I am guessing that if you once struggled with compulsive behaviors with carbs and sugar it doesn’t go away, like someone who struggles with alcohol will probably always be susceptible to abusing it. Sugar can have zero “addictive” effects on some people and a more intense effect on someone who’s physiology predisposes them to it. I have no interest in drugs or abusing alcohol but my history of eating disorders means restricting food feels better to me than eating. Exercise, which is seen as inherently healthy and beneficial, can have deleterious effects for me because it becomes compulsive to me. It is a compulsion for many, many people, and can lead to poor health outcomes but we somehow don’t label it as “addictive”. I guess I don’t understand the sweeping judgment that sugar is inherently damaging and addictive.
"Addiction," sugar, dopamine, pleasure
Even in the abstinence of a substance, the pathways can still be activated by it. This is controversial for addiction treatment, actually. Most suggest abstinence for this reason. Even behavioral triggers for addicts can cause a cascade reaction. For instance, say someone has overcome an addiction to legal pills. I’ve seen cases where even rattling the bottle sets off the cascade.
This is because addictions are both biochemical and behavioral. So, we become condition to the addiction stimulus (or sensory stuff, like sounds/tastes/environment) in addition to the dopamine mechanism of the brain.
Anything pleasurable has the potential to be addictive. In the case of exercise, absolutely it is 100% addictive. Ask anyone who is a serious martial artist. It’s a positive addiction, after a fashion, but one can argue there is the same neurochemical cascade for quite a few individuals. We often diagnose behavioral addictions, depending on presentation, and exercise can absolutely appear there, too. Pathology is pattern and purpose weighed against function. Again, naturally addictive substances (like alcohol) are still inherently addictive without, necessarily, causing addictions. Sugar is in the same category. Is it always dangerous? No, not if you eat maybe 2-3 teaspoons a day, including fruit and such.
Also, in the case of sugar it’s a bit different, as we are biologically primed to desire and consume it, since during our evolution it was rare to encounter. While we need exercise, and while for some it can also trigger the same response mechanism, it does not have the neurological and biochemical impact on us that sugar does.
And actually, sugar is similar to opioids in other ways: refining makes them both far more prone to being misused. Opioids have been used for millenia, and we often would encounter these in nature. While they were certainly addictive, many people also did, say, use cocaine and heroin without dangerous addictions in the early 20th century. It was only after we began to process these substances that they became truly addictive, because we did not evolve to cope with such powerful formulations. Raw opium is far, far, far, less addictive than heroin or morphine, but it’s still addictive, potentially. As for sugar, it’s much the same story. It’s now highly processed. It’s addictive in the way nicotine, alcohol, and caffeine all are. Any can be lethal in various degrees. Any can be disruptive and pathological, and sugar is no different.
It is not just biochemical predisposition, but environment too. Environment can create the perfect storm.
You’d be surprised at many beneficial things which can also be addictive. As with all things, it’s the dose that determines if it’s a cure or a poison. For most people here, sugar is not unlike exercise is for you. Many non-obese people also use food stimuli to “feel better.” I mean, look at the idea of comfort food, which many engage in regardless of size. There’s even the old stereotype about buying ice cream to get over a break up. Most Americans, at least, do not follow healthy diets. Most do not necessarily want to give up their diets, either.
As for the judgment, my opinions are informed by my biases, however they are also informed by my research, such as the studies I linked earlier. There is a lot of evidence that sugar absolutely does trigger brain responses similar (and in excess to in some studies) narcotics and cocaine. That’s not necessarily a judgment, so much as an observation based on research. I am always happy to entertain other ideas, and I am always grateful to be proven wrong, odd as that may sound. Science should always work like that, and constantly evolve 
One final thought though: there’s the fact that anything which significantly spikes insulin is probably not good to consume on a regular basis if you want to keep inflammation down. Sugar is a highly inflammatory food when consumed in any noticeable quantity. Maybe if, our of 30g of carbs a day, if 15g were sugar it’d be okay, I suppose. The problem is that no one eats such minuscule quantities for the most part. In that case, though, I don’t imagine the dopamine effect would be significant.
The other thing to consider is that a good chunk of glucose gets converted to fructose in the body. Fructose is absolutely horribly bad for you, addictive properties aside.
In the end, though, it’s just an interesting academic discussion. Each of us must make the choices that work for us. I have vegan friends that I worry about, however their health is their business and not mine. It’s why it’s vital we all make informed decisions. I don’t care about being wrong in my opinions - I care about making choices that result in positive health. Where I am getting at, is that, very rarely, do good health choices involve sugar at all in my experience. Impossible to avoid addiction and poor health? Not at all, actually, however I’d argue that it’s rare to consume sugar without either addictive overtones or a negative health impact.
That is amazing. This makes me want to research this subject in depth!
@Donna thank you for such an engaging discussion you really gave me a lot of insight into this. I appreciate your clinical background and understanding of the nuances of addiction and addictive behaviors and substances. It makes me wonder why so many people struggle with this to some degree or another. As you mentioned people have encountered opioids for many, many years in nature but not in the concentrated forms we have available today. It makes me wonder if we’re just biological driven to seek these substances at the cost of harming ourselves. I know from my ED background that there are studies on rats who are deprived of food and offered the chance to exercise. They become so addicted to the exercise that they end up passing up food when it’s offered even though they’re starving. They end up basically exercising to death. I know this feeling well. Is our population predisposed to this because of our genetics? Does the tendency to engage in addictive behaviors vary culture to culture? Such fascinating questions.
@Emacfarland I just enjoy talking… I love seeing different perspectives, too! It’s hard for me to understand why people wouldn’t have issues with some sugar, on a personal level. Conversations like this always make me learn and I (I’m honestly serious and not being ironic) always love having them. I also never learn anything without new information you know?
You have some interesting questions. I’m actually not sure about some of them! I will sneak off and see what I can find
Actually good to delineate how one is using the word “addiction” certainly its use in the podcast and in this thread is separate from any clinical application. From a clinical perspective- “addiction” based on DSM 5 and current practice is much narrower than folks here appear to be using it. Addiction is now termed “Substance Use Disorder” when used in a clinical context and requires impaired function as a result of use (e.g. repeatedly unable to carry out major obligations at work, school, or home due to use), although you could say being overweight may impair function that would not be considered eligible in consideration as “addiction.” And although sugar stimulates insulin which increases subsequent consumption of sugar it most likely does not fulfill another key criteria which is that consumption of sugar causes a direct activation of the brain reward system such that normal activities may be neglected.
I agree- lets use better language. Addiction is a word that is being largely abandoned by Diagnostic criteria because it can be experienced as stigmatizing by communities it is applied to and instead it is being replaced with “Substance Use Disorders.” Perhaps we should be more specific to why folks feel compelled to consume more and more sugar- Insulin and Leptin anyone? and abandon this pejorative term that implies that is a lack of will versus a disordered metabolic process.
Sugar is known to activate the same reward system on par with, or even sometimes stronger than, cocaine and heroin. I linked studies above which reference this, but here’s another abstract. The DSM 5 is flawed in that our diagnostic science outpaces the publication in some respects. However, even when taking substance abuse disorder into account, one could conceivably apply it to a true sugar addiction. Would I diagnose it before more clinical verification was available? Well, no. However, the main reason I diagnose is not necessarily for treatment - rather, it’s to bill insurance, as insurance cannot be billed without a diagnosis, and we typically treat symptoms rather than disorders. Mental health diagnosing is a tenuous art at best. Consider that if I see a client for grief who doesn’t have mental illness still must get a diagnosis if I am to be reimbursed by insurance. Additionally, further research appears promising where food addictions are concerned in general.
Regarding the DSM 5, actually includes behavioral and process addictions, which food addictions of any type currently fall under. There are several researchers working to study food addiction on its own rather than as a process addiction.
You guys may also find this interesting:
I think the key in this is not reward pathways but that “normal activities may be neglected” and significant decrease in functional impairment as a result- many people who cannot stop consuming sugar (largely due to insulin and leptin) are still very functional and can maintain jobs and relationships etc … In an eating disorder this is not the case- those at least under hospital care are not functional, but eating disorders aside I am not sure I would bill what is largely a problem of disordered metabolic pathway under a mental disorder this just adds unnecessary stigma unless you are using “food addiction” as just another term for binge eating?
No, food addiction and binge eating are distinct and different.
Binge eating has nothing to do with the food odd as it sounds, as anorexia has nothing to do with the food. Both are control oriented.
Food addiction is a literal addiction to food. It is currently being studied, and the reward pathways of the brain are implicated in its creation.
Could you discuss this further please?
I have struggled all my life with sugar addiction and am trying to find ways to help me conquer it.
Had a meltdown just a few minutes ago because when sugar cravings kick in I seriously feel like I MUST give in to them. Hunger levels and fat intake have zero to do with cravings as well so “eat more fat!” doesnt help.
Thanks!
I now think of carbs as cigarettes. Visualize that. I think they are as bad if not worse than cigarettes considering the effect they are having on healthcare.
Loving this topic! @KetogenicJoseph. You are right. Addictions to heroine and cocaine seem way worse than sugar addiction, but there is a definite scientific evidence that sugar can and in some cases creates a larger addiction response than cocaine. I suggest reading a book "Food Junkies: The Truth about Food Addiction by Dr. Vera Tarman. Here is one scientific study about physical cravings: https://foodaddictioninstitute.org/scientific-research/physical-craving-and-food-addiction-a-scientific-review/ This study from the University of Florida “presented summaries of the brain imaging research at several leading universities showing that “palatable food” created the same types of changes in the dopamine receptors of the human brain as alcohol and other widely recognized addictive substances.”
Many recovering addicts replace cocaine or heroin for food. And many patients with gastric bypass surgeries end up becoming alcoholics. Food is just a much more slow and socially acceptable addiction. If you have an alcoholic friend who can’t walk straight, it seems much more of an immediate and dangerous problem than a friend who goes to McDonalds every day and orders 3 meals and scarfs them down. Both addictions compel you to do things that are bad for you. One just kills you faster.
Note: I went to a food addiction group for 6 months before I could actually make Keto work because I kept falling off the wagon, due to what felt like uncontrollable urges to eat those evil carbs. I had to understand my addiction before I could heal my self.
@Suzanneb Like I mentioned in another comment, I had to go to a food addiction group for a while before I really could get into Keto full swing because I kept having “meltdowns” and such. I still do sometimes. I was very active in this addiction group for quite a while to help me understand my triggers, the emotions behind eating and some of the other baggage that follows food addiction. My sugar cravings have never entirely gone away, but it gets easier with two things… time (and practice not caving in) and understanding why I crave. My addiction group on facebook was really helpful. If it might help, check out http://www.whyweightforrecovery.com/ or any number of food addict groups. They usually have great communities and support systems.
I know I’m a bit late to this, but just wanted to say Go you! Kicking your addiction must have been hard and you are awesome!
Since this thread has been revived, let me put in my two cents’ worth.
First, like alcohol, a known addictive substance, sugar is not addictive to everyone. Some people can handle either or both of these substances, some can’t. Second, Dr. Robert Lustig, in his lecture on the problems with fructose, points out that fructose is metabolized by the same metabolic pathway the liver uses to deal with ethanol. (Remember that table sugar, sucrose, is a glucose molecule bound to a fructose molecule. These are cleaved almost immediately upon ingestion and metabolized separately.) Third, in those vulnerable to it, fructose has the same effect on the nucleus accumbens that ethanol has, in particular the down-regulation of dopamine receptors, which is the mechanism behind the addict’s need for more of the substance in order to achieve the same effect.
Lastly, it is impossible for an addict to convey the reality of addiction to a non-addict, and vice versa. I am just as baffled by my friends who can take only a couple of sips from a glass of wine or only a couple of nibbles from a brownie, as they are by why I continue drinking until somewhere after the second liter or don’t stop eating brownies until the baking pan is empty and I’ve scraped all the crumbs into my mouth.
After years of denial, I finally had to admit that I am just as powerless over sugar as I am over alcohol and other drugs. So again, to those who can handle these substances, mazel tov! Just be gentle with those of us who are not so fortunate.
@PaulL Loving the science. I didn’t know that about the nucleus accumbens! I totally agree. You can’t explain an addiction to someone who hasn’t experienced it. My sister thinks it is a ton of whooie. But it is soooo real.