What you’re getting yourself into
A look at the science behind addiction, and why sugar ticks the same boxes as cocaine.
I didn’t realise quite how controversial a topic this was until I started asking people whether they consider sugar addictive. So having waded through a few heated arguments in my attempt to get a feel for the general consensus on the matter, I decided it would only be fair to give this sugar subplot its own article.
Addiction can be defined as a chronic, relapsing disorder characterised by compulsive drug seeking and use despite adverse consequences. This term can apply to behavioural conditions beyond the usual clinical diagnosis applied to the use of substances like cocaine, caffeine, cannabis, opioids and alcohol.
As for the necessary neuroscience, the pathway to addiction is paved by dopamine, best understood as the molecule that makes you want more. The drug, or behaviour, can exert its intoxicating effects by flooding the brain with dopamine, accompanied by a variation of opioids, cannabinoids, GABA, and serotonin.
The result of those accompanying neurotransmitters, is that you feel pleasure, or relief from whatever has been ailing you.
The result of spiking dopamine is you want more of that stimulus that got you there. It imprints the process in your memory. The issue is that the same dose won’t produce the same flood of neurotransmitters, so you find out that you need bigger and bigger helpings. The stimulus can then manifest as a deleterious habit, known as addiction.
Can Sugar Be Diagnosed As An Addiction?
There isn’t a solid consensus for diagnosing addictions outside of the classic substances. Exercise can be a behavioural addiction that acts as an outlet for an eating disorder. Gambling was the initial one to be recognised by the Diagnostic and Statistical Manual (DSM).
Beforehand, it was simply classed as an impulse control disorder. Nowadays, it has been well established that certain behaviours, like exercise, video games, and sex, can share similar aspects of phenomenology and biology to substance use disorders.
Sugar hasn’t been recognised by the ICD as an addictive behaviour. Food as a whole hasn’t been recognised as addictive. The mindless overconsumption of food that might be termed an addiction, gets filed under binge eating disorders instead, which is characterised by concerns about dietary issues, body shape, and weight. Rather than the hijacking of the dopaminergic pathways that defines addiction.
And that’s fine, because I’m going to make the argument that belongs in the other category: a substance use disorder.
In other words, I’m saying that sugar is a drug, and should be treated with the same caution that one would give the likes of caffeine and nicotine. Not everyone who tries caffeine and nicotine winds up forming an abusive relationship with those substances. But in the right (or wrong) environment, they have the capacity to be deleterious.
How We Can Assess A Substance Use Disorder
Rather than simply describing why I think sugar is a drug, I’m going to show sugar bingeing can line up against the clinical markers of addictive substances. Which brings us back to the DSM.
The DSM-5 has 11 criteria for diagnosing a substance use disorder, across four subcategories
Impaired Control
1.Taking the substance in larger amounts or for longer than you’re meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
Social Impairment
5. Not managing to do what you should at work, home, or school because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational, or recreational activities because of substance use
Continued Use Despite Risk
8. Using substances again and again, even when it puts you in danger
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
Pharmacological Criteria
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance
These 11 criteria can be used to assess how serious the substance use disorder is.
Mild – Two or three symptoms indicate a mild substance use disorder.
Moderate – Four or five symptoms indicate a moderate substance use disorder.
Severe – Six or more symptoms indicate a severe substance use disorder.
How Sugar Fits Against The DSM
While we don’t have human studies that can settle the matter on sugar’s addictive properties, there are rat models that can give us an insight into how it affects brain chemistry and behaviour.
One such study from 2018, titled ‘Sugar Addiction, From Evolution To Revolution’, found that rats hyped up on sugar fit the following DSM criteria.
1.Taking the substance in larger amounts or for longer than you’re meant to
4. Cravings and urges to use the substance
8. Using substances again and again, even when it puts you in danger
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance
The three under social impairment could not be considered due to the subjects being rats, which left sugar with a respectable 5 out of 8, and what could at the very least be described as a moderate use substance disorder.
And what is it about sugar that makes it addictive?
We know the basic mechanisms that form an addiction, especially the interactions between dopamine, cholinergic and opioid systems. One paper used that to demonstrate that rats fed sucrose (fructose mixed with glucose) sparked a similar constellation of brain changes and behaviours that is characteristic of rats taking addictive drugs.
– The triggering of dopamine and opioids in response to the sucrose
– Increase in dopamine 1 receptors and decrease in dopamine 2 receptors, which increases impulsivity
– Increase in opioid receptor binding, which increases the severity of the craving
– Inhibition of acetylcholine that would otherwise signal satiation
– A state of low dopamine and high acetylcholine during withdrawal, which doesn’t signal satiety, but instead fosters aversion
There definitely appears to be a mechanism by which sugar can be addictive, and rats treated with sucrose do exhibit addiction in both their neurochemistry, and their behaviours. The question remains as to whether this can be repeated in humans, and we still lack the studies.
So the case of sugar addiction remains a hypothesis.
One extra mechanism that can contribute to sugar bingeing, is the way fructose is metabolised. There is no negative feedback loop when fructose is broken down by the liver, which allows it to rapidly burn through ATP reserves and require an extra dosing of fructose to repair the energy deficient state. Fructose also elevates the hunger hormone ghrelin, which further tilts your proclivity to overeat.
Why It’s Controversial
The counter arguments to the hypothesis usually present themselves along these lines.
1. It isn’t sugar, it’s the energy density and hyper palatability that’s driving overconsumption
– The evidence we have of the effects of sucrose would suggest that there is something more specific going on than hyper palatability, which is otherwise a bit of a blanket statement. Not that there isn’t a case to be made that sugar, fat, and salt can be engineered to reach irresistible bliss points. As for energy density, that wouldn’t exactly result in the withdrawal symptoms seen in rats.
2. If sugar was addictive, why aren’t there sugar addiction clinics, and why aren’t people eating bags of sugar?
– There are addiction clinics for sugar: just check out Weight Watchers. And people do eat sugar by the bag, because soda and candy are basically fructose dressed up with a few additives.
None of this is to imply that drinking a can of coke is as dangerous a move as taking a line of cocaine.The capacity of addiction to sugar is better compared to caffeine and nicotine. Both have the potential to become an addictive substance, when thrown into the right environment.
The same goes for sugar, which is why the majority of people will be able to eat sugar without spiralling to the point where they have secret stashes of oreos dotted around the house.
But even for the lucky people who don’t get trapped in a cycle of abuse, there’s plenty of reasons to moderate, minimise, or eliminate sugar.
How To Overcome A Sugar Addiction
If you’re showing symptoms of sugar addiction, then it’s worth asking yourself whether you should settle for moderation. Would an alcoholic beat his addiction by moderating? If he has to abstain to break the cycle, then maybe you should too.
This is just another issue that a carnivore diet resolves. The carbs included in dairy likely won’t have the same effect due to being limited in quantity and devoid of the fructose that dominates the addictive characteristics of sugar.
Besides the nuclear option, avoiding processed foods that are lathered with high fructose corn syrup and other sweeteners will do the lion’s share of reducing your sugar bingeing. A ketogenic diet with vegetables and low caloric fruits is certainly a good choice, as will be a diet that focuses on starches and non tropical fruits.
At the very least, you’ll now be armed with a few things to say the next time sugar addiction comes up over a coffee break.
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