When does a craving become an obsession?

Daryn Eller from Prevention examines how some woman were able to change their eating patterns

By Daryn Eller    Prevention     TODAY    5/24/2006 

According to Prevention magazine, there may be new evidence to suggest that getting hooked on food — from chocolate to chips — is a very real thing. Rosemary Ellis, Prevention magazine’s editorial director, visited “Today” to discuss food addiction and Daryn Eller’s article featured in the current issue of the magazine. Here’s an excerpt:
Are you addicted to food?: Science suggests that you can be hooked on chocolate, cookies, and chips. 

Here, the latest evidence, plus an 8-step program for regaining control

For nearly 15 years, Dana Littleton ate chocolate practically all day long. “I used to drown myself in it,” says the 34-year-old stay-at-home mom from Guntersville, AL. “I just couldn’t get through my day without chocolate. I’d be positively frenzied if I didn’t have it and feel calm and at ease when I did.”

Littleton recalls a day a few years ago when she was home with her two girls. It was a punishing 20ºF when she realized that she was out of Snickers, a favorite treat. So she bundled up 3-year-old Georgia and 4-month-old Caroline, put them in the car, and drove to the gas station. “I actually dragged a small baby out in the cold,” Littleton says. “Anyone who knows me would say that it’s out of character for me to do that — it was a sign that I was out of control. I wasn’t even out of the parking lot before I had inhaled two candy bars.”

Her habit had consequences, says Littleton, who started numbing herself with food after the death of her father at a young age. Her need for sweets helped drive her weight to 250 pounds; her back and knees hurt, and she had chest pains. “People tell me that at least I’ve never had an addiction like alcohol or drugs — something serious,” she says. “But I tell them my addiction was serious.”

Addiction — to food? 

It seems that everywhere you turn — dinner parties, your best friend’s kitchen, bookstores, even talk shows — someone is confessing to having a food addiction. For years, experts scoffed at the notion that you could be hooked on chocolate or chips. Some still do. But recently, high-tech medical scans have revealed surprising similarities in the brain chemistry of drug addicts and chronic overeaters — resemblances that have caught the attention of the National Institute on Drug Abuse.

“We’re involved in studies of brain changes associated with obesity,” says Nora D. Volkow, MD, director of NIDA, whose 2001 study pioneered some of the food-addiction research. “We’re doing it because many compounds that inhibit compulsive eating may also inhibit compulsive drug intake. The neurocircuitry overlaps.”

The behavior of compulsive eaters also lends credence to the idea of addiction — the cravings and preoccupation with food, the guilt, the way these overeaters use food to relieve bad feelings, and the fact that binges are frequently conducted at night or in secret. Now some addiction and obesity experts have started to use the “A” word in connection with food and even to speculate that it may be partly responsible for America’s rising obesity rate.

“Food might be the substance in a substance-abuse disorder that we see today as obesity,” says Mark Gold, MD, chief of addiction medicine at the University of Florida College of Medicine. “If you ask some of the questions that are used to diagnose drug abuse — for instance, ‘Do you continue to use the substance despite its negative effects?’ or ‘Do you have a preference for more refined substances?’ — and then replace substance with food, it’s not all that difficult to imagine that food addictions exist.”

No one — Gold included — is suggesting that an addiction to food could be as strong as the one that drives people addicted to cocaine or heroin. Still, the research into the connection between overeating and addiction isn’t just academic. It may finally put to rest the idea that anyone who eats excessively simply suffers from a lack of self-discipline. More important, the emerging evidence points to some very concrete steps anyone can take to eat in a saner, healthier way.

Blame it on the brain 

People like Littleton have long been accused of lacking willpower. But research at the US Department of Energy’s Brookhaven National Laboratory in New York suggests they may be missing something else instead: adequate brain receptors for dopamine, a chemical that is part of the brain’s motivation and reward system. “Dopamine is the chemical that makes you say aah,” says Gene-Jack Wang, MD, clinical head of positron emission tomography imaging at Brookhaven and leader of a series of studies investigating the brain chemistry of chronic overeaters. “It gets us to go over and grab something that will make us feel good.”

In 2001, Wang and his colleagues, Volkow among them, compared the brain scans of obese and normal-weight volunteers, counting up dopamine receptors. Obese people, Wang realized, had fewer dopamine receptors — and the more obese they were, the fewer of these crucial receptors they had. In fact, he says, the brains of obese people and drug addicts look strikingly similar: “Both have fewer dopamine receptors than normal subjects.”

It’s possible that drug use or compulsive overeating actually lowers the number of dopamine receptors. But it’s also possible that some people are born with fewer — and if that’s the case, say researchers, it could explain a lot. If overeaters or drug addicts are short on receptors for the aah chemical, they might not respond as readily to social interaction, art, sex, and other pleasures that ought to make them feel good. And that could be the reason they’re driven to consume things that prompt dopamine’s release — like illicit drugs (the most potent activator) or foods high in fat, sugar, and possibly salt. “If you have someone who is not responsive to natural reinforcers, that person may be more vulnerable to taking drugs,” Volkow says. “If you get stimulated only by food, guess what happens? You can easily fall into patterns of compulsive eating.”

What the compulsion feels like 

It doesn’t take a brain scan to see the similarities between someone addicted to drugs or drink and a compulsive overeater. Like the alcoholic who continues to drink despite seeing her life crumbling around her, the overeater will consume food to the detriment of her social and family life. She may know that her eating is harming her health, but it doesn’t matter, says Gold.

“I actually passed out once,” says Terry Young, 40, of Cincinnati, who calls herself a sugar addict. “It was a total binge, with a gallon of ice cream, cookies, candy bars — like an alcoholic on a bender.”

Young has struggled all her life to control her emotional eating, which she says she does almost as a way of medicating herself: She gorges to calm down after a hard day at work and fixes a big snack as a sedative before bed. It’s gotten so bad that she’s been known to steal her 7-year-old daughter’s treats. “If it’s in the house, it calls my name,” she says. She went on antidepressants and says they helped.

“Like cocaine addicts who can’t leave any cocaine behind, food addicts eat until no food is available,” says Gold. “You might say, ‘Yeah, I did that on Thanksgiving.’ But food addicts do this all the time.”

Patty White* of Los Angeles can relate. Her “drug” of choice is cheese of any kind, from Brie to the Cheddar in macaroni and cheese. Two years ago, the 45-year-old saleswoman gave up cheese for Lent, but as soon as that period was over, she binged. “I went cold turkey when I quit smoking, but this time, going cold turkey was a disaster,” she recalls. “I went wild. I gorged on cheese at every meal, gained 5 pounds in 4 days, and just felt disgusting.” Growing up, she saw family members go on similar binges — but they abused alcohol. “My grandfather was an alcoholic, and I see addictive behavior in other relatives,” she says. “I’m a lot like them. But my excessive behavior is with food.”

Is it nature … or nurture? 

Addiction and obesity both run in families, and experts believe that genetic components account for at least some of a person’s vulnerability. But animal research also suggests that the environment — mainly, how often you’re exposed to an addictive substance — can shift brain neurochemistry, increasing the likelihood of addiction. One hint that environment plays a role comes from studies in which animals were repeatedly given cocaine: Frequent use actually decreased the number of dopamine receptors, says Wang.

If that’s the case, we live in an environment perfectly designed to nurture food addictions. For decades, food-industry scientists have been working hard to figure out how better to hook people, claims David L. Katz, MD, MPH, director of the Yale-Griffin Prevention Research Center in Derby, CT, and author of The Flavor Point Diet. Manufacturers now excel at hitting the sweet spot — making us crave more and more of a food. “In a supermarket recently, I actually found a pasta sauce that, serving for serving, contained more sugar than a chocolate fudge sauce, though the sweetness was hidden because the pasta sauce was so salty,” Katz says. “The question is, why would anybody pour a packet of sugar over their pasta? And the answer is that if you get used to that much sugar, another pasta sauce will taste too bland. The food industry wants us to need more and more of the substance to feel satisfied, so we’ll go out and buy more and more of it.”

Animal research at Princeton University has also shown that the way you indulge may have consequences. Bart Hoebel, PhD, a professor of psychology, placed rats on an alternating schedule of 12 hours with no food, followed by 12 hours of access to both rat chow and a solution of 10% sugar (about as sweet as a soft drink) — a pattern that results in binge eating. As the days went by, the rats began upping their intake of the sugar solution, drinking more and more at a time. Hoebel found that after about a month, the rats’ brains were producing surges of dopamine during their binges. “In rats, binge eating promotes addiction just like binge drinking promotes alcohol addiction,” says Hoebel. “It’s possible that repeatedly bingeing on sweets could actually change the circuitry of your brain” — and make you want ever-increasing amounts.

Getting straight 

Researchers aren’t ready to declare the case closed on the causes of our collective weight problem. “The research is interesting, but I’d never say that people who struggle with food and weight issues are addicted in a clinical sense,” says Martin Binks, PhD, director of behavioral health at the Duke Diet & Fitness Center. “The evidence just isn’t there. And the implication is that if you have an eating problem, you’re destined to lose control — there’s nothing you can do.”

Yet the notion of an addiction to food may help people like Dana Littleton. “At some point, I realized that I had hit bottom, just as an alcoholic or drug addict would,” she says. Littleton took the same path that so many have taken before. “I prayed for strength to face what I had been running from. And for willpower — especially for chocolate. Then I got off my rear end.”

Whether you look outside or inside yourself for the determination to stop your destructive behavior, researchers agree that it’s important to recognize that you can change. High-fat, high-sugar foods may trigger some of the same brain effects as drugs like cocaine or heroin, but their impact isn’t as powerful, say researchers, who point out that addicted rats, for instance, will choose cocaine over food. While it may feel at times like a runaway train, how you eat isn’t out of your control, says Susan McQuillan, MS, RD, author of Breaking the Bonds of Food Addiction. Having a plan of action can help. With that in mind, here are eight steps you can take to get back on track.

1. Don’t go cold turkey 

Although treatment for life-threatening drug or alcohol addiction generally requires abstinence, an all-or-nothing approach is impossible for food addicts — everyone has to eat. Besides, some weight loss experts believe that such rigid thinking can make you crave the offending food more than ever. After Patty White’s cheese bender, she realized that by banishing it entirely, she’d set herself up for failure. Now she lets herself eat cheese, but in sensible amounts: “I sprinkle some on a taco instead of sitting down to a wedge of Brie.” Says Edward Abramson, PhD, professor emeritus of psychology at California State University, Chico, and author of the book Body Intelligence, “If someone told me that I could never eat another doughnut as long as I live, I would become so preoccupied with doughnuts that I’d probably gobble down a dozen by the end of the day. If I know I can have another doughnut sooner or later, I won’t feel so desperate. I can eat just one.”

2. Control your home environment 

Just as someone with an alcohol problem shouldn’t buy a magnum of champagne, you shouldn’t overstock your kitchen, says Gold. “You have to assume that every food or drink you buy will end up in your mouth. You’ll see a TV commercial or some other trigger, and that food will end up in your mouth.” Exercise purchase and portion control, Gold advises.

3. Temper temptation 

Sometimes it’s not just a food that sets you off but also the place in which you eat it — and that’s why putting yourself in a situation where you used to eat excessively can be a recipe for trouble. Ex–drug addicts face this problem all the time, reports Marcia Levin Pelchat, PhD, a research scientist at Monell Chemical Senses Center in Philadelphia. “Going back to the old neighborhood often triggers a strong craving,” she says. Similarly, the sight of the bakery where you used to buy brownies might melt your resolve. So shake up your routine. If tortilla chips are your weakness, don’t go to Mexican restaurants. If you always have ice cream while watching TV, read a book instead (or knit to keep your hands busy as you watch CSI: Miami).

4. Retrain your brain 

In order to be satisfied with two cookies instead of an entire bag, you need to change the way your brain sees food on the plate, says Gold. First, switch to smaller plates and bowls to automatically reduce portion sizes. “This can make people very distraught because the brain looks at the smaller portions and decides they’re not enough,” says Gold. “But over time, the brain gets used to it.” Next, leave more space on the plate by again reducing the amount of food you serve yourself. Each step may take several weeks to feel comfortable, but stick with it and consuming smaller portions will become second nature.

5. Adjust your tastebuds 

One of the best ways to gain control over your eating is to restore your sensitivity to flavors, says Katz. You can do it without depriving yourself: If sugar is your downfall, keep sugar cookies in your diet, but when picking prepared foods that aren’t supposed to be sweet — such as pasta sauce, bread, and chips — look for ones without added sweeteners. Check ingredient labels for all the names that sugar goes by, including fructose, dextrose, and corn syrup (for a list of sugar’s aliases, go to http://www.prevention.com/sugarlist). “By removing all that superfluous sugar from your diet, you’ll soon reset the sensitivity of your tastebuds,” explains Katz, who says that the same technique can be used to reduce your desire for salt or fat. Be forewarned: You’ll have to maintain vigilance. “Tastebuds are very adaptive little fellows,” Katz says. “If you let extra sugar and fat into your diet, you could be lured back into your old patterns.”

6. Exercise regularly 

Milky Ways and Big Macs aren’t the only things that satisfy the pleasure centers of your brain — so does exercise. In animals, at least, research has found that it increases dopamine levels and raises the number of dopamine receptors in the brain. Making a commitment to work out helped Littleton kick her chocolate habit. As a result of a vigorous exercise routine and a more sensible diet, she’s gotten down to 134 — a loss of 114 pounds in the past 3 years. “The feeling I get after I exercise is nothing like I’d get after eating chocolate,” she says. “It’s much better, and it doesn’t come with guilt.”

7. Learn to eat only when you’re hungry 

One classic tool that weight loss experts use to teach people how to better manage their appetite is the hunger scale. The scale ranges from 0 to 10, with 0 being ravenously hungry and 10 being overstuffed. “A food addict’s goal is to stay away from either of these extremes,” says McQuillan. Eat when you begin to feel hungry (2 or 3 on the scale) and stop when you feel comfortably satisfied (5 or 6). Though it’s obvious that you don’t want to eat to an overstuffed 10, using the scale to gauge when you should start munching is important, too: If you wait until you’re at 0, you may eat all the way up to 10.

8. Deal with your emotions 

Even if a brain scan at Wang’s lab were to show that you have a physiological basis for food addiction, it’s likely that there would be an emotional element, too. It’s important to stop using food to cope with your feelings, says McQuillan. This can mean getting better at tolerating sensations of sadness, anger, or boredom, rather than rushing to soothe them with food. Sometimes it means asking what you need to make your life better. “I failed when I tried to comfort myself with food after the death of my dad and after two miscarriages,” says Littleton. “I had to turn around to face it head-on. Now I’m in control of my decisions.”

*This name has been changed.

How strong are your food cravings? 

You might be a food addict if any of these descriptions fit. You continue to overeat even though you know it’s harming your health and possibly your family and social life; you hide out and eat alone; you feel compelled to finish all the food in your line of sight (or house); you eat to the point of pain or discomfort. Also consider the following four questions, suggests Mark Gold, MD, chief of addiction medicine at the University of Florida College of Medicine. They’re an adaptation of the CAGE questionnaire, a tool used to diagnose alcoholism. “You really need to answer yes to only two items to indicate that you may have a problem,” he says.

Have you ever felt the need to Cut down on your eating? Many people overeat on occasion; the difference is that you feel that if you don’t ration yourself, you will completely lose control.

Have you ever been Annoyed by criticism of your eating? If you get upset when anyone brings up what or how much you consume, it may mean that you are too attached to eating.

Do you feel Guilty about your eating? It builds up, because at every meal you say you’re going to control yourself — and you fail.

Have you ever needed an Eye-opener? You may wake up in the morning and feel compelled to consume. “We have patients who get up in the middle of the night and eat,” Gold says. “They say, ‘I finished a cake — I don’t know how I did it.’ ”

Daryn Eller writes frequently on health and nutrition from her home in California.