The Feingold diet is a food elimination program developed by Ben F. Feingold, MD to treat hyperactivity. It eliminates a number of artificial colors and artificial flavors, aspartame, three petroleum-based preservatives, and (at least initially) certain salicylates. There has been much debate about the efficacy of this program. Some mainstream medical practitioners deny that it is of any value, while other medical practitioners, as well as many people living with ADHD and parents of children with ADHD, claim that it is effective in the management of ADHD as well as a number of other behavioral, physical and neurological conditions including salicylate sensitivity. The debate has continued for more than 30 years, involving not only consumers and physicians, but scientists, politicians, and the pharmaceutical and food industries.
The Feingold Program
The Feingold Program eliminates three groups of synthetic food additives and one class of synthetic sweeteners:
- Synthetic colors (FD&C and D&C colors)
- Synthetic flavors (several thousand different chemicals)
- Synthetic preservatives (BHA, BHT, and TBHQ)
- Artificial sweeteners (Aspartame, Neotame, and Alitame)
The above-listed colorings and preservatives are made from petroleum. The word "synthetic" is used instead of "artificial" because not all artificial colorings are eliminated by the program. For example, titanium dioxide and coloring made from iron oxides are acceptable, posing no problem for most people. Only FD&C and D&C colorings are eliminated. There are thousands of synthetic flavorings, from a variety of sources, most of which are not specified in ingredient lists. Due to the "de minimis" principle, safety and neurotoxicity studies are not required for these chemicals. Aspartame and its related chemicals have recently been eliminated from the Feingold Program because of evidence that they may be harmful to the nervous system.
During the initial weeks of the Program, certain foods containing salicylates are removed and may later be reintroduced and tested for tolerance, one at a time. Most of the problematic salicylate-rich foods are common temperate-zone fruits, as well as a few vegetables, spices, and one tree nut. During this early period, foods like pears, cashews and bananas are used instead of foods like apples, almonds and grapes.
Contrary to popular misconception, soft drinks, chocolate and sugar have never been eliminated on the Feingold Program, although moderation is encouraged when consuming such items. Families can often continue to eat the types of food to which they are accustomed, including desserts. It is a matter of picking brands free of the unwanted additives. Most of the acceptable foods are easily available at supermarkets.
History
Dr. Feingold was a pediatrician and allergist, and was considered a pioneer in the fields of allergy and immunology. He served as Chief of Pediatrics, Cedars of Lebanon Hospital, Los Angeles, CA; later he established a number of allergy centers for Kaiser Permanente of Northern California, and served as Chief of Allergy at the Kaiser Permanente Medical Center in San Francisco.
First recorded case
Since the 1940s, researchers world-wide had discussed cross-reactions of aspirin (a common salicylate) and Tartrazine (FD&C Yellow #5). Dr. Stephen Lockey at the Mayo Clinic and later Dr. Feingold at Kaiser, found that eliminating both salicylates and synthetic food additives from patients' diets eliminated not only allergic-type reactions, but also behavioral changes in some of their patients.
The first clear case for Dr. Feingold was an adult patient referred to him for treatment of her severe hives in 1965. Typical treatments had not worked for her. Dr. Feingold placed her on a low-salicylate diet with no synthetic coloring or flavoring. Soon her hives were gone, and the patient was happy.
Ten days later, however, her psychiatrist called Dr. Feingold to ask, "What did you do to my patient?" She had been receiving treatment for a personality disorder for years, but in less than two weeks on the diet, her behavior had noticeably improved. Both doctors were puzzled. Dr. Feingold asked his staff to watch for other patients who did not respond to standard treatments. He suggested the diet regimen to them, and sometimes it worked. As more reports of behavioral improvement came in, he began to use the diet for people - especially children - with behavioral problems as well as allergy, and eventually found the diet often worked for children with behavioral problems even without allergy symptoms.
He named the diet the K-P Diet for Kaiser-Permanente (and he liked the pun of "K-P" as Kitchen Police). Later, as this diet became more well-known for helping hyperactive and learning disabled children, the media dubbed it the "Feingold diet."
Early use of the K-P / Feingold diet
In his early work with children (and adults) who suffered from what was then called "minimal brain dysfunction" (MBD), Hyperkinesis, or Hyperkinesis-Learning Disability (H-LD), Dr. Feingold found that response was variable, depending on the age of the child and the presence or absence of a history suggestive of neurological damage. In 1976, he reported that in five separate programs, totalling 360 children managed with the K-P diet, 30% to 50% of them showed favorable responses and could be removed from medication.
In 1977, Dr. Arnold Brenner published a study he had begun with the intention of disproving Dr. Feingold's claims. Of 32 children who had been under various medication treatments for years with poor success, and who were now put on the K-P diet, 11 (about 33%) were "markedly improved." Surprised, Dr. Brenner wrote that "the startling changes in patients who had been followed for years with other forms of therapy suggest strongly that this improvement was genuine." Although 33% does not appear to be a high rate of success, these were children who had already tried everything else - they were what is called "medication failures."
In the beginning, Dr. Feingold did not eliminate the preservatives BHA or BHT. By 1979, he reported having treated over 600 children with the diet, and that his success rate had risen to 60-70% once he had begun eliminating the preservatives as well. At that time TBHQ and aspartame, which are eliminated today, did not yet exist.
Initial controversy
In late 1972, Dr. Feingold was invited to present his findings at the annual conference of the American Medical Association in June 1973, which he did. Before that time, he had been treating children and adults with allergy symptoms as well as behavioral symptoms, but by 1972 he had arranged for a group of 25 children with a primary complaint of behavioral problems to be managed by the K-P diet. Dramatic improvement in behavior was repeated in this group as well. Dr. Feingold was again invited to participate in the June 1974 AMA conference, where he reported on 169 children in five separate samples that had experienced a success rate of 30 to 50 percent, depending on the age of the child and the sample. (Note, this was also before the diet eliminated preservatives.)
This led to the first controlled double-blind crossover study, at the University of Pittsburgh, which was funded by the National Institute of Education. It was directed by Dr. C. Keith Connors, with Dr. Feingold as consultant, and the favorable results were published in the August 1976 issue of Pediatrics , the official publication of the American Academy of Pediatrics.
Meanwhile, in 1974, the food industry became involved via its industry-supported organization called the "Nutrition Foundation of New York." This is an organization whose members included Dow Chemical, Coca Cola, and several companies who make, use, and distribute the food additives removed from the K-P diet. In December, 1974, the Nutrition Foundation issued a "proposal for the study of dietary relationship to hyperkenesis" which promised, in its final paragraph, that "no publicity will be given to the findings until the committee has approved the report for release." A two-week long conference, by invitation only, was arranged in January, 1975, in Glen Cove, Long Island. There, they created what they called the National Advisory Committee, which was not government-related in any way. One week later - and certainly long before any of the planned studies had been done, let alone published - this committee widely published its preliminary report concluding that "no controlled studies have demonstrated that hyperkinesis is related to the ingestion of food additives."
This conclusion is still quoted today, more than 30 years later. Adding to the confusion is the assumption that the National Advisory Committee is a governmental agency rather than an arm of industry. Over the next few years, the Nutrition Foundation funded and designed several small studies carefully crafted to show that the diet produced little effect. Although the studies were conducted at universities, which would normally have lent them credibility, Congressman Ben Rosenthal of New York complained, "Despite the compelling need for experts who can examine the food industry with a critical eye, nutrition and food science communities have fallen under the $200 billion industry's influence. At our more prominent universities, eminent nutritionists have traded their independence for food companies' favors."
A review of the early studies published by M.A. Lipton in 1983 concluded that possibly 2% of children respond adversely to food additives, and that "even the 2% are questionabl
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