Excerpt from Psychology Today’s article Nutrition in Recovery Addiction, What you eat in Recovery is so Important“.
From a public health perspective, the addiction problem appears to be relentless with substances of abuse increasing in potency. Meanwhile highly accessible and highly palatable food is a significant contributor to the changing human brain and addiction epidemic. There is increasing evidence to suggest that contemporary food (high in fat and sugar, low in fiber) is stimulating an evolution of the human microbiome, leading to a “Western gut.” (4) Some researchers believe that the conflict created by resource competition between humans and microbes creates an ongoing evolutionary arms race, and is a driver of metabolic disease (5). There is also evidence of the microbiome influencing anxiety and depression (6) via the gut-brain axis, potentially due to mediators that travel to the amygdala (7).
The concept of food addiction is no longer controversial. There is sufficient data in animals and humans to support this statement. What remains controversial is the nutritional approach to treatment. Based on what we know about addiction, it makes sense to work towards reducing exposure to addictive substances. Meanwhile, many of us who specialize in nutrition counseling for eating disorders can attest to the fact that attempts to restrict certain foods can lead to bingeing and the subsequent guilt, shame, and remorse. Individuals seeking addiction treatment should routinely be screened for an eating disorder and treated appropriately.
Let us assume a teenager consumes a diet largely comprised of highly processed convenience food (typically designed for maximum profit margins). These include snack foods such as chips and fruit snacks, frozen foods such as burritos and ice cream, delivery food such as pizza and Chinese, and fast food restaurant fare. The teenager has limited or no experience buying groceries and preparing food. Without even realizing it, most food choices are made based on taste, convenience, and familiarity. The gut will not be primed for digestion of fibrous fruits and vegetables, and there exists a strong preference for food that is salty (chips) or sweet and easily digestible (sweetened cereal with milk). Although there are no apparent weight problems, this can represent a form of food addiction, because the teen rejects foods that do not stimulate the reward system. This relationship to food is increasingly common in our society, and represents a systemic issue rather than an individual problem.
Fast forward: our teenager is now 23 years old, strung out on heroin, xanax, crystal meth, and alcohol. The patient presents to an addiction treatment center in Southern California 15 pounds underweight. The primary source of dopamine stimulation (drugs) is gone and the anhedonia sets in. Post detoxification we can predict an increase in substance-seeking behavior, predictable caffeine, nicotine, and sugar. The patient has progressed to coffee with creamer and sugar several times per day in addition to energy drinks. The patient is likely to smoke a half a pack of cigarettes before eating any food each day. Highly palatable food may feel like the sole source of pleasure that is left, yet there is no interest in cooking, particularly since there is a chef to prepare delicious meals such as tacos, spaghetti and meatballs, and teriyaki chicken.
The patient claims to be interested in recovering from addiction, getting out of their withdrawal-related depression, and eventually reducing some of their medications. In their first month of treatment they often regain their lost weight and develop patterns of night eating and a new habit of sour candy throughout the afternoon. Old wisdom from the recovery community would suggest that a liberalized approach to sweets, nicotine, and caffeine is favorable to help the individual get past the immediate crisis. New wisdom suggests that this behavior is a form of cross addiction that should be addressed early in recovery.