the science of food addiction · 2020-05-22 · food addiction proposed in 1956 by randolph....
TRANSCRIPT
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Objectives
In this webinar, we’ll review the following:
❏ Food addiction and other food relationships
❏ Brain biochemistry and how food can affect those usual pathways
❏ Practical clinical applications to reduce the symptoms of food addiction
Food addiction and other food relationships
Food Addiction
Proposed in 1956 by Randolph.
Introduced to describe patterns of specific eating behaviors and excessive consumption based on the hypothesis of similarities between such patterns and addictive behaviors.
Myriad mechanisms that are in motion when anticipating, approaching, ingesting, and reflecting about food.
Feel driven to engage in weight promoting eating behaviors, such as binge eating or compulsive overeating, when exposed to “addictive” food substances.
Source: Dimitrijevi et al 2015, D’Addario et al 2014, Cameron et al 2017
Eating Addiction
Complex behavior should not be addressed by concentrating on food itself, but rather the individual’s relationship with eating.
‘Eating addiction’ stresses the behavioral component, whereas ‘food addiction’ is a passive process that simply befalls the individual.
Particular regimens of palatable food availability may produce addiction-like brain changes, as well as binge-like eating and withdrawal symptoms.
Source: Benton 2016, Cameron et al 2017, Fletcher 2018
Source: Penzenstadler et al. 2019
Binge Eating Disorder (DSM-5)
Yale Food Addiction Scale
Development
The scale questions fall under specific criteria that resemble the symptoms for substance dependence as stated in the Diagnostic and Statistical Manual of Mental Disorders IV-R and operationalized in the Structured Clinical Interview for DSM-IV Axis I Disorders.
1) Substance taken in larger amount and for longer period than intended Questions #1, #2, #3 2) Persistent desire or repeated unsuccessful attempts to quit Questions #4, #22, # 24, #25
Source: Gearhardt et al. 2009
Comparing YFAS and BED Criteria
Source: Penzenstadler et al. 2019
Brain biochemistry and how food can affect those usual pathways
Deep Dive Into the Brain
Source: Makaronidis et al. 2018
Basic Science
Source: Frank 2020
Unhealthy Eating Behaviors
Affect BrainNeurotransmittersBehaviors Have
Consequences
Basic Science
Source: Frank 2020
Unhealthy Eating Behaviors
Affect Brain
Dopamine Function
Behaviors Have Consequences
Excessive Food IntakeFood Restriction
Sensitizes Dopamine System
De-sensitizes Dopamine System
Reward System
Source: Frank 2020
Changes In Dopamine
Function
Reinforces Disordered Eating
Behavior
Change In Eating
Frontal Cortex: Planning & Judgement
Nucleus Accumbens, Medial Forebrain Bundle, Ventral Tegmental
Area: Reward
Amygdala: Emotions &
Conditioned Effects
Hyperpalatable Foods
Certain combinations of sugar, salt, fat + refined carbohydrates elicit a greater response from the dopamine system.
Restrictive and subsequent binge consumption paradigm that results in promoting addictive-like eating behaviour.
Important impact on the regulation of mood and some individuals may over consume these nutrients to self-medicate from negative affective conditions such as anxiety, depression, mental fatigue.
Top hyperpalatable foods: chocolate, ice cream, french fries, pizza, cookie, cake, buttered popcorn, cheeseburger.
Source: Schulte et al. 2015, Fletcher 2018, Cameron et al 2017
Main Features of Food Addiction
Source: D’Addario et al. 2014
Dopamine Response to Unexpected Situations
Source: Adapted from Frank 2020
Dopamine Neuron RespondsUnexpected Situation
We get a random cupcake.
We get a cupcake every Monday.
If we then stop getting a cupcake every Monday.
Un-expectancy Learning Signal
Learning System
Brain starts to change in the minute that a different response occurs.
Every repeat of a new behavior changes into a stronger circuit.
In a heightened reward system, there is a bombardment of thoughts / feelings that feel intrusive.
However, you can work on a new behavior.
Source: Frank 2020, Cameron 2017
Other Things That Increase The Reward System
Music Sitting Up StraightHugs Looking at Old
Photos Spicy Foods
Funny VideoMeditationNature Exercise Go to a Museum
Key Diagnostic Constructs
Key diagnostic constructs that categorizes an action into a rewarding stimuli:
❏ Unsuccessful attempts to reduce or control the behavior❏ Spending a great deal of time thinking about, seeking, or desiring (craving)❏ Needing more to derive the same excitement/pleasure (tolerance)❏ Feeling restless or irritable when reducing or stopping (withdrawal)❏ Persisting despite negative consequences such as clinically significant impairment in social,
occupational, academic, and/or economic functioning❏ Emotional distress
Source: Gordon et al 2018, Dimitrijevi et al 2015
Neural Rewiring
Source: Hill et al 2020
Normal Brain Function
STA
RT
FINIS
H
Hotter!
STA
RT
FINIS
H
Colder!
Brain Function with BED
STA
RT
FINIS
H
YESSS!
STA
RT
FINIS
H
…….
YESSS!
YESSS!
…….
…….
YESSS!
Neural Rewiring
If the intention is still that a food is bad and anticipates the reward, then neural wiring won’t change. Still has the assumption and anticipation of food.
Use disorders should be viewed as a constellation of related syndromes that share similar but not entirely overlapping brain and behavior abnormalities, the most conspicuous of which is a failure to control consumption.
Source: Frank 2020
“My drug of choice is food. I use food for the same reasons an addict uses drugs: to
comfort, to soothe, to ease stress.”
- Oprah
Practical clinical applications to reduce the symptoms of food addiction
Baseline Applications
Baseline that should be followed to improve application of motivation, cognitive behavior therapy, skill building:
❏ Do not starve❏ Discover the feeling of hunger and eat when hungry❏ Resilience with stress and emotions❏ Sleep❏ Exercise
Source: Dimitrijevi et al 2015
Traits
Brain imaging studies show differences in the parts of the brain involved in eating in individuals with disordered eating.
People with disordered eating / altered food relationships share traits that existed before the disorder and may help to maintain that disordered relationship:
❏ Perfectionism❏ Obsessionality❏ High achievement oriented❏ Anxious
Source: Hill et al 2020, Cameron et al 2017
Tools can be practiced enough to acquire skills or used to be destructive.
Source: Adapted from Hill et al 2020
Traits and Their Treatment Strategy
TRAIT TRAIT AS STRENGTH TREATMENT STRATEGY
Uncertainty Intolerance Highly Structured Structured meal planning, create rules with choice. Discuss flexibility when structure isn’t available
Altered sensitivity to reward / punishment
Motivated by short term goals, avoids consequences Contingency management and non-negotiables
Obsessionality High error detection, attention to detail Specific, concrete details of what is added and why
Anxiety Thinks about the potential what-ifs, thinks through worse case scenarios, ability to plan and prepare
Redirect, re-attend, stop-reboot, reroute
Inhibition Inability to delay gratification, short term focused Use short term consequences and management
Perfectionism Achievement-oriented, striving for excellence Setting short term goals, Include other non-weight focused goals. Allow for flexibility
Nutritional Interventions
Increase fiber
Low sugar and no artificial sugar
High in anti-inflammatory Omega-3 fatty acids
Foods rich in Tyrosine
Increase Pregnenolone
Increase Resveratrol
Add DHA
Focus on Monounsaturated Fats
Source: Dimitrijevi et al 2015, Cameron et al 2017, Salamone 2012
Lifestyle Interventions
Movement
Sleep
Meditate
Listen to Music
Do something you enjoy
Source: Dimitrijevi et al 2015, Cameron et al 2017, Salamone 2012
Reframe Each Small Detail Daily
Food as medicine - adding on “dosing”
Distinguish between real vs processed food
Body healing vs body harming
Focus on adding foods, not subtracting
Utilize food for brain function
Source: Hill et al 2020, Frank 2020
Future Webinars:
Advantages of Ketogenic Protein Sparing Modified Fast vs. Keto Diet ProgramJune 23, 2020 | 12:00 EST
Obesity as a DiseaseSeptember 22 | 12:00 EST
Gearhardt AN, Davis C, Kuschner R et al. The addiction potential of hyperpalatable foods. Current Drug Abuse Reviews 2011; 4:140-145.
Benton D and Young HA. A meta-analysis of the relationship between dopamine receptors and obesity: a matter of changes in behavior rather than food addiction? International Journal of Obesity 2016; 40:S12-S21.
Vella SC and Pai NB. A narrative review of potential treatment strategies for food addiction. Eat Weight Disord 2017; 22:387-393.
Davis C. An introduction to the special issue on ‘food addiction’. Appetite 2017; 115:1-2.
Cameron JD, Chaput JP, Sjodin AM et al. Brain of fire: incentive salience, hedonic hot spots, dopamine, obesity, and other hunger games. Annual Review of Nutrition 2017; 37:183-205.
D’Addario C, Micioni Di Bonaventura MV, Pucci M et al. Endocannabinoid signaling and food addiction. Neuroscience and Biobehavioral Reviews 2014; 47:203-224.
References
Cassin SE, Buchman DZ, Leung SE et al. Ethical, stigma, and policy implications of food addiction: a scoping review. Nutrients 2019; 11:710.
Fletcher PC and Kenny PJ. Food addiction: a valid concept? Neuropsychopharmacology 2018; 43:2506-2513.
Dimitrijevi I, Popovi N, Sabljak V et al. Food addiction-diagnosis and treatment. Psychiatria Danubina 2015; 27(1):101-106.
Garcia-Garcia I, Horstmann A, Jurado MA et al. Reward processing in obesity, substance addiction and non-substance addiction. Obesity Reviews 2014; 15:853-869.
Penzenstadler L, Soares C, Karila L et al. Systematic review of food addiction as measured with the Yale Food Addiction Scale: implications for the food addiction construct. Current Neuropharmacology 2019; 17:526-538.
Gordon EL, Ariel-Donges AH, Bauman V et al. What is the evidence on food addiction? A systematic review. Nutrients 2018; 477(10):1-30.
References Continued
Schulte EM, Avena NM and Gearhardt AM. Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLoS ONE 2015; 10(2).
Hill L, Knatz Peck S and Wierenga C. Temperament Based Therapy with Supports. UC San Diego 4th Eating Disorders Conference. February 2020
Frank GK. Brain Mechanism that Drive Anxiety and Eating Disorder Behaviors. UC San Diego 4th Eating Disorders Conference. February 2020
Makaronidis JM and Batterham RL. Obesity, body weight regulation and the brain: Insights from fMRI. British Journal of Radiology 2018; 91:1089
Gearhardt AN, Corbin WR and Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite 2009; 52:430-436.
Salamone JD The mysterious motivational functions of mesolimbic dopamine. Neuron 2012; 76(3):470.
References Continued