Senior consultant endocrinologists Prof Datuk Dr Mafauzy Mohamed and Prof Datuk Ikram Shah Ismail speak on whether sugar causes hyperactivity in children.
Q: Does sugar make children hyperactive?
Mafauzy: Although there have been a few studies associating high sugar intake to hyperactive children, these children tended to have abnormal diet patterns, so it could be that the hyperactive children were taking more sugary food/drink rather than the sugary food/drink causing hyperactivity in children.
Hence, the medical community believes that so far, there is no strong scientific evidence to suggest that sugar makes children hyperactive.
Ikram: Adverse behaviour effects, including hyperactivity, are commonly attributed to excess sugar intake by parents and teachers, but several studies in which sugar was eliminated from the diet and/or children were challenged with sugar, failed to support an association between sugar intake and hyperactivity, attention span, or cognitive functioning.
Q: If it does not, what does make children hyperactive?
Mafauzy: There are a few causes of hyperactivity in children. A common cause is Attention Deficit Hyperactivity Disorder (ADHD). Other causes include hormone, brain, nervous system and psychological disorders.
A hyperactive child should be brought to a doctor to be diagnosed and treated.
Symptoms of ADHD in children include being impulsive, inattentive or a combination of the two. They are always running around and will not sit still to eat or be read to.
They don’t listen to instructions or only obey for a short time. These symptoms are not a result of sugar intake.
There is also no clear evidence that sugar causes hyperactive children to be even more hyperactive.
Ikram: Hyperactivity in children can be due to many factors. There are predominantly genetic factors in many of the children affected by hyperactivity.
Environmental factors may also play a secondary role in hyperactivity disorders.
The influence of diet on attention, hyperactivity, and behaviour is controversial.
Areas of investigation include food additives (artificial colours, artificial flavours, preservatives), food sensitivity (allergy or intolerance), essential fatty acid deficiency and iron and zinc deficiency.
The effect may be mostly psychological. Studies have shown that parents who believe in a link between sugar and hyperactivity see one, although others do not.
Another possibility is that children tend to be more excited at events like birthday parties where sugary foods are usually served.
People may have confused proximity with correlation, although the environment is probably more to blame than the food.
Q: In your experience with patients, is there a difference in the type of sugar that causes hyperactivity, such as processed sugar or natural sugars from fruits?
Ikram: No difference. Both sugars do not cause hyperactivity.
Q: Have you come across patients (children included) who became tired after taking processed sugar but not natural sugars? If there are such cases, why is that?
Ikram: Sometimes, when a child takes too much sugar, the blood-sugar levels rise too high. The body responds by producing a large amount of insulin, a hormone that sweeps sugar out of the blood and into body cells.
Blood-sugar levels may then drop quickly, and the child may feel shaky or sluggish.
Not surprisingly, low blood-sugar levels can trigger a craving for more sweets, which creates a vicious cycle of sugar highs and lows. This can happen with all kinds of sugars.
Q: Should parents be concerned?
Mafauzy: Parents should be concerned about high sugar intake (in drinks and food), not because it causes hyperactivity, but because high sugar intake can increase the risk for overweight/obesity and dental caries.
Taking drinks and food with high sugar content can also result in poor nutrient supply and reduced dietary diversity, and this may be associated with increased risk of diabetes mellitus, cardiovascular risk and other health effects in the future.
Q: Should sugar intake be reduced? How much sugar should children take?
Mafauzy: Intake of sugar should be less than 5% of the total energy intake for children and teenagers.
Intakes should be lower in infants and toddlers under two years old.
For example, the recommended energy intake for pre-schoolers is about 1,400 calories, and 5% is about 70 calories, which is about two teaspoons of sugar per day (5% is a conditional recommendation from the World Health Organisation but my recommendation is 10% – so in the above example, it will be four teaspoons).
Ikram: Many children can indulge in the occasional sweets and desserts without any problem.
In small amounts, sugar can even encourage nutritious eating.
Similarly, a recent study found that adding about a teaspoon of sugar to a serving of whole-grain breakfast cereal such as oatmeal, wheat bran or muesli, made a difference in whether children liked it, but it had no significant effect on their blood-sugar levels.
So, relax, go ahead and let your children enjoy sugar in moderation.
Q: What sugar-laden food should children avoid?
Mafauzy: Sugar-sweetened beverages, fruit juice, sugar in food, desserts and sweets. This also includes high-fructose corn syrup and fruit-juice concentrates.
Q: Even if children take a lot of sweets, is that all right for those who run and play outdoors a lot?
Mafauzy: No, because natural carbohydrates such as rice and bread already provide the necessary calories for energy. There is no need for added sugar in drinks or food.
Ikram: It is not all right as too much sugar can lead to cavities, obesity and diabetes.
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