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Addicted to Fat and Sugar?

Publication date: 09 February 2014

I watched the recent BBC Horizon documentary which asked the question, which is worse for you, fat or sugar? For the most part I found the programme very disappointing, and scientifically illiterate, but the final 10 minutes I found to be a real eye-opener. It featured an interview with Professor Paul Kenny, who has researched food addiction. Prof. Kenny's thesis is that it's the combination of fat and sugar (or refined carbohydrate) for example found in a doughnut that over-stimulates the brain's reward mechanism to the point that the counter-balancing appetite control mechanisms are swamped.

In the brain the main pathway associated with drug addiction is based on the neurotransmitter dopamine. A squirt of dopamine in the brain feels like "do that again, it's going to be good!". Of course in a serious addiction we have this promise of future reward that never gets fulfilled.

It's possible that in cases of obesity or food addiction the same or similar processes are operating in the brain as with heroine or cocaine addiction.

In nature, appetite evolved to drive us to eat but then a satiety mechanism kicks in which turns off appetite when we've had enough to eat. For the most part it works very well. But in the natural world foods high in both fat and sugar don't exist, so it's not that surprising that they can break the mechanism. These foods maximally stimulate appetite ("do that again") but the brake doesn't work or isn't strong enough. (Apparently a 50-50 fat-sugar combination is "ideal".)

I confess I was definitely in the sugar-is-the-bad-buy camp before. I still think it is "worse" for you than fat, but my perspective has changed.

The human body can cope with the occasional bit of bad stuff. The large majority of us are never going to stick to the perfect diet for all time.

In practical terms, the most important issue in weight management is not what is the perfect diet. Rather, (for some people at least) it is how to deal with addiction.

It seems obvious to me now that Prof. Kenny's insight fits with our everyday experience - the foods that we eat compulsively do seem to be fat-sugar combos. (Actually I think there are other addictive foods besides - wheat being one that springs to mind first. My guess is that other factors are at play in the neurobiology of wheat addiction.)

If food is an addiction, what are the practical consequences?

Weight loss clients need much more than just advice about what to eat. They need therapy and coaching for addiction.

We also need to reframe the problem and the outcome. If you're a cocaine addict or a serious alcoholic, the only real solution is complete abstinence. Sticking to just one pint, once a week, is not realistic - it's just not going to happen. Trying it would be a form of torture. I think it's the same for over-eaters. Obviously we can't abstain from food but I think people have got to recognise when they have a problem with a particular food (like doughnuts), and treat it like an addiction. Thinking you can have an occasional treat is probably not helpful - although we do need to build (healthy) pleasure into our lives, in other ways.

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