Notes and references for presentation

‘Fed Up with Children’s Behaviour’ by Sue Dengate

on the FED UP ROADSHOW 2010

(Numbers in brackets below refer to the scientific papers listed in the Bibliography at the end)

Additives are changing

At first, additives were only in junk food. Now they are in healthy foods and they are increasingly hidden. A 2007 survey found that most consumers eat more additives than they thin k (average 20 per day), don’t know where the additives are, and eat the same number of additives whether they are prepare food at home or eat out (1).

Children are changing

Increase in learning disabilities in Florida (2).

Research

1976: Feingold links additives to behaviour and LD (3).

1986: low additive/sugar policy reduces LD (4).

1994: sugar is not the problem (5).

2007: additives reduce ‘ability to benefit from schooling’, ‘normal, healthy children’ affected (7).

2010: EU warning labels ~ ‘an adverse effect on behaviour and attention in children’ (8).

* In the 1970s, Dr Benjamin Feingold - American paediatric allergist and head of the allergy for the Kaiser-Permanente hospital group in California – proposed that food additives were linked to behavioural problems and learning disabilities in children (3).

* A 1986 study in over 800 NY schools found that reducing additives in school lunches over 4 years reduced the number of children classified as learning disabled from over 12% to less than 5% and there was a nearly 16% increase in academic ranking compared to the rest of the nation's schools. Artificial colours, two preservatives (BHA and BHT) and sugar were removed from school breakfasts and lunches over a period of 4 years. Reductions were carried out in stages – after each stage there was a noticeable improvement. Additives but not sugar have since been linked to children’s behaviour and learning problems (4).

* A large controlled study in the US found no effects on children’s behaviour of hidden sucrose, aspartame or a control sweetener (cyclamate) although the children improved on the experimental diets which were low in additives (5).

* A British government-funded community-based, double-blind, placebo-controlled, within-subject, crossover, food challenge study examined the effect of 2 types of artificial food colour and additive preparations (representing typical consumption of sweets or candies) on 136 3 year olds and 119 8-9 year old children in the general population (not necessarily ADHD) (7).

* As a result of the findings above, from 21st July 2010, labels on foods using the Southampton Six artificial colours must carry the warning “may have an effect on behaviour and attention in children”. According to industry, most manufacturers would rather abandon the artificial colours than use the warning (8).

How many are affected?

In 2003 at the Dingle School in Cheshire, UK, a class of 6-year-olds was asked to avoid additive-free food (39 additives) at home and at school for two weeks while a twin in that class and his brother eating normally in another class were monitored by Professor Jim Stevenson from Southampton University. At the end of two weeks, 57 per cent of parents reported an improvement in their child's behaviour and 56 per cent recorded better sleep patterns and cooperation in the additive-free class. As well, the IQ of the twin on the additive free diet had improved by 25% while the additive-eating twin’s IQ had only improved by 10%. The twins were monitored by Prof J Stevenson of the psychology department at Southampton University (9). We have achieved unexpectedly similar results – nearly 60% of the parents report that their children have improved - with similar additive-free school trials in 3 NSW primary schools.

Allergy or Intolerance?

Clarke L et al, 1996 (10)

Allen et al, 1984 (11)

A low chemical elimination diet

Feingold, 1974 (3)

Gibson and Clancy, 1978 (12)

Clarke et al, 1996 (10)

RPAH Elimination Diet Handbook 2009 www.allergy.net.au (13)

Food Intolerance runs in families

Respiratory, skin, gastrointestinal, neurological and skeletal symptoms listed by Dr Feingold in 1976 (3).

More symptoms described by Loblay and Swain, 1986 (14)

Behavioural reactions such as irritability, restlessness, inattention and sleep disturbance described in Rowe and Rowe, 1994 (15)

Migraines and headaches. itchy rashes, irritable bowel symptoms

Loblay and Swain, 1986 (14)

The glutamate industry claims to have “proved” that MSG doesn’t cause headaches (or asthma, or Chinese Restaurant Syndrome or obesity) and is fact good for you. Others don’t agree (16).

Nutrition and the Myths of Fruit

* ‘It's a myth that fruit is packed full of vitamins and minerals ... The really sad thing is that we don't eat enough vegetables, such as cabbage ...’ ~ Professor Tom Sanders, Director of Nutritional Sciences, King's College London, 2008 (18)

* ‘The term “superfoods” is at best meaningless and at worst harmful’ ~ Catherine Collins, chief dietitian at St George's Hospital in London (18)

* ‘Two litres of apple juice a day … is not much different from giving them two litres of Coke from an obesity point of view.’ ~ Professor Martin Wiseman, medical and scientific adviser to the World Cancer Research Fund (WCRF), Visiting Professor, Institute of Human Nutrition, University of Southampton and Fellow of the Royal College of Physicians. According to Professor Wiseman, fresh fruit should be treated with caution: ‘One consequence of the government's Five-a-Day campaign is that children are eating fruit rather than vegetables to meet their target," he says. "If you are consuming an extra five pieces of fruit a day and changing nothing else [such as exercise], it will give you more calories because fruit is very sugary. Eating half a cabbage and some carrots won't.“ (19)

* The top 4 anti-cancer foods are all failsafe vegetables: Brussels sprouts, cabbage & family, garlic, shallots & family. (20)

Asthma

Sulphites: A 1999 WHO report concluded that 20-30% of asthmatic children are sensitive to sulphites - upgraded from the previous WHO, FDA and NAC estimate that less than 5% of asthmatics were sulphite sensitive (21). This is a conservative estimate - an Australian study showed that about 75% of Australian asthmatics were sensitive to dietary sulphites (22). Australia and NZ have by far the highest permitted sulphites for dried fruit in the world (3000 ppm compared to e.g. 2000 ppm in Europe). For more research on sulphites and asthma, see also (23, 24).

Benzoates: A girl who was diagnosed with asthma at the age of twelve months took asthma medication continously for seven years at which time she was admitted to hospital for severe asthma about once a month. When tested for additive sensitivity, she reacted to benzoates which were in her asthma medication and some frequently consumed foods and drinks. When she avoided benzoates, her asthma resolved and similar cases have since been reported (25). Benzoates were first implicated with asthma in the 1970s (23).

Salicylates: This review found that many more adult asthmatics are sensitive to salicylates than are aware of their sensitivity. While only 3% reported aspirin sensitivity, 21% of adult asthmatics reacted to oral challenges (26). More research on asthma and salicylates (22,24).

Colours: Artificial colours were first implicated with asthma in the 1970s (23). More research on colours and asthma (24)

MSG was not associated with asthma until 1987 (27, 24). The glutamate industry claims to have “proved” that MSG doesn’t cause asthma. Others don’t agree (17).

Dairy products. Children with true cows milk allergy are more likely to develop asthma by school age (28) - although children with allergic asthma are considered to be a small proportion of childhood asthmatics. For those who are sensitive to milk, it is a major problem since dairy foods are generally consumed many times every day (29).

Why don’t they make the connection?

Asthmatics were given an aspirin tablet they were told was not aspirin. Those who reacted within 30 minutes blamed the aspirin. Those who reacted more than 30 minutes later (up to hours later) didn't make the connection (30).

The restless ones

Symptoms. A 3 week double-blind placebo-controlled, repeated-measures study identified 24 children as clear reactors to tartrazine artificial food colouring (102). The authors found irritability, restlessness, inattention and sleep disturbance were associated with the ingestion of tartrazine in some children. The response and duration of effect was related to the dose (31).

The role of food chemicals (14, 32, 33).

The oppositional ones

Symptoms of Oppositional Defiant Disorder described by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

You can get rid of all of the symptoms of ODD just by changing what they eat – for example, The Shipley Project, a police trial of diet with persistent young offenders in the UK. Superintendent Peter Bennett from the West Yorkshire police conducted this trial of the Few Foods diet with chronic juvenile offenders aged 8-16. All improved, some dramatically. Those who remained on the diet did not re-offend. (34).

The quiet ones

Depression related to food intolerance (35).

The role of food chemicals (3, 14).

The autistic ones

Autism was first identified in 1943. In the 1970s, the incidence of autism was considered to be about 1 in 2,500 to 5,000 children. The Centres for Disease Control in the US now estimate that one of every 110 children will receive an ASD diagnosis by the time they are 8 - a rate 10 times higher than it was in the 1980s.

The gluten-free/casein free diet alone has been shown to be ineffective (36).

In our experience, the strict RPAH diet works well for autistics (32).

Injections of propionic acid in rats can result in result in brain and behavioral abnormalities similar to those seen in humans suffering from autism – these researchers hypothesise that autism may be a disorder involving altered PPA metabolism (37).

Slimak’s study of diet plus avoidance of VOCs: “There was a strong correlation (P<.000) between environmental exposure levels and autistic symptoms and behaviors. There appeared to be nothing inherently wrong with autistic children studied. The children in the program (universal diet and clean room) returned to normal physically, in temperament, in awareness of surroundings and others, in emotions and empathy, and in ability to learn. Based on the results of the present study, a broad spectrum of severe and chronic autistic symptoms appear to be environmentally based, apparently caused by chronic exposure to volatile organic compounds, and appear to be fully reversible in the proper environment” (38).

A smell-free holiday

Effects of VOCs

Researchers led by Dr Alexandra Farrow from the University of Bristol's Children of the 90s project found that that depression and headaches in mothers and illhealth in babies is associated with higher levels of exposure to VOCs (volatile organic compounds) used in aerosols (39).

We share the air

Canada is leading the world in the reduction of fragrances and other VOCs that can have an impact on health, behaviour and learning, including low fragrance policies in many hospitals and universities. See (40), the University of Toronto’s We Share the Air: Guidelines on the Use of Perfumes and Scented Products http://www.ehs.utoronto.ca/resources/HSGuide/Scent.htm and Slow Death by Rubber Duck: The Secret Danger of Everyday Things by Rick Smith and Bruce Lourie – don’t buy consumer products with fragrances because they usually contain phthalates. These authors who carried out the environmental chemicals version of an elimination diet, also recommend don’t eat food in plastic containers, if pregnant, don’t eat tuna, read labels and avoid anti-bacterial products with triclosan, and avoid non stick (Teflon) or stain resistant products (41).

Behaviour management

123 - Magic (DVD or book), discipline without too much talk or emotion, by Dr Thomas Phelan (42).

Reduce screen time

Children need at least 60 minutes (and up to several hours) of moderate to vigorous physical activity every day. Children should not spend more than 2 hours a day using electronic media for entertainment (e.g. computer games, TV, Internet), particularly during daylight hours, - one hour a day for children under 5, and none per day for children under 2. from The National Physical Activity Guidelines for Australians (43).

Effects of TV and computer games on the development of inattention, Swing EL and others, 2010 (44).

Benefits of TM meditation in schools (45).

More strategies in chapter 10, Fed Up

Artificial colours

Artificial colours pose risks of cancer, hyperactivity in children, and allergies, and should be banned, according to a new report by the Center for Science in the Public Interest. A top government scientist agrees, and says that food dyes present unnecessary risks to the public (46).

From July 21st 2010, a warning about artificial colours: "may have an adverse effect on activity and attention in children" must be used on foods in the EU. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:354:0016:0033:en:PDF This warning is not required in Australia where it is still up to parents to read labels.

The bread preservative

This study showed that the bread preservative, calcium propionate 282 caused irritability, restlessness, inattention and sleep disturbance in some children: Dengate and Ruben, 2003 (49).

This study showed that relatively small amounts of propionic acid (280, with the same effects as 282) affected neurobehavioral development of young rats Brusque et al, 1999 (50).

This study showed that injections of propionic acid caused symptoms of autism in rats: McFabe et al, 2007 (37).

MSG without numbers

“When MSG is added to a food, it must be included on the ingredient list as "monosodium glutamate.” [or flavour enhancer 621] Glutamate-containing food ingredients, such as hydrolyzed protein and autolyzed yeast extract, also must be listed on food labels. When glutamate is a component of natural protein foods, like tomatoes, it is not listed separately on the label.” From a glutamate industry website (51).

Natural food chemicals

Salicylates in foods using a German analyses done about 100 years ago (3).

Salicylates in Foods

An analysis of salicylates in foods Swain et al, 1984 (53).

Glutamates in Foods

A table of glutamates in foods in a FSANZ report (53)

BIBLIOGRAPHY

1. Additive survey commissioned by Birds Eye UK and carried out in Britain by ICM in November 2006. It included questionnaires from over 1000 consumers and independently researched 24 hour diet diaries by 100 consumers. Read more: “Additives Lurk in Everyday Diets, 1/5/2007, http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6233395.stm

2. Increasing enrolment in Learning Disabilities classes in Florida in ‘Environmental circumstances that can damage the developing brain’ by Richard W. Pressinger, 1997. Special Education Department, University of South Florida, Tampa, Florida. http://www.chem-tox.com/pregnancy/learning_disabilities.htm

3. Dr Ben Feingold. Why your child is hyperactive. Random House, New York, 1974 and Feingold BF. Hyperkinesis and learning disabilities linked to the ingestion of artificial food colours and flavours. J Learn Disabil.1976;9(9):19-27.

4. Schoenthaler SJ and others. The impact of a low food additive and sucrose diet on academic performance in 803 New York City public schools. International Journal of Biosocial Research, 1986 (8)2:185-195.

5. Wolraich and others, Effects of diets high in sucrose or aspartame on the behavioural and cognitive performances of children. New Eng J Med 1994;330(5):301-7.

6. A laboratory study found that combinations of food additives were potentially more toxic than additives ingested singly. Lau K and others, Synergistic interactions between commonly used food additives in a developmental neurotoxicity test http://toxsci.oxfordjournals.org/cgi/reprint/90/1/178.

7. McCann D et al, Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007;370(9598):1560-7. http://cme.medscape.com/viewarticle/562631

8. The warning ‘may have an effect on behaviour and attention in children’. According to industry, most manufacturers would rather abandon the artificial colours than use the warning. ‘Replacing Azo Dyes - Implications for EU Food Manufacturers’ http://www.basf-chemtrade.de/de/ersatz-von-azo-farben-implikationen-fur-europaische-food-produzenten.htm l

9. Nicole Martin. Food additives affect concentration: twin study. The Daily Telegraph, 1/5/2003, page A14. http://www.telegraph.co.uk/news/uknews/1428657/Twin-outshines-brother-on-additive-free-diet.html

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13. Anne Swain, Velencia Soutter, Robert Loblay, RPAH Elimination Diet Handbook with food & shopping guide. Allergy Unit, Royal Prince Alfred Hospital, 2009 and Swain AR, Soutter VL, RH L. Friendly Food. Sydney: Murdoch Books, 2002. www.allergy.net.au

14. Loblay RH, Swain AR. Food Intolerance. In: Recent Advances in Clinical Nutrition' Vol 2, 1986. Libbey, London. Eds: Wahlqvist ML and Truswell AS, pp169-177.

15. Rowe KS, Rowe KL. Synthetic food colouring and behaviour: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125:691-8. This study described behavioural reactions such as irritability, restlessness, inattention and sleep disturbance.

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18. Aida Edemariam, The Myths of Fruit, The Guardian, 23/1/08. http://www.guardian.co.uk/lifeandstyle/2008/jan/23/foodanddrink.healthandwellbeing

19 Andrew Purvis, Running on empty carbs, The Observer, Sunday 22/3/09. http://www.guardian.co.uk/lifeandstyle/2009/mar/22/obesity-children-eating-habits

20. Béliveau R Gingras D. Role of nutrition in preventing cancer. Can Fam Physician. 2007;53(11):1905-11.

21. Fifty-first meeting of the Joint FAO/WHO Expert Committee on Food Additives. Safety Evaluation of Certain Food Additives: sulfur dioxide and sulfites; evaluation of national assessments of intake of benzoates; evaluation of national assessments of intake of butylated hydroxyanisole (BHA); evaluation of national assessments of intake of butylated hydroxytoluene. Geneva: World Health Organisation, 1999.

22. Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7.

23. Freedman BJ. Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clin Allergy 1977;7(5):407-15.

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26. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. Brit Med J 2004;328(7437):434. This review found that many more adult asthmatics are sensitive to salicylates than are aware of their sensitivity. While only 3% reported aspirin sensitivity, 21% of adult asthmatics reacted to oral challenges.

27. Allen DH, Delohery J, Baker G. Monosodium L-glutamate-induced asthma. J Allergy Clin Immunol 1987;80(4):530-7.

28. Malmberg LP et al, Cow's milk allergy as a predictor of bronchial hyperresponsiveness and airway inflammation at school age. Clin Exp Allergy. 2010 Jul 4 E-pub.

29. Hill DJ, Firer MA, Shelton MJ, Hosking CS. Manifestations of milk allergy in infancy: clinical and immunologic findings. J Pediatr 1986;109(2):270-6.

30. McDonald JR, Mathison DA, Stevenson DD. Aspirin intolerance in asthma. Detection by oral challenge. J Allergy Clin Immunol 1972;50(4):198-207.

31. 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(5 Pt 1):691-8.

32. Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2(8445):41-2.

33. Breakey J et al. A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children. Aust J Nutr Diet. 1991;48:89-94.

34. Bennett CPW, McEwen LM, Rose E. The Shipley Project. J Nutr Envir Med 1998;8(8):77-83.

35. Parker G, Watkins T. Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance. Aust N Z J Psychiatry 2002;36(2):263-5.

36. Hyman SL and others, Dietary Treatment of Young Children with Autism: Behavioral Effects of the Gluten Free and Casein Free Diet. Presented at the International Meeting for Autism Research, Philadelphia, May 22, 2010. http://www.urmc.rochester.edu/news/story/index.cfm?id=2860

37. McFabe DF et al. Neurobiological effects of intraventricular propionic acid in rats: possible role of short chain fatty acids on the pathogenesis and characteristics of autism spectrum disorders. Behav Brain Res. 2007 Jan 10;176(1):149-69.

38. Slimak, K. 2003. Reduction of autistic traits following dietary intervention and elimination of exposure to environmental substances. In Proceedings of 2003 International Symposium on Indoor Air Quality and Health Hazards, National Institute of Environmental Health Science, USA, and Architectural Institute of Japan, January 8-11, 2003, Tokyo, Japan, vol 2, pp 206-216. http://www.immuneweb.org/articles/slimak.html

39. Farrow A and others, Symptoms of mothers and infants related to total volatile organic compounds in household products, Arch Environ Health. 2003 Oct;58(10):633-41.

40. University of Toronto Environmental Health and Safety: Guidelines for the use of perfumes and scented products http://www.ehs.utoronto.ca/resources/HSGuide/Scent.htm

41. Rick Smith & Bruce Lourie, Slow Death by Rubber Duck: how the toxic chemistry of everyday life affects our health UQP 2009 http://www.youtube.com/watch?v=cZoogKsFU8E

42. 1-2-3: Magic (DVD and book), discipline without too much talk or emotion, by Dr Thomas Phelan, www.parentmagic.com. In Australia the book & DVD are available from www.parentshop.com.au.

43. The National Physical Activity Guidelines for Australians www.health.gov.au

44. Swing EL and others. Television and Video Game Exposure and the Development of Attention Problems. Pediatrics, 2010 http://www.sciencedaily.com/releases/2010/07/100706161759.htm

45. Transcendental Meditation: Hocus-pocus or healthy practice? http://www.abc.net.au/catalyst/stories/2954785.htm

46. Kobylewski S, Jacobson MF. Food Dyes: A Rainbow of Risks. Centre for Science in the Public Interest. 2010 http://www.cspinet.org/new/201006291.html

47. Jacobson MF, Schardt MS. Diet, ADHD and behaviour: a quarter-century review. Washington DC: Centre for Science in the Public Interest, 1999. The authors reviewed 23 controlled studies on the effects of food colours and other dietary constituents on children's behaviour. The 34 page report with a 2009 update are available at http://www.cspinet.org/new/pdf/dyesreschbk.pdf

48. From July 21st 2010, a warning about artificial colours: "may have an adverse effect on activity and attention in children" must be used on foods in the EU. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:354:0016:0033:en:PDF This warning is not required in Australia where it is still up to parents to read labels.

49. Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health 2002;38(4):373-6.

50. Brusque AM, Mello CF, Buchanan DN et al. Effect of chemically induced propionic acidemia on neurobehavioral development of rats. Pharmacol. Biochem. Behav. 1999;64(3):529-34.

51. MSG without numbers, from a glutamate industry website: http://internal.ific.org/publications/brochures/msgbroch.cfm

52. Swain AR, Dutton SP, Truswell AS. Salicylates in foods. J Am Diet Assoc 1985;85(8):950-60.

53. Glutamates in Foods from Nicholas and Jones (1991) and Yoshida (1998) in FSANZ report http://www.foodstandards.gov.au/_srcfiles/MSG%20Technical%20Report.pdf