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
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