Is Sugar Addiction Real? A friendly, informal debate

By Michelle May, M.D.

jelly beansI was supposed to be writing an article for this month’s Am I Hungry? e-newsletter but instead, I was drawn into a respectful but passionate email discussion with R (not her real inital) about whether sugar addiction is real. Sugar addiction is becoming an increasingly hot topic, probably because it is so controversial. After about a dozen emails back and forth, I realized that I had written my e-newsletter article: “Is Sugar Addiction Real?”

I am sharing the gist of the discussion with you in the same format that it occurred: a friendly and lively back and forth email conversation between two people (R – anonymous and M – Michelle May MD) with two very different viewpoints. I hope you will continue this conversation by sharing your comments on our blog!

R – I’m writing a book on sugar addiction and would like to include www.AmIHungry.com as a resource and get permission to print your list of ideas of what to do instead of eat.

M – I have concerns about the concept of food addiction and the potential for harm so I’d want to be sure that your use of 101 Things to Do Besides Eat didn’t inadvertently suggest that Am I Hungry? supports that theory.

R – I do believe that sugar and food can be an emotional addiction and if your organization does not, then it seems best that I not involve you in my discussion. Thanks anyway.

M – What is “an emotional addiction?”

R – Using substances and activities as self-medication for emotional soothing in an irrational way (without regard for consequences). Alcohol and drugs very often have an emotional addiction component as well as a physical addiction component.

M – We’re not that far apart in terms of the experience, just in the use of the word addiction. How do you treat it if it is an addiction?

R – What makes you think that compulsive sugar eating is not an addiction?

M – By compulsive eating, do you mean binge eating? Are you recommending abstinence as the treatment?

I’ve been doing this work for 15 years and countless (literally, countless!) people are able to eat what they love without the compulsive/addictive/out of control feelings they used to have. For most of them, restriction and avoidance had played a major role in their “compulsion.” Once we remove the feelings of deprivation and give them mindful eating skills, the feelings of being addicted resolves. I wish you could sit in on our Mindful Eating for Binge Eating retreat and see it with your own eyes.

It sounds like you are pretty committed to your stance and I am not unrealistic enough to think you might consider an alternative explanation for what you have observed. You are certainly not alone these days. The problem is that it is VERY difficult to separate “addiction” from restriction. You will rarely see addiction research in humans that separates those who overeat from those who overeat and have been on multiple diets. The assumption is that “of course they diet – they overeat!” But how do they know which came first, especially if they don’t ask, or don’t control for that?

I’m not trying to be argumentative. I am just truly concerned because the “cure” is actually part of the cause and will ultimately make the problem much worse.

R – I’m actually talking about recovering alcoholics and drug addicts who have substituted sugar for their earlier drug of choice. Often they had addictive behaviors (hiding, stealing, sneaking) around sugar as children, soothing themselves with candy or doughnuts, say, before they turned to drugs and alcohol. There is binge eating in the sense of overeating but they experience serious cravings for sugar that mimic the cravings for alcohol. Their bodies also do not process sugar in a normal way, whether it be fermented sugar as in alcohol or refined sugars as in white flours and white sugar.

And no I’m not talking about abstinence but dealing with the emotional issues of anxiety, fear, restlessness, and boredom that underlie the need to soothe.

M – Most of the people we work with in our binge eating program describe a similar early onset of bingeing on sugar and certain other foods that are typically labeled “bad” such as snacks and fast food.

On your point, “dealing with the emotional issues of anxiety, fear, restlessness, and boredom that underlie the need to soothe” we are in 100% agreement! I just don’t believe that abstinence from sugar (unless it is simply a choice) is a necessary part of the treatment when you replace the restriction/binge pattern with mindful eating skills.

New research just came out that refutes sugar addiction; this article on the BBC News explains what I was trying to say.

R – Thanks. I find two things curious here. They say sugar isn’t an addiction but rather “a behavioral disorder like a gambling addiction.” So the behavioral disorder of gambling is an addiction, in their words, but the behavioral disorder of eating, which is like gambling, is not an addiction?

“Certain individuals do have an addictive-like relationship with particular foods and they can over-eat despite knowing the risks to their health.” So, if it’s an addictive-like relationship, how does that differ from an addiction? Interesting.

M – What is the benefit of labeling sugar as an addiction? It only reinforces powerlessness and the unattainable goal of abstinence – perhaps effective for alcohol treatment, but not effective for addressing the abundant food environment we live in. And I don’t need to add that gambling and alcohol aren’t required for existence but glucose in some form is.

We are in complete agreement that one of the underlying issues is “dealing with the emotional issues of anxiety, fear, restlessness, and boredom that underlie the need to soothe.” Adding deprivation and powerlessness to that list is not helpful.

Not being “allowed” to eat what you love promotes obsession, giving-in, giving-up, loss of control, guilt, shame, then back to attempted avoidance, and so on. (See Polivy’s extensive research on restraint). It is a vicious cycle that LOOKS like addiction, except that in addition to the unmet needs, one of the underlying drivers of this cycle is actually the MOST common treatment: Restriction > deprivation > cravings > bingeing > guilt > shame > more emotional reasons for eating…

The problem is paradigm blindness! If you don’t recognize that the treatment is part of the problem, then you prescribe more and more treatment for the apparently worsening problem.

Teaching mindfulness skills to become aware of the desire to eat for reasons other than hunger, building new coping strategies, and reinforcing the ability to choose the option that will BEST meet my need for self-care in that situation is, in my experience, extremely effective. In other words, chocolate chip cookies aren’t the problem unless they are your only solution.

This behavioral cycle does not need to be labeled as an addiction to be addressed. And I maintain that from my personal (yes, I had this problem at one time myself) and professional experience, as well as a growing body of health professionals (and hopefully more and more research as the paradigm blindness lifts), that mindfulness is able to create the shift that is so desperately needed today.

R – If sugar is seen as an addiction, as something that some of us cannot control with will power, then we are more likely, I believe, to seek help from all kinds of programs, including yours. Addiction is not a personal moral failing, as obesity is still considered in this Puritan legacy culture of ours. When people can acknowledge that their bodies don’t process sugar well, they can seek behavioral treatment.

M – Therein lies the disconnect. Trying to control sugar with willpower IS the problem! Why would I want to reinforce that faulty belief just to get them into my program? It would only undermine their long term recovery and their ability to eat sugar for pleasure in moderation. Once they stop trying to “control” themselves with resistance, food loses its power. Sometimes that is all that is needed to stop the addicted-like feeling they had previously. For some, no further treatment is even necessary.

I recognize that unless you have experienced this or seen if for yourself, is probably sounds completely unbelievable – too good to be true even. But it is. We’ve written up a just a few of the thousands of stories. I acknowledge that it is not research, but I KNOW it with every fiber of my being! Research doesn’t clearly support restriction (see Traci Mann’s study) or addiction and I have experienced and seen firsthand the harm they have caused. First do no harm.

Unfortunately, this sugar addiction craze IS going to drive more people to our programs eventually and that makes me very sad.

R – I think we’re miscommunicating here. Knowing that alcohol is an addiction helps people let go of trying to control it and seek a different sort of assistance. If sugar is not an addiction, not something you can’t control, then you should be able to control it. Seeing it as not an addiction perpetuates the “it’s your own fault” model.

M – First let me say that I neglected to acknowledge that we are absolutely on the same page about this from your previous email: “Addiction is not a personal moral failing, as obesity is still considered in this Puritan legacy culture of ours.”

What I don’t agree with is this concept (nor do I think the evidence supports it): “When people can acknowledge that their bodies don’t process sugar well…”

What I am trying to help you see (and this is the paradigm blindness that makes my work so challenging!) is that there is a THIRD option besides being “in control” or “out of control.” That is the option of learning how to be “in charge.” That is what Am I Hungry? is all about. I fully acknowledge that it doesn’t work for most alcoholism or drug addiction but it DOES work with food. This I know. And that is another reason that I maintain that sugar is not an addiction.

I know that you are familiar with a tiny piece of my work since you requested permission to reprint 101 Things to Do Besides Eat. It is a great tool, a form of distraction from the stimuli, but only one small part of our approach.

Please read chapter 1 of Eat What You Love, Love What You Eat before you publish your book. You can download it here for free; it will explain the behavioral cycle in terms that might be different from how you are used to thinking about it.

R – But many recovering alcoholics move to sugar when they get sober.

M – Right. But that doesn’t mean they are addicted to sugar. It means they have not yet learned how to cope appropriately with the stressors and triggers. (We see something similar in people who have bariatric surgery but have not addressed the underlying drivers for binge eating.)

Thank you for the thought-provoking dialogue. I hope you will include www.AmIHungry.com as a resource for those who don’t find the addiction model effective for them.

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