Hidden menace

For those with a history of addiction the well-publicised health risks of sugar could pose serious dangers. Nutritionist Helen Sandwell looks at the evidence

Pure, White and Deadly refers to a white crystalline killer, but not one that will appear on any drug classification list. The book of this title was written more than 30 years ago by a British physiologist Dr John Yudkin, who warned about the many serious health risks associated with sugar consumption.

For many years it was saturated fats that were largely seen as the culprit in the major non-communicable diseases, particularly heart disease. Only in the last decade have Yudkin’s stark sugar predictions been taken more seriously by the scientific community.

A diet high in sugar is now thought to be the leading factor in the development of obesity and can play a significant role in type 2 diabetes, heart disease, stroke, fatty liver disease and some cancers. Research is showing that even Alzheimer’s (also now referred to as type 3 diabetes) could be associated with a high sugar diet.

Earlier this year, the World Health Organization (WHO) produced guidelines for the maximum intake of free sugars – that’s all sugar added to food, as well as honey, syrup and the sugar present in fruit juice. They recommend that adults reduce their free sugar intake to 5 per cent of their total calories – just six teaspoons. A 500ml bottle of coke contains almost double this amount of sugar.

The intake of many people in the general population is likely to be way above this, but individuals in recovery can have notoriously high intakes of free sugar, anecdotally spooning several teaspoons into countless cups of tea or coffee.

However, it’s not only the sugar knowingly added, but the hidden sugars added by food manufacturers that are contributing to the rise in obesity and associated illnesses.

Katharine Jenner, campaign director of Action on Sugar comments: ‘Sugars are hidden in so many of our everyday foods. We eat and drink more than our maximum recommendation without even realising it.’

When individuals reach the point of recovery, long-term physical health becomes more of a priority. In considering long-term health, should we now be encouraging those with history of substance misuse to cut down drastically on sugar, which has previously been perceived as a relatively harmless vice?

A person who has experienced liver damage from alcohol or hepatitis C may be unaware that high levels of sugar can also contribute to damage. Although such individuals haven’t been specifically studied, cardiologist and science director at Action on Sugar, Aseem Malhotra says that, ‘The same rules apply to fatty liver disease from excess sugar consumption as they do from alcohol.’

But for those with a history of addiction, kicking the sugar habit may be particularly difficult. A hypothesis that is gaining ground suggests that sugar is an addictive substance. Researchers have described it as acting in the body in a similar way to psychoactive substances. Like addictive substances, it releases both opioids and dopamine – chemicals that are involved the brain’s reward pathways. Self-identified ‘food addicts’ describe using food to self-medicate, by eating in order to try to change a negative mood state.

What’s more, sugar consumption can share features typical of an addiction pathway, namely bingeing, withdrawal, craving and cross-sensitisation. Reward deficiency syndrome (RDS) is a gene-related condition where brain impairment results in abnormal craving behaviour, with an individual craving and seeking substances known to cause dopamine release. RDS demonstrates that a genetic commonality exists between a number of dopamine-activating substances, including alcohol, opiates and sugar.

The similarity in pathways has further been demonstrated in studies in animals with food bingeing behaviour, where pharmaceutical treatments for drug addiction – baclofen and naltrexone – have been shown to be effective in treating overeating. Since caffeine also affects dopamine levels, it’s no wonder that highly sugared coffees and energy drinks are favourites among those abstaining from other substances.

While sugar may well be considered as the lesser of many evils as far as addictive substances go, some residential treatment centres are already aware of the difficulties sugar can present and this is influencing the catering they provide.

‘We are increasingly paying attention to the effect sugar has on mood and the links between sugar and addiction,’ says Sarah Small, head of service at Clouds House. ‘Our kitchen team are progressively looking towards lower GI foods.’

At Hope House, similar measures have been introduced as head of service, Susanne Hakimi, explains: ‘Three years ago we implemented a low GI diet. Essentially what that means here is that bread, rice, and pasta, for example, are wholemeal. Chocolate, fizzy drinks and cakes are not allowed in the project.’

Hope House treats women with substance dependency as well as other compulsive disorders, including eating disorders. It’s not only food provision, but also education that’s important, as Susanne goes on to say: ‘Our chef also runs a workshop on nutrition, and the dangers of high sugar consumption.

‘We run an intense food group that educates the women and also allows them a space to discuss their issues with food. This has to be an ongoing development, as the women can eat out, and not necessarily healthily. We can only but educate and provide what we understand is healthy food.’

Aseem Malhotra, would certainly see these measures as heading in the right direction. As for recommendations for treatment providers in their catering provision, Aseem advises, ‘In terms of a healthy diet, it shouldn’t really have any added sugar at all.’

He thinks that ideally fruit juice and white bread should also be out: ‘The body doesn’t know the difference between sugar in fruit juice and sugar in coke. The impact of refined starches is similar to sugar.’

It’s all very well health professionals and scientists proclaiming we should cut out sugar but how easy is it, especially for those who experience cravings?

John Yudkin describes himself as a sugar ‘addict’ in Pure, White and Deadly, previously consuming close to 400g a day. His advice, based on personal experience, is to cut down gradually, the result being an increased appreciation of food.

‘Swamping everything with sugar tends to hide flavours,’ he adds. ‘When you really have got used to taking a very little sugar in your food and drinks, you will notice that your all foods have a wide range of interesting flavours that you had forgotten.’

Helen Sandwell is an independent registered nutritionist, www.goodfoodandhealth.co.uk