September 2010 Issue
Gray Area — Jury’s Still Out on Link Between Artificial Colors and Hyperactivity
By Christin L. Seher, MS, RD, LD
Vol. 12 No. 9 P. 8
Almost two years after authorities in the United Kingdom initiated a ban on six artificial food colors in response to research linking the consumption of those additives and hyperactive behavior, the debate in the United States continues as to whether there is a link and, if so, whether it is significant enough to warrant action.
Landmark Study Reopens the Conversation
With the release of a study in the September 2007 issue of The Lancet commissioned by the United Kingdom’s Food Standards Agency (FSA), the issue of food additives and hyperactivity was thrust back into the spotlight. The study, conducted by researchers at the University of Southampton, was a double-blind, placebo-controlled, crossover trial in which the effects of artificial colors and other food additives (sodium benzoate, a preservative) were investigated in 153 three-year-old and 144 eight- to 9-year-old healthy children. Based on their observation of behavior at home, at school, and during standardized testing (in the 8- to 9-year-old group), the researchers concluded that specific mixtures of food additives might increase hyperactivity in certain children.
Particularly intriguing about this research, and similar to a smaller study (in 3-year-olds only) conducted by the same researchers, the study demonstrated adverse effects of food additives in healthy, nonhyperactive children without a diagnosis of attention-deficit/hyperactivity disorder (ADHD).
A Long-Standing Debate
Managing the hyperactivity characteristic of ADHD often includes pharmacotherapy combined with behavior modification. For decades, however, the role of diet in exacerbating hyperactivity has been debated—most notably during the 1970s when the role of food additives was called into question by Benjamin Feingold, MD, who claimed that by eliminating artificial coloring, flavoring, and salicylates (found naturally in certain fruits and vegetables and in aspirin), hyperactive behaviors could be reduced by one half.
Despite fervent testimonials, research has failed to confirm Feingold’s observations or has reported only very minor improvement—and even then, only in highly sensitive individuals—following a strict elimination diet. There is little effectiveness at the population level, with no easy way to identify the few children for whom such dietary restrictions are truly beneficial. Regardless, research indicates that 52% of families with children with ADHD have tried some form of diet/supplement treatment and 49% have tried vitamin/naturopathic treatment to manage the condition, more than have utilized individual or family therapy.1
Further complicating the interpretation of this body of research are the interactions between other dietary components, hyperactivity, and sensitivities or allergies to specific food components, with some research suggesting that micronutrient deficiencies, imbalances between omega-6 and omega-3 fats, or common allergens such as wheat or dairy may also precipitate hyperactive behavior in sensitive individuals.2
Regulatory Agencies and Consumer Advocates Weigh In
According to the FDA, additives are used for a variety of purposes: to maintain or improve freshness, prevent food spoilage, improve or maintain nutritional value, and improve a food product’s taste, texture, or appearance. Specifically, color additives are used to compensate for color loss due to exposure to light, air, temperature, and moisture as well as to add color to or correct natural color in a food product, making it more appealing. Some ingredients have been added to the food supply for hundreds of years. Baking soda, sugar, salt, and vinegar have long been used as food additives/preservatives and are especially crucial to the food supply. Without them, foods would quickly spoil, increasing the risk for food-borne illnesses.
The production of all food additives in the United States must comply with Good Manufacturing Practices, and each ingredient must obtain premarket approval by the FDA unless generally recognized as safe to consume. Before a new artificial color can be used in the food supply, a manufacturer must petition the FDA, providing scientific data demonstrating that the ingredient is safe, from which the FDA determines whether the additive poses reasonable certainty of no harm.3 After approval, the FDA monitors the consumption and adverse effects to ensure continued use is safe.
In addition, manufacturers are required by law to list all ingredients in their products on the food label, allowing consumers to avoid foods with undesirable ingredients. Any synthetic colors (called certified color additives) must be listed individually on the label (eg, Yellow No. 5), while colors derived from natural sources (eg, dried beets) can be listed as “artificial colors.”
For these reasons, the FDA maintains that the nine certified food color additives currently approved for use in the United States are safe for consumption and that the link between these ingredients and hyperactive behavior is inconsistent and weak at best. It does recognize, however, that for certain children diagnosed with ADHD and food sensitivities, there may be some improvement in behavior with the restriction or elimination of specific artificial colors.3
But based on the findings from the 2004 and 2007 studies conducted in the United Kingdom, the FSA determined there was enough conclusive evidence to recommend a ban on six food dyes, calling for their removal from all food and drink products in the United Kingdom by the end of 2009. Since the ban was enacted, the food industry has responded positively, replacing banned colors with natural pigments in products. However, many of these same products are still sold in the United States containing the original artificial food colors.4
Despite claims of safety by the FDA, consumer advocate groups disagree. In 2008, the Center for Science in the Public Interest (CSPI) petitioned the FDA to remove eight artificial colors from the nation’s food supply: Yellow 5, Red 40, Blue 1, Blue 2, Green 3, Orange B, Red 3, and Yellow 6. The CSPI maintains that all artificial colors should be avoided and that eliminating them from the food supply is the most effective public health approach.4
The Bottom Line
Currently, a small but growing number of research studies indicate potential benefits for restricting or eliminating certain food additives from the diet of highly sensitive individuals, especially those already exhibiting hyperactive behaviors (eg, those diagnosed with ADHD). However, knowing which children display this sensitivity, and will thus respond effectively to dietary intervention, is extremely difficult. Even more problematic are the challenges associated with adopting a diet free of food additives, colors, and preservatives in the highly processed U.S. food supply. Before embarking on a strict elimination diet, such as those advocated by the Feingold association, parents should consult an RD to ensure their child’s nutritional needs are met.
As many products containing artificial food colors include highly sugared, processed foods, it is prudent to limit these items as part of a nutritious diet, regardless of their impact on hyperactive behaviors, while the scientific community continues to investigate a link.
RDs should continue working with parents to help introduce their children to nutritious whole foods, building a diet that centers on fruits, vegetables, whole grains, lean meats, and healthy fats, balanced with moderate amounts of physical activity. In addition, parents should be cautioned about attributing a child’s hyperactive behaviors to a specific “problem” food, as there are many environmental and social reasons driving behavior that they should also consider.
— Christin L. Seher, MS, RD, LD, is founder of Strategic Health Solutions, LLC, serving northeastern Ohio.
The Center for Science in the Public Interest maintains a “Chemical Cuisine” website where consumers can access the organization’s safety rankings for hundreds of food additives and preservatives, along with a description of where these additives are commonly found in the food supply. Visit www.cspinet.org/reports/chemcuisine.htm for more information.
1. Johnston C, Seipp C, Hommersen P, Hoza B, Fine S. Treatment choices and experiences in attention deficit and hyperactivity disorder: Relations to parents’ beliefs and attributions. Child Care Health Dev. 2005;31(6):669-677.
2. Sinn N. Nutritional and dietary influences on attention deficit hyperactivity disorder. Nutr Rev. 2008;66(10):558-568.
3. U.S. Food and Drug Administration, International Food and Information Council. Food ingredients and colors. Available at: http://www.fda.gov/Food/FoodIngredientsPackaging/ucm094211.htm. Accessed June 19, 2010.
4. Center for Science in the Public Interest. Petition to FDA on food dyes, 2008. Available at: http://cspinet.org/new/pdf/petition-food-dyes.pdf. Accessed June 19, 2010.