Substance abuse is a topic of discussion usually referencing alcohol and other recreational drugs; however, one of the most abused substances is in almost everything our culture eats and is largely unaddressed by society. A white or brownish, powdery, substance; a history riddled with violence, corruption, and international crime. I’m talking about sugar, of course. This is a dive into what sugar addiction is, how it’s gotten out of hand, and some ideas about how we can make changes as individual people and communities.
Let's talk about food addiction
Before we discuss sugar addiction, it’s important to define addiction. For the purpose of objectivity, we will use the American Psychological Association’s definition of addiction, "a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence.” In the DSM-5, the criteria of addiction is defined in multiple terms, and human association with sugar meets much of the criteria.1 Addiction is not commonly associated with sugar, however, the common use of sugar, the abundance ingested during binge consumption, and how it influences behavior, raises the concern of sugar being an addictive substance.
In a 2018 study about food addiction, researchers found that sugar meets most of the criteria for addiction and offered a hypothesis for why sugar is so addictive and subject to over-indulgence. Highly-palatable foods with high-glycemic-index carbohydrates overload reward centers of the brain, creating excessive dopamine release, promoting similar reward pathways associated with the addiction to caffeine and nicotine.2 Even with the global pandemic of obesity and diabetes, correlated with high-glycemic-index carbohydrates, sugar consumption remains excessive, to the point of hazardous use for many people. From the behavioral definition of addiction, one could certainly argue that sugar addiction is widespread and its consumption is potentially hazardous.
Is it really addiction, though?
There are arguments against calling sugar abuse, ‘sugar addiction’, scientifically founded yet specifically to oppose policy. A team of researchers in the United Kingdom stated, "We find 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.” Their conclusion explicitly stating that they are against “...premature incorporation of sugar addiction into the scientific literature and public policy recommendations.”3 It would appear that the researchers in this study are ignorant to, or would choose to ignore, the most common ingredient in all processed foods, globally; sugar.
Type 2 diabetes and sugar
Sugar is incredibly difficult to avoid. Any type 2 diabetic would agree that it’s more difficult to find sugar-free packaged foods than foods that have a ludicrous amount of sugar. So when the words, “...intermittent access…”, are used, the writer should note that access to sugar is easier and cheaper than access to whole foods, everywhere. In fact, sugar consumption has increased by a little over 8 million metric tons, globally, since that study was published.4 A criteria for addiction in the DSM-5 is the increase of a substance, which, as a globe, we have demonstrated over centuries.
Who is most affected by the sugar crisis?
Access to whole foods is an issue; not the market, the fruits, nuts, vegetables, meats, and other unprocessed foods that humans thrived on before the processed sugar boom. These higher-quality foods are more expensive and less accessible than highly processed sugary foods. Not only is there a trend between access to higher-quality foods and risk of diabetes, there is also a similar trend of access to foods and income.5 So those with less income are more at risk of both abusing sugar as a substance and also suffering chronic illness as a consequence.
What should we do?
One of the best things we can do is what we are doing now: educating ourselves. Sugar has become so common because it has flown under the radar in our foods for so long. It’s highly consumed without much thought, until a chronic illness diagnosis. The more we learn about the consequences of high sugar consumption, the less likely we are to abuse it. The more we think about sugar as a potentially harmful substance, the more serious we will treat it.
There's clearly a difference between the abuse of sugar and the abuse of nicotine, alcohol, or more illicit substances. I believe that difference is access. Sugar is not only easy to access, it's hard to avoid. It’s a substance that has had serious contemporary consequences for public health, with continually rising diabetes rates.
Recognizing sugar as a substance that is heavily abused and associating addiction with sugar, could motivate change in policy and better education. Ignoring the issue would likely continue the trend of rising chronic illness rates and increased sugar consumption. There is still debate about whether sugar addiction is a valid term or not, though it seems like recognizing the issue of overconsumption would be better for people’s health, than brushing it under the rug.
Have you experienced any foot complications from diabetes?