Addiction: A New Treatment Paradigm

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


Food Addictions and the Implications

Current research in 2013 shows that foods may exert the same addictive mechanisms as drugs. A study at the University of Bordeaux, France, in 2013 found that there are few studies of the addictiveness of sugar, but recent laboratory studies showed that sugar can actually have a stronger biochemical addiction basis than cocaine. A wide variety of chemicals of addiction, mainly glutamates, are now added to processed foods and drinks, and we are not questioning the relationship between these foods and the rising tide of drug addiction, and addiction to behavioral habits. Addiction is now proven to be a disease mechanism, not specific to a particular substance or behavior, and to decrease addiction a new holistic paradigm is needed.

A study of food addiction in 2013 at York University, Toronto, Canada, found that genetic study of patients with food addictions showed a relationship between the elevated dopamine signaling common to drug addiction and that of patient with binge eating and food cravings. The Yale Food Addiction Scale is now commonly accepted in accordance with substance dependence, and has been validated by a number of large studies, such as the 2013 study at Eastern Michigan University. While food addictions have been a subject of controversy and derision in scientific circles in the past, modern research shows that the same neurobiological mechanisms seen in drug addiction are also seen in food addiction. Added to this equation, though, are the wide array of glutamates added to commercial foods to enhance addictive qualities to promote sales. This started with acknowledgement of the ability of the additive monosodium glutamate to affect glutamate receptors and stimulate the person to desire to consume more and more of the food with monosodium glutamate, a phenomenon called umami stimulation.

The term umami derived from the Japanese description of one of the 5 tastes in the Daoist 5-element pattern of Nature, and was proven in 1908, by Kiunae Ikeda, to relate to taste receptors sensitive to the molecule glutamate, and the nucleotides that make up our DNA. Today, it is almost universally accepted in biology that there are 5 types of nerve receptors for taste, sweet, salty, sour, bitter and umami (acrid). While supposedly our scientists still debate whether this umami even exists, the food industry knows that it is real, and has invested a fortune to research hundreds of molecules that combine a glutamate with a nucleotide, adding these to processed foods to trick the human mind into a belief in their deliciousness, and to reinforce addiction. Unfortunately, this mad science has led to an altering of the human central nervous system, creating types of glutamate receptors that interact strongly with dopamine and GABA receptors, and may contribute greatly to the disease mechanisms in addiction. Today, we see that a subset of glutamate receptors, called NMDA receptors, in the human brain that correspond to these food additive chemicals, are linked to a wide variety of disorders, such as sleeping disorders and nocturnal bruxism. These metabotropic glutamate receptors (mGluRs) may create or contribute to a phenomenon in the brain called sustained excitotoxicity. The food industry continues to create more and more types of glutamate additives that promote food addiction, and profits, and so far is unapologetic. Awareness of foods and chemicals that contribute to addictive disease is essential. Food addictions are real, and can be treated with a comprehensive integrated approach, just like drug addictions.

The study of taste receptors in the peripheral nervous system has been fraught with misconceptions for over a century, and largely ignored, except, of course, in the food industry. A study in Germany in 1901 found that a prevalence of a type of taste receptor predominated in parts of the human tongue, but a 1942 paper by a Harvard biologist largely misinterpreted this data and theory and left biological science with the notion that there were zones on the tongue that had only this one type of taste receptor, in essence oversimplifying the biology in an attempt to narrow the findings into a neat box. This idea still persists, although it is easily disproven. Today, our study shows that the taste receptors are not solely responsible for the perception of taste, but work holistically with an array of areas in the brain, with stimulation of smell, touch and memory integral to the formation of the judgement of taste. This area of memory in the cerebral cortex is linked to the cingulate gyrus and amygdala, and is largely controlled by dopamine receptors, which integrate with glutamate and GABA receptors, to associate memory to taste with the actual sensory data. Of course, this is a learned response as well as an inherited one, and this biological mechanism of taste, appetite and desire for food is very similar to the mechanism of addiction to drugs. Food craving, binge and even withdrawal cycles are well studied, and are an obvious concern, but only recently have we linked these food habits to the biology of addiction. Like drug addiction, food addictions and cravings are corrected over time by changing both cognitive and behavioral habits, and relapse may occur easily because these learned cravings and taste desires become part of the memory and emotional memory. Simple stopping of the consumption of a type of food does not solve the whole cycle of dysfunction, and substitutions and creating of a memory of desire for a different type of food is needed. The food industry has taken advantage of our innate childhood desire for sweet and salty foods, and a programmed childhood reluctance to consume bitter and sour tastes, which are linked to more complex relationships to immune responses and microbes, and has built a strong desire for the elusive umami taste, with problematic glutamates. This was not blindly done and did not rely completely on consumer demand, but what a complex science of food desire, attraction and craving to increase sales and ignore public health.

Mayor Bloomberg of New York City, a very successful investment specialist in the United States, and the originator of Bloomberg News, which has expanded from its origin as a reliable business news site to a site of responsible news reporting (relatively), has taken a special interest in food addiction and the problems with unhealthy food, obesity and metabolic disease, which is costing the nation a fortune. In 2011, Bloomberg News posted a number of articles outlining the research in recent years on food addiction, which was not taken seriously until a few years ago. One of these articles is linked below in additional information. Here we see a study of The Scripps Research Institute from 2010 cited, where laboratory animals were fed commercially produced fatty and sugary foods and started binge eating during the one hour a day these foods were provided, such as Hormel bacon, Sara Lee pound cake, The Cheesecake Factory cheesecakes,and Pillsbury frosting. These animals were studied and found to exhibit the same dysfunction in the mesolimbic pathway as seen in studies of drug addiction. The scientists were amazed that identical neurobiochemical dysfunctions occurred with these foods as with drugs. A study at Princeton University studied laboratory animals given sugar water comparable to soft drinks and found that when these animals were given this drink every day they started to drink more and more per day, and eat less healthy food, showing withdrawal symptoms when the sugary drink was removed, with measurable changes in dopamine levels in the brain comparable to those seen in animals on addictive drugs. Foods that promote addictive neurobiology work against freedom of choice and are a public health threat. The widespread use of transfats and high-fructose corn syrup surely increases the potential for such addiction as well. While the food industry has pushed back with competing studies to disprove these food addictions, the overwhelming number of such studies verifying the facts from respected University Medical Schools and research institutes around the world cannot be easily dismissed. Issues in public health involve both the dissemination of information concerning addictive foods and chemicals, and the judicious regulation of these foods and food chemicals. Most of the public are not informed.

Research in recent years has confirmed that foods and drugs act similarly on key areas of the brain involved in addiction. A 2013 study published in The American Journal of Clinical Nutrition reported that sugars, not fats, stimulate the mechanism of craving, and that sugars activate the pleasure and reward centers in the brain, namely the nucleus accumbens, as much or more than drugs such as cocaine and morphine. Often, as patients go through treatment for drug addiction the mechanism shifts to a craving for sugars, and the result in a quick increase in weight. Such treatments programs as Alcoholics Anonymous have long suggested that abundant sugar be kept on hand to ease the abstinence from alcohol addiction, but it appears that this tactic merely transfers the mechanism of addiction from one substance to another, and does not cure the addiction. Often, patients going through treatment for various addictions, whether it be drugs, alcohol or cigarettes, balloon in weight and go back to the original addiction to stop their obesity.

Despite a wealth of scientific evidence, there is a strong reluctance to initiate a more holistic attitude to addiction in treatment programs, and demand that a diet that does not transfer the addiction cycle to sugar be included in the protocol. Many now believe that the transference of the addiction to sugar is perhaps the main mechanism in these treatments, and without it, the success rate would be greatly reduced. To truly break the disease mechanism patients need to be treated for addiction itself, not just one particular substance that the addiction involves. Breaking the cycle of addiction to just one addictive substance does not really cure the patient. The measure of success in addiction needs to be the restoration of normal homeostasis, not the abstinence from just one substance. Substituting artificial sweeteners for sugars will not achieve the goal either, as a 2010 study published in the Yale Journal of Biology and Medicine showed, as artificial sweeteners are perhaps more problematic in addiction than sugars themselves, still stimulating the mesolimbic pathways in addiction, but not satisfying the food reward pathways like sugars do, thus increasing the addictive response.

The bottom line is that there are a variety of addictions creating problems in the brain now, and scientifically they appear to be equivalent in CNS dysfunction. This means that a similar therapeutic approach could work to reverse these addictions and help patients get back to a healthy state of being again. No matter what the addiction or addictions are, understanding of the disease and a systematic and holistic protocol to correct this health problem, stop the cycle of binging, withdrawal and craving, and restore a healthy homeostasis is needed. Complementary Medicine can play a significant role in these tasks, and make it easier to stop harmful habits. The side effects in Complementary Medicine are improved overall health and quality of life.

Alcohol addiction

Alcohol presents perhaps the worst addiction history of any substance in human history. This fact led to the complete legal prohibition of alcohol for the public good in the United States, which was ironically overcome and canceled due to the wide persistence of alcohol use despite its illegality. Now alcohol is not a completely bad substance, as the promoters of abstention and prohibition made it out to be, and science has proven that those individuals that consume a drink or two a day have a dramatically healthier life. What was overlooked in alcohol prohibition was the pathology of addiction. By concentrating on the "evils of alcohol" we overlooked that disease acquired by many individuals. Ironically, after alcohol was again legalized, the American society took it up with greater vigor than before Prohibition, and when the subject of drug addiction came up as a public health problem decades later, many people criticizing drug addicts were themselves addicted to alcohol and other substances and behaviors. Even today, alcoholics, as we like to term them, are focused upon the alcohol, and not the disease, but more and more experts have come to the conclusion that abstinence is not an actual cure. The 12-step program turns the individual that believes that they have an addiction to a person that just places a trust in their support group and God and develops a fear of alcohol. What this program does not do is solve their disease, and scientific studies of efficacy of Alcoholics Anonymous have revealed a long-term success rate of only 5-10 percent because of this. The American Medical Association defines alcoholism as "a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations." Other medical groups include in this definition of alcoholism the condition of signs of physical addiction into the definition, and problems with physical health, as well as problems with withdrawal symptoms when stopping the habit. We still have a popular belief that the number of drinks consumed per week is a determinant, which is a most unscientific parameter, considering the results of study of alcohol addiction and the physiological aspects of the disease. In other words, our understanding of addiction continues to be guided by belief, not scientific fact, and this continues despite over a century of focus on alcohol addiction. Today, many experts think that we should abandon the term alcoholic altogether and treat this behavior as an addictive disease, focusing on the physical, biological and cognitive/behavioral disease mechanisms, not just the alcohol.

Alcohol abuse and alcoholism, now considered separate entities in public health and treatment, affect approximately 14 million citizens in the United States, and the WHO has estimated that at least 140 million individuals across the planet, with an array of health problems caused by excess chronic alcohol consumption. Alcohol abuse and alcoholism are the third leading cause of preventable death in the United States and estimates of cost to the society yearly reach as high as $220 billion, eclipsing both the societal costs of cancer and obesity. Addressing both the health issues as well as the addictive pathophysiology is important with this problem, and utilization of Complementary Medicine provides an array of treatment protocols to help the patient with excess alcohol consumption resolve these health issues in a proactive and step-by-step manner.

A 1998 review of scientific study of alcoholism at Harvard Medical School and the Massachusetts General Hospital Laboratory of Molecular and Developmental Neuroscience (see link below in additional information) revealed that alcohol abuse, or addictive disease, produces its pathological effects on the brain by disrupting the function of the abundant neurotransmitter glutamate. This occurs primarily by inhibiting the glutamate receptor on cells called the NMDA receptor. Tolerance to alcohol results in a measurable upregulation of this NMDA receptor, and since it is linked to the mediation of the excitatory effects of glutamate, abrupt withdrawal produces a hyperexcitation of neural activity. This neural hyperexcitation may lead to excitotoxicity and cell death of the neuron, as well as dramatic physical symptoms when severe. Delerium tremens (DTs) is the classic term for this neuroexcitation at its extreme, and witnessing DTs in the hospital is quite dramatic, as the patient appears to be suffering from very tactile hallucinations, as well as a seizure-like syndrome, and often has to be physically restrained. The experts at Harvard Medical School stated that "therapeutic strategies aimed at correcting glutamatergic dysregulation in alcoholism need to be explored." Unfortunately, this is not being accomplished, even in 2013. We also see even in this scientific report the unscientific language of bias, referring to the disease as "ethanol abuse", as if the patients actually abused alcohol, or their societal privileges concerning alcohol. By insisting that alcoholism, which is very poorly defined, is a problem centered on those alcoholics, or merely a problem handling alcohol, which is an evil spirit, we continue to ignore the steps necessary to properly treat alcohol addiction, and addiction in general. A wide range of health problems occurs with excess and chronic alcohol consumption, and each patient must be assessed and treated individually, and holistically, addressing both the addictive cycle in the brain, and the physiological problems with liver function and toxicity as well.

Now, another well known and studied fact is that alcoholism involves acetaldehyde toxicity. Even as far back as 1980, studies at prestigious University Medical Schools reported that biopsy specimens from alcoholics consistently showed that acetaldehyde dehydrogenase, an enzyme found predominantly in the liver, was significantly deficient in alcoholics compared to non-alcoholic subjects. This enzyme, controlling the rate of breakdown, or catabolism, of the main byproduct of alcohol, acetaldehyde, is found mainly in the mitochondria and cytosol of the liver cells, and in alcoholics, the concentration of the enzyme in the cell cytosol was depleted. This may have been due to a genetic, or epigenetic, phenomenon, or it may have been due to an overstressing of the enzyme metabolism, with more enzyme needed than created. It may also have been due to the metabolic effects of excess alcohol intake on the nutrient precursors of this enzyme. When looking at further study of this acetaldehyde breakdown dysfunction, we see mainly study that looks for a genetic explanation for alcoholism, but does not address the actual investigation of what causes this physiological dysfunction seriously. Follow up study in England, in 1982, revealed that in alcoholics with fatty liver disease the concentration of acetaldehyde dehydrogenase in the liver cell cytosol was also deficient compared to normal subjects, but not in the mitochondria of the liver cells. This study also confirmed that when these alcoholics abstained from alcohol that the concentration of acetaldehyde dehydrogenase in the cytosol of liver cells remained low when the overall level of acetaldehyde dehydrogenase activity in the body returned to normal with the decreased need. The study also showed that distinct isomers of this enzyme existed in the cytosol of the liver cells of alcoholics with fatty liver disease compared to the normal enzymes in the mitochondria of the cells. Obviously, as one abstains from alcohol, they need to promote improved liver health and function, and improved clearing of toxic levels of acetaldehyde in the body. A number of herbal and nutrient medicines have proven effective in this regard, including N-acetyl cysteine, a precursor of glutathione, our key cell detoxifying mechanism, betaine, an herbal and nutrient chemical well studied in its antioxidant and detoxifying effects, R-lipoic acid, a significant antioxidant and liver protective nutrient chemical, and various chelating minerals. These chemicals are combined in formulas, such as AL-Neutralizer for Vitamin Research Products. Various herbal extracts, such as Milk Thistle, are well studied and proven effective in reversing toxicity and damage in the liver and brain as well. A professionally guided therapeutic protocol is able to both help with addiction and clear the toxic long-term effects of this chronic alcohol abuse and restore healthy homeostasis.

Studies in recent years have also found that acetaldehyde toxicity in the brain, induced by chronic excessive alcohol intake, produces greater toxicity directly, and produces greater inhibition of glutamate metabolism. A 2014 study at the Federal University de Grande do Sul, in Porta Alegre, Brazil, found that aldehyde toxicity was nearly twice as inhibitory to glutamate uptake in the brain than alcohol toxicity (see study link below). This, of course, contributes greatly to the addictive cycle of dysfunction in the central nervous system. What this means for the patient with chronic overconsumption of alcohol is that attention must be paid not just to stopping alcohol consumption, but to clearing aldehyde toxicity and recovering function in the glutamate metabolism in the brain. By taking this more thorough approach to the problem, faster and more complete recovery will result. Besides alcohol-induced acetaldehyde toxicity creating the most significant damage to the liver and brain, and the most significant contribution to the cycle of addiction in the brain, the International Agency for Research on Cancer (IARC) announced that this alcohol-induced aldehyde toxicity is cancer causing. In 2014, the U.S. National Institutes of Health and the Institute on Alcohol Abuse and Alcoholism, in Bethesda, Maryland, U.S.A. reported that this alcohol-induced aldehyde toxicity produces such comorbid pathologies as cancer and fetal defects by inhibiting DNA repair, and altering epigenetic stability, as well as affecting mitochondrial health (see study link below in Additional Information). There can be no greater validation that patients with either chronic alcohol abuse, or alcoholism, which are distinct pathologies, need to address this aldehyde toxicity, as well as stopping or decreasing alcohol consumption. Simply going through the cycle of trying to stop alcohol addiction and relapsing, or even taking the 12-steps to complete abstention, does not completely clear the pathology of addiction, the dysfunction of the liver, and epigenetic and mitochondrial damage. Clearly, a more holistic approach to alcohol abuse and alcoholism is needed.

In addition to the alcohol-induced aldehyde toxicity, researchers in recent years are showing specific metabolic effects associated with alcohol-induced toxicity that need to be addressed in therapy as well. In 2013, researchers at Kanazawa University, in Uchinada, Japan, found that this acetaldehyde toxicity in the liver created advanced glycation endproducts (AGEs) that contributed greatly to the adverse health problems and liver dysfunction seen in alcoholism.

These researchers concluded that this alcohol-induced acetaldehyde-related advanced glycation endproduct excess contributed greatly to the fatty liver dysfunction and damage to the liver cells. A separate article on the website addresses the subject of Advanced Glycation Endproducts (AGEs) and the alteration of AGE receptors (RAGE), which is an increasingly important subject in public health, and related to cardiovascular disease, neurological degeneration, and cancer. The complex molecules are combinations of fats, proteins and carbohydrates, and are not only produced in the human metabolism, but have increasingly been ingested in the diet, with fast food and processed food creating many of these complex AGEs in battered meat, snacks, and fried foods that are enticing combinations of sweet carbohydrates with protein-rich meats and cheeses, and processed fats. Many glutamate molecules have been invented and added to these foods as well to induce a desire to keep eating them, contributing to the cycle of addiction as well. Helping the body to clear AGEs and reducing consumption of AGEs is thus very important to the overall protocol in recovery from alcoholism.

Not only metabolic concerns and aldehyde toxicity, but neurohormonal imbalance is revealed to be at the heart of the pathology in alcoholism. For instance, a 2005 study at the Institute of Endocrinology in Prague, Czech Republic, cited and linked in Additional Information, showed that chronic alcoholism was one of the causative factors for menstrual irregularity and heightened PMS in women with alcohol addiction, and this was centered on relative deficiencies of progesterone and pregenolone, as well as the deficient progesterone/pregnenolone ratio, which affected neurohormonal balance and contributed to both ovarian dysfunction and psychosomatic symptoms. Restoration of hormonal balance would be valuable in the holistic protocol in alcohol addiction, obviously. This is not achieved by taking synthetic hormone contraceptives or other synthetic hormonal treatments, which in fact supplant hormonal feedback regulation and contribute to imbalance. Studies in 2015, at the Max Planck Institute for Human Cognitive and Brain Sciences, in Leipzing, Gernany, also cited and linked in Additional Information, showed with fMRI study that progesterone directly mediates functional connectivity in the areas of the brain affected by addiction, such as the prefrontal cortex and hippocampus, and a randomized controlled human clinical study at the Yale University School of Medicine, in 2014, showed that progesterone imbalance directly contributed to addiction, with restoration of progesterone metabolism significantly reducing cocaine use in postpartum women with addiction. Use of bioidentical hormonal creams, especially progesterone stimulating and pregnenolone creams, combined with intelligent protocols combining acupuncture and herbal and nutrient medicine, would provide the patient with another protocol to achieve a healthy restoration of neurohormonal balance and function, directly helping to relieve symptoms and achieve a resolution of the addiction.

From these relatively early studies of the pathology of alcohol addiction we see that in addition to the addictive feedback cycle in the brain normally noted in all addictions, there are particular aspects of alcohol addiction that need to be addressed holistically. The 12-step program may be successful to stop the consumption of alcohol, but does not address these aspects of the disease. In most alcoholics, the continuing consumption of alcohol, perhaps tempered by the realization that it is causing harm, continues, though, and certainly the cycle of addiction mechanisms in the brain and these basic aspects of the disease need to be addressed. These two aspects mentioned are glutamate excitotoxicity, which we now know is also seen in ADHD, benzodiazepine addiction, and other neurological syndromes, as well as acetaldehyde toxicity, which we now know is central to a percentage of chronic fatigue syndromes, systemic candidiasis, and a number of other diseases, and contributes to excess accumulation of AGEs. In addition, chronic alcohol abuse and alcoholism create a number of potential nutritional deficiencies, as well as fatty liver and liver dysfunction, and potentially gastrointestinal dysfunction. Key nutritional deficiencies studied in chronic alcohol abuse include zinc, methionine, Vitamin B3 niacin and metabolites, Vitamin B1 thiamin and metabolites, and essential mineral malabsorption. Intelligent individual assessment and prescription of nutriceuticals could prevent a number of common alcohol-related health problems. Our research has led us to the conclusion that we need to treat a number of health problems in alcoholism, but standard medicine has done nothing in this regard, instead looking for an allopathic pharmaceutical cure, which still does not exist, and labeling the patients as mere alcohol abusers and alcoholics, while offering very little in the arena of treatment other than expensive specialized clinics that apparently only the rich can afford. This has continued for decades and is completely unacceptable in an advanced civilisation such as ours. Integration of Complementary Medicine provides a more complete and holistic, proactive approach to this type of addiction and related health problems.

Fortunately, there is some progress in Complementary Medicine in addressing these issues. Research has given us guidance on helping to correct the glutamate metabolism in the brain and gradually decrease improper NMDA expression, as well as helping the body to detox excess acetaldehyde. In addition, Complementary Medicine can be helpful to address the potential comorbidities of chronic alcoholism, which may not fully resolve even after stopping the consumption of alcohol. These associated health problems include alcoholic cardiomyopathy, where the muscle of the left ventricle in the heart is weakened, and may eventually result in chronic heart failure of congestive heart failure, as well as tachycardia and other related symptoms. Alcoholic Cardiomyopathy is characterized by an imbalance of muscle mass in areas of the heart, dilation of the ventricles, and thinning of the heart muscle walls. The compensation of the heart to these changes results in most of these cases being asymptomatic, and ignored, but the patients should perhaps pay more attention to restoring healthy heart function, as cardiovascular disease is the number one cause of death in the United States. Other health problems may also need to be addressed in alcoholism, such as gastrointestinal dysfunction, nutrient malnutrition and its chronic effects, and anxiety/depression syndromes. Calcium depletion is often noted, and may have a variety of adverse health effects over time, for example. Use of gastric acid inhibiting drugs to alleviate chronic GERD and heartburn may further deplete the absorption of these important nutrients, and a healthy restoration of gastric function and restoration of these metabolic systems may be needed. The present treatment of alcoholism not only overlooks the key aspects of the biology of the disease, but the associated health problems as well. Being thorough in one's approach is sensible and pragmatic. Complementary Medicine can help the patient to overcome these deficiencies in our health system and achieve better overall health as well as treatment for addiction.