Food Addiction and Emotional Regulation
posted: Feb. 14, 2023.
A Reflection on Food Addiction and Mood Regulation
Some people eat to live, and others live to eat. Reflecting, I use food both to sustain myself and as a mood regulation substance. To me, it’s a program of natural rewards gone awry. As a nutritional therapist, rationally I think about food’s macronutrient, micronutrient, phytonutrient, mineral, and vitamin qualities which are essential to good health. As a former chef, I love to prepare food, and present it in flamboyant fashion. As a connoisseur, I love to eat, and not only when I’m hungry. My problem is that carbohydrates (specifically, processed, and high glycemic carbs), as my chosen “substance” for reflection, have ill affected my health (both physically and psychologically), increased my weight since total abstinence from alcohol 3 years ago, and I believe that I have switched to food for emotional regulation. Experientially, the ketogenic approach has proven helpful. I hope to gain more insight into the problem, and substantiating my hypothesis, I wish to learn healthier strategies for dealing with life on life’s terms. I have been eating carbs since I graced the earth with my presence. However, while attempting to lead a healthy lifestyle, my relationship with food has been episodically problematic. Concerning this assigned project, I thought “here we go again, another one of these”, and was put off by the whole prospect. One never really likes to abstain from what one likes. After pouting a little, realizing that this could benefit me, I have become daily more interested and committed to the process.
As per my weekly journaling, I have dealt with cravings through ACT (Acceptance and Commitment Therapy) techniques of leaning into and questioning the thoughts, feelings, and bodily sensations (defusing), to be inquisitive instead of reactive. I’ve accepted the aversiveness of the project (something that works to some degree with substance use issues within the court system and through other natural consequences of behavior), and have reframed it as accountability. Consequently, cravings have subsided, and more days than not, I have made healthier choices. Additionally, the project has helped me to do more than lip service to practices of mindfulness meditation, intermittent fasting, and “surfing” through the cravings. Being completely transparent, I have noted all slips and relapses during the process within my journal. My primary support is my spouse who is also health minded, and through her own eating habits and food purchases has enhanced the project for me. I’ve learned that our main text gave no/little reference to eating/food addiction, and some reference to eating disorders (Fisher & Harrison, 2018, p. 262). Having experienced a low carb (ketogenic) diet before, my experience is that this project has been more of a reminder, but with a caveat. Giordano states that “some scholars propose that certain foods (particularly processed foods high in fat or sugar) have addictive properties due to their high hedonic value (and that) for some vulnerable individuals, the reward of consuming high calorie foods may lead to addictive, out of control behaviors” (Giordano, 2022, p.186).
To remove the stigma and judgement towards the person who eats to regulate mood, a public health model (an epidemiological model that attempts to prevent or reduce a particular illness or social problem in a population by identifying risk indicators), or biopsychosocial/disease approach should be adopted. With this view, like with any other substance or behavioral addiction, treatment approaches view the disease as chronic and primary, and treated as such. Harm reduction through moderation, MAT, CBT (and variations), mindfulness meditation, and better understanding of one’s relationship with food is essential. However, along with these measures, total abstinence from certain foods should also be considered.
The ketogenetic diet is one such approach. Here’s why I hold this position. I find myself eating my dinner, and then sitting down to watch a program on television, and then craving a snack. This only happens in the evenings, and that is exactly when I would I would have craved alcohol, as this is also the time I would experience distressing thoughts and feelings. Eating has taken the place of drinking to remove distressing thoughts and feelings (negative reinforcement), and to induce good feelings (positive reinforcement). As I would use alcohol to cope, I do the same with food. Much like addictive drugs, highly processed foods trigger dopamine reward pathways and cause behaviors (to include thoughts, feelings, memories, and bodily sensations) indicative of addiction. These behavioral symptoms include intense cravings and feelings of withdrawal when cutting back on this type of food. Choosing carbohydrates in my abstinent project, and committing to <30 carbs daily, my body is experiencing ketosis. A ketogenic diet is a high-fat, low-carbohydrate, moderate protein diet that shifts body metabolism to utilization of fatty acids. Burning fat and ketones become the primary source of energy rather than carbohydrates and glucose-a kind of trade off. Amongst many other potential neurometabolic effects, this state reduces circulating glucose and insulin, and causes changes such as appetite suppression, decreased hunger, greater satiety, breakdown of fats, and reduction of stored fat. Essentially, energy is received from fat rather than carbohydrates. Major mechanisms proposed in the literature include both neurobiological and metabolic pathways. Neurobiological changes involve alteration in neurochemical signals and changes in reward circuitry. Sounds like addictive behavior to me. These changes affect reward and appetite-satiety signaling and downstream reward pathways, and I go for a snack while full.
A salient observation from the recovery/relapse literature, is that the same brain mechanisms at play in substance use, are active in food (eating) addiction as well. Functional magnetic resonance imaging (fMRI) studies have recently shown that highly processed foods affect reward circuitry (in neural regions like the caudate and putamen) through both negative and positive reinforcement and leads to compulsive consumption of these foods. Animal models noted that consumption of these foods leads to a downregulation of D2 receptors, a release of hormones, reduces satiety, increases hunger for these foods, increases the reactivity of the dopamine system, and suggests that high glycemic index carbohydrates are a possible trigger mediating neurochemical response similar to addiction (Sethi et al, 2020, p. 277).
As a clinician, I understand the importance of differentiating diagnostically between food addiction and binge-eating disorder (BED). The latter has clear criteria within the DSM V as noted in the following: “the essential feature of binge-eating disorder is recurrent episodes binge eating that must occur, on average, at least once per week for 3 months” (American Psychiatric Association [APA], 2012, p. 350). The former, as the import of this reflection paper’s content, does not have official diagnostic criteria in the manual. However, it has been suggested that the diagnostic criterion for SUD is transferable to food addiction. For myself, this identifies and normalizes my behavior as it explains my attempt for self-regulation from a neurobiological and metabolic perspective. Embarrassingly, my BMI is considered in the obese range (26%), and it could be that this, along with other obvious symptomatology, suggests a comorbidity of disease. As “the constructs share similarities, yet are distinct,” according to one Giordano, “obesity, eating disorders, and chemical dependency on food are three distinct diseases” (Giordano, 2022, 188). This awareness has also been elucidated through attending an online food addicts anonymous (FAA) meeting for this course, as well as my regular AA meetings. In these support groups, I’ve become more aware of my actions, and by hearing the stories of others in the same struggles in recovery, I’ve been helped.
An explanation of the metabiological mechanisms follows:
Animal and human experiments with functional magnetic resonance imaging (fMRI)
studies have recently shown that ultraprocessed foods affect the neurobiological reward
pathway, and the degree of alteration is dependent on metabolic signals, such as
glucose oxidation. For example, in humans, processed foods high with refined
carbohydrates and fats are particularly effective in activating reward-associated
related neural regions, such as the caudate and putamen…
Animal models further find that a diet dominated by ultraprocessed foods leads
to downregulation of dopamine D2 receptors, which corresponds to
increased compulsive intake of ultraprocessed foods (but not chow).
Hormones such as insulin, leptin, ghrelin, and glucagon-like peptide (GLP)-1
modify natural and drug reward pathways in the brain. An increase in hunger
hormones can reduce satiety and increase the reactivity of the dopamine system.
These shifts signal the mesolimbic system to modify dopamine concentration through
both direct and indirect pathways. For example, insulin increases dopamine reuptake
in the presynaptic membrane and suppresses motivated behavior (Sethi et al., 2020, p. 277).
I recognize that I have been using carbohydrates for emotional regulation and am implementing healthier strategies around the issue. The abstinence project provided a catalyst for defusing and clarifying thoughts through reflective questioning and has assisted me with healthier strategies for emotional regulation. In comparing binge-eating disorder with food addiction, I’ve learned that treatment approaches are different, but overlapping at times as well. A ketogenic diet, along with intermittent fasting, support groups, mindfulness meditation and ACT techniques have proven efficacious to me, and these are substantiated in the literature. Stigma and discrimination should be removed through approaching the problem from a public health/biopsychosocial disease model. Food addiction should be diagnosed, treated, and generally viewed as any other substance or behavioral addiction, with direct impact on reward circuity. While all treatment approaches for disorganized eating and dysregulated reward circuitry would employ psychoeducation, CBT, MAT, support groups, mindfulness exercises, etc., binge-eating would concentrate primarily on development of a new relation to food. Ergo, dealing with food addiction, I suggest an abstinence-based program approach, experiencing ketosis, and working towards behavioral changes in relation to food.
- American Psychiatric Association. (2013) Diagnostic and statistical manual for mental disorders
- (4th ed., text rev).
- Fisher, G. L., Harrison, T. C. (2018), Substance Abuse: Information for school Counselors,
- Social Workers, Therapists, and Counselors. Pearson
- Giordano, A. L., (2022), A Clinical Guide to Treating Behavioral Addictions: Conceptualizations,
- Assessments, and Clinical Strategies. Springer Publishing
- Sethi, S., Sinha, A., Gearhardt, A. N., (2020). Low carbohydrate ketogenic therapy as a
- Metabolic treatment for binge eating and ultraprocessed food addiction. Current Opinion in
- Endocrinology, Diabetes & Obesity, 27(5), 275-282. Doi:10.1097/MED.000000000000571