Forget fat phobia – fear sugar instead, says top UK cardiologist

Here is an updated version of an article I wrote on sugar and its addictive properties for Business Day newspaper in January. It looks at more science behind the controversy in medical circles over sugar addiction – and why some doctors and dietitians still like to insist that sugar addiction doesn’t exist. Of course, not everyone who eats sugar becomes an addict, just as not everyone who drinks alcohol can be called an alcoholic. However, growing numbers agree with a top British cardiologist who says sugar is addictive, and deserves to be called Public Health Enemy Number 1, mostly because of its contribution to global epidemics of killer chronic diseases.  

By Marika Sboros

Picture: Facebook

Mary Poppins clearly got it  wrong. A spoonful of sugar doesn’t make the medicine go down. It makes you need more medicine in future, says British cardiologist Dr Aseem Malhotra.

And if you can’t stop eating sugar in all its different forms, you are a sugar addict, says Malhotra.

Sugar addiction is controversial worldwide, with many doctors  (practically every South African orthodox medical doctor  I’ve ever interviewed) saying there’s no proof that it exists.

Ditto for orthodox dietitians. They won’t say you can eat as much sugar as you like, of course. They will say sugar in moderation is necessary for a balanced, healthy diet, and they definitely  won’t say it’s addictive.

Growing numbers of medical specialists internationally will. They say obesity and Type 2 diabetes rank among many countries’ biggest health problems, and largely result from what many are now  happy to call an “addiction” to sugar.

US obesity specialist Dr Jacob Teitelbaum, author of Beat Sugar Addiction Now! (Fairwinds), calls sugar addiction the “canary in the coal mine”, a sign of undiagnosed health problems such as failing adrenal glands or “bad” gut bacteria.

No nutritional value

Malhotra says sugar deserves its reputation as “Public Health Enemy Number 1”, because, unlike fat and protein, “there’s absolutely no nutritional value or biological requirement for sugar”.

In his view, sugar is simply a source of “completely unnecessary calories”.

Dr Aseem Malhotra
Dr Aseem Malhotra. Picture: LOUIS HIEMSTRA

Malhotra is science director of Action on Sugar, a UK-based group of 23 specialists working to reach consensus with the food industry and government over harmful effects of a high-sugar diet, and to reduce hidden sugars in processed foods.

He is clearly an enemy of the sweet stuff, and has many many enemies among vested interests and orthodox establishments as a result.

Malhotra says the most recent update on global, regional, and national causes of death, the Lancet global burden of disease studies published in December 2014, shows that poor diet causes more disease – obesity, heart disease, diabetes, cancer (increasingly also dementia) – than physical inactivity, smoking and alcohol combined, and sugar is a major factor.

He says sugar can only currently be classified as “mildly addictive” according to research, but that doesn’t make it any less of a health threat than alcohol, tobacco, or cocaine.

South African-born US paediatric and  general surgeon Dr Robert Cywes is on the same page.  

Cywes, an adolescent and adult bariatric surgeon and a world-authority in treatment and management of adolescent and adult obesity, says sugar’s greatest threat to health in body and mind is that it is a proven source of a powerful brain “buzz” that releases feel-good chemicals.

He says the global obesity epidemic is the proven consequence of sugar addiction.

“People are not fat because they’ve been eating too much fat, as we were led to believe for nearly 40 years,” says Cywes.

“They are fat because they’ve developed an out-of-control relationship with a drug called carbohydrates.”

He’s not just talking about the white stuff extracted from sugar cane or beet that you spoon into tea or coffee everyday – sugar as a simple carbohydrate.

Carbohydrates are in fruit and vegetables, and starchy foods such as potato, rice, cereals, grains, bread, pasta, pizza. Even in so-called “healthier”, complex, unrefined versions, specialists remind us that all carbohydrates turn to sugar in the bloodstream.

Malhotra says sugar “certainly fulfills four criteria that suggests it should be regulated in the same way as tobacco and alcohol”:

  • It is toxic – directly to teeth; even in small amounts, it corrodes enamel; in larger amounts the fructose component is toxic to the liver;
  • It is unavoidable – added to and hidden in most processed foods by the industry;
  • It has potential for abuse;
  • It has proven negative impact on individual health and society

Sugar Free Karen ThomsonIf you doubt the addictive properties of sugar, ask Capetonian Karen Thomson, former model, granddaughter of the late pioneering heart surgeon Prof Chris Barnard, and an organiser of the first low-carb, high-fat summit held in Cape Town in February.

Thomson overcame addiction to alcohol and cocaine (she admits to “a very addictive personality”) but says her sugar addiction was “hardest to beat”. Thomson has documented her struggle to overcome sugar addiction in Sugar Free, Eight Weeks to Freedom From Sugar And Carb Addiction (Struik).

It prompted her to found HELP (Harmony Eating and Lifestyle Programme), a 21-day in-patient programme, and The Sugar Free Revolution, an eight-week online programme in partnership with Harmony Addictions Clinic to treat sugar addiction.

One difficulty many people – and doctors – seem to have with being able to see sugar as an addiction is that most sugar addicts are “functional” – that is, you seldom, if ever, see them incapacitated, or babbling incoherently after a hit of their drug of choice, as happens with alcoholics or drug addicts.

US specialist Dr Nitun Verma says that’s just a function of a “lack of understanding of the nature of addiction”.

Verma studied psychology, medicine at Stanford University, and created the Washington Centre for Sleep Disorders before starting PeerWell, a healthcare company focused on health through lifestyle change.

He says addiction is “a primary chronic disease affecting the brain’s reward circuitry” resulting in the “pathological pursuit of a reward”.

Behaviourally, this means the individual is “unable to consistently abstain and goes through a cycle of bingeing, withdrawal and craving”.

“The magnitude of reward from sugar overconsumption means addiction can emerge, as the latest studies show,” Verma says.

This addiction shows up not just in bingeing, withdrawal and craving, but also changes in the brain’s dopamine receptors – as shown in a study by US researchers in Current Topics in Behavioural Neurosciences in 2011.

Sugar appears not “as overtly psychologically intoxicating as alcohol or drugs”, Verma says. However, research shows that at high intake, sugar produces a magnitude of reward that’s “no less an addiction and threat to health than alcohol and smoking”.

Drug pushers

Research shows all carbohydrate foods, even unrefined carbs, trigger the nucleus accumbens, a brain region scientists have dubbed “ground zero” in conventional addictions such as gambling or drug abuse.

However, experts say solving the problem of sugar addiction is “more complicated than solving drug addiction”.

That’s because it requires “reducing the drive to eat unhealthy foods without affecting the desire to eat healthy foods when hungry”, according to a news release on groundbreaking research by Massachusetts Institute of Technology (MIT) neuroscientists published in Cell in January.

The study effectively looked at ways to “decode” sugar addiction in the brain. The neuroscientists are quoted as saying that for the first time they were able to  identify “how the brain encodes compulsive sugar seeking”, and that this appears to be  “distinct from normal, adaptive eating”.

They  say that their ultimate goal is “to develop safe, noninvasive approaches to avert maladaptive eating behaviors, first in mice and eventually in people”.

Which brings us round to who the real drug “pushers” are in this case.

Malhotra fingers the usual suspects: “Big food corporations who exploit the fact that sugar is cheap, tastes good and sells for their only interest: profit.

“I take issue with their manipulations and excesses that include targeting the most vulnerable members of society, including children, with mass advertising, and associating sugary products with sport, which is an absolute scandal.

“Remember, they are there to sell food, not take care of your health.”

Bridget Surtees, a Cape Town registered dietitian, who has 18 years experience as a paediatric dietitian, says cutting sugar from the diet isn’t easy because it’s present and hidden in many foods, including for babies. And will power on its own is “difficult to exert over a substance that has a biochemical drive”.

So where does responsibility lie most in tackling sugar addiction and related health issues?

Malhotra says exercise of personal responsibility requires “knowledge based on correct information and choice, but we have neither because the food industry has corrupted both”. Government has “a duty and responsibility to protect it citizens from the food industry’s excesses and”.

“Governments that are serious about tackling the increasing burden of chronic disease threatening the sustainability of health systems in the West will make tackling sugar the number one priority.”

How best to beat sugar addiction?

“Eat food your grandmother would recognise,” says Verma. “Change your food environment at home. Manage stress constructively so you don’t resort to food as a dietary anti-depressant.”

Malhotra says: “Just eat wholesome, real food. It’s so important for health in the short- and long-term.”

He would like a mantra implanted in everyone’s brain: “Food can be the most powerful form of medicine or the slowest form of poison.”

7 signs that you could be a sugar addict:

  • You reward or comfort yourself with sweet or starchy foods;
  • You must have dessert – a meal is not complete without something sweet afterwards;
  • You’ll make a special trip to the shops to satisfy your sweet tooth;
  • You have a secret sweet “stash”, or you binge on sugar when you’re alone;
  • You get the “afternoon slump” – a late-afternoon energy dip and craving for something sweet or starchy;
  • You justify sugar to yourself as healthy – (it’s organic!);
  • You’ve tried to stop eating it, but you don’t.


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