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ADHD and Food Allergies

Anthony Kane, MD
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 addadhdadvances /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
addadhdadvances
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 /childyoulove.html) treatment, ODD, parenting issues
(addadhdadvances /betterbehavior.html), and education. You may visit
his website at addadhdadvances . To sign up for the free ADD
ADHD Advances online journal send a blank email to:
subscribe@addadhdadvances ?subject=subscribeartcity
akane@addadhdadvances
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ADHD and Food Allergies
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