All about Food Addiction
by Ryan Andrews

Summary: many behaviors qualify as addictions — things we feel overwhelmingly compelled to do, despite the consequences. What’s food addiction, and how can we treat it?

When asked what substance he was first addicted to, guitarist Eric Clapton answered: “sugar.” and we all know the person who kicked the “hard drugs” only to become reliant on food as their “go-to” addiction of choice.

So, are we all doomed for food addiction?

Well, 97% of people prescribed opioid painkillers (with no history of addiction) don’t become addicts. and most of us wouldn’t rob a 7-11 for candy bars if the price of candy bars became unaffordable. but some people are more susceptible to addiction, whether it’s opioids or candy bars.

Thus, addiction is complicated: Social, motivational, emotional, and genetic factors all interact to create an addiction experience. An addictive substance alone doesn’t create addiction. However, some things are more addictive than others.

We often joke “I’m a ______ addict”, whether that’s video games, shoes, or ice cream. but what, exactly, is real addiction? and is it a useful concept for understanding food behavior?
What is addiction?

Addiction is an overpowering craving to repeatedly engage in an activity that provides temporary relief at the expense of terrible consequences. It’s something you feel compelled to do, even though it harms you.

To count as an addiction, there must also be withdrawal — feelings of discomfort, distress, and intense cravings – when our addictive substance or behavior is taken away or stopped.
What is food addiction?

Thus, food addiction involves a regular compulsion to eat and/or consume particular foods, even though those foods harm us — whether that’s because the foods are unhealthy (e.g. high in sugar), or because they make us sick, or cause us to become obese.

An occasional big meal: not addiction. regularly eating so much, and so rapidly, that you end up bloated and nauseated — but feel unable to stop? potential addiction.

After having a couple of cookies (or any potentially addictive food), a non-addict will feel indifferent about eating more. The experience of an addict is much different. Addicts become utterly single-minded in the pursuit of their “hit”. eating a couple of cookies (or any potentially addictive food) sets off an abnormal reaction – and they want more and more until they’re physically unable to swallow.

If you aren’t an addict, it’s not that you are a master of self-control, you just don’t have an insatiable appetite for more.

A food addict can be:

an overweight woman who is always trying Camiseta SS Lazio a new diet
a man who eats beyond fullness at dinner after snacking on junk food all day to help deal with job stress
a thin woman who never eats enough and is hungry all the time because she’s afraid of getting fat (in this case, her “hit” is not eating)
a lonely guy with nothing to do on a Friday night except watch TV and eat several bags of chips
a person who snacks all day to ease the boredom of an un-stimulating life
a perfectionist who is never quite satisfied with their body
a person suffering from a nutrition related disease (e.g., heart disease, diabetes, etc.) who gets disturbingly resistant when presented with treatment approaches

Some food addicts eat too much; some don’t consume enough. For a food addict, food provides the fun, entertainment, control, reassurance, or love that’s missing in their life. Food may also help to numb difficult emotions like fear and sadness. Some people even have addiction to restriction.

The Yale Food addiction test is a clinical tool for assessing food addiction (click to download in PDF).
Food dependence

But here’s the problem with determining food addiction: Unlike, say, heroin or gambling, we need food to live. Without an innate desire for food, we can wave bye-bye to evolution.

At what point does “big appetite” end and “food addiction” begin? and can you technically become “addicted” to something you need?

Researchers, while divided on the exact definition of “food addiction” or whether it truly exists, nevertheless agree that addiction is a pattern of behavior characterized by things like:

-near-constant searches for a “hit”
-an intense compulsion and/or desire for the substance or behavior
-strong, all-encompassing focus on getting that “hit”
-withdrawal symptoms when the “hit” is taken away
-needing more, or more intense “hits” as tolerance develops over time

By this definition, nearly anything — including food, water, or sex (i.e. things that are part of basic biology) — can be an addiction.

So let’s call it “food dependence”.

Over time, food (substance) dependence often becomes less about the high and more about preventing the negative feelings that come from abstinence. The ability to get pleasure from the food becomes more difficult, because small amounts of the same food aren’t as rewarding.
Substance dependence: official definitions

The Diagnostic and Statistical manual of mental Disorders (DSM-IV) defines “substance dependence” as 3 or more of the following 7 symptoms occurring within 1 year. We’ll look at how these might relate to food dependence.

Symptom 1: I use more over time.

Over time, tolerance increases.

Food example: When I used to buy groceries, I would take them home, eat a snack and go on with my day. now I buy groceries and I eat all day long until I have gone through half of what I bought.
Symptom 2: I have withdrawal symptoms.

I now take the substance to avoid withdrawal.

Food example: I eat processed snacks to correct being tired and/or depressed. To fix anxiety, I eat something crunchy, like chips or crackers to calm myself. I am afraid if I stop using food to correct my emotions, I will have nothing else to turn to.
Symptom 3: I use more than I intend.

Food example: One bowl of ice cream turns into 2 bowls, then 3 bowls. I start with one handful of chips and end up eating the whole bag.
Symptom 4: I’m trying or have tried to cut back.

I want to reduce my intake, and I’ve tried, but haven’t been successful.

Food example: I have tried to cut down or stop my eating, but it’s always on my mind and I find a way to defeat myself, even making a special trip to get a candy bar or chips.
Symptom 5: I spend time pursuing, using, or recovering from use.

I spend a lot of time on activities necessary to obtain the substance, or recover from its effects.

Food example: I will have a list of chores to do on Saturday. I will go to the store and buy groceries and spend the rest of the day eating what I bought, taking antacids, and sleeping.
Symptom 6: I miss important activities because of my substance use.

I miss or give up important social, occupational, or recreational activities.

Food example: I come home and eat. Then, I’m too full to exercise or meet with friends.
Symptom 7: I eat despite knowing the consequences.

I continue to abuse the substance despite knowing it’s giving me a persistent or recurrent physical or physiological problem.

Food example: I eat in spite of horrible knee pain from obesity. I’m so uncomfortable after a binge that I can’t lay down without regurgitation into my esophagus. My blood pressure is high. I’m miserable. I am embarrassed and afraid about being in social situations but I overeat anyway.

Time magazine graphic: Addiction: What happens in the brain?
What influences food addiction?

Many factors play a role in the development of food addiction.

Fear: Addicts may fear eating a reasonable amount of food, getting fat, and/or experiencing uncomfortable emotions and hunger.

Chronic overeating: eating too much of highly processed foods can stimulate brain opiates — “feel good” chemicals. regular bingeing might create a dependency on this “natural high”. We become dependent on a highly processed diet to feel “normal” and experience withdrawal symptoms when we don’t eat it.

Food restriction: What if I told you that starting tomorrow you could never have ice cream again? What would you do today? probably eat a bunch of ice cream – right? Cravings and reward responses from food are greater after a period of food restriction (whether real or imagined) and/or nutrient depletion. This is why diets and extreme restriction almost inevitably lead to binges.

Stress: various forms of stress can trigger addiction. Binging + food restriction + stress = a winning combination for food addiction. addiction can lie dormant when things are going well, then rear its ugly head when life trouble strikes.

Depression: depression usually changes appetite, hunger, and fullness signals, as well as sleep patterns (normally, good quality sleep helps us manage urges — sleep is “willpower fuel”).

Weak satiety mechanisms: Some people who struggle with food addiction aren’t as tuned in to their fullness cues. They “hear” hunger signals more loudly than satiety signals.

Automaticity: Food behaviours can be strongly ingrained habits that “wear a groove” into our nervous system. Some argue that they can’t be eliminated — just rendered dormant (temporarily).
What makes food addictive?

Are all pleasurable foods automatically addictive? probably not.
Hyperpalatability

Processed foods are engineered in ways that exceed basic reward properties of traditional whole foods, making them hyperpalatable.

Consider items such as ice cream, burgers, candy, melted cheeses, buttery/oily sauces, and so on – these are the foods that stimulate the release of opioids and dopamine in the brain and have addictive potential (note: artificial sweeteners can even trigger a dopamine response).

Rodent studies confirm this: Rats are unlikely to binge on normal rat chow. but when given the option of sweeter and fattier rat chow, rats go on a bender.

The table below shows the characteristics of some “normal” foods and some hyperpalatable foods. notice how much higher in sugar, fat, and/or sodium the hyperpalatable foods are — and how many ingredients each food contains.

What differentiates regular from hyperpalatable foods? Source: Gearhardt AN, et al. Can food be addictive? Public health and policy implications. Addiction. 2011;106:1208-1212.

Other things can contribute to the addictive potential of food:

Quantity: When served more, we eat more.

Processing & energy density: The right mix of fat, sweeteners, flours, caffeine and salt provides a strong reward. plain sugar packets Camiseta Atletico Mineiro or a bottle of olive oil aren’t very desirable. processed foods have combinations of ingredients not found in nature. many food components, like drugs, are not addictive until extracted and concentrated by modern processing (a whole grain vs. white flour in cake, a whole fruit vs. sugar in cookies, cocaine vs. cocoa leaves, opium vs. poppies, etc.).

Variety: When there are different colours, sizes, shapes, tastes, and textures, we eat more. people will eat more cookie dough ice cream versus plain vanilla and more trail mix versus plain raw almonds.

Nutrient composition of foods: When we eat nutrient-poor foods, we may end Camiseta AZ Alkmaar up eating more overall food in order to meet nutrient needs.

Access: The number one factor in addiction is availability. If the substance isn’t available, we can’t develop an addiction. When the substance is readily available, addiction will be more common (think: cigarettes in vending machines).

Cultural norms: When a behavior/substance is accepted within a group, it’s unlikely that behaviour will stop. many folks cut down on or quit smoking when jurisdictions outlawed smoking in restaurants and bars.
Individual preferences

Think about what foods have an “addictive” potential for you. It’s important to consider these questions because any one food isn’t universally “addictive.”

-What foods do you crave?
-What foods do you think about you aren’t physically hungry?
-What foods do you want to eat more of, even when you’re full?
-What foods do you typically deprive yourself of — but later, feel unable to control yourself around?
-What foods have emotional associations for you — say, foods you remember from childhood, or foods that seem to have “special powers” to make you feel better?

Answers to the aforementioned questions don’t usually include barley, pears, asparagus and black beans (but it’s possible).

While whole foods in their most unprocessed form are still potentially addictive (think sweet fruits and fatty nuts), the potential for true dependence/addiction is low compared to processed foods (such as fruit candies and flavoured fatty nuts).
Treating addiction

People aren’t responsible for having an addiction, but they are responsible for dealing with it.

To treat addiction, you must address the following factors:
Food availability and environment

If you feel out of control with certain foods or in certain situations, you probably are.

Our behaviour depends heavily on social and environmental cues. We can adjust our behaviour by adjusting cues from our routine and environment.

Thus: avoid people, places, and things that trigger addiction. use social pressure to your advantage. Addicts don’t like to use their drug with sober people staring at them.

The more available — and socially acceptable — an addictive substance is, the easier it is to get hooked. Make it hard to get.
Emotions

Food doesn’t help resolve emotions. and emotions aren’t a bad thing. They actually serve a useful purpose in life and can indicate that something is out of balance.

Food can be used as a coping mechanism for emotions that feel intolerable. once a “food rush” wears off, we’re left with the very same emotional problems… plus the additional problems addiction brings.

Many addictions stem from uncontrolled stress combined w