MILAN — Stories celebrating sugar-free lifestyles dominate social media fitness feeds, wellness websites and self-development podcasts. Reporting to the general public that sugar is addictive is about as original a headline as one declaring the sky is blue. Sugar, the educated American will tell you, lights up the same areas of the brain as cocaine, and, in fact, rats prefer the sweet white granules over the powdered white drug.
They’re not wrong. But some health professionals say such statements dangerously misrepresent a much more complex picture – to put it nicely. “Stop the bullshit,” says Dr. Jennifer Gaudiani, an internist and eating disorders specialist who founded and directs the Gaudiani Clinic in Denver. Here’s their view, and why it matters.
What’s the rub?
To be sure, it’s generally accepted in the medical community, including by those interviewed for this story, that sugar has properties that the term “addictive” describes well in a non-clinical sense. Experts also roundly acknowledge that many people find the concept of sugar addiction – or addiction to any super tasty, not-so-healthy food for that matter – comforting, even empowering, as some self-described food addicts assert.
If giving up a nutritionally void category of food for life helps them live full lives not spent refereeing a mental ping-pong game between surrender and restraint, most compassionate health professionals aren’t going to tell them they’re doing it “wrong.”
“If (the addiction model) works for them and they’re able to do what they want to do in life, then they know better than I,” says Lisa Du Breuil, a clinical social worker affiliated with the Department of Psychiatry at Massachusetts General Hospital in Boston who works with people who have both substance use and eating disorders.
But, like long-term weight-loss success stories, Du Breuil adds, happy lifelong sugar shunners are the minority. “If 100 million Americans are on a diet and they work for 5 percent, that’s 5 million saying diets work. I’m not going to argue with them,” Du Breuil says. “It doesn’t work for the 95 million.”
What’s more, Du Breuil and colleagues wonder where the headlines are about the research finding “little support for sugar addiction in humans,” as one comprehensive 2016 article in the European Journal of Nutrition concluded. Or the 2014 review in Neuroscience & Biobehavioral Reviews finding a lack of support for the notion that the brain responds to food in the same way it does to, say, opioids. The research shows, among other key differences, that while similar neuropathways are involved in both drug and sugar consumption, the brain changes that lead to needing more and more cocaine to get the same high aren’t seen with sugar.
These experts also take major issue with the rodent studies that are frequently taken out of context to support the concept of sugar addiction. Some studies do indeed show that rats go to town on sugar, but they also show that rats only do so when they’re given limited access to it and stressed. (Can you relate?) “When rats have access to sugar water as well as other foods, they do not binge on it,” Gaudiani says. “It’s diet culture that sets humans up for the belief that they have no power over a particular food type.”
Framing any food as addictive also pathologizes human nature, some experts say. “There’s a part of the brain that’s job is to keep us alive, so it rewards us for doing things that sustain life, and those things include eating, having sex and moving,” as well as connecting with other humans and nurturing children, Du Breuil says. So if you want to call sugar an addiction, she and comrades point out, you should also be prepared to call the desire to hang out with friends and squeeze your toddler addictions too. The brain’s reward center “lights up” for them all. “We pathologize pleasure,” Gaudiani says.
When it comes to highly caloric foods like sugar and fat, the brain really rewards us, making Hostess cupcakes and Fritos call to us much louder than carrot sticks and rice cakes. “People say, ‘I just can’t control myself around chips,’ but that’s normal! Who can eat just one Dorito?” says Marci Evans, a registered dietitian in Cambridge, Massachusetts, who works with people with disordered eating and body image issues. Here too, blame evolution, not an addiction. “For most of human history, the big risk to humans was starving to death,” Du Breuil says. “If you’re going to risk your life (for food), better to risk it for something that has a lot of bang for the buck.”
The reason some people feel especially “addicted” to sugar and some other foods, these experts say, is because their brains believe food is scarce – i.e., they’re dieting. “Our cave person brain only understands when its human mammal isn’t getting enough nutrition,” Gaudiani says. “It doesn’t understand that it’s 2018 and the person is on a cleanse or paleo or Whole30.” Just look at the classic Minnesota Starvation Experiment, in which healthy men were restricted to just under 1,600 calories a day for six months. The result? Food obsessions, dreams and fantasies and “extreme overeating” when their semi-starvation period ended, the American Psychological Association reports. In modern day, they might be called food addicts.
But perhaps most troubling to experts like Du Breuil is that the “food addict” label can appeal to people who actually – and typically, unknowingly – have eating disorders, and lead them to unproven treatments that are the exact opposite of what’s known to be most effective. In fact, up to 30 percent of people who meet the Yale Food Addiction Scale’s criteria for food addiction also meet the criteria for binge eating disorder, a 2016 paper in Clinical Psychology Review reports.
“Having an eating disorder, learning how to eat intuitively, is messy, it’s gray, it looks different for different people, it means having to be connected with your inner workings and it’s rarely linear, it’s rarely black and white,” Du Breuil says. “Identifying it as a substance use problem and having rules to follow feels better, especially at the beginning.”
A Different Type of “Treatment”
While the food addiction model encourages people to remove sugar (or their vice of choice) from their diets entirely, eating disorder treatments involve coaching people to consistently eat enough of all foods. Eventually, the brain realizes there’s no famine, and trusts that there never will be. Only then can it stop making the chocolate bars sing to you from across the room and your hand dive back into the bag of chips until your fingers reemerge with only grease. “With permission and abundance, what people find is that there is really such a thing as enough cheese curls and chocolate,” Gaudiani says.
While eating any and all foods (yes, even some chips and cake) doesn’t sound as healthy as rejecting sugar for life, Evans and others point out that optimal well-being includes being able to eat a cookie at a child’s birthday party or sharing a muffin with a good friend over coffee. Humans aren’t robots, they say, and we’re uniquely designed to thrive on an incredible variety of foods and to eat not only for nutrition, but also for social, emotional and cultural reasons. There’s even some research suggesting that enjoying eating supports nutrient absorption and digestion; stressing over your food – no matter how objectively healthy – can promote the opposite.
