By Allison Helms D.O.
Based on recent studies, there has been increased success with treating obesity and disordered eating as a type of addiction to a substance. Addiction is by definition the “compulsive need for and use of a habit-forming substance”. With this definition in mind, should carbohydrates be treated as an addiction? Wouldn’t a successful “addict” be able to achieve life-long “sobriety”? For clinicians that are using this approach toward carbohydrates, the answer is an emphatic yes!
Many people describe cravings for carbohydrates (especially sweets and starchy foods) during times of heightened stress. When people attempt to limit their intake, they experience symptoms similar to “withdrawal”, which include fatigue, irritability, lack of control, increased cravings, anxiety and depression. It may seem extreme to think of food as an addiction compared to a substance such as alcohol or heroin, because with the latter, they are socially unacceptable addictions, and complete abstinence dictates successful remission. Food (including carbohydrates) is what our bodies need for energy and nourishment, so if we feel we are “addicted”, overcoming the physiologic and behavioral factors that drive the addiction can feel impossible to comprehend.
From a physiologic standpoint, researchers have found that obese patients are deficient in the number of dopaminergic (D2) receptors in the brain. The same deficiency of D2 receptors has been attributed to drugs of abuse such as cocaine and heroin, suggesting a link between a range of compulsive behaviors. Furthermore, this lack of D2 receptors in obese individuals makes them less sensitive to reward stimuli, thus increasing their risk for food consumption as a compensatory mechanism.
Treatment with a carbohydrate addiction model has been used by clinicians to help patients understand the struggle with disordered eating and obesity. Sustaining weight loss is not simply a short term goal of reduced caloric intake and exercise, but rather a lifelong process that involves food choices based on the effecting behaviors and reducing cravings. The addiction model also helps patients understand that they will have relapses, and that retaining “carb sobriety” may require almost complete elimination of sweets/starchy foods permanently.
Along with nutritional education, teaching problem solving skills directed toward eating, emotional, and relational management has demonstrated improved maintenance of carb sobriety and weight loss. By recognizing disordered eating as a multi-faceted cause of obesity, using treatments that address each individual’s needs (biochemically, psychologically and socially) will ensure successful long-term maintenance of weight loss and relapse prevention.