Food for Thought

The Feingold diet was first proposed by Dr. Benjamin F. Feingold in the early 1970’s when he published his book, Why Your Child is Hyperactive. The basis of the Feingold diet is the removal of certain artificial foods and food additives, which, Feingold argues, are linked to hyperactivity in children with ADHD: “A Standard and Poor’s graph projecting the dollar-value increase in artificial flavors looks very much like a graph indicating the rising trend of H-LD for the same period” (Feingold, 1975). Primarily, the diet removes dyes, artificial flavors, artificial sweeteners and three preservatives (BHT, BHA, and TBHQ), although stricter diets also include the removal of salicylate-containing foods. Feingold’s early evidence showed 30 to 50 percent of hyperactive subjects showed improved symptoms improved after being on the diet. Although Feingold’s work originally erupted in excitement by parents and health professionals seeking drug alternatives, a storm of controversy followed…

Where’s the proof? Since the publication of what is now known as “the Feingold hypothesis,” hundreds of studies have been conducted attempting to confirm Feingold’s report. The studies range across variables like the substances permitted, diet duration, and sample size, so comparing results is often difficult. Nevertheless, the results are far from consistent.

To settle the firestorm of debate, in 1982 the National Institutes of Health (NIH) came together for a conference to advise health professionals and the public on diets and hyperactivity. The conference concluded that research, “did indicate a limited positive association between defined [Feingold-type] diets and a decrease in hyperactivity.” Furthermore, they recommended that further research be conducted; however, limited studies have been done since then.

A meta-analysis of 23 studies conducted by Kenneth Kavale and Steven Forness in 1983 failed to validate the Feingold hypothesis. They discovered a very small effect size across studies, only slightly better than what is to be expected by chance. In other words, on a normal distribution, the average experimental subject moves only from the 50th to the 51st percentile on a modified diet.

In another review, “The Feingold Diet: A Current Reappraisal,” by Dr. Jeffrey Mattes, the diet was not found to be effective for most children: “The positive results in a few studies have been inconsistent between studies and greatly outnumbered by negative results. Even among children whose parents feel the diet has helped them greatly, the improvement seems more often a placebo effect” (1983).

Despite the inconclusive results, Feingold and his associates do not waiver in their support and promotion of the diet as an effective treatment for children. But, is it really the removal of artificial additives that are causing the so-called improvement in some kids? Many argue that the observed results are, like Mattes described, a placebo effect. Symptom relief may really be the result of increased attention and structure placed on the child. Many reports suggest that providing children suffering from ADHD with structure and routine helps to reduce hyperactivity symptoms. So, maybe the Feingold diet is doing just that. ADHD has genetic roots, so it is possible that a subset of patients is responsive to dietary changes. In any case, the Feingold diet is yet unproven to be an effective treatment on its own.

Despite the lack of proof, testing a modified diet can’t hurt. Artificial additives and dyes aren’t found in most healthy foods anyway. As a parent, it is important to be thorough and precise when trying new diets, because it can be difficult to measure changes in behavior in a child whose behavior is already so variable, and restrictive diets are very difficult to enforce in children, especially once they go to school. It is recommended that the parent and child go through the food at home to determine what is safe to eat and that there is a systematic recording method in place. Remember…nothing is proven, but maybe worth a try!

For more information on Feingold and his results, visit the foundation website: www.feingold.org