Is sugar and food addiction actually the same thing?
Sugar addiction is real and it’s what we deal with all the time. I think they’re not exactly the same. Most people have an addiction or inability to not eat something. When you don’t eat it, you crave it and you have withdrawal symptoms. That’s what defines addiction, and sugar fits that 100%. Some people do have an addiction or a problem with overeating, without regard to what the food is, but most commonly it is a sugar addiction. (And when we say “sugar,” we mean starches as well, because starches get digested to sugar.)
So when we think about sugar addiction, I think about starches and sugar, and how you have to really address both of those. It’s common for someone to come to me and say, “I don’t crave sugar,” but they’re having bread all day long and that’s still metabolically the same thing as sugar, because our bodies digest the starch in the bread to sugar and it gets absorbed as sugar. I would say for the most part, when we talk about food addiction, we’re talking about sugar addiction—starch and carbohydrate addiction.
What do you think is the biggest cause of sugar and carb addiction?
There are multiple causes. A contributing factor, of course, is having it around too much. There’s no inherent need for a human to consume sugar. Historically, if you came across something sweet, you’d want to have it—like berries and things like that—but it’s only recently, say in the last 100 years or so, that we’ve had pastries and candies in a big way. Even in the last 10 or 20 years, the supermarket checkout line has candies and sugars. So, the main contributing factor is being exposed to an abundance of it, so you can’t avoid it.
It’s complicated, because if you raise a child on sugar—you use sugar as the motivating reward substance for children as has been done for so long—you’re introducing a behavioral drive toward the consumption of sugars. It’s used as a tool to change a child’s behavior, so you end up with an adult, like me, who was raised on sugar and had a pretty much unlimited supply. If I wanted it, I would go get it. I remember riding my bike down to the grocery store or convenience store and buying all different kinds of candies. A lot of people still joke about this when, now, it’s coming into focus for me that this is almost like teaching our children to smoke! To use a substance that’s harmful.
My parents smoked – for that generation in the 1960’s and 70’s in the U.S. it was quite common even for a doctor and his wife (my parents) to smoke. It was purely an addiction. It really seems repulsive almost to think that we would be smoking now in the house with our children, which is what they did. Sugar is similar in the way that it tastes good and it’s enjoyable. We create addicts by having it available cheaply and also by using it as a behavioral tool in our children. We’re then left with adults, like me, who still struggle to stay away from it. Once I get it, I want more of it. It rekindles that addiction, which makes it out of control. People are unable to control it.
You have been mentioning the obvious culprits – the candies, etc. Another common thing is that restaurants feed you delicious bread and crackers, which may make you think that you would have less room for the main meal, but that’s not the case, is it?
It’s really the other way, isn’t it? The strategy there is to enhance your appetite with bread, chips, crackers, when you come to the restaurant. You make someone even hungrier, momentarily, and then you feed them the main meal and dessert. Then you’ve heightened the experience for people. That’s a common response: you have the bread or the chips, and you want more. There are a lot of cultural differences, and I have to imagine this is why it’s so complicated. If you were raised in a country where you didn’t have sweets, you just had rice or bread, then you don’t have the whole package deal like we’ve had in the U.S., where you have free reign to have all of the bread, pasta, rice, fruit, and candies. We jumble all of these together as carbs, and certainly when we take them away from people, the cravings go away. You don’t have to have those cravings.
It’s more complicated. I remember I had an experience living in France during college and they didn’t really have a lot of sweets (back then anyway). A sweet would be this really tiny piece of sugar. Their carbs would be a baguette, bread, or the occasional pastry. A lot of cultures have learned that they will moderate the amount that they have. So, if you’re raised in a family that teaches you how to eat carbs sensibly, it’s almost like raising your family to drink responsibly. You don’t have that sugar addiction or carb addiction. That’s why it’s an individual thing when someone comes to me with these kinds of issues. The solution is that, yes, you can cut out all the carbs, and we do that, and it doesn’t matter which carb you were attached to, you’re not going to be having it. Our method really addresses all of these different sources of addiction. Over time, we can help people fine-tune if it was the bread or the rice or the beans. There are so many different variations on this theme. We help people to individualize their long-term approach, but initially to treat an addiction you have people avoid the addictive substance.
You’re so right in saying that it is an individual thing, because some people don’t seem to have this addiction at all.
Right. And in my experience, they’re not very compassionate or empathetic with those who do. I guess this is a human thing: if I don’t have a problem with alcohol or smoking or carbs, then why do they? The interesting thing about sugar addiction is that it’s encouraged. It’s widely available, it’s cheap, and it tastes so good—at least momentarily.
This leads into how to treat it with sugar-free things. One way to do it is to allow people to have things that are sweet but don’t have sugar in them, so that it doesn’t give that same reward in the brain, which is the ultimate source of the addiction. It’s actually a biochemical, biologic issue going on. It’s not just psychology; it’s physiology. Avoidance is a great way to treat it and so is using sugar-free substitutes for a while. I don’t know that there’s any health benefit to having a sugar alcohol or sucralose or something like that, but I find it very useful to help people get off the sugar.
Are you saying that this addiction is possible to go away for good or do you think it’s something that’s always going to be there?
I think it depends. Some people who have just a mild form of it, the cravings, the desire for it, can reduce or eliminate it for a while and then reintroduce with control. In my experience, if someone has a severe metabolic problem like obesity or diabetes, they tend to have to stay away, in some cases, forever.
It would be like an alcoholic who can’t really ever have alcohol, or it will lead to a full-blown relapse. Fortunately, that has reached the social awareness where you wouldn’t go to a party and offer a drink to someone who you know has had trouble with alcohol. I’m hoping that one day it’ll be the same for sugar and starch, where it would be unseemly and not socially acceptable to offer a sweet thing to someone who you know has a problem with sugar.
Are there any actionable points that could help someone to get over their sugar or carb addiction?
Sure. I borrow a lot of the research and understanding from other addictions. That was actually my research career before I started studying diets – low-carb and keto diets. I helped in the smoking cessation addiction world and there are a lot of things—like total-avoidance or cold turkey day—which are common behavioral tools for any addictive substance, alongside the substitutions. So, what we teach with the keto diet is that you’re really stopping all of the potentially addictive carbs in one day, which can lead to a withdrawal syndrome in some people. (Not everyone has the cravings or the irritability.) The substitutions are then something I’ll introduce a week or two after the total cessation of the carbs. I’ll introduce people to the sugar-free options like cauliflower turned into rice, cauliflower pizza crusts, mashed cauliflower, and all these other substitutes that give you the idea that you’re having those carbs, although you’re not. That’s been a useful tool in treating addictions – where you give someone a fake cigarette for a while, because there’s a lot of behavioral aspects to an addiction.
Cooking something becomes a pattern and people want to cook, so I’ll help them figure out how to cook within a keto framework. If you’re used to munching while watching TV, we’ll introduce the idea of having non-sugar-containing, non-carb substitutions so you can still munch. Fortunately, that behavioral thing will fade away like with most addictions. If you give someone a tool that substitutes a lot of the hand-to-mouth stuff, the behavior will fade away, because you’re really not getting that sugar reward internally and your brain figures that out over time. These are the things you can do: total avoidance (try the keto approach), or give substitutions for the sugar or carbohydrates. The ‘chaffle’ came onto the scene about 18 months ago in the keto world. It’s a cheese and egg waffle and I have to say, I’ve lost my voice talking about chaffles! They’re great. If you’re missing bread, toast, buns, or even waffles, look into chaffles. They really have helped a lot of people with that urge to have bread or some sort of sandwich. They’re also simple to make.
Stan asks: “How long will it take to lose the sugar and carb addiction once I cut them out?”
Again, it’s individualized. Some people have no cravings at all, which is remarkable. Some people just sail through. Hunger is something that is caused by carbs. The hunger goes away very quickly, most commonly in a day or two. What happens is that you become able to differentiate or tell the difference between carb cravings and being hungry. Over time, the cravings fade and hunger fades. It’s pretty amazing. Worst case, it may take a week or two.
Worst, worst, worst case – I remember a fellow who had quit smoking 50 years before and he said he’d still love to have a cigarette, so there are some people who will always crave sugar. They’ll always want it. If you look at it, you’re going to want it, you’re going to purchase it…this is called advertising. So, the worst, worst case is that you may have a lifelong craving, but you’ve learned to deal with it and live with it and not go down that pathway again.
Liz asks: “I’ve tried giving up sugar. It’s too difficult without using sugar substitutes. Is this okay?” You mentioned that that is one of the tools that you use to help folks.
I don’t really know which one is better, metabolically. Scientifically, these have not been well studied in terms of metabolic effects in the entire body. We know many of them are not absorbed very well and they don’t impact the blood sugar, but they can impact the ketone metabolism and there are probably other effects we haven’t learned about yet.
I think any of these other sugar alternatives are fine, at least temporarily, to get you off of sugar. The best one for you is the one that tastes best for you. It’s an individualized thing. Some people will love this version of Coke or Pepsi, but they won’t like that other version. Test them out, go through the different ones to see the ones you like. I remember that there’s a technique of substituting or mixing different sweeteners. If you really want to go to that length, you use half sucralose, half aspartame (or some other non-sugar sweetener) to get the taste right for what you like. Companies have made products that don’t fit everybody and it’s okay, within reason, to mix and match the different artificial sweeteners to suit your palate. But you’re going to find the urge for sweetness and how it tastes will change over time, which is fascinating. Often three to six months in, someone says, “I had that sweet thing and it really wasn’t as good as I remembered.” Yeah, because your whole body has changed and you’re not dependent on it. You’re not addicted to it anymore.
Deborah asks: “ When I eat carbs like bread and pasta, it triggers my food compulsions. Why does this happen?”
To me, the science, the biochemistry, the building blocks of these foods are really all the same. While they look different, they all get digested to sugar. Yes, you can debate that you get glucose, fructose, and with dairy it’s galactose and lactose, but it’s all sugar. Even though it looks different, it all has that same metabolic effect. That’s why when you have bread it increases your hunger and cravings for all of those different carbs, because it’s really giving you, biochemically, the same substance.
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