What is Food Addiction?
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For years, overeating and obesity were often diagnosed as eating disorders caused from emotional problems that could be solved by psychotherapy or counseling. Although this is true for many individuals who have used food to manage their emotions or deal with stress, the problem is more complex for the true food addict.
According to Kay Sheppard, a pioneer in the treatment of food addiction, “the term food addiction implies there is a biochemical condition in the body that creates a physiological craving for specific foods. This craving, and its underlying biochemistry, is comparable to an alcoholic’s craving for alcohol” (a refined carbohydrate). Just as alcohol is the substance that triggers the alcoholic’s disease, there are substances that trigger a food addict’s out-of-control eating.These substances are typically refined carbohydrates, sweeteners, fats and processed foods. These foods seem to affect the same addictive brain pathways that are influenced by alcohol and drugs.
Ms. Sheppard, says that “for some people, repetitive overeating and weight gain can be symptoms of food addiction, just as loss of control or inebriation results from excessive alcohol. I have seen that many food addicts, who participated in residential eating disorder centers, never found freedom from their food cravings even after completing treatment programs of 30 to 90 days. These individuals typically relapsed, returning to addictive eating after leaving treatment centers because they were never introduced to a ‘trigger-free’ food plan.Often they were encouraged to eat small amounts of their trigger foods,” Ms. Sheppard said. “I believe this is like the alcoholic being told they should be able to have a small glass of wine every now and then.Food addiction, like alcoholism, is a chronic, progressive, fatal disease. It is chronic because the condition never goes away, it is progressive because the individual needs more of the substance over time, and it’s fatal because many individuals with this disease die of complications related to their addiction, such as obesity, type II diabetes, heart disease and other chronic diseases.”
Traditionally, food addiction has been treated as an eating disorder, using the Diagnostic and Statistical Manual (DSM IV) for Eating Disorders for diagnostic and treatment purposes. On page 37 in her book, From the First Bite, Ms. Sheppard suggests food addiction fits in a different classification other than eating disorders. She suggests using the seven criteria from the Diagnostic Statistical Manual (DSM-IV) for substance abuse. Most food addicts who are in the advanced stages of their disease can say “yes” to all seven criteria.
1. Tolerance. The person needs increased amounts of the substance over time to achieve the same desired effect or feeling.
2. Withdrawal. When the substance is stopped, there are physiological and/or psychological withdrawal symptoms. The individual takes the substance again to relieve or avoid these symptoms.
3. Unintentional overuse. The person takes more of the substance or takes it over a longer period of time than intended.
4. Persistent attempts at cutting down on the substance are unsuccessful.
5. Preoccupation with the substance. A great deal of time is spent obtaining the substance, using the substance, or recovering from its effects.
6. The reduction of or abandonment of social, occupational or recreational activities in order to use the substance.
7. Use of the substance is continued despite persistent or recurrent physical and/or psychological problems exacerbated by the substance.
The majority of food addicts stay locked in the disease process due to lack of good information. Generally, the medical profession does not know how to treat this disease, treating the symptom of obesity instead of addressing the underlying condition. Effective treatment is based on abstinence from addictive food substances. Many individuals continue to overeat in order to avoid the discomfort of withdrawal. Often, the individual has a small amount of the addictive substance to alleviate this discomfort. The problem is that even a small amount of addictive foods will trigger the disease for true food addicts.
Scientific research using both animal models and human brain imaging studies strongly supports the concept of food addiction.
Professor Bart Hoebel and his teams at the Department of Psychology and the Princeton Neuroscience Institute have been studying signs of sugar addiction in rats for years. Until now, the rats under study have met two of the three elements of addiction: 1. they have demonstrated a behavioral pattern of increased intake; and 2. they have shown subsequent signs of withdrawal. His current experiments are capturing the phases of craving and relapse, which complete the cyclical picture of addiction. (1)
With obesity rates climbing in unison with the availability of refined foods, there is growing concern that food addiction may play a large role in the obesity epidemic. Mark Gold, chief of addiction medicine at the McKnight Brain Institute at the University of Florida, says that food, especially highly palatable food, can produce the same effects as drug abuse. Despite dire consequences, it is common for people to eat more than they intend. Failed diets, unsuccessful attempts to control overeating, preoccupation with food and eating, shame, anger and guilt-all the issues look like traditional addictions. Once bad patterns are established, Gold says, our biological systems break down. (2)
Kay Sheppard points out that, “All addictive substances start out as natural substances which are taken through a refinement process. These addictive substances are quickly absorbed, alter brain chemistry, and change mood.” As the world moves toward more processed and refined sugary foods, it is easy to see how we are increasingly using food as a drug rather than a source of nutrition. In animal studies, Dr. Serge Ahmed, a French researcher, and his team concluded “the super stimulation of our brain receptors by sugar-rich diets, such as those now widely available in modern societies, generate a supernormal reward signal in the brain, with the potential to override self-control mechanisms and thus lead to addiction.” (3) Treating secondary diseases such as obesity, diabetes, heart disease and countless other health-related problems rather than the problem itself will not facilitate recovery for these individuals or help them build a healthy future for their children.
References
- Bart Hoebel, Ph.D. “Sugar can be addictive, Princeton scientist says.” http://www.princeton.edu/main/news/archive/S22/
88/56G31/index.xml?section=topstories - Mark Gold, M.D. ” Yale Hosts Historic Conference on Food Addiction” http://opa.yale.edu/news/article.aspx?id=1581
- Serge Ahmed, Ph.D. “Intense Sweetness Surpasses Cocaine Reward” www.plosone.org/article/info:doi/
10.1371/journal.pone.0000698
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Refined food addiction: A classic substance use disorder
J.R. Ifland a,*, H.G. Preuss b, M.T. Marcus c, K.M. Rourke a, W.C. Taylor d, K. Burau d, W.S. Jacobs e, W. Kadish a, G. Manso f
a Refined Food Addiction (ReFA) Research Foundation, 5355 Memorial Drive, F-814, Houston, TX 77007, United States
b Georgetown University School of Medicine, 37th & O Street, NW, Washington, DC 20057, United States
c The University of Texas School of Nursing, 1700 Red River Street, Austin, TX 78701, United States
d The University of Texas School of Public Health, P.O. Box 20186, Houston, TX 77225, United States
e University of Florida School of Psychiatry, 100 S. Newell Drive, Mc Knight Brain Institute, Suite L4-100, Gainesville, FL 32611, United States
f University of Taxes School of Medicine, Houston, TX, United States
-Contents lists available at ScienceDirect; ELSEVIER-
s u m m a r y
Overeating in industrial societies is a significant problem, linked to an increasing incidence of overweight and obesity, and the resultant adverse health consequences. We advance the hypothesis that a possible explanation for overeating is that processed foods with high concentrations of sugar and other refined sweeteners, refined carbohydrates, fat, salt, and caffeine are addictive substances. Therefore, many people lose control over their ability to regulate their consumption of such foods. The loss of control over these foods could account for the global epidemic of obesity and other metabolic disorders. We assert that overeating can be described as an addiction to refined foods that conforms to the DSM-IV criteria for substance use disorders.
To examine the hypothesis, we relied on experience with self-identified refined foods addicts, as well as critical reading of the literature on obesity, eating behavior, and drug addiction. Reports by self-identified food addicts illustrate behaviors that conform to the 7 DSM-IV criteria for substance use disorders. The literature also supports use of the DSM-IV criteria to describe overeating as a substance use disorder. The observational and empirical data strengthen the hypothesis that certain refined food consumption behaviors meet the criteria for substance use disorders, not unlike tobacco and alcohol. This hypothesis could lead to a new diagnostic category, as well as therapeutic approaches to changing overeating behaviors.
Overeating in industrial societies is a significant problem that has been linked to an increasing incidence of overweight and obesity with their resultant adverse health consequences, including insulin resistance and diabetes mellitus, hypertension, and cardiacdisease. Overeating has been attributed to the ready availability of food, sedentary lifestyle, and economic considerations. While some or all of these ideas may have some degree of explanatory power, none of them address a critical question; namely, why do people in industrial societies persistently overeat despite considerable and repeated efforts not to do so?
We advance the hypothesis that a possible explanation is that processed foods with high concentrations of sugar or other refined sweeteners, other refined carbohydrates (such as flours), fat, salt, and caffeine are addictive substances, and, therefore, many people lose control over their ability to regulate their consumption of such foods. The addictive loss of control over these foods could account for the ever-increasing global epidemic of obesity and other metabolic disorders. Further, if it is shown to be valid, this hypothesis would have major implications for potential interventions to help reverse these trends.
The model of an addiction focused on processed foods containing high concentrations of refined sweeteners, flours, fats, salt, and/or caffeine is a biologically plausible explanation for this over consumption.
A growing body of research has found a correlation between the frequent consumption of fast food and soft drinks and obesity. The relationship between sweetened drinks, obesity, and diabetes has also been established. Indeed, per capita consumption of refined carbohydrates has progressed significantly over the last 40 years, parallel to the increased incidence of the metabolic syndrome, which includes insulin resistance, overweight, hypertension, dyslipidemia (disorder of lipoprotein metabolism; a condition where excess amounts of lipids or lipoproteins build up in the blood).
If the addiction hypothesis were true, then the overall US statistics would show a steady and dramatic increase in the consumption of refined foods corresponding to the steady and dramatic rise in overweight and obesity. This, in fact, is the case between 1970 and 1997 in the US. High fructose corn syrup and flour show the most dramatic increase in consumption, with 61.9 lbs and 50.8 lbs, respectively, between 1970 and 1997. Although many other factors besides a potential addiction mechanism contributed to the observed increases, these data are consistent with the hypothesis of a clinical disorder of addiction to refined foods. Similar increases were seen in the use of tobacco when coupled with reduced prices and heavy advertising. Between 1880 and 1920, cigarette consumption increased from 50 cigarettes per adult to 500.
Comparisons between overeating behavior and addictive drug behavior have been made. However, the comparison was difficult because it was presumed that the compulsive element associated with eating stems from appetite mechanisms while the compulsive element of drug use is derived initially from pleasure seeking and the powerful reinforcing properties of drugs of abuse in later stages of addictive disease. Separating the elements of a healthy appetite from harmful addiction is further challenged by findings in rat studies that the neuropathways of appetite and addiction (pleasure and reward) extensively overlap. Numerous review articles have also established a connection between the neuropathways activated in the consumption of palatable food and the key reward pathways activated in drug and alcohol use. Under the framework that we are proposing in this article, the hypothesis could be that the very same mechanisms—pleasure seeking followed by mindless behavioral reinforcement—that are operative in the loss of control over drug use are also operative in the loss of control over certain foods.
Our hypothesis of addiction to refined foods is based on a fundamental distinction between two general categories of food: refined vs. unrefined. The first category includes ingredients that are refined by an industrial process, such as sugar, other sweeteners, flour, salt, caffeine, and certain fats. The second category comprises foods found in nature, such as meat, poultry, fish, beans, grains, vegetables, and fruit. In our model, we hypothesize that humans can become addicted to foods in the refined category, but not to foods in the unrefined category, however prepared. Although, there is not yet sufficient evidence to assert that any of the refined ingredients may act as psychoactive drugs, our observations strongly suggest that foods containing these ingredients, or composed entirely from them, are consumed in a manner consistent with generally understood concepts of addictive behavior found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Like drugs of abuse, sugars and flours are substances found in nature, where they exist in much smaller concentrations than in food and in combination with fiber, water, vitamins, and minerals. We propose that, like drugs, they are not addictive until extracted and concentrated by modern industrial processes. Examples from the world of drugs include cocaine extracted from cocoa leaves, opium extracted from poppies, ethanol distilled from grains, fruits, and potatoes or nicotine smoked from dried tobacco. Importantly, there is good evidence that carbohydrate preference (and likely fat preference and salt preference) is ‘hard-wired’ into humans because it plays a crucial role in attracting people to eat safe and nutritious foods such as fruits. Whereas small concentrations of these substances contained in natural foods also have significant amounts of fiber, vitamins, and trace minerals that serve the useful purpose of directing us to eat such foods, large concentrations of these substances contained in refined foods may subvert this adaptation and lead some people to compulsively seek and consume refined foods.
In addition, a factor in the development of refined food addiction is the practice in industrial cultures of combining these substances with each other in ways which are entirely unnatural but which may enhance their potentially addictive force. Examples of these artificial combinations include soft drinks, which contain sugar and caffeine; doughnuts, which contain refined flours, sugar, salt, fat and sometimes caffeine from chocolate; and French fries, which contain fat, salt, and, often, dextrose. The combinations are in concentrations much larger than those found in nature, and are dissociated from foods with nutritional value such as meats and fruits. The refined food addiction hypothesis The DSM-IV defines substance dependence as three or more of the following seven symptoms occurring within 1 year: tolerance, withdrawal symptoms, substance taken in larger amounts or for a longer duration than intended, attempts to cut back, excessive time spent pursuing, using or recovering from use, reduction or discontinuation of important activities because of use, and continued use despite adverse consequences.
Our hypothesis is that overeating can be described as an addiction to refined foods that conforms to the DSM-IV criteria for substance use disorders. The DSM-IV criteria have been validated extensively across substances and cultures. The DSM-IV criteria have been established through an arduous process of consensus building among experts and are considered the best operational definition of addiction (substance abuse and dependence) currently available. Further, if our hypothesis is true, we expect that individuals with the disorder would meet the DSM-IV criteria for a substance use disorder.
NOTE: This article has been edited to provide a basic overview of refined food addiction from some of the chief clinical experts in the field. For the complete paper written by the authors, as well as tables of their data and references, please visit Food Addictions Summit at www.foodaddictionssummit.org.
