Updated: Jul 14
Have you ever pre-planned your cheat meal? Have you ever convinced yourself that you deserved that chocolate bar, that bag of chips or tub of ice cream, just to find yourself overdoing it and being left with an overwhelming feeling of guilt and regret?
Pretty much everyone has had the experience of going to the restaurant, eating a huge and filling meal, then still craving desert even if you knew you stomach was already bursting at the seams. Some experts would describe these as pathological food behaviors. Proponents will quickly say that doctors are overreacting and labeling normal behaviors with diagnoses that stereotype, cause stigma, or marginalize people with such behaviors. People suffering from addiction will continue to eat unhealthily even despite negative consequences on their health or on their relationships. People addicted to food will have trouble stopping the bad habit, either because they're convinced they don't need to or because they have trouble stopping. People who continue bad behaviors with negative consequences often have a way of minimizing the negative effects. Poor insight on their part is often due to the fact that the immediate positive effects of dopamine overrides the possibility of future negative effects down the road. This is similar to the dopamine hijacking that happens with smoking, or drugs. Turns out that you can get hooked on fat, sugar and salt in much the same way.
It's important to point out that eating is something we do to survive until reproduction. It's not normal to feel guilt, regret or to have a bad relationship with food.
Let's not forget that over 2/3 of people in western society are either overweight or obese, when a few generations ago, the stats were one in thirty. Having a healthy body weight is now only seen in a minority of people, which further normalizes the modern relationships that people have with food. Mother Nature never intended for us to discover food processing or to exploit our carefully crafted biology so that food company CEOs could buy a second yacht. Junk food is carefully created in order to hijack our brain’s biology, and like it or not, it’s here to stay. Now, I’m not suggesting that people avoid indulging in what life, food and culture has to offer. I’m simply hoping that you can reflect on your current relationship with food. Ask yourself if you have true control on what you eat, how much you eat, and whether or not eating comes with feelings of regret or guilt.
I regularly see overweight patients in the office. The majority would admit that the weight slowly crept up over years. "I've always had a slow metabolism" or "I don't understand, I eat super healthy" are some of the things I hear from people carrying excess body weight. It has become normal to celebrate with pizza and cake and the excess calories consumed on special events are rarely truly accounted for. I’m not suggesting that we keep people from celebrating with food, but that we create awareness around how overindulging can lead to increased risks of chronic disease.
Food addiction, like any other behavior, lands somewhere on a spectrum. At one end, there's the brain's reward-reinforcement-repeat pathway that leads to the occasional binge. At the other end, there are more severe versions including bulimia or anorexia nervosa, where pathological behaviors get adopted in order to counteract the excessive calories ingested. The scope of this article isn't an in-depth review of mental illnesses associated with pathological food behaviors, but to educate and give you practical tips so you can identify risky behaviors in yourself or your children.
How does addiction work?
Addiction is defined as a biopsychosocial disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. When most people think of addiction, they see drug addicts on the street begging for your change. The reality is that addictive behavior can also include many behaviors related to eating that we’ve normalized. For example, compulsively consuming unhealthy food, when you know it negatively affects your health can be included in behaviors of food addiction. But where do we draw the line? The occasional indulging of fast food in someone who has had 2 heart attacks? Is this behavior considered abnormal. How about the obese individual with unhealthy eating habits. How do we differentiate addiction, greed, personality or lack of motivation to change with the normal societal and cultural occasional indulgence of what modern life has to offer?
Food addiction, as a simple way of seeing it, is a loss of control in regards to the type or quantity of food you eat and includes abnormal feelings of guilt or regret after having eaten. Food addiction has many faces, and as stated before, many of these behaviors land somewhere on a spectrum. Food addiction can include mild to severe cravings that lead to consumption of unhealthy foods even if you know they're bad for you. It can also include consumption followed by feelings of guilt and regret to eating in a way that includes binge-eating, or even hiding your consumption from others. Overeating, followed by excessive use of laxatives, or exercise can also be included. If you’ve tried many diets, exercise gadgets or have wasted money you don’t have on weight loss supplements, food addiction may be the reason. The idea that food addiction is real has gained popularity since the advent of MRI and other brain imaging studies have confirmed that reward centers in our brain can light up in the presence of hyper-palatable processed food, much in the same way as these areas light up with cocaine and heroin. Although food addiction is not yet described as a mental health issue in the bible of mental health conditions, known as the DSM-5, many behaviors can still be pathological and suspicious. For the remainder of this article, we’ll simply be referring to having an abnormal relationship with food as food addiction, recognizing that it has many ways of manifesting itself.
The image people have of food addiction is probably wrong. Food addicts aren’t automatically overweight or living on the street begging for cheeseburgers.
They're normal people that have an abnormal relationship with food. If you can’t imagine a life without meat, without fast food or without ice cream you may have traits of food addiction. If you regularly overeat and have trouble controlling yourself, you may fall somewhere on the spectrum of food addiction.
The issue with food addition, which leads to it going largely unrecognized, is that it doesnt kill you quickly. It takes years to have negative effects. The fact that food won’t kill you as quickly as say, a crack addiction, is why most people have a tendency of disregarding it and blaming a lack of will power, or greed as the cause. We ignore that there is a deeper underlying issue. Food is not the problem, food is the solution. If it’s alcohol or drugs, you simply have to stop consuming, by any means necessary, but food addiction is something you manage, not treat. Food addiction is commonly considered as a symptom of another condition where food is used as a treatment for an underlying issue. For many, simply educating them on what a normal eating pattern is will help, while others will require more intense psychotherapy. Others find a reason that they connect with and motivates them to improve their relationship with food.
In order to survive, our brains evolved with intricate, yet primal rewards centers. They're extremely complex biochemically, but unimpressive in terms of how they work. Positive stimuli lead to neural signaling to our brains, which lead to the release of a potent neurotransmitter, called dopamine. This chemical will induce a feeling of joy and well-being, causing us to want to repeat that behavior. So most of our complex human behaviors can be simplified to three parts: reward-reinforcement-repeat. The dopamine pathway, was designed by Mother Nature and although she had the best intentions at heart, she never assumed we'd study it thoroughly and then find ways of exploiting it for profit.
Many different behaviors are associated with dopamine release. Kissing, hugging, eating and having sex are all associated with much needed dopamine release. This makes us feel good, reinforcing the behavior in order to incite us to repeat it, thus contributing to our reproduction and survival. So what's the association between dopamine and addiction?
The hijacking of our reward centers
Imagine this scenario. You are a caveman. You're hungry and starving. The need for dopamine release will motivate even the most stubborn of cavemen to walk hours in order to hunt or gather food. The dopamine released after finding food and eating it will reinforce the behavior and help motivate him to repeat it the next meal. Now let's assume that this food discovery and consumption induced the release of 1 mg of dopamine. The main triggers of dopamine release according to evolutionary biologists were salt, fat and sugar. This was hardwired into our biology and made us search great lengths to find nuts, seeds and fruits. Fast forward 2 million years. Food scientists have now discovered what makes us tick. They make a living out of finding each food's "bliss point". This is the exact concentration and ratio of salt, sugar and fat that triggers maximal dopamine release. Back in the day, those three nutrients were found naturally in food, surrounded by fiber that slowed down the absorption and dopamine release. Nowadays, food processing has removed fiber, so that calories are quickly absorbed. Then processing concentrates salt, and adds sugar and fats to achieve the perfect bliss point ratio. This makes our food hyper-palatable. Consuming this food leads to a super quick and supra-physiological dopamine release, in the order of 10-50 times the concentration of the levels seen with real food. The ensuing reward response can be so intense that it actually overrides other signals of fullness and satisfaction. We've evolved to dislike whole foods, since the dopamine released from consuming them is levels of magnitude less than our processed counterparts. Real food doesn't taste good after years of tasting processed junk.
With time, pathways involved in addiction and reward consolidate and become harder to bypass. The prefrontal cortex, which is involved in executive decision making, is also silenced by long term addiction. This area of the brain would usually tell us if a behavior is not compatible with societal norms, or if it has a high likelihood of having negative consequences. Addiction has a way of turning up the volume coming from reward centers looking for a quick fix, and turning down the volume coming from the prefrontal cortex that should be telling us that we really don't need to eat that desert. The longer we misuse addictive foods, the harder addiction will be to reverse.
The dopamine reward pathway has been exploited in all ways possible. Casinos use the perfect blend of lights and sound to trigger gambling addiction. Cigarettes cause a super quick spike in dopamine which drops within an hour, leaving the host craving for another cigarette anywhere from 45-90 minutes after finishing the previous one. Fast food companies have figured out how to give us a huge dopamine rush by creating processed foods with the perfect amount of salt, sugar and fat, after removing the fiber, making the unhealthy calories super easy and quick to digest and absorb. People can also get addicted to many artificial stimuli, like gambling, gaming, pornography, shopping, etc.
Addiction: tolerance and dependence
When talking about addiction of any kind, one must understand two key players: tolerance and dependence. Tolerance is when a repeated exposure to an identical stimuli produces less and less effect. We see this with most substances, like alcohol and cigarettes. With time, it takes more and more of the same substance to produce the desired effect. The same is seen with food, and over-consumption gets worse to compensate for the decreased dopamine production seen with prolonged processed food consumption. Dependency is defined as the presence of withdrawals when the substance, food in this case, is not consumed for extended periods of time. Many patients with food addiction will describe feelings of depression or anxiety when withdrawing from certain foods. Some have less intense reactions, but still get irritable or tired.
The tell-tale signs of food addiction
People with a high likelihood of food addiction tend to:
eat more than they had previously planned
keep eating even though they feel full
eat to the point of feeling ill
worry about not eating certain foods, or worry about cutting down on certain types of foods
go out of their way to obtain certain foods when they're not readily available
regret or feel guilty about their food consumption
have withdrawal symptoms when they go long periods without certain foods
I'm scared for our kids
What scares me the most is that studies show that our children are getting 50-60% of their calories from ultra-processed foods. Yup, not processed, but ultra-processed, where industrial chemicals are infused in the foods we eat to create flavor, color, or to preserve. These foods are engineered for quick absorption by removing fiber and for maximal dopamine release by exploiting our brain's bliss point. The dopamine release associated with these foods is so quick and intense that Mother Nature is not able to compete. For kids growing up these days, there is absolutely no desire to consume real food, since dopamine release would be negligible compared to French fries from McDonald's. It's 100% the parent's responsibility to ensure that processed foods are minimized in children, since they'll hijack their reward centers at a very young age. When kids crave cookies, think dopamine. The perfect example of food addiction in kids is the craving of snacks more than meals. I regularly hear parents tell me that their kids would much rather eat snacks than their meals. They seem to eat poorly at supper, claiming they're full or not hungry, and then an hour later, they ask for unhealthy snacks. It's no coincidence. These snacks are fiber depleted and nutrient poor but engineered to produce a dopamine release that the developing brain should never get exposed to. If your child throws a fit after you've refused to give him junk food, that's also highly suspicious for food addiction.
Food addiction and mental health in kids
If kids get constant dopamine surges induced by food and iPhones, could that negatively affect dopamine production and feelings of well being later in life. Yes. Constant surges in dopamine will lead to blunting of reward centers later in life. We see this phenomenon in many different contexts of addiction, where normal life activities don't produce any significant dopamine release anymore. Knowing that dopamine induces feelings of well being and joy, it's easy to imagine that loss of this reward mechanism can lead depression, mental issues and other addiction behaviors in search for that elusive dopamine surge. Removing processed foods in schools is by-far one of the most important measures of public health we can take to decrease the chances of our kids getting addicted to processed food.
Meet Joe. Once I had a patient who was overweight. He was 9 years old and his weight was at the 97th percentile, meaning that only 3% of kids his age were heavier. I threaded lightly, trying to educate the kid's mother that this could become a serious issue. She dismissed it as an overreaction on my part, stating that everyone in her family was "big-boned". She was severely overweight too. I proceeded to ask her to describe a typical day of eating for her son, which was laden with ultra-processed junk. I calmly suggested more fruits and veggies in their diets and that's when she went off on me. The mere threat of me suggesting they reduce processed food consumption in their house was enough to trigger an onslaught of insults and justifications to why they don't believe in my nutritional guidance. I quickly noticed the tell-tale signs of food addiction that plagued the mother as well. The child was simply a victim of his circumstances. I was never able to convince her, nor to help her convince herself that she might be addicted to processed food. That patient is now 19, severely overweight and treated for depression and adult-onset ADHD. I'm convinced he is a food addict as well. The challenge with addiction to food is always the same, you need to eat to survive. You can't avoid your triggers. And to change, you must admit that there is a problem. The dopamine surge can be so intense that the hijacking of the reward centers blinds the addicted from the negative consequences of their actions. That's why meth addicts live on the street in search of their next fix, or that gambling addicts lose it all in the pursuit of that next jackpot.
So when someone with a history of processed food consumption says "I could never eat that way", while referring to the plant-based diet, it's maybe the dopamine talking. These foods would trigger almost no reward response in some people. But have no fear, the dopamine surges can be reprogrammed after a few short weeks of abstaining from the abnormally intense stimuli. That's where willpower comes into play. Some can simply muscle through the first few days and weeks of coming off of processed foods, while it'll be an uphill battle for others. One must realize that your brain is simply acting on a dopamine craving that is hardwired for survival. That craving you feel is simply a drop in the brain's concentration of dopamine. Crazy how one simple chemical can bring extreme joy or extreme pain to people who underestimate its powers.
The perfect storm
Why are some people more vulnerable to addiction than others? Do some people actually have addictive personalities? Addiction is the end game of a complex interplay between many contributing factors that include:
the brain and the way your circuitry is wired
genetics and a family history of addiction of any type
environment and exposure to social pressure, addictive substances and lack of mature coping skills
the frequency and duration of use. This is why food addiction is often ignored or minimized, since it has become so common that it's often normalized
Food addiction is real.
I too have binged on unhealthy foods before and I will again. Specific and occasional behaviours around food doesn’t mean you suffer from a medical condition or pathology, but patterns of these behaviours over long periods of time may increase suspicion of a food addiction. These behaviours exist on a spectrum, from mild to severe and everyone’s case is different. If you think you may suffer from food addiction, talk to your doctor, or consider discussing with a therapist. Also reflect on how your behaviours around food sets an example for your children. The longer that a bad relationship with food exists in children, the more challenging it can be to manage. I recognize that this article could have triggered feelings of sadness, frustration and even anger in some people. A person’s relationship with food is very complex and dependant on many nuanced variables. It’s time to start having more open discussions about our eating behaviours.
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