Elimination diet

Annick Huberts-Bosch
About the Author

Annick Bosch is a PhD candidate at Karakter Child and Youth Psychiatry University Centre (Nijmegen, the Netherlands) at the TRACE project and specializes in ADHD.

The goal of the Elimination Diet (ED) is to diminish symptoms of ADHD and emotion dysregulation symptoms by means of the exclusion of specific food components. To follow the elimination diet, you need to be supervised by a dietician. He or she informs you on the list of foods that are part of the diet and can give advice on a meal plan and recipes.

The first part of the elimination diet plan consists of a 5-week phase where children follow a standardized elimination diet. All known food allergens and potential food triggers will be eliminated. In addition, sugar intake is restricted/normalized in the elimination phase. The second part (elimination diet reintroduction phase) may last up to 12 months and consists of four phases: 1) allergens; 2) sugar; 3) histamine-releasing or histamine-containing products; and 4) additives. Every 14 days a new food is introduced according to a standardized scheme in a sufficient amount as to be able to trigger ADHD symptoms. If the reintroduction of a food does not trigger the recurrence of ADHD symptoms, this food is added to the diet – after phase one is completed – and can be eaten freely. If food does seem to trigger a recurrence of ADHD symptoms according to parental ratings, the food is listed in the category ‘to be avoided’.

Results of two meta-analyses and one recent review study [1][2][3] demonstrate that elimination diets are likely to be more effective compared to other diets in reducing ADHD symptoms. For 30% of children, the diet was effective in reducing ADHD symptoms [1]. However, the elimination diet studies suffered from several limitations (i.e. no active control group, unknown long-term effects, unsatisfactory blinding, unknown biological effects and cost-effectiveness). That is why more research on effectiveness is needed.

Within the Eat2beNICE consortium, the TRACE study tries to address these issues. This is the first study to determine the short- and long-term effectiveness and cost-effectiveness of two dietary treatments (an elimination diet and a healthy diet) as initial addition to regular care as a treatment trajectory for children with ADHD. We will substantially improve upon previous studies by comparing an elimination diet with a healthy diet, comparing these two dietary treatments with regular care, examining the long-term and biological effects and including blinded and objective measurements.