January-February 2013 | Cooking Class

Food Fix

Can't get no satisfaction? One cupcake doesn't do it anymore? Increasing evidence suggests: YOU MAY BE AN ADDICT

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By the time she was 13, Hillary Buckholtz was seriously obese—and there was no mystery as to why. Every chance she’d get, the Potomac girl would sneak food, especially sweets. Her cravings were unbearable, and once she started eating cookies, candy or another sweet treat, it was hard for her to stop.

A learning disability made school difficult, and looking back, Buckholtz suspects she used food to numb her frustration.

“My problem wasn’t food or that I was overweight: The problem was that I used food to deal with life,” says Buckholtz, now 32 and a social media manager for a TV production company. “I don’t even like regular food. My thing is sugar and the junkiest junk food…cakes, cookies, ice cream, candy. When I eat sugar, my reaction is different from someone with normal eating limits. I want to eat more, and I become fixated on it.

“I’m a food addict,” she says, “and I’m addicted to sugar.”   

Not long ago, a statement like that would have been dismissed as little more than an excuse for overeating or consuming the wrong foods. But evidence in recent years has suggested that some foods may, in fact, hijack the brain’s reward system in susceptible individuals, much as cocaine, heroin and other drugs do.

The idea remains somewhat controversial. “There are scientists who don’t believe in food addiction, who believe the notion lets people off the hook when it’s really just a lack of self-control or an inability to control their impulses,” says Joe Frascella, director of the division of clinical neuroscience and behavioral research at the National Institute on Drug Abuse in Bethesda. Increasingly, however, doctors and scientists are viewing food addiction as not just a psychological condition, but a physiological one, too. And there’s evidence to back up that notion.

Groundbreaking studies using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans have demonstrated that when people with food addictions are shown pictures of and/or eat sweet, salty or fatty foods, the pleasure centers of their brains light up and stay lit up much longer than in those without an apparent food addiction. The stimulated pleasure center, in turn, triggers an intense desire for more.

At the same time, the prefrontal cortex—the part of the brain responsible for planning and decision-making—becomes impaired and unable “to rein in the impulsive drive to overeat,” says Dr. Pam Peeke, a nationally recognized nutrition and fitness expert who practices in Bethesda and is author of the recent New York Times best-seller The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction (Rodale, 2012).  

What all of that means, Frascella says, is that there are biological similarities in how foods and drugs can affect the brain’s reward system. And the similarities don’t end there. Mood changes and bingeing are common to both kinds of addiction. “And behaviorally, the relapsing nature—with withdrawal symptoms and intense cravings—is similar, too,” Frascella says.   

It was a decade ago that researchers at the Brookhaven National Laboratory in Upton, N.Y., found that brain scans of very obese people showed significant reductions in dopamine receptors.

Dopamine is the neurotransmitter that motivates people to eat and engage in other pleasurable behaviors. What that meant was that they couldn’t get the pleasure they craved from eating, say, a single doughnut; they needed considerably more to obtain the satisfaction they desired.

Peeke recommends meditation to help manage stress, one of the triggers for food addiction. Photo by Erick GibsonAlready, Peeke had been seeing evidence of this in her practice. “For years, many of my patients would show up sounding like little junkies. They’d say, ‘I need a hit of this’ or ‘I can’t get off the stuff,’ and they were always referring to some food product,” she says.

“The brain scans were game-changers because they show that regardless of addiction—whether it’s to drugs, food or alcohol—you see the same changes in the reward center of the brain: The total number of dopamine receptors is way down, allowing only a small amount of this pleasurable brain chemical to get through—and thus, people experience less and less pleasure and reward,” Peeke says. “That’s why addicts of any kind need more and more of their substance to even feel a small amount of pleasure.”

When the brain is continuously flooded with high levels of dopamine, she explains, many of the dopamine receptors shut down. As a result, when you do consume the desired food, “you don’t feel as much reward, and it takes more of a hyper-palatable food to actually enjoy the original pleasure you had when your dopamine-receptor population was normal,” Peeke says. “You need six cupcakes to get the pleasure you used to get from one.”

In a 2011 study involving 48 healthy young women, researchers at Yale University examined the relationship between the women’s food addiction scores and their level of brain activation on fMRI scans when they got or anticipated a rich, chocolate milkshake. In women with higher food addiction scores, the reward areas of their brains lit up like pinball machines when they viewed photos of the shake, just as the brains of drug addicts do when they see drug paraphernalia. Meanwhile, the areas of the brain that inhibit behavior became deactivated.

Add to that the fact that certain foods have mood-boosting effects similar to those of drugs. In a 2011 study at the University of Leuven in Belgium, researchers had people ingest either a fatty solution or a saline solution before listening to sad music. Those given the high-fat liquid felt more upbeat afterward; the saline-receivers felt saddened.   

Dr. David Kessler, the former Food and Drug Administration commissioner and author of The End of Overeating (Rodale, 2009), notes that there’s a “bliss point” of flavors: the fulcrum at which people “get the greatest pleasure from sugar, fat or salt.”

Food manufacturers have become adept at identifying that point, often combining taste sensations and flavor enhancers to make their chips, cookies or other packaged foods “hyper-palatable,” stimulating the appetite and causing consumers to want more. In other words, they override the body’s natural system for regulating satiety in a way that eating handfuls of unprocessed foods—such as apple slices or snap peas—wouldn’t.

This desire for food high in fat and sugar appears to have been hardwired into humans from caveman times, when it was a challenge to consume enough calories to survive. But it doesn’t make sense in a modern world where food is plentiful and physical activity is in short supply.

“A long time ago, food was not like this,” says Dr. Gene-Jack Wang, a senior scientist at Brookhaven National Laboratory who has done groundbreaking research on food addiction. “You wouldn’t eat steak and tomatoes until you got addicted to them. Internally, you’d have a system to regulate how much you eat, and you had external limitations—how many days are you going to hunt buffalo?

“The food is totally different now. A lot of it is processed and it’s very palatable,” he says. “Once you get used to those kinds of foods, which have a lot of sugar, fat and salt in them, other foods become kind of boring. The current food we have is more addictive.”  

Granted, not everyone is vulnerable to food addiction. Those who tend to get hooked on sugary and/or fatty foods often have a family or personal history of addiction, or have difficulty adjusting to life challenges due to abuse, trauma, depression or anxiety, Peeke says.

“I’m someone who’s genetically predisposed to addiction,” Buckholtz says. “There are members of my family with a history of substance abuse.” In her case, food is the substance of choice.

Some people with food addictions are overweight or obese. Others are not, thanks perhaps to a speedy metabolism or because they counteract their indulgences with lots of physical activity. Those who have a food addiction and want to lose weight typically face extra challenges. In a 2012 study involving people seeking weight-loss treatment, researchers at Bowling Green State University in Ohio found that those who scored higher in food addiction experienced more depression, emotional eating, binge eating and body shame—and were likely to lose less weight after seven weeks than others.  

Researchers know that food addiction can reduce the number of dopamine receptors. But can being born with fewer dopamine receptors cause someone to be susceptible to food addiction?

The answer appears to be yes, Peeke says. The research suggests that if you’re born with fewer dopamine receptors than normal, you may be predisposed to developing an addiction because it takes greater quantities of food to provide you with pleasure. Continuous overindulgence then decreases the receptor population even further.

“The other brain change that happens concurrently is that the brain’s braking system, the prefrontal cortex, is also damaged, impairing willpower and the ability to control impulsivity,” Peeke says. “It’s a double whammy.”    

Marlyn Glickman of Rockville has experienced the double whammy.

“I have to be vigilant about not turning to certain foods like peanut butter or cookies or crackers when I’m stressed out because they definitely make my eating run amok,” says Glickman, a 63-year-old and two-time breast cancer survivor. “If I get the sugary rush or that salty-crunchy feeling in my mouth, I’ll go find more of that genre, and having one cookie could easily turn into having 10.”

Sixty pounds overweight before she learned to manage her food addiction, Glickman won’t keep cookies in her house anymore. If she desperately wants one, she’ll have to go out and buy it, which is a deterrent. She also has developed other tools to cope with stress. “Now if I’m stressed out,” she says, “I try to replace the craving with an activity like going for a walk or swimming.”   

To overcome a food addiction “you need to have what I refer to as an epiphaME,” Peeke says. Having that “aha” moment and gaining the motivation to make meaningful lifestyle changes—whether it’s from a health scare, a desire to participate in an activity or simply feeling tired of living at the mercy of food—is the first step toward recovering from food addiction.

For Anne Foster, a 50-year-old event planner who lives in Rockville, that “epiphaME” came when her best friend died of cancer in 2002. “That was my wake-up call,” she says. “I stopped and said, ‘What the hell am I doing?’ ” At the time, Foster weighed 254 pounds, was prediabetic and had high blood pressure and high cholesterol. “I was a walking time bomb,” she says.

“I’d been obese all my life. For me, eating was a way of filling the void in my life, and I’d eat the foods I loved—bread, chocolate, cookies, cake—without paying attention to how much,” she says.

After her friend’s death, Foster sought Peeke’s help for her weight issues, ended an unhappy marriage and focused on taking better care of herself. Over 2½ years, she lost 130 pounds and found fitness. “Now I use exercise as a coping tool instead of food,” Foster says. “I work out a lot and eat healthier foods and I feel the best I’ve ever felt.”

Recovering from food addiction is a complex challenge, Frascella says, because “you have to eat. You don’t have to take cocaine three times a day. But food is something we have to have in order to survive physiologically. So it’s impossible to avoid food—but it’s not impossible to avoid high-fat, high-sugar foods.”

Judith Fitzpatrick, 58, a retired U.S. Army nurse who lives in Takoma Park, continues to find it a challenge to avoid sugary foods, even after losing 50 pounds and becoming more active. She’s addicted to sweets, she says. “I do crave them, so I have to be very vigilant.” She finds that if she eats fruit with her meal, she won’t crave dessert as much. And if she does, eating something sour, like half a grapefruit, “stops the cravings.”

As with any addiction, there is no cure, but there is the possibility of lifelong recovery. With determination, a strong support system and a mindful approach to living every day, you can reclaim control of your health, your weight and your life, Peeke says.

Hillary Buckholtz learned that as a teen after seeking Peeke’s help and losing 100 pounds by learning to eat properly and becoming physically active. She maintained the weight loss for 10 years. But when life became stressful again, some of her old habits returned.

Finally, in 2003, she started attending a self-help group for food addicts and overeaters, and “that changed everything,” she says. “I learned about the nature of food addiction and tools to deal with the daily stresses of life without using food.”

These days, she abstains from sugar entirely and sticks with a food plan that establishes boundaries and helps her maintain a normal weight. “By abstaining from sugar, I have more of a chance of eating normally—I still have to work at it, but it’s easier when sugar is off the table, because then I can think straight about food,” she says.

Now, instead of reaching for cookies, candy or other junk food when she feels stressed, Buckholtz does breathing exercises, goes to the gym or for a walk, or calls or texts a friend for support.

She still craves the sweet stuff, but has learned the cravings will pass. “Because I’m a real sneak with food, if I want to buy [a sweet treat] but I’m going to have lunch in an hour, I might text someone that I’m going to wait out the craving,” she says. “That way, I’m accountable to someone even if they don’t care.

“It’s a work in progress,” she says. “My food addiction is something I’ve accepted is a chronic condition that’s pretty much here to stay. I don’t believe there’s a cure—but I can manage it and have a great life.”

Are You a Food Addict?

Researchers at Yale University have developed a way to assess whether someone is suffering from a food addiction. The Yale Food Addiction Scale contains 27 statements or questions designed to gauge the extent to which you may be struggling to control your intake of certain foods.

You can get the full survey at www.yaleruddcenter.org/resources/upload/docs/what/addiction/FoodAddictionScale09.pdf. For a more user-friendly version, try Dr. Pam Peeke’s food addiction quiz at www.drpeeke.com/PopQuiz.htm.

Stacey Colino lives in Chevy Chase and frequently writes about health for national magazines.