Kay Sheppard, MA, LMHC, CEDS
Counselor Magazine, 28 September 2009 15:56.
“Show me a man who’s eating dessert, and I’ll show you a man who’s not drinking enough.” W.C. Fields
It seems Fields was an early observer of the sugar–alcohol connection. Is it possible that one can be as addictive as the other? Do refined carbohydrates trigger the addictive process? The term food addiction implies there is a physiological, biochemical condition of the body that creates craving for refined carbohydrates. We have come to understand that this craving and its underlying biochemistry is comparable to the alcoholic’s craving for alcohol. Science has begun to show us why.
Research has shown that food addiction is a biogenetic condition. Dedicated to understanding the biological/genetic basis of alcohol addiction, Dr. Ernest Noble and colleagues at UCLA have linked dopamine receptor D2 A1 to addiction. Previously linked to alcohol, cocaine and nicotine addiction, the A1 form of the reward/pleasure gene DRD2 has also been linked to carbohydrate craving and compulsive eating. Noble and his team found that a deficit of these dopamine receptors would cause subjects to be reward or pleasure deficient. To compensate for this deficiency, they discovered that alcohol activated the fewer D2 dopamine receptors stimulating the dopamine reward or pleasure system. According to Dr. Noble, “It is well established that food (particularly carbohydrates), like alcohol, when consumed, increases brain dopamine levels.” He and his team conducted and published a study in 1994, where they found the DRD2 A1 allele to be associated with obesity. “Thus,” he says, “individuals with the A1 allele, having a paucity of D2 dopamine receptors, have a deficiency in their dopamine brain reward system. To compensate for this state, they consume excessive amounts of food which eventuates in the development of obesity.” (6, 10)
Using brain imaging techniques, neuroscientist Gene-Jack Wang MD, observed that overeating behavior in morbidly obese individuals is similar to the loss of control and compulsive drug use seen in drug-addicted subjects. He and his team used PET scans to see if obese subjects had similar brain deficits. They measured brain dopamine reward/pleasure receptor levels in subjects with body mass index more than 40. They found these morbidly obese subjects had reductions in dopamine receptors, which were similar to those they observed in drug-addicted subjects. (7)
We now see that the brain of the food addict is predisposed to respond differently to addictive foods due to dopamine receptor deficiencies and that addictive foods stimulate and increase the transmission of the neurotransmitters dopamine and serotonin. When the brain is flooded with these neurotransmitters, euphoria results leading to the compulsive pursuit of a mood change by engaging repeatedly in episodes of binge eating. Tolerance builds, increasing the frequency and amounts of the substance needed.
How do addictive food substances compare to other addictive chemicals? Addictive substances are forms of plant life which have been refined or processed in order to be ingested by drinking, eating, inhaling or injecting. The refinement process facilitates quick absorption of substances into the blood stream which effectively alters brain chemistry and changes mood by flooding the brain with the neurotransmitters serotonin and dopamine. Food addicts seek this mood change by eating refined and processed carbohydrate foods which result in short-term highs. But what goes up, must come down, and the high is followed by a long period of depressed feelings. In order to avoid the low, the addict eats more. The food addict eats to feel better and always feels worse due to this flooding and depleting of neurotransmitters. (12)
As with all addictions, treatment and recovery are based upon abstinence from all addictive trigger substances. The need to abstain from addictive substances is common to both alcoholics and food addicts. Treatment of food addiction begins by introducing the concept of abstinence from addictive food substances.
But could sugar really be as addictive as cocaine? The findings of Serge Ahmed , PhD, University of Bordeaux, France, a scientist who specializes in addiction research, clearly demonstrate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals. His cocaine-addicted laboratory rats consistently chose sugar over cocaine. (9)
Studies by Avena, Rada and Hoebel, using laboratory rats demonstrate that the characteristics of sugar addiction are similar to the binging, withdrawal and craving experienced in drug addiction. Their findings indicate that sugar is potentially as addictive because it is a substance that acts on brain circuits such as the dopamine and opioid pathways. (3)
Most of our food supply has been processed and refined to point that it has become more a drug and less a nutrient. It is no surprise, although it is alarming, to see our country moving toward more refined and processed foods. Whole aisles of food in the grocery store contain no whole foods. The poor quality of our food supply is causing an increase in obesity and other health related issues. For food addicts, these highly refined foods act as mood-altering drugs with extensive negative health consequences. Refined food choices contribute to serious health issues: physical, mental and emotional creating a healthcare crisis. Nancy Appleton, PhD, has listed 140 reasons why sugar is ruining your health, in her recently released book, Suicide by Sugar. Her well researched list includes many health problems which could be eliminated by abstinence from refined and processed carbohydrates. (2)
You don’t have to be a researcher to recognize the poor quality of our food. Comedian Bill Maher in his 2005 HBO stand-up special says: “Last year we passed in our Congress this giant Medicare entitlement prescription drug bill… And it’s going to cost literally trillions and trillions of dollars. And while they were debating this, nobody ever stood up and said, ‘Excuse me, but why are we so sick?’ Could it be that we eat like Caligula? … Folks, it’s the food. I know that people hate to hear that. But when you look at those ads on the evening news at night, people…burping and bloating… Take a hint… You’re not going to die from secondhand smoke, or SARS, or monkey pox. It’s the food. The call is coming from inside the house. The killer is not West Nile or Avian Flu or shark attacks. It’s the buffalo wings. It’s the aspartame and NutraSweet, and the red dye number two and the high fructose corn syrup and the MSG and the chlorine and whatever…is in the special sauce.”
Why is this phenomenon such a secret? For two reasons: denial and deception. On a personal level most people don’t want to know what they really need to know about nutrition and are resistant to changing eating patterns. Because refined and processed foods are available in huge quantities and are marketed with such compelling advertising, the general population does not know or does not want to know how destructive these foods are to our health and well being. This is denial, delusion and lack of education in action. How many people watched Morgan Spurlock’s health decline in the documentary film, Super Size Me and continued to eat fast food? Briefly following the release of that film, the fast food business went on a “health kick” but their good intentions were quickly dismissed when it was discovered that those so-called healthy salads were high in saturated fat, calories and sodium.
The other reason for the declining quality of our food supply and the resulting health issues is due to outright deception by food processors. Many years ago, I had a conversation with a sweetener distributor who told me that it had been recommended at a Food Processors Convention that, “If you put more sugar in your product, people will buy more.” This “wisdom” has been taken to the ultimate degree. When we walk through grocery stores we see aisle after aisle of food that is virtually unfit for human consumption. One of our finer grocery stores here in Florida has only half an aisle of “health foods” and a three foot section of organic vegetables. That is no surprise because more than 1.6 billion dollars a year are spent marketing junk food to our kids. (5)
Our nations increasing epidemic of obesity tells only part of the story about the effect of refined and processed foods on our population. Obesity is obvious. What is not obvious is the normal or underweight person who uses unhealthy measures to control weight: drugs, smoking, purging, restrictive diets and excessive exercise. The fact is that food abusers and food addicts can come in any size or shape. And the sadder fact is that the health of our entire nation is being undermined by the quality of our food supply. Advocates for healthy eating, Dr. Kelly Brownell and Katherine Battle Horgen, in their popular book, Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis & What We Can Do About It, outline bold public policy initiatives for reversing the obesity epidemic and present steps individuals can take to safeguard their health in a culture that feeds its pets better than its children! (4) Unhealthy foods are cheaper, readily available, extensively marketed, and often subsidized by your tax dollar. The job is daunting.
Traditionally, food addiction has been treated as an “eating disorder” using the Diagnostic and Statistical Manual for Eating Disorders for diagnostic and treatment purposes. This has not been found to be effective for food addicts. Food addiction more accurately fits the criteria for substance dependence. (12) According to the DSM-IV, substance dependence is a maladaptive pattern of substance use which leads to clinically significant impairment or distress. It is characterized by tolerance, withdrawal symptoms, substance use 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. (1) Ifland, et al., hypothesize that overeating can be described as an addiction to refined foods that conforms to the DSM-IV criteria for substance use disorders (8)
In the early 1980s, clinicians stepped out of the Eating Disorders Box and commenced using the addictions model of treatment for food addicts. The first steps of such treatment are to break the binge cycle, support through withdrawal and introduce the concept of abstinence from refined and processed foods. The next stage is to provide accurate information about the nature of food addiction–a disease that is primary, chronic, progressive, and potentially fatal. The client is encouraged to identify how food addiction affected his or her life and as well as the lives of family members. Orientation to recovery support programs, relapse prevention techniques and development of an ongoing support system help to ensure continuing recovery. (11) We have learned that every healthy choice–whether it is physical, mental or spiritual in nature–is a good recovery choice that heals the addicted brain.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author, (1994).
- Appleton N, Suicide by Sugar, Garden City Park, NJ, Square One, (2009).
- Avena NM, Rada P & Hoebel BG, Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake, Neuroscience and Biobehavioral Reviews, 32 (2008) .
- Brownell, K & Horgen, KB, Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis & What We Can Do About It, Columbus, OH, McGraw- Hill, (2003).
- Federal Trade Commission Report, Marketing Food to Children and Adolescents, A Review of Industry Expenditures, Activities, and Self-Regulation, Appendices, Washington DC (July 2008).
- Ifland JR, Preuss HG, Marcus MT, Rourke KM, Taylor WC, Burau K, Jacobs WS, Kadish W & Manso G, Refined food addiction: A classic substance use disorder, Medical Hypotheses 72 (2009).
- Lenoir M, Serre F, Cantin L & Ahmed SH, Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698 (2007).
- Noble EP, Noble RE, Ritchie T, Syndulko K, Bohlman, MC, Noble LA, Zhang Y, Sparkes RS & Grandy DK, .International Journal of Eating Disorders, D2Dopamine Receptor Gene and Obesity, Vol. 15, No.3. 203-217 (1994).
- Sheppard K, Food Addiction: The Body Knows, Deerfield Beach FL, Health Communications, Inc. (1989, revised 1993).
- Sheppard, K, From the First Bite, Deerfield Beach FL, Health Communications, Inc. (2000) .
Please visit www.foodaddiction.org to watch web casts of these and many more scientists and clinicians who participated in the April 2009 Food Addiction Summit.