Monday, September 21, 2009

Why Aren't We Addicted to Broccoli?

This question about being addicted to food comes up over and over again in my practice, and I hear it in the media very often too. Here's a question that has intrigued me for a long time: why don't we become addicted to broccoli? Why cocaine, tobacco and chocolate?

Let me recommend a book that lays excellent groundwork for a discussion of our relationship to food: The End of Overeating: Taking Control of the Insatiable American Appetite by David A. Kessler, M.D. A former FDA commissioner, Kessler explains how the food industry has figured out how to make the foods they sell as luscious and appealing as possible. Not surprising at all. But food consultants take this a step further - or many steps further - and literally engineer the taste, texture and other sensory properties of food with chemicals. So there are very good reasons why, for example, "you can't eat just one" of just about anything that comes in a package.

So what are those food consultants doing? Are they addicting us to food? Can our brains become addicted to food? Well, yes and no. I've heard dozens of patients swear to me that they feel addicted to food. And we've surely all had the experience of eating something - chips, nuts, cookies - and not being able to put the brakes on. Even when we tell ourselves we have to stop, this is out of control, and we know we are going to feel sick when we finish, we can keep on going to the bottom of the box, wipe out the remaining sugar and salt with our finger, enjoy that last lick, and even wish for more.

It certainly feels like addiction. There are a couple of issues with this stance, however. First, we are clearly not addicted to all food. As much as you might like carrots or apples or tuna, have they ever evoked the same "I just can't stop" feeling you get from a bag of chips? I doubt it, unless you were beyond hungry.

And second, addiction has such a negative connotation that I have always advised my patients to avoid making food the enemy. We have to come to a peaceful coexistence with food. Unlike cigarettes and cocaine, food nurtures us and is necessary for our survival. Further, we cannot expect to eliminate even the least nutritious foods from our diet forever. Even the most health conscious person will have birthday cake, Halloween candy or holiday treats at some point. Unlike illicit drugs, sugary salty fatty food is all around us and is part of mainstream culture. We don't have a Dunkin' Cocaine on every corner or an eager grandma urging us to smoke her special Thanksgiving blend of tobacco!

And yet, we cannot deny the pull of certain foods. Kessler explains that we are not addicted to food, but we can become addicted to sugar, fat and salt. Our brains respond with more pleasure to sugar, fat and salt than to other nutrients. Experiments have demonstrated that animals will work harder to get them and will eat more of them. (Ditto cocaine.) Daily overeating of sugar, fat and salt condition us to eat more and more and more to get the same amount of pleasure.

Now, it may sound that we are doomed to overeating, ill health, obesity and feelings of failure. That's the "half-empty" reading of this piece. The "half-full" conclusion is that we are not overeaters because we lack willpower; rather, we have trained our brains to behave in a certain way. And what can be trained can be untrained.

Read Kessler's book. You won't be disappointed. As we go on, I will explore what we can learn from gastric bypass patients about the brain-food relationship.

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