Is sweetness addictive?

The Relationship Between Food Craving, Appetite-Related Hormones and Clinical Parameters in Bipolar Disorder

Obesity and weight gain in bipolar disorder (BD) have multifactorial underlying causes such as medication side effects, atypical depressive symptomatology, genetic variants, and disturbances in the neuro-endocrinal system. Therefore, we aim to explore the associations between food craving (FC), clinical parameters, psychotropic medication, and appetite-related hormones. In this cross-sectional investigation, 139 individuals with BD and 93 healthy controls (HC) completed the food craving inventory (FCI). In addition, blood samples (including leptin and acylated ghrelin) were analyzed and sociodemographic and anthropometric data were collected. Individuals with BD reported higher frequencies of total FC as well as craving for fat and fast food than HC. Additionally, we found a significant negative correlation between FC and ghrelin levels in BD. Smokers with BD reported significantly more craving for high fat foods than non-smokers. Age was significantly associated with FC independent of group. Individuals with BD taking olanzapine and quetiapine reported higher frequencies of craving for sweet food, while patients currently taking lithium reported less total FC compared to those without lithium therapy. Likewise, patients currently taking valproate reported less total FC and less craving for sweets than those not taking valproate. FC appears to be of clinical relevance in individuals with BD. Contrary to previous data, this does not seem to be a female phenomenon only and might encompass more than the specific craving for carbohydrates. Although due to the cross sectional design, causality cannot be determined, the association between depressive symptomatology and fast food craving warrants further research.

Food addiction in the light of DSM-5

The idea that specific kind of foods may have an addiction potential and that some forms of overeating may represent an addicted behavior has been discussed for decades. In recent years, the interest in food addiction is growing and research on this topic lead to more precise definitions and assessment methods. For example, the Yale Food Addiction Scale has been developed for the measurement of addiction-like eating behavior based on the diagnostic criteria for substance dependence of the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, diagnostic criteria for substance abuse and-dependence were merged, thereby increasing the number of symptoms for substance use disorders (SUDs) in the DSM-5. Moreover, gambling disorder is now included along SUDs as a behavioral addiction. Although a plethora of review articles exist that discuss the applicability of the DSM-IV substance dependence criteria to eating behavior, the transferability of the newly added criteria to eating is unknown. Thus, the current article discusses if and how these new criteria may be translated to overeating. Furthermore, it is examined if the new SUD criteria will impact future research on food addiction, for example, if "diagnosing" food addiction should also be adapted by considering all of the new symptoms. Given the critical response to the revisions in DSM-5, we also discuss if the recent approach of Research Domain Criteria can be helpful in evaluating the concept of food addiction.

Addictive behaviors in comorbid addiction and mental illness: preliminary results from a self-report questionnaire

OBJECTIVE

: The objective of this study was to pilot a new self-report screening instrument, the addictive behaviors questionnaire (ABQ), which screens for a broad range of impulsive-compulsive behaviors, in a treatment-seeking psychiatric population with comorbid addiction.

METHODS

: Psychiatric outpatients (N = 94) being treated for comorbid addiction and mental illness were approached consecutively by their therapists to fill out a number of self-report measures, in addition to the ABQ, including the Addiction Severity Index, Toronto Alexithymia Scale, and Reflective Activity Scale. The ABQ was evaluated both as a continuous measure and as a categorical measure using clinically relevant cutoff scores for each behavior. It was tested for internal reliability, test-retest reliability, and correlation with other scales.

RESULTS

: The completion rate for the ABQ was 74%. It demonstrated good internal reliability (continuous measure α = 0.81, categorical measure alpha = 0.82) and good test-retest reliability (continuous r = 0.68, categorical r = 0.76). The total ABQ score positively correlated with alexithymia (continuous r = 0.45, P < 0.001; categorical r = 0.37, P < 0.001) and negatively correlated with reflective activity (continuous r = -0.29, P < 0.01; categorical r = -0.27, P < 0.05). The behaviors that were most commonly endorsed as problematic were overeating, unhealthy relationships, excessive TV watching, and excessive shopping. Based on cutoff scores, 61% of the sample endorsed at least one problematic behavior and 31% endorsed 2 or more behaviors.

CONCLUSIONS

: These preliminary results suggest that the ABQ is reliable and easily administered by clinicians treating comorbid addiction in an outpatient setting. Further study is required with larger sample sizes, normative data, and comparable scales to help establish construct validity and cutoff scores.

Food addiction: an examination of the diagnostic criteria for dependence

The evidence for food's addictive properties is steadily growing. In addition to clinical and evolutionary plausibility, the possibility of addiction to food is supported by animal model research and increasingly by research with humans. Much as classic drugs of abuse "hijack" the brain, accumulating evidence with food suggests a similar impact, but with weaker effects. Although neurobiological evidence for food addiction is compelling, dependence as conceptualized with respect to alcohol and other drugs of abuse is fundamentally a behavioral disorder. Thus, we review the current state of food addiction research in the context of each of the diagnostic criterion for dependence (ie, tolerance, withdrawal, loss of control) and briefly explore other relevant addiction topics such as expectancies, reinforcement, and incentive salience. There is substantial evidence that some people lose control over their food consumption, suffer from repeated failed attempts to reduce their intake, and are unable to abstain from certain types of food or reduce consumption in the face of negative consequences. Although there is some evidence for other dependence criterion, further research is needed to examine tolerance and withdrawal to high-fat sweets, time spent in obtaining, using, and recovering from excess food consumption and the degree to which important activities are given up due to overconsumption. As science continues forward and both the public and elected leaders become aware that food may trigger an addictive process, this information will likely be used to inform policy. Thus, researchers need to carefully consider the implications of their work and the way in which the results may be interpreted.

Deutsche Übersetzung und Validierung der Yale Food Addiction Scale

Zusammenfassung. Exzessives Essen wird häufig mit süchtigem Verhalten in Verbindung gebracht. Bisher mangelte es im deutschen Sprachraum jedoch an einem Messinstrument, das spezifisch das Konstrukt Nahrungsmittelabhängigkeit erfasst. Um diesen Mangel zu beheben, stellt die vorliegende Arbeit die deutsche Version der Yale Food Addiction Scale (YFAS) von Gearhardt, Corbin & Brownell (2009) vor. Diese Skala ermöglicht es, Menschen mit ausgeprägten Symptomen einer Abhängigkeit von bestimmten Nahrungsmitteln zu identifizieren. Die psychometrischen Kennwerte dieses Fragebogens wurden an einer Stichprobe von überwiegend Studierenden (N = 752) getestet. Die einfaktorielle Struktur der YFAS konnte bestätigt werden, bei einer zufriedenstellenden internen Konsistenz. Konvergente Validität zeigte sich in mittleren bis hohen Korrelationen mit anderen Maßen problematischen Essverhaltens, während sich geringe Zusammenhänge mit anderen, aber dennoch verwandten Konstrukten, wie Alkoholabhängigkeit und Impulsivität, ergaben. Weiterhin zeigte sich die YFAS als signifikanter Prädiktor für die Häufigkeit von Essanfällen. Die YFAS scheint somit ein brauchbares Instrument für die Erfassung essensbezogener, suchtähnlicher Verhaltensweisen darzustellen.

Sweetness and food preference

Human desire for sweet taste spans all ages, races, and cultures. Throughout evolution, sweetness has had a role in human nutrition, helping to orient feeding behavior toward foods providing both energy and essential nutrients. Infants and young children in particular base many of their food choices on familiarity and sweet taste. The low cost and ready availability of energy-containing sweeteners in the food supply has led to concerns that the rising consumption of added sugars is the driving force behind the obesity epidemic. Low-calorie sweeteners are one option for maintaining sweet taste while reducing the energy content of children's diets. However, their use has led to further concerns that dissociating sweetness from energy may disrupt the balance between taste response, appetite, and consumption patterns, especially during development. Further studies, preferably based on longitudinal cohorts, are needed to clarify the developmental trajectory of taste responses to low-calorie sweeteners and their potential impact on the diet quality of children and youth.

Reward systems and food intake: role of opioids

Humans eat for many reasons, including the rewarding qualities of foods. A host of neurotransmitters have been shown to influence eating behavior and some of these appear to be involved in reward-induced eating. Endogenous opioid peptides and their receptors were first reported more than 30 years ago, and studies suggesting a role of opioids in the regulation of food intake date back nearly as far. Opioid agonists and antagonists have corresponding stimulatory and inhibitory effects on feeding. In addition to studies aimed at identifying the relevant receptor subtypes and sites of action within the brain, there has been a continuing interest in the role of opioids on diet/taste preferences, food reward, and the overlap of food reward with others types of reward. Data exist that suggest a role for opioids in the control of appetite for specific macronutrients, but there is also evidence for their role in the stimulation of intake based on already-existing diet or taste preferences and in controlling intake motivated by hedonics rather than by energy needs. Finally, various types of studies indicate an overlap between mechanisms mediating drug reward and palatable food reward. Preference or consumption of sweet substances often parallels the self-administration of several drugs of abuse, and under certain conditions, the termination of intermittent access to sweet substances produces symptoms that resemble those observed during opiate withdrawal. The overconsumption of readily available and highly palatable foods likely contributes to the growing rates of obesity worldwide. An understanding of the role of opioids in mediating food reward and promoting the overconsumption of palatable foods may provide insights into new approaches for preventing obesity.

Sugar overconsumption during adolescence selectively alters motivation and reward function in adult rats

BACKGROUND

There has been a dramatic escalation in sugar intake in the last few decades, most strikingly observed in the adolescent population. Sugar overconsumption has been associated with several adverse health consequences, including obesity and diabetes. Very little is known, however, about the impact of sugar overconsumption on mental health in general, and on reward-related behavioral disorders in particular. This study examined in rats the effects of unlimited access to sucrose during adolescence on the motivation for natural and pharmacological rewards in adulthood.

METHODOLOGY/PRINCIPAL FINDINGS

Adolescent rats had free access to 5% sucrose or water from postnatal day 30 to 46. The control group had access to water only. In adulthood, rats were tested for self-administration of saccharin (sweet), maltodextrin (non-sweet), and cocaine (a potent drug of abuse) using fixed- and progressive-ratio schedules, and a concentration-response curve for each substance. Adult rats, exposed or not exposed to sucrose, were tested for saccharin self-administration later in life to verify the specificity of adolescence for the sugar effects. Sugar overconsumption during adolescence, but not during adulthood, reduced the subsequent motivation for saccharin and maltodextrin, but not cocaine. This selective decrease in motivation is more likely due to changes in brain reward processing than changes in gustatory perception.

CONCLUSIONS/SIGNIFICANCE

Sugar overconsumption induces a developmental stage-specific chronic depression in reward processing that may contribute to an increase in the vulnerability to reward-related psychiatric disorders.