A Health Crisis Hiding in Plain Sight (4 of 5)
You're watching your favourite TV show, and suddenly in the break you're bombarded with ads for your favorite snacks.
Before you know it, you're in the kitchen, rummaging through the cupboards for those irresistible crisps or biscuits.
Sound familiar?
Most of us would chalk this up to a lack of willpower or giving in to a simple craving.
We might feel guilty, but rarely question why these foods have such a powerful hold on us.
But what if these ultra-processed foods are actually designed to hijack our brains?
Are we unknowingly falling victim to an addiction to these products?
And how might this affect us beyond our waistlines?
What about our mental health
This post is the fourth in our ongoing series about the International Food Addiction Consensus Conference (IFACC), where experts tackled these very questions.
Today, we'll dive into the complex relationship between ultra-processed foods, mental health, and eating disorders.
But if you missed the previous three posts and want to catch up, then you can access them here:
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.
For your convenience, here are links to the first six speakers discussed in my previous posts:
Dr Chris van Tulleken – Ultra-Processed Food: Addiction, Policy and the Need for this Conference.
Michael Moss – The Extraordinary Science of Addictive Junk Food.
Dr Vera Tadman – Beyond Moderation into Abstinence: Why Food Addicts Need Zero Tolerance.
Prof Adrian SotoMota – Lessons Learnt from Patients about Food Addiction.
So let's jump in and start exploring how dopamine, our brain's reward chemical, plays a crucial role in this story, and discover why some experts are calling for a radical rethink of how we treat eating disorders in light of food addiction research.
First up, the complicated subject of the treatment of eating disorders.
Dr David Wiss – Ultra-Processed Foods and Mental Health: Where do Eating Disorders Fit into the Puzzle?
Dr David Wiss is a registered dietician nutritionist with an interest in Food Addiction and eating disorders.
Unfortunately, he was unable to attend in person but dialed in via video-call.
Dr Wiss is particularly interested in the connection between Food Addiction/Eating Disorders and trauma/adverse childhood experiences.
Studies support the view that Ultra-Processed Foods contribute, not only to intestinal permeability and poor nutrition but also, to cognitive decline, depression, and dementia.
However, despite evidence that these foodstuffs are a significant health risk, they are still included in treatment plans for eating disorders.
Ultra-Processed Foods and Mental Health: Rethinking Eating Disorder Treatment
Dr Wiss explained that there is controversy surrounding the issue of Ultra-Processed Foods in eating disorder treatment because the mainstream perspective is of an “all foods fit” philosophy.
This philosophy stems from the desire to combat diet culture and restrictive eating, which are significant factors in eating disorders.
But this fails to recognise the direct contribution of Ultra-Processed Foods to overeating, and binge eating behaviours.
So it’s not surprising that Dr Wiss argues for a more nuanced approach towards eating disorder treatments, which takes Ultra-Processed Food addiction into consideration.
Particularly for those individuals with binge-type disorders.
He called for a balance between the need for food inclusivity and attention to food quality.
A theme that cropped up time and time again in all the talks on the day, was how conflicts of interest hinder progress, and Dr Wiss’s talk was no different.
Conflicts of Interest in Nutritional Approaches
He criticised mainstream nutritional approaches for being heavily influenced by the “Big Food” and “Big Pharma” industries which dismiss concerns about Ultra-Processed Foods as being pseudoscience.
Here he emphasised the need to consider the biological as well as the psychological effects of Ultra-Processed Foods – which he then went on to explain.
He talked us through how early life adversity can lead to both eating disorders and Ultra-Processed Food addiction, explaining that there is a complex relationship between the two. Different pathways are involved, which means patients need personalised and nuanced treatment approaches.
The Role of Inflammation and Gut Health
Dr Wiss also highlighted that inflammation and gut health are important factors in the mechanisms that link Ultra-Processed Foods to mental health issues (such as depression and anxiety).
This is why the development of effective treatment strategies needs to take into account biology as well as psychology.
The key message from this talk is that the eating disorder field needs to be more flexible in its approach to food philosophies.
Currently, it has a very rigid perspective which does not necessarily serve well the diverse range of patients and their individual needs.
Look out for a future blog post where I will go into more depth about Dr Wiss's talk.
We then continued our exploration of the relationship between food addiction and eating disorders, taking a psychiatric perspective.
Dr Timothy Brewerton – A Psychiatric Perspective: The Significance of Food Addiction in the Evaluation and Treatment of Eating Disorders and Related Comorbidity
Dr Timothy Brewerton is a Professor of Psychiatry and Behavioural Sciences at the Medical University of South Carolina.
Unfortunately, he was unable to attend in person but dialed in via video-call.
Dr Brewerton has a particular expertise in eating disorders, and how food addiction may play into such a diagnosis.
Comorbidity in Food Addiction: A Psychiatric Perspective
He told us that, commonly, Ultra-Processed Food addiction travels alongside other issues (this is called comorbidity), not just eating disorders .
Ultra-Processed Food Addiction can be found alongside:
Eating disorders – particularly those characterised by binge eating;
Mood disorders – especially major depression;
Anxiety disorders – including PTSD;
Adverse Childhood Events;
Substance-related and addictive disorders – alcohol, nicotine, cannabis, gambling;
Neurodiversity – OCD, ADHD, and autism;
Personality disorders;
Non-psychiatric medical conditions – cardiovascular and endocrine disorders such as diabetes.
From what he told us, comorbidity of Ultra-Processed Food Addiction with an additional problem is the rule rather than the exception.
The Complexity of Diagnosis
Clearly, it is a very complicated picture, because for an individual with Ultra-Processed Food Addiction, the other difficulties may be what are, initially, most “visible” to a clinician.
This could result in those other problems being treated without the underlying Ultra-Processed Food Addiction being addressed.
But this doesn’t have to be the case because Ultra-Processed Food Addiction is now a measurable entity due to the development of the Yale Food Addiction Scale (a validated questionnaire).
The Importance of Comprehensive Assessment
So, having a comprehensive medical and psychiatric assessment is absolutely crucial to being able to capture the complete picture of what is going on for the patient.
If clinicians are not routinely using tools like the Yale Food Addiction Scale then they could be missing this problem when it is being masked by other issues that the patient is also experiencing.
Having a more complete understanding of the problem enables the clinician to tailor an effective treatment plan for the patient that addresses all of the different aspects of the problems they’re battling.
Look out for a future blog post where I will go into more depth about Dr Brewerton's talk.
We then went on to take a deeper look at the role of dopamine in the context of addiction.
Dr Anna Lembke – From Dopamine Nation to Dopamine Planet
Dr Anna Lembke is a Professor of Psychiatry at Stanford University and the author of a best-selling book - Dopamine Nation.
Unfortunately, she was unable to attend in person but dialed in via video-call.
Dr Lembke gave a fascinating talk which clearly explained the role of dopamine in addiction, and how the modern world has made many aspects of life more potent in triggering a dopamine response in our brains.
Understanding Pleasure and Pain in Food Addiction: the Role of Dopamine
Pleasure and pain are processed by the same brain systems which work to keep them in balance.
Dr Lembke uses the analogy of a see-saw, with ‘pain’ on one side and ‘pleasure’ on the other, to explain how this balance between the two works.
The chronic repeated use of a pleasurable substance (or the doing of a pleasurable behaviour) changes the brain’s chemistry.
This change leads to the see-saw tilting more towards the pain side by way of compensation – the pain being cravings and withdrawal symptoms.
The system is trying to counteract the ‘pleasure’ to bring everything back into balance.
However, the repeated consumption of addictive substances (or repetition of addictive behaviours) alters the brain’s chemistry to the point that the see-saw becomes more and more weighted towards the ’pain’ side.
This means that the individual needs more and more of the substance or behaviour just to feel ‘normal’ and to stave off the unpleasantness.
This is what leads to the addiction.
The 'Dopamine Fast': Resetting Reward Pathways
Dr Lembke emphasised the importance of early intervention because in her experience of treating patients she has found that addictions progress and become more, and more, deeply entrenched.
She recommends doing what she calls a ‘dopamine fast’, i.e. abstaining from the trigger(s) for a minimum of four weeks.
This, she says, will reset the reward pathways.
She told us that the Dopamine Fast, commonly, causes withdrawal symptoms in the beginning, but these improve after 10-14 days.
After this time many people start to feel better and have a clearer perspective about their consumption patterns.
Often finding that they have reduced their depression and anxiety symptoms as a result.
In the context of food, this will help individuals start to regain pleasure from healthier foods (that may have been lost when Ultra-Processed Foods took over) and reduce their compulsive behaviours.
Healthy Coping Mechanisms and Natural Dopamine Release
She suggests that healthy coping mechanisms could work in the opposite way.
What this means is that tilting the see-saw to the ‘pain’ side first results in it compensating towards the dopamine release.
For example, engaging in physically effortful or challenging activities such as exercise or cold water baths, brings about a natural dopamine ‘hit’ without a subsequent deficit.
So by embracing short-term discomfort we can potentially achieve improvements over the longer-term for our mood regulation and overall well-being.
This approach can help us build resilience and maintain a more balanced emotional state over time.
Look out for a future blog post where I will go into more depth about Dr Lembke's work and a review of her book.
All of the talks were recorded and the 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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