FOOD ADDICTION - MYTHS, CAUSES AND TREATMENTS

While much media attention is given to overcoming drug addiction and alcoholism, the world is arguably facing a much larger problem with highly processed foods. Food addiction is far more common than either of these issues and the health consequences are far less emphasized. As it shares many similarities with substance abuse disorders, addiction to certain foods may be just as difficult to overcome, if not more!

The following article takes a closer look at food addiction and why it can be very difficult to beat; discussing symptoms, underlying causes, potential treatment options and more.

What is Food Addiction?

Food addiction is a common term used to describe addictive behavior to a food, a type of food or food in general. While it can apply to any food, it usually refers to processed foods and not regularly consumed foods considered essential for survival. Processed foods are often higher in fats, sweeteners and additives that are more addictive (and less healthy) than their whole food counterparts. 

Despite food addiction being a relatively well-known condition, there is no consensus yet as to what constitutes food addiction^[1]. It is currently viewed as a type of substance abuse disorder, with many reviews comparing it to the likes of substance abuse, eating disorders and overeating leading to weight gain.

Prevalence. As there are no true criteria for food addiction, its prevalence is not well-known. In epidemiological studies, which made use of varying criteria, food addiction has been estimated to affect between 2.6-11.4% of the general population, up to 25% of obese individuals and between 56-97% of those with binge eating disorders. Food addiction is linked with BMI, weight gain, substance abuse, such as smoking and drinking, eating disorders, as well as high sugar intake.^{[2] [3] [4]}

Symptoms

Symptoms can vary, but generally include several of the following:

• Overeating
• Excessive grazing (unrestrained, repetitive eating in small portions throughout the day)
• Frequently consuming larger amounts of food than intended
• Constant cravings
• Psychological and/or physical dependence on particular food or on food-related addictive behavior that results in withdrawal symptoms when the food or behavior is omitted
• Lack of control in relation to one’s eating habits, despite knowing the harm involved
• Difficulty cutting down on addictive behaviors
• Prioritizing eating over obligations, social activities and recreation
• Needing to partake of the addictive behavior more each time to feel satisfied
• Spending lots of time trying to recover from the food addiction

3 Myths About Food Addiction

Food addiction is often mistakenly linked with obesity, weight shame, and eating disorders, which has perpetuated several myths on the matter, as discussed below.

1. Obese People Suffer from Food Addiction and Out of Control Eating

Food addiction is often coupled with the image of obesity. While it seems intuitive to think of over-eating as a cause for becoming fat, in most cases it isn’t true. It is estimated that food addiction affects roughly a quarter of obese individuals and roughly 11% of those with healthy weights. Many people who suffer from food addiction also battle to put on weight and many people with obesity struggle to lose weight despite attempting to starve themselves, control what they eat, eat healthily or exercise regularly. Both conditions are complex and often stem from multiple causes.

2. Regularly Consuming certain Food Counts as Food Addiction

Repeatedly consuming one or a few of the same foods on a regular basis cannot constitute a food addiction. Most people consume the same types of food every day, such as a cup of coffee in the morning, the same cereal for breakfast, and similar vegetables over the course of the week for lunch or dinner. Even the occasional or daily unhealthy treat cannot be considered as a food addiction.

As mentioned above, a food addiction is a serious problem that contains elements of severe addiction and dependency on food or a particular type of food. It can be likened to using food like an addictive drug, where the person is unable to stop excessively eating the food, experiences severe withdrawal symptoms when forced to stop, and continues to indulge in the activity, despite understanding that it is unbalanced and destructive.

In this respect, it is the degree of control a person has over their eating habits that dictates whether they are suffering from an eating disorder or not.

3. Food Addiction is the Same Thing as Binge Eating Disorder

Binge Eating Disorder may seem to be the same thing as a food addiction to some, however, the two conditions, while associated, are quite distinct.

Despite over half of those with binge eating disorder exhibiting symptoms of food addiction, it is not necessarily true that they suffer from food addiction. Instead, they are addicted to binge eating episodes where they consume an excessive amount of food in a very short space of time, resisting or not experiencing the feeling of satiety. They often compensate for this behavior with excessive exercise, purging or food restriction.

In food addiction, the person does not engage in binge eating behavior unless they also suffer from binge eating disorder^[5]. They are addicted to the food, not necessarily to the excessive consumption of it. They may indulge in the food more frequently and consume more than average amounts, yet it is often not comparable to a binge eating episode. Food addiction is distinct due to the way the person feels extremely adamant that they cannot function without having the food on a regular basis. In Binge Eating Disorder, the person often deprives themselves of food after an episode, engaging in an unstable eating pattern different from someone with food addiction.

How Can Food Be Addictive?

What gives food its highly addictive potential is a composite of factors, from the type of food to the way it affects the brain and body. The below points highlight just how food can easily become an addiction in susceptible individuals.

We Physically Depend on Food

Our dependency on food is one of the main reasons we can easily become addicted to it in the first place. Food is naturally “addictive” as part of our baseline survival instincts. We need to eat on a consistent basis to function. Hence, the body contains several mechanisms to ensure that we eat regularly, including sensations of hunger, fatigue, decline in mood, and cravings for food as required.

Is Food Addiction Valid if Food is Essential? Some will argue that eating food can’t count as an addiction since it is necessary for our survival. In most cases of food addiction, the food consumed is not essential to survival and is often consumed excessively or at times when it is non-essential (i.e. in the absence of a true need for the food).

The Brain Reward Pathway in Driving Food Addiction

Eating is Biologically Rewarded. We are designed to be motivated by consumption when it’s required, thanks to the brain’s reward pathway. In response to food, the reward centers of the brain become activated through the release of dopamine. Dopamine is associated with motivation, reward, pleasure and addiction, giving rise to a better mood and enhanced energy levels.

Addiction is Sponsored by “Reward Debt.” While rewarding consumption post-hunger may be essential to our survival, the reward overshadows hunger and survival instincts in full-blown food addiction. In this case, the reward pathway becomes faulty through the overactivation of the network in response to increased consumption of highly addictive (rewarding) foods. This eventually leads to a reduced reward-response to food in food addicts, which is generally compensated through overeating for more reward. Eventually, the response can become blunted to the point that food is no longer able to provide a reward or prove satisfying; however, the craving for the reward typically becomes intensified. The exact same thing can be seen in drug addicts or alcoholics.

Compulsion Overtakes Thought. Brain areas involved in planning, memory and goal-directed behavior form part of the brain reward pathway related to both food and food addiction. When the addiction takes precedence, this area is hijacked to get more of what the person craves, to gain a reward. The person also often becomes impulsive, reflecting diminished activity and control in these areas.^[6]

Appetite Secondary to Reward. In some cases, contradictory activations within the reward pathway in response to food have been observed. The individual may lose their desire to consume the food they are addicted to but still act in accordance with the addiction, consuming the food irrespective of their appetite or desire to do so. This change is associated with compulsive eating, irrespective of whether one feels hungry and shows a disassociation between the reward experienced and the addictive food itself. In this respect, any activity or thought that is able to release dopamine in this pathway and trigger the reward network is likely to prompt the addictive behavior.

Cycles of Overconsumption, Inhibition and Diminishing Returns

As highlighted above, most chemical systems in the body work off of inhibition loops that help to regulate tissue functions, behaviors and overall health. Faulty inhibition loops are common aspects of food addiction and substance abuse disorders, leading to heightened consumption in order to achieve the same reward or benefit. This contributes to the difficulty of cutting down or stopping seen in addiction.

Aside from dopamine signaling, there are a few other inhibition loops that can apply in the context of food addiction:

• Out-of-Control Eating, Leptin and Ghrelin. Leptin and ghrelin are two hormones that govern hunger and satiety. Imbalances in these hormones are specifically involved in perpetuating food addictions and eating disorders. Ghrelin is referred to as the ‘hunger hormone’ and becomes elevated when the body is starving or requiring food^[7]. As we satiate our appetite, leptin becomes elevated and decreases the actions and concentrations of circulating ghrelin^[8]. In humans and animals with food addictions and eating disorders, leptin levels are shown to be high all the time^{[9] [10]}, despite the individual’s increased compulsion to eat. After a while, overeating for reward throws the appetite out of balance, potentially promoting a reduction in viable leptin receptors. This can lead to a decreased sense of satiety in response to food, coupled with a reduced general appetite, which is typically compensated for by the addictive food and reward involved.
• Food-Derived Opioids, Pain Relief and Reward. Opioids are a class of chemicals known to block bodily pain and improve mood. They can become highly addictive, particularly due to their positive effects, as well as their ability to stimulate the reward pathway. The body produces its own natural opioids in response to painful stimuli and intensive physical activity, such as endorphins and enkephalins. Sugar is a common dietary opioid, as well as various active ingredients in chocolate. Foods high in either are known to be some of the most addictive for this reason. Studies show that “chocoholics” and those with a sweet tooth may have an under-functioning opioidergic system^[11]. This deficit can lead to heightened cravings for opioids, where increasing amounts are required to reward and satisfy addiction. In those addicted to opioids, pain (physical or emotional), sweet foods, stress or pleasurable stimuli that trigger reward may all promote the addictive behavior.
• Insulin, Blood Sugar and Sweet Cravings. Energy deficits are another common reason for food addiction that tend to create a catch 22 cycle of dependency. Blunted insulin responses often lead to lower or inconsistent blood sugar levels, which result in cravings for foods high in sugar when energy levels dip. Overeating sugar-rich or fat-heavy foods is capable of promoting hyperinsulinemia, which leads to a blunted insulin response. 
• Neuronal-Excitability, Stimulation and Sustained Focus. There is growing evidence to suggest that glutamate is a required component of the brain reward pathway, serving as a co-neurotransmitter to dopamine^[12]. Elevations in glutamate, which give rise to excessive excitatory activity in the brain, can promote overeating in animal studies. This is similarly seen in animal models of drug addiction^[13], whereby excess glutamate can trigger the reward pathway^[14]. Aside from potentially triggering reward, excess glutamate and neuronal excitability can eventually lead to reductions in neuronal activity that can promote addiction to foods that enhance neuronal stimulation. This is due to high circulating glutamate levels, lowered glutamate receptor expression and/or neuronal cell death induced by glutamate overload (neuro-excitotoxicity). Foods that promote neuronal excitability and glutamate transmission include salty foods, protein-heavy foods, and calcium-rich foods, as well as some additives, particularly monosodium glutamate.

It should be mentioned that when addictive food is removed from the equation, all of the above can contribute towards withdrawal symptoms as well.

Causes

Most experts will agree that there is no known single underlying cause for food addiction. The following mechanisms can further explain the causes and development of food addiction in susceptible individuals:

Neurological Imbalances often precede eating disorders and food addiction, contributing towards brain changes that reinforce addictive behavior. Examples include neurotransmitter imbalances in dopamine, vagus nerve dysfunction (dysautonomia), and neurological growths or damage in brain areas pertaining to reward and appetite regulation. These are generally brought about by substance abuse disorders, severe stress, affective disorders, malnutrition, birth defects or problematic development through childhood.

Gut Dysbiosis. Our gut bacteria interact with the cells in the digestive tract, communicating with multiple systems in the body including the nervous system, immune system and digestive system. The body relies on them to digest various dietary nutrients, increase absorption and produce nutrients that we don’t get otherwise from the diet. In this sense, they govern aspects of appetite and metabolism, serving to regulate our nutritional needs based on the kind of foods they require to sustain their survival, which is essential to our overall health. It is commonly observed that dietary preferences change in line with the bacteria present. When the ratio of bacteria is in balance, one often craves to eat healthy foods that promote the existence of the full spectrum of healthy gut bacteria. In those with obesity and eating disorders, the ratio becomes unbalanced, often leading to a state of gut dysbiosis, wherein diversity is reduced and a few strains become dominant. This promotes cravings for unhealthy foods that encourage these bacteria and discourage competition.

Energy Deficits have the potential to drive food addiction in an effort to compensate for low energy levels, as explained above with regard to insulin signaling. Low energy levels are often self-medicated through the consumption of processed foods that are low in nutrients and high in sugar or fats. Despite the understanding that our energy levels are largely reflective of our blood sugar levels, there are many other factors involved in energy production. These include physical activity levels, nutritional status, circadian rhythm, and our state of overall health. In this respect, food addiction may be caused by a number of things that destabilize these factors, such as disease, infections, pollutants, allergies, malnourishment, unbalanced dietary habits, sleep disruption, a lack of exercise and more.

Common Drugs of Choice in Food Addiction

While food addiction can technically be related to any type of food, it most often applies to food that has a greater impact on our body’s inherent pathways for consumption. These include processed foods, foods high in opioids, neurologically stimulating foods and occasionally, foods that the individual is intolerant towards.

Processed Foods constitute the bulk of food addictions in the modern era^[15]. They contain more addictive substances, are higher in calories and much lower in nutrients than unrefined foods, which serve to balance the metabolism and properly correct energy deficits. Recent research on animals has shown that highly processed foods are also capable of inducing withdrawal symptoms, compounding their addictive potential.^[16]

The “Food Intolerance Cycle.” As counterintuitive as it may sound, those with food intolerances often crave the food they are intolerant towards, in some cases making these foods some of the most addictive. This usually pertains to the fact that the food contains one or more vital nutrients that the individual needs, yet they are unable to digest or absorb the nutrient. Digestive difficulties often give rise to symptoms of allergy or sensitivity, due to the incomplete breakdown of solids in the gut. This can lead to a mildly vicious cycle in which consuming the food leads to more symptoms, reduces nutrient absorption, and results in further cravings for the food. Enhancing digestibility and supplementing the missing nutrient elsewhere in the diet often reduces or negates the “food addiction.”

Risk Factors

The following list summarizes known risk factors that can increase the chances of developing a food addiction:

• Prior or Current Substance Abuse Disorders. Chronic substance abuse is known to promote brain changes that threaten to concretize addictive behavior permanently in an individual. These brain alterations share a similar overlap with all types of addiction, including food addiction^[17]. Those with current or prior substance abuse disorders often have or go on to have food addictions or even eating disorders.
• Pre-existing Eating Disorders. Bulimia nervosa and binge eating disorder are both known to substantially increase the risk for food addiction and often occur with symptom overlap. As seen in substance abuse disorders, eating disorders equally promote brain changes that can enforce cycles of addiction, especially those pertaining to food.
• Severe Stress, anxiety or trauma. Stress serves to inhibit dopamine, which can increase reward-seeking behavior motivated by relaxation as well as addictive behavior. Comfort eating is a classic example of stress-induced food addiction. Additionally, the opioid system in the body can be inhibited through heightened stress levels (increased cortisol and adrenocorticotropic hormone), implicating chronic stress as a potential trigger for craving sweet things.
• Depression. Depression is a very common risk factor for food addiction^[18], due to being constituted by neurotransmitter imbalances in the reward pathway, stress, and various energy deficits that promote motivation loss, fatigue and more.
• Metabolic Diseases. As explained above, energy deficits add to the risk of developing food addictions in an effort to maintain stable energy levels. Metabolic diseases are characterized by energy deficits, particularly faulty insulin signaling and neurotransmitter release. Examples include metabolic syndrome, obesity, cardiovascular disease, non-alcoholic fatty liver disease and chronic fatigue syndrome.
• Pain-related disorders. Pain is a source of physiological stress that, if chronic, can promote energy deficits and a blunted response to the opioid system. All three of these factors can lead to a decrease in the reward experienced that can cause the individual to indulge in a food addiction to compensate.
• Sedentary Living. Low levels of physical activity have been linked to promoting lower energy levels and increased food consumption, which may encourage food addiction onset. On top of regulating our energy levels and overall metabolism, exercise is vital for sustaining balanced neurological activity and neurotransmitter release.
• Gender. Women are more likely to develop food addictions and eating disorders than men. This is possibly due to there being a higher prevalence of pertinent risk factors amongst women, including depression, pain-related diseases, stress, sedentary living and pre-existing eating disorders.
• Age. Children, adolescents and young adults are more prone to developing food addictions than elderly individuals, who often have reduced appetites.
• Genetics can increase the risk for energy deficits, growth and developmental abnormalities, and various neurological conditions which can substantially increase the likelihood of an individual developing a food addiction later in life.

Food Addiction Vs Substance Use Disorders: Could Food Be More Difficult to Beat?

Could food addiction be more difficult to overcome than a substance abuse disorder? Food Addiction reflects many similarities with drug addiction and substance abuse disorders. Those with substance abuse disorders also often have food addictions.

The following section discusses and compares food addiction to substance abuse disorders in an effort to answer the above question.

Food is More Easily Accessible. In some cases, food addiction may be more difficult to overcome, as eating is essential to survival and food is both cheap and widely available. Therefore, the food addict will encounter their drugs of choice whenever they go grocery shopping. A drug addict can more easily avoid their drug of choice, despite experiencing more intense withdrawal symptoms.

Food Commonly Brings People Together. Most people socialize over food, give food as gifts and integrate eating habits into their social lives. Hence, it may be more challenging for a person with food addiction to put an end to their addiction due to social pressures. A drug addict may find it easier to drop all ties with friends and associates that engage in substance abuse, as the drug is not an essential component of survival or socializing. Moreover, many street drugs disassociate the abuser from their surroundings, often preventing the abuser from forming close social ties with others. For a food addict, this is not the case. Friends and family of the food addict may be less understanding, either promoting the food addiction through gifts and offers, or through becoming too controlling of the food addicts eating habits, and unintentionally driving the behavior.

Food is Less Harmful, Yet May Be as Addictive as a Drug. Overall, the effects of food consumption share a significant overlap with the consumption of many harmful addictive substances, including alcohol and methamphetamines. However, most will agree that the consequences of substance abuse are far worse and far more noticeable than that of food addiction. Despite food addiction being harmful to health, those with food addiction may not be as motivated by the consequences of their actions to quit the behavior. A drug addict potentially has more reason to overcome their addiction due to the greater degree of damage it causes in a shorter space of time.

Food is Not Taken as Seriously as Abusive Substances. People’s general attitudes about food are vastly different from their attitudes about abusive recreational drugs. Those with food addiction often do not need to hide their activities and can easily perpetuate their addictions publicly without being noticed. Food is not illegal to consume, nor is it restricted or limited to certain conditions or age groups. While most people have a general understanding of healthy eating, most people don’t feel the need to be fully healthy until it begins to have a noticeable impact on their health. Even then, some people are limited by their budgets or their misconceptions of health, which often substantiates the view that a healthy diet does little to nothing to improve their well-being. This hinders the food addict’s ability to put an end to their habits.

Possible Treatment Options

Food addiction is usually treated through implementing lifestyle strategies that aim to improve overall health, such as:

Education. In a 2-3 month long trial, educational programs coupled with a low-carb diet plan and social support showed great promise in treating addictions to processed foods in 103 participants. Results included significant reductions in food addiction symptom scores, an average weight loss of 2-3kg over the period, and an improvement in general mental well-being^[19]. Education can enhance the participants understanding of their health and improve their relationship with food, allowing them to get actively involved in correcting the problem.

Self-Discipline. Studies show that addicted individuals who actively attempt to resist their cravings, increase activity in this portion of the brain, which leads to decreased activity in the brain areas associated with addictive reward. This emphasizes that the individual is able to intervene by applying self-discipline. It is advisable to devise an eating program or schedule that one can stick to, that includes calculated healthy rewards, in order to develop discipline with regard to eating behavior.

Removing Cues. The brain intelligently creates neural networks that fire with more efficiency, the longer they are practiced. In the case of food or any other kind of addiction, the addictive food or substance serves as a visual cue for activating the network in anticipation of a reward. This results in behavior that leads to the food or substance’s consumption. Removing any cues or reminders of the addictive food is helpful in lowering the activation of the reward pathway, which can help prevent the addictive behavior from taking place.^[20]

Build a Focus for Health. As part of the biology underpinning addiction, brain areas pertaining to attention and focus are often hijacked for the purpose of reward-seeking behavior. It is important to intervene and build a focus toward the goal of breaking the addiction, shifting one’s attention to healthy behaviors. Reminders that one is quitting, avoidant thinking pertaining to the addiction and dedicating time daily to healthful activities can go a long way toward shifting one’s focus. Social support may also be indispensable, particularly as eating is often not viewed as a harmful activity.

Practicing Nutrient-Dense Caloric Restriction. Fasting and/or lowering food intake is one of the best ways to regulate the systems that govern appetite, particularly in the case of overeating. The foods consumed ought to be eaten at appropriate times, in appropriate portions and ought to be highly nutritious and low in calories, consisting of a healthy balance of whole foods (the opposite of highly processed addictive foods that are known to unbalance the appetite). This will give the body a chance to rectify faulty receptor expression and levels of chemicals involved in regulating appetite, metabolism and reward, including:

• Leptin and its receptors, allowing the body to build back up to a point where one can experience optimal satisfaction after eating.
• Insulin receptor expression and insulin levels, encouraging the normalization of blood sugar levels. This will also promote the use of excessive glycogen and fat stores, which are often left to accumulate in scenarios where insulin signaling becomes faulty.
• Dopamine levels and receptors, as low caloric, nutritionally balanced meals are not likely to trigger the reward pathway in the brain as much.

Exercising. Adequate physical activity can help to regulate metabolism and appetite, as well as enhance energy levels. It is recommended to get at least 150mins of moderate-intensity exercise per week, however, some individuals may require more.

Spending Time on Healthy Rewarding Activities. Rewards form an inherent part of our biology and are not to be disdained when put to good use. In the case of addiction, the brain is primed for reward due to being unable to acquire as much as it once could from rewarding stimuli. During recovery, this need for reward can be used to encourage healthy behaviors, such as exercising and healthy recreation. The reward inherent in these behaviors involves achievement, the development of skills and self-discipline.

Cognitive Behavioral Therapy is sometimes used to treat food addiction in the context of an eating disorder, such as bulimia nervosa or binge eating disorder. It is generally recognized that those with food addiction alone do not require such intensive therapy in order to overcome their addiction.^[21]

Pharmaceutical Interventions are prescribed to patients with food addiction who have an underlying psychiatric disorder, such as depression. In these instances, treating the psychiatric condition often helps the food addiction symptoms, however, other strategies that aim to improve overall health are also usually required.

Conclusion

On a neurobiological level, food addiction looks almost identical to other substance abuse disorders, where the addiction is able to hijack the individual’s behaviors and give rise to withdrawal symptoms. Addiction to food can be more difficult to overcome, due to the fact that it is under-recognized, stigmatized, easy to indulge in and sometimes even encouraged by societal practices. More effort should be made to enhance awareness about the consequences of overeating and the benefits of leading a healthier lifestyle. Treatments for food addiction include education, social support, taking control of one’s eating habits, consuming nutritionally balanced foods, exercising and engaging in healthy, rewarding activities.

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