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Response to “Sugar, the most dangerous drug of our time”

A column by Paul van der Velpen, General Director of the Amsterdam Public Health Service appeared on their website on 12 September 2013.

In this column, Van der Velpen states that sugar is the most dangerous drug of our time. According to him, someone who eats biscuits continues to eat them even though his stomach hurts. The column also suggests that quitting sweet foodstuffs may be just as hard as quitting smoking and that addiction therapy would be better than dieting.

This column only gives Mr Van der Velpen's opinion and is not based on scientific facts. In recent years various independent expert committees (including the Dutch Health Council and the European Food Safety Authority, EFSA) have studied the facts concerning the role of sugar on our diet and health. The Health Council's Guidelines for a healthy diet 2006 made the following statements about sugar: "recommendations on the levels of monosaccharide and disaccharide consumption consistent with adequate nutrition and the prevention of chronic diseases have not been made, because insufficient scientific evidence is available to support firm conclusions1." In their 2010 scientific report, the EFSA concluded the following about sugar: "there are insufficient data to set an upper limit for (added) sugar intake2."

There is also no scientific basis for the statement 'sugar, the most dangerous drug of our time'. Meta analyses show clearly that sugar intake is entirely non-addictive. The mesolimbic dopamine system seems to play a role in addiction (in which physical tolerance and withdrawal occurs). This system is not linked directly to the intake of sugar.

Physiologically, sugar addiction does not exist; eating too many sweets is learned behaviour. This learned behaviour doesn't meet the criteria of 'dependency on a drug' as included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and the WHO3. Sugar does also not appear on lists of drugs or substances that are potentially addictive4. The conclusion of an extensive review by Dr D Benton and published in Clinical Nutrition was: "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 disorders5."

Eating sweets and other treats is experienced as pleasurable. And we are allowed to enjoy food.

  1. Guidelines for a healthy diet 2006, Dutch Health Council.
  2. EFSA Journal 2010;8(3):1462. Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre.
  3. Dr. J. Snel, SHARE, Amsterdam University, Suiker in Perspectief Editie: Mentale en fysieke conditie | October 2006.
  4. Nutt, D. J. (1997). The neurochemistry of addiction. Human Psychopharmacology., 12, S53-S58.
  5. Benton D. (2010). 'The plausibility of sugar addiction and its role in obesity and eating disorders', Clinical Nutrition.

 


Response from Dr. Rob Markus, Neuropsychologist Maastricht University:

It's not my style to respond to media hypes. But now that the Amsterdam Public Health Service does so, I feel compelled to respond to and rectify this. In his column on 12 September 2013, the General Director of the Amsterdam Public Health Service, Paul van der Velpen, stated that sugar is 'the most dangerous drug of our time'. My response to his main propositions is given below.

Public Health Service proposition 1: 'sugar is the most dangerous drug of our time and is addictive'

Sugars are not drugs. In contrast to sugar, drugs are harmful toxins and are harmful to the brain, liver, stomach, heart and blood vessels. In contrast to sugars, drugs create structural (receptor) changes to those areas of the brain that are involved in addiction (particularly the mesocorticolimbic pathway, with the most important transmitter; dopamine); lead to tolerance (increasing amounts needed for the same experience), and physical dependence (withdrawal symptoms occur when someone quits) and to the risk of fatal overdose as consequence. Those wishing to place sugars in this category should visit the Jellinek rehab clinic and speak with drug addicts and their relatives, or maybe even take the comparison test themselves. Sugars are not drugs; they do not have the same effect on the brain, don't appear on the National Institute for Public Health and the Environment ranking of modern harmful drugs (such as crack, heroin, tobacco, alcohol, cocaine etc) and also appear not to work as such, as shown in a critical examination of all available scientific studies (>160 studies!) by leading nutrition scientist David Benton (The plausibility of sugar addiction and its role in obesity and eating disorders. Benton D. Clinical Nutrition, December 2009).

The misconception that sugar is addictive (like a drug) originates from rat research. A number of animal studies have shown increased dopamine release (and reinforcement of sugar preference) following consumption of sugary drinks; this has been attributed incorrectly as addiction and transferred to humans (where it has taken on a life of its own). The painful misconception, however, is that increased dopamine release in the brain is indicative of an addiction: in the first instance this is a normal physiological response to the experience of pleasure/enjoyment. Increased dopamine concentrations can be found after almost everything that we enjoy; but to suggest that we become fat through sex is just as absurd.

Public Health Service proposition 2: sugar addiction is the cause of the obesity epidemic

According to the Public Health Service Director, the incidence of obesity has taken on epidemic proportions because we eat too much sugar. But, in the first instance, excess weight is created if we consume more calories than we burn; it makes no difference what we eat. Scientific literature shows that obese people don't consume more sugars; rather they display significant preferences for energy-rich foods based mainly on fats (with higher calorific values than sugars). What's more, people with obesity tend to binge-eat at the end of the day; a time at which sugar concentrations are highest (so in sugar addiction, binge-eating particularly shouldn't occur at that time).

In short, weight problems cannot be blamed on one kind of food or one ingredient. This applies particularly to sugar; it is not addictive and in principle, won't make you fat. Of course, just like any other foodstuff it can contribute to weight gain: particularly if you eat too much without a proportional amount of exercise. Let's stay balanced about these things.

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