Written by Monique Bellefleur, Ed.M, Director of Community Education at MEDA
MEDA recently held an exhibit at a local high school’s annual wellness fair. A woman approached our table and expressed concern that we were giving out lollipops. She thought it was wrong for us to be giving out an addictive substance (sugar) to high schoolers, especially when MEDA promotes recovery from eating disorders.
So the question is – is giving out sugar to high schoolers akin to giving them recreational drugs? Is sugar, specifically, an addictive substance?
To answer this question, we first have to define addiction. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, no longer utilizes the term “addiction”. Instead, the DSM 5 outlines Substance Use Disorders – Mild, Moderate, and Severe for each class of substance (Note, food and sugar are not on the list of addictive substances). Substance Use Disorders are defined as:
“…when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.” (SAMHSA, 2015)
Therefore one way in which we can define a problematic substance use disorder is the way in which the substance is affecting our daily functioning.
I can say that I have worked with clients struggling with binge eating disorder (BED) or bulimia whose binge-food of choice involves a heavy dose of sugar. Rightfully so, these clients feel their behaviors involving sugary foods are getting in the way of their everyday lives. However, I have also worked with clients who binge on vegetables and report a similar experience. Furthermore, I have worked with many clients struggling with all types of eating disorders whose fear of sugar, flour, or wheat negatively affects their daily functioning. The restriction of sugar further limits the foods they can eat and often the social interactions they can participate in (hello, birthday cake!). Unfortunately, mainstream media and diet culture propagate the idea that sugar is the new gateway drug to complete loss of control with food.
So is it the sugar or our relationship to sugar that is addictive?
In a study published in Neuroscience and Biobehavioral Reviews (2008), “Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake”, researchers hypothesized that sugar has the potential to be an addictive substance. The study found that “Based on the observed behavioral and neurochemical similarities between the effects of intermittent sugar access and drugs of abuse, we suggest that sugar, as common as it is, nonetheless meets the criteria for a substance of abuse and may be ‘addictive’ for some individuals when consumed in a ‘binge-like’ manner.” (Avena, N. M., Rada, P., & Hoebel, B. G., 2008). This study, conducted on rats, involved depriving the rats of food for 12 hours at a time and then giving them access to a sugar solution. When finally given access to sugar, the rats would binge. I hypothesize that the rats would probably binge on any edible object after being deprived of nutrients for 12 hours. The study by Avena et. al. also admitted that it was not able to conclude whether or not a rat would endure pain or face physical obstacles in order to continue to self-administer sugar as rats have done in previous studies involving cocaine (Deroche-Gamonet et al., 2004).
Another study published in Clinical Nutrition, “The plausibility of sugar addiction and its role in obesity and eating disorders” concluded that “there is no support from the human literature for the hypothesis that sucrose may be physically addictive or that addiction to sugar play a role in eating disorders” (Benton, 2010). Based on these studies, the research indicates that there is no evidence to support that sugar is physically addictive in humans. There is research that indicates sugar may be addictive for rats only when consumed in a binge-like manner (Avena et al, 2008), which further implies that it could be the binge behavior, not necessarily the substance, that is addictive.
Although I am not a researcher nor have I done an extensive review of all the literature on sugar addiction, I can speak anecdotally from the experiences my clients have shared with me. What I hear time and again from clients is that their eating disorder is “about the food but not about the food”. The eating disorder is about the feeling or lack thereof that comes from engaging in an eating disorder behavior: the numbness, the distraction, the dissociation, the comfort. So often it is not the sugar or the actual food (although, let’s be real, sugary, starchy foods often taste better than other foods) that feels impossible to let go of, it is the cycle of bingeing and restricting/purging that acts like a whirlpool.
After all, a binge can be a maladaptive form of self-care: the only time my client has to be alone; the only time my client chooses what they want to do, not what someone else tells them to do; the only time my client feels grounded. When food has been your primary coping mechanism for years, of course it is hard to let go of that dysfunctional relationship. The point is, the behavior is addictive, not the sugar.
We need food to survive. Food gives us energy, pleasure, and something to bond over. I hypothesize that if we did not demonize the way in which food can alter the human form to be outside our society’s current acceptable body size, and if we did not label foods as good or bad (resulting in people feeling morally good or bad based on their food choices), we would be able to have a much more balanced relationship with sugar and food in general.
Everyone wants the forbidden fruit when we are told it is forbidden. When we are told we can’t have sugar, we want it even more. For some people, restricting a certain food group could be helpful in their recovery, and I am in full support of people finding what works for them in eating disorder or addiction recovery. However, I have also seen the nasty underbelly of what happens when someone “falls of the wagon” and starts to eat sugar, flour or wheat again after a period of restriction = shame, embarrassment, guilt and feeling like a failure. This pattern is the same binge-restrict cycle that clients have struggled with in the past but stretched over a longer period of time.
The alternative philosophy we support at MEDA is that “all foods fit” and that the foods you eat have nothing to do with your moral worth. We find that when people can step outside the black and white thinking that diet culture prescribes, previous binge-foods no longer seem like forbidden fruit. Clients can then begin to take steps toward listening to their body and eating intuitively, which might mean having a lollipop and might mean having a salad. Healthy eating is flexible eating.
Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 32(1), 20–39. http://doi.org/10.1016/j.neubiorev.2007.04.019
Benton, D. (2010). The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition, 29(3), 288-303. https://pdfs.semanticscholar.org/6bd7/13a6a6d028a4471cbef1c75597f1379dc6c8.pdf
Deroche-Gamonet V, Belin D, Piazza PV. Evidence for addiction-like behavior in the rat. Science. 2004;305:1014-1017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/#R55