The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children

Abstract

Aims: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. Methods: A sample of 1873 children were screened in their fourth year for the presence of hyperactivity at baseline (HA), of whom 1246 had skin prick tests to identify atopy (AT). Children were selected to form the following groups: HA/AT, not-HA/AT, HA/not-AT, and not-HA/not-AT (n = 277). After baseline assessment, children were subjected to a diet eliminating artificial colourings and benzoate preservatives for one week; in the subsequent three week within subject double blind crossover study they received, in random order, periods of dietary challenge with a drink containing artificial colourings (20 mg daily) and sodium benzoate (45 mg daily) (active period), or a placebo mixture, supplementary to their diet. Behaviour was assessed by a tester blind to dietary status and by parents' ratings. Results: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. These effects were not influenced by the presence or absence of hyperactivity, nor by the presence or absence of atopy. There were no significant differences detected based on objective testing in the clinic. Conclusions: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment. Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy.

Food additives and preschool children

“…5 mg; Carmoisine 2 . 5 mg; Ponceau 4R 5 mg; sodium benzoate 45 mg) had significant adverse effects on hyperactivity in comparison with the placebo; this food additive mix is similar to that of Bateman et al (Sunset Yellow 5 mg; Tartrazine 5 mg; Carmoisine 5 mg; Ponceau 4R 5 mg; sodium benzoate 45 mg), who found a similar response (67) . Mix B used by McCann et al (Sunset Yellow 7 .…”

“…This is evident in Table 2 where four of the five studies examined the effects of various colours on hyperactivity and behaviour (64,(66)(67)(68) ; all of these studies included tartrazine, the colour most strongly associated with this effect, with many food manufacturers still hesitant to use it in their products (8) . Three studies included a blend of colours and two also included a preservative, sodium benzoate (67,68) . Each of these four studies noted some changes to behaviour in varying responses.…”

“…The other three studies requested the removal of food colourings (66) and sodium benzoate (67,68) . In three studies, parents were asked to record any dietary infarctions or deviations from this diet (65,67,68) ; however, parents may not have been aware of every food consumed over the several week trials, for example when the child was in childcare; or may have been unaware of ingredients in some foods.…”

“…In 1973, Dr Ben Feingold postulated that the consumption of food additives and natural salicylates (present in fruits) were an important factor in the development and maintenance of hyperkinesis and hyperactivity in children (61) . Since this time, these effects have been widely investigated (62)(63)(64)(65)(66)(67)(68)(69) . In order to examine this association, a literature search was carried out to identify double-blind placebo controlled trials, which examined the effects of food additives on behaviour in preschool children.…”

Food additives, essential nutrients and neurodevelopmental behavioural disorders in children: A brief review

“…Small study numbers and inconsistent methodologies noted discrepancies between parental observations and other objective assessments (8)(9)(10)(11).…”