Introduction
There are a number of controversial areas in medicine when it comes to
ADHD. Food allergy is certainly one of them.
The classic allergic reaction, which is classified as the type-1
hypersensitivity reaction, can be elicited by food, but this is fairly
uncommon. When we discuss food sensitivities in ADHD we are discussing
a different, not well-defined, mechanism.
One of the main progenitors of the food allergy/ADHD connection is Dr.
Doris Rapp. Dr. Rapp was a pediatric allergist who noticed that many
children in her practice had significant physical and behavioral
changes when exposed to certain foods. They may have red ear lobes,
dark circles under their eyes, or glazed eyes after eating certain
foods. These children could have tremendous swings in behavior. They
can be calm one minute and wildly hyperactive a few minutes later.
To make it more interesting, children with food allergies usually crave
the food that affects them negatively. That means a child who is
allergic to peanuts will demand peanut butter and jelly for lunch
everyday, and for the rest of the afternoon you have to peel him off of
the ceiling.
What is Food Allergy?
The classic allergic reaction operates through a very specific
mechanism. The reaction is caused when a specific type of antibody,
called IgE, reacts with a specific provoking substance called an
allergen. The result of this interaction is an allergic response and
the person is deemed allergic to that allergen.
The specific type of antibody involved in classic allergy is called
IgE. The proposed antibody mechanism for this type of food allergy does
not involve IgE, but a different antibody called IgG. This is
significant because standard allergy testing tests only for IgE
antibodies. If your child has IgG mediated sensitivity, his allergy
test is going to miss it. That means that your child may have a severe
allergy to a specific food, but your allergist will tell you he is not
allergic to it.
Why the Controversy?
Reason 1: Diagnosis
I said this was a very controversial area of medicine and here is one
of the reasons why. Food allergies are very difficult to diagnose. One
reason is that the symptoms wax and wane. When a child has a classic
allergy, for example to bee stings, then every time a bee stings him,
he will have a reaction. Food allergies don’t work that way.
There seems to be a threshold that must be exceeded before there are
any symptoms. In addition, this threshold seems to vary from day to
day. On some days a food will affect the child, and on other days it
won’t. Dr. Rapp explains this phenomenon using the analogy of
a barrel.
We can view each allergic child as if he has a barrel. As long as the
barrel is empty or only partially full, your child will have no
problems. Your child won’t become hyperactive until his
barrel is overflowing.
Various things will fill your child’s barrel. Let’s
say your child is sensitive to chocolate, cats, and peanut butter. Each
of these things all can partially fill his barrel. As long as he only
has peanut butter or only plays with the cat, his barrel is only
partially full. That means that there are no symptoms and that his
behavior is fine. Then, one day he has a peanut butter and jelly
sandwich, has chocolate ice cream for dessert and plays with the cat
all afternoon. These things in combination make his barrel overflow,
and by evening he is out of control. Your child has food allergies, but
sometimes they affect him and sometimes they don’t.
The barrel can change sizes. If your child has a cold or is upset his
barrel gets smaller. It takes less to make it overflow. If he is happy
his barrel is bigger. It takes more to make it overflow. If he
isn’t eating well and that day he is low on certain nutrients
his barrel gets smaller.
Many traditional allergists find this barrel concept ludicrous. It
doesn’t fit into the pattern of how other allergies work.
Reason 2: Method of Diagnosis
The next problem is the way in which you test for food allergies. Dr.
Rapp describes a technique called provocation-neutralization testing.
This method works as follows: Say that a child frequently has headaches
after eating eggs. The practitioner will give an intradermal injection
of egg extract. If this elicits the child’s headache, then
the child tests positive for egg allergy. Other signs of a positive
test include an increase in pulse rate of 20 points, a large skin
reaction (this indicates a classic IgE reaction), a change in the
child’s handwriting, or some other physical or emotional
complaint. This last criterion “some other physical or
emotional complaint” is problematic. It is too vague. The
result is that when studies compared how several physicians evaluated
the same group of patients, their results didn’t agree. For
each patient if there were twenty different doctors with twenty
different sets of findings. None of their diagnoses matched.
Reason 3: The Mechanism
As I mentioned before, the proposed mechanism is an IgG mediated
response. Some food allergists diagnose specific food allergies by
measuring IgG levels. This runs counter to all of modern allergy
practice.
Allergists give allergy shots to treat allergy. The way this works is
they give a low level of allergen, which is not enough to elicit an IgE
reaction. The dose is slowly increased until eventually the patient can
tolerate a significant exposure to the allergen.
This is how it works. The repeated low-level exposure to the allergen
induces the body to make a different antibody to the substance. This
antibody attaches to the allergen and deactivates it before IgE can
cause the allergy reaction. What is this antibody that allergists try
to induce to cure their patients of their allergies? You guessed it,
IgG. So the very antibody the traditional allergists have been inducing
for decades to successfully treat allergies, the food allergy people
claim is the antibody guilty of causing allergies.
For a traditional allergist this is nothing short of heresy. IgG has
been used for decades to treat allergies successfully. Comes along Rapp
and her friends and they claim that IgG causes allergy? This is a
little hard for some people to accept.
Just how strongly do allergists reject this idea? I once tried to
contact an Israeli physician who was a food allergy specialist to
discuss with him provocation-neutralization testing. I called the
hospital where he is on staff and asked to speak with him. For some
reason the operator instead put me through to the head of the
Department of Allergy.
I began discussing with him the theory of food allergies,
provocation-neutralization testing and IgG testing. He told me that he
was the head of a committee of allergists who were in the process of
testifying before the Israeli Knesset to get legislation passed to make
IgG testing illegal in Israel.
Can you imagine? You visit a prison in Israel. In one cell there is car
thief. In the next cell there is a mass murderer. And in the next cell
there is a guy who tested someone for food allergies. Now
that’s pretty strong opposition!
Do Food Allergies Really Exist?
The formal medical societies like the AMA claim there is no such thing
as food allergies. Rapp and her friends have been screaming for decades
that they do exist. So, what is the bottom line? Does it really make
sense that what a child eats can affect him so strongly that experts
will diagnose him as having ADHD?
We know that the brain is a highly complicated and sensitive organ. We
know that many foods have a physiological effect on the body without
inducing a classic allergic response. For example, people who are
sensitive to monosodium glutamate can have a severe reaction to eating
it. The chemicals in red wine affect certain people. We also know that
ingesting certain foods alters brain function. Diet has been proven to
influence neurotransmitter function. Components of foods can also be
used as drugs. For example, tryptophan, tyrosine, and choline have been
used in the treatment of sleep disorders, pain, depression, mania,
hypertension, shock, or dyskinesias.
The logic of Rapp’s argument is so strong and there is enough
circumstantial evidence, that I feel that the question is really the
other way around. We know that the brain is intricate and has
tremendous metabolic requirements. We know that some people have very
strong reactions, including behavioral changes, to certain foods. These
things are undisputed. If it turns out that foods do not elicit
significant problems in sensitive children, in my opinion, we would
need to explain why not!
Are we really seeing an allergy mechanism to food? I prefer to stay out
of that debate. Rather than be ostracized by the doctors who specialize
in allergy, I feel it is safer to call them food sensitivities. There
are no doctors who specialize in sensitivity.
Does Your Child Have Food Sensitivities?
A large number of ADHD children may be having a negative response to
food, and this response may be the primary cause of their ADHD. In what
type of child should you suspect food allergies?
The following is a list of symptoms that resulted from food allergies
in certain children:
Hyperactivity
Changes in mood
Halitosis
Sleep disturbances
Delay in sleep onset
Migraines
Other headaches
Abdominal pain
Bedwetting
Tantrums
Eczema
Asthma
Seizures
Research shows that by treating the food allergies all of these
symptoms can be relieved.
If you see your child’s symptoms in this list it is possible
that food allergies may be contributing to his problem. If your child
also has other allergic problems, such as allergy or asthma, then food
allergies are almost certainly contributing to his problems.
What Should You Do?
As I wrote in How to Help the Child You Love, there are a number of
approaches to diagnosing food allergies. None of them are well
substantiated and all of them have difficulties. Yet, many people find
that these diagnostic techniques worked for them. Therefore,
I’d suggest you could use them provided you have it on good
authority that the person administering them has a strong record of
success. In my experience, these techniques are more of an art than a
science. They really depend upon the talent of the diagnostician.
As I said last time, the best approach to finding food allergies in
your child is an elimination diet. It doesn’t really matter
which one you choose. I prefer the three that I outline in How to Help
the Child You Love. (see http://addadhdadvances.com/childyoulove.html)
Conclusion
Researchers claim that the percentage of ADHD children whose behavioral
symptoms are affected by foods ranges from 60% to 75%. This, however,
is probably not an accurate number. Parents who consent to have their
children participate in diet studies usually believe they have observed
food-induced problems in their children. Therefore, children who
participate in these studies are more likely to respond to foods than
the general population. The truth is we do not know what percentage of
ADHD children will respond to dietary changes, but it seems that the
number is significant.
Treating the food sensitivities in ADHD children has a number of
advantages over using medication. One major advantage all the current
methods of treatment can be used to treat pre-school children. Most
clinicians do not use medication on pre-school children. A more
significant advantage of treating food allergy is that when it works,
it works all day. In contrast, Ritalin wears off in about 4 hours.
All this, of course, is providing that food allergies really do exist.
The main thing to remember is that if you think your child has food
allergies, then the biggest mistake you can make is to go to an
allergist. They don’t believe in food allergies. And whatever
you do, do not go to an allergist and ask to have your child
provocation-neutralization tested for food allergies. He is going to
laugh at you.
Food allergy is an alternative medicine diagnosis. Still, there are
physicians who specialize in diagnosing and treating these
sensitivities, but they no longer call themselves allergists. Rapp and
her group were so ostracized by the formal allergy societies that they
eventually broke off and formed a new field called Environmental
Medicine.
Therefore, if you want a physician to treat your child you need to find
an Environmental Medicine specialist. They are not so common, but they
are around.
As I mentioned before, there are a number of approaches to treating
food sensitivities. The one you can do yourself is to use an
elimination diet. I devoted a large section of How to Help the Child
You Love describing exactly how to use elimination diets to diagnose
and treat food sensitivities.
In the final analysis, I feel it is fair to say that many ADHD children
have sensitivities to the foods they eat. These sensitivities may
exacerbate their ADHD symptoms. I won’t go so far as to say
that food allergies cause ADHD. That means that if your ADHD child has
severe food sensitivity, treating that sensitivity may not get rid of
his ADHD. However, until you treat his food allergy, nothing else you
do will really help your child’s ADHD, either.
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
About The Author
Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book, numerous
articles, and a number of online programs dealing with ADHD
(addadhdadvances.com/childyoulove.html) treatment, ODD, parenting
issues (addadhdadvances.com/betterbehavior.html), and education. You
may visit his website at http://addadhdadvances.com. To sign up for the
free ADD ADHD Advances online journal send a blank email to:
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