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Title: The Role of Sugar in ADHD
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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The Role of Sugar in ADHD
by Anthony Kane, MD
Introduction
How sugar influences ADHD is one of those controversial
areas in medicine. There are two sides to the debate. On
one side, there is the official medical establishment that
claims numerous scientific studies show that children do not
react to sugar and that sugar does not play a role in ADHD.
On the other side, there are all the mothers who have
personally witnessed that when they give their children
sugar, within a few minutes, their children are bouncing off
the walls. So, the question is with whom does the truth lie.
Evidence for the Medical Establishment
In 1985, Dr. Mark Wolraich published the most influential
study demonstrating that sugar plays no role in ADHD.
Wolraich’s team examined 16 hyperactive children for three
days. The researchers manipulated the sugar content of
their diet, but found no effects on behavior or learning.
The same group later published a review article and
concluded “the few studies that have found effects have been
as likely to find sugar improving behavior as making it
worse.”
In 1994, Dr. Richard Milich examined thirty-one children
whose mothers felt they were sugar sensitive. He gave all
thirty-one children a sugar-free drink. However, he told
half of the mothers that their child’s drink contained sugar.
The mothers who thought that their child had received the
sugar drink all rated their child as being more hyperactive.
These mothers also were more critical of their children and
hovered over them more. Milich concluded that the parental
expectations about the affects of sugar are the cause of the
perception that sugar makes children more hyperactive.
These expectations also influence the way the parents
interact with their children.
There are a few more articles about sugar, but they are
mostly a rehashing of earlier studies. The general consensus
of the scientific literature is that sugar does not lead to
hyperactivity. Unfortunately, some of us have children who
have not read these studies.
Analysis
Wolraich’s study was quite thorough. Thirty-seven different
measurements of behavior and learning were taken. They
intensively studied 16 boys in a hospital setting for three
days. So what could be the flaw of this study? I just said
it. “16 boys,” “hospital setting,” “three days.”
Sixteen boys is a very small sample size. If even 10% of
the ADHD population is sugar sensitive, and the number is
very likely much less, a sample of 16 boys may not contain
a single child who was sugar sensitive.
A “hospital setting” is not a normal environment. Just
because a child can maintain himself in a controlled
environment like a hospital, doesn’t mean that he would
function the same way at school or at home.
“Three days” is a very short time. If the effects of sugar
were additive, say over the course of a week, then the study
would miss this. This is still a very good study, but it is
premature to conclude from it that sugar plays no role in
ADHD.
Dr. Milich concluded that it was the mother’s expectations
that affected how they viewed the effects of sugar on her
child. Even if true, the results of this study are still
insignificant. We have known for a long time that
expectations influence perception. This is basis of the
placebo effect. All that this study proved was that parents,
who expect their children to behave hyperactively, perceive
their children behaving hyperactively. We knew that before
the study.
As for Wolraich’s review article, although it is a very good
article it has the basic flaw inherent in all survey studies.
The author must choose which studies to include and which to
exclude in his review. To put it another way, review articles
are highly susceptible to bias on the part of the authors.
Therefore, although Wolraich’s review article is very good
and seems to be very thorough it is not the final word, like
many believe it to be.
Evidence Implicating the Role of Sugar in ADHD
Now for the Side of Motherhood
Wender and Solanto tried to link an increase in aggressive
behavior in ADHD children to sugar ingestion. They compared
17 ADHD children with 9 age-matched normal children to assess
the affects of sugar ingestion. They gave sugar or placebo
challenges as part of a high carbohydrate breakfast. They
did not find a relationship between sugar and aggression.
Although the children with attention deficit disorder with
hyperactivity were significantly more aggressive than the
control subjects, eating sugar did not elicit this behavior.
However, they did find something else. Inattention, as
measured by a continuous performance task, increased only
in the ADHD group following sugar ingestion. The ADHD
children showed no change following placebo, and the control
group showed no change at all. So, according to this study,
sugar ingestion as part of a high carbohydrate meal will
exacerbate inattentiveness in some ADHD children.
Langseth and Dowd found that 74% of 261 hyperactive children
in their study had abnormal sugar metabolism. These
children displayed reactive hypoglycemia after eating
refined sugar. What happened metabolically was that the
large ingestion of sugar caused a surge of insulin to be
released by the pancreas. This caused, in reaction, a
significant decrease in blood sugar levels accompanied by a
surge in the epinephrine levels.
Girardi found that sugar ingestion triggered other metabolic
abnormalities in ADHD children. His team at Yale gave a
standardized oral glucose challenge to 17 children with ADHD
and 11 control children and compared the results.
Baseline and oral glucose-stimulated plasma glucose and
insulin levels were similar in both groups, including the
glucose level bottoming out at 3-5 hours after oral glucose
ingestion. This drop in glucose stimulated a rise in plasma
epinephrine and norepinephrine in both groups. However, the
rise in the ADHD children was nearly 50% lower than in the
control children.
Both groups showed deterioration on the continuous
performance test in association with the late fall in
glucose and rise in epinephrine. However, the drop in test
scores in ADHD children was significantly greater. ADHD
children also had quicker reaction times than normal
children, corresponding with impulsivity. This study
suggests that children with ADHD have a general impairment
of hormone regulation. It appears that sugar may accentuate
this defect.
Sugar and Nutrition
There is another effect of eating refined sugar. You have
probably heard that table sugar is called “empty calories.”
This is a true, but not complete picture. Table sugar is a
nutrient vacuum. It provides no nutritional benefit other
than calories, but it requires a lot of other nutrients to
process it. It depletes the child’s nutritional base. That
means that if a child’s ADHD is caused or exacerbated by the
lack of certain nutrients, having a high sugar meal may
drain these nutrients and push him into a nutrient deficiency
state. And this would not necessarily happen during a
three-day test in the hospital, as in Wolraich’s study,
where the children were receiving adequate nutrition.
We have studies that show children who don’t eat breakfast
don’t perform as well in school. We also have studies showing
that children who eat sugar with a high carbohydrate meal do
poorly on tasks requiring concentration. There are also
claims that some children display increased aggressive behavior.
Conclusion
What do we make of all this? Most researchers say that sugar
doesn’t make children hyperactive. Yet, everyone has seen
children go crazy on sugar. How do we resolve this
contradiction? What do we conclude from all this?
There is no concrete evidence that sugar causes ADHD.
However, the evidence against this notion is also not very
strong. We know that ADHD children frequently have abnormal
sugar metabolism. We know that eating sugar does affect
learning and behavior negatively, particularly after a low
protein carbohydrate meal. This occurs even in normal
children. We know that the metabolism of sugar drains the
body’s reserve of other vital nutrients. What should we
conclude?
Basically, it is very likely that the medical researchers are
correct in saying that sugar ingestion does not cause ADHD.
All that means is that if you give a normal child too much
sugar, he will not develop ADHD. However, it is clear that
refined sugar does exacerbate some of the ADHD symptoms such
as inattentiveness and possibly aggression in many children.
There are mixed results as to whether or not it affects
normal children in a similar but less pronounced way.
My Recommendations
So, after examining all the evidence, I would recommend
that you should try to give your children protein-containing
meals for breakfast and lunch during the school year. You
should try to keep all your children and yourself away from
refined sugar.
Does this mean that I am saying sugar makes children
hyperactive? Not exactly. I feel that the medical research
is not conclusive either way.
You will have to judge for yourself the affect of sugar
on your own child. However, even if refined sugar does not
exacerbate your child’s ADHD symptoms, I have yet to see
one study that shows that refined sugar does anything positive.
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
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Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
parenting issues (http://addadhdadvances.com/betterbehavior.html),
ODD, and education.
You may visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart
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