Low salicylate or Feingold diet as an intervention for Autism or Asperger's syndrome and other Autism Spectrum Disorders


This fact sheet is one of over 350 fact sheets for parents of children with autism and Aspergers syndrome. Visit www.autism-help.org for practical information on communiation issues, behavioral strategies, tips for school, personal stories and more.


what are Salicylates?

Salicylates are a natural plant toxin common in most stone fruits, berries, citrus fruits (with the exception of lemon), some vegetables and very high in honey, yeast extracts and almonds. Researchers such as Rosemary Waring (Birmingham University) found a significant proportion of people with Autism were Salicylate Intolerant, meaning they were unable to properly metabolize Salicylates. This was found associated with deficiencies in an enzyme, Phenolsulphurtransferase, the lack of which lead to suppressed immunity and detoxification functions in Salicylate intolerant children.


The low Salicylate diet is commonly known as the Feingold Diet which includes eliminating artificial colorings, flavorings, preservatives and nitrates. Salicylate intolerance has been particularly linked to attentional problems and hyperactivity but more recently to mood and anxiety disorders.


Feingold diet

The Feingold diet is a food elimination program developed by Ben F. Feingold, MD to treat hyperactivity. It eliminates a number of artificial colors and artificial flavors, aspartame, three petroleum-based preservatives, and (at least initially) certain salicylates. There has been much debate about the efficacy of this program. Some mainstream medical practitioners deny that it is of any value, while other medical practitioners, as well as many people living with ADHD and parents of children with ADHD, claim that it is effective in the management of ADHD as well as a number of other behavioral, physical and neurological conditions such as Autism and Asperger’s syndrome. The debate has continued for more than 30 years, involving not only consumers and physicians, but scientists, politicians, and the pharmaceutical and food industries.

Feingold program

The Feingold Program eliminates three groups of synthetic food additives and one class of synthetic sweeteners:
• Synthetic colors (FD&C and D&C colors)
• Synthetic flavors (several thousand different chemicals)
• Synthetic preservatives (BHA, BHT, and TBHQ)
• Artificial sweeteners (Aspartame, Neotame, and Alitame).

The word “synthetic” is used instead of “artificial” because not all artificial colorings, such as titanium dioxide, are eliminated by the program. Only FD&C and D&C colorings are eliminated. Aspartame and its related chemicals have recently been eliminated from the Feingold Program because of evidence that they may be harmful to the nervous system.

During the initial weeks of the Program, certain foods containing salicylates are removed and may later be reintroduced and tested for tolerance, one at a time. Most of the problematic salicylate-rich foods are common temperate-zone fruits, as well as a few vegetables, spices, and one tree nut. During this early period, foods like pears, cashews and bananas are used, instead of foods like apples, almonds and grapes.

Contrary to popular misconception, soft drinks, chocolate and sugar have never been eliminated on the Feingold Program, although moderation is encouraged when consuming such items. Families can often continue to eat the types of food to which they are accustomed, including desserts. It is a matter of picking brands free of the unwanted additives. Most of the acceptable foods are easily available at supermarkets.


initial controversy over Feingold diet

In 1973, Dr. Feingold presented his findings at the annual conference of the American Medical Association. By that time he had eight years of clinical experience with the diet: he had treated hundreds of children, and was beginning to use this experience to develop a more user-friendly diet.

Within a few months, the Nutrition Foundation, an organization whose members included Dow Chemical, Coca Cola, and several companies who make, use, and distribute the food additives removed from the K-P diet, published statements claiming that there was “no valid scientific support” for the K-P diet. These statements are still quoted today, more than 30 years later. Over the next few years, the Nutrition Foundation funded and designed several small studies carefully crafted to show that the diet produced little effect.

A review of these studies published in 1983 concluded that possibly 2% of children respond adversely to food additives, but that even 2% was “questionable,” and that there was no need for further research on additives or for any improvement in product labeling. However, when toxicologist Bernard Weiss and autism expert Bernard Rimland analyzed these same studies, they found that they actually did support the positive effects of the Feingold diet. Because of the confusion with weight-loss diets, and because more than just diet is involved in the management of ADHD suggested by the Feingold Association, the “Feingold Diet” was renamed the “Feingold Program.”


research findings over Feingold diet

Many studies show that 70% or more of hyperactive children respond positively to the removal of synthetic additives, especially when salicylates or allergens are removed. There is controversy, however, over what happens when researchers take children whose behavior has improved on a diet that eliminates several thousand additives, and then challenge them with one or a few additives, usually synthetic colors.

Especially in the early studies, if such a challenge did not produce a change in behavior, researchers often concluded that the diet had not directly caused the initial improvement in behavior. Rather, the assumption was that the improvement had been due to a placebo effect.

There are other possible reasons for the failure of a challenge to evoke a response, however. For example, the amount of additive used as a challenge might have been too small to cause an effect. A comparison of studies using food dyes as the challenge indicates that there is likely a dose-related response: when a larger dose of the challenge is used, more children react to it. In addition, the effect of a challenge additive might only be seen in synergy with other additives or foods, or the additive used for the challenge may simply not be among those causing the original effect.


more recent findings

Recent studies show that between 50% to 85% of children placed on an additive-restricted diet show improvement. For example, in a 1994 study of 200 children, 75% of the children improved on a Feingold-type diet; more than 82% of them got worse in a double-blind challenge using small-to-modest amounts of the single food dye Tartrazine (Yellow #5), and a dose-response effect was observed.

In the biggest such study ever performed, in 1986, the performance of over a million children in 803 New York City public schools was studied for seven years. The children's average standardized test scores rose 15.7% during the years that additives were removed from their breakfast and lunch menus.

In 1997, an association between brain electrical activity and intake of provoking foods was shown in children with food-induced ADHD. Another study showed that an oligoantigenic diet (a diet with the least possible risk of allergic reaction) can work as well as Ritalin for conduct-disordered children. Other research demonstrated the positive effect of treating young criminals with dietary intervention and correction of mineral imbalances, and that toddlers show both significant reductions in hyperactive behavior when additives are removed from their diet, as well as increased hyperactivity when exposed to a very small (20 mg) amount of food coloring and a benzoate preservative. This effect was observed by parents whether or not the child was hyperactive or atopic.

A number of studies conducted since 1980 using diets similar to the Feingold Program report greater than 70% of children responding positively to the diets. Others that eliminated synthetic colors and flavors, but included salicylates still reported greater than 50% positive response.


criticisms of the Feingold diet

Over the years, a number of criticisms of the Feingold Program have been presented. Many of these center on the difficulty in avoiding synthetic additives, especially in processed or fast food or while eating out, or with social or emotional side-effects the diet may cause. Others center on the range of symptoms claimed to be improved by the Feingold Program.


Food and diet-related issues

Some critics say that the Feingold Program requires a significant change in family lifestyle and eating patterns because families are limited to a narrow selection of foods, and that such foods are often expensive, and must be prepared “from scratch”, greatly increasing the amount of time and effort a family must put into preparing a meal.

Like any change in diet, the Feingold Program does require that patients make changes in the food that they eat. However, these changes do not usually require significant changes in the types or cost of food a family may choose or the way a family chooses to prepare them. It does require making careful selections between similar alternatives, rather than wholesale changes.

Such choices can be more difficult to make in circumstances where little is known about the exact ingredients used in a product, such as at a restaurant or when purchasing food from a vending machine. This requires that a family identify restaurants or products that are not likely to create a problem. Questionable choices can also be avoided by bringing appropriate food when necessary, such as bringing a lunch to school. Parents are encouraged to keep treats available at home and school, so that the children never need feel deprived or left out.


Nutritionally, the the Feingold Program is little different from what the child would experience without it. While some fruits and a few vegetables are eliminated in the first weeks of the Program, they are replaced by others. Often, some or all of these items can be returned to the diet, once the level of tolerance is determined. Studies have found that children on the Feingold Program actually ate better than those eating a “usual” diet, and were more likely to achieve the Recommended Dietary Allowance (RDA) of various nutrients.


Psychological or behavioral issues

Other critics express concerns about social or emotional side-effects that putting children on a specific diet may have. These include that their self esteem may be undermined by implanting notions that they are unhealthy and fragile, or that children may experience situations in which the children's eating behavior or “fear of chemicals” are regarded as peculiar by other children. Some have even gone so far as to speculate the Feingold Program could contribute to a child developing an eating disorder in later life.

No clinical evidence whatsoever supports these speculations. While it is possible to use any therapy abusively, this is obviously not the intention of the Feingold Program. Children can continue to enjoy the same circumstances and experiences any other child would, and at the same time avoid the additives that trigger their symptoms.

The issues that a child on the Feingold Program faces are very similar to the issues that a child with an allergy to a common product such as lactose or peanut butter must deal with, or a condition such as diabetes. With that perspective, a child on the Feingold Program would hardly stand out as “different.” In fact, the Feingold Program could be seen as relatively liberal, as it includes sugary foods, junk foods and even fast food.


Issues around multiple symptoms

Some feel that it is absurd to think that one intervention could improve symptoms as diverse as asthma, allergies, bedwetting, chronic ear infections, headaches, and insomnia all at once. Critics point to the fact that effectiveness against a wide range of unrelated symptoms is frequently a hallmark of treatments that work via the placebo effect.

The diet was originally designed as a diagnostic elimination diet to improve food-related asthma and allergic reactions. It is therefore not surprising that it influences these problems. Only later was it found to also be effective in treating behavioral issues. In addition, many children with ADHD suffer from multiple comorbid symptoms. It has been found that there is a profile of the child most likely to benefit from the diet. The child may not have all of these symptoms: some may have few symptoms and others seem to have all of them. While the underlying physiological reason is not understood, when a patient eliminates the additives to which they are sensitive, many or even most of the symptoms contained within the profile are improved. Research supports dietary intervention for each of the symptoms in turn.


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This autism fact sheet is licensed under the GNU Free Documentation. It is derivative of an Autism and Asperger's syndrome-related articles at http://en.wikipedia.org

The low Salicylate diet is commonly known as the Feingold Diet which includes eliminating artificial colorings, flavorings, preservatives and nitrates