Sugar: The addiction we don’t discuss

America is in the middle of an obesity crisis:

According to the most recent National Health and Nutrition Examination Survey (NHANES), 18.5 percent of children and 39.6 percent of adults had obesity in 2015–2016. These are the highest rates ever documented by NHANES.1 There were no statistically significant changes in youth or adult rates compared with the 2013–2014 survey, but rates have increased significantly since 1999–2000, when 13.9 percent of children and 30.5 percent of adults had obesity.

The map that accompanies this disturbing report, titled ” The State of Obesity: 2018“ and issued by the Trust for America’s Health and the Robert Wood Johnson Foundation, shows an apparent correlation between those states with the highest obesity rates and Trump country.

Correlation is not causation, but it is interesting that the seven states with the highest rates of obesity at 35 percent and higher are Iowa, West Virginia, Oklahoma, Arkansas, Louisiana, Mississippi, and Alabama.

According to the Miliken Institute of Public Health at The George Washington University, our rate of obesity has tripled since the 1960s. Most of the increase has come after the 1980s, leading to our current state where 70 percent of Americans are either overweight or obese. Think about that for a minute: It means that in a group of 10 people, only three would be of healthy weight or underweight.

Obesity can shorten one’s lifespan by 14 years. It is also associated with 100,000 annual premature deaths. Estimates of the cost of obesity range from $150 billion to $190.2 billion, or nearly 21% of annual medical spending in the United States.

How did we reach this state?

According to the National Institute of Diabetes and Digestive Health, part of the Department of Heatlh and Human Services:

Factors that may contribute to weight gain among adults and youth include genes, eating habits, physical inactivity, TV, computer, phone, and other screen time, sleep habits, medical conditions or medications, and where and how people live, including their access to healthy foods and safe places to be active.

The Mayo Clinic expands on that, and includes the bromide that we have heard for years:

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat.

Most Americans’ diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

But what if our food is the major culprit? More specifically, the sugar in our food? In Salt, Sugar and Fat, How the Food Giants Hooked Us, Michael Moss talks to the men involved in increasing the amount of sugar in prepared foods. In writing about Howard Moskowitz’ work for the major food producers, Moss discusses the case of Prego spaghetti sauce and how Moskowitz introduced the different varieties of spaghetti sauces offered.

“That’s Howard’s doing. That is Howard’s gift to the American people.… He fundamentally changed the way the food industry thinks about making you happy.”

the food industry already knew some things about making people happy—namely, sugar. Many of the Prego sauces—whether cheesy, chunky, or light—have one feature in common: The largest ingredient, after tomatoes, is sugar. A mere half cup of Prego Traditional, for instance, has more than two teaspoons of sugar, as much as two-plus Oreo cookies, a tube of Go-Gurt, or some of the Pepperidge Farm Apple Turnovers that Campbell also makes.

Why so much sugar? It was needed to reach the “bliss point” of flavor that would cause a product to be so perfectly aligned with taste that buyers would not just enjoy it, but would race to the store to buy more.

And why would they race to the store to buy more? Perhaps because sugar is addictive, and the food industry knows this. They know that sugar in a diet will increase the cravings for more sugary foods. More than two-thirds of America’s sugar intake is from processed foods.

As early as 1975, critics of added sugar were speaking out. One was Jean Mayer, a nutrition professor at Harvard University:

But what made Mayer an industry threat was his pioneering research on obesity, which he called a “disease of civilization.” He is credited with discovering how the desire to eat is controlled by the amount of glucose in the blood and by the brain’s hypothalamus, both of which in turn are greatly influenced by sugar.

In 1975, taking his growing concern about sugar to the cereal industry, he penned a piece of advocacy journalism that newspapers around the country ran under the headline, “Is It Cereal or Candy?” In it, Mayer made his view perfectly clear. Citing the dentist’s report and the FDA’s abdication of its responsibility to protect the health of consumers, Mayer conceded one point to the industry. Many of their brands were, in fact, fortified with added vitamins and minerals. But the fortification was merely a ruse. Some candy bars had more protein than many cereals. Mayer dubbed them “sugar-coated vitamin pills” and wrote, “I contend that these cereals containing over 50% sugar should be labeled imitation cereal or cereal confections, and they should be sold in the candy section rather than in the cereal section.”

Eventually the industry stopped some cereal advertising directed at children. But the introduction of commercial fructose in the late 1980s changed everything once again. 

The true power of fructose, however, lay in its sweetening powers. It is far sweeter than glucose, the other component of table sugar. On a relative scale, with the sweetness of table sugar marked as 100, glucose clocks in at 74, while fructose hits 173.

The real revolution occurred in 1980, when Coca-Cola switched to the newly available high fructose corn syrup. Coke also doubled its advertising budget that year. By 1984, the company’s ad budget had reached $181 million. And look what happened:

The increase in obesity cannot be blamed on Coke alone. All of the major food producers started using the high fructose corn syrup in their nonalcoholic beverages, from drinks like Capri Sun to Dr. Pepper. But the increase in sugar and marketing caused the sale of Coke to quadruple between 1980 and 1997, from $4 billion to $18 billion. By 2010, we were drinking soda (all brands) at a rate of 44.7 gallons per capita, per year, which was actually down from 1997’s consumption of 54 gallons.

There have been studies that show that sweets sometimes eased the pain of withdrawal from opiate addiction. A 2015 article in the Journal of Drug Abuse asked the question, “Is Sugar a Gateway Drug?

Addiction is a chronic, relapsing disorder with genetic, biochemical and psychosocial antecedents. Chronic use of drugs of abuse results in characteristic biochemical changes in the mesolimbic pathway of the brain including reduced extracellular dopamine levels and down regulation of dopamine 2 receptors. Similar biochemical changes have been identified with consumption of high concentrations of sugar. Cross-sensitization between sugar and drugs of abuse has been demonstrated to occur. This raises the possibility that sugar could act as a gateway drug, increasing the subsequent risk of becoming addicted to drugs of abuse. This article examines the research that indicates sugar can act as a gateway drug.

Although sugar is not ordinarily viewed as a drug of abuse, intermittent binging with sugar triggers neurochemical responses in the MLP that parallel those produced by DOA [drug of abuse]. Furthermore, evidence has demonstrated sugar may be addictive when consumed in a binge-like manner [6].

Although quantitatively different, the neurochemical changes produced by the intermittent ingestion of sugar are qualitatively similar to the changes produced by DOA in the MLP [6]. These include increased release of DA [54,56,58], reduced D2R mRNA [64], and down-regulation of D2Rs [7,63]. The resultant hypodopaminergic state is associated with increased drug seeking [49].

Conclusion

If sugar acts as a gateway drug, what implications does this have for future generations? Per capita soft-drink consumption has increased nearly 500% in the past 50 years [89] and consumption of high-fructose corn syrup increased >1000% from 1970 to 1990 [90]. The full impact of this increase in sugar intake on the BRC, the MLP, and addictive behaviors remains to be determined. Further research is needed to clarify sugar’s role as a gateway drug. Additionally, further research examining strategies for minimizing sugar’s adverse impact on the MLP and the subsequent development of addictions is recommended.

The processed food industry has been studying this question for years, as shown by how hard it tried to hook children on cereals that were, nutritionally little more than candy. They wanted the “drug-seeking” behavior to lead to increased sales. It worked for them. For us? Not so much.

We have been trained, from early childhood, to crave processed foods that contain high concentrations of sugar in whatever form. And sugar is in almost all processed foods today. Avoiding it becomes a balancing act more demanding than avoiding products made in China.

I thought that by consuming diet soft drinks I was cutting back on sugar, and I was, but the non-sugar sweeteners appear to trigger the same intense cravings that are caused by sugar itself. I knew I was in trouble when my A1c, which measures your blood glucose level over a period of three months, began to creep upward when I moved to a rural area in Maine three years ago.

I have long known that I was a sugar addict, as it led to my being diagnosed as having Type 2 diabetes in 2015. I controlled that easily through diet and exercise. In the summer of 2018 I learned, through an endoscopy, that I also suffered from celiac disease. This diagnosis required a major overhaul of my diet to exclude all sources of gluten. While doing so, I happily enjoyed the benefits of the increasing awareness of gluten intolerance and celiac disease in the form of “gluten-free” processed food. Big mistake. Although the processed foods were indeed gluten-free, they were certainly not sugar-free.

A couple of weeks ago, after examining all of the different diets out there including the popular Whole 30 diet, I settled on the one that seemed to specifically address my own personal addiction: The Blood Sugar Solution, by Dr. Mark Hyman. I followed his 10-Day Detox Diet.

There is a lot of hype and commercialism, as well as money to be made, in promoting diets like this that address the problems created by the food industry. I wasn’t concerned about that, though, only about my health. I had suffered major physical challenges since my move and wanted to regain the health I enjoyed while living in California.

Hyman explains how sugar and non-sugar sweeteners set up cravings for more of the same. HIs diet eliminates not just all sweeteners, but a list of other foods that trigger inflammatory responses: dairy, gluten, grains, beans, and processed and factory-made foods. Also excluded are caffeine and alcohol. No more morning lattes for me, or wine with dinner.

At least for 10 days—and I figured I could do anything for 10 days.

The first few days were tough. I felt tired and mildly unwell. So as a reward, I allowed myself the occasional bowl of popcorn and glass of wine. Realizing that I was only sabotaging myself, I restarted the program from day two. I chose that day because ratatouille was on the menu.

The food was delicious: all fresh food, mostly organic, with lots of dark leafy green salads, nuts and seeds, and a wonderful morning shake that seemed to replace my coffee and yogurt breakfast habit.

There is a good deal in the book about the psychological effects of the foods we eat and recommendations for ways to handle them. Part of the detox diet included breathing exercises to be done throughout the day. Each day starts with 30 minutes of physical exercise and ends with a stress releasing detox bath.

The preparation of the meals in the diet is time-consuming, and required me to drive down to Portland where the nearest Trader Joe’s is located for some of the raw seeds, nuts, and oils that are not available out here in the country. But Hyman lays out a complete shopping list for your pantry, as well as items that should be removed from it.

And the food! My god, it is delicious! There are some ingredients that I don’t care for (jalapeño peppers, for one) and have decided not to use, and there are some ingredients I have never used in meal preparation. But these are menus I will continue to prepare long after the diet is over, just because they taste so darn good. 

Although I still have two days left to go, I have already dropped 13 pounds and a total of five inches. Walking for a half hour down the tree-shaded road here in Maine is a pleasure and not the chore I thought it would be. But the real reward is that I no longer crave sweets or alcohol. I do miss coffee though, and am looking forward to my first cup in just a few days.

It’s a small price to pay for breaking my sugar addiction. 

Unfortunately, the United States’ sugar industry is protected.

The United States is among the world’s largest sugar producers. Unlike most other producing countries, the United States has large and well-developed industries for both sugarcane and sugar beets. Since the mid-1990s, sugarcane and sugar beets have accounted for about 45 percent and 55 percent, respectively, of domestic sugar production. U.S. sugar production expanded from an average of 6.0 million short tons raw value (STRV) in the early 1980s to an average of 8.1 million STRV since 2005/06. The production increases are due to the substantial investment in new processing equipment, adoption of advanced field- and storage-management practices,  the use of improved crop varieties, and acreage expansion (as sugar commanded higher prices relative to alternative crops). For more information about the U.S. sugar sector, see Background.

The U.S. sugar program uses price supports, domestic marketing allotments, and tariff-rate quotas to influence the amount of sugar available to the U.S. market. For more information about the U.S. sugar program see Policy.

Yeah, tariffs. And health costs aside, according to a Heritage study quoted by Tom Worstall, writing for Forbes:

In fiscal year (FY) 2013, Americans consumed 12 million tons of refined sugar, with the average price for raw sugar 6 cents per pound higher than the average world price. That means, based on 24 billion pounds of refined sugar use at a 6-cents-per-pound U.S. premium, Americans paid an unnecessary $1.4 billion extra for sugar. That is equivalent to more than $310,000 per sugar farm in the United States.

Just like drugs, we pay a higher price for sugar than the rest of the world. We pay more and the sugar industry reaps the benefits, to the tune of $1.4 billion a year. 

Under the current administration which is interested in banning vaping products but not guns, we are unlikely to see any regulatory assistance in our battle with obesity. That leaves it up to individuals to learn how to read and understand nutrition labels. (Perhaps they will notice that sugar is one of the only ingredients that does not have a daily recommended amount, like salt, fat, protein, and carbs. Sugar has a very strong lobby.) There is help online for those able to seek it. 

And perhaps someday we can wipe out the food deserts in our cities, so that all Americans will have access to the type of foods that can sustain them in good health.

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