Feingold diet

The Feingold diet is an elimination diet initially devised by Benjamin Feingold following research in the 1970s that appeared to link food additives with hyperactivity; by eliminating these additives and various foods the diet was supposed to alleviate the condition.

Popular in its day, the diet has since been referred to as an "outmoded treatment"; there is no good evidence that it is effective,[1][2] and it is difficult for people to follow.[3]

Technique

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The diet was originally based on the elimination of salicylate, artificial food coloring, and artificial flavors;[4] later on in the 1970s, the preservatives BHA, BHT,[5] and (somewhat later) TBHQ[6] were eliminated. Besides foods with the eliminated additives, aspirin- or additive-containing drugs and toiletries were to be avoided. Even today, parents are advised to limit their purchases of mouthwash, toothpaste, cough drops, perfume, and various other nonfood products to those published in the Feingold Association's annual Foodlist and Shopping Guide.[4] Some versions of the diet prohibit only artificial food coloring and additives.[7] According to the Royal College of Psychiatrists as of 2014 the diet prohibited a number of foods that contain salicylic acid including apples, cucumbers and tomatoes.[3]

Feingold stressed that the diet must be followed strictly and for an entire lifetime, and that whole families – not just the subject being "treated" – must observe the diet's rules.[7]

Effectiveness

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Further information: Diet and attention deficit hyperactivity disorder

Although the diet had a certain popular appeal, a 1983 meta-analysis found research on it to be of poor quality, and that overall there was no good evidence that it was effective in fulfilling its claims.[2]

In common with other elimination diets, the Feingold diet can be costly and boring, and thus difficult for people to maintain.[3]

In general, as of 2013 there is no evidence to support broad claims that food coloring causes food intolerance and ADHD-like behavior in children.[8] It is possible that certain food coloring may act as a trigger in those who are genetically predisposed, but the evidence is weak.[9][10][11]

Reception

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For decades, the Feingold Program required a significant change in family lifestyle because families were limited to a narrow selection of foods. Such foods were sometimes expensive or had to be prepared "from scratch," greatly increasing the amount of time and effort a family must put into preparing a meal.[4] As more and more foods without the potentially offending additives are being produced and available in neighborhood supermarkets, this is much less a problem.[5]

While some fruits and a few vegetables are eliminated in the first weeks of the Program, they are replaced by others. Often, some or all of these items can be returned to the diet, once the level of tolerance is determined.[12]

History

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Feingold was Chief of Pediatrics at Cedars of Lebanon Hospital in Los Angeles, CA, until 1951, when he became Chief of Allergy at Kaiser-Permanente Medical Center in San Francisco.[5][13] He continued his work with children and adults with hyperactivity and allergy until his death at the age of 82, in 1982.[5][14]

Since the 1940s, researchers worldwide had discussed cross-reactions of aspirin (a common salicylate) and tartrazine (FD&C Yellow #5).[5][15][16] Dr. Stephen Lockey[17] at the Mayo Clinic and later Feingold at Kaiser, hypothesized that eliminating both salicylates and synthetic food additives from patients' diets not only eliminated allergic-type reactions such as asthma, eczema and hives,[18] but also induced behavioral changes in some of their patients.

Feingold presented his findings at the annual conference of the American Medical Association in June 1973.[19][20] This led to a controlled double-blind crossover study published in the August 1976 issue of Pediatrics.[21]

A two-week-long conference was arranged in January 1975, in Glen Cove, Long Island. There, the Nutrition Foundation attendees created what they called the National Advisory Committee. The committee widely published its preliminary report concluding that "no controlled studies have demonstrated that hyperkinesis is related to the ingestion of food additives."[5]

References

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  1. ^ Turka LA, Caplan A (July 2011). "What is the evidence for our standards of care?". J. Clin. Invest. 121 (7): 2530. doi:10.1172/JCI59185. PMC 3127439. PMID 21737884.
  2. ^ a b Kavale KA, Forness SR (1983). "Hyperactivity and Diet Treatment: A Meta-Analysis of the Feingold Hypothesis". Journal of Learning Disabilities. 16 (6): 324–30. doi:10.1177/002221948301600604. ISSN 0022-2194. PMID 6886553. S2CID 41744679.
  3. ^ a b c "Eating well and mental health". Royal College of Psychiatrists. January 2014.
  4. ^ a b c Barrett S (March 11, 2002). "The Feingold Diet". Quackwatch. Retrieved 15 April 2021.
  5. ^ a b c d e f Smith, Matthew (2011). An alternative history of hyperactivity: Food additives and the' Feingold Diet. Rutgers University Press. ISBN 978-0813550169.
  6. ^ Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE (April 2011). "Dietary Sensitivities and ADHD Symptoms: Thirty-five Years of Research". Clinical Pediatrics. 50 (4): 279–93. doi:10.1177/0009922810384728. PMID 21127082. S2CID 17503227.
  7. ^ a b Kanarek RB (July 2011). "Artificial food dyes and attention deficit hyperactivity disorder". Nutr. Rev. 69 (7): 385–91. doi:10.1111/j.1753-4887.2011.00385.x. PMID 21729092.
  8. ^ Tomaska LD and Brooke-Taylor, S. Food Additives – General pp. 449–54 in Encyclopedia of Food Safety, Vol 2: Hazards and Diseases. Eds, Motarjemi Y et al. Academic Press, 2013. p. 452. ISBN 978-0123786135
  9. ^ Millichap JG, Yee MM (February 2012). "The diet factor in attention-deficit/hyperactivity disorder". Pediatrics. 129 (2): 330–37. doi:10.1542/peds.2011-2199. PMID 22232312. S2CID 14925322.
  10. ^ FDA. Background Document for the Food Advisory Committee: Certified Color Additives in Food and Possible Association with Attention Deficit Hyperactivity Disorder in Children: March 30–31, 2011
  11. ^ "Scientific Opinion on the re-evaluation of Sunset Yellow FCF (E 110) as a food additive". EFSA Journal. 7 (11): 1330. 2009. doi:10.2903/j.efsa.2009.1330.
  12. ^ Dumbrell, S.; Woodhill, J.M.; Mackie, L. & Leelarthaepin, B. (December 1978). "Is the Australian version of the Feingold diet safe?". The Medical Journal of Australia. 2 (12): 569–70. doi:10.5694/j.1326-5377.1978.tb131717.x. PMID 364258. S2CID 34426994.
  13. ^ Feingold, B.F. (1975). Why Your Child is Hyperactive. Random House. ISBN 0-394-73426-2.
  14. ^ Bourne, A (1982). "Obituary: Ben F. Feingold, MD" (PDF). Ecology of Disease. 1 (2/3): 199.
  15. ^ Feingold, B.F. (1973). Introduction to clinical allergy. Charles C. Thomas. p. 157. ISBN 0-398-02797-8.
  16. ^ Settipane GA, Pudupakkam RK. (1975). "Aspirin intolerance. III. Subtypes, familial occurrence, and cross-reactivity with tartarazine". Journal of Allergy and Clinical Immunology. 56 (3): 215–21. doi:10.1016/0091-6749(75)90092-5. PMID 1151014.
  17. ^ Lockey, SD (September–October 1959). "Allergic reactions due to F D and C Yellow No. 5, tartrazine, an aniline dye used as a coloring and identifying agent in various steroids". Annals of Allergy. 17: 719–21. PMID 14417794.
  18. ^ Lockey, SD Sr. (1977). "Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products". Annals of Allergy. 38 (3): 206–10. PMID 842907.
  19. ^ J.G. Beall, Jr. (October 30, 1973). "Food Additives and Hyperactivity in Children" (PDF). Congressional Record - Senate: 35401–07.
  20. ^ Feingold, Ben F. (1982). "The Role of Diet in Behaviour" (PDF). Ecology of Disease. 2 (2/3): 153–65. PMID 6090095.
  21. ^ [non-primary source needed]Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA (August 1976). "Food additives and hyperkinesis: a controlled double-blind experiment". Pediatrics. 58 (2): 154–66. PMID 781610.

Further reading

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