Is sugar addiction real?
This is part 1 of a 2-part discussion on the topic of sugar addiction. Stay tuned for part 2.
When you think of sugar, do you think about the satisfaction from eating a sweet treat or do you think of it as something you need to avoid at all costs? Carbohydrates, particularly sugar are probably one of the most demonized foods in diet culture. Among the internet craze, you won’t ever be short of a post or video highlighting another #lowcarbrecipeidea, #avoidthesugarcrash or #howtocurbsugarcravings. There is so much content online on sugar addiction being an epidemic. So let’s find out if carbohydrates and sugar are really the bad guys they’re made to be, whether sugar addiction is really a thing and how it connects to the realm of eating disorders.
Carbohydrates tend to get a bad rap YET they are important
Diet culture has somehow made carbohydrates look like the bad guy. But that is far from the truth and the role of carbohydrates is often sadly misunderstood. Carbohydrates are essential for our body’s energy and metabolic functions and are one of the 3 main macronutrients. Did you know that carbohydrates, which are made up of sugars and starches, are our body’s MOST preferred energy source? Carbohydrates are the easiest macronutrients to break down to make energy readily available to our bodies in the form of glucose.
When our bodies do not get enough carbohydrates from the diet, it will be forced to break down protein and fats instead to use as energy. While the body is pretty smart in using alternative sources for energy, it is not designed to use these sources long term. There are undesirable and dangerous consequences to breaking down muscle mass for protein and the buildup of ketones from breaking down fat stores in the long run.
So yes, carbohydrate or any sugar-containing foods, really are ESSENTIAL in our diet.
What is considered an ‘addiction’? Criteria for an addiction
So we’re on the same page about carbohydrates aka sugar being essential, but are they addictive? While most dietitians like us are skeptical of food addiction claims, it is a very big topic in diet culture whether we like it or not. When talking about sugar addiction, diet culture generally refers to sugary foods and not just your typical rice, bread or pasta.
What qualifies or defines an addiction? Well, an addiction can be seen as a state of dependency of a substance or behavior even if it causes harmful consequences due to the brain’s reward circuit. According to the American Society of Addiction Medicine (ASAM), there is a set of criteria, using the acronym ABCDE, to diagnose an addiction (1).
not being able to Avoid consistently
impacts/impair one’s Behavioural control
Having a Craving for drugs or rewarding experiences
Diminished recognition of significant problems with one’s behaviours and interpersonal relationships
dysfunctional Emotional response
Looking at the above criteria, folks who believe they have a hard time controlling sugar consumption may see themselves with all those symptoms. However, there is nuance in our relationship with sugar that might be confused with a sense of addiction. Let’s look at the evidence.
‘Sugar addiction’ vs substance use addiction explained
Sugar as an addictive substance is highly debated in research. The argument that supports ‘sugar addiction’ seems to be rooted in the fact that sugar triggers our brain’s reward center the same way other addictive substances (ie.drugs) do, leading to compulsive and out of control eating behaviour (2,3). Dopamine is a chemical in the brain that is responsible for feelings of pleasure and reward (many call it the ‘feel good’ hormone). Evidence has shown that sugar releases dopamine and therefore cravings for sugar are a way to trigger more dopamine release (3). These same pathways in the brain are also triggered in frequent substance-use (4).
The issue with this argument is addictive substances like drugs can trigger the dopamine reward pathway, but so do many other things. In fact, this dopamine response is common in many everyday behaviours that are not labelled as ‘addicting’. For example, dopamine is released when listening to good music, hugging a pet, having a laugh, seeing a loved one or engaging in hobbies (5). We do not label someone laughing at a joke for being at risk of a laughing addiction, do we? More accurately, these should be described as pleasurable experiences in the same way that sugar-containing foods can provide.
Actual addictive substances like alcohol or nicotine also lead a person to use more and more of that substance each time to experience their desired feelings (6). This inevitably makes it more difficult to reduce use or avoid it altogether even if the person knows there are harmful consequences. Eating sugar does not have the same exact compounding effect on neural pathways (6) and most importantly, cravings for sugar is also our body’s natural response to starvation.
What makes sugar cravings different from a true addiction, is that we require sugar to survive, but we do not need drugs or alcohol to live. Therefore as a biological survival mechanism, the body will create intense sugar cravings if it experiences physical or mental deprivation of food. And this mechanism for the body creates urgency to get its needs met which can feel very similar to the urges in addiction. Additionally, in substance-use studies, it is always clear that the chemical makeup such as nicotine itself is what leads to addictive behaviours no matter what form it comes in- cigarettes, tobacco, pouches, etc. Yet, in the case of sugar, people may report intense cravings for cakes, donuts, chocolates rather than other sugar-containing foods like quinoa or beans. In starvation, the body is looking for quick and digestible sources of energy (11). It makes sense that sugary snacks are the perfect fit for what the body is looking for instead of heavily fibre-bound foods.
The problem with labelling sugar as addictive
When we look at treatment for substance addiction, the plan always involves avoiding that substance in order to recover- in other words, practicing abstinence. And because we do not require the substance to survive, abstinence works. However, we cannot abstain from food! The body requires glucose to survive, we cannot avoid sugar all together. Labelling sugar as addictive can become a form of food policing that causes people to restrict sugar without tending to what the body actually needs. And as mentioned before, when sugar (energy) intake restriction occurs, the body will fight through instinct to make sure we get our needs met, not for just pleasure and coping, but to live. This exacerbates the compulsion with food in the long run. And any recommendations that promote more food restrictions often lead to a poor relationship with food and eating all together. It becomes a constant battle to fight food because we’re not dealing with a chemical addiction, we are dealing with overcoming survival instincts.
An evidence based approach to intense food cravings is actually called food habituation where we develop trust with ourselves around the food through repeated exposure to reduce any deprivation that may have been occurring (7). This is of course done only after we've ensured the person is eating regularly and adequately. Can you imagine using a habituation strategy with drugs or alcohol, recovery would be impossible. This is why comparing sugar to drugs or alcohol does not make sense, and treatment that calls for abstaining from food will never work long-term.
Stay tuned to Part 2 of this discussion to find out more how “sugar addiction” is relevant in eating disorders and on what to do if you feel like you have a sugar addiction.
Disclaimer: the information provided is not intended as medical advice or to diagnose or treat a medical disease. It is strictly for informational purposes. Consult with your medical provider such as a dietitian before implementing any dietary changes, the information provided does not replace medical advice provided by your healthcare provider.
Written by Sharon Sun, RD
Reviewed by Abby Hsiao, RD
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References
"Policy Public Statement: Definition of Addiction." American Society of Addiction Medicine, Aug. 2011, www.asam.org/docs/default-source/public-policy-statements/1definition_of_addiction_long_4-11.pdf.
Smith, L., & Jones, T. (2022). Sugar and the Brain: Understanding the Impact of Sugar on Mental Health. Journal of Nutritional Neuroscience, 15(4), 297-308.
Lowe, M. R., & Gizewski, E. R. (2021). Dopamine and sugar: A review of the role of dopamine in the reinforcing effects of sugar consumption. Behavioral Neuroscience, 135(5), 537-547.
Avena et al. , 2008 Like have an addiction to drug or alcohol
Krach, S., Paulus, F. M., Bodden, M., & Kircher, T. (2010). The rewarding nature of social interactions. Frontiers in behavioral neuroscience, 4, 1141.
Westwater ML, Fletcher PC, Ziauddeen H. Sugar addiction: The state of the science. Eur J Nutr. 2016;55(2):55-69. https://doi.org/10.1007/s00394-016-1229-6. doi: 10.1007/s00394-016-1229-6.
Essayli, J. H., Forrest, L. N., Zickgraf, H. F., Stefano, E. C., Keller, K. L., & Lane‐Loney, S. E. (2023). The impact of between‐session habituation, within‐session habituation, and weight gain on response to food exposure for adolescents with eating disorders. International Journal of Eating Disorders, 56(3), 637-645.
Westwater, M. L., Fletcher, P. C., & Ziauddeen, H. (2016). Sugar addiction: the state of the science. European journal of nutrition, 55(2), 55-69.
Stice, E., Burger, K., & Yokum, S. (2013). Caloric deprivation increases responsivity of attention and reward brain regions to intake, anticipated intake, and images of palatable foods. Neuroimage, 67, 322-330.
Vasiliu, O. (2022). Current status of evidence for a new diagnosis: food addiction-a literature review. Frontiers in Psychiatry, 12, 824936.
Jun, D. (2023). The Effects of Hyper-Paltable Foods on Energy Intake and Eating-Related Experiences in Free-Living and Real-Time Conditions Among Adults (Master's thesis, University of Kansas).
Ziauddeen, H., & Fletcher, P. C. (2013). Is food addiction a valid and useful concept?. obesity reviews, 14(1), 19-28.
