Sugar and the hyperactive child: myth or fact?

For decades now, sugar-laden holidays have been a source of celebration and consternation. Parents and grandparents alike happily satisfy a child’s sweet tooth with birthday cakes, Christmas cookies, and Halloween candies, and then brace themselves for the ensuing “sugar high.” But studies suggest that this burst of energy may be more mythical than factual.

Benjamin Feingold, M.D., founder of the Feingold Diet, was among the first in 1973 to suggest that diet can affect children’s behavior. He was not the first, however, to identify hyperactivity in kids. That distinction goes to Dr. Heinrich Hoffman, who in 1845 described children who could not sit still in his book, The Story of Fidgety Philip. But it was Feingold’s support for an additive-free diet that caused researchers and parents alike to scrutinize foods and food additives (including sugar) and their effect on children’s behavior.

Skirting the science

The mainstream medical community was quick to dismiss the Feingold Diet, citing a lack of evidence. Parents, however, embraced it as an alternative to the drugs commonly used to treat hyperactivity and shown to have serious side effects. 

Some studies actually showed improvement in children’s behavior when artificial colors and flavors, caffeine, MSG, chocolate, and some simple sugars were eliminated from their diet, but most found little or no effect.

Fast-forward to 1996 when researchers investigating Attention Deficit Hyperactivity Disorder (ADHD) aimed to find out if sugar was the culprit. They reviewed all relevant data including 12 randomized (half the kids were given sugar and half were given artificial sweetener), placebo-controlled, double-blind (moms and kids were unaware of which kids got sugar and which got artificial sweetener) studies. The researchers found no difference in behavior between the two groups. This was true of kids with ADHD and kids without. But when moms were asked to rate their children’s behavior, those moms who thought their kids had eaten sugar described their kids as “hyper.” Similarly those moms who thought their kids had not eaten sugar viewed their kids as “not hyper.” In fact, this was true whether their child had actually eaten sugar or not. Researchers also found that some children, when told by their parents that sugar would make them hyper, actually became hyper after eating what they thought was sugar. This phenomenon may explain why so many parents, despite evidence to the contrary, hold firm to their belief that sugar makes kids hyper.

More recently, a 2012 overview of research on diet-related approaches to ADHD concluded that while sugar does not usually affect children’s behavior or cognitive performance, “a small effect on subsets of children cannot be ruled out.” The researchers suggested that the effect may be tied to daily sucrose intake and total consumption, or it may be tied to a reactive hypoglycemic response to sugar load. Nevertheless, much of the effect is probably tied more to perceptions of the link between hyperactive behavior and sugar than it is to actual effect.

Identifying the hyperactive child

Sugar aside, parents are right to be concerned about hyperactivity and ADHD. (No one likes an unruly child.) But not every Fidgety Philip is hyperactive or has ADHD. Some kids are simply “high energy” or “intensely curious.”

The American Psychiatric Association estimates that 5 percent of school-aged children have ADHD. Rates vary from state to state, with a low of 5.6 percent reported in Nevada and a high of 15.6 percent in North Carolina. (If this range seems troublingly wide, consider that since these numbers are based on diagnosis and treatment data, it’s possible that the difference has to do with diagnostic practices than with geographic differences in children’s health.) When one considers the average annual cost of treating children and adolescents with ADHD—a staggering $42.5 billion—the impact is even more compelling.

Lacking a simple diagnostic test, the diagnosis of ADHD is difficult given that symptoms of ADHD (inattention, hyperactivity, impulsiveness) are similar to those of anxiety, depression, and other types of learning disabilities.

Although ADHD can’t be cured, it can be managed with a combination of behavioral therapy and medication. And while there is no evidence linking sugar and ADHD, several studies suggest that omega-3 fatty acid supplements may improve behavior in some children, with no or minimal side effects. Because ADHD is a chronic condition, close monitoring by parents, teachers, and health care professionals and ongoing doctor follow-ups will ensure that treatment plans reflect the latest research. For more on hyperactivity and ADHD, review this and this.

Making the case for less sugar

Despite the absence of a link between sugar and ADHD, parents should still be concerned about other harmful effects from eating (or drinking) too much sugar. Sugary drinks (soda, fruit juice) are a common source of sugar. It’s estimated that one-half of the U.S. population over the age of 2 years consumes sugary drinks on any given day.

Sugary drinks have been linked to poor diet, type-2 diabetes, weight gain, and obesity. In fact, childhood and adolescent obesity rates have doubled and tripled respectively in the past 30 years. In 2010, more than one in three U.S. children and adolescents were either overweight or obese. This factor alone puts them at greater risk for a myriad of short- and long-term health effects such as high blood pressure, high cholesterol, stroke, type-2 diabetes, and various cancers.

In addition, dentists have long recognized the link between sugar and tooth decay. Acid-producing bacteria in the mouth feed on sugar. More sugar leads to more bacteria, which in turn produce more acid. Acid damages the surface of the teeth and increases the risk of decay.

Kids’ bodies need sugar—within limits. The American Heart Association recommends that preschoolers consume foods with a total of no more than 4 teaspoons of added sugar a day, and no more than 3 teaspoons a day for children ages 4–8. However, children as young as 1–3 years typically get three times the recommended amount (12 teaspoons!). But before you institute a ban on cookies and milk, consider ways to satisfy your child’s sugar needs without tipping the scales in the wrong direction.

You can limit your child’s sugar intake by:

  • Making water (or reduced fat milk) the drink of choice. Avoid sugary drinks such as full-calorie sodas, sports drinks, fruit juices or drinks, and energy drinks. Even 100 percent fruit juice is packed with sugar and calories. The AAP recommends that parents avoid giving their babies juice until they are at least 12 months of ageTo further reduce the amount of sugar in each serving of juice, many pediatricians suggest diluting the juice with water.
  • Having sweets for special occasions. Kids want what they can’t have, so think long and hard before you ban sweets. Instead, consider limiting them to birthdays, holidays, and other special occasions. 
  • Offering healthy sweets. Satisfy your child’s craving for something sweet with homemade fruit smoothies or frozen fruit popsicles. 
  • Avoiding sweets (or any food) as rewards. Our bodies signal us to eat when hungry and to stop eating when full. When parents use food as a reward, they override their children’s hunger and satiety cues and increase the risk of overweight and obesity. Choose instead to reward your children with an activity, such as a trip to a nearby park or 30 minutes of Mom’s or Dad’s undivided attention. 
  • Controlling your child’s surroundings. By being aware of the people, places, and things that influence your child’s eating habits—family, friends, school, child care centers, television, movies, and books—you can better control what your child eats and how your child behaves.

Last updated July 15, 2017

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