What is Sugar Addiction?
Sugar addiction refers to an individual's addiction to "free" or "added" sugars. That is, sugars which are not naturally present in a food stuff, meal etc. A good example would be the sugars added to fruit juices to further sweeten them.
It is often cited that this addiction is a key contributor to weight gain and subsequently obesity (and a myriad of other metabolic and health disorders). Many popular "experts" have cited sugar as the key factor in to the ever increasing prevalence of obesity.
Is Sugar Addiction validated in the research?
It's important to note that, before we dive into the "whether it is" or "is not" validated, addiction itself is a highly complicated subject and the spectrum of addictive behaviours and symptoms is not consistent between cases and is not always easily defined.
How do we classify addiction?
Before we can make a case for sugar as an addictive substance, we must first define addiction, which is referred to as substance use disorder (SUD) in the literature.
Experts utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a tool to unify diagnostic criteria in clinical and/or experimental design. The current version of this manual known as the DSM-5 includes a section for SUD and it incorporates eleven criteria for diagnosis.
A patient must fulfill at least two of these criteria to be classified as having a SUD. In turn, these eleven criteria, by their characteristics, can be compiled into four broader groups.
The majority of data collected on the subject of sugar addiction (easier to refer to it this way than sugar SUD which may confuse people) has been achieved in animal models (quite simply, lab based tests typically performed in a population of rats although other animals may sometimes be used). Whilst it would be an injustice to give this subject a broad stroke and sum it up in a few words, for the sake of simplicity and understanding, that's exactly what we're going to do (my blog, do what I want).
So, when we look at the animal model research there does appear to be some vindication to using the term "sugar addiction" however, a more accurate descriptor may addiction like tendencies towards "sweetness" in foods.
The animal model research has shown that there may be an issue of altered self-control and the development of a craving towards sugar/sweetness. There is also some data showing "drug withdrawal" like symptoms in rats when overfeeding and subsequently restricting sugary/sweet foods and, most interestingly, once sugar is introduced (even in lab rats already addicted to cocaine) the rats will almost always switch over to consuming sugary/sweet foods. This is because the reward from sugar/sweetness surpasses that of even cocaine.
What we must consider with these findings though is how transferable and applicable are these when implemented in a human model. The studies in animal models typically use;
- Genetic differences between animal and human models
- Artificial settings (these animals are bred for this purpose and are in some cases force fed extreme amounts of the nutrient / food stuff).
- Much higher dosages of sugar and or sweeteners than would ever be found in real life scenarios.
- Sugar and or sweeteners in large concentrations but also in isolation. There are very few, if any, foods that are purely sugar and I've yet to see and or hear about an individual who simply eats table sugar or drinks honey purely on there own.
In Summary (Animal Model Research);
A case can be built for addiction to sugar in animals. However, critical appraisal of the data would suggest the main driver of addictive tendencies is the "sweetness" of a food rather than the sugar / calorie content itself (at least in an animal model given the present state of the data).
These findings may also not necessarily practically transfer over into a human model so using them as the sole foundation for an argument in favour of the existence of sugar/ sweetness addiction in humans wouldn't carry much weight.
There has been little empirical work done in human models to investigate sugar addiction. This is mainly due to how difficult it would be to study (given the ethics of it) and the lack of clarity in defining what addiction is and how it would present itself in these cases.
Instead the majority of the research is driven towards food addiction (FA), and how some individuals may suffer from FA towards highly palatable foods (typically higher in saturated and trans fats, added sugars, sweeteners, caloric content and degree of processing).
It's easier to look at sugar addiction then as a part of FA itself, rather than the sole considerate for all the health issues surrounding food addiction (obesity, eating disorders etc.), as a growing body of evidence disputes sugar itself being the key determinant. We have to broaden the scope as opposed to isolate it in this sense as food is typically a "mish mash" of multiple components and this is before we even consider the environmental factors, social factors, emotional attachment etc. some individuals may have in relation to given foods.
Identifying Food Addiction
The food addiction behavioural phenotype (essentially, "this person fits the description") is identified using the now widely popular 25-item Yale Food Addiction Scale (YFAS).
Criteria include; persistent eating despite negative consequences, persistent desire for food, unsuccessful attempts to cut down and impairment of functioning because of overeating.
The criteria are defined with respect to ‘certain foods’, and the YFAS provides 21 examples from 5 food categories: sweets (e.g. ice cream), starches (chips), salty snacks (pretzels), fatty foods (pizzas), and sugary drinks.
"Diagnosis" for FA can be achieved if an individual meets at least three of the criteria and suffers some kind of clinical impairment (so has an additional health issue basically).
Food Addiction over Sugar Addiction
As we have discussed earlier, little quality, relevant evidence supports sugar as an addictive substance, and the animal neuroscience literature suggests sweetness or palatability (how good it tastes) to be critical elements of addictive-like eating. That is, sweet foods rather than sugar per se might be the ‘substance’ of interest, but looking at food addiction overall may be a more time worthy endeavor.
Examination of dietary profiles associated with problematic eating in young adults has shown that consumption of energy-dense, nutrient-poor foods (e.g. sweets, "fast food" etc.) is positively correlated with FA score and BMI (arguably the greatest associative health detriment used by those who promote "sugar addiction" and change in policies to address sugar addiction).
Interestingly, dietary intake of carbohydrates or sugar was not significantly associated with FA diagnoses or scores, suggesting a limited role of sugar in putative addictive-like eating in humans. More work is obviously required here but it does suggest we are wasting our resources going after "sugar" when it appears to be a myriad of issues (not purely isolated to the food itself but environment, social pressures, emotional coping etc.).
It's important to note at this stage that not all all obese people are food-addicted and not all food-addicted are obese. In one study it was found that 96% of a population of people who suffered with bulimia nervosa were clinically FA. This only highlights how complex the issue is and the futility in isolating one specific food substance (not even a given macronutrient because those who back the theory of food addiction state it is equivocally just added sugars that lead to addiction).
Are we simply misinterpreting sugar addiction when self-diagnosing?
Whilst I hate to make statements that may not be backed by data I hope I'm not the only one in saying that virtually all cases of "sugar addiction" are self-diagnosed. Just go check out any poorly ran social media page which uses the term "sugar addiction" to sell their products or services and check the comments section. You can find a bunch of poor people who have been roped in looking for some kind of explanation as to why they can't stop eating x, can't lose y amount of weight etc. etc. Not to say that they're looking for a way out but many people are roped into a "mob" like mentality and would easily buy into terminologies and ways of thinking if they're not well versed on the research and how things actually work in the body. Just look at the celery juice guy, best example of an idiot who uses big words to get people to buy in.
Now, again, this isn't to say that sugar may not have any role (although now I'd like to think we believe otherwise and see that "sweetness" may be the guilty party in this rather than the sugar itself) but it just may be a cause of misinterpreting our current health state and giving this general diagnosis because it's easy to do so. So, what may be misinterpreted for "sugar addiction"?;
Without over complicating this too much, insulin resistance is most typically associated with overweight/ obesity (however can also be found in women with PCOS and other populations). Insulin resistance can lead to reductions in blood sugar control / regulation which can subsequently lead to fatigue. What do we reach for when we're fatigued? Something "sugary" (often tending to be sweet, calorie dense and highly palatable) to give us a "pep in our step". A destructive cycle, but an alarmingly common one.
Poor Sleep Quality and Lack of Sleep Quantity
Sleep plays an important role in blood sugar regulation and it's been found that even those with only a few days of sleep deprivation have near identical levels of blood sugar control to diabetics (i.e. they aren't very good).
The World Health Organization (WHO) recently stated we are in a period of global sleep "famine". Put two plus two together; we're sleeping less and or worse, our blood sugar control is reduced, we reach for highly palatable, sweet foods.
Shout out to my one female reader out there, this is for you! Your hormonal profile can also play a part in your tendencies towards certain foods. I've worked with enough clients to know cravings go up around a certain time (let's just say it attracts bears and if anyone gets this reference you get five internet points) of the month and this is mainly due to hormonal driven reductions in blood sugar control. So again, not an addiction to sugar, it's just "that time" again.
There are other possible factors such as change in taste bud profile in tandem with body weight and maternal influences, but I'm conscious this is getting long now and, quite frankly, it's the weekend and I want to go snort some sugar.
Sugar addiction may not be the sole perpetrator for the abundance of health issues our society is facing. It's existence is even questionable and we may be investigating the non-guilty party here. Sweeteners and or sweetened foods may be the true culprits behind some cases of FA (but even then, there's a vast spectrum of these sweeteners and their individual effects on FA, both from a mechanistic perspective and how they fare in direct intervention based studies, are poorly understood).
FA is a very real issue however, and our tendencies and addictive like behaviours towards certain sweet foods may fall under the broader umbrella of addiction to food. Understanding that there may not be a extrinsic phenotype to food addiction (i.e. how someone looks) is important too, as it can effect those who are under, healthy and overweight.
More work needs to be done to figure out how we can help people with food addiction and all it's complexities. It's very real and if you need help reach out and speak to a qualified professional as FA may be a gateway to even more serious mental health issues.
Thanks for reading!
Burrows, T., Kay-Lambkin, F., Pursey, K., Skinner, J. and Dayas, C. (2018). Food addiction and associations with mental health symptoms: a systematic review with meta-analysis. Journal of Human Nutrition and Dietetics, 31(4), pp.544-572.
de Vries, S. and Meule, A. (2016). Food Addiction and Bulimia Nervosa: New Data Based on the Yale Food Addiction Scale 2.0. European Eating Disorders Review, 24(6), pp.518-522.
Pursey, K., Collins, C., Stanwell, P. and Burrows, T. (2015). Foods and dietary profiles associated with ‘food addiction’ in young adults. Addictive Behaviors Reports, 2, pp.41-48.
Westwater, M., Fletcher, P. and Ziauddeen, H. (2016). Sugar addiction: the state of the science. European Journal of Nutrition, 55(S2), pp.55-69.
Wiss, D., Avena, N. and Rada, P. (2018). Sugar Addiction: From Evolution to Revolution. Frontiers in Psychiatry, 9.
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