Restricted Elimination Diet Could Help ADHD Symptoms in Children
Diet has been linked to attention deficit/hyperactivity disorder (ADHD) from the time doctors and parents first thought that sugar was causing kids to seemingly “bounce off the walls.” Because certain foods may be triggers for symptoms, doctors in the Netherlands have tested a restricted elimination diet, or RED, and found that eliminating certain foods may in fact help children with ADHD.
Children with ADHD Can Be Helped By Identifying Individual Food Triggers
Attention Deficit/Hyperactivity Disorder affects about 3 to 7% of school-aged children in the United States, according to the American Psychiatric Association. The exact cause is unknown, but experts suspect the condition has both genetic and environmental factors. Symptoms include inattention, hyperactivity and impulsive behavior. Some children also exhibit “oppositional defiant disorder” (ODD) in which they express hostility and rebelliousness toward authority figures.
Lidy Pelsser PhD of the ADHD Research Center in Eindhoven tested a diet restricted to certain foods including rice, white meat, vegetables and fruits on children between the ages of 4 and 8 for five weeks. Among the foods eliminated from the diet were wheat, tomatoes, oranges, eggs and dairy products. The diet was not “eat this and not that” per se; each child had a meal plan individualized for foods that may cause them problems.
A control group received instructions on how to eat a “healthy diet.”
Because the diet is extremely difficult, not every child was able to stick with the plan. Forty-one of the 50 children assigned to the RED diet finished the first phase. However, 78% of those who did complete the study responded by having fewer symptoms of both ADHD and ODD. When the offending foods were reintroduced, symptoms returned in those who had originally responded favorably.
In a second phase of the study, the researchers tested the theory that eating certain foods would induce high levels of immunoglobulin G (IgG) antibodies linked to symptoms of ADHD. After challenging the children with high-IgG (foods most commonly associated with food allergies, such as eggs and milk) and low-IgG foods, the researchers found no association between IgG blood levels and behavioral effects. They conclude that the use of blood tests to identify trigger foods is not advisable.
If parents want to try the RED diet for their ADHD child, physician oversight and parental involvement is crucial, says Jaswinder Ghuman MD, an associate professor of psychiatry and pediatrics at the University of Arizona who wrote a commentary accompanying the study. Planning meals and ensuring compliance can be time consuming and expensive. There is also a risk of malnutrition.
The diet tends to work better for younger children, ages 3 to 7, but if there is no improvement in two to five weeks, it should be discontinued. If the diet works to reduce symptoms, Dr. Pelsser says, the child won't need medication. "The children responding favorably to the RED do not meet the criteria for ADHD or ODD anymore. Consequently there is no need for medication."
For parents who aren’t ready to tackle the restrictive elimination diet yet, there are some simple dietary changes that can be made to identify trigger foods for ADHD symptoms. The first step would be to keep a detailed food diary, tracking what foods the child consumes and monitoring for a pattern of behavioral difficulties. Eliminating foods one at a time may help pinpoint those that are triggers for hyperactivity.
While there really is no conclusive evidence to directly link sugar and hyperactivity, excess junk food does replace the more nutritious components of a child’s diet which could be responsible for behavioral problems. Cut out sweets and sodas except on special occasions.
Eliminating food additives and preservatives may not help every ADHD child, but some research finds that turning away from foods with artificial food colorings, flavors and sweeteners may help about 5% of children. Dr. Benjamin Feingold first introduced the concept of an additive-free diet that avoids such ingredients as Yellow No 5, Red 40, and Blue 1. For the most part, these colorings are added to make foods more “kid-friendly”, but have no real nutritional value.
Recently, children who have behavioral problems due to iron deficiency have been helped by the ADHD medication Ritalin. If your child is at risk for excessive lead exposure, have him or her tested by a pediatrician. If he or she is deficient, iron supplementation and emphasizing iron-rich foods such as lean red meat, enriched breakfast cereals and pastas, and cooked beans and lentils may help.
Pelsser LM, et al "Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial" Lancet2011; 377: 494-503.
Ghuman JK "Restricted elimination diet for ADHD: the INCA study" Lancet 2011; 377: 446-448.