Maintenance Phase - The Trouble with Sugar

Episode Date: April 11, 2023

This week we're tackling three big ideas about sugar: It causes hyperactivity in kids, it's as addictive as cocaine and it raises blood sugar in universal, predictably spiky ways.  Thanks to David Johnston for helping us with sources for this week’s episode!Support us:Hear bonus episodes on PatreonDonate on PayPalGet Maintenance Phase T-shirts, stickers and moreBuy Aubrey's bookListen to Mike's other podcastLinks!Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole SmithSugar Rush: Science, Politics and the Demonisation of Fatness by Karen ThrosbyIs sugar really as addictive as cocaine? Scientists row over effect on body and brainSugar Is Not the EnemyDr. Benjamin F. Feingold, Controversial PediatricianIs There Such a Thing as a ‘Sugar High’?Effects of Diets High in Sucrose or Aspartame on The Behavior and Cognitive Performance of ChildrenSugar and the Hyperactive ChildSome popular diets are based on this carb-rating scale. Here’s why it could be misleading.Glycemic Index: History and Clinical ApplicationGlycemic Index and Glycemic Load Low glycaemic index or low glycaemic load diets for overweight and obesityWhat is the glycaemic indexDon't Play a Numbers Game, Experts Say, Just Eat Your VegetablesSugar addiction: the state of the scienceThanks to Doctor Dreamchip for our lovely theme song!Support the show

Something is happening outside. I think he's like a Sob-later or something? Ring! One of those. Wait hang on. Is it the vacuum lady? Oh, no, it's the fucking leaf blower! God damn it! Give me a second, I'm gonna look up the window. Oh, there's fucking nothing to blow! Uh-huh. God knows we've had the fucking time in the lead up to this episode. I have postponed this one two times, I think. But that makes this one worse. Uh-oh, that's even good. You don't want people to know how much time you have?

I've actually had time to think about it. Welcome to maintenance phase, the podcast that spikes your glycemic index. No, it's not what we're talking about today, like, like, Hoses? This is, I will say, an argument that I have that is ongoing with a member of my family who says, oh, I can feel that that spikes my glycemic index.

And my response to him is the glycemic index is a document. So what you're saying is like, my dictionary hurts. Oh. I can't believe you're about to tell me that some piece of health information is false. On the show, I feel betrayed. Roode! Uh, I'm Michael Hobs.

I am, Obrich Gordon. If you would like to support the show, we're back to tiny repeating machine. I'm trying to do it alongside you. If you would like to support the show, you can get T-shirts, mugs, tote bags, all manner of things at T-Public. You can subscribe at Patreon or at Apple Podcasts. They're the same audio. So audio. And today, Michael, we are talking about myths about sugar.

Take me on a journey. There are so many places this can go. I am a boosting with things to tell you. You are bursting. You all, you've texted in the last like two weeks, is like, I'm go. I am a boosting with things to tell you. You are bursting. You all, you've texted in the last like two weeks, is like, I'm excited, I'm excited, I'm excited. I can't tell you any of the things. But like, I definitely had a conversation

with a friend of mine yesterday, and she was like, is this gonna be about the fucking rat study again? Oh, like I've been yelling at my friends about the stuff that I have been learning, non-stop to the point that they have been learning, non-stop, to the point that they are tired of it. The little sugar rats.

The little sugar rats. I'm excited to meet them. So we're gonna focus on three big ideas. One, the idea that sugar makes kids hyperactive. Okay. Two, that we can predict how different foods impact most people's blood sugar. Okay.

And three, that sugar is addictive, and particularly the claim that gets made most frequently is sugar is as addictive as cocaine. This is a discourse that has been around for a while, which I have complicated thoughts on, so I'm excited to get into this. So Michael, I thought that we should start with a little conversation about what sugar is. Please do. I went to my favorite, as you know, cafe gratitude. Oh, check out.

And Los Angeles. And they had a key lime pie that they were like, it's raw and it's sugar-free. And I was like, oh, how do you sweeten it? And they were like maple syrup. Oh, yeah. And that is not sugar-free. I remember like, oh, how do you sweeten it? And they were like maple syrup. And I was like, that is not sugar-free. I remember reading somewhere that anything you see

on the ingredients list that ends with oats, like dextrose, sucrose, lychtoes, nactose, it's all sugars. Sure. They hide sugar in the ingredients lists as like if that paraded cane juice. Yeah, absolutely. This is also where we get the idea that like agave

is like better for you, quote unquote. It's for ass a cave. So when people think about sugar, they think about those images of like a coke bottle and then a bunch of teaspoons full of white granulated sugar, right? Folks are thinking of, sugar, you put in your coffee.

It is worth noting that multiple kinds of sugar exist and all of them exist naturally. Glucose occurs naturally in honey, agave, and fruit, especially dried fruit. It can also occur in cured meats like salami because they will use a salt and sugar pack to draw the moist sugar out of the meat, right? Right. Fruit toast is a sugar that's found in fruits and vegetables. Lactose is the sugar that's found in dairy. Oh, yeah. Maltose is a sugar that is found in sprouting grains. There's also logos, pathos, and evens.

It's like a new school, yes. So different sugars are processed differently. Glucose, for example, is absorbed through your intestines and directly into your bloodstream. Fruit toasts, on the other hand, is processed in your liver and doesn't appear to increase blood sugar or create the same kind of insulin response as glucose does. So different sugars operate differently.

According to Harvard, quote, for most people, one type of sugar isn't better than another. This entire episode is a cafe gratitude sub-tweet. You're like, I'm just, I'm still mad about this. Michael, every episode of the show is a campaign of grosses. I'm too heat.

Dude, I quit eating all sugars after I watched that YouTube video. This was in like 2011 or something. I don't know this YouTube video that you're talking about. Oh, the Robert Lustig one, sugar, the bitter truth. Oh, I know about Lustig, but I haven't seen the video. I watched it and then I was like, okay, for a month, I'm gonna try eating no sugar. So no berries, no desserts, and I did, in fact lose a bunch of weight and then the minute I started eating sugar again

I gained it all back just like everything. Okay, great Just like everything. It's like I don't know what the point of that was. I was trying to think of a name Like what would be the name for the Robert Lustig video and the closest I came up with was an inconvenient tooth Better but that would have to be about the dental effects, you know? Okay, are you ready to dive in to our first big cultural idea about sugar? Give me rats. Let's go. No. Okay, so first up, we're gonna talk about the idea

that sugar makes kids hyperactive. Yes, I grew up believing this. I mean, this is something that's kind of like in the background of like, don't feed the kid sugar because they'll be like ramped up all day. Which, I gotta say anecdotally, like really feels true. Almost all of these really ride the coattails of it feels true. Right?

Like that's how this stuff gets as far as it does. This one was huge when we were coming up and it's only gotten bigger in the years since. There are some schools now that have rules about only bringing sugar-free snacks. Oh, interesting, okay. The first time we hear in scientific literature, a connection between sugar and behavior is 1922. Okay. The idea was first floated in a paper that was looking for dietary causes of behavioral issues.

It suggested that sugar consumption could lead to becoming, quote, the neurotic child. Ooh. From there, it genuinely just kind of sat on a shelf for 50 years. It didn't really go anywhere. People weren't super concerned about it. It didn't really hang on until it resurfaced in the 1970s

when researchers started looking into ADHD. The biggest boost that this idea gets is in a book called Why Your Child is Hyperactive by Dr. Ben Finegold. And Ben Finegold creates the fine-gold diet and writes this book about children and hyperactivity. And both of those books really point the finger at sugar, artificial sweeteners, and artificial additives. The Washington Post actually wrote an obituary

of Dr. Fine Gold that includes a pretty good synopsis, and I am going to agree, dang, send it to you. I get to do my little audiobook voice. Mm. Dr. Fine Gold proposed that at least half of the children diagnosed as hyperactive would be helped if they eliminated factory-produced soft drinks, cake, candy, pudding, processed cheeses, and luncheon meats. He also said foods such as cucumbers and many fruits containing salicylics.

Salicylics. Contributed to hyperactivity as did tea, mint, and winter grain. That's a gum. He said treatment of hyperactive children with emphetamines was doubtful therapy and should be used only as last resort. So this is this dumb shit, where it's like, it's not the very well-established thing that your child has been diagnosed with.

It's like his diet. Yeah. It's like taking baths to cure autism shit. It is sort of mobilizing parental discomfort with the idea of giving your kids drugs. Yeah, it's like taking baths to cure autism shit. It is sort of mobilizing parental discomfort with the idea of giving your kids drugs. And it is sort of giving folks who have that discomfort somewhere else to go with it. And that place to go with it is no soda, no cake, no cucumbers. Cucumbers. Right? T. Fuck you, T. Someone's finally saying it.

The idea essentially was that eating sugar triggered insulin spikes, which led to adrenaline spikes and hyperactivity. But the data was regarded with some skepticism by other scientists because it was pretty weak, right? Yeah. Fine Gold's book wasn't based on randomized controlled trials, it wasn't based on meta-analyses, it wasn't really based on any hard and fast research. It was based mostly on his own anecdotal observations in his own clinical practice as a pediatric allergist. Yeah. So, the fix is kind of in on fine gold's work, starting in the 80s in earnest.

There's a 1983 research review in the Journal of Learning Disabilities on this idea of sort of quote unquote, the fine gold hypothesis. They looked at 23 studies and found that, quote, diet modification is not an effective intervention for hyperactivity as evidenced by the negligible treatment effects which are only slightly greater than those expected by chance. Of course. We also get a research review in 1986 that finds that, quote, although the results of correlational studies suggested that high levels of sugar consumption may be associated with increased rates of inappropriate behavior, the results of dietary challenge studies have been inconsistent and inconclusive.

Most studies have failed to find any effects associated with sugar ingestion, and the few studies that have found effects have been as likely to find sugar-improving behavior as making it worse. So does this mean the entire idea of sugar highs and sugar making kids hyperactive is based on this idea that it causes ADHD? That is sort of the root of it, right? And then it becomes more generalized. It sort of seeps out.

It leaches out into culture more broadly. And folks develop this association that is like any high energy or frankly just like irritating behavior from kids is likely a result of any sugar they may have eaten. So we get these couple of sort of research reviews and people are like, I don't know about this, right? But there is a moment when you talk to people who know ADHD research and who know sugar research,

if you ask them when this was debunked, they will say 1994. Oh yeah. 1994, there's a study published in the New England Journal of Medicine. They're looking at both sucrose or sugar and aspartame. The sample size is half pre-school age kids who are three to five and half elementary school age kids who are six to ten. All of the kids involved are described by their parents as being quote-unquote sensitive

to sugar. Okay. Kids and their families followed three different diets for three weeks each. One was high in sugar, but had no artificial sweeteners. One was low in sugar, but used asperate, as a sweetener. One was low in sugar and used a placebo. They used saccharin as their sweetener. Okay. Essentially what they did was clear out these families' cupboards

and replace them with totally new food each week. So it's a home invasion but in reverse? Yep, totally. They're putting things in. They also found a way to test whether or not people were sticking to the diet. Okay. They added high amounts of ascorbic acid to the aspartame, which is vitamin C, and they added high levels of riboflavin to the sucrose.

Oh, and they P tested people. Right. Because it all comes out on your P. And then they would be like, okay, you really did it or you really didn't. Do. In addition to that, they also took fasting blood work, they did behavioral assessment, and they did cognitive assessment every week

of this experiment. It is kind of funny to me that they think having a good methodology will prevent like the woo, woo, weirdo is online from still being like, oh, it causes ADHD. Are you ready for their findings? Yes, I think that it's the cucumbers. It is the cucumbers.

They didn't cut out cucumbers. Actually, the cucumbers. They found that neither sugar nor asper team, quote, adversely affects the behavior or cognitive functioning of children. OK. But they also found this, quote, cognitive or behavioral differences

were as likely to be found between sham diets as they were between experimental diets. And the few differences associated with the ingestion of sucrose were more consistent with a slight calming effect than with hyperactivity. Interesting. So like, a, people reporting bigger differences around the fake made up diets.

They're like cosmetic changes. Yeah. And B, if there was any effect, it wasn't really statistically significant. But it appeared that it was actually like chilling kids out a tiny bit. So give kids sugar if you want them to calm down. That's the maintenance phase in George's mouth.

Yeah, exactly. Around the same time, there is an editorial in the New England Journal of Medicine from Dr. Marcel Kinzborn, who's a pediatric neurologist, and says that actually, like, this is kind of a chicken or the egg situation, right? Like, does sugar consumption make you less inhibited or does disinhibition lead to an increase in sugar consumption?

Right, right. And ultimately, Dr. Kinsborne includes this pretty like mic drop-y quote. He says, there is no evidence that sugar alone can turn a child with normal attention into a hyperactive child. The same applies to Asper team, which has also been suspected of causing behavior disorders

in some children. Sugar clearly does not induce psychopethology, where there was none before, but it may on occasion aggravate an existing behavior disorder. Sugar-free diets can be burdensome and socially inhibiting, and they should not be endorsed purely on the basis of anecdotal evidence.

So basically, there might be some conditions that maybe your kid has that makes them hyperactive, but at the population level, we just can't say that there's any link between sugar and hyperactive behavior or hyperactive disorders or other mental conditions. Right, at this point, we're talking about 10 years of research reviews, RCTs, all of this kind of stuff that keep looking for this link and keep not finding it, right? I remember reading a super fascinating study years ago on the effects of alcohol.

We often think that things like, you know, barfights are kind of the way that people act when they're drunk in Western societies. We think of those as like the biological effects of alcohol. But what this study pointed out was that alcohol effects are actually very cultural. And there's some societies where it leads to a ton of violence. And there's some societies where it doesn't. Like where it's like, I love you, man, kind of drinking.

Totally. And what they said was basically, there's like societal expectations about how to behave when you're drunk that actually affect your behavior when you're drunk. And I do wonder if there's something like that with sugar. I remember as a kid, I was always told that like sugar will make you hyperactive. Yeah.

So maybe it did make me hyperactive because somewhere in my brain, it was like, you just had some sugar, you should not get hyperactive now. I mean, Michael, you are handing me a segue on a silver platter. Mm. Most of the explanations that they're now exploring

for this are social. One of them is that this is it as you noted a self-fulfilling prophecy, parents express so much anxiety about kids' behavior around sugar that it cues kids to act that way. Children are basically that horse that tapped its foot to do math. Horse math.

Like that is one of the possible explanations here. Another of the possible explanations is like think about where you're getting sugar when you're a kid. It's usually birthday parties, celebrations, big gatherings. If you have ever seen a child at a birthday party, you know that emotions run high. That's not sugar. That's children. But one of the most popular explanations for this is that it may actually be a response to restriction of sugar. One dietician told the New York Times, quote,

the psychological effect of food restriction cannot be overstated. When we restrict children's access to sugar, they are naturally going to become more preoccupied with and drawn to these foods, and overreact and have erratic behavior when they do get them. It is very possible that essentially what we're seeing in like families that are nervous about sugar

is that those parents are expressing a high level of anxiety around their kids having sugar. They're restricting it really heavily. Their kids are only getting it when they're in sort of social settings with other kids. Like kind of all of these explanations are coming into play for some families. Dude, that's how I was with MTV. What are you talking about? Like kind of all of these explanations are coming into play for some families.

Dude, that's how I was with MTV. What are you talking about? We didn't have cable. And so I would go over to Friends Houses and all I wanted to do was watch music videos. No, that was our family too. My parents would talk about like, we can't have TV in the house. If we have TV, all we do is watch TV. And there wasn't any recognition of like, when you have it all the time, the bloom is

off the rose. Right. And you have actual willpower around it. I had no MTV willpower. I know I can't have this thing, so I'm going to be like a camel filling up my hump with TV, right? Or maybe the Bjork videos were just really good and it was worth it. I mean, the Bjork videos are good.

Gondrie Hive. It is worth noting just to close out this section that today, most mainstream professional associations and health organizations do not recommend any dietary interventions for people with ADHD. There just isn't enough evidence to suggest this is an effective treatment for most kids with ADHD. Kids may have ADHD and food allergies or

sensitivities, but ADHD isn't treated or caused by dietary sources. Just like full stop, right? And yet it is the first place that we go as a society because we think of this as like personal responsibility shit. There's always a lot of anxiety about children among like middle-age and older people just because like the mores and the music and the behavior of kids is just a total mystery to everyone who's a little bit older. And so things like autism and ADHD,

there's this little thing in the back of your little middle age brain that goes, maybe this is fake. Yeah, absolutely. It allows people who don't have ADHD to dismiss, people who do have ADHD, right? Yeah, my kids don't have ADHD. Yeah, absolutely.

Probably just a cucumber or something. Uh, Michael, Aubrey. Are you ready for our next big idea about sugar? I want the rats, give me rats. I'm here for the rats. The next big idea we're gonna dig into is the idea that we can predict how different foods impact most people's blood sugar.

Is this the glycemic index section? This is the glycemic index section. Thank you. I'm excited. Have you heard of the glycemic index from anybody other than me? Ah, for the last like three years, you've ducking up the constantly.

I've been learning to do the glycemic episode for so long. My understanding is that it's like a real thing that like certain foods spike your blood sugar and then some of them spike it more. So this is the whole thing of like eating brown rice rather than white rice and eating high fiber foods rather than low fiber foods. Rather than spiking your insulin like a little Everest,

they flatten the curve. Yes, they make it a little hill. Yeah, it's like the hill from the Windows desktop background. I mean, you kind of nailed it, right? The glycemic index is also where we get these like very internet-y kind of claims that potatoes are worse for you than a Snickers bar. Or an Apple is worse for you than Ice Cream.

Those are all just people parroting out results from the glycemic index, which really does rank ice cream as being a lower glycemic choice than an apple. It really does rank carrots as having more sugar than table sugar. Is that because the ice cream has fat mixed with sugar and so it slows down how much it hits your body?

You're just skipping ahead, my friend. Could you stop skipping ahead. Like, what? Could you stop skipping a hit? A lot of people seem to think that our show is scripted. What? They think this whole thing is fake. I was like, no, no, no, no, no, no. I really don't know where Aubrey's going with this,

which is why I keep ruining the episodes. Yeah, totally. That's why we both keep doing it. I know. So just to get into the next level of detail with the glycemic index, it's basically a scale that is plotted from zero to 100, right? The guy who created the glycemic index

is a Welsh physician and sixth generation doctor named David Jenkins. He went to Oxford. He's invested into the order of Canada for his contributions as a nutrition scientist. Here is the study design for coming up with the initial glycemic index. This is published for the first time in 1981.

They have volunteers fast for 12 hours, as you do with fasting blood work, right? He would then feed a group of volunteers one food on its own. Okay. Just potato or just strawberries or just milk. Okay. And then two hours later, he would measure their blood sugar to see how that food had impacted their blood sugar. Okay. This is where we get to the first problem with the study. Would you like to guess how big the groups of volunteers were for each of these foods?

Oh, is it like two people and ones like his cousin or something? Five to 10 people. And is there big variation between the people and how much it's spiking it? Totally, there's individual variants. The other part of the study design is the way that they are feeding people these foods

isn't you're eating a potato or an apple. They want to have the same quantity of carbohydrate. So they're feeding people 50 grams of carbohydrate in a given food. How much is 50 grams of carbs? Is that like more than we would typically eat in a day? Oh my god, Michael, here are some examples. A small bottle of coke, like 16 ounces of Coke, 50 grams of carbs.

A cup of white rice, 50 grams of carbs. 10 cups of popcorn. Okay. 50 grams of carbs, 20 cups of cucumber, 50 grams of carbs. That gives me 80 HD. So people are sitting there eating 20 cups of cucumber. Yeah, that's a lot of cucumbers, man.

People also don't usually fast for 12 hours and then only eat one food, right? This is like dry toast without jam, it's popcorn without butter, and then it's not eating anything else for two hours. Right. So when you eat potatoes alone, your blood sugar does one thing.

When you eat potatoes with a steak, the fat and the protein in that steak slow down your digestion. And they kind of flatten the curve of the glycemic index, right? So potatoes will have less of an effect if you are eating them with something with a lot of fat, a lot of fiber, some protein, whatever. Same thing is true if you put some avocado on some toast, right? Right. Avocado has a ton of fat and fiber in it, both of which slow down digestion and change the

impact, the glycemic sort of impact of the bread, right? So basically, you can't really say that like potatoes have 35.7, glycemic and nice because it depends on what you're eating them with and what you've eaten before and how much you're eating, et cetera. Yes, and that is the first problem of five problems. It's a glicemic and next thing I've missed in our era. The second sort of issue here is that lots of things influence the glycemic index of a food, right?

Potatoes come in different shapes and sizes. If you are frying potatoes in oil, those potatoes are gonna have more fat, they're gonna be digested differently and have a different glycemic index than a baked potato or a boiled potato, right? The type of sugar that a given food contains can change its glycemic index.

Fructose, for example, has a score of 23, but maltose has a score of 105. The structure of the starch in the food can impact its glycemic index, its ripeness. Of course, because of sugar, yeah. Totally. So an unripe banana has a glycemic index of 30, and an overripe banana has a glycemic index of 30, and an overripe banana has a glycemic index of 48. How a food is processed can impact its glycemic index.

For example, rolling oats disrupts the structure of its starches and makes them easier to digest and therefore raise its glycemic index. And how much we chew food can impact its glycemic index. And how much we chew food can impact its glycemic index? That's right. My understanding is that's like the very first diet. Was the like chew your food diet? Show your food a hundred times.

So maybe he was onto something and like, it's like I never remember that was. Not only. Thing three, with the glycemic index, we now know that individuals responses to different foods vary widely from person to person. A food that doesn't really move the needle on my blood sugar might make yours go through the roof.

This is true of two diabetic friends that I had years ago, one of whom could eat popcorn all day and was like, it's totally fine, I love popcorn. And the other one could have one handful and her blood sugar would go bananas, right? Oh yeah. But this is like not very well known to people who are not sort of managing

their blood sugar for medical reasons, right? There is not a diet or a dietary intervention for people with diabetes or insulin resistance that is considered to be evidence-based. Oh. There is nothing. So how do they test it for people with diabetes? How do they figure considered to be evidence-based. Oh. There is nothing. So, how do they test it for people with diabetes? How do they figure out how much it's spiking?

Do they just do it on an individual basis and then go from there? You get a blood sugar monitor, you test your blood sugar, and I think in many cases, folks are instructed by their health care providers to try out different things and test your blood sugar and see what it does. Wow. Problem number four. The glycemic index is build in popular diets as a method of weight loss, but research consistently shows it does not deliver weight loss.

One meta-analysis of randomized controlled trials on low glycemic diets followed for up to 17 months that looked at 2,300 fat people found no difference in body weight and waist circumference. Another review from Cochran analyzed six RCTs with 202 participants who followed low GI diets for five weeks to six months, and they found that they lost an average of one kilogram more than people on other diets, right? Yeah. And it sounds like every diet study. And then the last thing to know about the glycemic index is that it isn't actually

recommended for individual use. Oh. Medical associations and institutions don't actually recommend generally that individuals use the glycemic index as a standalone tool to decide what to eat. The NHS has this to say, quote, foods with a high GI are not necessarily unhealthy and not all foods with a low GI are healthy. For example, watermelon and sometimes parsnips

are high GI foods while chocolate cake has a lower GI value. Also, foods that contain or are cooked with fat and protein slow down the absorption of carbohydrate, lowering their GI. For example, crisps have a lower GI than potatoes cooked without fat. In the UK, they use the word crisps to mean elevator.

Tin foil. The last thing I'll say on this point is that the glycemic index also isn't recommended for individual use by the American Diabetes Association for people with diabetes. They rate the current data as poor quality. There is some evidence that the glycemic index may be helpful in prevention, but it is not recommended in treatment. So again, the folks who ostensibly need it the most

are not recommended to use this as their tool for deciding what to eat. So basically it's like any other framework I guess where it's like maybe useful in certain circumstances. I mean, maybe people use it and like it and that's fine. But as a sort of population level of recommendation it just isn't very meaningful. Yeah, and it's hard to figure out. It's not very intuitive. You have to have these tables with all these pages and pages of results.

And then, of course, all this stuff breaks down too, as soon as you go to like a fucking restaurant. These conversations are mostly happening among people who are not diabetic, don't have PCOS, and don't necessarily have insulin resistance. So, they're mostly people as a result who have a very imprecise understanding of blood glucose and how it all works, right? Like a me. Like a you.

But you haven't taken me to rats yet. Myth three is where we get to the rats. Let's do small mammals. Save in the best for rats. Oh. Oh. That was actually pretty good. You've topped yourself.

So, Michael, our third and final big idea that we're going to tackle today about sugar is the idea that sugar is addictive and particularly that sugar is as addictive as cocaine. I know where you're going with this shit. I always hate this, where oftentimes you hear this rhetoric that's like it affects the same part of your brain as heroin or whatever. That just seems like the pleasure part of the brain.

Yes, absolutely. I think particularly this claim that sugar is as addictive as cocaine has really gained traction in the last five or so years, right? I wanted to start us out by saying that this is kind of a tough one because feelings run high about this one, right? Okay, cocaine is so fun. I genuinely would not know. I have not done cocaine.

Dude, I thought, due to the dare program that I would constantly get offered cocaine, and like, I am not cool enough to have ever been offered cocaine in my whole life. And like, I absolutely would have done cocaine if someone had offered it to me. So listen, I had a coworker at one point who described me as having a two drink personality. That's good. Right, he was like, it's like you've already had

a couple of drinks. That's kind of your vibe. Yeah. I might say there is already a whisper of cocaine in your default setting, right? Yeah, a couple of dreams. Yeah. That's kind of your vibe. Yeah. I might say there is already a whisper of cocaine in your default setting, right? Yeah, a little bit. So turning up the volume on that is really something. Imagine my little voice and personality.

So I think you a little clip of how this is getting sort of build in mainstream media outlets. This is a clip from Good Morning America from about two years ago. The fucking title is Studies Show Added Sugar can be just as addictive as Street Drugs. Street Drugs! Again, I'm living that I've never been offered cocaine on the street. Alright everybody, time to check your sweet tooth. Are you addicted to sugar? Some studies in the field of nutritional science and medicine show that

diets high in added sugar can be as addictive as some street drugs like cocaine. So cutting added sugar from your diet, if you're consuming too much, can have some powerful and significant and positive effects on your overall health. There's actually been a very significant body of medical research, nutritional science research, that shows using a test called a functional MRIs, that when people ingest foods that are high in added sugar, that the same part of their brain that gets stimulated when they get exposed to cocaine also gets triggered and stimulated with foods that are high in added sugars. In general, the more added sugar in a food, the more that brain-reward center will be

triggered, making you want more and more of it. Okay, so I should stop doing cocaine and I should stop eating sugar. I'm at least not eating sugar that will have the same benefits as cocaine. We should say that the research that exists around sugar and the dangers of sugar are all about added sugars. So we're not actually talking about the sugar that exists in a nectarine or the sugar that exists in, oh, or whatever, right? Like we're not talking about sort of naturally existing

sugars, we're talking about in the preparation of a food. Someone adds cane sugar, honey, fructose, whatever, and sweetens a food. That's what we're talking about with most of this research. But we're not very good at making those distinctions individually and it has allowed quite a few diets and quite a few spurious claims about any form of sugar. Right. This is a tough one because, again, feelings run high here.

I know and love a number of people who consider themselves, like, deeply consider themselves to be addicted to sugar. I also know and love people who are in recovery from addiction to drugs and alcohol who are profoundly frustrated with this discourse around sugar addiction. Hmm.

My goal here isn't to get in between anyone and their understanding of their own body, but to take a look at what the research says about this thing that's popping up more and more as kind of a buzzword and a really snappy kind of claim, right? I think one of the problems is the term addicted has a bunch of like different kind of individual and social meanings and also has this element

of physiological addiction. Like you go through like actual withdrawals, but then there's also psychological addiction. Like I remember years ago I interviewed a psychologist about sex addiction and what he said is that like on some level you can get addicted to anything. Like you can get addicted to skiing to the point where it disrupts your work life

and your social life, and that's a real thing, and you don't wanna take that away from people if they say that they're addicted to something, but it's also distinct from physiological symptoms of addiction. Yeah, absolutely. I mean, like there are lots of ways

to talk about addiction and dependency, and sugar addiction as a concept in the research is debated. There was one 2016 review in the European Journal of Nutrition that reviewed the available data, and here is what they said. I'm sending you a brick. It says, we find little evidence to support sugar addiction in humans. And findings from the animal literature suggest that addiction-like behaviors such as binging occur only in the context of intermittent access to sugar, not the neurochemical effect of sugar. Oh, okay, so we don't find it in humans

and when we find it in animals, it's like if you restrict their sugar intake for a while, then they kind of like binge on it when they finally get access to it. Right, so that's a 2016 review. their sugar intake for a while, then they kind of like binge on it when they finally get access to it. Right. So that's a 2016 review. Here's a 2018 review from the British Journal of Sports Medicine.

It says, consuming sugar produces effects similar to that of cocaine, altering mood, possibly through its ability to induce reward and pleasure, leading to the seeking out of sugar. Sounds great sentence. It's not a great sentence, that's true. When this study came out, one of the authors went even further and told the Guardian quote,

in animals, it is actually more addictive than even cocaine. So sugar is pretty much probably the most consumed addictive substance around the world and it is wreaking havoc on our health. Okay. That 2018 meta-analysis that says sugar is as addictive as cocaine led to really significant backlash with nutrition researchers. Oh, yeah.

But the sound bite sugar is as addictive as cocaine made it much further than the backlash, which is like more nuanced, more reasoned. You have to talk to more people versus like somebody makes a graphic on Instagram and is like, sure as addictive as cocaine and it gets shared a hundred thousand times and then there you are, right? Here is what appears to have happened. Okay.

It appears that the authors of the 2018 study may have straight up misunderstood the animal studies. Oh. Those studies restricted rats to having sugar for two hours every day. Okay. But when you take away the restriction, the quote-unquote addictive behaviors also went away. Oh, okay. The rats did the same thing.

They had the same, quote unquote, addictive behaviors for saccharin for the artificial sweetener. Oh. So this appears to be about sweetness, not about sugar per se. Oh, like the taste sensation. In this study, rats were offered sugar water,

saccharin water, or cocaine water. Dude, seriously? Yeah. I've never been offered that either. I'm livid. I'm livid. These rats are offered these different things, and then they're given levers, right,

to get more of the thing. And the evidence here is the sugar rats wanted the most of the sugar, but also so did the saccharine rats, and the cocaine rats didn't necessarily want a huge amount of cocaine water. The cocaine rats were too busy explaining the podcast they're about to launch. There's a piece in the guardian about this

called Is Sugar Really Is Addictive as Cocaine. Scientists row over effect on body and brain. ROW was invented to help headline writers fit their headlines. In this piece, they talked to a Cambridge psychiatrist who was like, yeah, I mean, rats are gonna eat food and not cocaine. Ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha-ha- Yeah. I should say that this one is debated in part because the data just isn't there yet. Multiple reviews on this topic describe the data as nascent or in its infancy.

Right. Many of the studies that we're talking about are mouse and rat studies, their animal studies, there are some human studies, but not as many as there are rat studies. It's also debated because dopamine and brain response alone may not actually constitute the same kind of dependency as drugs or alcohol.

The core argument about sugar addiction is that sugar consumption leads to dopamine release, lighting up the same part of our brain as drug use. As you noted, that is kind of just a pleasure center of the brain. Sugar has a little bit more of an impact, right? Like it creates more of that response, but lots of foods create that response in your brain, right?

It appears that drugs like cocaine, like heroin, like opiates, sort of writ large, actually hijack the controls of that reward center and make it stop working or work less effectively over time. We don't really have data that shows that with sugar. I get a dopamine response every time I get a poke on Facebook. Who's poking? Are we getting in the time machine going back to 2007?

I wanted to see what reaction that would get from you. Nothing. You gave me nothing. I gave you nothing. I have nothing to say about posts. This episode has about one million sources, but there are two books that were particularly helpful and both of them are forthcoming later this year. Oh, how did you read them? How did you get these? I'm fancy. Ooh. Because of our show, people sometimes email us and say,

hey, do you want to read this book before it comes out? And I say, yes. Will you open those emails? I can open them. I can. Also, one of them is a book that I read and ended up blurbing because I liked it so much. What?

You read? Wow. Ha, ha, ha, ha, ha. Patreole. Like a chump? Wow. Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha And the second is by someone I don't know. It is called sugar rush, science, politics, and the demonization of fatness. It's by Karen Thrasby and it's out in August. I'm livid that you didn't rely on any YouTube videos for this.

This is a quote from Fat Talk, parenting in the Age of Diet Culture by Virginia SoulSmith. Virginia. Out later this month, by the way, pre-order it, team. She says, dopamine is also known as the feel-good hormone. It surges in our brains whenever we experience pleasure and defenders of the sugar addiction model

cite this as evidence because the sugar dopamine response can look like the response seen in the brains of people using narcotics. But we also get dopamine responses from purely benign activities like seeing a puppy, hugging a loved one, or feeding our babies. People who feel addicted to sugar interact with it quite differently than people who struggle with alcohol or drug dependency. So-called food addicts don't endanger their children or lose their life savings to obtain their highs. So even the chair of the UK organization Action on Sugar,

acknowledges that sugar is fundamentally different than other substances that we consider addictive. In 2014, Graham McGregor, who's the chair of Action on Sugar, told the Times, quote, I agree that sugar is not like tobacco. It's not as addictive, but it's a major source of hidden calories. And if you get it down, it will help with obesity. It's not as addictive, but it's a major source of hidden calories. And if you get it down,

it will help with obesity. It's an overstatement. Sometimes to get your point across, you need to make it stronger. This is the thing we've confronted a lot before, where it's like a lot of this stuff that sort of seems like scientific messaging is actually like policy messaging. Yeah, it's social. Yeah, it's designed to be rhetorical or to like reach a goal. Part of what happens when you invoke an addiction model is that you also invoke all the trappings of that model, right? And the main way, certainly in the US that we engage with addiction is abstinence.

Right. And it is not very feasible for people to fully abstain from all forms of sugar, and it's also not great for your body to not have any kind of glucose entering your system. In the absence of a clear sort of scientific consensus here, our cultural attitudes about sugar and addiction both have sort of moved in hard to like fill the gap, right?

Sugar has long been discussed as a possible sort of moved in hard to like fill the gap, right? Sugar has long been discussed as a possible sort of dietary cause of people getting fat. It's been long discussed as a dietary cause of people getting diabetes. All kinds of stuff that we heavily stigmatize. Addiction is also something that we heavily stigmatize, right? So when someone proposed that sugar was addictive,

it reinforced two very deeply held sets of biased beliefs that fat people can't control themselves and that addicts are sort of like wretched and to be pitted and don't have self-control, and they sort of did it to themselves, sort of the vibe, right, with addiction. And what it's rhetorically trying to do is bring some of the suspicion and fear and alarmism that we bring to conversations about drugs to sugar now.

But again, we don't actually have research that bears that out. We might, at some point, who knows, but as it stands, we don't have research that very clearly illustrates any kind of, like, again, scientific consensus that sugar is an addictive substance. I don't understand why people are doing this. I think they're doing it for, like, marketing or, like, public relations purposes, because, like, it doesn't seem, like, it's supported by the biological evidence at all. It seems like they're doing this maybe as a way of like reducing stigma.

Like, oh, they can't help it. They're addicted or something. But like, I don't think this is gonna have that effect. I think this is probably coming from a similar place as the redefinition of Quaranton Quotobi said he has a disease, right? Yeah. Which is sort of the desire to garner more attention to an issue that some researchers

feel like isn't getting the attention that it deserves. It's messaging that's designed to kind of grab you by the lapels and shake you, right? It has the side benefit, quote-unquote benefit, right? Of reinforcing how we already feel about food, making more fear about food in a time when we're sort of moving in a slightly more anti-diet direction or have been, right? This is a way that you can reclaim your deep fear and discomfort around food that feels beyond reproach, right?

And it's a way that you can think and talk about fat people without explicitly saying fat people. You can talk about sugar addicts and sugar addiction and the scourge of sugar addiction. I think there is this idea that that might be less destructive, right, that like an addiction frame is less stigmatizing. I would say have some conversations with some addicts. I just don't think that these very superficial

relabeling of the terminology around widely stigmatized groups really does anything. I think you can call fatness a disease or not call it a disease, but fat people are very stigmatized in our society. Yeah, so the only thing that's gonna happen is they're just gonna attach the stigma to the new term. I am of a mind that if there are new terms coming about

to describe a particular minoritized community, that that should be the decision of that community, not the decision of doctors who are like, I've decided this is what's best for you. And any sort of rhetorical move that you use to amplify your message has some consequences, some of which you will foresee and some of which you will not. I mean, this is clearly a rhetorical move

to get people to think differently about sugar, but what it has done is created a really fundamental misperception of the sort of like chemical functions of sugar in your body, right? This sort of use of an addiction parallel really lends a sense of urgency, right? This sort of use of an addiction parallel really lends a sense of urgency, right? That this is like a matter of life and death that we can't fuck around.

And that's not actually what's happening with sugar, right? There is no such thing as one day you have too much sugar and then you die if you're not, like diabetic or something else, right? Yeah, there's no opioid overdose analogy to sugar. Right. What we're talking about is for say, the onset of diabetes, years and years and years

of creeping up blood sugar that can be caused by lots of things. And as we learned earlier, different things for different people and different sugars for different people, right? It's caused by cucumbers. That's what I learned in the last hour. That's what you, that's where we left it, right?

Oh, that's why I'm fat. I keep drinking tea. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.

Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.

Yeah. Yeah. Yeah. Yeah. Yeah. Thank you. you