To the Editor: We applaud the article by Henry R. Kranzler, M.D., et al. (1) and concur that sweet taste preference, rather than being a marker for alcoholism risk or a generalized alteration in rewarding response to hedonic stimuli in those with alcohol dependence (2), instead reflects a chemosensory adjustment to the effect of alcohol on the olfactory system. Both acute alcohol intoxication (3) and chronic alcoholism (4) are associated with an impaired olfactory ability. Smell is approximately 90% of what is described as taste or flavor; hyposmic individuals perceive food as bland or tasteless (5). In order to compensate, spices and enhanced true taste (e.g., sugar) are added to food (6). Therefore, through a learned response paradigm, those who are alcohol dependent develop a preference for a higher concentration of sugars, even in the absence of other foods.

Alternatively, because of chronic excess daily use of sugars, they may induce an up-regulation of the sweet taste receptors, raising their sucrose threshold and their associated sucrose hedonic curve (7). Thus, preference for higher sucrose concentration in individuals dependent on alcohol may represent only a behavioral compensatory response for those with alcohol-induced olfactory loss and thus, as Dr. Kranzler et al. found, would not be useful as an indicator of risk for developing alcohol dependence.