The Food and Drug Administration has over 3000 ingredients listed on its database of additives that are permitted in US food items. Out of this number, nine of them are approved synthetic food coloring. Food colors and additives have been a topic of increasing concern, especially with the rise of neurocognitive conditions among our young. It's with justification as studies continue to explore the potential risk of these added food ingredients. A great example was seen in a 6-week trial of 200 kids who went on a synthetic color-free diet. During the study, 150 of the children showed improvements in behavior while on the diet. While there can be other contributing factors, it can not be dismissed that diet may have an effect on cognitive function and behaviors. Taking a deeper look into the food coloring and additives that children are exposed to can shed light on areas of nutritional implications and ADHD.
What is ADHD?
Attention Deficit/Hyperactivity Disorder, commonly known as ADHD, is one of the most common neurobehavioral conditions. Key features are in areas of inattention, hyperactivity, and impulse behaviors. In early childhood, many of these symptoms can be normal toddler behavior. But as they develop, their behaviors can become persistent, which requires clinical evaluation. A diagnosis of ADHD can happen as early as age 5, dependent on the child's symptoms and parents' concerns. It's important for a proper assessment as ADHD can have an overlapping presentation with Autism Spectrum Disorder, PANS/PANDAS, or anxiety.
Who Does ADHD Affect?
Risk factors for developing ADHD include inborn and environmental factors. If a child's parents or older sibling has ADHD, this increases their risk factor by 50% and 30% (respectfully) of developing the condition. Maternal health during pregnancy, premature delivery, and low birth weight have also been linked to the development of ADHD in pediatrics. After birth, environmental exposures such as heavy metals and industrial plastics can affect children's brains and negatively influence a developing brain. Contracting a bacterial or viral infection, specifically one that results in encephalitis (brain inflammation), can be a risk factor for developing ADHD. Lastly, inadequate nutrition resulting in nutrient deficiencies can greatly impact an adolescent's cognitive function, adding to a compounded predisposition to ADHD.
Symptoms of ADHD
There are a variety of ADHD symptoms due to the fact that this condition encompasses difficulties with attention, overactive behaviors, and impulsivity. Here are the most commonly experienced symptoms of ADHD:
- Difficulty focusing
- Forgetful
- Easily distracted
- Appears to not listen when spoken to
- Always in constant motion
- Fidgety
- Is often running, jumping, and climbing
- Excessive talking
- Difficulty in waiting and in turn-taking
- No sense of others' personal space
- Unaware of dangerous situations like running into the street
What are Food Colors and Additives, and What Are They Made From?
The food industry uses coloring and additives to preserve items for freshness, maintain or enhance nutritional value, and improve taste, texture, plus appearance. Food coloring, AKA dyes, is synthetic pigments that are added to foods to augment the natural color, offset the loss of color due to air exposure or temperature changes, or make an item "more appealing." In the US, the FDA regulates the use of synthetic color additives. There are nine certified commercial color additives that are approved for use in the US. This includes FD&C Blue numbers 1 and 2, FD&C Green number 3, FD&C Red numbers 3 and 40, FD&C Yellow numbers 5 and 6, Orange B, and Citrus Red number 2. These artificial food colorings are made up of numerous chemicals, some of which are sourced from petroleum.
Aside from food colorings, there are additional additives used in the food industry. The function of additives is to increase shelf life, provide a smooth texture and taste, enhance the item's appealing look, and control the pH of the food. They can be categorized as sweeteners and flavor enhancers, anticaking agents, preservatives, stabilizers, gelling agents, thickeners, or emulsifiers. Some common and impactful food additives are Aspartame, Xanthum Gum, Brominated Vegetable Oil (BVO), Pectin, Titanium Dioxide, Monosodium Glutamate (MSG), Sodium Benzoate, BHA, BHT, Polysorbate 80, Carrageenan, and High Fructose Corn Syrup. While they all serve a purpose, there is literature exploring the potential link between many of these items and adverse health outcomes.
What Is The Link Between Food Colors And Additives And Attention Deficit Hyperactivity Disorder (ADHD)?
Pertaining to ADHD, colorants and chemical additives have become a mainstream medical topic for their potential implication on neurocognitive function. When it comes to food coloring, FD&C Red 40 is the most scrutinized dye. A 2020 report from the California Environmental Protection Agency expressed that intake of synthetic dyes in some children may be associated with behavioral signs, including inattentiveness, hyperactivity, and restlessness. Their findings were that Red No. 3 and 40, along with Yellow No. 5, have the most notable effects of artificial dyes when it comes to children's behaviors. Multiple studies have been geared towards the combo effect of food coloring with the additive Sodium Benzoate. In one study, they looked at a group of three-year-olds and eight/nine years old and found an increase in hyperactivity in those that had either a food coloring beverage, a beverage with Sodium Benzoate, or a combo of the two. Another study had an elimination period where three-year-olds had one week with artificial dyes and Sodium Benzoate eliminated from their diet. For the following three weeks, they were given a beverage that contained both additives. Results revealed a significant increase in hyperactivity during the additive weeks. Another interesting elimination diet investigation took 26 children who met the diagnosis of ADHD and eliminated multiple food preservatives and food colorings. Sixteen of those kids were then part of the controlled food challenge, where they ate multiple additive foods on challenge days and no additives on placebo days. On the placebo days, there was a significant improvement in their symptoms compared to food additive days.
Many of the other food additives may impact gut health and a child's microbiome, which can have an effect on brain health. Potential impacts on the microbiota have been assessed when it comes to the mentioned categories of food additives. Non-nutritive sweeteners, in particular, can lead to glucose intolerance which may affect gut microflora. Gut-brain connection has a contributory effect on ADHD, as many of our neurotransmitters are made in the gut.
Newer research has suggested that high fructose diets may contribute to brain inflammation and ADHD behaviors. While an independent correlation has not been established, evidence suggests it is a compounded contributor to impulsive behaviors.
How to Test for Food Color and Additive Reactions?
There are dozens of food colors and additive ingredients that are utilized in modern-day food options. One way to understand if your child's behavior is being affected by food coloring or additives is to test for an immune reaction against the item.
Additional Labs That Can Help Individualize Treatment for Patients Suffering from ADHD
The following labs can also be useful for individualizing treatment plans:
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Gut Health Plus Zonulin
Getting a comprehensive look at gut health is often a valid investigation in kids dealing with ADHD. If a child's diet includes processed foods with artificial dyes, preservatives, and other additives, then there is a good chance that gut dysfunction or inflammation is occurring. A tall-tale sign would be gut dysfunction symptoms such as bloating, constipation, diarrhea, or abdominal pains. Diagnostic Solutions has a comprehensive stool analysis called GI-MAP + Zonulin that looks at microbial content and indicators of inflammation. Zonulin is a specific marker for leaky gut, which is important to measure if a child is having a reaction to food additives.
Micronutrients
If your child is not primarily consuming whole-food nutrient-dense foods, they may be susceptible to nutrient deficiencies. Research shows that deficiencies in Vitamin D, Zinc, Magnesium, and Iron may contribute to ADHD symptoms. Micronutrients can be tested with a micronutrients test to assess deficiencies in multiple micronutrients with a single test.
Neurotransmitters
With emerging evidence suggesting that food additives can be detrimental to gut health, the appropriate ability to produce neurotransmitters should be investigated in kids with ADHD. A Comprehensive Neurotransmitter Profile can assess your child's ability to secrete and metabolize neurotransmitters. This information can assist you and your child's doctor with the best treatment plan options.
How to Avoid Additives and Food Colors in Nutrition & Supplements
Avoiding additives and food colors whenever possible may be beneficial to many aspects of your child's health. From gut health to blood sugar regulation to ADHD symptoms, your child's health may improve by eliminating these non-nutritive food additives. One of my first nutrition tips to patients is that they begin reading the labels of everything they are looking to purchase. The most ideal way to buy food is to shop for food around the outside perimeter of the store because this is where all the produce, meat, and essential health-focused foods will be located. If you opt to travel down the aisles, checking labels for every item you are considering buying will open your eyes to all the "extras" that are in food. Minimal ingredients on the labels are usually a good sign. But beware of words that can be deceiving. A common term on the ingredients list is "natural flavoring." This can be misleading as there is no regulation on the term "natural," and this additive can potentially be chemical flavoring. Opting for natural food coloring that fruits and vegetables provide, such as carotenoids from carrots or betaine from beets, is a great option when reading package ingredient labels. Avoiding culprits that we know have potentially harmful effects on health, such as MSG, High Fructose Corn Syrup (HFCS), Polysorbate 80, and Carrageenan, can be done by purchasing foods that use safer options or are fresh and should be eaten in a timely manner.
Summary
Dietary implications for ADHD should be considered, as evidence suggests there may be a correlation. While studies on synthetic food colors are more prevalent, there is much more that can be investigated in terms of food additives and the combination of food additives. Looking at this from a bio-individual perspective is important, as each child responds differently to their environmental exposures, including their diet. If you suspect your kid is reacting to dyes or additives in foods, working with a healthcare provider can help you get to the root cause of this issue. Finding answers and providing solutions can assist your child in their symptoms of ADHD and overall health.
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