Can Humans Be Addicted to Food?

Dr. David Wiss

September 3, 2022

Addictions

This clip was recorded as part of the Positive Approaches to Health Podcast (The PathPod) and was part of an important conversation on food addiction that aimed to answer the following questions:


  • Can we be addicted to food? 

  • What does that look like?

  • Is there help for food addiction?

I've spent a lot of time exploring the literature contributing to the topic of food addiction and mostly trying to put it in the context of eating disorders, which will consider the roles of dietary restraint, diet culture, weight stigma, weight bias, and then putting it all into a social context. 

One could look at food addiction as a neurobiological process where reward pathways are overactivated in the brain and we're seeing a clear, consistent body of evidence to support that, especially with respect to addiction to sugar. But it needs to be put in a social context by considering what neighborhoods people live in, the family that people live with, access to resources, etc.

So I think one of the discernments that needs to be made in the food addiction conversation is that there is an important need to discern between food and ultra-processed food. This looks at the relationship between dopamine and food

I think one of the arguments against food addiction is that food in its natural state (e.g., almond, plum) doesn't seem to lead to addictive processes. But it's very clear that highly palatable, ultra-processed foods with added ingredients are sufficient to produce neurochemical changes that “hijack the brain” in susceptible individuals.

This is where the conversation around trauma comes back in. If someone had a lot of early life adversity and they were exposed to trauma that changed their biology and made them more susceptible to reward-based processes, that person might be more susceptible to addiction-like eating. This may be one reason why there are growing numbers of people with binge eating disorders. 

One of the disservices in the food addiction conversation has been equating it to cocaine and heroin. They had some animal models that showed “sugar is more addictive than cocaine.” And I think that didn't help the conversation around food addiction.

What I think is much more helpful is to look at it more like addictions to caffeine or nicotine. So if we were to take the caffeine example, someone might ask: is coffee addictive? And is it a health problem?

Parallels with Caffeine Addiction 

You would get a lot of people that would say: “I really like my coffee. I enjoy it. I like the taste. I have one cup in the morning, but I'm not addicted.”

And then you would get other people that would say, without a doubt: “I am not okay without my cup of coffee.” And then there are other people that need coffee throughout the entire day. There are some people that when they don't get it, they get a headache. And if someone else doesn't get their coffee, they might be thinking about it a little more than would feel normal or healthy.

But if you were to take this caffeine example and think about the question: “can food be addictive?” Let's first ask: “can caffeine be addictive?”

And it would probably be difficult to make the argument that people were addicted to green tea. It has a low dose of caffeine in it. There are probably some people that drink a lot of green tea throughout the day and need it, but probably don’t experience loss of control. 

But once you start increasing the dose of caffeine and you go to coffee, it's a little bit more potent. And then you get these major corporations that are adding a little bit of caffeine, making coffee that is more addictive. Anyone knows that the Starbucks and the Coffee Beans of the world have coffee that's a little bit more “rewarding” than you might be able to make at home. At least that's been my experience.

But then if you were to take it one step further and start looking at energy drinks, you get these commercialized products that have 300+ mg caffeine along with some other ingredients in them. 

So you get people (and this is something we see often in early addiction recovery) that might drink four energy drinks in a day. And so is caffeine addictive for most people?

One might say no, but I would probably say yes. It really depends on how you operationalize and define addiction. Dependency perhaps is a better word.

But there's a small subset of people that have a real caffeine use disorder. And they are not okay without high doses of caffeine and it can be a real problem for daily functioning. 


Does Food Addiction Actually Exist? 

And if we were to look at food in a similar fashion, we would say that most people might not have addictive processes around food. But when there is early life trauma, when there is a lot of stress and other forms of adversity, the risk does go up. If people live in neighborhoods that have very limited access to higher quality food and they just get over-exposed to certain foods, we're starting to see a little bit more of what would appear to be a food addiction.

And then there are people that have a severe actual food addiction and have a relationship with food that causes significant social impairment and emotional distress, which can be exacerbated by a fear of gaining weight. 

There are people (and this comes a lot from dietitians) screaming from the rooftop: “food addiction doesn't exist! It doesn't exist.” I find that to be very tunnel-minded.

People tend to see the world through the lens of their own experience. If that person has never experienced an addiction, they are less likely to view food as potentially addictive. 

As someone who has experienced multiple addictions throughout my life, my answer is “absolutely! Ultra-processed food addiction does exist!” It exists for a small subset of the population the same way alcohol and drug addiction exists, but it shows up in a higher percentage of the population.


Food Addiction Eating Disorder

The most recent systematic review and meta-analysis reported a prevalence of food addiction around 20% worldwide, which is a little bit higher than drug and alcohol addictions. I think alcohol and drugs are somewhere in the 10-15% range, probably getting higher these days with some of the epidemics and crises out there.

But the food addiction prevalence is much higher in clinical populations, particularly among those that have eating disorders. And this is where the conversation gets really polarizing and people have a lot of differing views. When someone has bulimia nervosa or a binge eating disorder and then they have really severe food addiction symptoms, can you separate the signal from the noise?

Can you say that it's actually food addiction? Or are the food addiction symptoms a relic of the eating disorder symptoms? That's where it gets really confusing.

If someone's been on a diet for a major portion of their life and they have internalized weight stigma, they have a lot of conflict around the body that they live in and they're constantly trying to diet, they might end up with higher food addiction symptoms than the average person because of their dieting behavior. And this gets even more complex when there is purging involved. 

So that's where I think the future of food addiction needs to be: being able to disentangle the actual food addiction signal from some of these other factors that make the signal a little bit less clear. I think once we're able to do that, we can make some progress on potential solutions.

But in terms of solutions, I do work clinically with people and I've had a lot of success with eating disorder treatment and even considering the role of addiction-like eating. I recently published a peer-reviewed article about it, and it is open-access, which means it is accessible to all! 


Implications of Ultra-Processed Food Addiction 

I strongly believe that the food addiction conversation needs to have public health and policy implications. I do think that to expect people to be able to recover with abstinence-based models is somewhat unrealistic without adequate social support, especially since sugary foods are so ubiquitous in the food supply.  

There's a very small subset of the population that does food-based abstinence and I usually don't endorse that approach unless it feels clinically appropriate. There are cases when that's the only approach and it’s meaningful work to help someone with this condition. Sometimes food addiction has genetic underpinnings related to dopamine receptors. 

But to think about ultra-processed food addiction as something that brings food companies to the table, we can start to have conversations around how we can improve the national and international food environment in conjunction with trauma-informed care, for example:


  • Helping people's nervous systems through contemplative practices. 

  • Reducing exposure to highly palatable food.

  • Promoting health equity.

  • Giving people better access to food.

I think this angle from a public health standpoint will be way more fruitful than saying: “here's the clinical implication of food addiction.” That being said, people that have severe ultra-processed food addiction can find pathways to recovery and it's going to differ from person to person.

Some people might identify specific foods that are “triggering” and for other people, it might be specific ingredients. But if anyone is going to do a very targeted type of nutrition intervention, it's very important that they stay well-fed and well-nourished, and eat foods from all of the different food group categories (fruits, vegetables, whole grains, dairy or dairy alternative, protein or protein alternative, and beans/nuts/seeds). 

And there are adequate substitutes now for people that don't eat from all categories (e.g., vegans, vegetarians). One should also eat foods that are salty, crunchy, smooth, cold, and hot, all to satisfy the dopamine pathways in the brain enough so that they aren't “walking on eggshells.”

The biggest criticism of food addiction recovery is that people try to go on an extreme (i.e., not sustainable) diet. It seems to be just a matter of time before they get exposed to certain foods and then they're binge eating again. And then the problem often gets worse.

So there is an important need to look at food addiction not just at the individual level and separate that from classic eating disorder symptoms, but also to look at it in the community, neighborhood, and larger ecological context. Are you here for it?

Are you looking for treatment for food addiction? The Wise Mind Nutrition program provides a gentle approach to food addiction treatment and recovery. Our app-based program will help you find a path that works for you, and most importantly, will be sustainable over time. 

We do find it helpful to work on mindful eating as well as do some body image work, in order to recover from food addiction. The app-based program can be used as a stand-alone treatment, or you can use it alongside working with one of our practitioners. Don’t hesitate to reach out with any questions or concerns. We’re here for you!