Feingold Diet
What is the Feingold Diet?
The diet was created by Ben F. Feingold, M.D. who was both a pediatrician and allergist.
Initially, the diet was intended for asthma and skin issues.
The Feingold diet is now used primarily as a natural treatment for hyperactivity (ADHD), asthma, eczema or migraines.
There are other symptoms that may benefit as well including impulsivity, short attention span, sleep disturbances, bedwetting, poor coordination, speech difficulties, struggles with auditory or visual processing and comprehension.
The Feingold diet removes certain foods that are high in salicylates as well as artificial additives like food dyes, flavorings & fragrances, artificial sweeteners, and three preservatives:
BHA (Butylated Hydroxyanisole)
BHT (Butylated Hydroxytoluene)
TBHQ (Tertiary Butylhydroquinone).
There are 2 stages to the Feingold Diet. The first is elimination and the second stage is a trial reintroduction of the salicylate foods.
After a favorable response to Stage One is observed for at least six to eight weeks, you may proceed to Stage Two if desired.
During Stage Two reintroduction, salicylate items (one at a time) can be trialed and measured for tolerance.
The Feingold diet is similar to other diets such as:
The low-salicylate diet but it includes other food chemicals.
The Failsafe diet but the Failsafe diet is more comprehensive and includes all types of phenols rather than just salicylates.
Is This Diet Right for My Child?
This diet may be worth trying if you:
Notice that your child experiences more than one of the symptoms found here
If your child has food sensitivities to other common allergens and you noticed some improvements with other elimination diets
If you have noticed that processed foods with artificial ingredients seem to negatively affect your child.
If your child’s diet is not excessively restrictive such that further restriction would cause an undue burden or restrict the child’s intake and nutrition even further
If Organic Acid Testing indicated a salicylate sensitivity (i.e. elevated marker 61)
Recommended Foods
Proteins
Fruits
Stage one fruits (fresh, frozen or canned in only water + salt or calcium chloride and canned fruit in it’s own juice + citric acid)
Vegetables
Stage one vegetables (fresh, frozen or canned in only water + salt or calcium chloride and canned fruit in it’s own juice + citric acid)
Eggplant, pumpkin, garlic, radishes, asparagus, jicama, rhubarb, kale, rutabaga, kohlrabi, beans (all types), leek, snow peas, beets, lettuce, broccoli, lentils, spinach, broccoli rabe, mushrooms, squash, brussel sprouts, sugar snap peas, cabbage, okra, sweet potato, carrots, olives, turnips, cauliflower, onions, celery, parsley, chard, parsnips, collard greens, yams, corn, potatoes, zucchini
Grains & Legumes
Beans (dried or canned with only water or salt added)
Rice and uncolored, unflavored popcorn kernels
Nuts, Seeds & Their Oils
Olive oil
Dairy
Butter
Natural cheese without added flavorings or colors
Plain, unflavored yogurt made from whole milk without pectin
Other
Honey and maple syrup
Foods to Avoid
Fruits
The following contains naturally occurring salicylates and should be avoided in any form, whether fresh from your garden, canned, dried, frozen, or juiced.
Vegetables
The following contains naturally occurring salicylates and should be avoided in any form, whether fresh from your garden, canned, dried, frozen or juiced.
Peppers (including bell, cayenne, chili), cucumbers & pickles, tomatoes,
Nuts, Seeds & Their Oils
Almonds
Sweeteners
Synthetic Sweeteners such as Aspartame (NutraSweet®, Equal®), Acesulfame-K, Cyclamates, Saccharine (Sweet N’Low®), and Sucralose (Splenda®)
Preservatives
BHA (Butylated Hydroxyanisole)
BHT (Butylated Hydroxytoluene)
TBHQ (Tertiary Butylhydroquinone)
Other
Synthetic (artificial) colors, food dyes: FD&C – Any color including Blue No.1, Blue No. 2, Green No.3, Red No. 40, Red No. 3, Yellow No. 5, Yellow No. 6
Synthetic (artificial) flavors or vanillin
Aspirin and medication containing aspirin are also eliminated on Stage One.
Natural Salicylates:
Chili Powder
Paprika
Cloves
Coffee
Wine & Wine Vinegar
Tea (all types)
Reships
Oil of wintergreen (methyl salicylate)
Birch Oil
Lifestyle Changes
Any artificial coloring, flavoring, or petrochemical preservative that goes in your mouth or on your skin can be a problem. This includes:
Dental products such as toothpaste, toothbrush, dental floss, mouthwash
Hair and body products like shampoo, lotions, cosmetics, colored bubble bath and bathtub crayons
Certain vitamins, medicines, etc.
Markers, stamp pads, tattoos and hand soaps at school or in public bathrooms
Avoid personal care and household products that contain fragrances. Nearly all fragrances today are made from petroleum, and inhalation and ingestion can be problematic when it comes to petroleum-based food additives. Avoid any scented candles and plugins. Look for brands labeled “free & clear” for laundry detergents etc.
Acceptable non-food items include:
White or clear unscented liquids
Laundry detergent without added dyes or fragrance (“free and clear”)
Plain white unscented tissues, toilet tissue, paper towels and napkins
Plain white or foil cup liners
Plain unscented band-aids, cotton balls, Qtips, hydrogen peroxide
Helpful Resources
All Natural Mom's Guide to the Feingold Diet: A Natural Approach to ADHD and Other Related Disorders
Supplements
Ensure that any herbs which are taken regularly are not in high salicylates.
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Feingold Diet in the Research
Diets for ADHD
The most common dietary interventions for ADHD are food supplementation diets (e.g. PUFAs, vitamins) and elimination diets, however there is no clear evidence that supports dietary interventions for the treatment of ADHD. [1]
Elimination diets and fish oil supplementation seem to be the most promising dietary interventions for a reduction in ADHD symptoms in children. [2]
The indications for diet therapy include the following: medication failure or adverse reaction, parent or patient preference, symptoms or signs of mineral deficiency, and the need to substitute an ADHD-free healthy diet for an ADHD-linked diet. [9]
EPA and DHA fatty acid supplementation is associated with less marked impulsive behaviour in children with ADHD and a Mediterranean diet may improve impulsivity as well. [10]
As many as 33% of children with ADHD may benefit from dietary restrictions and an estimated 8% of children with ADHD may have symptoms related to synthetic food colors.[20]
Food Additive Elimination Beneficial
Artificial food color exclusion produced significant effects in ADHD symptoms but often in individuals selected for food sensitivities. [3]
Eliminating artificial food dyes from children's diets is not a panacea for the treatment of ADHD and only a portion of children respond positively to the removal of synthetic food dyes from the diet. [4]
Accumulated evidence suggests that a subgroup of children with ADHD shows significant symptom improvement when consuming an artificial food coloring-free (AFC-free) diet and reacts with ADHD-type symptoms on challenge with AFCs. Some children in addition to being sensitive to AFCs are also sensitive to commonly allergenic, nonsalicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes). [5]
Given the positive, yet small effects and the fact that food additives do not provide any health benefits, it is recommended that children preventatively minimize consumption of processed food products with these ingredients. [6]
Although it is likely that only a minority of children with ADHD will respond to dietary intervention, the evidence persistently suggests that for some children such intervention can be quite effective. [7]
Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. [8]
Elimination of AFCs from the diet may provide benefits to children with attention-deficit/hyperactivity disorder. [18]
Causes of ADHD
This study suggests that a diet high in refined sugar and saturated fat can increase the risk of ADHD or hyperactivity, whereas a healthy diet, characterized by high consumption of fruits and vegetables, would be protective. [11]
In Spanish children with ADHD, there were clear associations between greater irritability and less sleep, poor adherence to a Mediterranean diet, greater technology use, children who were not breastfed and children born via cesarean. [12]
Children with ADHD demonstrated a higher intake of refined grains and a lower proportion of dairy, calcium and vitamin B-2 and dietary/nutrient differences may play a role in the pathophysiology of ADHD. [13]
There is no clear evidence supporting a role of food or nutrient-based intervention strategies in the etiology and therapy of ADHD. [14]
There is evidence supporting the etiological link between exposure to environmental toxicants, like heavy metals and persistent organic pollutants, and the development of ASD. [15]
Artificial Food Colorings and Hyperactivity
Since 2011, it is evident that dyes are linked to harmful effects in children. A study conducted at Southampton University in England found a link between food dyes and hyperactive behavior in children. [16]
The high prevalence of azo dyes in the food supply of Singapore and their ability to elicit proinflammatory responses in vitro suggest a potential health risk to the local population.[17]
Artificial food colors (AFCs) can cause adverse behavioral changes in a subgroup of children with ADHD and in a subgroup of the general pediatric population as well, and this may be dose dependent. The azo dyes are metabolized in the gut and some metabolites of dyes are more readily absorbed. [19]
The Bottom Line
Overall, there is quite a bit of research to suggest a connection between hyperactivity or ADHD and certain salicylate containing ingredients like artificial food colorings. There are many factors to consider before attempting an elimination diet. The diet is not excessively difficult to follow given the surge in “healthy” food products with an emphasis on natural ingredients. This presupposes that the parents/guardians have access to a grocery store with these types of options and can afford the potential added cost. One of the biggest hurdles with this diet is for the parent/guardian to learn what ingredients to look for that must be avoided, as the list is extensive. The research shows that for a subset of individuals with sensitivity, the diet is effective in reducing symptoms and thus if the child has multiple symptoms indicating a sensitivity, the diet may be well worth implementing.
Scale: 1 - 5 Stars ★ (1 Star Being Worst, 5 Stars Being the Best)
We rate the quality and quantity of the Research supporting the efficacy of the diet in improving symptoms as well as the Ease of Adherence, taking into account the cost, resources available, time required, social acclimation to the diet including options available in restaurants and grocery stores which assist in convenience and adherence
Ease of Adherence ★★★
There is much to learn about what foods are acceptable but there is detailed guidance available and a strong community.
Research ★★★★
The research indicating effectiveness for those that do have a sensitivity is strong
Grade: A
Disclaimer:Diet changes can be difficult to implement and/or potentially dangerous if not approached properly. If you are considering making dietary changes, we strongly advise working with a registered dietitian to ensure that your child's nutrition needs are being met. A dietitian can provide professional, practical guidance on how to implement dietary changes in a way that works for you and your family.
The information provided in the Autism Nutrition Library is intended for educational purposes only and should not be interpreted as medical nutrition therapy, nutrition counseling, diagnosis, prognosis, health care treatment, instruction, advice, or any other individualized medical service. Always let your physician know about any of your health concerns, and check with your doctor or dietitian before making any diet, medication, exercise, or lifestyle changes.
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[1] Cagigal C, Silva T, Jesus M, Silva C. Does Diet Affect the Symptoms of ADHD. Curr Pharm Biotechnol. 2019;20(2):130-6.
[2] Heilskov Rytter MJ, Andersen LB, Houmann T, et al. Diet in the treatment of ADHD in children - a systematic review of the literature. Nord J Psychiatry. 2015;69(1):1-18.
[3] Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013;170(3):275-89.
[4] Kanarek RB. Artificial food dyes and attention deficit hyperactivity disorder. Nutr Rev. 2011;69(7):385-91.
[5] Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE. Dietary sensitivities and ADHD symptoms: thirty-five years of research. Clin Pediatr (Phila). 2011;50(4):279-93.
[6] Ly V, Bottelier M, Hoekstra PJ, Arias Vasquez A, Buitelaar JK, Rommelse NN. Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017;26(9):1067-79.
[7] Nigg JT, Holton K. Restriction and elimination diets in ADHD treatment. Child Adolesc Psychiatr Clin N Am. 2014;23(4):937-53.
[8] Stevenson J, Buitelaar J, Cortese S, et al. Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies. J Child Psychol Psychiatry. 2014;55(5):416-27.
[9] Millichap JG, Yee MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. 2012;129(2):330-7.
[10] San Mauro Martin I, Sanz Rojo S, González Cosano L, Conty de la Campa R, Garicano Vilar E, Blumenfeld Olivares JA. Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: A randomised clinical trial. Neurologia. 10.1016/j.nrl.2019.09.007
[11] Del-Ponte B, Quinte GC, Cruz S, Grellert M, Santos IS. Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. J Affect Disord. 2019;252:160-73.
[12] San Mauro Martin I, Sanz Rojo S, Garicano Vilar E, González Cosano L, Conty de la Campa R, Blumenfeld Olivares JA. Lifestyle factors, diet and attention-deficit/hyperactivity disorder in Spanish children - an observational study. Nutr Neurosci. 10.1080/1028415X.2019.1660486
[13] Chou WJ, Lee MF, Hou ML, et al. Dietary and nutrient status of children with attention-deficit/ hyperactivity disorder: a case-control study. Asia Pac J Clin Nutr. 2018;27(6):1325-31.
[14] Lange KW. Dietary factors in the etiology and therapy of attention deficit/hyperactivity disorder. Curr Opin Clin Nutr Metab Care. 2017;20(6):464-9.
[15] Ye BS, Leung AOW, Wong MH. The association of environmental toxicants and autism spectrum disorders in children. Environ Pollut. 2017;227:234-42.
[16] Bakthavachalu P, Kannan SM, Qoronfleh MW. Food Color and Autism: A Meta-Analysis. Adv Neurobiol. 2020;24:481-504.
[17] Leo L, Loong C, Ho XL, Raman MFB, Suan MYT, Loke WM. Occurrence of azo food dyes and their effects on cellular inflammatory responses. Nutrition. 2018;46:36-40.
[18] Trasande L, Shaffer RM, Sathyanarayana S, et al. Food Additives and Child Health. Pediatrics. 2018;142(2):e20181408.
[19] Stevens LJ, Kuczek T, Burgess JR, Stochelski MA, Arnold LE, Galland L. Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children. Nutr Rev. 2013;71(5):268-81.
[20] Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012;51(1):86-97.e8.
AUTHOR
Sinead Adedipe, MS
Brittyn Coleman, MS, RDN/LD, CLT
The information provided in the Autism Nutrition Library is intended for educational purposes only and should not be interpreted as medical nutrition therapy, nutrition counseling, diagnosis, prognosis, health care treatment, instruction, advice, or any other individualized medical service. Always let your physician know about any of your health concerns, and check with your doctor or dietitian before making any diet, medication, exercise, or lifestyle changes.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any other information storage and retrieval system, without the written permission of Brittyn Coleman. This program is for the recipient ONLY.
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