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Feingold Diet and Autism Ranking: No evidence

Sweets The Feingold diet (also known as the Feingold Program or KP Diet) is a type of exclusion diet which requires the individual to avoid artificial additives and salicylates.

The Feingold diet is based on the idea that some additives (such as synthetic colourings, flavourings, and preservatives) are harmful.

It is also based on the idea that salicylates (which are natural plant substances found in some foodstuffs such as citrus fruits and some medicines such as aspirin) are harmful.

The Feingold Association of the United States claims that the diet can be used to treat people with a wide range of conditions including autism and attention deficit hyperactivity disorder.

It also states that it can be used to help tackle a wide range of mental and physical health problems including gastrointestinal problems and sleep disturbances.

Please Note

The National Institute for Health and Care Excellence (NICE) made the following observations on the use of exclusion diets for adults on the autism spectrum: 

“... there is very little evidence regarding safety and efficacy for exclusion diets ... for the treatment of autism”. 

Our Opinion

Eating a healthy, balanced diet is recommended for everybody in order to maintain good health. Anyone with a particular condition (in addition to or separate from autism) may be recommended to follow a special diet by a dietitian and this should be followed on an individual basis.

The Food Standards Authority has reported that there is some research to suggest that certain artificial food colours and the preservative sodium benzoate could be linked to increased hyperactivity in some children. However, to date, we have been unable to identify any studies into the effects of the Feingold diet or other additive-free diets on people on the autism spectrum published in English-language, peer-reviewed journals.

Determining if the Feingold diet has any significant benefits for individuals on the autism spectrum is therefore not currently possible. We must wait until further research of sufficiently high quality has been completed.

The Feingold diet can involve significant inconvenience and cost, as well as significant limitations on what you can eat. Because of this, we cannot recommend its use. However, because additive-free diets are commonly used interventions for people on the autism spectrum we strongly recommend that further research is undertaken into these diets. 

This research should take the form of small scale pilot studies which use scientifically robust, experimental methodologies. It should also investigate if there are different subsets of individuals on the autism spectrum (such as those with gastrointestinal problems or those with intolerance to additives) who might benefit most from the diet.

Disclaimer

Please read our Disclaimer on Autism Interventions


Aims and Claims

Aims

According to the Feingold Association of the United States website, accessed on 2 July 2013, The aim of the Feingold Diet is to “determine if certain foods or food additives are triggering particular symptoms” and then to manage those symptoms by excluding those foods or food additives from the diet.

Some researchers have suggested that the Feingold diet, like other diets which exclude certain foodstuffs, may work because some people, including some people on the autism spectrum, are allergic to those foodstuffs.  For example, according to De Theije et al (2014),

“Based on clinical and preclinical observations, it seems feasible to hypothesize that allergic reactions to foods indeed trigger or worsen the manifestation of neurodevelopmental disorders in at least a subset of patients. In children with ASD, these allergic reactions could be both IgE as non-IgE-mediated, while in ADHD, it is more likely that non-IgE-mediated, cell-mediated, or non-allergic responses to foods are involved. We hypothesize that both prenatal and postnatal allergic immune activation regulate complex, but critical, neuroimmune interactions and therefore affect neurodevelopment and brain function. “

Please note:  

  • IgE antibodies are found in the lungs, skin, and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores, and animal dander. They are involved in allergic reactions to milk, some medicines, and some poisons. IgE antibody levels are often high in people with allergies.
  • IgE antibodies and reactions occur to proteins in foods, whereas the additives and salicylates avoided in the Feingold diet are not proteins.

Claims 

According to the Feingold Association of the United States website, accessed on 2 July 2013, the Feingold program can help with behaviour, learning and health problems.

Behaviour problems include marked hyperactivity, impulsive actions, compulsive actions, and emotional concerns.

Learning problems include short attention span, neuro muscular involvement, cognitive and perceptual disturbances.

Health problems include frequent physical complaints and sleep problems.

It also claims a success rate for families following the diet correctly at over 80%.

Audience

According to the Feingold Association of the United States website, accessed on 2 July 2013,

“Although foods / additives can induce many different symptoms in different people, the majority of families who use the Feingold Program do so to help a family member with behavior and/or learning problems”.

The website listed a number of groups who may benefit including those with a wide range of conditions including ADD/ADHD, allergy, asthma, autism/PDD)/Asperger syndrome, conduct disorder, depression, eczema, gastrointestinal (GI) problems, learning difficulties, Tourette syndrome etc.

Key Features

According to the Feingold Association of the United States website, accessed on 2 July 2013,

“The Feingold Program (also known as the Feingold Diet) is a test to determine if certain foods or food additives are triggering particular symptoms. It is basically the way people used to eat before “hyperactivity” and “ADHD” became household words, and before asthma and chronic ear infections became so very common.”

It goes on to say,

“It is a new way of shopping and eating that combines old-fashioned nutrition with modern convenience. We guide you through the process, step by step.

“First, we teach you how to determine if certain food additives or foods are triggering undesirable symptoms.

“Next, we show you how to find the food you enjoy, but in a more natural version. We also guide you to finding healthier non-food products.

“Then we show you how to comfortably make these changes a part of your life.

“Finally, we provide continual updates as products change. We share the tips we have learned so that you can streamline your shopping and have more free time to enjoy feeling good.’

In practice, the Feingold Diet requires the individual to avoid some additives (such as synthetic colourings, flavourings, and preservatives) as well as salicylates (natural plant substances found in some foodstuffs and medicines).

If you are following the Feingold diet, you should ensure that the rest of your diet is healthy and well-balanced. 

Because it can be difficult to balance your diet, we strongly recommend that you seek advice from a responsible health professional such as a health visitor or general practitioner (GP). This may lead to a referral to a dietitian – in particular one with experience of working with individuals on the autism spectrum.

Cost and Time

Cost

The cost of the Feingold diet depends on things like whether the whole family is following the diet, whether you are buying or making meals yourself, where you are buying the foodstuffs from and so on.

In practice, the major cost of following the Feingold diet is usually buying additive-free or low-salicylates foodstuffs, which are sometimes more expensive than foodstuffs which contain these things.

There may be additional costs for any materials you buy (such as recipe books or DVDs).

Time

According to the Feingold Association of the United States website, accessed on 2 July 2013,

“Its not possible to predict how long the diet will take to have an effect since there are so many variables. We can look back, however, and see how others have responded. It is fairly common to see a clear, noticeable improvement in as little as 3 days, but some people take 2 to 3 weeks. A minority of people report that the symptoms temporarily got worse before they got better. A person who is not on medication is likely to have a faster response than one who is (especially if the medicine is artificially colored!).”

There is no consensus for how long someone should continue on the diet, if the trial has been successful. However some people recommend that the individual stays on the diet for life, since it is feared he or she may regress if the diet is not followed.

Suppliers and Availability

Suppliers 

According to the Feingold Association of the United States website, accessed on 2 July 2013,

“The majority of the foods can come from your neighborhood supermarket. You might have to go to a health food store to get natural toothpaste and natural lollipops, or if you prefer, they can be mail-ordered from suppliers who cater to Feingold families.”

Credentials

There are no formal qualifications for people using the Feingold diet for since any individual, parent or carer can choose to implement the diet.

However, if you are contemplating a significant change of diet you should definitely seek advice from a qualified medical practitioner, paediatrician and/or dietitian.

The British Dietetic Association has information about qualified dieticians in the UK.

Related Suppliers and Availability


Risks and Safety

Hazards

There are many potential risks to withdrawing normal or regular foods, especially from young children. For example, according to Mari-Bauset et al (2015), “The combination of food selectivity and restrictive diets can make it difficult to achieve an adequate diet, consequently resulting in an excessive intake of certain foods and/or deficiencies and malnutrition due to insufficient amounts of other foods. In turn, inadequate intakes may lead to the development of chronic and degenerative conditions that tend to appear in the third or fourth decade of life (cardiovascular disease, high blood pressure, diabetes, dyslipidaemia, and osteoporosis, among others) or even earlier, in the case of menstrual disturbances, sleep apnoea, and psychosocial disorders”.

Contraindications

There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for the Feingold diet. 

However, some people on the autism spectrum eat only a limited range of food. They already have a less healthy and less varied diet than other people. Restricting what they eat even further may reinforce those rigid eating patterns. It may also increase their social isolation (because they can’t eat the same food as their peers at parties or restaurants). 

If you have concerns about your own diet or your child's diet you should seek advice from a responsible health professional such as a health visitor or GP. This may lead to a referral to a dietitian – in particular one with experience of working with individuals on the autism spectrum.

History

According to the Feingold Association of the United States

‘In the late 1960’s and early 1970’s, Dr. Feingold developed what he named the “KP” diet. (It was based on the Lockey allergy diet used at the Mayo Clinic.)

‘Dr. Feingold found that he could help about half of the children who were diagnosed with what was then called hyperkinesis or hyperactivity. The media changed the name of the KP Diet to the Feingold Diet, and parent support groups chose the name “Feingold Associations” to honor the doctor who had helped their families’

Current Research

We have been unable to identify any studies into the effects of the Feingold diet (or other additive-free diets or low-salicylate diets for people on the autism spectrum published in English-language, peer-reviewed journals.

The Feingold Association of the United States website lists various research studies but none of these appears to be an efficacy study of the Feingold diet for people on the autism spectrum.

We found a number of research reviews which looked at the Feingold diet for people with other conditions, particularly attention deficit hyperactive disorder. In general, these reviews concluded that the Feingold diet is unlikely to provide any significant benefits.  For example, 

  • Harley and Matthews (1978) reported “Experimental studies on Dr. Feingold's hypothesis are reviewed and the evidence fails to support the dramatic anecdotal reports of behavioral change, either qualitatively or quantitatively. Suggested sources for the discrepancy between the clinical anecdotal reports and experimental findings are presented.”
  • Kavale and Forness (1983) reported “The primary finding indicates that diet modification is not an effective intervention for hyperactivity as evidenced by the negligible treatment effects which are only slightly greater than those expected by chance. When the data were refined into groupings related to outcome and design variables, support was rendered for the primary finding. It is concluded that extant research has not validated the Feingold hypothesis and that diet modification should be questioned as an efficacious treatment for hyperactivity.”
  • Mattes (1983) reported “A review of all published, completed controlled studies, however, indicates that the Feingold diet is probably not effective, except perhaps in a very small percentage of children. The positive results in a few studies have been inconsistent between studies and greatly outnumbered by negative results. Even among children whose parents feel the diet has helped them greatly, the improvement seems more often a placebo effect, e.g., due to the increased attention the child is receiving, than a true effect of artificial colorings or flavorings.”
  • Wender (1986) reported “The claimed therapeutic effects of this diet have been investigated in a number of well-designed studies reviewed here. These studies generally refute a causal association between food additives and behavioral disturbance in children.”
  • Williams and Cram (1978) reported “A series of clinical studies of the Feingold diet have produced mixed results. More recently, there have been four sets of experimental studies which have resulted in rigorous tests of the original diet and a modified diet with salicylates included but artificial additives excluded. None of the studies give unqualified support for the hypothesized diet effects, and there are reports which refute the thesis. There are findings which suggest that some hyperactive children (10 to 25 percent), particularly younger ones, respond favourably to a diet free of artificial additives.” 

We identified a single review which looked at salicylates as a treatment for various conditions including attention deficit hyperactivity disorder.

  • Perry et al (1996) reported “There is much (renewed) interest about the effects of salicylates on food intolerance, attention-deficit disorders, and cardiovascular disease. Current evidence for the efficacy of salicylate-elimination diets in the treatment of attention-deficit disorders and hyperactivity is weak, and further investigation is required on the relationship between salicylates and cardiovascular disease.”

The Food Standards Authority website, accessed on 28 June 2017, reported that there is some research to suggest that certain artificial food colours and the preservative sodium benzoate could be linked to increased hyperactivity in some children (irrespective of whether they happen to be on the autism spectrum). 

Status Research

We have been unable to identify any studies into the effects of the Feingold diet for people on the autism spectrum published in English-language, peer-reviewed journals so we cannot comment on the status of these.

Ongoing Research

We have been unable to identify any studies into the Feingold diet that are currently underway.  If you know of any studies we should include please email info@researchautism.net with the details. 

Future Research

Summary of Existing Research

We have been unable to identify any studies into the effects of the Feingold diet for people on the autism spectrum published in English-language, peer-reviewed journals.

We found a number of research reviews which looked at the Feingold diet for people with other conditions, particularly attention deficit hyperactive disorder. In general, these reviews concluded that the Feingold diet is unlikely to provide any significant benefits.  

The Food Standards Authority website reported that there is some research to suggest that certain artificial food colours and the preservative sodium benzoate could be linked to increased hyperactivity in some children. 

Determining if the Feingold diet has any significant benefits for individuals on the autism spectrum is therefore not currently possible. We must wait until further research of sufficiently high quality has been completed.

Recommendations for Future Research

There is a need for small scale pilot studies which use scientifically robust, experimental methodologies to determine if the Feingold diet provides any benefits for people on the autism spectrum.

These studies should investigate if there are different subsets of individuals on the autism spectrum (such as those with gastrointestinal problems or those with intolerance to additives or salicylates) who might benefit most from the diet. 

These studies should also investigate which parts of the diet (exclusion of additives, or salicylates or both) provide the most benefits to which groups of people. 

It may then be possible to determine if further, large-scale trials into the diet are justified.

Studies and Trials

We have been unable to identify any studies into the effects of the Feingold diet for people on the autism spectrum published in English-language, peer-reviewed journals. 

If you know of any studies we should include in this section or in our publications database please email info@researchautism.net with the details. 

Other Reading

This section provides details of other publications on the Feingold diet. You may be able to find more publications on the Feingold Diet in our publications database.

If you know of any other publications we should include in this section or in our publications database please email info@researchautism.net with the details.

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Other Reading


Personal Accounts

The Feingold Association of the United States website contains a range of personal accounts on the use of the diet.   

Additional Information

According to the NHS Choices website, accessed on 28 June 2017, 

“Food additives are ingredients added to foods for various reasons – for example, to make them last longer.

Common food additives

You’re most likely to see the following types of additives on food labels:

  • Antioxidants stop food going off or changing colour, including foods prepared with fats or oils (such as meat pies or mayonnaise), bakery products, soup mixes and sauces.
  • Colours are used to make food more attractive. They can be natural in origin, such as curcumin (E100), which is a yellow extract of turmeric roots, or artificial, such as tartrazine (E102).
  • Emulsifiers, stabilisers, gelling agents and thickeners prevent foods from separating and give food body and texture. For example, pectin (E440) is the most common gelling agent and is used in jam.
  • Flavour enhancers bring out the flavour in foods without adding their own flavour. For example, monosodium glutamate (E621) or MSG is used in processed foods such as soups and sauces.
  • Preservatives keep food safe to eat for longer. For example, nitrite and nitrate (E249 to E252) are used in bacon, ham, corned beef and other cured meats, to stop bacteria from growing.
  • Sweeteners are used with or instead of sugar to make food taste sweet. Examples include aspartame (E951), saccharin (E954) and sorbitol (E420)”.

According to the Food Standards Agency website, accessed on 11 September 2017, 

“…certain artificial food colours and the preservative sodium benzoate could be linked to increased hyperactivity in some children.”

“A European Union-wide mandatory warning must be put on any food and drink …that contains any of the six colours. The label must carry the warning ‘may have an adverse effect on activity and attention in children.”

Related Additional Information


Updated
01 Nov 2017
Last Review
01 Sep 2017
Next Review
01 Sep 2020