Is Food Addiction a Real Thing?

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Are you addicted?

When my partner and I first moved in together, he – a naturally thin person whose eating is highly internally regulated and who has never restricted any food in his life AND even enjoys guilt-free overeating on occasion – suggested cookies as a grocery item list. I had just regained a few pounds after my most restrictive dieting period ever, and I looked at him like he was crazy. “Uh, NO! I can’t have cookies in the house or I’ll just EAT ALL OF THEM! I’m addicted to those foods!” He looked at me calmly and said, “Well, that won’t happen to me and I want cookies.” It would be four more years before I stopped dieting and the cookie tug-of-war would peacefully come to an end and I would once and for all stop feeling like I was addicted to sweets.

I recently had a conversation with a woman who considers herself a food addict and has been a member of Overeaters Anonymous for 16 years. She manages her self-described addiction by eating no refined grains and no sugar at all. She maintains a high-protein, low-carb diet. After talking a while I found out a few other things: 1. She was criticized for her weight at a young age, 2. She started self-restricting cookies when she was 7 or 8 years old, and 3. She was often a much higher weight, tried all the diets, and this total abstinence regimen is the only one that has “worked” for her in terms of keeping her weight down long-term. She also frequently talks longingly about what she can’t have but would love to eat. She sometimes bakes brownies just to enjoy the smell and gives them away to friends without having any. She said she never stops thinking of herself as fat, even though she is now “normal weight.” If ever there was a person my heart went out to, it was this person.

We hear stuff like this all the time. Sugar is addicting. Fat is addicting. Refined carbs are addicting. Salt combined with any of those foods is addicting. I was once accused of being addicted to cheese, which is ridiculous because anyone who knows me knows chocolate is my drug of choice! (If I thought of it that way, which I don’t)

To learn more, I emailed a colleague who specializes in nutrition for recovering addicts and food addiction. He sent me a paper which apparently is the foundation for food addiction treatment right now, “Understanding and Addressing Food Addiction” by The National Center on Addiction and Substance Abuse. The paper admits little is known about food addiction, which is why they have chosen to look at it through the lens of substance addiction. Food addiction was considered for the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) but rejected, so in the absence of any other diagnostic criteria, the Yale Food Addiction Scale (a scale that is primarily based on the diagnostic criteria for substance dependence) is often used to determine food addiction.

The paper talks about possible risk factors for food addiction including “obesity/overweight”, early exposure to “overeating and unhealthy eating” at a young age through family or peer groups, genetics, personality trait and psychological tendencies, and more. They state that the individual characteristics associated with food addiction are being female, over age 35, and overweight or obese (interestingly, the same people that are often on a diet). It discusses the relationship of food addiction to eating disorders (there is a higher correlation than in non-ED populations).  It talks about the similar neurological responses of the brain to highly palatable foods (the aforementioned sugar/fat/salt combo) and addictive substances. And in the end, it concludes:

“The food addiction model, like that of substance addiction, describes the ways in which certain food properties or ingredients can produce addiction in individuals who are susceptible to their effects and who consume them in a manner that induces the addictive process (i.e., eating certain types of highly palatable, calorie dense, and nutrient-poor food on an intermittent but repeated basis).  It allows for an explanation and an intervention strategy for those cases of disordered eating that are not adequately accounted for by existing psychological or medical causes.”

In other words, in the absence of psychological or medical reasons for an “addictive” response to food, it blames the food itself.

I find this paper, while highly referenced, problematic. I don’t think it’s asking the right questions.

One major problem is that nowhere does it mention restrained eating or dieting behaviors and their relationship to food-addicted behavior. This is a huge omission because it’s well-documented that highly restrained eaters often have frequent episodes of disinhibition (aka overeating or binge eating), especially with “forbidden” highly palatable foods (read some of that data here and here). Who on a diet hasn’t felt addicted to the very foods they weren’t supposed to eat? It’s no surprise to me that people with eating disorders have experienced more food addiction symptoms; high degrees of eating restraint are common in eating disorders.

I have qualms about treating food the same way as addictive substances. We don’t need addictive substances to live for the most part, and most of us, in our usual activities of daily living, will never come across those substances unless we search them out. They’re easy to avoid (cigarettes and alcohol being exceptions to some degree). Food, on the other hand, is everywhere, and we need it every few hours to achieve nutritional adequacy. One might encounter “trigger” foods multiple times in a day. This puts the onus on the addicted person to try to avoid contact with trigger foods or those who are eating them, and that could lead to extreme social isolation. I had a friend who, once he joined OA, couldn’t eat with me anymore because of potential exposure to all his trigger foods – which was becoming everything except non-starchy vegetables.

Yet another problem is that this paper views highly palatable foods as inherently bad for health; they simply aren’t, and there is no adequate body of evidence to conclusively show this (and we know now that our patterns of eating impact our health much more than individual foods). Many people can incorporate these demonized foods into a balanced diet quite easily without overdoing it or feeling ruled by them (those people all live in France, plus the three I know here. Kidding! I know four here.). In my experience, these are people relaxed eaters who have never dieted and never felt they had to change their body shape or weight.

A lot has been made of the similar ways that highly palatable foods and addictive substances light up certain neural pathways. But guess what – those are pleasure pathways. They also light up when we receive hugs from people we love, hang out with our pets, or have sex. So the lighting up of those pathways alone do not indicate addiction.

There may be truly food-addicted people out there, because anything is possible – but this “addiction” does not happen in a vacuum. If you showed me a food-addicted person who had never dieted, never felt bad about his or her appearance, never been exposed to our pervasive culture of food fear, and never observed or felt weight stigma, I might buy the construct of food addiction in which food is the problem more readily. If that food was broccoli, I’d have no doubt. But it’s never broccoli, and there are few people who meet that criteria.

We’re asking the wrong questions. Based on all I know about dieting, food restriction and disinhibition, food addiction tendencies are more likely driven by high dietary restraint, weight stigma, and a toxic culture of food-fear than a chemical dependency on food. The evidence is the many people who have gotten free of this feeling of food addiction once they healed their relationships to food, eating and their bodies.

So is food addiction a real thing? I think the feeling of addiction to food is a very real thing, yes. But is it the food itself that causes the addiction? In most cases, I don’t believe it is. And I don’t believe more restriction is the answer.

My feelings of addiction to sweet foods went away when I started to feed myself without restraint and abandoned body-shame as a way of life. Once I legalized all foods, the power any one type of food had over me disappeared. I think if we started treating food addiction with liberalization, not more deprivation, we’d quickly see fewer and fewer cases of it.

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Dear Penn Jillette: Your Diet is BS

Penn_Jillette_in_Denver_2015I read last week that Penn Jillette went on a crazy diet and lost a lot of weight.

Penn Jillette is a professional magician and used to have a show with his magic partner, Teller, called “Penn & Teller: Bullshit,” on which they debunked various “pseudoscientific ideas, paranormal beliefs, popular fads and misconceptions” (thanks wiki!). Oh the irony, amiright??

He said he was inspired to lose weight (ultimately 100 lbs in all) because he had been sick, and diagnosed with very high blood pressure. I agree that something like that could indeed use a nutrition intervention, but instead of making some reasonable, sustainable changes to diet and exercise, he dove in headfirst to dietland.

First he went on a diet for two weeks that consisted of only 5 potatoes a day, which provides around 800 calories and 20 grams of protein, not enough for most active hamsters. Unsurprisingly, he lost 18 pounds after two weeks. This is called a monotrophic or mono diet. It’s apparently also featured on many pro-anorexic websites according to this article.

He then switched to something called a Nutritarian diet by Dr. Joel Furhman (look it up yourself, no way I’m linking to this diet page) that he described thusly: “Turn on the TV, look at the billboards, read magazines — see all that food? I don’t eat any of that. I eat no animal products, no refined grains, and extremely low salt, sugar, and oil.” By the way, the text at the bottom of Furhman’s diet website: “There is no guarantee of specific results. Results can vary.” He’s required to put that there by law because by now it’s well-established that diets don’t work to produce sustainable weight loss, results cannot be predicted with any degree of accuracy, and within 3 to 5 years most or all weight is regained…and because his diet is no different. This is Penn’s moment to pull the curtain aside and expose who the Wizard really is, but no. Instead he just goes on the diet.

Anyhoo, the rest of the article in which Jillette talks about his new transformed way of eating reads like the most disordered of food journals. Here’s an especially concerning excerpt: “I had a handful of unsalted, dry-roasted peanuts with Tabasco sauce….I guess I had two handfuls. I love eating spicy in the middle of the night. The peanuts were very filling so I didn’t eat the rest of the day. One thing I learned from my lifestyle change is that I don’t have to eat all the time. When I don’t eat, I get focused and clearer and … well, happier” [italicized emphasis mine]. That focused, clear feeling? A lot of us have had that in the early stages of dieting. I have a theory that this is your brain readying you to look for food because you’re basically starving. I had a lot of energy at my thinnest, but it was reserved only for thinking about food, looking for food, scrounging food and quickly scarfing food. I was the most ambitious and effective office-hunter-gatherer you ever saw. I may have been happier, but I didn’t really have time or emotional space left to recognize if I was since FOOD! WAS THAT FOOD I JUST SAW?! GIVE ME THAT FOOD! ME WANTY FOOD!!!

More tidbits from the Sad and Curious Food Ramblings of Penn Jillette with a little of my own interpretations thrown in:

“It had been about 36 hours without food, and I wanted to eat.” (extreme restriction)

“I had watermelon. Usually when I eat watermelon it’s a joke amount, like a whole watermelon, cut up and very cold. Watermelon is magic. It’s like candy but really good for me. There seems to be no limit to the amount of watermelon I can eat.” (binge behavior, food moralizing)

“My dessert in the middle of the night was the idea for which I will win the Nobel Prize. I invented this. I took a lot of blueberries, like four big containers (this one is expensive), rinsed them off and then put way, way, way too much cayenne pepper on them. Way too much. Lots. I shook that around and then added way too much cocoa powder, no fat, no sugar. It’s like a Mexican flourless chocolate blueberry cake. It’s my favorite food. I went to bed with my mouth on fire and my belly full.” (okay, I just included this one because it’s weird as hell, but also a bit bingey)

“…I was hungry after our Vegas show at the Rio… I got up and had a hummus wrap with Tabasco. This was store-bought and a bit too salty. That wasn’t enough, so I had a bunch of spoonfuls of peanut butter. This is my downfall — too salty, too sugary, too high fat, oil, and salt, but so good. I ate so much it would make you sick. It made me happy.” (binge and then guilt. Serious fucking alarm bells for disordered eating going off for me right now)

“I was full, but I still had some peanut butter for bedtime.” (finishing off with some superfluous eating)

I get that getting diagnosed with high blood pressure and other metabolic-type conditions can be scary and they are something that can be helped with improvement in eating habits and exercise. But look around; do all the “healthy” people you know eat even remotely like this? (Gawd, I hope not). We don’t need to become diet addicts and emotional slaves to food to drop pounds in the name of “health.” We don’t need to miss meals for 36 hours and slather hot sauce on everything because we’re not eating what we want, not really, or enough to satisfy our appetite. We really don’t need to eliminate sugar, fat and salt from our diets. Most of these changes, I’m predicting, will not be sustainable for him, as they usually aren’t for most people. So far he’s maintained the weight for 17 months; a lot of us ex-dieters did that too. It’s too early to know how this will play out for him, but based on statistics alone, he will regain that weight between 3 and 5 years after he lost it. But most significantly, what Penn has done here is conflate weight and health, and that is the ultimate bullshit.

Penn Jillette can do what he wants with his body, that’s his business. But now he’s writing a book to tell us how we, too, can lose a third of our body weight by developing an eating disorder. Penn, you didn’t find the cure to obesity, and statistically speaking, your weight loss has a 95% chance of failure by year five. If you do manage to become one of the elite 5% who maintain your weight loss longer than this you will probably have to do it by developing a sub-clinical eating disorder that everyone will applaud and will make you secretly crazy. Again, that’s your choice, but your book makes you part of the $60+ billion diet industry which fails just about everyone, and that’s just wrong.

We don’t need another diet book from someone with extreme disordered eating habits that has only maintained his weight loss for 17 months, so I’m calling bullshit on you, Penn Jillette.

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I Forgot to Eat the Damn Cake

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I DID eat this cake.

A while back I wrote about my frustration when someone did that thing I now call the Dance of the Dessert, that “should I?/I shouldn’t!” thing and then they do and then they loudly proclaim their guilt to anyone in the nearby vicinity. Seriously: yawn.

Well, something completely the opposite of that happened to me the other day: I forgot to eat the cake. And until now, I didn’t even bother to talk about it.

You see, this is the kind of thing that might happen when you give up dieting and dieting mentality and embrace internally regulated, totally normal eating. You might do things like accidentally forget to eat some cake, even if you intended to. And you don’t feel that bad about it.

In my dieting days, I was definitely the person to worry about eating the cake (though I would still eat it because IT WAS CAKE). I was also the person to sneak back into the break room later on and cut off another “thin” slice and eat it furtively…and then cut off just another “tiny” slice because I I just couldn’t stop…and then I’d scoop up the icing dregs off the edges of the plate and lick the knife clean (apologies to all those who got to the cake after me…it was probably decimated). Ironically, I was the thinnest I’d ever been…but I still felt so wretched for eating that cake. More restriction would follow until the next cake or doughnut or brownie or tart or…

Last week reminded me how far I’d come since then. Two co-workers had birthdays, and therefore there were two cakes being served up during our weekly team meeting. I had just eaten breakfast and so wasn’t really in the mood for cake. I also have a sensitive tummy and I know putting too much in there first thing in the morning will be misery all day. So I declined the cake and planned to come back for some in the afternoon when I like to have a snack and would have a nice appetite for it – there was plenty and I was confident there would be some left by then.

The day wore on. I was out of the office during lunch so I didn’t get to the break room to see if there was cake left to have as dessert. I got back to the office and at mid afternoon had my current favorite snack of banana with Nutella (because Nutella is awesome). I went home.

Then it hit me…I forgot to go back and get a slice of cake. Damn.

It was completely my intention earlier that day to partake in cake, but in reality, I clearly wasn’t feeling it. And that is the wonderful thing about not being underfed or food-restricted all the time – you don’t eat cake just because it’s there and you’re starving. I also know there will be cake again, and that I will probably have some, which is why missing it this time wasn’t such a big deal.

I don’t tell you this story to brag about my internally regulated eating skills. I feel neither good nor bad about forgetting to get the cake. It was a neutral incident, so I don’t feel smug about it as I might have in my food-restricted days. My behaviors do not make me thin. They simply make me relaxed around food.

I’m telling you this because if you are still feeling crazy around food and it’s getting a bit much for you, I want you to know there is hope. If you are struggling with getting to normal eating, I want you to know that it does happen, and it’s a wonderful relief. Internally regulated eating is that happy place where you get to have your cake and eat it too…or not, if you simply don’t feel like it.

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Episode 12 is available now! Aaron and I had fun talking about the Tell me I’m Fat episode of This American Life.

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