Is there a link between sugar and ADHD/strange behaviours?

Often the question has come up if TTM is related to ADHD. In English:  is TrichoTilloMania related to Attention-Deficit/Hyperactivity Disorder? As the following article indicates, yes, there might be a
link. Maybe not so close that TTM will be renamed ADHD (Attention-Deficit/Hair Disorder), but perhaps the link is through diet, and specifically chocolate.

NEW YORK TIMES, November 2, 1999, PERSONAL HEALTH

Diet Change May Avert Need for Ritalin
By JANE E. BRODY

My sister-in-law Cindy Brody thought that large amounts of sugary
foods turned Sam, her otherwise normally active son, into a wild
and aggressive animal, though well-designed studies have repeatedly
failed to find a relationship between sugar per se and
hyperactivity.

Then, through careful observation, Cindy realized that sugar itself
was not the culprit; rather, it was chocolate that typically made
Sam hard to control.

For a quarter of a century now, parents of hyperactive children
have been besieged with claims that various common foods, food
additives and preservatives were the cause of the syndrome that is
now called attention-deficit/hyperactivity disorder, or A.D.H.D.

And over and over again, many leading health organizations,
bolstered by a collection of mostly small and often poorly done
studies, have disputed such claims.

Children with the disorder are hard to manage, disruptive at home
and in the classroom, and they often fail in school. The main
symptoms are difficulty concentrating, short attention spans, easy
distractibility, excessive activity and impulsiveness.

The vast majority of children with diagnoses of the disorder are
given Ritalin (methylphenidate), a stimulant that has the
paradoxical effect of calming them down and helping them to get a
better focus on the task at hand. The use of Ritalin in children
has skyrocketed in the last decade, increasing two and a half times
in the first five years of the 1990's.

Is Ritalin the Only Answer?

While Ritalin is highly effective -- it helps 70 percent to 90
percent of children with the disorder, often significantly -- there
is growing concern about its extensive use and occasional abuse,
its common side effects and its possible and still unknown
long-term effects on children who take it for many years.

Various estimates hold that 3 to 5 percent of schoolchildren have
the disorder, which affects twice as many boys as girls. But in
some schools as many as 20 percent of boys in the upper elementary
grades are being given Ritalin. Critics say that many boys
exhibiting normal (testosterone-induced?) activity and
aggressiveness are being improperly labeled hyperactive and treated
with a drug that may ultimately do them more harm than good.

Prompted by these concerns and nagging questions about the effects
of diet on behavior, the Center for Science in the Public Interest,
a nutrition advocacy group, has taken a new hard look at the
studies that explored various dietary factors in A.D.H.D. and the
pronouncements by health authorities that there is little or no
evidence to support such a relationship.

A new report, released last week, reviews 23 of the best studies
conducted since the mid-1970's and public statements from the Food
and Drug Administration, the American Academy of Pediatrics, the
International Food Information Council and the American Council on
Science and Health, among others.

It concludes that the evidence strongly indicates that for some
children, behavioral disorders are caused or aggravated by certain
food additives, artificial food colors, the foods themselves or a
combination.

In 17 of the 23 studies, behavioral improvements were noted when
the children's diets were modified. Eleven other studies, ones that
were not as well designed, showed even greater improvements on
restricted diets.

The center and a group of physicians and scientists who share this
conclusion have urged the Department of Health and Human Services
to advise parents and health professionals to try changing the
diets of children with A.D.H.D. before placing them on stimulant
drugs (Ritalin or amphetamines) that may suppress their appetites
and cause weight loss, insomnia, stomachaches and, in rare cases,
tics. The petitioners also expressed concern about a laboratory
study that found an increase in liver tumors in mice (but not rats)
given doses of Ritalin not much greater than what children receive.

The center has also asked the Health and Human Services Department
to commission new and better studies on the relationship between
diet and behavior in children, and the Food and Drug Administration
to require behavioral tests for certain food additives.

Last year, a consensus conference convened by the National
Institutes of Health noted in its final report that "some of the
dietary elimination strategies showed intriguing results suggesting
future research" but then failed to include diet in its research
recommendations.

Meanwhile, the report suggested that the food industry refrain from
using suspect additives and that the government "consider banning
synthetic dyes in foods and other products widely consumed by
children," including cupcakes, candies, sugary breakfast cereals,
vitamin pills, drugs and toothpaste.

Is Diet Worth a Try?

Although only a small percentage of children with the disorder are
expected to benefit significantly from changes in their diets, the
new report urges parents to try the changes before resorting to
drugs. Children who suffer from asthma, eczema or hives are
especially likely to benefit, some research has indicated.

Controlling behavior through diet requires first identifying and
then removing from the child's diet those foods or chemicals that
seem to cause the unwanted behaviors. The task is not easy, but it
has been done successfully for many children with food allergies.

There are several ways to approach the problem. One is to start
with a very basic diet of foods that are beyond suspicion and one
at a time add back possible culprits for a few days and carefully
monitor the results. Another is to eliminate one suspect food or
substance at a time from the child's usual diet and see if there is
an improvement.

The substances that have most often been linked to worsening
A.D.H.D. symptoms include artificial colors and flavors; foods that
naturally contain salicylates, like apricots, berries and tomatoes;
and foods that sometimes cause allergic reactions, like milk, wheat
and corn. Some children may also react to chocolate.

Parents, and children when they are old enough, will have to become
compulsive label readers to avoid the offending foods. And of
course, keeping a child away from problem foods can be a daunting
task, especially when the child eats lunch in school, goes out to
eat or eats in other people's homes. Some children may be teased
about their dietary restrictions; others may rebel at being
deprived of foods and treats they love. On the other hand, as one
11-year-old from Waldorf, Md., put it, "I would rather be different
because of what I eat than because of how I behave."

Single copies of the report, "Diet, A.D.H.D. and Behavior," are
available for $8, and a brochure, "A Parent's Guide to Diet,
A.D.H.D. and Behavior," which summarizes the report and suggests
ways of modifying the diet, is available for $1.50 from
C.S.P.I.-Behavior, Suite 300, 1875 Connecticut Avenue, Washington,
D.C. 20009. The reports are also posted on the center's Web site
( http://www.cspinet.org  ).