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We reward children with it over the holidays or for a job well done in school. And we reward ourselves with it after a particularly stressful day or to celebrate a birthday or a special success.

We add sugar to our coffee, bake it into our favorite treats, and spoon it over our breakfast. We love the sweet stuff. We crave it. But are we addicted to it?

There's an increasing body of research that tells us excess sugar could be as addictive as some street drugs and have similar effects on the brain.

"Addiction is a strong word," says Dr. Alan Greene, a children's health and wellness expert and the author of books like "Raising Baby Green" and "Feeding Baby Green."

"In medicine we use 'addiction' to describe a tragic situation where someone's brain chemistry has been altered to compel them to repeat a substance or activity despite harmful consequences. This is very different than the casual use of 'addiction' ('I'm addicted to "Game of Thrones!"')."

In Greene's opinion, evidence is mounting that too much added sugar could lead to true addiction.

Eating sugar releases opioids and dopamine in our bodies. This is the link between added sugar and addictive behavior.

Dopamine is a neurotransmitter that is a of the "reward circuit" associated with addictive behavior. When a certain behavior causes an excess release of dopamine, you feel a pleasurable "high" that you are inclined to re-experience, and so repeat the behavior.

As you repeat that behavior more and more, your brain adjusts to release less dopamine. The only way to feel the same "high" as before is to repeat the behavior in increasing amounts and frequency. This is known as substance misuse.

Cassie Bjork, RD, LD, founder of Healthy Simple Life, states that sugar can be even more addicting than cocaine.

"Sugar activates the opiate receptors in our brain and affects the reward center, which leads to compulsive behavior, despite the negative consequences like weight gain, headaches, hormone imbalances, and more."

Bjork adds, "Every time we eat sweets, we are reinforcing those neuropathways, causing the brain to become increasingly hardwired to crave sugar, building up a tolerance like any other drug."

Indeed, research on rats from Connecticut College has shown that Oreo cookies activate more neurons in the pleasure center of the rats' brains than cocaine does (and just like humans, the rats would eat the filling first).

And a 2008 Princeton study found that rats may become dependent on sugar, and that this dependency could be related to several aspects of addiction: cravings, binging, and withdrawal.

Researchers in France agree that the casual link between sugar and illegal drugs doesn't just make for dramatic headlines. Not only is there truth to it, but also they determined the rewards experienced by the brain after consuming sugar are even "more rewarding and attractive" than the effects of cocaine.

"Stories in the press about Oreos being more addictive than cocaine may have been overstated," admits Greene, "but we should not take lightly the power of added sugar to lure us again and again, and to rob us of our health."

He adds, "Medical addiction changes brain chemistry to cause binging, craving, withdrawal symptoms, and sensitization."

Sugar is also much more prevalent, available, and socially acceptable than amphetamines or alcohol, and so harder to avoid.

But whether sugar is more addictive than cocaine, researchers and nutritionists suggest that sugar has addictive properties, and we need to be getting less of it.

"The drug analogy is always a tough one because, unlike drugs, food is necessary for survival," says Andy Bellatti, MS, RD, strategic director of Dietitians for Professional Integrity.

"That said, there is research demonstrating that sugar can stimulate the brain's reward processing center in a manner that mimics what we see with some recreational drugs."

Bellatti adds, "In certain individuals with certain predispositions, this could manifest as an addiction to sugary foods."

The World Health Organization (WHO) has been cautioning people to reduce their intake of "free sugars" to less than 10 percent of daily calories since 1989. The organization says that doing so can lower the risk of becoming obese or overweight, or experiencing tooth decay.

"Free sugars" include both the sugars naturally found in honey and fruit juice, and sugar added to food and drinks. On food labels, added sugars include words such as glucose, corn syrup, brown sugar, dextrose, maltose, and sucrose, as well as many others.

In 2015, WHO further suggested reducing free sugar daily intake to less than 5 percent of calories, about 6 teaspoons. In the United States, added sugars account for 14 percent of the average person's daily calorie intake.

Most of this comes from , including energy drinks, alcoholic drinks, soda, fruit drinks, and sweetened coffee and teas.

Other common sources are snacks. These don't just include the obvious, like brownies, cookies, doughnuts, and ice cream. You can also find large quantities of added sugar in bread, salad dressing, granola bars, and even fat-free yogurt.

In fact, found that high-calorie sweeteners are in over 95 percent of granola bars, cereals, and sugar-sweetened beverages, most often in the form of corn syrup, sorghum, and cane sugar.

The Office of Disease Prevention and Health Promotion's 2015-2020 Dietary Guidelines suggest cutting consumption of added sugars to less than 10 percent of calories per day.

To help consumers, the Food and Drug Administration has developed a new food label that lists added sugars separately, which manufacturers are required to use (though some smaller manufacturers have until 2021 to comply).

"You need food to survive, and I think it's unrealistic to think you will be able to completely 'quit' sugar," says Alex Caspero, MA, RD, a blogger, health coach, and founder of Delish Knowledge.

"The problem is that we aren't meant to enjoy sugars in such concentrated amounts.

"In nature, sugar is found surrounded by fiber, in sugar cane and fruits. It naturally comes in a container that produces a shorter blood sugar response and aids in fullness. Today's sugars are refined and concentrated."

Caspero adds, "The good news is that we can adapt our taste buds to accept less sugar. Reducing sugar, especially concentrated sugars, not only limits the amount of sugars ingested, but also makes less sweet foods seem sweeter."

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We reward children with it over the holidays or for a job well done in school. And we reward ourselves with it after a particularly stressful day or to celebrate a birthday or a special success. We add sugar to our coffee, bake it into our favorite treats, and spoon it over our breakfast.

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Written by Daisy Whitbread
BSc (Hons) MSc DipION

Powered by USDA Nutrition Data.

Sugars are simple carbohydrates naturally occurring in a variety of foods, including, fruits, vegetables, and milk. Sugar is also used as a food ingredient, added to processed foods for its sweet taste. It is these added sugars that cause health problems, not the sugars naturally occurring in foods.

Consumption of added sugar has increased rapidly over recent years and is believed to contribute to rising rates of obesity, type II diabetes, and heart disease.

High sugar foods to limit or avoid include puddings, milkshakes, ice-cream, fruit juices, sugary soda drinks, cakes (especially with frosting), candies, fruit yogurts, fast foods, cereal bars, and commercial cereals. In this list, both the grams of sugar and teaspoons of sugar is given. 1 teaspoon is equal to 4 grams of sugar.
For more information see the article of high carb foods to limit or avoid, or see the nutrient ranking of 200 foods high in sugar.
Printable One Page Sheet

Use the ranking tool links below to select foods and create your own food list to share or print.

View more nutrients with the nutrient ranking tool, or see ratios with thenutrient ratio tool.

Data Sources and References

U.S. Agricultural Research Service Food Data Central

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Top 10 Foods Highest in Sugar (To Limit or Avoid)

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High sugar foods to limit or avoid include puddings, milkshakes, ice-cream, fruit juices, sugary soda drinks, cakes (especially with frosting), candies, fruit yogurts, fast foods, cereal bars, and commercial cereals.

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What kills more people: sugar or cigarettes? You may want to hold off before you answer this question. A closer look at the statistics behind what kills people could show a sweeter killer.

Initially, people didn't know that cigarettes could cause bad health. Media, doctors, and societies didn't associate cigarettes with bad lungs and cancer. It had taken years before people understood that cigarettes caused damage to our bodies. This was because people didn't feel pain and were not sick right after smoking one cigarette. Instead, a cigarette helped to take people's stress and anxiety away.

A cigarette made a person feel calm and gave them a burst of energy. One cigarette didn't show any immediate harm. So why stop smoking if nothing instantly bad happens? The damage that happens from smoking cigarettes is not noticeable at first. You won't see the damages that smoking causes until you wake up one morning with a cough.

Over time, a smoker will face an increased risk of countless health problems. But it wasn't until anti-smoking advertisements were released that people changed their opinion. More research on the health benefits of smoking was done, and experts concluded that smoking kills. Now everyone knows only too well the harm smoking can do.

Cigarettes have been known to cause:

Severe Genetic Damage Within Minutes

Throat Cancer

Stomach Cancer

Lung Cancer

Bladder Cancer

Pancreatic Cancer

Increased Stillbirth Risk

Heart Attacks

Stroke

Chronic Obstructive Pulmonary Disease (COPD)

Cigarettes are bad for you, but people still smoke them around the world. This might be because it contains an addictive substance, nicotine. Nicotine stimulates dopamine in the brain, which is responsible for the pleasurable sensations that smokers feel. However, the more you smoke, the more your nerve cells become immune to the enjoyable emotions brought on by smoking. As a result, smokers usually increase their intake of nicotine to get that desired feeling.

Can sugar be as poisonous as cigarettes? The answer is yes.

It's hard to avoid sugar because sugar is everywhere. Whereas it is easier to prevent a cigarette and nicotine. There are the obvious items that contain sugar, like coca cola, chocolate, candy, biscuits, cake, pudding, jello, and cereals. But did you know that there are hidden sugars in your food too? Sugar can also be found in your bread, yogurt, smoothies, ketchup and even in baked beans. Even foods that are masquerading as 'skinny' are packed with sugar too. Avoiding sugar is difficult.

There are Two Types of Sugar: Naturally-Occurring Sugar and Added Sugar

Added sugars are sugars that are contributed during the processing of foods and beverages. It is the ingredients, such as honey, high fructose corn syrup, and agave that are used in foods to provide added sweetness. Natural-occurring sugar is never added to the processing of foods and beverages. Instead, the food item already came with sugar. For example, fructose in fruit and lactose in milk.

Sugar found in fruit and dairy are not bad for you. The protein found in dairy and the fiber in fruit helps your body absorb the natural sugar slowly. Slowing down the digestion of sugar prevents the spike of insulin response and harm to your liver.

Eating added sugar can quickly decrease your health. The editors at 'Eat This, Not That!' did an enormous amount of research and concluded that added sugar makes eating healthy almost impossible. The more added sugar you consume, the less healthy food choices you'll make and eat. This is because sugar can mess with our taste buds and bodily systems.

Many of us overindulge with sweets. The average adult consumes approximately 63 grams of sugar each day. That is twice of the recommended daily amount. By eating more sugar than our bodies need we are storing the excess as fat. This leads to an increase in obesity and diabetes.

What Sugar Does To Your Body

When you digest sugar, it immediately goes to your stomach where digestive juices dilute it. Then enzymes begin to break it down into glucose. This glucose is released into the bloodstream, where it is converted into energy. Insulin is then released and absorbs the excess glucose in the blood to stabilize sugar levels. When you eat too much sugar, an overflow of insulin goes into your system to try to manage the toxic substance. The result is a sugar rush.

The more sugar that is in the bloodstream, the more insulin released. If your body releases too much insulin, your blood sugar will drop below normal levels. This is called hypoglycemia, better known as a sugar crash. This is a way of our bodies telling us that it wants more sugar. The sugar that we continue to eat that is not used for energy is converted into fat. The more frequent this process is, the more insulin that is required. This means our body will stop using sugar as energy and convert it to fat straight away instead. This can lead to obesity, heart disease, and diabetes.

Feeling sluggish all the time or always being thirsty and hungry could be signs that you have been on a sugar binge. If this continues and you are not eating sugar in moderation, you will notice that you have put on weight. High sugar diets are a big part of why 68.8% of Americans are obese.

When you are obese, your cells can become resistant to the usual effects of insulin and will struggle to absorb glucose from the blood to use for energy. This will cause your pancreas to go into overdrive to produce more insulin. But despite your pancreas's hard work, your cells still won't accept the glucose. The result is excess sugar floating around in your bloodstream with nowhere to go.

You could damage virtually every organ in your body if your blood is saturated with sugar. Pumping sugary blood through your blood vessels would be like pumping thick sludge through a tiny pipe. This can lead to high blood pressure, kidney failure or kidney disease, and can affect other parts of your body, such as your heart, brain, and eyes.

Can You Get Addicted To Sugar

Can sugar be as addictive as cigarettes? The answer is yes. According to a study by the University of Florida, sugary foods can be as addictive as nicotine and cocaine. During their study they found that people with obesity were drawn to images of junk food, in the same way, cocaine addicts were drawn to images of white powder.

You won't know the damage sugar can cause right away because it happens over time. Just in the same way that one cigarette won't cause you any harm instantly. Instead, eating an increased amount of sugar over time will add up to bad health. What you eat and do to your body every day has a long-term impact on your health. If you eat sugar in moderation, then you can continue to stay healthy.

Article shared from Diabetes Daily

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Sugar vs Cigarettes: Which is Worse For You? - Modern Women's Health Lisa M. Jukes

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What kills more people: sugar or cigarettes? You may want to hold off before you answer this question. A closer look at the statistics behind what kills people could show a sweeter killer.

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Too Much Sugar: Destroying Your Brain & Body

It is a well-known fact that by eating too many sweets and sugary treats, with not enough exercise, you begin to put on weight. But there are other side effects as well. Not many people know what happens to your brain when you eat too much sugar, or what insulin resistance is, or even why your brain needs sugar. However, here at All-American Home Care, we are committed to educating all Americans on the perils of an "overdose" on sugar, and why a healthy and carefully moderated amount is not necessarily a bad thing.

That's right; you don't need to cut all sugar out of your diet, just most of it. Continue reading to find out about the effects of too much sugar on your body and mind, and to also learn about simple and quick ways that you can begin to reduce the amount of sugar you consume daily, and how to get sugar out of your body and to start living the healthy lifestyle that is possible for everyone.

Sugar's Reward Response

In today's world, sugary, high-energy foods are abundant. It's no longer necessary to scavenge for these delicious treats. Unfortunately, our brains are still functionally very similar to those of our predecessors, and they need sugar like no other animal on earth.

Sugar and the brain are interconnected since Mesolimbic dopamine, a reward system in the brain, is triggered when we eat sweet things like candy or cakes. Dopamine is a neurotransmitter secreted by neurons that can serve as a positive signal. When the reward system is activated, it encourages us to engage in certain behaviors again.

Sugar's "hits" of dopamine encourage quick learning to preferentially locate more sugary meals in your environment. Foods that raise blood glucose levels increase the brain's desire for addiction.

Sugar Addiction

Sugar addiction, unlike many other types of substance abuse or behavior compulsions, is quite easy to identify. Sugar addiction is characterized by excessive consumption of sugar-sweetened foods and beverages. The person may eat incessantly, eat to avoid boredom, and become hyper and crash as a result of high glucose energy in the body.

Additional research on brain activity has bolstered the theory that overeating affects our brain's reward system, which in turn drives overeating. A similar process is also thought to be responsible for addiction's tolerance.

As time passes, more and more of the drug is needed to get the same high. In studies, it's been shown that eating too much leads to a decreased reward response and an increasing dependence on high-calorie, low-nutrient foods that are high in sugar, salt, and fat.

How Sugar Impacts Memory

Excess sugar has negative effects on the body. Sugar and brain health are co-related. Even one instance of high glucose in the bloodstream can lead to slow cognitive function and memory and attention problems.

Brain inflammation due to a high-sugar diet can lead to memory problems, which proves that the brain and glucose are interlinked. According to research published in the journal Behavioral Brain Research that took place in 2016, when rats were fed high sugar diets, they developed inflammation in the hippocampus, but not when they were fed a conventional diet.

Sugar's inflammatory harm may not be permanent, though, which is a relief. A study published in the journal Nutrients in 2015 indicated that lowering sugar intake and supplementing with omega-3 fatty acids and curcumin improved working memory.

Sugar Has Effects on Mood

Sugar has been shown to have a negative impact on mood. A brain-imaging study found that in healthy young adults, the ability to interpret emotions is impaired when blood glucose levels are increased.

According to research, sugar consumption has been related to depression and other poor mental health symptoms after a long period. Over time, a person's long-term mental health may be affected by their consumption of added sugars, whereas a reduced intake of added sugars may be linked to greater mental health.

Multiple recent studies have identified several possible reasons for the negative effects of consuming added sugars, such as:

Blood pressure and inflammation have been related to depression as a result of consuming added sugar.

Diets high in sugar can cause blood sugar to rise and fall rapidly, resulting in hormonal swings and changes in mental state.

Sugar addiction is connected to depression because of sugar's impact on dopamine levels (the brain's pleasure and reward chemical).

A study published in Diabetes Care indicated that persons with type 2 diabetes experienced heightened levels of despair and anxiety when their blood glucose levels spiked suddenly (elevated blood sugar).

How Sugar Affects the Brain

When it comes to the human brain, it's no surprise that it consumes the most glucose-supplied energy. In the absence of glucose, the brain's chemical messengers, the neurotransmitters, cannot function. Sugar deprivation impairs the ability of these critical cells to communicate with one another, resulting in decreased cognitive function.

A complication of diabetes, hypoglycemia (low glucose levels), can also be caused by it. Low levels of brain-derived neurotrophic factors, or BDNF, are also found in those who consume a lot of sugar in their diets. BDNF aids in the formation of synapses, which are connections between nerve cells. Without this essential protein, the growth, development, and communication of these nerve cells are severely hindered. Multiple neurological processes begin to deteriorate when synapses are unable to interact effectively.

The brain suffers when blood sugar levels are out of balance, and this can lead to cognitive loss if the problem persists. The Diabetes Research Institute estimates that over 34 million individuals in the United States have diabetes, while the World Health Organization (WHO) estimates that over 422 million people worldwide have the condition. You might wonder what effect diabetes and sugar consumption have on the brain.

In 2014, researchers at the Johns Hopkins Bloomberg School of Public Health revealed a startling association between diabetes and severe cognitive loss in middle-aged people. The findings of their study suggest that BDNF and glucose metabolism may be linked.

Some of the Key Symptoms of an Overdose on Sugar

When you consume more sugar than you should be one day, it's not a big deal. Or even when you do it for a week straight, and possibly even a month. However, when it becomes a habit to grab a pop for lunch, and have dessert after every meal, and even start to bring sugary snacks with you in the car, eventually the problems will begin to build up.

For example, in extreme cases, overconsumption of sugar has led to insulin resistance and dementia, which both stem from the root cause of brain damage. Thus, not just your body's health is under threat from this deeply important and relatively unknown health concern. With too much sugar, your memory can start fading, and your thinking speed can actually start slowing down as more and more sugar becomes present in your bloodstream around your brain, which has been shown to be toxic to the brain cells present there. It can even kill your brain cells.

The reason overconsumption is so bad is not that you've done it once or twice in a month. It's because the amount of sugar that you are eating has become a habit, which leads to an unhealthy cycle that just breeds more and more health concerns. Additionally, careful research has been done into the amount of sugar that should be consumed by humans, and obviously, numbers do vary. However, it is important that everyone stays mindful of this health crisis. As Americans, with 100 million of our fellow countrymen afflicted by diabetes (study by the CDC, or Center for Disease Control and Prevention), this health concern is the largest struggle of our generation.

What Is Insulin Resistance, and Why Is It Important?

Insulin resistance is one of the major ailments that affect many people struggling with healthcare issues related to abnormal bloodstream and blood sugar levels in America, and over 80 million Americans are believed to be insulin resistant in 2020, once again according to the CDC.

Insulin resistance is also one of the major high blood sugar causes. When your blood sugar levels are abnormal to your unique numbers, there is more sugar in your bloodstream. This means that, when the hormone insulin attempts to pull sugar from your bloodstream and into your muscles to give you energy, it is pulling more sugar than is required from your blood and attempting to store it in your cells.

As they are programmed to do, your cells will protect themselves from this and become insulin resistant. Insulin is created by your pancreas, which will respond to the ineffectiveness of the insulin by creating and releasing into your body MORE insulin, which only makes the problem worse, and causes your body to further reject insulin.

Why Sugar Overdoses Lead to Dementia

So, what is the effect of sugar on the brain? Well, when your body digests sugar, it transforms this sugar glucose, which is your body's primary source of energy. Your brain also requires a certain level of glucose to continue functioning, just like the rest of your body's organs do. However, unlike your body's other cells, your brain cells are not equipped to absorb or transform sugar. Rather, they just take it directly from the bloodstream, which can create a problem.

Now that your brain has sugar in it, insulin must use it, so your brain has the energy necessary to perform everyday mental and bodily functions- for instance, breathing, blinking, thinking, monitoring, operating, and more.

If the aforementioned lifestyle describes you, then your brain will often have a high level of sugar and, thus, insulin in it. This is basically drowning your brain in sugar, as it can't be converted into energy (glucose). And, then, if the brain can't get the energy it needs, this leads to brain damage and the unfortunate death of brain cells. The insulin resistance that has been developed over the years is the negative effect of what too much sugar does to your brain.

How Can You Start Living a Healthier Lifestyle?

So, you've read everything above, and now you're pondering the information. How do you prevent insulin resistance and revert to the normal blood sugar levels that you should have, and can achieve? Well, by cutting back on the amount of sugar you consume every single day.

Reducing the amount of sugar you eat and drink every day involves not just eating differently, but also acting differently. Take the stairs some days instead of the elevator, if possible. Try biking to work, or to the park, or wherever you're going instead of driving. This is a proven and effective way of how you can get sugar out of your body. Develop healthy routines such as growing a small garden in your backyard if you live in a house that supports that, or maybe in your windowsill if not. Many foods will lower your blood sugar levels fairly quickly, such as fruits and vegetables.

There are many wonderful benefits that come with eating and drinking and living healthier in general. For example, your stress levels are lowered (fatty and sugary foods have been proven to be filled with stress-inducing hormones), and so, therefore, you are sick less, meaning you can work more often, and make more money. Additionally, with lower stress levels, you actually live longer and have a lower blood sugar level, which will continually make you healthier. Getting back on a healthy cycle instead of the insulin-glucose unhealthy one that prevails when sugar is frequent in your diet will change your life.

Who Can Help?

If you now see why too much sugar is not good for your health, and you are ready to begin becoming a healthier person, be sure to have the right professionals by your side. All-American Home Care is prepared to help you out with all situations related to this topic. We have over 5 years of experience on a professional level.

Our mission is to educate all Americans about the importance of good eating and having a healthy lifestyle. We are the premier choice for Americans who are looking for ways to protect themselves and their loved ones from the downfalls of dementia. We can also equip you with ways to live as healthy of a life as possible.

Our company was founded on the idea that every patient deserves the utmost in home-care services. Founded in 2011, All-American Home Care has always strived to aid all Americans with the burdens poor health education can bring, especially to those who are not in good health due to government failings and limited education. Our team of experts provides reliable information to help you in your time of need.

Contact us today if you are ready to start taking steps towards living a healthy lifestyle.

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How Sugar Affects on the Brain: Too Much Sugar The Effects on Brain

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It is a well-known fact that by eating too many sweets and sugary treats, with not enough exercise, you begin to put on weight. But there are other side effects as well. Not many people know what happens to your brain when you eat too much sugar, or what insulin resistance is, or even why your brain needs sugar.

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Sugar is pretty amazing. It's the purest form of energy available to us and - unlike fats and proteins - can actually cross the blood-brain barrier. Sugar quite literally feeds your brain. And it tastes great, too!

We need sugar to live. But we don't need added sugar.

But for some of us, it feels like we need sugar. Desperately. In fact, researchers have found that sugar lowers both opioid and dopamine receptor availability in our brains. Put simply, sugar activates the reward and pleasure centers of our brains the same way addictive substances do.

It's no wonder we consume so much of the stuff. According to the American Heart Association, the average American adult eats somewhere between 22 and 30 teaspoons worth of added sugar in a day. Women and children should only be eating about 6 teaspoons (25 grams) of sugar a day; men's intake should only be slightly higher, at 9 teaspoons (36 grams). Nine teaspoons of sugar may sound like a lot (and it is), but it's also what you'll drink in an average 12-ounce can of soda.

Reducing your sugar intake can be a positive step toward improving your overall health. It can help with digestive issues like irritable bowel and acid reflux, but that's not all. Eating less sugar can also improve anxiety and stress, reduce fatigue, ease joint pain, and cut down on headaches and migraines. According to the American Heart Association, 8 out of 10 adults are trying to reduce the amount of sugar they eat, but it's not easy. For people who've become chemically dependent on sugar, it's even harder.

We spoke to registered dietitian Beth Czerwony, RD, LD, about what sugar addiction is - and what to do if you feel like your sugar cravings are out of control.

What is sugar addiction?

Plenty of people have a sweet tooth, so how do you know if you're addicted to sugar? Is there an invisible threshold that you cross between cookie number one and cookie number two?

You can't be diagnosed with a sugar addiction, at least not yet. But self-reflection and an honest conversation with a healthcare provider is the best way to start to get a handle on the issue.

According to Czerwony, the key features of sugar addiction are volume, frequency and feelings.

Ask yourself these questions:

Do you feel like you don't have control over how much sugar you eat?

Do you think about sugar all day?

Are you eating sugar throughout the day, or do you feel that you're eating more sugar than you should?

Are you eating so much sugar that you're making yourself sick to your stomach?

Do you eat sugary foods you don't even like, just to get a boost?

If you're answering "yes," chances are you are dealing with dependency.

It's even more likely if you're attempting to get or stay sober in other areas of your life. "People that have struggled with an addiction to alcohol, for example, will often turn to sweets to replace it," Czerwony notes. "So, sugar addiction really is a chemical imbalance."

Unaddressed, Czerwony says the long-term consequences can include elevated risks of:

Unlike many other substance use disorders, your body needs sugar. It just doesn't need added sugars. That makes managing your sugar dependence a bit tricky - abstaining from the stuff is impossible.

Steps to take to break a sugar addiction

When it comes to breaking a sugar addiction, there's no quick fix. You're making a significant lifestyle change, and it will take time and effort. We've compiled a list of the mental, physical and dietary changes that will help you fend off sugar cravings and help you manage your eating habits.

Focus on eating a balanced diet

Sometimes, the best advice is also the most obvious.

"If you're getting in the recommended five servings of fruits and vegetables a day, protein and high-fiber foods, it will help stabilize your blood sugar," Czerwony says.

As you build a balanced diet, be aware that there are added sugars lurking in most highly processed foods. This means that you may be eating a lot more sugar than you realize.

Don't skip meals

Whether it's a side effect of a busy life or a conscious choice, skipping meals opens the door to sugar cravings.

It happens to all of us from time to time. "If you don't eat all day because you're busy or you're not hungry, you'll be way past hungry by the time you get home. You'll end up having one big meal right before bed or stopping at a drive-thru."

Eating nourishing food consistently throughout the day prevents you from getting too hungry, which enables you to make better food choices.

"It's tough," Czerwony concedes, "but nowadays, we have all kinds of meal replacement shakes and bars, convenience cheese sticks and yogurts - those types of things." There are also lots of fast food alternatives now, like meal prep kits and healthy heat-and-eat subscription services.

Plan and prep

Improvising tends not to work out very well for those of us with a raging sweet tooth, whether we're at the grocery store or standing in front of the fridge.

"Not everybody's a home chef," Czerwony says, "and that's OK. But it's important to invest the time to plan a grocery list, buy meal prep-friendly foods and healthy snacks and know what you're going to have each day of the week - it's about getting into that pattern."

Make time for movement

Stress hormones play a big role in sugar cravings. Exercise is a prov e n stress reducer and a great way to calm sweet cravings.

" Exercise will help decrease your ghrelin levels. It can also help you to be more tired, get to sleep and stay asleep a little bit longer, which also reduces cravings," Czerwony explains.

Exercise doesn't have to be vigorous to be helpful, either.

"Everybody's level of athleticism and pain tolerance is different," Czerwony notes. "I never tell people they have to hop on the treadmill. If you have fibromyalgia, for example, and can't run, let's do some seated exercises, or let's go for a light walk. Whatever you're able to do.

"Things like yoga, Tai Chi, light stretching - they'll help, too. Just moving your body will help you reduce those stress hormones."

She adds that when we're investing time and effort in intentional movement, we tend to be more mindful about what we eat.

Get plenty of sleep

We already know that a good night's sleep is crucial to our health. But not nearly enough of us realize how connected our sleep habits are to our sugar cravings.

We have two hormones in our stomach: leptin and ghrelin. Leptin signals to our brain that we're full. Ghrelin, on the other hand, sends the message that we're hungry.

"Your ghrelin levels increase when you don't have good sleep," Czerwony explains. "So, you find yourself waking up and saying 'I want that donut' instead of having a balanced breakfast."

It's harder to make good choices when you're tired, and even harder to pass up the short-term energy boost sugary foods offer. Being well-rested will reduce your sugar cravings and - when they do happen - make them easier to ignore.

Drink Lots of water

Sometimes, we think we're hungry ... and really, we're just thirsty.

Czerwony emphasizes that hydration is especially important when you're trying to kick a sugar habit. "If we have concentrated sugar in our bloodstreams," she explains, "you can dilute that down with the water." That will help reduce blood sugar peaks and valleys, which, in turn, helps keep cravings managed.

Journal your food intake

Do you grab a candy every time you walk past your co-worker's candy bowl? Or help yourself to the leftover bits of toaster pastry that your kid leaves in the morning? Do you always order a margarita at that one great hole-in-the-wall restaurant?

It's really easy to eat (or overeat) sweets without realizing it - especially, Czerwony notes, if you're grazing or mindlessly snacking.

You might want to consider food journaling. "We can manage what we monitor," Czerwony states. "If we don't realize what we're doing, we can't manage it."

If you have a history of anorexia or bulimia, food journaling might be a trigger. If that's the case for you, either skip this tip or try adjusting your approach. Instead of noting the amount of food eaten and calories consumed, for example, try checking off a box every time you eat a serving of vegetables or drink 8 ounces of water.

Don't eliminate food groups that aren't harming you

If you peruse the World Wide Web, you'll see plenty of people claiming that you'll feel so much better if you just stop eating [fill in the blank]. Czerwony isn't convinced.

"Certainly, if you have a lactose intolerance or an allergy, consider eliminating dairy. If you have a gluten intolerance or celiac disease, consider eliminating gluten. But don't cut out food groups that aren't harming you," she says. "If you do, you'll have to really focus then on getting the calcium, the magnesium and the vitamin D that you're lacking as a result. That doesn't serve us well and sets us up for failure."

Do you need to 'detox' from sugar?

Oh, the internet. It has so much information and advice to offer - and so much of it is contradictory. The value of sugar detoxing is one of those topics.

Let's start by defining our terms. A sugar detox involves cutting all added sugars from your diet for a set period of time, from as little as a week to as long as a month. The premise is that, after an initial period of "withdrawal," you'll no longer crave sweets the way you do now.

The approach works for some (lucky) people, but it's not the best call for most of us. Detoxing makes sense if you have an addiction to a dangerous substance, but we consume sugar every day in one form or another, so you're never truly cutting it out of your diet. You're just dramatically reducing your intake.

"I'm not a fan of going 'cold turkey,'" Czerwony cautions. "I think that it's abrupt. And that anything that's too rapid is not going to work long term.

"If you do a sugar detox, you could get hangry. You could get upset. And the first thing you're going to do is reach for something sweet to make yourself feel better. You're more likely to stick with a new behavior if you're making smart choices and small, reasonable behavioral changes over time."

According to Czerwony, sugar detoxing isn't helpful for most folks. "Some people are able to rip the Band-Aid ™ off and move on," she says, "but for the majority of people, that's just not a healthy way to look at it. You'll relapse into you're old behaviors, feel ashamed that you couldn't quit sugar and then you're going to try again. You're setting yourself up for a bad cycle."

Talk to a doctor

If you feel like your sweet tooth is taking over your life, Czerwony advises that enlisting the support of your primary care doctor or a healthcare provider is an important step to take.

"The first line of defense is having an open and honest conversation with your healthcare provider," she says. "That way you really can get ahold of the issue."

That conversation will probably lead to the provider ordering some lab work.

"They really need to see what you're working with," she continues. "Do you have elevated blood sugar? Do you have elevated lipids? If you do, that needs to be addressed and taken care of, which may require prescription medication."

Czerwony also notes that there are anti-obesity medications on the market that help decrease appetite and cravings for sweets. Not all providers are willing to prescribe those medications, but it's a conversation worth having.

"If your primary care doctor isn't comfortable addressing this issue, or if you feel that you more specific care, see a dietitian."

Sweet relief

If your feel like your sweet tooth is becoming a problem, physically or mentally, you're not alone - and it's not all in your head. For some of us, a few lifestyle changes will be enough to break our sugar addiction. Others will need medical intervention to overcome the chemical reactions fueling the craving. Whatever your situation, being kind to yourself and open with your healthcare provider can only help.

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A registered dietitian explains why sugar can be so addictive - and what to do if you feel like your cravings are out of control.

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Abstract

The experimental question is whether or not sugar can be a substance of abuse and lead to a natural form of addiction. "Food addiction" seems plausible because brain pathways that evolved to respond to natural rewards are also activated by addictive drugs. Sugar is noteworthy as a substance that releases opioids and dopamine and thus might be expected to have addictive potential. This review summarizes evidence of sugar dependence in an animal model. Four components of addiction are analyzed. "Bingeing", "withdrawal", "craving" and cross-sensitization are each given operational definitions and demonstrated behaviorally with sugar bingeing as the reinforcer. These behaviors are then related to neurochemical changes in the brain that also occur with addictive drugs. Neural adaptations include changes in dopamine and opioid receptor binding, enkephalin mRNA expression and dopamine and acetylcholine release in the nucleus accumbens. The evidence supports the hypothesis that under certain circumstances rats can become sugar dependent. This may translate to some human conditions as suggested by the literature on eating disorders and obesity.

Keywords: binge eating, dopamine, acetylcholine, opioid, nucleus accumbens, withdrawal, craving, behavioral sensitization, rat

1. OVERVIEW

Neural systems that evolved to motivate and reinforce foraging and food intake also underlie drug-seeking and self-administration. The fact that some of these drugs can cause addiction raises the logical possibility that some foods might also cause addcition. Many people claim that they feel compelled to eat sweet foods, similar in some ways to how an alcoholic might feel compelled to drink. Therefore, we developed an animal model to investigate why some people have difficulty moderating their intake of palatable foods, such as sweet beverages.

In this animal model, rats are food deprived daily for 12 h, then after a delay of 4 h into their normal circadian-driven active period, they are given 12-h access to a sugar solution and chow. As a result, they learn to drink the sugar solution copiously, especially when it first becomes available each day.

After a month on this intermittent-feeding schedule, the animals show a series of behaviors similar to the effects of drugs of abuse. These are categorized as "bingeing", meaning unusually large bouts of intake, opiate-like "withdrawal" indicated by signs of anxiety and behavioral depression ( Colantuoni et al., 2001, 2002), and "craving" measured during sugar abstinence as enhanced responding for sugar ( Avena et al., 2005). There are also signs of both locomotor and consummatory "cross-sensitization" from sugar to drugs of abuse ( Avena et al., 2004, Avena and Hoebel, 2003b). Having found these behaviors that are common to drug dependency with supporting evidence from other laboratories ( Gosnell, 2005, Grimm et al., 2005, Wideman et al., 2005), the next question is why this happens.

A well-known characteristic of addictive drugs is their ability to cause repeated, intermittent increases in extracellular dopamine (DA) in the nucleus accumbens (NAc) ( Di Chiara and Imperato, 1988, Hernandez and Hoebel, 1988, Wise et al., 1995). We find that rats with intermittent access to sugar will drink in a binge-like manner that releases DA in the NAc each time, like the classic effect of most substances of abuse ( Avena et al., 2006, Rada et al., 2005b). This consequently leads to changes in the expression or availability of DA receptors ( Colantuoni et al., 2001, Spangler et al., 2004).

Intermittent sugar access also acts by way of opioids in the brain. There are changes in opioid systems such as decreased enkephalin mRNA expression in the accumbens ( Spangler et al., 2004). Signs of withdrawal seem to be largely due to the opioid modifications since withdrawal can be obtained with the opioid antagonist naloxone. Food deprivation is also sufficient to precipitate opiate-like withdrawal signs (Avena, Bocarsly, Rada, Kim and Hoebel, unpublished, Colantuoni et al., 2002). This withdrawal state involves at least two neurochemical manifestations. First is a decrease in extracellular DA in the accumbens, and second is the release of acetylcholine (ACh) from accumbens interneurons. These neurochemical adaptations in response to intermittent sugar intake mimic the effects of opiates.

The theory is formulated that intermittent, excessive intake of sugar can have dopaminergic, cholinergic and opioid effects that are similar to psychostimulants and opiates, albeit smaller in magnitude. The overall effect of these neurochemical adaptations is mild, but well-defined, dependency ( Hoebel et al., 1999, Leibowitz and Hoebel, 2004, Rada et al., 2005a). This review compiles studies from our laboratory and integrates related results obtained by others using animal models, clinical accounts and brain imaging to answer the question: can sugar, in some conditions, be "addictive"?

2. DEFINING ADDICTION

Throughout this review we use several terms with definitions for which there is not universal agreement. Addiction research traditionally focuses on drugs of abuse, such as morphine, cocaine, nicotine and alcohol. However, recently a variety of "addictions" to non-drug entities, including gambling, sex, and in this review, food, have been investigated ( Bancroft and Vukadinovic, 2004, Comings et al., 2001, Petry, 2006). The term "addiction" implies psychological dependence and thus is a mental or cognitive problem, not just a physical ailment. "Addiction" is often used synonymously with the term "dependence" ( Nelson et al., 1982) as defined by DSM-IV-TR ( American Psychiatric Association, 2000). We will use the term dependence in its all-encompassing meaning to describe the results of a battery of animal studies that model human drug addiction in each of its major phases ( Koob and Le Moal, 2005).

Drug dependence is characterized by compulsive, sometimes uncontrollable, behaviors that occur at the expense of other activities and intensify with repeated access. Dependence is difficult to demonstrate convincingly in laboratory animals, but criteria have been suggested using animal models. We have used models that were developed with rats for studying drug dependence and adapted them to test for signs of sugar dependence.

Bingeing

The diagnostic criteria for addiction can be grouped into three stages ( American Psychiatric Association, 2000, Koob and Le Moal, 1997). The first, bingeing, is defined as the escalation of intake with a high proportion of intake at one time, usually after a period of voluntary abstinence or forced deprivation. Enhanced intake in the form of binges may result from both sensitization and tolerance to the sensory properties of a substance of abuse that occurs with its repeated delivery. Sensitization, which is described in greater detail below, is an increase in responsiveness to a repeatedly presented stimulus. Tolerance is a gradual decrease in responsiveness, such that more of the substance is needed to produce the same effect ( McSweeney et al., 2005). Both are thought to influence the powerful, acute reinforcing effects of drugs of abuse and are important at the beginning of the addiction cycle since both can increase responding and intake ( Koob and Le Moal, 2005).

Withdrawal

Signs of withdrawal become apparent when the abused substance is no longer available or chemically blocked. We will discuss withdrawal in terms of opiate withdrawal, which has a clearly defined set of symptoms ( Martin et al., 1963, Way et al., 1969). Anxiety can be operationally defined and measured in animals using the elevated plus-maze, in which anxious animals will avoid spending time on the open arms of the maze ( File et al., 2004). This test has been extensively validated for both general anxiety ( Pellow et al., 1985) and anxiety induced by drug withdrawal ( File and Andrews, 1991). Behavioral depression in animals can also be inferred, without reference to emotion, using the forced-swim test, which measures swimming escape efforts vs. passive floating ( Porsolt et al., 1978). When signs of opiate withdrawal are precipitated with naloxone, it suggests that inactivation of opioid receptors is the cause. When the same signs are produced spontaneously during abstinence, one can surmise that it is due to lack of stimulation of some opioid system.

Craving

The third stage of addiction, craving, occurs when motivation is enhanced, usually after an abstinence period ( Vanderschuren and Everitt, 2005, Weiss, 2005). "Craving" remains a poorly defined term that is often used to describe the intense desire to self-administer drugs in humans ( Wise, 1988). For lack of a better word, we will use the term "craving" as defined by increased efforts to obtain a substance of abuse or its associated cues as a result of addiction and abstinence. "Craving" often has reference to extreme motivation, which can be measured using operant conditioning. If abstinence makes the animal significantly increase its lever pressing, one can take this as a sign of enhanced motivation.

Sensitization

In addition to the above diagnostic criteria, behavioral sensitization is thought to underlie some aspects of drug dependence ( Vanderschuren and Kalivas, 2000). Behavioral sensitization is typically measured as increased locomotion in response to repeated administrations of a drug. For example, after repeated doses of amphetamine followed by abstinence, a challenge dose, which has little or no effect in naïve animals, causes marked hyperactivity ( Antelman and Caggiula, 1996, Glick et al., 1986). Animals sensitized to one substance often show cross-sensitization, which is defined as an increased locomotor response to a different drug or substance. Cross-sensitization can also be manifest in consummatory behavior ( Piazza et al., 1989). Animals sensitized to one drug may show increased intake of a different drug. In other words, one drug acts as a "gateway" to another. For example, animals sensitized to amphetamine show accelerated escalation of cocaine intake ( Ferrario and Robinson, 2007), and animals sensitized to nicotine consume more alcohol compared with non-sensitized animals ( Blomqvist et al., 1996). This behavior is thought to occur when different drugs activate the same neural circuitry, and it is the reason why many clinicians require complete drug abstention as a condition of treatment for addicts ( Wise, 1988).

The first question addressed by this review is whether any of these operationally defined behavioral characteristics of substance dependence can be found with intermittent sugar access. The second question explores neural systems to discover how sugar could have effects like a drug of abuse.

3. DRUGS OF ABUSE AND PALATABLE FOOD ACTIVATE A COMMON SUBSET OF NEURAL SYSTEMS

Overlaps in the brain circuitry activated by food and drug intake suggests that different types of reinforcers (natural and artificial) stimulate some of the same neural systems ( Hoebel, 1985, Hernandez and Hoebel, 1988, Kelley et al., 2002, Le Magnen, 1990, Volkow and Wise, 2005, Wise, 1988, 1989). There are several regions in the brain involved in the reinforcement of both feeding and drug intake ( Hernandez and Hoebel, 1988, Kalivas and Volkow, 2005, Kelley et al., 2005, Koob and Le Moal, 2005, Mogenson and Yang, 1991, Wise, 1997, Yeomans, 1995), and many neurotransmitters, as well as hormones, have been studied in these and related brain regions ( Harris et al., 2005, Kalivas, 2004, Leibowitz and Hoebel, 2004, Schoffelmeer et al., 2001, Stein and Belluzzi, 1979). This review will focus on DA, the opioids, and ACh in the NAc shell, which so far, are the neurotransmitters that we have found to be involved with the reinforcing effects of intermittent sugar intake.

3.A. Dopamine

It is well established that addictive drugs activate DA-containing neurons in areas of the brain that process behavior reinforcement. This was shown for drugs delivered systemically ( Di Chiara and Imperato, 1988, Radhakishun et al., 1983), and for drugs micro-injected or infused locally ( Hernandez and Hoebel, 1988, Mifsud et al., 1989). The mesolimbic DA projection from the ventral tegmental area (VTA) to the NAc is frequently implicated in reinforcement functions ( Wise and Bozarth, 1984). The NAc is important for several components of "reward" including food seeking and reinforcement of learning, incentive motivation, stimulus salience and signaling a stimulus change ( Bassareo and Di Chiara, 1999, Berridge and Robinson, 1998, Salamone, 1992, Schultz et al., 1997, Wise, 1988). Any neurotransmitter that directly or indirectly stimulates DA cell bodies in the VTA reinforces local self-administration, including opioids such as enkephalin ( Glimcher et al., 1984), non-opioid peptides such as neurotensin ( Glimcher et al., 1987) and many drugs of abuse ( Bozarth and Wise, 1981, Gessa et al., 1985, McBride et al., 1999). Some addictive drugs also act at DA terminals ( Cheer et al., 2004, Mifsud et al., 1989, Nisell et al., 1994, Westerink et al., 1987, Yoshimoto et al., 1992). Thus, any substance that repeatedly causes the release of DA or reduces DA reuptake at terminals via these circuits may be a candidate for abuse.

A variety of foods can release DA in the NAc, including lab chow, sugar, saccharin, and corn oil ( Bassareo and Di Chiara, 1997, Hajnal et al., 2004, Liang et al., 2006, Mark et al., 1991, Rada et al., 2005b). The rise in extracellular DA can outlast the meal in food-deprived rats ( Hernandez and Hoebel, 1988). However, in satiated animals, this DA release appears to be contingent on novelty since it wanes with repeated access, even when the food is palatable ( Bassareo and Di Chiara, 1997, Rada et al., 2005b). An exception, which is described below (Section 5.C.), is when animals are food deprived and fed sugar intermittently.

Extracellular DA decreases in reaction to drug withdrawal ( Acquas et al., 1991, Acquas and Di Chiara, 1992, Rada et al., 2004, Rossetti et al., 1992). The symptoms of withdrawal from dopaminergic drugs are less well-defined than those observed during withdrawal from opiates. Therefore, it may be easier to discern the signs of withdrawal when using foods that release both DA and opioids. Sugar is one such food.

3.B. Opioids

Opioid peptides are heavily expressed throughout the limbic system and linked to DA systems in many parts of the forebrain ( Haber and Lu, 1995, Levine and Billington, 2004, Miller and Pickel, 1980). The endogenous opioid systems exert some of their effects on reinforcement processing by interacting with DA systems ( Bozarth and Wise, 1986, Di Chiara and Imperato, 1986, Leibowitz and Hoebel, 2004). The opioid peptide enkephalin in the NAc has been related to reward ( Bals-Kubik et al., 1989, Bozarth and Wise, 1981, Olds, 1982, Spanagel et al., 1990) and can activate both mu and delta receptors to increase the release of DA ( Spanagel et al., 1990). Morphine alters gene expression of endogenous opioid peptides while increasing opioid peptide production in the NAc ( Przewlocka et al., 1996, Spangler et al., 2003, Turchan et al., 1997). Opioids are also important components of this system as cotransmitters with GABA in some accumbens and dorsal striatal outputs ( Kelley et al., 2005).

Repeated use of opiates, or even some non-opiate drugs, can result in mu-opioid receptor sensitization in several regions, including the NAc ( Koob et al., 1992, Unterwald, 2001). A mu-receptor antagonist injected into the NAc will attenuate the rewarding effects of heroin ( Vaccarino et al., 1985), and systemically such drugs have been used as a treatment for alcoholism and heroin dependence ( Deas et al., 2005, Foster et al., 2003, Martin, 1975, O'Brien, 2005, Volpicelli et al., 1992).

Ingestion of palatable foods has effects via endogenous opioids in a variety of sites ( Dum et al., 1983, Mercer and Holder, 1997, Tanda and Di Chiara, 1998), and the injection of mu-opioid agonists in the NAc increases intake of palatable foods rich in fat or sugar ( Zhang et al., 1998, Zhang and Kelley, 2002). Opioid antagonists, on the other hand, decrease ingestion of sweet food and shorten meals of palatable, preferred foods, even at doses that have no effect on standard chow intake ( Glass et al., 1999). This opioid-palatability link is further characterized by theories in which the reinforcing effect is dissociated into a dopaminergic system for incentive motivation and an opioid "liking" or "pleasure" system for hedonic responses ( Berridge, 1996, Robinson and Berridge, 1993, Stein, 1978). Evidence that opioids in the NAc influence hedonic reactions comes from data showing that morphine enhances rats' positive facial taste reactivity for a sweet solution in the mouth ( Pecina and Berridge, 1995). The dissociation between the "wanting" and "liking" systems is also suggested by studies in humans ( Finlayson et al., 2007).

3.C. Acetylcholine

Several cholinergic systems in the brain have been implicated in both food and drug intake, and related to DA and the opioids ( Kelley et al., 2005, Rada et al., 2000, Yeomans, 1995). Focusing on ACh interneurons in the NAc, systemic administration of morphine decreases ACh turnover ( Smith et al., 1984), a finding that was confirmed by in vivo microdialysis in freely-behaving rats ( Fiserova et al., 1999, Rada et al., 1991a, 1996). Cholinergic interneurons in the NAc may selectively modulate enkephalin gene expression and peptide release ( Kelley et al., 2005). During morphine withdrawal, extracellular ACh increases in the NAc while DA is low, suggesting that this neurochemical state could be involved in the aversive aspects of withdrawal ( Pothos et al., 1991, Rada et al., 1991b, 1996). Likewise, both nicotine and alcohol withdrawal increase extracellular ACh, while decreasing DA in the NAc ( De Witte et al., 2003, Rada et al., 2001, 2004). This withdrawal state may involve behavioral depression, because M1-receptor agonists injected in the NAc can cause depression in the forced-swim test ( Chau et al., 1999). The role of ACh in drug withdrawal has been further demonstrated with systemically administered acetylcholinesterase inhibitors, which can precipitate withdrawal signs in non-dependent animals ( Katz and Valentino, 1984, Turski et al., 1984).

ACh in the NAc has also been implicated in food intake. We theorize that its overall muscarinic effect is to inhibit feeding at M1 receptors since local injection of the mixed muscarinic agonist arecholine will inhibit feeding, and this effect can be blocked by the relatively specific M1 antagonist pirenzapine (Rada and Hoebel, unpublished). Feeding to satiety increases extracellular ACh in the NAc ( Avena et al., 2006, Mark et al., 1992). A conditioned taste aversion also increases ACh in the NAc and simultaneously lowers DA ( Mark et al., 1991, 1995). D-fenfluramine combined with phentermine (Fen-Phen) increases extracellular ACh in the NAc at a dose that inhibits both eating and cocaine self-administration ( Glowa et al., 1997, Rada and Hoebel, 2000). Rats with accumbal ACh toxin-induced lesions are hyperphagic relative to non-lesioned rats ( Hajnal et al., 2000).

DA/ACh balance is controlled in part by hypothalamic systems for feeding and satiety. Norepinephrine and galanin, which induce eating when injected in the paraventricular nucleus (PVN), lower accumbens ACh ( Hajnal et al., 1997, Rada et al., 1998). An exception is neuropeptide-Y, which fosters eating when injected into the PVN, but does not increase DA release nor lower ACh ( Rada et al., 1998). In accord with the theory, the satiety-producing combination of serotonin plus CCK injection into the PVN increases accumbens ACh ( Helm et al., 2003).

It is very interesting that when DA is low and extracellular ACh is high, this apparently creates not satiety, but instead an aversive state ( Hoebel et al., 1999), as during behavioral depression ( Zangen et al., 2001, Rada et al., 2006), drug withdrawal ( Rada et al., 1991b, 1996, 2001, 2004) and conditioned taste aversion ( Mark et al., 1995). We conclude that when ACh acts as a post-synaptic M1 agonist it has effects opposite to DA, and thus may act as a "brake" on dopaminergic functions ( Hoebel et al., 1999, Rada et al., 2007) causing satiety when DA is high and behavioral depression when DA is relatively low.

4. BEHAVIORAL SIMILARITIES BETWEEN DRUG SELF-ADMINISTRATION AND INTERMITTENT, EXCESSIVE SUGAR INTAKE

The concept of "sugar addiction" has been bandied about for many years. Clinical accounts of "sugar addiction" have been the topic of many best-selling books and the focus for popular diet programs ( Appleton, 1996, DesMaisons, 2001, Katherine, 1996, Rufus, 2004). In these accounts, people describe symptoms of withdrawal when they deprive themselves of sugar-rich foods. They also describe food craving, particularly for carbohydrates, chocolate, and sugar, which can trigger relapse and impulsive eating. This leads to a vicious cycle of self-medication with sweet foods that may result in obesity or an eating disorder.

Although food addiction has been popular in the media and proposed to be based on brain neurochemistry ( Hoebel et al., 1989, Le Magnen, 1990), this phenomenon has only recently been systematically studied in the laboratory.

As outlined in the overview in Section 1, we use a feeding schedule that induces rats to binge on a sugar solution, then apply the criteria for drug dependence that are presented in Section 2 and test for the behavioral and neurochemical commonalties given in Section 3. Rats are given 12-h daily access to an aqueous 10% sucrose solution (25% glucose in some experiments) and lab chow, followed by 12 h of deprivation for three or more weeks (i.e., Daily Intermittent Sugar and Chow). These rats are compared with control groups such as Ad libitum Sugar and Chow, Ad libitum Chow, or Daily Intermittent Chow (12-h deprivation followed by 12-h access to lab chow). For the intermittent access groups, availability is delayed 4 h into the animal's active period in order to stimulate feeding, which normally ensues at the onset of the dark cycle. Rats maintained on the Daily Intermittent Sugar and Chow regimen enter a state that resembles drug dependence on several dimensions. These are divided into behavioral (Section 4) and neurochemical (Section 5) similarities to drug dependence.

4.A. "Bingeing": Escalation of daily sugar intake and large meals

Escalation of intake is a characteristic of drugs of abuse. This may be a combination of tolerance, in which more of an abused substance is needed to produce the same euphoric effects ( Koob and Le Moal, 2005), and sensitization, such as locomotor sensitization, in which the substance produces enhanced behavioral activation ( Vezina et al., 1989). Studies using drug self-administration usually limit access to a few hours per day, during which animals will self-administer in regular intervals that vary as a function of the dose received ( Gerber and Wise, 1989) and in a manner that keeps extracellular DA elevated above a baseline, or "trigger point" in the NAc ( Ranaldi et al., 1999, Wise et al., 1995). The length of daily access has been shown to critically affect subsequent self-administration behavior. For example, the most cocaine is self-administered during the first 10 min of a session when access is at least 6 h per day ( Ahmed and Koob, 1998). Limited periods of access, to create "binges", have been useful, because the pattern of self-administration behavior that emerges is similar to that of a "compulsive" drug user ( Markou et al., 1993, Mutschler and Miczek, 1998, O'Brien et al., 1998). Even when drugs, such as cocaine, are given with unlimited access, humans or laboratory animals will self-administer them in repetitive episodes or "binges" ( Bozarth and Wise, 1985, Deneau et al., 1969). However, experimenter-imposed intermittent access is better than ad libitum access for experimental purposes, since it becomes very likely that the animal will take at least one large binge at the onset of the drug-availability period. Moreover, a period of food restriction can enhance drug intake ( Carr, 2006, Carroll, 1985) and has been shown to produce compensatory neruoadaptations in the mesoaccumbens DA system ( Pan et al., 2006).

The behavioral findings with sugar are similar to those observed with drugs of abuse. Rats fed daily intermittent sugar and chow escalate their sugar intake and increase their intake during the first hour of daily access, which we define as a "binge" ( Colantuoni et al., 2001). The animals with ad libitum access to a sugar solution tend to drink it throughout the day, including their inactive period. Both groups increase their overall intake, but the limited-access animals consume as much sugar in 12 h as ad libitum-fed animals do in 24 h. Detailed meal pattern analysis using operant conditioning (fixed-ratio 1) reveals that the limited animals consume a large meal of sugar at the onset of access, and larger, fewer meals of sugar throughout the access period, compared with animals drinking sugar ad libitum (; Avena and Hoebel, unpublished). Rats fed Daily Intermittent Sugar and Chow regulate their caloric intake by decreasing their chow intake to compensate for the extra calories obtained from sugar, which results in a normal body weight (Avena, Bocarsly, Rada, Kim and Hoebel, unpublished, Avena et al., 2003b, Colantuoni et al., 2002).

4.B. "Withdrawal": Anxiety and behavioral depression induced by an opioid-antagonist or food deprivation

As described in Section 2, animals can show signs of opiate withdrawal after repeated exposure when the substance of abuse is removed, or the appropriate synaptic receptor is blocked. For example, an opioid antagonist can be used to precipitate withdrawal in the case of opiate dependency ( Espejo et al., 1994, Koob et al., 1992). In rats, opiate withdrawal causes severe somatic signs ( Martin et al., 1963, Way et al., 1969), decreases in body temperature ( Ary et al., 1976), aggression ( Kantak and Miczek, 1986), and anxiety ( Schulteis et al., 1998), as well as a motivational syndrome characterized by dysphoria and depression ( De Vries and Shippenberg, 2002, Koob and Le Moal, 1997).

These signs of opioid withdrawal have been noted after intermittent access to sugar when withdrawal is precipitated with an opioid antagonist, or when food and sugar are removed. When administered a relatively high-dose of the opioid antagonist naloxone (3 mg/kg, s.c.), somatic signs of withdrawal, such as teeth chattering, forepaw tremor, and head shakes are observed ( Colantuoni et al., 2002). These animals are also anxious, as measured by reduced time spent on the exposed arm of an elevated plus-maze ( Colantuoni et al., 2002) ().

Behavioral depression has also been found during naloxone-precipitated withdrawal in intermittent sugar-fed rats. In this experiment, rats were given an initial 5-min forced-swim test in which escape (swimming and climbing) and passive (floating) behaviors were measured. Then the rats were divided into four groups that were fed Daily Intermittent Sucrose and Chow, Daily Intermittent Chow, Ad libitum Sucrose and Chow, or Ad libitum Chow for 21 days. On day 22, at the time that the intermittent-fed rats would normally receive their sugar and/or chow, all rats were instead injected with naloxone (3 mg/kg, s.c.) to precipitate withdrawal and were then placed in the water again for another test. In the group that had been fed Daily Intermittent Sucrose and Chow, escape behaviors were significantly suppressed compared with Ad libitum Sucrose and Chow and Ad libitum Chow controls (; Kim, Avena and Hoebel, unpublished). This decrease in escape efforts that were replaced by passive floating suggests the rats were experiencing behavioral depression during withdrawal.

Signs of opiate-withdrawal also emerge when all food is removed for 24 h. Again this includes somatic signs such as teeth chattering, forepaw tremor and head shaking ( Colantuoni et al., 2002) and anxiety as measured with an elevated plus-maze (Avena, Bocarsly, Rada, Kim and Hoebel, unpublished). Spontaneous withdrawal from the mere remove of sugar has been reported using decreased body temperature as the criterion ( Wideman et al., 2005). Also, signs of aggressive behavior have been found during withdrawal of a diet that involves intermittent sugar access ( Galic and Persinger, 2002).

4.C. "Craving": Enhanced responding for sugar following abstinence

As described in Section 2, "craving" in laboratory animals can be defined as enhanced motivation to procure an abused substance ( Koob and Le Moal, 2005). After self-administering drugs of abuse and then being forced to abstain, animals often persist in unrewarded operant responding (i.e., resistance to response extinction), and increase their responding for cues previously associated with the drug that grows with time (i.e., incubation) ( Bienkowski et al., 2004, Grimm et al., 2001, Lu et al., 2004). Additionally, if the drug becomes available again, animals will take more than they did prior to abstinence (i.e., the "deprivation effect") ( Sinclair and Senter, 1968). This increase in motivation to procure a substance of abuse may contribute to relapse. The power of "craving" is evidenced by results showing that animals will sometimes face adverse consequences to obtain a substance of abuse such as cocaine or alcohol ( Deroche-Gamonet et al., 2004, Dickinson et al., 2002, Vanderschuren and Everitt, 2004). These signs in laboratory animals mimic those observed with humans in which the presentation of stimuli previously associated with a drug of abuse increases self-reports of craving and the likelihood of relapse ( O'Brien et al., 1977, 1998).

We used the "deprivation effect" paradigm to investigate consumption of sugar after abstinence in rats that had been bingeing on sugar. Following 12-h daily access to sugar, rats lever press for 23% more sugar in a test after 2 wks of abstinence than they ever did before (; Avena et al., 2005). A group with 0.5-h daily access to sucrose did not show the effect. This provides a cogent control group in which rats are familiar with the taste of sucrose, but have not consumed it in a manner that leads to a deprivation effect. The results suggest a change in the motivational impact of sugar that persists throughout two weeks of abstinence, leading to enhanced intake.

Additionally, like the drugs described above, the motivation to obtain sugar appears to "incubate", or grow, with the length of abstinence ( Shalev et al., 2001). Using operant conditioning, Grimm and colleagues (2005) find that sucrose seeking (lever pressing in extinction and then for a sucrose-paired cue) increases during abstinence in rats after intermittent sugar access for 10 days. Remarkably, responding for the cue was greater after 30 days of sugar abstinence compared with 1 week or 1 day. These results suggest the gradual emergence of long-term changes in the neural circuitry underlying motivation as a result of sugar self-administration and abstinence.

4.D. "Cross-sensitization": Increased locomotor response to psychostimulants during sugar abstinence

Drug-induced sensitization may play a role in the enhancement of drug self-administration and is implicated as a factor contributing to drug addiction ( Robinson and Berridge, 1993). In a typical sensitization experiment, the animal receives a drug daily for about a week, then the procedure stops. However, in the brain there are lasting, even growing, changes apparent a week or more later when a low, challenge dose of the drug results in hyperlocomotion ( Kalivas et al., 1992). Additionally, cross-sensitization from one drug to another has been demonstrated with several drugs of abuse, including amphetamine sensitizing rats to cocaine or phencyclidine ( Greenberg and Segal, 1985, Kalivas and Weber, 1988, Pierce and Kalivas, 1995, Schenk et al., 1991), cocaine cross-sensitizing with alcohol ( Itzhak and Martin, 1999), and heroin with cannabis ( Pontieri et al., 2001). Other studies have found this effect with non-drug substances. Behavioral cross-sensitization between cocaine and stress has been demonstrated ( Antelman and Caggiula, 1977, Covington and Miczek, 2001, Prasad et al., 1998). Also, increases in food intake ( Bakshi and Kelley, 1994) or sexual behaviors ( Fiorino and Phillips, 1999, Nocjar and Panksepp, 2002) have been observed in animals with a history of drug sensitization.

We and others have found that Intermittent sugar intake cross-sensitizes with drugs of abuse. Rats sensitized with daily amphetamine injections (3 mg/kg, i.p.) are hyperactive one week later in response to tasting 10% sucrose ( Avena and Hoebel, 2003a). Conversely, rats fed Daily Intermittent Sugar and Chow show locomotor cross-sensitization to amphetamine. Specifically, such animals are hyperactive in response to a low, challenge dose of amphetamine (0.5 mg/kg, i.p.) that has no effect on naïve animals, even after 8 days of abstinence from sugar (; Avena and Hoebel, 2003b). Rats maintained on this feeding schedule but administered saline were not hyperactive, nor were rats in control groups (Daily Intermittent Chow, Ad libitum Sugar and Chow, Ad libitum Chow) given the challenge dose of amphetamine. Intermittent sucrose access also cross-sensitizes with cocaine ( Gosnell, 2005) and facilitates the development of sensitization to the DA agonist quinpirole ( Foley et al., 2006). Thus, results with three different DA agonists from three different laboratories support the theory that the DA system is sensitized by intermittent sugar access, as evidenced by cross-sensitization. This is important since enhanced mesolimbic dopaminergic neurotransmission plays a major role in the behavioral effects of sensitization as well as cross-sensitization ( Robinson and Berridge, 1993), and may contribute to addiction and comorbidity with poly-substance abuse.

4.E. "Gateway effect": Increased alcohol intake during sugar abstinence

Numerous studies have found that sensitization to one drug can lead not only to hyperactivity, but also to subsequent increased intake of another drug or substance ( Ellgren et al., 2006, Henningfield et al., 1990, Hubbell et al., 1993, Liguori et al., 1997, Nichols et al., 1991, Piazza et al., 1989, Vezina, 2004, Vezina et al., 2002, Volpicelli et al., 1991). We refer to this phenomenon as "consummatory cross-sensitization". In the clinical literature, when one drug leads to taking another, this is known as a "gateway effect". It is particularly noteworthy when a legal drug (e.g. nicotine) acts as a gateway to an illegal drug (e.g. cocaine) ( Lai et al., 2000).

Rats maintained on intermittent sugar access and then forced to abstain, subsequently show enhanced intake of 9% alcohol ( Avena et al., 2004). This suggests that intermittent access to sugar can be a gateway to alcohol use. Others have shown that animals that prefer sweet-taste will self-administer cocaine at a higher rate ( Carroll et al., 2006). As with the locomotor cross-sensitization described above, underlying this behavior are presumably neurochemical alterations in the brain, such as adaptations in DA and perhaps opioid functions.

5. NEUROCHEMICAL SIMILARITIES BETWEEN DRUG SELF-ADMINISTRATION AND INTERMITTENT SUGAR INTAKE

The studies described above suggest that intermittent sugar access can produce numerous behaviors that are similar to those observed in drug-dependent rats. In this section, we describe neurochemical findings that may underlie sugar dependency. To the extent that these brain alterations match the effects of drugs of abuse, it strengthens the case that sugar can resemble a substance of abuse.

5.A. Intermittent sugar intake alters D₁, D₂ and mu-opioid receptor binding and mRNA expression

Drugs of abuse can alter DA and opioid receptors in the mesolimbic regions of the brain. Pharmacological studies with selective D ₁, D ₂ and D ₃ receptor antagonists and gene knockout studies have revealed that all three receptor subtypes mediate the reinforcing effects drugs of abuse. There is an up-regulation of D ₁ receptors ( Unterwald et al., 1994) and increase in D ₁ receptor binding ( Alburges et al., 1993, Unterwald et al., 2001) in response to cocaine. Conversely, D ₂ receptor density is lower in NAc of monkeys that have a history of cocaine use ( Moore et al., 1998). Drugs of abuse can also produce changes in gene expression of DA receptors. Morphine and cocaine have been shown to decrease accumbens D ₂ receptor mRNA ( Georges et al., 1999, Turchan et al., 1997), and an increase in D ₃ receptor mRNA ( Spangler et al., 2003). These finding with laboratory animals support clinical studies, which have revealed that D ₂ receptors are down-regulated in cocaine addicts ( Volkow et al., 1996a, 1996b, 2006).

Similar changes have been reported with intermittent access to sugar. Autoradiography reveals increased D ₁ in the NAc and decreased D ₂ receptor binding in the striatum (; Colantuoni et al., 2001). This was relative to chow-fed rats, so it is not known whether ad libitum sugar would also show this effect. Others have reported a decrease in D ₂ receptor binding in the NAc of rats with restricted access to sucrose and chow compared with rats fed restriced chow only ( Bello et al., 2002). Rats with intermittent sugar and chow access also have decreases in D ₂ receptor mRNA in the NAc compared with ad libitum chow controls ( Spangler et al., 2004). mRNA levels of D ₃ receptor mRNA in the NAc are increased in the NAc and caudate-putamen.

Regarding the opioid receptors, mu-receptor binding is increased in response to cocaine and morphine ( Bailey et al., 2005, Unterwald et al., 2001, Vigano et al., 2003). Mu-opioid receptor binding is also significantly enhanced after three weeks on the intermittent sugar diet, compared with ad libitum chow. This effect was observed in the accumbens shell, cingulate, hippocampus and locus coeruleus ( Colantuoni et al., 2001).

5.B. Intermittent sugar intake alters enkephalin mRNA expression

Enkephalin mRNA in the striatum and the NAc is decreased in response to repeated injections of morphine ( Georges et al., 1999, Turchan et al., 1997, Uhl et al., 1988). These changes within opioid systems are similar to those observed in cocaine-dependent human subjects ( Zubieta et al., 1996).

Rats with intermittent sugar access also display a significant decrease in enkephalin mRNA, although it is difficult to judge its functional significance ( Spangler et al., 2004). This decrease in enkephalin mRNA is consistent with findings observed in rats with limited daily access to a sweet-fat, liquid diet ( Kelley et al., 2003). Assuming this decrease in mRNA results in less enkephalin peptide being synthesized and released, it could account for a compensatory increase in mu-opioid receptors, as cited above.

5.C. Daily intermittent sugar intake repeatedly releases dopamine in the accumbens

One of the strongest neurochemical commonalities between intermittent sugar access and drugs of abuse has been found using in vivo microdialysis to measure extracellular DA. The repeated increase in extracellular DA is a hallmark of drugs that are abused. Extracellular DA increases in the NAc in response to both addictive drugs ( De Vries and Shippenberg, 2002, Di Chiara and Imperato, 1988, Everitt and Wolf, 2002, Hernandez and Hoebel, 1988, Hurd et al., 1988, Picciotto and Corrigall, 2002, Pothos et al., 1991, Rada et al., 1991a) and drug-associated stimuli ( Ito et al., 2000). Unlike drugs of abuse, which exert their effects on DA release each time they are administered ( Pothos et al., 1991, Wise et al., 1995), the effect of eating palatable food on DA release wanes with repeated access when the food is no longer novel, unless the animal is food deprived ( Bassareo and Di Chiara, 1999, Di Chiara and Tanda, 1997, Rada et al., 2005b). Thus normally feeding is very different than taking drugs because the DA response during feeding is phased out.

However, and this is very important, rats fed daily intermittent sugar and chow apparently release DA every day as measured on days 1, 2 and 21 of access (; Rada et al., 2005b). As controls, rats fed sugar or chow ad libitum, rats with intermittent access to just chow, or rats that taste sugar only two times, develop a blunted DA response as is typical of a food that looses it novelty. These results are supported by findings of alterations in accumbens DA turnover and DA transporter in rats maintained on an intermittent sugar-feeding schedule ( Bello et al., 2003, Hajnal and Norgren, 2002). Together, these results suggest that intermittent access to sugar and chow causes recurrent increases in extracellular DA in a manner that is more like a drug of abuse than a food.

An interesting question is whether the neurochemical effects observed with intermittent sugar access are due to its postingestive properties or whether the taste of sugar can be sufficient. To investigate orosensory effects of sugar, we used the sham feeding preparation. Rats that are sham feeding with an open gastric fistula can ingest foods but not fully digest them ( Smith, 1998). Sham feeding does not completely eliminate post-ingestive effects ( Berthoud and Jeanrenaud, 1982, Sclafani and Nissenbaum, 1985), however it does allow the animals to taste the sugar while retaining almost no calories.

The results of sham feeding sugar for the first hour of access each day show that DA is released in the NAc, even after three weeks of daily bingeing, simply due to the taste of sucrose ( Avena et al., 2006). Sham feeding does not further enhance the typical sugar-induced DA release. This supports other work showing that the amount of DA release in the NAc is proportional to the sucrose concentration, not the volume consumed ( Hajnal et al., 2004).

5.D. Accumbens acetylcholine release is delayed during sugar binges and eliminated during sham feeding

Sham-feeding revealed interesting results with ACh. As described in Section 3.C., accumbens ACh increases in the midst of a meal when feeding slows down and then stops ( Mark et al., 1992). One could predict that when an animal takes a very large meal, as with the first meal of a sugar solution and chow, the release of ACh should be delayed until the satiation process begins as reflected in gradual termination of the meal. This is what was observed; ACh release occurred when this initial "binge" meal was drawing to a close ( Rada et al., 2005b).

Next we measured ACh release when the animal could take a large meal of sugar while sham feeding. Purging the stomach contents drastically reduced the release of ACh ( Avena et al., 2006). This is predictable based on the theory that ACh is normally important for the satiation process ( Hoebel et al., 1999, Mark et al., 1992). It also suggests that by purging, one eliminates the ACh response that opposes DA. Thus when "bingeing" on sugar is accompanied by purging, the behavior is reinforced by DA without ACh, which is more like taking a drug and less like normal eating.

5.E. Sugar withdrawal upsets dopamine/acetylcholine balance in the accumbens

Behavioral signs of drug withdrawal are usually accompanied by alterations in DA/ACh balance in the NAc. During withdrawal, DA decreases while ACh is increased. This imbalance has been shown during chemically-induced withdrawal with several drugs of abuse, including morphine, nicotine and alcohol ( Rada et al., 1996, 2001, 2004). Mere abstinence from an abused substance is also sufficient to elicit neurochemical signs of withdrawal. For example, rats that are forced to abstain from morphine or alcohol have decreased extracellular DA in the NAc ( Acquas and Di Chiara, 1992, Rossetti et al., 1992) and ACh increases during spontaneous morphine withdrawal ( Fiserova et al., 1999). While withdrawal from an anxyolitic drug (diazepam) precipitated by a bendodiazepine-receptor antagonist does not lower extracellular DA, it does release accumbens ACh, which may contribute to benzodiazepine dependency ( Rada and Hoebel, 2005)

Rats that have intermittent access to sugar and chow show the morphine-like neurochemical imbalance in DA/ACh during withdrawal. This was produced two ways. As shown in , when they are given naloxone to precipitate opioid withdrawal, there is a decrease in accumbens DA release coupled with an increase in ACh release ( Colantuoni et al., 2002). The same thing occurs after 36 h of food deprivation (Avena, Bocarsly, Rada, Kim, Hoebel, unpublished). One way to interpret deprivation-induced withdrawal is to suggest that without food to release opioids, the animal suffers the same type of withdrawal seen when the up-regulated mu-opioid receptors are blocked with naloxone.

6. DISCUSSION AND CLINICAL IMPLICATIONS

Food is not ordinarily like a substance of abuse, but intermittent bingeing and deprivation changes that. Based on the observed behavioral and neurochemical similarities between the effects of intermittent sugar access and drugs of abuse, we suggest that sugar, as common as it is, nonetheless meets the criteria for a substance of abuse and may be "addictive" for some individuals when consumed in a "binge-like" manner. This conclusion is reinforced by the changes in limbic system neurochemistry that are similar for the drugs and for sugar. The effects we observe are smaller in magnitude than those produced by drug of abuse such as cocaine or morphine; however, the fact that these behaviors and neurochemical changes can be elicited with a natural reinforcer is interesting. It is not clear from this animal model if intermittent sugar access can result in neglect of social activities as required by the definition of dependency in the DSM-IV-TR ( American Psychiatric Association, 2000). Nor is it known whether rats will continue to self-administer sugar despite physical obstacles, such as enduring pain to obtain sugar, as some rats do for cocaine ( Deroche-Gamonet et al., 2004). Nonetheless, the extensive series of experiments revealing similarities between sugar-induced and drug-induced behavior and neurochemistry, as chronicled in Sections 4 and 5, lends credence to the concept of "sugar addiction", gives precision to its definition, and provides a testable model.

6.A. Bulimia nervosa

The feeding regimen of Daily Intermittent Sugar and Chow shares some aspects of the behavioral pattern of people diagnosed with binge-eating disorder or bulimia. Bulimics often restrict intake early in the day and then binge later in the evening, usually on palatable foods ( Drewnowski et al., 1992, Gendall et al., 1997). These patients later purge the food, either by vomiting or laxative use, or in some cases by strenuous exercise ( American Psychiatric Association, 2000). Bulimic patients have low β-endorphin levels ( Brewerton et al., 1992, Waller et al., 1986), which might foster eating with a preference or craving for sweets. They also have decreased mu-opioid receptor binding in the insula compared with controls, which correlates with recent fasting behavior ( Bencherif et al., 2005). This contrasts with the increase observed in rats following a binge. Cyclic bingeing and food deprivation may produce alterations in mu-opioid receptors, which help perpetuate bingeing behavior.

We used the sham feeding preparation to mimic the purging associated with bulimia. The finding described in Section 5.C., that intermittent sugar access repeatedly releases DA in response to the taste of sugar, may be important for understanding the bingeing behaviors associated with bulimia. DA has been implicated in bulimia by comparing it to hypothalamic self-stimulation, which also releases DA without calories ( Hoebel et al., 1992). Bulimic patients have low central DA activity as reflected in analysis of DA metabolites in the spinal fluid, which also indicates a role for DA in their abnormal responses to food ( Jimerson et al., 1992).

The overall similarlites in behavior and brain adaptations with sugar bingeing and drug intake described above support the theory that obesity and eating disorders, such as bulimia and anorexia, may have properties of an "addiction" in some individuals ( Davis and Claridge, 1998, Gillman and Lichtigfeld, 1986, Marrazzi and Luby, 1986, Mercer and Holder, 1997, Riva et al., 2006). The auto-addiction theory proposed that some eating disorders can be an addiction to endogenous opioids ( Heubner, 1993, Marrazzi and Luby, 1986, 1990). In support, appetite dysfunctions in the form of binge eating and self-starvation can stimulate endogenous opioid activity ( Aravich et al., 1993).

Bulimic patients will binge on excessive amounts of non-caloric sweeteners ( Klein et al., 2006), suggesting that they derive benefits from sweet orosensory stimulation. We have shown that purging leaves DA unopposed by satiety-associated ACh in the accumbens (Section 5.D.). This neurochemical state may be conducive to exaggerated binge eating. Moreover, the findings that intermittent sugar intake cross-sensitizes with amphetamine and fosters alcohol intake (Sections 4.D. and 4.E.) may be related to the comorbidity between bulimia and substance abuse ( Holderness et al., 1994).

6.B. Obesity

Sugar and obesity

Obesity is one of the leading preventable causes of death in the US ( Mokdad et al., 2004). Several studies have correlated the rise in the incidence of obesity with an increase in sugar consumption ( Bray et al., 1992, Elliott et al., 2002, Howard and Wylie-Rosett, 2002, Ludwig et al., 2001). The US Department of Agriculture has reported that per capita soft-drink consumption has increased by almost 500% in the past 50 years ( Putnam and Allhouse, 1999). Sugar intake may lead to an increased number of and/or affinity for opioid receptors, which in turn leads to further ingestion of sugar and may contribute to obesity ( Fullerton et al., 1985). Indeed, rats maintained on the diet of intermittent sugar access show opioid receptor changes (Section 5.A.); however, after one month on the diet using 10% sucrose or 25% glucose, these animals do not become overweight ( Colantuoni et al., 2001, Avena and Hoebel, 2003b), although others have reported a metabolic syndrome ( Toida et al., 1996), a loss of fuel efficiency ( Levine et al., 2003) and an increase in body weight in rats fed sucrose ( Bock et al., 1995, Kawasaki et al., 2005) and glucose ( Wideman et al., 2005). Most studies of sugar intake and body weight do not use a binge-inducing diet, and the translation to human obesity is complex ( Levine et al., 2003). As described in Section 4.A., it appears that rats in our model compensate for sucrose or glucose calories by decreasing chow intake (Avena, Bocarsly, Rada, Kim and Hoebel, unpublished). They gain weight at a normal rate ( Colantuoni et al., 2002). This may not be true of all sugars.

Fructose is a unique sweetener that has different metabolic effects on the body than glucose or sucrose. Fructose is absorbed further down the intestine, and whereas circulating glucose releases insulin from the pancreas ( Sato et al., 1996, Vilsboll et al., 2003), fructose stimulates insulin synthesis but does not release it ( Curry, 1989, Le and Tappy, 2006, Sato et al., 1996). Insulin modifies food intake by inhibiting eating ( Schwartz et al., 2000) and by increasing leptin release ( Saad et al., 1998), which also can inhibit food intake. Meals of high-fructose corn syrup can reduce circulating insulin and leptin levels ( Teff et al., 2004), contributing to increased body weight. Thus, fructose intake might not result in the degree of satiety that would normally ensue with an equally caloric meal of glucose or sucrose. Since high-fructose corn syrup has become a major constituent in the American diet ( Bray et al., 2004) and lacks some effects on insulin and leptin, it may be a potential agent for producing obesity when given intermittently to rats. Whether or not signs of dependency on fructose are apparent when it is offered intermittently has yet to be determined. However, based on our results showing that sweet taste is sufficient to elicit the repeated release of DA in the NAc (see Section 5.C.), we hypothesize that any sweet taste consumed in a binge-like manner is a candidate for producing signs of dependence.

Fat and obesity

While we have chosen to focus on sugar, the question arises as to whether non-sweet, palatable foods could produce signs or dependence. The evidence is mixed. It appears that some signs of dependence are apparent with fat, while others have not been shown. Fat bingeing in rats occurs with intermittent access to pure fat (vegetable shortening), sweet-fat cookies ( Boggiano et al., 2005, Corwin, 2006), or sweet-fat chow (Berner, Avena and Hoebel, unpublished). Repeated, intermittent access to oil releases DA in the NAc ( Liang et al., 2006). Like sugar, bingeing on a fat-rich diet is known to affect the opioid system in the accumbens by decreasing enkephalin mRNA, an effect that is not observed with acute access ( Kelley et al., 2003). Also, treatment with baclofen (GABA-B agonist), which reduces drug intake, also reduces binge eating of fat ( Buda-Levin et al., 2005).

This all implies that fat dependency is a real possibility, but withdrawal from fat-bingeing is not as apparent as it is with sugar. Le Magnen (1990) noted naloxone could precipitate withdrawal in rats on a cafeteria-style diet, which contains a variety of fat- and sugar-rich foods (e.g., cheese, cookies, chocolate chips). However, we have not observed signs of naloxone-precipitated or spontaneous withdrawal in rats fed pure fat (vegetable shortening) or a sugar-fat combination, nor has such a result been published by others. Further studies are needed to fully understand the differences between sugar and fat bingeing and their subsequent effects on behavior. Just as different classes of drugs (e.g., dopamine agonists vs. opiates) have specific behavioral and physiological withdrawal signs, it may be that different macronutrients may also produce specific withdrawal signs. Since craving of fat or cross-sensitization between fat intake and drugs of abuse has yet to be documented in animals, sugar is currently the only palatable substance for which bingeing, withdrawal, abstinence-induced enhanced motivation and cross-sensitization have all been demonstrated (Sections 4 and 5).

Brain imaging

Recent findings using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in humans have supported the idea that aberrant eating behaviors, including those observed in obesity, may have similarities to drug dependence. Craving-related changes in fMRI signal have been identified in response to palatable foods, similar to drug craving. This overlap occurred in the hippocampus, insula, and caudate ( Pelchat et al., 2004). Similarly, PET scans reveal that obese subjects show a reduction in striatal D ₂ receptor availability that is associated with the body weight of the subject ( Wang et al., 2004b). This decrease in D ₂ receptors in obese subjects is similar in magnitude to the reductions reported in drug-addicted subjects ( Wang et al., 2001). The involvement of the DA system in reward and reinforcement has led to the hypothesis that alterations in DA activity in obese subjects dispose them to excessive use of food. Exposure to especially palatable foods, such as cake and ice cream, activates the several brain regions including the anterior insula and right orbitofrontal cortex ( Wang et al., 2004a), which may underlie the motivation to procure food ( Rolls, 2006).

7. CONCLUSION

From an evolutionary perspective, it is in the best interest of humans to have an inherent desire for food for survival. However, this desire may go awry, and certain people, including some obese and bulimic patients in particular, may develop an unhealthy dependence on palatable food that interferes with well-being. The concept of "food addiction" materialized in the diet industry on the basis of subjective reports, clinical accounts and case studies described in self-help books. The rise in obesity, coupled with the emergence of scientific findings of parallels between drugs of abuse and palatable foods has given credibility to this idea. The reviewed evidence supports the theory that, in some circumstances, intermittent access to sugar can lead to behavior and neurochemical changes that resemble the effects of a substance of abuse. According to the evidence in rats, intermittent access to sugar and chow is capable of producing a "dependency". This was operationally defined by tests for bingeing, withdrawal, craving and cross-sensitization to amphetamine and alcohol. The correspondence to some people with binge eating disorder or bulimia is striking, but whether or not it is a good idea to call this a "food addiction" in people is both a scientific and societal question that has yet to be answered. What this review demonstrates is that rats with intermittent access to food and a sugar solution can show both a constellation of behaviors and parallel brain changes that are characteristic of rats that voluntarily self-administer addictive drugs. In the aggregrate, this is evidence that sugar can be addictive.

Acknowledgments

This reseach was supported by USPHS grant MH-65024 (B.G.H.), DA-10608 (B.G.H.), DA-16458 (fellowship to N.M.A) and the Lane Foundation.

Footnotes

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Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake

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The experimental question is whether or not sugar can be a substance of abuse and lead to a natural form of addiction. "Food addiction" seems plausible because brain pathways that evolved to respond to natural rewards are also activated ...

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Our expert explains why it’s common to think that sugar can be an addictive substance, and gives us advice on how to break old habits. Find out more.

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Have a sweet tooth? You're far from alone-U.S. adults consume an estimated average of 17 teaspoons of added sugar per day, which is double the amount recommended by the American Heart Association. Added sugar can contribute to a wide range of health problems, including obesity and chronic disease. For this reason, many may turn to sugar substitutes to try and reduce their intake of added sugars.

Keep reading for more details on how sugar substitutes can impact health, plus the top sugar alternatives recommended by nutrition experts.

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How Do Added Sugars Impact Health?

Added sugars are a type of sugar added during the processing of foods. They are also found in packaged sweeteners, syrups and honeys and concentrated fruit or vegetable juices.

Meanwhile, naturally occurring sugars found in fruits, vegetables or dairy products are not considered added sugars. Instead, the total amount of sugar found in a food-including both naturally occurring sugars and added sugars-is listed as "total sugars" on a nutrition label. Unlike added sugar, there is currently no recommendation for the amount of total sugar you should consume per day.

Added sugars are often found in the following products:

Soda

Sports drinks

Baked goods

Cookies

Cakes

Candy

Breakfast cereals

Syrups or toppings

Consuming high amounts of added sugar can negatively impact health and contribute to chronic inflammation and increase the risk of several conditions, including type 2 diabetes and heart disease, as it can overload the liver.

Plus, excessive intake of added sugars, particularly those found in sugary drinks, can lead to weight gain by turning off your body's appetite-control system, making it easier to fill up on high-calorie drinks without feeling satiated, notes Harvard Health.

The American Heart Association recommends limiting your intake of added sugars to less than 6% of total calories per day. For most women, that translates to about 100 calories, or 6 teaspoons of sugar daily. For men, it equals approximately 150 calories, or 9 teaspoons of sugar, the organization notes.

Are Sugar Substitutes Safe?

Sugar substitutes are used in place of sugar to enhance the flavor or add sweetness to foods and beverages. They typically have far fewer calories and are significantly sweeter than sugar, meaning that you only need a very small amount to achieve the same level of sweetness.

Sugar substitutes are typically plant or chemical-based. A few sugar substitutes are Generally Recognized As Safe (GRAS) by the Food and Drug Administration (FDA), including stevia and monk fruit-this means they don't require FDA approval, due to the general agreement among qualified experts that they are safe for use in food and drinks.

Sugar alcohols are another type of sugar substitute that are GRAS by the FDA. Unlike artificial sweeteners, these compounds occur naturally in some foods and can also be manufactured. They have a chemical structure that is similar to sugar but contain less calories. Examples include sorbitol, mannitol and xylitol.

Meanwhile, several other types of sugar substitutes are approved by the FDA as food additives, including artificial sweeteners such as:

Aspartame (Equal and NutraSweet Natural)

Advantame

Neotame (Newtame)

Sucralose (Splenda)

Saccharin (Sweet 'N Low and Sugar Twin)

Acesulfame K (Sunett and Sweet One)

Though artificial sweeteners are approved for use as a food additive by the FDA, there are some concerns associated with certain types. "Recent research shows that certain sugar substitutes can cause health problems," says Amy Shapiro, a New York-based dietitian and founder of Real Nutrition NYC, a private nutrition practice.

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"Some research points to artificial sweeteners altering the gut microbiome and leading to weight gain, even though they are zero calories, as they can increase sweet cravings," explains Shapiro. She notes that sugar alcohols can also cause digestive issues like bloating, gas and diarrhea for some people, especially if consumed in large amounts.

Aspartame, in particular, has recently faced some controversy. In fact, it was recently labeled as "possibly carcinogenic to humans" by the World Health Organization and the International Agency for Research on Cancer. However, keep in mind that this conclusion was based on limited evidence. Additionally, scientists note that consuming up to 40 milligrams per kilogram of body weight is safe, meaning that an adult weighing 154 pounds (70 kilograms) would need to drink 9 to 14 cans of diet soda each day to exceed this limit.

Regardless, some experts advise using these sugar substitutes with caution. "I recommend limiting or avoiding consumption of artificial sweeteners such as aspartame, saccharin or sucralose due to unknown long-term effects on health," says Sarah Olszewski, a registered dietitian based in Syracuse and owner of Sarah Lynn Nutrition, a nutrition counseling service. Olszewski also notes that it might be a good idea to limit your intake of sugar alcohols, especially if you experience digestive issues after eating them.

Still, Olszewski explains that including these ingredients in your diet from time to time is probably safe, noting that while they may have negative effects when consumed in large quantities on a regular basis, their impact is likely small when used in moderation. Emily Spurlock, a Boise-based registered dietitian, agrees, stating, "the overall consensus is that the artificial sweeteners approved for use in the U.S. are safe when used in reasonable quantities."

4 Sugar Substitutes, Recommended by Experts

There are several nutritious ingredients that you can swap in for refined sugar in your diet. Here are a few of the top choices recommended by experts.

Monk Fruit

Monk fruit is a low-calorie sweetener derived from Siraitia grosvenorii, or Swingle fruit. Olszewski notes that it's a good choice because it's derived from plant sources, is free of calories and doesn't have a significant impact on blood sugar levels. While more research is needed to evaluate the potential health benefits of monk fruit, some studies show it may help reduce inflammation, protect brain health and even act as an antioxidant.

Stevia

Shapiro recommends stevia, as it's natural and sourced from the leaves of the Stevia rebaudiana plant. Stevia is lower in calories than refined sugar, and it might even offer some health benefits.

According to one systematic review, stevia may actually help reduce blood pressure levels in people with type 2 diabetes. In another study, supplementing with stevia for 24 weeks improved blood sugar control, insulin resistance and cholesterol and triglyceride levels in people with type 2 diabetes. On the other hand, researchers found that it also increased body weight in people with obesity.

Raw Honey

Raw honey is another natural sugar to consider, notes Olszewski. In fact, research suggests that certain compounds in honey may offer antioxidant, anti-inflammatory, antimicrobial and anti-cancer effects, which could be beneficial for a variety of conditions.

A review of 18 studies suggests raw honey could reduce fasting blood sugar and total cholesterol levels when consumed within a "healthy dietary pattern". Another study in over 18,000 adults linked increased consumption of honey to a decreased risk of prediabetes.

As with any sugar, it's best to enjoy honey in moderation. Additionally, experts note that high-risk populations, such as older adults, people who are sick, people who are pregnant and lactating and kids younger than 6, should not eat raw honey.

Maple Syrup

"Although still high in sugar, [maple syrup] does contain some minerals," says Shapiro. In addition to zinc, manganese, potassium and calcium, maple syrup also contains small amounts of other important nutrients, including amino acids. It contains antioxidants, too, especially if you opt for darker varieties.

However, because it's still high in sugar, Shapiro recommends limiting your intake to about 1 teaspoon at a time to avoid going overboard.

Consuming high amounts of added sugar can have negative health consequences and might even contribute to certain chronic conditions. Additionally, while some sugar substitutes are considered safe, they might also be associated with health concerns if consumed in excess.

Therefore, enjoying ingredients like honey, stevia, monk fruit or maple syrup in moderation might be a better option for long-term health.

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4 Top Sweetener Alternatives, According To Experts

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Explore four of the best sugar substitutes and alternatives, according to experts. Here's all you need to know, including how they impact your health.

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How The Sugar Industry Covered Up Its Lethal Effects - Life Extension

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The Journal of the American Medical Association reported that the sugar industry paid Harvard scientists to cover up research that proved the significant role that sugar plays in creating heart disease and diabetes.

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How The Food Industry Manipulates Taste Buds With ‘Salt Sugar Fat’

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From food scientists who study the human palate to maximize consumer bliss, to marketing campaigns that target teens to hook them for life on a brand, Pulitzer Prize-winning journalist Michael Moss’ new book goes inside the world of processed, packaged goods.

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The brain uses more energy than any other organ in the human body and glucose is its primary source of fuel. But what happens when the brain is exposed to an excessive amount of sugars in the standard American diet? In this case, more is definitely not better.

The effects of sugar on the brain can include:

Impaired cognitive skills and decreased self-control: For many people, having a little sugar stimulates a craving for more.

Drug-like effects in the reward center of the brain: Scientists have proposed that sweet foods-along with salty and fatty foods-can produce addiction-like effects in the human brain, driving the loss of self-control, overeating, and subsequent weight gain.

In early humans, this stimulus helped lead them to calorie-rich foods, which aided survival when food was scarce. But now, this primitive drive contributes to our epidemics of obesity and diabetes. The behavioral and neurobiochemical characteristics of substance abuse and overeating are quite similar, and the idea of food addiction is gaining ground among scientists.

This article discusses the effects that sugar has on the brain, including its impact on the reward response. It also covers how it affects memory, mood, and cognition.

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Sugar Impacts the Brain's Reward Response

Reward Response:

In humans, high-glycemic foods have been found to activate regions of the brain associated with the reward response and provoke more intense feelings of hunger than low-glycemic foods. Foods that cause a higher elevation in blood glucose produce a greater addictive drive in the brain.

The glycemic index is a way of classifying carbohydrate-containing foods to estimate how quickly they are digested and their potential for increasing blood sugar levels. The various types of carbohydrates are processed differently in the body, some causing rapid spikes and dips in blood sugar and others leading to slower, more gradual increases and declines.

High-Glycemic Foods

High-glycemic foods are those with a high value on the glycemic index. They are digested quickly and cause a rapid increase in blood glucose levels.

Examples of high-glycemic foods include:

Processed foods

High sugar foods

Cereals, doughnuts, and white bread

Low-Glycemic Foods

Low-glycemic foods are those that have a low value on the glycemic index. Such food can help people control blood sugar levels and body weight and reduce the risk for health conditions such as heart disease and type 2 diabetes.

Examples of low-glycemic foods include:

Sugar Causes Addiction-Like Responses

Additional studies on brain activity have provided evidence supporting the idea that overeating alters our brain's reward system, which then further drives overeating.﻿﻿ This same process is thought to underlie the tolerance associated with addiction.

Over time, greater amounts of the substance are required to reach the same level of reward. Studies imply that overeating results in a diminished reward response and a progressively worsening addiction to low-nutrient foods rich in sugar, salt, and fat.

Sugar Has Effects on Memory

In addition to sugar's negative effects on the brain, it also harms the entire body. Even a single instance of elevated glucose in the bloodstream can be harmful to the brain, resulting in:

Inflammation in the brain can contribute to further memory difficulties. A 2016 study published in Behavioral Brain Research found inflammatory markers in the hippocampus of rats fed a high sugar diet, but not in those fed a standard diet.

The good news, however, is this inflammatory damage from sugar may not be permanent.

In addition, research published in the journal Nutrients in 2015 found reducing sugar consumption and supplementing with omega-3 fatty acids and curcumin improves working memory.﻿﻿

Sugar Has Effects on Mood

Another serious effect of sugar on the brain its its impact on mood. Such effects may include:

Compromised emotional processing: In healthy young people, the ability to process emotion is compromised with elevated blood glucose, according to a brain imaging study.

Increased anxiety: Another study published in Diabetes Care found that people with type 2 diabetes reported increased sadness and anxiety during acute hyperglycemia (elevated blood sugar).

Higher risk for depression: One of the largest studies to link sugar with depression-an analysis of dietary consumption and mood of 23,245 individuals enrolled in the Whitehall II study-found higher rates of sugar consumption were associated with a greater incidence of depression.

Sugar Intake Hinders Mental Capacity

Elevated blood glucose harms blood vessels. Blood vessel damage is the major cause of the vascular complications of diabetes, leading to other problems, such as damage to blood vessels in the brain and eyes, causing retinopathy.

Studies of long-term diabetics show progressive brain damage leading to deficits in:

Frequent exposure to high glucose levels diminishes mental capacity, as higher HbA1c levels have been associated with a greater degree of brain shrinkage.

Additional research shows that a diet high in added sugar reduces the production of brain-derived neurotrophic factor (BDNF), a brain chemical essential for new memory formation and learning. Lower levels of BDNF are also linked to dementia and Alzheimer's disease, according to a study published in the journal Diabetologia.

A Word From Verywell

As the research shows, any sugar added in our food is dangerous. We can avoid these dangers by satisfying our sweet tooth with fresh fruit in place of refined sugars.

Eating fresh fruit provides the satisfying sweetness of sugar-laden treats with the added bonus of the fruit's fiber, antioxidants, and phytochemicals that curtail the surge of sugar in the bloodstream and block its negative effects.

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Understanding What Sugar Really Does to Your Brain

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Sugar can produce addiction-like effects, driving loss of self-control, overeating, and weight gain. Learn more about the negative effects of sugar on the brain.

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Sugar cravings are often caused by imbalances in blood glucose levels. Low blood sugar levels might cause you to crave something sweet in order to bring up these levels. Other factors that can play a role include psychological stress, medications, hormone imbalances, and health conditions.

It's not unusual to crave carbs, sugar, and chocolate when you are stressed or dealing with depression. Cravings can be your body's way of letting you know it's not getting something it needs, such as a specific vitamin or mineral. Having certain cravings, such as for chocolate or other sweets, is also often linked to how you feel emotionally.

You don't have to completely deprive yourself of the treats you enjoy. The key is understanding why you are craving them and making sure that your overall diet is balanced and nutritious.

Learning a little more about the connection between food and mood can empower you to control your cravings rather than letting them control you.

Why We Get Cravings

A food craving is defined as an intense desire for a specific food. Most people experience cravings at one time or another,﻿﻿ and there are many factors that determine their frequency and intensity.

Common Causes of Food Cravings

Research has shown that cravings can also be driven by memories rather than bodily cues. Consistently having a certain food at a certain time creates a mental link-you might say it almost "feeds" the craving.

For example, if you grab a snack from the vending machine at work at the same time each afternoon, your desire for the snack may be less about satisfying hunger and more out of habit.

Sweets and decadent meals are often associated with vivid memories of food at social gatherings, such as holidays, parties, and family get-togethers. If you find yourself thinking about your Grandma's molasses cookies or your mom's famous apple pie, you may be missing your family members, not the food.

It might sound like cravings are "all in your head," but that doesn't mean you're imagining them. In fact, they're most often based in biology.

In 2004, researchers used fMRI machines to look at people's brains as they experienced food cravings. They noticed similarities in the neuroanatomy of food-craving brains and those of people who were addicted to drugs and alcohol (who may also experience cravings for these substances).

In a 2011 study, researchers found that when one area of the brain was activated, it temporarily decreased food cravings, particularly for sweet foods and carbohydrates.

Findings from similar studies have helped researchers understand the phenomenon of food addiction, which can be another factor if someone is experiencing persistent cravings. Research has also shown that some foods tend to be more "addictive" than others, including highly processed foods with a high glycemic load.

The Serotonin Theory

One theory about food cravings involves serotonin, a neurotransmitter needed for mood regulation. Researchers believe that having an imbalance of serotonin in the brain contributes to the development of depression.

When you're craving carbs, you're usually being drawn to foods that encourage serotonin production.﻿﻿ In a sense, reaching for sugary, carbohydrate-rich foods can be a way of self-medicating depression.

Research seems to support this theory: Having a meal high in carbohydrates tends to raise levels of serotonin, while a high-fat, high-protein meal may reduce them.﻿﻿ The effect of carb cravings on low mood may be stronger when people eat food with a high glycemic index, such as candy, as these cause a higher peak in blood sugar levels.

The Role of Tryptophan

Tryptophan is an amino acid that is a precursor of serotonin. That means your body needs tryptophan to make serotonin. Tryptophan may also produce a calming effect through interactions that take place within the realm of the gut-brain axis.

A diet with plenty of high-tryptophan foods may be helpful in boosting mood and managing cravings. Tryptophan is naturally found in protein-rich foods such as seafood, eggs, and poultry, and can also be taken in the form of a supplement.

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Chocolate Cravings

Researchers have isolated certain alkaloids in chocolate that may raise the levels of serotonin in the brain.﻿﻿ These studies have speculated that cravings for chocolate (so-called "chocoholism") may have a biological basis with serotonin deficiency being one factor.

In some cases, feeling like you need chocolate might indicate you're not getting enough magnesium in your diet. Although chocolate (particularly dark chocolate) does contain some magnesium, nuts and legumes also contain magnesium and don't have as much sugar and are generally more satisfying.

Coping With Food Cravings

While you might feel better at the moment, overindulging in sweets to cope with stress has long term physical consequences such as weight gain. There are also emotional consequences. Over time, a high-sugar diet may worsen symptoms of depression (especially if you tend to feel guilty about having or "giving in" to cravings).

There are some ways you can learn to cope not only with cravings but what is causing them. It's important to address what's really driving you to reach for a cookie when you're upset so you can better care for your mind and body.

Acknowledge Behaviors

Practice becoming more aware of your emotional triggers for eating. The next time you pick up a "comfort food," stop and ask yourself why you're reaching for it.

Feeling sad, anxious, or lonely? Identify your feelings, then pause and reflect on the action you usually take (such as reaching for a sweet treat). Try replacing comfort food with another comforting, enjoyable activity, such as going for a walk, taking a warm bath, or curling up with a good book.

Sometimes, you might realize that you're not particularly upset-but just bored. Eating is a physical, emotional, and often a social activity, so it makes sense to pursue it if you need some stimulation.

It can also help to make sure you always have healthy snacks on hand. That way, if you are tempted to reach for something out of boredom, you'll be less likely to pick something high in fat and sugar.

Get Active & Eat Well

If you're working on finding new activities to replace snacking or distract yourself from cravings, you may want to try using the opportunity to exercise. Regular physical activity stimulates "feel-better" endorphins, which can help improve your mood.

As you're tuning in to your body, you may also find that there are times when you think you're hungry, but you're actually dehydrated! When you first feel a craving, reach for your water bottle or fill up a glass of water first. You may find this was just what your body needed.

After you've rehydrated, check back in with your body. If you're still feeling hungry, the next step is to pause and think about what to eat. What you're hankering for at the moment may not be what your body really needs.

Practice Mindfulness & Moderation

Similar to how your mind might think you're hungry when you're actually thirsty, the meaning of a particular craving may be more complex than it seems. This is where practicing mindfulness can be helpful.

Sugar cravings are amplified and most intense when you're hungry. If you go too long without a meal or a snack, your body is likely to start looking for a quick source of energy. While this might address your hunger now, you aren't likely to stay feeling satisfied until your next meal.

When you're truly hungry, choose nutritious foods that will address your hunger and provide your body with the energy it needs. If you still want dessert after a balanced meal, have a little. But if you've had something filling and satisfying to eat, you may find that you no longer want the dessert.

Avoid completely depriving yourself and don't beat yourself up if you "give in" to a craving. Focus on looking for healthier substitutes instead. For example, choose a small serving of dark chocolate avocado mousse instead of a chocolate bar. Or allow yourself the dessert you really want-but only have one small portion.

Mindful eating helps you plan meals and snacks intentionally, rather than mindlessly grazing all day. You may find it useful to keep a food journal, meal diary, or use an app to help you track.

Remember: No food is "bad" in and of itself. It's the quantity and frequency that determine how the foods impact your overall health.

Talk to Your Doctor

If you've tried addressing your cravings on your own without success, you may want to talk to your doctor. Sometimes, cravings for certain foods can be a sign of an underlying health condition. For example, you might crave certain foods if you are deficient in essential vitamins and minerals.

Medications can stimulate appetite or cause blood sugar problems, including drugs used to treat depression and bipolar disorder. Other prescription and over-the-counter medications can affect your appetite as well.

If you have constant sugar cravings, talk to your doctor about the medications you're taking. You may be able to adjust the dose or switch to a different drug.

If not, once your doctor is on board, you'll be able to work together on developing strategies for coping with cravings and their cause. You can also seek additional assistance from a dietician or mental health professional.

A dietitian can help you come up with a satisfying meal plan to ensure that you are eating balanced meals throughout the day. This can help decrease those cravings. A mental health professional could help you identify potential triggers and find alternative ways to deal with cravings.

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Why Do I Crave Sugar? 4 Potential Causes

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Find out what causes food cravings that cause us to self-medicate with carbs, sugar, and chocolate when we're depressed.

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Why Is Sugar Addiction A Problem?

From cupcakes to pies to iced coffee drinks, sugar is found in many foods and is almost impossible to avoid. Emotional or psychological dependence on sugary foods and drinks, also known as a sugar addiction, is a real cause of concern for health officials in America. Processed foods and refined grains create additional sugar in the body once the body metabolizes the food. Sugar in moderation is not harmful; however, many overdo it. A recent study suggests Americans eat far too much sugar. To be specific, approximately 75% of Americans eat excess amounts of sugar, many of whom could be classified as having a sugar addiction.

How Do People Develop a Sugar Addiction?

Sugar consumption can create a short-term high and a spark of energy in the body. Some studies have suggested sugar is as addictive as cocaine. People often enjoy the dopamine release sugar brings. However, due to the addictive nature of sugar, long-term health effects like obesity and diabetes are a risk of sugar overindulgence. Similar to other compulsions or behavioral addictions, sugar addiction is a special risk for people with low moods, anxiety and stress.

Additionally, people who suffer from constant tiredness may reach for carb-rich sugary foods for a boost. Sugar releases endorphins in the body and combines with other chemicals in the body, resulting in a surge of energy. Once someone mentally connects sugar with help providing energy, they may become dependent on it, usually inadvertently. People may begin to crave sugar to balance irritability, emotional lows, and other conditions. Eventually, there is little control over avoiding sugary foods, and a sugar addiction has developed.

Signs of a Sugar Addiction

Unlike many other substance use disorders or behavioral compulsions, sugar addiction is often easy to spot. The clearest signs of sugar addiction involve consumption of large amounts of food or drinks laden with sugar. The individual may eat constantly, eat to combat boredom, and become hyper and crash. They may even talk about craving sugar after stressful or irritating life experiences.

Sugar Addiction and Emotional Eating

People may find sugar's ability to provide instant energy combined with the good taste of sugary foods enticing. Sugar provides some with a "quick fix" during a long and stressful day. People who are enduring breakups or other emotionally stressful situations often turn to chocolate or pints of ice cream to comfort themselves during the difficult time. However, those who turn to sugar to deal with emotional issues are more likely to become addicted. Other indications of sugar addiction for emotional relief are weight gain and difficulty focusing on daily responsibilities. In turn, this can damage self-esteem, cause feelings of helplessness, and lower self-worth, which in turn leads to more sugar consumption and a more severe addiction.

Sugar Addiction and Binge Eating

A particularly worrisome aspect of sugar addiction is binge eating. Binge eating is eating too much and too rapidly, followed by feelings of guilt, shame, and disgust. This can include a focus on sweets for the same effect of binge eating non-sugary foods-emotional regulation and self-medication. It is critical to remember that food, especially sugar, is a short-term fix for emotional conditions. If you or someone is struggling with depression and using food as a crutch, consider therapy or rehab.

Sugar Addiction and Anxiety

Anxiety and sugar craving have a direct relationship. Eating disorders like binge eating or anorexia occur for underlying reasons. Often times, the person suffering such disorders is struggling for psychological and emotional reasons. Stress eating is common example of the relationship between eating disorders and anxiety, and sugar consumption is commonly associated with stress eating.

Anxiety causes the stress hormone cortisol to be released in the body, and for some, that means not being hungry. For others, the stress may encourage people who already like sugar into more cravings. In cases of sugar addiction coupled with eating to soothe anxiety, the end result is typically weight gain. Despite sugar initially boosting serotonin levels in the brain, sugar can worsen anxiety as sugar lows create feelings of fatigue and depression.

Sugar Addiction and Alcoholism

There is a surprising genetic link between children of parents who abuse alcohol and their sugar addiction. A recent study confirmed dopamine receptors in the brain light up when we consume sugar, similarly to the receptors lighting up in the brain of someone who abuses alcohol. This can encourage people who struggle with sweets into alcoholism or moderate alcohol consumption.

Alcohol-dependent individuals have a higher preference for sweets and experience sugar cravings and sugar withdrawals. The genes in parents who abuse alcohol, as well as their preference for sugar, gets passed down to their children. As a result, the child now has a predisposition to both of these compulsions.

Sugar Withdrawal

Many who eliminate sugar from their diet find themselves experiencing withdrawal symptoms of irritability, fogginess, moodiness, and low energy. Since many struggling with sugar addiction have binged on sugary foods, withdrawal and cravings can be intense. Tragically, many choose to go back to eating sugary foods for the chemical release in the brain. A much better alternative is to do a dietary swap, whereby the sugar user exchanges unhealthy sweets for natural and healthy options to regain control.

There Is Hope for You

Change begins with realizing there is a problem with one's sugar addiction. Secondly, modifying one's diet, as well as self-control can help, but going cold turkey isn't ideal. Someone with a sugar addiction, especially if they have another substance abuse disorder or a co-occurring mental health condition, will likely have difficulty in purging themselves of cravings. If you or someone you know has a sugar addiction, especially if complicating factors are present, please contact a dedicated treatment provider today to find out more about your options.

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Sugar Addiction - Find Help Today - Addiction Center

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From cupcakes to pies to iced coffee drinks, sugar is found in many foods and is almost impossible to avoid. Emotional or psychological dependence on sugary foods and drinks, also known as a sugar addiction, is a real cause of concern for health officials in America.

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8 Surprising Places Sugar is Hiding in our Food

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Learn the 8 super surprising places that sugar is hiding in your food! These are things that you are probably eating every day without even knowing it!