The National Institutes of Mental Health states that millions of American youths experience anxiety, with 25 percent of adolescents experiencing an anxiety disorder at some point between ages 13 and 18 years. As a parent or caregiver, you can recognize when your child’s anxiety is a normal response to certain events and when it is a disorder that is severe enough to interfere with life and possibly require specialized help.
You probably also already know that your child’s anxiety levels aren’t constant. You may have noticed that some situations trigger panic attacks, obsessive-compulsive behaviors or other signs of anxiety, such as fatigue, poor concentration and fidgeting. At other times, your child’s anxiety is minimal. Situations such as an upcoming test at school and hearing parents’ arguments are obvious causes of increased anxiety in susceptible children, but are you aware that your child’s diet can also play a significant role in their day-to-day stress and anxiety levels?
In particular, sugar and caffeine are two substances that may have more effects on your child’s brain than you’d expect. Although common, sugar and caffeine can increase children’s anxiety for a number of reasons. The following article summarizes the effects of sugar and caffeine and, in case you feel that your child is getting too much of them, provides suggestions for quickly and painlessly cutting back.
Sugar’s Relationship to Anxiety in Children
While you may already suspect that sugar is related to anxious behaviors in your child, you may not know exactly what it is about sugar that causes it. Sugar affects your child’s brain by interacting with neurotransmitters, which are chemicals that send signals between nerve cells. Specifically, it interferes with dopamine, a neurotransmitter whose functions include increasing feelings of pleasure and well-being, and allowing normal sleep patterns. Children who regularly consume high amounts of sugar may be at risk for poorer sleep, leading to more daytime fatigue and more anxious behaviors. In addition, large quantities of sugar can cause anxiety when dopamine’s activities are suppressed.
Almost everyone associates sugar with hyperactivity, and the effects in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) can be especially severe. Symptoms, including hyperactivity, impulsivity and anxiety, may be made worse with a high-sugar, low-nutrient diet, according to Dr. L.F. Marti from the Department of Pediatrics and Psychiatry at the University of Puerto Rico School of Medicine and Center for the Advancement of Interdisciplinary Research on Children with Attention and Learning Differences in a 2010 study.
Compared to adults, children are more vulnerable to the anxiety-provoking effects of sugar, according to research by Dr. William Tamborlane and Dr. Timothy M. Jones from the Yale School of Medicine and described in the Chicago Tribune. Interestingly, sugar increases adrenalin levels in children but not adults. Adrenalin, also called epinephrine, is a stress hormone; you feel more anxious when levels of adrenalin increase.
Sugar provides no essential nutrients, and too much sugar can have an indirect effect on your child’s anxiety by displacing nutrients necessary for staying calm and relaxed. Vitamins and minerals such as magnesium, manganese, the B vitamins and vitamin C are required for the synthesis of neurotransmitters in your child’s brain. Here are some examples of when high-sugar foods might be replacing these essential nutrients in your child’s diet.
- Snacking on candy instead of fruit.
- Having soft drinks or other sugar-sweetened beverages instead of milk.
- Choosing sugar-sweetened breakfast cereal instead of oatmeal or whole-grain cold cereal.
- Packing cookies or pudding instead of trail mix or pretzels in lunch boxes.
- Filling up on sweets between meals instead of being hungry for whole grains and lean proteins at mealtimes.
Caffeine, Anxiety and the Central Nervous System
Caffeine interacts with neurotransmitters, too. For example, as Warwick Hospital’s Anthony P. Winston and colleagues explain in an article from 2005, caffeine blocks gamma-aminobutyric acid (GABA) receptors in the central nervous system, especially in regions of the brain known as the thalamus, hippocampus, cerebral cortex and cerebellar cortex. GABA is a neurotransmitter that promotes relaxation, and blocking of its receptors interferes with your child’s ability to relax – therefore likely increasing anxiety.
Another effect of caffeine on the central nervous system, or CNS, is to block adenosine receptors, according to Jennifer L. Temple at the University of Buffalo in an article published in 2009. Adenosine, which is another neurotransmitter, increases feelings of sleepiness and relaxation; as with the blocking of GABA receptors, blocking of adenosine receptors increases nervousness. Furthermore, taking in caffeine leads to feelings of pleasure and reward by increasing the effects of the neurotransmitter dopamine.
Caffeine acts on the central nervous system to stimulate the “flight or fight response,” which prepares people to face challenges. When your child feels these effects, a normal response is to feel anxious – whether or not, in reality, there is something to worry about. Winston et al (2005) state that the physiological effects of caffeine include:
- Raised heart rate, or tachycardia.
- Increased blood pressure.
- The need to urinate due to a diuretic effect – which further raises blood pressure, according to research published by Jan Fagius from University Hospital, Sweden, and Sakari Karhuvaara from the University of Turku, Turkey.
- Confusion.
- Tremors and restlessness.
Of course, caffeine also disrupts sleep. Disturbing sleep in children can lead to inability to concentrate and poorer performance in school, nervousness and behavior problems. Just think about how cranky children can get when they’re tired and you’ll understand how consuming caffeine at – or within hours of – bedtime can cause your child to become even more anxious. The half-life of caffeine is five hours, which means that half of the caffeine that children ingest is still in their bodies after five hours, according to the International Food Information Council Foundation. Consuming caffeine in the afternoon or evening is likely to interfere with sleep, especially in caffeine-sensitive children. Nighttime sleeplessness and daytime fatigue can both increase anxiety.
How Much Sugar and Caffeine are Children Consuming?
Typical consumption of sugar and caffeine may be high enough to play a significant role in anxiety. According to an article in Circulation: Journal of the American Heart Association, the average U.S. child in 2005 had 29.8 teaspoons of sugar per day, or the equivalent of 119 grams or 476 calories. That’s an increase of 19 percent over 1970 levels. Anthony P. Winston breaks down the values further; they range from about 12 grams of sugar per day for 1- to 3-year-olds to 25 grams for 14- to 18-year-old females and 34 grams for 14- to 18-year-old males. These values refer to total sugars, which include natural sugars in foods such as fruit and dairy products, and added sugars, such as white sugar and corn syrup.
Compared to recommendations, normal intake of added sugars – the ones most likely to be in junk foods – is high. The American Heart Association suggests limiting added sugar intake to only half of your discretionary calories, which are about 250 calories on a 2,000-calorie diet. Added sugar intake to meet these recommendations is 32 grams, or 8 teaspoons per day; Winston reports that children average 18 grams of added sugars daily.
There is no recommended level of caffeine specifically for children. Average intake in the U.S. is 14 to 22 milligrams per day, according to Winston. That’s the amount in some tea beverages and energy drinks. The amount has increased by 70 percent since 1980, according to Jennifer Temple.
Common Sources of Sugar and Caffeine
You can help your child make better food choices and reduce sugar intake if you know which foods are highest in added sugars. Soft drinks, energy drinks, candy, baked goods, ice cream and jams are usually high in sugars. These are some examples from the USDA’s Nutrient Data Laboratory. You can see that added sugar can quickly add up to be far more than recommended daily limits.
- 1 12-ounce can of a regular soft drink, such as Coke or lemon-lime soda: 33 grams of sugars
- 1 regular-sized Milky Way bar: 35 grams of sugar.
- 1 cream-filled cupcake: 19 grams of sugar.
- 1 16-ounce can of Red Bull energy drink: 50 grams of sugar.
- 1 cup chocolate ice cream: 16 grams of sugar.
- 1 tablespoon of jam: 10 grams of sugar.
As mentioned above, some healthy foods naturally contain sugars. Fruit contains sugars called fructose and glucose, and milk is a source of another kind of sugar called lactose. For comparison, these are the sugar contents of some fruits and dairy products, as listed in the USDA’s Nutrient Data Laboratory. None of the sugars listed here are added sugars.
- 1 medium apple: 19 grams of sugar.
- 1 medium orange: 12 grams of sugar.
- 1 cup of grapes: 24 grams of sugar.
- 1 cup of fat-free milk: 13 grams of sugar.
- 1 cup of fat-free plain Greek yogurt: 6 grams of sugar.
- 1 cup of low-fat cottage cheese: 6 grams of sugar.
If your child doesn’t drink coffee, you might be surprised to discover that your child may actually be consuming caffeine regularly. In fact, caffeine is not only in coffee, but also in tea, chocolate and caffeinated soft drinks and energy drinks. Caffeine content can vary by brand, but these are some values from the USDA’s database.
- 1 cup of regular coffee: 100 to 200 milligrams of caffeine.
- 1 grande Starbucks Caffe Latte or Caramel Macchiato: 150 milligrams of caffeine.
- 1 12-ounce can of Coke or Mountain Dew: 35 to 54 milligrams of caffeine.
- 1 cup green or black tea: 50 milligrams of caffeine.
- 1 1.5-ounce Hershey’s Special Dark Chocolate bar: 20 milligrams of caffeine.
- 1 1.5-ounce Hershey’s milk chocolate bar: 9 milligrams of caffeine.
- 1 cup of decaffeinated coffee: 10 milligrams of caffeine.
Reading Labels to Discover Sugar and Caffeine in Foods
Learning some of the main sources of sugar and caffeine is a good first step when you want to help your child limit these possibly anxiety-provoking dietary components. Often, you can find out the sugar content of many foods by reading nutrition facts panels on packages. Also, check the list of ingredients for added sugars, such as honey, brown sugar, molasses, raw sugar, corn syrup and high-fructose corn syrup. The main ingredients are toward the beginning of the list of ingredients, so foods with sugars listed first or second are high-sugar. Not all food packages state caffeine content on the label, but they may list caffeine as an ingredient. You can also check the USDA’s Nutrient Data Laboratory for sugar and caffeine content of thousands of common foods.
The following foods may be adding to your child’s sugar intake without you even realizing it. You can tell if they have added sugar by reading their lists of ingredients.
- Sugar-sweetened cereals, especially flavored instant oatmeal and cold breakfast cereals targeted toward children.
- Fruit-flavored yogurt.
- Fruit drinks that aren’t 100 percent fruit juice.
- Granola bars, energy bars and protein bars.
- Coffee drinks and sweetened teas.
- Sweetened condiments, such as ketchup and barbecue sauce.
Additional Ways to Help Your Child Limit Sugar and Caffeine
Gradually reducing sugar and caffeine intake can make the transition easier for your child and help prevent anxiety caused by withdrawal symptoms. If your child, for example, normally has a large coffee beverage after school, purchase her a medium and then a small size before switching to a decaffeinated choice. Similarly, to reduce added sugar consumption, you can gradually shift from serving your child a sugar-sweetened cereal at breakfast. Offer a bowl half filled with the original cereal and half filled with an unsweetened, whole-grain option. Eventually, shift to an entirely unsweetened bowl of cereal.
Reducing your child’s sugar intake can be easier when you make one swap at a time. You might offer your child fruit instead of syrup to eat with pancakes in the morning, carrot sticks and fresh fruit instead of cookies at lunch, trail mix or air-popped popcorn instead of a sugary ice pop for an afterschool snack and serve fruit salad instead of fruit pie for dessert. Make an additional switch each week, and your child’s diet will gradually improve. Sugar content will decrease as nutrient content increases. These changes can help dramatically reduce your child’s anxiety faster than you may have imagined, and make them healthier overall to boot!
Make Good Choices Easy for Your Child
Your own actions can help your child’s ability to limit sugar and caffeine. Don’t store too much junk food in the house – if children don’t see it and can’t grab it, they won’t eat it. Instead, keep ready-to-eat healthy alternatives, such as baby carrots, whole fruit, whole-wheat pretzels and low-fat cheese sticks, within easy reach in the fridge or pantry. To help prevent anxiety over the new snacks themselves, don’t make a big deal out of healthier food swaps. Make them seem natural so that your child has no reason to worry about the changes. Remember to be a good role model for your child by eating the same nutritious foods as you’re asking her to eat.
Eliminate the “Need” for Caffeine
Some children and adolescents use caffeine for the same reasons as adults; that is, caffeine wakes you up and helps you focus. Unfortunately, since it also contributes to anxiety, it is not healthy for your child. Take a careful look at your child’s sleep patterns; is he getting enough sleep to stay alert the entire day? If not, your child may intentionally be choosing caffeine to stay awake at school. If that’s the case, work on developing healthier sleep habits, such as going to bed at the same time each night, allowing at least 8 hours for sleep and sleeping without a television. Getting more sleep can make it easier for your child to stop using caffeine, and it can reduce anxiety.
You can’t always prevent anxiety attacks in children who are prone to them by simply making nutritional or dietary changes, some parents find they are more successful with a structured program specifically developed for helping children overcome anxiety like the one we offer , but you can take steps to reduce their occurrence if they are not yet severe. Substantial evidence suggests that limiting sugar and avoiding caffeine while focusing on a nutritious diet can help prevent unnecessary anxiety, so it’s a great first step to take. Start today and remember that you can make the transition to a healthier life a lot easier by making the changes gradually and becoming a good role model – you may even find your OWN anxiety levels improve!
Sources
http://www.nimh.nih.gov/statistics/1ANYANX_child.shtml, www.ncbi.nlm.nih.gov/pubmed/21766545, http://www.foodinsight.org/Content/3147/Caffeine_v8-2.pdf, http://apt.rcpsych.org/content/11/6/432.full, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699625/, http://articles.chicagotribune.com/1990-05-10/news/9002070650_1_adrenalin-blood-sugar-levels-researchers, http://circ.ahajournals.org/content/120/11/1011.full.pdf
Photo Credits: muggezifter, annie.manning, patrix
