Amounts of Artificial Food Colors in Commonly Consumed Beverages and Potential Behavioral Implications for Consumption in Children

Abstract

Artificial food colors (AFCs) are widely used to color foods and beverages. The amount of AFCs the Food and Drug Administration has certified over the years has increased more than 5-fold since 1950 (12 mg/capita/day) to 2012 (68 mg/capita/day). In the past 38 years, there have been studies of adverse behavioral reactions such as hyperactivity in children to double-blind challenges with AFCs. Studies that used 50 mg or more of AFCs as the challenge showed a greater negative effect on more children than those which used less. The study reported here is the first to quantify the amounts of AFCs in foods (specifically in beverages) commonly consumed by children in the United States. Consumption data for all foods would be helpful in the design of more challenge studies. The data summarized here should help clinicians advise parents about AFCs and beverage consumption.

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Clinical Pediatrics
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DOI: 10.1177/0009922813502849
published online 13 September 2013CLIN PEDIATR
Laura J. Stevens, John R. Burgess, Mateusz A. Stochelski and Thomas Kuczek
Implications for Consumption in Children
Amounts of Artificial Food Colors in Commonly Consumed Beverages and Potential Behavioral
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Original Article
Introduction
Artificial food colors (AFCs) are added to many foods
worldwide. They are synthesized from raw materials
obtained from coal tar or petroleum by-products. In
1900, 80 different dyes were used in the United States,
but over the years most of these were taken off the mar-
ket because of safety concerns. Currently, there are 9
AFCs allowed by the Food and Drug Administration
(FDA; see Table 1). In addition to the AFCs that dissolve
in water, there are also lake AFCs. These are AFCs bound
to aluminum. Lakes are not soluble in water but are used
to color some foods because they tint by dispersion.
These types of foods include fats, gums, waxes, and oils.
Lakes are sometimes used to color fruit drinks prepared
from a powder mix but not in ready-to-drink beverages.
Artificial food colors are added to foods for cosmetic
reasons to make products more appealing. They are used
to standardize the color in products where colors may
fade during production and storage. They are also added
to make artificially flavored foods the appropriate col-
ors. For example, Red #40 is used to color foods that do
not contain real strawberries or cherries but instead use
artificial strawberry or cherry flavors. AFCs are often
added to intensify the natural color of the food because
brightly colored foods attract customers, especially chil-
dren. AFCs are used instead of natural dyes because they
are cheaper and more stable to heat, light, and other pro-
cessing exposures. Children and adolescents may con-
sume more AFCs than adults because of their higher
consumption of colored beverages, cereals, candy, and
other brightly colored foods.1
The Joint Food and Agriculture Organization/World
Health Organization Expert Committee on Food
Additives sets the acceptable daily intake (ADI) for each
color based on studies in animals (see Table 1). The ADI
is the number of mg/kg of body weight per day that can
be ingested without appreciable health risk. In the
United States the FDA also sets ADIs which are slightly
different from FAO/WHO values. The amount for each
color was set based on toxicity studies in animals;
behavioral responses of animals or children to AFC
challenges were not considered.
502849CPJXXX10.1177/0009922813502849Clinical PediatricsStevens et al
research-article2013
1Purdue University, West Lafayette, IN, USA
Corresponding Author:
Laura J. Stevens, Nutrition Science Department, Purdue University,
700 W. State Street (G-46), West Lafayette, IN 47907, USA.
Email: stevens5@purdue.edu
Amounts of Artificial Food Colors in
Commonly Consumed Beverages and
Potential Behavioral Implications for
Consumption in Children
Laura J. Stevens, MS1, John R. Burgess, PhD1, Mateusz A. Stochelski, BS1, and
Thomas Kuczek, PhD1
Abstract
Artificial food colors (AFCs) are widely used to color foods and beverages. The amount of AFCs the Food and
Drug Administration has certified over the years has increased more than 5-fold since 1950 (12 mg/capita/day)
to 2012 (68 mg/capita/day). In the past 38 years, there have been studies of adverse behavioral reactions such as
hyperactivity in children to double-blind challenges with AFCs. Studies that used 50 mg or more of AFCs as the
challenge showed a greater negative effect on more children than those which used less. The study reported here
is the first to quantify the amounts of AFCs in foods (specifically in beverages) commonly consumed by children in
the United States. Consumption data for all foods would be helpful in the design of more challenge studies. The data
summarized here should help clinicians advise parents about AFCs and beverage consumption.
Keywords
Allura Red, artificial food dyes, attention-deficit/hyperactivity disorder, childhood behavior problems, FD&C artificial
food colors, hyperactivity, sleep, tartrazine
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2 Clinical Pediatrics XX(X)
In the past 38 years, questions have arisen over the
safety of the current AFCs for some children, especially
a subpopulation of children with behavioral problems
such as attention-deficit/hyperactivity disorder. The
range of behavioral reactions reported also included irri-
tability, sleep disturbance, restlessness, and aggression.
To read more about this research see the following
reviews: Arnold et al,2, Stevens et al,3 Stevens et al,4
Kanarek,5 Weiss,6 and Millichap and Yee,7 and a 2012
meta analysis by Nigg et al.8 One thing that seems clear
from the behavioral studies is that a greater proportion
of children reacted to higher doses (≥50 mg) of AFCs9-12
than to lower amounts (<50 mg).13-19 Other important
factors were age of the child (younger children were
more reactive than older children) and time of evalua-
tion (1-3 hours postchallenge were more revealing than
later evaluations). Participants in these studies were
thought by their parents to be reactive to AFCs and were
diagnosed with “hyperkinesis,” “hyperactivity,” or
“behavior problems,” which included restlessness, irri-
tability, and sleep problems. All studies used parent rat-
ing scales except Swanson and Kinsbourne9 and Goyette
et al,19 who used a learning test and a visual distraction
test. Challenges were either with a mixture of AFCs or
Yellow #5 and/or Yellow #6. Some of the studies used a
single bolus of AFCs for the challenge while others
studied short-term exposure to AFCs.
Sources of Artificial Food Colors in
the American Diet
In 1977, the US National Research Council prepared for
FDA the results of a survey of industry on the use of
food additives, including AFCs.20 They combined use
level data with estimates of food consumption to calcu-
late intakes of each AFC by age-group. These data are
presented in Table 2. The total amount of dyes certified
by the FDA has increased 5-fold from 1950 (12 mg/
capita/day) to 2012 (68 mg/capita/day),21 including both
adults and children. Figure 1 shows the dramatic
increases in certified amounts of the total dyes, Red #40,
Yellow #5, and Yellow #6 since 1950. This estimate is
based on certification data collected by the FDA, which
tests all batches of AFCs for safety and purity in the
United States in a given year. Of course, certification
amounts are not the same as consumption amounts
because some unknown portion of the dyes will be
thrown away and never eaten. There is no recent AFC
consumption data for children or adults. These kind of
data have been collected in Australia,22 Brazil,23,24
Kuwait,25 and Ireland.26 For example, a survey by Food
Standards Australia and New Zealand assessed dietary
exposure by children and adults aged 2 years and older
to AFCs by measuring AFCs in 651samples of processed
foods and beverages and food consumption data from
1995. Australia and New Zealand allow both dyes that
are approved for use in the United States and several
dyes not approved in the United States—Amaranth,
Carmoisine, Brilliant Black, Brown HT, Green S,
Ponceau 4R, and Quinoline Yellow. They reported that
the range of dyes in fruit juices and fruit drinks was 0 to
60 mg/kg with a mean of 5 mg/kg and 0 to 58 mg/kg
with a mean of 18 mg/kg in soft drinks. They concluded
that dietary exposure for each color was well below the
ADI even for high (90th percentile) consumers. This
report had some limitations because it did not account
Table 1. Artificial Food Colorsa Allowed in the United States by the Food and Drug Administration and Their Acceptable
Daily Intakesb.
FD&C Colors Common Name Type of Chemical Shade ADIb (mg/kg/d) ADIb 30 kg child/d (mg)
Blue #1bBrilliant Blue Triphenylmethane Blue 6 180
Blue #2 Indigotine Sulfonated indigo Dark blue 2.5 75
Green #3 Fast Green Triphenylmethane Blue-green 2.5 75
Yellow #5 Tartrazine Azo Yellow 7.5 225
Yellow #6 Sunset Yellow Azo Orange 3.75 112.5
Red #3 Erythrosine Xanthene Pink 2.5 75
Red #40 Allura Red Azo Red 7 210
Citrus Red #2cCitrus Red Azo Orange
Orange BdOrange B Pyrazolone Orange-red
Abbreviations: FD&C, foods, drugs, and cosmetics; ADI, acceptable daily intake.
aOther dyes are allowed in drugs and cosmetics but not in foods.
bAcceptable daily intake (ADI) is the number of mg/kg of body weight per day that can be ingested without appreciable health risk.
cOnly used to dye orange skins.
dOnly for use in hot dog and sausage casings but no batches have been certified for at least 10 years.
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Stevens et al 3
for the other 10% who consumed more AFCs. Also, a
total AFCs consumption per person per day was not
calculated.
Data in pounds for each color was obtained using the
Freedom of Information Act from FDA and converted to
milligrams, then divided by US population for a given
year, then divided by 365 days. Total AFCs is the sum of
all colors for a particular year.
Artificial food colors are found in many different
foods, especially beverages, candy, ready-to-eat cereals,
desserts, and snack foods. They are also used in tooth-
paste, mouthwash, and many pediatric medications.
Many beverages contain AFCs and may account for a
large proportion of the AFCs consumed by children.27
These include sugar-sweetened or artificially sweetened
carbonated sodas, fruit-flavored drinks and punches,
Table 2. Amounts of Artificial Food Colors Consumed in the United States by Children in 1977, Consumers Onlya,b.
FD&C Color Age (Years) No. of Children
Intake (mg) by Age and Percentiles
Mean 50% 90% 95% 99%
Red #40
2-5 903 26.0 22.0 50.0 84.0 95.0
6-12 1776 35.0 27.0 56.0 68.0 90.0
13-17 1133 33.0 28.0 62.0 75.0 100
Yellow #5
2-5 903 13.0 11.0 23.0 28.0 37.0
6-12 1776 15.0 13.0 25.0 29.0 37.0
13-17 1133 15.0 13.0 27.0 31.0 41.0
Yellow #6
2-5 903 12.0 11.0 21.0 23.0 34.0
6-12 1776 14.0 13.0 24.0 29.0 41.0
13-17 1133 14.0 12.0 25.0 30.0 38.0
Blue #1
2-5 903 3.9 2.9 8.1 9.7 15.0
6-12 1776 4.5 3.8 8.7 11.0 15.0
13-17 1133 4.6 3.9 9.1 12.0 16.0
Blue #2
2-5 903 1.4 0.8 3.0 4.4 9.4
6-12 1776 1.6 1.0 3.4 5.3 11.0
13-17 1133 1.4 1.0 3.5 5.3 9.5
Green #3
2-5 903 NAc0.6 1.8 2.3 3.3
6-12 1776 1.1 0.4 2.3 2.7 3.5
13-17 1133 1.2 1.0 2.5 3.0 3.0
Red #3
2-5 903 9.1 8.5 16.0 18.0 26.0
6-12 1776 9.9 9.1 17.0 20.0 28.0
13-17 1133 9.6 8.8 17.0 19.0 26.0
Abbreviations: FD&C, foods, drugs, and cosmetics; NA, not applicable.
aSource: The 1977 Survey of Industry on the Use of Food Additives. Committee on GRAS List Survey, Food and Nutrition Board, National Acad-
emy of Sciences. 1979. Available from FDA using Freedom of Information Act.
bLake AFCs are not included in the data.
cIndecipherable from table in the 1977 report.
0
10
20
30
40
50
60
70
1950 1960 1970 1980 1990 2000 2010
Milligrams/per capita/per day
Year
Total AFCs Red #40 Yellow #5 Yellow #6
Figure 1. Trends in the amount of artificial food colors
manufactured for the US market since 1950 as certified
by the Food and Drug Administration for 3 common food
colors and the total of all colors.
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4 Clinical Pediatrics XX(X)
fruit drink dry mixes, sports, and energy drinks. Most
cola, root beer, and pepper-type products do not contain
AFCs but instead use caramel color made by heating
carbohydrates to a high temperature. However, caramel
color seems to have its own set of problems and is rich
in advanced glycation end products, which increase
insulin resistance and inflammation.28,29 A few carbon-
ated drinks are clear and dye-free. Other beverages such
as fruit drinks, sports beverages, and energy drinks com-
monly, but not always, contain AFCs. Most artificially
sweetened beverages also contain either caramel color
or AFCs. One-hundred percent fruit juices contain no
AFCs. Serving sizes have dramatically increased over
the years with 6.5-ounce bottles before the 1950s,
8-ounce bottles in the 1950s, 12-ounce cans beginning
in 1960, 20-ounce plastic bottles in the 1990s, followed
by 42-ounce bottles in 2011.30
How much of these beverages do children in the
United States consume each day? Researchers gathered
the following data to study childhood obesity so it is not
known if the beverages consumed were colored with
caramel coloring or AFCs. In 2011, Lasater et al31
reported that 91% of 3583 children, aged 6 to 12 years,
consumed on average 517 mL/d of sugar-sweetened
beverages. Using 2007-2008 National Health and
Nutrition Examination Survey data, they reported that
77% of all the children daily consumed on average 377
mL of fruit drinks and soda, 12% drank 289 mL of sports
drinks, and 16% consumed 219 mL of diet drinks.
The aim of the study reported here was to quantify
the amounts of AFCs found in beverages commonly
consumed by children and adolescents.
Materials and Methods
A total of 108 beverages that listed AFCs as an ingredient
were purchased from local grocery stores, superstores,
pharmacies, and convenience stores. Powdered colors
were obtained from Sensient Colors LLC (St. Louis,
MO) and were used as standards. The standards were
made up in water or 5% acetic acid solution. The 5%
acetic acid solution was used for products containing
lakes to release the dyes from aluminum. Dry beverage
mixes were prepared in water or 5% acetic acid for those
containing lakes. Beverages with intense coloration were
diluted either 1:5 or 1:10 with water or 5% acetic acid to
fall within the range of the standard curve. Following
sample preparation, 200 µL of sample was loaded in trip-
licate onto a FALCON (Franklin Lakes, NJ) 96-well flat
bottom assay plate, catalog number 353228.
Spectrophotometric analysis was done using a Power
Wave X spectrophotometer (Bio Tek Instruments,
Winooski, VT). Wavelengths used were 500 nM for Red
#40, 525 nM for Red #3, 425 nM for Yellow #5, 480 nM
for Yellow #6, 630 nM for Blue #1, 610 nM for Blue #2,
and 625nM for Green #3. For samples containing lakes,
5% acetic acid was used as a blank, otherwise water was
used. Blank absorbance values were subtracted from the
sample absorbances accordingly. Results from the spec-
trophotometer, in mg/mL, were multiplied by 240
mL/8oz to calculate the total amount of each dye in 8
fluid ounces (fl oz).
Results
The results of the spectrophotometric analyses of 108
beverages, giving estimations of the total AFCs for
8-ounce (240 mL) servings, are found in Table 3. A total
of 29 carbonated beverages were analyzed, and the
amounts of total AFCs per serving ranged from 0.7 mg
(Big Blue, Blue #1) to 34 mg (Faygo Redpop, Red #40).
Forty-seven fruit flavored drinks or punches contained
from 0.2 mg (Country Time Pink Lemonade, Red #40)
to 52.3 mg (Kool-Aid Burst Cherry, Blue #1, Red #40).
Analyses of 16 sports beverages found a total of dyes
ranging from 1.1 (Propel Zero Sports, Blue #1, Red
#40) to 22.1 mg (Powerade Orange, Yellow #6, Red
#40) while there were from 0.7 (Full Throttle Blue,
Blue #1, Red #40) to 18.8 mg (Full Throttle Red Berry,
Blue #1, Red #40) in 16 energy drinks. Not surprisingly,
Red #40 was used most commonly. Small amounts col-
ored a few beverages pink (7 Up Cherry, 1 mg Red #40)
with much larger amounts needed to produce a bright
red color (Big Red, 24.3 mg Red #40 or Faygo Redpop,
34.2 mg). Red #40 with Blue #1 was also used to dye
drinks a purple or grape color (Faygo Grape, 3.5 mg
Blue 1, 11.6 mg Red #40). Yellow #5 colored beverages
a clear, yellow shade while Yellow #6 was used to color
beverages an orangey, golden color. Red #40 and
Yellow #5 and/or Yellow #6, dyed beverages orange
(Orange Crush, 16.6 mg Yellow #6, 17 mg Red #40).
The few green beverages got their color from Yellow #5
and Blue #1 (Tum-E Yummy Green, Blue #1 0.2 mg,
5.8 mg Yellow #5). No beverage listed Green #3 or Red
#3 on its label. Blue #2 was not used in any of the sam-
ples because in solution it rapidly fades when exposed
to acids, alkali, and sugars.32 Some products were dyed
with both Yellow #5 and Yellow #6 (Tang, 24.6 mg
Yellow #5, 18.2 mg Yellow #6). Since the wavelengths
for these 2 yellow dyes overlap, only one color was
selected (the larger concentration of the two) to calcu-
late the total AFCs. The choice of 240 mL to represent
one serving was conservative—many carbonated bev-
erages come in 12-fl oz cans and bottles or even larger
plastic bottles while sports and energy drinks come in
16 fl oz or more plastic bottles or aluminum cans.
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5
Table 3. Amounts of Artificial Food Colors (AFCs) in Milligrams in 108 Beverages per Serving (240 mL ≈ 8 Fluid Ounces).
No. Tested Predominate AFCs Lowest Amount of Total AFCs (mg) Highest Amount of Total AFCs (mg) Median (mg)
Carbonated soft drinks
Red, strawberry, cherry, pink 10 Red #40 7 Up Diet Cherry 0.9 Faygo Redpop 34.2 11.3
Orange 9 Red #40, Yellow #5 Nihi Peach 1.9 Orange Crush 33.6 24.9
Yellow, lemon, citrus 4 Yellow #5 Generic Citrus 1.2 Faygo Moon Mist 6.8 3.8
Blue, purple, grape 6 Red #40, Blue #1 Big Blue 0.7 Faygo Grape 15.1 11.7
Fruit juice drinks and punches
Red, strawberry, cherry, pink 19 Red #40 Country Time Pink Lemonade 0.2 Kool-Aid Burst Cherry 52.3 15.5
Orange 11 Yellow #5 and #6, Red #40 Kool-Aid Jammer Peach-Mango 2.4 Sunny D Orange Strawberry 41.5 9.9
Yellow, lemon, citrus 6 Yellow #5 Sunny D Tangerine-Strawberry 1.3 Sunny D Citrus Punch 26.6 4.5
Blue, purple, grape 9 Blue #1, Red #40 Tum-E Yummy Glue 0.3 Little Hug Grape 15.4 4.7
Green, lime 2 Yellow #5, Blue #1 Tum-E Yummy Green 6.0 Hawaiian Punch Green 19.0 12.5
Sports drinks
Red, strawberry, cherry 4 Red #40 Gatorade Fruit Puncha13.2 Powerade Fruit Punch 17.4 17.4
Orange 2 Yellow #5,# 6, Red #40 Gatorade Orangea3.2 Powerade Orange 22.1 12.7
Yellow, lemon, citrus 3 Yellow #5 Gatorade Lemon Limea3.4 All-Sport Lemon Lime 6.1 3.8
Blue, purple, grape 6 Blue 1 Propel Zero Sport 1.1 Gatorade Blueberry
Pomegranatea
2.6 2.3
Green 1 Blue #1, Yellow #5 Powerade Sour Melon 11.1 Powerade Sour Melon 11.1 11.1
Energy drinks
Red, strawberry, cherry 6 Red #40 AMP Cherry Energy Burst 2.3 Full Throttle Red Berry 18.8 8.2
Orange 1 Yellow #5 HyDrive Energy Orange 6.7 HyDrive Energy Orange 6.7 6.7
Yellow, lemon, citrus 3 Yellow #5 Full Throttle Citrus 5.4 NOS Original 7.6 7.3
Blue, purple, grape 6 Blue #1, Red #40 Full Throttle Blue 0.7 AMP Grape 8.2 1.7
aLow calorie.
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6 Clinical Pediatrics XX(X)
Discussion
The concentrations of AFCs per unit volume reported in
Table 3 are similar to amounts that were reported several
decades ago. In 1968, the Certified Color Industry pub-
lished a list of processed foods in which certified colors
were used.33 The report showed that beverages (liquid
and powdered) contained a wide range of concentrations
from 5 to 200 ppm (1.2 mg/240 mL to 48 mg/240 mL).
These results are similar to Table 3 in which the range is
0.2 to 52.3 mg/240 mL. In 1980, the CRC Handbook of
Food Additives reported colors and concentrations in
carbonated beverages for various flavors: strawberry
and cherry, 14.4 to 24 mg/mL; orange, 12 to 18 mg/240 mL,
lemon; grape, 4.8 to 18 mg/240 mL.27 These too are in
ranges similar to those in Table 3. Although carbonated
drink consumption has declined since 2000 (53.0 gal-
lons/person/year in 2000 to 44.6 gallons/person/year in
2011), there have been increases in the number of differ-
ent beverages available, serving sizes, and consumption
of fruit juice drinks (3.7 gallons/person/year in 2000 to
4.7 gallons/person/year 2011).34 Although Gatorade had
been formulated in 1965 for athletes, sports beverages
generally entered the market in the early 1990s and
energy drinks a decade later. Their sales continue to
increase each year.34 For example, sports drink have
increased from 2.2 gallons/person/year in 2000 to 4.3
gallons/person/year in 2011. Sales of energy drinks were
up 16.6% in 2011 compared with 2010.
According to Beverage Digest Fact Book 2012, a sta-
tistical yearbook of nonalcoholic beverages, in 2011 the
average American consumed an estimated 44.6 gallons
of carbonated beverages drinks, 4.7 gallons of fruit juice
drinks, 4.3 gallons sports beverages, and 2.4 gallons of
powdered drinks.34 Although not every brand of the 108
beverages analyzed for this study was listed in the
Beverage Digest Fact Book, of the 29 brands of carbon-
ated beverages, intake in millions of cases (1 case = 192
fl oz) sold in 2011 in the United States ranged from 5.1
million cases (Diet 7 Up Cherry) to 623.8 million cases
(Mountain Dew). Of the 47 fruit-flavored drinks, vol-
ume ranged from 0.3 million cases (Crystal Light Pink
Lemonade) to 20.5 million cases (Hawaiian Punch). Of
the 16 sports beverages, sales ranged from 12.1 million
cases (All-Sport beverages) to 561.0 million cases
(Gatorade). Sales of energy drinks ranged from 1.2 mil-
lion cases (HyDrive beverages) to 13.5 million cases
(AMP beverages).
Estimating the amounts of AFCs in beverages and
foods that children consume is important for designing
new challenge studies. Combining the data in Table 3
with the beverage intake data, it is possible that, depend-
ing on the beverage choice and the serving size, the
amounts of AFCs consumed in beverages could range
from less than a milligram to 90 mg or more. For exam-
ple, if a child drank 2 cans (720 mL) of a bright red or
orange beverage he or she could consume more than 90 mg
of AFCs in just these beverages without considering
AFCs in the rest of the diet. On the other hand, if a child
consumes the equivalent of 2 cans of a slightly colored
beverage, he or she would consume only a couple of
milligrams of AFCs.
The early behavioral studies that used only 26 to 27
mg of mixed dyes were not representative of what many
children were consuming. (See Table 2, which lists the
amounts of different AFCs consumed in the United
States by children in 1977. These data were compiled by
the joint efforts of food manufacturers and the Food and
Nutrition Board of the National Academy of Sciences.)
In these older studies, the children were challenged
with even lower amounts of each dye. For example,
only 10, 7, and 6 mg of Red #40, Yellow #5, and Yellow
#6, respectively, were given in the 27-mg challenge
mixture. Of the 10 red carbonated beverages listed in
Table 3, in a 240-mL serving, 6 exceeded 10 mg of Red
#40 and in 9 orange sodas all but one contained more
than 7 and 6 mg of Yellow #5 and Yellow #6, respec-
tively. Swanson and Kinsbourne9 reported that 17 of 20
children reacted to a challenge of 100 to 150 mg of an
AFC mix as assessed by a learning task. Pollock and
Warner10 reported reactions to a 125-mg mix of AFC in
8 of 19 children based on a parents’ standard rating
scale. Rowe and Rowe11 reported a dose–response effect
of Yellow #5 of 1 to 50 mg in 34 hyperactive children.
Studies using 50 or more milligrams of dyes were often
criticized and dismissed as containing too much color.
Williams et al13 commented about their study in which
only 3 of 26 children responded to the AFC challenge,
“It is relatively certain that the amount of artificial col-
ors in a commercial food would be a fraction of the
amount in the challenge cookies [26 mg].” Clearly, that
was not true in 1978 or now.
Based on 2 studies in the United Kingdom,35,36 in
July 2010 the European Union began to require warning
labels on foods that contained AFCs stating that the
product might cause hyperactive and inattentive behav-
ior in some children. Unfortunately, these 2 studies chal-
lenged children with a mixture of AFCs plus sodium
benzoate, a preservative. Therefore, they could not con-
clude whether the changes in behavior were due to the
dyes, the sodium benzoate, or the combination. In the
United States, the Center for Science in the Public
Interest petitioned FDA to require warnings on food
labels or a ban of AFCs. The FDA committee, after a
2-day meeting of listening to experts, did not find
enough evidence to ban or require warning labels. The
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Stevens et al 7
vote, however, was close, 8 to 6. They concluded that
current evidence did not establish a causal relationship
between consumption of AFCs and hyperactivity in
most children although they did acknowledge for the
first time that dyes adversely affected a subset of sensi-
tive children. However, 93% of the committee recom-
mended that more studies are warranted, including a
“robust intake estimate.”37
Important questions about the role of AFCs in child-
hood behavioral problems remain. Do AFCs cause
behavioral changes in a subset of a general population
of children with and without attention-deficit/hyperac-
tivity disorder as suggested by Bateman et al35 and
McCann et al?36 If so, which AFCs are responsible for
behavioral changes? Although Red #40 is the most
widely used AFC certified by the FDA, does it produce
behavioral changes in children? Is there any synergis-
tic action of a mixture of AFCs? How much AFCs
should be used for future challenge studies in the
United States? To answer the last question, measure-
ment of AFCs in artificially colored foods commonly
consumed by children should be undertaken followed
by a study of how much of these beverages and foods
American children consume each day by obtaining
food frequency records and calculating the amount of
dyes in the selected foods and beverages per child.
These data can be used to choose reasonable amounts
of AFCs in future challenge studies.
Clinical Suggestions
Parents who wish to try a dye-free diet should be encour-
aged to read ingredients lists on all products they pur-
chase. Any beverage that has a color with a number (ie,
an AFC) should be avoided—for example, Red #40 or
Yellow #5. However, not all beverages are dyed. Among
carbonated sodas Sprite, 7 Up, Squirt, and Sierra Mist
are clear and do not contain dyes. Some brands of fruit
drinks and sports drinks have flavors that are dyed with
AFCs while other flavors are not. For example, Powerade
White Cherry has no dye but all the other Powerades are
colored with AFCs. Snapple Green Tea, Sweet Tea and
Peach are uncolored but Very Cherry and Grape Punch
have Red #40. All natural Snapple beverages have either
vegetable-based dyes or no dyes. Of the energy drinks,
Monster Energy has no AFCs, but Red Bull lists “col-
ors” with no further explanation. Rockstar Lemonade
has no AFCs, Rockstar Energy Drink has caramel color-
ing, but Rockstar Blue contains Blue #1 as does Rockstar
Fruit Punch (Red #40 and Blue #1). Most of the bever-
age powders like Kool-Aid and Wylers have AFCs, but
Crystal Light Pure uses turmeric for color and no AFCs.
Crystal Light Natural Lemonade has Yellow #5 so the
term “natural” does not necessarily mean no AFCs.
There are many pure, 100% fruit juices available such as
Juicy Juice, Ocean Spray, Minute Maid, and Welch’s. Of
course, parents should be reminded that all sugar-sweet-
ened beverages can be a major source of unwanted calo-
ries for children and can promote dental decay, and even
pure fruit juices are high in natural sugars and calories.
Furthermore, in 2011 the American Academy of
Pediatrics stated that children should not consume
energy drinks and rarely need sports drinks.38
Conclusion
Most sweetened and artificially sweetened carbonated
beverages, fruit drinks and punches, sports drinks, and
energy drinks are dyed with either caramel color or
AFCs in widely varying amounts. Many of these bever-
ages are consumed daily by children in the United
States. Estimating average intake of AFCs in the total
diet would greatly benefit the design of challenge stud-
ies to test the effects of AFCs on behavior.
Acknowledgments
The authors wish to thank Theresa Snuffer for her help mea-
suring AFCs in beverages.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
1. Deshpande SS. Handbook of Food Toxicology. New
York, NY: Marcel-Dekker; 2002.
2. Arnold LE, Lofthouse N, Hurt E. Artificial food colors
and attention-deficit/hyperactivity symptoms: conclu-
sions to dye for. Neurotherapeutics. 2012;9:599-609.
3. Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold
LE. Dietary sensitivities and ADHD symptoms: thirty-
five years of research. Clin Pediatr (Phila). 2011;50:
279-293.
4. Stevens LJ, Kuczek T, Burgess JR, Stochelski MA,
Arnold LE, Galland L. Mechanisms of behavioral, atopic,
and other reactions to artificial food colors in children.
Nutr Rev. 2013;71:268-281.
5. Kanarek RB. Artificial food dyes and attention deficit
hyperactivity disorder. Nutr Rev. 2011;69:385-391.
6. Weiss B. Synthetic food colors and neurobehavioral
hazards: the view from environmental health research.
Environ Health Perspect. 2011;120:1-5.
at PURDUE UNIV LIBRARY TSS on September 18, 2013cpj.sagepub.comDownloaded from

8 Clinical Pediatrics XX(X)
7. Millichap JG, Yee MM. The diet factor in attention-defi-
cit/hyperactivity disorder. Pediatrics. 2012;129:330-337.
8. Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of
attention-deficit/hyperactivity disorder or attention-defi-
cit/hyperactivity disorder symptoms, restriction diet, and
synthetic food color additives. J Am Acad Child Adolesc
Psychiatry. 2012;51:86.e8-97.e8.
9. Swanson JM, Kinsbourne M. Food dyes impair perfor-
mance of hyperactive children on a laboratory learning
test. Science. 1980;207:1485-1487.
10. Pollock I, Warner JO. Effect of artificial food colours on
childhood behaviour. Arch Dis Child. 1990;65:74-77.
11. Rowe KS, Rowe KJ. Synthetic food coloring and behav-
ior: a dose response effect in a double-blind, placebo-
controlled, repeated-measures study. J Pediatr. 1994;125:
691-698.
12. Ward NI. Assessment of chemical factors in relation to
child hyperactivity. J Nutr Environ Med. 1997;7:333-342.
13. Williams JI, Cram DM, Tausig FT, Webster E. Relative
effects of drugs and diet on hyperactive behaviors: an
experimental study. Pediatrics. 1978;61:811-817.
14. Harley JP, Matthews CG, Eichman P. Synthetic food
colors and hyperactivity in children: a double-blind chal-
lenge experiment. Pediatrics. 1978;62:975-983.
15. Weiss B, Williams JH, Margen S, et al. Behavioral responses
to artificial food colors. Science. 1980;207:1487-1489.
16. Conners CK, Goyette CH, Newman EB. Dose-time
effect of artificial colors in hyperactive children. J Learn
Disabil. 1980;13:512-516.
17. Adams W. Lack of behavioral effects from Feingold diet
violations. Percept Mot Skills. 1981;52:307-313.
18. Levy F, Dumbrell S, Hobbes G, Ryan M, Wilton N,
Woodhill JM. Hyperkinesis and diet: a double-blind
crossover trial with a tartrazine challenge. Med J Aust.
1978;1:61-64.
19. Goyette GH, Connors CK, Petti TA, Curtis LE. Effects of
artificial colors on hyperkinetic children: a double-blind
challenge study [proceedings]. Psychopharmacol Bull.
1978;14:39-40.
20. Survey of Industry on the Use of Food Additives (1977)
by the National Research Council. Washington, DC:
National Academy Press; 1979.
21. US Food and Drug Administration. Report on the
Certification of Color Additives. Washington, DC: US
Food and Drug Administration; 2010.
22. Food Standards Australia New Zealand (FANZ) Survery
of Added Colors in Foods Available in Australia. http://
www.foodstandards.gov.au/scienceandeducation/moni-
toringandsurveillance/foodsurveillance/surveyofad-
dedcolours5519.cfm. Accessed August 14, 2013.
23. Toledo MC, Guerchon MS, Ragazzi S. Potential weekly
intake of artificial food colours by 3-14-year-old children
in Brazil. Food Addit Contam. 1992;9:291-301.
24. Machinski Júnior M. Estimates of maximum limits of
food colours use in Brazil through the Danish Budget
Method and the Bär and Würtzen-modified method. Food
Addit Contam. 1998;15:481-486.
25. Husain A, Sawaya W, Al-Omair A, et al. Estimates of
dietary exposure of children to artificial food colours in
Kuwait. Food Addit Contam. 2006;23:245-251.
26. Connolly A, Hearty A, Nugent A, et al. Pattern of
intake of food additives associated with hyperac-
tivity in Irish children and teenagers. Food Addit
Contam Part A Chem Anal Control Expo Risk Assess.
2010;27:447-456.
27. Noonan JE, Meggos H. Synthetic food colors. In: Furia TE,
ed. CRC Handbook of Food Additives. Vol. 2. 2nd ed. Boca
Raton, FL: CRC Press; 1980:339-383.
28. Nseir W, Nassar F, Assy N. Soft drinks consumption and
nonalcoholic fatty liver disease. World J Gastroenterol.
2010;16:2579-2588.
29. Emanuele E, Martinelli V, Carlin MV, Fugazza E,
Barale F, Politi P. Serum levels of soluble receptor for
advanced glycation endproducts (sRAGE) in patients
with different psychiatric disorders. Neurosci Lett.
2011;487:99-102.
30. Department of Nutrition at Harvard School of Public
Health. Fact sheet: sugary drink supersizing and the obe-
sity epidemic. June 2012. http://www.hsph.harvard.edu/
nutritionsource/files/2012/10/sugary-drinks-and-obesity-
fact-sheet-june-2012-the-nutrition-source.pdf. Accessed
August 14, 2013.
31. Lasater G, Piernas C, Popkin BM. Beverage patterns and
trends among school-aged children in the US, 1989-2008.
Nutr J. 2011;10:103.
32. Marmion DM. Handbook of U.S. Colorants: Foods,
Drugs, Cosmetics, and Medical Devices. 3rd ed. New
York, NY: Wiley-Interscience; 1991.
33. Certified Color Industry Committee. Guidelines for good
manufacturing practice: use of certified FD&C colors in
food. Food Technol. 1968. Vol. 22.
34. Beverage Digest Fact Book 2012: A Statistical Yearbook
of Non-Alcoholic Beverages. Bedford Hills, NY: Beverage
Digest Company; 2012.
35. Bateman B, Warner JO, Hutchinson E, et al. The effects of
a double blind, placebo controlled, artificial food colour-
ings and benzoate preservative challenge on hyperactiv-
ity in a general population sample of preschool children.
Arch Dis Child. 2004;89:506-511.
36. 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:
1560-1567.
37. US Food and Drug Administration. Certified color addi-
tives in food and possible association with attention defi-
cit hyperactivity disorder in children. http://www.fda.gov/
advisorycommittees/committeesmeetingmaterials/foo-
dadvisorycommittee/ucm250901.htm. Accessed August
14, 2013.
38. Committee on Nutrition and the Council on Sports
Medicine and Fitness. Sports drinks and energy drinks for
children and adolescents: are they appropriate? Pediatrics.
2011;127:1182-1189.
at PURDUE UNIV LIBRARY TSS on September 18, 2013cpj.sagepub.comDownloaded from