LOW SALICYLATE OR FEINGOLD
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
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
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
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.
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
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
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
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
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.
Click here for the full
range of Asperger's and Autism fact sheets at www.autism-help.org
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