I was recently sent an article written by Jon Robison titled, “A Little Nutrition Sanity – Sugar: The Other White Powder – Rhetoric vs. Reality.” Feel free to read that before reading this as this article. It’s not required though as I quote most the relevant aspects here…

Jon Robison isn’t the first to take a crack at unraveling food addiction as it relates to sugar. A lot of important work has been done in this regard. But as you’ll see, Robison’s work is problematic. Even from the opening line, Robison struggles to make logical connections and escape his biases.

“The latest round of sugar bashing probably traces its origin back to an article by the lawyer (not nutritionist) Jon Banzhaf in the “New Scientist” in 2003…”

What comes after the ellipses isn’t important because Robison doesn’t use this opening line to make any sort of argument. He doesn’t quote anything from Banzhaf’s article or make any sort of refutation. The line exists solely as an ad hominem attack against Jon Banzhaf, designed to discredit anyone who isn’t a nutritionist from having a say in this discussion. It’s nothing more than a basic tactic of manipulation.

In a piece in “The New York Times” in 2011, Dr. Robert Lustig summed up the gathering storm against the sweet tasting white powder saying:

“Sugar is not just an empty calorie…It’s not about calories. It has nothing to do with calories. It’s a poison by itself.”

Of course the sugar as “empty calorie” concept makes no sense at all. A calorie is a measure of energy, and carbohydrates (including sugar) are nutrients – sugar provides both.

Focus on the first sentence of the final paragraph. “Of course the sugar as ’empty calorie’ concept makes no sense at all.” That’s a bold statement which requires an argument to be made to support it. Robison follows up with his argument in the next sentence: “A calorie is a measure of energy,” “carbohydrates are nutrients,” and “sugar provides both.”

The problem with this argument is that he’s conveniently left something out. Micronutrients. Vitamins and minerals and such. When people claim that sugar is an “empty calorie,” they are almost always making the case that sugar does not contain a relevant amount of vitamins and minerals. 

As you can see from this nutrition facts panel, sugar indeed is “empty” of micronutrients as proponents of the “empty calorie” argument claim.

Screen Shot 2015-09-03 at 1.19.49 PM
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Why did Robison leave this out? Was it an oversight? Or is Robison purposefully manipulating the discussion to conform to his biases? It’s hard to make the case that he’s not purposefully manipulating the discussion because the manipulation continues throughout.

Its damaging effects have been compared to those of another white powder…

The emphasis is mine. The use of the word “damaging” is more manipulation. Most people’s argument goes like this: “Sugar is more addictive than cocaine.” Robison knows this because he addresses this exact argument later in his piece. So why is he trying to first claim that people argue that sugar is more damaging than cocaine? That’s not the argument at all.

Slight of hand.

Even more unfortunately, a number of self-proclaimed food experts are stuck in the food addiction (FA) paradigm, resulting in outrageous recommendations to an already confused and anxious population.

Hold on to your seats, this is about to get more complicated. Robison started out talking about sugar, but now he’s conflating the discussion to include food addiction (FA). Not only that, he’s poisoning the well by suggesting that *only* “self-proclaimed” experts believe in the existence of food addiction. This is absolutely not the case. Many well-schooled people with various degrees in psychology, psychiatry, and nutrition believe that FA exists. It’s not only “self-proclaimed experts” as Robison would have you believe.

I’m glad Robison has brought up FA though, because he’s heading into deeper water without a life jacket. And it doesn’t appear he’s very good at swimming.

In his book, “The End of Overeating: Taking Control of the Insatiable American Appetite,” physician and former Food and Drug Administration Commissioner David Kessler, focuses on the alleged addictive qualities of highly palatable (sugary and/or fatty) foods. He claims that the only way to deal with these foods is to banish them. He suggests:

“The enduring ability to eat differently depends on coming to view these foods as enemies, not friends.”1

The solution according to Kessler is to retrain the brain to think:

“I’ll hate myself if I eat that.”

Eating disorder experts know only too well that, far from moving us towards that End Of Overeating, this approach is one that has led, and will continue to lead, to exactly the opposite – more confusion, more anxiety, more shame, and more overeating. And amazingly, Kessler seems to agree as he completely contradicts himself some pages earlier in the book saying:

“The loss of control that characterizes conditioned hypereating is magnified by diets that leave us feeling deprived.”2

So, Kessler advocates for restriction and deprivation to treat overeating while saying that doing exactly that is why the overeating became such a problem in the first place. Could it get any more confusing?

The reason Robison has used Kessler as an example is because Kessler’s proposed solution is ridiculous. This is a classic manipulation tactic: Find a radical edge case who believes in the hypothesis and make it seem as if all people who believe in this hypothesis also believe the same radical, ridiculous solutions are necessary.

Ten people can all believe that we have the ability to land on the moon. Nine of them could have very rational ideas for how to accomplish that. Let’s say the 10th person has a completely irrational solution, such as launching an unprotected human being out of a canon aimed towards the moon. Now imagine that Robison believes it’s impossible to land on the moon and wants to write an article about how it’s impossible. He takes this tenth person’s insane solution and pretends that all people who believe we can land on the moon also buy into this crazy theory of how to do it. Instantly, all 10 people are painted as insane.

The benefit to Robison is that he doesn’t have to think critically. Nor does he have to challenge each individual solution and argue against it. Lazily, in one fell swoop, Robison can simply manipulate the conversation and write everyone off.

So, what is it about this wonderful tasting stuff that inspires such trepidation? Well, the argument by the naysayers goes something like this:

When people ingest sugar, it lights up the same nerve pathways in the brain that get lit up when people take cocaine. Therefore sugar must be addictive – just like cocaine.

Now we’re getting into classic “sugar is more addictive than cocaine” argument. Do you think Robison can make an argument against this without relying on manipulation? Let’s find out.

So, what about sugar? It is undeniably true that eating sugary foods increases the release of dopamine through these pathways and makes us feel good. Does this mean we are addicted to sugar?

Although it is certainly more titillating to conclude the answer is yes, in this case it turns out that the more truthful answer to the question is a much more boring, not really. Because in fact, the list of things that light up these dopaminergic pathways does not stop at drugs of abuse and highly palatable foods. Here is a partial list of other things that light up these pathways:

  • Music
  • Humor
  • Winning a prize
  • Expecting to win a prize
  • A mother recognizing her child
  • Attractive faces
  • Smiling faces
  • Oh yes – and being in love!

So the argument is that because rather benign and non-addictive things like “attractive faces” light up the reward pathways in the brain, sugar (which also lights up reward pathways in the brain) can’t be addictive.

This is a division fallacy. Just because some things light up the reward center of the brain and aren’t typically seen as “addictive,” doesn’t mean something that lights up the reward center of the brain can’t be addictive.

Addiction is multifactorial. Robison’s argument isn’t much different than saying, “gambling can’t be addictive because look at all the people who aren’t addicted to it” while ignoring all the people who are addicted to it. This is especially true when you look at other examples he conveniently left out of the list that are addictive such as gambling, skydiving (thrill-seeking), and shopping.

This is because addiction is not based on a single factor. It’s produced by many factors in tandem. This is why most people are not addicted to gambling while many people are. Robison is grossly oversimplifying the reality in order to create specific arguments that protect his biases.

Interestingly, a closer look at the details unearths other discrepancies in the comparison between sugar and drugs of abuse when it comes to mechanisms of action. In fact, although these substances all do share some common pathways, sugar actually influences different populations of nerves in the brain, causes different patterns of firing, and induces different timings of the release of dopamine. As Benton explains:

“Reward response is highly dependent on the substances tested, demonstrating that multiple reward mechanisms operate that can encode for different stimuli.”

Again, contrary to the hype, in a recent consensus paper, an esteemed group of European scientists came to a similar conclusion saying:

“With respect to the rewarding property of foods, there is overlap with neuronal pathways involved in substance use disorders. However, this overlap in itself does not validate the concept of food addiction.”

Robison uses this quote to end this section of his article. It’s, in effect, his closing argument for this section. But it’s an argument that proves nothing. “…this overlap in itself does not validate the concept of food addiction.” Nor does it invalidate it. So why are we wasting our time with it? I’ll tell you: Because Robison seems to incorrectly conclude that it does invalidate it. It’s a logic mistake.

Perhaps the most damning repudiation of the FA hypothesis – (hypothesis after all, because suggestive information from studies involving rats eating Oreo cookies is hardly conclusive proof of anything involving humans) – comes from work that has been accumulating related to Binge Eating Disorder (BED). BED is the most common of all eating disorders, affecting some 3.5% of women and 2.0% of men in the United States. It is defined this way by the Binge Eating Disorder Association:

“Also called compulsive eating, emotional eating or overeating, binge eating disorder is characterized by recurring episodes of binge eating, feeling out of control while bingeing, and feeling guilt and shame afterward.’

Proponents of the FA hypothesis often cite BED as conclusive evidence of the addictive nature of foods – particularly highly palatable ones that contain substantial amounts of fat, and of course, sugar.

Robison is pouring on the manipulation. “Perhaps the most damning repudiation of the FA hypothesis – (hypothesis after all, because suggestive information from studies involving rats eating Oreo cookies is hardly conclusive proof of anything involving humans)…”

This is a strawman argument. The main argument for the existence of FA has nothing to do with an Oreo cookie rat study. Yet Robison is claiming that FA is a mere “hypothesis” precisely because—as he suggests—this study is the only evidence. It’s so manipulative it’s comical.

Now that he’s done with that manipulation he moves onto the next round: conflating addiction with binge eating disorder. He wants to make the case that all cases of food addiction are not really food addiction, but binge eating disorder. And he does so behind a third layer of manipulation: by comparing one of many types of addiction treatments (the abstinence model) to the typical treatment protocol for binge eating disorder.

Here is the problem – if these foods, including sugar, are addictive in a manner homologous to cocaine and other drugs of abuse, the appropriate treatment to cure the “addiction” ought to follow an addiction model (below) based on abstinence, and similar to that which is used to treat addiction to drugs of abuse like cocaine.

Addiction Model (applied to food)

Dietary restraint
Food avoidance
Good foods / bad foods

But in fact, by far the most effective treatment for the out of control overeating that is the defining hallmark of BED is quite the opposite, as represented below:

Cognitive Behavior Therapy (best treatment for BED)

Decreased dieting
Flexible eating
All foods fit

The problem is that the abstinence model is only one model for addiction treatment. And it’s not without great controversy. The abstinence/self-control model has a very poor success rate, regardless of the substance. I would not personally argue that this is the best “addiction” treatment protocol for anyone, though it *is* a necessary step in relieving the body of any chemical dependency.

A more relevant treatment model focuses on the human being, their history, their triggers, their relationships, and their trauma and aims to heal the holes that they are using the addiction to fill. Gabor Mate, a leading addiction researcher, had this to say about the people he works with:

The hardcore drug addicts that I treat, are, without exception, people who have had extraordinarily difficult lives. The commonality is childhood abuse. These people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside of Vancouver who wasn’t sexually abused, for example, as were many of the men–or abused, neglected and abandoned serially, over and over again.That’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.

As I said before, addiction is multifactorial. It’s not just sugar or just gambling or just heroin. And the best addiction researchers don’t advocate for a pure, classic abstinence model as Robison would have you believe.

That’s right… people who binge on specific foods learn to incorporate those foods safely and effectively into their eating regimens. Can you imagine treating cocaine addiction with this model – through moderate, restricted use? Of course not! But the research on the treatment of BED is quite conclusive, as one intuitive eating expert put it:

“Multiple studies have examined the results of binge eaters consuming their forbidden foods as part of treatment. While food addiction theory would predict an increase in binge eating behavior with exposure to these foods, the opposite occurred as people experienced a decrease in binge eating in all of the studies.”

Robison is making this argument from a position where he has already concluded that ALL food addiction *must* really be binge eating disorder. This is not a conclusion that’s widely agreed upon. So Robison’s argument regarding treatment protocols is based on a fabricated paradigm where food addiction doesn’t exist.

I could use the same tactic with gambling by saying, perhaps all gambling addiction is really just a binge gambling disorder. While gambling addiction “theory” would predict an increase in binge gambling behavior with exposure to gambling, the opposite is actually true. To heal binge gambling, people just need to be shown how to gamble safely. Therefore, there is no such thing as gambling addiction.

See how easy that is? We can just pretend gambling addiction is just a binge gambling disorder. Case closed. Robison is living in a fairy tale where he gets to draw and paint all that exist. And his favorite colors are black and white.

We in the health professions (and lawyers as well, evidently) seem to be constantly in need of pathologizing some food or another. Unfortunately the evidence does not support that scaring people about what they eat is an effective behavior change tool.

Even as we wind down Robison’s arguments, we can’t escape the manipulation. This is such a disingenuous, gross generalization. Not all health professionals “pathologize” certain foods. Nor do we employ scare tactics. This is composition fallacy and a last ditch effort by Robison to attack an entire group of people in order to make his argument seem more relevant and to avoid challenging those who have deeper, more authentic, and more relevant arguments, presumably because he is unable to intellectually handle them.

Hopefully Robison will use my rebuttal to explore his biases and think deeper about this. Addiction is a very complex topic with many moving parts and complex mechanisms. There are real people living in the real world who are struggling with food addiction. That doesn’t mean food is the problem, though. Heroin and gambling aren’t problems either. Skydiving and shopping—also not problems.

The problem lies in the individual’s relationship with these mechanisms. But heroin, shopping, gambling, and food all have unique pulls on the mind and body of the addict. People like Robison want to flush that critical fact down the drain. And that’s very dangerous.

UPDATE 09/08/2015

I commented on Jon’s article with a link to this rebuttal. After a couple days it had not been approved so I reached out to ask him about approving the comment so others could decide for themselves. Here was his response (note this is from a guy with a PhD who is supposed to be open to critical analysis of his work)…

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More about the content and less of a personal attack? Did he even read the rebuttal? It’s COMPLETELY about the content and the way he manipulated the conversation. Now he’s hiding from the critique rather than backing up his original arguments or re-committing to exploring the topic.

Shameful.

Comments

  • Melissa says:

    Great article, Kevin. Thank you for this example of how to be a critical thinker and review content with a careful eye. Not to dismiss the topic, but I feel like this blog post is a piece of education that I may have missed. I’ll be saving it for future reference.

  • Skye C says:

    I learned a lot from this post. Keep them coming. Would love to read more.

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