For this DrTalks I have an amazing expert with us. I have Dr. Angela Zechmann or Dr. Angela as her patients know her. She is an obesity medicine specialist in Olympia, Washington and she has been practicing for 17 years.

Her flagship program is the Empowered Weight Loss. She’s helped thousands of patients and their families from her unique and compassionate approach. And Dr. Angela, along with her assistant Marcel Holmes, host a weekly podcast called Keep the Weight Off, which is a fabulous podcast.

I’ve been on it and a fun fact about Dr. Angela. When I attended my very first meeting, I don’t even know, 12 years ago, for the American Society of Bariatric Physicians, she was assigned to be my mentor.

So our connection goes goes way, way back. So very excited to have Dr. Angela with us today to talk about food addiction. She has so much information for you.

She even made some slides to show all of this. So, Doctor Angela, can you tell us about how you got interested in food as an addictive substance? Oh, I am happy too.

So, I’ve been practicing obesity medicine for 17 years, and what I noticed is that for I would find myself, like I didn’t start in obesity medicine, I started in epidemiology, I started in pediatrics, and then I went into public health and I went into epidemiology.

And it was super interesting because I grew up surrounded by highly processed foods. And I had a sweet tooth. And, I was I just thought, there’s something wrong with me, like, what’s going on?

Like, I’m eating chocolate chip cookie dough for dinner, and I can’t stay away from this stuff. And my solution was, in 2003, which is before I got into obesity medicine and before we even really understood what was going on from a scientific perspective, I decided I’m going to go sugar free in 2003.

So totally and completely sugar free. I can tell you during that year, there was not one day that I didn’t have a sugar substitute, but I was sugar free.

I also did a figure competition, and what I realized at that point in time was I was trying to use exercise and restrictive eating to manage my sugar addiction, and so I actually met criteria for a restrictive eating disorder, believe it or not.

So, so that was my solution to this problem. And of course, you know, what are we told when we’re struggling with the disease of obesity and we’re struggling with this problem, we need to diet and exercise and we need to exert self control.

And of course, Jillian Michaels. I can’t stand the woman. She gives the underlying message that this is all your fault. Something is wrong with you. You just need to diet and exercise.

And the more you exercise, the better. And of course, you know, that’s what worked for her. Of course she caught obesity is a disease. She caught the disease for her at in very early, early stages.

Diet and exercise does not work for most people. And so what I started to understand in obesity medicine is what if this is not my fault? What if there’s something else going on?

What if there are forces going on in my brain that I am not aware of? And that’s what I want to talk about today. So obesity is an end point. So I want you to think about the weight gain as an end point.

And there are all kinds of contributing factors. And the factor that I’m going to focus on most today is this factor right here, which is the reward potential of processed foods and the addiction capacity of processed foods.

Now, this is very controversial, and has been for many, many years. But I want to show you some of the research that’s been done because guess what? It is no longer controversial. Okay.

So, this is a food label for a food. And what you’ll see is that, this thing has, it has like 60 calories or something, and it’s got some carbs. It’s got a little bit of protein in it.

Any idea what this is, Carolynn? What? This is. Looking at. We got. I had to zoom in there. It doesn’t have very many calories. I don’t know, like some sort of snack cookie sort of thing.

Like a low calorie cookie? No, actually, this is baby carrots. Oh, it’s just your baby carrots. That’s all it is, right? If you look at the ingredients, there’s a few ingredients in there.

Baby carrots. Oh, yeah. Sorry, I oh. Here is another food label for, something else. And notice that, it’s got 60 calories. It has one gram of protein, 11g of carbs, five of which are sugar.

It’s got a whole bunch of ingredients in it, many of which most people can’t pronounce. It’s got dyes in it. So what do you think this might be? Oh, okay.

See, blueberry. And I like, like, a blueberry, snack bar. It is, Pop-Tarts. Pretty gross. Now, how many of us would think nothing of giving this to our kids for breakfast or for a snack, right?

Pop tarts, mini crisp. And yet, it is really, really powerfully addictive. And I’ll explain why that is so, I want you to understand the Nova food classification system.

So there’s a difference between baby carrots and these processed foods. So there are four classes of foods in the Nova classification system. Where did this come from? It came from a public health research facility in Brazil, in Sao Paulo, Brazil.

Okay. So it helps us to think about foods based on the processing that they go through. So food processing involves physical, biological and chemical processes that occur after foods are separated from nature.

But before they they’re consumed or used in the preparation of dishes and meals. So if you think about foods that were first harvested in or gathered or, or, when the animal was initially sacrificed, think about what happens after that before you go to purchase it.

And the Nova Food classification system gives you that sense. Okay. Does that make sense? Carolynn. Yep. Okay. So I’m just going to go through briefly what some of the things are so ultra processed or natural foods come directly from the plant or animal.

So when I think of minimally unprocessed, sorry, unprocessed, minimally processed foods. So so when I think of unprocessed foods, I think of like what I do around here in August, I’ve got blackberry bushes all over my yard, and I just go pluck the blackberries off and eat them.

That’s totally unprocessed. The baby carrots would be a minimally processed foods. So, you know, they they got it ready for you to eat. They took the peel off of it.

They washed it. They they provided it for you. So those are some unprocessed or minimally processed foods. Then we have processed culinary ingredients.

Which that’s group two. And I want you to think about things. They they’re natural. They’re from nature. But they have gone through some sort of pressing or grinding or pulverizing or refining something like that.

So butter oil, brown sugar, white sugar, those kinds of things. Okay. So their culinary ingredients, they need to be processed. You could actually do this in your own home, though doesn’t require any sort of industrial processing.

Think about olive oil as an example. Okay. The next is processed foods which basically is some combination of group one and group two. So for example, you take salmon and smoke it and salted or dry it, beef jerky, that sort of thing.

Examples would be like tomato paste. Like you can tell the what the actual real food is. And but it’s also been processed in some way, and it usually requires some sort of industrial processing and beer and wine follows in this category as well.

Okay. So that’s processed foods. Then we have ultra processed foods, which I’m going to read you the definition of ultra processed foods because this is really important.

They are industrial products. So they’re made in factories and they’re made entirely or mostly from substances extracted from foods. Okay. So oils, fats, sugar, starch, proteins, they’re derived from food constituents, like hydrogenated fats or modified starch.

And they’re made in laboratories from food substrates, with flavor enhancers, colors and food additives. Okay. These attitudes are used to make the product hyper palatable.

That means really, really good tasting and, they’re very reinforcing. Beverages can be ultra processed as well. And usually group one foods are a very small part of or even absent from ultra processed foods.

So examples of ultra processed foods would be breakfast cereals and breakfast bars, hotdog buns, instant foods like instant puddings, colas and energy drinks, ice cream, biscuits, baked goods, cakes, pastries, chips, Doritos, baby formula, fishy crackers, Nilla wafers, chicken tenders and the list goes on.

And on and on and on. And I might add here that 65% of kids calories come from ultra processed foods. Okay, so think about, for a minute, a standard lunch or dinner that is a burger and French fries and a soda.

What’s in this stuff? Well, they’ve stripped all the fiber out of it. That’s because when food has fiber in it, it’s going to spoil more easily. And it takes longer to cook.

So they strip the fiber out. They’ve also adulterated it to be enormously pleasurable. And they add sugar to the French fries, they add sugar to the burger sauce, and the ketchup is basically sugar to.

So research is showing that it’s uniquely ultra processed foods that create this addictive response in the brain. Okay. So what I found is that what I would do is after a party, for example, I remember one Christmas we had chocolate cake and I found myself in the pantry after everybody had gone to sleep just shoveling chocolate cake in as fast as I could.

And I’m like, what’s going on? Like, why am I doing this? After parties, I would be eating leftover cake off paper plates, or I would actually dig it out of the trash.

And I’m like, this is really disturbing behavior. Like, what’s going on here? Well, you notice I wasn’t digging rotten apples out of the trash, right?

So I’m digging out the ultra processed food. And so it turns out that it’s not. It’s the processing piece of it that makes it so completely rewarding.

Okay. These foods are absolutely unique. Okay, so it’s not my sweet tooth. That’s the problem. This is actually an addictive drug. It’s my addiction okay.

So that’s what I want you to understand okay. I have so many people who will come in and they actually describe that. They feel almost as you described, compulsive, like they can’t stop eating some of these foods, whether it’s the goldfish crackers or fast food or a certain sweet that they like.

And so I think your description is so powerful and what, what so many people hear sometimes I tell my patients, you know, the way to think of those ultra processed foods are things you couldn’t make on your own, even if you tried, right?

I can’t replicate a McDonald’s burger. I can’t replicate those little pop tart, crisp things you showed me, right? I couldn’t make those. They have to be so heavily refined and require things that are basically not food that I can go by myself, that that I couldn’t make those ultra processed foods even if I try.

So sometimes that’s the way I think about them too. Yeah. Yeah. So these foods are actually addictive drugs okay. And that is very controversial. A lot of people have a hard time thinking about that.

Like how could this be. And so Arthur Schopenhauer, who’s a German philosopher, says all truth passes through three stages. First is its ridicule. So that’s what’s going on right now.

This whole idea of food addiction is being ridiculed. Second, it’s violently opposed. So, the food industry, in thinking about this is going to be just think about when, we went through all the issues with nicotine addiction, you know, in that in the 60s and 70s, like violently opposed by the people who are making it, of course.

And then third, it’s accepted as being self-evident. So we’re at we’re at stage three when it comes to nicotine addiction. We’re at stage 1 or 2 when it comes to ultra processed food addiction.

Okay. So what is the evidence for food addiction? There are are there similarities with other substances that cause addiction? So think about this for a minute.

What happens? Foods have changed. So we’ve talked about the refining of it. They’re being processed in ways that increase both the potency of the reward from food and the speed of absorption.

So the addictive parts of it are getting absorbed more quickly. And those are the two factors that really increase the addictive potential of any other substance.

Okay. So think about coca leaves. Coca leaves are found in South America. And people chew on coca leaves. They don’t get addicted to coca leaves. But what happens if you extract the main ingredients and, pulverize it and add ingredients to it?

And what happens to it? You end up with cocaine. Highly addictive. And crack cocaine. Okay, so that is a natural substance. The ingredients have been extracted out.

The primary ingredients extract it out. Bunch of chemicals, add it processed into a very highly addictive drug. Think about grapes. People eat grapes all the time.

People don’t get addicted to grapes. What if you extract the primary ingredients out of it, add chemicals to it, and you get a substance that is problematically addictive for many, many people.

So think about, sugar cane so you can chew on sugar cane. You don’t get addicted to sugar cane, but you pull out the primary ingredients and you process it, add some water to it, and you get a substance that’s highly addictive.

What about wheat products? Okay, you extract the primary ingredients, add a bunch of chemicals to it. And you end up with a substance that’s highly addictive.

All right, so what ingredients of food show evidence of addiction? What parts of the food? There are four potentially addictive items that are in food.

There’s salt that can be addictive. Potentially fat could potentially be addictive. Sugar could potentially be addictive. And caffeine actually be addictive.

So I’m going to go through each of these and ask which ones of these are potentially addictive. And this is all done by, Doctor Robert Lustig. So I want to give him credit for going through this.

So is salt addictive? What do you think, Carolynn? Absolutely. I had a patient recently who was eating bowls of salt at a time, so, especially when it’s added to other things, usually people don’t get too addicted to it on its own, but when it’s combined with other things, that’s usually, you know, those, those pretzels or chips you can’t stop eating.

So I would say yes. Yeah. So that’s where it’s in and of itself. In rodents it is addictive. It shows its own addiction. But in humans it’s addictive.

When combined with other other stuff. Yeah, yeah, yeah. What about fat? Is that addictive? You know, I’d say no. I have a lot of people who’ve done high fat diets when it’s by itself and they’re just doing a keto diet, people will tend to eat a lot less.

They feel really satiated, satisfied, they feel full. So I would say by itself, without adding salt or sugar to the fat. That it’s not addictive in and of itself.

You’re absolutely correct. Not addictive. What about sugar? Well, I think we, you know, those of us who’ve listened to you talk so far, and who who have experienced that feeling of feeling addicted to sugar ourselves, know in our heart that some of us are addicted to sugar.

Yes. And it turns out it’s fructose in particular that is highly addictive. And alcohol and fructose are basically the same molecule. So and they get processed in the liver the exact same way.

What about caffeine? I certainly get dependent on it. You know, you’ll get those headaches and feel crummy if you haven’t had it. So I would say definitely addictive.

Yes, it is addictive. 30% of people who consume caffeine show evidence of addiction. However, it is not toxic and it does not cause metabolic disease.

So this is, addiction that. The interesting thing is, though, if you combine it with sugar, it makes the sugar more addictive. So okay, so there is a growing body of evidence that sugar is addictive.

And so I’ve heard Doctor Nikolaevna speak. So she did the preliminary research because she’s like we think this is sugar. We’re going to use a rat model and we’re going to ask the questions.

We’re going to look at all the criteria for addiction. And we’re going to ask the question, is sugar addictive in the brain? Okay. And she said in the early 2000s when she first started publishing this research, she could not use the word food and the word addiction in the same sentence, otherwise her papers wouldn’t get published.

That’s how controversial it was. Okay, but she talks about how we’re dealing with an epidemic. An epidemic of hedonist eating. So what’s the difference?

So there’s two kinds of hunger. There’s hunger in which your body needs nourishment and calories. And so there is a feeling that you need to eat. And then there is hunger, hadronic hunger, which is pleasure driven hunger.

So what we’re dealing with is an epidemic of pleasure driven hunger. Okay. So does that make sense? The difference between the two? Absolutely. Yeah. Yeah.

And there is a growing body of evidence. So she’s done research in the brains and behavior of rats. And the hallmark of addiction is an overproduction of dopamine in the brain.

Okay. So dopamine is the pleasure hormone. It gets produced in the brain in what’s called the nucleus accumbens, which is a part of the brain. And so when you give rats a sugar solution, the rats brains increase release dopamine above the baseline levels.

And you can see that I’m not going to show you the actual data that’s beyond the scope of this. But they did notice that when they took the sugar away, the rats experience withdrawal symptoms like aggression.

Okay. They also showed and this is super interesting, they also showed changes in the opiate system of the brain. So the opiate system is what gives us relief from pain okay.

So it acts similar to sugar acts similar to morphine in the brain. Did you know that Carolynn. I did and you know when that became really clear to me.

So I’m a family physician. And one of the things that we’re trained on is to do circumcisions on newborn babies. And yes, what we give newborn one day old babies to calm them down while we’re doing a circumcision.

These things called sweeties. Exactly. Water packets that we scored in their mouth while we’re doing the procedure. I haven’t of them down. Oh, wow. Look at that.

Yes, that calms them down. It, it releases morphine, opiates in the brain like morphine wood. Okay. And the interesting thing about rats is they gave them.

They give, rats, they have two different sets of rats. So some rats have been sugar or have been given sugar solution along with their chow. And other rats have not been given any sugar solution.

Give both of those groups of, rats naloxone, which blocks the opiate receptor. Guess what happens to the rats that have been given sugar solution? What happens?

They go through withdrawal. They show signs of withdrawal. But what about the rats that have just been given, regular rat chow? No withdrawal symptoms.

Isn’t that interesting? Yeah. So if you look at Pet scans of dopamine centers, here, I hope you can see this. The red is normal dopamine receptor activity.

Okay, what happens is people who have addictions end up with what we call dopamine downregulation. In other words, the dopamine receptors are not working correctly.

And that’s why it takes so much of the drug to just feel normal. Okay. So this is somebody with a cocaine addiction experiencing dopamine downregulation.

They also have Pet scans on people with obesity. And they have even fewer dopamine receptors than people with cocaine addiction. Super interesting. And it’s because there’s an underlying sugar addiction going on here.

Okay. So, the Yale Food Addiction Scale is a tool that has been used clinically. It was developed by Doctor Ashley Gearhart. I actually interviewed her on my podcast.

It is fascinating to listen to her talk. She took all of the criteria that were used to diagnose a drug or alcohol addiction and apply them to processed foods, and, I just want to kind of go through very quickly what the criteria are for addiction, because I want you to understand that, tolerance, meaning you need more and more of the substance to get the effect you want.

And that’s because of the dopamine downregulation. Okay. You go through withdrawal symptoms again because of the dopamine downregulation, you need to have that substance and to prevent withdrawal cravings, cravings.

So in the world of food addiction, you could call that food noise. You’ve heard of people talking about food noise. That’s cravings. Those are physical symptoms.

And then you also have psychological symptoms of addiction. Like you’re unable to fulfill major role obligations. And, your relationships can be affected by this.

You take the substance in larger amounts over longer periods. So, you know, what I noticed with my sugar addiction is I would sit down with Girl Scout cookies, and I would plan to eat two Thin Mints, and I’d end up eating whole sleep.

Right. You know, it’s like, or Oreos, those kinds of things, attempts to quit or cut down in the world of sugar addiction, that would be called a diet, right?

Lots of time spent seeking the food, lots of mental energy spent thinking about it, or recovering from the use of the drug. We actually have food hangovers, food comas, giving up important activities because of the substance use, using the substance, even when it puts you in danger.

And this is more for substances like alcohol or, opiates, those kinds of things where you don’t have your cognitive capacity, and use despite negative consequences.

What do you think about though, with number ten, you know, when we see someone who has, say, diabetes and they often it’s like their sweet tooth, you know, their cravings seem to be more intense because of some of the half the physiology of diabetes.

And they they struggle even more. Right. And so it kind of it’s like they know that this sugar is something that is worsening their diabetes, yet they are unable to stop.

You know, in some cases. Actually so used despite negative consequences. Absolutely. Yeah. So the criteria for addiction, it’s a mild addiction if you have 2 or 3 symptoms, it’s a moderate addiction if you have 4 or 5 symptoms and it’s a severe addiction if you have six or more symptoms okay.

So that’s just drug alcohol. Addiction. Processed food is not yet defined as an addictive, substance at this point in time. Okay. I want to talk about tolerance for a minute, needing a substantially higher dose of the substance to achieve the desired effects, which is why we keep eating more and more and more.

Okay, that’s an important piece of sugar addiction. The other piece of this is withdrawal. Experiencing negative physical and psychological symptoms. And and what I want you to understand about it is when you decide to stop eating ultra processed food and get off sugar and flour products, you’re going to experience withdrawal.

And the classic symptoms of withdrawal are depression, anxiety, irritability. Okay, I always tell my patients, you’re going to want to divorce your husband and quit your job.

Insomnia. You’re not able to sleep very well. And massive, massive cravings. So we have to prepare people for these withdrawal symptoms. And a lot of the reasons why people have a hard time, working at getting healthier again is because of these withdrawal symptoms.

They’re very powerful. You talked a little bit about how people with diabetes continue to eat sugar. So this is a classic example of the negative consequences that occur.

And Doctor Robert Lustig, who has been at our obesity medicine conferences, has spoken widely about this. Yet he said, we need to just call a spade a spade diabete.

This is processed food disease. Okay. Cardiovascular disease. There was a study that came out, I believe this is from 2019. They looked at the use of sugar sweetened beverages, and they discovered that people, who consume sugar sweetened beverages, the use of sugar sweetened beverages was positively associated with mortality, meaning more people died primarily through cardiovascular disease, mortality, meaning heart attacks and strokes.

And it showed a graded association with dose. What that means is the more sugar sweetened beverages you drink, the higher your risk. Okay, so yes, people do continue.

With their sugar addiction despite negative consequences. That’s very clear in the Yale food Addiction scale. She, Doctor Gearhart applies rigorous criteria for addiction.

It’s interesting because I did not show up as having an addiction to, processed food, but I definitely struggle with it. And I asked her about that, and she said, well, a lot of people don’t struggle, don’t meet criteria for alcohol addiction, but yet they struggle with their use of alcohol.

Right. So we call that like alcohol abuse maybe, you know, and so it’s like it’s not helping your health. Maybe it’s not a true addiction, but it’s still very triggering for you.

You drink afterwards and you should drink one sort of thing. Yeah. Exactly. So how much are we addicted to ultra processed food? This has been translated into many different languages, tested and validated all over the world.

And there’s now a version for children, which is very cool. And if you’re interested in taking the Yale Food Addiction Survey Scale survey, where that taking that, you can just Google Yale food addiction.

It’s super easy to find. She’s now at the University of Michigan, so you’ll end up on a site, at the University of Michigan, and there are all these different versions of it you can test yourself on.

So what do you think? Are they percentage of adults that meet criteria for addiction to ultra processed food? Oh gosh, that’s a little tough because I work with so many people who struggle with this.

So I feel like maybe I’m overestimating it, but I would say about 20%, of the population are like addicted to it. So when they and and it’s true because we see people who are struggling with obesity and so our population has a higher percentage of addiction.

When you just survey the general standard American public, it’s about 14%, which is similar to other known addictive substances like alcohol and nicotine.

Okay. But remember, these are people who meet addiction criteria. There are probably a whole another 30% of people, or 40% of people who actually struggle but don’t meet addiction criteria.

What about children? What do you think? Oh, I’m worried that it’s higher, maybe 25%. If you test children in the general public, it works out to be about 12%.

Well that’s good. So it’s not quite as bad. But we want you to be thinking about something. We do not allow children to be exposed to any other addictive drug, okay?

We don’t let them smoke. We don’t let them drink alcohol. We certainly don’t want them into cocaine and morphine and heroin and all of that. So we don’t allow children to be exposed to this.

And yet we allow our food industry to market directly to them. Ultra processed foods containing a highly addictive substance. Okay, so ultra processed food addiction is uniquely difficult to treat. Why?

Because we get exposed to it really early, like I had chocolate cake before I was even one, right? My parents decided, we’re not giving this kid chocolate cake on her first birthday because she makes a mess out of it.

We’re giving her a white cake. We have ubiquitous access. It’s everywhere. We are socially encouraged to indulge in this constantly. Lots of cultural norms around this.

And we have a multibillion dollar marketing campaign trying to get us to eat this stuff. And of all of the processed foods, most of them, as a matter of fact, 74% of them have added sugar in them, and 50% of the sugar that people get is comes from ultra processed foods.

Okay, so there’s something called the bliss point, which I want you to be aware of. This is the exact amount of sugar that, makes a food most pleasurable.

This is documented really well in a book by Michael Moss called salt, sugar, fat. Have you read this book, Carolynn? I haven’t, I’ve heard about it for a long time, actually.

Oh, good. It’s so good. Michael Moss interviewed, food scientists from various food industries, and he he became, I mean, he understands he documents all of their secrets.

And so the bliss point is the precise amount of sweetness, no more and no less, that makes food and drink most enjoyable. Okay, so the food industry knows exactly what they’re doing and they’re making food socially acceptable.

Think about it, kids birthday parties, Starbucks, teenagers are going to Starbucks and drinking sugar and caffeine. We take our kids to McDonald’s all the time and think nothing of it.

The Girl Scouts are selling drugs. I like to joke around and say, I used to be a drug lord. I have two daughters. They’re in their 30s now, but when they were kids, I was the Girl Scout cookie mom, and we have the kids go sell Girl Scout cookies, and we would take the money for the troop and for the Girl Scouts.

Like, what do drug lords do? They have other people sell the drugs for them and then they take the profits. And. So is a drug lord without even realizing it.

Not only is it socially acceptable, you’ll often get pressured right? If you’re that person at that birthday party and you’re like, no, I’m good. I don’t need the cake. I don’t need the cupcake people.

I’ll have some, have some. Are you sure you want it for later? You know, you want another piece? Like people not just. Is it socially acceptable? You’ll actually get pressured into that.

These things in many cases. Sadly. And think about the baking traditions that we have. Like what is a more wonderful than grandma and grandchild baking together, or mom and child baking together like she’s using.

She’s got powdered sugar. That’s a little kid like she might as well be dabbling in cocaine. It sounds crazy, doesn’t it? Like. But once you understand the biochemistry of this, you really.

It makes sense. Now, a lot of people will say, hey, you know what, doc? Like, this isn’t really an addiction because I can still function even though I might have a sugar problem or a flower problem.

I don’t I don’t get totally worked out. I can still function. The loss of control does not have to be as extreme as we think. You know, like I don’t end up cognitively impaired when I use sugar, right?

So it doesn’t have to include periods of blackouts and incapacity function. The most common addict in our society is actually a smoker. Right. And we know these people are fully functioning.

They are not intoxicated. Their withdrawal from nicotine is not life threatening. But smoking causes preventable death. And I want you to start thinking about ultra processed foods in the same way you think about nicotine, okay?

If you’re fully functioning, you’re not intoxicated. You’re withdrawal is not going to be life threatening. You don’t have to go into a, sugar addiction center to get off sugar.

And but it’s very similar to a nicotine addiction. Ultra processed food meets all of the criteria that prompted the U. S. surgeon General to mandate warning labels on cigarets in 1988 and banned cigaret advertising.

And so Doctor Gearhart and her colleague, Antonio de Feliciano de Felice, Antonio published a paper in 2022, and they’re, they’re landing call or their call is we need to start putting warning labels on these ultra processed foods to help people learn how to make better decisions about whether they want to eat this stuff or not.

Okay. So we need to have the Surgeon General mandate warning labels on ultra processed foods as well. Well, I don’t think that’s going to happen anytime soon.

We’ve got too big of a food lobby working against us right? Right. If anything, we see ultra processed foods that somehow have this stamp of approval, that they have whole grains or are low fat.

Exactly. So very recently in May of 2024, there was the first annual International Food Addiction Consensus Conference. And this conference had several goals.

It was led by 40 experts in clinical medicine, research and academics. International. So ten countries represented here. They worked for nearly a year trying to develop a consensus around what is food addiction and what can we agree on.

Okay. And the goals were really to classify this addiction as a distinct disorder that can be formally diagnosed by clinicians. So we would have a diagnosis in DSM, which is the diagnostic and Statistical manual that psychiatrists use to diagnose addiction.

And we would have, the International Classification of Disease Code for ultra processed food addiction. Okay. They had put it in to have food addiction as a, as a diagnosis.

And they got back feedback saying people don’t get addicted to broccoli. You can’t call this food addiction. Okay. So it set the stage for targeted treatment options.

We want to ameliorate, meaning get rid of the comorbidities and provide a platform for prevention. That is a huge key here. So we want to reduce the risk to future generations and reduce the cost of this addiction to society.

And so 37 of the 40 participants agreed on the summary. And they’re like, we can’t call it food addiction. That’s not correct. We need to call it ultra processed food addiction.

Based on the novel food classifications scale. So it is these, highly concentrated substances through and which all of these additives have been, put in.

That’s what’s causing the addiction. And there’s also, a question like, what’s the difference between ultra processed food addiction and binge eating?

So it’s going to be my question is like how do you differentiate that? Yeah. So remember I was like in the closet after Christmas. Like I couldn’t I was just binging on chocolate cake.

Like, is this a binge eating disorder or is this ultra processed food addiction? They can occur together, but they can also be separate. So that’s something to understand.

They can be different. Okay. The interesting thing about ultra processed food addiction is that it’s both a substance disorder and, behavioral addiction.

So in other words, you eat the food. It changes the brain chemistry because of the substance. Behavioral addictions, for example, gambling is a behavioral addiction.

You’re not ingesting anything, but the act of it changes the brain chemistry. A sex addiction would be similar. The act of it changes the brain chemistry.

Food addiction is both. It’s the act of it as well as the substance of okay, so the definition of ultra processed food addiction from the international consensus conferences.

It’s a chronic disease. So once you have it, it’s not going away. And that’s really important thing for people to understand. It involves complex interactions between brain circuitry, genetics the environment and an individual’s life experiences.

It turns out that people who have experience early trauma or at higher risk for ultra processed food addiction. Okay, people with ultra processed food addiction use food in ways similar to drugs of abuse.

They obsess about food. They engage in eating behaviors that become compulsive and often continue despite the harmful consequences. Okay, they added a few things to this, which is really, really important, like the treatment of other people with substance use disorders, abstinence from ultra processed food is increasingly seen as the best course of action for most people with ultra processed food addiction.

Others may be able to moderate certain foods. And so for me, what I’ve discovered is that there are certain combinations of things that I’m okay with and certain combinations of things that I am not okay with.

Like I discovered marzipan is going to drive me absolutely insane. My mother used to make Russian teacakes. It’s that really highly potent combination of sugar and flour that sends my brain off into I don’t know where, and I end up with cravings for days and days and days and I’m not going there.

Okay. My boyfriend, it’s chips for him. Like chips are. He gets started and he can’t stop. Okay, so ultra processed food addiction may explain some of the 30% of people in eating disorders treatment that never get better.

Okay? Because when you have an ultra processed food addiction, this idea that all foods fit, this idea of intuitive eating, it’s not going to work. The brain chemistry is not going to allow for that.

Intuitive eating does not. I think intuitive eating is fabulous in many ways. It doesn’t account for ultra processed foods, right? We our brains did not evolve in an environment where there was ultra processed foods.

And if you’ve ever given a young child an ultra processed food, you will see that they do not intuitively eat that food. They will want more and more of it.

Yes, yes. And Doctor Gerhart talks about how these foods are designed to create more richness. We want more and more and more of it, as opposed to water or broccoli where you have it and then you’re satiated.

Right? So it’s the it’s that difference between, physical hunger and he donut hunger. Okay. So people may be asking, what do I do? What do I do if I’m now recognizing that I might have an ultra processed food addiction?

Eventually we will have support in terms of warning labels, and it will be socially unacceptable. But right now we’ve got a big problem because, it’s so socially acceptable.

So what I recommend is to begin to think about ultra processed foods like you think about cigarets, right? So you don’t give them as gifts. They used to in the old days.

But both nicotine and ultra processed foods are just as addictive. They’re just as dangerous, just as unhealthy. Eventually, we’re going to have a warning labels on ultra processed foods.

But until then, it’s up to us as individuals to recognize that this is an addictive thing. And so I recommend watching a documentary called Fed Up. This came out in 2014.

It really helps us understand what the food industry is doing and how they talk about how, you know, moderation is okay and you know, you need to balance it with exercise.

And all the best that the food industry says. Remember that when you’re going to go through your detox, you’re going to have all these withdrawal symptoms.

And so you need to be prepared for that. You need to be prepared to go through a detox. What the research shows about, going through a detox is that you’re going to have withdrawal symptoms for 1 to 2 weeks, and you’re going to have cravings for a while as well.

But within about four weeks, your brain chemistry is going to be rebalanced again. So the dopamine receptors will come back. The interesting thing is that addiction causes so much of an abnormality in that nucleus accumbens of the brain that it basically cuts off the prefrontal cortex.

The prefrontal cortex is what allows you to have insights and allows you to think about the future. And there is very good evidence that when people are in the throes of an addiction, that part of the brain gets shut off.

And so what will happen is when you get off the addictive drug, you’re going to have that part of your brain working again, and you’re going to be able to see the consequences better in terms of what this drug has been doing to you.

And then, the recommendation is at the end of four weeks of complete sobriety from the substance, reevaluate, okay, do I want to stay off this? Do I want to see if I can moderate?

Do I want to, test certain foods, reevaluate your relationship with these foods? But you have this complete understanding that these truly are addictive drugs.

Okay, there are some people who have struggled with nicotine addiction in the past, and, you know, they have one cigaret and they’re off and running right.

And there are others who, you know, their nicotine addiction wasn’t as severe and they can have a couple of cigarets when they’re out socially and it doesn’t trigger.

So think of sugar addiction in the same way. You’re going to discover that there are certain foods that it’s just best not to do it, you know? And that’s what I’ve decided about marzipan and marzipan and Russian tea cakes.

And every year on my birthday, I have to have a talk with myself, like, am I going to have a piece of cake? Like, I know that’s going to trigger me? But I, I’ve learned to manage it pretty well, too.

So and I think that, like you said, that insight, that reflection of, you know, are you the person who can have cake on a birthday party and move on a few times a year, or is it really triggering for you?

And now all you’re thinking about is cake for days and days? And I feel like I’m that way with cake, too. I hear you on the cake. But yeah, something like creme brulee that I also really enjoy.

I can have that once or twice a year, really enjoy it. And it’s I’m not like thinking about it constantly. And there’s usually not leftovers of that dessert either.

Yeah. Sit on your counter. Tempting. And the problem with cake is that there’s leftovers. And so I’ve discovered that I have to just, I can’t just put it in the trash.

I have to put it down at a garbage disposal. So, I want all of our people watching this to understand that it is entirely possible to get through the detox and live a normal, happy, healthy life.

I see it all day, every day. It’s super, super fun. Recognize that a short term diet is never going to work when you have, ultra processed food addiction.

And, you know, the truth of the matter is, it doesn’t matter whether you’ve put weight on or not, whenever you’re eating ultra processed foods, you’re not going to be healthy.

You’re just not. You can’t be healthy if you’re eating processed foods. And so you want to really think about that. Make sure that you get in to see an obesity specialist.

Carolynn and I are just one of thousands of us out there. Now consider medications. Medications can be really, really helpful for this. We need to treat the underlying disorders that come along with this.

The insulin resistance and diabetes. It used to be in the old days, hardly anybody came in with prediabetes. You probably didn’t never see that like because when I started in 2007, prediabetes was fairly rare.

And now it’s everywhere. Almost everybody comes in really, really sick. And so it’s really important to understand that this is a disease that needs to be treated.

And the addiction is just one piece of it. Okay. I have free resources that I want to let everybody know about. I’ve got a Facebook group called Sugar (and Flour!) Buster’s Society.

And I have a podcast which Carolynn alluded to called Keep the Weight Off. And I also have, we’ll give you links to the five day sugar detox menu that I’ve developed.

And I’m also going to be providing you with, a link to get my mini course called How to Get Rid of Belly Fat. And this is all of the information that I teach our new patients when they first get started with us.

It’s all in a 70 minute mini course. And so I’m offering that to you, for signing up for this. I also have an online program called Empowered Weight Loss where we’re doing weekly group coaching, and I’ve got a six month curriculum that I’m taking you through to help you with some of these more, important skills when it comes to understanding addiction and helping to get through the addiction.

And we have a dedicated Facebook group for empowered weight loss as well. And the goal is, I want you to understand you’re not alone in this. Like so many people are struggling.

You know, alcoholics have AA, they need that social support because alcohol is everywhere and it’s widely accepted and it’s pushed on you. And so empowered weight loss is similar to that.

People with ultra processed food addiction need that same kind of support. And so that’s what we do. An empowered weight loss is to give you the support that you need.

Okay. And so, if you’re interested in that, there’s the website to go to to get signed up for that. Okay. I think I am done so. Well thank you, Dr. Angela, what a wealth of information.

And, you know, I think such a powerful case that for many people, these foods, they’re not they’re not healthy for any of us. But they are addictive for some people, and they’re really problematic for others.

And really, the solution for most people is going to be to to really cut them out of your life. Yeah, yeah. Just plan on eating foods from group one, group two, and occasionally group three.

You know, the you know, getting having tomato paste is fine. It’s just all of those added ingredients and pulverized sugar and flour. Like it’s just hard for your body to handle.

Yeah. Or we didn’t evolve with it. Our brains are not really meant to handle it, and it’s easy to lose control with it or just not eat eat it in a balanced way.

So thank you so much and thank you for all those ways people can find you. Yeah. Thank you. I really appreciate being on here. Thank you so much.

Angela Zechmann, MD, MPH

Food Addiction: Insights And Evidence