My guest, Dr Jen Unwin
I invited Dr Jen Unwin, Consultant Clinical and Health Psychologist to write a blog on the subject of sugar addiction. This is a particular interest of hers, and she’ll be running a residential workshop in Bristol in May 2021, details of which are here.
I must make it clear that whether or not sugar addiction is a clinical entity is itself contentious, and the views in this blog are not mine (Helen McCarthy). I hope that Jen’s article is of interest to many of you, and let me know if there are other areas you’d like to see guest blogs on in future.
Dr Jen’s article:
The man or (more commonly) woman in the street is often heard to say ‘I’m addicted to chocolate’ or some other food. It seems broadly accepted by ‘the public’ that the stuff we put in our mouths can lead to unwanted addictive behaviours with unwelcome impacts on our health and wellbeing. Yet sugar addiction is not a formally recognised disorder unlike drug/alcohol use, nor is it yet seen as a process addiction like gambling, shopping and sex. Neither is it recognised as an eating disorder. The result is little research and no services to help people who suspect this is their issue.
I use the term sugar addiction and not food addiction, as some people do. The evidence suggests that it is foods containing sugar or refined carbohydrates such as flour, often in combination with fat and salt, which are particularly problematic in terms of ‘moderation’. And of course, flour, pasta and other carbohydrates are just glucose molecules holding hands, soon to become sugar in the body. Your liver cannot tell the difference between the sugar in a Coke and the sugar in a glass of fruit juice or a slice of toast. Robert Lustig in the US has done more than anyone to highlight the dangers of sugar https://youtu.be/dBnniua6-oM. Not all food is ‘addictive’. Certainly not whole real foods such as eggs, fish, meat and non-starchy vegetables. The original human diet. Think about Pringles. Designed in the lab to be irresistible, hyperpalatable and moreish. With not one single essential nutrient. Food as entertainment not nourishment.
What are the symptoms of addiction? According to the American Society of Addiction Medicine, addiction is when a person is unable to abstain consistently from a substance, at the cost of their mental and physical health. ICD-10 lists the symptoms of ‘dependence’ as cravings, having more substance than intended and for longer, taking the substance to manage withdrawal symptoms, needing more to get the same effect, neglecting other activities and persisting despite evidence of harm.
Seems to apply to sugar, carbs and ultra-processed food? It certainly applied to me and many people I’ve spoken to about this. Just about everyone in our type 2 diabetes remission group endorsed experiencing these symptoms in the past. Cravings that feel impossible to resist once they start, despite intellectually having decided not to eat. A craving so strong it had me driving to town to get a pot of ice cream and sauce from the cinema. Thinking ‘I’ll just have a small slice of cheesecake to be polite’, then offering to clear up so I could sneak another big slice in the kitchen. Getting the shakes if I didn’t have sugary foods, needing to eat more and more to feel satisfied. Preferring to eat alone or at home. Being desperate to stop eating sugar and carbohydrate heavy foods because of weight gain and fatigue, but always going back to them.
Not everyone gets addicted to sugar. Just as not everyone gets addicted to alcohol. Nicole Avena http://www.drnicoleavena.com has designed a research instrument called the Yale Food Addiction Scale. Maybe 8% of the general population could be considered as addicted to food but up to 70% of people with type 2 diabetes in some studies. High scores on the YFAS are associated with mental health problems and obesity. Sugar addicts usually report close relatives with the same or other addiction problems. There are probably both genetic and environmental factors at play. Often a sugar addict’s earliest memories are of sugary, carb-laden foods and how to get more of them. Sometimes, the tendency to find pleasure in sugary foods interacts with some difficult experience or trauma and becomes a form of emotional management. This process can mean that the person develops fewer ‘healthy’ coping strategies for uncomfortable emotions such as boredom, anxiety or sadness.
What is the mechanism of addiction? Sugar and refined carbohydrates hijack the dopamine reward centre in the brain. Sugar consumption leads to high levels of dopamine in the brain. We are then motivated in a very powerful way to repeat the behaviours that led to this result. Overtime, the brain down regulates dopamine receptors in an attempt at balance. Hence the need for more and more to get the same effect. Unfortunately, this also leads to more low mood and lack of motivation for other things over time. Furthermore, when we eat sugar, insulin is released. Insulin allows tryptophan to cross the blood/brain barrier in greater amounts that normal and is converted in to serotonin. Serotonin is our major feel-good transmitter. Tryptophan can be depleted over time, once again leading to long-term reductions in this mood balancing hormone. Sugar makes you feel good in the short-term but is robbing you of your well-being over time both mentally and physically. Joan Ifland https://www.drjoanifland.com has edited the most amazing book with all the research on this topic to date.
Sugar and carbohydrates also override natural satiety signals. Protein and fat lead to natural satiety, the brain signals us to stop eating via the action of leptin. However, carbohydrate over rides this mechanism. That’s why people joke that they always have room for pudding. It’s true. When eating carbohydrates, such as fruit and nuts, in the autumn was a matter of life and death, this really mattered. Those of us alive today exist because our ancestors had the ability to over eat when it counted and survived the winter. These days, we live in a perpetual ‘autumn’ with a never-ending supply of sugary foods and fruits. The human body did not evolve to cope with our modern food environment. Carbohydrate is digested into sugar. The body produces insulin to quickly remove the sugar from the blood stream and store it as fat. Whenever we have high insulin, we cannot burn fat and will be in storage and survival mode. Weight gain and other metabolic diseases such as type 2 diabetes can eventually ensue. There is now an epidemic of these disorders.
What should we do? We have to eat. The answer is simple but not necessarily easy. The same as alcohol, drug or nicotine addiction, the essential first step for sugar addiction recovery is abstinence from drug foods. This is always sugar and refined carbohydrate as a foundation. Not easy, but it is possible. I’ve seen hundreds of people do this. Sugar and refined carbohydrate contain no essential nutrients or minerals that you cannot find elsewhere in your diet. Also, alcohol and nicotine may need to be eliminated in time because they too hijack the brain reward centre. Have you noticed how people who give up smoking end up putting on weight, also that bariatric surgery patients sometimes develop problems with alcohol for example? On occasion, people will need to exclude dairy, nuts and/or caffeine depending on their own reactions to those things. Each person must work out their own trigger foods over time. What can you NOT moderate, that is the key thing to notice? I can bet it won’t be eggs or broccoli! Your reward will be freedom from cravings, overeating, shame, low mood and illness. Follow a well formulated LCHF diet as a starting point. I did some research with https://www.lowcarbprogram.com/ showing that low carbohydrate food plans reduce food addiction symptoms significantly after 12 weeks. The paper is currently out to peer review.
The other essential part of long-term recovery is building up the feel-good transmitters dopamine and serotonin naturally to avoid relapse. Exercise, hobbies, yoga, helping others, being outdoors etc can all help your mental health. Follow what makes you feel good. Join the recovery tribe and get support and guidance. I recommend the Facebook group Sugar Bomb in your Brain https://www.facebook.com/groups/1682784168624569/ . I’m running a 4-day intensive in Bristol in 2021 https://www.bittensaddiction.com/en/news/
Recovery is possible and it’s amazing!
Dr Jen Unwin is a Chartered Clinical and Health Psychologist and Fellow of the British Psychological Society. She is a certified Nutrition Network Advisor. Alongside her husband Dr David Unwin, GP she has helped hundreds of people reverse their type 2 diabetes, lose weight and regain their health. She is a recovering sugar addict and in the process of setting up an online clinic to help others find food freedom. Connect on Twitter @jen_unwin