Does the Feingold Diet Work for ADHD?

The Feingold Diet was created by Dr. Benjamin Feingold, a Californian pediatrician and allergist.

He originally designed the eating pattern for his young patients with allergy symptoms, such as hives, asthma, and eczema. After noticing behavioral improvements, he began using the diet to help children with ADHD, autism, dyslexia, and other behavioral issues.

The diet eliminates artificial colors, sweeteners, substances known as salicylates, and three preservatives — butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and tert-Butrylhdryquinone (TBHQ).

Feingold believed that avoiding these ingredients, as well as a few foods, improved focus and behavior.

Salicylates occur naturally in foods and are found in aspirin. Feingold believed that people allergic or sensitive to aspirin may also be intolerant to salicylate-containing foods.

While salicylate sensitivity does exist, no evidence suggests a firm connection between this sensitivity and behavioral issues.

Despite anecdotal reports from some proponents, there’s little evidence that this diet improves behavioral problems in children with ADHD or other conditions. Furthermore, no research connects any ingredients or foods to worsened behavior.

Summary

The Feingold Diet aims to improve behavioral problems in children by eliminating food preservatives, colors, sweeteners, and salicylate-containing foods.

To follow the diet, your child must only eat from a strict list of approved foods, completely avoiding others. After a set period, you can slowly reintroduce certain foods to see if your child’s symptoms return.

There are two main phases of the diet:

1. Remove potential triggers. Avoid all foods that may lead to behavioral issues, including artificial flavors, colors, preservatives, sweeteners, and foods containing salicylates.
2. Test salicylates. After removing these foods and ingredients for a period, try reintroducing salicylates into the diet. If behavioral issues reemerge, return to the first phase.

Though no specific time frame is given, Feingold stated that your child should see results in 1–6 weeks.

While some people can slowly reintroduce salicylate-containing food and ingredients, others may need to stay in the first phase indefinitely. Artificial colors, flavors, preservatives, and sweeteners are banned completely and never reintroduced.

Feingold recommended making all meals from scratch so that your child doesn’t accidentally eat forbidden ingredients. He asserted that food labels are often incorrect or misleading and should not be trusted.

Despite these claims, food labels are highly regulated and monitored for accuracy (1).

Furthermore, keep in mind that most of the diet’s stipulations are intended to be followed for life. Intentionally restricting your child’s nutrient intake brings up many ethical and medical concerns and should never be attempted without first consulting a health professional.

Summary

The Feingold Diet eliminates numerous foods and additives from your child’s diet. After a set period, you may reintroduce salicylate foods to determine whether they affect behavior.

The Feingold Diet eliminates an extensive list of foods and substances, at least temporarily.

Substances to avoid

• medications containing salicylates (aspirin)
• preservatives, including:
  • butylated hydroxytoluene (BHT)
  • butylated hydroxyanisole (BHA)
  • tert-Butrylhdryquinone (TBHQ)
• all artificial colors, such as:
  • blue 1 (Brilliant Blue)
  • blue 2 (Indigotine)
  • green 3 (Green S or Fast Green)
  • orange B
  • red 2 (Citrus Red)
  • red 3 (Erythrosine)
  • red 40 (Allura Red AC)
  • yellow 5 (Tartrazine)
  • yellow 6 (Sunset Yellow)
• artificial flavorings, such as:
  • vanilla
  • peppermint (including mint-flavored toothpaste and mouthwash)
  • strawberry, raspberry
• artificial sweeteners, such as:
  • aspartame (Equal, NutraSweet)
  • sucralose (Splenda)
  • saccharin (Sweet’N Low)
  • acesulfame-K (Ace-K)
• synthetic pesticides
• perfumes and fragrances

Foods to avoid

The following foods are high in salicylates and must be culled during the diet’s first phase:

• Fruits: apples, applesauce (colored or artificially sweetened), apricots, berries, cherries, currants, grapes, nectarines, oranges, peaches, plums, prunes, raisins, tangerines, and tomatoes
• Vegetables: alfalfa sprouts, broccoli, chicory, cucumbers, eggplant, endives, okra, peppers, pickles, radishes, squash, sweet potatoes, spinach, watercress, and zucchini
• Nuts and seeds: almonds, chestnuts, and other nuts and seeds
• Grains: breakfast cereals (unless free of preservatives and coloring) and processed crackers
• Spices: allspice, anise seeds, cayenne, cinnamon, cloves, curry, cumin, dill, ginger, mustard, oregano, pimento, rosemary, tarragon, thyme, and turmeric
• Drinks: coffee, tea, diet soda, and fruit juices
• Other items: jams, jellies, mint flavoring, chewing gum, and any foods with food coloring or additives

Furthermore, foods containing gluten or the milk protein casein may need to be eliminated, though Feingold recommended visiting an allergist before removing either compound from your kid’s diet.

Summary

You must eliminate any foods containing artificial colors, flavors, preservatives, sweeteners, or salicylates from your child’s diet.

Aside from the banned items, all foods are permitted on the diet.

While Feingold suggested limiting added sugars, he saw no reason to avoid sugar completely. Stevia and sugar alcohols like xylitol and sorbitol are allowed.

Stevia is a natural, plant-derived sweetener. Meanwhile, sugar alcohols have a chemical structure similar to those of both sugar and alcohol. Despite the name, they don’t contain any ethanol — the compound that results in intoxication.

The diet encourages fresh, whole produce that’s low in salicylates, such as:

• Fruits: bananas, cantaloupe, dates, grapefruit, honeydew, kiwi, lemons, mangoes, papaya, pears, pineapple, and watermelon
• Vegetables: bean sprouts, beets, Brussels sprouts, cabbage, carrots, cauliflower, celery, kale, lettuce, mushrooms, onions, peas, potatoes (except sweet potatoes), and sweet corn
• Protein sources: beans and lentils

Summary

Fruits and vegetables low in salicylates are encouraged, and all foods not banned are technically allowed. These include foods containing sugar, sugar alcohols, and stevia.

Despite many personal success stories, most studies from the 1980s and 1990s have failed to demonstrate the Feingold Diet’s effectiveness (2, 3, 4, 5).

As a result, little funding and research have been dedicated to the diet for the past few decades. Nonetheless, some scientists have criticized the framework of these older studies and called for more research (6).

Research on food additives

Most modern research on diet and hyperactivity involves artificial food additives and colors. Though natural food dyes exist, most are artificially made due to their superior consistency, vibrancy, and cost (7).

Recent reviews have found little evidence that salicylates or artificial food additives lead to or worsen hyperactivity, ADHD, or autism in children or adults (8, 9, 10).

While some improvements in behavior may occur in a small subgroup of children with food sensitivities, the Feingold Diet should not replace treatments administered by your healthcare provider (8, 9, 11).

Calls for more research

Many scientists call for more research on food additives and behavior due to the large number of methodological flaws or inconsistencies in the available studies (7, 8, 9, 11).

For example, some studies looked at behavioral issues in young children, while others examined teenagers.

Furthermore, since over 3,000 natural and artificial food additives exist, it’s difficult to study each one’s relation to hyperactivity. Plus, many studies relied on parental reports, which can lead to bias and/or inaccuracies (1, 7).

Finally, hyperactivity, autism, and other behavioral disorders are complex and highly individual, meaning that what may exacerbate symptoms in one person may not in another. Therefore, it’s essential to treat each person on an individual basis (12, 13).

Safety of food additives

The Food and Drug Administration (FDA) considers food additives and colors safe for consumption based on the available science. Only nine artificial food colors are permitted, and none have been directly linked to hyperactivity or behavioral disorders (14).

For children with suspected sensitivities, an elimination trial by a trained health professional like a registered dietitian can test for these sensitivities while ensuring a nutritionally adequate diet for your child (8, 9, 10).

Though artificial additives and food dyes aren’t tied to hyperactivity in children, parents should still focus on providing a balanced diet comprising whole, minimally processed food.

Summary

No evidence suggests that the Feingold Diet prevents, treats, or cures ADHD or other behavioral issues in children or adults. Yet, children with sensitivities to certain food additives may benefit from avoiding them.

Alongside a lack of evidence supporting its efficacy, there are many downsides to the Feingold Diet.

Very restrictive

The Feingold Diet restricts many healthy foods, including certain nuts, fruits, and vegetables. It also forbids any foods containing synthetic additives or dyes.

Such restrictions may not only make grocery shopping difficult, especially for parents planning family meals, but also demonize foods starting at an early age, which may promote a negative relationship with food later in life (15, 16, 17).

Most medical professionals agree that children should not be on restrictive diets except in rare circumstances involving conditions like phenylketonuria, celiac disease, food allergies, or epilepsy — and then only under medical supervision (15, 16, 17).

Difficult to follow

Most processed foods contain additives to increase freshness, enhance flavor or appearance, and maintain quality. The Feingold Diet allows none of these foods, even as a rare treat.

Furthermore, it requires parents to make many dishes from scratch to prevent children from accidentally consuming a banned ingredient. Thus, it may strain financial resources and increase meal prep time, especially if other family members require different meals (18).

Finally, the diet may increase food anxieties, particularly at restaurants, schools, or celebrations like birthday parties, as there will be few foods your child can eat (18).

May lead to nutrient deficiencies

The Feingold diet forbids many healthy foods, such as certain fruits, vegetables, nuts, seeds, and breakfast cereals, which may lead to nutrient deficiencies.

Though your child may be able to get enough nutrients on the diet with careful planning, it can be overwhelming for parents to prepare meals that fit the diet’s restrictions, provide adequate nutrients, and are enjoyable.

If your child is a fussy eater, which occurs more often in children with hyperactivity, this poses an additional risk of nutrient deficiencies. That’s because your child may only prefer commercial items that aren’t permitted on the diet (19, 20).

Summary

The Feingold Diet is highly restrictive and difficult to follow. Thus, it may lead to nutrient deficiencies and food anxiety, which are particularly dangerous for children.

No evidence suggests that the Feingold Diet prevents or treats ADHD, autism, or other behavioral disorders in children or adults. Plus, it’s overly restrictive, time-consuming, and may lead to nutrient deficiencies.

That said, a small percentage of children with hyperactivity may experience behavioral improvements after certain food additives are eliminated from their diet.

If you suspect your child has a sensitivity to additives or other foods, work closely with a health care professional who can safely guide you through an elimination trial.

Yet, you should never replace medical treatment with a diet.