Episode Transcript (Auto-Generated by Apple Podcasts Transcribe)
Welcome to Nutrition For Mortals, the podcast that says life is too damn short to spend your time and attention worrying about your food choices.
So let's take a deep breath and then join us, two registered dietitians and friends, as we explore the world of nutrition with a special focus on cultivating a healthy and peaceful relationship with food.
My name is Matt Priven, and I am joined, as always, by my co-host and the best dietitian on planet Earth, Jen Baum.
Hey, Jen.
Hey, Matt.
And I'm going to say all the things that I say at the beginning of an episode.
Hit them.
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A portion of our Patreon goes to support the Hunger Project, which is a wonderful organization.
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Really?
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All right.
What are we talking about today?
Matt, we are back to sugar.
We're back to sugar.
Things have come full circle.
We had our Sugar Is Not a Drug episode, and today we're going to be talking about sugar and hyperactivity.
Can we reveal that we're recording this on Halloween?
I feel like that's so perfectly timed.
I know.
I know.
We were just talking about how we wish we had timed this episode to come out yesterday when we released an episode, but, oh, well, alas, we're still recording it.
But yes, this episode is happening on Halloween.
So how appropriate.
All right, so we're talking about sugar.
All roads lead back to sugar.
But how are we talking about sugar today?
Yeah, it's a great question.
So I want to tell you a little bit.
I don't think I've actually told you this yet, but I wanted to tell you about why I wanted to dive into this topic of sugar and hyperactivity.
And that is because last year, so I have two kids, and last year, my oldest kid came home from middle school and told me that they weren't allowed to bring candy or sugary foods into school because they were told that, quote, it makes kids hyper and it causes them not to focus.
And so you can imagine that I did not love an entire food group being disallowed from school.
And so ever since then, I have been thinking about wanting to talk about this hypothesis or this idea that sugar causes kids to be hyper.
And then I also thought this is a great opportunity to talk a little bit about if sugar intake is linked to the development of ADHD or Attention Deficit Hyperactivity Disorder, or even if consuming sugar exacerbates symptoms of ADHD.
So, we're really doing a deep dive into the world of sugar and hyperactivity.
I love the origin story.
So, your kid came home, and did you...
How did you describe to them how you feel about sugar and hyperactivity?
Yeah, I think I just said, that's not true.
Without having, you know, without having like as much knowledge as I do right now.
But then we had a really good conversation about how, you know, you can include foods that contain sugar, as well as eating lots of other foods, and that, you know, it's important to be able to have lots of favorite foods within all categories.
So, we definitely like debriefed a little bit about it.
But, I mean, I don't know, Matt, you have a kiddo also.
And have you ever heard this kind of idea from teachers or from other adults that, oh my gosh, if I give kids anything sugar-containing, they're going to be bouncing off the walls?
I hear this from everybody.
This is ever-present my entire life.
When I was a kid, now that my...
I have a kid, we hear it from all sorts of other influences.
This is a classic one is, oh no, she had a piece of candy and it's already 7 p.m.
She's going to be bouncing off the walls and never going to get to bed.
And we're going to have to tie her down.
Like this is so classic.
And yeah, I think it also has a lot to do with diagnoses of ADHD.
And when somebody says, oh, my kid has ADHD, or I have it, people come out of the woodwork to tell them to make dietary adjustments, right?
And so this is this is really kind of baked into the culture.
Yeah, for sure.
I mean, I feel like the other classic example is like the birthday party example, where, you know, parents might be like, oh, I brought my kid to a birthday party, and then they ate cake and they drank juice and like, you know, then they didn't go to sleep for like 10 hours or something like that.
So there's all these like very interesting cultural narratives around what happens to kids if they're consuming sugar.
Exactly.
It's become one of those things where it's so normalized that people say it just to talk, like a cake gets served and they go, Uh-oh, the kids are going to be up all night.
Like, do people just say it to say it?
And so I'm glad we can actually talk about, is there truth to this?
What does the research say?
How did we get here exactly?
And so where should we jump in?
Yeah, that's the perfect question.
And so like we often do on the show, I really want to give some history and some background.
I, you know, started my research really trying to trace the origin of this hypothesis that sugar causes kids to become hyperactive.
And so as I started doing some digging, I very, very quickly came across a book that was titled Why Your Child Is Hyperactive, written by a man named Dr.
Ben Feingold.
Why Your Child Is Hyperactive.
Okay, so Ben Feingold has the answer.
What year is this?
This is 1974.
So this is a 1974 self-help book written all about children, diet, and behavior.
Okay, interesting.
And so before we even get into the text, like what do we know about Dr.
Ben Feingold?
Who is this guy?
Yeah, so he was actually a doctor that began his career as a pediatrician.
He served as a medical officer in the Navy.
And then after he left the Navy in 1945, he really shifted his specialty and focus and became an allergist.
And he became a pretty prominent allergist pretty quickly.
In 1951, he joined the Kaiser Permanente Medical Care Program in Northern California as chief of the Department of Allergy.
So he has this pretty straightforward medical background where he works his way up to be the department head at a pretty prestigious organization.
Oh, okay.
Interesting.
So he's an allergist.
He's not necessarily coming from the world of psychology or psychiatry here.
That's right.
And his background as an allergist is really important to our conversation today.
First, because it's obviously going to inform how he thinks about medicine and health, but also because he has this very pivotal moment when he's practicing at Kaiser Permanente in the Department of Allergy that gets him thinking about how diet is connected to behavior.
And so, Matt, I'm going to have you read this quote from Why Your Child Is Hyperactive, where Dr.
Feingold describes this pivotal moment.
And, you know, just to set this up a bit more, the year is 1965.
Dr.
Feingold, like I said, is working at his allergy clinic at Kaiser Permanente, and a woman comes into the clinic with hives.
And so, Matt, would you read this quote, please?
Quote, she was suffering from acute hives.
Her face was swollen, mainly about the eyes.
She looked and obviously felt miserable.
I read the medical history of this patient, examined her and tested her for allergies.
Since the tests were negative, I concluded that artificial food colorings and flavors might be involved.
Food additives had been a causative factor in previous cases of hives I had seen.
I immediately placed her on a diet to which she quickly responded.
The skin condition vanished within 72 hours.
Then, some 10 days following the diet prescription, I received an unusual call from the Kaiser Permanente Chief of Psychiatry.
He said, What did you do with that patient?
And I replied that we had simply placed her on the elimination diet.
The psychiatrist then revealed that this woman had been in psychotherapy for about two years.
She'd been hostile and aggressive, unable to get along with her husband or family or coworkers.
In less than two weeks, these conditions had also cleared.
I was startled.
However, the fact remained that with the diet control eliminating food colors and flavors, the giant hives had disappeared and her behaviors had become quite normal.
All right.
Thoughts?
Okay.
Interesting finding, Mr.
Feingold.
Anecdotes are not quite the same as, you know, robust scientific data.
And is this the foundation of this book?
Is the end of one study with a client here?
Well, I would say that this is like the first direct link, so to speak, that Ben Feingold observes between diet and behavior, right?
So, you know, he has been using the model of an elimination diet in the setting of treating people with allergies.
But now, you know, with this call from the chief of psychiatry, the seed is planted, so to speak, that this elimination diet he has been using to treat allergies may also impact behavior.
Okay.
I mean, this person came in with acute hives and a swollen face.
It sounds like you just didn't find the allergic reaction of note here.
It sounds like there's something else happening, of course.
And then there's a bunch of presumptions that make huge leaps here.
But okay, so I see what you're saying.
This is the start of the idea.
This is the seed of the relationship between diet and hyperactivity or behavior changes.
Yeah, I think that's probably a better way to say it, is that it's this kind of pivotal moment, like I said, where he's starting to connect behavior with diet.
I will say it's so funny, right, Matt, on the show.
We do love a good quote that leaves us with more questions than it does answers, right?
Absolutely.
Absolutely.
Yeah.
Okay.
So this is 1965.
This moment with the woman coming into his clinic is 1965.
And at this point, Ben Feingold is 65, 66 years old.
So he's really kind of towards the end of his career.
And in the next part of the book, Why Your Child is Hyperactive, he mentions how, you know, he doesn't really think much more about this particular case.
He's thinking about retiring.
And then all of a sudden, he starts to hear more and more about the sudden uptick in cases of hyperactivity in children.
So just for context, I think it's important to remember that in the late 1960s, the early 1970s in the US., this is when a lot more attention starts being paid to what we now call ADHD, what was then called hyperkinesis learning disability.
You know, you had more papers being written about the uptick in hyperactivity in children.
Newspapers started covering the condition more.
There was also this seven-page spread in Life magazine devoted to ADHD children, which was a pretty big deal at the time.
So my point here is that you have a lot more attention being paid to what we now know as ADHD.
And as a consequence, this awareness about hyperactivity in children was just much more in the cultural zeitgeist.
Yeah.
So interesting shift.
I imagine a lot of things are changing in the 60s, right?
We've got some distance from World War II, and at least here in America, the country is changing dramatically at the time.
I'm sure the role of parents in the job of parenting is changing.
So a lot of things probably are changing that make this kind of complicated to figure out what happened here.
Yeah, for sure.
For sure.
And so, you know, when Ben Feingold hears about this uptick of hyperactivity in children, it's like almost like this light switch goes off for him.
He's like, I'm not going to retire.
I feel like I can help with this problem.
I feel like I can help these children.
And then, all of a sudden, he kind of remembers this 1965 case with the woman whose behavior improved when she went on his elimination diet.
And he pretty much jumps to the conclusion that the increase in children's behavioral issues, their hyperactivity, their difficulty concentrating, is a consequence of their diet.
And this was super different than mainstream thinking at the time.
I mean, this was a time when psychiatrists viewed and classified ADHD as a neurological disorder.
And so Dr.
Feingold's idea about diet causing hyperactivity and ADHD in children was very, very different than mainstream thinking.
Okay.
Well, I love a passion.
He seems passionate.
That's cool.
Yeah.
I mean, I will say, I think really this guy doesn't have like food charlatan vibes to me.
I really do think he wanted to help these kids.
I mean, he had devoted his life to medicine.
He had obviously been working with patients for a long time.
I think his motivations were pure.
I think he really was trying to help.
I think it's just that he kind of jumped the gun with his hypothesis because, you know, what he essentially started to do was to see children in his clinic who met the criteria for ADHD, and he put them on what he called the KP diet, but what then became known as the Feingold diet.
The Feingold diet.
Okay.
I can't wait to get into this, but, you know, in the quote I read, we're kind of focused on artificial food colors and flavors, right?
And so, I mean, I kind of get it, like the food system is changing so dramatically, and they're observing this increase in the incidents or prevalence of hyperactivity.
And so, I mean, an association, a guess, a hypothesis, nonetheless, I kind of get the idea here.
Sure.
I mean, I don't think it's a bad hypothesis to test.
I think all good science starts out with a question that you then have to go about testing.
And I think Ben Feingold was trying to do that.
It's just that the way he was doing that was essentially to perform a lot of case studies where he put kids on his elimination diet and then just observed the results.
So what does the Feingold diet actually entail?
Yeah, so the Feingold diet recommended that kids cut out all artificial flavors, artificial food colors, and salicylates.
And so, you know, just for people listening who might not be aware, salicylates are a group of organic compounds that can be found in plants, in foods, in medications.
For example, aspirin contains salicylates, as do foods like apricots and prunes.
And people can be sensitive to them.
So in addition to all foods that contain artificial flavors and colors, the Feingold diet also recommends cutting out all sources of salicylates, including things like tomatoes or prunes or berries or grapes.
So it was a pretty restrictive diet.
This is the kind of eating style where you have to walk around with a little list of every thing that could possibly show up in a food so you can cross-reference everything you're about to eat.
For sure.
I mean, this is like you'd have to read all food labels.
But Matt, I am curious.
I'm going to totally flip this around on you.
What are you not hearing needs to be eliminated on the Feingold diet?
Sugar.
Bigger food groups.
Yeah, I know.
That's exactly right.
So even though this book, Why Your Child Is Hyperactive and The Feingold Diet, is really where this idea that sugar makes children hyperactive originates.
Feingold never tells his patients to cut out sugar.
In fact, I'm going to actually have you read one more quote from the book.
This is from one of several case studies that Feingold writes about after he starts putting kids with ADHD on his elimination diet.
And so again, just to set this one up a little bit more, the year is 1972.
You have a mother who brings her son into Feingold's clinic.
Feingold refers to this patient as Johnny A., who is a six-year-old boy, and who is having bouts of, quote, what his mother describes as erratic behavior and bouts of hyperactivity.
And so Matt, if you would read this quote, please.
A quote about Johnny A., here we go.
Quote, after a year of endurance and frustration, the boy's mother finally decided to seek medical help.
She had a hunch, deserving of any doctor's consideration, that large amounts of carbohydrates, sugar from any source might be triggering the hyperactivity and aggression.
Her fair-haired, wiry son loved soft drinks, candy, and cake, not exactly abnormal for any healthy child.
He also seemed to go completely wild after birthday parties and during family gatherings around holidays.
Right, so this mother suspects sugar, but even after this mother expresses her concerns to Feingold, he never tells her to cut sugar from Johnny A's diet.
He tells her to cut out food dyes and food additives and salicylates.
But he actually also says in his book, quote, the mother was worried about meeting Johnny A's insatiable sweet tooth demands.
I suggested her own kitchen, homemade candy, homemade ice cream, homemade baked goods, steering clear of synthetic colors and flavors.
And so, I mean, it's just to me really fascinating that at no point in his book does Feingold ever mention anything about the need for cutting out sugar.
In fact, it's so interesting if you go to the very back of this book, Why Your Child is Hyperactive, he gives these sample meal ideas for kids.
And just to give you an example, a sample breakfast that he would recommend would be grapefruit segments, French toast, syrup, and chocolate milk.
So again, not needing to cut out sugar at all.
But from this book, or maybe even from this paragraph, people are like, huh, the birthday party connection.
I wonder if that's it.
So even though he's not recommending to cut out sugar, this was sort of the start of this connection.
Yes.
I mean, it really seems to me that as a consequence of this book being published, that we get this huge leap being made by parents, that even if your child maybe doesn't have ADHD, sugar is still linked to behavioral problems, like acting out or being more hyperactive.
And so, I mean, it's funny, right?
It's just an anecdote in a book.
It's one mother's belief, but it just really takes off as this deeply ingrained cultural idea.
I mean, this is the issue with correlation does not equal causation is based on what we've heard so far, we could just as plausibly say that going to a birthday party is associated with hyperactivity.
Yeah, for sure.
Exactly.
That's based on the data we have so far.
That would be a correct statement.
And so it's again, the consequence of anecdotal evidence combined with a pervasive idea that kind of just feels true on some level.
Right, right.
And it feels true because sugar is a source of energy.
It's a very sort of crystallized source of energy, both literally and figuratively.
But with food, we think of energy a little differently than the way we think about energy from caffeine or energy from a stimulant medication.
But it just feels true because sugar is just like this very pure source of carbohydrate energy.
But it does not mean that sugar necessarily causes hyperactivity.
There's much research to be done still.
Yeah, exactly.
And I would also say, I mean, even if we think about how, you know, consumption of sugar is portrayed in media, right?
Like, you have this idea of a sugar rush.
You have cartoons and kids' shows and kids' movies, you know, kind of showing kids bouncing off the walls when they consume sugar or, you know, juice or something like that.
And so there's just like lots of ways that I think this idea has been like suggested to generation after generation of parents.
Yeah, this is sort of a power of suggestion thing, where it becomes like an internal feedback cycle of like truthfulness, which I'm guessing kind of is going to continue as we go through the history.
Yeah, for sure, for sure.
So where should we go next?
Yeah, so, you know, Finegold publishes Why Your Child Is Hyperactive in 1974.
The diet, the Finegold diet, becomes super popular.
You have a lot of parents putting their children with ADHD on this diet, and Ben Feingold gets super big as well.
I mean, he makes a ton of TV appearances.
His diet starts to gain more and more traction as a possible, you know, quote, cure for some children with ADHD.
And so actually, let's listen to a quick clip from a documentary from the 1970s called Hyperactive Children, where we'll actually hear Dr.
Ben Feingold talking about his diet, and then we'll also hear a reporter talking about the increase or uptick in children being diagnosed with ADHD.
It's a sort of natural foods diet.
You have to eliminate many soft drinks, cereals, a lot of dairy products, cake mixes, and other prepared foods.
Even most cold medicines and vitamins are artificially colored.
The list goes on.
But which of the colors and flavors are the culprits?
We cannot identify which color or which flavors.
And you eliminate every one, and then you get a result.
If you don't, you may miss enough to get the result, you see.
If you start going compound by compound, the child couldn't live long enough because you're dealing with thousands of compounds.
Do you know what the mechanism is, what it is about eliminating these colors and flavors that makes the child respond?
We haven't the slightest notion.
Dr.
Feingold happened onto his theory when he was treating a woman for hives.
He eliminated some food from her diet, including artificially colored and flavored foods.
Her hives went away, and her psychiatrist reported that the diet seemed to cure her anxieties as well.
Dr.
Feingold began to prescribe the elimination diet for hyperactives.
That's just about all the science there is to it, say his critics.
They say he hasn't waited for the scientific community to verify why, or even if his theory is right.
Instead, Dr.
Feingold has gone out promoting his diet all over the country, straight to the grassroots.
Yeah, so you can see that he got pretty big pretty fast.
And there was even this increase in what were called like Feingold groups, where people would come together and discuss what food options their kids could eat on the Feingold diet.
But as you heard that reporter say at the end, the medical community felt very critical of the Feingold diet and just Dr.
Feingold's approach.
Is the classic dynamic between somebody's got a novel idea, should we let people try it if it's not too dangerous to try, or should we wait for the science?
So, you know, this is a tension we've talked about many times, but it sounds like, you know, we're really talking about nervous parents who are trying to take care of their kids and are unsure of how to do it.
So it's a very vulnerable group.
Yeah, for sure.
You know, I think the real problem that both the medical and the scientific community had at the time was that, you know, why your child is hyperactive is essentially just a collection of case studies and anecdotal evidence.
And so what happened next was that researchers wanted to start testing Feingold hypotheses, right?
They wanted to see if sugar actually was causing kids to become hyperactive and if this elimination diet was actually necessary or effective.
Sweet.
Let's get into it.
So it seems like there's a couple of buckets here, like there's like the sugar.
How does sugar influence people who have like a diagnosis of ADHD versus people who don't?
And so can we start with the latter?
Like, can we look at the research question around what is the influence of sugar on hyperactivity in kids who do not have a diagnosis of attention deficit hyperactivity disorder?
Yeah, that's a great question to start with.
And so, you know, after Feingold's book comes out, you have a lot of studies starting to be done in the late 1970s, the 1980s, the early 90s, where you have this hypothesis being tested.
Does sugar increase or cause hyperactivity in children?
And, I mean, in terms of a nutrition science question to try to answer, it's definitely an easier one than some, right?
You can test this hypothesis a little more easily because we're talking about one variable being tested, essentially.
And so, during these few decades, you have numerous challenge studies that test the hypothesis that sugar ingestion leads to increased activity levels in kids.
And, you know, these are what you and I would consider to be very well-designed studies.
You know, you have these studies that are putting cohorts of children and their families on high sugar diets for weeks at a time, and then comparing the higher sugar intake group to a lower sugar intake group over time.
And these studies find again and again that there were no differences in the behavioral or the cognitive measures for any of the children across groups.
And so we start to see the result over and over that suggests that sugar doesn't seem to be impacting kids' behavior or causing hyperactivity.
Okay, awesome.
Yeah, and then you also have several meta-analyses that were done.
I looked at two in particular that, of course, I will link in the show notes.
You have one from 1986 and one from 1995.
And when they looked at the body of evidence almost a decade apart, both concluded that there was no evidence to support a link between sugar intake and hyperactivity in kids generally.
And I know that people are probably thinking like, but Jen, that research is so long ago.
What about more recent research?
But honestly, like, there hasn't really been much more recent research because we pretty much answered this question.
And I mean, you know, of course we can't say for certain that there may not be a small subset of kids who are more sensitive to like big changes in blood sugar.
But from all of these really well designed trials, we kind of have this question answered.
And it really does seem like sugar causing hyperactivity in kids is largely a myth that's been disproved by well designed trials.
But Jen, I just know it's true.
I don't believe the research.
I know.
I know.
It feels true.
It seems true, but the research really doesn't support it.
Then why is my kids so hyper?
Make them chill out.
Well, I mean, I think that that's the question.
I mean, I think probably people listening are like, well, but what's then going on?
Because it seems like a phenomenon that so many of us may have observed.
And I mean, I think there could be a lot of other things potentially going on that I want to talk about.
I mean, there's this idea that something else could be causing the hyperactivity, like kids could be overstimulated, or maybe your kiddo didn't sleep well the night before, because we know that that can impact kids' behaviors the next day.
I mean, you also have this idea where if you keep telling kids they can't have sugar because it's going to make them crazy, they might kind of act crazy when they finally get it, right?
That's something called priming that we know can have an effect.
I love, yeah, tell me more about the priming thing.
I just want to put a fine point on that, because I love this idea.
I mean, like I said, it's this idea of, you know, if you keep telling somebody over and over that something is going to happen, then that becomes an internalized belief.
And so that when it finally happens, it kind of just tends to play out the way someone thinks it's going to play out.
So in this case, you know, you keep telling your kid, you're going to go crazy if you have that juice.
Well, when they drink the juice, they're going to act bananas because they've been told they're going to act bananas.
Yeah, it's great.
It's sort of like a Dr.
Jekyll and Mr.
Hyde situation.
Yeah, exactly.
I mean, the other big thing that I think is likely going on is confirmation bias.
And, you know, confirmation bias is just the tendency to seek out and prefer information that supports our preexisting beliefs.
And so, again, if you believe that your child is going to act out or have behavioral issues when they go to a birthday party, you're going to see them start to become overstimulated and link it back to the sugar, not the fact that maybe they're in an environment with lots of other kids, not because maybe they're overstimulated in general.
So I also think that confirmation bias has a lot to do with this potentially.
I mean, there's so many judgments baked into this, like overstimulated.
They're just stimulated by being at a fun birthday party.
That's great.
That's probably what we're trying to do with the birthday party.
Yeah.
I mean, I think we've all been in, like, very kind of chaotic environments where we notice our own energy is just up and maybe a little bit more chaotic.
So I, again, I think it's more a product in those situations of the environment itself and how a kiddo is responding to it, than it is, like, related to the cupcake.
Yeah.
And I love that idea of, you know, this has something to do with the expectations of the parents about what's about to play out when their kid eats sugar.
Is there science into this question?
Like, this seems like it could be a great place for some psychological studies.
I mean, what have you found out about sort of this dynamic between parent and child?
I love when you set me up perfectly.
Yeah, there actually have been studies where they've tested the expectations that parents or caregivers or teachers have when kids eat sugar.
And so, you know, just to give you one as an example, you know, I looked at a study that was done in 1994.
It was published in the Journal of Abnormal Child Psychology, and it was titled, Effects of Sugar Ingestion Expectancies on Mother-Child Interactions.
And I want to talk a little bit about this study, because I just thought it was like so sneaky in a great way.
And so, in this study, essentially, researchers recruited 31 different boys and their mothers, and these boys were all reported by their moms to be, quote, sugar-sensitive, whatever that kind of meant to them.
So, already in place, you have some level of expectation or perception by these boys' mothers that their kids are going to react a certain way to consuming sugar.
And so, what the researchers did was that they told the moms that their kids were either going to receive a very sugary challenge drink on an empty stomach or an unsweetened drink on an empty stomach, an artificially sweetened drink on an empty stomach.
But here is the sneaky part.
All the kids were actually given the artificially sweetened, non-sugar-containing beverage.
And not unsurprisingly, what the researchers found was that the moms who were told that their kid had ingested sugar rated their kid as more engaged in hyperactive behaviors, significantly more acting out compared to the moms who had been told that their kids drank an unsweetened beverage.
So just like a fascinating way to kind of test perceptions around sugar.
I love that type of study design.
And it just kind of highlights this idea that parents have certain expect...
Why do they say expectancies and not expectations?
The word was right there for you.
I don't know, it was the 90s.
Parents have certain expectations about how their kids are going to behave.
And they can kind of impose that onto their kids, even when they actually don't know what they ate.
Yeah, exactly.
Exactly.
And this wasn't the only study done like this.
I read a couple that kind of had this similar kind of bait and switch where mothers thought their kids were going to be eating or drinking something sugary, and then had the moms rate their kids behavior or the level of hyperactivity.
And so you had quite a few of these studies indicating that expectancies, now I'm just going to use that word to bother you, or perceptions really did impact how these parents were viewing their kids' behavior.
Wow, that's fascinating.
Okay, so we're really kind of pulling back the curtain on this idea that's been so prevalent for 50 years here, that sugar influences the hyperactivity in kiddos in general.
But can we dig into the question of ADHD now?
Yeah, let's do it.
All right, so how should we think about the research question here?
Yeah, I would say that I think scientists have approached this topic and asked two different questions.
And so we will take these one at a time.
The first question is whether or not consuming a high sugar diet could increase the risk of developing ADHD or lead to the development of ADHD.
And then the second is whether or not consuming sugar exacerbates symptoms of ADHD in kids or adults, right?
So if somebody with ADHD consumes something that contains sugar, are they going to notice an increase in symptoms like hyperactivity, or difficulty concentrating, or difficulty focusing?
So in terms of the first question, I think it's really important to make it very clear that ADHD is not caused by consuming sugar.
I felt incredibly depressed after being on social media for a while, looking at the different narratives around this question, because I would come across videos that would say things like, sugar in a baby's brain is called ADHD, or sugar toxicity in your child is what's causing all behavioral issues.
And, you know, why don't we play a clip just to kind of illustrate a little bit of what I'm talking about.
“Hey, it's Dr. Ebony Cornish.
So I always talk about how sugar and yeast can have a negative impact on the adult brain.
But did you know it has even more of a negative impact on the pediatric brain?
You know, when I have kids and parents who come to my office, and they complain of ADHD, OCD, maybe even some cognitive impairment, and even my kids on the autism spectrum, we always start with diet. Diet, diet, diet.
Because I'll be surprised how much sugar these kids are exposed to right when they wake up in the morning.
May that be from the sugary cereals that they're eating, or drinking that juice that's high in sugar and is supposed to be healthy.
And then the sugar content they have throughout the day with unrefined carbs and high sugars and snacks, their brain is inflamed.
So that's why they're leaving the house, and they're having a lot of these cognitive conditions, because it leads to leaky gut and yeast overgrowth.
So listen, if your kid is not grocery shopping, keep that sugar out of the house.”
She really wanted to say shit in that last phrase there.
She was like, keep that sugar out of the house.
Oh my gosh, I know.
And like just so much like inflammatory language, you know, just like all of this, like leaky gut and all these wellness words.
And it's like, it just makes my blood boil.
I have such a strong response to it.
It makes me so mad.
Oh, wait, let me scratch at that.
Why are you so mad?
I love it.
I love that you love that I'm angry.
Well, because, all right, Matt, I'm gonna, I'll rant a little bit.
It upsets me deeply because, you know, ADHD is a neurological condition and a neurodevelopment disorder that impacts certain parts of the brain and is largely genetic.
And we don't have any evidence to suggest that higher intakes of sugar as a child leads to the development of ADHD or that sugar in a baby's brain is ADHD.
But like, the way this woman talks subtly implies that if you just cut out sugar from your child's diet, you're going to somehow what, like cure their ADHD or autism?
Subtly implies?
I, yeah, exactly.
Overtly implies that that's what's going to happen.
It makes me so upset.
It makes me so angry.
Yeah.
I mean, she talks about kids coming in, complaining of ADHD or OCD.
It's like, do you understand?
What is her?
Do we happen to know what kind of provider she is?
I mean, she's a doctor.
I didn't look that deeply into her credentials, honestly.
And so I-
Is this TikTok?
Where do we get this?
Should we look?
Should we look up her credentials?
Sure.
Let's do it.
Okay.
Let's do it.
The girl from Ipanema goes…
Okay.
Okay.
Okay.
I found her.
I found her.
So she is-
she's an MD.
She's a physician.
It says she provides integrative medicine services and serves as a functional medicine director of the Amen Clinic East Coast Division.
So she is a doctor.
Amen.
Okay.
Jesus Christ.
All right.
So this is a functional medicine doctor.
Yeah.
So for the people who have given us critiques about our episode on functional medicine, yeah, this is what we're talking about.
Some people give terrible advice in the functional medicine community.
And this is an example of that.
Not everybody in the functional medicine community, but TikToks like this that seem to directly imply that cutting out sugar from your child's diet is going to cure autism or ADHD is incredibly irresponsible.
Please stop doing it.
And while we're dunking on this woman, she does not know the difference between refined and unrefined carbohydrates.
She said the wrong word there.
All right.
Have we torn her apart enough?
Yeah.
But thank you for the taste of what people are saying online.
Yeah, this is aggravating, to say the least.
Yeah.
Research question number three, I guess, is the relationship between sugar, diet, however you want to frame it, and symptoms of ADHD or manifestations of ADHD, the experience of living as somebody with ADHD.
Yeah.
So this question is slightly more nuanced.
I will say just at the outset, I did not come across any conclusive data to support the idea that sugar exacerbates symptoms of ADHD or increases hyperactivity in the majority of individuals.
And so there have been some studies that seem to suggest that sugar intake increases ADHD symptoms.
But when I looked at those studies, they had so many confounding factors or methodological issues that I don't really think you can draw any firm conclusions from them.
And so just as an example of what I'm talking about, many of these studies relied on information from questionnaires given to parents or caretakers of children with ADHD, rather than direct observation or interviews with the subjects who had ADHD.
And so this is very problematic because, as we've already discussed, many parents or caretakers already hold the belief that sugar increases hyperactivity.
And so if you're just talking to the parents and not observing the kids, that's a big problem.
Absolutely.
And you're going to want to control the environment.
You want to control something here, rather than just assessing kids in the wild who are exposed to all different factors.
Yeah, for sure.
And I will also say that other problems with these types of studies found that, you know, sugary containing foods that were analyzed in these studies maybe also contained caffeine, for example, which could of course confound the results.
They even noticed that there is emerging data to suggest, you know, higher than expected rates of binge eating in individuals with ADHD, you know, which of course would lead both you and I to wonder if someone's symptoms of ADHD like difficulty concentrating or focusing is a consequence of them not eating all day rather than directly related to their intake of sugary foods.
But Jen, I thought binge eating was eating a lot.
What do you mean they're not eating all day?
Well, Matt, many binge eaters often will restrict their intake, forget to eat over the course of the day, and then that results in them being overly hungry later on.
And so, these types of folks might consume a lot of food later in the day, but that doesn't mean they weren't hungry or maybe experiencing the symptoms of being undernourished earlier in the day.
Right.
Thank you.
Okay, I get it now.
Thank you.
So, it seems like these preliminary studies you looked at, it was hard to kind of glean any actionable information or really take any conclusions away.
Yeah, that's right.
I mean, I did find one meta-analysis from 2020 titled Sugar Consumption, Sugar-Sweetened Beverages, and Attention Deficit Hyperactivity Disorder.
This study pooled seven different studies and found actually that there was a significant positive association between overall sugar intake and sugar-sweetened beverage intake and the symptoms of ADHD.
However, upon closer look, these seven studies that were pooled in this meta-analysis were not randomized control trials.
They were observational studies.
And the authors of this meta-analysis noted that there was a really high level of heterogeneity in their analysis.
And all that means is there was a lot of variation between the studies that they looked at.
And when we have a high level of heterogeneity, it can make the meta-analysis assumptions incorrect.
And so that's just my very long-winded, research-y way of saying that results are inconclusive even from this meta-analysis.
And we would need better studies in this particular area to really test this hypothesis.
Yeah, absolutely.
So the underlying question here is, does sugar influence the symptoms of ADHD?
And with association studies, one of the risks is that we have an association that could go the opposite way.
Reverse causation could be something we're actually seeing.
So in this case, it would be, the symptoms of ADHD cause high sugar intake.
That sounds very plausible to me.
I mean, you and I have worked with many people with ADHD, and there are unique challenges with nutrition and eating.
Should we talk about that a little bit now?
Well, for sure.
I mean, I think it's really, really important that we talk about the fact that individuals with ADHD can have very unique challenges, nourishing themselves, feeding themselves.
You know, things like lowered appetite in the setting of stimulant medications, nutrient deficiencies, sensory challenges with textures that can make them maybe more particular or perhaps more limited in their food choices, difficulty remembering to eat, and then perhaps over consuming food later in the day, right?
We just talked about that.
I think it can also be really common for individuals who have ADHD to use food as part of a self-stimulatory behavior.
You know, those are specific behaviors that may help someone with ADHD self-soothe or channel their energy.
And so, I really want to acknowledge and recognize that individuals with ADHD can have unique challenges when it comes to feeding themselves, but that is so different than the statement, sugar increases symptoms of ADHD.
Yeah, that's kind of what I was getting at too.
I think that's super important to call out.
I mean, these unique challenges, you know, we talk about neurodivergence.
I mean, we're going to have a divergent array of nutrition recommendations that makes sense for different people.
And you know, I think that's part of the fun of our job too, was working with different people with different challenges.
Yeah, absolutely.
And I mean, so, you know, I guess I want to really hit this home because I think when it comes to thinking about sugar or blood sugar for individuals who have ADHD, I do think it's super important that folks with ADHD work on making sure they're consistently nourished throughout the day, so that they're preventing things like dips in blood sugar, which could cause them to feel less energetic, which could then make focusing or concentrating even more challenging.
And so again, I think there's a lot of work that could be done, that could be really helpful around nourishing frequently, you know, maintaining blood sugar levels, making sure you're not skipping meals.
But again, so, so different than saying sugar causes ADHD, or a person with ADHD should never consume anything sugar-containing.
Absolutely.
And I mean, I will also say, like we always do on the show, Matt, that if someone with ADHD has figured out a way to feed themselves that works well, you know, keep on keeping on.
I just think that generally demonizing sugar for anyone with ADD or ADHD, that's what bothers me.
I think it's very much possible to have a peaceful relationship with sugar-containing foods and have ADHD.
Absolutely.
And, you know, I'm thinking more and more about the idea of like expectations from parents and childhood.
And like, if you have ADHD, I bet there's been a lot of expectations on you throughout your life about how you were going to react to foods, or like expectations around what you're good and not good at in terms of self-care, especially around food.
And so, you know, I meet a lot of folks with ADHD who feel like, well, I'm just not good at consistency.
I'm not good at grocery shopping or thinking about what I'm going to eat for the day or taking breaks, especially when I'm on a medication and I'm kind of in the flow of my workday.
It's hard for me to take a break and go have lunch.
And I think that there's this feedback cycle of like, well, I've been told my whole life I'm just not good at this stuff.
And, you know, hey, maybe this discussion just opens the door a little bit to be like, yeah, maybe I just need some new techniques or some support that I haven't had.
Yeah, yeah, for sure.
I would agree with that.
I also think too that diet and ADHD is one of these areas on social media that people are just bombarded with so many ideas, differing recommendations, you know, these kind of like, oh, well, you know, all of these foods need to be eliminated because that's what's going to help your ADHD.
And so I also think that that could very much contribute to someone with ADHD not knowing exactly how to feed themselves or being unsure or confused about the best ways to nourish themselves.
And so I think that that piece, that cultural piece probably really impacts people who are trying to figure out how to feed themselves with ADHD.
Absolutely.
You know, like this episode, Matt, it reminds me so much of our MSG episode simply because this like sugar causes kids to be hyperactive is just this long held cultural belief that essentially is just a myth that continues to persist.
Isn't it interesting?
Yeah.
We're just missing the racism.
Exactly.
We didn't have the racism.
Otherwise this would be exactly parallel to our MSG episode.
Yeah.
It's just one of those myths.
We have to shake off culturally and, you know, an idea.
It's hard to, you know, weed it out of the population, but we're trying our best here.
Yeah.
We're doing our best.
We're doing our part here at Nutrition For Mortals.
Anything else we should be saying about sugar and hyperactivity today?
I don't think so.
Hopefully this has summed it up pretty well, and hopefully we can all walk away allowing our kids to have a cupcake and a glass of juice at a birthday party, which was really my end goal of this entire episode.
And I'm going trick or treating soon.
This is the, I'm going to encourage my kid to have all the skittles she can handle and I'll report back.
All right.
I like it.
I like it.
I don't know if you remember this.
I bet you do because we have the same brain.
Do you remember?
You remember Matt TV?
Of course.
You remember Stuart?
I fucking love Stuart too!
That's so weird because that's so specific.
I brought up Stuart to a bunch of people and I feel like everyone's like, so what are you talking about?
And I'm like, you know, the guy who's like, look what I can do.
Look what I can do.
And then he'd be like, he'd be like, remember there's this like whole sketch where he's like, you know, he's never supposed to have sugar.
Yes.
And there's this like one where he's like, cotton candy.
It's as fun to eat as it is fun to make.
It looks like hair and it tastes like wonderfulness.
I'm sorry, Stuart, I can't let you have any cotton candy.
No, I'll let you have something healthy like peanuts, but you can't have any sugar, okay?
Okay.
Here you go.
Give me some cotton candy, quick!
Okay.
Stuart!
No, Stuart, give me that!
Stuart!
Stuart, give me that!
Stuart, give it to me!
Stuart, why did you lie to me?
I don't know why you saw an opening when I took it.
Are we so old that we were talking about Mad TV?
How many people listening remember Stuart from Mad TV?
Just you and I.
It's down to just you and I.
How about this?
If you remember Stuart from Mad TV, please leave us a comment on our Instagram, and then we will grow this community of old people who remember this sketch.
All right, Matt, I will see you in the next one.
All right.
See you, Jen.
Nutrition For Mortals is a production of Oceanside Nutrition, a real life nutrition counseling practice in beautiful Newburyport, Massachusetts, where we provide individual nutrition counseling, both in person and online via telehealth.
Feel free to learn more about our practice at oceansidenutrition.com.
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