Folk wisdom has recognized the role of empty calories in weight gain and obesity for years, but there has not been much public discussion about the addictive qualities of sugar.

Sugar is demonstrably more harmful than cannabis, which is classified by the Food and Drug Administration in the same category as heroin, while nicotine and alcohol are known to be both addictive and harmful but are taxed, regulated and sold over the counter.

Much of the legal battle surrounding nicotine centered on whether smoking caused disease and if it was addictive. The courtroom drama went on for years and might not have been settled yet if the tobacco industry had not been so brash as to discuss it in written documents.

In a collusive meeting in the Plaza Hotel in New York City in 1953, the five major tobacco companies conspired to “deny that smoking caused disease and to maintain that whether smoking caused disease was an ‘open question,’ despite having actual knowledge that smoking did cause disease.”

Today we know that empty calories contribute to obesity and increased risk for Type 2 diabetes, both of which strongly correlate with heart disease. Never mind that sugar is not good for teeth and is connected in common lore with hyperactivity.

Based on the health factors alone, sugar is a harmful, but sugar has many similarities with addictive substances as well.

A 2008 study by the National Institutes of Health found that “intermittent, excessive intakes of sugar have effects on dopamine, acetylcholine and opioid neurotransmitters that are similar to psychostimulants and opiates, albeit smaller in magnitude. The overall effect of these neurochemical adaptations is mild, but well- defined, dependency.”

Like studies in the 1950s that first linked nicotine to illness, this NIH study was undertaken on lab rats, which have a physiology similar to humans.

Sugar addiction has been the topic of books and the focus for diet programs, but the 2008 NIH study was one of the first to examine these effects in a scientific laboratory setting.

When deprived of sugar- rich foods, patients describe symptoms of withdrawal: bingeing, anxiety, depression, craving.

Patients describe cravings for carbohydrates, chocolate and sugar, which can trigger impulsive eating and relapse in a vicious cycle of self-medication.

One effect of addictions is the “gateway effect” where the intermittent use of one drug used leads to the use of another. It is not unusual for a legal drug (e.g., nicotine) to act as a gateway to an illegal drug (e.g., cocaine).

Rats that are placed on intermittent sugar diets and then forced to abstain showed a 9% increase in alcohol consumption. This suggests that intermittent use of sugar might be a gateway to alcohol use.

The question of whether sugar and other substances should be freely available, taxed, illegal or available by prescription is up to us, the informed public.

While we are considering this, let’s keep in mind that there are popular substances that are banned outright for which there is no proof of harm, while others that are harmful are taxed and regulated but used freely.