Could cravings be withdrawal symptoms?

Sarah’s story may sound familiar. For years, she struggled to find a way to improve her nutrition, lose some excess body fat, and feel better. But no matter which Mediterranean, vegetarian, whole-food, or low-carb approach a dietitian recommended, Sarah always ended up feeling worse.

Within hours or even days of changing her usual diet (like many Americans, Sarah’s diet came primarily from restaurants and ultra-processed foods), Sarah felt tired and sluggish. She had become moody and irritable. And she was tortured by cravings and ruminations about food. No amount of willpower or motivation was ever enough for Sarah to endure this misery for long. Naturally, she felt discouraged.

A timely stroke of luck brought Sarah’s story a happy ending. A news article she read referenced a 2022 review article1 discuss the science behind the symptoms of so-called “food withdrawal” – assessing whether certain foods might have addictive properties similar to those of certain drugs. What struck Sarah was the information summarized in the image below.

Thomas Rutledge

Source: Thomas Rutledge

Thinking about the symptoms she experienced while trying to improve her nutrition, Sarah realized that they were mostly the same as those mentioned in the review article describing the lack of food in humans and other animals. These were also much of the same symptoms experienced by people withdrawing from substances such as nicotine, alcohol, and other addictive drugs. Had she become “addicted” to an ultra-processed diet?

For the first time, Sarah wondered if she had thought wrongly about her health and eating habits. Maybe her nutritional difficulties weren’t a sign of bad will or bad genetics, as she told herself. Maybe instead, her body was simply experiencing a reaction every time she tried to stop eating hyperpalatable foods. Physical and emotional symptoms could be signs of withdrawal, not weakness. The way food seemed to hijack her brain when she tried to make healthy changes was a lot like what some people feel when they quit an addictive substance.

However, the most powerful insight for Sarah was the new path to improvement revealed by this perspective. Based on this food withdrawal model, Sarah realized that perhaps she could stop searching for a perfect diet and start thinking about her health and nutrition goals from a recovery perspective. Some key differences between a conventional behavior change plan to improve nutrition and a recovery model approach are summarized in the figure below.

Thomas Rutledge/Stock images by PowerPoint

Source: Thomas Rutledge/PowerPoint stored images

To be clear, whether foods can actually be addictive in the same way drugs are may still be up for debate – and regardless, all people struggle with their diet are not potentially dependent on sugar or ultra-processed foods. Fortunately, addiction is far from universal, even among people who use powerful habit-forming substances such as alcohol, nicotine, and opioids. However, just as there is overwhelming evidence that a subset of drug and alcohol users are likely to become addicted to these substances, there is also growing evidence that some people may develop symptoms. resembling an addiction in response to certain foods.2

For people in the latter subgroup – perhaps like Sarah – the conventional tactics of willpower, overnight dietary changes, portion control and calorie tracking are less likely to succeed because aversive cravings and withdrawal symptoms they are likely to experience.

Instead, it might be more helpful for people in this subgroup to adopt recovery model tactics that have been shown to be effective in treating substance use. In a recovery model, for example, treatment is often supported by groups and sponsors rather than left to individual heroism. Behavioral changes are more likely to be incremental (e.g., “12-step” approach in Alcoholics Anonymous) rather than being made “all at once.” Recovery models also emphasize mental health, spirituality, and changes in the social and physical environment to a greater extent than conventional diet and weight loss programs.

Perhaps the most important difference between a recovery model and a conventional behavior change program is its emphasis on the development of a new, healthier identity and lifelong efforts to maintain new patterns of behavior. If you’ve ever heard the expression “There is a cure for addiction.” You just have to do it every day,” she captures the themes of daily commitment and renewal at the heart of many recovery treatment models.

Even without a full-blown addiction to drugs or ultra-processed foods, many of us pursuing goals related to nutrition, wellness, and healthy living would likely benefit from incorporating elements of the recovery model in our treatment plans.

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