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Episode 16

  • Can you be addicted to food?

  • Is it possible to find recovery from food addiction?

  • What should therapists know about food addiction?

Food addiction is a real thing, even if the DSM doesn’t say it yet.  Food addiction is not an addiction to eating, it’s an addictive reaction to types of food and ways of eating. Today is the second part of the podcast where we will examine the current science on the topic of food addiction.  If you didn’t get a chance to listen to Part 1, head over to episode 15 to listen to the interview from last week.

In this Podcast: 

  • Binge eating disorder is the most recent addition on food related issues to the DSM
  • Binge eating disorder is not the same as food addiction. There are overlapping symptoms, but they are distinct concepts. 
  • Current research asserts that food addiction meets 4/11 criteria in the DSM and the other 7 seem plausible as well
  • Research has found clear connections between the brain processes in substance addiction and those found in people experiencing food addictive behaviors.
  • Hyperpalatable foods are at the center of the discussion about food addiction
  • Hyperpalatable foods are foods that have an increased level of fat, salt and carbohydrates, usually a combination of the two is needed. 
  • Estimates put hyperpalatable foods at 60% of the United States food supply.
  • Hyperpalatable foods are designed to increase the dopamine spike that naturally occurs when eating. 
  • Tolerance (addictive process) makes the brain require more dopamine and so more hyperpalatable foods are “requested” (via cravings) by the body
  • A body being flooded with hyperpalatable foods is less likely to want healthier options because they don’t have the ability to spike the dopamine as high as the engineered food. 
  • Research has shown that thinking about eating certain foods raises the dopamine levels in people with food addictive behaviors. Additionally, that the food cue raises the dopamine level higher than actually eating the food. 
  • Much of the diet industry is founded on moderation and food addiction suggests that moderation may not be available to all people
  • This has implications for our work as therapists in helping people who come to us with issues related to food and ways of eating
  • A measure of food addiction was created by Yale and is linked below
  • Food addiction is not an official diagnosis, but is being considered for future inclusion

Helpful Links:

What Is the Evidence for “Food Addiction?” A Systematic Review

The Neural Correlates of “Food Addiction”

Yale Food Addiction Scale (YFAS) | Measurement Instrument Database for the Social Sciences

Food addiction as a new piece of the obesity framework | Nutrition Journal | Full Text

Food addiction: a valid concept? | Neuropsychopharmacology

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

From Passive Overeating to “Food Addiction”: A Spectrum of Compulsion and Severity

Fighting food addiction

Food Addiction in the Light of DSM-5

Which Foods May Be Addictive? The Roles of Processing, Fat Content, and Glycemic Load

Breakdown of dietary restraint following mere exposure to food stimuli: interrelationships between restraint, hunger, salivation, and food intake – PubMed

The effect of pre-exposure to food cues on the eating behavior of restrained and unrestrained eaters – PubMed

Frontiers | Food Addiction in Gambling Disorder: Frequency and Clinical Outcomes | Psychology

Most Food in America is Hyper-Palatable and ‘Difficult to Stop Eating,’ Scientists Say

A commentary on the associations among ‘food addiction’, binge eating disorder, and obesity: Overlapping conditions with idiosyncratic clinical features – PubMed

How Food Addiction Works (and What to Do About It)

The Brain Hungers for Dopamine – Neuroscience News

Binge Eaters’ Dopamine Levels Spike at Sight, Smell of Food | BNL Newsroom

Binge Eating Disorder: Symptoms, Causes, and Treatment

Free Treatment Planning Tool  www.betsybyler.com/treatmenttool

Transcript:

You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler, and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and confidence needed to add substance use to their scope of practice.  So join me each week as we talk about All Things Substance.

Welcome back. I hope you had a chance to listen to Kelly Coffey’s interview from last week.  This week, we’re going to talk about food addiction; what the current science has to say about it. The DSM added binge eating disorder in its last iteration. This is a big step  in addressing eating issues that aren’t anorexia or bulimia. 

For a long time,  those are the only few things that we had.  Binge eating disorder was something that they included and that I do think is a step in the right direction.  However, it’s not the whole story. 

Binge eating disorder includes symptoms such as: eating much more rapidly than normal, eating until uncomfortably full, eating large amounts without feeling hungry, eating alone due to feelings of embarrassment or shame, and feelings of guilt or disgust with oneself in relation to their eating patterns.

When we’re talking about food addiction, we’re looking at a few different concepts that are really specific to addiction.  As I’ve been in different groups online, I’ve noticed people throwing the word addiction around to mean something that someone does too much or seems to be fixated on. And I understand the use of the word when it comes to those things, as it’s kind of a shorthand. The problem though, is that addiction is a medical term and it is something that has a specific meaning.

I feel like the average public can go ahead and use that term however they wish.  As therapists though I feel like we have a higher responsibility to make sure that we’re using terms in the right context. We know that there is always a power differential when it comes to our clients, they really do trust our word and a lot of times aren’t going to question what different therapists say.   It’s not because they’re ignorant or just want someone to tell them how to do things, but because they trust that our training has taught us these things.

 When we apply that to the world of addiction and we’re using the word addiction in casual ways that don’t actually mean addiction, I think that it might be misleading.  We wouldn’t say that someone’s “so bipolar” because we know that bipolar disorder is really specific . But the average population of people, they do use the word bipolar to mean someone who has mood swings and not specifically  manic and depressive episodes.

Addiction has a really specific meaning as being physically and mentally dependent on a particular substance or behavior. It’s a chronic disorder with biological, psychological, social, and environmental factors influencing its development and its maintenance.  If we look at that definition and then binge eating disorder, we can see that there is quite a difference between the two. They’re similar, but not exactly the same.

Criteria for addiction, according to the DSM, includes 11 bio-psychosocial symptoms grouped into four categories. Those four categories are: social impairment, risky use, impaired control and pharmacological criteria.  The last one, referring to things like tolerance and withdrawal.

The current evidence puts food addiction as being able to meet four out of 11 of those with definite evidence backing it up.  The other seven are plausible, but don’t have scientific backing at this time.

I should  state that there are people who believe that food can’t be an addiction because it is a basic biological need, much like sex is also a basic biological drive. More research is needed in order to clarify what we’re talking about. 

Sometimes in the literature binge-eating and being overweight are used synonymously along with food addiction. However, the research does distinguish between the two saying that they are related concepts and that there are overlap, but that they are also distinct.

In one study, it was found that the number of people  that had binge eating disorder symptoms, 56.8% of them also had food addiction behaviors. Further found that 24.9% of overweight individuals listed food addictive behaviors and 11.1% of average or healthy weight individuals reported food addictive behaviors.  

The idea being that while food addiction can contribute to being overweight, it’s not necessarily a prerequisite. There are healthy weight individuals who struggled with food addiction as well. There are biological factors in addiction that are also found  in people who struggle with identified food addiction behaviors.

One of those factors is the brain pathway and the reward center.  I think that most of us know that there are foods that light up the brain reward pathway in a similar way to drugs and alcohol.   One of the findings that might not be super well known is that there is something called a Delta FOSB expression and this has to do with the opioid expression in the brain.  Delta FOSB is a splice variant  of the FOSB gene. Which directly and positively regulates drug self-administration and reward sensitization through positive reinforcement while decreasing sensitivity to aversion.

I’m not going to get too far into the different genes and the transmitters that are happening in the brain, mainly because it is not my area of specialty.  I think that the articles already do a great job. So if you want to know more about that, please look at the show notes so that you can see the links that I’ve cited.

A number of studies have observed clear biological and behavioral similarities between drug use and overeating such as:  altered dopamine expression, cravings,  relapse to highly palatable food, impaired control over the behavior, neglect of relationships and role obligations and continued problematic behavior in the face of negative health outcomes.

There are common behavioral symptoms between food addiction and substance use such as relapse and increased use of amount of food. There’s common psychological factors such as preoccupation and impaired control. And there’s similarities between the consumption of hyper palatable foods and the use of addictive drugs.

Let’s talk about hyper palatable foods. If you listened to last week’s episode, you heard Kelly Coffey talk about hyper-palatable foods, and you may have seen it in the news from time to time.   Hyper-palatable foods do not refer to a specific macro nutrient found in a given food. Instead,  this is a combination of macronutrients that are put together in a man-made way into new foods. The combination of these macronutrients is not found naturally, but instead have been created. 

Hyper palatable foods are things that are high in fat, salt, and carbohydrate. Now it typically is the hyper palatable foods are high in at least two of those things, not one at a time. So high in fat and salt, high in salt and carb , high in carb and fat.  Those are considered hyper palatable foods and some studies have found that 60% of the foods in America are hyper palatable.

The modern food environment has been described as being a toxic food environment, exemplified by the increase of chemical additives and flavor enhancements in our food supply.  Some have even suggested that the highly processed foods we eat would be more correctly labeled food, like products, to distinguish them from natural sources of energy, like fruits and vegetables that comprise the diet of our ancestral predecessors.

So when we eat food, just regular normal, healthy food, there’s a dopamine spike. This is just a natural part of our body’s function and was designed, make sure that we eat by giving us pleasurable feelings.  Our body is set to want pleasurable feelings and to want them as much as possible and at the highest level possible.

And so in come hyper palatable foods. What happens if a food is engineered to increase dopamine in the system to a higher degree?  This is what they have found with hyper palatable foods.  

Consuming hyper palatable foods { remember they are high in fat, salt, and carbohydrate in some combination} that when those foods are consumed, the dopamine spikes higher.   However, it only spikes higher for a particular amount of time. Our body gets used to the extra dopamine rush and starts wanting that instead of an average amount. .

What this means is that when someone’s eating hyper palatable foods on a consistent basis,  they’re going to be less likely to want to consume average palatable foods  that occur naturally.   So an average healthy option doesn’t seem as appealing because it’s not going to give your body the dopamine spike.

So let’s say that somebody is eating a steady diet of hyper palatable foods for the most part. Things that are processed, that have a lot of additives and are really shelf stable.  Fast food, a lot of quick foods, things that are designed to give you a quick rush of carbs  and have been given a lot of additives to make them taste better.

So in that person who has a steady diet of hyper palatable foods, an average level of food so apples, oranges, green beans, asparagus, any of those kinds of things; they’re not going to taste as good because the palate is used to having this high concentration of those three macronutrients.

These foods don’t have that,  their flavors are going to be more subtle because they’re not enhanced chemically and they’re not going to cause that hit.   The person’s body is going to be wanting that hit again, whatever it is. And they’re more likely to crave those foods and more likely to go back to them. And the research supports this.

This isn’t necessarily food addiction. It is just an example of how these hyper palatable foods affect people. So let’s take that example and put it on somebody who has a predisposition for addiction, that they have the genetic variants that make them more likely to become addicted to something.

Hyper palatable foods are able to meet those needs. Now, of course, they’re not going to have the dopamine release of a drug or alcohol, it’s just not. However, our brain scans show us that they are lighting up those areas. Particularly chocolate has been found to light up those areas. Remember that we’re talking about addiction.

The brain is making changes and requiring more and more dopamine because there’s no longer the same sensitivity to an average level of dopamine in studies that they’ve done.  In studies that have been done they found this to be true.

Over time a person with a steady diet of hyper palatable foods is going to need to eat more of those in order to meet the same dopamine spike. In episode seven, when we talked about the brain science, we talked about the fact  that an addicted brain has heightened sensitivity to negative feelings and decreases sensitivity to pleasurable feelings. So a person is getting less pleasure from a pleasurable activity in this case, eating and the negative feelings associated with not getting enough of that are heightened for the person. This is why it is so hard for people to stay away from certain foods. 

There’s been a lot of information in the news talking about sugar and  the assertion that the sugar industry paid off scientists to say that fat was the problem rather than sugar.  Well, it sounds plausible to a lot of us because money drives a lot of things. We do know that what happened was things became low-fat all over the place.  

If you look at the rates of obesity in our country, that’s when they started to spike really high.

So, as we found things that were low fat, they jacked up the carbohydrates, jacked up the salt, jacked up the sugar to make up for the lack of fat.  

You could put a sticker that says a hundred percent fat-free on a 10 pound bag of sugar and technically that would be correct.  We know that foods high in sugar aren’t great for the system because they don’t really give us much,  but a spike in energy and dopamine, and then a crash following. We’re encouraged to eat foods that are more nutrient dense .

None of the state of our current food industry is an accident.  Most food companies that are making these hyper palatable foods are doing so in a way that they want people to consume them more often and more of it because it relates to higher profits. The rising obesity epidemic is not their problem.  If they can make a food taste better, if they can make it more cheaply,  if they can make it more desirable, then that’s what they’re going to do. 

Marketing of these foods is also not accidental. This is how smells are used to entice people in order to buy things.  When you walk into a grocery store and you smell the bakery, or you smell things cooking, you are drawn to those things. The way grocery stores are designed,  in order to get the staples you have to go on the outside of the store, which means you have to pass by every aisle of all of the processed foods. And there are shiny end caps to show you different products that you didn’t know you needed. So instead of putting all of the naturally occurring foods in one section of the store and all of the processed foods in another section of the store, you have to walk by all of them. That is not accidental.

In the U S we have a huge diet industry and it is no coincidence that I’m publishing two episodes about food right before new year’s and right after new year’s. Because at least in the United States, this is the time when people are talking about food and diets and exercise. 

Most of the diets that are put out commercially  are putting out the message that you can have any food you want, you just have to be smart or you just have to do it in moderation. That works for some people.  In order to make one of those diets work, moderation has to be available to you. 

The thing about food addiction is that it’s not something that you’re addicted to every food. You’re not addicted to eating.  The problem comes with certain foods or ways of eating.  That is really different for each person based on their genetic makeup.  Just like some of us, like one food and others don’t.

For instance, people love cherries, right?   I’m talking about the fruit. And I think the flavor of cherry is the worst flavor on the planet earth followed only by beets, which tastes like dirt and coming in a close third is celery or celeriac root.  Now, there are some of you listening who love all three of those things. Why is that? I don’t know. It’s just part of how our palates developed. Hyper palatable foods are meant to make up the differences. 

Most people think that hyper palatable foods tastes good. If you aren’t used to eating them, they probably don’t taste good to you because there’s a lot of stuff in there that  your body’s not recognizing as food, , but average Americans have a lot of hyper palatable food in their diet even if they’re not going to fast food all the time. This makes average healthy foods seem  dull and boring and sometimes like punishment.  You have to eat your vegetables in order to get your dessert. 

Our body responds to things that make us feel good. And it used to be, our bodies were designed to feel good when we ate food to encourage us to do it more so that we survive. Now that’s not really the issue in a lot of countries.

So let’s take January 1, for instance.  Lots of people are going to go on a diet. They’re choosing various diets for various reasons. Could be something that their doctor told them about could be something that they read about could be something they got in the mail could be something they saw on the internet. They’re choosing something that they feel like this might be the thing that works for them.

People are going to go on these diets and some of them will do pretty well for awhile. The problem is that eating in that kind of a way where you’re restricting some or all of different kinds of foods,  isn’t necessarily sustainable for life.  

So what happens is people get through that initial time and they decide that they want to go back to eating somewhat normally. And some people can. What tends to happen though, is that the weight comes back.  If you look at the research, the number of times that people gain weight back, and then some is staggering and demoralizing for people.

What if your body, or in our case our clients, don’t relate well to certain foods. And what I mean is , when they eat a certain food, that they don’t feel satisfied, they want more. Alcoholics Anonymous was based on the fact that when people who were alcoholics drank alcohol, that their body wanted more. They had an abnormal reaction to alcohol. It wasn’t Oh, this tastes good. And I’m fine now I don’t need to drink more. It was, this tastes good. I want all of it.

So what if there are certain foods or ways of eating that people don’t relate well to and the message of the diet industry is you can have anything you want just in moderation. The idea being that moderation is available to everyone when it isn’t.  Some people can have one or two bites of a thing and they feel satisfied and they don’t have cravings for more. There are going to be a subset of the population who, for them that does not happen. 

Moderation is not available to them around certain foods and it’s not necessarily, Oh, all white sugar is garbage and you have to get rid of it or white flour or carbohydrates or whatever.  It’s going to be really specific.  What food addiction is saying is that there are biological processes here that are at play.  That dopamine is getting spiked, that they’re getting more and more immune  to average level dopamine spikes from regular food.  Their body is getting desensitized to things and not recognizing consequences as easily as they used to. 

So let’s say an average person overeats to the point that they feel sick or even throw up. The normal response to that is not to eat that way again. That is not the way for people who struggle with food addictive behaviors, they will do that again.  Because while the experience was unpleasant, their body is in an addictive process where they are more prone to forget the details of that. Decide that it wasn’t that big a deal and they might as well do it again. This can happen multiple times a day.

Part of the reason I wanted Kelly Coffey to come on the show is that she talks about this.  About one night, having eaten herself into feeling terribly sick, passing out from just , feeling awful, waking up and going to the fridge again, to start the cycle over. This isn’t just binge eating. This is something driving it and it’s not necessarily emotions. Yes, there are people who overeat in response to emotion. Good, bad, bored. You name it.

They have found that food cues are more effective in spiking  dopamine than actually eating the food in a body that is in that addictive process. So what I mean is assuming the food addiction is a real process, which I believe it is. That a person who is addicted to a specific food, that if we map their dopamine spikes and watch what’s happening in their body, thinking about eating the food and getting ready to eat the food has a higher dopamine spike than actually eating the food. Meaning that they don’t enjoy eating the food as much as they do thinking about it. That isn’t something they probably know on a conscious level, but if they think about it, it’s there. 

That’s really similar with drugs, alcohol, and gambling. I was talking to a man last night who has a gambling podcast that I’m going to be on in a few weeks.  And he was talking about how the drive to the casino was great , that he was feeling on top of the world. I’m willing to bet  if we were able to follow dopamine spikes and the power of the processes in the body , before, during, and after a gambling session that we find the same thing.

It’s also the same with drugs. In some respects, drug cues and alcohol cues are spiking dopamine already when they start thinking about how much they’re going to use, how it’s going to feel, what’s going to happen and they’re getting ready and sort of doing all the ritual, for lack of a better phrase, around the use.

Addiction gets cued in to those factors.  

For someone using drugs, it could be a certain lighter, a certain outfit, a car, a place , music that they would listen to, people they would be with, smells, sounds. It just depends.  This is how our brain functions. Cues make us move towards a behavior. 

All of the signs that we see for fast food, for candy, pictures, things that we see are designed to make us move towards that object. We don’t see a lot of advertisements for broccoli or chicken that hasn’t been fried or doctored in some way. 

Because that’s not enough to trigger those things in our brain, unless we’re just truly hungry and not flooded with hyper palatable foods. When your palate gets flooded with these foods , it makes average food seem unappetizing. This can be a pretty nasty cycle.

It isn’t just about self-control or willpower. There are actual things happening here.   Proponents of labeling these behaviors as food addiction are not suggesting that someone is addicted to all foods, they are suggesting that there are behaviors that are very similar to drug and alcohol behaviors that are happening in the body of someone who is addicted to these specific foods.  The idea being that if you remove those foods, if you remove the substance that causes craving that the cravings will disappear.  

You might be wondering what these behaviors are.   Well, there are a few measures. One of the main ones is called the YFAS which is  Yale Food Addiction Scale. It’s available online. I’ll put the link in the show notes so that you’re able to take a look at these behaviors. 

The implication for us as therapists has to do with people when they come in wanting to talk about their weight and body image. They’re going to come in talking about whatever thing they’ve tried or whatever thing they’re going to try and our job is to pay attention to patterns. 

What are they talking about?  What kind of foods do they keep coming back to? How do they feel about it? What kind of behaviors do they have that they’re not telling you about? There’s a lot of hiding and lying and covering up behaviors that people do when they’re eating in these ways that’s happening and they’re not going to necessarily share because there’s a lot of shame about it.

Our job is to pay attention and just watch. It’s not a matter of us having to figure out how to fix them. We’re looking for ways that keep tripping them up and encouraging them to maybe think about. What would it be like if you didn’t eat that food anymore. 

The United States has figured out how to capitalize on our biological processes and use them against us. I’m speaking about the United States only because I am not certain what the food systems are like in other countries. I do know that we have one of the highest obesity rates and that we have so much information about health and food and wellness and messages everywhere and it doesn’t seem to matter. 

This is why a lot of people who have bariatric surgery end up gaining the weight back because the amount of food wasn’t the problem.  It was the ways of eating.  What they found in research is that when someone has food addictive behaviors, appetite suppressants don’t work. Because it’s not about appetites.

There’s some evidence to suggest that using a medication called naltrexone, which is an opiate blocker, has some efficacy in helping with food addiction. Because what it does is it’s blocking part of the reward pathway from that  opioid expression in the body.  That may be helpful in food cravings. This isn’t about needing a stimulant to curb appetite, because it’s not about appetite this is about a purely pleasure driven process.

So as you look around and you see all these advertisements  for different diets and wellness plans, just keep all of this in mind. I find it really interesting to see what thing each program is promising. And I wonder if it’s more simple than what they’re looking at. Maybe it’s not eating hyper palatable foods  and letting your body return to its normal state.

If there’s an addiction though. There will not be a day that that person can go back to eating that food normally, because tolerance is a thing and addiction is progressive. 

The concept of food addiction is controversial.  It is being debated and the science is happening as we speak. I agree with Kelly, as she said last week that the science is moving in the right direction. I believe that it is. And that eventually we will have a clearer picture.

Another topic that’s controversial that I mentioned earlier is sex and whether it can be an addiction too. So we’re going to delve into that topic in the next couple of weeks,  I’m going to be interviewing some experts on this topic and bringing you the information.

Thanks so much for joining in, and I hope We all have a great new year.

If you’re ready to take the next step in addressing your client’s substance use head on over to betsybyler.com/treatment tool. The treatment planning tool I created will help walk you through the process of evaluating your clients use and deciding how and when to intervene. The tool is completely free and will be delivered to your email so that you can use it right away.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist, friends, and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast and until then have a great week.

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