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BMJ editorial highlights the evidence that food additives can have adverse effects in children

Posted Sep 12 2008 12:03pm
Posted on 26 May 2008

Back in September of last year I reported on a study which found that certain food additives (specific colourings and the food preservative sodium benzoate) had been found to have a statistically significant adverse effect on children’s behaviour and attention [1]. This study (sometimes referred to as the ‘Southampton study’) was actually performed in ‘normal’ children, though its findings would be likely to have special significance for children affected by attention deficit hyperactivity disorder (ADHD).

Despite what looked like quite compelling evidence of a significant problem here, the UK’s Food Standard’s Agency (FSA) did what it usually does when evidence comes to light that a foodstuff is hazardous to health: it dished out some proactive-sounding rhetoric and then promptly sat on its hands.

The Southampton study was subsequently reviewed by the European Food Safety Authority. Re-analysis of the data from this study led to “broadly similar conclusions” to the original paper (i.e. that food additives had statistically significant effect on activity and attention).

The EFSA panel also reviewed a wider body of evidence regarding the effect of food additives and ‘hyperactive’ behaviour. Of 22 studies spanning a 20-year period, 16 (80 per cent) reported adverse effects in at least some children. Lumping studies together (in the form of a ‘meta-analysis’) showed a significant effect too.

Despite this, the EFSA did not recommend a change in policy regarding these food additives. Part of the rationale for a decision to do nothing centred on the opinion that exclusively focusing on food additives may “detract from the provision of adequate treatment” for children with the hyperactivity. Personally, I’m having enormous difficulty following the EFSA’s logic on this one: why if food additives have been found to be detrimental is something not being done, and who said anything about focusing exclusively on this issue in the management of hyperactivity anyway? Seems to me that the EFSA contrived a hypothetical situation which made it easier for them to do nothing.

The EFSA review was reported very negatively in the British Medical Journal [2]. In a news item entitled “European agency rejects links between hyperactivity and food additives”, the journalist Rory Watson proceeds to inform readers of the EFSA’s “highly critical assessment” of the Southampton study.

The apparent disconnect between the EFSA’s findings and Rory Watson’s take on it was brought to our attention in the form of an editorial which appeared this week in, ironically enough, the BMJ [3]. This article, authored by Professor Andrew Kemp (professor of paediatric allergy and clinical immunology in Sydney, Australia) reviews the EFSA report and in particular, the finding that food additives can have a significant affect on childhood behaviour and attention.

Professor Kemp refers to the EFSA opinion that focusing on food additives may detract from other approaches, but quite rightly points out that “neglecting the substantial body of evidence on dietary factors” may also lead to inadequate treatment too.

Professor Kemp then turns his attention to some recent recommendations that have come from the American Academy of Paediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder. This body is enthusiastic about drug therapy for hyperactivity, but generally down on behavioural therapy. On the subject of dietary factors, though, the subcommittee remains silent: the influence of diet on hyperactivity was omitted from the recommendations, something which Professor Kemp is at a loss to explain (and so am I, to be honest).

Professor Kemp also draws our attention to the fact that food elimination is generally regarded as an ‘alternative’ approach, and thus something that some may view with some suspicion due to a ‘lack of evidence’. However, there is good evidence in this area, and Professor Kemp suggests that a trial of dietary therapy is therefore justified.

Personally, I don’t think the only resistance to dietary management is it’s ‘alternative’ image. Another issue is that the food industry is a powerful lobbyer and source of research funding, and some individuals may therefore be reticent about making recommendations that might be frowned upon by industry. Here in the UK, we’ve had considerable problems with conflict of interest within the FSA, and I shouldn’t imagine for one moment that the UK is the only part of the World where such conflicts can exist.

Whatever the reason, I think Professor Kemp has done a good job of exposing another example of where official bodies do not appear to be acting in the best interests of individuals. There is an argument for believing that the EFSA’s decision not to recommend a change in policy regarding additives was out of keeping with the results found in science. One wonders what the point of performing studies is if, at the end of the day, their findings are, basically, ignored. The EFSA’s inertia obviously mirrors that of the UK’s FSA. Let’s be plain about this, the science as it stands suggests that the regulatory authorities’ softly, softly approach with regard to additives is likely to put the health of children at risk.

Is it really too much to ask those we look to for guidance on health matters to give the very best advice they can? I wouldn’t be surprised if there’s a fair few parents who, on reading this, will feel a little let down.

Fortunately, as we can see, there are some within the establishment who are prepared to do what looks like the right thing. We get some indication of Professor Kemp’s motivations in the very first line of his editorial when he writes: “Whether preservatives and colourings cause or exacerbate hyperactive behaviours is an important question for many paediatricians and parents.” See that? Those, to me, look like the words of someone who is focused on being of service to real people with real problems. I reckon there’s quite a number of doctors, scientists and academics who might do well to take a leaf out of Professor Kemp’s book.

References:

1. McCann D, et al. Food additives and hyperactivity behaviour in 3-year old and 8/9 year old children in the community: A randomised double -blind-placebo controlled trail. Lancet 2007; 370: 1560-67

2. Watson R, et al. European agency rejects links between hyperactivity and food additives. BMJ 2008;336:687

3. Kemp A, et al. Food additives and hyperactivity. BMJ 2008;336:1144

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