Food for Thought: Exploring Cravings and Compulsions

In the not-so-distant past, many people, including physicians, believed obese people were extremely weak-willed individuals. If they would stick to their diets and exercise more, the belief went, obese individuals could slim down and live happily ever after. Sometimes, obese people did lose weight with diets, drugs, a new gym membership, or surgery (or all of the above), only to relapse later, seemingly proof of the weak-willed theory. Yet the Centers for Disease Control and Prevention (CDC) says 42 percent of adults in the United States are obese. Do they all suffer from no self-control?

Experts are learning one culprit behind the obesity epidemic has nothing whatsoever to do with strength of character, stick-to-it-tiveness, or other tired ideas that have spectacularly failed to resolve the weight problem with which so many people struggle. The newer belief, backed by research, is many people are addicted to some foods, particularly those containing sugar and foods scientifically engineered to taste really really good.

Another issue is that most people don’t think they have enough time to accomplish everything they need to do. So when it comes to shopping for fresh fruits and vegetables, preparing, and cooking food versus sliding a pre-prepared tray into the microwave for two minutes, the choice seems obvious. But it may not be the best choice for your health and brain.

Self-portrait

Source: Nicole Avena, Ph.D.

Sugar and Ultra-Processed Foods

Nicole Avena, Ph.D., and author of Sugarless, is a research pioneer who broke the code on a central cause of overweight and obesity in the United States: food compulsion. This theory was developed after years in the laboratory, feeding rats sugary substances—or depriving them of these foods. The most desirable foods "are foods highest in added sugar and also highly processed. Examples are donuts, cake, sugar-sweetened beverages, candy, etc. Any food that contains high amounts of added sugar consumed in excess regularly has addictive potential,” says Avena. She says some food cravings are so powerful that an obese person will drive 40 minutes to a Krispy Kreme to devour the sugary donuts—even if the individual is diabetic.

Avena notes most ultra-processed foods contain sugar—although some have large amounts of added fat—and induce the release of dopamine, the feel-good, do-that-again neurochemical. According to Avena, eating sugary food does not have the same effect as eating an apple, although both contain sugar. “As we continue to consume more and more apples, the body becomes used to them, and the release of dopamine we get after eating them decreases.” This is not true for ultra-processed sugary foods, which generate a significant dopamine release every time the highly processed food is consumed.

Avena says about 20 percent of adults and 15 percent of kids and adolescents crave ultra-processed foods. She explains, “These ultra-processed foods are any food that has undergone various rounds of industrialized processing and contains refined carbohydrates and/or added fats. UPFs contain little to no whole food items packed with colors, emulsifiers, flavorings, and other food additives.” Reading the list of contents can help determine if a food is ultra-processed. Avena says if a product is not comprised primarily of whole food ingredients and sugar is listed at the top of the ingredients list, it’s likely to be ultra-processed.

University of Michigan Professor Ashley Gearhardt, Ph.D., and an editor of the second edition of Food Addiction: A Comprehensive Handbook, says dependence on ultra-processed foods is comparable to an addiction to tobacco and explains, “The taste and flavor profile of cigarettes and processed foods or beverages play a key role in their reinforcing properties.” Commonly consumed UPFs include candy, pastries, packaged salty snacks, fried foods, many fast foods and frozen convenience meals, and sweetened beverages. Meta-analyses representing data from 281 studies across 36 countries estimated approximately 14 percent of adults and 12 percent of children meet the threshold for a substance use disorder for their patterns of UPF intake, based on DSM criteria for an SUD.

Cravings for Junk Foods

Avena says some food cravings are similar to strong cravings for drugs and alcohol in situations of relapse, except there are many more food triggers in our society. Most people are bombarded daily with food cues in advertisements. According to Avena, responses to these cues may include increased heart rate, salivation, and neural activity, and cravings intensify the longer an individual abstains from the substance.

Avena also believes ultra-processed foods can be more addictive than cigarettes, in part because of their pervasiveness in society and the lack of restrictions on their marketing. Another similarity: Dopamine release is the hallmark sign of substance abuse and is also seen in sugar dependence. Whenever someone uses drugs or alcohol, dopamine is released. If highly-processed foods are frequently eaten, dopamine is constantly being released—mimicking instances of drug addiction.

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A growing body of evidence suggests that ultra-processed foods (UPFs) may trigger compulsive processes in some individuals. The association of UPFs with functional impairment across multiple domains (social, physical, psychological) suggests this is a pressing clinical issue. Yet, the lack of official recognition of this diagnosis as a potential disorder in the DSM poses an obstacle to the development and evaluation of novel dependence-focused treatments.

Health Issues Caused by Ultra-Processed Foods

A high consumption of ultra-processed foods is linked to greater risks for heart disease, type 2 diabetes, obesity, depression, anxiety, and death from all causes.

In a study of 10,775 participants for 8 years, researchers found that consumption of 19.9 percent of total daily calories from UPF was associated with cognitive decline in individuals younger than 60 years old. The study also found that consuming a Western dietary pattern resulted in a reduction in the left hippocampus and gray matter volume in cognitively healthy individuals. On the flip side, healthy dietary patterns consisting of foods low in UPFs were associated with higher gray and white matter, total brain volume, and lower oxidative stress and inflammation.

What likely happens is diets high in sugar promote inflammation and oxidative stress, which may impede brain function. Says Avena, “If the brain is deprived of nutritious foods and fed foods that produce free radicals, inflammatory cells circle within the brain and could contribute to brain tissue injury—which may explain why Alzheimer's disease, memory problems, or other neurological impacts are being seen.

Summary

A growing body of evidence suggests ultra-processed foods may trigger compulsive processes. Cookies, salty snacks, frozen pizzas, deli sandwiches, baked goods, and sausages are cheap; they’re convenient, shelf-stable, and they’ve been engineered to be hyper-palatable. UPFs are often high in refined carbohydrates (white flour, added sugars), saturated fat, and salt and frequently contain additives designed to make them more palatable (flavor enhancers) or eye-appealing (color additives).

It’s a broad category. However, overall, this category accounts for about 60 percent of Americans' daily food supply. Exposure in childhood or even in utero can cause cravings for these foods. Food dependence may trigger addiction-like symptoms in some individuals, including withdrawal. More research is needed, but ultra-processed food use disorder (UPFUD) seems an important condition to add to the DSM.