| Curry School of Education || University of Virginia |
Sugar apparently is not as bad for children as popularly believed. A study reported in the New England Journal of Medicine concludes that contrary to the belief of many parents... sugar does not turn their children into hyperactive terrors. In fact... the researchers say their study suggests that sugar may even have a slight calming effect.
The researchers say that despite their findings... they expect many parents will continue to believe sugar causes bad behavior in children. They suggest that parents who are concerned about hyperactive children should not just blame sugar... but should take them to a doctor for an examination.
After hearing a story on National Public Radio, I clipped these two paragraphs from the UPI newswire (3 Feb 1994). I also looked at the study itself. It was conducted by Mark Wolraich and colleagues and included a double-blind design in which lots of families participated. The families' diets were closely controlled (e.g., food stuffs removed from house, meals prepared by the research project). Over many weeks, families ate foods that were sometimes sweetened by sugar and sometimes sweetened by two artificial agents; they got these special diets in different orders. Differences in the sweeteners did not affect children's activity level or several other measures.
Though these results probably do not surprise many of us, I thought the UPI story had it right: "many...will continue to believe sugar causes bad behavior." How come common wisdom indicates a connection when careful research doesn't? Perhaps it's because our informal observations miss some other critical factors. Here are alternative explanations for the appearance of a connection between consumption of sugar and hyperactive behavior:
In any case, there's pretty good scientific consensus that sugar consumption does not cause hyperactivity. Perhaps, in some extraordinarily rare cases, sugar may cause problems, but those cases wouldn't be reason to make general statements about causation.
Another popular notion is that food additives, especially artificial colorings and flavorings, cause hyperactive behavior. The idea that food additives cause hyperactivity was championed in the 1960s and 70s by Ben Feingold, who wrote the widely cited book, Why Your Child Is Hyperactive. Feingold argued that salicylic acids in some foods (it occurs naturally in, for example, tomatoes and strawberries) and, especially, food additives caused an allergic reaction that was manifested as hyperactivity.Based on this assumption, Feingold developed the "Feingold Diet" (also known as the Kaiser-Permanente Diet) in which people ate very carefully controlled foods and avoided other products that might contain salicylates (e.g., toothpaste with artificial colorings). He provided case studies indicating that following the diet reduced hyperactive behavior in children. The diet was very difficult to follow, making it hard to test it's effects independently; scientists had to devise equally difficult diets as placebos. However, many careful studies of the effects of the Feingold diet were conducted; they revealed that it did not help reduce hyperactivity. When Ken Kavale and Steve Forness aggregated all the studies of the Feingold diet done by the early 1980s, they could find few benefits from it. At best, there may be a small subgroup of children for whom it works. To see a graphic representation of the effect size for the Feingold diet in comparison with other interventions, see our pages on effective interventions.
Regardless of whether sugar or other food stuffs cause behavior problems, there's still every reason to promote healthy food consumption among our children. Furthermore, there's also good reason to demand that our foods are not laden with unhealthy agents (e.g., carcinogens).
There is more on the topic of hyperactivity in lots of sources, including ('natch) a book on learning disabilities written by my colleagues, Dan Hallahan, Jim Kauffman, and me. There's lots of information on the internet, but beware that what's there has not been evaluated carefully and may be misleading.
Here are some links providing further information about the relationship between sugar (and diet in general) and hyperactivity. I hope they are useful. Note that I've included some that promote the apparently mistaken connection between diet and hyperactivity.
In a 1996 issue of Nutrition Bytes, Jeff Comisarow provides a thorough discussion of the topic of sugar and hyperactive behavior
Diet and Nutrition and the ADD Child
Pediatricians at UT Southwestern Medical Center say that there's no real evidence that sugar causes hyperactivity.
Linda Russell, who's a dietitian at Nemours Children's Clinic (Jacksonville, FL, USA), has a Q&A page on diet and hyperactive behavior
UVa's Children Medical Center page on feeding children with ADHD is helpful
Some dieticians are appropriately circumspect about the effects of diet on behavior.
David Winter of the Baylor University Medical Center has a 1997 page on diet and behavior
A 1988 article called Taking the Hype Out of Hyperactivity from the International Food Information Council Foundation discusses both sugar and food additives
Noel Peterson advocates food allergy testing
The HealthCare Network, an information source for alternative healthcare manufacturers, asserts that sugar is bad for us and says it can cause hyperactivity (check the disclaimer at the bottom of the page)
The National Institute of Health's information about Diets And Childhood Hyperactivity. Also see the NIMH page on ADHD.
David Hancock promotes elimination of sugar and adherence to other dietary regimens on his page, Conquering hyperactivity--the natural way
Raley's & BelAir Stores site has a CFM page (link will go 404 if the CF database is changed) that refers to some of the same research to which I refered, but goes on to suggest controlling diet in hopes of reducing hyperactivity.
The Internet is full of testimonials about the benefits of diet therapies:
On Kidsource, Lynn Murphy of the Feingold Association, advocates the diet as an alternative to drug therapy
Stephen Barrett, who maintains QuackWatch, gives a good analysis of the Feingold diet
Some chiropractors are bullish on diet therapies:
Writing for the National Network for Child Care in 1995, Elisabeth Schafer (Iowa State University), tells why hyperactivity is not linked to food additives
Parents Helping Parents refers to a meeting featuring the Feingold diet, a dietary connection to better behavior, learning and health
The Feingold Association of the United States maintains a web site called the dietary connection to better behavior, learning & health
On her page from the November 1997 ADDed Attractions newletter, Brandi Valentine comments on the absence of evidence for diet therapy
Andrew Weil used to recommend diet as one of several means for treating hyperactivity--others included cranial manipulations, bio-feedback, and so forth (old URL: http://cgi.pathfinder.com/drweil/qa/0,1471,1149,00.html now resolves to his main site, not the original article); his newer Web site is more cautious about fructose and hyperactivity.
Nutramed, purveyors of diets, have a page on hyperactivity
The ADD Action Group includes recommendations about dietary therapy among it's various therapies (craniosacral therapy, educational kinesthetics, and so on). It also provides an article called "Scientific Studies Linking Diet to ADHD are Often Ignored" Jane Hersey
The Expanded Dictionary of Metaphysical Healthcare includes the Feingold diet among its list of naturalistic methods
The April 1997 newsletter of the Well Mind Association has a section on fat and the Feingold diet
On it's page about attention deficit-hyperactivity disorder, the Learning Disabilities Association includes an assertion that 1-2% of children may be improved by adherence to the Feingold diet (and that sugar causes hyperactivity)
Hyperactive Childrens Support Group, a U.K. group concerned about hyperactivity, has pages that offer a food program and proclaim the benefits of the Feingold diet
Hallahan, D. P., Kauffman, J. M., & Lloyd, J. W. (1999). Introduction to learning disabilities (rev ed.). Needham Heights, MA: Allyn & Bacon.
Kavale, K. A. & Forness, S. R. (1983). Hyperactivity and diet treatment: A meta-analysis of the Feingold hypothesis. Journal of Learning Disabilities, 16, 324-330.
Wolraich, M.L., Lindgren, S.D., Stumbo, P.J, Stegink, L.D., Applebaum, M.I., & Kiritsy, M.C. (1994) Effects of diets high in sucrose or Aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 330, 301-307.
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