The effect of artificial food colors (AFCs) on child behavior has been studied for more than 35 years, with accumulating evidence from imperfect studies. This article summarizes the history of this controversial topic and testimony to the 2011 Food and Drug Administration Food Advisory Committee convened to evaluate the current status of evidence regarding attention-deficit/hyperactivity disorder (ADHD). Features of ADHD relevant to understanding the AFC literature are explained: ADHD is a quantitative diagnosis, like hypertension, and some individuals near the threshold may be pushed over it by a small symptom increment. The chronicity and pervasiveness make caregiver ratings the most valid measure, albeit subjective. Flaws in many studies include nonstandardized diagnosis, questionable sample selection, imperfect blinding, and nonstandardized outcome measures. Recent data suggest a small but significant deleterious effect of AFCs on children’s behavior that is not confined to those with diagnosable ADHD. AFCs appear to be more of a public health problem than an ADHD problem. AFCs are not a major cause of ADHD per se, but seem to affect children regardless of whether or not they have ADHD, and they may have an
aggregated effect on classroom climate if most children in the class suffer a small behavioral decrement with additive or synergistic effects. Possible biological mechanisms with published evidence include the effects on nutrient levels, genetic vulnerability, and changes in electroencephalographic beta-band power. A table clarifying the Food and Drug Administration and international naming systems for AFCs, with cross-referencing, is provided.
Electronic supplementary material
The online version of this article (doi:10.1007/s13311-012-0133-x) contains supplementary material, which is available to authorized users.
Keywords: ADHD, Food dyes, Artificial food colors, Hyperactivity, Child behavior, FDA
In March 2011, the United States (U.S.) Food and Drug Administration (FDA) Food Advisory Committee held a hearing on the behavioral effects of synthetic food dyes, technically known as artificial food colors (AFCs). The focus of the meeting was on attention-deficit/hyperactivity disorder (ADHD), so discussion of that disorder was requested as background for understanding the data on AFCs. The controversial committee decision (8-6 vote) was not to recommend banning AFCs or requiring a warning label. This article summarizes relevant background information, further needs for research, and interim conclusions. 1
AFC Classification Systems