{{Short description|Elimination diet initially devised by Benjamin Feingold}} The '''Feingold diet''' is an elimination diet initially devised by Benjamin Feingold following research in the 1970s that appeared to link food additives with hyperactivity; by eliminating these additives and various foods the diet was supposed to alleviate the condition.
Popular in its day, the diet has since been referred to as an "outmoded treatment"; there is no good evidence that it is effective,<ref>{{cite journal |vauthors=Turka LA, Caplan A |title=What is the evidence for our standards of care? |journal=J. Clin. Invest. |volume=121 |issue=7 |pages=2530 |date=July 2011 |pmid=21737884 |pmc=3127439 |doi=10.1172/JCI59185 }}</ref><ref name="KavaleForness1983"/> and it is difficult for people to follow.<ref name=rcp/>
== Technique == The diet was originally based on the elimination of salicylate, artificial food coloring, and artificial flavors;<ref name=Quackwatch/> later on in the 1970s, the preservatives BHA, BHT,<ref name=MatthewSmith/> and (somewhat later) TBHQ<ref name="Stevens2011"> {{cite journal | doi = 10.1177/0009922810384728 |vauthors=Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE | title = Dietary Sensitivities and ADHD Symptoms: Thirty-five Years of Research | journal = Clinical Pediatrics | date= April 2011 | volume = 50 | pages = 279–93 | pmid = 21127082 | issue = 4 | s2cid = 17503227 }}</ref> were eliminated. Besides foods with the eliminated additives, aspirin- or additive-containing drugs and toiletries were to be avoided. Even today, parents are advised to limit their purchases of mouthwash, toothpaste, cough drops, perfume, and various other nonfood products to those published in the Feingold Association's annual ''Foodlist and Shopping Guide''.<ref name=Quackwatch/> Some versions of the diet prohibit only artificial food coloring and additives.<ref name=karanek/> According to the Royal College of Psychiatrists {{asof|lc=yes|2014}} the diet prohibited a number of foods that contain salicylic acid including apples, cucumbers and tomatoes.<ref name=rcp/>
Feingold stressed that the diet must be followed strictly and for an entire lifetime, and that whole families – not just the subject being "treated" – must observe the diet's rules.<ref name=karanek>{{cite journal |author=Kanarek RB |title=Artificial food dyes and attention deficit hyperactivity disorder |journal=Nutr. Rev. |volume=69 |issue=7 |pages=385–91 |date=July 2011 |pmid=21729092 |doi=10.1111/j.1753-4887.2011.00385.x |doi-access=free }}</ref>
== Effectiveness == {{further information|Diet and attention deficit hyperactivity disorder}} Although the diet had a certain popular appeal, a 1983 meta-analysis found research on it to be of poor quality, and that overall there was no good evidence that it was effective in fulfilling its claims.<ref name="KavaleForness1983">{{cite journal|vauthors=Kavale KA, Forness SR |title=Hyperactivity and Diet Treatment: A Meta-Analysis of the Feingold Hypothesis |journal=Journal of Learning Disabilities |volume=16 |issue=6 |year=1983 |pages=324–30 |issn=0022-2194 |doi=10.1177/002221948301600604 |pmid=6886553|s2cid=41744679 }}</ref>
In common with other elimination diets, the Feingold diet can be costly and boring, and thus difficult for people to maintain.<ref name=rcp>{{cite web |title=Eating well and mental health |publisher=Royal College of Psychiatrists |url=http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/eatingwellandmentalhealth.aspx |date=January 2014}}</ref>
In general, {{asof|2013|lc=yes}} there is no evidence to support broad claims that food coloring causes food intolerance and ADHD-like behavior in children.<ref>Tomaska LD and Brooke-Taylor, S. ''Food Additives – General'' pp. 449–54 in Encyclopedia of Food Safety, Vol 2: Hazards and Diseases. Eds, Motarjemi Y et al. Academic Press, 2013. p. 452. {{ISBN|978-0123786135}}</ref> It is possible that certain food coloring may act as a trigger in those who are genetically predisposed, but the evidence is weak.<ref name=Peds2012>{{cite journal |vauthors=Millichap JG, Yee MM |title=The diet factor in attention-deficit/hyperactivity disorder|journal=Pediatrics |volume=129 |issue=2 | pages=330–37 |date=February 2012 |pmid=22232312|doi=10.1542/peds.2011-2199 |s2cid=14925322}}</ref><ref name=FDAdyecomm>FDA. [https://web.archive.org/web/20110331210358/http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/FoodAdvisoryCommittee/UCM248549.pdf Background Document for the Food Advisory Committee: Certified Color Additives in Food and Possible Association with Attention Deficit Hyperactivity Disorder in Children: March 30–31, 2011]</ref><ref name=EFSA2009>{{cite journal | year = 2009 | title = Scientific Opinion on the re-evaluation of Sunset Yellow FCF (E 110) as a food additive | url = http://www.efsa.europa.eu/en/efsajournal/pub/1330 | journal = EFSA Journal | volume = 7 | issue = 11| page = 1330 | doi = 10.2903/j.efsa.2009.1330 | doi-access = free }}</ref>
== Reception == For decades, the Feingold Program required a significant change in family lifestyle because families were limited to a narrow selection of foods. Such foods were sometimes expensive or had to be prepared "from scratch," greatly increasing the amount of time and effort a family must put into preparing a meal.<ref name="Quackwatch">{{cite web|author=Barrett S|author-link=Stephen Barrett|date=March 11, 2002|title=The Feingold Diet|url=http://www.quackwatch.org/01QuackeryRelatedTopics/feingold.html|access-date=15 April 2021|website=Quackwatch|publisher=}}</ref> As more and more foods without the potentially offending additives are being produced and available in neighborhood supermarkets, this is much less a problem.<ref name="MatthewSmith" />
While some fruits and a few vegetables are eliminated in the first weeks of the Program, they are replaced by others. Often, some or all of these items can be returned to the diet, once the level of tolerance is determined.<ref name="Dumbrell78">{{cite journal | author = Dumbrell, S. | author2 = Woodhill, J.M. | author3 = Mackie, L. | author4 = Leelarthaepin, B. | name-list-style = amp |date=December 1978 | title = Is the Australian version of the Feingold diet safe? | journal = The Medical Journal of Australia | volume = 2 | issue = 12 | pages = 569–70 | pmid = 364258| doi = 10.5694/j.1326-5377.1978.tb131717.x | s2cid = 34426994 }}</ref>
== History == Feingold was Chief of Pediatrics at Cedars of Lebanon Hospital in Los Angeles, CA, until 1951, when he became Chief of Allergy at Kaiser-Permanente Medical Center in San Francisco.<ref name="MatthewSmith">{{cite book | author=Smith, Matthew | title=An alternative history of hyperactivity: Food additives and the' Feingold Diet | publisher=Rutgers University Press | year=2011 | isbn=978-0813550169}}</ref><ref name="WhyYourChild">{{cite book | author=Feingold, B.F. | title=Why Your Child is Hyperactive | url=https://archive.org/details/whyyourchildishy00fein | url-access=registration | publisher=Random House | year=1975 | isbn=0-394-73426-2}}</ref> He continued his work with children and adults with hyperactivity and allergy until his death at the age of 82, in 1982.<ref name="MatthewSmith" /><ref name="Feingold Obituary"> {{cite journal | author = Bourne, A | title = Obituary: Ben F. Feingold, MD | url = http://www.TalkingAboutTheScience.com/DOCS/Feingold82-obituary.pdf | journal = Ecology of Disease | date= 1982 | volume = 1 | issue = 2/3 | page = 199}} </ref>
Since the 1940s, researchers worldwide had discussed cross-reactions of aspirin (a common salicylate) and tartrazine (FD&C Yellow #5).<ref name="MatthewSmith" /><ref name="IntroAllergy">{{cite book | author=Feingold, B.F. | title=Introduction to clinical allergy | publisher=Charles C. Thomas | year=1973 | page=157 | isbn=0-398-02797-8}}</ref><ref name="Settipane1975"> {{cite journal | author = Settipane GA, Pudupakkam RK. | title = Aspirin intolerance. III. Subtypes, familial occurrence, and cross-reactivity with tartarazine. | journal = Journal of Allergy and Clinical Immunology | date= 1975 | volume = 56 | pages = 215–21 | pmid = 1151014 | issue = 3 | doi=10.1016/0091-6749(75)90092-5}} </ref> Dr. Stephen Lockey<ref>{{cite journal | author = Lockey, SD | title = Allergic reactions due to F D and C Yellow No. 5, tartrazine, an aniline dye used as a coloring and identifying agent in various steroids | url = http://www.feingold.org/Research/lockey1959.html | journal = Annals of Allergy | volume = 17 | pages = 719–21 | date = September–October 1959 | pmid = 14417794 | archive-date = 2008-11-20 | access-date = 2008-04-01 | archive-url = https://web.archive.org/web/20081120164415/http://www.feingold.org/Research/lockey1959.html | url-status = dead }}</ref> at the Mayo Clinic and later Feingold at Kaiser, hypothesized that eliminating both salicylates and synthetic food additives from patients' diets not only eliminated allergic-type reactions such as asthma, eczema and hives,<ref>{{cite journal | author = Lockey, SD Sr. | title = Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products. | journal = Annals of Allergy | volume = 38 | issue = 3 | pages = 206–10 | date= 1977 | pmid=842907 }}</ref> but also induced behavioral changes in some of their patients.
Feingold presented his findings at the annual conference of the American Medical Association in June 1973.<ref> {{cite journal | author = J.G. Beall, Jr. | title = Food Additives and Hyperactivity in Children | url = http://www.TalkingAboutTheScience.com/studies/FeingoldCongressionalRecord1973.pdf | journal = Congressional Record - Senate | date= October 30, 1973 | pages = 35401–07}} </ref><ref>{{cite journal | author = Feingold, Ben F. | title = The Role of Diet in Behaviour | url = http://www.feingold.org/Research/PDFstudies/Feingold82.pdf | journal = Ecology of Disease | volume = 2 | issue = 2/3 | pages = 153–65 | year = 1982 | pmid = 6090095 | archive-date = 2008-12-05 | access-date = 2008-04-01 | archive-url = https://web.archive.org/web/20081205024332/http://www.feingold.org/Research/PDFstudies/Feingold82.pdf | url-status = dead }}</ref> This led to a controlled double-blind crossover study published in the August 1976 issue of ''Pediatrics''.<ref>{{npsn|date=August 2016}}{{cite journal |vauthors=Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA | title = Food additives and hyperkinesis: a controlled double-blind experiment | journal = Pediatrics |volume=58 |issue=2 | pages =154–66 |date=August 1976 | pmid = 781610}}</ref>
A two-week-long conference was arranged in January 1975, in Glen Cove, Long Island. There, the Nutrition Foundation attendees created what they called the National Advisory Committee. The committee widely published its preliminary report concluding that "no controlled studies have demonstrated that hyperkinesis is related to the ingestion of food additives."<ref name="MatthewSmith" />
== References == {{reflist}}
== Further reading == * [https://web.archive.org/web/20230130003307/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935821/pdf/cap.2008.022.pdf ”Psychopharmacological and Other Treatments in Preschool Children with ADHD: Current Evidence and Practice“] J.K. Ghuman et al., ''J of Child & Adolescent Psychopharmacology'', Vol. 18, No. 5, 2008
{{DEFAULTSORT:Feingold Diet}} Category:Diets Category:Food sensitivity