Elimination diet no more effective than healthy diet for children with ADHD

Press release TRACE publication, 11 July 2023

An elimination diet is no better at reducing ADHD symptoms in children compared to a healthy diet based on Dutch nutrition guidelines. This can be concluded from the short-term results of the TRACE study conducted by Karakter child and adolescent psychiatry (Nijmegen, The Netherlands), in collaboration with the Dutch National Institute for Public Health and the Environment (RIVM) and with dieticians specializing in food hypersensitivity. The TRACE study is one of the clinical trials of the Eat2beNICE project. Long-term results are now being investigated.

In the elimination diet, all food allergens and triggers such as cow’s milk, gluten and artificial colors were removed as much as possible. Among the 84 children who followed this diet for five weeks, more than one-third (35%) had reductions in ADHD symptoms. For the 81 children who followed the healthy diet, this was half (51%). So a healthy diet seems to work even better.

Usual ADHD care more effective than elimination diet

The TRACE study also included 58 children who received usual care (parental counseling and/or medication). For 58% of them, this care was effective in reducing ADHD symptoms. This is a bigger reduction compared to the elimination diet, but similar to the healthy diet. In addition, in both diets the children’s blood pressure, heart rate and physical symptoms (such as abdominal pain, headaches) improved. Also, in the group of children who followed the elimination diet, sleep problems decreased. This was not the case in the care as usual group.

Research on long-term effects needed

The short-term results suggest that for the majority of children, food allergy or hypersensitivity is not associated with the degree of ADHD symptoms. It is possible, however, that in a proportion of children ADHD behavior is exacerbated by minor nutrient deficiencies. A healthy diet can counteract this. To determine whether a dietary treatment can be included in the ADHD treatment guideline, knowledge about the long-term effect of the diet is needed. The effects after 1 year are currently being investigated in the TRACE study.

TRACE study

It has long been suspected that there is a link between food and hyperactive behavior. Parents sometimes find that their child becomes a lot more active after eating foods high in artificial colors such as candy, chips or pudding. There is also increasing demand for the treatment of ADHD without medication. This is why the TRACE study was launched in 2015. A total of 223 children aged 5 to 12 participated. This study was funded from the EU research project Eat2beNICE and by the Dutch Ministry of Health, Welfare and Sport.

The results were published today in the scientific journal European Child and Adolescent Psychiatry. The article is available online here.

Further information

Publication: A. Huberts-Bosch et al. 2023. Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial. European Child Adolescent Psychiatry. https://doi.org/10.1007/s00787-023-02256-y

Webinar: Elimination Diet by Annick Huberts Bosch MSc Radboud University Netherlands