HHS urged to Recommend Dietary Changes as Initial Treatment

WASHINGTON — In a new review of two dozen scientific studies, the nonprofit Center for Science in the Public Interest (CSPI) contends that food dyes and certain foods can adversely affect children’s behavior. CSPI, in a 32-page report titled “Diet, ADHD, and Behavior,” charges that federal agencies, professional organizations, and the food industry ignore the growing evidence that diet affects behavior.

     The report cites 17 controlled studies that found that diet adversely affects some children’s behavior, sometimes dramatically. Most of the studies focused on artificial colors, while some also examined the effects of milk, corn, and other common foods. The percentage of children who were affected by diet and the magnitude of the effect varied widely among the studies. Six other studies did not detect any behavioral effect of diet.

     “It makes a lot more sense to try modifying a child’s diet before treating him or her with a stimulant drug,” said Dr. Marvin Boris, a pediatrician in Woodbury, New York, whose 1994 study found that diet affected the behavior of two-thirds of his subjects. "Health organizations and professionals should recognize that avoiding certain foods and additives can greatly benefit some troubled children."

     Several experts on diet and behavior joined Boris today calling on Donna Shalala, Secretary of the U.S. Department of Health and Human Services (HHS), to encourage parents and professionals to modify children’s diets before resorting to drug treatment. They asked HHS to undertake new research into the link between diet and behavior and to “consider banning synthetic dyes in foods and other products (such as cupcakes, candies, sugary breakfast cereals, vitamin pills, drugs, and toothpaste) widely consumed by children.” Those experts include Ted Kniker, University of Texas Health Science Center at San Antonio, and Joseph Bellanti, Georgetown University Medical Center.

     ADHD’s main symptoms are reduced attentiveness and concentration, excessive levels of activity, distractibility, and impulsiveness. An estimated three to five percent of school-age children have ADHD, though some surveys put the percentage as high as 17 percent. Stimulant drugs, such as Ritalin and amphetamines, are often highly effective in reducing the symptoms of ADHD, and millions of children have been treated with them. One recent study found that 18 to 20 percent of fifth-grade white boys in two cities had been diagnosed with ADHD and were being treated with stimulant drugs.

     Ritalin and other drugs sometimes cause side effects, including reduced appetite, stomachaches, and insomnia. A 1995 study conducted by the federal government’s National Toxicology Program (NTP) found that Ritalin caused liver tumors in mice.

     “The NTP study sends a strong warning that Ritalin may cause cancer—in the liver or other organs—in humans. Millions of young children take Ritalin for long periods of time, and children may be especially vulnerable. It would be prudent for HHS to discourage doctors from prescribing Ritalin, especially in the absence of an explicit warning about the cancer risk,” says Samuel Epstein, professor of occupational and environmental health at the School of Public Health, University of Illinois Medical Center in Chicago.

     Epstein and several other cancer specialists, including Emmanuel Farber, University of South Carolina School of Medicine, Marvin Legator, University of Texas Medical Branch at San Antonio, and Richard Clapp, Boston University, urged HHS to sponsor new animal and human studies on Ritalin and other stimulant drugs.

     “The Department of Health and Human Services should withdraw its printed and Internet documents that largely dismiss the effect of food ingredients on behavior. For starters, the FDA should halt distribution of a pamphlet on food additives that it co-published with an industry group, the International Food Information Council,” said Michael F. Jacobson, executive director of CSPI and lead author of the report. “It’s high time that the government — as well as doctors — provided the public with accurate information that might help many children.”

“Diet, ADHD, and Behavior” is also available for $8, and a “Parent's Guide to Diet, ADHD, and Behavior” is available for $1.50, from CSPI-Behavior, Suite 300, 1875 Connecticut Ave., Washington, DC 20005.