Long time listeners of Chasing Life probably know that Halloween is kind of my favorite holiday. If you visit my house, you'll see that I go all out with the decorations. I'll spend hours working on this. And there's also something about the dopamine rush that comes with watching a horror movie or a perfectly timed jump scare in a haunted house. I love it. There's also the sugar rush that comes from eating your favorite Halloween candy. I know, I know. But I got to tell you, Halloween candy has become somewhat of a hot topic of debate here at CNN. We take the issue very seriously.

I'm Wolf Blitzer in The Situation Room with my very favorite Halloween candy, the crispy, sweet and always delicious Kit Kat Bar. How's this for breaking news? Kit Kat?

Hey, Sanjay, it's David Rind from the One Thing podcast. I've got an entire bag of Three Musketeers here. My absolute favorite. These are going right in the freezer, which is where all your candy should be. Are people not freezing their candy? Freeze your candy, people.

I will die on this island alone if I must. If we're going from Halloween. You have to go candy corn friends.

You know, Sanjay, there are so many different amazing options here in the candy aisle. And really you can't go wrong. I mean, everywhere you look and there's like new candies. But at the end of the day, the one thing that everyone loves that you cannot go wrong with is the Hershey miniatures. I'm sorry, Mr. Goodbar Crackle regular with almonds. This is the best.

Those last two voices were, of course, my friends Kate Bolduan and Jake Tapper. For the record, I'm with Kate. My favorite candy is the candy corn, despite what my senior producer, Amanda Sealy, has to say about this. Now, as you hear this, you may be surprised to learn that I indulge in a little candy on Halloween. Given all that we've talked about with regard to sugar and its impact on the body. Most of us know that excess added sugar is not good for us, period. It's been linked to type two diabetes, obesity, a lot of different health conditions that maybe you don't even think of. There are recent studies linking it to anxiety and depression and faster aging. And at the same time that we know all this. We also know that Americans are somewhat sugar obsessed. We eat or drink an average of 15 to 19 teaspoons of sugar every day. Just to give you some context. That's about 5 to 8 fun sized candy bars. So the average American needs to cut back on their sugar probably by at least half, if not more. But how do we do that without taking the sweetness out of life, especially when it seems like sugar has snuck its way into so many different foods you might not even expect? There is sugar in pasta sauce. There is sugar in breakfast meats. It is everywhere. It's not just the holidays like Halloween.

If you're one of the unfortunate people that really struggles with craving and compulsion around sugar, you're stuck in a food environment that is constantly feeding you cues. You know, eat sugar, eat sugar.

Laura Schmidt is a sociologist and a professor of health policy in the School of Medicine at the University of California at San Francisco. She is a leading expert in the field of sugar studies. And what she's going to teach us today is that the truth about how much sugar we should eat and when we should eat it is far more complicated than you might think. The headline is it's bittersweet. She also says that for some of us, the spookiest part of sugar may be in how we think about it.

If you're already struggling with craving an addiction, turning it into a big boogeyman probably isn't the greatest idea.

On today's podcast, Laura Schmidt, who will weigh in on everything from artificial sweeteners to why some say sugar can be just as addictive as cocaine. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life.

Let me start off by asking a little different question. Do you think that we have been overly villainizing sugar?

Yes and no. I think that. There's. There's a problem in the way that we talk about food and nutrition, which is that we focus on single ingredients or single nutrients. Some people say saturated fat is great and I can eat all that meat I want, but no carbs. You know, there are lot of different nutrient focused strategies. And the problem with that is that from a health standpoint, that's not what matters. What matters is the whole diet. What matters is having all of the macronutrients and a relatively good balance. So that's the part that is it's problematic to only focus on sugar and certainly to villanize it. On the other hand, Americans are consuming about 19 teaspoons of sugar a day. That is way, way over the limit. Men should be consuming maybe nine teaspoons a day. Women six. So we're way over the limit on sugar in America. It's in everything. It's in 72% of the foods in your grocery store. And we really need to be thinking about ways to dial that particular ingredient down.

It seems like an impossible task to really know how much you're consuming because, again, reading some of your work, it's everywhere. I mean, you know, you think of things that are sweet having sugar in it, but it's pasta sauce, it's breads. It's it's all these other things. Why is why is sugar and pasta sauce? What is it the role that it's playing in something that is not sweet?

The food companies have three ingredients that they can use to make food more palatable. And some people say hyper palatable. So extremely attractive to consumers. And that's sugar, fat and salt. And pretty much they bury the combination of sugar, fat and salt in most of our ultra processed foods. And often they're put in there because the industrial food production process kind of makes stuff tastes bad. Like one reporter from The New York Times once went into a Dorito factory and got a Dorito chip that didn't have all the coating on it. It was just the good old Dorito chip and unvarnished and it tasted like cardboard. And so the companies have to put sugar, fat and salt and chemical additives in the food in order to make it taste okay. And so that's why we find sugar in everything. We also find salt in various fats, in everything. Right. There's a lot of really important and interesting science going on in the field right now around how does the human body sort of respond or reward system to these combinations of ingredients and what what really triggers the desire to eat more? We are biologically rigged to like sugar and we all know it. We experience it every day. The sensation of sweetness on our tongue is the reward center in your brain kicks off immediately when it gets that sensation of sweetness. And this makes a ton of sense from an evolutionary standpoint because, of course, our ancestors were hunters and gatherers, and it would be make a ton of sense to be biologically rigged to go for that that sweetness. The glucose is what fuels our bodies. The problem is we're not do it. We're not hunters and gatherers anymore. We're we're people living in a food environment that bombards us with sugar and and ingredients that make that are desirable and that we're rigged to want.

And that makes it challenging. So going back to the nine teaspoons versus six teaspoons for women, how can you possibly know, given given how ubiquitous sugar is in our diet? It sounds like a little bit of a fool's errand to say, hey, look, I listen to what Dr. Schmidt says on the podcast and I'm now going to eat just 6 or 9 teaspoons of sugar that you couldn't possibly know.

No, you need a chemistry degree to read the back of the ingredient package, the ingredients label. You know, there are 69 names for sugar and in counting more, we haven't really found them all yet. But, you know, there's a saving grace here, and that is that the number one source of added sugar in our diets is sugar sweetened beverages. It is a huge percentage. It's the main way that we consume added sugars. And so that's why a lot of my work in this space just focuses on that, because there's nothing redeeming in a soda or a sports drink or an energy drink from a health standpoint. Right. I mean, there may be lots redeeming from a pleasure standpoint. And and if you've got a budget of 6 or 9 teaspoons a day of sugar, then you can have one can of soda. Right? That's about right. And then you've, you know, used up your budget for the day.

But but but no pasta sauce. No cereal.

No bread.

Right? No bread.

It's hard. But, you know, the thing about soda is that for one thing, so if we can just help people to lower or quit their consumption of that one product, that will make a big dent in their health. And that's what we do at UCSF. We have a big niche funded trial. And what we've done is we've taken 16 hospital campuses in Sutter Health and we've randomized them. And we said, okay, a few of them we're going to take. A soda out of the workplace. People can bring it in. Fine. But for the people who consume a lot and want to quit, we're going to not sell it right in there in front of them. And then in addition, we're going to give people who drink a lot of soda and want to quit. We're going to give them a little grief intervention based on like what doctors do for alcohol in five minutes. They assess, do you have a problem? And if you do, here's what you can do about it. And some motivational counseling to help them quit. And we have found that this intervention actually lowers waist circumference. People lose waist circumference, which is a really important marker for metabolic health. But employees, when we when we piloted this intervention at UCSF, they lost a half an inch in their waist in the ten months. And this was simple, very 15 minutes on a zoom with a counselor. And we take it out of your workplace. And this is what I view as the low hanging fruit, simple, accessible interventions targeting people who really do drink too much. You know, they want to quit. And just providing them a little support, counseling and making it not so tempting to have it all over your work environment.

I love that. One thing that I've that's been a common theme that's come up in many of the interviews I've done is a reminder of just how biodynamic the body is. They can get bad quickly, but it can also get good quickly. People can improve quickly. And I think that should be inspiring.

And when you talk about biodynamics, my colleague at UCSF, who's a pediatric endocrinologist, Rob Lustig, did a trial and he took kids off of sugar for two weeks and their fatty liver problems improved. And you're looking at incredibly impactful interventions just by taking one thing out of the diet.

What's your stance on using artificial sweeteners?

I follow the World Health Organization's recent guidelines around this. And W.H.O. at this point is recommending people without diabetes stay away from it. The problem with the chemical additives in our food supply, which are now a topic of major concern in the field, is that in America, we don't follow the precautionary principle, which would say before we put this chemical in cereal that a child eats every morning. We should be thinking about whether it's safe. Instead, we flip it around and we say, put it in the cereal and wait to see if it's safe. And that's the problem. When it comes to artificial sweeteners, there's science on both sides. There are some very influential papers and published in major journals like Nature that show very negative effects on the microbiome, the gut microbiome. And there are studies that show that consumption of these products actually increases your weight, can produce obesity. And there's a lot of debate about what's going on there. Is that reverse causation or not? But I think if there are multiple studies suggesting that something is potentially harmful, we ought to be thinking twice about it. Now, that said, in our work with, say, folks who drink too much soda and want to quit, what we find is that artificial sweeteners provide this sort of gateway. And I come from an addiction research background, and I know that there are a lot of habitual behaviors that happen around addiction and that if you're able to provide functional equivalents and substitutes, at least temporarily, while people are adjusting to not having the substance, it helps a lot. And so for people who really have a bad soda habit, artificial sweeteners may be putting a little soda in, mixing it with soda water and then gradually titrating yourself off is one way that you can kind of use artificial sweeteners in a limited way to help yourself completely get off the sugar.

Do you do you drink coffee?

Yes.

Do you sweeten it.

So you just have black or maybe with cream.

I've been ever, ever since. You know, I started I was working on alcohol for about 20 years, and then I shifted over to working on sugar because it felt to me like we have all these great public health strategies to deal with alcohol and we have none to deal with sugar and we're feeding it to children. Particularly, I was compelled when I learned that actually the fastest growing cause of liver transplant in America is not alcohol cirrhosis. It's nonalcoholic cirrhosis due in part to excess sugar consumption. That got my attention. Yeah. That's an interesting thing. And it turns out that our bodies you know what particular kind of sugar fructose hits our liver? Our liver often transforms it into fat, and that fat stays in the liver. And so we've got about 40% of the U.S. population of adults with fatty liver disease. It was the fat liver stuff that made me take a double take. And that's when I started 15 years ago, having 60 spoons from sugar. And it was like the American Heart Association recommends and I'm fine, I'm fine.

And you look great.

I don't count it and I'm not crazy about it. And I certainly wasn't with my children. One of the really cool things that kind of got me hooked on alcohol research when I was younger was this study. They were looking at the different cultural traditions and how people teach children about alcohol, and they could show in these epidemiological studies that Jewish families raised children that actually were less likely to develop drinking problems. And part of that is because there's a cultural tradition of when you have a kid around and everyone's toasting and drinking, you let them have a little sip. You teach the child that this is a special occasion thing. And when we're all celebrating Hanukkah or we're all celebrating somebody's birthday. Yeah, people take a little sip. But then most of the time, we don't drink it. We don't drink it every day. And that actually insulates children when they grow up from alcoholism. And so when when you have sugar in your house, you shouldn't tell your children, don't eat it or, that's bad or Halloween. No, no, you must you must never enjoy Halloween and go trick or treating and and binge on sugar. You say, Yeah, it's tasty, isn't it? And it's great. And that's why we have it on special occasions. We have a lot of moralism in America around, you know, what we eat and what we drink. And so taking some of that energy out of how we raise our children around healthy diet, I think there's wisdom in that. And teaching children that dessert for breakfast is not what we do here. We don't just pour out a huge cereal bowl of, you know, Twix or sugar snaps. We make a beautiful birthday cake and we celebrate with that.

I think that's really lovely. And I think you're right. I mean, I have three teenage girls as well, but we did I think you'll appreciate is we had the switch, which would show up the morning after Halloween and the switch which would switch out all the candy for something else with a little child or something like that. And that's how we got the candy out of the house because we knew if we kept it in the house, it was probably going to, over time, get eaten.

Yeah.

We're going to take a quick break here. But when we come back, Professor Schmidt weighs in on the debate around whether sugar is actually addictive or not. Plus, we got some real tips on how to curb a sweet tooth. We'll be right back.

You mentioned Robert Lustig earlier, your colleague. I did a piece for 60 Minutes with him several years ago all around Sugar The Toxic Truth, it was called. One of the things that he sort of gravitated around, I remember during our discussion was the addictiveness of sugar. And I think people have even said that sugar can be as addictive a substance as cocaine, for example. And again, you're very practical person. I can tell in the time that we're talking and I want to not be hyperbolic. But what about the addictive qualities of sugar? Is it that addictive?

Addictive? Well, I come out of an addiction background, and I actually 20 years ago, I even published a paper on Sugar and said, you know, we don't have the evidence that it's addictive just because rats prefer it to cocaine water than in an animal experiment or.

That that was the experiment that everyone sort of cited, was that these rats were in a cage and they had they had water, cocaine, sugar, and there was sugar that they kept tapping the the button for tapping the lever for.

Yeah. As the studies have stacked up, I've come around to thinking it probably is that.

It's not addictive.

That it is addictive. And I'm one of the big skeptics. And so the way psychiatrists think about addiction, you know, it's physical things like withdrawal and tolerance and then it's psychological things like loss of control and use despite harm. And at this point, we've got evidence on all of these diagnostic criteria for sugary foods and in particular, the foods that people with binge eating disorder binge on, which tend to be a combination of carbohydrates and fats in high quantities. The tricky thing about addiction is that a lot of it depends on the way the drug is consumed and the footprint of the drug in our reward system and in our bodies. So, you know, people up in the Andes Mountains have been chewing coca leaves forever. And it's like having a cup of coffee. But you take coca leaves and you refine the cocaine out of them and you inhale it, you smoke it, which is a very fast route of administration, right? It goes straight into your in your bloodstream and you get a massive high out of that. And it's highly addictive. And so if you really step back and you look at addiction from that frame of reference, you you have addictive substances like crack and you have nicotine, right? Nicotine produces a very mild high even when smoked. Right. So they're all different and they all have different pathways. And I think that the science on addiction and sugar is kind of coming out to suggest that, no, it's not like a chemical addiction, like nicotine, where it directly acts on the brain. It has an indirect route to act on the brain. And so I think a lot of it comes down to the route of administration. Also, the dose makes the poison. And so the more you consume, the more likely it is to be addictive. There's just been a lot of evidence building in this area. And I've come around. I was a real skeptic, but I've come around to agreeing that it probably is.

Given that and given how palatable sugar is and how we evolved as human beings, and now your belief, along with other scientists, that it is addictive. It sounds like a tough train to stop. Can we train our brains for moderation? I know you have. You said you eat a very healthy diet, but I'm just talking in general. How challenging is it to to train our bodies and brains to moderately consume sugar?

Also, I'm economically stable. I have the time and the money to get myself over to the produce stand or the farmers market in order to buy myself a healthy diet and work around what's in the grocery store. And most people in America don't have that privilege. I think that if the norms could shift a little bit on this on this topic and they are to some extent that it becomes less normalized to be eating massive quantities of sugar. That would help people a lot because as long as something is sort of everybody's doing it, it's normalized and it's everywhere. If you're one of the unfortunate people that really struggles with craving and compulsion around sugar, you're stuck in a food environment that is constantly triggering. It's constantly feeding you cues. Eat sugar. Eat sugar. My colleague Alissa Appel, who's a psychologist, has done some research on people with obesity, and she's found that about half of people with obesity experience, compulsion and craving for food and the other half don't. And I think that's a really, really interesting finding because that means that if we're trying to help people with weight control and therefore cardiometabolic disease prevention, we need to be thinking about the half of people that actually have a psychological issue and need help with that. They need counseling, they need mindful eating interventions. They need strategies. They need help not just with us binging on them. Don't eat sugar. Or, you know, shaming people. They actually need a counseling intervention. But we need to be thinking in a much more sophisticated way. In fact, I think we need to stop debating whether it's sugar's addictive or not and actually just focus on the fact that people tell us they crave it. People tell us they can't stop eating it. People tell us they binge on it and let's get them some help. That's something that is amenable to change in the way that anything that causes craving is. There are strategies, there are tools. And I want to mention pharmacological interventions because it's very interesting to me that, you know, coming from an alcohol background, there's a drug called naltrexone, and we give that to people who suffer from alcoholism and drug abuse and it helps them. And it was a real big push in the addiction field to give drugs to people who have addiction. And I always felt like that is just a crime that's withholding an effective intervention. Now, it turns out that now tracks on also works for people with food, craving food addiction. And of course, GLP one agonist medications work for both alcoholism and food, craving.

Like smoke and.

The like and so forth. I'm not I'm not an advertiser and I'm very, very concerned about the long term health risks. We are very unknown. But I, I do think it's interesting and important to point out that those drugs work on both problems. They work for people with food cravings and they also work for people with alcoholism.

What did you think of when Michael Bloomberg was mayor of New York? He had this proposal, essentially. Movie theaters and places like that could not sell sugar sweetened drinks larger than eight ounces. And just adding that intervention or that obstacle actually slowed down how much people were actually consuming.

It works. And it was originally tried with alcohol in Europe. And and it does work. You know, anything you can do to put friction between yourself and that addictive substance is good, right? And this is why the mindful eating interventions really help people, because it's it's about just putting some time in between the craving to drink and then drinking the soda. Just doing that helps people. Or teaching them a technique called surfing the urge. You're feeling that? 3:00. Got to have that soda. Want to go to the vending machine and you just stop. You put in your earphones and you listen to three minutes of a guided meditation where you just watch what it's like to really crave something and allow it to be there. And that helps. So any friction you can put between the consumer and the product helps. But then you have to think about, well, what are the negative side effects of doing anything in public health with the Big Gulp policy? Consumers hated it and people don't really why somebody's banging on them and telling them what to do. For one thing, not everybody who has diabetes or whatever it is has a compulsion to drink soda or each other. Right? Not everybody. Maybe half of people with obesity do. Right. So we have to find the people who who need that targeted intervention to address the underlying issues that they've got. And for everybody else, we ought to be thinking about engineering our food system to make it easier to eat healthy things.

So, look, Professor, with all you know, the Halloween's coming up. How how do you how do you approach sweets? How do you approach sweets without the guilt?

Without the guilt, I love to cook. And if I have six teaspoons of sugar a day, I can have a big old piece of chocolate cake and I can make it. I know how much sugar is in it because I put it in there and I have a big old thing of white sugar in my cupboard and let's have a nice piece of chocolate cake and enjoy it and savor it. And and let's let the kids have fun. But the great Pumpkin can come, too. And that's fun, too. There are ways to enjoy this thing and savor it and get up the next morning and not feel bad about yourself. Right.

Hey, look, I like that. Especially coming from you, the sugar expert. So I appreciate that. Happy Halloween. And thank you for this. What a pleasure.

Thank you, Sanjay.

Before we go, we're ending today's episode, as we always do with Paging Dr. Gupta. And another question from the Listener mailbag. This one is about zero calorie sweeteners. Alex from Chicago asks, Is it true that people who use these types of sweeteners instead of sugar tend to gain more weight? And if it is true, then why? All right. This is really fascinating and a bit counterintuitive. First of all, here's some interesting data. There was this 2023 study from the University of Minnesota, which followed more than 3000 men and women over 20 years. And they found that the long term use of things like saccharin and aspartame diet drinks were associated with increased levels of fat, specifically visceral fat, the fat that's inside your abdomen. Now, again, I know this is going to seem counterintuitive, but think of it like this. Sugar substitutes can play tricks on the brain. Meaning, even though you just eat something sweet, the sugar substitutes, you haven't gotten the calories associated with that. So as a result, you may start to forage for those calories. Your body really craving the energy. It's why some people may drink diet sodas throughout the day, but then go scavenging for ice cream late at night because these sugar substitutes are often low to zero calories. Our bodies simply aren't satisfied in the same way that calorie dense sugar can satisfy. And all of that, sadly, can lead to overeating and gaining weight. So many doctors agree with Dr. Schmidt on this, that unless you are a diabetic when it comes to artificial sweeteners, it might be best to just opt for the real thing. But again, of course, in moderation. I hope that answers your question, Alex. And that's it for today's show. Tune in next week for a conversation about the art of compromise. Thanks for listening.

Chasing Life is a production of CNN Audio. Our podcast is produced by Aaron Matheson, Jennifer Lai, Grace Walker and Jesse Remedios. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Sealy is our showrunner. Dan de Zula is our technical director and the executive producer of CNN Audio is Steve Lickteig. With support from James Andrest, John Dionora, Haley Thomas, Alex Manesseri, Robert Mathers, Leni Steinert, Nicole Pesaru and Lisa Namerow. Special thanks to Ben Tinker and Nadia Kounang of CNN Health and Katie Hinman.