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The word addiction tends to conjure up images of hard drugs, high crime and wasted lives. Surely these are powerful images with their tragic basis in fact. But there are two addictions which together account for more preventable death in America than any other cause. One is fairly obvious, the other much more insidious – cigarettes and sugar.Over half a century ago the Surgeon General released a report linking cigarette smoking with lung cancer. Seven years later, Luther Terry issued Smoking and Health: Report of the Advisory Committee to the Surgeon General, a comprehensive report which clearly established the scientific basis for the link between smoking and lung cancer, bronchitis, emphysema, coronary heart disease and low birth weight pregnancies. At the time of the report, 46% of adult Americans (51.9% of males, 33.9% females) smoked. Since that time there has been a steady decline, with 19.3% of US adults continuing to smoke.
Despite these gains, recent reports from the CDC indicate that even though cigarette consumption fell 2.5% from 2010 to 2011, overall tobacco consumption only dropped 0.8% because of the sale of other smokeable tobacco products (i.e. cigar and pipe products which are less subject to current tax policies). Each day more than 3,800 persons younger than 18 smoke their first cigarette; about 1,000 of them begin smoking on a regular basis. More than 99% of “addicted” habitual smokers begin before the age of 26. The health toll is staggering. In the US, tobacco use is responsible for one in five deaths – approximately 443,000/year, over one tenth the result of secondhand smoke exposure. On average, smokers die 13-14 years earlier than nonsmokers.
Although not immediately apparent a half-century ago, nicotine is a clearly addictive compound. Nicotinic acetyl choline receptors release several neurotransmitters in the central nervous system. Smoking cessation programs seek to address both the addiction and the withdrawal symptoms. Various combinations of medication, biofeedback, group and psychosocial approaches have been tried – along with a host of “alternative” methods such as acupuncture, hypnosis, herbs, aromatherapy and cigarette substitutes. Even though some programs report episodic success rates approaching 50%, most programs report a 6-month success rate in the 5-15% range. There are even genetic studies which suggest that certain genetic variants are more closely associated with the ability to quit. Clearly there is room for more research. Interestingly, despite extensive medical and social research into the topic, it appears that the political approach of increasing cost through tax policy, as well as advertising bans and prohibitions of sale to minors have had a more dramatic impact on the declining rate of addiction than any medical approach to date.
Certainly less obvious, but considerably more insidious is the addiction to sugar. Even though there are neuroreceptors in the body labeled “nicotinic” because of their ability to be activated by nicotine (a result of the biochemical structural similarity of nicotine to the essential neurotransmitter acetyl choline), neither cigarettes nor nicotine itself are substances native or vital to our metabolism. Sugar, however, in various forms, plays an essential role in our body’s metabolism. Even if we do not ingest any sucrose (the form of most table sugar), there are sugars in fruits and grains and vegetables, and many of the biochemical intermediaries through which the body processes these foods consist of various types of sugars. In short, sugar is not a recreational drug – it is a food. And yet, the current epidemic of obesity in this country correlates roughly, among other things such as decreasing exercise, with the movement to develop “low fat” food products, in which carbohydrates were substituted for fat in an effort to maintain/enhance taste.
With the aid of sophisticated imaging, Dr. Eric Stice of the Oregan Research Institute has demonstrated that dietary sugar appears to activate the same regions of the brain on MRI as does cocaine. Other studies have documented the similarity between the MRI scans of brains of obese people and those of known drug abusers. Moreover, the response to sugar seems to follow an addictive pattern, with heavy users developing tolerance to its effects – encouraging the use of increasing amounts. Although the specific intermediaries of this addictive pattern require further definition, the link with obesity and cardiovascular disease has become increasingly clear, prompting the American Heart Association to release an official recommendation limiting dietary intake of added sugar to more than 150 calories/day.
Interestingly enough, weight loss programs share a similarly discouraging success rate as smoking cessation programs. Clearly, for sugar, as for cigarettes, knowledge is a necessary but not sufficient component of recognizing and confronting the problem. Whether or not, as in the case of cigarettes, public policy will need to have a role is not yet clear. However, based on the research already available, it is clear that the aggressive prevention and healthy lifestyle programs of the sort promoted and supported by the Florida Heart Research Institute will continue to play a vital role in our battle against heart disease and the addictive behaviors which promote and support it.
