This piece is a follow-up from last month’s issue, The Underbelly of Health. In this article, we dissect the underpinnings of mass consumed drugs that most people take for granted: caffeine and sugar. Both of these chemical compounds have been studied consistently over the past century for their uses and effects on humans. It is important we talk about them together as well as separately, as they play different yet congruent roles in the lives of Americans and people worldwide and provide a telling glimpse into the inconsistencies upon which our political, economic, and social systems function.
We have evolved with a common neural circuitry that responds similarly to both the foods we need for survival as well as toxic plants that enhance our ability to survive through enhanced physical performance or increased alertness. However, technological advances in the production of certain types of food and drugs as well as widespread commodification through slave labor and other exploitative practices have outpaced our body’s adaptation and made substances that were previously advantageous in the small, naturally-occurring quantities available, now destructive to our well-being. The stories of caffeine and sugar are both cyclical in nature: exploitation made each readily available, fueling dependency on these commodities, followed by further economic exploitation to keep up with demand.
How many times have you heard someone say that they cannot function without their morning jolt of caffeine? Replace “caffeine” in that sentence with any other psychoactive drug and imagine the change in your reaction. However, we have normalized the message in this particular case. The potential for addiction to caffeine varies drastically from person to person. I know that if I have coffee for even two consecutive days, if I do not maintain a regular pattern of consumption I will have withdrawal headaches, possibly migraines, as well as fatigue and depression.
Caffeine is considered the most highly-used drug in the world, as it is estimated that about 85% of people consume caffeine - everyone from adults to preschool-aged children. As little as 10-20 milligrams can be psychoactive, but most people consume coffee, tea, and soda without regard to their reliance on it. Meet-ups around the world are centered around coffee, whether professional or casual, and serve as a ritual that provides structure for social interaction. Caffeinated beverages have a long history of social use in many different cultures--coffee in the Arab world, tea in China, cacao and maté in Latin America--but even earlier these plants were used for their medicinal properties. These drinks did not come to Europe until the 16th and 17th centuries and during that time served as a display of colonialism.
Coffee is synonymous with productivity. If you’ve thought about how busy you are or how much you work during the week, you could consider coffee to be the driving force for that. Our society’s insatiable need to be productive is fueled by our coffee addiction. But coffee is not the only place to find caffeine. Energy drinks contain anywhere from 50 to 500 milligrams of caffeine, which are amounts that can lead to caffeine intoxication which has serious health consequences. Caffeine is also available as a supplement, in much higher doses than your regular cup of coffee, and it can be lethal in high amounts.
This should not be taken to minimize the seriousness of more debilitating addictions like those to heroin, cocaine, and alcohol, but rather to point out that it is all about degrees and context. These are not two mutually exclusive groups of “Addicts” and “Non-addicts,” but rather there are certain dependencies that we have labeled socially acceptable. While the effects of these dependencies may not lead to the same disruptions in daily life, they are, in fact, dependencies. Caffeine Use Disorder is now considered a clinical disorder and diagnostic criteria can be found in the DSM-5.
The reward system in our brain that responds to addictive drugs is the same system that responds to certain foods we consume. The gluten in wheat has been proven to have some of the same effects as opioids in the body and there is growing recognition of sugar addiction.
Early in our evolutionary history, it was difficult to find foods with a significant amount of sugar or fat, both of which are necessary for our bodies to properly function and this reward system drew us to foods that were more energy and calorie-dense to increase our chances of survival. But today, almost everything in our pantries has sugar in it, even when it probably shouldn’t. Go look at the Nutrition Facts in your child’s cereal.
Heart disease is currently the leading cause of death in the United States. In the 1950s, evidence emerged that sugar was a prominent factor in Coronary Heart Disease (CHD). The sugar industry then paid for its own research to point the finger at Fat instead. This led to an extremely misguided trend that continues today toward fat-free diet foods that typically use sugar in place of fat. We now have a much better understanding of our body’s need for fat and the adverse health consequences of too little fat, like vitamin D deficiency.
Of course, fat has many of its own issues, also created by the food industrial complex, which we touched on in this article from our previous issue. Other food industries have also funded their own biased research studies over time, which has led to widespread confusion about government-sponsored nutrition models, such as MyPlate and the Food Pyramid.
Despite the confusion, there is a definite consensus that Americans consume too much sugar, but the public health message disseminated by government programs is fundamentally at odds with supply-side policy programs like the U.S. Sugar Program. The elements of the program work together to keep the price of domestic sugar high--as much as two times the average price around the world--and, while the program claims to come at no cost to taxpayers, it is actually paid for by all Americans consumers as we pay an inflated price for all sugar-containing products.
In addition, we may think a program like this is necessary to protect American farmers, but a report from the Government Accountability Office found that it in fact mainly benefits sugar producers and high-fructose corn syrup manufacturers. There may also be a tendency to think this is good because higher prices will deter consumers from purchasing sugar and therefore improve health. Supply and demand! The sacred market at work. However, this program guarantees producers a certain amount of compensation for their sugar, and if the market does not pay that price, the government essentially buys sugar from the producer and sells it for them at a direct cost to taxpayers, keeping the sugar industry in business.
There is a very dark history behind the power of sugar producers and the widespread availability of sugar that is in no way natural, inevitable, or necessary, but instead comes back to the same story of exploitation that lives in the background of so much of the world around us. Sugarcane production and processing was the largest slave industry in the Americas: about 60-70% of all slaves taken from Africa ended up on sugar plantations. It also stands out among industries dependent on slave labor as the most brutal, followed by coffee plantations. It was the only industry in which the population of slave laborers was decreasing because of significantly higher death rates.
Do you think that is all in the past? Incarcerated laborers at the Louisiana State Penitentiary are still harvesting sugarcane. The United States has the highest incarceration rate in the world, but Louisiana’s rate dwarfs the national average. Similar to Maryland, the demographics of Louisiana’s incarcerated population are the complete inverse of its general population: while the state population is 60% white and 32% black, the incarcerated population is 30% white and 66% black.
We also still get our coffee essentially through slave labor. More than a third of the entire global coffee supply comes from Brazil, where there are serious concerns about the use of slave labor. Even spending extra money on fair trade certified products is no guarantee that labor conditions are significantly different because most of the extra money goes toward marketing and processing rather than the farmers.
Addiction is not just a physiological condition, but instead is a direct result of the structure and conditions our society has created over time. All kinds of health issues, such as substance abuse, disordered eating, obesity, diabetes, asthma, and depression will continue to flourish unless we disrupt the unhealthy stranglehold that multinational corporations have on our food supply and address the blatant hypocrisy that permeates our political system.
Unfortunately, there is no succinct list of actions that will resolve problems we have highlighted here as some are baked into the fundamental structure of our systems and will take many years to undo while others are due to technological advancements and will not be undone. Rather, we challenge our readers to refrain from judging the consumption patterns of others—whether it is the consumption of food or other substances—and instead take time to consider the confluence of social, emotional, physiological, environmental, and political factors that influence addictive tendencies and our patterns of behavior more generally. If you have not seen Johann Hari’s TED talk from 2015: Everything You Know About Addiction is Wrong, please take a moment right now to watch--these 15 minutes are well worth your time. It is only by taking a more compassionate approach to humanity’s problems that we will be able to come together to form the unified front necessary to tackle our most challenging issues.
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