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Coloring the Truth: Color Additives in Nutrition and Health

Clemens, Roger, DrPH; Pressman, Peter, MD, MS, FACN

doi: 10.1097/NT.0000000000000285
Food Science

Food coloring additives are widely utilized, have important functions, and are generally poorly understood in terms of their chemistry, health impact, and regulation. The following review summarizes which coloring additives are required for certification by the Food and Drug Administration and which are exempt from certification. The chemical structure of coloring agents is described, and the distinction is made between the 2 principal forms of agents: dyes and lakes. The extensive and still controversial and important history of the alleged association between artificial food colors and childhood behavioral abnormalities is critically reviewed along with the epidemiological and neuroscience components of the discussion. Finally, the regulation of food coloring additives is discussed. Apart from an updated narrative on the color of nutrition, this topic serves as an example of the importance of a rigorous and critical review of a scientific literature in order to get at “the truth.”

Roger Clemens, DrPH, is part-time faculty within the University of Southern California (USC) International Center for Regulatory Science program, where he enjoys an adjunct appointment as professor of pharmacology and pharmaceutical sciences and assistant professor of regulatory and quality sciences within the USC School of Pharmacy for the past 17 years. He also developed and facilitates graduate nutrition courses in the Global Medicine program within the USC School of Medicine. He served as Scientific Advisor for Nestlé USA for more than 21 years. Dr Clemens is a past president of the Institute of Food Technologists (IFT) and former member of the IFT Board of Directors. He cofounded, established, and contributes to a Food, Medicine, and Health column published monthly in Food Technology since 2004. Dr Clemens was recognized by his peers as an elected fellow for his distinguished contributions in nutrition and food science. He is a fellow in the American Society for Nutrition, American College of Nutrition, IFT, and International Academy of Food Science and Technology. Dr Clemens serves on several editorial boards (eg, Food Chemical Toxicology, Journal of Food Science, Toxicology Research and Applications) and continues to serve as a reviewer for many journals, including but not limited to Journal of Nutrition, American Journal of Clinical Nutrition, Nutrients, and Food Science and Technology. Not surprising, Dr Clemens is well published (>50 original manuscripts and commentaries), has authored several book chapters at the nutrition and health interface, and is in the process of editing and writing new publications in starvation and nutrition, food regulations, and food toxicology. In addition, Dr Clemens is a respected communicator in the nutrition and health arena with more than 500 interview occasions across media types in the United States and internationally and continues to be invited to speak at conferences and symposia. Dr Clemens received an AB in Bacteriology, an MPH in Nutrition, and a DrPH in Public Health Nutrition and Biological Chemistry from the University of California, Los Angeles.

Peter Pressman, MD, MS, FACN, is vice president, Medicine Public Health & Nutrition at The Daedalus Foundation, Alexandria, Virginia, and director of Medical Operations at Polyscience Consulting in Chatsworth, California. He is a graduate of Bowdoin College, the University of Chicago, and Northwestern University Medical School, and was trained at the University of Wisconsin and Rush-Presbyterian St Luke's Medical Center. After serving as assistant professor of medicine, director of Educational Programs of the Pacific Center for Health Policy & Ethics, and associate director of the Internal Medicine Residency Program, all at USC/Keck School of Medicine, he attended at Cedars-Sinai Medical Center in Los Angeles and later deployed in the developing world as a naval medical officer. Pressman has been continuously active in both internal medicine and surgical education, focusing on special topics in nutritional support. Pressman is a reviewer for the Journal of Food Science and the Journal of Food & Chemical Toxicology and serves on the editorial board of Toxicology Research and Application. He has served on the Food Additive Task Force of the International Special Dietary Foods Industries, along with distinguished scientists representing the European Union and from the Chan School of Public Health, Harvard University. With the Daedalus Foundation, Pressman has been instrumental in designing and coordinating healthcare services and product development in support of civil (medical) preparedness, rapid response, and daily health requirements of those struggling with natural or manmade disasters. In process now is GeoHealth, a global cloud-based, cell phone–enabled system for early detection and tracking of communicable disease blooms such as those associated with Ebola virus, Middle East respiratory syndrome coronavirus, and Zika virus. At Polyscience Consulting, Pressman is responsible for provision of clinical medical and behavioral sciences expertise in the multidisciplinary solution of applied biotechnology and medical nutrition challenges brought by clients. Polyscience is conceived as a center of excellence for medical nutrition, toxicology, integrative medicine, public health, and therapeutics. A focus on advocacy for underserved and imperiled populations both domestically and in the developing world is paramount in client recruitment and project initiatives. Responsibilities include but are not limited to research evaluation, process design, coordination among investigators, public education and outreach, and media relations.

The authors have no conflicts of interest to disclose.

Correspondence: Roger Clemens, DrPH, International Center for Regulatory Science, USC School of Pharmacy, 1540 Alcazar St, CHP 140, Los Angeles, CA 90089 (

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