by Jenn Krebs, N.D.
If there is ever a topic which I feel most qualified and least qualified to talk about, it is food addiction. While so much of my clinical background and experience has focused on the complex relationship we have with our bodies and our food, there are still so many questions I have regarding why we eat more than we need.
Not surprisingly, I see quite a bit of stress-induced, compulsive and/or emotional eating in my private practice. I have always believed that as physicians we attract patients that can benefit, not simply from our knowledge and study, but from our own personal challenges and experiences. My interest in and knowledge of this subject comes from a very personal place.
Over the years I have worked with patients with varying degrees of eating dysfunction. I work with individuals who would not fit a “clinical diagnosis” for any particular eating disorder; they simply eat larger amounts of foods (i.e. sugar, chips, bread, pasta, chocolate) than they would like, and they want to learn how to control their portions and to understand what lies beneath their eating too much. In addition, I work with patients actively struggling with binge disorders and food addiction.
The best way to start this discussion is to define and distinguish between “eating too much” and food addiction. I define “eating too much” as any circumstance where we eat more than we need to simply nourish ourselves and/or meet the caloric demands of our day. A true food addiction is defined as frequent episodes of compulsive overeating, where there is a lack of control regarding both the choices and amounts of food one is consuming and where one eats well past the point of feeling comfortably full. Binge Eating Disorder is a newer term used to describe less frequent episodes of overeating, where there may be less of an obsessive, addictive or compulsive nature to the binging and more of an emotional or psychological depth to the behavior; these episodes are often brought on or aggravated by stressful, emotionally-charged situations.
While it could be easily argued that in the more compulsive, addictive cases, looking at the foods one eats is of paramount importance. And in binge eating disorders, it is more important to look at the deeper psychological issues. But in my experience, both areas need to be explored regardless of the diagnosis. I see similarities in all cases of overeating: the behaviors very often occur secretly behind closed doors; there tends to be excessive time spent thinking about food (whether it is fantasizing about food, planning the next meal or binge, or dreading certain parts of the day or night where one feels powerless toward food); stress tends to be a major contributing or aggravating factor; and there is often a complex mix of emotions that occurs post binge, including but not limited to, disgust, guilt, anxiety, embarrassment and depression.
I am writing this newsletter in two parts. Part one will focus on the foods that feed our need to overeat. Part two will focus on the emotion-focused and body-centered approaches that I have spent the past 25 years studying, practicing and, more recently, implementing clinically into my practice. My intention is to put in writing what has evolved from a keen interest in eating disorders into an integrated approach to the treatment of food addiction that addresses the foods we overeat, the body we stuff, and the emotions and stress we swallow.
If we are truly committed to looking at why we eat too much, we must look at our relationship to stress, our emotions, our food and our bodies, while keeping in mind the fact that certain foods can and do hold us in the grip of a true addiction. It is not until we eliminate the foods that cause a physiological addiction, increase the foods that our body needs to feel satisfied and satiated, and open a dialogue between our bodies and minds, that we innately know when enough is enough. We don’t need to count calories, restrict all carbohydrates, and measure our portions to know when we are full. We can maintain the enjoyment, pleasure, and community of food, while remaining connected to our inner experience of satisfaction and nourishment. For many of us it is not until we put all these pieces together that we free ourselves from the prison of overeating.
Part One – Foods that Feed an Addiction
There are four rules I have when working with food addiction. I use the word “rules” because I want patients to understand the importance and gravity of how food affects our physiology and biochemistry. The rules can appear challenging and restrictive at first, but with time they can become an effortless way of life.
Much is written about food addiction being more challenging to treat than other addictions because we cannot totally give up food or eating. As I have had more and more success with working with food addiction, I find that rationale odd; I believe we can indeed identify and give up the specific foods that trigger the compulsivity and addiction, and, at the same time, remain nourished and satisfied by food.
Patients often ask me, “How strict do I need to be in following these rules?” Following one or two of the rules may help in curbing or decreasing mindless or emotional eating, but to actually eliminate the compulsive and addictive nature of food addiction, it takes strict adherence to all FOUR rules.
- Eliminate refined sugar (being mindful of natural sugars including certain fruits and vegetables)
- Avoid packaged and processed foods
- Decrease or eliminate grains
- Increase your intake of healthy fats
Eliminate refined sugar (being mindful of natural sugars including certain fruits and vegetables)
I define refined sugar as all food products made with white sugar, corn syrup, high fructose corn syrup, sucrose, fructose, dextrose, and all artificial sweeteners. In addition, I include evaporated cane sugar (which you see in many health food stores and products) and agave nectar as sugars to avoid. Natural sugars are raw honey, pure maple syrup, molasses, and stevia. While I believe the addictive nature of refined sugars is far greater than that of the natural sugars, I do recommend that natural sugars and higher glycemic fruits and vegetables be limited by anyone struggling with a true food addiction.
Much has been written about sugar and its effect on keeping us coming back for more. Studies have shown that sugar causes complex hormonal reactions in the body involving serotonin, insulin and leptin that leave us feeling less than satisfied and far from satiated … and wanting more sugar! Studies have shown sugar to stimulate beta-endorphin receptor sites in the brain, the same sites that are stimulated by cocaine, nicotine, opiates and alcohol.
More simply put, when we use a cheap source of fuel (i.e. sugar), our bodies burn through the quick fix rapidly and want more, more, more! While sugar may feel good going down, we often feel a dip in energy after. It is these ups and downs that make it very difficult for us to navigate our natural cues of hunger and satiety; they confuse our physiology so that we don’t know what our bodies really need to feel healthy and satisfied.
I won’t beat around the bush. I consider refined sugar a drug. I see the hold it has on so many individuals. Interestingly enough, patients know it too! We innately know sugar is not good for us. We feel the grip it has on us, and we know when we feel helpless or out of control.
Avoid Packaged and Processed Foods
I define packaged foods as the foods you find in the inner aisles of the grocery stores, foods that come in wrappers, bags, boxes, bottles and cans … the chips, the cereal, the cookies, the sodas, the juices, the candy. Processed foods are foods that you cannot make in your own kitchen because a few (or many) of the ingredients aren’t for sale … those ingredients are chemicals. These chemicals allow processed foods to have ridiculously long shelf lives, to look colorful, playful and more appetizing (not really), and to tickle and tantalize (or rather assault) our taste buds keeping us coming back for more!
These chemicals preserve, color, bleach, texturize, deodorize, sweeten and flavor our food. Some of the top contenders that you may recognize are aspartame, sodium benzoate, BHA (butylated hydroxyanisole), high fructose corn syrup, MSG, and sodium nitrate/nitrite. You may also see the term “artificial flavors” listed in the ingredients of packaged and processed foods; it is a blanket term that refers to a long list of chemicals developed in laboratories to mimic natural flavors.
One of the reasons chemicals and artificial flavors exist is to hook us in and keep us coming back for more. To be sure, chemicals are placed in our foods to extend their shelf life and make foods look more appetizing, but you can bet they are created and strategically used to make sure we get hooked and buy the food again. During an interview with 60 Minutes in 2011, flavorists (the scientists who create and tweak artificial flavors) admitted to intentionally trying to create and design flavors that establish cravings and leave people wanting more … in my opinion, they stopped short of admitting they create drugs for legal consumption.
Make no mistake about it, processed foods are engineered to establish cravings and to make sure you eat more than you need. One reason they exist is to ensure you become a returning customer.
Decrease or Eliminate Grains
This rule is a more recent rule, and one that I believe to be very significant in breaking free from the hold of food addiction. This rule, by far, is the most difficult one for patients to face. While there is a certain amount of mainstream acceptance and understanding that processed foods, refined sugars and trans fats should be avoided, talking about decreasing or eliminating grain is a much tougher sell. Despite considerable resistance, I do persist in stating my case because I truly believe it to be an important piece of successful treatment. In my opinion, it is why previous treatments may have failed; why we continue to crave certain foods, have food on the mind, and eat more than we need to, even after giving up sugar and processed foods.
Here are some common responses I hear. “But grains are an important food group!” “Grains are an important source of fiber for me.” “But I love bread and pasta.” “That will be so tough, I’m not sure if I can do it” I am the first one to sympathize and to understand these woes. Grains are everywhere. Even if we try to avoid them, they pop up in everything.
Grains have become a staple of our diet for a number of reasons. Some reasons we know and some may be surprising. Grains have a longer shelf life than other whole foods, such as meat, fruit, vegetables and dairy. Grains tend to be less expensive and more easily available. In modern times, we have been able to grow and process grains easily and therefore they have become a very affordable source of calories.
Some diets are high in grain because we don’t feel safe eating much else! Even well-informed and well-intentioned healthy eaters eat more grain because they are concerned about, and rightly so, the safety of our food supply. A typical scenario of an individual wanting to make the right food choices may be …. I am nervous about eating fish because of metals and industrial chemicals, and I am not comfortable with the factory- farming practices of much of the meat that is available to me. I am not eating as many fruits and vegetables as I would like because I can’t afford the extra cost of buying organic. Add on to this scenario, individuals avoiding eggs and other animal products due to the fear of cholesterol and saturated fat (we will talk more about that in a moment), and the result is an individual eating a diet consisting mostly of whole and refined grains. Often times after reviewing the diet more closely, the individual realizes he/she is eating a higher percentage of refined grains than initially thought.
It is hard for many to even imagine a diet low in grain or without grain. But it is important to consider if you are someone who feels the addictive hold of food. Even if we give up all sugar and all processed foods, eating grains (yes, both refined and whole grains) seems to trigger compulsive and addictive eating. In my experience grains contribute to obsessive thinking and rumination that is focused on food. Refined grains act like sugar in our bodies, producing similar insulin and serotonin surges. While whole grains may produce less of a hormonal effect, whole-grain flours have been shown to produce a significant serotonin “high,” and the whole grain itself can impact cravings and compulsivity. Decreasing grains in one’s diet and eliminating grains during the sensitive times and meals when binging occurs, can have a significant impact on food addiction. Individuals that give up grains completely report a decrease in appetite; they no longer think about food or the next meal, and they begin eating only when they are hungry and stop eating when they are satisfied!
A question I get a lot … “Is giving up grains really safe?” “Don’t we need grains in our diet?” I have been researching these questions a lot lately. What I have found is that grains do not provide us with any nutrient that we cannot get from another food. Grains can actually deplete our bodies of certain nutrients, can be challenging for many to digest, and can spike blood sugar and insulin much like sugar. We can get all the nourishment and fiber we need by eating vegetables, fruits, protein and healthy fats. If we struggle with food addiction and feel powerless to the hold foods have on us, we can certainly live and even thrive without grain in our diets.
Increase Healthy Fats
This is a fun rule! It can be hard work to restrict or eliminate foods. But this rule says we can eat plenty of delicious and satisfying food.
Fats have gotten a bad reputation over the years. Yes, there are some types of fats that we should avoid, but without a doubt, we need fat in our diet. And when we eat plenty of fat, a funny thing happens … we feel satisfied. We then pair eating more fat with the elimination of foods that flood the brain with serotonin and that spike blood sugar and insulin, and we don’t overeat!
Fats are essential. Fats are needed in order to absorb certain nutrients. Fat is the more reliable and preferred energy source in the body. Remember I talked about sugar being a “cheap source of fuel.” Well fat is the opposite. Fat is the ideal energy source for how we move our bodies on a daily basis. It sustains us through the day on many levels; our energy, our blood sugar and our moods are more even relying on this “superior fuel.”
So I can hear the thoughts coming into my readers’ heads right now. “Isn’t eating more fat unhealthy?” Answering this question is a struggle because of all the misinformation that has been circulating for so many years. Yes, it is well understood and documented that eating trans fat is not healthy and strongly associated with heart disease. There is also agreement that omega-3 fatty acids are essential and beneficial. However there is mounting evidence that contradicts long held beliefs about the dangers of eating animal fats. Saturated fat has been demonized by the media and medical communities for many years. Contrary to popular opinion, recent studies are finding that there is no association between saturated fat intake and increased risk for cardiovascular disease. By the same token, new studies are debunking the long-held belief that eating dietary cholesterol increases blood lipid levels; for the vast majority of individuals it does not affect cholesterol levels and in some cases improves HDL levels.
Here is a list of foods that I consider to be great sources of healthy fats in the diet: eggs, nuts, nut butters, avocado, olive oil, coconut oil, butter, cod liver oil, fish oil, and salmon. While some will disagree with me, I also recommended high quality animal products (grass-fed, organic) as a way to increase fat and protein intake and both satisfy and nourish the body.
I hear one last lingering question. “Doesn’t eating more fat, make you fat?” If you are eating refined sugar and refined grains and increasing fat intake, yes, sure it does. But in fact eating more healthy fats while decreasing sugars and grains, allows you to access and burn more stored body fat, retain and even increase lean body mass, and lose weight.
So here I am venturing into the topic of weight or weight loss. This is the perfect place for me to end this discussion. If you know me or work with me, you know that I am not a huge fan of weight loss programs. While I have spent a great deal of my career working with eating dysfunction, I have avoided becoming associated with or marketing my own work as a weight loss program. My emphasis has always been on reconnecting with our bodies and our natural cues of fullness and satiety. My focus is on understanding and letting go of our unhealthy behaviors and relationships surrounding food and body image. If weight loss occurs as a result of this work, and it certainly can, then great.
However, identifying the foods that trigger overeating, nourishing our bodies with foods that provide energy and satisfaction, and improving our relationships to the food we eat, the bodies we live in, and the stress we live with … that’s the work I love to do.
Look for Part Two … coming next month!