A controversial new Dutch study may have found a link between food allergies and ADHD. However, many experts are dismissing the findings. The study found that in children with ADHD, putting them on a restrictive diet to eliminate possible, previously unknown food allergies or sensitivities decreased hyperactivity for 64% of them. “There is a longstanding, somewhat inconsistent story about diet and ADHD,” said Jan Buitelaar, the lead author of the Dutch study and a psychiatrist at the Radboud University Nijmegen Medical Centre. “On the one hand, people think it’s sugar that’s the trigger, others think that food coloring could be causing ADHD. Our approach was quite different. We went [with] the idea that food may give some kind of allergic or hyperactivity reaction to the brain.”
There have been previous studies in this field, but they were limited. “This has long been viewed as a kind of a controversial approach,” Buitelaar said. “When we started the research, I was skeptical, but the results convinced me.”
In the study, of the 41 kids who completed the elimination diet, 32 saw decreased symptoms. When certain foods thought to be “triggers” for each child were reintroduced, most of the children relapsed. Among 50 kids given a “control” diet that was just a standard, healthy diet for children, no significant changes were noted. Given these findings, Buitelaar recommended that the elimination diet become part of standard of care for children with ADHD. However, while pediatricians acknowledge some effectiveness, they were against the elimination diet as part of the care for children with ADHD.
“People seem to think that dietary modification is essentially ‘free,’ but it is difficult, socially disruptive, and presents the risk for nutritional deficiency,” said Dr. Michael Daines, a pediatric allergist-immunologist at the University of Arizona. Though Daines is willing to work with families who want to try an elimination diet for treating ADHD, he feels it will only have an effect if the child is having a true food allergy or intolerance.
A coordinating committee representing 34 professional organizations, advocacy groups and federal agencies oversaw the development of the guidelines. The coordinating committee selected a 25-member expert panel, chaired by Joshua Boyce, M.D., co-director of the Inflammation and Allergic Disease Research Section at Boston's Brigham and Women's Hospital. The panel used an independent, systematic literature review of food allergy and their own expert clinical opinions to prepare draft guidelines. Public comments were invited and considered as well during the development of the guidelines.
“These guidelines are an important starting point toward a goal of a more cogent, evidence-based approach to the diagnosis and management of food allergy,” says Dr. Boyce. “We believe that they provide healthcare professionals with a clear-cut definition of what constitutes a food allergy and a logical framework for the appropriate use of diagnostic testing and accurate interpretation of the results.”
Additional topics covered by the guidelines include the prevalence of food allergy, natural history of food allergy and closely associated diseases, and management of acute allergic reactions to food, including anaphylaxis, a severe whole-body reaction. They also identify gaps about what is known about food allergy.
“The food allergy guidelines provide a rigorous assessment of the state of the science, and clearly identify the areas where evidence is lacking and where research needs to be pursued,” says Daniel Rotrosen, M.D., director of the Division of Allergy, Immunology and Transplantation at NIAID. “This information will help shape our research agenda for the near future.”
Food allergy has become a serious health concern in the United States. Recent studies estimate that food allergy affects nearly 5 percent of children younger than 5 years old and 4 percent of teens and adults. Its prevalence appears to be on the rise. Not only can food allergy be associated with immediate and sometimes life-threatening consequences, it also can affect an individual's health, nutrition, development and quality of life. While several potential treatments appear promising, currently no treatments for food allergy exist and avoidance of the food is the only way to prevent complications of the disease.
More information on the guidelines may be found at http://www.niaid.nih.gov/topics/foodAllergy/clinical/Pages/default.aspx
The authors used survey data from Project EAT (Eating Among Teens), in which two groups of adolescents (1608 middle school and 3074 high school students) completed surveys in 1999 and 2004 regarding eating habits, parental styles, and various socioeconomic variables.
Cross-sectional results for adolescent girls indicated a positive association between maternal and paternal authoritative parenting style and frequency of family meals. For adolescent boys, maternal authoritative parenting style was associated with more frequent family meals. Longitudinal results indicated that authoritative parenting style predicted higher frequency of family meals five years later, but only between mothers and sons or between fathers and daughters.
Dr. Nick and his colleagues analyzed epidemiological and health data on 156 CF patients over 40 year of age who receive care at National Jewish Health, the largest adult cystic fibrosis clinic in the nation. In addition, data were analyzed on nearly 3,000 patients from around the nation who were included in the Cystic Fibrosis Foundation Patient Registry from 1992-2007.
The researchers found that the fate of females changes considerably in the older CF population. It has long been recognized that a “gender gap” is present in CF, favoring males. Historically, females have been diagnosed later, had a poorer prognosis, and survived fewer years than males.
Accordingly, Dr. Nick's analysis showed that fewer females diagnosed as children survived to age 40. However, among those diagnosed as adults, females represented a significant majority, accounting for 72 percent of patients in Colorado and 54 percent nationally. Among the adult diagnosed patients, females survived on average 9 to 14 years longer than males.
The complex factors that account for the differential fate of female CF patients is not understood, although Dr. Nick believes it could be a mixture of behavioral and biological factors.
Dr. Nick's findings also indicate that patients diagnosed as adults do not really have milder diseases — as is commonly believed — just a delayed onset of an equally severe form of the disease. Although patients diagnosed as adults live longer than those diagnosed as children, the adult-diagnosed patients lose lung function as rapidly those diagnosed in childhood, and approximately 85% die of respiratory failure or post-transplant complications.
Dr. Nick believes there is a significant number of adults whose CF remains undiagnosed. His analysis indicates that once those patients are accurately diagnosed, proper care can significantly improve their health. Patients diagnosed as adults and subsequently followed at a CF center reversed progressive lung function decline and improved their lung function for at least four years. Older patients commonly do not get specialized CF care. It is generally recognized that the team approach to treatment provided by the 112 CF Foundation-accredited Care Centers results in better clinical outcomes. However, less than half of long-term CF survivors continued to be seen at CF Centers as they pass 40 years, with the fewest among the adult-diagnosed patients.
“In the coming years, more and more cystic fibrosis patients will be living into their 40s, 50s and beyond,” said Dr. Nick. “Our findings concerning the role of gender, in survival, progression of disease, and type of care in current long-term survivors provides important insights that will help us prepare for better treatment of the steadily aging CF population.”
While most private health funds provide rebates for visits to APDs, some patients may be eligible for a Medicare rebate instead.
The Medicare Allied Health Initiative allows chronically ill people being managed by their GP under the Enhanced Primary Care (EPC) Program access to Medicare rebates for ADP services. Eligible patients are those with a chronic condition, defined as one that is likely to be present for at least 6 months. This includes, but is not limited to, asthma, cancer, cardiovascular disease and diabetes. General practitioners must be managing the patient through the GP Management Plan (GPMP) and the need must be identified as part of a Team Care Arrangement (TCA). (Please note these are not the only criteria for Medicare eligibility for a GPMP, TCA and referral.) The dietitian must provide a service that is directly related to the management of the patient’s chronic condition. General practitioners must then fill out the EPC Program Referral Form for Allied Health Services under Medicare for the rebate to be possible. The Medicare rebate is currently $48.95 per service with out-of-pocket expenses counting toward the extended Medicare safety net. Patients are given a maximum of five allied health visits per calendar year.
Medicare rebates are now also payable for group services for patients with type 2 diabetes, on referral from a GP. Contact Medicare for further information about eligibility, requirements, rebates and referral forms.
Nastaran’s individually-designed client plans:
- Provide early diagnosis of nutrition-related health problems
- Facilitate better management of chronic conditions through diet and lifestyle change
- Lead to fewer nutrition-related secondary complications such as neuropathies from diabetes
- Dispel myths regarding fad diets
- Teach patients how to take personal responsibility for their own health status
- Raise awareness regarding nutrition-related problems like high cholesterol, diabetes and hypertension
Placement in Practitioner’s Office
Some practitioners would prefer their patients receive all medical services in their own offices. Nastaran is available for scheduled placement in your office to meet with patients you believe would benefit from professional nutrition services. From once a month, to once a week, Nastaran can accommodate your office and patient needs.
Lunch & Learn
Recognizing how quickly nutritional information changes, Nastaran offers free lunchtime programs in your office, specifically tailored to your patient base and staffing needs.
- Eating for thyroid disorder
- Celiac disease
- Chronic fatigue
- Supplement protocols
- Diabetes care and prevention
- General Nutrition
- Pediatric Nutrition
Please contact Nastaran directly with any questions regarding any of our services.