MedDocs Publishers Journal of Addiction and Recovery Open Access | Review Article Food addiction: A new form of dependence? Walter Milano1; Uberia Padricelli2; Anna Capasso3* 1Mental Health Unit District 24 ASL Napoli 1 Center, Italy 2Pharmacy Hospital San Paolo ASL Napoli 1 Center, Italy 3Department of Pharmacy, University of Salerno, Italy *Corresponding Author(s): Anna Capasso, Abstract Department of Pharmacy, University of Salerno, Italy Food addiction is a behavioral dependency that is char- Email: [email protected] acterized by the compulsive consumption of palatable foods (for example, foods high in fat and sugar) - the types of food that markedly activate the reward system in humans and Received: Jan 31, 2017 in other animals - despite the negative consequences. The Accepted: Feb 20, 2018 psychological dependence has also been observed with the presence of withdrawal symptoms when the consumption Published Online: Feb 24, 2018 of these foods is interrupted by the replacement of low fat Journal: Journal of Addiction and Recovery or sugar foods. In the compulsive eater, the ingestion of trig- Publisher: MedDocs Publishers LLC ger foods causes the release of the neurotransmitters sero- tonin and dopamine. This could be another indicator that Online edition: http://meddocsonline.org/ neurobiological factors contribute to the addiction process. Copyright: © Capasso A (2018). This Article is distributed On the contrary, abstinence from addictive foods can trig- under the terms of Creative Commons Attribution 4.0 ger withdrawal symptoms. The subsequent decrease in se- international License rotonin levels in the individual can promote higher levels of depression and anxiety. Therefore, the Food addiction may be considered a “new dependence” related to compulsive consumption of food. In particular, as regards food addic- Keywords: Eating Disorders; Food Addiction; Obesity; Junk tion and eating disorders, there is still no precise definition, Food. but the interest in this problem is very strong. As reported in the DSM-V, substance dependence is characterized by physiological, cognitive and behavioral symptoms, demon- strating that the subject continues to use it despite being aware of the problems arising from it. A few decades ago, the thought that food could be a substance that creates “ad- diction” and that its excessive consumption could be defined as Food Addiction on a par with “Drug Addiction” was con- sidered heresy. There are numerous evidences that allow us to “consider food as a drug”, above all if it is manipulated re- fined food (Fast-Food, snack bars, chips...). Food Addiction is a new hypothesis to explain the growing phenomenon of obesity, a global problem that is affecting our era and which brings with it serious consequences for health. Cite this article: Milano W, Padricelli U, Capasso A. Food addiction: A new form of dependence? J Addict Recov- ery. 2018; 1: 1003 1 MedDocs Publishers Short Review tions and the pleasure and so the first ones will be promised by The term Food Addiction means a “new dependence”: that the second. What we pursue, in fact, is the pleasure that derives of food. There is not yet a precise definition, but the interest in from the satisfaction of these needs and the astuteness of evo- this problem is very strong. The Anglo-Saxon expression “addic- lution consists in proposing some pleasant objectives to reach tion” comes from the Latin “addictus”, indicating who was sold deeper and more essential goals. The obvious attractor that is as a slave to pay a debt and therefore who suffers a submis- at the center of every fundamental motivation is precisely the sion by someone or something or becomes a slave, employee. achievement of a pleasure [4]. Most brain circuits that drive There are chemical dependencies related to the use of opiates hunger and pleasure formed before the primates appeared. The (morphine and heroin), psychostimulants (cocaine and amphet- pleasure that comes from eating is not just an accessory to the amines), cannabinoids (marijuana and hashish), nicotine or mechanisms of nutrition is an element of our affectivity. In our alcohol. There are also non-chemical addictions such as those organism are adapted provisions that seem to have survived the related to pathological gambling, physical exercise, surfing the conditions in which they originally proved effective [5]. There internet, sex or compulsive work. Finally, there is a form of de- are many similarities between food addiction and drug addic- pendence linked to food. The characteristics of some types of tion. The use of cocaine determines the release of dopamine in eating behavior are very similar to the abuse substances. An the neurons of striated nuclei of the brain, the same phenom- important change is observed with the publication of DSM V, enon was detected after ingesting food. People who consume where the diagnosis of “substance-related disorders” has been drugs have a reduced sensitivity of dopaminergic systems, the replaced with that of “addiction and related disorders”; this same that has also been found in obese individuals. Since food will allow a diagnosis of dependence not so closely linked to and drugs activate overlapping pleasure circuits in the brain, substance abuse and that includes those forms that concern for well-known behavioral interactions exist between them, which example the game, internet and even food [1,2]. In DSM-V, sub- are probably the result of shared central cabling [5]. stance dependence is characterized by physiological, cognitive The dependence on substances and the over-consumption of and behavioral symptoms, demonstrating that the subject con- food share similarities both from a physiological and behavioral tinues to use it despite being aware of the problems deriving point of view, which can lead to the hypothesis of a common- from it [1]. As for the other addictions, the food addiction is also ality of the underlying neuronal mechanisms. Indeed, studies characterized by the compulsion to consume the food object of micro dialysis and PET studies show that both the substance of addiction (for example, you can not start the day if you have of abuse and the food activate the mesolimbic dopaminergic not consumed one or more doses of the desired food), loss of system and that the level of pleasure experienced subjectively control, continuous use of the substance in question despite is correlated with the amount of dopamine released in the stria- negative consequences [3]. tum, especially in the nucleus accumbens (NAc). The subjective Talking about food addiction seems trivial, in some ways we sensation of pleasure varies among individuals relative to the are all dependent on food. However, there are ways of assump- baseline level of dopaminergic activity and the increase in the tion that deviate from the main task and change themselves release of this neurotransmitter is a crucial element in the phe- by assuming particular ways that become pathological. The nomena of reinforcement, dependency, hedonism, motivation behavior is marked by a sort of ritual that is always the same: [6,7]. everything springs from the idea of a compulsion and at the In this perspective, the reward system (amygdale, insula, same time from the awareness of being unable to resist this thalamus, ventral and dorsal striatum, ventral regions of the impulse. Then, there is a growing emotional tension, typical of cingulated cortex and of the frontal orbit and of the prefrontal the moment preceding the beginning of the compulsive act. cortex) seems to be primarily called into question. The common The anticipatory phase of a new assumption of the substance is mechanisms between food and drug abuse are to be found in characterized by an intense desire and motivation in the search the complex interaction between hypothalamic nuclei, in par- for drugs or, in the case of food addiction, food; this desire is ticular lateral, influencing the reward mechanism, and the -me commonly called craving and involves the precipitation of the solimbic circuit, which is crucial in the reinforcement mecha- binge [2]. The next step is the unfolding of the act with the ten- nism; moreover, the hypothalamus would be central to research sion gradually loosening as the fulfillment is achieved. The con- and consumption mechanisms [6,7]. clusion of the ritual is characterized by the awareness of having lost control once again. Substantially, the person is not able to The main neurotransmitters of the reward system are dop- stop bingeing or overfeeding, regardless of the knowledge of amine (DA), endocannabinoids (eCB) and endogenous opioids. the negative consequences determined by this behavior, with Opioids give food its connotation of gratification and pleasure interference in the performance of daily activities and quality of and encourage us to eat it again. The DA instead is the neu- life [3]. The difference between food and substances of abuse rotransmitter used for the behavior that stimulates us to re- is linked to the difference in power of the stimulus that they search and therefore to pleasure. All functions that increase the manage to evoke. The activity of drugs of abuse is so strong and production of DA, in some brain regions, increase the sense of over-maximal that it usually results in faster, more lasting and pleasure and its research. Such mechanisms are also at the root devastating effects over time. The important point is that when of dependence on certain drugs [8-12]. Dopamine is therefore we talk about nutrition we are talking about primary needs that a fundamental neurotransmitter in order to talk about “addic- must be satisfied and it is therefore necessary that the satisfac- tion” and its increase in the organism favors the probability of tion of the need be linked to pleasure. “addiction”, being central in the mechanisms of learning new signals and regulating behavior [13]. Important studies on Originally, there are the simple food needs and the desire to animals have confirmed alterations of these systems in condi- respond to the needs of the body by feeding.