The Side Effects of Artificial Food Coloring and Dyes: Cancer and ADHD

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Nearly 50 years ago, Cedars-Sinai chief of pediatrics Ben Feingold, published heresy, suggesting that artificial food colors could induce behavioral disturbances. Dow Chemical disagreed, as did Coca Cola, as well as other players within the trillion-dollar processed food industry, who were able to convince the medical establishment that it was all just one elaborate placebo effect. But the truth can only be buried for so long. In 2004, a randomized, double-blind, placebo-controlled food challenge was published. Hyperactivity in preschoolers was reduced significantly when artificial colorings and the preservative sodium benzoate were eliminated from their diets. But hyperactivity jumped back up when the additives, rather than a placebo, were reintroduced into their diets. The researchers suggest that benefit would accrue for all children if they didn’t consume artificial food colors or benzoate preservatives.

Then another randomized, double-blind, placebo-controlled food challenge was published in probably the most prestigious medical journal in the world. This time, researchers found that artificial colors and other food additives in processed foods appeared to exacerbate hyperactive behaviors—inattention, impulsivity, and overactivity—among young children, with more pronounced effects in three-year-olds relative to eight-or nine-year-olds. And indeed, a more recent randomized controlled trial in eight-or nine-year-olds in Hong Kong didn’t observe a significant effect. The authors suggested it may be because older children may be less sensitive, or the dose used was too small relative to what the kids typically consumed.

But what happens in children already diagnosed with ADHD if you remove artificial food colors? In a meta-analysis of randomized controlled trials for dietary interventions for ADHD, excluding artificial food colors from the diet significantly improved behavior.

In this meta-analysis, the data over here suggest that food colors were harmful, whether assessed by parents, observers, or attention tests, compared to studies showing the opposite. You can actually see the difference in brain waves on EEG compared to placebo.

As I highlighted years ago, the European Union requires warning labels of potential adverse effects on activity and attention in children. However, although the Food and Drug Administration in the United States has banned a few artificial colors like Red Dye No.1, Red Dye No. 2, and Red Dye No. 4 due to cancer concerns, no warning labels are required, and many artificial colors still predominate processed foods. Among grocery store products marketed to children, about 40 percent contain at least one artificial color.

In 2021, a report from the California Environmental Protection Agency highlighted the potential neurobehavioral effects of artificial food dyes in children. The authors concluded that although not all studies implicated them, the current medical literature provides a substantial amount of evidence that consumption of synthetic food dyes is associated with adverse neurobehavioral outcomes in kids, and that the FDA’s Acceptable Daily Intake levels may not adequately protect children.

For years I’ve been concerned that Red No. 3 still hasn’t been banned from food, given that it was banned more than 30 years ago from inclusion in any products that go on our skin due to cancer risk. Finally, in October 2023, the California Food Safety Act was signed banning Red Dye No. 3 from food and drinks sold throughout the state, while consumer groups, including the Center for Science in the Public Interest ,continue to petition the FDA for a national ban to prohibit use of this carcinogen.

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• Barciela P, Perez-Vazquez A, Prieto MA. Azo dyes in the food industry: features, classification, toxicity, alternatives, and regulation. Food Chem Toxicol. 2023;178:113935.
• Lok KYW, Chan RSM, Lee VWY, et al. Food additives and behavior in 8- to 9-year-old children in Hong Kong: a randomized, double-blind, placebo-controlled trial. J Dev Behav Pediatr. 2013;34(9):642-650.
• Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012;51(1):86-97.e8.
• Sonuga-Barke EJS, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013;170(3):275-289.
• "Children’s Environmental Health Center, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency. Health effects assessment: potential neurobehavioral effects of synthetic food dyes in children. CalEPA OEHHA. April 2021. "
• Bateman B, Warner JO, Hutchinson E, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child. 2004;89(6):506-511.
• McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007;370(9598):1560-1567.
• Batada A, Jacobson MF. Prevalence of artificial food colors in grocery store products marketed to children. Clin Pediatr (Phila). 2016;55(12):1113-1119.
• Feingold BF. Hyperkinesis and learning disabilities linked to artificial food flavors and colors. Am J Nurs. 1975;75(5):797-803.
• "Center for Science in the Public Interest. Color additive petition pursuant to 21 U.S.C. §§ 379e, 721(b)(1) to remove FD&C Red No. 3 from the permanent list of color additives approved for use in food and dietary supplements, 21 C.F.R. § 74.303, and for use in ingested drugs, 21 C.F.R. § 74.1303. CSPInet.org. Oct 24, 2022."
• California Food Safety Act, AB-418, Chapter 328, 2023.
• Lehto S, Buchweitz M, Klimm A, Straßburger R, Bechtold C, Ulberth F. Comparison of food colour regulations in the EU and the US: a review of current provisions. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2017;34(3):335-355.
• Hansen WH, Davis KJ, Fitzhugh OG, Nelson AA. Chronic oral toxicity of Ponceau 3R. Toxicol Appl Pharmacol. 1963;5:105-118.
• Collins TF, Black TN, Ruggles DI, Gray GC. Teratological evaluation of FD&C Red no. 2–a collaborative government-industry study. II. FDA’s study. J Toxicol Environ Health. 1976;1(5):857-862.
• Chung KT. The significance of azo-reduction in the mutagenesis and carcinogenesis of azo dyes. Mutat Res. 1983;114(3):269-281.
• List of officers and trustees. The Nutrition Foundation, Inc.
• The National Advisory Committee On Hyperkinesis and Food Additives. Final report to The Nutrition Foundation. QuackWatch.org. October 1980.
• Code of Federal Regulations. General specifications and general restrictions for provisional color additives for use in foods, drugs, and cosmetics, 21 U.S.C. 371, 379e, 379e note. March 22, 1977. Updated October 28, 2024.
• Kirkland AE, Langan MT, Holton KF. Artificial food coloring affects EEG power and ADHD symptoms in college students with ADHD: a pilot study. Nutr Neurosci. 2022;25(1):159-168.

Motion graphics by Avo Media

• ADHD
• artificial colors
• cancer
• industry influence
• red dye #3