The relationship between sugar and ADHD and behavior is one of the most controversial discussions in medicine. Most studies in nutrition do recognize that excessive sugar may contribute to diabetes, heart disease, obesity, and immune system dysfunction. However, the exact role of sugar in relationship with ADHD is still unclear, and definitive and replicated studies are scare or have not shown consistency.

Actually, there are many kinds of sugars, and several sources of various kinds of sugar. Chemists define sugar as a class of edible crystalline substances that include sucrose or table sugar, lactose or milk sugar, and fructose or fruit sugar. Sugar is a basic food carbohydrate that appears in sugar cane and sugar beets but also in fruit, honey, sorghum, and maple syrup. Commonly, when people refer to sugar, they think of sucrose or table sugar. The average American consumes an astounding 2-3 pounds of sugar each week probably because there are many hidden sources in processed foods such as bread, breakfast cereal, mayonnaise, peanut butter, ketchup, and many prepared meals. Diets that seek to limit sugar must also consider intake of other types of sugar and hidden sources of sugar.

Physiologically, excess sugar, which breaks down into glucose in the bloodstream, stimulates the pancreas to secrete higher insulin levels to drop the blood sugar level. This rapid fluctuation is not healthy because it places stress on the body. Another problem with sugar is that it may depress the immune system.

The debate of the role of sugar in ADHD has two clear-cut sides. First are the anecdotes of mothers who declare that, after eating anything sugary, their children are bouncing off the wall with activity. These people are convinced that foods and drinks that include sugar cause their children to be hyperactive and less attentive. They may refer to a few studies that appear to correlate sugar and restlessness or simply repeat anecdotal evidence of people they know or have read about on-line. On the other side is the official medical opinion that claims numerous studies show that children do not react to sugar and that sugar does not play a role in ADHD.

First, many mothers of children with ADHD declare that when their children ingest foods and drinks with sugar, they become overactive, restless, and inattentive. The relationship of diet and behavior became popular with the Feingold Diet that eliminated many food products, including sugar. The ideas were well covered in the media and took hold during the 1970s when the movement for alternative methods, taking responsibility for one's own health, and natural foods became popular. According to Feingold, diets eliminating certain things could help improve concentration and reduce impulsiveness and other ADHD symptoms. In the 1982, the National Institutes of Heath held a scientific consensus conference to discuss diet and behavior. They did find that elimination and restriction diets did help about 5 percent of children, most of whom had food allergies.

A few studies appear to confirm the mothers' claims. Wender and Solanto tried to link an increase in aggressive behavior in ADHD children to sugar ingestion. To assess the effects of sugar ingestion, they compared 17 ADHD children with nine age-matched normal children. They found that sugar ingestion as part of a high-carbohydrate breakfast increases the tendency for inattentiveness in some children with ADHD.

Some research indicates that children with ADHD may have abnormal sugar metabolism. Researchers Langseth and Dowd found that 74 percent of 261 hyperactive children in their study had displayed hypoglycemia or low blood sugar after eating refined sugar. Therefore, they concluded that eating large amount of sugar moved the pancreas to release a large amount of insulin, causing a significant decrease in blood sugar levels and a surge in epinephrine levels. Girardi and a team at Yale found that sugar ingestion triggers other metabolic abnormalities. They gave standardized oral glucose or simple sugar to 17 children with ADHD and 11 control children and compared the results. The glucose levels were similar in both groups, and both groups showed deterioration on a continuous performance test. However the drop in test scores in children with ADHD was significantly greater, and those with ADHD displayed impulsive behavior. The study appears to show that children with ADHD have a general impairment of hormone regulation and sugar may accentuate the defect.

Another metabolic happening may occur when eating refined sugar. Some have described sugar as ''empty calories''. Although it does provide no nutritional benefits other than calories, sugar does require a lot of other nutrients to process it thereby depleting the person's nutritional base. Therefore, if the lack of nutrients is related to ADHD, having a high sugar meal may drain these nutrients and push the individual into a nutrient deficient state. Some studies show that children who do not eat breakfast do not perform as well in school. Also, some studies show that children who eat sugar with a high carbohydrate meal do poorly on tasks requiring concentration and are much more aggressive. According these studies, it appears that that sugar does have some effect of physiology of at least some children.

The second position is that of the medical establishment that has determined sugar plays no role in hyperactivity. Hoover and Milich (1994) conducted a study using parents' evaluations of how sugar affects their children. They looked at 35 children who were reported to be sugar-sensitive by their mothers. The children were randomly assigned to an experimental group and a control group. Mothers of the children in the experimental group were told that their children received a large dose of sugar. Mothers in the control group were told their children received a placebo. Actually, all received a placebo; none were given sugar. Mothers in the sugar-expectancy group looked at their children and criticized them more. When the mothers believed that their children consumed sugar, they behaved as if their children were in greater need of supervision. Another study provided children with sugar one day and a sugar substitute the next day. Parents, children, and staff did not know whether the children were receiving sugar or the sugar substitute. Half of the parents were told their children received sugar, and half were told they were given a substitute. On any given day of the study, parents who were told their children received sugar rated them as more hyperactive and restless. Milich concluded that the parental expectations about the effects of sugar are the cause of the perception that sugar makes children more hyperactive. These expectations influence the way the parents interact with their children. According to these studies, expectations of the parents have lots to do with perceived hyperactivity. In 1985 White and Wolraich examined sixteen hyperactive children for 3 days in a hospital setting. The researchers manipulated the sugar content of the diet but found no effects on behavior or learning. Both of these studies were with very small samples. They concluded that the few studies that have been done found the effects are just as likely that sugar improves behavior as making it worse.

In reality, there are few repeated studies on the relationship of sugar and ADHD, and several of them, like the experiment of White and Wolraich, were done in a hospital setting in an artificial setting. Some recent nutritional studies have shown that large amounts of sugar can have a numbing effect on children and can actually induce tiredness. A study from George Washington University found that children with ADHD who ate a high-protein diet performed as well or better afterward than children without ADHD. Foods high in protein are meat, fish, yogurt, beans, peanut butter, and eggs. A study from Oxford University found that adding omega-3 fatty acids will moderate ADHD symptoms. Omega-3 fatty acids, which are contained in salmon, mackerel, sardines, and flax oil, are not a normal part of most diets.

There is no concrete evidence that sugar causes ADHD, and no major study has confirmed this fact; however, evidence that sugar does cause hyperactivity is not strong either. Scientists do have some idea that children with ADHD frequently have abnormal sugar metabolism, but normal children may also experience situations when sugar drains the body's reserves of vital nutrients. Most nutritionists recommend that eating balanced meals from all food groups is the best strategy. Removing as many simple and refined carbohydrates from the diet as possible could have a positive effect not only on ADHD, but also on the health of people in general. These types of carbohydrates include candy, cake, white bread, potatoes, white rice, and pasta.

These foods are quickly broken down in the body, often causing surges and dips in energy. The balance of eating green vegetables, fruits, whole grains, proteins, and healthy fats promotes general well-being and eliminates the possibility of a nutritional deficiency that might affect the child's behavior.

Bibliography:

1) Hoover, D., and Richard Milich. Effects of sugar ingestion expectancies on mother-child interactions. Journal of Abnormal Psychology 22 (4):501-15.

2) White, J. W., and M. Wolraich. 1995. Effect of sugar on behavior and mental performance. American Journal of Clinical Nutrition 62(supple):242S-9S.

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