Sugar consumption is often associated with behavioral disorders in children, and excessive sugar consumption leads to an increase in mood and hyperactivity in children ("sugar rush"). is that true?

Does Sugar Rush Cause ADHD?

Sugar Rush

Consumption of products with high sugar content is increasing globally over time. Understanding the relationship between carbohydrate consumption and mood needs to be straightened.

A meta-analysis of 31 studies (1259 subjects) showed no positive effect between carbohydrate consumption and mood. Instead, carbohydrate consumption was associated with increased levels of fatigue and less alertness ("sugar crash") than placebo in the first four hours after consuming carbohydrates. From this article, it is concluded that the "sugar rush" is just a myth.

Hypothesis about the correlation between sugar consumption and ADHD

In theory, glucose can increase extracellular dopamine release in the striatum area that is associated with the reward system. Consuming sugar in the long term will lead to desensitization of dopaminergic receptors. So, it requires a higher glucose intake as compensation to achieve the same satisfaction level.

Consequently, after consuming sugar, there is a progressive decrease in the dopamine response. This dysfunction inhibits inhibitory mechanisms in the frontal cortex. The frontal cortex is associated with the pathomechanism of Attention Deficit and Hyperactivity Disorder (ADHD).

Reward System Mechanism for Attention Deficit and Hyperactivity Disorder (ADHD)

ADHD affects nearly 10% of all children in the United States, and it tends to increase over time. The cause of ADHD is still unknown, but several studies have suggested a possible association with impaired dopamine signaling, in which dopamine D2 receptors are decreased in brain regions associated with the reward system. The same pattern also exists in several reward deficiency syndromes such as drug addiction, food addiction, as found in obese people.

Research on Sugar Consumption with ADHD

A case-control study by Yu et al. 2016 studied 173 children with ADHD and 159 children without ADHD, aged 4-15 years. The study found a dose-response relationship between consumption of sugar-sweetened beverage (SSB) and ADHD (odds ratio for moderate SSB consumption: 1.36, odds ratio on high SSB consumption: 3.69, statistically significant), if female subjects were excluded, the results the same was obtained. However, this study contradicts studies with a stronger level of scientific evidence (cohort studies and meta-analysis).

A meta-analysis conducted by Wolraich in 1995, concluded that from 16 experimental studies, sugar consumption did not increase the risk of attention deficit and/or hyperactivity in children.

In a cohort study conducted by Del Ponte et al. In 2019, 2924 children aged 6-11 years, also showed no association between high consumption of sucrose and the incidence of ADHD when compared with the group of children who consumed low sucrose (odds ratio in boys 0.66 and girls 2.71).

In a study by Kim and Chang, of 107 children categorized at risk according to the ADHD diagnosis criteria, it was concluded that there was no significant association between consumption of simple sugar and the development of ADHD.

Sugar Consumption Recommendations for Children

Although it does not affect the incidence of ADHD, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition recommends that the maximum daily sugar intake should be less than 5% of daily energy intake based on age (4 grams of sugar is equivalent to one teaspoon).

The following are recommendations for daily sugar intake by ESPGHAN:
  • 2-4 years old: maximum is 15-16 grams of sugar
  • Age 4-7 years: maximum is 18-20 grams of sugar
  • Age 7-10 years: maximum 22-23 grams of sugar
  • Age 10-13 years: maximum is 24-27 grams of sugar
  • Age 13-15 years: maximum is 27-32 grams of sugar
  • Age 15-19 years: maximum is 28-37 grams of sugar

The term "sugar rush" based on scientific evidence is inappropriate. Based on a meta-analysis by Mantantzis et al., there is no correlation between sugar consumption or carbohydrates with mood and behavior. Based on this study, sugar consumption is associated with increased fatigue and alertness (sugar crashes).

In several studies, excess sugar consumption in children has not been shown to increase "hyperactive" behavior in children or the risk of ADHD. Scientific evidence regarding excess carbohydrate consumption tends to make you tired and unfocused (sugar crash). Besides having no nutritional benefits, excess sugar consumption can also increase the risk of obesity, diabetes mellitus, heart and vessel disease, and dental caries.