For GPs and health professionals
Clinical information about the SUGAR® Diagnostic Assessment and its relevance to your patients.
If you are a client looking for information about the SUGAR® Diagnostic Assessment, you can find out more here.
Why this matters to your practice
Sugar and carbohydrate addiction is not a lifestyle choice or a failure of self-discipline. It is an increasingly well-evidenced clinical condition — one that may be driving or complicating the presentations you are seeing in your patients every day.
Patients with unexplained fatigue, mood instability, weight dysregulation, sleep disturbance, or difficulty maintaining sobriety from alcohol or other substances may have an unaddressed metabolic component to their difficulties. In many cases, that component is sugar and carbohydrate dependence — and it is not being assessed.
The SUGAR® Diagnostic Assessment offers a structured, evidence-informed framework for identifying whether this is the case, and for providing patients with a clear, personalised path forward.
The clinical evidence base
The connection between sugar, fructose metabolism, and addictive behaviour is increasingly well supported in the peer-reviewed literature.
Research published in Nature Metabolism (Andres-Hernando et al., 2025) has identified a shared biochemical pathway — fructose metabolism via the enzyme ketohexokinase (KHK) — that drives both sugar preference and alcohol intake. When alcohol is consumed, it triggers endogenous fructose production through the polyol pathway, activating the same metabolic route as dietary sugar. Blocking fructose metabolism in animal models significantly reduced voluntary alcohol consumption, providing a mechanistic basis for understanding sugar and alcohol as metabolically intertwined rather than separate conditions.
This builds on earlier work by Dr Robert Lustig, who described fructose as producing metabolic, hedonic, and societal parallels with ethanol — driving the same hepatic pathways, the same dopaminergic reward dysregulation, and the same pattern of compulsive use (Lustig, 2010).
The broader connection between metabolic health and psychiatric presentation is also increasingly recognised. Research in metabolic psychiatry — including the work of Dr Chris Palmer (Brain Energy, 2022) and Dr Georgia Ede (Change Your Diet, Change Your Mind, 2024) — points to metabolic dysfunction as a significant and underaddressed driver of mood disorders, cognitive impairment, and treatment-resistant presentations. When the brain is running on a dysregulated fuel supply, psychiatric and addiction treatment becomes significantly harder.
For patients in recovery from alcohol or drug dependence who are relapsing despite engagement with treatment, unaddressed sugar and carbohydrate dependence may be a key missing piece. Many patients in this group are consuming large amounts of sugar and ultra-processed food — often as a direct replacement for the primary substance — with metabolic consequences that closely mirror the symptoms that drove the original addiction.
What the SUGAR® Diagnostic Instrument assesses
The SUGAR® Diagnostic Instrument is the first and only clinical tool developed specifically for the assessment of sugar and carbohydrate addiction. Developed by Bitten Jonsson RN and Börje Dahl of Dahl & Dahl Prevention & Addiction Center, it is based on ICD-11 and DSM-5 addiction criteria and administered as a structured clinical interview.
The tool makes a clinically important distinction between two conditions that present similarly but require fundamentally different treatment approaches:
Then type these two as bold subheadings followed by normal paragraph text:
Harmful use — where a patient is experiencing damaging consequences from their relationship with sugar or ultra-processed food, but is not chemically addicted. A moderation-based approach may be appropriate here.
Pathological use (addiction) — where the patient is chemically dependent on sugar, flour, or ultra-processed food. This is a chronic, complex, and serious condition. Moderation is not an appropriate treatment target. The evidence-based approach is abstinence (Ifland, Preuss & Marcus, 2018; Jonsson, 2023).
Correctly identifying which condition is present has significant therapeutic implications. Patients who are genuinely addicted cannot moderate their way to recovery, and repeatedly attempting to do so — without understanding why it isn't working — compounds shame, erodes motivation, and delays appropriate treatment.
Then below that, still in the same text block, add these two subsections with Heading 3 styling:
Addiction Interaction Disorder screening
Embedded within the SUGAR® assessment is screening for Addiction Interaction Disorder (AID) — the recognition that addiction is rarely confined to a single substance. For patients with complex presentations involving alcohol, prescription medications, recreational drugs, or other substances alongside disordered eating, this screening provides a more complete picture of the addiction landscape. Dahl & Dahl Prevention & Addiction Center, who co-developed SUGAR®, also developed ADDIS — a widely used diagnostic instrument for alcohol and drug dependence — and the AID screening within SUGAR® draws directly on that tradition.
The addiction development curve
Every SUGAR® assessment produces an addiction development curve — a visual map of how a patient's relationship with sugar and food has developed from the beginning of harmful use to the present day. This includes connections between food use, weight, mood, and other substances across the patient's lifetime. Practitioners report that this curve is one of the most effective tools available for breaking through denial and increasing treatment compliance, precisely because it presents the patient's own history without argument or confrontation.
What I offer to referring professionals
I work with referrals from GPs, psychiatrists, counsellors, addiction workers, dietitians, and other health professionals.
Following assessment, I can provide a summary report of findings and recommendations, shared with the patient's consent. I am happy to liaise directly with referring practitioners where this would support continuity of care.
The SUGAR® assessment does not replace existing treatment — it complements it. I always work alongside a patient's clinical team, not in isolation from it.
What the assessment involves for your patient
The process comprises three meetings. An initial 30-minute introductory session establishes whether the assessment is appropriate and prepares the patient for the process. A 60 to 70 minute diagnostic interview using the SUGAR® Diagnostic Instrument follows, after which I prepare a personalised report including the addiction development curve. A final 45-minute results and recommendations meeting delivers the findings and a specific, tailored set of recommendations.
The full assessment is priced at £675, which covers all three meetings, the pre-assessment questionnaire, preparation, and the results report. Patients self-fund. Referral conversations for specific patients are free of charge.
Professional consultations
If you would like to discuss the SUGAR® framework in more depth — including its application to specific patient presentations, co-occurring conditions, or complex cases — I offer one-to-one professional consultations for GPs, counsellors, psychiatrists, and other practitioners.
These sessions are designed for clinicians who want to understand the metabolic dimension of addiction more fully, or who are working with patients whose presentation they suspect may involve sugar or carbohydrate dependence.
Professional consultation — 50 minutes — £150
Sessions are conducted online via video call.
Who can use SUGAR®?
Only practitioners who have completed the SUGAR® certification and licensure programme are authorised to use this tool. I am a certified and licensed SUGAR® Diagnostic Instrument practitioner, trained directly under Bitten Jonsson RN.
For more information about SUGAR® certification and training, visit bittensaddiction.com or nutrition-network.org.
References
Andres-Hernando, A., Orlicky, D.J., Garcia, G.E., et al. (2025). Identification of a common ketohexokinase-dependent link driving alcohol intake and alcohol-associated liver disease in mice. Nature Metabolism, 7, 2250–2267.
Ifland, J., Preuss, H.G., Marcus, M.T., Rourke, K.M., Taylor, W.C., Burau, K., Jacobs, W.S., Kadish, W., & Manso, G. (2009). Refined food addiction: A classic substance use disorder. Medical Hypotheses, 72(5), 518–526.
Ifland, J., Preuss, H.G., & Marcus, M.T. (Eds.) (2018). Processed Food Addiction: Foundations, Assessment, and Recovery. CRC Press.
Jonsson, B. (2023). SUGAR® Diagnostic Instrument. Dahl & Dahl Prevention & Addiction Center.
Lustig, R.H. (2010). Fructose: metabolic, hedonic, and societal parallels with ethanol. Journal of the American Dietetic Association, 110(7), 1307–1321.
Palmer, C. (2022). Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health. BenBella Books.
Ede, G. (2024). Change Your Diet, Change Your Mind. Balance Publishing.
Tarman, V., & Werdell, P. (2014). Food Junkies: Recovery from Food Addiction. Dundurn Press.