Can you be addicted to sugar?

This BBC podcast is supported by ads outside the UK. Get great savings on family favorites at Tom Thumb. This week at Tom Thumb, get medium-ass avocados for the member price of two for a dollar, limit six. Plus, get value packs of signature select bone-in fresh whole chickens, thighs or drumsticks for the member price of...

97 cents per pound with digital coupon. Limit two each. Also this week at Tom Thumb, mix and match selected varieties of Nabisco snack crackers, Ritz, Chips Ahoy, or Nilla wafers. And get them for $2.47 each when you buy three. Member price. Visit TomThumb.com. For more deals and ways to save. From unsolved mysteries to unexplained phenomena. From comedy gold to relationship fails. Amazon Music's got the most ad-free top podcasts. Included with Prime. Download the Amazon Music app today.

Welcome to the Inside Health Podcast with me, James Gallagher. Episodes are released weekly wherever you get your podcasts, but if you live in the UK, you can listen to the latest episodes a whole week earlier than anywhere else. First, on BBC Sounds. Hello there. I'm just enjoying a little chocolatey treat here because it's getting close to Easter and you can't move in the supermarkets for chocolate eggs at the moment. So I thought we should think about sugar.

a bit today. Later, we're going to find out if I know how to brush my teeth properly. But first... I want to know if we should be classifying sugar as an addictive substance. It's certainly desirable. I really want to polish the rest of this off right now. But...

Does eating loads of sugar make you crave it even more? Well, to discuss, I'm joined by Professor Suzanne Dixon, who specialises in neurobiology of appetite at the University of Gothenburg, and Professor James Brown from the School of...

Biosciences at Aston University. Suzanne, James, welcome to Inside Health. Hi. Thank you very much. Nice to be here. Suzanne, can I start with you? If we're going to try to tackle this question of whether we can be addicted to sugar, we should probably just define what is an addiction.

The term addiction, even in the whole field of psychiatry, is not one that we... tend to like to use very much these days and tend to speak about substance use disorders. And of course, a substance can include food as well as alcohol and drugs of abuse. And the idea of an addiction is that it goes beyond... consuming what would be a healthy amount and that there would be health consequences of over-consuming and in ways that seemed impossible to avoid.

So if you're addicted to something, you might, for example, continue to over-consume it despite knowing that it has terrible negative consequences for your health. That would be an example of a criteria. There are others, things like withdrawal effects. I can't say that it's going to be terribly strong for stopping to eat certain foods and of course we can't take foods out of the diet altogether. Terms like tolerance, that means that you have to eat.

more and more of the same addictive substance over time in order to get the same rewarding effect of the food or the substance. So as you see, I'm hesitating because I feel it's very difficult to apply those kinds of criteria to food. It's very much a grey zone, whereas it's much easier to apply those kinds of terms to substances of abuse. James, what do you make of the term sugar addiction? Me personally?

So I tend not to use the word addiction. It's difficult because I'm nearly 50 years old and I've grown up with that word being used for everything. So I tend to use substance use disorder for what might be in the past alcohol addiction or cocaine addiction.

or harmful pattern of use if it's something that's behavioral. And there is debate over whether non-chemical behaviors that we're exposed to that give the brain what we call reward are... something that could be classed as an addiction, whether it's mobile phone use, porn, gambling, etc. So I think if we lean into that gentle language of harmful pattern of use, it's easy to see that actually sugar consumption can have a harmful pattern of use in some people.

Whether it's an addiction in the traditional classical definition sense, that's really... being debated by people. People definitely crave sugar though, don't they? What's happening in the brain when that's happening? Suzanne? So craving is actually a function of the reward system. The reward system, you can think of as having two different activities. One is coding for the pleasure. But if we like it and we get pleasure from it...

Then that brings me to the second point. You want it. And wanting is a powerful drive. You know, it's a very strong motivational drive. It helps us to go and search out foods that we like or other experiences that we like. So the reward system is definitely engaged.

But, you know, it's a bit complicated. And I like to think of it a bit like, OK, I love chocolate. It's Easter. Let's just take the example of a cream egg, which we all know well and have loved since our childhood. Now, the very first one of those that I would eat... I would think, wow, I'm really enjoying this so much. And I know that my dopamine system will be having a party.

But if a few hours later I was to come along and eat a second, the experience wouldn't be quite so wonderful and so on. If I ate six, you can imagine that by the end of it, really, I'm not enjoying them at all. And in fact, my dopamine system would... not be responding in the same way that it did to the first cream egg. So over time, the dopamine system will change its response to the same food.

This is very interesting because while we might not get a dopamine response with a cream egg, you could come along perhaps with a completely different type of food, maybe some crisps, and then our dopamine system would start to be happy again.

And if you think about this, this means that our dopamine system is a really important system for our survival because it helps us... to go out into our environment, to crave, to want, to seek, and get a diversity of foods, not just cream eggs, from our environment. And that's different to drugs of abuse, whereby you're more likely to have the dopamine system more continually engaged. You have to come along with diverse foods and different foods to keep the dopamine system happy.

James, how good is sugar at activating that bit of the brain? If you look in animal studies, very good. Part of the problem is because it's difficult technically to scan a human brain and measure dopamine release, it can be done. They're expensive experiments. a lot of the research is in animal models the extent the the power of sugar to cause that sense of reward

It is complicated and nuanced, though, because reward is experiential. So the reward of eating it, but we also have anticipatory reward. And that's the reward we feel when we know we're going to engage in something that we get reward from. So for people that maybe have higher levels of sugar consumption, which can, as Suzanne said, lead to desensitization of this reward part of the brain.

we know that they can potentially have more of this anticipatory reward, that drive to engage with something in the future. And that's a really powerful driver of behaviour. Suzanne, is this why we eat even when we're not hungry? It's the second stomach for ice cream, right? I mean, I think that it is to do with the palatability of the food. I mean, we're talking here about sugar addiction, but I mean, next to our coffee machine, there's a bowl of sugar at work here.

And I never see anybody, including myself, going and pinching sugar cubes. So there's something special about combining it with things like fat and salt. that gives it a special palatability, you know, cocoa solids in the case of chocolate, and just seems to send pleasure signals to our brain. And our brain recognises this and makes us desire it. So I think that...

Coming back to evolution, our ancestors might be lucky to kill a wild boar. What are they going to do about that? Just have a reasonably small or middle-sized portion? No, they're going to massively overeat and they're going to eat as much of the food that's available. Isn't there something unique about foods which are often sugary? You don't really hear that thing of people overeating.

chicken in comparison to what you can do to a dessert trolley yeah again it comes back to that palatability now whilst you know The protein, which chicken has a lot of protein, does have energy in it. It's a lot less than fat and the body has to work harder to get that energy than it does with carbohydrates. So our drive to consume the foods that we've evolved to eat are driven.

largely buy that fat and sugar content. Does that mean we have a tendency to binge on those kinds of foods, like hardwired into us? It's really important to acknowledge human beings are incredibly different and varied in their neurology, their physiology, their biology in general

And therefore, some people will be more likely to binge on sugary foods than other people. And there are genetic reasons for this. There are lots of different genes that we know if they are mutated, for example, can impact. of sweet things that can lead to a higher preference for sweet foods because of the way in which glucose which is part of sucrose or table sugar is transported around the body so

For some people, there will be a bigger drive to binge on sweet things than there will be for others. And how much of that difference is due to genetics versus environment and upbringing and early life food exposure? Suzanne? Oh, that's a tough one. I'm very sure, very, very sure that genetics and upbringing both play a role. I mean, we could think of our own kids. You know, I have a boy and a girl. They're all grown up now. But when they were kids, my boy always went for the porridge.

with sugar breakfast, you know, lots of sweet stuff. And I think to this day he still would. Whereas our girl was very much the savoury eater. She would be happy with a full Scottish breakfast in the morning. We can't really explain why they would differ quite so much. Genetics for sure must play a role, but I don't think we're... anywhere near to knowing which genes are involved there. James, how much do our hormones play a role in whether we tend to eat sugary foods and how much?

If you look at appetite in general, it's an incredibly complex drive, as is fullness. And there are multiple different neurological and hormonal inputs that can either make us feel hungry, make us feel full. some cases increase or change our preference for food so this is probably most noticeable with female sex hormones because of the change throughout the month but also across the life and therefore

You can see that there is some evidence. Again, it's very emerging evidence in humans, but more in rats, about changes in taste preference during different points of the menstrual cycle or during pregnancy. so hormones in general if we go beyond female sex hormones are very involved and we have lots of different hormones with funny names like ghrelin and leptin and endocannabinoids etc which all have an impact on

our appetite or our sense of fullness, and some of them can enhance the pleasure and reward derived from eating particularly sweet or salty or high-fat snacks. So it's a really complicated interplay. of our genetics our environment our emotions as well because we don't just eat homeostatically which is i'm hungry or hedonically which is i like that thing i'm going to eat it we also eat emotionally in many cases it's a way of managing

emotions for some people so that really complex interplay of our genes our environment our hormones whether we've slept whether we're stressed i was going to say stress is one of those ones where it really kicks in isn't it i think most people have have had that they've had a really

tough day at work and it's like i'm gonna have some cake tonight or something like that or i'm opening the chocolate yeah in the same way as people often turn to other what we would call maladaptive or less healthy rewarding activities at the end of something stressful reward

isn't always about the motivation to seek something in the future it can sometimes also just soothe and give us a sense of quiet if we're stressed so when we're stressed and again hormones are involved in this we have hormonal systems including cortisol, which we know is involved in sugar cravings. And we also know that chronic sugar consumption impacts cortisol levels. So there's a two-way relationship between stress and sugar consumption and what we eat in general when we're stressed.

Can he become, I don't want to say dependent because I think that's quite a loaded word, but you know, after Christmas, there's a...

tub of chocolates on the go nearly all of the time and then you can kind of get into a quite normal habit of having chocolate every day that you might not have been doing in November. It takes a bit of effort to stop eating sugar, like the body doesn't... like it yeah certainly for some people and there are a number of reasons for that but if you look at a neurological level then we do know that one of the receptors for dopamine so dopamine is this

brain chemical that's passed from neuron to neuron and it has to bind to a receptor to activate the next neuron in the chain. And there are a family of these receptors. And one of them called the D2 dopamine receptor. We know that if you have chronic drug or in this case, sugar use, this can actually reduce the sensitivity of those receptors.

meaning that you can either feel less reward from the same thing so you chase more of it or importantly you can have a reduced inhibitory control which this receptor is involved with and that means being able to stop yourself from eating something sugary by cognitively saying no hang on a minute i i want that but actually i should eat something more healthy so chronic overeating of sugar can have an impact on our

ability to step away from eating sugar and equally there are some people that do feel those short-term kind of withdrawal light effects. I was wondering whether you would use the word withdrawal. symptom i pause you probably picked it up because it's not the same as the withdrawal from substances we would typically be addicted in inverted commas too but some people do report negative impacts on withdrawal of sugar

from their diet, particularly in the days and up to a week maybe or two after they do that. Suzanne, what's going on when people say they're addicted to sugar then?

To be honest, if someone tells me I'm addicted to sugar, I'm really not convinced. I mean, in the food field, it's a bit of a joyous term, isn't it? It means I really enjoy chocolate a lot. Or I love sugary foods and I'm addicted to them. And in a way, you're explaining your behaviour in a rather positive way, but perhaps also giving yourself an excuse. It also implies a lack of control, doesn't it? I think. Like I'm powerless because I'm addicted to it. That's the other side. I have a problem.

and therefore I have an excuse for overeating the foods. But to be honest, I don't think that by far the majority of people have anything that resembles food addiction. And I think in its extreme form... What you're really seeing, as we discussed a bit earlier, is a behavioural addiction towards food that results in binging in very large quantities and overeating. And most people are really not eating to that kind of level.

Where do you draw the line in between normal behaviour and something that is unhealthy or could be a food addiction? Because I'm just thinking lots of people have probably... binged on too much chocolate or eaten way more of a packet of biscuits than they should have done or have felt some of those as you call them withdrawal light symptoms when they're giving up. Many of the things sound like a form of addiction.

It's true. And again, this is where I think language is powerful because there may be people listening to this who have had struggles with substance use disorders, who feel it's diminishing to say that people can be addicted to sugar. The way I would probably personally phrase it, it is if somebody's relationship with sugar was having a negative impact on their health and yet they still engage with it then that's when it's turning into an unhealthy habit which is impacting that person

And they're aware of it, and yet they still engage with eating sugary foods. Suzanne, how strong is the evidence around us having, if not for sugar, then some kind of... addiction to food because you've mentioned it a couple of times that it may skew more towards that behavioral side of things something more like gambling would be your classical example of a behavioral rather than a substance based addiction wouldn't it

I think when you start to see it impacting on your quality of life and your health, you really are developing a problem. Binging and nighttime eating, all these very extreme behaviours, you know, feeling safe when you have a big... bag of chocolate biscuits by the side of the bed and constantly thinking about food. I mean, this is not normal. And I would argue very strongly that this is in the psychiatry domain.

you would really require psychiatric intervention as well as nutritional support to deal with people who have this rather extreme behaviour. Really important and significant question to end on. What's an appropriate amount of chocolate to eat over Easter?

James? So I have ADHD and binge eating disorder, which means I have to give advice that I clearly will not take myself. And that is when you're eating your Easter eggs, ask yourself, am I still enjoying this? And if you are still enjoying... it that's okay if you've got to the point where you're just eating it because there's some there or you feel like you need to get rid of it but you

got that kind of slightly full slightly sickly feeling you've probably passed the point of too much challenge accepted both of you thank you so much thank you Get great savings on family favorites at Tom Thumb. This week at Tom Thumb, get medium-ass avocados for the member price of two for a dollar, limit six. Plus, get value packs of signature select bone-in fresh whole chickens, thighs or drumsticks for the member price of...

97 cents per pound with digital coupon. Limit two each. Also this week at Tom Thumb, mix and match selected varieties of Nabisco snack crackers, Ritz, Chips Ahoy, or Nilla wafers. And get them for $2.47 each when you buy three. Member price. Visit TomThumb.com. This podcast is sponsored by Talkspace. You know when you're really stressed or not feeling so great about your life or about yourself? Talking to someone who understands can really help. But who is that person? How do you find them?

Where do you even start? Talkspace Talkspace makes it easy to get the support you need. With Talkspace, you can go online, answer a few questions about your preferences, and be matched with a therapist. And because you'll meet your therapist online, you don't have to take time off work or arrange childcare. You'll meet on your schedule, wherever you feel most at ease.

If you're depressed, stressed, struggling with a relationship, or if you want some counseling for you and your partner, or just need a little extra one-on-one support, Talkspace is here for you. Plus, Talkspace works with most major insurers, and most insured members have a $0 copay. No insurance? No problem.

Now get $80 off of your first month with promo code SPACE80 when you go to Talkspace.com. Match with a licensed therapist today at Talkspace.com. Save $80 with code SPACE80 at Talkspace.com.

Well, now on Inside Health, I'm going to head to the bathroom to meet Claire McCarthy, a dental hygienist at King's College London. Last series, she helped us look at the state of children's teeth and at plans for supervised toothbrushing in schools and nurseries. You can hear that still on BBC Sounds. But she said adults could improve their toothbrushing game too. And she challenged me to see if my technique is up to scratch. So let's go find out. We're reconvening.

In the BBC bathrooms. Really sorry about this, Claire. Welcome back. Thank you. I've got my wash bag with me. So do you want to see my teeth brushing techniques? Yes, please. It's a bit weird. Open it up. I've seen it all. My theory is that my technique is never going to be perfect. So I have one manual toothbrush and one electric toothbrush so that if I'm bad with one and bad with the other, they'll even out. That's James logic. What would you like to see me do?

I'd like to see your electric tooth brushing technique if that's okay. Electric? Okay. Yes please. You are using a nice round small. head on your electric toothbrush. It is actually my favourite one. I was under the impression that the best evidence on electric toothbrushes was the ones that spin and rotate rather than the ones that vibrate up and down. You're correct actually. The oscillating, rotating, pulsating brushes.

perform superior to manual toothbrushes and they are slightly better than the sonic electric toothbrushes. But listen, it's all down to technique. Go for it. Show me what you do at home. Pretend I'm not here. That is going to be very hard. This is a very cramped bathroom. Right. So I'm just going to squirt some toothpaste on to the end of my toothbrush. So I start like this.

So I get a little bit of toothpaste onto all of my teeth. This is a really clever approach, James, actually. And the other thing that you did correctly was you applied the toothpaste to a dry toothbrush head. Wetting the toothbrush before putting the toothpaste on dilutes the active ingredients in the toothpaste. Yeah, thumbs up. Excellent. Okay, so let's have a look. Switch that baby on. Okay. Okay.

So I can see that you're holding the electric toothbrush steady and you're letting it stay long enough on one particular tooth to actually clean it before you move to the next one. So your technique is actually very good. I'm going to give you a little bit of...

support here what I'm going to suggest is that you move the toothbrush a little bit lower down onto the gums so you're brushing half on the gum and half on the tooth at the same time. Gum and tooth. Yes please. Because I was always paranoid, particularly with an elastic toothbrush, about brushing away the gums. That is a concern for a lot of people. However, there's a natural crevice between the gum and the tooth and that's where the bacteria can sit.

And they think, well, he'll never find me here. So what we want you to do is bring the toothbrush a little bit lower down. So the bristles of the brush are overlapping half on the gum, half on the tooth. And then you hold the toothbrush steady if it's an electric toothbrush and let the brush do the work. It's doing two things. It's removing the bacteria, the plaque, the sticky stuff, and it's also massaging the gum as well at the same time. Tell me when I've hit the sweet spot then. I will.

I always say to patients, count to five before moving to the next tooth. So just one, two, three, four, five, and then move along. How does it feel? I've never brushed my gums like that before. They will love you for it. Manual? Okay, manual toothbrush. Let's have a look at your technique. It's so hard to brush your teeth while I're hygiene. This is, like, literally two feet from your face. I know. Sorry about that.

Okay, you've actually got quite a good technique. So you're using circles. I would say slow down just a little bit. Slow down. And just smaller circles. And do tooth by tooth. I don't know if I put the dexterity. Oh, you do. You do. You're doing really well. And you're looking in a mirror when you brush your teeth as well, which is really important. Do we have any sense of how good we are as a nation at brushing our teeth?

On average, people spend 39 seconds brushing their teeth. And 90% of that 39 seconds is spent on the surfaces you can see, so the surfaces that are facing outward, and only 10% on the inside surfaces, which is only 3.9 seconds. I think we could do better. 12% of the population have severe gum disease. 10% of the population are what we class as periodontally healthy or have healthy gums.

And everybody else in between, so approximately 80% of the population, have some degree of either gingivitis, which is... bleeding gums, which is the early stages of gum disease, and then moderate and more severe disease in the middle. So we actually have... So the overwhelming majority of us are in there could do better. Yes, we could. We could all do better. And is that all brushing technique?

It's brushing is one part of it and brushing will clean 60% of the surfaces in your mouth, but you also need to be cleaning in between your teeth. So would you like me to show, would you like me to have a look? We haven't finished in my bag. Oh, here we go. Oh, excellent. He's got dental floss. Brilliant. Right. Would you like to show me your technique? I kind of go...

Okay, what you could do that would just make it a little bit more effective is when you put the floss between your teeth, instead of sliding it over and back in a sawing motion, what you think about is sliding it just slightly beneath the gum. pressing against the tooth and then sliding it down keeping it in contact with the side of the tooth so that you're cleaning the sides of the teeth it's going to take a little bit longer but it

will work much better for you. You really should be trying to use something at least once in every 24 hours between your teeth. There are so many. Is there any evidence on what is best? So, floss is one of the most difficult... tasks and oral hygiene and it is only for people like you who have spaces are very tight together but for everyone else if you have a space that's a little bit larger and you can fit some little brushes or little

plastic sticks or wood picks in between, that would really help. Just push it in and through and go in and out about five times. Is there a best time of day to brush your teeth? Well, before bed is what we consider the most important time. Nighttime, your saliva flow stops. So if you have bacteria on the surfaces of your teeth and in between, it means while you're sleeping...

The bacteria and whatever you've eaten during the day have a little bit of a field day and that's when they can be most prolific. Definitely go to bed clean. 100%. What about in the mornings? Because some people have the kind of like... I'm not going to brush my teeth before breakfast because then my cereal tastes all minty. And some people are like, no, that's the best way. Otherwise, your mouth is too acidic and you'll damage your teeth while you do it.

I think it is entirely up to you just making sure that if you've had, say, orange juice or something like that for breakfast or something really acidic that you've... I had a little rinse around with water first before you go in there brushing and, you know, maybe being a bit too aggressive because that could cause a little bit of tooth wear. What about toothpaste? Because at one level it's really easy. You can just buy a cheap... tube of fluoride toothpaste but actually the market is awash with

thousands of different brands but how do you make the right choice it's literally an entire aisle it is it is and it's it's you know heaven for me i see people choosing the wrong thing and i'm excuse me can i intervene for a moment i can't help myself the main thing is

is that you're choosing something that has got fluoride in it and it will be on the back of the packet and then those specialist toothpaste particularly for whitening should be used with caution maybe doing that twice a week or something like that you could end up with some swear really dumb question but how do you know when you're finished like mine now having had the extra brush feel all right but can you tell by mouth feel alone if you've done a good job

Yeah, you should roll your tongue around the surfaces of your teeth. And if there's plaque or biofilm on them, they'll feel a little bit furry or a little bit grainy and rough. So try to get in the habit of doing that.

But the main thing is that you're brushing for a minimum of two minutes. Two minutes of brushing. Is that kind of one of those five a day, 10,000 steps? It's kind of like just out there, a good rule of thumb. Or is that actually we have the proof that no, two minutes is the number?

It's a little bit of a rule of thumb. If you're going to spend the required amount of time on each surface, it is going to take you two minutes to get around the mouth. And it is a realistic and achievable amount of time that you could expect somebody to brush their teeth. Somebody normal like yourself. Oh, I'll take normal. Not like those toothy people spend a little bit longer doing it because this is our bread and butter.

How does ageing affect our teeth? As we get older, things start to break down. We're not producing the same amount of collagen, connective tissue, and the resistance to maybe a low-grade inflammation or infection where, you know, in your 20s and you're 30s. it didn't affect you when you get into your 40s then things start to kind of get a bit more challenging but there are lots of other things as well that affect the health of your gums like

smoking and we also know that gum disease is linked to so many other systemic diseases. We kind of know that oral health is a marker for everything else going on in the body. It is. You can tell a lot about a person's overall health by just looking at their teeth and gums. I'm going to smile at you. Yeah, you have a lovely smile. It's beautiful. There we go. Yeah. End of programme. Thank you, Claire. You're most welcome. Thank you, James.

end of program and end of this series of inside health so thank you so much for joining us we'll be back at the beginning of july and in the meantime you can explore an interactive guide of health issues that some people can find uncomfortable discussing visit Thanks for listening to Inside Health with me, James Gallagher. The producers were Tom Bonnet and Hannah Robbins. This programme was a BBC Wales and West production for Radio 4. Bye bye. you

Help keep our community safe and healthy during National Prescription Drug Take Back Day, October 25th. Find a collection site near you at deatakeback.com. Do your part to lower overdose deaths and prevent drug misuse before it starts. At the BBC, we go further so you see clearer. Through frontline reporting, global stories and local insights, we bring you closer to the world's news as it happens. And it starts with a subscription to BBC.com. from the BBC. Find out more at