Wednesday, December 29, 2021

Part IV - Alternative Treatments and ADHD - Sweeteners

     Another topic of investigation within the ADHD world, has been the connection between sugar and behavior. Some parents and researchers have claimed that sugar is one of the key factors in the onset, severity and continuation of symptoms with children diagnosed with ADHD. However, yet again, a glimpse of the evidence is important before assuming this claim as true. A 1994 double-blind controlled trial of 48 children was conducted to investigate the role of sugar in behaviorally and cognitively challenged children (per parent report).M Twenty-five of the children were considered the control group, with no reported sensitivities to sugar and 23 of the children were classified as having sugar sensitivities.M All of the children underwent three consecutive three-week trials of differing sweetener combinations, the first consisting of sucrose only with no artificial sweeteners, the second consisting of low sucrose levels and mostly aspartame sweeteners, and the third consisting of saccharin (placebo).M The researchers controlled for variables such as preservatives, artificial dyes, and additives which are oftentimes blamed for additional behavioral and cognitive complications.M Outcomes of the study showed no difference among groups.M In addition to the fact that no effect was observed, the researchers further stated that even when intake of the listed sweeteners exceeded normal dietary levels, the effect remained unsubstantial.M Similarly, in a randomized, double-blind, placebo-controlled crossover study, researchers examined the effects of heightened doses of aspartame on the behavior and cognition of children labeled with the ADD diagnosis.N Children were given aspartame or placebo for alternate 2-week periods to determine effect.N Outcomes of this study showed no clinically significant differences between the placebo and aspartame administrations in regard to symptoms, behavior or cognition.N Though not as reliable as controlled research studies, anecdotal evidence has suggested that there is a relationship between sugar intake and hyperactive behaviors.O A 1994 research study looking at the connection between sugar intake and hyperactive behavior in children showed that sweeteners do not affect behavior.O This particular study examined the differences between diets high in sucrose, aspartame, and saccharin and found that even when doses exceeded normal intake levels, no differences were observed in hyperactivity.O Similarly, a 1991 study looked at the difference between a sugar-sweetened diet compared to a saccharin/aspartame-sweetened diet (placebo).P Subjects in the study group were 17 children diagnosed with ADHD and were compared to the control group of 9 children without the ADHD diagnosis.P Results showed no difference in levels of aggression between the study and control groups.P Despite this finding, children with the ADHD diagnosis did show increased inattention following sugar ingestion when compared to the control group.P However, the researchers stated in conclusion, “This result is of questionable clinical significance inasmuch as aggressive behavior was unchanged. The finding may be due to the combination of the sugar challenge with a high-carbohydrate breakfast. These findings should be replicated and any possible clinical significance should be documented before any dietary recommendations can be made.”P Again, though the elimination of sugar may have a positive effect on some ADHD-diagnosed children, the apparent evidence is not overwhelming.
M. Wolraich ML, Lindgren SD, Stumbo PJ, et al. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. The New England Journal of Medicine. 1994; 330: 301-306. 
N. Shaywitz BA, Sullivan CM, Anderson GM, et al. Aspartame, behavior, and cognitive function in children with attention deficit disorder. Pediatrics. 1994; 93:70-75.
O. Kanarek RB. Does sucrose or aspartame cause hyperactivity in children? Nutrition Reviews. 1994; 52: 173-175.
P. Wender EH, Solanto MV. Effects of sugar on aggressive and inattentive behavior in children with attention deficit disorder with hyperactivity and normal children. Pediatrics. 1991; 88: 960-966.

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