"If you look at the peer-reviewed evidence, we cannot say sugar absolutely makes kids hyper; however, you can't discount that sugar may have a slight effect" on behavior, said Kristi L. King, senior pediatric dietitian at Texas Children's Hospital and spokeswoman for the Academy of Nutrition and Dietetics.
In the mid-1990s, a meta-analysis
reviewed 16 studies on sugar's effects in children. The research, published in the medical journal JAMA, concluded that sugar does not affect behavior or cognitive performance in children. "However, a small effect of sugar or effects on subsets of children cannot be ruled out," the article said.
Like adults, some children may be more sensitive to blood sugar spikes than others. This may mean they are more likely to become aroused when consuming sugar.
Notably, a small percentage of children with attention-deficit hyperactivity disorder may be extra sensitive to sugar, and their behavior changes when they eat it, according to Jill Castle, a registered dietitian and childhood nutrition expert who teaches a parenting course called the ADHD Diet for Kids
. "They may become more aggressive or hyperactive or difficult to parent," Castle explained. Minimizing sugar in the diet can be beneficial for these children.
According to Castle, lots of sugary foods can also equate to elevated amounts of food dyes, artificial flavors or other additives that could be problematic for a child with ADHD, often making it difficult to tease out whether sugar is the culprit.
Complicating the issue is the fact that we don't have a way to determine whether there is a link. "Is there a biomarker? A hormone level?" King asked. "It's disheartening for parents. ... They want answers. And unfortunately, nutrition is such an individual thing."
Sugar and hyperactivity: Positive link or parent perception?
The idea of a link between sugar and hyperactivity in children dates to the 1970s, when the Feingold diet was prescribed by a pediatrician with the same name as an eating plan to alleviate symptoms of ADHD.
"His diet eliminated artificial flavorings, sweeteners and preservatives -- and so sugar kind of got lumped in, as well," King said.
This diet may have led parents to perceive that sugar is a culprit when it comes to kids' excitable behavior -- even if it is not the true cause of one's hyperactivity.
In one study
from the mid-'90s, researchers gave children a drink containing a sugar substitute. One group of moms was told that their kids were drinking a high-sugar drink; the other group was told the truth, that their kids were consuming a sugar substitute. Mothers who were told that their kids consumed sugar rated their kids as more hyperactive, even though they didn't consume any sugar.
"Just thinking their children were consuming sugar caused moms to perceive their children as being more hyperactive," King said.
"When children consume sugar, it's usually around something fun: holidays, birthdays, celebrations; there's already that excitement there," she said. "I don't think you can say the sugar made them run around and play with friends. ... That would be very hard to separate out."
Instead, a release of the hormone adrenaline might explain a child's overly energetic behavior. "It's a flight or flight hormone; when you are excited or fearful, it increases heart rate and directs blood flow to the muscles, which may make children more antsy and have the urge to keep moving, so you may be perceiving that as hyperactivity," King said.
To try to determine whether your child is truly sugar-sensitive or just excited about a celebration, Castle recommends eliminating sugary foods from the diet for a few weeks and then testing the child with a sugary food like soda, frosted cake or a tablespoon of sugar in 100% juice, and watching the child's response. "It may be a quick way to determine how sugar may be affecting the child," Castle said.
Then again, like the parents in that study, you may just think they're being hyper just because you know that they consumed sugar.
Tips for parents
Even though most kids don't have a sugar sensitivity, that doesn't mean sugar is good for their health. Sugary foods and beverages deliver calories without any nutrients. What's more, eating foods high in added sugars throughout childhood is linked to the development of risk factors for heart disease, such as an increased risk of obesity and elevated blood pressure in children and young adults.
To keep kids healthy, the American Heart Association recommends
that children ages 2 to 18 consume less than 6 teaspoons -- or 24 grams -- of added sugars daily. To put that number in perspective, consider that 24 grams is the amount of sugar in just one 1.55-ounce chocolate bar. A 12-ounce can of regular soda contains about 40 grams of sugar, well over a day's worth.
If you are looking for ways to cut back on sweets for your children, here are some tips to get started:
Gradually reduce the amount of sweets in your child's diet. This is good advice for all kids, with and without ADHD. "I teach the 90/10 Rule for the appropriate balance of nourishing foods and sweets and treats, which equates to one to two normal-sized portions of sweets or treats each day, on average," Castle said. If there seems to be a strong sensitivity to sweets, Castle recommends removing sweets and added sugar from the diet as best as you can.
Establish routine meals and snacks on a predictable schedule. "Anecdotally, this is one of the main things I work on with families, and they tell me they feel their child is calmer and better-behaved. There is something to be said for nourishing the brain and body on predictable, consistent intervals of three to four hours," Castle said.
When introducing foods with added sugars, pair them with protein, healthy fat or fiber. This helps to blunt the effects of blood sugar surges and drops, and it optimizes satiety.
Castle and King suggest the following combinations:
- Cookies with milk
- Candy or chocolate with nut butter on crackers
- Ice cream with nuts or oatmeal crumble topping
- Cake with milk or milk alternative
Experts say you can also include your treat as part of a snack or meal. "If you're at a party, try veggies and hummus and then having some dessert!" King said. "Or eat a small, sensible meal with lean protein, like turkey meat; add some cheese and baby carrots, and then add a fun treat or small sugar-sweetened beverage."
Don't eat sugar on an empty stomach. Doing so can lead to a surge in blood sugar, and that itself may alter a child's behavior, according to Castle.
Make sure that your child is drinking plenty of water. Also, avoid sugar-sweetened beverages on top of eating sugary foods, King advised.
Don't hype up sugar. If you don't have sugar and candies in your house often, and you bring sweets home and make a big deal about it, your child may pick up on it and become excited, King explained.