Friday, February 27, 2015

Sugar Addiction, hunger cues, and Artificial Sweeteners as a “step-down” from addictive food as a weight loss strategy

By Amy Buzzell
Contact: Physicians Healthy Weight Center, healthyweightcenter@hotmail.com, (603) 379-6500
Is sugar addictive?  How about artificial sweeteners?  Researchers have been investigating these questions for years.  What they have found is that sugar can trigger neurochemicals in the brain which make us feel “happy”, and for those with certain genetic predispositions, sugar can make us feel REALLY happy - can actually be addictive.  
How does sugar addiction work, and how does it occur?  Sugar creates a ‘bump’ in the feel-good brain chemical  dopamine in the reward center.  This sweet food stimulates a “happy response”  in the brain whenever sweets are eaten. The brain remembers this “happy response”  and wants more sugar, more often, to repeat the good feeling.   For those predisposed to  sugar addiction, over time the brain becomes desensitized, so larger amounts are needed to feel satisfied.  A sugar addiction will cause binging, withdrawal, cravings, and may even increase drives for other addictions. Like any other addiction, when sugar is removed from the diet, the body can go through withdrawal symptoms such as anxiety, reduced will power, impulsive behaviors, hopelessness, depression, cravings, and relapse.

High sugar consumption over time, especially when paired with high fat foods, often leads to a cascade of other chemical problems in the body, most notably a problem called metabolic syndrome.  People start to notice belly fat weight gain, and that can be a signal that insulin resistance is occuring, which then can lead to prediabetes, high blood pressure, high triglycerides, inflammation, hormone problems such as PCOS, and more.  People may try to go on a diet to try to reverse these problems, but , but when withdrawal symptoms appear, that’s when dieters often give up.  The symptoms are so depressing and frustrating, that without help, they can derail the best intentions.
When sugar is consumed, it has been found to cause a pleasure or reward-response in the brain. The pleasure center of the brain signals dopamine, the 'happy' neurochemical, which then signals motor movements (reaching for another cookie!). With long-term sugar consumption, researchers have found that gene expression changes, increasing concentration of excitatory dopamine receptors while reducing the concentration of inhibitory dopamine receptors. In addition, dopamine released with sugar consumption is tolerated more and more by the body; as dopamine fluctuations  increase, the brain starts to resist it. Over time,  increasing doses of sugar are needed to activate the pleasure center of the brain.
Tasty, hyperpalatable foods that trigger this pleasurable reward-response are usually calorie-dense, high glycemic index, rapidly digested carbohydrate, and high in saturated fat. These food components are addictive, causing a reward-response in the brain, and the body wants more of that reward/pleasure-response ASAP!  When these trigger foods - sugar, white flour, calorie dense, and high saturated-fat foods - are consumed regularly, it can become hard to eliminate them from the diet. This chain of events can be hard to fight, and can make it extremely difficult to reach a healthy weight goal.
We can help you avoid the addictive response to sugar and other addictive foods by helping you recognize the difference between hedonic and homeostatic hunger.  Homeostatic hunger occurs when you haven’t eaten for a few hours and you sense that your body needs food (stomach hunger); it is the body’s actual need for food as FUEL.  Hedonic hunger, on the other hand, is the desire to eat because it is enjoyable,  and it will be a source of FUN (heart/head hunger).   Hedonic hunger is controlled by the reward center in our brains, and many different factors can increase or decrease our neurochemical drive to “eat for fun”.  There is nothing wrong with enjoying food - but -  there is nothing fun about feeling out-of-control, or feeling controlled by excessive hedonic hunger signals.  The good news is that research has revealed many strategies to bring hedonic hunger under control.    
The first thing we need to know is that the two types of hunger can interact:  If you do not meet your needs for food as fuel (homeostatic hunger),  then the drive to eat for pleasure may be  driven up as well (hedonic hunger).  Hedonic hunger can be driven too high, which leads to overeating.  Eating meals and snacks on a regular schedule (and not going too long between meals), and eating meals with a healthy balance of protein and other nutrients will help BOTH types of hunger.  
The next thing we need to know is that excess exposure to high glycemic carbohydrate/high fat foods also drives up hedonic hunger.  Even seeing or smelling these ‘trigger foods’ can increase our drives to ‘eat for fun’.  Eating excess sugar is a powerful  trigger for  these out-of-control dopamine surges in the reward center of our brains.   
Interestingly, artificial sweeteners do not trigger the dopamine 'reward' response in our brain the way sugar does!   For those who love sweet tastes, and are are sugar-addicted, but  are not ready to cut all sweetness out of their diets, there IS a way to come down off a sugar addiction without going ‘cold turkey’.   “Products with artificial sweeteners such as sucralose  may be used as a 'step-down' strategy for those who are sugar/sweet-addicted, since the products will still taste sweet, but NOT trigger addictive chemical brain responses - sort of how like alcohol-free beer TASTES like beer, but can be consumed safely by alcoholics.” (Warren, 2015) In a comparison of desire for real sugar, artificial sweetener, or water, the impulse over time for sugar was significantly greater than both artificial sweeteners and water, which were much less desirable.   “Some of our patients are worried that artificial sweeteners will simply continue a sugar addiction.   Research suggests that this is not the case, neurochemically.  For those who are genetically predisposed to sugar addiction, the consumption of sugar creates addictive symptoms of cravings, impulsive eating, anxiety, and binging, as well as neurochemical changes in the brain which worsen the cravings over time.   Artificial sweeteners do not appear to  cause this addictive brain change.  A patient may choose to stop all sugar and sweeteners, ‘cold-turkey’ if you will, or if they prefer, they can choose to break their sugar addiction through judicious  use of some calorie-free sweeteners.  Once they remove the sugar, they will not experience the sugar-induced dopamine surges and crashes, even if they are using calorie-free sweeteners,  and their addictive response will be extinguished.   They will experience increased control over their food consumption.  They may ultimately decide to discontinue all sweeteners, and over time their taste preferences will change as well.


“Some food purists insist that all people have to ‘go cold turkey’ off all sweet foods.  While this approach works for some, the problem with insisting on a restrictive ‘one size fits all diet’ is that this  feeds into all-or-nothing, black-and-white, extremist/perfectionist thinking.  Perfectionism can be counterproductive, and unrealistic for many. Perfection is not necessary for success or health, and perfectionism can actually lead people into yo-yo dieting cycles.   We need to understand ourselves,  our own history with foods, and understand how our brain chemistry can be affected by our food and lifestyle choices.  Once we understand, then we can create realistic plans for success.  There are many different paths to health, and we must choose the path that is best for each of us as a unique  individual.”  (Warren, 2015)  

Those who are addicted to sugar can feel trapped - they may feel they need it to feel normal.   When sugar is abruptly  taken away, withdrawal symptoms come on, and dieters often give up.  Sugar withdrawal can derail the best of intentions.  This is where our program becomes highly beneficial, with use of research to help control cravings while working toward a healthy weight. “In our program we will help you remove  and replace  addictive substances, create a healthful, realistic nutrition plan, activity and exercise strategy, provide continuous support, accountability, stress management tactics, problem solving, counseling, and education - and re-education - along  with the latest research.  We have the tools to help break food addictions, while also retraining the brain to prefer, or even crave, healthier foods.  We also have the option of using medication to help control withdrawal while patients are building new lifestyles, creating and solidifying new habits, new healthy lifestyle patterns.  While medication is certainly not necessary for weight loss, some people find it to be an incredibly helpful tool, as an adjunct to lifestyle change - never a replacement for healthy lifestyle, of course.   Medication may help maintain abstinence in some cases as well.  For certain patients, we use a method similar to the Finnish Sinclair Method for alcohol addiction, which uses medication on a ‘prn’ or ‘as needed’ basis to help block re-activation of addictions, for those with serious addiction.   But the bottom line is that new healthy lifestyles ARE possible to achieve, and maintain.
And feel free to give us a call, anytime, for help in designing your healthy life program!
References:
Dr. Warren, Jennifer. February, 2015
http://www.ncbi.nlm.nih.gov/pubmed/21243471 Stice, E., Yokum, S., Zald, D., and A. Dagher. 2011. Dopamine-based reward circuitry responsivity, genetics, and overeating. Curr Top Behav Neurosci. 6: 81–93.
http://www.ncbi.nlm.nih.gov/pubmed/20116437 Stice, E., Yokum, S., Bohon, C., et al. 2010. Reward circuitry responsivity to food predicts future increases in body mass: moderating effects of DRD2 and DRD4. Neuroimage. 50(4): 1618–25.
http://www.ncbi.nlm.nih.gov/pubmed/19014506 Blum, K., Chen, A.L., Chen, T.J., et al. 2008. Activation instead of blocking mesolimbic dopaminergic reward circuitry is a preferred modality in the long term treatment of reward deficiency syndrome (RDS): a commentary. Theor Biol Med Model. 5:24. Review.
http://mashable.com/2015/02/18/brain-on-sugar/

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