Saturday, September 29, 2012

What I've Learned About Food Addiction

This post applies to all so read on.
I'm addicted to desserts and I can't keep them in the house. They just call to me. I can't simply eat a piece or a small portion—no, not me.  Once I start I can't stop and I have to eat them until their gone or I need to throw them in the trash—although sometimes, I’m embarrassed to say, I dig them out of the trash because I just can't let them slip away. And I never know when I'll get to eat them again. Avoidance—total avoidance seems like the only way—yet it never seems to work. I just have no willpower.

No, that's not me speaking—although these statements were certainly true for me at some point in my life. Yes, that time in my early twenties when my eating was emotionally driven and I had no idea what hunger and comfortable fullness felt like.  Rather, the comments above were spoken by many patients that walk into my offices—by the overweight who have unsuccessfully struggled to lose some weight with rigid diets and deprivation, and by those of average weight and below who now approach food in a black and white way, seeing food as the enemy. 

And why wouldn’t they, and you, feel that there is no hope, that you must be addicted to food in the way others are addicted to drugs? The debate about food addiction has again emerged, with media distortions and outrageous researcher conclusions on rat studies and MRI findings. And it will leave you feeling hopeless—unless you see how you are being manipulated and left to believe you are powerless.

Yum! Salted caramel.
The Wall Street Journal put out a rather balanced piece on food addiction. Yet the NY Times article on this subject is an embarrassment.  "Can Food Be Addictive?" makes reference to several studies suggesting that overeating is an addiction, perhaps not much different than addictions to drugs and alcohol. The examples cited?

"...Princeton University and University of Florida researchers have found that sugar-binging rats show signs of opiate like withdrawal when their sugar is taken away — including chattering teeth, tremoring forepaws and the shakes. When the rats were allowed to resume eating sugar two weeks later, they pressed the food lever so frantically that they consumed 23 percent more than before", they tell us. 

Well, I’ve never had my paws shake and my canines never chattered, but this sounds like sugar dependency is a serious culprit! That’s what they’re leading us to believe. But a more detailed review of this 2011 study sheds a whole different light on things. We learn that rats were first deprived, going 12 hours without food to eat, prior to being given the sugar solution. And, this binging was dependent upon the timing of the feeding. One blog describes how "... rats who had received only the food chow on this intermittent schedule, or had unrestricted access to food and sucrose, did not show these effects." That's right—not depriving the rats and actually allowing them access to food including sugar prevented binge eating. The blog reporting on this study appropriately summarizes:

I don't wait for special occasions to eat these!
“This means that after being deprived of the food or drug the rat will self-administer extremely large quantities of the substance once it is available again. This behavior tapers off once the animals are sated, but these binges will consistently occur after each period of deprivation.”

Ok, so they binged when given sugar. But more importantly the research actually confirms the very problem with food deprivation and the resulting out of control eating that we see in our clients who feel trapped in this cycle. No, there was no problem when they could freely feed on food and sugar as desired. Rather, the problem with binging resulted from the withholding of food for long periods, which set the rats and sets my rat-like readers up for trouble.

Might I add that we are not rats in our ability to step in and change our situation. We are not limited to our cages—we can choose to step out of our environment and to control our triggers. And we can certainly avoid deprivation—the biggest trigger for binge eating. You didn’t need a rat study to tell you that, though!

Another study referenced by the NY Times article to support the food addiction theory drew equally absurd conclusions. Researchers at Oregon Research Institute surveyed 151 teens who were in a healthy weight range about their eating habits and food cravings. Then they did brain-scan studies on them while the kids looked at pictures of chocolate milkshakes—more activity in the brain was considered to be linked with greater cravings. Next, they gave them a milkshake to drink while they were having an MRI scan. The kids who'd reported eating the most ice cream over the past few weeks prior to the MRI scans registered lower activity in their reward centers from the milkshake—in other words, less craving for the milkshakes. To me that’s a good thing. Those very kids who had access and consumed these items regularly did not have their brains light up as if they were getting some big reward when offered a milkshake—no, it was no big deal to them.

Yet the NY Times states that these findings "suggest that just as drug abusers and alcoholics need increasingly larger doses over time, children who are regular ice-cream eaters may require more and more ice cream for the reward centers of their brains to indicate that they are satisfied."   One study author similarly concludes that not having as great a response to eating the food (based on MRI) is problematic—that “over consumption of these foods down regulates reward processes. That may, in turn, make you eat more." Really? That's quite a strange conclusion to draw, in my opinion, especially as these kids were not overweight. (in spite of their more frequent ice cream consumption.

Further, this study attributes possible addictive-like qualities of ice cream shakes, made with Haagen Daz ice cream, to the high fat content.  But if it is about the fat, why don’t we have addictions to such high fat items as prime rib or deep fried chicken? Or whole milk, even? No, this just isn’t seen. 

High fat and satisfying!
So maybe it's not the nutrient, the fat or sugar (as implicated above) content at all but the conditions under which we eat. Is it any surprise that those reward centers of the brain would light up in MRIs, similar to what occurs with other addictions, when these very food items are used in our culture as rewards? You know, you had a hard day, so you indulge yourself with an ice cream, ironically just as the old Haagen Daz ads suggested? Or as a young child, you scrape your knee and your mom gives you some cookies to feel better. If we could only allow ourselves to enjoy such pleasurable foods as ice cream without the value judgment we add to it!

The take home message.

What's not in question is how you feel. Clearly, when you experience out of control eating you feel as if your are addicted to food—that you have no control over certain food items or types and that it therefore must be out of your hands to seize control. And with the recent studies I referenced, you might be convinced this is true. But the only clear link with what feels like food addiction is food deprivation. 

This is not a meal!
Continuing to use food as a reward for a hard day or for eating healthy all week is a huge mistake. 

If you’re feeling like you’re addicted to food, consider changing your relationship with food and move from black and white thinking, giving yourself permission to eat those foods you enjoy but think are forbidden. 

Eat in a balanced way--and I don't mean by following the My Plate way. Rather, make the foods you eat enjoyable. Sure, include satisfying less processed foods, too--but not at the exclusion of other foods. 

And take charge of your environment—focus on mindfully eating and truly enjoying your food so you know when you have eaten just enough.

Read more about this approach in some older posts below: 

Saturday, September 15, 2012

Lessons From My Final Day

It was to be my last day on this earth—or so I believed just a few days ago. Really. I was riding the winding, hairpin-turn-filled precipitous narrow roads of Corsica, part of a lovely relaxing vacation. Only I was hardly relaxed. 

Rather, I honestly feared that this would be my last car ride, my last day of absorbing the spectacular beauty of nature, the last opportunity to tell my family I love them all. Traumatized and almost teary I saw no way out. And I’m not exaggerating. Once you turn onto this two-way road wide enough for one Smart car at best, there is no making a U-turn and shifting directions. We had decided to visit this much raved about, difficult to access beach, a killer descent from mountain road to sea. There were no guard rails to protect us as we clung to each cliff edge. How could they allow me to travel on this?, I thought to myself.

After a tense stay at this beautiful beach (yes, we made it down), I could only think about how I could survive the return back up. My husband was confident and self-assured—he would be on the inside while I’d watch the wheels teeter on the irregular tattered road’s edge, which dropped down to the sea. Closing my eyes might be the only option—yet having them open made me feel like I could help—like I may control the situation. But I compromised—open, closed, open, closed, all the while trying to breath. It was an isometric workout of sorts—abdominal muscles tightening at every turn, right quadriceps struggling to break my fall as we neared the edge at every turn.  Not a very religious person, I found myself silently singing prayers, statements of faith, in hope that I’d make it.

And obviously I did. And would you believe I saw a link between my experience and your eating struggles?

My thoughts?

Why do we have to wait until we’re at the end of our rope to appreciate what we have and what our lives might be?

Can’t we keep our eyes open, so to speak, and take control in a constructive way?

Do we need to have a traumatic wake-up call for us to move to action—for self-care, to treat ourselves better, for recovery, to make a difference in the lives of those around us?

Must we live life teetering on the edge?

Can’t we entrust our care in the hands of those who can drive us to safety, when we are at a loss to take the wheel ourselves?

Yes, this was the scariest ride of my life—but I realize that lots of cars make it down—and back up—to the top again. Apparently people get through it—and do so by choice, even if they do know what awaits them. Yes, people, like you and me, survive what we never dreamed we could get through.

Sunday night begins the Jewish New Year, Rosh Ha Shana, a contemplative time when we reflect on where we’ve been and where we’re going; a time to acknowledge that while not all is under our control, what we do in this world can make a difference. The theme is life and death, but it is a holiday filled with hope for what the upcoming year may bring.

So while I’m in my appreciative mode, still reeling from this trip, in my pre-Rosh Ha Shana spirit, let me thank you dear readers, for reading, for commenting, for teaching me what I needed to learn at times. Thanks for giving me a place to voice my own concerns and for simply listening—and please accept my apology if I have misunderstood you or responded inappropriately. 

And regardless of your religion, thanks for taking my words so seriously and hopefully, moving to action to make the coming year a better one.

Monday, September 10, 2012

Isn't it Time to be Angry?

A guest post from an appropriately angry patient

Was it 1 year or 2 years ago we last met? I really can't tell you. But I clearly remember how I felt seeing her. I wanted to feel her emotion, to hear her move from passivity and hopelessness. I believed in her ability to fight this thing--this bulimia turned anorexia-- to get out of her own way, but I'm not so sure she had the same belief then.

Now she's coming back, and in anticipation of our session, she's indulging me--and you-- with some passion. She's angry, appropriately so--and I'm thrilled. Yes, it's time to direct that anger toward recovery.

Shannon's Recovery Survival Kit

You don't want to recover for a very simple reason: you're scared. You're scared of life, growth, feelings, worries, people, rejection, change, and you're hiding away from it all. Your ED is driving you into a morgue and you're letting it, because you're too scared to fight back.

Recovery doesn't make people 'too fat'. Recovery makes people the way they were supposed to be, and much happier than they would have ever been with an eating disorder.

New perspective: you are not terrified of gaining weight. You wish more than anything to just get the weight gaining part over and done with and to forget this ever happened to you, to leave it all behind, to be 'normal'.  You want your shape back, your health back, your life back.

What to do? Relax. Honestly. Take a massive deep breath and then use the worst swear word you can towards your eating disorder for making you this way. F*!@# it all. Really, really hate your disorder for a moment.

There'll always be a 'reason' to give up on recovery; don't fall for the trap.

I'm so, so sorry you had to suffer so badly. Remember, that those thoughts and impulses are false. False. You do not deserve a single second of that bullshit; those thoughts have grown in your scared mind at a time of vulnerability and you've come to accept them as truth; the thoughts of 'I'm fat, I'm a failure, I'm disgusting'. These thoughts were built on your deepest doubts - therefore, they are false as they have no actual basis.

Fall down seven times, stand up eight. You're a fighter. You're a winner. Be the winner in this battle. You deserve every last little bit of your life back, which your ED has stolen from you. Fight for it. Your ED is right old bastard for causing you to have self-harm urges; hate it all the more for it. You're perfect and wonderful and nobody should ever have to go through this hell. I love you, and know that I'm here - don't give up now. Xxx

Gaining weight = gaining bone, gaining muscle, gaining fat, gaining flesh, gaining mind, gaining self, gaining you. Gaining weight does not = becoming fat, becoming ugly, becoming hated, becoming out of 'control', becoming lazy, becoming stupid.


You may like your body like this for now, but you'll love your real body even more. This isn't the way yours, or anybody's, body was meant to be. You like it in a sick, disordered way; you know that feeling of seductive, poisonous relief when you can touch your skeleton and know you're too small? That feeling, this feeling of liking your body slowly burning away into bone, bone, skin, pure, bone, is the thing that will destroy you and drive you into your grave by the end of the year, if you let it. Don't let it.

Your disorder is like a Venus flytrap. It lures you in with its promise if skinnybonecontrolperfectionbeautylovehappinessthin, and you're so absorbed by the lies of it all that, when it finally snaps shut and destroys you, it's too late. There's that final panic at the end of 'wait-no-no-I-was-kidding', but it's too late, and then you die a very painful and lonely death.

Don't let yourself be lured in. You know how this ends. Stay strong, love, and don't believe a single thought you think of liking your bones.

Never be scared of gaining weight. Gaining weight means growth. Gaining weight means repair, and life. Gaining weight means breaking free. To be able to gain weight and not feel guilty at all - that's an amazing feeling.

Here's the trouble; that you think skinny is good. Sure, it's good for now, but the rush of weight-loss is very addictive, and will be nearly impossible to resist. It's impossible to maintain an underweight weight that's unnatural for your body, and be simultaneously recovered. (I tried to be 'recovered' when I was underweight for a very long time. It just doesn't work.) If you're having to count calories and/or exercise to 'keep your weight down', then the weight that you're at is simply not right for your body, and this is something you'll have to accept. Not accepting this will only lead to more intense body hate, low self-esteem and, ultimately, an eating disorder.

Undo the lies you believe. Challenge the shit out of all those thought; skinny girls are not better, happier people. They are just - people. People like you with insecurities, fears, worries. These things do not go away if you reduce your body mass.

You cannot recover by 'exercising and eating healthy'. End. You need to be able to let your body gain weight, gain fat, and eat the foods you never thought you could. You need to do the thing that seems 'lazy', and 'fattening', and 'bad', and let your body take that much-needed rest and feed it with little bits of everything.

Ultimately, you want to be able to eat anything without anxiety and to miss 'exercise time' without anxiety. The true aim of recovery is flexibility and acceptance towards yourself, no matter what you ate or how much you exercised; if your exercise and eating habits are encouraging the opposite, then you know you need to stop.

I've been told so many times that 'relapse is normal'.

Immediately, the disordered side of me became ecstatic.

Relapsing is normal! F*@#!ing yes, let's relapse! If I don't relapse, I'll be a bad anorexic, because everyone relapses. So let's plan a relapse baby -

You get the idea.

What that saying should really be is:

Relapsing is 'normal', just like tripping up is normal.

However! You wouldn't trip up on purpose, just because 'oh, it happens'. (It would just hurt, and not do you any good.)

Don't let your ED tempt you into relapse, just because 'it happens'. That's gonna hurt too, and definitely won't do you any good.

Did you honestly like your body when it was at a low BMI last time? No! You despised it. Our bodies will never be enough for our eating disorders. Not thing enough, toned enough, anything enough.

EDNOS is a real eating disorder, just as serious as anything else. BED is a real eating disorder, just as serious as anything else. All disordered eating is serious and potentially deadly, and extremely damaging. If you are suffering to any extent, you deserve help.

Your ED will never let you be merely thin.

Your ED will never let you stop.

Your ED wants you to be a skeleton.

A skeleton. Pure bone. Pure white. Pure.

No skin, no fat, no organs, no heart, no you.

Your ED is an uncontrollable monster.

It will drive you to your death, if you let it;
don't you dare let it. You are worth more.

If you go with your ED, you will fail. There is nothing good down there.

In the end, you will either die, or recover.

Choose wisely.

If the disordered side of you got excited at the 'pure, pure, bone' part; you know ED is f*!@#ing with your mind and heart.

I hate it. I hate all of it. I hate eating disorders. They turn us into monsters.

F*!@# YOUR ED. Live the live you were born to live.

Please share your feedback on this awesome post.
Thanks, Shannon, for sharing.

Saturday, September 1, 2012

You, Me, and My Mother—Getting More Personal

Acknowledging (not blaming) your influences

Her recent diagnosis of cancer brings me to this slightly different post than you’re used to reading from me. I hope you find it useful—I believe you will—so please read on.

I rarely give credit to my mother, although to say she has had a major impact on me would be a silly understatement. More often, my inner circle hears my complaints—my failure to accept her as she is, to live up to my unrealistic ideal, and my frustration in her difficulty over the years to see me as my own person. You know, the usual mother/daughter crap. I can be uber-rational, she primarily utilizes the right side of her brain—the “act on how you feel, not what you know side”. We are a challenging combination at times. That said, the profound positive influence she’s had on me and on the work I do is worthy of this post.

The Early Years

I grew up on mayo sandwiches, Frosted Flakes and Fruit Loops. I loved canned mushrooms—right from the can—and those olive-green asparagus tips-and peas too. What a weird kid, no?
I ate Swanson TV dinners—those foil-contained frozen meals, most notably turkey, stuffing, gravy and mashed potatoes with a tiny side of super sweet food-coloring-infused red dessert—which I would eat occasionally for dinner on a folding “snack table” right in front of the TV.  It was the 60s of course, and my mother’s 1950s housewife generation saw convenience as key. Canned food was better than fresh in that era—or so it seemed from my youth’s perspective, just as infant formula trumped breast milk. After all, it was “scientifically formulated”, so it had to be better. Processed food was the new black back then. Everyone had to have it.

As my mother engaged in various diets over the years, I took to baked fish and steamed, fat free vegetables just as easily. I joined her in grapefruit eating with dry toast and coffee for breakfast (the Scarsdale Diet, it was called) in my teen years, but was equally entitled to enjoy her fabulous baked goods for desserts. My first real introduction to balance, perhaps?

My mother encouraged and allowed me full reign in the kitchen—something I've simply taken for granted—until working with so many individuals for whom this was not the case. The kitchen could get messy, and that was all right. She would call me from work and ask if I can start making the fried chicken cutlets (no, not during the Scarsdale grapefruit diet phase, of course!) and I would confidently hop to it.

I learned to be comfortable around all types of food, with cooking and without rigidity in the kitchen. I can't remember seeing a written recipe in my childhood home, but I knew from an early age how to make a chicken soup, and a kugel and chicken cacciatore, to name a few. These days, I do like the structure of a recipe to start with, then play with it from there.

Defending weight

My mother was, and remains, a beautiful plus-size woman. And like many of you living above society’s acceptable BMI have experienced, she had her share of size prejudice and condescension at times. In spite of my average to slim size, I think I always identified with her struggle. I silently sided with the overweight underdog, until I found my passion verbalizing my reactions to such injustice, and finding ways to guide and support those struggling with their eating behaviors and their weight.

Combine this with my mother being the most compassionate individual I know. Really. The warmest, most generous heart you'll ever encounter lives in her. Yes, readers, she deserves any credit due me for the work I do—for my passionate acceptance regardless of size, for the need for balance, for my (sometimes) gentle support you'll hear from me.

Only now can I make sense of what I heard upon returning home from my Freshman college year, 25 pounds higher than I was that September. “You could use to lose about 20 pounds,” I recall her saying. That was more than 30 years ago and it has never left me. At that time, what I heard was “you're not good enough, pretty enough, thin enough...”.

Would it have been better to address my emotional ups and downs as an insecure college student? Or to inquire about how I was eating and if I was taking care of myself? Could she have encouraged some reasonable physical activity, rather than telling me to “hold your stomach in” and “put your shoulders back”? Of course. But no one ever guided her in that way—it just wasn't what she knew. And now I can acknowledge that she only feared that I might follow her path with a lifelong and painful weight struggle. So lifelong, that in spite of her recent diagnosis of cancer, she expressed concern that her weight had increased a bit (following a possible weight drop due to her medical woes). This is what still worries her!

But this time I didn't argue. Okay, I did start to help her see that weight loss is not a smart thing at this point, and that what was most important was her focusing on staying healthy and well fueled. But that doesn't work well with the emotional side I spoke of earlier! Okay, time for me to work on letting it go...

What's the relevance for you and your struggles?

First, if I might encourage it, start to take an accounting of what you do have, the blessing you've been given; try, even if it feels rather late to start this, to see the positives in the people whom you've struggled with. Don't wait until it's too late.

Move from the extremes—even ones that seem so healthy. Black and white thinking has no place in a healthy diet, in this dietitian's opinion. And life is too short to deny yourself the foods you love.

Remember that it's never too late to change. I, for one, was raised on all candy-coated cereals and now have no taste for them. That said, I do love my desserts (have you noticed?) Tastes for food can develop and be nurtured, so to speak. As you know, I've become quite the food snob—I love my coffee roasted to perfection and ground fresh daily, and have my favorite oils—walnut; real, not artificially-flavored truffle; and intense and slightly spicy Mediterranean olive oils. From canned mushrooms to this—who would have guessed?

As for weight, as I have learned to listen to my body and its signals—the very message you read throughout this blog—my weight has settled to a very appropriate place for me—without diets or extremes. Letting go of unrealistic goals is essential. And patience is key, along with an awareness that reducing your size does not equate with happiness—even though you may think it holds the key.

That negative stuff you're still carrying, still feeding with your binging or your restricting or both? Time to work it through. Find an eating disorder therapist in your area along with a behavioral RD—we really work hand-in-hand; explore support groups (not OA, please, whose philosophy is a polar opposite to that which you read in this blog) and use your supports.

But start by believing that you're worth it—regardless of your size! Because you are.

If you enjoyed this post please share it or leave a comment. My mother hardly ever reads this blog, but I will encourage her to read this post. So any comments directed to her would be welcome as well.

Thanks for reading!