Rushing for Birthday Sugar

My youngest son O will soon be turning one; a whole trip around the sun. As I prepare for the influx of sugary snacks, chiefly cake, I'm reminded of the common scapegoat of parents with hyperactive children, "Oh, must have been all that sugar she ate."

In recent history, sugar has become somewhat of a boogie man. The media likes to portray it as the source of all our health woes: weight gain, diabetes, heart disease; the list goes on and on. The weight (pun intended) of sugar's importance on health is still somewhat debated within science (and a discussion for another day). It is clear that moderation (as with all things) is key. But one thing is for certain: it doesn't cause hyperactivity in children.

Let's discuss the history of this myth. Near as I can tell, the myth began with the publishing of Feingold diet in 1973 by Benjamin Feingold, M.D. His diet advocated for the avoidance of salicylate, artificial food coloring, and artificial flavors as a treatment for hyperactivity in children. By the mid 80's it had been thoroughly debunked by a meta-analysis. Though the diet never actually mentioned sugar, it brought sugar as a cause for hyperactivity under scrutiny; thus the myth grew and persisted in popular consciousness. In 1995, however, a paper in The Journal of the American Medical Association showed quite clearly that there was no causative link between sugar and behavioral changes. At this point you may be wondering, what actually happens when my kid eats that much sugar? That's an excellent question.

There are a couple steps to understand what the body does with sugar, we'll start with insulin. I'm sure most know the function of insulin: to help the body absorb sugar from the blood stream. Diabetes is characterized by faulty insulin production. When you eat sugar the pancreas is stimulated to release insulin proportional to the amount of sugar present in the blood. Funny enough, eating too much sugar, resulting in a large release of insulin that (with a serum half life of 4-6 min) is estimated to stick around for as long as 1 hour, can result in a blood sugar crash resulting in lethargy (the exact opposite of the mythical rush). Once in the cell, glycolysis takes over to break down sugar, passes the results along to the citric acid cycle and electron transport chain to produce cellular energy. 

So why does this myth persist if such clear evidence has been presented? Let's look at the lines of faulty logic that help it limp along. The main argument I hear presented on the "clear" effect that sugar has on someone's child is that they see it happen: the argument from anecdote. This reasoning has a couple problems. Chiefly, anecdotal evidence cannot, by definition, control for confounding factors. It's really not surprising that little Johnny gets hyper whenever he eats cake at a birthday party; it's a birthday party. He's seeing friends, playing, laughing, etc. Any number of these things can lower inhibition and make kids hyper. If it's that obvious, why do more parents not realize? Put simply, confirmation bias: they're noticing only the causes that they believe are the culprits. Their kids are likely a bit more wound up every time they are with friends, they likely don't notice because there's not an excess of sugar involved.

So next time your kid is begging for another piece of Susie's mom's homemade chocolate cake from scratch that's just the best cake that they've ever had ever in the whole wide world... Don't worry about them getting hyper. Just give them the cake.