The Diet Factor in Attention-Deficit/Hyperactivity Disorder by Millichap & Yee, 2012. Articles reprinted from the January 2012 Feingold eNews. Shula Edelkind, author. On Monday, January 9, 2012, the Journal of Pediatrics published a paper by J. Gordon Millichap, MD and Michelle M. Yee, CPNP, as yet another review of the studies on diet and ADHD, called "The Diet Factor in Attention-Deficit/Hyperactivity Disorder." See the full text here This article has received a great deal of publicity and I wanted to provide a bit of detail about it, the various factual errors, omissions, and misinformed conclusions. The Millichap paper claims to be a "comprehensive overview" of the research. Millichap promises -- twice, and right in his abstract -- that he plans to talk about recent research. He says, "Results of recent research and controlled studies are emphasized" and "The literature on diets and ADHD ... is reviewed with emphasis on recent controlled studies." However, in spite of his promises, Millichap omits almost all the recent research, including the most significant study on the topic -- the McCann study published in The Lancet in 2007. This is the study that resulted in the British government calling for the banning of dyes in England, and led to the European Parliament's requirement that manufacturers put warning labels on most foods that contain the dyes. This is the study that led the American Academy of Pediatrics to say, in their 2008 Grand Rounds article, "Thus, the overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of children, admit we might have been wrong." See paper. But apparently, this study isn't important enough for Millichap to include in his "comprehensive review." Millichap says that in the past 20 years, until 2010, only two scientific articles on additive-free diets can be found in PubMed. Those, of course, would be the two he lists in his references: Egger 1992 Carter 1993 Boris 1994 Schulte-Körne 1996 Uhlig 1997 Pelsser 2002 Pelsser 2009 Connolly 2010 and Stevenson 2010. I do think that's a few more than two, but yet we wonder why he missed the following papers on additives and ADHD also published in those two decades: Pollock & Warner, 1990 Ward, 1990 Schoenthaler et al, 1991 Breakey, 1992 Egger et al, 1992(a) Novembre et al, 1992 Rowe & Rowe, 1994 Weiss, 1994 McFadden, 1996 Reyes et al, 1996 Breakey, 1997 Schmidt et al, 1997 (used few-foods diet) Ward, 1997 Arnold, 1999 Stubberfield & Parry, 1999 Kidd, 2000 Arnold, 2001 Berdonces, 2001 Dengate & Ruben, 2002 Schnoll et al, 2003 Breakey, 2004 Bateman et al, 2004 Schab & Trinh, 2004 Lien et al, 2006 Lau et al, 2006 McCann et al, 2007 Banerjee et al, 2007 Curtis & Patel, 2008 Sinn, 2008 Pelsser et al, 2009 Schoenthaler, 2009 Kiddie et al, 2010 Kamel & El-lethey, 2011 Pelsser et al, 2010 Millichap says, based on 30-year-old studies, "An occasional child might react adversely to dyes and preservatives in foods and might benefit from their elimination." But one paragraph later, he admits that "a literature review [Stevens 2011] shows that of children with suspected sensitivities, 65% to 89% react when challenged with 100 mg of artificial food colors." Did he really not notice what he wrote? In his description of the Feingold Diet, Millichap cites Dr. Feingold's 1975 book, with no mention of the work of the nonprofit Feingold Association or the many changes that have taken place in our food supply over the past 37 years. For example, he writes that the diet eliminates luncheon meats, sausage and hot dogs, but the Feingold Association's current Foodlist books include many acceptable brands of each. Millichap claims that people following the Feingold diet would consider red and orange synthetic dyes "especially suspect." This is not true. All the synthetic dyes are eliminated on the Feingold diet. But wait -- oops -- there is no FDA-approved FD&C synthetic orange food dye! In describing the Feingold diet, Millichap says that the preservatives BHA and BHT are eliminated. This is true, but he says nothing about the related preservative, TBHQ. For several decades, ever since it entered the food supply, TBHQ has also been eliminated -- but one wouldn't know that if their only source of information is Dr. Feingold's 30+ year old books and published papers. Millichap and Yee repeat the common mistake many writers make when they discuss sugar and ADHD. They confuse "sugar" with sugary foods that are loaded with synthetic additives. They ridicule parents who believe that their children react to "sugar" and say that it is just due to their imagination. (If the authors took a close look at food labels, they would see that most of the junk foods don't even contain sugar; they contain high fructose corn syrup, a sugar that enters the blood faster and has more contaminants than ordinary table sugar.) The authors speak favorably about a "healthy diet pattern and lifestyle to prevent and control ADHD." But it's hard to understand why they don't accept a diet removing petrochemical, cancer-causing additives as a healthy diet pattern, or why children on such a diet would need "frequent evaluation by an understanding physician and dietician" as though they might develop deficiencies ... deficiencies of what? petrochemicals? The Feingold Diet is described as "time consuming and disruptive to the household" but they are not clear about why they believe this and do not cite any research studies to support their conclusion. While we accept the concept that a dietary change can be difficult at the beginning (which is why there is a parent support group) the authors seem to not realize that the most "time consuming and disruptive" factor in a household is a hyperactive child!