If you do work that includes guiding people around food, nutrition and health you have most likely heard someone say, “I am addicted to sugar, once I start it seems impossible to stop”. If this is how you feel, know that you are NOT alone. I hear this statement over and over in my clinical practice.

In the past, I too felt like I was a sugar addict. My desire for anything sweet seemed to stretch far beyond just having “a sweet tooth”. There was a compulsion to head straight for the cupboard in our house that had all the biscuits, or for the freezer for the ice cream. If I bought a bag of pick n’ mix sweets, I seemed to have a total inability to stop and put the remainders away, even if my body was telling me that it clearly had had enough. I simply had to keep eating until the bag was empty… It felt like all “the evidence” (read lived experience) pointed to an addiction to sugar.

 

So let’s look at it, is sugar addiction real?

 

When it comes to the evidence for sugar “addiction” you can, if you look hard enough usually find evidence that backs up this point of view. But what happens if we dig a little deeper?

Some schools of thought support the hypothesis that it is indeed a real condition and there has been a push to get Food Addiction, of which sugar addiction would be a subgroup, to be included in the DSM. Organisations like Overeaters Anonymous, OA, which is based on the same premise as Alcoholics Anonymous, believe that any “white” foods such as white flour, white rice and white sugar is an addictive substance and thus the only way to overcome this addiction is total abstinence. This may very well work for some, but it may also be an approach that keeps people stuck in a loop of self-blame and self-shame, reinforcing the belief that they are broken because they fail to stay off the white stuff, again and again. (Hint – you are not broken; your body is simply doing its best to try and keep you alive!)

The sugar addiction model is based on a comparison between refined sugar and drugs of abuse such as cocaine and heroin. This evidence comes from studies on rats where the rats where fed either sugar solutions or cocaine and it seemed that the rats much preferred sugar over cocaine. These studies have a few problems when it comes to see them as conclusive evidence for sugar addiction being a real thing.

 

In the very comprehensive review study Sugar Addiction: the state of the science (Westwater 2016) the researchers looked at and compared both animal studies and the limited number of human studies available to compare the substance of sugar to the drug of heroin and cocaine.  In doing so they found a few variables in the rat studies that questions the validity of sugar addiction as a true substance addiction. They also question the validity of Food Addiction (FA).

One of these where that the rats only expressed binge like behaviours when they were in an intermittent feeding schedule with either 16h or 24h fasting. They also binged / consumed the highest amount of sugar in the immediate time of reinstated access to the sucrose solution. This is different to how they would consume the drugs where they tend to consume more and more to get the same initial hit. What was really interesting is that when the rats had ad libtum access to food and sugar solutions they did not express the same binge-like behaviours as when they did not.

 

Humans aren’t rats of course and Westwater et.al also looked at the more limited research on humans when it comes to Food Addiction and sugar addiction. In this case most of the current research is done by using the Yale Food Addiction Scale (YFAS) and the more recent YFAS 2.0. This is a scale where several things are measured such as persistent eating despite negative consequences, unsuccessful attempts to cut down and impairment of functioning because of overeating. It also provides 21 examples of foods from five different categories. These are sweets, starches, fatty foods, salty snacks and sugary drinks. Depending on the scoring an individual can be “diagnosed” with “food addiction”.

The biggest question when it comes to YFAS is: Is it measuring what it thinks it is? Food Addiction shares many overlaps with Binge Eating Disorder (BED). Binge Eating Disorder is already included in the DSM-V with very specific criteria for diagnosis. It was added in 2013, yet many people never receive a diagnosis or isn’t considered sick enough to fit all the criteria for a diagnosis but could still do with support to recover, but that is an article for another day!

The criteria for BED is:

  • Recurrent and persistent episodes of binge eating
  • Binge eating episodes are associated with three (or more) of the following:
  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of being embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty after overeating.
  • Marked distress regarding binge eating
  • Absence of regular compensatory behaviours (such as purging).

 

What differs from BED and Food Addiction, is that BED is an eating disorder with a multifactorial aetiology and Food Addiction is seen as the cause of food / sugar being an addictive substance that drives the addictive behaviour and compulsion to eat beyond what feels physically comfortable to the individual.

 

The science doesn’t seem to conclude that sugar addiction as a substance type addiction is real, however for the individual struggling with binge eating the feeling of addiction is very real. I very much believe in validating our clients that what they feel they are experiencing is a real valid lived experience. However, it is not because sugar itself is an addictive substance. What we need to remember is that restriction drives binge eating. This means that total abstinence is not the answer. Instead, we need to together with our client explore any and all potential underlying triggers and causes to the binge eating behaviours.

 

Questions you may want to explore are:

 

  • Are you currently actively restricting food intake or food groups?
  • Are you currently dieting or have in a recent past?
  • Do you have a history of food insecurity?
  • Are you actually eating enough, throughout the day?

Bingeing might also be functioning as an emotional coping mechanism and/or as a trauma response, which does still not make your bingeing on sugary foods a substance addiction.

 

What’s next?

 

Things that I work with people on to support their relationship with food is:

  • Establish a regular eating pattern
  • Work on blood sugar regulation through the pairing of carbohydrates with fats and proteins
  • Work on letting go of food rules and invite them to give themselves permission to eat ALL foods.

This might seem like really basic suggestions but in my work with clients for over almost a decade, many of which have struggles with feelings of addiction around food, I have seen this simple nutrition advice to be incredibly effective in calming down binge eating behaviours, so don’t underestimate how powerful regular eating and simply eating enough food for the body to feel adequately nourished consistently can be.

 

Conclusion, the topic of Food Addiction is still controversial, but the current science does not support evidence of such. However, the lived experience of feeling addicted to food is very real and may form part of a binge eating disorder. There is almost always an element of some kind of restrictive eating behaviours, and often but not always, food is being used as an emotional coping tool / trauma response. Both are of importance to address for healing and recovery to occur.

 

 

References

Margaret L. Westwater, P. C. F. H. Z., 2016. Sugar Addiction: the state of the science. European Journal of Nutrition, Issue 55.


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