Manisses communications Group, Inc.

Addiction Professional Online

March 2005
Letter from the Editor

The print version of Addiction Professional has featured several articles on nutritional
considerations in addiction recovery. This latest edition of our online supplement takes
the discussion into a somewhat different realm: looking at food, particularly sugar, as a
substance of abuse.

If you have any comments about the article, or thoughts about what kinds of topics you
would like us to feature in our online edition, you can reach me at genos@manisses.com

Recently a writer of one of our first online articles sent me comments about our most
recent article, Chris Fajardo’s look at the roots of the 12-Step tradition. Thomas Greaney
complimented Fajardo’s work and mentioned the work of 12-Step historian Wally P.
Person is a proponent of the “Back to Basics” approach to recovery, which emphasizes
four one hour meetings to address the critical steps.

“I see the Back to Basics meetings as a brilliant way to demystify the 12 Steps for the
newcomer and the AAer who has not done their first 4th Step,” Greaney wrote. “The 12
Steps, as outlined in Alcoholics Anonymous, represent a spiritual program of ACTION!
Unfortunately, many individuals attempting recovery today (and for the last decade or
more) have gotten the message that they can take their time learning about and
incorporating the 12 Steps into their lives. This is not only ill-advised, it is potentially
FATAL.

“Another regrettable trend is encouragement by some treaters to have clients over

identify with the problem instead of the solution,” Greaney continued. “‘I was the
problem, I am the problem, I will always be the problem’ is a recipe for continued poor
self-esteem and relapse. My hope is that clients see themselves as children of a Higher
Power and align themselves with the solution. We can be dispensers of hope to each
other.”

Gary A. Enos
Editor

Yes, Sugar is a Drug

By Betty Streett, LCSW, NCAC II

Dr. Richard and Judith Wurtman of the Department of Brain and Cognitive Sciences at
the Massachusetts Institute of Technology (MIT) used the term “carbohydrate cravers” to
describe many human subjects who have over many years participated in their research
into overeating. This research reveals that a large percentage of overweight clients
preferred reined-sugar products and complex carbohydrate snaks such as popcorn, chips
and candy, and reported that these snacks relieved feelings of depression, anxiety and
boredom. The Wurtmans found that high-carbohydrate meals also alleviate these
symptoms. Apparently complex carbohydrates and refined sugar were acting as mood
altering drugs.

In fact, extensive neurochemical research shows that the final mechanism of drug action
is the same for sugar and complex carbohydrates as it is for all other drugs of abuse. They
all alter levels of the neurotransmitter serotonin. Serotonin is one of the most important
chemical messengers in the brain. It is pervasive throughout the neural network and is
even present in the blood, being manufactured in the intestines as well as in serotonergic
neurons in the brain.

Serotonin is involved in the regulation of so many vital metabolic systems, including the
release of dopamine and endorphins (the natural neurochemical equivalent of opiates),
that a low level of serotonergic activity is perceived by the brain to be life-threatening;
individuals with low brain serotonin experience feelings of impending doom.
Physiologically expressed, they feel as if they are literally “dying” for a drink of alcohol,
a cigarette, a rock of crack, a candy bar, or any one or combination of a large array of
substances and behaviors, depending upon which they identify as being useful for
increasing brain serotonin in the neuronal synapse.

Low brain serotonin produces the array of symptoms substance abuse counselors know as
the “abstinence syndrome”: depression, anxiety, irritability, anger, lethargy, poor memory
and mental confusion, and sleeplessness. Any substance or behavior that increases brain
serotonin relieves these symptoms.

Sugar and complex carbohydrates increase brain serotonin though their effect on insulin.
Serotonin is produced in the serotonergic neuron by combining a naturally occurring
chemical with tryptophan, a dietary amino acid. Whenever we eat foods containing
protein, a variety of amino acids including tryptophan are absorbed into the bloodstream.
The amino acids used by brain neurons must be transported across the blood/brain
barrier. There is a competition for uptake access this barrier among the large amino acids
with tryptophan often the loser. When a load of glucose produces an insulin surge in the
bloodstream, the competing amino acids are absorbed by other cells, leaving a direct
pathway for tryptophan to enter the brain this process immediately increases serotonin
levels.

Some carbohydrate cravers experience withdrawal symptoms if they go on sugar-or carb-

free diets. As with addicts who try to control or abstain from their drug of choice, such
attempts are ultimately met with failure. Also like other addicts, carbohydrate cravers eat
alone, hide food, protect supplies, obsess, and defend themselves psychologically through
denial; rationalizing and blaming people, places and things for their illness. Low self-
esteem coupled with feelings of anxiety, depression and guilt complete the addictive
disease syndrome.

And carbohydrate craving is just as deadly as other forms of addiction. In the

carbohydrate craver, long-term use of sugar and complex carbohydrates to medicate
feelings often leads to a condition called hyperinsulinemia (chronically high levels of
insulin in the blood). The Oct. 14, 1992 issue of the Journal of the American Medical
Association reports that physicians have identified a condition that has been coined
“syndrome X.” It is now recognized that hyperinsulinemia, hyperlipidemia (chronically
elevated levels of fat in the blood that often accompany carbohydrate use in the form of
candy, doughnuts, cookies, cake, etc.), hyperglycemia (chronically elevated levels of
sugar in the blood) and hypertension often occur together in the same person, and that
person is most often a carbohydrate craver.

Elevated insulin levels are related to both high serum lipid (fat) levels and reduced high-
density lipoprotein (HDL, good) cholesterol. Hyperinsulinemia is thus related to the
incidence of both cardiovascular disease and diabetes. Obesity and overweight are not
just a matter of appearance. Accepting one’s annually increasing weight isn’t just a
decision about appearance; carbohydrate craving carries serious health consequences.

For the carbohydrate craver, recovery involves abstinence from eating in a way that will
produce an insulin surge – remember that insulin is the mechanism of drug action. This
explains the success of the Atkins diet. But much more than dieting is involved, since
there is real brain dysfunction driving the condition, and most of the staunchest Atkins
devotees either return to overeating carbohydrates or turn to other expressions of
addictive disease to treat their underlying symptoms.

Carbohydrate cravers need treatment; the treatment intervention is just as important for
them as it is for other addicts. Treatment may include counseling, behavioral
modification, medication and 12-Step meetings.

Counseling provides education about the disorder, behavioral interventions, insight and
support, as well as diet recommendations. Carbohydrate cravers frequently suffer from
symptoms of hypoglycemia when their blood sugar falls rapidly after the initial insulin
surge. These symptoms often lead to more sugar/carbohydrate intake. The hypoglycemic
reaction can be avoided by eating a hypoglycemic diet; several small meals a day, each of
which do not produce an insulin surge. Insulin surges may be avoided by eating protein,
such as cheese and crackers with fresh fruit, cottage cheese ad fruit, tuna salad or egg
sandwiches, etc., using low-fat options in cheese, mayonnaise, bread and crackers, the
use of whole grain breads, pasta and cracker (in fact any high fiber food) will moderate
insulin surges as well.

The Wurtmans’ research shows that aspartame (Nutrasweet) products actually lower
brain serotonin by introducing more competing amino acids; therefore, they should be
used with care or not at all by carbohydrate cravers. In fact, more recent research shows
that any use of sugar substitutes increases total caloric intake throughout the day – the
brain will not bee fooled!

Exercise is important in increasing the release of serotonin, dopamine and opiates in the
brain. One needn’t do aerobics. Jog or lift weights, although these are fine exercises for
the healthy if not overdone (any serotonin-stimulating activity may be addictive). A
simple walk around the neighborhood can increase brain serotonin, with the goal of
maintaining some form of moderate physical activity for 20 minutes every other day.

Light also lifts serotonin. Exercise done in the sun is doubly beneficial. Carbohydrate
cravers should plan outside activities as much as possible, or just sit or stand outside for a
while each morning, at lunchtime and in the afternoon. When inside, they should keep
curtains and drapes open, and rooms well-lighted with wide-spectrum light bulbs.

Keeping a high level of tryptophan in the blood is also helpful. Foods high in tryptophan
include sunflower, sesame, poppy and pumpkin seed; peanuts, soybeans and most peas
and beans; cheese; and most meats. A nutritionist can supply a list of foods and their
amino acid contents.

Rat research shows that being in groups elevates brain serotonin, while being alone
lowers it. A wonderful group is Overeaters Anonymous, whether one is over weight or
not.

Many carbohydrate cravers control their weight in other destructive ways, such as
overuse of laxatives, vomiting and not eating regular meals, yet keep their blood sugar
and insulin levels dangerously elevated. The test for qualifying for Overeaters
Anonymous is loss of control over eating. In many areas where Overeaters Anonymous
isn’t available, open meetings of Alcoholics Anonymous may substitute.

Of course, a primary benefit of 12-Step group attendance and other group therapy is the
peace of mind that results from working the steps and from the therapeutic intervention.
As in other forms of addiction, carbohydrate cravers also suffer from chronic anger and
resentment; serenity is a necessary component of long-lasting recovery.

Yes, sugar is a drug. It lifts depression, reduces anxiety, increases energy, and reduces
pain. But for the carbohydrate craver, it is a dangerous and potentially fatal drug of
addiction. With adequate, accurate information and treatment, recovery isn’t only
possible, it’s likely.

Betty Streett is a licensed clinical social worker with more than 30 years of experience in
clinical practice and research. She is the author of the books 12 Steps to Loving Yourself
and Smoke and Mirrors: The Magical World of Chemical Dependency.