Eggs, Dairy, Nuts, and Soy: Testing for Food Sensitivities with an ADHD Elimination Diet
Bad reactions to certain foods might exacerbate your child’s ADHD symptoms. Find out how you can identify the dietary culprit — while still making sure your child’s eating healthy and balanced foods.
When parents think of alternative approaches to managing ADHD — beyond taking medication — they may think of behavioral interventions, taking fish oil or vitamins. Sometimes, though, changing a child’s diet by detecting food sensitivity and eliminating the offending food can significantly improve ADHD symptoms.
Sean’s mom suspected that eggs made her eight-year-old explosive and unmanageable. His anger sometimes lasted a whole day. She wanted to know how to determine if Sean had food sensitivity, and how to correct it if he did. I talked with her about the other therapies Sean was trying. He was taking medication and working with a behavioral therapist. I told her that he could be sensitive to eggs or perhaps gluten, soy, or a host of other foods. I also told her that testing for and eliminating food sensitivities is not a stand-alone treatment. The approach should be part of a program that is used in conjunction with ADHD medication and other interventions.
Sean turned out to be sensitive to gluten. When he strictly avoided foods that contained gluten, his ADHD symptoms significantly improved. When he accidentally consumed food that contained gluten, he had a noticeable negative reaction, which lasted for up to 24 hours. Although it was a lot of work for his mom to stay on top of the diet, she felt the results were worth the effort.
Food Sensitivity and ADHD
In 2011, Lancet published the results of a study1 that gauged diet’s effect on ADHD symptoms. Researchers recruited 100 children with ADHD, and placed 50 of them on a restricted diet, consisting mainly of rice, meat, vegetables, pears, and water, with some children getting a few other foods. The other 50, the control group, received a normal diet. At the end of five weeks, 64 percent of the children on the restricted diet had significant improvement in their ADHD symptoms, while none of the control group had improved.
It is important to distinguish between food sensitivities and food allergies. A food allergy is an allergic reaction to a certain food that can be detected by a skin or blood test. Most children with ADHD do not have food allergies, although some might.
Food sensitivity is evident when a food causes some type of physical or behavioral symptom in a person, but no true allergy can be found through testing methods. Food sensitivity can cause stomachaches, rashes, headaches, or, in the case of ADHD, increased hyperactivity, impulsivity, and lack of concentration. A negative blood or skin test for food allergies does not mean that a child is not sensitive to certain foods.
Eliminate the Problem
The best way to find out if your child has food sensitivity is through an elimination diet, in which one or more foods is removed for a period of time in order to see if there is an improvement in ADHD symptoms. There are three types of elimination diets:
- the “oligoantigenic” or “few foods” diet is strict, eliminating nearly all foods except a limited number that generally cause no problems. This diet is mainly used in research studies.
- the multiple-food elimination diet removes foods that most commonly cause food sensitivities. My version eliminates dairy products, wheat, corn, soy, eggs, nuts, citrus, and artificial colors and flavors.
- the single-food elimination diet removes only one or two foods.
Adam is an eight-year-old with moderately severe ADHD. He took stimulants, but they were only partially effective. Despite behavioral interventions, he continued to have problems at home and at school. He could not finish his work or sit still in class. To test for food sensitivity, he was placed on a multiple-food elimination diet for three weeks. He couldn’t eat gluten, eggs, dairy, soy, citrus, or nuts.
At first, there was no change in his behavior, only a lot of arguing about what foods he could and couldn’t eat. One week later, his parents began to see changes in Adam’s activity level, ability to focus, and cooperation. He was able to apply himself to work in a way that he never had before. He commented to his parents, “My brain is a lot less foggy.” After three weeks, the family started adding foods back one by one, observing any changes in his behavior. In the end, it was gluten and eggs that caused problems.
Sadie, 10, has inattentive-type ADHD. She was sweet and cooperative, tried hard in school, but was spacey. Medication had not helped. She benefited a little from school interventions and a targeted 504 Plan, but her focus was still variable. Her mother had noticed that when she ate dairy products she seemed to be more distractible, so she removed dairy from her diet. A week later, Sadie was better able to get her homework done and follow through on tasks. Sadie still had trouble focusing at times, but being off dairy products made a big difference.
Not every test for food sensitivity is such a resounding success. I have seen parents who are convinced that their child’s condition is worsened by something he is eating. But when we put the child on an elimination diet, there is no change in the child’s behavior.
What About Your Child?
Unfortunately, there is no easy way to diagnose a child for food sensitivity. In my experience, if a child has allergies, eczema, or gastrointestinal problems, he is more likely to have food sensitivity. Some kids who are healthy also respond positively.
I wish we had a lab test that could determine food sensitivity. Some practitioners use food sensitivity tests to measure levels of immunoglobulin g antibodies to foods, but these have not been proven to be reliable. In the end, doctors have to remove suspected foods and observe the resulting behavior.
Determining food sensitivity in your child should be done with a medical doctor or nutritionist, who can help you select the best diet and monitor the results. The only exception would be if you were doing a single-food elimination diet. Even then, it is important to be strict about the foods you are eliminating and to monitor results carefully. Using a calendar or computer program to make notes can be helpful.
I have seen hundreds of kids with ADHD, and many respond well to an elimination diet. Families who have had success are happy that they can maximize their child’s potential.
D-I-Y Elimination Diets
If you believe there are one or two foods that may be affecting your child — the most common offenders are wheat (gluten) and dairy (casein) — eliminate those foods for three weeks. I usually recommend eliminating both at once, in case he or she is sensitive to both, which is not uncommon. However, some parents prefer eliminating one at a time, and that is fine, as well.
Observe your child’s behavior. If you see improvement, add the food or foods back, one at a time. If your child’s behavior gets better when your child is off the food, and worsens when he eats it, you have your answer.
Sometimes you have to repeat the process a couple of times as “life happens” while you are doing this. You may not be sure if it was the food or a sleepless overnight or a negative incident at school that caused a behavioral change. It is best to do elimination diets when things are stable and quiet on the home front, not on vacation or during the start of a new school year.
Sandy Newmark, M.D., is a member of the ADDitude ADHD Medical Review Panel.
1 Pelsser, Lidy M., Klaas Frankena, Jan Toorman, Huub F. Savelkoul, Anthony E. Dubois, Rob Rodrigues Pereira, Ton A. Haagen, Nanda N. Rommelse, and Jan K. Buitelaar. “Effects of a Restricted Elimination Diet on the Behaviour of Children with Attention-Deficit Hyperactivity Disorder (INCA Study): A Randomised Controlled Trial.” The Lancet, vol. 377, no. 9764, 2011, pp. 494-503.
2 Carter, C M, et al. “Effects of a Few Food Diet in Attention Deficit Disorder.” Archives of Disease in Childhood, vol. 69, no. 5, Nov. 1993, pp. 564–568.
3 Nigg, Joel T., and Kathleen Holton. “Restriction and Elimination Diets in ADHD Treatment.” Child and Adolescent Psychiatric Clinics of North America, vol. 23, no. 4, 2014, pp. 937–953., doi:10.1016/j.chc.2014.05.010.
4 Pelsser, L M, and J K Buitelaar. “Favourable Effect of a Standard Elimination Diet on the Behavior of Young Children with Attention Deficit Hyperactivity Disorder (ADHD): A Pilot Study.” Ned Tijdschr Geneeskd, vol. 147, no. 52, 27 Dec. 2003, p. 2612.
5 Pelsser, Lidy M. J., et al. “A Randomised Controlled Trial Into the Effects of Food on ADHD.” European Child & Adolescent Psychiatry, vol. 18, no. 1, 2008, pp. 12–19., doi:10.1007/s00787-008-0695-7.