Intermittent Fasting, Intermittently?

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It’s Q&A Day at 10almonds!

Have a question or a request? We love to hear from you!

In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

So, no question/request too big or small 😎

❝Have you come across any research on alternate-day intermittent fasting—specifically switching between one day of 16:8 fasting and the next day of regular eating patterns? I’m curious if there are any benefits or drawbacks to this alternating approach, or if the benefits mainly come from consistent intermittent fasting?❞

Short and unhelpful answer: no

Longer and hopefully more helpful answer:

As you probably know, usually people going for approaches based on the above terms either

  • practise 16:8 fasting (fast for 16 hours each day, eat during an 8-hour window) or
  • practise alternate-day fasting (fast for 24 hours, eat whenever for 24 hours, repeat)

…which latter scored the best results in this large meta-analysis of studies:

Effects of different types of intermittent fasting on metabolic outcomes: an umbrella review and network meta-analysis

There is also the (popular) less extreme version of alternate-day fasting, sometimes called “eat stop eat”, which is not a very helpful description because that describes almost any kind of eating/fasting, but it usually refers to “once per week, take a day off from eating”.

You can read more about each of these (and some other variants), here:

Intermittent Fasting: What’s The Truth?

What you are describing (doing 16:8 fasting on alternate days, eating whenever on the other days) is essentially: intermittent fasting, just with one 16-hour fast per 48 hours instead of per the usual 24 hours.

See also: International consensus on fasting terminology ← the section on the terms “STF & PF” covers why this gets nudged back under the regular IF umbrella

Good news: this means there is a lot of literature into the acute (i.e., occurring the same day, not long-term)* benefits of 16:8 IF, and that means that you will be getting those benefits, every second day.

You remember that meta-analysis we posted above? While it isn’t mentioned in the conclusion (which only praised complete alternate-day fasting producing the best outcomes overall), sifting through the results data discovers that time-restricted eating (which is what you are doing, by these classifications) was the only fasting method to significantly reduce fasting blood glucose levels.

(However, no significant differences were observed between any IF form and the reference (continuous energy restriction, CER, i.e. calorie-controlled) diets in fasting insulin and HbA1c levels)

*This is still good news in the long-term though, because getting those benefits every second day is better than getting those benefits on no days, and this will have a long-term impact on your healthy longevity, just like how it is better to exercise every second day than it is to exercise no days, or better to abstain from alcohol every second day than it is to abstain on no days, etc.

In short, by doing IF every second day, you are still giving your organs a break sometimes, and that’s good.

All the same, if it would be convenient and practical for you, we would encourage you to consider either the complete alternate-day fasting (which, according to a lot of data, gives the best results overall),or time-restricted eating (TRE) every day (which, according to a lot of data, gives the best fasting blood sugar levels).

You could also improve the TRE days by shifting to 20:4 (i.e., 20 hours fasting and 4 hours eating), this giving your organs a longer break on those days.

Want to learn more?

For a much more comprehensive discussion of the strengths and weaknesses of different approaches to intermitted fasting, check out:

Complete Guide To Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting – By Dr. Jason Fung

Enjoy!

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  • Even small diet tweaks can lead to sustainable weight loss

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    It’s a well-known fact that to lose weight, you either need to eat less or move more. But how many calories do you really need to cut out of your diet each day to lose weight? It may be less than you think.

    To determine how much energy (calories) your body requires, you need to calculate your total daily energy expenditure (TDEE). This is comprised of your basal metabolic rate (BMR) – the energy needed to sustain your body’s metabolic processes at rest – and your physical activity level. Many online calculators can help determine your daily calorie needs.

    If you reduce your energy intake (or increase the amount you burn through exercise) by 500-1,000 calories per day, you’ll see a weekly weight loss of around one pound (0.45kg).

    But studies show that even small calorie deficits (of 100-200 calories daily) can lead to long-term, sustainable weight-loss success. And although you might not lose as much weight in the short-term by only decreasing calories slightly each day, these gradual reductions are more effective than drastic cuts as they tend to be easier to stick with.

    Small diet changes can still lead to weight loss in the long run. Monkey Business Images/ Shutterstock

    Hormonal changes

    When you decrease your calorie intake, the body’s BMR often decreases. This phenomenon is known as adaptive thermogenesis. This adaptation slows down weight loss so the body can conserve energy in response to what it perceives as starvation. This can lead to a weight-loss plateau – even when calorie intake remains reduced.

    Caloric restriction can also lead to hormonal changes that influence metabolism and appetite. For instance, thyroid hormones, which regulate metabolism, can decrease – leading to a slower metabolic rate. Additionally, leptin levels drop, reducing satiety, increasing hunger and decreasing metabolic rate.

    Ghrelin, known as the “hunger hormone”, also increases when caloric intake is reduced, signalling the brain to stimulate appetite and increase food intake. Higher ghrelin levels make it challenging to maintain a reduced calorie diet, as the body constantly feels hungrier.

    Insulin, which helps regulate blood sugar levels and fat storage, can improve in sensitivity when we reduce calorie intake. But sometimes, insulin levels decrease instead, affecting metabolism and leading to a reduction in daily energy expenditure. Cortisol, the stress hormone, can also spike – especially when we’re in a significant caloric deficit. This may break down muscles and lead to fat retention, particularly in the stomach.

    Lastly, hormones such as peptide YY and cholecystokinin, which make us feel full when we’ve eaten, can decrease when we lower calorie intake. This may make us feel hungrier.

    Fortunately, there are many things we can do to address these metabolic adaptations so we can continue losing weight.

    Weight loss strategies

    Maintaining muscle mass (either through resistance training or eating plenty of protein) is essential to counteract the physiological adaptations that slow weight loss down. This is because muscle burns more calories at rest compared to fat tissue – which may help mitigate decreased metabolic rate.

    Plastic containers filled with pre-portioned meals.
    Portion control is one way of decreasing your daily calorie intake. Fevziie/ Shutterstock

    Gradual caloric restriction (reducing daily calories by only around 200-300 a day), focusing on nutrient-dense foods (particularly those high in protein and fibre), and eating regular meals can all also help to mitigate these hormonal challenges.

    But if you aren’t someone who wants to track calories each day, here are some easy strategies that can help you decrease daily calorie intake without thinking too much about it:

    1. Portion control: reducing portion sizes is a straightforward way of reducing calorie intake. Use smaller plates or measure serving sizes to help reduce daily calorie intake.

    2. Healthy swaps: substituting high-calorie foods with lower-calorie alternatives can help reduce overall caloric intake without feeling deprived. For example, replacing sugary snacks with fruits or swapping soda with water can make a substantial difference to your calorie intake. Fibre-rich foods can also reduce the calorie density of your meal.

    3. Mindful eating: practising mindful eating involves paying attention to hunger and fullness cues, eating slowly, and avoiding distractions during meals. This approach helps prevent overeating and promotes better control over food intake.

    4. Have some water: having a drink with your meal can increase satiety and reduce total food intake at a given meal. In addition, replacing sugary beverages with water has been shown to reduce calorie intake from sugars.

    4. Intermittent fasting: restricting eating to specific windows can reduce your caloric intake and have positive effects on your metabolism. There are different types of intermittent fasting you can do, but one of the easiest types is restricting your mealtimes to a specific window of time (such as only eating between 12 noon and 8pm). This reduces night-time snacking, so is particularly helpful if you tend to get the snacks out late in the evening.

    Long-term behavioural changes are crucial for maintaining weight loss. Successful strategies include regular physical activity, continued mindful eating, and periodically being diligent about your weight and food intake. Having a support system to help you stay on track can also play a big role in helping you maintain weight loss.

    Modest weight loss of 5-10% body weight in people who are overweight or obese offers significant health benefits, including improved metabolic health and reduced risk of chronic diseases. But it can be hard to lose weight – especially given all the adaptations our body has to prevent it from happening.

    Thankfully, small, sustainable changes that lead to gradual weight loss appear to be more effective in the long run, compared with more drastic lifestyle changes.

    Alexandra Cremona, Lecturer, Human Nutrition and Dietetics, University of Limerick

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Why Psyllium Is Healthy Through-And-Through

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    Psyllium is the powder of the husk of the seed of the plant Plantago ovata.

    It can be taken as a supplement, and/or used in cooking.

    What’s special about it?

    It is fibrous, and the fiber is largely soluble fiber. It’s a “bulk-forming laxative”, which means that (dosed correctly) it is good against both constipation (because it’s a laxative) and diarrhea (because it’s bulk-forming).

    See also, because this is Research Review Monday and we provide papers for everything:

    Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy

    In other words, it will tend things towards being a 3 or 4 on the Bristol Stool Scalethis is not pretty, but it is informative.

    Before the bowels

    Because of how it increases the viscosity of substances it finds itself in, psyllium slows stomach-emptying, and thus improves feelings of satiety.

    Here’s a study in which taking psyllium before breakfast and lunch resulted in increased satiety between meals, and reduction in food-related cravings:

    Satiety effects of psyllium in healthy volunteers

    Prebiotic benefits

    We can’t digest psyllium, but our gut bacteria can—somewhat! Because they can only digest some of the psyllium fibers, that means the rest will have the stool-softening effect, while we also get the usual in-gut benefits from prebiotic fiber first too:

    The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and Healthy Controls

    Cholesterol-binding

    Psyllium can bind to cholesterol during the digestive process. Why only “can”? Well, if you don’t consume cholesterol (for example, if you are vegan), then there won’t be cholesterol in the digestive tract to bind to (yes, we do need some cholesterol to live, but like most animals, we can synthesize it ourselves).

    What this cholesterol-binding action means is that the dietary cholesterol thus bound cannot enter the bloodstream, and is simply excreted instead:

    Plantago consumption significantly reduces total cholesterol and low-density lipoprotein cholesterol in adults: A systematic review and meta-analysis

    Heart health beyond cholesterol

    Psyllium supplementation can also help lower high blood pressure but does not significantly lower already-healthy blood pressure, so it can be particularly good for keeping things in safe ranges:

    ❝Given the overarching benefits and lack of reported side effects, particularly for hypertensive patients, health care providers and clinicians should consider the use of psyllium supplementation for the treatment or abatement of hypertension, or hypertensive symptoms.❞

    ~ Dr. Mina Salek et al.

    Read in full: The effect of psyllium supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials ← you can see the concrete numbers here

    Is it safe?

    Psyllium is first and foremost a foodstuff, and is considered very safe unless you have an allergy (which is rare, but possible).

    However, it is still recommended to start at a low dose and work up, because anything that changes your gut microbiota, even if it changes it for the better, will be easiest if done slowly (or else, you will hear about it from your gut).

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon

    Enjoy!

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  • Surgery is the default treatment for ACL injuries in Australia. But it’s not the only way

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The anterior cruciate ligament (ACL) is an important ligament in the knee. It runs from the thigh bone (femur) to the shin bone (tibia) and helps stabilise the knee joint.

    Injuries to the ACL, often called a “tear” or a “rupture”, are common in sport. While a ruptured ACL has just sidelined another Matildas star, people who play sport recreationally are also at risk of this injury.

    For decades, surgical repair of an ACL injury, called a reconstruction, has been the primary treatment in Australia. In fact, Australia has among the highest rates of ACL surgery in the world. Reports indicate 90% of people who rupture their ACL go under the knife.

    Although surgery is common – around one million are performed worldwide each year – and seems to be the default treatment for ACL injuries in Australia, it may not be required for everyone.

    PeopleImages.com – Yuri A/Shutterstock

    What does the research say?

    We know ACL ruptures can be treated using reconstructive surgery, but research continues to suggest they can also be treated with rehabilitation alone for many people.

    Almost 15 years ago a randomised clinical trial published in the New England Journal of Medicine compared early surgery to rehabilitation with the option of delayed surgery in young active adults with an ACL injury. Over half of people in the rehabilitation group did not end up having surgery. After five years, knee function did not differ between treatment groups.

    The findings of this initial trial have been supported by more research since. A review of three trials published in 2022 found delaying surgery and trialling rehabilitation leads to similar outcomes to early surgery.

    A 2023 study followed up patients who received rehabilitation without surgery. It showed one in three had evidence of ACL healing on an MRI after two years. There was also evidence of improved knee-related quality of life in those with signs of ACL healing compared to those whose ACL did not show signs of healing.

    A diagram showing an ACL tear.
    Experts used to think an ACL tear couldn’t heal without surgery – now there’s evidence it can. SKYKIDKID/Shutterstock

    Regardless of treatment choice the rehabilitation process following ACL rupture is lengthy. It usually involves a minimum of nine months of progressive rehabilitation performed a few days per week. The length of time for rehabilitation may be slightly shorter in those not undergoing surgery, but more research is needed in this area.

    Rehabilitation starts with a physiotherapist overseeing simple exercises right through to resistance exercises and dynamic movements such as jumping, hopping and agility drills.

    A person can start rehabilitation with the option of having surgery later if the knee remains unstable. A common sign of instability is the knee giving way when changing direction while running or playing sports.

    To rehab and wait, or to go straight under the knife?

    There are a number of reasons patients and clinicians may opt for early surgical reconstruction.

    For elite athletes, a key consideration is returning to sport as soon as possible. As surgery is a well established method, athletes (such as Matilda Sam Kerr) often opt for early surgical reconstruction as this gives them a more predictable timeline for recovery.

    At the same time, there are risks to consider when rushing back to sport after ACL reconstruction. Re-injury of the ACL is very common. For every month return to sport is delayed until nine months after ACL reconstruction, the rate of knee re-injury is reduced by 51%.

    A physio bends a patient's knee.
    For people who opt to try rehabilitation, the option of having surgery later is still there. PeopleImages.com – Yuri A/Shutterstock

    Historically, another reason for having early surgical reconstruction was to reduce the risk of future knee osteoarthritis, which increases following an ACL injury. But a review showed ACL reconstruction doesn’t reduce the risk of knee osteoarthritis in the long term compared with non-surgical treatment.

    That said, there’s a need for more high-quality, long-term studies to give us a better understanding of how knee osteoarthritis risk is influenced by different treatments.

    Rehab may not be the only non-surgical option

    Last year, a study looking at 80 people fitted with a specialised knee brace for 12 weeks found 90% had evidence of ACL healing on their follow-up MRI.

    People with more ACL healing on the three-month MRI reported better outcomes at 12 months, including higher rates of returning to their pre-injury level of sport and better knee function. Although promising, we now need comparative research to evaluate whether this method can achieve similar results to surgery.

    What to do if you rupture your ACL

    First, it’s important to seek a comprehensive medical assessment from either a sports physiotherapist, sports physician or orthopaedic surgeon. ACL injuries can also have associated injuries to surrounding ligaments and cartilage which may influence treatment decisions.

    In terms of treatment, discuss with your clinician the pros and cons of management options and whether surgery is necessary. Often, patients don’t know not having surgery is an option.

    Surgery appears to be necessary for some people to achieve a stable knee. But it may not be necessary in every case, so many patients may wish to try rehabilitation in the first instance where appropriate.

    As always, prevention is key. Research has shown more than half of ACL injuries can be prevented by incorporating prevention strategies. This involves performing specific exercises to strengthen muscles in the legs, and improve movement control and landing technique.

    Anthony Nasser, Senior Lecturer in Physiotherapy, University of Technology Sydney; Joshua Pate, Senior Lecturer in Physiotherapy, University of Technology Sydney, and Peter Stubbs, Senior Lecturer in Physiotherapy, University of Technology Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Best Salt for Neti Pots?
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    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    I am interested in what I can substitute for ham in bean soup?

    Well, that depends on what the ham was like! You can certainly buy ready-made vegan lardons (i.e. small bacon/ham bits, often in tiny cubes or similar) in any reasonably-sized supermarket. Being processed, they’re not amazing for the health, but are still an improvement on pork.

    Alternatively, you can make your own seitan! Again, seitan is really not a health food, but again, it’s still relatively less bad than pork (unless you are allergic to gluten, in which case, definitely skip this one).

    Alternatively alternatively, in a soup that already contains beans (so the protein element is already covered), you could just skip the ham as an added ingredient, and instead bring the extra flavor by means of a little salt, a little yeast extract (if you don’t like yeast extract, don’t worry, it won’t taste like it if you just use a teaspoon in a big pot, or half a teaspoon in a smaller pot), and a little smoked paprika. If you want to go healthier, you can swap out the salt for MSG, which enhances flavor in a similar fashion while containing less sodium.

    Wondering about the health aspects of MSG? Check out our main feature on this, from last month:

    What’s the deal with MSG?

    I thoroughly enjoy your daily delivery. I’d love to see one for teens too!

    That’s great to hear! The average age of our subscribers is generally rather older, but it’s good to know there’s an interest in topics for younger people. We’ll bear that in mind, and see what we can do to cater to that without alienating our older readers!

    That said: it’s never too soon to be learning about stuff that affects us when we’re older—there are lifestyle factors at 20 that affect Alzheimer’s risk at 60, for example (e.g. drinking—excessive drinking at 20* is correlated to higher Alzheimer’s risk at 60).

    *This one may be less of an issue for our US readers, since the US doesn’t have nearly as much of a culture of drinking under 21 as some places. Compare for example with general European practices of drinking moderately from the mid-teens, or the (happily, diminishing—but historically notable) British practice of drinking heavily from the mid-teens.

    How much turmeric should I take each day?

    Dr. Michael Greger’s research (of “Dr. Greger’s Daily Dozen” and “How Not To Die” fame) recommends getting at least ¼ tsp turmeric per day

    Remember to take it with black pepper though, for a 2000% absorption bonus!

    A great way to get it, if you don’t want to take capsules and don’t want to eat spicy food every day, is to throw a teaspoon of turmeric in when making a pot of (we recommend wholegrain!) rice. Turmeric is very water-soluble, so it’ll be transferred into the rice easily during cooking. It’ll make the rice a nice golden yellow color, and/but won’t noticeably change the taste.

    Again remember to throw in some black pepper, and if you really want to boost the nutritional content,some chia seeds are a great addition too (they’ll get cooked with the rice and so it won’t be like eating seeds later, but the nutrients will be there in the rice dish).

    You can do the same with par-boiled potatoes or other root vegetables, but because cooking those has water to be thrown away at the end (unlike rice), you’ll lose some turmeric in the water.

    Request: more people need to be aware of suicidal tendencies and what they can do to ward them off

    That’s certainly a very important topic! We’ll cover that properly in one of our Psychology Sunday editions. In the meantime, we’ll mention a previous special that we did, that was mostly about handling depression (in oneself or a loved one), and obviously there’s a degree of crossover:

    The Mental Health First-Aid That You’ll Hopefully Never Need

    Don’t Forget…

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  • Can You Repair Your Own Teeth At Home?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small 😎

    ❝I liked your article on tooth remineralization, I saw a “home tooth repair kit”, and wondered if it is as good as what dentists do, or at least will do the job well enough to save a dentist visit?❞

    Firstly, for any wondering about the tooth remineralization, here you go:

    Tooth Remineralization: How To Heal Your Teeth Naturally

    Now, to answer your question, we presume you are talking about something like this kit available on Amazon. In which case, some things to bear in mind:

    • This kind of thing is generally intended as a stop-gap measure until you see a dentist, because you cracked your tooth or lost a filling or something today, and will see the dentist next week, say.
    • This kind of thing is not what Dr. Michelle Jorgensen was talking about in another video* that we wrote about; rather, it is using a polymer filler to rebuild what is missing. The key difference is: this is using plastic, which is not what your teeth are made of, so it will never “take” as part of the tooth, as some biomimetic dentistry options can do.
    • Yes, this does also mean you are putting microplastics (because the powder is usually micronized polymer beads with zinc oxide, to which you add a liquid to create a paste that will set) in your mouth and quite possibly right next to an open blood supply depending on what’s damaged and whether capillaries were reaching it.
    • Because of the different material and application method, the adhesion is nothing like professional fillings (be they metal or resin), and thus the chances of it coming out again or so high that it’s more a question of when, rather than if.
    • If you have damage under there (as we presume you do in any scenario where you are using this), then if it’s not professionally cleaned before the filling goes in, then it can get infected, and (less dramatically, but still importantly) any extant decay can also get worse. We say “professionally”, because you will not be able to do an adequate job with your toothbrush, floss, etc at home, and even if you got dentist’s tools (which you can buy, by the way, but we don’t recommend), you will no more be able to do the same quality job as a dentist who has done that many times a day every day for the past 20 years, as buying expensive paintbrushes would make you able to restore a Renaissance painting without messing it up.

    *See: Dangers Of Root Canals And Crowns, & What To Do Instead ← what she recommends instead is biomimetic dentistry, which is also more prosaically called “conservative restorative dentistry”, i.e. it tries to conserve as much as possible, replace lost material on a like-for-like basis, and generally end up with a result that’s as close to natural as possible.

    In other words, the short answer to your question is “no, sorry, it isn’t and it won’t”

    However! A just like it’s good to have a first aid kit in the house even if it won’t do the same job as an ambulance crew, it can be good to have a tooth repair kit (essentially, a tooth first-aid kit) in the house, precisely to use it just as a stop-gap measure in the event that you one day crack a tooth or lose a filling or such, and don’t want to leave it open to all things in the meantime.

    (The results of this sort of kit are so not long-term in nature that it will be quick and easy for your dentist to remove it to do their own job once you get there)

    If in doubt, always see your dentist as soon as possible, as many things are a lot less work to treat now, than to treat later. Just, make sure to advocate for yourself and what you actually want/need, and don’t let them upsell you on something you didn’t come in for while you’re sitting in their chair—that’s a conversation to be had in advance with a clear head and no pressure (and nobody’s hands in your mouth)!

    See also: Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn

    Take care!

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  • No, sugar doesn’t make your kids hyperactive

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s a Saturday afternoon at a kids’ birthday party. Hordes of children are swarming between the spread of birthday treats and party games. Half-eaten cupcakes, biscuits and lollies litter the floor, and the kids seem to have gained superhuman speed and bounce-off-the-wall energy. But is sugar to blame?

    The belief that eating sugary foods and drinks leads to hyperactivity has steadfastly persisted for decades. And parents have curtailed their children’s intake accordingly.

    Balanced nutrition is critical during childhood. As a neuroscientist who has studied the negative effects of high sugar “junk food” diets on brain function, I can confidently say excessive sugar consumption does not have benefits to the young mind. In fact, neuroimaging studies show the brains of children who eat more processed snack foods are smaller in volume, particularly in the frontal cortices, than those of children who eat a more healthful diet.

    But today’s scientific evidence does not support the claim sugar makes kids hyperactive.

    Sharomka/Shutterstock

    The hyperactivity myth

    Sugar is a rapid source of fuel for the body. The myth of sugar-induced hyperactivity can be traced to a handful of studies conducted in the 1970s and early 1980s. These were focused on the Feingold Diet as a treatment for what we now call Attention Deficit Hyperactivity Disorder (ADHD), a neurodivergent profile where problems with inattention and/or hyperactivity and impulsivity can negatively affect school, work or relationships.

    Devised by American paediatric allergist Benjamin Feingold, the diet is extremely restrictive. Artificial colours, sweeteners (including sugar) and flavourings, salicylates including aspirin, and three preservatives (butylated hydroxyanisole, butylated hydroxytoluene, and tert-Butrylhdryquinone) are eliminated.

    Salicylates occur naturally in many healthy foods, including apples, berries, tomatoes, broccoli, cucumbers, capsicums, nuts, seeds, spices and some grains. So, as well as eliminating processed foods containing artificial colours, flavours, preservatives and sweeteners, the Feingold diet eliminates many nutritious foods helpful for healthy development.

    However, Feingold believed avoiding these ingredients improved focus and behaviour. He conducted some small studies, which he claimed showed a large proportion of hyperactive children responded favourably to his diet.

    bowls of lollies on table
    Even it doesn’t make kids hyperactive, they shouldn’t have too much sugar. DenisMArt/Shutterstock

    Flawed by design

    The methods used in the studies were flawed, particularly with respect to adequate control groups (who did not restrict foods) and failed to establish a causal link between sugar consumption and hyperactive behaviour.

    Subsequent studies suggested less than 2% responded to restrictions rather than Feingold’s claimed 75%. But the idea still took hold in the public consciousness and was perpetuated by anecdotal experiences.

    Fast forward to the present day. The scientific landscape looks vastly different. Rigorous research conducted by experts has consistently failed to find a connection between sugar and hyperactivity. Numerous placebo-controlled studies have demonstrated sugar does not significantly impact children’s behaviour or attention span.

    One landmark meta-analysis study, published almost 20 years ago, compared the effects of sugar versus a placebo on children’s behaviour across multiple studies. The results were clear: in the vast majority of studies, sugar consumption did not lead to increased hyperactivity or disruptive behaviour.

    Subsequent research has reinforced these findings, providing further evidence sugar does not cause hyperactivity in children, even in those diagnosed with ADHD.

    While Feingold’s original claims were overstated, a small proportion of children do experience allergies to artificial food flavourings and dyes.

    Pre-school aged children may be more sensitive to food additives than older children. This is potentially due to their smaller body size, or their still-developing brain and body.

    Hooked on dopamine?

    Although the link between sugar and hyperactivity is murky at best, there is a proven link between the neurotransmitter dopamine and increased activity.

    The brain releases dopamine when a reward is encountered – such as an unexpected sweet treat. A surge of dopamine also invigorates movement – we see this increased activity after taking psychostimulant drugs like amphetamine. The excited behaviour of children towards sugary foods may be attributed to a burst of dopamine released in expectation of a reward, although the level of dopamine release is much less than that of a psychostimulant drug.

    Dopamine function is also critically linked to ADHD, which is thought to be due to diminished dopamine receptor function in the brain. Some ADHD treatments such as methylphenidate (labelled Ritalin or Concerta) and lisdexamfetamine (sold as Vyvanse) are also psychostimulants. But in the ADHD brain the increased dopamine from these drugs recalibrates brain function to aid focus and behavioural control.

    girl in yellow top licks large lollipop while holding a pink icecream
    Maybe it’s less of a sugar rush and more of a dopamine rush? Anastasiya Tsiasemnikava/Shutterstock

    Why does the myth persist?

    The complex interplay between diet, behaviour and societal beliefs endures. Expecting sugar to change your child’s behaviour can influence how you interpret what you see. In a study where parents were told their child had either received a sugary drink, or a placebo drink (with a non-sugar sweetener), those parents who expected their child to be hyperactive after having sugar perceived this effect, even when they’d only had the sugar-free placebo.

    The allure of a simple explanation – blaming sugar for hyperactivity – can also be appealing in a world filled with many choices and conflicting voices.

    Healthy foods, healthy brains

    Sugar itself may not make your child hyperactive, but it can affect your child’s mental and physical health. Rather than demonising sugar, we should encourage moderation and balanced nutrition, teaching children healthy eating habits and fostering a positive relationship with food.

    In both children and adults, the World Health Organization (WHO) recommends limiting free sugar consumption to less than 10% of energy intake, and a reduction to 5% for further health benefits. Free sugars include sugars added to foods during manufacturing, and naturally present sugars in honey, syrups, fruit juices and fruit juice concentrates.

    Treating sugary foods as rewards can result in them becoming highly valued by children. Non-sugar rewards also have this effect, so it’s a good idea to use stickers, toys or a fun activity as incentives for positive behaviour instead.

    While sugar may provide a temporary energy boost, it does not turn children into hyperactive whirlwinds.

    Amy Reichelt, Senior Lecturer (Adjunct), Nutritional neuroscientist, University of Adelaide

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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