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Is Food Addiction Better Described As Eating Addiction?



sharma-obesity-addiction-typesThe term “food addiction” has found its way into both the scientific and popular literature.

Now, a thoughtful paper by Johannes Hebebrand and colleagues, published in Neuroscience & Biobehavioral Reviews, argues that there is in fact little evidence for addiction to “food” per se (as you would see in addiction to a specific substance) and that therefore, it may be better to describe the addiction-like overconsumption of food as a behavioural addiction, in this case, an addiction to eating.

Eating is intrinsically rewarding and reinforcing, and food consumption is well-known to activate the reward system in the brain; this applies particularly in the physiological state of hunger. It is easy to see that the rewarding properties of food and their activation of the reward pathway might lead intuitively to the idea that food substances may have addictive properties. However, just because eating behavior engages these reward systems, it does not necessarily follow that specific nutrients (substances) are able to evoke a substance addiction. Instead, the complex activation of the reward system as the initial step of the process ending in addiction can be viewed as being dependent on eating (subjectively) palatable foods irrespective of their nutritional/chemical composition.”

Per se, foods are nutritionally complex and there is hardly any evidence to suggest that under normal physiological circumstances humans crave specific foods in order to ingest a specific ‘substance’. Instead, the diet of subjects who overeat typically contains a broad range of different, subjectively palatable foods. It can be argued that access to a diversity of foods, especially a diverse range of palatable foods, may be a pre-requisite for the development of addictive-like eating behavior.”

There is currently no evidence that single nutritional substances can elicit a Substance Use Disorder in humans according to DSM 5 criteria. In light of the lack of clinical studies that have aimed to detect addictions to specific nutrients, it cannot as yet be ruled out that a predisposed subgroup does indeed develop such a substance based addiction, which in theory may be substantially weaker than in the case of addictions based on well-known exogenous substances such as alcohol, cannabis, nicotine or opiates. The fact, that clinical case studies do not abound on an addiction like intake of specific nutrients or even specific foods, would suggest that such cases are rare, if they exist at all. Alternatively, the addiction is so weak that it is not adequately perceived and reported as such. This leads to the question as to the boundaries between excessive consumption and the beginning of a true addiction.”

Thus,

“…there is very little evidence to indicate that humans can develop a “Glucose/Sucrose/Fructose Use Disorder” as a diagnosis within the DSM-5 category Substance Use Disorders. We do, however, view both rodent and human data as consistent with the existence of addictive eating behavior. The novel DSM-5 (APA, 2013) currently does not allow the classification of an “Overeating Disorder” or an “Addictive Eating Disorder” within the diagnostic category Substance-Related and Addictive Disorders; indeed, the current knowledge of addictive eating behaviors does not warrant such a diagnosis. However, efforts should be made to operationalize the diagnostic criteria for such a disorder and to test its reliability and validity. It needs to be determined if such a disorder can occur distinct from other mental disorders.”

Overall I believe that reframing the perceived loss of control over food intake often reported by my patients as a “behavioural” rather than a “substance” addiction may be helpful in approaching this rather complex topic and may well open the path to novel therapeutic approaches more consistent with our current understanding of behavioural addictions.

@DrSharma
Vienna, Austria

ResearchBlogging.orgHebebrand J, Albayrak O, Adan R, Antel J, Dieguez C, de Jong J, Leng G, Menzies J, Mercer JG, Murphy M, van der Plasse G, & Dickson SL (2014). “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neuroscience and biobehavioral reviews PMID: 25205078

8 Comments

  1. Dr. Sharma, I wonder about whether we should really call this subjective loss of control an addiction at all, in view of the ample evidence for possible disorders of physiological appetite stimulation. I think that may actually be another way of blaming the victim.

    Let’s look at other disordered physiological cravings. People with diabetes insipid us crave water, and have subjective feelings of loss of control over drinking water when it is present, yet we do not say they have “water addiction”. People with restless legs syndrome, or sleep apnea, or narcolepsy crave sleep, and have subjective feelings of loss of control over sleep, yet we do not say they have sleep addiction. What if days regulation of appetite hormones were truly similar? That’s not necessarily DSM material.

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  2. “very little evidence” yet when we willfully stop eating sugar, wheat, omega 6 oils, dairy products, and a long list of chemicals, the desire to eat them and other stuff laced with chemicals goes away. Perhaps it is not “very little evidence” in those of us with the problem, but then we are a small subset of the population. Very little evidence will become much larger if you only look at those who are truly addicted, but we are probably less than 1 or 2 percent of the obese population.

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  3. As a specialist in addiction medicine, and especially food addiction, I would like to respond to some of the arguments made in this very thought provoking article.

    The first is that Johannes Hebebrand and colleagues say that there is little evidence for food addiction. Just looking at the bibliography presented by the Food Addiction Institute (http://foodaddictioninstitute.org/scientific-research/bibliographies/), one can see the enormous body of research that supports the contention that food (particularly sugar, and the combination of sugar / flour and fat) is addictive. One need not look further than at the scientific research of Dr N Volkov, which is now informing addiction physicians in their clinical practice.

    Secondly: My book, “Food Junkies: the Truth About Food Addiction”, highlights just how well the DSM V can be applied to food, as well as eating behavior. I maintain that food, as well as eating behavior, can be addictive, if it involves the limbic reward circuitry. Furthermore, I describe, using clinical examples, how excessive consumption and true addiction can be distinguished.

    This article is useful in that it highlights the behavioral aspect of food addiction. I hope that this perspective can be included alongside the contention that the substance of food is itself addictive. Both represent addictive dynamics and including both angles will contribute towards a better understanding of the complex nature of food addiction.

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  4. I disagree completely. There are primary substances in the majority of cultural foods (such as modern frankenwheat, and some degree of sugar/fructose) that are incredibly addictive. There are extensive monies spent by corporations designing foods to be incredibly addictive — low level long term, not high-level like a street drug, but just as useful for the people making money off it.

    It isn’t just sticking it in your mouth that makes Oreos and Doritos addictive. It isn’t just swallowing that makes everything made of wheat addictive. But substances such as modern wheat underlying a huge % of the cultural foods do tend to make a ton of foods as a whole market — sort of a cola wars effect — pretty addictive.

    Real food if that definition is limited to healthily-raised meat/seafood/eggs/veggies is not generally addictive. You tell most people to try low-carb and they say, “OMG I could never give up BREAD!” Few people would cry over having to give up broccoli. And yet we chew and swallow that too.

    There are a ton of hormonal, neurological etc. effects from ingesting anything — heck, even from smelling something, let alone actually eating it. Of course this has the potential to be addictive depending on what is actually IN that stuff and how our bodies react to it.

    People pontificating from armchairs about why they assume people eat too much usually seems to end up with a lot of ivory tower nattering about problem behaviors and emotional eating. Yet you can switch up a cows foods and fats and the lazy overweight cows become energetic leaner cows (nobody wants that!) and this completely without regard to their relationship with their mother.

    Our culture will never hold the agri and food industry responsible for doing what every business is designed to do — make profit in any way they can. Everything in the food industry from the ground up, and a whole lot of scheming chemistry designs nearer the top, is designed to addict humans for profit. Thinking it’s got to be as obvious as crack is ridiculous.

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  5. Better described as “human engineered food addiction” as food produced by nature displays none of the addiction characteristics.

    Sugar is the culprit, and human engineered food containing sucrose is overwhelmingly addictive. simply because it has been designed to be, so as to maximize sales.

    honey vs sweets is the best example, both are pure sugar, but you quickly get bored of the former whereas I can easily eat the latter to extreme’s.

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  6. I believe there has been plenty of research using MRI that show sugar and sugar/fat/salt foods “light up” the same pleasure paths in the brain that cocaine does. That aside, anecdotal evidence shows without a doubt that certain people cannot stop eating certain foods (chocolate, potato chips, crackers all come to mind…put a box of assorted candies or a bowl of Ruffles in front of some people and it will disappear even whilst they are otherwise engaged in conversation before they even realize it or taste it. Anyone who uses food as a drug (and no one is using baked chicken and steamed broccoli for comfort or distraction) or experiences a loss of control with food is addicted to eating and, yes, may be addicted to certain “foods” (or, more accurately, non-foods) — they experience withdrawal symptoms when they eliminate sugar and/or processed foods that contain the chemicals and additives that trick our brains and hook us on wanting more all the time. How many times has someone insisted to you, in all seriousness, that she “cannot live without” soda…candy…snack foods…french fries…etc? Or has joked about being a “chocoholic” or “saltaholic” or “addicted to” a certain kind of boxed cereal or bagged snack? I believe there is absolutely both a physical, in some cases, and a psychological (in all cases) component to the act of compulsive overeating, binge eating, and using food for comfort/distraction/social tool (using food as a drug).

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  7. Very interesting post! I have always questioned “addiction” to foods. The definition of addiction is a questionable thing in and of itself. But I don’t think I have worked with anyone overweight or obese that ever said “I just can’t stop eating raw fruits and vegetables.” It can’t just be the act and process of eating that keeps people at the table too long. All I know is I am not smart enough to have the answers. Keep up the good work doc. For myself, after doing weight management for 6 1/2 years now I have come to one conclusion, the more I learn… the less I know.

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  8. I don’t agree. There are plenty of people without an eating addiction that do have however some food addictions (chocolate, chips, etc…)

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