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Sugar: the hidden drug.

Visualise a drug that can get us high, can fill us with energy and can be taken orally. It doesn’t have to be injected, smoked, or snorted for us to experience its sublime and calming effects. Imagine that it mixes well with pretty much every food and virtually all beverages, and that when given to babies it provokes a feeling of pleasure so profound and intense that its pursuit becomes a driving force throughout their lives.

Could the taste of sugar be a kind of intoxication?

What about the possibility that sugar itself is a drug? Overconsumption of this drug have long-term side-effects, but in the short-term the side effects are mild and not always easy to identify – there is no staggering or dizziness, no slurring of speech, no passing out or drifting away, no palpitations or respiratory distress. When sugar is given to children, the parents might only experience a milder form of the extreme variations on the seemingly natural emotional rollercoaster of childhood, from the initial consumption to the tantrums and whining of what may or may not be withdrawal symptoms a few hours later. Essentially, it makes children happy, at least during the time whilst they’re having it. It eases their distress, calms their pain, helps focus their attention and leaves them excited and joyful until the effects wear off. The only problem is that children will come to require another dose, perhaps to demand this imaginary drug, on a regular basis.

It won’t be long before parents took to using this imaginary drug to calm their children down when needed, to alleviate discomfort, to prevent outbursts of unhappiness or to divert attention. Once the drug is identified with pleasure, it is used to celebrate birthdays, a football game, good grades at school and other celebrated events.  Soon gathering of family and friends, major holidays and celebrations all becomes incomplete without it. And people in developing countries are quick to follow the trend and the underprivileged of the world are happily spending what little money they have on this drug instead on nutritious meals for their families.

There is something about the experience of having sugar and sweets, especially when we’re kids, that begs the comparison to a drug. I have a son, still relatively young, and I believe raising him would be a far easier job if sugar and sweets were not an option, if managing his sugar intake did not seem to be a constant issue in our parental experience. Even those who strongly defend the place of sugar and sweets in modern diets admit that this does not include allowing kids to eat it as much as they want and whenever they want, and that most parents will want to ration their children’s sugar and sweet consumption.

But why is rationing necessary? Children crave many things such as dinosaur and football cards, Star Wars paraphernalia, ninja turtles stuff etc., and many foods taste good to them. So, what is it about sweets that makes them so distinct in need of rationing?

This question is more than purely academic, because almost everybody’s response to sugar and sweets is pretty much identical to that of children: once people are exposed, they consume as much sugar as they can get their hands on. The main barrier to greater consumption – up to the point where people become obese and diabetic – seems to be availability and price. As the price of a kilogram of sugar has dropped over the centuries, the amount of sugar consumed has inevitably risen.

Some people ask themselves if sugar is really an addictive substance, or do people just act as if it is? This question is not easy to answer. Certainly, people have acted as though sugar is addictive, but science as of now, provides no definitive evidence. Until recently, nutritionists studying sugar did so from the natural perspective of viewing it as a nutrient – a carb – and nothing else. Sometimes they argued about whether or not it might play a role in diabetes or heart disease, but not about whether it triggered a response in the brain or body that made us want to have more of it. That was until recently, not their area of scientific interest.

Some neuroscientist and psychologists interested in the effects of sugar, or why we might need to ration sugar intake, did so typically from the standpoint of how these sugars compare with other recreational drugs, where the mechanism of addiction is pretty much understood. Lately, this comparison has received more attention as the public-health community has looked to ration our sugar consumption as a population in schools etc., and has therefore considered the prospect that one way to regulate sugar – like cigarettes – is to establish that it is addictive. Sugar, is different than other recreational drugs in that that it’s both a nutrient and a psychoactive substance with some addictive characteristics.

One of the main reasons sugar seem to escape social disapproval as a drug is that, it does not cause the kind of immediate visibly intensified physical and psychological activity or any of the other cues associated with other drugs. Sugar seems to cause pleasure with a price that is difficult to determine immediately and paid in full only years or decades later. With no visible, directly noticeable consequences, questions of long term damage is seldom asked. Most of us today will never know if we suffer even subtle withdrawal symptoms from sugar, because we’ll never go long enough without it to find out.

The history of sugar is closely linked to that of other ‘food drugs’. For example, Rum is distilled, of course, from sugar cane. When sugar began to be added, in the 17th century, to coffee and tea, their consumption went up dramatically. Sugar was used to sweeten spirits and wine in Europe as early as the 14th century; even cannabis preparations in India and opium-based wines and syrups contained sugar.

Sugar is also a critical ingredient in some blends of cigarettes. One of the most known one is Camel. The justification for it addition to tobacco is flavour and smoothness, however, it certainly adds to the addictive influence.

Sugar, more than anything, seems to have made life worth living (as it still does) for so many, particularly those whose lives lacked the kind of pleasures that relative wealth and daily hours of leisure might otherwise provide.

Children certainly respond to sugar immediately. Give babies a choice of sugar water, plain water or milk, and they choose the sugar water.

If sugar is only a distraction to kids and not actively a pain reliever or a psychoactive inducer of pleasure that overcomes any pain, we have to explain why, in clinical trials, it is more effective in soothing the distress of infants than the mother’s breast milk.

Research on the question of whether sugar is addictive and thus a variant of a recreational drug of abuse is surprisingly limited. Until the 1970s, and for the most part since then, mainstream researchers have not considered this question to be particularly relevant to human health. The very limited research allows us to describe what happens when rats and monkeys consume sugar, but humans are different of course. Critical experiments are rarely done on humans, and certainly not children, for the obvious ethical reasons: we can’t compare how they respond to sugar, cocaine and heroin, for instance, to determine which is more addictive.

Sugar induces the same responses in the region of the brain known as the “reward centre” as nicotine, cocaine, heroin and alcohol. Addiction researchers have come to believe that behaviours required for the survival of a species – specifically, eating and sex – are experienced as pleasurable in this part of the brain, and so we do them repeatedly. Sugar stimulates the release of the same chemicals – especially dopamine, a neurotransmitter– through which the potent effects of these other drugs are activated. Because drugs tend to work this way, people have learned how to refine them into concentrated forms that heighten the rush. Coca leaves, for instance, are mildly stimulating when chewed, but powerfully addictive when refined into cocaine; even more so taken directly into the lungs when smoked as crack cocaine. Sugar, too, has been refined from its original form to concentrate and heighten its rush and effects.

The more we use these substances, the less dopamine we produce naturally in the brain. The result is that we need more of the drug to get the same ‘kick’, while natural pleasures, such as sex and eating, seem to lessen.

There is little doubt that sugar can alleviate the physical craving for alcohol. The 12-step manual of Alcoholics Anonymous recommends the consumption of sweets and chocolate in lieu of alcohol when the cravings for drink arise. Unsurprisingly, the consumption of sweets in the US doubled with the beginning of alcohol prohibition in 1919, as Americans apparently turned en masse from alcohol to sweets.

By the early 20th century, sugar had assimilated itself into all aspects of our eating experience, and was being consumed during breakfast, lunch, dinner and snacks. Nutritional scientists were already suggesting what seemed obvious: that this increased consumption was a product of at least a kind of addiction – the development of the sugar appetite, just like alcohol appetite – raises by gratification.

Now days, a century later still, sugar is an abundant ingredient in prepared and packaged foods and it can only be avoided by rigorous and determined effort. There is sugar not only in the obvious sweet foods such as cookies, ice creams, chocolates, fizzy drinks, sports and energy drinks, sweetened iced tea, jams, spreads and breakfast cereals – but also in peanut butter, salad dressing, ketchup, barbecue sauces, canned soups, processed meats, bacon, hot dogs, crisps, roasted peanuts, pasta and pesto sauces, tinned tomatoes and breads.  Essentially almost in everything.

From the 1980s onwards, manufacturers of products advertised as “healthy” because they were low in fat, or specifically in saturated fat, took to replacing fat calories with sugar to make them equally, if not more, palatable – often disguising the sugar under one or more of the 50 names by which the combination of sugar and high-fructose corn syrup might be found. Fat was removed from candy bars so that they transformed into “health-food bars”, in spite of the added sugar. Fat was removed from yoghurts and sugars added, and these became “heart-healthy snacks”. It was as though the entire food industry had decided that, if a product wasn’t sweetened at least a little, our modern palates would reject it and we would purchase instead a competitor’s version that was sweet.

Some people reward themselves with a drink whereas for others it’s chocolate, dessert, ice cream or coca cola which makes their day.  For those of us who are parents, sugar and sweets have become the reward for our children’s accomplishments, to demonstrate our love and our pride in them, to motivate them, to bribe them.

It’s common to think of this transformation as driven by the mere fact that sugars and sweets taste good. However, the more likely reason is to think about this as sugar took over our diets because the first taste, whether for an infant today or for an adult in earlier centuries, is a kind of intoxication; it’s the trigger of a lifelong craving, not identical but very similar to the effect of other recreational drugs.

Because it is a nutrient, and because the obvious illnesses connected to its consumption are benign compared with those of nicotine, caffeine and alcohol – at least in the short term and in small doses – sugar remained nearly resistant to moral, ethical, religious or health based attacks.

Until quite recently, nutritionists have blamed chronic disease on pretty much any element of diet or environment – on fats and cholesterol, on protein and meat, on gluten and glycoproteins, growth hormones and oestrogens and antibiotics, on the absence of fibre, vitamins and minerals, and surely on the presence of salt, on processed foods in general, on over-consumption and sedentary behaviour –  nowadays,  they’ve started conceding that it’s that sugar has played much sinister role than merely getting us all to eat too much.

So how do we establish a safe level of sugar consumption? In 1986, the US Food and Drug Administration (FDA) concluded that most experts considered sugar safe. And when the relevant research communities settled on caloric imbalance as the cause of obesity and saturated fat as the dietary cause of heart disease, the clinical trials necessary to begin to answer this question were never pursued.

The traditional response to the how-little-is-too-much question is that we should eat sugar in moderation.  But we only know we’re eating too much when we’re getting fatter or manifesting other symptoms of insulin resistance and metabolic syndrome.

Insulin resistance is the fundamental defect present in type 2 diabetes, and in obesity. Those who are obese and diabetic also tend to be hypertensive; they have a higher risk of heart disease, cancer and strokes, and possibly dementia and even Alzheimer’s. If sugar and high-fructose corn syrup are the cause of obesity, diabetes and insulin resistance, then they’re also the most likely dietary trigger of these other diseases. Put simply: without these sugars in our diets, the group of related disease would be far less common than it is.

Metabolic syndrome ties together a host of disorders that the medical community typically thought of as unrelated, or at least having separate and distinct causes – including obesity, high blood pressure, high blood sugar and inflammation – as products of insulin resistance and high circulating insulin levels. Regulatory systems throughout the body begin to fall out of sync, with slow, chronic, pathological consequences throughout.

When we notice the symptoms of consuming too much sugar, the assumption is that we can dial it back a little and it’ll be ok – drink one or two sugary beverages a day instead of three; or, if we’re parenting, allow our children ice cream on weekends only instead of every day. But if it takes years or decades, or even generations, for us to get to the point where we display symptoms of metabolic syndrome, it’s quite possible that even these apparently moderate amounts of sugar will turn out to be too much for us to be able to reverse the condition and return us to health. And if the symptom that show up first is something other than getting fatter – cancer, for instance – we’re truly out of luck.

Those who argue in favour of moderation in our food consumption tend to be individuals who are relatively lean and healthy; they define moderation as what works for them. This assumes that the same approach and amount will have the same beneficial effect on all of us. Unfortunately, this is not how things work and what might work for one does not necessarily work for another.

If it takes 20 years of consuming sugar for the consequences to appear, how can we know whether we’ve consumed too much before it’s too late? Isn’t it more reasonable to decide early in life (or early in parenting) that not too much is just as little as possible?

Any discussion of how little sugar is too much also needs to account for the possibility that sugar is a drug and perhaps addictive. Trying to consume sugar in moderation, whatever that mean, in a world in which substantial sugar consumption is the norm and virtually unavoidable, is likely to be no more successful for some of us than trying to smoke cigarettes in moderation. Even if we can avoid any meaningful chronic effects by cutting down, we may not be capable of managing our habits, or managing our habits might become a real burden. Some of us certainly find it easier to consume no sugar than to consume a little.

If sugar consumption is a slippery slope, then promoting moderation is not a trusted solution.

In my own mind, I keep returning to a few observations – unscientific as they may be – that make me question the validity of any definition of moderation management in the context of sugar consumption.

Now days we know that the evidence against sugar is quite definitive and compelling. But taking the sugar out completely will mean food will not taste the same – unless, of course, we replace the sugar with artificial sweeteners.  Artificial sweeteners as a replacement for sugar muddy these waters even more. Much of the anxiety about these sweeteners was generated in the 60s and 70s by the research, partly funded by the sugar industry, that led to the banning some artificial sweetener as a possible carcinogen, and could cause cancer (at least in rats, at extraordinarily high doses). Though this particular anxiety has faded with time, it has been replaced by the suggestion that maybe these artificial sweeteners can cause metabolic syndrome, and thus obesity and diabetes.

This suggestion comes primarily from epidemiological studies that show an association between the use of artificial sweeteners and obesity and diabetes. But it is likely that people who are predisposed to gain weight and become diabetic are also the people who use artificial sweeteners instead of sugar.  Therefore, the accuracy of these studies is somewhat doubtful.

What we want to know is whether using artificial sweeteners over a lifetime – or even a few years or decades – is better or worse for us than however much sugar we would have consumed instead. It’s hard for me to imagine that sugar would have been the healthier choice. If the goal is to get off sugar, then replacing it with artificial sweeteners is one way to do it. Another way is natural sweeteners.

Ultimately, the question of how much is too much becomes a personal decision, just as we all decide as adults what level of alcohol, caffeine or cigarettes we’ll consume. Enough evidence exists for us to consider sugar very likely to be a toxic substance, and to make an informed decision about how best to balance the likely risks with the benefits. To know what those benefits are, though, it helps to see how life feels without sugar. People who quit smoking will tell you that it was impossible for them to grasp intellectually or emotionally what life would be like without cigarettes until they quit; that through weeks or months or even years, it was a constant struggle. Then, one day, they reached a point at which they couldn’t imagine smoking a cigarette and couldn’t imagine why they had ever smoked, let alone found it desirable.

A similar experience is likely to be true of sugar – but until we try to live without it, until we try to sustain that effort for a short period of time, we’ll never know.

Is it the sugar or the sweet taste that stimulates the ‘reward centre’?  well, it’s actually both. But more about this in another article.

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