Dr. Pamela Peeke, an internationally recognized physician and expert in integrative medicine, nutrition and fitness discusses this, and more, in her New York Times bestselling book, The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction.
In this interview, she shares some of the science behind food addiction and, more importantly, simple measures that can make a dramatic difference in your ability to achieve and maintain lifelong recovery from food addiction.
Before embarking into natural medicine, Dr. Peeke was a senior science research fellow at the National Institutes of Health (NIH)—probably the most prestigious and well-respected research institute in the US.
The NIH coordinates a lot of very good research and is funded by the federal government. It was here that Dr. Peeke came to understand the nature of food addiction, and the path to recovery.
Yes, Food Addiction Is Real
While, like nearly all doctors, she did not receive any training in nutrition during medical school, she went back and became a Pew Foundation Scholar in Nutrition and Metabolism at the University of California, Davis after spending several years working in critical care and trauma.
"From there, I came to the National Institutes of Health where I set up a laboratory with my wonderful mentor, Dr. George Chrousos, looking specifically at the relationship between stress and fat," Dr. Peeke says.Around that same time the NIH established the Office of Alternative Medicine (OAM), and the first director of that office, Dr. Joseph Jacobs, asked her to join him as a senior research scientist, to look at issues pertaining to nutrition.
"We were the ones who laid the golden egg in trying to put together the toxic stress-belly fat connection, showing what happens to fat distribution when you're undergoing toxic stress: ongoing high levels of stress associated with helplessness, hopelessness, and defeat.
When we started putting this together, we discovered that: no wonder you're packing on a lot of belly fat! As a result, I became kind of known as 'the belly doctor.'"
"From there, I started peering into this whole relationship between specific kinds of food and what they do to the body," she says. "That's when I stumbled upon refined, processed foods, especially what we now call 'the hyperpalatables.'Her book, The Hunger Fix, grew out of this research, and is the consumer level complement of the first professional's textbook on the subject, titled Food and Addiction: A Comprehensive Handbook, which was published one month prior to the launch of The Hunger Fix.
[These are] sugary, fatty, and salty food combinations that seem to hijack the reward center in the brain, and literally, have it undergo changes that are absolutely identical to the changes that happen in all addiction.
These include drugs, alcohol, and other process addictions like sex and gambling. Food is unique in that it is both a substance and process addiction. Over time, we built enough scientific evidence to be able to say that food addiction is real."
The Role of Dopamine in Food and Drug Addiction
The correlation between food addiction and recreational drug addiction is quite striking, and probably stronger than most people suspect. A critical player in all forms of addiction is the neurotransmitter dopamine.
The groundwork for these revelations was laid by the current director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow, an addiction psychiatrist with a compulsive fondness for chocolate.
"She's reed thin, runs six miles a day, admits to being delightfully compulsive and has always been fascinated with this pull to eat chocolate," Dr. Peeke says, noting that a lot of great research begins when an investigator decides to look into something that affects them personally.
This was the case with Dr. Volkow, whose curiosity about her own compulsions led her to piece together exactly what happens in the brain during addiction. Her first seminal paper on this subject was published in 2002.
The breakthrough came with the introduction of high-detail brain imaging devices like functional magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning, which offered high quality views of the brain.
To understand addiction, first you need to understand the basics of pleasure and reward. There are two types of pleasure and reward that are deeply primal. One is sex and the other is food. Both are absolutely essential for survival.
Your brain can secrete dopamine simply by looking at a picture of a loved one or a beautiful sunset. But while studying the the brain's reward center, Dr. Volkow realized that you will not feel pleasure or reward unless dopamine binds with its receptor, called the D2 receptor.
D2 receptors are located all throughout the reward center in your brain. When dopamine links to this receptor, immediate changes take place in brain cells and then you experience a "hit" of pleasure and reward.
Now, how come eating a delicious apple will make you feel pleasure but is unlikely to lead to addiction, whereas eating cake can, in vulnerable brains, lead to over-the-top pleasure and a driving compulsion to eat more cake—again, and again, and again?
Dr. Peeke explains:
"If the birthday-cake-type experience, which is something that involves a food far sweeter than an apple, takes place, your brain can handle it. But what happens when birthday cake is available 24/7?Addictive eating behavior, by current estimates, affects to some degree 1 in 12 adults. There's a wide spectrum of addictive eating, from people who are mildly affected but can control with modified lifestyle habits, to people who are seriously compulsive overeaters and are suffering with significant health consequences.
Now we have a problem... People who are vulnerable---have had an early history of any kind of abuse or trauma--- have mood issues, or a history of addiction themselves and/or genetically in their family, these people are at much higher risk to now develop an addictive-like eating behavior.
This is especially when they regularly consume what we now call "the hyperpalatables" – refined, processed sugars, fats, and salt."
As well, addictive eating is experienced by men and women of all sizes. Dr. Peeke notes that one of her most challenging patients was a size 4 woman who only ate a discreet amount of cookie dough on a daily basis. So, you don't have to be severely overweight to be addicted to food.
"It's not just about weight. Some of my toughest addictive-eating behavior people are very small people," Dr. Peeke says. "They struggle every day. Addictive-like eating actually covers the entire gamut of the weight spectrum."
How Addiction Develops
The primary directive of your mind and body is survival, and it will go through some interesting adaptations to survive. When you indulge in too much of these hyper-stimulators—be it cocaine, sugar, alcohol, or sex—your brain's reward center notes that you're overstimulated, which the brain perceives as not good for your survival, and so it compensates by decreasing your sense of pleasure and reward.
It does this by downregulating your D2 receptors, basically eliminating some of them. But this survival strategy creates another problem, because now you don't feel anywhere near the pleasure and reward you once had when you began your addiction, no matter whether it's food or drugs. As a result, you develop tolerance which means that you want more and more of your fix but never achieve the same "high" you once had. There's no period at the end of the sentence. And, all the while, the addictive cravings grow stronger.
"Dr. Volkow, through her extraordinary work...showed that the reason why people who have addiction continue with their addiction has very little to do with the pleasure or reward they're getting out of it; it has to do with the pain and the angst of withdrawal, and they don't want that," Dr. Peeke says.Dr. Volkow's work revealed that the changes taking place in the brains of drug addicts are identical to those occurring in people addicted to food. Regardless of the source of the addiction, you see very little dopamine bonding with its D2 receptors in the brain, as their numbers have been drastically decreased due to continued exposure to the addictive substance/process.
"In the normal brain's PET scan of the reward center, you see a beautiful red-orange because it's all lit up where the dopamine is bonding with the D2 receptors. You show them a sunset or something pleasurable, and you can see beautiful binding going on. What do you see in the addictive brain? Not a whole lot; almost no orange there. For that matter, those D2 receptors are so low in number that these people are in angst. They crave more and more and more of whatever that fix is.
What Dr. Volkow's study was able to show was: 1) food addiction is real and 2) that the changes that take place in the brain's reward center are identical across the board for all addiction. It doesn't matter what the addiction is so long as it's truly an addiction and it meets criteria. This is huge. She also showed that 3) the reward center is just one brain center that is affected. The other one is the frontal cortex, right behind the forehead.
That means you have an impairment of the 'CEO of the brain' in its ability to rein in impulsivity, irritability, impatience, and all of the things associated with withdrawal and addiction. You can't stay vigilant. It's hard to pay attention. You can't be mindful. You can't plan, organize, or strategize. Basically, you're out of control. Now, you have an out-of-control CEO of the brain and you've got a hijacked reward center. What you have, is a full-on addiction."
Early Trauma 'Primes' Your Brain for Future Addiction
Experiencing abuse (e.g. physical, emotional, sexual), neglect, or other trauma during the formative years of childhood, adolescence and young adulthood can significantly affect your frontal cortex, thereby making you more susceptible to addiction. Dr. Susan Mason at Harvard University, working with the Nurses' Health Study II, showed that women who had the highest levels of abuse during childhood had a 90 percent increased incidence of food addiction. In her book, Dr. Peeke also talks about the role of epigenetics, noting there's a "sweet spot" between the ages of eight and 13 when your genome is particularly vulnerable to epigenetic influence.
"That means each of your genes has almost like an on-off switch, a dimmer switch. You're turning things on and off, and leaving molecular markers based upon what happens to you. A lot of these then influence how you self-soothe and whether or not you're self-destructive. These follow you into adulthood, which is precisely why it's so important to remember that you need to address all of these issues. You're not a robot... That's why you have to look at the mental, spiritual, and psychodynamic of all of this... There lies so much of what goes on.If you're wondering whether you may have an issue with food and addiction, there is now a published and credentialed assessment you can take called the Yale Food Addiction Scale. Dr. Peeke provides a short and long version of this test in The Hunger Fix, as well as a quick and easy online version www.drpeeke.com/PopQuiz.htm. addiction.
Even for people lacking a distinct history of abuse and trauma there are conditions that set us up for self-soothing and often self-destructive addictive behavior. Dr. Volkow herself says that as much as she has very high levels of self-regulation and compulsivity...When she's stressed and when she is sleep-deprived – the two S's – she'll cave to the crave.
She also showed that, believe it or not, it's not the consuming of the food that actually results in the highest levels of dopamine release in the brain; it's the cues and the triggers...Just by showing people pictures or getting them triggered, they have very high levels of dopamine secretion. The thing is when they actually consume, especially if they're addictive, they're not experiencing the level of reward that anticipating the fix will provide."
So, there are those who meet criteria, but Dr. Peeke believes the majority of people struggling with addictive eating behavior fail to exactly meet the criteria for the Yale Food Addiction Scale. They fall into an "almost" category and include people who binge (at any level). Regular binge eating and food addiction have a 100 percent correlation because when you binge, it's almost always on the hyperpalatables---refined sugar and processed fats.
"This is a moving target right now. The vast majority of people who subjectively binge do not meet the criteria for actual binge-eating disorder. I think there's large, large number of people out there struggling with addictive-like eating behavior, and some actually meet full on criteria for food addiction," she says.
Confronting Cross Addiction
The origin of food addiction includes any combination of genetic family history of addiction, mental health conditions, trauma, abuse and an environment that is filled with hyperpalatable foods. But there's also another critical source of addictive eating--- cross addiction. As people are detoxing from alcohol, drugs, nicotine or other process addictions (sex, gambling), they often transition from one addictive behavior to another.
This cross addiction process often follows a hierarchy of getting clean from the most illicit fixes to ones that are may be "legal" but very problematic. For instance, a very common pattern observed is for detoxing alcoholics to stop drinking their calories, and instead seek their sugar from every kind of sweet. As well, smoking and drinking large amounts of caffeine are typical recovery behaviors, all clearly leading to their own mental and physical health fall-out. As well, recent studies have shown that approximately 30% of compulsive food addicts who have undergone bariatric weight loss surgery become alcoholics.
Other cross addictions include stimulant (nicotine, cocaine, methamphetamine, Adderall) addicts who compulsively overeat during recovery. Finally, many people are detoxing from more than one addiction (alcoholic who smokes cigarettes and pot and gambles), further complicating treatment. Therefore, it is essential that the treatment of food addiction must include an acknowledgement of the powerful and challenging cross addictions that can occur when undergoing treatment for other addictive behaviors.
Intermittent Fasting May Help Cut the Ties That Bind You to Food...
From personal experience, I've found intermittent fasting to be a highly effective tool that helps your body to shift from burning sugar to burning fat as its primary fuel, and with that change, food cravings have a tendency to simply vanish. So is it possible to differentiate between a craving resulting from metabolic dysfunction (insulin resistance) as opposed to some other more deep-seated food addiction that may not respond to intermittent fasting?
That question remains unanswered, for the time being, as intermittent fasting has not been tested specifically for people meeting the criteria of food addiction. Still, Dr. Peeke agrees that such results are "provocative and compelling," and from my perspective, if you're struggling with food addiction, I believe giving it a try would certainly be worthwhile.
"One of the things... I write about in The Hunger Fix, [is to create] a platform for being able to get a better grasp of how to eat better—do your physical activity, do your spiritual checking-in, confront and get help with a history of abuse and trauma, meditation, etc. One of the things I like to do is just say, 'Okay, let's take a breath here. Make it simple,' right? The majority of people out there are just lost.
They're getting hammered with temptation, cues, and triggers for self-destructive eating. In a way, cocaine addiction is a bit easier. I'm not giving you a moderate diet of cocaine; you're done [with cocaine], that's it. Whereas when it comes to foods and beverages, it gets more complex, especially since refined sugars are ubiquitous. They're in salad dressings. They're in ketchup. They're everywhere. You have to be much more vigilant, and you have to pay attention...
In Michael Moss' book Salt Sugar Fat: How the Food Giants Hooked Us, he looked at corporate America and the food industry. He was able to tease out something called 'the bliss point.' Millions of dollars have been spent trying to figure out what the bliss point is. That is, for every refined, processed food out there, which one can most rapidly ignite the reward center in the brain?"
Are You Addicted to Food?
Dr. Peeke created a short and easy to use synthesis of the Yale Food Addiction Scale. Simply answer these two questions for any given food or beverage you think you may have a problem with:
Dr. Peeke's treatment approach in The Hunger Fix includes an individualized and customized approach honoring each person's unique journey. The overall goal is to achieve and maintain a sustainable recovery based upon the practice of Recovery Lifestyle habits and behaviors. The plan incorporates elements from a wide range of resources, cognitive learning, meditation, spirituality, 12-step, epigenetic nutrition, and physical activity.
- If I consume this, will I feel loss of control?
- If I consume this, will I feel shame, blame, and guilt? "Overeating and binging are highly associated with feelings of loss of control, as well as shame, blame, and guilt, so if you answer yes, one of the things you have to do is just say these simple words: 'This just does work for me'," Dr. Peeke says.
"Take it and put it in a virtual shelf. We'll come back and revisit that when the smart part of your brain, the frontal cortex, is more healed, enlightened, educated, and has had more practice at being able to work with whole foods, and with better ways of eating, whether it's intermittent fasting or whatever else. But you're going to put more tools in that frontal cortex toolbox...
Remember, I said the D2 receptors were downregulated and the D2 receptor population came down? Well, I've got great news for you: the D2 receptor population grows back. You're able to actually feel more reward when you look at the sunset or you have a relationship with someone [once you break your addiction], because people with full-on addiction have almost no joy and almost no feeling of reward or pleasure with anything. Within the first six months or within the first month, you're able to feel it starting to come back again. That's part of the healing process."
Exercise and Mindfulness—Two Helpful Adjuncts on the Road to Recovery
Physical activity prompts neurogenesis and neuroplasticity, so by exercising you're allowing a more rapid healing to take place in your frontal cortex and reward center. Similarly, meditation has been shown to epigenetically turn off inflammatory gene groups, and to turn on genes that increase neurogenesis. So both are extremely critical when addressing successful long term recovery from any kind of addiction.
"This all goes hand in hand with healing the microbiome and the gut," Dr. Peeke says. "It goes hand in hand with healing throughout the body, to reduce insulin sensitivity, to decrease all the signs and symptoms of metabolic syndrome, and to reverse them. When you do what I call 'mind, mouth, and muscle,' –the three pillars I used when I established this program in The Hunger Fix—what you're able to do is an integrative, more holistic approach.For example, if you're addicted to sugary soda, clear out all sodas and replace them with beautiful glass decanters filled with pure water and float combinations of slices of fruit, berries, citrus, cucumbers and mint leaves. "Everyone can do this at home," Dr. Peeke says. Her book is filled with many more options and substitutes like this, which have evolved over years of experimentation in addiction centers.
In the mind, it's checking in with one's self, being able to augment the mental capacity to be able to say yay or nay. Organize. Strategize. To be able to decrease impulsivity, irritability, and impatience. To be able to heighten vigilance and mindfulness. Mindfulness is king here. When you're mindful, you take it hour by hour, moment by moment, so that what you're able to do is stay on track. People who have addictive-like habits tend to want to just speed it along. They're like, 'Come on, let's get this over with.' You can't do that. Take a breath. You can do this.
With physical activity, with every step you take you're able to change gene expression along the entire spectrum of the metabolic syndrome to be able to augment brain health and brain healing from the entire addictive process... Now, with nutrition, there's no question, you absolutely can't keep hammering yourself with addictive products for which you say yes (to loss of control) and yes (to feeling shame, blame, and guilt). Instead, you're going to substitute what I call false fixes (the addictive products) with healthy fixes."
You can also experiment with imagery, which can be very potent. Keep in mind you have options. Some do well with negative imagery, such as imagining a skull and crossbones on an addictive food. Others respond better to positive imagery attached to a healthier, recovery-friendly food choice. Here's another helpful exercise:
"I ask every single person to sit down and to develop something I call 'The Power Why.' Why do I want to do this at all? Why don't you just continue whatever addictive behavior you've got? Why? And you got to dig deep. You can't just say, 'Well, I want to be healthy.' What else is important in your life? You want to be here to do what? What is gnawing at you? You really need to take a moment. Close your eyes and go deep.
I'll give you an example. One of my most successful women is a woman who was once pushing 300 pounds. She'd struggled with figuring out her Power Why. It wasn't the obvious---health consequences. One day, she was told she was going to receive a national award for the work she had done in her community. She's a huge activist in the community. She was going to be on stage to receive the award with her entire family in attendance. It was going to be a year away.
Something clicked in her brain. She said, 'I want to be proud of myself. I want to walk the talk. If I'm promoting health and well-being, I got to live it.' That's what did it. A year and 150 pounds later and mentally and physically fit she stood proudly before the audience and accepted her award---not just for community service, but for achieving and maintaining food addiction recovery. That was 12 years ago and she's still living the recovery lifestyle."
If you suffer with weight issues and suspect food addiction might be an issue, I highly recommend reading Dr. Peeke's book, The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction. I think it will help a lot of people to release their food addictions and achieve long term recovery. Because it's not just about understanding food. It's becoming enlightened about why addictive eating happens and how to create a food addiction recovery lifestyle that you can live long term. It's about having practical strategies that allow you to actually apply that knowledge and make the critical and sustainable changes to break the addiction cycle once and for all. You can connect with Dr. Peeke on Facebook or Twitter, and also find more information on her website, DrPeeke.com.