Hello, there once again. Thank you for joining me in part 2 of my series The ADHD Diet – where I examine the role food plays in controlling ADHD behavior and its symptoms.
This series is turning out to be my favorite set of posts on the blog. There is so much I have learned on this topic, which I am excited to share with you.
We kicked off this party last week with an item essential in so many of our favorites: SUGAR
Today, let us rock-n-roll everything that is used to give the bright colors to our candies and colas, or even to our vegetables and fruits – the FOOD DYES.
Your kid is at a birthday party – There are macaroni and cheese, bright cupcakes, assorted gummies, more candy, jelly beans, marshmallows, chips, soda, colorful drinks – the usual stuff.
Guess what is the one thing that all these things have in common – food dyes or, more specifically, artificial food colors (AFC) (yup even in those veggies that go with that dip!)
Are these food dyes driving our kids up the wall?
The simple answer is that there is no simple answer. The research findings give us conflicting results. What’s more, even regulatory position varies across the globe.
What are Artificial Food Colors (AFCs)?
Natural food colors are extracted from a vegetable, animal, mineral, or microbiological sources. Do you know we get:
- red-purple (betanin) from beetroots
- red (lycopene) from tomatoes
- yellow (curcumin) from turmeric
- green from the chlorophyll in leaves
- caramel from heated sugar (obviously!), and
- brilliant blue from Spirulina (a bacteria!)?
Food dyes which do not have their origin from one of these natural sources are termed as Artificial or Synthetic Food Colors.
Why Aren’t Natural Food Colors Used More Often?
Natural food colors have certain limitations.
- They are more expensive than their artificial alternatives.
- Since they are derived from food products, they may bring in their own flavor – which affects the flavor of the resulting product.
- They tend to become washed out when subject to harsh sunlight or high temperatures, affecting the sale of the product.
- Since they are derived from a food product, they can cause an allergic reaction if the person consuming the product is allergic to the food that the dye is made up of.
Plus there is the burden of expectation.
As consumers, we have come to expect our foods to be of a certain color – apples to be shiny red, broccoli intense green, our jelly bean candy to be a vivid rainbow. We associate specific colors with festivals – red and pink heart-shaped cookies for valentines, orange with black spider topped cupcakes for Halloween and the omnipresent green and red for Christmas.
How do companies maintain such colors, consistently within budget? They use artificial food colors (or those which are not derived from plant, animal, or mineral sources)
Is Artificial Food Color Bad For Your Children’s Behavior?
This topic has been of much interest to researchers for nearly half a century.
In 1973, Dr. Feingold first proposed that much of the hyperactivity and learning problems seen in school-aged children was due to the ingestion of certain foods and food additives (including AFCs). He went on to devise a diet (popularly known as the K-P diet) that was free of all AFCs and a few other foods.
In 1975, he published a best selling book for parents Why Your Child is Hyperactive.
Dr. Feingold’s research methodology was severely criticized. It lacked necessary stuff like control groups, double-blind studies. Most importantly it only relied on parents’ observations which may not be objective.
However, his diet became quite a rage amongst parents in the following decades.
Given the popularity of his diet and promise it offered, many researchers tested his diet (and/or extensions of his diet or other elimination diets) using more scientific methods.
By 1983 the number of studies evaluating the K-P diet that had been published was so large that it was possible to do a meta-analysis of these studies. (Remember what a meta-analysis is? In the world of scientific research and study, it is a study of a number of studies. In other words, it is a super-study.)
This 1983 meta-analysis concluded that the K-P diet did not work as a treatment for hyperactivity.1
The K-P diet excludes more than just AFCs from your diet. In 2004, another meta-analysis was done by Schab and Trinh2. Their analysis focused on the effects of just AFCs on hyperactivity. Schab and Trinh concluded that AFCs promote hyperactivity in children and more so in some children who are sensitive to AFCs. However, they said their study was not sufficient to make any recommendations for changes in diet.
Around the same time as Schab and Trinh, a study3 was commissioned by the UK government. This was the largest controlled trial to date of the effects of artificial food additives on children’s behavior. It involved 277 3-year olds who were divided into subgroups as being hyperactive, children with allergies, children who are both hyperactive and with allergies and children who are neither.
Researchers tested a number of artificial food colorings along with one common preservative – sodium benzoate. Both parents rating of behavior, as well as clinical assessments using computer games designed to test attention and impulsivity, were used.
Results clearly showed detrimental effects of the food additives across all 4 subgroups (i.e. irrespective of the fact whether the child had allergies or was hyperactive or not) according to parental ratings though not as per clinical assessments.
Publication of this study led to renewed calls for a UK ban on these kinds of artificial additives.
A team of researchers at the University of Southhampton, UK4 sought to confirm the findings of the above study. This team included 3-year old and 8/9-year old children in their study. They concluded that artificial colors or preservative (or both) in the diet result in increased hyperactivity in both the age groups.
These were two very significant studies for the UK government.
Meanwhile, in the US, the Center for Science in the Public Interest (they call themselves America’s Food Watchdog) petitioned the FDA to ban the use of food dyes. They argued that food color contributed to behavior problems. There were no health benefits to these dyes, they contended there was no justification for incurring the associated health risks.5
Subsequently, in 2011, the FDA reviewed the evidence of AFCs and ADHD and have a public hearing. This review concluded that the evidence available was not sufficient to suggest that artificial food dyes were the cause of behavior problems.6
Meanwhile, another meta-analysis conducted in 20117 reached a different conclusion. They concluded that a subgroup of children with ADHD was sensitive to synthetic color additives, flavors, or salicylates and could benefit from a restricted diet.
Finally, in 2015 Nigg, Lewis et al did yet another meta-analysis8 (yes, they did justify the need to do it again!). They concluded that restricting AFCs in the diet does have a beneficial effect. However, they only recommended further study of the subject and did not make any dietary recommendations.
Regulation of AFCs
Today the FDA permits the use of 7 colors
Erythrosine ( a pink shade)
Another 2 colors are allowed only for specific purposes – Citrus Red 2 for orange peels and Orange B for sausage and hot dog casings.
The Southampton Study financed by the Food Standards Agency of the United Kingdom identified 6 food colors associated with possible hyperactivity in young children.
- Sunset Yellow FCF (E110)
- quinoline yellow (E104)
- carmoisine (E122)
- Allura Red (E129)
- Tartrazine (E102)
- ponceau 4R (E124)
In UK, the FSA has encouraged a voluntary ban on the use of these colors. In fact, it publishes lists of retailers, manufacturers, and restaurants that have product lines that are free from these colors.
In the European Union, it is mandatory to carry a warning on any food or drink that contains any of these colors. The label must clearly state “May have an adverse effect on activity and attention in children.”
In the US, it is interesting that amongst the colors permitted to be used are three colors (Sunset Yellow, Allura Red, and Tartrazine) which the Southhampton study clearly identified as among those being associated with hyperactivity.
What is more is that there is no warning required because the FDA clearly believes that these color additives are safe for consumers, when used in accordance with FDA regulations. Check out its FAQ page for consumers here – how hard they are trying to stress that these are safe!
To Food Dye or Not to Food Dye?
That is the million dollar question. Everything from research findings to regulatory position across geographies is inconsistent and hence confusing. Clearly, there is clearly no easy answer.
I would say it is better to err on the side of caution. There are no health benefits of artificial colors. [In this blog post, we haven’t even begun to look at the health hazards other than those associated with ADHD]. Hence, it is best to reduce these to the extent you can.
Here are some everyday practical tips to follow
- Read the labels before you buy stuff – You will get an idea of how much of the permitted color additives are contained. Go for those which have less.
- Buy natural, organic stuff – Avoid processed foods, packaged vegetables or fruit. The more the packaging the greater the chance that it has dyes in it.
- Fill up the house with non-AFC alternatives – like fresh fruit juice or homemade lemonade instead of colas and soda or even with lots of fresh water bottles.
And finally, let your kid have his cheat days once in a while – when out with friends, at a birthday party. Totally denying your child something often has reverse consequences.
What do you feel about these synthetic food colors? Should the FDA be doing more to limit their use?
Got a question? Ask away. I will try my best to answer.
1 Kavale KA, Forness SR. Hyperactivity and diet treatment: a meta-analysis of the Feingold hypothesis. J Learn Disabil. 1983;16:324-330
2 Schab DW, Trinh NH. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr. 2004;25:423-434
3 Bateman B, Warner JO, Hutchinson E, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child. 2004;89:506-511 [pubmed]
7 Dietary sensitivities and ADHD symptoms: thirty-five years of research. Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE Clin Pediatr (Phila). 2011 Apr; 50(4):279-93.[Researchgate]
8 Nigg, Joel T. et al. “Meta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives.” Journal of the American Academy of Child and Adolescent Psychiatry 51.1 (2012): 86–97.e8. PMC. Web. 24 Apr. 2018. [PMC free article]