Processed food addiction—what the Science says

 
Processed Food Addiction: Foundations, Assessment, and Recovery is NOT a beach read. That is unless you have insomnia on vacation. Joan Ifland, Marianne Marcus, and Harry Pruess have delivered a serious tome on the dangers of processed food. It is not a pretty sight. I waded through 31 chapters and 454 pages in my quest to understand the subject. It is a technical book written in strict, academic form. The book represents a major advance in the field since Food and Addiction. What a remarkable achievement in just a few years. The field has attracted many researchers. Over the next three weeks I will present their findings, the case they make, and my assessment of that case. For a nontechnical summary of the key points in the book see a popular article by the senior editor.
 
Note, my typical posts on this site are nontechnical in easy-to-understand language. The technical treatment of processed food addiction in this book requires me to drift into a technical treatment. To understand the topic as presented by these food-addiction researchers, I must answer in their language—RS.
 
Processed Food Addiction. Addiction is a combination of impulsivity and compulsivity (1). Impulsivity involves “unplanned reactions . . . without regard for negative consequences.” Compulsivity results from “repetitive actions that are excessive and inappropriate.” They define processed food addiction as “the compulsive consumption of food despite a lack of hunger or a desire to stop eating” (2). The premise of Processed Food Addiction? “Science has demonstrated similarities between chronic overeating and drug addiction to a point where the possibility of chronic overeating functioning as an addiction cannot be ignored” (1). Note food addiction of any type is not recognized in Diagnostic and Statistical Manual of Mental Disorders (DSM 5). The editors describe Processed Food Addiction as a textbook. It also appears to be making a case for inclusion of food addiction in DSM 6.
 
Relationship to obesity. Many of the early chapters identify processed food addiction with obesity (2-8). In a later chapter we learn that not all processed food addicts are overweight or obese, but most are (9). Not stated, but implied in many chapters, is that anyone who is obese is a probable processed food addict. Binge eating is a key indicator of food addiction (5,9,10). Overeating is a key symptom of food addiction. One chapter rejects the close association between food addiction and weight gain. The connections between food addiction, obesity, and binge eating are controversial (10).
 
Relationship to drug addiction. Throughout Processed Food Addiction the parallels to drug addiction are clear (3,12,13). Terms like abstinence (9,13,15,16,17), binging (18,19), craving (11,14,20), crime (3), cues (3,9,11,15), detox (21), highs (6), intoxication (22), pushers (17), recovery (15,18,23), triggers (11,17), violence (3,23), and withdrawal (18,19,22) occur throughout the book. The authors assume food addiction is as devastating and debilitating as drug addiction. The authors proclaim that the effects of food and drug addiction is similar. One chapter acknowledges possible exceptions (10).
 
Chemical structure of methylamphetamine or meth
Meth is a Stimulant Use Disorder (structure courtesy of Dr. Ron Pegg)

Substance abuse not process abuse. The thrust of Processed Food Addiction hinges on the difference between substance abuse and process abuse. DSM 5 differentiates between the two disorders. The book labels food addition as a Substance Use Disorder (SUD). Examples of substances causing SUDs are alcohol, hallucinogens, marijuana, nicotine, opiods, sedatives, and stimulants. We would classify eating addiction is a Process Use Disorder (PUD). PUDs include gambling, shopping, sex, and video game addictions. The rationale given is that “addictive substances must be misused in the behavior” (11). I understand that all current SUDs trace back to a single chemical. Declaring food abuse as an SUD would be a departure from that practice. Or would it?

 
Chemical structure of caffeine
Caffeine is a stimulant found in food and beverages. It is not a Substance Use Disorder (courtesy of Dr. Ron Pegg)
What chemicals in processed food are candidates for addictive agents? Sugar is the most probable addictive substance in food (10-13). Carbohydrates contain one or more sugar molecules. Glucose and fructose are monosaccharides. Circulating glucose in the bloodstream is necessary for proper brain function. Fructose performs no essential function in the human body. Sucrose and lactose are the most common disaccharides in the human diet. Sucrose contains a molecule of glucose and a molecule of fructose. Glucose and galactose comprise lactose. Fructose is a prime candidate as an addictive agent (11). Other potential chemicals that pose as addictive substances include sodium chloride and caffeine.
 
More nebulous addictive substances are dairy, fat, flour and gluten (11,14). Of particular concern are sugar and fat combinations (10,11) such as chocolate products (14). Another concern is polysubstance abuse—many addictive foods in a single item (11,14-16,22). Fast food meals are prime examples of polysubstance abuse. And then there are the 15,000 food additives present in processed products (15). Each added chemical represents a potential addictive agent.
 
Why processed food? The stated premise is “that the difference between addictive processed foods and nonaddictive, unprocessed foods is a key factor in the loss of control over eating.” This chapter describes concentration of sugar and flour by unnatural processes. Concentration of natural materials occurs in modern industrial processes. Food processing also combines natural ingredients like sugar and caffeine in unnatural products like soda. Ultra-processed, calorie-dense, palatable, grocery, junk, and addictive foods are synonyms (11).
 
Evidence. Neuroimaging data provides the strongest evidence for processed food addiction. Brain scans with fMRI (functional Magnetic Resonance Imaging) show similar responses in drug and food addicts (2,11). The neural pathway featuring dopamine is also observed in both types of addicts (2,11,21,25). Clinical manifestations of addictive behavior added to the addiction profile (8,9,11,19,23,26). A recovering food addict describes the devastation wrought by her experiences (18). Almost 200 written testimonials appeared in chapters illustrating specific criteria for SUDs. These statements came from Food Addicts Anonymous and Food Addicts in Recovery Anonymous.
 
Treatment. The addiction model replaces failed weight-reduction programs (14,26,29). Twelve-step programs developed to assist processed food addicts in recovery include Overeaters Anonymous, Food Addicts in Recovery Anonymous, and Food Addicts Anonymous (8,9,11,16,27). Even clients who are not food addicts can benefit from these programs (21). For addicts who don’t recover with a help from a twelve-step process, therapy is available (8,16,17,19,26,28). Some treatments permit electronic mentoring via video, laptop or cellphone (28). Residential treatment may lead to six to twelve month stays (19). Abstinent diets are critical in achieving recovery. These diets consist of four basic elements: protein, starch, fruit or vegetable and fat. Recommended fat options are cold-pressed oils or fat (11,26).
 
Perspective. To this point in the blogpost, I have presented the point of view of the authors in the book. I admit that I have no expertise in food addiction research. I do have opinions based on my knowledge of food chemistry and what I have read in the book and the scientific literature. Processed Food Addiction makes no clear distinction between addiction, eating disorders, and disordered eating (3,5,15,17). Not all researchers in the field subscribe to a food addiction model (10,30). The chapter that was most convincing to me of the reality of food addiction was the one that described limitations of the theory (10). Consistency and certainty in science usually denote advocacy and not investigation. All other chapters were adamant in their perspective. Weight-loss and eating disorder programs have not been effective. Other SUD rehabilitation efforts have had limitations (31-32). Will food addiction programs be more successful?
 
I do understand food processing. The authors of chapters in the book have little concept of what food processing involves. Yes, processors purify table sugar and concentrate it from its natural state. Most American sugar comes from sugar cane and sugar beets. When added to most processed foods it is present at at lower levels than in ripe bananas, mangoes or other high-sugar fruits. Yes, these ripe fruits have fiber, vitamins, and minerals. If the sugar is addictive in a fresh pastry, it is also addictive in ripe fruits. Many industrial processes do not concentrate molecules in the final product. Many processes actually dilute these molecules. They also mention chocolate as a source of caffeine. Theobromine, not caffeine, predominates in the composition of chocolate.
 
back of a tee-shirt with the structure of theobromine, a chemical in chocolate
Chocolate contains theobromine and very little caffeine
 
The editors of Processed Food Addiction present a strong argument for addiction to processed food. The greatest limitation of the book is a lack of specific compounds linked to that addiction. DSM 6 must redefine the concept of Substance Use Disorders to accept food as an addictive substance. The authors counter the argument by showing how food satisfies each criterion for SUDs outlined in DSM 5.
 
Next week: How food fits the criteria for Substance Use Disorders
 

References

(1)  Ifland, J., M.T. Marcus, and H.G. Preuss, 2018. Introduction: Learning about processed food addiction. Processed Food Addiction xiii-xvii.

(2)  Ellis, R.J., M. Michaelidis, and G-J. Wang, 2018. Neurodysfunction in addiction and overeating as assessed by brain imaging. Processed Food Addiction 27-38. 

(3)  Ifland, J. and P.M. Peeke, 2018. Overlap between drug and processed food addiction. Processed Food Addiction 3-25.

(4)  Stice, E. and Z. Stice, 2018. Neural vulnerability factors for overeating: Treatment implications. Processed Food Addiction 39-55. 

(5) Marcus, M.T., 2021. Mindfulness therapies for food addiction. Processed Food Addiction 107-118. 

(6)  Ifland, J. and E. Epstein, 2018. DSM 5 SUD criterion 3: Time spent. Processed Food Addiction 175-186.

(7)  Ifland, J. and C.L Willie, 2018. DSM 5 SUD criterion 5:  Failure to fulfill roles. Processed Food Addiction 205-215. 

(8)  Ifland, J. 2018. Adaptation of SUD and ED practice parameters to adolescents and children with PFA. Processed Food Addiction 397-416. 

(9)  Ifland, J., K.K. Sheppard and H.T. Wright, 2018. The Addiction Severity Index in the assessment of processed food addiction. Processed Food Addiction 289-303. 

(10) Criscitelli and N.M. Avena, 2018. Sugar and fat addiction. Processed Food Addiction 67-75. 

(11) Ifland, J., H.G. Pruess, M.T. Marcus, W.C. Taylor, K.M. Rourke, H.T. Wright, K.K. Sheppard, 2018. Abstinent food plans for processed food addiction. Processed Food Addiction 77-106. 

(12) Pruess, H.G. and J. Ifland, 2018. Sugar consumption: An important example whereby recognizing food addiction may prove important in gaining optimal health. Processed Food Addiction 57-66. 

(13) Ahmed, S.H., 2012. Is sugar as addictive as cocaine? Food and Addiction 231-237.

(14) Ifland, J. 2018. DSM 5 SUD criterion 4: Cravings. Processed Food Addiction 187-204.

(15) Zeidonis, D.M. and J. Ifland, 2018. Premises of recovery for adults. Processed Food Addiction 321-340. Chapter 24

(16) Ziedonis, D.M. and J. Ifland, 2018. Avenues of success for the practitioner. Processed Food Addiction 341-353. Chapter 25

(17) Ifland, J., 2018. Strategies for helping food-addicted children. Processed Food Addiction 417-447. 

(18) Gold, D., 2018. Case study: Severe processed food addiction. Processed Food Addiction 147-155.

(19) Willey, C.L. and J. Ifland, 2018. Adaption of APA practice guidelines for SUD to processed food addiction. Processed Food Addiction 355-374.

(20) Meule, A., 2018. Assessment of food cravings. Processed Food Addiction 137-145. 

(21) Ifland, J. and H.T. Wright, 2018.DSM 5 SUD criterion 11: Withdrawal. Processed Food Addiction 277-287. 

(22) Donovan, D.M. and J. Ifland, 2018, Diagnosing and assessing processed food addiction. Processed Food Addiction 121-136. 

(23) Ifland, J. and D.M. Ziedonis, 2018. Introduction to recovery from processed food addiction. Processed Food Addiction 207-320.

(24) Ifland, J. and J.M. Cross, 2018. DSM 5 SUD criterion 8: Hazardous use. Processed Food Addiction 241-254. 

(25) Ifland, J. and C.L. Willey, 2018. DSM 5 SUD criterion 10—tolerance. Processed Food Addiction 263-276. 

(26) Ifland, J. and H.T. Wright, 2018. Insights from the field. Processed Food Addiction 383-396. 

(27) Ifland, J., H.G. Pruess, and M.T. Marcus, 2018. Conclusion: Nurturing the sapling. Processed Food Addiction 449-454. 

(28) Ifland, J. and R. Piper, 2018. Preparing adults for recovery. Processed Food Addiction 375-381. 

(29) Ifland, J. and R.S. Roselle, 2018. DSM 5 SUD criterion 9: Use in spite of consequences. Processed Food Addiction 255-262. 

(30) Penzenstadler, L., C. Soares, L. Karila, and Y. Khazaal, 2019. Systematic review of food addiction as measured with the Yale food addiction scale: Implications for the food addiction construct. Current Neuropharmacology17(6):526-538. https://pubmed.ncbi.nlm.nih.gov/30406740/

(31) Stein, D., S. Deberard, and K. Homan, 2013. Predicting success and failure in juvenile drug treatment court: a meta-analytic review. Journal of Substance Abuse Treatment 44(2):159-168.

(32) Smiley, R. and K. Reneau, 2020. Outcomes of Substance Use Disorder monitoring programs for nurses. Journal of Nursing Regulation 11(2):28-35. https://www.ncsbn.org/OutcomesofSubstanceUseDisorderMonitoringProgramsforNursesJNR.pdf

 

11 thoughts on “Processed food addiction—what the Science says”

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  10. Thank you for your comments and formulas. No bromine in theobromine? Like no chlorine in chlorophyll, which annoys the chlorophobes.
    Number of additive substances (15,000) is irrelevant and worse yet, misleading. How much matters, “dose makes the poison”(Paracelsus). Why are people so resistant (scared?) to see this?
    I’ll await next week to see if they cover nonbiological reasons for eating, including the comfort aspect of infant nursing, which may relate to addiction.

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    1. Their biggest hole in the food addiction theory is there is no substance in the Substance Use Disorder. All other SUDs link directly to a chemical. They don’t even understand chemicals much less the dose makes the poison. You will be disappointed about the nonbiological reasons. Infant nursing is addressed.

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