Food sensitivity does exist!

Additional Information for Diet Detectives

Diet and ADD - a summary for parents

Many people have very strong views about the role of diet in ADD and ADHD. Some are positive and some are vehement there is no connection! It is important that whatever your interest or involvement with ADD you are well informed about where diet fits in.
People reading this may be -

Why should anyone consider diet?

The research up until the mid 80's refuted the "diet causes hyperactivity" hypothesis. But that did not mean diet did not have a role in some children. Different researchers around the world developed better research methods. For instance, the early workers had hid the artificial colours in chocolate biscuits. Now we know chocolate is suspect in 75% of food sensitive children. The later researchers investigated the diet question in slightly different ways Mostly they had more exclusions than Feingold had in the 70's. These researchers published in the late 80's and 90's. They did find a diet-behaviour link that was statistically significant. Now we can say that those who think there is no diet-behaviour link are wrong. Those who would like the up to date research can see my review article "The role of diet and behaviour in childhood" in the J Paediatrics and Child Health, vol 33, 1997, or read my book for the interesting details.

Can diet be useful for ADD children?

The NH&MRC are right in saying diet should not be part of treatment for every ADD child. However, there are still a significant number to whom it is an important part of treatment.
Who are most likely to find diet useful? At this time this is not completely clear. It would be very useful if it was!
Diet is more likely to be useful if any of the following occur -

What might diet change in ADD and ADHD children?

I have a summary of the results of my research on the behaviours parents assessed diet as changing. It is published in Chapter 3 of my Masters thesis. Note that the biggest change is in mood - being less irritable, touchy, cranky. An important point is that change in mood was also found by other researchers around the world, each like me, researching diet for over 10 years. Parents use words like "easier to live with" about their children on their diet. Other symptoms that changed were - difficult to reason with, impulsive, poor concentration, demanding and argumentative, restless, difficult to control, tantrums and sleep problems.

What might diet change in physical symptoms?

Food sensitivity can affect not just the brain but adverse symptoms can be in any of the body's systems. This is important as families or individuals with ADD children who are food sensitive may have any of these symptoms and the symptoms may decrease with dietary intervention.
Central Nervous System, CNS
- Attention Deficit Hyperactivity Disorder ADHD, Attention Deficit Disorder ADD; irritability, mood changes, tantrums, poor self-esteem, aggression, developmental delays, hypoactivity;
- headache, migraine, problems settling to sleep or sleep, night terrors, nausea, car sickness; Gastrointestinal - swelling around mouth and throat, mouth ulcers, gagging, itchy throat, retasting food, tummy aches, vomiting, looseness or diarrhoea, Irritable Bowel Syndrome, lower gut cramping, halitosis (bad breath), constipation;
Genitourinary - frequency, scalding, mucous, bed-wetting, strong smelling urine;
Respiratory - ear aches, hay fever, rhinitis, post nasal drip, constantly clearing throat, wheezing, asthma;
Skin - eczema, psoriasis, urticaria, dermatitis, strong body odour;
Systemic - limb pains, feeling faint, anaphylactic shock.

What are common problem foods?

The diet detective process is an investigation process for each child.
What are the "usual suspects" -
Those high in additives - coloured and flavoured lollies, soft drinks, ice-cream and icypoles;
Those high in suspect natural chemicals - tomato sauce, spice, fruit juice, tangy fruit, and chocolate;
Those high in added MSG - soup cubes, 2 minute noodles, some potato and corn crisps;
Some preservatives - benzoates in soft drinks, sulphites in cordials, propionates in bread.
You need to get the full detail to run a useful trial of diet.

Before you panic and wonder how you child would survive, and since we are emphasising the positive side of ADD management, let me tell you what they can still eat. Good plain food and lots of it! Cereal and milk, plain biscuits, some juice, bread with plain cheese or meat or peanut butter fillings, some fruit, meats, fish, chicken, legumes, potato, including plain hot chips, rice or pasta, vegetables, and desserts like fruit and white custard, ice-cream, or pavlova. Fortunately the number who have to completely exclude sugar is very small so there are allowed lollies, biscuits and cakes. I remind the children that this diet is not for their waistline (most food sensitive children are normal weight or lean); it is a "brain" diet!

There are two important additions to the usual suspects -

Most people think there is "one diet" for investigating behaviour. If fact, there is one for each family.
To work this out I take a family sensitivity history. With the parents I find out what "allergic type" symptoms are in family members and what factors make them worse. People tell me things like the example in my book..."Aunty Jane can't eat spice; my mother and I get headaches from perfume, and Grandpa can't eat tomatoes". The diet detective trick here is that limitation or exclusion of whole foods is dependent on whether the food is, or was, a problem to the child or any first degree relative. If there is no family history of allergic type symptoms the child needs only consider the "usual suspects" outlined above.

These can be as big a problem as food. They can include strong smells (food sensitive children often really love or hate perfumes or petrol; and there is often one family member who gets a nickname "the smell" or one who hates walking through the perfume department in large department stores).
Environmental factors can include smells, paint, petrol, perfume, flowers, cigarettes, inhalants commonly implicated in allergy, that family members react to. The child may be worse on windy days. Other factors include increased family stress, contact dye in finger paint or coloured playdough, infections, insect bites, and seasonal factors. This "Total Body Load" is the total load of factors that may affect symptoms. Food is still an important part of this. The trick is to lower all these parts to the "Total Body Load" as much as possible. Individuals vary in which are most important in their family. Each family need only concentrate on those that affect their symptoms.

HOW do you stick to a diet?

See a dietitian, preferably one experienced in food sensitivity. If your child needs speech therapy you see a speech therapist. It is the same here. You can learn the finer points on how to be a "Diet Detective", finding out about information on allowed and disallowed foods, what you can eat at meals every day, what commercial foods to use, and how to manage fussy eating habits. You can also get my book; you do need all the information.

Decide where you can eat out - carvery's, grills, fish and chips with the fish crumbed, McDonalds with no Mac sauce. Ask for help at takeaways and restaurants.

Children can still have plain potato chips and crisps, allowed plain biscuits, desserts, lollies and cordial. Sometimes people feel cross about things they didn't know. They don't expect to know all the physiotherapy or speech therapy. Diet is a specialist area too.

"What is going on?"

The mechanism is not known, but it is certainly a pharmacological reaction - like alcohol. A good way to look at it is to consider a child who has behaviour problems, and whose parents are trying usual management and caring professionals are providing useful guidelines, but the child is accidentally being given varying amounts of alcohol. This has an add-on effect that makes everything more complex. In food sensitivity it is suspect foods and chemicals which are aggravating everything.

How do reactions show?

It is rare for people to see a reaction to a single food unless they are already on their diet, or the child is a preschooler, or they are very sensitive to that food. There are 3 types of reactions:-

To investigate whether diet affects a child, you do what I call "Diet Detective Work"

To see if diet has a role you need a baseline and you get that by lowering the Total Body Load of all suspect foods, smells etc at the same time. It often takes up to 4 weeks for any diet effect to show. Behaviour often gets worse in the first week during withdrawal. Then you challenge to find out which of the exclusions are important in your family. To do this you reintroduce everything, or groups of chemicals or single foods, for seven days or until adverse symptoms appear.

When is a reaction really a reaction to food?

When you know your baseline is right i.e. symptoms are minimal, and you bring in a test food and use it every day and you are sure the change is not due to anything else. When in doubt, double the amount of test food. If yesterday's behaviour was due to tiredness make sure sleep is sufficient and see if problems resolve. If problems are worse food is suspect. It is not always clear. Sometimes you may take the food out and reintroduce it on another occasion.

Reactions are also dependant on how "risky" test foods are. As one child said "some foods are a little bit bad, and some foods are "werry" bad". Several low risk foods can add up.

A good aspect of lowering the family "total body load" is that favourite foods can be reintroduced first. Since the load of suspect foods has been minimised, the favoured ones may be managed.

Some members of ADDISS have reported tolerating a glass of PepsiMax, but not Coca Cola.

Diet does interact with behaviour management.

Each child is still responsible for his or her actions.

Diet can be described to the child as being used "to see if, by using the diet, he can handle himself better". (Read "she" for girls.)The interaction may not be clear if the child is better by the end of the diet trial. It is often as if he is handling himself as everyone knew he was capable of. It is during challenges that any diet effect is clarified. While reintroducing suspect foods the child can try to continue the new behaviour. Where the child's bad moods, impulsivity, sleep problems, restlessness, or any other symptom return, the role of diet is shown. In over 20 years I have only had a two reports of children who were reported to improve usefully and who remained good throughout all challenges.

Many mothers report that a difficult diet is easier than a difficult child. Diet can interact in a useful way. One Mum explained the change on diet as the upward spiral effect. She had been worn down by trying management that wasn't changing anything. After the diet she found the child was less moody and touchy, so she got the energy and motivation to do more behaviour management, that bought its own benefit and so on.

Diet and medication interact.

Medication acts as if it helps the child cope with the "total body load" much easier. Generally parents report that on the diet the main change is that the child is "easier to live with", and that on medication school work improves.

Does diet affect girls and boys differently?

Just as new research say boys and girls brains are different, then the diet effect reflects this.

Outward directed behaviour - ADHD, hyperactivity, impulsive actions, aggression -occurs more often boys. Inward directed behaviour - ADD, daydreaming, impulsive speech, lack of self confidence - occurs more often girls. Of course there is overlap and variation along these scales. Each child is different.

Nutrition and food sensitivity.

Food sensitivity is not related to the quality of the diet. Because some food sensitive children are fussy, some may have inadequate diets. Steps you can take are:- Get diet working well first by finding enough accepted foods to run the diet trial; do the challenges so you know what are the important exclusions; help the fussy child change now that she feels better on the diet; then attend to good eating habits. If you try to do everything at once you will be overwhelmed! One of the benefits parents report is that when the child feels better on the diet the fussiness decreases!

Conclusion

Somehow issues of whether people believe diet has a role, and whether diet is difficult seem to be important when discussing a role for diet. However, all treatments for ADHD and ADD children are difficult in their own way. If there are indicators that you child needs speech therapy you do it because it will help your child, even if it is difficult. Diet is now one of the treatment options. Look at the indicators for whether diet should be considered. If they are there it is worth spending some time finding out how much diet can help. You can choose 'easy', 'medium', or strict levels of diet to suit your own family lifestyle. See my book "Are you food sensitive?" for details.

Links to relevant organisations

Access to "Are You Food Sensitive?" e-book: http://www.dietinvestigation.com

UK ADD Group: http://www.web-tv.co.uk/addnet.html

The Feingold Association of the United States: http://www.feingold.org

Dietitians Association of Australia: http://www.daa.asn.au/

Food Watch Catherine Saxelby: http://www.foodwatch.com.au

Nutition Australia: http://www.nutritionaustralia.org/

Journal of Paediatrics and Child Health:
http://www.blackwell-science.com/products/journals/xjpch.htm

Sabine Spiesser: http://www.users.bigpond.net.au/allergydietitian/

Food Anaphylactic Children Training & Support Assn: http://www.allergyfacts.org.au

FSANZ: http://www.foodstandards.gov.au/

RECIPES

Fresh pear muffins Makes 18 large muffins

Wet mix 125gm butter 1/2 cup sugar 1/2 cup golden syrup 2 eggs 1 cup milk 2 cups fresh pears peeled and diced = 3 whole pears Dry mix 3 cups Self Raising flour

Measure milk and eggs and allow to stand. (Curdling is less if all ingredients are at room temperature.) Turn oven on, set at 180 - 200 degrees C. Grease muffin tins or use non stick pans. Cream butter, sugar and golden syrup. Beat in eggs and add milk. Stir in the diced pears. Stir in the flour. Do not overstir. Muffin texture is enhanced by minimal mixing and minimal time before getting them into the hot oven. Heap mixture into muffin pans using a large spoon. Bake for 25 - 30 mins until a golden brown. Remove from oven, allow to stand 5 minutes before removing from pans. Muffins are best eaten on the day they are cooked. Muffins may be frozen wrapped in airtight bags. Sandwich bags are useful for storing individual muffins. Note - canned pears may be used. Drain syrup well and reduce milk to 3/4 cup. Note 2 - Wheat flour can be replaced with cornflour. Use 2 level teaspoon of baking powder to each cup of cornflour. When using cornflour use Jumbo size eggs.

Yo- yos Makes 36 single 18 pairs

1 cup S R Flour 1/2 cup cornflour 1/3 cup icing sugar 125 gm butter

Turn oven on. Set to 180 degrees C. Cream butter and icing sugar, work in flours to make a stiff dough Roll into balls (about the size of a walnut), place on oven tray. Using a fork flatten each ball a little. Bake until light fawn colour 15 - 20 minutes. Allow to cool. Join together to make yo-yos with melted butter icing.

Icing. Sieve 2/3 cup icing sugar. Melt 1 tablespoon (60 gm) butter in 1 tablespoon (1/8 cup) hot water.

Note this recipe can be made without wheat flour. Use 1 1/2 cups cornflour and 2 level teaspoons of baking powder, with butter and icing. Dairy free margarine can replace butter where dairy is suspect.

Compiled by Joan Breakey Dietitian/Nutritionist

Probiotics and Prebiotics - do they change food sensitivity?

PROBIOTICS - changing your gut flora by eating food containing different flora (bacteria).

PREBIOTICS - changing your gut flora by changing the type of food that goes into the gut.

Everybody has gut bacteria, or flora, that are usually present. These are determined by the usual diet. The usual gut flora contain quite a variety of bacteria.

You can change your gut flora in two different ways -

1. By changing what you usually eat. Different bacteria thrive on particular foods. If you change the type of food you eat in some way you will change the proportion of the various bacteria that grow in your gut. Prebiotics is the name given to the process of changing your flora by changing the food eaten. ["pre" = "before"]. If your usual food is high in grains/ bread/ pasta one type of bacteria will predominate. If your usual food is high in meats, fish, chicken or legumes different bacteria will thrive. Well cooked starches may encourage different bacteria to those produced after soft cooked breads.

2. The other way to change your gut flora is to feed yourself different bacteria. This is called Probiotics. This happens when you eat food containing live bacteria, such as in yoghurt with acidophilus. Since digestion occurs all along the gut, many of the bacteria do not suvive to make a difference to your usual flora in the intestine. Those bacteria thought to survive to be useful in the bowel are those in Nestle LC1 and Valalia GG and Yacult. You need only 1/4 cup / day. However you need to keep having these every day or you will revert to your usual flora. If someone is extremely sick, such as infants with diarrhoea in developing countries, or people with severe medical problems in the gut, researchers have found that feeding probiotics has been useful. The research has shown that providing new flora has helped enhance gut wall health and normal function. Research in Europe shows that use of Lactobacillus GG enhances normal function in immunological and non-immunological mechanisms that provide barriers to absorption of undesirable antigens. This is particularly so where there is inflammation of the gut.

The important question for those who suspect food sensitivity is "Does it help if you have an inherited allergy to some food?" At this time we do not know. Are probiotics useful after a gut infection or after antibiotics? After a gut infection, or after using antibiotics, it appears wise to re-establish preferred gut flora using a probiotic food. Are probiotics useful in intolerance to natural and added chemicals? In Australia those working with food sensitive families have not seen useful improvements in food tolerance after families have used probiotic foods to find out. This may be because probiotics do not affect absorption of natural and added chemicals in those who are sensitive to them.

Are probiotics useful in those allergic to whole foods? The European research supports its use here, especially in infants, especially where diarrhoea is present. The main problem is that most infants with allergies cannot tolerate dairy foods, and so cannot be given a yoghurt to provide the preferred bacteria. If you have an infant you are concerned about, do discuss this with your doctor or dietitian. You may need to find a bacterial preparation with the desired bacteria with no dairy solids in it. This discussion raises an important idea. Usually, most thinking about food sensitivity is about what foods and chemicals should be excluded. Further research will look at the next layer in this complex issue. That is, can we change factors affecting digestion, absorption, metabolism or excretion so that reactions are lessened. At present, it is best to concentrate on doing "diet detective work" to ensure you have the diet right for you and your family.

More information on Commercial Foods

The story of high Spirit foods.

Presentation at Eating into the Future Conference Adelaide SA 1999.

Joan Breakey DNFS Cert Diet TTTC Bsc MAppSc

Once upon a time in a galaxy far, far away lived a people who were rather like us. Their food was like ours, except that it contained a part called Spirit. The people were a primitive society so no one knew much about Spirit. They enjoyed their food. Spirit was spread throughout the food supply with varying amounts in different foods. It varied even more with different seasons and in different provinces. Some foods had none at all. Mostly foods high in spirit were in short supply. In some villages they were only used on special occasions or in their natural medicines.

In other villages the local food was high in Spirit. The effect of Spirit was not noticeable even there, as the people had adapted well, or were tolerant of the excitable or active behaviour it caused. In all the provinces of the planet, the people developed practices that included using minimal high Spirit food in babies and in those who were frail. A small number of people decided they would not eat high Spirit food as it kept them awake, or they got sick in some way. Most other people who never had these things happen told them they were just fussy. As the planet people travelled they bought foods from other provinces home to their villages. Their communities tried out the new foods and often just added those, like spicy Spirit foods, in very small amounts, and a tradition of careful use of foods that happened to be high in Spirit resulted.

As the planet developed, the planet people became good at investigating their world and their food. They learned that their food contained many parts that were good for life extending.

The planet people modernised in many ways. They had access to many high Spirit foods and enjoyed them. Very few had problems, and these happened only in certain families anyway, mostly the families who were seen as fussy about food. Big food suppliers learned how to make high Spirit parts, so they added them to foods. The planet people liked them as the new foods looked and tasted good and the food suppliers made more and more.

One year a charismatic healer expert in rashes, noticed that when he stopped sick people eating high-Spirit-food, not only did the rashes go away but their brains worked much better. This was seen as a miracle by some people, especially the families who were seen as fussy about food. They started societies promoting low Spirit food. The charismatic healer really disturbed the big villages with his idea that high Spirit foods may be poisonous for all children. He focussed on the increased intake of added Spirit as the poison.

Healers who were good at investigating problems put children on low Spirit foods and hid one of the added Spirit parts to see what would happen. Not much did, so all the other healers and the rulers said added Spirit was of no concern. Other healers who were also good at investigating things saw that high Spirit foods could have different effect on a small number of people. Some of this small number became excitable, some wakeful, some "touchy", some acted immature, and some wanted to fight everyone. Some got headaches, sometimes very bad ones, and some became sick. These investigators gradually understood more. They saw that an added Spirit part that was not investigated was used in much greater amounts than the one used in the first investigations. They also noticed that hiding added Spirit in favourite children food was a problem as the favourite brown food was high in a natural Spirit. They noticed that some children had problems with some foods which were not high in Spirit at all. These were foods that often caused rashes.

Some people who were good at investigating things found that many natural high Spirit food contained parts that prevented many of the illnesses that made many planet people die early. It was interesting that those illnesses did not occur much in the families who were seen as fussy about food.

The issue about Spirit turned out to be quite complicated. Some healers said it was so complicated it could not be a problem really, especially as it seemed to be affecting only a small number. Other healers continued to work with the families using low Spirit diets and saw that they were useful.

There arose in the planet people a big muddle whereby people knew that Spirit parts affected how contented people some people felt, how clearly they thought and whether they had some distressing symptoms. Most of the people were busy with other important happenings. Some even forgot that this knowledge was available. They forgot that if a small number are not thinking clearly, act before thinking, or are not content, it can affect others. The healers who were seeing these things reminded all the others who were good at finding things out to consider this knowledge in all their new learnings.

Reports of additives that cause reactions

Presentation at Eating into the Future Conference Adelaide SA 1999.

Joan Breakey DNFS Cert Diet TTTC Bsc MAppSc

What are the additives and natural chemicals considered suspect in Australia, UK, USA, and Canadian research? Artificial colours, flavours, preservatives, some added natural colours, as well as naturally occurring salicylates, amines and monosodium glutamate. Many researchers exclude perfumes. Here I want to share some findings about added colours and flavours from over 20 years of practice in this area. The detail is presented in my thesis and in my book "Are you food sensitive?" I developed what I call the "diet detective approach". Families excluded all suspect foods to give a baseline diet on which most symptoms resolved. Then I found single foods which they trialed. These foods were allowed except for one ingredient.
You can see from the following that both added natural and artificial colours and flavours are among suspect items.

Natural Flavours

Premium natural jelly (a mild product) is often tolerated by age 7, but needs 50% dilution in under 5's; natural flavoured unpreserved lemonade is often not tolerated in under 5 year olds, or in those with eczema. Natural vanilla icecream was not tolerated in 25% of my research group; natural flavoured uncoloured soft drinks (flavour strength equals usual soft drinks) need dilution before they are tolerated.

Natural flavoured lollies were mild flavoured when first released. Tolerance is decreasing as the flavour is increasing. Natural strong smoke flavours in ham and bacon are suspect. Mild flavoured ham and bacon from major supermarkets are better tolerated than speciality smoked bacon. Bacon bone which absorbs more flavours was noted as suspect in the early 1980's.

Artificial flavours

Low dose artificial flavour in caramels, white marshmallows or coconut macaroons are usually tolerated in over 5 year olds. Artificial vanillin in icecream is as well tolerated as natural vanilla icecream. The amount of artificial flavour in fruit juice drinks is poorly tolerated, as are white milk bottle lollies which contain no colour or preservative. Some families have reported that Pepsi cola produces much less reaction than Coca cola. Coca cola is the "real thing" for producing reactions! Artifically flavoured and coloured chewable antibiotics cause reactions, as does Panadol paediatric syrup. Flavours are usually added in ten time the dose of colour in foods, but they are 15 times the dose of colour in paediatric syrups.

Natural Colours

Where Natural colour is added but not visible, such as in natural Icecream cones, it is usually tolerated. Where the amount is visible, as in margarines it does cause reactions over time.

Artificial Colours

Where artificial colour is added but not visible, such as in home brand sponge cakes, it causes reactions. The dose of artificial colour in the capsules for some medicines appear tolerated in over 10 year olds. Added colour in finger or face paint or playdough when it is visible on the skin after use, is often reported causing reactions in the high users, who are often preschoolers. Bakers yellow artificial colour in products such as croissants cause reactions. .

Preservatives

Benzoate in canned natural Schweppes lemonade causes reactions. Sulphites in dried pears are not often reported as a problem in those with ADD, eczema or migraine. However one third of the research group reported reactions to sulphite in natural lemon cordial. Other workers do report reactions to sulphites in asthma and hay fever. Nitrates in home cooked pickled pork and corned beef are low risk. Half of the research sample reacted to bacon and ham. (Smoke flavours and production of amines in aged products contributed to reactions.) Propionates in breads were a problem to 30%. MSG in Soy Sauce was reported a problem in 65%. The lower amine chicken noodle soup is better tolerated. Foods which contain sorbates, gallates and nisin, in the doses currently used, are not reported as causing reactions.

It is important to remember the two old adages: "There are no poisonous substances, only poisonous doses", and "One man's meat is another man"s poison". The first is important as stresses the issue of dose. The second is important as it acknowledges that additives that are no problem to most people may be "poison" to some individuals. It is also important as it accepts that a small dose that may be no problem to most people may be a problem to some susceptible individuals.

Natural chemicals, especially those in spice, fruit and aged foods, also cause reactions. The examples quoted here are documented to show the various additives which cause reactions.

Ask Food Industry and Government for "Full Ingredient Labelling".

Presentation at Eating into the Future Conference Adelaide SA 1999.

How can the Food Industry respond?
There is a history of reasonable cooperation between the food industry, health professionals and food sensitive consumers in Australia. With new consideration of food law the existing level of trust is at an important crossroad.

I recommend the following issues be considered:

How can Government ensure it is enabling a new safe food supply?
The public health issue has been solved. Additives do not need to be banned. They do not cause hyperactivity in all children. However, that does not mean governments have no further obligation in providing a safe food supply.

I recommend the following issues be considered:-

I believe it is worth keeping the needs of food sensitive consumers in perspective. What I, and others who work with food sensitive people, ask is not unreasonable. We are not asking for additives to be banned. We are not asking for warning labels. We are asking for full ingredient labelling, that is all.

Joan Breakey, Dietitian

DIETARY MANAGEMENT OF HYPERKINESIS AND BEHAVIOURAL PROBLEMS 1977

by Joan Breakey

* This was the beginning of my "the diet detective work".

* Individual differences in foods tolerated were starting to be noticed.

* Some children reacted to chocolate.

* As well as perfumes; paint, petrol and the smell from felt pens caused reactions.

* As well as additives and natural chemicals, some individuals reacted to whole foods such as milk, wheat, eggs, and peanuts.

* When behaviour improved with diet allergic symptoms, such as eczema and diarrhoea, also improved.

Presented at the International Congress of Dietetics Sydney 1977

Published in the Australian Family Physician (1978) 7:720-4

Abstract

The work of Dr Ben Feingold has highlighted a relationship between foods eaten and behaviour. The application of the Australian version of the Feingold diet for hyperkinesis and other behaviour and learning disorders was investigated and factors altering dietary effectiveness were evaluated. The sample of 71 families seen by a dietitian in private practice included 15 hyperactive children via a Community Health Centre (after testing and found positive to a colour allergy test). The remainder, included eight adults were referred privately by GP's and a local psychiatrist. The period of diet use by the group ranged from two to sixteen months, with an average of six months,.

Questionnaires were given to parents at monthly follow-up meetings to help understand the factors involved in the use of the diet within the family.

Of the 71 families using the diet, 62 felt sufficient change to continue adherence. Thirty-five had a "dramatic" response as evidenced by changes in behaviour, learning difficulty, sleep patterns or bedwetting. As well as the exclusions suggested by Feingold and Woodhill, it was found that, in individual cases behaviour deterioration consistently correlated with relatively high intakes of milk, bread and flour products, eggs, tinned pineapple juice, potatoes, pumpkin, zucchini, bananas, peanuts or chocolate.

With careful dietary instruction intakes of nutrients reached Recommended Dietary Allowances for Australians, and no vitamin supplementation was necessary.

Feingold advises that best results are obtained if the whole family complies with the diet. From this group it became evident that in many families response to the diet was not restricted to the hyperactive child, with reports from parents of specific, consistent changes in themselves or in siblings after dietary infringements by them individually.

The Feingold concept has broadened the base of diet therapy further into behavioural areas with the awareness of the significance of the effect of compounds other than nutrients in foods.

A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children 1991

by J. Breakey, M. Hill, C. Reilly and H. Connell

* Information from 500 children using diet was collected over five years in the 1980's.

* Some improved so much they became just like children are generally.

* Some improved a useful amount but were still outside the normal range.

* One in ten benefited from using both diet and medication.

* There were no differences in the proportion of boys or girls who responded to diet.

* Information on salicylate in Australian foods was now available and was a useful guide.

* However, tolerance of foods did not follow the analysis completely e.g. apples were not tolerated.

* The level of strictness needed to concentration was greater than to improve behaviour.

* As children grow their tolerance improves, so babies and preschoolers need strict diet adherence.

* Food sensitive children are fussy eaters: sensitive to texture, thickness, smell and taste of food.

* Most are sensitive to smells, also to bright lights, certain sounds, and scratchy clothes.

* They seem to be hyper-reactive to their environment as much as being hyperactive!

* This study showed that diet factors "aggravate the underlying tendency".

* In this study I had the help of Michael Hill, statistician, Dr Helen Connell, senior Child Psychiatrist and author, and my supervisor, Conor Reilly, Professor of Nutrition.

Published in the Australian Journal of Nutrition and Dietetics (1991) 48:3 89-94

Abstract:
Five hundred and sixteen children attending a metropolitan child psychiatry service trailed a low additive low salicylate (LALS) diet as part of management of behavioural and learning problems. The mean age was 7.8 years; 85% were males. A positive response was obtained in 79.5% of children, with a normal range of behaviour achieved in 54.5%. Of the 25% in whom diet was necessary but not sufficient, half also required stimulant medication. Non-responders were 9.3%, those not available to follow up were 8.7% and those not implementing the treatment 2.5%. As well almost 50% limited or excluded other foods, particularly chocolate, milk and wheat. Amongst presenting problems change occurred in behaviour, social, learning, activity, sleep and allergic problems. There was no gender effect, but an age effect was evident with the proportion of responders in the under nine group being significantly higher. If there was a family history of allergy, and where there was intolerance to any food, the likelihood of a positive outcome was higher, but outcome was not affected by a belief that food affected the child. Additives and salicylates are better thought of as aggravating the underlying predisposition in susceptible children, rather than as causative agents.

A REPORT ON THE USE OF A LOW ADDITIVE AND AMINE, LOW SALICYLATE DIET IN THE TREATMENT OF BEHAVIOUR, HYPERACTIVITY, AND LEARNING PROBLEMS IN CHILDREN

by Joan Breakey

* Contains the detail of my study on diet and ADHD and ADD.

* There are four main sections:-

1. The history of the thinking on food and behaviour, especially in the 1900's. It brings together the work of over 200 references to show how ideas on hyperactivity, and on the role of diet, developed over time.

2. The study of 500 children in the 1980's which showed that diet "aggravates the underlying tendency". Diet factors make whatever ADHD problems a food sensitive child has, worse. Dietary intervention decreases the problems, sometimes enough that the child moves to within the normal range.

3. An in depth study of 112 children over 18 months. A comprehensive list of ADHD and behaviour problems were investigated. The surprising result was that the area diet most changed was mood! When the list was analysed, the area that the parents reported the most change in was "irritable, touchy and cranky". Another unexpected change was in the "off with the fairies, difficult to get through to" category. ADHD features such as "poor concentration, impulsivity and restlessness" also improved, but not as much. Tolerance of natural chemicals and additives was also carefully monitored. Clinical studies like these can give the broad picture of how parents feel about diet management and how diet interacts with other care.

4. This section is a review of all aspects of the diet itself, using my research and all other researchers' work up to the early 1990's. This forms the detailed scientific basis of the foods allowed in my book "Are you food sensitive?"

I am happy to provide this thesis at cost for A$25.00 which includes GST and postage in Australia. Use the Book Order page on this Web Site.

Thesis for the degree of Master of Applied Science 1995
School of Public Health Queensland University of Technology

ABSTRACT

A review of the literature on diet and hyperactivity [more correctly termed Attention Deficit Hyperactivity Disorder - ADHD] showed that dietary factors do not cause hyperactivity, so additives do not need to be banned. But they do effect some children.

The suspect diet substances being investigated have broadened, as have the problems diet affects. There is individual variation in presenting problem profiles, in symptoms that change, in amount of change, and in suspect chemicals not tolerated. Relevant issues are the dose of suspect chemicals and the age and susceptibility of each child.

A series of clinical studies were carried out over several years to investigate this relationship and report findings. In the first study of 516 families parents reported that improvement occurred in behaviour, social, learning, activity and sleep problems, as well as in physical symptoms generally termed "allergic". Suspect diet substances and smells are better thought of as aggravating the underlying predisposition in susceptible children.

The more detailed second study of 112 children has shown dietary treatment to be clinically useful, and to produce demonstrable statistically significant change. Improvement was significant on the simple t-test evaluation of the change in the average RBRI scores; this significance was confirmed statistically with complex multivariat analysis of the behavioural profiles of the different responder groups. Almost 70% of parents reported benefit using the LAALS Diet. While the core features of ADHD [poor concentration, impulsivity and activity] were reported as improving, the most striking diet change, was in mood, with irritability improving more than any of those.

It is suggested that these food sensitive children are better described as hyper-reactive than hyperactive, reacting to many aspects of the environment, with the food components aggravating this.

An evaluation of the diet itself was made. The food substances and environmental factors which should be excluded were assessed. At different levels of strictness these exclusions form the initial screening elimination diets to investigate food intolerance in children. In addition, variation requiring reduction or exclusion of foods commonly implicated in allergy has to be incorporated, after family diet history.

In 1974 Feingold recommended a diet as the global treatment for hyperactivity. By 1994 dietary treatment has developed into a process better named Dietary investigation and management of food intolerance in children. Families begin management with a screening diet to investigate whether food intolerance is present; conduct challenges, and if there is a diet effect, use single food challenges to progress to an Individual food intolerance diet. The various diets and instructions for single food challenges are provided.

Clinical research is a useful way of investigating the many factors involved in this complex area of study. The observations presented have provided a position which allows a broader understanding of the issues occurring in the clinical situation. Guidelines for further research are presented.

References on the role of Diet in Behaviour 1999

Breakey, J. (1997) Review article The role of diet and behaviour in childhood. Journal of Paediatrics and Child Health vol 33 pp190-194.
Re salicylate
Janssen, K. Hollman, P. Venema D. van Staveren, W. Katan, M. (1996) Salicylates in Foods. Nutrition reviews vol 54 no 6 pp 357-359.
Venema, D.P. Hollman, P.C. Jannssen, K.P.L.T.M. and Katan, M. (1996) "Determination of Acetylsalicylic Acid and Salicylic Acid in Foods, Using HPLC with Fluoresence Detection" J. Agric. Food Chem. vol. 44, pp. 1726-1760.
Re flavours
Breakey J. (1998) Are you food sensitive? CE Breakey Medical Pty Ltd. Brisbane.
Perry, C.A. Dwyer, J. Jeffrey, A. Gelfand, M.D. Couris, R.R. and McCloskey, W. (1996) Health effects of Salicylates in Foods and Drugs Nutrition Reviews, vol.54, no.8, pp. 225-240.
Re Fruit exclusion in elimination diets
Mahan, LK. Escott-Stump, S. Eds. (1996) Krause's Food Nutrition and Diet Therapy. WB Saunders Philadelphia.
Thomas, B. Ed. (1994) Manual of Dietetic Practice. 2nd Edn. Blackwell Science London.
Re phenolics
Ber, A. (1985) Neutralisation of Phenolic (Aromatic) Food Components J. of Orthomolecular Psychiatry, vol. 12, no. 4, pp.5-10
Re gut flora production of phenolic compounds and sulfation mechanism
Sinaiko, R.J. (1996) The Biochemistry of Attentional/ Behavioural Problems, presented at the 1996 Feingold Association Conference in Orlando, Florida.
McFadden, S. (1996) Phenotypic variation in xenobiotic metabolism and adverse environmental response: focus on sulphur-dependant detoxification pathways. Toxicology Jul 17:111(1-3) pp 43-65.
Re noradrenaline function in ADD
Girardi, NL. Shaywitz, SE. Shaywitz, BA. Marchione, K. Fleischman, SJ. Jones, TW. Tamborlane WV. (1995) Blunted catecholamine response after glucose ingestion in children with attention deficit disorder. Pediatr Research Oct;38(4) pp 539-42.
Re flavours as haptens
Taylor, S.L. and Dormedy, E.S. (1998) The Role of Flavouring Substances in Food Allergy and Intolerance Advances in Nutrition Research vol.42, pp.1-43.
Re probiotics
Salminen, S. Isolaurie, E. Salminen, E. (1996) Probiotics and stabilisation of the gut mucosal barrier. Asis Pacific Journal of Clinical Nutrition. vol 5 pp 53-56.
Re Autism
Lucarelli, S. Frediani, T. Zingoni, A. Ferruzzi, F. Giardini, O. Quintieri, F. Barbato, M. D'Eufemia, P. Cardi, E. (1995) Food allergy and infantile autism. Panminerva Med Sept vol 37 (3) pp 137-41.
Knivsberg, A. Reichelt, K. Nodland, M. Hoien, T. (1995) Autistic Syndromes and diet: a follow-up study. Scandinavian Journal of Educational research vol 39 (3) pp 223-236.
Re EFA supplementation
Stordy, J.B. (1997) Dyslexia, attention deficit hyperactivity disorder, dysparexia - do fatty acids help? Dyslexia Review, J. Dyslexia Institute Guild, vol. 9, no. 2.
Stevens, L. Zentall, S. Abate, M. Kuczek,T. Burgess, J. (1996) Omega-3 Fatty acids in boys with behaviour learning and health problems. Physiology and behaviour vol 59 (4/5) pp 915-920.

A big "thank you" to Jean Ryan, Dietitian, Brisbane, for help in compiling these!

Amines in food - the position in 2000

Summary of presentation to Dietitians Association of Australia, Qld Branch July 2000
Joan Breakey M App S. B Sc. DNFS. Cert Diet. TTTC.

Suggestions for practice in 2001,
especially for migraine and irritable bowel syndrome.

The following guidelines are provided where amine exclusion is being undertaken -
Unless amine restriction is to accompany use of MAOI medication, amines should not be excluded in isolation.
They should be minimised, as per the DAA guidelines and the book "Are you food sensitive?" as part of the exclusions in an initial elimination diet for investigation into food intolerance. They should be excluded with suspect additives, salicylates, and monosodium glutamate.
The guidelines provided by RPAH Sydney, represent the very careful position. Exclusions of all foods reported to contain any amines is rarely necessary. The variation in amine content in food from the research is reflected in the variation in tolerance in practice. Because of this the following suggestions are made.
Foods listed below may be used with the stated qualifications, which are very important, except in particular individuals who know they react, even when conditions are perfect. Individuals with severe reactions may also wish to exclude these from their initial diet and trial them with the stated qualifications, one at a time, once diet is established.
Bananas, avocado, and broccoli and cauliflower may be used as long as they are "just ripe".
Mild flavoured spinach may be used. What is "mild" to one person may be "strong" to another.
Pork may be used as long as it is bought on the day the butcher gets it in, and cooked that day, or frozen.
Canned tuna or salmon can be used, as long as it is bought from a shop with a high turnover, and used that week. Once opened the food has to be eaten that day or frozen.
Ham and bacon may be used if bought fresh from a big self serve deli section where ham and bacon are minimally aged. The food has to be eaten that day or frozen.
Figs and sugar bananas may be used if just ripe.
Malt or white spirit vinegar a little may be used as an ingredient in a freshly prepared food.
Very fresh nuts [except almonds - excluded because of salicylates].
Copha is allowed.
Meat browned only until it smells good to the individual.
Add exclusion of any food that "smells stale" to the susceptible person
Add exclusion of any food that "tastes strong" to the susceptible person
Food sensitive individuals usually have a very good sense of smell. Use it!! Sometimes they are not aware of how noticing they are in comparison to the average person. The person in the family who is most keen to throw out food because they say it is "stale" is usually the most amine sensitive.

Once diet is established, after 4 weeks, individual food trials can be taken
Note: individuals vary in what they think they can handle.
That is appropriate.
Remember tolerance depends on "the total body load" of other suspect substances, such as salicylates, additives, MSG, stress, smells, hormone changes, and the presence of infections. Work with a dietitian and read "Are you food sensitive?" Use the idea of how "robust" you feel. People can decide on a particular occasion by smelling or tasting a food whether they will tolerate a particular amount. They are making a judgement based on what other suspect foods they have eaten and factors such as their stress and tiredness levels. Many food sensitive people become very good at judging what they can tolerate. This allows much needed flexibility to the diet. They say simply "I can tell what I can manage". We have much yet to learn about the pharmacology of amine sensitivity.

Each of the following can be trialled, one at a time, each in gradually increasing doses until symptoms appear, or for seven days.
Matured cheese, in small amounts, only if it smells very fresh.
Wine, as long as it has a "good quality bouquet" to the individual.
Chocolate is either tolerated or not tolerated. Rarely is its tolerance related to quality of flavour.
Reactions reported in those with Irritable Bowel Syndrome [IBS] and migraine are often after eating out. Is it because they ate aged food or "rich" food which is often high in amines as well as salicylate? Reactions are also reported after aged meats, including lambs fry [with a strong smell], and after cheeses that smell "stale" or "off" to the individual. It is of interest to note that chocolate is very often reported to cause migraines, but rarely produces the bad gut urgency and cramping of IBS.
I suggest that staling or strong smells - as noticed by the susceptible individual - are important. Patients report better tolerance if they avoid anything that smells "strong" or "stale" to them - at that time. Tolerance is better when they feel "robust" and worse when they feel "fragile".
----------------------------

Practice in the 1990's in Australia.
The current Australian position on the dietary management of food allergy and food intolerance in children and adults as reported by the Dietitians Association of Australia in 1996 recommends that amines be excluded in the initial exclusion diet. The paper does not provide many references on amines. Current practice is to use a careful approach and to exclude any foods reported to contain any amines.
This discussion uses relevant articles available to 2000, as well as findings in practice.
See the bibliography for references, with notes on important aspects.

What does the research say?
Advice provided on lowering amines in diets is based on analysis data, and also on reports of foods reported to induce severe reactions in patients on Monoamine oxidase inhibitor [MAOI] medication. Normally amines are oxidised by MAO enzymes in gut, nervous system and in platelets. At this time it is not known why amine sensitive people react to amines. They appear to be like all food sensitive people who have adverse reactions to natural and added chemicals in food which are no problem to the rest of the population.
On MAOI medication amines are not oxidised and patients notice headaches and some have rises in blood pressure - hypertensive crisis - which can be fatal. They need dietary advice to exclude foods containing amines.
The research provides some important information.
1. Various researchers find different amounts. The idea that particular foods contain set amounts is out of date.
2. The variation depending on preparation conditions and storage is very great. Food which is safe when very fresh may be quite dangerous when stored, and especially becoming stale or putrid.
3. Banana peels are very much higher than bananas. Avoiding the smell of the peel can be important.
The biogenic amines - aromatic amines
The amines discussed here are those found in foods and in the body:
Tyramine
The most often researched as it is implicated in reactions in people on MAOI's.
Tyramine is produced from the amino acid tyrosine, particularly that present in the dairy protein, casein, developed during cheese making. It is produced by bacteria with decarboxylase enzymes.
As reactions in people on MAOI's have been assumed to be due to the para form of Tyramine [p-TA] it has been analysed, but the meta form has also been reported to have marked effects on neurotransmitter amines - dopamine, noradrenaline and 5-Hydroxy Tryptamine.
Phenyl ethyl amine
Phenyl ethyl amine is formed by microbial decarboxylation of the aromatic amino acid phenylalanine. It is important as it is the amine in chocolate.
Tryptamine is formed from the amino acid tyrosine.
Catecholamines include noradrenaline [NA], adrenaline [A], and dopamine [DA].
5-Hydroxytryptamine [5-HT] - an endogenous vasoconstrictor
Histamine [H] - a powerful vasodilator
Diamines - putrescine and cadaverine
Polyamines - agamatine, spermidine, spermine

Findings from the research
From the research analysis we can learn that amines are formed in food by a number of different processes, and that there is the wide variation in the amount of biogenic amines in suspect foods.

Variations in amine concentration is caused by:-
1. the source of the foodstuff - foods containing proteins can provide the nitrogen
2. storage conditions - in aging of meats and maturing of cheeses
3. fermentation - in sauces and in Marmite
4. method of preparation - amount of heat and browning
5. time, before cooking and during aging
6. temperature - some temperatures are ideal for aging and amine production
7. acidity - lower acidity increases the amount of amines produced
8. cooking - increases volatilisation and decreases content
An increase in flavour intensity - sharpness - is associated with increased levels of amines.
Amines are increased during deterioration (putrefaction) of food.

Another important finding from the research is the acknowledgement of individual variation in tolerance. This is known from reports of reactions in people on MAOI's.

What is the position in USA? McCabe's review of 1986 provides a good review. Two points made are that iron deficiency seems to lower levels of MAO enzymes, and that the tyramine content cannot be predicted from appearance, flavour or variety. These are of clinical interest as many patients presenting for investigation of suspected food sensitivity have low iron levels which recover when they lower their salicylate intake, and because food sensitive people [as distinct from patients on MAOI medication] often have a supersensitive sense of smell, they may well be able to detect increases in amines.

The UK Manual of dietetic practice [Thomas 1994] provides a very useful table including a note to exclude any food which has previously produced unpleasant symptoms, and also to "eat fresh to reduce degradation of protein".

A suggested article to read is that by Kenneth et al [1999] which emphasises concern about foods which combine more than one ingredient likely to be high in amines, such as pizzas containing pepperoni and mozzarella cheese and vegie burgers which contain soy products and sauces. It is reported that pizzas will be tolerated if the ingredients are fresh.
High tyramine levels are reported in soy products with fermented soybean and bean curd [fermented tofu], and chilli soybean paste. The article recommends that all soy sauces and indeed all soybean products should be avoided.
However, his concept of the importance of freshness could also be applied to soy products.

Reported amounts of biogenic amines in food
Some points of interest

Food mg/100gm Tyramine TA

Stilton - blue 217 Note - different
Canadian Chedder 25 - 150 researchers give
Eng & NZ Chedder 50 - 100 different results
Gruyer 5 - 25
Brie, cream cheese, cottage NT
Pickled herring 303 [Others found 30-50]
Belgian dry sausage 151
Chicken liver 10 - 30
Other results 1 - 10
Banana 1 - 10
Lemon juice 2.5
Avocado 2.3
Sauer Kraut 2 - 10
Chocolate .01 - 1
Yeast extract English 10 - 220
Canadian 7 - 8
Soy Sauce Japan 15 - 90
Canada 0.2
Wine .02 - 2.5
Beer .1 - 2.2
BBQ & other fermented sauces no data available.

mgm/100gm Phenylethylamine PEA
Mild chedder 0 - 44 PEA does not increase with aging
Chocolate .1 - 1.4 most in unsweetened
Cotto Salami 70
Swede 4
Rapeseed cake 9

mgm/100gm Tryptamine T
Chedder cheese 0 - 4
Highest levels in blue cheese 100
Meat products 1 - 3 decrease on cooking but increase with putrefaction


Catecholamines mgm/100gm noradrenaline NA, adrenaline A, dopamine DA
banana .14 - 2 NA
banana .8 - 8 DA
avocado .4 - .5 DA

5-Hydroxytryptamine 5-HT
banana 1 - 3 5-HT
ripe tomato 0 - 1.2 5-HT
chocolate .1 - 2.7 5-HT

Histamine H
Grape juice concentrate 3.5
Spinach, eggplant, corn 2 - 6
Yeast extracts 20 - 280
Soy sauce 0 - 27
Sauerkraut 1 - 20
Red wine 1 - 2
Pepperoni 1 - 55
Putrefied ham 2 - 9
Sashami raw tuna 920
Tuna scombroid incidents 10 - 300
Acceptable 1 - 28
Decomposed 2 - 714
Swiss cheese 116 - 250
Blue cheese 230
Sharp cheddar 5 - 130
Meat products 0 - present if improper handling
Stockley reports in 2000 wine averages 1mg/l but higher if spoiled

Diamines - putrescine and cadaverine

Sea foods <15 - dramatic increase if spoiled to 58
There is a suggestion they act as Histamine potentiators in scombroid poisoning.
Diamines can react with nitrate to produce carcinogenic compounds.

Meat e g pork <1 - if putrefied increase to 25 of C, 149 S

Polyamines - agamatine, spermidine, spermine

Sea food <5 - same in wholesome and decomposed

Meat e g pork <1 - if putrefied inc to 806 S, 340 S

Fresh ham and sausages <25 - if smoked they increase

Cheeses low

Also reported in tomatoes, bananas, apples, oranges - levels not given

Sprouts develop amines as they deteriorate

Chives contain - tyramine, putrescine, cadaverine, spermine and spermidine!! Amounts are not known. Test carefully after diet is established.

References on amines in food

Thanks to dietitian Fiona Florakx for her extensive literature search.

Allen DH, Van Nunen S, Loblay R, Clarke, L. Adverse reactions to food.
The Medical Journal of Australia 1984; Sept; Special supplement : S37-S42.
Provides documentation of amine exclusion as part of elimination diet in Australia in 1984

Breakey J. Dietary management of the hyperkinetic syndrome. 1977 Brisbane
Yeast extracts, tomatoes excluded re histamines as well as chocolate; and overripe bananas.

Breakey J. Are you food sensitive? How to investigate your own diet. CE Breakey Medical Pty Ltd, Brisbane1998.
Provides information on overall exclusions when investigating food sensitivity, including amines.

Coutts, R. Baker, G.B. Franco, M. P. Foodstuffs as sources of psychoactive amines and their precursors: content, significance and identification. 1986, Advances in drug research; 15 : 169- 217.
This useful reference contains information on a number of different amines in food and quantities.

Dietitians Association of Australia. The dietary management of food allergy and food intolerance in children and adults. Australian Journal of Nutrition and Dietetics 1996;53:3 89-98.
The DAA position paper. Research cited re amines is Maga JA 1978.

Freitag FG, Ignacio R, Salas MA, Karoum F, Wolf ME, Diamomnd S. Apparent lack of correlation between tyramine and phenylethylamine content and the occurrence of food precipitated migraine - re-examination of a variety of food products frequently consumed in the US and commonly restricted in tyramine-free diets. 1996; 7(3) : 239-49.
Tyramine increases in poorly conserved foods, particularly meat and fish. N0on-spoiled levels very low.

Ganzler K, Kovacs A, Simon-Sarkadi L. Determination of biogenic amines by capillary electrophoresis. Journal of chromatography. 1999; March 26; 836 (2): 305-13.
1999 profiles of several amines [including cadaverine and putrescine], in wine, salami and chives.

Garrow JS. Human nutrition and dietetics: 9th edition. USA : Churchill Livingstone, 1993.
Considers lowering tyramine in relation to migraine and with use of MAOI's.

Gigirey B. Changes in biogenic amines and microbiological analysis in albacore muscle during frozen storage. Journal of Food Protection. 1998; May 61(5) : 608-15.
The level of biogenic amines such as putrescine, cadaverine, histamine, spermidine increase.

Gloria M.B. Vale, S.R. Determination of biogenic amines in cheese. Journal of AOAC International. 1997; Sept-Oct; 80 (5) : 1006-12.
Considers biogenic amines found in cheese and fish

Goodman and Gilman's The Pharmacological Basis of Therapeutics 1991
Very good re structures of amines and similar biological compounds.

Izquierdo P.M. Biogenic amines in spanish beers. Abstract only. 1996;Dec; 203(6) : 507-11.
Provides information on the various amines in beer.

Kenneth I, Schulman MD, Walker MS. Refining the MAOI diet: tyramine content of pizzas and soy products. Journal of clinical psychiatry. 1999; March 60 : 3. 191-194.
1999 reference. Provides information on amines in fermented soy products and emphasises freshness.

Kovacs A, Simon-Sarkadi L, Ganzler K. Determination of biogenic amines by capillary electrophoresis. Journal of chromatography. 1999; March 26; 836 (2) : 305-13.
1999 reference; recommended. Provides information on various amines and their sources.

Lehninger AL. Principles of biochemistry: 2nd edition. New York : Worth Publisher, 1996.
Gives useful picture of biochemistry of various amines.

Mahan LK. & Escott-stump S. Krause's Food, nutrition and diet therapy. 9th edition. USA : W.B. Saunders, 1996.
USA dietetic text. Mentions amines among pharmalogical agents in food.

McCabe B J. Dietary tyramine and other pressor amines in MAOI regimens: A review : Journal of the American Dietetic Association. 1986; vol. 86, August, pp. 1059-1061.
Good review. Update with data after 1986.

McMurray J. Fundamentals of organic chemistry : 2nd edition. Pacific Grove: California : Brooks/Cole Publishing Company, 1992
Useful for chemical structures

Pfunstein B, Tricker E, Preussmann R. Mean daily intake of primary and secondary amines from foods and beverages in W. Germany. Food and chemical toxicology. 1991; August 5 (29) : 11: 733-739.
Useful article on intake.

Richling E. Decker C. Haring D. Herderich M. Schreier P. Analysis of heterocyclic aromatic amines in wine by high performance liquid chromatography-electrospray tandemmass spectrometry. Journal of chromatography. 1997; Dec 791(1-2) : 71-7.
HA's found in wines are 100 fold lower in wines than in meat and meat products.

Salfield. Controlled study of exclusion of dietary vasoactives amines in migraine. Archives of disease in childhood, 1987.
Reported no significant difference in those on high and low amine diets and migraine.

Sullivan EA, Schulman KI. Diet and monoamine oxidase inhibitors: a re-examination. Canadian Journal of Psychiatry. 1984; Dec 29(8) : 707-11.

Swain A. Friendly Food. Murdoch Books, 1991.
Provides current guide to amines for exclusion from the initial elimination diet, from RPAH Sydney.

Stockley CS. Histamine: the culprit for headaches? Wine industry Journal. 1996; 11 (1):42-44.
Useful recent review by a clinical pharmacologist.

Sweet. Monoamine oxidase inhibitor dietary restrictions: What are we asking patients to give up? Journal of clinical psychiatry. 1995; 56 : 196-201.
Lists foods to avoid while on MAOI's.

Thomas B. Manual of Dietetic Practice 2nd edition. Edited for the British Dietetic Association by B. Thomas. London, Blackwell Science, 1994.
UK dietetic text. Useful information. Mentions individual variation and the need to eat fresh.

Williams SR. Basic nutrition and diet therapy: 9th edition, 1992.
UK text. Contains extensive list of tyramine [only] containing foods with tryamine content included.

Title: Review Article The role of diet and behaviour in childhood.

Author: J Breakey M App Sc
Dietitian in Private Practice
PO Box 8 Beachmere 4510

In the Journal of Paediatrics and Child Health (1997) 33, 190-194

Abstract
This short review has summarised the most important research, particularly that from 1985 to 1995, on the relationship between diet and behaviour. Relevant studies particularly those using double-blind placebo controlled food challenge methodology were selected, and presented within a historical context. Summary tables of the early development of concepts and later pertinent studies are provided. The research has shown that diet definitely affects some children. Rather than becoming simpler the issue has become demonstrably more complex. The range of suspect food items have broadened, and some non-food items are relevant. Symptoms which change include those seen in attention deficit disorder (ADD) and attention deficit disorder (ADHD), sleep problems and physical symptoms, with the later research emphasising particularly changes in mood. The reports also show the range of individual differences both in the food substances producing reactions and in the areas of change.

Even Newer Research - "keep watching this space"

 

Food sensitivity does exist!

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