Click here for Part One of our ‘The Sugar Saga’ series: How an obscure sugar lobbying group helped start a global health crisis.

Click here for Part Two of our ‘The Sugar Saga’ series: Just how bad is sugar? The truth is bittersweet.

Click here for Part Four of our ‘Sugar Saga’ series: Sugar tax and the slow crawl out of a health crisis.

“The extreme intensity of reward and craving produced by addictive drugs, like cocaine, largely explains, together with their toxic effects, why these drugs tend to be universally prohibited… ” So begins the conclusion paragraph of a paper published in 2013 under the title, Sugar addiction: pushing the drug-sugar analogy to the limit.

“There is now strong evidence supporting the notion that hyperpalatable foods, notably those high in added sugar, can induce reward and craving that are at least comparable to addictive drugs.

“Although more research in humans is clearly needed to confirm this conclusion, there is now solid evidence in nonhuman animals showing that sugar and sweet reward can even be more rewarding and attractive than addictive drugs, probably owing to an underlying robust neural substrate. Such biological robustness may be sufficient to explain why people can have difficulty to control the consumption of foods high in sugar when continuously exposed to them,” the authors conclude.

Theirs was not the first nor last paper to reach such a conclusion. In fact, the past decade and a half has seen a growing body of research into the addictive qualities of certain foods, sugar in particular, at times leading to eye-catching (if not misleading) headlines such as “Oreos more addictive than cocaine, study finds”.

As suggested by the title, Sugar addiction: pushing the drug-sugar analogy to the limit, the authors were on a mission “to review research that tests the validity of the analogy between addictive drugs, like cocaine, and hyperpalatable foods, notably those high in added sugar (i.e. sucrose)”.

While the wording of the “conclusion” quoted above may seem to suggest that they do find sugar to possibly be as addictive as drugs such as cocaine, theirs is not necessarily the last word on the subject.

Another study, published three years later under the title Sugar addiction: the state of the science, found “little evidence to support sugar addiction in humans, and findings from the animal literature suggest that addiction-like behaviours, such as bingeing, occur only in the context of intermittent access to sugar. These behaviours likely arise from intermittent access to sweet-tasting or highly palatable foods, not the neurochemical effects of sugar.” To be clear, the study admits that sweet foods can lead to a display of addictive behaviour, but they cannot conclusively say that has anything to do with the chemical make-up of sugar. That is to say, one could display the same addictive behaviour to sweet-tasting foods, even if they have a sweetener other than sugar, or if they have been deprived of sweetness.

Yet another even more recent study, published in 2018, Sugar Addiction: From Evolution to Revolution, states that “there is no shortage of compelling human data”. However, the authors “propose that processed FA [food addiction] in humans is much more like caffeine or nicotine addiction than it is like cocaine or heroin”.

“There is a subtlety to food addiction where a significant majority of the people who meet criteria may not be aware of it, likely because it is not widely accepted as a social norm.”

The authors lay out standard criteria that mental health professionals use to diagnose “addiction” behaviour and then demonstrate how these apply to sugar.

They conclude that “there is strong evidence of the existence of sugar addiction, both at preclinical and clinical level. Our model has demonstrated that five out of 11 criteria for SUD [substance use disorder] are met, specifically: use of larger amounts and for longer than intended, craving, hazardous use, tolerance, and withdrawal. From an evolutionary perspective, we must consider addiction as a normal trait that permitted humans to survive primitive conditions when food was scarce. As we evolved culturally, the neural circuits involved in addictive behaviours became dysfunctional and instead of helping us survive they are in fact compromising our health.”

Whichever of a large number of studies on the relationship between sugar and addiction one chooses to study in detail, one thing is undeniable: continuous excessive consumption of sugar can be disastrous for human health for various reasons, one of the most important being that it might lead to obesity, which can open up a host of health complications.

“Sugar is also a comfort food; most carbohydrates have a comfort effect on the body and mind. It works with the reward centre in the brain; hence your state of mind actually plays the most important part to leading a healthy lifestyle, because the secondary effect of that will be your choices and your behaviour,” says Mariam Forgan, a registered dietitian who works alongside an endocrinologist in the therapeutic management and reversal of lifestyle-related chronic conditions, such as metabolic syndrome, obesity, insulin resistance, diabetes and hypertension.

“There are studies that reflect that sugar actually works with the same receptor in the brain as a drug,” she adds. Indeed, all three studies mentioned above – including the one that concludes that sugar in itself is not addictive – concur that aside from the toxic effects of certain drugs,  sugar and drugs recruit similar networks in the brain.

“It works with the reward centre in the brain, giving a temporary feeling of calm, relaxation and contentment; but it’s short-term,” says Forgan. She further describes sugar addiction as a secondary addiction to a primary emotional addiction: “Say, for example, you’re feeling anxious, and you don’t want to feel anxious. You might look for a distraction, and often it’s something crunchy, something that tastes good, the crunch sort of relieves a bit of the anxiety in the jaw. But it’s also just an escape from that moment in time, it’s a temporary sort of relief, like a drug.”

Among the practical tips she gives clients to help them cut down on sugar – and she has a few, more about those later – she also helps them to work out what emotional state they might be addicted to.

“That’s where the primary addiction is, you have to ask yourself, what emotion am I addicted to? Am I addicted to self-pity? Am I addicted to always feeling guilty? Do I create situations in my life so that I feel guilty so that I can reward myself with food? Everything can change once a person is aware of themselves, both their strengths and their shortcomings, then they can work with that,” says Forgan.

She points out other behaviours that might lead to unpleasant emotional states, such as procrastination, which might lead to one eventually feeling rushed and under pressure.

“That in itself is addictive, because some people associate that pressure with productivity,” and she explains that such emotional states can cause one to reach for sugar, either as a reward or as an escape.

“Often one has to work at replacing a crutch with something that’s more constructive, beneficial and not as self-destructive,” she adds.

When we consume carbohydrates, our blood sugar increases and the cells in the pancreas release the hormone insulin into the blood, which then lets other cells know to pick up the sugar, thereby reducing the blood sugar levels. However, a high-sugar diet can lead to insulin resistance, which is when the excess glucose reduces the ability of the cells to use blood sugar for energy. Obesity, smoking and high blood pressure can also lead to insulin resistance, which, according to Forgan, leads to more cravings.

“Even with diabetics… obviously the epitome of insulin resistance; some need external insulin because they are so insulin resistant. Some will tell you that the more insulin they inject, the hungrier they become; and the craving is often for sugar. So they’re stuck in this vicious cycle,” Forgan explains.

Therefore, for those looking for practical ways to manage their sugar consumption, Forgan recommends targeting insulin resistance as the first step alongside figuring out emotional addictions: “To try and get a handle on that you have to cut out your carbohydrates; or at least initially go on a very low-carbohydrate lifestyle. I’m not saying Banting because it isn’t a one-size-fits-all solution. But when there’s not enough glucose to use as fuel, your body goes into ketosis, it starts using the ketones from the fat stores as fuel.

“That’s when the ketosis interacts with your hunger hormone and you don’t have the cravings. You don’t feel hungry so it becomes easier to create a lifestyle and manage weight loss. Once the fat around the pancreas and the liver starts to shrink, it starts reversing insulin resistance and optimising the body’s overall metabolism. And then you can start reintroducing carbohydrates again, in small, moderate amounts depending on the body and physical activity level. But you first have to reverse the insulin resistance,” she says.

Another principle Forgan recommends for developing a healthy diet is consistency. That doesn’t mean eating the same meal over and over, but sticking to certain eating times.

For example, avoiding situations where one is rushing around all day, skipping meals and surviving on caffeine: “Being in a constant state of rushing means that you’re distracted from how you’re truly feeling. And often people can make mistakes because by the time night comes they’re still hungry because they didn’t eat properly in the day. That has a ripple effect on certain habits and patterns that can affect one’s health.”

She recommends preparing ahead of time, such as having a rough idea of what one’s meals might look like for the week, or preparing meals ahead of time, such as on weekends or the day before, as a way to encourage consistency and reduce the likelihood of craving for meals with added sugars.

Even with the growing body of research, over-the-counter literature on sugar and the potential dangers of its overconsumption, as well as the various tax levies, sugar is still big business, and it features in a large array of products on supermarket shelves, from spices, sauces, bread and cereals, to the more obvious culprits such as soft drinks and ice cream.

According to the South Africa Sugar Association, sugar contributes about R14-billion in direct income to the economy, and direct employment amounts to about 85,000 jobs.

Countries like India and Brazil have much higher numbers. Should the battle to reduce sugar consumption succeed, what might the future look like for economies that are largely dependent on sugar? What might supermarket shelves look like? Early studies have come out from countries that have started to see a significant reduction in consumption, and some results are surprising. DM/ML

Don’t miss part four, Sugar tax and the slow crawl out of a health crisis.