Simon Thornley
Professional Teaching Fellow
The University of Auckland
•
Dairy photo
•
Museum photo…
In a nutshell…
• What is addiction?
• Addiction and mental health?
• Is sugar addictive?
• Why does this matter?
Addiction
• ‘loss of control’
• Withdrawal
• ‘pathognomonic’
• DSM – V
• prioritise substance over:
• Social
• Work
• Law
‘Appetite for drugs’
Why smoke?
Tobacco Withdrawal
Symptoms
Duration
(weeks)
<4
Prevalence
(%)
50
Depressed
Restless
<4
<4
60
60
Poor
concentration
↑↑ appetite
<2
60
>10
70
Craving
>2
70
Irritable
Negative re-inforcement
Withdrawal
Puff
Nicotine
metabolised
More
puffs
Withdrawal
relief
Automatic behaviour
Rational
behaviour
Cortex
Addiction
Automatic
Mid brain, brain
stem
Why are cigarettes addictive?
Nicotine delivery
Royal College of Physicians, Nicotine in Britain, 2000
Eating & addiction?
• Executive, had tried: obesity surgery, laxatives,
diets, everything
“Often I would shake until I could
put some sugar in my mouth”
Atkins R. Dr Atkins New Diet Revolution. London: Vermillion, 2003.
• “I had an hour’s drive from my office
to my home, and I knew every
restaurant, every candy
machine and every soft drink
dispenser along the whole route.”
Reward centre
Dopamine and reward
• Activation of reward
centres lead to strong
sub-conscious urges to
smoke in the presence of
‘cues’
• Similar to food, sex,
caffeine, alcohol (hence
weight gain)
Biological pathways
• Sugar  dopamine release
• like drugs of abuse, but less so.
• Correlation: obesity & D2 receptor
density
•
Volkow ND, Wise RA. How can drug addiction help us understand obesity?
Nature Neurosci 2005;8(5):555–60.
• Rodents:
•sugar reliably
induces withdrawal
•fat does not.
Avena NM, Rada P, Hoebel BG. Sugar and Fat Bingeing Have Notable Differences in
Addictive-like Behavior. J. Nutr. 2009;139(3):623-28.
Automatic eating
• 40 secretaries (cross-over)
• Ate 4.6 (P<0.05) more
chocolates/day if at desk (&
visible), rather than shelf 2m
away
Wansink B, Painter JE, Lee YK. The office candy dish: proximity’s influence on estimated and actual
consumption. Int J Obesity 2006;30(5):871–5.
Big tobacco likes sugar…
• 5% of the weight of cigarette is sugar
“Acetaldehyde [burnt sugar] alone maintained
lever pressing at a greater rate than nicotine
at equal mg/kg doses. This is consistent with
other findings at this laboratory.”
(Philip Morris, 1983)
https://www.health.govt.nz/system/files/documents/pages/philip-morris-07.pdf
Am J Public Health. 2007 November; 97(11): 1981–1991.
Addiction & mental health
• ↓ impulse control
• Automatic behaviour in
response to cues
Not everyone agrees…
• “There is no support … for the
hypothesis that sucrose may be
physically addictive...”
•
David Benton, The plausibility of sugar addiction and its role in obesity and eating
disorders, Clinical Nutrition, Volume 29, Issue 3, June 2010, Pages 288-303
•
Sponsored by World Sugar Research Organisation, but views entirely independent.
Benton’s arguments
• Subtle differences in dopamine release in
animal models of addiction comparing drugs
with sugar
• Obese people do not crave sugar…
• Long term starvation ≠ craving
• Opiate antagonist have little effect on binge
eating
Case Report
• 38 year old woman from Wisconsin
“I cut all processed sugar and
flour from my diet …”
NZMJ 27 February 2009, Vol 122 No 1290
• “I had horrible stomach
pains, all my joints and
muscles throbbed, and I had
the shakes constantly.”
• “I don’t even know how to
describe the horrible
headaches that went along
with all this.”
• “The worst part … lasted 3 weeks.
The first 3 days were normal, but
then on the fourth day the worst
cravings began. All I could think
about was ice cream, chocolate,
and cheesecake”
Am I alone?
Overeater’s anonymous
• “When you are addicted to drugs
you put the tiger in the cage to
recover;
• when you are addicted to food, you
put the tiger in the cage, but take
it out three times for a walk”
• Kerri-Lynn Murphy Kriz (thesis)
So what?
• Addiction theory resolves
conflicting evidence about
effects of sugar intake on kids’
behaviour
Measure: Usual intake
• Sugary soft drinks strongly associated
with:
• Violence
• Suicidal behaviour
• ↓ cognitive development
• ADHD
Epidemiology
• Large effects: e.g. 4+ sodas/day
154% more likely to destroy
belongings of others (95% CI: 70%
to 280%), compared to none.
Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. ADHD Is Associated With a “Western” Dietary Pattern in
Adolescents. J. Atten. Disord. 2011;15(5):403-11.
Solnick SJ, Hemenway D. Soft drinks, aggression and suicidal behaviour in US high school students. Int. J. Inj. Contr. Saf.
Promot. 2013:1-8.
Azadbakht L, Esmaillzadeh A. Dietary patterns and attention deficit hyperactivity disorder among Iranian children. Nutrition
2012;28(3):242-49.
Suglia SF, Solnick S, Hemenway D. Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds. The Journal
of Pediatrics 2013;163(5):1323-28.
Short term sugar intake
• Short term feeding with sugar,
compared to control
• No difference on task performance
• Intervention relieves withdrawal.
Conclusion…
• Sugar plays no role in ADHD
Short term vs. long term intake
• Short term: sugar relieves
withdrawal
• Long term: more closely related to
level of addiction (tolerance).
Environment
• Limit:
• Cues (advertising)
• Availability (sales)
• Measures to curb tobacco likely to
work for sugar
Welcome to
Auckland
City
Hospital…
As part of
your healthy
diet…
So what?
Sugar
Tobacco
• NZ: sale unrestricted.
• Age restrictions
• Advertising not
restricted
• Advertising
restricted
• Largely ignored by
health sector
• Focus for healthcare
intervention
• Voluntary withdrawal
of soft drinks in
schools in 2006.
• Focus for eradication
• Heavily taxed
Harm?
Sugar
•
Weight gain
•
Gout
•
Hypertension
•
CVD
•
Fatty liver disease
•
T-2-Diabetes
•
Mental health issues (cohort studies)
•
Rotten teeth (cohort)
•
Mental health issues (cohort)
•
Lung cancer
Tobacco
•
•
•
•
•
•
Lung cancer
Other cancers
COPD
CVD
Rotten teeth
Passive smoking
• Glue ear
• Respiratory disease
What would we like to do?
• Ban sales of sugared soft drinks from in &
around schools to NZ wide ban (Tokelau)
• Health promotion
• Sugar taxes (Mexico)
• Safe, low energy sweeteners, why do we need
to play Russian roulette with sugar?
Case-series coming off sugar
1.6
1.4
Craving for sweets
1.2
Mean Rating (sem)
Fatigue
1
Moodiness
0.8
0.6
0.4
0.2
0
Baseline
0
4
8
Weeks After Starting Diet
12
16
20
24
Changes in a Symptom Questionnaire During a Very Low
Carbohydrate Diet Program. Westman et al.
In a nutshell…
• Addiction theory
• explains central role of sugar in our food
supply (↑sales & profit)
• explains statistical association between
sugar intake and mental health
• Justifies tobacco-like measures to limit
intake