It seems that sugar itself isn't so much the culprit as sugar ingested in place of a well balanced meal. C Keith Conners, director of behavioural research in the department of psychiatry at the Children's Hospital National Medical Center in Washington, DC, was the first to suggest that the effect of sugar is modified by the foods consumed along with it. Conners and his cohorts found that when sugar is consumed alone, the effects are different from when it is consumed along with protein or starch or as part of a well balanced meal. The combination of sugar and starch in the absence of substantial protein (a combination found, for example, in children's' sweetened breakfast cereals) increased deviant behaviour, not only in children who were mentally disturbed, but also in normal children.

In one of Conners' studies, three groups of hyperactive children between 8 and 13 received either a high carbohydrate breakfast, a high protein breakfast or no breakfast. On different days, children in each group also received a non nutritive orange drink sweetened with aspartame or sucrose. Children who received the high carbohydrate breakfast with the sucrose drink did significantly worse than controls on a recognition test, while those eating the high protein meal did substantially better than any other group (New Medical Science, December 1987).

Conners' conclusion: hyperactive children may benefit from a high protein, low carbohydrate, sugar free diet.

Two other observational studies showed that hyperactive children process food more rapidly than others, are smaller than normal children and hence may need more protein than most (American Journal of Clinical Nutrition 39: 520-24, 1984)

In another study of children aged 4-7, the higher the ratio of carbohydrates to protein in their diets, the greater the destructive, aggressive and restless behaviour (J Consult Clin Psychol 48: 760-9, 1980).

Leo Galland, American nutritional expert on the diets of children, suggests that you cut all sugar out of your hyperactive child's diet other than 4 oz of fruit juice and two pieces of fresh fruit a day.

Before trying drugs, first rule out food sensitivities and food additives. One study (The Lancet: 1: 540-5, 1985) showed that 62 out of 76 overactive children (that is, 82 per cent) treated with an elimination diet improved, and the behaviour of 21 more than a third became entirely normal. The most common offenders were invariably artificial colours and preservatives.

These results were confirmed in a double blind study of 10 hyperactive children, matched against 10 controls. Both were given a commercial orange drink, but the hyperactive group's contained tartrazine. After 24 hours, there was a significant increase in urinary zinc in the hyperactive children receiving tartrazine, suggesting that the artificial colorant may bind with the zinc, causing more of it to be excreted. Furthermore, only the hyperactive children had any changes in behaviour or emotion. Four had severe reactions (two developed eczema and one asthma after 30-45 minutes), and five, moderate reactions (NI Ward et al, J Nutr Med 1: 51-57, 1990).

Other foods besides additives can provoke hyperactive like symptoms. Another experimental double blind study tested 13 hyperactive children against a matched set of 13 controls with 40 different food and inhalant allergens. The salicylates caused the greatest frequency of responses (80 per cent), while sugar, corn, beef and egg caused 25-30 per cent of responses, and cat hair and house dust, another 25 per cent (Int J Biosocial Res 4: 40-2, 1983).