Study: Diet May Help ADHD Kids More Than Drugs | Hacker News Reader

Study: Diet May Help ADHD Kids More Than Drugs

npr.org

64 pointssquarepeg39 comments

altering your child's diet without a doctor's supervision is inadvisable.

WTF? I'm sure this is just a CYA, but the idea that most people need the advice of a medical professional to make dietary decisions is absurd. Sure, be careful about any radical fad diets, but adding or eliminating certain foods is quite safe. People do that all the time due to price fluctuations, availability and changing tastes with no ill effects.

Yeah, I raised an eyebrow on that point as well. Funny how the doctor can state authoritatively that 64% of kids' ADHD symptoms can be traced to diet, but there are no specific details on what the relevant diet elements are. It's as if she wants to protect children by keeping parents ignorant.

Thankfully, the original study (linked to below) gives a summary.

The diet was composed for each kid individually, but the basic "few-foods" diet was rice, meat, vegetables, pears, and water. Potatoes, fruits and wheat were added for some kids, at prescribed intervals.

They were following this protocol: http://www.springerlink.com/content/k7444741381w544k/fulltex...

The researchers did a food allergy panel to determine what foods were individually eliminated according to the subjects' Immunoglobulin G (IgG) response.

Interestingly, IgG is the longer-term response compared to the more immediate Immunoglobulin E response which causes the most dramatic allergy reactions such as rapid airway constriction.

The implication is that IgG type sensitivities are under-diagnosed because the symptoms are elusive and subtle, and ADHD often happens to be one of them.

The hypothesis was that IgG tests may pinpoint foods that in some way trigger ADHD symptoms. This was found to be incorrect.

"We recorded no difference in behavioural effects after challenge with high-IgG or low-IgG foods. These results suggest that use of IgG blood tests to identify which foods are triggering ADHD is not advisable. However, IgG blood tests might be useful in other diseases." [1]

To me, this says that any deviation from restricted diet caused a relapse in ADHD symtoms. A less technical explaination about IgG testing here: http://www.tldp.com/issue/174/IgG%20Food%20Allergy.html

[1] http://marrym.web-log.nl/files/adhd-and-elimination-diet-rct...

Thank you so much for the correction.

I had somehow read only the part about the sequence of food reintroduction having no association but missed the conclusion from that, which now of course seems obvious.

That really is something different. I'm surprised that this lede was buried in the articles on this result I've read. So the mystery continues. Very curious.

That conclusion was really buried in there. Some form of confirmation bias on the part of a reader, perhaps?

This statement is necessary because the normal way people approach this problem is to declare one food the culprit, cut out that food, perceive that the problem has been cured, and declare success. There's a placebo affect, for one thing, which would be transmitted from parent to child through the parent's mood and expectations, plus there are random fluctuations in the child's behavior from day to day that will be attributed to whatever is foremost in the parent's mind, which in this case would be the alteration in diet.

People do this stuff all the time when cutting out gluten, starting to take fish oil, etc. It's really weird how someone will choose one thing at random out of all the alternatives, because that thing was pitched to them at just the right time by just the right person, and immediately start to believe it is a powerful force in their lives. There are dozens of dietary "miracle cures" for ailments ranging from depression to acne, and for each one, there are many people who swear by it. A trained doctor can be helpful in tempering expectations, reminding parents that short-term changes can't be taken seriously, and forcing a patient approach.

For instance, if peanut butter is cut from the kid's diet, and two days later the kid has a really bad day at school, many parents would jump to the conclusion that peanut butter was the only thing keeping the kid sane and start feeding it to him every day in every form they could think of. That would be a very bad thing if peanut butter was actually what was causing the problem. The doctor's job is to persuade the parents to be patient and evaluate the evidence more reasonably.

There's also the possibility that there will be parents that severely restrict their child's diet in a way that causes malnutrition too...

[edit] Not saying that it's a good reason to make that statement, but that's what that CYA aspect probably is...

This shouldn't be downvoted. It's a real risk. It's easy to over-restrict a child's diet.

I don't know about most, but a lot of people seem to be making poor dietary decisions to begin with (lots and lots of soft drinks, for example). Are they really all aware how bad it is what they are doing?

In general, sure it's safe. But once you admit a prior probability of a suspected allergic reaction to food, things change.

I think the concern is that completely eliminating a previously-regularly-consumed food due to potential hypersensitivity may risk a severe reaction when the food is re-introduced.

So they basically hypothesized ADHD is often a symptom of a food allergy, tested that premise and found some strong evidence for it. Just the kind of straightforward and useful study that somehow never seems to get funding.

Have a glance at the charts in the Lancet PDF (that erikpukinskis helpfully linked) to see the improvements versus the control group and the way that reintroducing high-sensitivity foods caused a regression:

http://marrym.web-log.nl/files/adhd-and-elimination-diet-rct...

Wow. If I was a NYTimes health reporter, I would start researching a story on how up-and-coming young families are requesting food allergy tests for their seemingly asymptomatic kids as a matter of course, because that's clearly going to be the trend now.

On page 500, under Discussion: "Blood tests assessing IgG levels against foods did not predict which foods might have a deleterious behavioural effect. ... We recorded no difference in behavioural effects after challenge with high-IgG or low-IgG foods. These results suggest that use of IgG blood tests to identify which foods are triggering ADHD is not advisable. However, IgG blood tests might be useful in other diseases."

I wonder if the IgG test they used is that reliable, though.

It might be that their results are limited by the accuracy of the ImuPro test, which would be a shame.

The article title is a bit misleading. It looks like they done a blind search on foods the children ate and by process of elimination found foods whose removal caused the reduction of ADHD like symptoms from 64% of kids in their sample. The Two signal paragraphs are:

Pelsser compares ADHD to eczema. "The skin is affected, but a lot of people get eczema because of a latex allergy or because they are eating a pineapple or strawberries." According to Pelsser, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food. Researchers determined that by starting kids on a very elaborate diet, then restricting it over a few weeks' time.

...

"In all children, we should start with diet research," she says. If a child's behavior doesn't change, then drugs may still be necessary. "But now we are giving them all drugs, and I think that's a huge mistake," she says.

My questions as someone ignorant of this area are 64% seems a confident generalization, theres no real physiological basis with respect to neurochemistry given for what causes these er mental allergies, what foods or absence thereof created the best results, is this scalable - it seems very trial&error so susceptible to misapplication and corner cutting and

I don't know how to read the following statement:

>Also, Pelsser warns, altering your child's diet without a doctor's supervision is inadvisable.

I think reaction to food can vary greatly from individual to individual, so maybe a broad generalization doesn't make sense. Or rather it makes sense to determine individual problems, rather than broad common problems.

Supposedly they could have created a similar study by just testing a single problematic food item (I don't know, wheat or whatever), and they should also have found an effect - only smaller.

It does not seem to outlandish that different things can trigger allergies, yet all allergic reactions are somewhat similar.

Full study here: http://www.adhdenvoeding.nl/cms/wp-content/uploads/2011/02/P...

That looks like a pre-press version. This version has the graphics and layout and such:

http://marrym.web-log.nl/files/adhd-and-elimination-diet-rct...

Thanks. The press release information in the NPR report submitted as the link here hardly begins to describe the study design. The link to the study suggests which issues in study design

http://norvig.com/experiment-design.html

to look at to see just how generalizable these results may be. With the sample size and length of study described here, I'd look for a lot more replication over populations from more countries studied over longer periods before reaching the same conclusion as the NPR story.

There was indeed criticism when this story broke a few months ago here in The Netherlands about the applicability and breadth of the study, meaning more work would need to be done to be able to apply this for more ADHD kids.

Here's a better summary article:

http://www.theaustralian.com.au/news/health-science/diet-cha...

Yes, that article draws attention to the important issue that the study was not "blind" and thus subject to influence by observer-awareness effects.

After some supplemental reading, the hypothesis of ADD/ADHD symptoms as a reaction to food allergies has been tested before[1], the authors had done a previous experiment published back in 2009, and it appears this experiment was designed to avoid criticisms[2] of past experiments in the field.

[1] http://www.ncbi.nlm.nih.gov/pubmed/8257176 [2] http://www.ncbi.nlm.nih.gov/pubmed/17048717

Cool!

Is the full text of [2] available anywhere? I can't seem to find it with web searches.

ADHD has a long history of claims of diets supposedly helping kids with the diagnosis. It began with the Feingold diet, went on to the Gluten-free/Casein-free diet, and now apparently exclusion diets. I am rather sceptical.

That's what makes this study interesting. Instead of a "hey, maybe this works" regimen, the foods excluded from the diet in this study are individualized according to the patients' measured allergic response.

It would be interesting to look at the data, even with this small sample, to see how different the individual diets ended up being.

Some doctors attribute ADHD, particularly the inattentive sort, to actually be a manifestation of general allergic reactions which really just makes people tired, and triggers symptoms that would classify a person as having ADHD according to the DSM (Remember, the DSM generally makes no distinctions as to what causes a condition, it only diagnoses it.) They often try to treat the allergies first, which is generally a good start.

I have both ADHD and a mild latex allergy. Ironically, the latex allergy makes eating almost any fruit shitty ( http://en.wikipedia.org/wiki/Oral_allergy_syndrome#Cross_rea... )

However, my diet has definitely kept clear of most of these foods when possible for a long time now (although I really do love avocados), and even did the fatty fish thing for a while, but symptoms haven't changed for me.

The conclusion of the original study is that it isn't an allergic reaction that is causing the symptoms, but that somehow restricted diets still work.

Their "few-foods diet" was rice, meat, vegetables, pears and water. Then, based on the needs of the individual kids, likes and dislikes (and maybe their known susceptibility to various allergens?), etc, potatoes, fruit and wheat were added.

You could try just sticking with the reduced few-foods diet for a month and see if symptoms improve.

I read this article on the ketogenic diet and epilepsy a while back:

http://www.nytimes.com/2010/11/21/magazine/21Epilepsy-t.html

If I understand correctly, nobody completely understands why these dietary changes effect such significant benefits. But the results are interesting, to say the least.

About six years ago, I was forced to change my own diet quite radically. It has been a huge adjustment, but the process has made me acutely aware of just how much certain foods can effect me physically and mentally. And, too, how the physical reaction to certain foods effects me, mentally. So my bias here is obvious -- it's good to see investigation into possible causes. Especially when the medications for ADHD are a bit scary.

As a pretty strongly affected ADHD person and as the parent of an extremely affected seven year old, my experience is that no, diet alone will not help kids more than drugs. I'm a vegetarian, eat right, work out - all the right things - and, although they help, they are no replacement for some type of methylphenidate (i.e. Ritalin or Concerta). I don't need a study to tell me that "One approach does not work for all people."

Sorry for the rant - I just think it's easy for non-ADHD people to dismiss ADHD. I see hyper kids who get called "ADD" and then people make comments/decisions about truly ADHD kids from these people ("Just don't feed them red dye #10!" (or whatever)).

Read the study, it's not dismissive at all. According to the authors, roughly 1 in 3 kids don't respond to changes in diet.

As someone who recently abandoned methylphenidate for my new BFF bupropion, I understand the sensitivity to common claims that ADD/ADHD is primarily a lack of will power or a lack of parental/teacher discipline. But I still believe in science. Part of my early treatment involved vitamin supplements for serum deficiencies in iron, B12, and D. Bringing those levels up did not alleviate the symptoms for me, but I'm open to scientific investigation of reports that such supplements were a crucial difference for other people.

My kids are more ASD rather than ADHD but dietary changes and nutritional supplements and generally treating previously unrecognized health issues did a lot for them. While I was really, really sick, I got asked at times if I was (or accused of being) ASD or ADHD. I have no reason to believe I am either, though if I am feverish, in pain, throwing up, heavily medicated and so forth, my attention span and social skills are definitely impaired. Getting healthier has done a lot for my "social skills" (which I actually have, I just sometimes am too screwed up to effectively execute) and attention span/ability to focus.

The OA's theory does not surprise me. Food is just chemicals we put into our body. Alter the chemicals, alter the effects on behavior and health. And I wouldn't be surprised that, in addition to the cases where an allergy is involved, a lot more kids today are getting too much sugar and too much caffeine, and possibly trace elements from plastics and pesticides and detergents, and none of the latter group should probably be going into our bodies at all -- and weren't for the first few million years of our existence because they didn't exist yet!

From an anecdotal perspective, I can tell you that diet has the most significant effect (either in aggravating or helping) ADD, this is great advice. With children, it's even worse since any effect that food would have would be multiplied because they're smaller (just like drugs are dosed way less)

Downmod? Care to elaborate?

Is this relevant to Hacker News because a significant portion of us are ADD and need to cut out the bahama mamas from our drink diet?

We've gotten to the point where damn near any article is argued to be relevant to Hacker News. Keep fighting the good fight... I'm with you in spirit.

Filed under "no shit Sherlock".

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