Retrospective Outcome Monitoring of ADHD and Nutrition (ROMAN): The Effectiveness of the Few-Foods Diet in General Practice
Open accessAbstract
INTRODUCTION: Double-blind placebo-controlled studies investigating the effect of a few-foods 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 underlying mechanism(s) is of vital importance: finding an easier method or biomarkers for diagnosing food-induced ADHD and ascertaining the incriminated foods may lead to redundancy of the few-foods approach.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Pelsser et al. report that adults who adhered to elimination diets experienced improvements in attention and impulse control, though findings require confirmation in larger, well-controlled studies.
“Pelsser et al. [182] report that adults who adhered to elimination diets experienced improvements in attention and impulse control, though these findings require confirmation in larger, well-controlled studies.”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [182]
The Results (Comparison T2 Versus T1; page unavailable) report improved ADHD scores during a few-foods diet, but the participants were 57 children, not adults. The Conclusion (Strengths and Limitations; page unavailable) notes that this was an open study rather than a randomized controlled trial; it does not specifically call for confirmation in larger, well-controlled studies. (LLM, conf=0.89)
Experimental — accuracy not yet measuredZinc is frequently reported at lower levels in individuals with ADHD, although the direct impact of supplementation in adults is still under investigation.
“Zinc, a cofactor in neurotransmitter metabolism, is frequently reported at lower levels in individuals with the condition, although the direct impact of supplementation in adults is still under investigation [182].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [182]
The Introduction discusses food additives, fish oil and the few-foods diet in ADHD, while the Results concern children following that diet. Searches for zinc, lower zinc levels and zinc supplementation in adults found no passage addressing the cited claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMagnesium has shown promise in reducing hyperactivity and inattention in children, but adult data are limited.
“Magnesium has shown promise in reducing hyperactivity and inattention in children, but adult data are limited [182].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [182]
The Introduction discusses fish oil, food additives, and the few-foods diet, while the Discussion reports outcomes for children following the few-foods diet. Searches for magnesium supplementation and limited adult data found no passage addressing either part of the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
The quality of health care delivered to adults in the United States
McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa022615 · Cited by 5,079 · see citing works
Subcommittee on Attention-Deficit/Hyperactivity Disorder, S. C. O. Q. I. A. M. (2011) · Pediatrics · doi:10.1542/peds.2011-2654 · Cited by 2,185 · see citing works
Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014) · International Journal of Epidemiology · doi:10.1093/ije/dyt261 · Cited by 1,822 · see citing works
Gut/brain axis and the microbiota
Mayer, E. A., Tillisch, K., & Gupta, A. (2015) · Journal of Clinical Investigation · doi:10.1172/jci76304 · Cited by 1,503 · see citing works
Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., Epstein, J. N., Hoza, B., Hechtman, L., Abikoff, H. B., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31819c23d0 · Cited by 1,182 · see citing works
Sonuga-Barke, E. J. S., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., Stevenson, J., Danckaerts, M., van der Oord, S., Döpfner, M., et al. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12070991 · Cited by 1,167 · see citing works
Attention deficit hyperactivity disorder
Thapar, A., & Cooper, M. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00238-x · Cited by 1,081 · see citing works
DuPaul, G. J., Anastopoulos, A. D., Power, T. J., Reid, R. R., Ikeda, M. J., & McGoey, K. E. (1998) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/a:1023087410712 · Cited by 445 · see citing works
DuPaul, G. J., Reid, R., Anastopoulos, A. D., Lambert, M. C., Watkins, M. W., & Power, T. J. (2015) · Psychological Assessment · doi:10.1037/pas0000166 · Cited by 392 · see citing works
CONTROLLED TRIAL OF OLIGOANTIGENIC TREATMENT IN THE HYPERKINETIC SYNDROME
Egger, J., GRAHAM, P. J., Carter, C. M., Gumley, D., & Soothill, J. F. (1985) · The Lancet · doi:10.1016/s0140-6736(85)91206-1 · Cited by 326 · see citing works
Attention Deficit Hyperactivity Disorder:Diagnosis and Management
Boon‐yasidhi, V. (2013) · Journal of the Psychiatric Association of Thailand · Cited by 245 · see citing works
Pelsser, L. M. J., Frankena, K., Toorman, J., Savelkoul, H. F. J., Dubois, A. E. J., Pereira, R. R., Haagen, T. A., Rommelse, N. N. J., & Buitelaar, J. K. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62227-1 · Cited by 217 · see citing works
Self-citationStorebø, O. J., Krogh, H. B., Ramstad, E., Moreira-Maia, C. R., Holmskov, M., Skoog, M., Nilausen, T. D., Magnusson, F. L., Zwi, M., Gillies, D., et al. (2015) · BMJ · doi:10.1136/bmj.h5203 · Cited by 209 · see citing works
Effects of a few food diet in attention deficit disorder.
Carter, C. M., Urbanowicz, M., Hemsley, R., Mantilla, L. B., Ströbel, S., GRAHAM, P. J., & Taylor, E. A. (1993) · Archives of Disease in Childhood · doi:10.1136/adc.69.5.564 · Cited by 171 · see citing works
A Review on the Role of Inflammation in Attention-Deficit/Hyperactivity Disorder
Leffa, D. T., Torres, I. L. D. S., & Rohde, L. A. (2018) · NeuroImmunoModulation · doi:10.1159/000489635 · Cited by 167 · see citing works
Pelsser, L. M., Frankena, K., Toorman, J., & Rodrigues Pereira, R. (2017) · PLOS ONE · doi:10.1371/journal.pone.0169277 · Cited by 145 · see citing works
Self-citationMolecular genetic studies of ADHD and its candidate genes: A review
Li, Z., Chang, S., Zhang, L., Gao, L., & Wang, J. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.05.005 · Cited by 123 · see citing works
Hamilton, S., McAleer, D. M., Ariagno, K. A., et al. (2014) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000000179 · Cited by 109 · see citing works
Current topic: An auditable protocol for treating attention deficit/hyperactivity disorder
Hill, P. (2001) · Archives of Disease in Childhood · doi:10.1136/adc.84.5.404 · Cited by 104 · see citing works
A randomised controlled trial into the effects of food on ADHD
Pelsser, L. M. J., Frankena, K., Toorman, J., Savelkoul, H. F. J., Pereira, R. R., & Buitelaar, J. K. (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-008-0695-7 · Cited by 96 · see citing works
Self-citationMathee, K., Cickovski, T., Deoraj, A., Stollstorff, M., & Narasimhan, G. (2019) · Journal of Medical Microbiology · doi:10.1099/jmm.0.001112 · Cited by 68 · see citing works
Zelm, R. V., Coeckelberghs, E., Sermeus, W., van Overstraeten, A. D. B., Weimann, A., Seys, D., Panella, M., & Vanhaecht, K. (2017) · International Journal of Colorectal Disease · doi:10.1007/s00384-017-2863-z · Cited by 56 · see citing works
DuPaul, G. J., Fu, Q., Anastopoulos, A. D., Reid, R. R., & Power, T. J. (2020) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-020-00618-7 · Cited by 35 · see citing works
[Effect of an oligo-antigen diet on the behavior of hyperkinetic children].
Schulte‐Körne, G., Deimel, W., Gutenbrunner, C. M., et al. (1996) · PubMed · Cited by 23 · see citing works
Stobernack, T., de Vries, S. P. W., Pereira, R. R., Pelsser, L. M. J., ter Braak, C. J. F., Aarts, E., van Baarlen, P., Kleerebezem, M., Frankena, K., & Hontelez, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029422 · Cited by 18 · see citing works
Self-citationPelsser, L., van Steijn, D. V., Frankena, K., Toorman, J., Buitelaar, J., & Rommelse, N. (2013) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2012.00652.x · Cited by 13 · see citing works
Self-citationRothenberger, A., & Rothenberger, L. G. (2012) · Current Treatment Options in Neurology · doi:10.1007/s11940-012-0197-2 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives
Bogdańska-Chomczyk, E., Majewski, M. K., & Kozłowska, A. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms262211020 · Cited by 15 · see citing works
“Magnesium has shown promise in reducing hyperactivity and inat-tention in children, but adult data are limited [182].”
Influential
- Authors
- Pelsser, L., Frankena, K., Toorman, J., & Rodrigues Pereira, R.
- Affiliations
- Wageningen University & Research (NL)
- Corresponding author
- Pelsser, Lidy
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-03-12
- Volume
- 11
- Pages
- 96-96
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7081264
- OpenAlex
- W3011645363
- Cited by
- 25
- References
- 28
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 4
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion, cc-by)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- diet, attention deficit hyperactivity disorder, oppositional defiant disorder, elimination diet, food reintroduction, children, general practice, dietary triggers, secondary prevention, ADHD Rating Scale, teacher ratings, psychiatric interview, biomarkers, ADHD subtypes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
