*3.5. Behavioral Reactions to Intolerant Foods before Starting the OD*

In the pre-diet phase, 13 out of 16 children consumed several of the observed sensitive foods at the same time. Because of the overlap with the incompatible foods, a reliable prognosis is difficult. In three subjects incompatibilities were observed individually and without overlapping with one another. This was due to the fact that they only reacted to one incompatibility each.

One child showed an increase and decrease in ACS according to the course of the week, so that ACS increased at the weekend without a change in diet (Figure 7A). Overall, none of the children's behavior disturbances can be attributed to a clear food sensitive reaction just on the basis of the data from the pre-diet phase. Two illustrative examples are shown in Figure 7A,B. Figure 7A shows the food sensitivity of one subject before starting the diet. Food sensitivity was safely detected during the reintroduction phase: to milk, cocoa, peanut and corn. Out of four intolerant foods, three were consumed at different timepoints in the pre-diet phase as shown below.

Looking at the individual foods, milk shows an average decrease in ACS within the first 24 h after consuming by −1.67. In the following days there is an increase in ACS compared to the value before the intake (<24 h = −0.67; 24–48 h = +0.67; 48–72 h= +1).

When cocoa is consumed, an immediate increase in ACS is only notable on day 10 (+2). On day 13 there is a delayed increase the next day (+1). The remaining days (day 3, day 6–8) are inconspicuous, with an average increase of 0.5 in the first 24 h (<24 h = 0.5; 24–48 h = −0.5; 48–72 h= −0.5).

Corn was consumed only in small amounts. On day 4, most corn was consumed in the form of popcorn, with a delayed increase of ACS the next day (+3). (<24 h = −0.67; 24–48 h = +1; 48–72 h= −2).

Due to the weak fluctuations, no clear statement is possible. Overall, possible changes in ADHD symptoms due to intolerant foods overlap, which makes a reliable prognosis of individual food sensitivity almost impossible.

Figure 7B shows the reactions of another participant. Food sensitivities safely detected during the reintroduction phase were to bell pepper and wheat. Wheat was supplied daily in the form of baked goods (bread). On average, there was a mean decrease in ACS in the days after ingestion compared to the initial value (<24 h = −0.75; 24–48 h = 0; 48–72 h = −0.75).

Bell peppers were eaten as spice powder (day 3) or raw (day 12). There is a small increase in ACS (+2) on the respective days, but day 12, when raw paprika was eaten, is particularly noteworthy with an increase from +3 to 15 (<24 h = +2; 24–48 h = 0; 48– 72 h = +0.5).

It is also noticeable that on days with physical activity (soccer training, swimming training) ACS is relatively low (day 1, 2, 5) or decreased compared to the previous day (day 8). One reason for an increase in ACS could be that subject in 7B had a friend visiting him on day 6 and a birthday party on day 7.

The overlay of food makes a reliable prognosis difficult. In addition, there are fluctuations that may be related to special events in everyday life, which makes it difficult to identify possibly ADHD-promoting foods.

**Figure 7.** (**A**) Food sensitivity of participant 1. Reactions to different foods in the pre-diet phase. Food sensitivities safely detected during the reintroduction phase: milk, cocoa, peanut and corn. Peanuts are not mentioned because they were not eaten in the pre-diet phase. (**B**) Food sensitivity of participant 2. Reactions to different foods in the pre-diet phase. Food sensitivities safely detected during the reintroduction phase: bell peppers and wheat. ACS value declared by parents, displayed in red bars on the left axis. Amount of intolerable food consumed in grams \* shown in lines on the right axis. \* estimated amount.
