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Neurotherapeutics

, Volume 9, Issue 3, pp 599–609 | Cite as

Artificial Food Colors and Attention-Deficit/Hyperactivity Symptoms: Conclusions to Dye for

  • L. Eugene ArnoldEmail author
  • Nicholas Lofthouse
  • Elizabeth Hurt
Article

Abstract

The effect of artificial food colors (AFCs) on child behavior has been studied for more than 35 years, with accumulating evidence from imperfect studies. This article summarizes the history of this controversial topic and testimony to the 2011 Food and Drug Administration Food Advisory Committee convened to evaluate the current status of evidence regarding attention-deficit/hyperactivity disorder (ADHD). Features of ADHD relevant to understanding the AFC literature are explained: ADHD is a quantitative diagnosis, like hypertension, and some individuals near the threshold may be pushed over it by a small symptom increment. The chronicity and pervasiveness make caregiver ratings the most valid measure, albeit subjective. Flaws in many studies include nonstandardized diagnosis, questionable sample selection, imperfect blinding, and nonstandardized outcome measures. Recent data suggest a small but significant deleterious effect of AFCs on children’s behavior that is not confined to those with diagnosable ADHD. AFCs appear to be more of a public health problem than an ADHD problem. AFCs are not a major cause of ADHD per se, but seem to affect children regardless of whether or not they have ADHD, and they may have an aggregated effect on classroom climate if most children in the class suffer a small behavioral decrement with additive or synergistic effects. Possible biological mechanisms with published evidence include the effects on nutrient levels, genetic vulnerability, and changes in electroencephalographic beta-band power. A table clarifying the Food and Drug Administration and international naming systems for AFCs, with cross-referencing, is provided.

Keywords

ADHD Food dyes Artificial food colors Hyperactivity Child behavior FDA 

Notes

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Supplementary material

13311_2012_133_MOESM1_ESM.pdf (511 kb)
ESM 1 (PDF 510 kb)

References

  1. 1.
    Burrows A. Palette of our palates: a brief history of food coloring and its regulation. Compr Rev Food Sci Food Saf 2009;8:394-408.CrossRefGoogle Scholar
  2. 2.
    Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry 2012;51:86-97.PubMedCrossRefGoogle Scholar
  3. 3.
    Feingold BF. Adverse reactions to food additives. Presented at: The American Medical Association Annual Meeting; June 24–28, 1973; Chicago, IL.Google Scholar
  4. 4.
    Feingold BF. Hyperkinesis and learning disabilities linked to artificial food flavors and colors. Am J Nurs 1975;75:797-803.PubMedGoogle Scholar
  5. 5.
    Feingold BF. Hyperkinesis and learning disabilities linked to the ingestion of artificial food colors and flavors. J Learn Disabil 1976;9:551-559.CrossRefGoogle Scholar
  6. 6.
    Feingold BF. The role of diet in behaviour. Ecol Dis 1982;1:153-165.PubMedGoogle Scholar
  7. 7.
    Feingold BF. Hyperkinesis and learning disabilities linked to the ingestion of artificial food colors and flavors. Speech to: American Academy of Pediatrics; November 8, 1977; New York, NY.Google Scholar
  8. 8.
    Feingold BF. Why Your Child is Hyperactive. New York: Random House, 1975.Google Scholar
  9. 9.
    Lipton MA, Mayo JP. Diet and hyperkinesis: an update. J Am Diet Assoc 1983;83:132-134.PubMedGoogle Scholar
  10. 10.
    Mattes JA. The Feingold diet: a current reappraisal. J Learn Disabil 1983;16:319-323.PubMedCrossRefGoogle Scholar
  11. 11.
    Feingold BF. A view from the other side. Speech to: Newspaper Food Editors and Writers Association; June 8, 1977; Milwaukee, WI.Google Scholar
  12. 12.
    Conners CK, Goyette CH, Southwick DA. Food additives and hyperkinesis: preliminary report of a double-blind crossover experiment. Psychopharmacol Bull 1976;12:10-11.PubMedGoogle Scholar
  13. 13.
    Defined diets and childhood hyperactivity. NIH Consens Statement, 1982:4:1-11.Google Scholar
  14. 14.
    Kavale KA, Forness SR. Hyperactivity and diet treatment: a meta-analysis of the Feingold hypothesis. J Learn Disabil 1983;16:324-330.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Stevens L, Kuczek T, Burgess JR, Hurt EA, Arnold LE. Dietary sensitivities and ADHD: 35 years of research. Clin Pediatr 2011;50:279-293.CrossRefGoogle Scholar
  17. 17.
    Egger J, Carter CM, Graham PJ, Gumley D, Soothill JF. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet 1985;1:540-545.PubMedCrossRefGoogle Scholar
  18. 18.
    Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125:691-698.PubMedCrossRefGoogle Scholar
  19. 19.
    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. Ach Dis Child 2004;89:506-511.CrossRefGoogle Scholar
  20. 20.
    McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007;370:1560-1567.PubMedCrossRefGoogle Scholar
  21. 21.
    Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 2000.Google Scholar
  22. 22.
    Regulation (EC) No 1333/2008 of the European Parliament and of the Council. In: Official Journal of the European Union. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:354:0016:0033:en:PDF.
  23. 23.
    Center for Science in the Public Interest, 2008. Petition to Ban the Use of Yellow 5 and Other Food Dyes, in the Interim to Require a Warning on Foods Containing These Dyes, to Correct the Information the Food and Drug Administration Gives to Consumers on the Impact of These Dyes on the Behavior of Some Children, and to Require Neurotoxicity Testing of New Food Additives and Food Colors. Available at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248005.pdf. Accessed April 6, 2012.
  24. 24.
    FDA/CFSAN Food Advisory Committee, 2011. Center for Food Safety and Applied Nutrition, March 30-31, 2011, Food Advisory Committee MeetingGoogle Scholar
  25. 25.
    Certified Color Additives and Childhood Hyperactivity, Food Advisory Charge and Questions. Available at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM247999.pdf. Accessed May 19, 2012.25. FDA/CFSAN Food Advisory Committee, 2011. 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. Available at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248549.pdf. Accessed May 19, 2012.
  26. 26.
    FDA/CFSAN Food Advisory Committee, 2011. Overview and Evaluation of Proposed Association between Artificial Food Colors and Attention Deficit Hyperactivity Disorders (ADHD) and Problem Behaviors in Children. Interim Toxicology Review Memorandum, September 1, 2010, Attachment 4. Available at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248113.pdf. Accessed May 19, 2012.
  27. 27.
    FDA Food Advisory Committee, 2011. Quick Minutes: Food Advisory Committee Meeting March 30-31, 2011. Available at: http://www.fda.gov/advisorycommittees/committeesmeetingmaterials/foodadvisorycommittee/ucm250901.htm. Accessed 19 May, 2012.
  28. 28.
    Weiss B. Synthetic food colors and neurobehavioral hazards: the view from environmental health research. Environ Health Perspect 2012;120:1-5.PubMedCrossRefGoogle Scholar
  29. 29.
    Diagnostic and statistical manual of mental disorders, 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000.Google Scholar
  30. 30.
    Arnold LE, Bozzolo H, Amato A, et al. Acetyl-l-carnitine (ALC) in attention-deficit/hyperactivity disorder (ADHD): a multi-site placebo-controlled pilot trial. J Child Adolesc Psychopharmacol 1997;17:791-801.CrossRefGoogle Scholar
  31. 31.
    World Health Organization. ICD-10: International statistical classification of diseases and related health problems, 10th revised ed. New York, NY, 2008.Google Scholar
  32. 32.
    Santosh PJ, Taylor E, Swanson J, et al. Reanalysis of the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) based on ICD-10 criteria for hyperkinetic disorder (HD). Clin Neurosci Res 2005;5:307-314.CrossRefGoogle Scholar
  33. 33.
    Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: American Psychiatric Association, 1980.Google Scholar
  34. 34.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206-1252.PubMedCrossRefGoogle Scholar
  35. 35.
    Pelham WE, Fabiano GA, Massetti GM. Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. J. Clin Child Adol Psychol 2005;34:449-476.CrossRefGoogle Scholar
  36. 36.
    Farone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 2005;57:1313-1323.CrossRefGoogle Scholar
  37. 37.
    Pearce, N. Epidemiology in a changing world: variation, causation, and ubiquitous risk factors. I J Epidemiol 2011;40:503-512.Google Scholar
  38. 38.
    Wender PH. The minimal brain dysfunction syndrome. Ann Rev Med 1975;26:45-62.PubMedCrossRefGoogle Scholar
  39. 39.
    Akinbami LJ, Xiang L, Pastor PN, Reuben CA. Attention deficit hyperactivity disorder among children aged 5-17 years in the United States, 1998-2009. NCHS Data Brief 2011;70:xx.Google Scholar
  40. 40.
    de la Burde B, Choate MS. Early asymptomatic lead exposure and development at school age. Pediatrics 1975;87:638-642.CrossRefGoogle Scholar
  41. 41.
    Fergusson DM, Horwood LJ, Lynskey MT. Early dentine lead levels and subsequent cognitive and behavioural development. J Child Psychol Psychiat 1993;34:215-227.PubMedCrossRefGoogle Scholar
  42. 42.
    Bouchard, MF, Bellinger, DC, Wright, RO, Weisskopf, MG. Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics 2010;125:1270-1277.CrossRefGoogle Scholar
  43. 43.
    Marks AR, Harley K, Bradman A, et al. Organiophosphate pesticide exposure and attention in young Mexican-American children: The CHAMACOS study. Environ Health Perspect 2010;118:1768-1774.PubMedCrossRefGoogle Scholar
  44. 44.
    Sagiv SK, Thurston SW, Bellinger DC, et al. Prenatal organochlorine exposure and behaviors associated with attention deficit hyperactivity disorder in school-aged children. Am J Epidemiol 2010;171:593-601PubMedCrossRefGoogle Scholar
  45. 45.
    Hoffman K, Webster TF, Weisskopf MG, Weinberg J, Vieira VM. Exposure to polyfluoroalkyl chemicals and attention deficit/hyperactivity disorder in US children 12-15 years of age. Environ Health Perspect 2010;118:1762-1767.PubMedCrossRefGoogle Scholar
  46. 46.
    Mayer AM. Historical changes in the mineral content of fruits and vegetables. British Food Journal 1997;99:207-211.CrossRefGoogle Scholar
  47. 47.
    Sánchez-Villegas A, Toledo E, de Irala J, Ruiz-Canela M, Pla-Vidal J, Martínez-González MA. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr 2012;15:424-432.PubMedCrossRefGoogle Scholar
  48. 48.
    Ward N, Soulsbury K, Zettel V, et al. The influence of the chemical additive tartrazine on the zinc status of hyperactive children — a double-blind placebo-controlled study. J Nutr Med 1990;1:51-58.CrossRefGoogle Scholar
  49. 49.
    Ward NI. Assessment of chemical factors in relation to child hyperactivity. J Nutr Med 1997;7:333-342.CrossRefGoogle Scholar
  50. 50.
    Arnold LE, DiSilvestro R. Zinc in attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005;15:619-627.PubMedCrossRefGoogle Scholar
  51. 51.
    Stevenson J, Sonuga-Barke, E, McCann, et al. The role of histamine degradation gene polymorphisms in moderating the effects of food additives on children’s ADHD symptoms. Am J Psychiatry 2010;167:108-1115.CrossRefGoogle Scholar
  52. 52.
    Uhlig T, Merkenschlager A, Brandmaier R, Egger J. Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder. Eur J Pediatr 1997;156:557-561.PubMedCrossRefGoogle Scholar
  53. 53.
    Dalel A, Poddar MK. Short-term erythrosine B-induced inhibition of the brain regional serotonergic activity suppresses motor activity (exploratory behavior) of young adult mammals. Pharmacol Biochem Behav 2009;92:574-582.CrossRefGoogle Scholar
  54. 54.
    Dalal A, Poddar, MK. Corticosterone effects of erythrosine in rats. Toxicology Mec Methods 2010;20:287-297.CrossRefGoogle Scholar
  55. 55.
    Aboel-Zahab H, el-Khyat Z, Sidhom G, et al. Physiological effects of some synthetic food colouring on rats. Boll Chim Farm 1997;136:615-627.PubMedGoogle Scholar
  56. 56.
    Schaubschlager WW, Zabel P, Sclaak M. Tartrazine-induced histamine release from gastric mucosa. Lancet 1987;2:800-801.PubMedCrossRefGoogle Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2012

Authors and Affiliations

  • L. Eugene Arnold
    • 1
    • 2
    Email author
  • Nicholas Lofthouse
    • 1
  • Elizabeth Hurt
    • 2
  1. 1.Department of PsychiatryThe Ohio State UniversityColumbusUSA
  2. 2.Nisonger CenterThe Ohio State UniversityColumbusUSA

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