Sugar, and the Addiction Nobody Names

Sugar is, in my view, the single largest addiction in our culture, and it is the one most often left off the list.

We name alcohol. We name nicotine. We name our phones. Sugar gets a pass, because we are so used to turning to it to change the way we feel that it barely registers as a choice anymore.

It is a huge emotional coping strategy. And it is also an industry. A lot of our processed foods are engineered to keep us reaching for more, and sugar is in nearly everything: your breads, your sauces, your yogurt, your coffee drinks, the granola marked healthy on the front of the box. It hides.

Addiction is a precise word here, even when it feels too big to apply to a bag of pretzels.

An addiction is simply defined as what do we turn to to change the way we feel? It could be our magic rectangles, our phones. It could be our Annie's organic cauliflower crackers. It could be a glass of wine. An addiction simply is something we turn to to change the way we feel, because we don't have the capacity or the willingness to be with what's so in that moment.

That definition takes the shame out of the conversation and puts the mechanism back in, and the mechanism is real.

These foods are not designed for us to have restraint. They are engineered to turn on in our bodies the 'I want more, I want more,' and to turn off the 'I'm satiated.'

Notice what most of us rarely overeat: carrot sticks and plain protein. Sugar and protein act on your brain chemistry in different ways, which is a big part of why willpower alone was never the whole answer.

Red grapes and chocolate cake carry very different nutrition, and your blood sugar counts the grams in both.

What Sugar Actually Does Inside Your Body

The chain starts on your plate and ends in your cells.

When you eat sugar, or a refined starch your body breaks down into sugar, your blood sugar rises fast. Your pancreas answers with a surge of insulin to move that sugar out of your blood and into your cells.

A big spike tends to bring a big drop. An hour or 2 later your blood sugar dips, and you feel it: tired, foggy, irritable, shaky, and reaching for the next sweet thing. That is the craving loop. It is chemistry, and it has very little to do with willpower.

Each of those dips is also a stress signal. Your body answers with stress hormones, cortisol among them, to bring your blood sugar back up. So a day of sugar spikes and crashes is also a day of stress hormone spikes, on top of whatever else your life is already asking of you.

Ride that loop several times a day for years, and your cells stop answering insulin the way they used to. That is insulin resistance. Your body makes more and more insulin to do the same job, stores more fat around your middle, and, as 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis' shows, runs hotter with inflammation.

Sugar also feeds organisms in your gut you are trying to calm down, including Candida.

And sugar that stays high in your blood binds to proteins in your tissues, forming what researchers call advanced glycation end products. They stiffen tissue and add to the inflammatory load, from your blood vessels to your skin.

This is why steady blood sugar is the ground your gut heals on.

The Blood Sugar Rollercoaster, Hour by Hour

Take a very ordinary day, seen from the inside of your bloodstream.

• 7:00 AM. A glass of orange juice, a bowl of granola with flavored yogurt, and a coffee. It feels like a healthy breakfast. In total sugar, it can carry close to twice the AHA's 25 gram daily cap, with almost no protein to slow it down.
• 7:30 to 8:00 AM. Blood sugar climbs fast. Your pancreas releases a large wave of insulin to clear it. You feel bright and busy.
• 9:30 AM. The insulin has done its job a little too well. Blood sugar dips below where it started. You feel foggy and restless, and you reach for a second coffee and a muffin from the break room.
• 10:00 AM. Your adrenals release cortisol and adrenaline to lift your blood sugar back up. You may feel a flutter of anxiousness that has nothing to do with your inbox.
• 12:30 PM. A quick sandwich at your desk, eaten while answering emails, with a bag of chips. Another spike, eaten in fight or flight.
• 3:00 PM. The crash. Shaky, irritable, heavy-eyed, and unable to string a clear thought together. This is the hour the vending machine, the chocolate in your drawer, or the latte calls your name.
• 6:30 PM. You get home ravenous, eat crackers while you cook, and eat dinner fast.
• 9:30 PM. A glass of wine or a bowl of ice cream to unwind.
• 10:00 PM. The wander into the kitchen, looking for something without knowing what.
• 3:00 AM. Blood sugar drops in the night. Cortisol and adrenaline surge to correct it, and you are wide awake with a racing mind.
• 6:30 AM. You wake exhausted, and the day starts again with the same breakfast.

Nothing in that day looks like a problem. Every choice in it is normal in our culture. That is exactly why the rollercoaster goes unnoticed: it looks like a regular day, and it feels like being a tired Woman in Midlife.

Now picture the same day steadied. A savory breakfast with 25 to 30 grams of protein. Lunch eaten sitting down, vegetables first. A 10-minute walk after dinner. No sweets before bed. Your blood sugar draws gentle hills instead of cliffs, and for many Women, the 3 PM crash and the 3 AM waking can ease within the first week or 2.

Kharrazian offers a simple check. After a meal, you want to feel neither tired nor energized, simply no longer hungry. If eating gives you a clear lift, your blood sugar was running low before you ate. If you feel sleepy or foggy after a meal, especially a starchy one, that points toward insulin resistance.

Why Midlife Changes the Math: Estrogen and Insulin

Many Women tell me, 'I'm eating exactly what I ate at 35, and my body is responding completely differently.' They are right, and there is a reason.

Estrogen helps your cells respond to insulin. It supports insulin sensitivity in your muscles, liver, and fat tissue, and it helps steer where your body stores fat. As estrogen swings and then falls across Perimenopause, that support weakens.

The shift shows up in body composition. The Study of Women's Health Across the Nation, known as SWAN, followed Women through the Menopause transition and found that fat gain speeds up and lean muscle declines starting in the transition itself, with more of that fat settling around the middle.

Muscle is where most of the sugar from a meal goes. Less muscle means less room to store sugar, so the same meal leaves more of it in your blood.

Add the other Midlife changes on top:

• Cortisol driving glucose from the inside, so a chronically stressed Woman can run higher blood sugar on a clean diet
• Broken sleep from night sweats and falling progesterone, and as 'Stress: The Load Women Stop Noticing', next, shows, even 1 short night makes your body more insulin resistant the next day
• Less movement, as work and caregiving fill the hours
• Thyroid that slows, turning down the pace of your whole metabolism

This is why 'eat less, move more' so often falls short in Midlife. Weight gain in these years usually has several threads pulling toward the same place.

Blood sugar keeps a long record. Insulin resistance can build for years, from your 20's and 30's on, before a fasting glucose looks abnormal, as 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis' describes, and the way you steady your blood sugar in your 40's and 50's shapes your heart, your brain, and your energy at 60 and beyond.

Hormone therapy is part of this conversation for some Women. In the Women's Health Initiative, Women taking estrogen plus progestin had about 21 percent fewer new diagnoses of diabetes than Women on placebo. Bring it to a skillful prescriber as a question, since every decision about starting or stopping hormones stays with them. The Hormone Therapy chapter walks through your options.

The Brain Reward Loop

Sugar reaches your brain as surely as it reaches your blood. When you eat something sweet, your brain releases dopamine, the chemical of wanting and reward. Dopamine is the 'more, please' signal, and it is strongest when a food is sweet, fatty, salty, and new all at once.

Animal research shows how strong the loop can become. In rats given intermittent access to sugar, Nicole Avena, Bartley Hoebel, and colleagues at Princeton documented bingeing, changes in dopamine signaling, and signs resembling withdrawal when the sugar was taken away. Rats are not Women, and the research in people is still developing, and the pattern will sound familiar to many of us.

The blood sugar crash feeds the loop from the other side. In a small 2013 study in the American Journal of Clinical Nutrition, men who drank a high-glycemic shake had lower blood sugar and more hunger 4 hours later than after a nearly identical low-glycemic shake. Brain scans showed more activity in the nucleus accumbens, a central reward and craving region, as their blood sugar fell.

Put those together. The spike brings a dopamine reward. The crash brings a craving. The craving arrives exactly when your blood sugar is lowest, so the next sweet thing feels urgent and your ability to choose feels weakest.

Kharrazian describes 1 more loop that keeps Women stuck. A food your body reacts to can trigger an adrenaline response that feels like a lift, and that lift drives cravings for the very food provoking the reaction. Removing reactive foods breaks a neurochemical loop, which is part of why cravings often quiet once the Autoimmune Protocol is underway.

Taste recalibrates. Many Women who spend 30 to 90 days with far less sugar find that foods that once tasted normal now taste intensely sweet, and the intensity of the craving drops. That is a real change in how your body perceives sweetness, and it arrives with time.

Dr. Anna Lembke, a Stanford psychiatrist who specializes in addiction, gives this loop a picture in her book Dopamine Nation. She describes a balance in the brain, a scale with pleasure on 1 side and pain on the other. Every time something tips the scale toward pleasure, the brain pushes back an equal amount toward pain to level itself.

Tip it often enough, and the pushback grows stronger and lasts longer. Over time, the balance comes to rest on the side of pain, and the sweet thing stops bringing joy and simply brings you back to baseline. That is the afternoon cookie that no longer feels like a treat and still feels impossible to skip.

Lembke often asks her patients to step away from their substance for 4 weeks. She tells them the first 2 weeks are usually the hardest, and that by 4 weeks many feel much better. The same arc often holds for sugar: the hardest days come first, and the reward for staying arrives later.

The Order You Eat Matters

This one surprises people, because it asks you only to sequence what is already on your plate, with nothing eliminated.

The order you eat that plate in matters more than most people realize. Start with vegetables first. Fiber creates a kind of mesh in your digestive tract that slows how quickly glucose hits your bloodstream. Then protein and fat. If you are eating a starch later on in reintroduction, eat it last. In small clinical studies, eating the carbohydrate last lowered the after-meal blood sugar spike by about half, same meal, same food, just a different order.

Jessie Inchauspé, known as the Glucose Goddess, popularized this exact sequencing in her book Glucose Revolution, built on real research into how meal order affects post-meal blood sugar.

This is also why the basket of bread before dinner matters. When the starch comes first on an empty stomach, it arrives with nothing to slow it down.

Building a Steady Plate

A steady plate is simple once you see its parts.

• Protein at every meal. 25 to 30 grams at breakfast, and a real portion at lunch and dinner. Wild fish, pasture-raised poultry, grass-fed meat, and eggs if you tolerate them. Protein is the anchor that keeps a meal from turning into a spike.
• Vegetables, and many kinds of them. Aim for 6 to 15 different kinds of vegetables a day, with more vegetables than fruit. Cooked vegetables are gentler on your gut while it heals. Raw vegetables are fine if you tolerate them, and for some Women raw can constipate or bloat.
• Healthy fat. Olive oil, avocado, coconut, and olives slow digestion and keep you full.
• Starchy vegetables, in a portion. Sweet potatoes, squash, taro, and plantain are important on a grain-free plate. Grain-free is not carbohydrate-free. A common early mistake is cutting grains, forgetting to replace them, dropping too low, feeling terrible, and blaming the diet.
• Fruit as a side, paired. A handful of berries with a meal, or with a few nuts or a spoon of coconut butter, rather than fruit alone on an empty stomach.

A few rules of thumb carry the rest.

• Never send a carbohydrate in alone. Pair it with fiber, fat, or protein.
• Do not skip meals. A skipped meal tips your body into a small emergency, and the emergency drives the swing.
• Keep sweets and starches away from bedtime, so the night does not end with a crash at 3 AM.
• Walk for 10 minutes after eating, or do 10 to 20 air squats if you are at work. Working muscles act like a sponge, soaking up glucose from your blood.