Retrospective Outcome Monitoring of ADHD and Nutrition (ROMAN): The Effectiveness of the Few-Foods Diet in General Practice

Abstract

Introduction: Double-blind placebo-controlled studies investigating the effect of a fewfoods diet (FFD) on attention-deficit/hyperactivity disorder (ADHD) have provided consistent evidence that ADHD can be triggered by foods, indicating the existence of a food-induced ADHD subtype. In 2001 the "few-foods" approach was included in an ADHD treatment protocol. This approach consists of (a) determining, by means of an FFD, whether food is a trigger of ADHD; (b) reintroducing, in FFD responders, foods to assess which foods are incriminated; (c) finally composing a personalised diet eliminating the involved foods only. In the Netherlands the few-foods approach is applied in practice. We aimed to retrospectively assess its effectiveness on ADHD and oppositional defiant disorder (ODD) in real life. Methods: Data from all children who started the few-foods approach in three specialised healthcare facilities during three consecutive months were included. Behavior was assessed at start and end of the 5-week FFD, using the ADHD Rating Scale and a structured psychiatric interview. Clinical responders (behavioral improvements ≥40%) proceeded with the reintroduction phase. Results: Data of 57 children, 27 taking medication and 15 following some elimination diet at start, were available. No differences were noted between parental scores of children with and without medication or some elimination diet at start. 21/27 (78%) children stopped taking medication during the FFD. 34/57 (60%) children were ADHD responders, 20/29 (65%) children meeting ODD criteria were ODD responders. 26/34 (76%) ADHD responders started the reintroduction phase; 14/26 (54%) still participated at six months. Teacher data were available of 18/57 (32%) children. 9/18 (50%) children were ADHD responders. Conclusion: The FFD, if applied by trained specialists, may lead to clinically relevant reduction of ADHD and ODD symptoms in general practice, and a concomitant decrease of ADHD medication. These results corroborate the existence of an ADHD subgroup with food-induced ADHD. Defining and eliminating the incriminated foods, i.e. the underlying causal triggers, may result in secondary prevention of food-induced ADHD. Research into

Towards Tailored Gut Microbiome-Based and Dietary Interventions for Promoting the Development and Maintenance of a Healthy Brain

“…Nonetheless, the precise positive and negative consequences of gut microbiota manipulation, mainly through dietary interventions in adolescent mice, have yet to be fully understood, and require more in-depth study. In this respect, human dietary interventions have already emerged as promising alternatives or adjuvant therapies for the prevention and clinical management of NDDs, at least for specific subsets of patients (23)(24)(25)(26)(27). However, further human trials should be conducted to investigate the precise role of dietary modification in rescuing behavioral and cognition alterations induced in early life, and to understand whether gut microbiota modulation mediates these effects.…”

“…In the context of NDDs, some dietary interventions, including dietary advice and specific diets or certain dietary components and supplements, may influence the onset and manifestation of neurodevelopmental impairments in childhood neurological disorders, at least in specific cohorts (23)(24)(25)(26)(27). However, a high inter-individual variation in the clinical response to different dietary interventions has been well-documented, and patient subgroups with the same diagnosed condition respond differently to certain dietary interventions (26).…”

“…In the context of NDDs, some dietary interventions, including dietary advice and specific diets or certain dietary components and supplements, may influence the onset and manifestation of neurodevelopmental impairments in childhood neurological disorders, at least in specific cohorts (23)(24)(25)(26)(27). However, a high inter-individual variation in the clinical response to different dietary interventions has been well-documented, and patient subgroups with the same diagnosed condition respond differently to certain dietary interventions (26). Accordingly, within the framework of Nutritional Psychiatry, research has focused on "precision nutrition, " which is currently working on the design of tailored microbiome-based and dietary intervention strategies to promote the development and maintenance of a healthy brain (26)(27)(28)(29).…”

“…However, a high inter-individual variation in the clinical response to different dietary interventions has been well-documented, and patient subgroups with the same diagnosed condition respond differently to certain dietary interventions (26). Accordingly, within the framework of Nutritional Psychiatry, research has focused on "precision nutrition, " which is currently working on the design of tailored microbiome-based and dietary intervention strategies to promote the development and maintenance of a healthy brain (26)(27)(28)(29). It is important to note that potential new tailored dietary-based intervention strategies could pave the way to preventing the development of NDDs in subjects with risk indicators and constitute also new alternatives for improving the clinical management of subjects diagnosed with NDD.…”

Augmenting Clinical Interventions in Psychiatric Disorders: Systematic Review and Update on Nutrition

“…Eliminating the underlying suspected trigger foods may work as secondary prevention of food-induced ADHD: the “few-foods approach” is a diagnostic protocol allowing to determine whether or not individually composed few food diets (one food per week is added to the diet) are a trigger of ADHD. If the behavioral problems do not recur, the food can be included in the diet without restriction ( 123 , 124 ).…”