Many parents will acknowledge that too much soda and candy makes their kids bounce off the walls on a sugar high, but what if a child's persistent hyperactivity was caused by tomatoes, eggs, gluten or some other seemingly innocuous food?
That is what a Dutch study published Thursday found: In kids with ADHD, researchers found that putting them on a restrictive diet to eliminate possible, previously unknown food allergies or sensitivities decreased hyperactivity for 64 percent of kids.
It isn't the first time researchers have tried to link ADHD to things kids eat, such as sugar, food dyes or other preservatives, but even with this recent study, pediatricians remain skeptical of a true connection between diet and hyperactivity disorders.
For Lynne Edris, 45, of Mechanicsburg, Pa., an elimination diet was one of a series of non-pharmacological interventions that she tried with her son, Bobby, in hopes of keeping him off prescription meds.
"He was about three at the time and his hyperactivity symptoms were pronounced. I tried food elimination, [which] basically takes you back to white meat chicken and few other things that they can eat," she said.
Edris spent three months trying the diet and slowly reintroducing other foods, but never saw any effect on her son's symptoms.
Now Edris is a ADHD coach working with parents of children with ADHD and said that while every once and a while a parent will have a lot of success with food elimination, for the most part, hopeful parents are disappointed when it fails, especially because of the amount of effort that has to go into keeping a young child on such a strict regimen.
Bobby, now 15, currently is being treated with ADHD medication and behavioral interventions.
Proof in the Pudding or Placebo Effect?
Similar to Edris' experience, past studies on food elimination diets for ADHD have had mixed results, with elimination of specific "trigger" foods working partially or completely for some children but failing in others.
"There is a longstanding, somewhat inconsistent story about diet and ADHD," said Jan Buitelaar, the lead author of the Dutch study and a psychiatrist at the Radboud University Nijmegen Medical Centre. "On the one hand, people think it's sugar that's the trigger, others think that food coloring could be causing ADHD. Our approach was quite different. We went [with] the idea that food may give some kind of allergic or hyperactivity reaction to the brain" because of an allergy or sensitivity the child may have.
The past studies have been limited, Buitelaar noted, and many pediatricians are skeptical of the connection between diet and ADHD.
"This has long been viewed as a kind of a controversial approach," Buitelaar said. "When we started the research, I was skeptical, but the results convinced me."
In the study, of the 41 kids who completed the elimination diet, 32 saw decreased symptoms. When certain foods thought to be "triggers" for each child were reintroduced, most of the children relapsed. The eliminated diets, which lasted five weeks, consisted predominantly of rice, white meat and some vegetables.
Among 50 kids given a "control" diet that was just a standard, healthy diet for children, significant changes were not noted. Given these findings, Buitelaar recommended that the elimination diet become part of standard of care for children with ADHD.
Though pediatricians acknowledge the limited effectiveness that some patients see with diet changes, most were against including the elimination diet, which can be a harrowing experience for parents and children, as standard of care.
"People seem to think that dietary modification is essentially 'free,' but it is difficult, socially disruptive, and presents the risk for nutritional deficiency," said Dr. Michael Daines, a pediatric allergist-immunologist at the University of Arizona.
Currently, food elimination diets are not standard of care in the U.S. or in the Netherlands, where the study was performed. They are used limitedly when parents specifically request to attempt this alternative treatment for the hyperactivity disorder.
No Jujubes for Junior
Though Daines is willing to work with families who want to try an elimination diet for treating ADHD, he feels it will only have an effect if the child is having a true food allergy or intolerance.
Edris felt similarly: Because ADHD can only be diagnosed by a cluster of symptoms (and not something biological such as a blood test), she thought that it was more likely that some children had allergy-related ADHD and it was only such children who would see a benefit from the diet.
This could be the case for some children, agreed Dr. Anne Francis, a pediatrician in the Elmwood Pediatric Group in Rochester, N.Y.
There is "no question that allergic children show symptoms very similar to ADHD in terms of behavior," she said.
Edris was drawn to try the elimination diet because she was hoping to be able to avoid giving her young son prescription medication for his ADHD. While dietary changes are seemingly a non-invasive treatment option to explore, pediatricians, even those who support the diet as a type of ADHD treatment, warn against parents trying it alone.
"Restricted diets should be undertaken with caution and under close medical supervision to assure appropriate nutrition," said Dr. Karen Warman, an associate professor of Clinical Pediatrics at Children's Hospital at Montefiore.
Given the difficulty most parents may have with getting their kids to eat such a bland, restricted diet, many pediatricians feared that even trying the diet would prove impractical for many parents.
While Dr. Michael Manos, head of the center for Pediatric Behavioral Health at Cleveland Clinic Children's Hospital, said the new study was well done, it didn't dismiss the fact that pharmaceutical and behavioral interventions are much more effective than even the benefit noted by some in the study.
"I would not go so far as to say this ... should be 'standard of care'," added Dr. Kathi Kemper, director of program in complementary and integrative medicine at Wake Forest University Baptist Medical Center.
"What is standard of care is to take the entire child, including lifestyle, family values and culture, into consideration when helping them meet the challenge of ADHD so they can have better attention, focus, self-discipline and patience to help them succeed in school and in life," she said.