the HAES files: the other white powder – sugar and food addiction

by Health At Every Size® Blog

by Jonathan Robison, PhD, MS

Gary Taubes was at it again recently, responding to “The Fat Trap” by Tara Parker-Pope spouting the same old rhetoric about how carbohydrates are poison and how the “obesity epidemic” is the result of too many carbs. As usual, his response was short on confirming evidence for his claims other than mentioning several clinical studies (no names or references) and the fact that severely restricting carbs has evidently helped him to lose weight.

The latest round of sugar bashing probably traces its origin back to an article by the lawyer (not nutritionist) Jon Banzhaf in the New Scientist in 2003 in which he argued that “fats and sugars can act on the brain in the same way as nicotine and heroin.” In a piece in The New York Times in 2011, Dr. Robert Lustig summed up the latest attack on the sweet tasting white powder from the health professionals perspective saying:

“Sugar is not just an empty calorie…It’s not about calories. It has nothing to do with calories. It’s a poison by itself.”

Of course the sugar as “empty calorie” concept makes no sense at all. A calorie is a measure of energy and carbohydrates are a nutrient – sugar has both. But that aside, the supposed dangers of sugar have certainly become legendary. Its damaging effects have been compared to those of another white powder and an entire industry – non-sugar sweeteners – has grown up around the fear produced by the legend. Experts have claimed that “most Americans are addicted to sugar” and a quick Google of sugar addiction will bring up almost 11 and a half million hits, more than 5 times the number for cocaine addiction!

What is it about this wonderful tasting stuff that inspires such trepidation? Well, the argument by the naysayers goes something like this. When people ingest sugar, it lights up the same nerve pathways in the brain that get lit up when people take cocaine. Therefore sugar must be addictive just like cocaine. In fact, the effect of virtually all drugs of abuse is largely dependent on activation of the body’s reward circuit or pleasure center – the mesolimbic dopamine system. While there are undoubtedly other mechanisms involved as well, all of these drugs exert their influence primarily by increasing the release of dopamine, which makes us feel good. So, what about sugar? Actually, it is true that eating sugar and sugary foods also increases the release of dopamine through these pathways and makes us feel good. Does this mean we are addicted to sugar? The biggest clue to the answer for this question is that sugar is only one of many factors besides addictive drugs that lights up these pathways. Here are a few others:

            Music

            Humor

            Winning a prize

            Expecting to win a prize

            A mother recognizing her child

            Attractive Faces

            Smiling Faces

            Oh yes, and being in love!

Are we to claim a pathological undercurrent for the enjoyment of all of these? Writing in 2010 in a review article in The Journal of Clinical Nutrition, Dr. David Benton, professor of psychology at the University of Swansea, Wales summed up the reality this way:

“That such a wide range of pleasant phenomena activate these mechanisms suggests that rather than seeing the stimulation of these pathways as something unusual or worrying, it can be viewed as one of a wide range of positive experiences that routinely stimulate a common circuitry.”

Interestingly, a closer look at the details unearths other discrepancies in the comparison between sugar and drugs of abuse when it comes to mechanisms of action. In fact, although these substances all do share some common pathways, sugar actually influences different populations of nerves in the brain, causes different patterns of firing, and induces different timings of the release of dopamine. As Benton explains:

 “reward response is highly dependent on the substances tested, demonstrating that multiple reward mechanisms operate that can encode for different stimuli.”

In spite of the evidence, the sugar as evil mantra is not likely to disappear anytime soon. You only have to go to the bookstore to see that – Beat Sugar Addiction Now, Break Out of The Sugar Prison, Lick The Sugar Habit, The Sugar Addict’s Total Recovery Program, How To Break Your Sugar Addiction Today, Little Sugar Addicts, Suicide By Sugar and of course Freedom from Obesity and Sugar Addiction – to name only a few titles. Even more unfortunately, many so-called experts are stuck in the food as addiction paradigm, leading to outrageous recommendations to an already confused and anxious population. In his recent book, The End of Overeating: Taking Control of the Insatiable American Appetite, physician and former Food and Drug Administration Commissioner David Kessler focuses on the alleged addictive qualities of highly palatable ( sugary and/or fatty) foods. He claims that the only way to deal with these foods is to banish them. He suggests that

 “the enduring ability to eat differently depends on coming to view these foods as enemies, not friends.” The solution according to Kessler is to retrain the brain to think “I’ll hate myself if I eat that.”

We know only too well that far from moving us towards that End Of Overeating,  this approach is one that has led and will continue to lead to exactly the opposite – more confusion, more anxiety, more shame and more overeating. My friend and colleague Dr. Karin Kratina has been treating disordered eating for many years. She shared the following with me about her experiences with the concept of food as addiction. She asks her clients “if I gave you a bag of sugar and a spoon, how much would you eat?” She says they look at her like she is crazy! I’m guessing this would be an unlikely response from someone offered the other white powder.

We in the health professions (and lawyers as well, evidently) seem to be constantly in need of pathologizing some food or another.  I plan to write more on this soon,

28 Responses to “the HAES files: the other white powder – sugar and food addiction”

  1. After years of trying to avoid sugar and feeling better when I do, I have back slid into
    Bulimia. It would be nice if I could be so disciplined because in my case, having Lyme disease and resulting candida, I feel much better when I adhere to a no sugar diet. But it is very difficult and exaserbates the food obsessive nature of an eating disorder to have to be so vigilant around my food.

    For me, intuitive eating is my best bet. Making food choices this way is the healthiest way for me to go. It is hard to break the good food bad food habit, but I feel like I must if I am to recover from an eating disorder.

    People who diet all the time and yo-yo up and down in weight have what is called Disordered Eating. They may not have full blown eating disorders but they are clearly in an unhealthy pattern that could be remedied by intuitive eating as well.

  2. Great article – sharing now!

    I also wrote about this issue recently (http://www.eatwhatyoulovelovewhatyoueat.com/2012/02/am-i-addicted-to-food.html) – here’s an excerpt:

    “My observation is that part of what appears to be addiction is the belief that a food is “bad” or we are “bad” for wanting or eating it. We experience guilt or shame, perhaps even resorting to secret eating. The thought, “I shouldn’t be doing this! I’m out of control!” is followed by another thought, “Might as well eat it all, for tomorrow I’m going back on my diet!”

    The other main driver for this addictive-feeling spiral is the desire to eat food we like in order to avoid or suppress something we don’t like. When we eat for reasons other than hunger, the satisfaction (or numbness) is short-lived. The underlying trigger is still present, and thus the cycle continues.

    Without a doubt, the eat repent repeat cycle must be resolved – but calling it addiction takes away the power to change and prevents us from learning to use food in an enjoyable, moderate way. I know without a doubt that mindful eating CAN help people relearn to eat what they love and love what they eat – and deal with their other triggers in more effective ways. The problem is that most people who suffer don’t even realize that there is another option besides abstinence!”

  3. Thank you so much, Jon, for saying the things I haven’t had the Sanity Watchers Points lately to say!

  4. Dear Jon, thank you so much for this counterpoint to Gary Taubes’ and David Kessler’s misguided and hysterical reactions to fat.

    From a purely neurochemical standpoint, I do believe that REFINED sugar is addictive. The distinction between complex carbohydrates that occur naturally in healthy foods like beans, for example, stand in huge contrast to refined sucrose, or table sugar. This is a distinction you didn’t make in your post.

    The problem with the hysteria surrounding the topic of sugar addiction is that it is just another outgrowth of the destructive non-native “weed” that chokes out all indigenous opinions. Again, as always, it is a matter of social prejudice and semantics. Another problem is that scientists and “experts” carry huge clout in a fat-hating society.

    Would you be willing to grant me permission to “reblog” this post on my WordPress blog “Fat Science?” Thank you!

  5. Can you please address Dr. Lustig’s claims that he makes in the Sugar: The Bitter Truth video (http://www.youtube.com/watch?v=dBnniua6-oM)? Is the science wrong?

  6. Fabulous post! By the way, much research on the impact of simple sugars and carbs on seratonin, mood and PMS by the Wurtman couple out of MIT. As I recall it, their research only added support that including simple sugars helped our mood, decreased cravings, etc. More recent behavioral research endorses includion of sweets and avoidance of deprivation for long term weight management (and in my mind, mental health!)

  7. I could be mistaken, but my understanding is that Taubes did not lose a tremendous amount of weight on Atkins, maybe 25 pounds or so, and that in order to maintain the loss, he has to eat NO carbs of any kind, fruit and vegetables included. Sacrificing that much for just over 10% of my body weight? I’ll pass.

  8. Oh, and sugar? It’s a common binge food for recovering alcoholics, which is why so many of them wind up in OA. (I lived with one, and he could put away a whole package of Oreos so fast I thought I had forgotten to buy them.) And certainly there are people with bulimia and BED who would eat sugar right out of the bag like that. But that’s not most of us.

  9. “if I gave you a bag of sugar and a spoon, how much would you eat?” She says they look at her like she is crazy!

    That’s a ridiculous question though. We have been conditioned to not look as sugar in itself as “food” just like we wouldnt eat straight wheat flour from the bag or drink oils we use to cook with, rather it’s something we add to food. And, this is very effective conditioning, hence the crazy looks from people being asked this question. However, in people who don’t have this conditioning yet they will eat pure sugar…as much as they can get. For example: Kids, all little kids if given the chance will eat straight sugar in crazy amounts. I once found my daughter had gotten into the sugar bowl and had repeatedly dipped her wet little hand in, licking off sugar and going back for more, over and over. I had to take it away becasue she wouldn’t stop. Most parents will have similair stories.
    Now, if this person asked a real question about something that is basically pure sugar (example: If I gave you soda and a straw?; If I gave you a bag of candy (gummy worms,swedish fish, good and plentys, jelly beans, etc….. how much would you consume?) I’m sure the answer would be closer to “I would eat/drink until I feel sick”.
    This is also proof that conditioning to not see an edible/caloric item as food we should eat DOES work. The same can be done with all foods that we wish to eliminate from our diet, It takes a lot of conditioning to no longer see that item as food we would eat but it can and does work.

    • I would assume that the counselor quoted is treating mainly adults and teenagers, not very young kids. Little kids are attracted to sugar primarily because it’s a source of energy and they need a lot of it.

  10. I agree in principle, but insulin crashes are real. When I eat sugary things, I want more sugary things. When I eliminate it for a while, chocolate and ice cream can sit neglected for weeks, I’m happy with more nutritious foods, don’t get uncomfortably hungry and have more even energy levels.

    • There are definitely people whose bodies have more trouble than average processing the stuff. And like anything else, it’s possible to overdo it. But that’s a lot different from saying “nobody should eat it ever,” which is what the authors discussed in the OP are saying.

      • Insulin crashes are indeed real, sugar sensitivity is real. The point here is that using language like “food addiction” is not only inaccurate, it is harmful and alarmist propaganda to incite fear/hatred towards food as well as increased fear/hatred of fatness, and it keeps the weight cycling industry and the junk science authors prosperous while causing severe psychological, emotional, and bodily harm.

  11. I agree that some of the dismissive comments regarding sugar ‘addiction’ are over-simplistic.

    Clearly not everybody who craves sugary (or fatty) foods is addicted. These cravings are likely fuelled by a combination of deprivation, hormonal and nutrient imbalances due to poor diet, and emotional dysregulation. However, that is not to say that sugar addiction is impossible. Sugar does have an effect on the mesolimbic dopamine system, along with all those other pleasant experiences listed in the blog. Although not everybody who eats sugar will become addicted, not everyone who drinks alcohol is, or will become, an alcoholic. But in people with genetic predisposition to addictions and addictive behaviours, exposure to a rewarding substance coupled with other experiential triggers, may well lead to hyper-responsiveness to a material or activity leading to dependence. It is well known that genetic factors are a major component of addiction, and multiple co-existing addictions are common. Some researchers in the field are moving towards a model of ‘addiction syndrome’ rather than considering individual substance or behavioural addictions as distinct pathologies.

    The ‘bag of sugar’ example is not realistic. As noted by other comment posters, most people would not eat pure sugar, although there are some who might. Likewise, most smokers would not ingest a bottle of pure nicotine, or alcoholics drink a keg of pure ethanol. However, when deprived of these substances, as is done with experimental animals, it is possible that their daily function may become impaired and their levels of distress increased to a degree where they may go to extremes to obtain their ‘fix’. While it might be interesting to study this further in humans, I fear that ethics approval may be difficult to obtain!

    • Right, because if you drink a keg of pure ethanol or a bottle of pure nicotine, you die. (And believe me, if it were possible to do that and not die, there are people who would do it.) Nobody will die from eating a few spoonfuls of sugar right out of the bag, or even the entire bag, unless they don’t have enough insulin in them to process it. Eating a whole bag of sugar at a sitting might make you barf, but that’s not the same thing.

  12. No link to the Taubes article/talk you refer to at the beginning of the post?

  13. Thank you for your post. It’s been challenging for me to see whether food addiction and HAES/intuitive eating relate or connect at all. I tried an OA approach to my recovery, & I just couldn’t get beyond that addiction approach to it. I believe I do have choices as to whether I use food to numb myself or not.

    I posted on my blog a similar and not so-similar post about how when we label food with such righteous/unrighteous labels, things can go a muck.

    I’m sad that I used to be so scared of sugar, or “white death”, as I labeled it. For even as infants, our first food outside of the womb was sugar/milk. How would babies eat, if their mother’s milk had not had sugar? I no longer fear food the way I used to. I know that food is not love. Love is not food. My relationship with food is evolving. It’s exciting. It’s freedom.

    http://eatingasapathtoyoga.wordpress.com/2012/03/07/white-death

  14. I am still working on intuitive eating, but having spent five years in a very food phobic environment (a great deal of good food/bad food polarizing here), I find that allowing myself to eat whatever feels very naughty, and incredibly freeing.

    What I have observed in myself is that I am eating things that taste really good to me, are generally not all that healthy, and often do actually make me feel worse. In the beginning (this has only been happening for a few months), I would beat myself up. Then I decided to not worry about it and see how the experiment went. In the past, few weeks, I have found that I still enjoy the tasty things that make me feel bad, but I also am eating less of them and starting to WANT to eat things that make me feel better. This isn’t something I’m forcing myself to do, there is just a shift in what my body and brain are wanting/needing.

    Giving myself the leeway has been such a relief and I know that my experience is going to inform how I talk to my patients about their health and food choices. It is showing me that ‘non-compliance’ may just be what a person needs to experience to find their own way in the craziness our society has created around food.

    I am incredibly interested to see what happens when I graduate in June and am no longer in this environment. :)

    • What a wonderful gift you are giving yourself and your patients, DeAun, through your own exploration of “non-compliance” and letting go of restrictive eating. And how ironic that the medical education environment might not, it appears from what you wrote, be the most supportive for your health and well-being. My own exploration is posted below yours. I would be interested to read more about your exploration over time, on the listserves, and again, wonderful what you are doing!

  15. Thank you. I do wonder about the need to label everything a “sickness” or “disease” and then subsequently vilify people who are deemed to be suffering from it. Look forward to your further thoughts on this.

  16. Thank you, Jon, for your well explained article, a voice of reason in a sea of needless and unhealthy carb-phobia.

    I used to believe I was addicted to chocolate. I had been unable to go a day without it for ~20 years.

    Then I took Jean Antonello’s advice in her book, “Naturally Thin” (pls. note, I don’t agree with her advocacy of thinness or claims everyone will get thin by eating as she describes!), but her insights on sugar cravings were brilliant, and I could probably say, life-changing.

    I took her advice, one day, to fill up on normal (non-dieting) meal foods all day long, at the first sign of hunger, and eat until my body stopped me (not my head, but allowing my body to force me to put the food down., each time I was ate, due to fullness.) As the chocolate cravings increased at night, I had to pack away huge amounts of food: sandwiches, eggs, unsweetened cereal, pasta, fruit, juice, meat, etc. But amazingly, earth-shatteringly, I made it through the night. The next day, I did the same, this time putting away lots of food, but less than the previous day, because I had filled up so well the day before. I got through a week that way (it took a lot of concentration, preparation, and courage to eat that way for this chronic meal-skipping, food-phobic ex-dieter.) It taught me how much food I had been depriving myself of, thanks to years of various teachings from various restrictive diets. Because I am extremely plus-size, no doctor had ever told me to be sure to eat enough. The message was always to cut back.

    So the cause of my “sugar addiction,” this experiment and advice from Jean’s book made me realize, was intermittent starving! It showed me just how much more I really needed to eat daily (which gradually decreased, but not by a lot! as I filled up daily.) I haven’t been able to stick to that sugar-free lifestyle, and am not sure I want to (nor does Antonello tell people they can never have sugar: she suggests around once or twice a month, more or less, to help a person focus on fueling themselves with sufficient meal foods (and not cover up the need for *calories from meal foods* by getting in those calories via sugar.) Eating sugar can definitely begin to replace necessary meal foods in the diet, including fruit, sandwiches, etc.

    Lesson I learned, and that Jean teaches: those of us with overwhelming sugar cravings are intermittently undereating (typically dieting at least part of the day), even if we are plus-sized. Doctors are doing harm by advocating dieting/undereating for weight loss, by inadvertently causing massive daily cravings for table sugar! Instead of filling up on meal foods steadily throughout the day, and getting all the macro and micro nutrients in addition to calories provided by those foods, dieters end up famished, sooner or later, and feel out-of-control cravings for table sugar, and not in moderation. Anorexics often have raging sweet tooths for this reason.

    It would make so much sense and be far healthier if doctors and public health officials would go back to advocating eating at least 3 regularly scheduled meals, in between snacks as needed, and eating from the full variety of normal (non-dieting) meal foods in the quantities and proportions that satisfy us, until our bodies stop us: trusting that they will. This would prevent all kinds of chaotic, less healthy, out of balance eating, and the weight gain that comes from the body having to do everything it can to find ways to pack on extra calories and body fat as a survival mechanism under conditions of intermittent undereating and an unreliable supply of food that we’re giving it.

    There is no need or benefit to the “intuitive eating” practice of waiting to eat until hungry, and using a hunger scale: in fact, they can severely overcomplicate matters, and worsen disordered eating, especially for chronic dieters/intermittent undereaters, and those afraid of eating for fear of weight gain. Just advocate eating at consistent meal and snack times, til the body stops the person from eating more. Eating one’s choice of proteins, starches, fruits, vegs, and (mostly heart-healthy) fats. Over several days of eating that way, the body will start to adjust quantites needed per meal (for those who can accomplish this demanding-enough feat of shifting to consistently eating regularly scheduled meals or snacks (with a little time flexibility depending on the day’s schedule, but not habitual delaying and no! skipping.) For people who have difficuty with delaying or skipping, they may need the help of an ED counselor and dietitian, as I have, to overcome the harmfulness of dieting and “intuitive eating” advice.

    Thanks again, Jon.

    • Hmm… I thought about whether this might apply to me, but even when I was a naturally-thin child (before puberty hit) I had a sweet tooth. Sweets were never freely available to me, but they weren’t exactly a “forbidden” food either. I think in my case I just really like sweets. (Though, oddly enough, I’m not much of a soda drinker.) Sweets are the one thing that I’m still “not sure about”–not sure if I’m taking a fully HAES approach to them (am I TRULY giving myself permission?), not sure if I should treat them the same as other foods. (With children, Ellyn Satter does not treat them quite the same as other foods… but I’m not a child and don’t need to worry about learning to like new foods… but maybe they are still doing some crowding out of other foods?) I certainly wouldn’t use the word “addicted”, but I do seem to react differently to sweets than other foods, for example, still wanting to eat them at a point on the hunger-fullness spectrum where I wouldn’t keep eating more boring food. (I also find some of my favorite fruits fall into that category [strawberries and Concord grapes when they're in season locally], and some savory foods that I really like.)

      • Hi Puritan,

        Obviously I can’t comment on how sweets work for you, but I’d like to share my experience. I had a rabid sweet tooth. I would eat chocolates till I felt sick and continue eating them. Even once I knew I felt ill, and put the box/bar away, I’d go back within minutes to get more. Same with gummy sweets (loooove gummy cola bottles).

        When I came across HAES and then books like ‘When women stop hating their bodies’ and ‘Overcoming overeating’ by Hirschmann and Munter, I decided to give legalising food a go. It was absolutely terrifying – I didn’t believe that if I allowed myself to have ANY kind of food I wanted that I wouldn’t become Mr Creosote and eat until I exploded.

        I stopped dieting and eating what I felt like when I was hungry. And you know what, it was like a lightswitch flicking on. Or off. I stopped wanting that stuff more or less immediately. It really was the forbidden nature of it. I still eat them occasionally, but never to excess. I just don’t want more than a taste. A few weeks ago I was lying in bed and just fancied a bit of chocolate. My husband brought me a couple of squares of dark chocolate. I ate one and forgot about it. I recently noticed the other square was still sitting there on my bedside table, probably growing something revolting – it went straight in the bin. The rest of the bar is still in the cupboard.

        I still haven’t managed to throw away my bathroom scales (partly because they were top of the range and very expensive), but I rarely weight myself now, more out of curiosity and disbelief. Because my weight hasn’t changed by more than a pound either way in the nine months or so since I made this change.

        Believe in yourself and your body. It knows what to do.

        Ang :)

  17. *to clarify, I meant that necessary meal foods include fruit, and foods such as sandwiches. For all of my references to sugar here, I meant *table sugar.*

    By the way, the latest diabetes advice from the Mayo Clinic, in their recent book for diabetics, was for diabetics to have a MINIMUM of 5 servings of fruit per day, and a MINIMUM of 5 servings of vegetables per day. They said it is fine for diabetics to eat unlimited quantities of fruits and vegetables, as long as those aren’t replacing a regular, balanced meal.

    Hooray! I think many diabetics have needlessly ended up craving table sugar because the old typical diabetic guidelines of 2 servings/day of fruit probably made plenty of diabetics crave sugar. Unrestricted fruit is a great step forward (along with ensuring plenty of starches, and enough protein, and heart-healthy fats.)

  18. Like Alice, most of the “food addiction” I have seen in my office has been the result of undereating and/or what I call “I can’t, I won’t, I shouldn’t, I will today but won’t tomorrow” thinking. Once those are healed, “food addiction” is also healed.

    Unfortunately, there was so much countering of the suggestion of eating pure sugar that the concept was missed in the replies above. I was surprised at most of them as they have never happened, and I have used this concept since the late 80s.

    When someone believes they are addicted to sugar, I work with them from this perspective for quite a while. Eventually I ask, “If I gave you a bag of sugar, how much would you eat?” In all my years. only one client has found this at all appealing. Then I ask, “If you mix it with butter, how much would you eat?”

    Well, as a person who was a horrendous binge eater and believed I was addicted to many foods, I can tell you, pure sugar not so exciting, mix it with butter, and I would have (and did) eat a lot!

    Then I ask, “Now, if you add chocolate to it, how much would you eat?” Lot’s more! Then add ingredients to make a cake? Then make the cake?

    So, it is not the sugar per se that we are after, but the taste. Of something forbidden. That is triggering.

    An alcoholic might prefer vodka, but if he can’t get it, he will drink it anywhere. Even in cough syrup or vanilla extract. No so with someone “addicted to sugar.” I have NEVER met someone who would willingly get “high” on only pure sugar.

    For me, I conclude, again, it is not the sugar. My next question was, then what is it?

    Well, I’ve been in recovery for over 25 years, and have helped many, many clients become completely neutral regarding previously forbidden foods following 3 principles: 1) Eat enough (as Alice discussed), 2) allow free access to food, 3) remove ALL judgment.

    While I am sure there will be many who will want to point out problems, I cannot argue with success. I have seen it too many times. And am forever grateful, HUGELY grateful, to be free of food issues, and to have NO food call to me or hijack me. Unless I’m hungry, in which case I eat what I want, and walk away satisfied. There was a time I just knew that was impossible.

    Karin Kratina, PHD, RD, LDN
    http://www.nourishingconnections.com
    http://www.nutritiontherapy.org

  19. That should read I stopped dieting and STARTED eating what I wanted….!

Trackbacks

Follow

Get every new post delivered to your Inbox.

Join 1,017 other followers

%d bloggers like this: