Featured article in the Summer 2015 Issue of Nutrition Close-Up; written by Neva Cochran, MS, RDN, LD
The concept of food addiction has become popular in the lay press as well as among some health professionals. But can food actually be addictive in the same sense as drugs or alcohol? In March 2009, The Journal of Nutrition featured this topic in SymposiumFood Addiction: Fact or Fiction?1 Rebecca Corwin, PhD, RDN, LDN, a researcher and Professor of Nutritional Neuroscience at The Pennsylvania State University, was co-chair of the symposium. I spoke with Dr. Corwin to further explore this subject.
Question: Based on your research and that of others, can foods be addictive in the same way as drugs and alcohol?
People definitely struggle with food-related issues in todays extremely challenging food environment, but that does not mean they are addicted to the food. There are several reasons why food cannot be as addictive as drugs or alcohol.
First, while food and drugs act on the same areas of the brain, drugs have much stronger effects because they go directly to the brain. Food doesnt do this so its effects are much more subtle, which makes it very difficult to become addicted.
Second, currently there is no official way to diagnose food addiction. The term food addiction is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In addition, the main research tool that has been used to assess food addiction (the Yale Food Addiction Scale) is exactly that: a research tool. It has not yet been confirmed as a clinical diagnostic tool.
Third, there is very little evidence that substances in food, like sugar or fat, are addictive in humans. If people were truly addicted to sugar, any sugary substance (e.g. milk, fruit, juice, honey, or table sugar, etc.) would satisfy the craving. But people usually crave specific foods, not specific substances. For instance, eating a cupcake might satisfy the craving for cake, but eating something with a similar fat and sugar content, like a cookie or ice cream, will not.
Finally, treatment of drug or alcohol addiction is different from that recommended for food. With drug or alcohol addiction, complete abstinence is usually recommended. This doesnt work very well for people struggling with food. If the favorite food is removed from the diet, desire for that food can increase and bingeing on it may occur at some point. One successful treatment for food-related eating disorders requires that the craved food not be eliminated but added back to the persons diet in a controlled and rational manner. Treating food the same way as drugs or alcohol may actually make matters worse.
Q: What particular foods have been implicated as addictive and why?
Foods rich in fat, sugar, and salt, such as cookies, cakes, candy, ice cream, chips, and dips, are the usual suspects. The evidence for fat and salt addiction, even in animal studies, is very weak. But foods containing fat and salt have great appeal to humans and are often eaten to excess; therefore, they may be considered addictive. Sugary foods have been implicated, not only because of their innate appeal to humans (even as infants, we really like sweets), but also because animal research has found some signs of addiction in rats consuming sugar solutions. However, even these studies clearly showed that the manner in which the sugar was consumed was far more important than the amount. Specifically, rats needed to binge on the sugar to show addiction-like symptoms. If rats just sipped the sugar throughout the day, no evidence for addiction was shown, even if the total amount consumed was quite large.
Dairy products, especially cheese, have been implicated as addictive, because of morphine-like compounds they contain. But the concentration of these is so low that thousands of pounds of cheese would have to be consumed to get enough of the morphine-like compound to have an effect.
Q: The headlines often suggest the results of rat addiction studies can be applied to humans. What are some of the concerns with doing this?
Rats are great models and can teach us much, but results of rat studies may not apply to humans. Rat research is generally very well controlled so a single factor at a time can be tested. People live in a far more complex environment with many factors influencing behavior that are difficult to control.
Q: Are there unintended consequences of implicating a single food or ingredient as addictive?
Eliminating a single ingredient from the diet (e.g. gluten) often means removing an entire food group (e.g. wheat products). As a result, intake of an essential nutrient like folate can become inadequate, with consequences for the individual or an unborn child if a woman is pregnant. When foods must be eliminated, care should be taken to ensure the nutrients they contain are obtained from other foods or supplements.
Eliminating sugar may inadvertently lead to increased cravings and binge-type eating. Therefore, reducing the sugar intake, rather than eliminating it, is probably a better approach.
Q: What do you think about a recent journal article1 that suggests the term eating addiction is preferable to food addiction to emphasize the behavioral aspect of the problem?
Even if eating addiction were to become a new diagnostic category similar to gambling disorder, how would it be treated? People still must deal with the struggles they have with food.
Perhaps one benefit of viewing the behavior, rather than the food, as addictive is that attention is focused on an individuals behavior. Then treatment strategies can address changes in behavior. This is what cognitive behavioral therapy already does with a fair amount of success. I am not sure how labeling eating as an addiction would help those who are struggling. The bottom line is that these struggles are difficult and working with a behavioral therapist and a registered dietitian nutritionist specializing in eating disorders can help.
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Neva Cochran, MS, RDN, LD, is a nutrition communications consultant, appearing regularly in national and local media to discuss current nutrition topics.
References
- Symposium Food Addiction: Fact or Fiction? Journal of Nutrition, 139: 617-632, 2009
- Eating addiction, rather than food addiction, better captures addictive-like eating behavior Neuroscience & Biobehavioral Reviews 47: 295306, 2014
Key Messages
- Foods rich in fat, sugar, and salt are often thought to be addictive, but animal studies show addiction to fat and salt is weak. Signs of addiction to sugar solutions have been found in rats, but even in these, the manner in which the sugar was consumed was far more important than the amount.
- Eliminating a single ingredient from the diet, such as gluten, often means removing an entire food group, in this case, wheat products. As a result, intake of an essential nutrient like folate may become inadequate, so care should be taken to ensure such nutrients are obtained from other foods or supplements.