Sugar is not an addictive substance: masterpost

There's so much nonsense doing the rounds about how "sugar is addictive just like illegal drugs are addictive", usually coming from LCHF cultists. So here's a masterpost of all the information to put that myth to rest once and for all.

Also though; here's my collection of reviews of That Sugar Film, in case you missed it: That Sugar Film: Link Dump

Update: September 2018

Here's a great new article; Is Sugar Really Bad For You, by Jessica Brown via BBC Future. It's wonderful to see such good and factual content on a major platform for once.

• Overall, evidence that added sugar directly causes type 2 diabetes, heart disease, obesity or cancer is thin.

You'll find much of the supporting evidence for the facts laid out in this article, below.

Studies on sugar addition, food addiction and eating addiction:

The plausibility of sugar addiction and its role in obesity and eating disorders.

http://www.clinicalnutritionjournal.com/article/S0261-5614%2809%2900239-8/abstract

• The [above] predications have in common that on no occasion was the behaviour predicted by an animal model of sucrose addiction supported by human studies.
• There is no support from the human literature for the hypothesis that sucrose may be physically addictive or that addiction to sugar plays a role in eating disorders.

 

The mesolimbic system and eating addiction: what sugar does and does not do.

http://www.sciencedirect.com/science/article/pii/S2352154616300638 

• Sucrose is reinforcing and it promotes dopamine release independent of its taste.
• Drugs and sucrose have strong yet transient effects on the mesolimbic system.
• Addictive drugs severely disrupt brain plasticity after long-term exposure.
• No data currently suggest similar central adaptations following sucrose.

 

Eating is addictive but sugar and fat are not like drugs, study says.

http://www.eurekalert.org/pub_releases/2014-09/uoe-eia090914.php

• People can become addicted to eating for its own sake but not to consuming specific foods such as those high in sugar or fat, research suggests.
• An international team of scientists has found no strong evidence for people being addicted to the chemical substances in certain foods.
• The brain does not respond to nutrients in the same way as it does to addictive drugs such as heroin or cocaine, the researchers say. 

 

“Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior.

http://www.sciencedirect.com/science/article/pii/S0149763414002140

• “Eating addiction” describes a behavioral addiction.
• An “eating addiction” is not necessarily associated with obesity.
•  Consider “eating addiction” as a disorder in DSM-5 “Non-Substance-Related Disorders”.

Sugar addiction: the state of the science

http://link.springer.com/article/10.1007/s00394-016-1229-6

• Given the lack of evidence supporting it, we argue against a premature incorporation of sugar addiction into the scientific literature and public policy recommendations. 

Eating dependence and weight gain; no human evidence for a 'sugar-addiction' model of overweight.

https://www.ncbi.nlm.nih.gov/pubmed/28330706

• The current findings indicate that sugary foods contribute minimally to 'food dependence' and increased risk of weight gain. 

See also...

Sugars and Health Controversies: What Does the Science Say?

http://advances.nutrition.org/content/6/4/493S.abstract

We conclude that added sugars consumed in the normal forms in which humans consume them, at amounts typical of the human diet and for the time period studied in randomized controlled trials, do not result in adverse health consequences. Although more research trials are needed in many areas of sugar consumption and health, there is little scientific justification for recommending restricting sugar consumption below the reasonable upper limit recommended by the Dietary Guidelines for Americans, 2010 of no more than 25% of calories. 

 Bonus Content:

• Australian obesity increases despite lower sugar intake.
• Soft drink and added sugar consumption on the decline in Australia.
• Is sugar addictive? Probably not, say Cambridge neuroscientists.
• Chronic fructose substitution for glucose or sucrose in food or beverages has little effect on fasting blood glucose, insulin, or triglycerides: a systematic review and meta-analysis.
• Researchers say fructose does not impact emerging indicator for cardiovascular disease.
  “This is more evidence that fructose has adverse effects only insofar as it contributes to excess calories,” said Dr. Sievenpiper. 
• Adiposity among 132 479 UK Biobank participants; contribution of sugar intake vs other macronutrients.
  Fat is the largest contributor to overall energy. The proportion of energy from fat in the diet, but not sugar, is higher among overweight/obese individuals. Focusing public health messages on sugar may mislead on the need to reduce fat and overall energy consumption."
  An excellent commentary on this study can be found at Gibney On Food.
• Focus On Sugar Is Hampering UK Obesity Battle.
• Sugar Fixation Hampering Obesity Battle.
• Weightology: No, You're Not Addicted To Sugar.
• No, Sugar Isn’t The New Heroin.

 Even More: Do people need to "quit sugar" to lose weight?

• Weight loss in overweight subjects following low-sucrose or sucrose-containing diets.
  Conclusion: These results provide no justification for the exclusion of added sucrose in weight-reducing diets.
• Metabolic and behavioral effects of a high-sucrose diet during weight loss.
  Results showed that a high sucrose content in a hypoenergetic, low-fat diet did not adversely affect weight loss, metabolism, plasma lipids, or emotional affect.
• Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women.
• Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids.

Bonus Content: Studies on the effects of restricting food choices. 

 

Selective carbohydrate or protein restriction: effects on subsequent food intake and cravings.

http://www.ncbi.nlm.nih.gov/pubmed/16844265

• The results indicated that selective food restriction resulted in selective behavioural consequences.
• Specifically, carbohydrate-restricted participants consumed more of a high-carbohydrate food than did controls or protein-restrictors, in addition to reporting more cravings for high-carbohydrate foods over the restriction period.
• Overall, selective food restriction is demonstrated to have negative psychological and behavioural consequences. 

Even more:

• Flexible vs. rigid dieting strategies: relationship with adverse behavioral outcomes. 
• Rigid vs. flexible dieting: association with eating disorder symptoms in nonobese women.
• How does thinking in Black and White terms relate to eating behavior and weight regain?

Also:
Restricting Your Children's Chocolate Could Do More Harm Than Good.

"In terms of parenting practice, the results indicate that in the short term, restricting 'bad' foods is an effective means to promote healthier eating habits. But by restricting access you may encourage a preoccupation with unhealthy foods which in the long term could encourage the very behaviour you are trying to prevent," explains Professor Ogden.

 And finally:

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Ending the unhealthy obsession with calorie deficit.

Always take a selfie.

I'll try to make this as clear as I can. Calories In / Calories Out is definitely a thing, but people need to STOP worshiping this idea about "calorific deficit", because it's stupid.

Now, don't get me wrong... and in fact I'll address this pre-emptively before the inevitable strawman attacks start: you cannot lose fat in a calorific surplus. If you take in more calories than you can put to use, that energy gets stored as body fat. Calories from any source as well, mind you.

However... the EMPHASIS on being in calorific deficit is all wrong. Note how I used to capital letters to emphasise the word emphasis just now. I'm not saying "take people out of deficit". I feel like I can't just say what I'm saying any more, I have to specify what I'm not saying as well, every paragraph or so. I'm going to go ahead and predict that a few people will still miss that and make stupid comments all the same once I share this to facebook.

Why not focus on being in deficit though?

As a profession coach and trainer and a specialist in Flexible Dieting with an interest in eating disorder awareness, recovery and avoidance, I've had active and athletic people come to me on... one particular example that I have in mind is a female athlete who came to me a few years back on 1300 calories a day and quite unhappy. She is now well aware that she REQUIRES a 3000 calorie a day minimum in order to see best results and performance at training, and to remain injury free.

That's something of an extreme example with very high fueling requirements, but it is quite common for me to reverse diet a female athlete from as low as 1100 or even 900 calories per day all the way up to 23, 2400, maybe 2600 calories per day subject to the amount they actually require to facilitate good results at their level of prowess at training.

Predicting an amount that is in deficit is easy. Literally, it's any amount that's less than would support current mass (including fat mass) and activity levels. All of these programs and diets where you just have an arbitrary amount like 1200 calories to restrict to, that's just about being in deficit and it's stupid. Some "macro plan" that doesn't end on a round number? Also stupid. Those "these are the only foods you're allowed to eat" type plans? They're not even smart enough to understand that how you'd lose weight on that plan is because you would be in deficit.

Now, on a personal level, "I just eat these foods and avoid those foods" is fine if people are happy with the food choices they're making and the results  they're seeing. I don't mean to insult people for not having a working knowledge of nutrition... other than the ones who are trying to enforce those choices onto others, and especially if they're charging money for it.

I have digressed. Where was I?

Picking an amount that is in deficit is easy, but it's not what is good.

As a coach who is giving sports nutrition advice, you need to be focused on how much people require, AKA how much they can utilise. That is, how much they can put to good use to fuel performance, to recover, and to adapt to training with the creation of lean mass. FKN IDIOTS WHO ARE BOUND TO SHOW UP TO TRY ARGUE WITH ME PLEASE NOTE: "how much they can put to use" does not translate to "a calorific surplus that would preclude fat loss", no matter what way you try to twist it.

Going back to those examples of mine from eariler: As a coach, you're never going to find out that your athlete requires 2400 or 2800 or 3000+ calories per day while you're thinking "results come from being in deficit, if you were in deficit you'd be seeing results". You won't have the BRAINS OR THE BALLS to raise their targets that high, so long as you're still married to and they're still enslaved by this brain dead notion of being focused on "calorific deficit". Rather, you're likely to slash intake targets even lower, clutch at straws about "not eating clean", or accuse the client of lying about their intake. These are the sort of things I keep getting told about, anyway.

Understand this: Not seeing fat loss does not necessarily automatically infer that you are "not in deficit" or that eating more would mean "going into surplus". While in deficit, tapping into fat stores is only one of many adaptations the human body might make and not necessarily it's preferred option. The further you go into deficit of an adequate amount, the less energy and resources the body will make available for other functions in order to preserve those fat stores.

Bottom line? If you're an athlete (and by this I mean anyone training with an interest in improving performance and body composition) you need to be fueled in a manner to facilitate performance and maintain condition. You can't build or maintain lean mass without making those resources available.
If you're a coach... if you're a trainer, train people and fuel them for results. We're supposed to be qualified professionals, stop trying to starve people thin with the same sort of logic I'd be dismayed to read on some kind of pro-ana blog.

You're not doing IIFYM if all you're doing is calculating a deficit, much less if you're just slashing further and further below some arbitrary amount.

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Reviews of That Sugar Film: link dump

By no means whatsoever could this be considered
"too much sugar". Don't let silly people spoil your enjoyment
of nutritious & delicious foods.

What we know about sugar is that you really don't want to have too much of it terribly often.

What does "too much" mean, though? Well, according the World Health Organisation we should limit to no more than 6 teaspoons of added sugar on a daily basis. Key word here is "added", as the naturally occurring sugars within nutritious foods are absolutely fine within the context of a balanced diet of appropriate total energy provision.

Another word for those naturally occurring sugars is "intrinsic". We're talking about the fructose in fruits and vegetables, the lactose in dairy products, and so on. Various unsavory characters out there are making a lot of money via fear mongering over carbs in general, sugars in particular, and in some cases fructose specifically. Rarely are they actually people with a medical or dietetic background. More often they are simply marketers (at best) or outright charlatans and con men (and women).

Again, to reiterate: intrinsic sugars within an appropriate total intake are of no concern whatsoever. Added sugars in less nutritious & more indulgent choices should be limited. No country as best I am aware has healthy eating guidelines to the contrary, all recommend that added sugars be limited. The suggestion you'll often read from Low Carb High Fat trolls enthusiasts that the official guidelines support massive consumption of sugars is ridiculous and disingenuous. In other words they are lying through their teeth.

However it is possible that people might be unaware of the amount of sugar in some choices of foods and condiments that wouldn't seem obvious. This may be a valid concern which That Sugar Film addresses, however, none of the other claims it makes about sugar should be seen as even vaguely accurate.

A few quick side notes:

1. It seems apparent that anti-sugar quackitivists also similarly fear monger over artificial sweeteners and in some cases other plant based sweeteners such as stevia. There is ample and on going research to support the safety of non-nutritive sweeteners such as aspartame. 
2. Sugar is not addictive "like drugs are addictive".
3. Be aware of how much "still sugar, but not regular cane sugar" is often in expensive "sugar free" products. In some cases more so than in the conventional brands they would claim to be "healthier" than.

Reviews of That Sugar Film:

Do Not Believe The Shoddy Science in That Stupid Sugar Film.

This one might be my favourite.

Gameau’s panel of experts includes a supergroup of charlatans and cranks, [such as] the floppy-haired nutrition guru David Wolfe. A self-described “Health, Eco, Nutrition and Natural Beauty Expert” and “one of the world’s top authorities” on “chocolate and organic superfoods,” Wolfe spends his days touting the spiritual and health benefits of such things as deer antler spray (a “levitational,” “androgenic force”), baby-reflexology, and “earthing” (in which people plug themselves into the ground wire of an electrical outlet so as to “naturally discharge electrical stress from our bodies”).
Seen outside the context of That Sugar Film, the man appears to be a lunatic.

Sugar, sugar everywhere, but not a grain to be seen.

Thanks to Prof. Tim Crowe at Thinking Nutrition.

Damon claimed that his weight gain happened despite eating the same amount of food than before his high-sugar experiment. Yet only a very superficial attempt was made to estimate how much food was being eaten over the 60 days, making such a claim unreliable at best.

So, is there something insidious about sugar calories that can lead to greater weight gain? Not really. Sugar, including fructose, is not inherently fattening relative to other foods. Its effect on body weight is from the extra energy it adds to our diets, that’s all.

Those Sugar Films, How Do They Stack Up?

A great write up of this and a couple of other films about sugar, from The Nutrition Press.

Taking a closer look at the show’s talent, we find a lack of relevant expertise. The show’s chief sugar adviser, David Gillespe, is a former lawyer and founder of a software company. He has no scientific or nutrition qualifications and his book Sweet Poison, which supposedly reveals the true health effects of dietary fructose, has no scientific basis. It is certainly true that Australians are consuming too much sugar but Gillespe’s claim of 40 teaspoons as the average Australian’s daily sugar intake is an over-estimate by about 10 teaspoons. He also says that the average family of four consumes the equivalent of 6 x 1kg bags of sugar each week. Doing the math, based on his own figure of 40 teaspoons, a family of four would consume 4.48kg. Based on 30 teaspoons, this figure is 3.36kg.

D-discussion on ‘That Sugar Film’: Diabetes Counseling Online.

Some of these processed foods that are referred to in the film are baked beans, containing the equiv of 1 tsp of sugar per serve. Using baked beans as an example, the beans themselves are highly nutritious and 1 tsp sugar is in the sauce, which also contains nutrients such as lycopene that we need to obtain from cooked tomatoes.  That 1 teaspoon of sugar is not enough to spike your BGLs and baked beans do have a low glycemic index, so they’re a good option for us when we need a meal in a hurry.

There are also other processed foods such as tinned and frozen vegetables, some breakfast cereals, some grainy breads and dairy products that as a dietitian I regularly encourage people to use.  If these products weren’t being recommended, then chances are that people might inadvertently choose something less nutritious in an effort to have a little less sugar. Learning to label read is so important here. Some of the healthier, lower GI breakfast cereals are really convenient options in our busy lives, as well as containing important nutrients that we need for wellbeing, despite containing some added sugars.

Food Watch Reviews That Sugar Film.

Damon consumes lots of liquids which have been shown to be easier to over-consume than whole foods e.g. apples vs apple juice. I’m guessing his intake DID exceed what he was eating before and these sweetened liquids were responsible for the fat gain in the abdominal region as well as the decline in liver function.

Who ever said flavoured milk or iced tea drinks are ‘healthy’? They may be healthier choices than sweetened soft drinks but they are not on any 'Must Eat Lists' or Pyramids.

 

That Sugar Film review: Powerful propaganda proves little.

What limits the film is that its central method of argument is unscientific by definition, despite the facts and figures provided by a slew of presumed experts. Simply put, Gameau's one-man experiment is not rigorous enough to prove anything at all, however striking his results seem.

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Let's all stop pretending that support for a sugar tax is motivated by anything other than fat shaming.

Things that aren't logical bother me.

Case in point: This sugar tax so many people seem to be clamouring for all of a sudden.

It would have virtually no impact on me as I don't use a lot of sugar or foods with a lot of added sugar in them as far as I'm aware, but on purely logical grounds, the idea doesn't cut it.

Public health policy needs to be based on facts, not assumptions. The statistics say that while cases of obesity are on an upward trajectory, sugar usage is already on a downward trajectory and has been for some time.

I feel like the support for the idea has a lot less to do with being concerned about people's health or the economic ramifications of a population more susceptible to lifestyle preventable conditions such as type2 diabetes for example, and a lot more to do with generic, run of the mill fat shaming.

To use the "carrot and the stick" analogy, this is all stick. We're going to hit people in the hip pocket where they'll feel it the most, until they learn not to / can't afford to be fat people sitting around loading up on sugar all day. Newsflash jerks: the stats say that's not happening anyway. Even if it was happening, it's still a jerk-like approach based on the biased assumption that quote unquote "fat people" are all a bunch of lazy good for nothings.

I don't believe that's the case. Lazy good for nothings come in all variety of shapes and sizes. By no means does that exclude any of the larger variety, but personally I've known some quite skinny ones who wouldn't work in an iron lung either. You wouldn't have 'em around just to swear at once in a while because they'd some how mess that up even.

Now, here's how this actually works.

People will gain weight because their energy intake exceeds their energy requirement. That excessive energy intake (we know this is a fact) is from "a little too much of everything across the board", and not "because supermarkets have an aisle devoted to soft drink" or because "sugar is hidden in foods you've been lead to believe are healthy" or whatever other nonsense you might have read, usually from someone with no relevant qualifications who's appointed themselves an expert all the same. It's a little or perhaps more than a little too much across the board, not any single thing in particular.

However, it might not actually be that people are consuming more than what should be a normal amount of food. This is a two part equation, and the other part which is also quite likely to be a significant factor is a lack of energy expended via strenuous activity.

This doesn't mean people are lazy. It just means they are not suitably motivated to train.

If you have up to an hour of travel to get to work, 8 to 12 hours there trying to get stuff done, probably being frustrated by incompetent management, under staffing, outdated IT systems, whatever else... up to an hour to get home again, battling traffic or wedged in like sardines on a train or tram... it's not fkn LAZINESS if you don't then jump and hit the gym.

Don't get me wrong though, I have done it myself. Straight to the gym after a 12 hour shift and an hour drive to and from home again. But the difference is that I would have been looking forward to the gym all day. That was the easy part for me. The good part after 12 hours of extreme mental effort and emotional restraint required not to lose my shit with anyone during the day.

My point is that hitting the gym after a hard day at work requires a certain level of motivation and the absence of that motivation should not be interpreted as laziness, especially if a lighter person would escape your criticism.

Reasons people aren't motivated are various but I'd suggest it's something to the tune of "I don't enjoy it, I'm not good at it, and even when I've forced myself it didn't get me anywhere anyway" and ditto for why people can't just "eat healthy" according to someone else's rigid and narrow interpretation of the concept for that matter too.

More Carrot, Less Stick.

Limiting consumption of added sugars in nutritionally sparse snack choices is an excellent idea, and is recommended the Australian Guide to Healthy Eating and in official guidelines around the world. Being enthusiastic about fitness, exercise, training and being active is something that should add quality and enjoyment to your life while also being beneficial to health and wellbeing.

You can't "enforce" this stuff via negative reinforcements, shaming and financial penalties though. People need to be encouraged and empowered to find the balance to include physical activity in their daily routine while also meeting their other obligations. They need to be empowered to find the balance of healthy & more indulgent foods within eating habits that are appropriate over all.

All of this needs to be something that we feel good about and are enthusiastic to participate in. Not something we're obliged to do to deflect the criticisms of others. While the various branches of the "wellness" related industries use shame based tactics to promote overly restrictive diets and approaches to exercise that are more punishing than productive, we're not addressing the problem. We're adding to it.

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Science and sense based recommended reading this week.

I haven't kept up with my "week in review" posts for some reason but here's a bunch of great and informative stuff you might enjoy &/or be enlightened by.

• Imogen died wanting to be thin.
  After years of suffering and starvation, Imogen Brennan realised anorexia would claim her life if she didn't get help. Here, she shares her story in the hope of changing misconceptions about eating disorders.

• Intuitive eating is inversely associated with body weight status in the general population.
  Thanks to The Nutrition Guru & The Chef.
  "A recent study has shown that those who intuitively eat (listen to their hunger and fullness signals) and don't have a list of forbidden foods, are less likely to be overweight or obese."

• Re-examining High Fat Diets For Sports Performance
  Thanks to Gabrielle Maston for this one.
  "The push behind this diet is not driven by science. Nope, only by a few popular social media scientists that have driven this through anecdote and poorly designed studies."

• Carbs, Diet Cults & Broscience: A Look Into Fitness Fallibility
  This is a long one, looking into critical thinking or rather the abscence of it in regard to certain theories and practices in the fitness scene.

Finally here's a nice video on The Science Of Persuasion.

As they said on the I Fucking Hate Pseudoscience page, "It's interesting how closely the minds of marketers and con artists align".

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