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Will Rehabs Ignore ‘Food Addiction’ Science?
Last week, a New York Times article titled “Off the Drugs, Onto the Cupcakes” generated more than 150 comments. It opened with the story of dramatic weight gain in a man who “ballooned” to 250 pounds (from 135) after getting off heroin and cocaine, placing the blame on high-cal, high-sugar foods served in rehab. Citing a study with amphetamine-injected rats that gained more weight after the drug was stopped than did rats not amphetamine-injected, the writer of the piece added, “His story is familiar to those in recovery who often gain significant weight on the road to well-being.”
The article goes on to discuss the way sugar is sometimes encouraged through Alcoholics Anonymous as a substitute for alcohol and drugs and states, “Research has found that food and drugs have similar influence on the brain’s reward center,” and indemnifies sugar in particular. It points to yet another rat study (released before being published in a peer-reviewed journal) suggesting that “Oreos are as addictive as cocaine” that received widespread media attention but also professional criticism. Because of “more awareness of sugar’s effect on the brain,” the article notes, some rehabs are “overhauling their meal plans and hiring ‘culinary nutritionists’.”
But is there really sound scientific evidence that sugar or other food components are “addictive” in the way that alcohol and other drugs are?
Is Food (and Sugar) Addiction Real?
…although people can develop a compulsion to overeat – driven by the positive feelings the brain associates with eating – the brain doesn’t respond to nutrients in the same way that it does to addictive drugs.-Anne Fletcher
A comprehensive just-released review of the scientific literature by a team of international experts puts the kabash on the notion that people can become addicted to specific foods or food ingredients, such as sugar and fat, noting that “the currently available evidence for a substance-based food addiction is poor.” So despite powerful statements we see in the press or online such as “Food Can be as Addictive as Drugs” or “Why Food Addiction is Deadlier than Drinking,” the scientists said that there is not enough research from which we can draw conclusions. According to their findings, although people can develop a compulsion to overeat – driven by the positive feelings the brain associates with eating – the brain doesn’t respond to nutrients in the same way that it does to addictive drugs.
This is not to say that some individuals don’t develop an addiction-like relationship with certain foods that can cause pain and suffering, but the experts prefer to use the term “eating addiction,” suggesting that the focus in obesity treatment should be more on a person’s relationship with eating and less on food itself. They state, “’Eating addiction’ stresses the behavioral component, whereas ‘food addiction’ appears more like a passive process which simply befalls an individual.”
Highlights of “Eating vs. Food Addiction” Scientific Review
The 12-expert review of the scientific literature is elaborate and too long to detail, but following are some highlights:
- Just because eating behavior engages reward systems in the brain, it doesn’t necessarily follow that specific food components can evoke a “substance addiction.” For most of us, eating is rewarding and reinforcing – we like to eat, and when something tastes especially good, we want to eat it repeatedly. Since it’s known that eating food does activate the reward system in the brain, particularly when we’re hungry, it’s logical to think that food substances could have addictive properties. But this doesn’t necessarily mean that specific food components can cause addiction. Rather, the researchers say, “the complex activation of the reward system… can be viewed as being dependent on eating (subjectively) palatable foods irrespective of their nutritional/chemical composition.”
- With one exception (caffeine,) “there is currently insufficient scientific evidence to label any common food, ingredient, micronutrient, standard food additive, or combination of ingredients as addictive.” When we call a food or ingredient “addictive,” it implies that it has the capacity to make susceptible people addicted to it in the way that alcohol and drugs do. Certainly, some foods such as high-sugar, high-fat combinations are rewarding. However, as the authors state, foods are nutritionally complex – made up of multiple components – and “hardly any” evidence is available to suggest that under normal physiological circumstances humans crave specific foods in order to ingest a specific “substance.”
- People who overeat usually do not restrict their diets to specific nutrients (that would be difficult to do) and instead are exposed to a wide range of palatable foods, which appears to render certain individuals vulnerable to overeating.
Diets of people who overeat typically contain a broad range of tasty foods. The researchers say it can be argued that our access to an array of highly palatable foods may be a pre-requisite for the development of addictive-like eating behavior in some and that one possible approach to overcome this would be to restrict access to only a small number of such foods. “Without access, it would be unlikely for such addictive-like behaviors to be expressed,” and in overweight individuals, this would likely result in eating fewer calories, they suggest. However, in surveying more than 200 formerly overweight people who lost weight and kept it off for my Thin for Life books, one of their common behaviors was to not deprive themselves of favorite foods. “If I want something, I have it,” was a common statement. Nevertheless, most limited their exposure to such foods – for instance, by not keeping tempting foods in their homes.
Thus, “sugar addiction” in humans – if there is such a thing – may not be relevant for the development of obesity…-Anne Fletcher
- Rats are not people. Most evidence for so-called “sugar addiction” comes from rat studies, typically involving intermittent access to palatable sugar solutions. Humans and rats do, indeed, seem to have an innate or quickly learned motivation to consume sweet foods. However, aside from a single case study, the review states that addiction-related behaviors because of sugar consumption (such as tolerance and withdrawal) have not been observed in humans. While pointing out that rat experiments (typically involving single substances such as sugar or very simple combinations) are needed to understand how a single nutrient may affect neurobiology and behavior, the authors state, “It is arguable whether they are directly relevant for human pathology.” They again emphasize the complexity of human eating that involves mixtures of nutrients. (It’s fascinating to note that in most sugar addiction models with rats, the animals do not become obese but instead “down-regulate” their calorie intake from other sources to maintain a stable body weight. Thus, “sugar addiction” in humans – if there is such a thing – may not be relevant for the development of obesity, say the researchers.)
Will Rehabs Follow Suit With Scientific Practice?
As Harvard University’s John Kelly, Ph.D., said in Inside Rehab, “Dissemination from research to front-line practice takes about ten years, on average, and that’s only if it becomes fashionable.” So who knows whether those practicing food restrictions because of notions that certain foods are addictive will change?
While none of the treatment facilities I visited for Inside Rehab appeared to use any bizarre dietary practices at the time of my visits for the book, it’s not uncommon for unfounded notions about nutrition and recovery to go hand-in-hand. For instance, one rehab encouraged avoidance of sugar and caffeine, indicating that they can contribute to mood swings, a questionable premise. Granted, it’s wise to avoid caffeine and sugar in excess. But as a registered dietitian (who now works with people at an addiction treatment facility), my opinion is that it’s unnecessary to make recovery any more challenging for someone going through a rough time. Moreover, I know of no sound reason why people in addiction treatment need to pay attention to sugar and caffeine in their diets any more than other individuals.
Certainly, helping people eat well is part of helping them live well. Individuals with drug and alcohol problems commonly enter treatment with a less-than-desirable diet, and sometimes, they’re malnourished. Vitamin/mineral supplements are often needed in early recovery. Once they get back on track with a well-balanced diet, however, most simply need healthful food that’s not out-of-the-ordinary.
That’s not to say that teaching people how to eat healthfully should not be part of a comprehensive, holistic approach to treatment. In personal communication with Northfield, Minnesota’s Carleton College philosophy professor Barbara Allen, Ph.D., about the New York Times article, she noted the young man who gained all the weight had stated that he learned how to be sober but not how to take care of himself. He’d been quoted as saying, “I didn’t know how to cook or grocery shop because I’d never done it. I didn’t learn any life skills or how to live like an adult.”
Who disagrees that it would be good to help the whole person? No one. Wouldn’t life skills be great! That’s controversial?-Dr. Barbara Allen
Dr. Allen remarked, “This young guy got off of drugs and had no clue about the world, so he ate a lot of crap. No big surprise. Who disagrees that it would be good to help the whole person? No one. Wouldn’t life skills be great! That’s controversial? Why, why, why does there need to be something mysterious called sugar addiction, etc. that is the ‘cause’ of everything? Cookies are not a good thing eaten to excess and perhaps comfort food in general is not so great. But how about that word ‘comfort?’ For me, the point is that someone needed to find comfort in food to an excess. That doesn’t sound like an addiction (I’m no expert) but it does sound like a poor coping strategy and that some form of behavior modification and cognitive therapy could be a good idea. Still the main point of the article is that he didn’t know how to cook or shop for food. Who in that state would not go for processed, ‘junk,’ fast, and easy?”
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