salicylates and Attention-Deficit-Disorder-with-Hyperactivity

This article is intended to provide a comprehensive overview of the role of dietary methods for treatment of children with attention-deficit/hyperactivity disorder (ADHD) when pharmacotherapy has proven unsatisfactory or unacceptable. Results of recent research and controlled studies, based on a PubMed search, are emphasized and compared with earlier reports. The recent increase of interest in this form of therapy for ADHD, and especially in the use of omega supplements, significance of iron deficiency, and the avoidance of the "Western pattern" diet, make the discussion timely. Diets to reduce symptoms associated with ADHD include sugar-restricted, additive/preservative-free, oligoantigenic/elimination, and fatty acid supplements. Omega-3 supplement is the latest dietary treatment with positive reports of efficacy, and interest in the additive-free diet of the 1970s is occasionally revived. A provocative report draws attention to the ADHD-associated "Western-style" diet, high in fat and refined sugars, and the ADHD-free "healthy" diet, containing fiber, folate, and omega-3 fatty acids. The literature on diets and ADHD, listed by PubMed, is reviewed with emphasis on recent controlled studies. Recommendations for the use of diets are based on current opinion of published reports and our practice experience. Indications for dietary therapy include medication failure, parental or patient preference, iron deficiency, and, when appropriate, change from an ADHD-linked Western diet to an ADHD-free healthy diet. Foods associated with ADHD to be avoided and those not linked with ADHD and preferred are listed. In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients. Iron and zinc are supplemented in patients with known deficiencies; they may also enhance the effectiveness of stimulant therapy. In patients failing to respond or with parents opposed to medication, omega-3 supplements may warrant a trial. A greater attention to the education of parents and children in a healthy dietary pattern, omitting items shown to predispose to ADHD, is perhaps the most promising and practical complementary or alternative treatment of ADHD.

Topics: Anemia, Iron-Deficiency; Attention Deficit Disorder with Hyperactivity; Child; Combined Modality Therapy; Complementary Therapies; Diet, High-Fat; Dietary Fiber; Dietary Sucrose; Dietary Supplements; Fatty Acids, Omega-3; Feeding Behavior; Flavoring Agents; Folic Acid; Food Coloring Agents; Food Hypersensitivity; Humans; Nutritional Requirements; Salicylates; Treatment Outcome; Zinc

Children were included in this challenge study if according to parental report (1) the child's hyperactive behavior had been noticeably improved for at least 3 mo. as a result of adherence to the Feingold diet and (2) dietary violations such as those used in the study were reported to have a noticeable negative effect. Evaluations of 14 objective measures in a double-blind, cross-over design yielded no significant differences between diet infraction and noninfraction conditions. In addition to questioning the stated efficacy of the diet, findings suggest that one should not depend solely on parental report when evaluating a dietary effect and should also weight potential negative effect of adherence to the diet.

Topics: Attention Deficit Disorder with Hyperactivity; Child; Female; Food Additives; Humans; Male; Salicylates

A review of case notes from our Sydney-based paediatric allergy services, between 1 January 2003 and 31 December 2011, identified 74 children who had been prescribed diets that eliminated foods containing natural salicylates before attending our clinics. The most common indications for starting the diets were eczema (34/74) and behavioural disturbances (17/74) including attention deficit hyperactivity disorder (ADHD). We could find no peer-reviewed evidence to support the efficacy of salicylate elimination diets in managing these diseases. We do not prescribe these diets, and in a survey of European and North American food allergy experts, only 1/23 respondents used a similar diet for eczema, with none of the respondents using salicylate elimination to treat ADHD. A high proportion (31/66) of children suffered adverse outcomes, including nutritional deficiencies and food aversion, with four children developing eating disorders. We could find no published evidence to support the safety of these diets in children. While this uncontrolled study does not prove a causal relationship between salicylate elimination diets and harm, the frequency of adverse events appears high, and in the absence of evidence of safety or efficacy, we cannot recommend the use of these diets in children.

Topics: Attention Deficit Disorder with Hyperactivity; Child; Child Behavior Disorders; Diet; Eczema; Humans; Salicylates; Treatment Outcome

Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Combined Modality Therapy; Female; Food Additives; Humans; Learning Disabilities; Male; Salicylates

A food additive-free diet has been recommended as a component of the treatment of developmental/behavioral disorders in children. This diet was initially developed by Dr. Benjamin Feingold for the treatment of aspirin sensitivity in adults, and then extended by him to the management, particularly, of hyperactivity and learning disability in children. The rationale for this diet and the methods employed in investigating its use are described. The claimed therapeutic effects of this diet have been investigated in a number of well-designed studies reviewed here. These studies generally refute a causal association between food additives and behavioral disturbance in children. Suggestions are made regarding the approach towards food additive-free diet therapy in the management of developmental/behavioral disorders.

Topics: Acting Out; Attention Deficit Disorder with Hyperactivity; Child; Child Behavior Disorders; Feeding Behavior; Food Additives; Food Coloring Agents; Humans; Learning Disabilities; Research; Salicylates

Topics: Attention Deficit Disorder with Hyperactivity; Child; Food Hypersensitivity; Food Preservatives; Humans; Salicylates; Sucrose

Topics: Attention Deficit Disorder with Hyperactivity; Butylated Hydroxytoluene; Child; Epidemiologic Methods; Erythrosine; Food Coloring Agents; Food Preservatives; Humans; National Institutes of Health (U.S.); Research; Salicylates; United States

Topics: Adolescent; Adult; Attention Deficit Disorder with Hyperactivity; Child; Child, Preschool; Female; Food Additives; Humans; Hyperkinesis; Learning Disabilities; Male; Salicylates; United States; United States Food and Drug Administration

Topics: Attention Deficit Disorder with Hyperactivity; Child; Food Coloring Agents; Food Preservatives; Humans; National Institutes of Health (U.S.); Research Design; Salicylates; United States

Topics: Attention Deficit Disorder with Hyperactivity; Child; Food Additives; Humans; Salicylates

Topics: Ascorbic Acid; Attention Deficit Disorder with Hyperactivity; Child; Diet; Humans; Respiratory Tract Infections; Salicylates