The Science of Sugar Addiction (part 3)

Update October 11, 2014*

You can’t go a week without hearing this ’sugar is as addictive as a street drug’ meme. I heard ’sugar is the new heroin’ a few days ago, right after listening to a podcast where a guy said drinking one soda is actually a binge.  Both were from popular low carb gurus with tremendous influence over people’s health.

The meme seems to be replicating and spreading quickly, which is easy to understand. It’s a simple, nicely-packaged concept, easy to digest.  It reduces stress to have answers to scary topics, so people naturally gravitate towards simple answers.  Whether those answers are right or wrong is a whole other story.

Take note that sugar or carb addiction memes are often associated with images of half naked women in a sexually-charged, drug-addicted moment.  Why do you think that is?  It subconsciously equates sugar with another concept that our culture’s Puritanical underpinning sees as ‘naughty’.

Evil Sugar 300x99 The Science of Sugar Addiction (part 3)

 

 

Simplify. Sexualize. Sold.

The use of these memes associating sugar with dangerous drugs and sexual misconduct works great for marketing, because it generates fear and a desire to distance oneself from the evil substance, regardless of any actual scientific evidence.  Usually those spreading the memes loudest are selling a low carb diet or detox/cleanse.

See how this works?  Stoke people’s fears, then sell them something to alleviate the fear, even if the ’selling’ is only of credibility or notoriety (equaling power) and not actual products.

The central problem with this meme is that carb addiction is not the defined phenomenon being claimed, as much as people staunchly defend this modern-day idea.  Convincing people they are addicted to a macronutrient causes more problems than it supposedly solves.

The people spreading these memes most likely don’t know any real drug addicts. They may possibly former addicts themselves or sympathetic to addicts, which actually makes sense., but this doesn’t make the information true. I am not trying to belittle anyone’s experiences here, these people may have some serious health/metabolic issues, no doubt, but that’s a metabolic issue, not a food issue.

If you truly believe sugar consumption is an addiction in the same way as drugs, you may have a desire to help people kick that addiction.  However, the suburban diet gurus popularizing the idea of sugar addiction to sell low carb diet programs, products, sugar free magic or their own notoriety are most likely opportunists, feeding on people’s fears.

Addiction Defined

So, how does one define an addiction, a condition that requires actual medical treatment or counseling?

http://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction

From DSM 4 (1994) Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of addiction is based on a list of 7 symptoms happening in the span of one year.  The minimum requirement is 3 out of 7, to qualify as addiction.

1) Tolerance

2) Withdrawal Symptoms

3) Taking in larger amounts or for a longer duration

4) Attempts to cut back

5) Excessive time spent pursuing, using or recovering from use

6) Reduction/discontinuation of important activities because of use

7) Continued use despite consequences

In the latest DSM 5, the definition of addiction has changed.  There are now 11 criteria with different requirements for qualification. The term itself has changed from ‘addiction’ to ’substance dependence’.

There’s been controversy* on this, whether new broader definitions will help more people get assistance or will label more people addicted and be an excuse to over-prescribe medicine.  I wonder (hope) if this is similar to declaring obesity a disease, in that it may actually benefit more people and reduce the stigma associated with both issues. I don’t know right now, none of us know, as it’s too early in the game to have any reliable statistics, but I did find the following article which seems to make a lot of sense.

“The new DSM-5 embraces addiction as a spectrum disorder with the qualifiers of “mild,” “moderate,” and “severe”. A scaled approach to addiction is clinically apt: We’ve all treated patients with varying levels of severity. A spectrum not only enables health care providers to capture this variance but also provides specific guidelines on how to rate degrees. If the patient endorses two or three items on the list, then she has a “mild substance use disorder,” if four or five items, “moderate,” and if six or more items, “severe.”

http://www.psmag.com/health/when-it-comes-to-addiction-the-dsm-5-gets-it-right-but-57203/

So far, the take-home is if you are an addict, you should be working with a medical professional and in some type of therapy, not taking advice from Facebook or blogs.

Science on Sugar Addiction

I looked into the science of sugar addiction. I had to, because most people claiming sugar addiction are only sharing their personal experience or opinion.  Anecdotes and educated opinions can be useful, but they aren’t science.

The best thing I found was a review of the scientific literature on the topic:

Alan Aragon’s Research Review May 2010 AARR “Is Carbohydrate Addiction Based on Science or Fiction?”

http://alanaragon.com/researchreview

First, there are divided camps on whether ‘food addiction’ is an actual condition, and then there’s this examination on any science behind the idea. Aragon reviews relevant papers defining food as addiction/substance dependence and quotes a leading pro-sugar-addiction researcher whose paper ironically states this:

“Drugs of abuse are different from food. The shared neural substrates for food and drug cravings probably evolved to encourage healthy behaviors such as eating and reproduction. Drugs of abuse are undesirable because they are able to take over these substrates and to divert efforts away from healthier goals.” (Corsica & Pelchat)

So there’s that.  Although there are some similarities, drugs of abuse and food also have different biologically-classified effects on human physiology, and there are obvious realities which don’t seem to support the idea of actual sugar addiction.

It’s highly suggested you get Alan Aragon’s Research Review, especially for this article. For now, here’s a spoiler:

“In sum, the data suggesting the abuse potential of carbohydrates is interesting. However, it’s highly preliminary, limited in relevance, and sorely inconclusive. Hopefully future research will produce more definitive answers to the lingering questions.”

In the same vein as the assertion that sugar is addictive, there’s a hypothesis that some people use carbohydrate consumption as self-medication in reaction to emotional stress.  Again, the science behind this is inconclusive and controversial, with studies having poorly-controlled variables and questionable correlations with real-world circumstances.  The evidence is inadequate to classify carbohydrate consumption as ’self-medication’ in the same sense as the use of drugs of addiction.

I said previously there seems to be a small subset of people vulnerable to eating behavior that appears similar to addiction, specifically with palatable carbohydrates.  This does not mean sugar is an addictive substance.  In regards to dopamine and cravings or eating behaviors, it appears there may be a vulnerability in a small subset of people wherein food cravings share similarities with drug cravings within the framework of a concept called STR (sensitivity to reward).  It’s not reasonable, given the current available research, to therefore conclude that sugar in and of itself is a physiologically addictive substance.

Are there similarities between drug addiction and sugar/food addiction?  Are there similarities in the brain with anything that gives us pleasure? There is indeed a similar neural phenomenon when pleasure is involved, regardless of the substance or activity in question. We see similarities with neural mechanisms and pathways (down-regulation of dopamine receptors) and issues with opioids, serotonin and adrenaline between obese people and drug addicts. There are many things happening here, and it is a far cry from saying ’sugar is a drug’ or that it is even remotely similar to crack or heroin.

Now, this may lead to better research, and hopefully the new DSM 5 allows more people to get support they need. At this point, it’s not nearly as clear or confident as the pro-sugar-addiction camp suggests. They are also leaving out many other important details in these comparisons.

Scientific Studies on Sugar/Food Addiction

*“Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior

  • Evidence for addiction to specific macronutrients is lacking in humans.
  • “Eating addiction” describes a behavioral addiction.
  • An “eating addiction” is not necessarily associated with obesity.

http://www.sciencedirect.com/science/article/pii/S0149763414002140

The plausibility of sugar addiction and its role in obesity and eating disorders.

There is no support from the human literature for the hypothesis that sucrose may be physically addictive or that addiction to sugar plays a role in eating disorders.”

http://www.clinicalnutritionjournal.com/article/S0261-5614(09)00239-8/abstract

“Is food addiction a valid and useful concept?

Food addiction has an established and growing currency in the context of models of overeating and obesity, and its acceptance shapes debate and research. However, we argue that the evidence for its existence in humans is actually rather limited and, in addition, there are fundamental theoretical difficulties that require consideration. We therefore review food addiction as a phenotypic description, one that is based on overlap between certain eating behaviours and substance dependence. To begin, we consider limitations in the general application of this concept to obesity. We share the widely held view that such a broad perspective is not sustainable and consider a more focused view: that it underlies particular eating patterns, notably binge eating. However, even with this more specific focus, there are still problems. Validation of food addiction at the neurobiological level is absolutely critical, but there are inconsistencies in the evidence from humans suggesting that caution should be exercised in accepting food addiction as a valid concept.”

http://www.ncbi.nlm.nih.gov/pubmed/23057499

“I am in the camp arguing that it is the intermittent exposure to highly palatable, often sugary foods, often coupled with some compensatory food restriction and significant distress that results in food intake that can in any way be called “addictive”—not simple overconsumption of high-calorie foods. Both caloric restriction and intermittent sugar intake alter dopamine transmission in response to rewards (Corwin, Avena, & Boggiano, 2011), and intermittent—but not continuous—access to high-fat substances induces the typical “sawtooth” pattern of binge-restrict behavior in animals; reflective of human ED behaviors where individuals restrict food intake in between periodic episodes of binge eating.

Thus, perhaps it is the combination of these two behaviors, bingeing on fatty foods and subsequently attempting to restrict caloric intake, that produces an exaggerated response to food rewards and encourage compulsory food intake akin to compulsory drug intake.”

http://www.scienceofeds.org/2013/04/04/binge-eating-when-should-we-call-it-an-addiction/

Best of Facebook/Twitter:

“when I hear ’sugar addiction’ I hear ‘binge eating disorder’” @Go_Kaleo

Binge Eating Disorder defined:

http://www.nationaleatingdisorders.org/new-dsm-5-binge-eating-disorder

On Fancy Words Used By Bloggers

“dopamine receptors and addiction semantics aside, carbs are essential for healthy physiological function and meth is not. all other facts are irrelevant, and Alex’s p.o.v. is missing that key detail.

ie: i crave water when thirsty, pleasure ensues when i satisfy that urge. comparing my desire to crave water to a desire for meth is missing the whole damn point.”

by Matthew Bowen http://dyenutrition.wordpress.com/

On Sugar Cravings

“The desire for sugar is hard-wired into our brains. For millions of years, it served an evolutionary advantage. It is not pathological or shameful. Leave it to our culture to pathologize a trait that has served an evolutionary purpose and led to our species’ survival and success. Much like body fat.”

Go Kaleo http://gokaleo.com/2013/03/08/how-to-get-off-teh-dietz/#comment-11855

The Sweetness of Evolution

http://www.lastwordonnothing.com/2012/09/20/the-sweetness-of-human-evolution/

On Sugar as the New Heroin

by Scott Kustes http://www.realfooduniversity.com/blog/

“Did you know that sex stimulates the same pleasure centers as heroin?! Did you know that most everything pleasurable stimulates the same pleasure center of the brain (the Nucleus accumbens) http://en.wikipedia.org/wiki/Nucleus_accumbens)? Did you know that making vague claims like “stimulates the same pleasure centers of the brain as heroin” is not only misleading, but also bad science? Did you know that people that make claims like “sugar is as addictive as cocaine/heroin” have probably never known a cocaine or heroin addict?”

REFERENCES:

http://www.dannyroddy.com/main/2012/2/27/sugar-pure-white-awesome.html

*Controversy: DSM defends itself against NY Times article

http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf

http://dsmfacts.org/issue-accuracy/apa-corrects-new-york-times-article-on-changes-to-dsm-5s-substance-use-disorders/

http://www.psychologytoday.com/blog/day-without-pain/201305/the-dsm-5-and-addictive-disorders

http://www.nytimes.com/2012/06/06/opinion/the-dsm-gets-addiction-right.html?_r=0

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03144.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

More on Sugar Addiction:

Part 1Is Sugar Addiction Real?

Part 2- Why We Believe Sugar is Evil

Part 4- Sugar Addiction = Eating Disorder

Read More about Carbs & Sugar:

25 Things You Should Know About Sugar

The Truth About Carbs & Sugar

 

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