Gearhardt tells me about some of the most extreme cases of food addiction she has encountered during her research. One type 2 diabetic patient was aware of the dangers of continuing to consume high-sugar foods: amputation, blindness, and death. She couldn’t stop despite her best efforts. She wouldn’t eat just one doughnut; she’d devour the entire box. “She said: ‘I just can’t resist.'” Gearhardt compares the situation to those who have lung cancer yet are unable to quit smoking.

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What precisely is 14% of the population addicted to? Food with a high concentration of refined carbs and/or added fats. UPFs – defined by the authors as “industrially produced foods containing ingredients not available in home kitchens” – are the primary source of such food. Not all UPFs are addictive. Sweets and salty snacks are more likely to be addictive than plant milk and meat analogues, which are also ultra-processed but serve a purpose, in this case substituting animal products.

But food can’t be as addictive as alcohol or smoking, I tell Chris van Tulleken, a psychiatrist and the author of Ultra-Processed People. “I agree that food is not addictive,” he said. “However, UPF isn’t food.” Food’s purpose is to offer nourishment. The primary goal of UPF is profit and financial expansion.” What has changed, according to Gearhardt, is the food. Our bodies’ reward system is designed to ensure that we acquire enough sugar and fat to survive. “Our survival system has gone into hyperdrive,” she adds of UPFs.

From Biscuits to Brain Chemistry: The Intricate Web of Food Addiction

Biscuits are one example cited in the BMJ review. Homemade biscuits contain butter and sugar (aka fat and carbs), but most people will not consume the entire batch at once. However, with a packet of ultra-processed cookies, it can be difficult to quit. According to the researchers, the latter are “more accessible, convenient, and heavily marketed than homemade versions, and are thus likely to be a more potent driver of addictive food intake.” “If I had to make my chocolate or pizza, I probably wouldn’t eat it that often,” adds Gearhardt.

In this regard, packaged biscuits are analogous to cigarettes. No, seriously. “Processed tobacco leaves have been available for hundreds of years for people to make their addictive tobacco products,” says the study’s authors. “However, the invention of the cigarette roller in the 1880s to mass-produce cigarettes … contributed to a more than 1,000% increase in cigarette smoking.”

The BMJ paper mentions “extracellular dopamine in the brain striatum” as the precise mechanism of food addiction. I asked Gearhardt to elaborate. Eating UPFs increases dopamine, a chemical in the brain that makes us feel good. It then crashes, leaving us feeling awful. We want the nice sensation back, so we eat more UPFs. The dopamine surges are similar to those induced by alcohol and nicotine, and the ensuing addiction levels are nearly equivalent (14% of people are addicted to alcohol, and 18% are addicted to nicotine, according to the BMJ study).

“Addictive products are not addictive for everyone,” Van Tulleken argues. Almost 90% of people can experiment with alcohol without developing a problematic relationship; many can experiment with cigarettes or even cocaine.” Similarly, not everyone who consumes UPFs will become addicted; nevertheless, current research indicates that one in every seven will. “Many UPFs for many people are addictive,” Van Tulleken concludes. “And when people experience food addiction, it is almost always to UPF products.”

Unlike ethanol (the alcohol we drink) and nicotine, scientists have yet to identify a single molecule that causes food addiction. “It is not one molecule that is addictive,” Van Tulleken argues. “People can be addicted to diet cola, or stuffed-crust pizza, or chocolate bars.” The experts agree that a single component, such as sugar, is unlikely to be the culprit, and that the issue is more likely to be related to how substances interact.

Science of Ultra-Processed Food Addiction

Consider carbohydrates and lipids. Unprocessed foods typically contain one of the following: 100g of apple contains 55 calories from carbohydrates and 1.5 calories from fat, while 100g of salmon contains no carbohydrates and 73 calories from fat. UPFs, on the other hand, have significantly larger levels of both in far more equal proportions – a 100g chocolate bar has 237 calories from carbs and 266 calories from fat. “The combination of refined carbohydrates and fats seems to have a supra-addictive effect on brain reward systems,” according to the study. This could be one of the reasons why traditional diets are so healthy all across the world, whether they are high in vegetables, fruit, meat, fish, or dairy – they are built on whole foods.

Then there’s the issue of how quickly we consume UPFs and feel their effects. Substances that have a rapid effect on our brains are more likely to be addictive, which is why people become addicted to cigarettes rather than nicotine patches. Similarly, minimally processed nuts are quite high in fat, but our systems need time to digest them, so we don’t get a quick dopamine rush. UPFs, on the other hand, have been designed to get carbohydrates and fat to the gut — and eventually the brain – as rapidly as possible.

The chemicals in UPFs could be a third source of addiction. Another analogy may be drawn with cigarettes, which frequently contain additives such as sugar, chocolate, menthol, and salt to improve flavor and increase brand loyalty. Similarly, in UPFs, flavor additives enhance sweet and savory flavors, while texture additives improve mouthfeel. According to the researchers, “While food additives are not likely addictive on their own, they could become powerful reinforcers of the effects of calories in the gut.” Additives may also aid in the maintenance of high levels of consumption. Artificial sweeteners, for example, can boost our capacity to absorb glucose, giving us a higher sugar high and pushing us to consume more fizzy beverages.

UPF addiction is not yet a recognised condition, and no treatment is available in the United Kingdom. Dr. Fernando Fernandez-Aranda, one of the review’s authors, works at the University Hospital of Bellvitge, near Barcelona, treating eating disorders (including binge eating) and behavioral addictions. In a study of 400 eating disorders, he discovered that 5-6% of patients reported devouring solely UPFs. “We suspect that the reinforcing and rewarding effect of the food is the triggering factor for overeating in these cases,” he explains. Their biggest cited trigger is the food’s palatability.”

Cognitive behavioral therapy is the primary treatment for binge eating disorders. “We may need to introduce other models where exposure with relapse prevention or desensitisation in front of specific foods are part of the management tools” for UPF addiction, adds Fernandez-Aranda. The researchers list numerous intriguing prospective treatments in their review. They include the medicines naltrexone and bupropion, which may alleviate symptoms, as well as a diabetic medication that appears to lessen food cravings and 12-step addiction programs.

Awareness, Intervention, and the Quest for a Healthier Diet

But, if you’re concerned about UPF addiction, what can you do now? “Trying to quit UPFs now is like trying to quit smoking in the 1960s,” Van Tulleken explains. UPFs are ubiquitous, accounting for more than half of the normal UK diet. While eating, he encourages reading the ingredients list. “Ask yourself if this is truly food. You can easily transition from addiction to repulsion.”

As with any addiction, the first step, according to Fernandez-Aranda, is to recognize that there is a problem. “Would you be able to stop eating UPFs?” Could you react in a different way than eating when confronted with bad emotions? What do you think about when such UPFs aren’t available?” Then, if required, seek medical assistance. “Early detection of eating disorders, triggered by UPFs or not, is crucial to reduce their duration.”

What difference does it make whether we’re addicted to UPFs? The effects of addiction, according to the BMJ report, include “neural dysfunction, impulsivity, and emotion dysregulation, as well as poorer physical and mental health and a lower quality of life.” Van Tulleken is even more direct regarding UPFs: “Poor diet – by which we mean a UPF diet – has now overtaken tobacco as the leading cause of early death.”

I inquired if Gearhardt had fully eliminated UPFs from her diet. “No! “I’m drinking a glass of wine right now!” She emphasizes that no one should ever eat crisps or chocolate, but a diet containing 60% UPFs is excessive. “It’s a matter of rebalancing the scales.” We’d have an issue if we turned on the faucet and got soda instead of water.” However, for many individuals, particularly in disadvantaged areas, UPFs are the only option that is both available and inexpensive.

Individuals cannot overcome UPF addiction, according to all experts. “People are desperate to change their relationship with food but the pull is too strong,” Gearhardt said. “We need to change the environment and make the food industry accountable.” The researchers want the government to regulate UPFs that increase “craveability” by hitting customers’ “bliss point.” They highlight existing policies that could be implemented in the industry. More than 100 countries, for example, levy a tax on sugary drinks, which, according to studies, reduces consumption by 15%. Products might be altered to make UPFs less dangerous; the UK’s salt reduction initiative, which ran in the 00s and early 10s, contributed to a 15% drop in sodium intake and around a 40% reduction in mortality from stroke and heart disease. More than 20 nations now have warning labels on UPFs, and short-term research shows that they lower purchasing significantly.

Labeling people as “addicts” may sound derogatory. According to the experts, experimental studies have revealed that an addiction model appears to diminish stigma towards persons who are obese. “This aligns with evidence that campaigns highlighting practices of the tobacco industry such as predatory marketing and engineering addictive products were effective in driving public attitudes against tobacco.”

The review’s most disturbing statistic is that 12% of children are addicted to UPFs. Gearhardt has met nine-year-olds who have non-alcoholic fatty liver disease as a result of their diet. “The most important step is to stop marketing UPFs to children,” Van Tulleken adds. They are our most vulnerable population, and they are completely unprotected.” he said, “Evidence from Chile and Mexico [which have a bundle of healthy food policies] shows that kids will heed the warnings on UPFs and tell their parents to stop buying them – just as I used to tell my dad to stop smoking.”

The vast majority of us are not addicted to UPFs, but we may have an unhealthy connection with them, just as many people are dependent on alcohol but are not alcoholics. In my case, I should probably avoid purchasing large packs of crisps. Others may have a more difficult time.

References:

1. BMJ 2023;383:e075354

Source: Medindia