For many decades, additives have been used in a variety of foods for various purposes. Some time ago, salt was used to preserve meats and fish, sugar to conserve fruit, herbs and spices were added to food to improve flavor, and cucumbers were pickled in vinegar solution. In this day and age, people want to consume food that is safe, inexpensive, and convenient, while maintain the flavors and colors of food items, but without the hassle of doing it themselves. With today's advances in technology and food additives, it is possible to have all of these, but at what cost? Studies, dating as far back as 1976, hypothesized an existing link between food additives and hyperactivity, which is known as the "Feingold Hypothesis". (1)
What is a Color Additive?
A color additive is a dye or matter that is capable of creating a color (alone or by means of a response with other substances) when added to foods, drinks, drugs, cosmetics, or even the human body. (1,2,3) In the United States, the Food and Drug Administration is accountable for monitoring all color additives. All color additives allowed for use in foods are categorized as "certifiable" or "exempt from certification". However, whether a color additive is certifiable or exempt from certification, both undergo severe standards of safety before their approval for utilization in foods.
Color Additives Exempt from Certification
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Color additives exempt from certification are colors that are obtained from natural sources, like insects, vegetables, fruits, minerals, or animals. For example, Italian liquor Campari contains an exempt dye called carminic acid. (4) This bright magenta color originates from dried bodies of female insects called cochineal (Dactylopius coccus Costa), which are collected mostly in Peru and Canary Islands. The female insects and their unhatched larvae obtain their color by feeding on red cactus berries. The insects are then harvested, dried, and crushed into a dye. Most of the insect's predators find carminic acid very unpleasant. Seventeen to Twenty-Four percent of carminic acid can be derived from dried cochineal. In order to produce pigments of pink, red, and purple, which are used for food coloring, it takes about 70,000 of cochineal to generate a pound of carmine. "Dannon strawberry yogurt gets its color from carmine, and so do many frozen fruit bars, candies, and fruit fillings, and Ocean Spray pink-grapefruit juice drink." (5)
Certifiable Color Additives
Certifiable color additives are manmade. (1,2,3) Every batch is tested by FDA and the manufacturer for safe consumption. Currently, in the United States, there are nine certified colors permitted for use in food; seven of the nine color additives are used in food manufacturing. Good Manufacturing Practices are the regulations that restrict the quantity of color added to foods. If too much color is added then it would increase the costs and make the foods unappealing to customers.
Since, a certifiable color additive is a more intense coloring than most coloring obtained from natural sources; it is used widely, but in smaller quantities. Also, certifiable color additives usually do not pass on unwanted flavors to foods. Certifiable color additives are more stable, therefore they provide better color consistency and mix together easily to offer an extensive variety of shades in color.
Dyes and Lakes
For food use, certifiable color additives are available as "dyes" or "lakes." (2,3) Dyes are man-made as powders, liquids, granules, or other forms, which are soluble in water. Dyes are commonly used in dry mixes, dairy products, baked goods, beverages, and other products. Lakes are forms of the dyes that are insoluble in water. Lakes are best for coloring products that have fats and oils or foods that are lacking enough moisture to dissolve dyes. Most common uses are chewing gum, coated tablets or candies such as Advil, Skillets, M&Ms, cake and donut mixes, hard candies, etc.
What is Flavor?
Flavor usually is a combination of various chemicals, but a single compound frequently delivers the primary scent. (5) "The taste buds on our tongues detect 'flavor', which is mainly the smell of gases released through drinking, chewing, or sucking of the food you are consuming. The gases flow out of the mouth and up the nostrils, or up the passageway in the back of the mouth, to a thin layer of nerve cells called the olfactory epithelium, located at the base of the nose, right between the eyes. The brain combines the complex smell signals from the epithelium with the simple taste signals from the tongue, to assign a flavor to what's in your mouth, and decides if it's something you want to eat".
What is a Flavor Additive?
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Today, on practically every label of processed foods you can find the words Artificial Flavor and/or Artificial Colors. Artificial flavor or flavor enhancer is a substance that imitates natural flavors and those that enhance flavor. (6) According to the article, "Why McDonald's Fries Taste So Good", processing techniques destroy the flavor from foods; "artificial flavor" is added to make processed foods flavorful again. (5) Schlosser (2001) discusses that biotechnology has made high advances in developing more realistic meat flavors by using techniques like heating mixtures. For instance, Red Arrow makes natural smoke flavor by burning sawdust and trapping the scent chemicals released into the air.
Why Food Additives are Utilized?
Food additives are used for many different reasons. For example, color additives are used "1) to offset color loss due to exposure to light, air, temperature extremes, moisture, and storage conditions; 2) to correct natural variations in color; 3) to enhance colors that occur naturally; 4) to protect flavors and vitamins that may be affected by sunlight during storage; 5) to provide an appealing variety of wholesome and nutritious foods that meet consumers' demands; and 6) to provide color to colorless and 'fun' foods." (1,2,3) Without color additives, food items would not be the colors they are. For instance, mint ice cream would not be green, colas would not be brown, and margarine would not be yellow.
Flavor additives and enhancers are used to improve the taste and smell of food, especially processed items, for greater appeal to the consumer. (5,6) In addition, Schlosser declares that the flavor added to processed food often costs less than the packaging of the food. (5) The amount of flavor to be added to the processed food is a very tiny amount and is very inexpensive, but the fast food industries make a profit, so it works out for them.
Furthermore, scientists have concluded that there is a connection between flavors and memory. The flavors of your childhood bring happy memories into mind and adults often return to them, not always knowing the reason. These so-called "comfort foods" bring pleasure and reassurance, which fast food industries are always working hard to promote. For instance, the happy memories of Happy Meals at McDonalds can lead to constant visits to McDonalds as an adult, like the customers who eat at McDonalds four or five times a week. "Comfort foods" lead to the fast food industries making a profit because the link between flavor and memory keeps customers coming back throughout their life. Thus, Eric Schlosser (2001) claims, "without the flavor industry, today's fast food industry could not exist."
Food Additive and Hyperactivity: Is there a Connection?
Over 30 years ago, Ben Feingold, a retired physician and a former chief of the Department of Allergy at the Kaiser-Permanence Medical Center in San Francisco, theorized the cause and treatment of hyperactivity. (7,8,9) Feingold established his theory about the link between food additives and hyperactivity primarily based on his observations of adverse reactions to aspirin, which is chemical structure is similar to salicylates (that happen naturally in many foods), and understanding of studies by other researchers on aspirin intolerance. In addition, numerous people intolerant of aspirin exhibit hypersensitivity to tartrazine (Yellow Dye No. 5). Therefore Feingold developed the hypothesis that consuming salicylates, artificial flavors, and artificial color additives play an important role in triggering hyperactivity. Using his observations and theory, Feingold published a book that includes his philosophy of treating and preventing hyperactivity by altering the diet to avoid all foods containing artificial (synthetic) colors and/or flavors and all foods high in salicylates.
In 1976, a study published in Pediatrics, titled "Food Additives and Hyperkinesis: A Controlled Double-Blind Experiment" by Conners et al evaluated the "Feingold Hypothesis". (10) A sample of 15 children finished the entire 12-week program. The subjects completed a 2-week pre-treatment stage (no medications) and a 2-week baseline stage. Before starting treatment, questionnaires were completed by parents and teachers semiweekly about the child's current behavior. The subjects were randomized to receive the experimental (K-P) diet or the control diet for four weeks each. Data was collected by parents and teachers each week for symptom ratings. An assessment was completed by a nutritionist for determine previous dietary status using a dietary questionnaire, 24-hour recall, and food frequency measure. For dietary compliance, parents recorded everything the child ate or drank in detail for 6 days of the each month and any violations that have happen during each diet period.
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The study concluded that the results were inconclusive regarding the link between hyperactivity and consumption of salicylates, artificial flavors, and artificial colors. According to the study, the data strongly supports that children consuming the Feingold diet were rated less hyperactive by the teachers. However, the same results were not observed by the parents, which may have been affected by many factors. Nonetheless, any definite conclusions should not be drawn from this study alone, since it was a small sample and lack of uniformity in the results.
In 1978, a study published in Pediatrics, titled "Hyperkinesis and Food Additives: Testing Feingold Hypothesis" by Harley et al evaluated the "Feingold Hypothesis" (11). 36 school-age boys, who were referred to the hospital for evaluation of "hyperactivity", were selected to participate in the study. The subjects were divided into three phases of the study, spring (N=10), summer (N=10), and fall (N=16), at which point, the subjects were randomized to receive the experimental diet or the control diet. The study began with a consistent interview process and a 2-week baseline phase. The subjects were on the each diet for 3 weeks during the spring and summer, and 4 weeks during the fall. Various data was collected during the study, such as neurological and physical examinations, classroom observations, and parent observations.
The study established that there is no significant data to conclude the effectiveness of the experimental (Feingold) diet. The highest ratings were derived from the parents, which may be questioned, since identifying hyperactive behavior in children by parents have been recognized to be less dependable and vulnerable. Ratings lowered in the classroom and nearly vanished in the objective neuropsychological, classroom, and laboratory observational data. However, the study stated that further research must be completed on this topic before any conclusions may be established.
In 1978, a study published in Pediatrics, titled "Synthetic Food Colors and Hyperactivity in Children: A Double-Blind Challenge Experiment" by Harley et al evaluated the phase 2 of the previous study, titled "Hyperkinesis and Food Additives: Testing Feingold Hypothesis". (12) A sample of 9 subjects was selected for this study from the highest ranking subjects in phase 1. The subjects were observed, for the first 2 weeks of baseline, on the regular diets for social-psychological, classroom behavior, and dietary information. The next 2 weeks of baseline, the subjects were observed on the experimental diet provided for the same parameters. Afterwards, the subjects continued the experimental diet for 9 weeks of the program. Classroom behaviors were record using a similar system as the Werry and Quay. Dietary compliance was determined by the detailed record the parents kept throughout the 11-week program.
The study reports that there is no clear evidence that shows a relationship between artificial additives and hyperactivity. In addition, the study discusses other authors that have determined similar results. Nonetheless, parents are focused on the Feingold diet because of the discontent of other therapy attempts, as well as, it offers an appealing and simple treatment.
In 1978, a study published in the Journal of Learning Disabilities, titled "Does Diet Affect Hyperactivity" by Rapp examines if dyes, food, or allergy relate to increased hyperactivity in some children, if sublingual food or food-coloring may be of problem-solving value, and assesses the benefit of a diet that lacks in major suspect foods and food coloring. (13) A sample of 24 non-asthmatic hyperactive children was selected for the study. The parents completed a detailed medical questionnaire about their child, including clinical signs and symptoms of allergy and allergic-tension-fatigue-syndrome and the Abbott Hyperkinesis Index Sheets during various times. Sublingual dye and food tests were conducted on the subjects on different days. Then a 7-day experimental diet trial was started, during which parents had to keep a detailed diet record of the child and to note any behavioral changes or other symptoms. After the 7-day diet, the excluded foods were re-introduced into the child's diet one at a time, while parents continued to record a detailed list of the diet and behavioral changes or symptoms.
The results of the study show that 14 of the 19 subjects have history of allergy. 17 of the 24 subjects exhibited usual allergic nasal and skin symptoms to dust and pollen. The sublingual dye test revealed that 9 of the 24 subjects had a moderate increase in activity, 5 subjects had a slight increase, and 10 of the 24 subjects had no change in activity. During the 7-day diet, 52% of the subjects showed moderate to extreme improvement within one week and continued for at least 12 weeks in 11 of the 17 subjects who pursued chosen dietary changes. Other chronic symptoms were improved moderately to extremely in 65% of the subjects within one week and continued for at least 12 weeks in 15 of the 17 subjects who pursued chosen dietary changes. In conclusion of the study, it was determined that there is a relationship between allergy and hyperactivity. In addition, the study stated that the avoidance of the selected dietary changes does have beneficial effect in children with hyperactivity.
In 2007, a study was published in the Lancet, titled "Food additives and hyperactive behaviour in 3-year-old and 8/9-year old children in the community: a randomized, double-blinded, placebo-controlled trial" by McCann et al assessed the "Feingold hypothesis". (14) A sample of 137 3-year-old children and 130 8/9-year-old children completed the study. A hyperactivity questionnaire was completed by the teachers for all the children. Parents were required to complete a 24-hour recall for the study dietitian, which determined the baseline levels of the additive containing food consumed by the children. In addition, a research assistant and a study dietitian provided complete disclosure about the study and its dietary consequences. The study was also allowed by the local ethics committee.
According to the data, there were no significant changes in the effects between 3-year-olds and 8/9-year-olds in the mix B (active mix). However, the effects of mix A (active mix) in 3-year-olds were greater than in the 8/9 year-olds, which allowed for documentation of the various reactions to the food additives. The correlation between food additives and hyperactivity continued in 3-year-olds and 8/9 year-olds when limiting data to the children who drank more than 85% of the juice and had no omitted data. The outcomes of the study demonstrate that there is a link between artificial food additives and hyperactive behavior in children.
In conclusion, the evidence demonstrates inconclusive results about the connection between food additives and hyperactivity. According to the data from the early years, the Feingold recommended diet of eliminating food items containing artificial colors, artificial flavors, and salicylates to treat and prevent hyperactivity does not show consistent outcomes for the subjects. (7,8,9) In addition, the study done by Rapp in 1978 conducted a study on hyperactivity and food additives, but also taking allergy into account, which previous studies did not do. (13) The study reported that hyperactivity is related to allergies and that avoidance of food additives may be beneficial. According to the recent study, the results state that there is a link between artificial additives and hyperactivity. (14,15)
A variety of factors may have facilitated and/or inhibited testing the hypothesis of the studies. For instance, the thorough screening processes assisted in accepting suitable subjects and eliminating any extraneous variables. The double-blind, randomized, and placebo-controlled aspect reduced the influence of prejudices and unintentional physical cues on the results, as well as, maintained a good balance of subjects between the treatment and experimental groups. The population samples were small to truly establish the conclusions about the relationship between food additives and hyperactivity. Also, the food frequency questionnaire (FFQ) and 24-hour recall offered an easy and cost effective method to collect information from the subjects (16). However, FFQ and 24-hour recall are not always accurate, since people have to rely on their memory. Additionally, among all the studies, the longest therapy program was 12 weeks, which may not be a long enough study to truly see tangible long-lasting results.
Overall, the inconclusive evidence confirms that further research must be done for definite results. Currently, it is still an open question. (1,2,3,7,8,9) However, according to the International Food Information Council Foundation, people that wish to exclude food items including food additives because of preference or alleged sensitivity may achieve this by reading the label and restricting such items. (1,2,3)