Maintenance Phase

The Trouble with Sugar

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Michael: Something is happening outside. I think there's a saw blade or something. 


Aubrey: Rrrrr, one of those. 


Michael: Wait, hang on. 


Aubrey: Is it the vacuum lady? 


Michael: Oh, no, it's a fucking leaf blower. 


Aubrey: God damn it. 


Michael: Oh. Give me a second. I'll shut the window. 


Aubrey: Ooh.


Michael: Now there's fucking nothing to blow. 


Aubrey: [laughs] 


[Maintenance Phase theme music]


Aubrey: Would you like to kick us off? 


Michael: I spent hours thinking of one, and I could not come up with a good one. 


Aubrey: I was going to say, God knows we've had the fucking time in the lead up to this episode. I have postponed this one, two times, I think. 


Michael: But that makes this one worse [unintelligible [00:00:48] 


Aubrey: Uh-oh. [laughs] You don't want people to know how much time you have?


Michael: I actually had time to think about it. Welcome Maintenance Phase, the podcast that spikes your glycemic index. 


Aubrey: No, no. 


Michael: Is that what we're talking about today? Glycolysis? 


Aubrey: 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 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.'” [laughs] 


Michael: 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. 


Aubrey: [laughs] Rude. 


Michael: I am Michael Hobbes. 


Aubrey: I am Aubrey Gordon. If you-


Aubrey and Michael: -would like to support the show-- 


Aubrey: [laughs] we're back to tiny repeating machine. 


Michael: I'm trying to do it alongside you. 


Aubrey: [laughs] If you would like to support the show, you can get T-shirts, mugs, tote bags, all manner of things at TeePublic. You can subscribe at Patreon or at-


Aubrey and Michael: Apple podcasts. 


Aubrey: They're the same audio.


Michael: Same audio.


Aubrey: And today, Michael,- 


Michael: Aubrey. 


Aubrey: -we are talking about myths about sugar. 


Michael: Take me on a journey. There are so many places this can go. 


Aubrey: I am a bursting with things to tell you. 


Michael: You are bursting. You've texted in the last two weeks is like, “I'm excited. I'm excited. I'm excited.” [laughs] 


Aubrey: I can't tell you any of those things, but I definitely had a conversation with a friend of mine yesterday, and she was like, “Is this going to be about the fucking rat study again?” I've been yelling at my friends about the stuff that I have been learning nonstop to the point that they are tired of it. 


Michael: The little sugar rats. 


Aubrey: The little sugar rats. 


Michael: I'm excited to meet them. 


Aubrey: So, we're going to focus on three big ideas. One, the idea that sugar makes kids hyperactive. Two, that we can predict how different foods impact most people's blood sugar. And three, that sugar is addictive. And particularly, the claim that gets made most frequently is, sugar is as addictive as cocaine. 


Michael: 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. 


Aubrey: So, Michael, I thought that we should start with a little conversation about what sugar is. 


Michael: Please do. 


Aubrey: I went to my favorite, as you know, Cafe Gratitude- 


Michael: Oh, yeah, God. 


Aubrey: -in 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.” I was like, “Then that is not sugar free.” 


Michael: I remember reading somewhere that anything you see on the ingredients list that ends with -ose, like dextrose, sucrose, lactose, nactose, it's all sugars. They hide sugar in the ingredients lists as like evaporated cane juice. 


Aubrey: Yeah, absolutely. This is also where we get the idea that, “Agave is better for you.” 


Michael: [unintelligible [00:03:50] 


Aubrey: So, when people think about sugar, they think about those images of a Coke bottle and then a bunch of teaspoons full of white granulated sugar. 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 moisture out of the meat. 


Michael: Oh, of course. 


Aubrey: Fructose is a sugar that's found in fruits and vegetables. Lactose is the sugar that's found in dairy. Maltose is a sugar that is found in sprouting grains. 


Michael: There's also logos, pathos—


Aubrey: Ethos 


Michael: [unintelligible [00:04:39] in school. Yes. 


Aubrey: So, different sugars are processed differently. Glucose, for example, is absorbed through your intestines and directly into your bloodstream. Fructose, 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, “For most people, one type of sugar isn't better than another.” 


Michael: This entire episode is a Cafe Gratitude subtweet. [Aubrey laughs] I'm like, "I'm still mad about this." 


Aubrey: Michael, every episode of the show is a Cafe Gratitude subtweet.


[laughter]  


Michael: Dude, I quit eating all sugars after I watched that YouTube video. This was in 2011 or something. 


Aubrey: I don't know this YouTube video that you're talking about. 


Michael: Oh, the Robert Lustig one, Sugar: The Bitter Truth? 


Aubrey: Oh, I know about Lustig, but I haven't seen the video. 


Michael: I watched it and then I was like, “Okay, for a month, I'm going to try eating no sugar.” So, no berries, no desserts. I did, in fact, lose a bunch of weight. And then the minute I started eating sugar again, I gained it all back. 


Aubrey: Just like everything. 


Michael: Okay, great. [chuckles] Just like absolute everything. 


Aubrey: Just like everything.


Michael: It's like I don't know what the point of that was. 


Aubrey: I was trying to think of a name, like, what would be the name for the Robert Lustig video? The closest I came up with was an inconvenient tooth. 


[laughter] 


Michael: That's way better. 


Aubrey: But that would have to be about the dental effects, you know?


[laughter] 


Aubrey: Okay. Are you ready to dive in to our first big cultural idea about sugar? 


Michael: Give me rats. Let's go. 


Aubrey: [laughs] No. 


[laughter]  


Aubrey: Okay. So, first up, we're going to talk about the idea that sugar makes kids hyperactive. 


Michael: Yes. I grew up believing this. This is something that's in the background of like, “Don't feed the kids sugar because they'll be ramped up all day,” which I got to say, anecdotally it really feels true. 


Aubrey: Almost all of these really ride the coattails of, it feels true. 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? 


Michael: Oh, interesting. Okay. 


Aubrey: The first time we hear in scientific literature, a connection between sugar and behavior is 1922. 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 “the neurotic child.” From there, it genuinely just 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 Feingold. And Ben Feingold creates the Feingold Diet and writes this book about children and hyperactivity. Both of those books really point the finger at sugar, artificial sweeteners, and artificial additives. The Washington Post actually wrote an obituary of Dr. Feingold that includes a pretty good synopsis, and I am going to send it to you. 


Michael: I get to do my little audiobook voice. “Dr. Feingold proposed that at least half of the children diagnosed as hyperatactive 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 salicyl-" 


Aubrey: Salicylates. Yeah. 


Michael: “Salicylates contributed to hyperactivity, as did tea, mint and wintergreen.” That's a gum. [Aubrey laughs] "He said treatment of hyperactive children with amphetamines 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. It's like taking baths to cure autism shit. 


Aubrey: It is mobilizing parental discomfort with the idea of giving your kids drugs and it is 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. 


Michael: Cucumbers. Okay.


Aubrey: Tea. Fuck you, tea. 


[laughter]


Michael: Someone's finally saying it. 


Aubrey: The idea essentially was that eating sugar triggered insulin spikes, which led to adrenaline spikes and hyperactivity. But the data was regarded with some scepticism by other scientists because it was pretty weak. Feingold'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. 


So, the fix is in on Feingold's work starting in the 1980s in earnest. There's a 1983 research review in the Journal of Learning Disabilities on this idea of “the Feingold hypothesis.” They looked at 23 studies and found that, “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.” 


Michael: Yeah, of course. 


Aubrey: We also get a research review in 1986 that finds that, “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.” 


Michael: So, does this mean the entire idea of sugar highs and sugar making kids hyperactive is based on this idea that it causes ADHD? 


Aubrey: That is the root of it. And then it becomes more generalized. It seeps out. It leaches out into culture more broadly. And folks develop this association that is, like, any high energy or frankly, just irritating behavior from kids is likely a result of any sugar they may have eaten. So, we get these couple of research reviews and people are like, “I don't know about this.” 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. 


Michael: Oh, yeah. 


Aubrey: 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 preschool age kids who are 3 to 5 and half elementary school age kids who are 6 to 10. All of the kids involved are described by their parents as being “sensitive to sugar.” 


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 aspartame as a sweetener, one was low in sugar and used a placebo, they used saccharine as their sweetener. Essentially what they did was clear out these families' cupboards and replace them with totally new food each week. 


Michael: So, it's a home invasion, but in reverse. 


Aubrey: Yep, totally. 


Michael: They're putting things in. 


Aubrey: They also found a way to test whether or not people were sticking to the diet. They added high amounts of ascorbic acid to the aspartame, which is vitamin C, and they added high levels of riboflavin to the sucrose. 


Michael: Oh, and they pee tested people, because it all comes out in your pee. 


Aubrey: And then they would be like, “Okay, you really did it or you really didn't.” 


Michael: Dude. 


Aubrey: In addition to that, they also took fasting blood work, they did behavioral assessment, and they did cognitive assessment every week of this experiment. 


Michael: It is funny to me that they think having a good methodology will prevent the woo-woo weirdos [Aubrey laughs] online from still being like, “Oh, it causes ADHD.” 


Aubrey: Are you ready for their findings? 


Michael: Yes, although I think that it's the cucumbers. 


Aubrey: They didn't cut out cucumbers. 


Michael: Actually, the cucumbers. 


Aubrey: They found that, neither sugar nor aspartame "adversely affects the behavior or cognitive functioning of children.” But they also found this, “cognitive or behavioral differences were as likely to be found between sham diets as they were between experimental diets. The few differences associated with the ingestion of sucrose were more consistent with a slight calming effect than with hyperactivity.” 


Michael: Interesting. 


Aubrey: So, A, people were reporting bigger differences around the fake made up diets. They're like cosmetic changes. And B, if there was any effect, it wasn't really statistically significant, but it appeared that it was actually chilling kids out a tiny bit. 


Michael: So, give kids sugar if you want them to calm down. That's the Maintenance Phase endorsement. 


Aubrey: [laughs] Yeah, exactly. Around the same time, there is an editorial in the New England Journal of Medicine from Dr. Marcel Kinsbourne, who's a paediatric neurologist and says that actually, "This is kind of a chicken or the egg situation." Like, "Does sugar consumption make you less inhibited or does disinhibition lead to an increase in sugar consumption?" And ultimately, Dr. Kinsbourne includes this pretty mic droppy quote. 


Michael: He says, “There is no evidence that sugar alone can turn a child with normal attention into a hyperactive child. The same applies to aspartame, which has also been suspected of causing behavior disorders in some children. Sugar clearly does not induce psychopathology, 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. 


Aubrey: 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. 


Michael: Right. I remember reading a super fascinating study years ago on the effects of alcohol. We often think that things like bar fights or the way that people act when they're drunk in Western societies, we think of those as the biological effects of alcohol. But what this study pointed out was that alcohol effects are actually very cultural. And there are some societies where it leads to a ton of violence, and there are some societies where it doesn't, where it's like, "I love you, man," kind of drinking. 


Aubrey: Totally. 


Michael: What they said was basically there's societal expectations about how to behave when you're drunk that actually affect your behavior when you're drunk. I do wonder if there's something like that with sugar. I remember as a kid, I was always told that sugar will make you hyperactive. So, maybe it did make me hyperactive because somewhere in my brain, it was like, “You just have some sugar. You shouldn't act hyperactive now.” 


Aubrey: Michael, you are handing me a segue on a silver platter. [laughs] Most of the explanations that they're now exploring for this are social. One of them is that this is, 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. 


Michael: Children are basically that horse that tapped its foot to do math. 


Aubrey: Horse math. 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. 


Michael: That's children. 


Aubrey: But one of the most popular explanations for this is that it may actually be a response to restriction of sugar. One dietitian told The New York Times, “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 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 social settings with other kids and all of these explanations are coming into play for some families. 


Michael: Dude, that's how I was with MTV. 


Aubrey: [laughs] What are you talking about? 


Michael: We didn't have cable, and so I would go over to friends' houses, and all I wanted to do was watch music videos. 


Aubrey: 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. There wasn't any recognition of like, “When you have it all the time, the bloom is off the rose.” 


Michael: Right. And you have actual willpower around it. I had no MTV willpower. 


Aubrey: I know I can't have this thing, so I'm going to be a camel filling up my hump with TV. 


Michael: Or, maybe the Björk videos were just really good and it was worth it. 


Aubrey: The Björk videos are good. 


Michael: Gondry [unintelligible [00:19:22]


Aubrey: 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. And yet, it is the first place that we go as a society, because we think of this as personal responsibility shit. 


Michael: There's always a lot of anxiety about children among middle-aged and older people just because the [unintelligible [00:20:04] 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-aged brain that goes, “Maybe this is fake.” 


Aubrey: Yeah, absolutely. It allows people who don't have ADHD to dismiss people who do have ADHD, right? 


Michael: Yeah. My kids don't have ADHD. 


Aubrey: Yeah, absolutely. 


Michael: It's just probably cucumbers or something.


Aubrey: Michael. 


Michael: Aubrey. 


Aubrey: Are you ready for our next big idea about sugar? 


Michael: I want the rats. Give me rats. I'm here for the rats. 


Aubrey: The next big idea we're going to dig into is the idea that we can predict how different foods impact most people's blood sugar. 


Michael: Is this the glycemic index section? 


Aubrey: This is the glycemic index section. Thank you. 


Michael: I’m excited. 


Aubrey: Have you heard of the glycemic index from anybody other than me?

 

Michael: [chuckles] For the last three years, you talking about this constantly. 


Aubrey: [crosstalk] wanting to do the glycemic episode for so long. 


Michael: My understanding is that it's like a real thing, that certain foods spike your blood sugar and then some of them spike it more. This is the whole thing of 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. 


Aubrey: Yes. They make it a little hill. 


Michael: Yeah, it's like the hill from the Windows desktop background. 


Aubrey: You nailed it. The glycemic index is also where we get these very internety 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. 


Michael: Is that because the ice cream has fat mixed with sugar, and so it slows down how much it hits your body? 


Aubrey: You’re skipping ahead, Michael. Could you stop skipping ahead? 


Michael: A lot of people seem to think that our show is scripted. 


Aubrey: What? 


Michael: They think this whole thing is fake. [Aubrey laughs] I was like, "No, [unintelligible [00:22:12] I really don't know where Aubrey is going with this," which is why I keep ruining the episodes. 


Aubrey: [laughs] Yeah, totally. That's why we both keep doing it. 


Michael: I know. 


Aubrey: So, just to get into the next level of detail with the glycemic index, it's basically a scale that is plotted from 0 to 100. The guy who created the glycemic index is a Welsh physician and 6th 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. He would then feed a group of volunteers, one food on its own, just potato or just strawberries or just milk. And then two hours later, he would measure their blood sugar to see how that food had impacted their blood sugar. This is where we get to the first problem with this study. Would you like to guess how big the groups of volunteers were for each of these foods? 


Michael: Oh, is it two people and one's, like, his cousin or something? 


Aubrey: 5 to 10 people. 


Michael: Is there big variation between the people and how much it's spiking it? 


Aubrey: Totally. There's individual variance. 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. 


Michael: Wait, how much is 50 grams of carbs? is that more than we would typically eat in a day? 


Aubrey: Oh, my God, Michael, here are some examples. A small bottle of Coke, 16 ounces of Coke, 50 grams of carbs. A cup of white rice, 50 grams of carbs. 10 cups of popcorn, 50 grams of carbs. 20 cups of cucumber, 50 grams of carbs. 


Michael: But that gives me ADHD. 


Aubrey: So, people are sitting there eating 20 cups of cucumber. 


Michael: Yeah, that's a lot of cucumbers, man. 


Aubrey: People also don't usually fast for 12 hours and then only eat one food. This is like dry toast without jam. It's popcorn without butter. And then it's not eating anything else for two hours. 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 flatten the curve of the glycemic index. 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. Avocado has a ton of fat and fiber in it,, both of which slow down digestion and change the impact, the glycemic impact of the bread. 


Michael: So, basically, you can't really say that potatoes have 35.7 glycemic index because it depends on what you're eating them with and what you've eaten before and how much you're eating, etc. 


Aubrey: Yes, and that is the first problem of five problems with the glycemic index that I have listed out here. 


Michael: Oh, okay. Good God. 


Aubrey: The second issue here is that lots of things influence the glycemic index of a food. Potatoes come in different shapes and sizes. If you are frying potatoes in oil, those potatoes are going to have more fat. They're going to be digested differently and have a different glycemic index than a baked potato or a boiled potato. 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. 


Michael: Oh, of course, because of sugar. Yeah. 


Aubrey: Totally. So, an unripe 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. How much we chew food can impact its glycemic index? 


Michael: My understanding is that's the very first diet was the, like, chew your food diet. 


Aubrey: Chew your food a hundred times. 


Michael: So, maybe he was onto something and [crosstalk] something remember that was. 


Aubrey: Yeah, totally. 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? 


Michael: Oh, yeah. 


Aubrey: But this is not very well known to people who are not managing their blood sugar for medical reasons. There is not a diet or a dietary intervention for people with diabetes or insulin resistance that is considered to be evidence-based. There is nothing. 


Michael: 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? 


Aubrey: You get a blood sugar monitor, you test your blood sugar, and-- I think in many cases, folks are instructed by their healthcare providers to try out different things and test your blood sugar and see what it does. 


Michael: Wow. 


Aubrey: 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 Cochrane analyzed six RCTs with 202 participants who followed low GI diets for five weeks to six months, and then they found that they lost an average of 1 kilogram more than people on other diets. 


Michael: Yeah. It sounds like every diet study. 


Aubrey: Then the last thing to know about the glycemic index is that it isn't actually recommended for individual use. 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, “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.” 


Michael: In the UK, they use the word crisps to mean elevator. 


Aubrey: Tinfoil. 


Michael: [laughs] 


Aubrey: 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. 


Michael: So, basically, it's like any other framework, I guess, where it's maybe useful in certain circumstances. Maybe people use it and like it and that's fine, but as a population level recommendation, it just isn't very meaningful. 


Aubrey: 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. 


Michael: And then, of course, all that stuff breaks down too as soon as you go to a fucking restaurant. 


Aubrey: 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. 


Michael: Like me. 


Aubrey: Like you. [laughs] 


Michael: Oh, you haven't taken me the rats yet. 


Aubrey: Myth three is where we get to the rats. 


Michael: Let's do small mammals. 


Aubrey: Saving the best for rats. 


[laughter] 


Michael: That was actually pretty good. You've topped yourself. 


Aubrey: 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. 


Michael: 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. 


Aubrey: 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. I wanted to start us out by saying that this is kind of a tough one because feelings run high about this one. 


Michael: Okay, because cocaine is so fun. 


Aubrey: I genuinely would not know. I have not done cocaine. 


Michael: Dude, I thought, due to the DARE program that I would constantly get offered cocaine. And I am not cool enough to have ever been offered cocaine in my whole life. I absolutely would have done cocaine, if someone had offered it to me. 


Aubrey: So, listen, I had a co-worker at one point who described me as having a two drink personality. 


Michael: [laughs] That's good.


Aubrey: He was like, “It's like you've already had a couple of drinks. That's your vibe.” 


Michael: Yeah. 


Aubrey: I might say there is already a whisper of cocaine in your default setting. 


Michael: Yeah, little bit.


Aubrey: So, turning up the volume on that is really something. 


Michael: Imagine my little voice and personality. 


Aubrey: I sent you a little clip of how this is getting billed in mainstream media outlets. This is a clip from Good Morning America from about two years ago. 


Michael: The fucking title is, Studies show added sugar can be just as addictive as street drugs. 


Aubrey: Street drugs. 


Michael: Again, I'm livid that I've never been offered cocaine on the street. 


Dr. Jen: All right, 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 is actually been a very significant body of medical research, nutritional science research, that shows using a test called a functional MRI, 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. 


Michael: Okay. So, I should stop doing cocaine and I should stop eating sugar. If I stop eating sugar that'll have the same benefits as cocaine. 


Aubrey: 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 oats" or whatever. We're not talking about 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. 


This is a tough one, because, again, feelings run high here. I know and love a number of people who consider themselves, 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. 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 a buzzword and a really snappy claim. 


Michael: Right. I think one of the problems is that the term, addicted, has a bunch of different kind of individual and social meanings and also has this element of physiological addiction, like, you go through actual withdrawals. But then there's also psychological addiction. I remember years ago, I interviewed a psychologist about sex addiction. What he said is that, "On some level, you can get addicted to anything. You can get addicted to skiing to the point where it disrupts your work life and your social life." That's a real thing. You don't want to take that away from people, if they say that they're addicted to something, but it's also distinct from physiological symptoms of addiction. 


Aubrey: Yeah, absolutely. 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. 


Michael: It says, “We find little evidence to support sugar addiction in humans, and findings from the animal literature suggest that addiction-like behaviours, such as bingeing, occur only in the context of intermittent access to sugar, not the neurochemical effects of sugar.” Oh, okay. So, we don't find it in humans. When we find it in animals, it's like, if you restrict their sugar intake for a while, then they binge on it when they finally get access to it. 


Aubrey: Right. So, that's a 2016 review. Here's a 2018 review from the British Journal of Sports Medicine. 


Michael: 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.” It's not a great sentence. 


Aubrey: It's not a great sentence. [giggles] That's true. When this study came out, one of the authors went even further and told The Guardian, “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.” That 2018 meta-analysis that says sugar is as addictive as cocaine led to really significant backlash with nutrition researchers. But the sound bite sugar is as addictive as cocaine made it much further than the backlash, which is more nuanced, more reasoned, you have to talk to more people versus somebody makes a graphic on Instagram and is like, “Sugar is as addictive as cocaine and it gets shared 100,000 times and then there you are."


Here is what appears to have happened. It appears that the authors of the 2018 study may have straight up misunderstood the animal studies. Those studies restricted rats to having sugar for two hours every day. But when you take away the restriction, the “addictive behaviors” also went away. The rats did the same thing. They had the same “addictive behaviors” for saccharine, for their artificial sweetener. So, this appears to be about sweetness, not about sugar per se. 


Michael: Oh, like the taste sensation. 


Aubrey: In this study, rats were offered sugar water, saccharine water, or cocaine water. 


Michael: Dude, seriously? 


Aubrey: Yeah. 


Michael: I've never been offered that either. [Aubrey laughs] I'm livid. 


Aubrey: These rats are offered these different things and then they're given levers to get more of the thing. The evidence here is the sugar rats wanted the most of the sugar, but also so did the saccharine rats. The cocaine rats didn't necessarily want a huge amount of cocaine water. 


Michael: The cocaine rats were too busy explaining the podcast they're about to launch. 


Aubrey: [laughs] There's a piece in The Guardian about this called Is sugar really as addictive as cocaine? Scientists row over effect on body and brain. 


Michael: Row was invented to help headline writers fit their headlines. 


Aubrey: In this piece, they talked to a Cambridge psychiatrist who was like, “Yeah, I mean, rats are going to eat food and not cocaine?” 


Michael: [laughs] Fair point, Cambridge psychologist. 


Aubrey: Yeah, man. 


Michael: Yeah. 


Aubrey: 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. Many of the studies that we're talking about are mouse and rat studies. They're 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 just a pleasure center of the brain. Sugar has more of an impact. It creates more of that response. But lots of foods create that response in your brain. It appears that drugs like cocaine, heroin, opioids 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. 


Michael: I get a dopamine response every time I get a poke on Facebook. 


Aubrey: Who's poking? Are we getting in the time machine going back to 2007? 


Michael: [laughs] I wanted to see what reaction that would get from you. Nothing. You gave me nothing. 


Aubrey: I gave you nothing. I have nothing to say about pokes. [Michael laughs] 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. 


Michael: Oh, how did you read them? How did you get these? 


Aubrey: I'm fancy. 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.” 


Michael: Would you open those emails? Actually not-- [laughs]  


Aubrey: [laughs] Also, one of them is a book that I read and ended up blurbing because I liked it so much. 


Michael: What? You read? {Aubrey [laughs] Betrayal. 


Aubrey: Like a chump. 


Michael: Wow. 


Aubrey: So, those two books that are coming out later this year are Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole-Smith. 


Michael: Oh, Virginia. Yeah. 


Aubrey: We love Virginia. 


Michael: Yeah. 


Aubrey: 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 Throsby, and it's out in August. 


Michael: I'm livid that you didn't rely on any YouTube videos for this. 


Aubrey: This is a quote from Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole-Smith. 


Michael: Virginia.


Aubrey: Out later this month, by the way. Pre-order it, team. 


Michael: She says, “Dopamine is also known as the feelgood 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.” 


Aubrey: 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, “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 an overstatement. Sometimes to get your point across you need to make it stronger.” 


Michael: If this is the thing we've confronted a lot before where it's like, a lot of this stuff that seems like scientific messaging is actually policy messaging. 


Aubrey: Yeah, it's social. 


Michael: Yeah, it's designed to be rhetorical or to reach a goal. 


Aubrey: Part of what happens when you invoke an addiction model is that you also invoke all the trappings of that model. And the main way, certainly in the US, that we engage with addiction is abstinence. It is not very feasible for people to fully abstain from all forms of sugar. It's also not great for your body to not have any kind of glucose entering your system. In the absence of a clear scientific consensus here, our cultural attitudes about sugar and addiction both have moved in hard to fill the gap. Sugar has long been discussed as a possible 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. 


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 wretched and to be pitied and don't have self-control, and they did it to themselves, sort of the vibe with addiction. 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, again, scientific consensus that sugar is an addictive substance. 


Michael: Yeah. I don't understand why people are doing this. I think they're doing it for marketing or public relations purposes, because 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 reducing stigma like, “Oh, they can't help it, they're addicted,” or something. I don't think this is going to have that effect. 


Aubrey: I think this is probably coming from a similar place as the redefinition of, “Obesity” as a disease, which is the desire to garner more attention to an issue that some researchers feel isn't getting the attention that it deserves. It's messaging that's designed to grab you by the lapels and shake you. It has the side “benefit” of reinforcing how we already feel about food, making more fear about food in a time when we're moving in a slightly more anti diet direction or have been. 


This is a way that you can reclaim your deep fear and discomfort around food that feels beyond reproach 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, that an addiction frame is less stigmatizing. I would say, have some conversations with some addicts. 


Michael: I just don't think that these very superficial re-labeling 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. So, the only thing that's going to happen is they're just going to attach the stigma to the new term. 


Aubrey: 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.” Any 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. 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 chemical functions of sugar in your body. 


This sort of use of an addiction parallel really lends a sense of urgency that this is a matter of life and death that we can't fuck around. That's not actually what's happening with sugar. There is no such thing as one day you have too much sugar and then you die, if you're not diabetic or something else. 


Michael: Yeah, there's no opioid overdose analogy to sugar. 


Aubrey: Right. What we're talking about is, for say, the onset of diabetes. 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. 


Michael: It's caused by cucumbers. That's what I learned from last hour. That's where we left it, right? 


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


Michael: Yeah.


[laughter] 


[Transcript provided by SpeechDocs Podcast Transcription]

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Aubrey Gordon

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Michael Hobbes

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