This article is for you if you relate to having an addictive relationship with certain foods. For simplicity, this article references problems with impulsive, compulsive, and out-of-control food consumption that causes distress and impairment to your daily life as food addiction (FA).

The concept of FA itself is complex, somewhat controversial, and can occur both with and without other mental health or addiction problems, as well as with or without weight gain. The idea that the consumption of certain foods could meet the criteria for addiction is still being debated in the literature, and despite a growing body of evidence, is not an accepted psychiatric diagnosis or even an accepted everyday term. Some argue that to class food as an addiction minimises the seriousness of drug and alcohol disorders while others feel that it stigmatises or shames those who struggle with eating, weight and obesity as being morally at fault.

The reality is that many people suffer quietly or seek help for eating (certain foods) that feels addictive to them and that causes impairment to their physical or mental well-being, especially self-blame, loneliness and shame that occurs in the aftermath.

Worldwide, 16.2% of people are found to experience FA according to a meta-analytic review of 51 studies that used the Yale Food Addiction Scale - this is based on the diagnostic criteria for substance use disorders (SUDS) in relation to certain foods.

Food addiction is not included in the current psychiatric diagnostic manual (DSM-5) but - if mapped onto the criteria for SUDS - would include the following:

• Cravings - consuming more food for longer periods of time than intended

• Desire or repeated unsuccessful attempts to stop

• Much time is spent sourcing food, consuming it, or recovering from eating

• Social, occupational or recreational activities given up or reduced

• Continued use despite harm (e.g., physical health)

• Tolerance - needing to eat more; marked decrease in reward effect

• Withdrawal symptoms - irritability, fatigue, loss of motivation, low mood and renewed food cravings

At the mild end of the scale, intake of certain foods may be simply accepted as a brief regret and easily halted. However at the moderate to severe end can become a daily battle with food and metabolic dysfunction, and, for some, weight gain and associated health challenges. This can also result in social stigma - as there is a often perception that being overweight or obese is a choice (rather than including biological or other external factors).

With similarities and some overlap with eating disorders (EDs) such as anorexia, bulimia and binge eating, there are specific differences to FA that mean it may stand alone as its own problem. But it can also co-occur with EDs - and when this is the case it makes disordered eating particularly challenging to overcome and requires specialised treatment for the ED as well.

One of the problems with a potential diagnosis for FA is that it’s been elusive to pin down exactly what food/s (or substance within the food) is causing the addictive process in the brain. Food addiction has been argued by some to be a behavioural addiction where the focus is on the eating process itself and less on the food. But this leaves out the fact that certain foods do contain ingredients that can drive the brain's reward processes in a way that differs from food found in nature.

Let’s first explore the process of addiction in the brain before looking at how our food environment has changed and the implications for addiction.

What is the addictive process?

The main brain systems involved in addiction include two elements - the dopaminergic seeking system and the opioid reinforcement system.

1. The seeking system is the exciting “I want” feeling that drives us towards something perceived to be rewarding and this largely involves a neurotransmitter called dopamine. The process of what is experienced as rewarding in a person's brain is highly individual and depends on many factors.

2. The opioid reinforcement “hit” that follows then releases other pleasurable neurochemicals including oxytocin - this reinforces the brain's learning capacity to seek the reward again in the future.

The seeking system can be activated and excited for a long while whereas the reinforcement system is generally short-lived. After the reward, for a period of time balance is obtained. This is until the seeking system is activated again - this can be through entering a withdrawal state or through being cued in your environment to once again seek reward. This cycle of seeking, reward, withdrawal, cues and cravings is what can create eventual reliance on the thing in order to feel “normal.”

With certain foods like refined sugar, rat studies have found the same kind of brain-based alterations in regions of the brain as are found in substance addictions and recruitment of these two systems.

Being able to now become addicted to food raises the question of whether this is another example of an environmental mismatch, given the rapid and dramatic changes to our food environment.

Food vs ultra-processed food

When it comes to food, humans are wired to survive periods of famine and food scarcity. We evolved to be motivated to seek and consume naturally occurring calorie-dense foods such as nuts and meat. Our brain’s seeking and reward systems help us with this by cueing signals that calorie-dense food is available and reinforcing consumption. Available food was consumed until satiated to maintain well-being and body weight and there was the capacity to “binge” on available foods to store nutrients in reserve, as food was less consistently available.

But our food environment rapidly changed about 50 years ago with industrialized agriculture - changes that occurred to feed more people on a larger scale and that include different food growing, storage and processing practices. Most food in a supermarket now differs dramatically from the calorie-dense foods found in nature. Natural unprocessed foods are either high in sugar such as fruit or high in fat such as meat. High sugar and high fat rarely occur together in nature.

Ultra-processed foods (UPFs) are industrialised foods that involve ingredient combinations that are not seen in nature and tend to be high in calories (sugar and fat) and low in nutrients (e.g., a packet of biscuits, a tub of ice cream). Unlike in nature, UPFs are now everywhere and can cue your brain to experience cravings and urges to eat them. Also unlike in nature, they are available 24/7 at the click of a button on your smartphone and are often cheap.

Food marketers understand our human wiring for reward and how to create products that result in cravings. Products that release substances that temporarily soothe stress and cause pleasure. These products have taste additives and are made to be hyper-palatable - such as the quantity of sugar, fat and salt. Water and fibre are also often removed from UPFs to give them a desirable texture and the ability to consume them quickly and in greater quantities.

There may be other components in non-UPFs that have changed in our modern food environment that contribute to FA for some people. Casomorphins (found in A1 cows dairy) and gliadorphins (in gluten) are two food-derived opioid peptides that have opioid characteristics so can stimulate the opioid reinforcement system. Both cow's dairy and gluten have changed through industrial processing and there may be consequences for our brains and health. There are individual differences in the response to these opioid peptides and while they won’t adversely affect all people, for some they are low-intensity long-term foods that can impact food cravings and health outcomes.

A very brief mention needs to go to alcohol and alcohol-induced eating. Alcohol causes disinhibition, disrupts appetite and circadian rhythm and can cause hangovers and cravings for certain foods - usually fat and salt. There can also be cross-addiction to food where alcohol abstinence results in certain food cravings (often refined sugar).

Summary

Many potential individual underlying reasons drive the urge to consume certain foods once triggered - but usually, it is UPFs with high-fat and high sugar content (as well as additives and salt that enhance the rewarding effect) that have the highest addictive potential, in a vulnerable individual.

Consumption of these foods can drive cravings while abstinence can result in the eventual cessation of cravings - in much the same way that people report no longer having cravings for alcohol after a period of time without it.

“Food addiction is a behavioural and subjective experience that is both “not about the food” and is also “about the food.”

It’s about the food in the sense that FA is a modern problem and generally involves UPFs or industrialised foods which are now all around us. It’s also not about the food in the way that not all humans experience FA even though UPFs are all around us. Some people may experience greater challenges with feeling compelled to eat certain foods in an addictive way. We'll be sharing a follow-up article about these potential vulnerability factors next.