Brightly Colored Behavior Problems?

A few months into 2010 I evaluated Cody (not his real name), a 6 year old boy with anger problems and impulsivity.  He took Adderall (dextroamphetamine) for his impulsivity and distractibility (ADHD symptoms), but despite an adequate dose the drug did not help as much as his mother and teacher hoped.  His teachers reported he was difficult to manage, and angry.  He did not attend to school work and had problems making and keeping friends.  His mother said he was easily distracted, poorly behaved and would not follow directions.

When looking at Cody's diet I saw that he ate a steady diet of processed food, starting with brightly-colored sugary breakfast cereals, and ending with dinners of packaged microwave meals.  His mother, who worked during the day, said she gravitated toward the convenience of these foods.

I recommended to his mother that Cody stop eating processed foods.  To eliminate colorings, additives and preservatives I recommended he eat whole foods.  Whole foods such as meat, vegetables and fruits require preparation.   His mother obtained a crock pot to make meals more convenient to cook.  I recommended Cody eat eggs each morning for breakfast, cooked any way (hard boiled eggs are convenient) and eat them as often as he likes during the day.  Eggs provide a number of vital nutrients, some of which are difficult to obtain in the Standard American Diet (or SAD).  Among these is an important brain nutrient known as choline, which is found in the yolk.

The results of this diet change were remarkable.  Only 2 weeks later, his mother said he had not needed Adderall, the medicine he took to help with hyperactivity, impulsivity and concentration, for more than a week.  His teachers reported he was a "new kid."  His sleep improved, and he was able to sleep through the night.  His mother said that if he goes off his new diet and eats, say, a fast food burger topped with American cheese (synthetically dyed), he becomes "impossible to deal with."  The same happens when he eats colored candies.  Cody appeared to be sensitive to food additives, probably colorings and preservatives.  

While recommending a dietary course I favor diets that restrict refined carbohydrates in order to prevent blood sugar swings that can affect a child's mood.  Refined carbohydrates, and sugars in particular, are also a significant sources of colorings, additives and preservatives. A diet of whole (not processed, but natural) foods eliminates additives, preservatives, food colorings and dyes from the diet.

Since the advent of food processing, parents long complained their children reacted to colored sweets with behavior problems.  They finally found an ally in Dr. Ben Feingold.  But in the medical community, Dr. Feingold's 1976 paper proposing dietary food additives are linked to hyperactivity and learning disabilities in children generated decades of controversy and debate.  Then on September 6, 2007, the Lancet reported a study of 153 three-year-old and 144 eight-to-nine-year-old normal children.  The researchers first removed all artificial colors, flavors and preservatives from their diets. Next, children in the experimental group were given a drink containing a mixture of artificial food colorings and sodium benzoate (also known as benzoate of soda), a preservative common to soft drinks and processed foods in the U.S.  Included among the artificial colorings were four coal tar-derived food colorings still common to U.S. foods:

Sunset yellow (F D & C Yellow # 6),
Tartrazine (F D & C Yellow # 5)
Quinoline yellow (F D & C Yellow # 10)
Allura red AC (F D & C Red # 40)

The research team found that the addition of these and other food colorings to sodium benzoate promoted hyperactivity in this normal population of children as compared to the control group (the group that did not drink the mixture).  

In light of this study, in 2008 the editors of the American Academy of Pediatrics’ journal, AAP Grand Rounds, declared “Thus, the overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong.”  They go on to recommend “a trial of a preservative-free, food coloring-free diet is a reasonable intervention” for hyperactive children.  

The elimination of food colorings, additives and preservatives is a first line recommendation for both children and adults in my practice.  I have eliminated these from my own diet as well, as this is a prudent step for anyone who wants to optimize their health.  While not all of my patients report miraculous results, reports are overwhelmingly positive.