Is sugar addiction at the heart of Type 2 diabetes?

Could sugar addiction be at the heart of Type 2 diabetes? South African family physician, Dr Beth Vale, works in the public health system and reflects on Type 2 diabetes in this article.

Should we be looking more closely at sugar addiction?

A great deal of reflection has led me to the conclusion that most of what we believe about Type 2 diabetes is probably a delusion. We frame it as a disease, and we categorise it with other NCDs. In a manner that is a lot more enlightened than when I was a medical student, and we have identified the connections that are fuelling its development.

But we still regard it as a disease in the traditional sense of the word – a chronic medical condition characterised by insulin resistance and relative insulin deficiency that results in raised glucose levels, and we frame that disease in relation to poor dietary habits. That’s a bit like saying alcoholism is a chronic neurological condition caused by progressive degeneration of the brain related to excessive alcohol intake. That’s true, but we know that the narrative is incomplete if we fail to include an understanding of addiction.

We know that alcoholism is due to a chronic compulsion to consume an addictive substance. Whatever further damage occurs is as a result of that addiction, and whatever we do in relation to alcoholism is based on that central understanding. We also know that a very small proportion of alcoholics are curable, and even those who have been in prolonged remission are subject to relapses.

Can sugar be an addiction?

It’s very difficult for us to see the sugar addiction at the heart of Type 2 diabetes in the same light because we are culturally conditioned to delude ourselves. Addiction, we assume, is something that happens when things go sadly wrong. People fall prey to addiction when circumstances and anguish collide, and the substance does the rest.

“Is it fair, we ask, both to conventional addicts and people with diabetes alike, to draw parallels between the horrors of substance addiction and the comfortable, homely lives that we and our moms and dads, grannies and grandpas, uncles and aunties, all live as we develop Type 2 diabetes?

Well, it depends how you see it. The first thing to consider is whether you see sugar as a food or as a drug.”

We need to ask ourselves whether sugar has any nutritional value. The short answer is “no”. That is not to say it has no value. We don’t question whether coffee or hot chocolate have any nutritional value. We don’t demand that the salt or pepper or herbs and spices we use to flavour our meals have nutritional value. We use these items to experience pleasure. And they can be used safely by almost all people without them developing an insatiable appetite.

History of sugar

If there are any doubts as to the nature of sugar, just look at its history. Once the preserve of a technologically advanced Ottoman Empire, it drove Western European powers mad with desire. They desperately needed land in the tropics to cultivate the crop and slave labour to harvest it.

Christopher Columbus colluded with financial backers in Spain and a particularly cruel and evil mistress who was the Governor of the Canary Islands to replicate a slave labour model that had been implemented to grow sugar cane on the land she ruled over on behalf of the
Spanish Crown. All they needed was more land to cultivate and they found it on the other side of the Atlantic. The plants that were taken over from the Canaries in Columbus’s caravels in 1492 found fertile soil in the Caribbean islands and within 50 years, the West’s growing addiction was being fed by sugar extracted from their brutal plantations. And the more they made, the more they needed.

The desire overwhelmed everything in its path. It drove the subjugation of millions of people in West Africa and the capture and transportation of slave labour across the middle passage. It stained the consciousness of humanity with myths about racial superiority that allowed the slave trade and the genocide of indigenous populations to continue. It entrenched predatory capitalism as a legitimate human pursuit. There’s nothing comparable in the history of the world. Not even the cocaine trade in South America or the heroin trade in Afghanistan has had anything close to the negative impact that sugar had in the New World over 500 years. But there are parallels to other drug industries that are unique to sugar.

Sugar is the drug that started it all. In “Candide”, a sweeping satirical epic novel written in 1759, the French philosopher Voltaire describes a world of hardship and horror that the protagonist and his companions encounter in their travels. In the New World they
learn of slavery. An escaped slave, missing both a hand and a leg, explains his mutilation:

“When we work in the sugar mills and we catch our finger in the millstone, they cut off our hand; when we try to run away, they cut off our leg; both things have happened to me. It is at this price that you eat sugar in Europe.”

Also in the 1700s, with amputations being emblematic of the cane fields, a Quaker leader was quoted as saying that: “For every pound of sugar, we may be considered as consuming two ounces of human flesh.”

Not to put too fine a point on it, but the undeniable reality that amputation has become emblematic of the global diabetes epidemic 300 years later strikes me as a deeply ironic karmic twist in the tale of this cursed substance!

Diabetes care pathway

One of the reasons for writing a piece on this topic is the focus on the diabetes care pathway (specifically Type 2 diabetes) that I was engaged with earlier this week. We tell a story of patients who are struggling with addiction. They need to be empowered to control their condition.

At every point in the care pathway there is a common theme – the health system is powerless against diabetes unless patients are empowered with the skills they need to confront their addiction and to modify the diet and the life experience that fuels it. This is a life experience that has its structural roots in the complex history of the modern world. Much of the global population is compelled by a combination of macro-economic factors, corporate greed, and addiction, to consume cheap calories in the form of sugar, and to pay a heavy price with diabetes-ridden bodies and premature death.

“The health system is powerless against diabetes unless patients are empowered with the skills they need to confront their addiction and to modify the diet and the life experience that fuels it.”

This is a life experience that may also be characterised by other forms of compulsive behaviour such as alcoholism, again rooted in the thick tar of modern life and human frailty, but it is purely social convention that allocates one form of addiction to Rehab and a 12-step programme and another to a Chronic Club.

What do you think? Could Type 2 diabetes be closely linked to sugar addiction?

See more of Beth’s work at www.thebodyarchive.net

Photo by Sharon McCutcheon and Myriam Zilles on Unsplash

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