might be a definitive study on the ADHD food link controversy. The study was six weeks in length and designed to test whether artificial color additive mixtures and the preservative sodium benzoate could cause hyperactivity. There were two test groups: 3-year-olds, and eight- and nine-year-olds. The study used mixtures of the seven items listed below. However, in this study it turned out that three of the six dyes (shown in red font in chart below) used in the test mixtures either are not currently approved in the US or have never been approved for use in food in the US. This raises an obvious question, regardless of its outcome, how can these results be applied to the ADHD food link controversy in the US? Following is a table that lists the ingredients used in their mixtures.

Food Color Used in Above Study

Name in the United States

Current Approval Status in United States

Quinoline Yellow

D&C Yellow No. 10

Not certified in US for Food, only for Drugs and Cosmetics

Ponceau 4R

No Equivalent in US

Has never been approved for any use in the US

Allura Red

FD&C Red No. 40

Currently certified for use in US for Food, Drug and Cosmetics

Azorubine (carmoisine)

In 1939 listed as D&C Red No. 10, certified drugs and cosmetics only. Never approved for food additive.

1963, this color was de-listed because sufficient safety had not been submitted for certification.

Tartrazine

FD&C Yellow No. 6

Certified for use in Food, Drug and Cosmetics; Known allergen can cause hives in small segment of population and must be declared on label as ingredient when used as additive in food.

Sunset Yellow

FD&C Yellow No. 5

Currently Certified in US for use in Foods, Drugs and Cosmetics

Sodium Benzoate

Not a color, used as Preservative in wide variety of packaging

Approved for use in foods in US, recognized safe when used as antimicrobial agent, inhibits growth of bacteria, yeasts, and molds; concentration not to exceed 0.1%

Analysis of Southampton Study

On three different occasions scientists from the UK and Europe reviewed the results of this study. Upon publication of the study results, the first group to review the data was the Committee on Toxicity, an independent group of United Kingdom scientists. They issued this conclusion: The results of this study present additional support of a possible ADHD food link between the test mixtures used and hyperactivity in children. However, because of its limitations the study results cannot be extrapolated across the general population and we recommend further study.

2008: In March of 2008 the European Food Safety Authority completed its assessment of this study and concluded that it provided limited evidence that these specific additives had a small effect on activity and attention in children in this study. They mentioned that the small changes in attention and activity was not equated with effect in different settings. Further, mixtures were used and it could not be determined if any one ingredient might be safe, and any one ingredient may have certain effects. It was also noted that observed effects were not consistent across the different age groups and across the different mixtures. Thus the hope of finally answering the adhd food link controversy did not occur.

2009: In 2009 this same group evaluated the study further, and concluded "The available scientific evidence does not substantiate direct causal link between the color additives and behavioral effects." Based on these findings, and the fact that three of the six colors used in their mixtures were not used in the US, any actionable significance for the United States food industry was difficult if not impossible to make.

2010: The European Union (EU) nevertheless, began requiring warning labels on foods that contained any of the food color additives that were tested in the Southampton Study stating that Manufacturers must include a statement including the color name or number and: "May have an adverse effect on activity and attention in children." The United States expressed concerns to the World Trade Organization about the EU decision citing that this warning label was not based on adequate scientific study and evidence. The US already has a requirement that all food color additives be identified by name an all food products.

Back to 2008: Seizing on the opportunity of the publication of the Southampton Study the Center for Science in the Public Interest (CSPI) in the United States petitioned the FDA to remove color additives from certification and to remove them from food, claiming these colors caused hyperactivity and behavior problems in children. To support their argument they cited various publications including the Southampton Study, and a 2004 analysis of 21 studies.

FDA: Advisory Committee - Possible Link ADHD and Food Color

With all this as background the FDA convened an advisory panel to investigate all available literature and clinical studies from 1982 through 2011, including the Southampton Study, and the 2004 analysis report and presented its findings and conclusion in March of 2011. There desire was to finally identify after all these years a causal adhd food link or not. The following web address provides comprehensive background information and the methods of their review. After all was said and done, they presented their findings and conclusion at a public meeting in March of 2011, a summary of which is provided below.

FDA Advisory Committee PDF File Background and Conclusion

FDA Advisory Panel Conclusion, March 2011

"The task before this Food Advisory Committee is to consider available relevant data on the possible association between consumption of synthetic color additives in food and hyperactivity in children, and to advise FDA as to what action, if any, is warranted to ensure consumer safety.

Based on our review of the data from published literature, FDA concludes that a causal relationship between exposure to color additives and hyperactivity in children in the general population HAS NOT been established. For certain susceptible children with Attention Deficit/Hyperactivity Disorder and other problem behaviors, however, the data suggest that their condition may be exacerbated by exposure to a number of substances in food, including, but not limited to, synthetic color additives. Findings from relevant clinical trials indicate that the effects on their behavior appear to be due to a unique intolerance to these substances and not to any inherent neurotoxic properties. - in other words similar to an allergic reaction of sorts based on that individuals internal ability to tolerate a particular substance.

What If I Have ADHD?

What do you do with this information? Should you eliminate all processed food and any food that contains artificial colorings? The answer is use common sense. Seek medical advice from someone who has much experience managing ADHD. Have a complete history and physical done. This will help differentiate all the possible causes of your symptoms. Look in your refrigerator and cabinets. Does everything there contain items that contain a certain color of dye? Be sure to relate to your doctor everything that they ask for. If you feel that you feel worse when you drink three cans of red cream soda a day, eliminate it from your diet for a month and assess those results. It cannot be ruled out that there may be an adhd food link intolerance of food colors for you individually. However, if you have a strong family history of ADHD, it is likely that food coloring is not causing your primary symptoms.


Resources:

Food and Drug Administration
Center for Food Safety and Applied Nutrition (CFSAN)
Color Additives Information
USDA Food Safety and Inspection Service
USDA Food Additives Fact Sheets
International Food Information Council Foundation
American Dietetic Association (ADA)
The Food Allergy and Anaphylaxis Network
Food and Nutrition Information Center


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