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September 21, 2017

Can I Be Addicted to Food? – Dr. Ralph Carson

is food addiction realIn a previous blog post, I discussed “food addiction” and compulsive eating. In that blog, I shared hope that treatment for loss of control eating is possible. I believe that we can learn how to create a healthy relationship with food. In today’s blog, I want to explain a little more about the science behind “food addiction.”
 
I get a little concerned when people say, “I’m addicted to food.” It’s important to know that being “addicted to food” is different from being addicted to alcohol, nicotine, caffeine or other (chemical substances).
 
If one is addicted to alcohol or drugs, they are obligated — or at least strongly encouraged — to completely abstain from those substances. This is feasible because alcohol and drugs aren’t critical to human survival. You can live without alcohol and drugs — but you could not survive without food.

What is addiction?

If we are addicted to a substance (i.e. cocaine, opioids, amphetamines, nicotine, alcohol, caffeine), our brain’s neurocircuits (reward pathways) are hijacked by that addictive substance. Here’s how it works:
  1. Addictive chemicals enter through a selective blood barrier (think of it like a black box within the brain).
  2. These toxic chemicals immediately initiate changes to the cerebral neurons by altering their genetic information (transcription factors) or blueprint. The new command signals demand that the brain seek and consume the offending substance — or suffer severe consequences.
  3. Once this process takes place, the individual will never be able to have the substance again — without suffering an immediate and unrelenting relapse, wanting to use the substance again and again. This is a chemical addiction. 
This same takeover (hijacking of the neurocircuits) can happen in the brain as a result of certain thoughts, behaviors, memories, and fantasies. Examples of this include sex, foods, gambling, shopping, and the internet. This latter phenomenon is sometimes described as a “process addiction;” no chemical-altering substance enters the brain.
 
So, we have both 1) chemical addiction and 2) process addiction.
 
Why do foods bring us so much pleasure?
 
Both food and drugs result in pleasure because they cause the brain’s reward center to release dopamine (a feel-good neurotransmitter). Drugs do this by direct contact. Food can do this through sensory input (smell, taste, mouthfeel, appearance, or sound) or previous pleasant experiences triggered by thoughts or cues (memories or fantasies).
 
The more dopamine that is released, the more dopamine the brain will need to create a similar reward response (tolerance). If this reward response is interrupted (the individual abstains from the substance), the individual will feel bad and will crave the experience or substance.
 
For a chemical addiction, (including substances like cocaine, opioids, amphetamines, nicotine, alcohol, caffeine) this drive to get pleasure will become unmanageable.
 
For a process addiction, (sex, foods, gambling, shopping, and the internet), the drive initially seems unmanageable. However, armed with appropriate skills that are repeated frequently, eventually this inappropriate behavior becomes manageable.   
 
Eventually, through skills learned in therapy, one can recover from both types of addiction and return to their previous state of normalcy.
 
These examples may help you understand the difference:
 
Out of control/unmanageable: Pretend someone is squeezing your neck to the point of suffocation and then lets go just before you lose consciousness. You will immediately gasp. An expert would say that it is better to breathe out first to get rid of the carbon dioxide saturating the lungs. However, if you repeat the strangulation, you will still gasp when the grip around your neck is removed. You will still gasp if you try more than a hundred times to exhale. That is because it is out of your control.
 
Manageable: I am compelled to eat sugary foods in the evening while watching TV. But, I choose to constructively change my behavior and no longer experience the overwhelming urge to overeat. If, in the future, I do get an urge, I can control and override it. The food no longer controls me (as opposed to the case of an addictive substance like alcohol). 

Are foods truly addictive? 

So let’s talk about “food addiction.” When it comes to food, we do not see the same chemical alterations of the brain’s neurons and circuits in one who compulsive overeats — when compared to one who is addicted to alcohol or drugs.
 
When compared to a brain of a person with a chemical addiction, the compulsive eater’s DNA transcription facts do not change; permanent brain changes do not occur; dopamine returns to its previous balanced and appropriate output.
 
As I mentioned before, food’s input is multisensory (taste, smell, mouthfeel, appearance, sound). When you combine this input with previous pleasant experiences (memory traces) it could potentially activate the reward circuit in a similar fashion as an addictive chemical.
 
Chemical addiction — An addictive substance enters the brain and permanently changes the signaling mechanism. This creates the “have to have it” feeling; relapse is inevitable. Negative consequences (e.g. withdrawal) will ensue if the user does not give into the urges.  
 
Process addiction — No substance enters the brain and there is no permanent change to the signaling mechanism. It may feel good when sensory input and thoughts are reintroduced; but there is not that “have to have it” feeling.” There is no withdrawal and the individual can manage their urges.
 
[As an aside, caffeine is the only food that meets the DSM-V criteria for being addictive, though its addictive potential remains controversial by some researchers].

Is sugar addictive? 

What about sugar, you might ask. Sugar is undeniably a chemical that enters the brain. Because of this, some may want to label it an “addictive substance.” But sugar (glucose) does not permanently alter the reward pathways as a drug.
 
Sugar presents itself as a thought or fantasy. Don’t believe me? Here’s an example: when people say they are craving sugar, they typically don’t reach for a bag of sugar. What they reach for is a cookie, a donut, ice cream, a chocolate bar, or a brownie. Their true urge is not just for sugar; the urge is for something soft, chewy, moist, warm, creamy, smooth, and sweet. Sometimes called “mama foods,” these sweet foods represent love, warmth, comfort, and security.
 
Why do we crave certain foods and not others?
 
Many individuals experience loss of control eating over their favorite snack foods or desserts. One might say it’s because they are addicted to sugar, but yet they will be more likely to experience a loss of control while snacking on chocolate chip cookies — not on rice cakes. We can control the intake of the rice cake because it feels more like we are eating Styrofoam (no sensory enticement) and is rarely associated with fond memories.
 
An individual can overconsume sugar (in both processed and refined foods), but I would call this a compulsive (though manageable) habit — not an uncontrollable addiction. I don’t call it sugar addiction. I call it compulsive eating.

How can one stop overeating?

So, why do people compulsively overeat when food items are not truly addictive (meaning no permanent brain changes have taken place)? Here’s one theory: our emotional brains are programmed to make sure we eat by either 1) creating pain (hunger pains) or 2) producing pleasure (enjoying highly palatable foods that taste good). Our brains do this because food is necessary for survival.
 
The person with a history of compulsive overeating can learn to change their relationship with food through clinical therapeutic interventions. But, they will still have compulsive eating habits. These habits will be ingrained by old pathways embedded in the brain (even though they may be greatly weakened).
 
Those who make the brave efforts to get treatment for overeating must know this: if they overconsume highly palatable foods — even after treatment at an eating disorder clinic — they can be vulnerable to returning to their old compulsive eating habits.
 
Can I have withdrawal symptoms from foods?
 
Another area I’d like to address is this: some people feel real, physical withdrawal symptoms when they stop eating certain binge or trigger foods: chips, cookies, ice cream, chocolate, bread etc. The symptoms reported (difficulty concentrating, irritability, shakes and jitter, nausea, headache etc.) actually result from low blood sugar that stems from a drastic alteration in carbohydrate intake.
 
When one consistently consumes a healthy, balanced mixed food plan (with fiber, carbohydrate, protein, and fat) distributed in several feedings throughout the day, these “withdrawal” symptoms will be resolved.
 
Unlike studies on rats, where the sugar-restricted rodents clearly exhibit withdrawal behavior (paw tremors, teeth chattering, head shaking, escape behaviors and aggression), humans do not experience true withdrawal from food items. Rather, humans may have a conditioned psychological dependence (we have a false sense of having to have them). What this once again teaches us is that humans are not rats!

Treatment for food addiction 

Now that you understand the science behind food addiction, I’d encourage you to reach out to us if you think that you have a problem with compulsive eating. We are happy to discuss treatment options available at our eating disorder clinic with you.

Ralph Carson, RD, PhD, is a nutritionist and exercise physiologist with over 40 years of experience. He is currently Vice President of Science and Innovation for Eating Recovery Centers (ERC) and the Binge Eating Treatment and Recovery Program (BETR) in Chicago and other locations. BETR focuses on loss of control and binge eating. Dr. Carson is an active member on the board of the International Association of Eating Disorder Professionals (iaedp) and author of The Brain Fix: What’s the Matter with Your Gray Matter.
 
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