September 15, 2011

Medical history scholar revisits Permanente allergist Feingold’s hyperactivity diet

Medical historian Matthew Smith's book discusses Feingold Diet controversy of the 1970s.

In the mid-1970s, a book by Kaiser Permanente’s leading allergist Dr. Ben Feingold (1899-1982) ascended “The New York Times” Best Sellers list.

Feingold was featured prominently in the press, from “The Washington Post” to “Newsweek” to the “Phil Donahue Show,” claiming to have discovered a link between food additives—such as artificial coloring—and hyperactivity, now commonly known as Attention Deficit Hyperactivity Disorder (ADHD). He published his findings in the popular book, “Why Your Child Is Hyperactive,” (Random House, 1974) , which was soon followed by another bestseller he co-authored with his wife, Helene, “The Feingold Cookbook for Hyperactive Children” (Random House, 1979).

He called his new diet the Kaiser Permanente (K-P) Diet. (The abbreviation was also short for “Kitchen Police.”) It became widely known as “The Feingold Diet.”

An alternative history of hyperactivity

Matthew Smith, Lecturer and Wellcome Trust Research Fellow at the University of Strathclyde (Glasgow, Scotland), recently published “An Alternative History of Hyperactivity: Food Additives and the Feingold Diet” (Rutgers University Press, 2011). The book chronicles the development of the Feingold Diet, the sensation it caused, and its ramifications for medical research and the history of medicine.

Allergist Ben Feingold, MD, with young patient and mother at Kaiser Permanente in San Francisco.
Allergist Ben Feingold, MD, with young patient and mother at Kaiser Permanente in San Francisco.

Smith writes that hyperactivity was a new and urgent worry of Cold-War America. As the country became increasingly interested in scientific and mathematical advancement, Americans became anxious about their children having the discipline and focus to do well in those subjects . Before 1957, the year the Soviet Union launched Sputnik, there were few journal articles pertaining to hyperactivity, Smith writes, and those that were published differ from more recent descriptions of hyperactivity. After 1957, “hundreds of researchers began studying the disorder.”

Smith said in a phone conversation that by the late 1960s, after a decade or so of intense debate, there was more or less a consensus that hyperactivity was caused by a “genetic glitch.”

A few years later, Feingold presented an alternative cause. Through his medical practice, Feingold discovered that when children’s diets were stripped of food additives, symptoms of hyperactivity disappeared in some patients.

Feingold’s breakthrough occurred during the height of the first organic food movement in the United States, Smith pointed out. A lot of parents were also dissatisfied, he added, with the idea that “the solution was a bottle of Ritalin,” a drug used to treat hyperactivity beginning in the 1960s.

When Feingold published his book in 1974, he tapped into a lot of that dissatisfaction, Smith said. The press ran with the story.

Feingold and Kaiser Permanente

Kaiser Permanente was “quietly supportive” of Feingold’s research, Smith said.

Feingold joined the organization in 1951 as the chief of the department of allergy. He had earned his MD from the University of Pittsburgh in 1924. In the late-1920s, he worked at the Children’s Clinic at the University of Austria in Vienna with Clement von Pirquet, who coined the word “allergy” in 1906.

Ben Feingold, MD, with Permanente founding physician Sidney Garfield
Feingold with Permanente founding physician Sidney Garfield

Feingold believed that “Kaiser Permanente’s system of private medical insurance was ‘a new trend in medicine,’” Smith writes. Over the next quarter of a century with Kaiser Permanente, Feingold set up numerous allergy clinics and became a “highly respected researcher” and “dedicated clinician.” He was perhaps previously most renowned for his work on flea bite allergies. With a grant from the National Institutes of Health, Feingold established the Laboratory of Medical Entomology in San Francisco, where he brought in “millions of fleas.”

In 1976, for Feingold’s 25th anniversary with Kaiser Permanente, Cecil Cutting, MD, executive director of The Permanente Medical Group, said: “Dr. Feingold has repeatedly brought national acclaim and recognition to our program with his expertise in allergy, his development of poison oak desensitization, flea antigen work, basic research in immune mechanisms, and presently in the effects of food additives.”

Controversy over Feingold’s findings

The rest of the medical community, for the most part, did not support the diet. Some treated Feingold’s latest work as “nothing more than quackery,” Smith writes.

There were numerous studies to test the effectiveness of the diet in the years following Feingold’s publication. Many of those pointed toward evidence that the Feingold Diet was ineffective, Smith said

There were problems with a lot of the studies, though, he added. Some of those studies were funded by the Nutrition Foundation, a lobbying organization for the food industry.

Smith said that when some of the studies showed that the diet was effective in some of the population, the findings were deemed inconclusive. He said that those studies “rejected the positive findings.”

Smith also added that Ritalin has only been effective in 80 percent of the population. Without making a definitive claim, he hypothesized that the Feingold Diet may be effective in some of the other cases.

The thesis of Smith’s book is that there could be a lesson for medical research from the case of the Feingold Diet. He talked with many parents who used the diet and found it effective. “Trials are always going to be an artificial situation,” he said. In the real world, things may play out differently. In short, “Talk to the people who use it.”

Regardless of the circumstances, the Feingold Diet lost its wide appeal by the mid-1980s.

A new day for the Feingold Diet?

The diet did not disappear altogether, though. The Feingold Association of the United States, for example, kept promoting the diet. Some of the diet’s supporters even took it further than Feingold would have, Smith said

The Feingold Diet appeared in the press again this year. In March, the Food and Drug Administration (FDA) opened hearings into a possible connection between artificial food coloring and hyperactivity, in which the FDA panel was to decide whether to ban artificial coloring in food. The FDA specifically cited Feingold’s research in calling for the new hearings.

The FDA panel decided not to ban artificial colorings. They said there is not a definitive link between food additives and hyperactivity, but there is enough evidence to call for more research. They also suggested that artificial food coloring may negatively affect those children already prone to hyperactivity.

Smith said that there has been other positive research done on the link between hyperactivity and food additives, some of which does not mention Feingold, perhaps because of the controversy surrounding his diet.

“It’s still a possibility that the Feingold Diet may have its day,” Smith said. “Who knows?”

Edward Derbes is a 2010 graduate of the University of California, Berkeley (UCB), earning a bachelor’s degree in Rhetoric with High Distinction (Magna Cum Laude). He co-founded and was senior editor of Divergence Magazine of Cypress, California, and formerly served on the editorial staff of the College of Environmental Design e-News at UCB. Derbes grew up in New Orleans, Louisiana.