From the FIX – Food Addiction: It’s Not An Eating Disorder

I don’t think everybody is a food addict but I do think a lot of food is addictive.

Except the cookies might be just as deadly as alcohol and the same goes for chips, in fact, anything that’s processed or made out of sugar, flour, and fat… or anything that you eat even when you don’t want to. Yet, it would be a mistake to stick the Eating Disorder label onto this type of eating. This is because it’s much more than that.

In the new book, Food Junkies: The Truth About Food Addiction, Vera Tarman, MD, the Medical Director of Renascent, Canada’s largest treatment center, tackles (along with contributor Philip Werdell) one of the more controversial addictive substances: food. The Fix interviewed Dr. Tarman recently about the distinction between addiction and disorders, the place of food addiction amongst modes of recovery as well as trigger foods and how to deal with them.

Food addiction? Really? 

People have this response that food addiction can’t be as bad as cocaine addiction partly because society doesn’t see overeating as a problem; it is, in fact, encouraged: all-you-can-eat buffets, bigger portions and so on. It’s not seen as being as dangerous as over drinking. But I think we have a lot more food addicts than other addicts. They’re just undiagnosed. The professionals just want to say that it’s an eating disorder; they don’t want to see it as a syndrome.

But what is the difference between disordered eating and food addiction?

Overeating relies on emotional eating and it fits the eating disorder paradigm. With binge-eating disorders and bulimia the idea is that people are treating their emotional and psychological state with food. If we can treat underlying emotions then the disorder is better regulated. If we can figure out, for example, if it was an interfering mother as a young child, or sexual abuse…whatever it was that is engineering this bulimia—then we can control it.

With food addiction, we’re talking about a biochemical reaction to food. You take some sugar and now you want more. It’s just like with alcohol or cocaine or cigarettes. Everybody has to have the rest of the Mars bar, but the food addict finishes it and then is thinking: I might as well have everything because that’s what I really want. And no amounts of therapy helping to deal with other issues will resolve that. With therapy, food addicts just become really well-informed and insightful food addicts—just like the alcoholic. There’s no amount of therapy that will make a person put down that drink.

With addiction, the treatment is: put down the alcohol, put down the cocaine, put down the sugar and then let’s deal with the issue.

Can you have both an eating disorder and a food addiction?

Clinically, you can have both. That’s why we need better tools, similar to the “20 questions” for AA. There are 20 questions for food addicts, but they’re very general, very broad. We need to have better tools actually to help distinguish: is this bulimia or food addiction? So much of food addiction is still at the level of rat studies. There’s not much clinical work yet because we need to have tools to study people. With something like the 2012 Yale Food Addiction Scale (Ashley N. Gearhardt, William R. Corbin, Kelly D. Brownell) we’re able to say that at least 5% are food addicts, but I’d say that there are more. If you look at the obese population, you could have 30 to 40% and add bulimia or bingeing disorder. At the first Annual Food Addiction conference I went to this year, the keynote speaker was Nicole M. Avena, who has done studies that show rats choose sugar and saccharine over cocaine. There’s more research that needs to be done.

Why is there reluctance to accept food addiction as an issue?

Obesity is the last stigma that we don’t want to acknowledge because we can make fat jokes quite easily and if it’s addiction then we’ll have to take it more seriously. So is food addiction something that we just don’t want to see? The people who are not that reluctant to accept it are family doctors – they’re the ones who are in the trenches. They have people coming in and saying, “For God’s sake, I’ve been in Weight Watchers, I’ve been on Atkins and I still can’t stop. What do I do next? I think I’m a food addict.” But when you talk to psychiatrists they don’t want to hear about this. They send you to an eating disorder clinic; they’re still stuck on the fact that this is bulimia, bingeing disorder and I don’t know, I’m just speculating here – is it territory? Academic environment is very territorial; they are often the last people that look at ideas, when we’re talking about academics it’s intellectual property and you defend your own, and now I’m really going into speculator territory. It makes me wonder if there’s something there. It’s like: “We’ve got it, it’s eating disorders, we have the treatment, let’s not confuse the issue, there’s meds for this, that’s what we’re going to do.”

But why do you think the professionals aren’t open to different solutions? What is the treatment then?

I’m suggesting abstinence from certain foods – there’s no money in that kind of treatment. If I actually said, you know, choose another diet and some company is going to make some money from it, then that probably would be accepted. The solution is: identify the trigger foods and then stop them. The trigger foods are chemically interacting with your brain in such a way that you will crave more once you start.

Can you give some examples of trigger foods?

Most obvious one would be sugar and then next is flour because those are refined carbohydrates that become sugar, according to the glycemic index. So, for example, a bagel gives you a bigger hit than sugar does. Another example would be pop. Pop has a tremendous amount of salt in it. The reason why it’s so sweet is because it disguises the salt in it and part of the reason why people want to drink more is because it’s like salt water. Drinking pop is like drinking ocean water when you’re thirsty – it’s only going to dehydrate you. And, finally, processed foods – they are genetically engineered and they contain sugar, salt and fat. This is the golden triangle of addictive food.

But what about natural sugars, like fruit? Are they safe?

Fruit has a lot of fiber in it and the fiber mitigates the effect of sugar. For example, you might eat three peaches in the night but the next day you might not want to do that because fiber almost limits how much you’ll want to eat; you’ll feel bloated. So generally speaking fruit is okay because it’s self-limiting but if it’s not and the person is bingeing on cherries, like bags and bags of cherries, then they’ve gone past the point where they can eat fruits. In the book, I look at profiles of different people and I’m mapping out different stages of food addiction: early, middle, late. Depending on which stage you are in, fruit might not be appropriate.

So is it only the type of food that can cause addiction? What exactly causes someone to become a food addict?

A rare person can just have five chips because that’s the maximum number of calories they want to consume. The very nature of processed foods is that it’s addictive. Eating processed foods does not mean you’re a food addict. I do think that there’s genetic predisposition just like with cocaine and alcohol – and it’s the same mechanism, Dopamine-2 receptors, that makes them predisposed. Also we’re starting to find out that in-vitro eating patterns have influence: when a pregnant woman is eating sweets, she might be predisposing her baby to eat sweet foods. All of this is experimental and it hasn’t been proven clinically – it’s not at that stage – but it’s certainly an interesting question to throw out there.

There’s also another component – if you have a history of addiction, there’s cross-sensitivity so that a person who’s been using cocaine will get a quicker buzz from sugar than somebody who doesn’t. And, anecdotally, I always ask my patients: how is your eating? And there’s a huge portion of people that say, I eat more than I did before.

Without any specific treatment in place, is a 12-step program the best we have right now and which one should one choose?

Yes, 12-step programs for food addiction are probably the best way to go right now because it’s not an acknowledged diagnosis, there’s no treatment and the best you’re going to get is an eating disorder clinic and they’re going to suggest controlled eating, which doesn’t work. Like with alcohol, you have to drink, but you don’t have to drink alcohol, you can drink water, you will have to decide what your trigger foods are: some people can eat fruit, some people can’t, some people can eat dairy, some people can’t. Some programs will say you have to do weights and measures. But it’s not a diet—you relieve the obsession of food.

People say that smoking is harder to quit than heroin and it is partly true because smoking used to be everywhere. So you might say no to smoking but there’s a smoker next to you … and you want a cigarette now. And it’s the same with food, you go by McDonalds and smell it and go, “yes, I’m going to have some.” This is why 12-step programs work because it’s 24/7 support. There’s also a big online food addiction support community because there’s so little outside (for example, Food Addicts Anonymous Internet Meeting).

There are many different 12-step models because they all disagree about the diet. You have to make a point to shop and find the one you like. Most are more demanding than AA because food is in your face all the time—you can’t get away from it. You can get away from temptation and the cues to use, so the suggestion is to speak to your sponsor every day, you have to call three different people to kind of buffer you against onslaught.

What is the bottom line?

I don’t think everybody is a food addict but I do think a lot of food is addictive. It’s like alcohol. Everybody gets drunk if they drink too much, but there’s only a subpopulation that when they drink, they drink excessively and abusively and those are alcoholics. So this book is not saying everybody is an addict but everybody can learn from this about the dangers of food addiction.

Jowita Bydlowskais a regular contributor to The Fix. Her memoir Drunk Mom was published by Penguin.