A Health Crisis Hiding in Plain Sight (Post 3 of 5)
'Just one more spoonful' you say, and before you know it the whole tub of ice-cream has gone.
Then you berate yourself for your lack of willpower, perhaps even feeling a sense of shame at your apparent personal failing.
But what if willpower isn't the issue?
What if this is a sign of something much more complex?
In this next post of my on-going series about the International Food Addiction Consensus Conference (IFACC), these are the kinds of questions we’ll address.
This is the third post in the series - if you missed the other two, then you can catch them here:
The next three speakers helped to connect the dots between public health concerns and the experience of the individual.
I have written about each presentation in the same order that they were given on the day, but you can click on any title in the list below to jump straight down to a particular talk, if you don’t want to read all of them.
Dr Vera Tarman – Beyond Moderation into Abstinence: Why Food Addicts Need Zero Tolerance.
Prof Adrian SotoMota – Lessons Learnt from Patients about Food Addiction.
For your convenience, here are links to the first three speakers from my previous post:
So let’s jump into the presentations, starting with Dr. Vera Tarman who presented a compelling argument for the zero-tolerance approach as a treatment for food addiction.
Her talk challenged the popular 'everything in moderation' mantra, offering a fresh, albeit controversial, perspective on treatment.
Dr Vera Tarman – Beyond Moderation into Abstinence: Why Food Addicts Need Zero Tolerance
Dr Vera Tarman is a specialist in addiction medicine, and the author of the book “Food Junkies: The Truth About Food Addiction”.
She promotes a pragmatic approach to treatment which balances medical and psychological strategies with practical advice.
Her view is that there are several stages of severity in the problem.
It starts with ‘substance use’, moves through ‘substance misuse’, and finally reaches ‘substance addiction’.
With this view, different treatment approaches would be required depending on where an individual sits in the range.
Beyond Moderation: The Case for Abstinence in Food Addiction
The model that she uses recognises that there are both physiological and psychological components to addiction.
To understand the physiological side of things (dopamine receptor downregulation) we can use a metaphor.
The Physiological Component: The Dopamine Doorbell Metaphor
Imagine that your brain is a house with many different doors, all of which have a doorbell.
Dopamine is a chemical messenger in your brain and in this analogy we can imagine it is represented by visitors at the doors.
Of course, they’re going to ring on the bell at the door to draw attention to the fact that they want to come in.
The bells represent receptors in the brain that interact with the dopamine.
So, every time something enjoyable, or rewarding, happens (like winning at a game or eating your favourite food), dopamine is released in the brain.
Those doorbells start ringing.
Now, if you keep ringing the doorbells over and over again, after a while, anyone living inside the house would probably get fed up, and remove some doorbells to stop the constant noise.
The brain effectively does the same.
When the dopamine keeps being released, the brain will start to reduce dopamine receptors.
This means that the same amount of dopamine will no longer have the same effect, so activities that used to make you feel good just don’t hit the spot anymore.
So what do you do?
It makes perfect sense to try to ramp things up a bit, doesn’t it…do more of the activity, or consume more of the thing that gave you the pleasure or reward in the first place.
And that can work, temporarily.
But going back to our analogy, the people in the house would start getting annoyed again and even more of the doorbells would be removed.
Then you’ll have to ramp up even more!
So you can see that over time, more and more...and more and more of the ‘thing’ is needed to get the pleasure or reward from it.
And then eventually what can happen is that you're doing ‘the thing’ just to prevent symptoms of withdrawal that happen when you’re no longer doing it.
The Psychological Component: Associations and Relief
To help understand the psychological side of things, it’s really useful to know that the brain is super quick at making powerful associations and connections between things.
So if you’re experiencing negative feelings and comfort yourself by eating something super delicious, your brain will quickly make a connection between the thing you ate and the feeling of relief or comfort that you felt.
So then the next time you’re feeling bad, your brain will automatically try to guide you to find that thing you ate last time because it remembers you felt better after eating it.
It’s like having a little voice in your head telling you that everything will be okay if you can just eat some [insert your preferred comfort food here].
The Case for Abstinence in Food Addiction
‘Everything in moderation’ is a phrase that we often hear, but Dr Tarman argues that for some people moderation is just not possible, due to the depth of their addiction.
Abstinence has to be the approach.
She describes food addiction as being a chronic, progressive condition caused by changes in the brain’s reward system.
But the good news is that it can be managed into remission with vigilance, and the proper treatment approach.
A key message from her talk was that prevention is crucial in addressing food addiction before it develops, especially in children and teenagers (who are particularly vulnerable).
Look out for a future blog post where I will go into more depth, particularly through the lens of how our psychology and physiology combine.
Having looked at treatment strategies, it was then time to examine how food addiction relates to other eating disorders.
Prof Adrian SotoMota – Lessons Learnt from Patients about Food Addiction
Professor SotoMota specialises in internal medicine, data science, and human metabolism.
This means he can understand the physiology but is also able to do a deep dive into number-crunching to look at the statistics coming out of nutrition research.
His research focuses on trying to differentiate between ‘Food Addiction’ and Binge Eating Disorder (BED).
This is a crucial research question because differentiating between the two problems means differentiating between treatment approaches.
Data-Driven Insights: Differentiating Food Addiction from Binge Eating Disorder
The talk involved a lot of data science and discussion of the research tools (questionnaires) that are used in the research, and I have to admit that numbers do not float my boat!
But the key message that I took away was that the data suggest Food Addiction and Binge Eating Disorder may be separate things.
Key Research Findings
A really interesting suggestion coming out of the data is that around 70-75% of people diagnosed with Binge Eating Disorder might better fit a diagnosis of Food Addiction.
Implications for Treatment Approaches
Treatment for Binge Eating Disorder focuses on managing bingeing episodes through psychological tools, and behavioural changes.
Food Addiction treatment is similar to other substance use disorders, involving abstinence and strategies for avoiding triggers.
So this is really important because up to 75% of the patient group could be getting the wrong treatment!
Imagine the frustration, and feelings of failure or hopelessness, you would have if you weren't responding in the way that would be expected despite receiving treatment.
This then could feed into a cycle of worsening, rather than improving symptoms.
It's not hard to imagine that patients could perceive the lack of improvement as a personal failing, and end up grappling with tough emotions like guilt and shame, on top of everything else.
The Cycle of Food Addiction and Health Consequences
In this way, Food Addiction can become a deeply entrenched chronic condition with a repeating cycle of recovery and relapse.
Not only is this challenging to overcome, but it also has the potential to result in long-term physical health conditions such as obesity, diabetes, and cardiovascular disease.
And the economic impact on the individual of financing their addiction also shouldn’t overlooked, or underestimated!
So, understanding that a significant proportion of Binge Eating Disorder diagnoses could actually be cases of Food Addiction can help with the development of more effective, and targeted, long-term treatment and maintenance protocols.
This would reduce the risk of relapse, and hopefully improve the quality of life of the patients.
Not only does this research have the potential to revolutionise treatment approaches, but it also helps shift the paradigm in how eating disorders as a whole are approached.
Ultimately, this will improve patient care and outcomes.
Building on the distinction between food addiction and eating disorders, we then turned to take a more detailed look at how Ultra-Processed Food Addiction can be understood.
Dr Erica LaFata – The Research on Why Ultra-Processed Food Addiction is Best Conceptualized as a Substance-Use Disorder.
Dr LaFata is a clinical psychologist who specialises in understanding the addictive mechanisms associated with Ultra-Processed Foods (UPFs).
In her talk, she drew parallels between substance use disorders (SUDs) and behavioural addictions.
She highlighted genetic, neurobiological, and treatment similarities, along with commonalities such as emotional regulation issues, impulsivity, and reward system activation.
Ultra-Processed Food Addiction as a Substance-Use Disorder: Behavioral Criteria for Diagnosis
Addictions are diagnosed using behavioural criteria, such as:
‘loss of control’;
‘continued use despite negative consequences’;
‘withdrawal symptoms’;
cravings;
impairment; and
distress.
Using these criteria to assess Ultra-Processed Food consumption, Dr LaFata suggests that addictive responses can be triggered not only by the ingredients in Ultra-Processed Foods but also by the way those ingredients are processed.
Evidence from Animal Studies
Studies have shown that consuming Ultra-Processed Foods affects the brains of rats, with evidence that the functioning of neurotransmitters in their brains is altered.
There is also evidence of neurobiological changes leading to an escalation in tolerance (meaning that the rats ‘need’ to eat more and more of the Ultra-Processed Food), along withdrawal symptoms when they are denied access to it.
Furthermore, the rats changed their behaviours towards some of their usual activities in favour of eating the Ultra-Processed Foods, which suggests they became addicted to it.
Human Evidence of Ultra-Processed Food Addiction
But it’s not only rats that are affected negatively by eating this kind of foodstuff.
There is sound evidence in humans of:
Craving;
Binge eating;
‘Use despite negative consequences’; and
Mood-altering effects;
all associated with the consumption of Ultra-Processed Food.
What’s more, and very scarily (!), there is now evidence of the human brain being susceptible to actually changing in response to the consumption of Ultra-Processed Foods.
Going back to our first speaker, Dr van Tulleken, he did an experiment where he ate a diet made up of 80% Ultra-Processed Foods for a month.
Brain scans taken before and after the experiment showed that the areas of his brain responsible for reward had linked up with the areas that are involved with repetitive, automatic behaviours.
This is similar to what we see when addictive substances such as nicotine, alcohol, and drugs are ingested.
Perhaps it's not surprising then that estimates suggest approximately 14% of adults may be struggling with food addiction; a prevalence similar to alcohol and tobacco dependence.
Aligning Terminology and Research
Dr LaFata suggests that the narrower term ‘Ultra-Processed Food Addiction’ should be used, rather than the broad term ‘Food Addiction’, which makes sense to me.
I think most of us intuitively know that it’s not an addiction to broccoli that we’re talking about here.
She explained that aligning the terminology with the existing research on processed foods would allow connection to broader health impacts beyond addiction, better targeting public health interventions, and strengthening the scientific and public discourse.
Look out for a future blog post where I will go into more depth to understand the implications of Dr LaFata’s research.
All of the talks were recorded and the Collaborative Health Community (CHC) is making them available to be watched on-demand.
You can gain access here: https://the-chc.org/fas/conference
They are only asking for £25 to access all 12 talks, which is really good value for all those hours of content.
The proceeds will go towards next year’s event and funding the research - the experts give their time freely but it is still a huge financial undertaking to run this project.
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