A few weeks ago a wrote a post on food addiction and mentioned that I was working on a blog post for The Academy of Nutrition and Dietetics blog. It came out last week and I wanted to re-post it here but with a couple of other thoughts.
One of the things I love most about my job is that I get to blend the science of food and nutrition with the art of working with people in the real world. It's the careful balance of art and science that I found so gratifying. This relates to the topic of food addiction. In the real world, it can be a very heated and emotional discussion. I have seen ardent defenders and spirited critics of the concept as well as everything in between.
My purpose in writing this particular post was to review the actual research. I wanted to get clear and share what we know about food addiction via research, what we don't know, and what we need future research to take us. This is different than the clinical hat I normally where because I only minimally address application side of things. So please keep that in mind, along with the fact that I had an EXTREMELY limited word count! In any case, I hope that it's informative and I hope we can all keep an open mind to such a complex topic. The original version was posted here but I have pasted it below. I'd love to hear your thoughts and comments.
I’m a chocoholic. I’m addicted to sugar. Once I start eating chips and salsa, I can’t stop.
How many times have you heard these and similar sentiments? If you’re like me, then you’ve heard them a lot! But over the past several years these sayings haven’t only been used casually, but also seriously considered in scientific circles. With the rise of obesity and the DSM-V’s (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) recent inclusion of Binge Eating Disorder, RDNs face difficult questions about how to address the issue of food addiction.
Below I’ll review the most recent scientific literature, completed by H. Ziauddeen and PC Fletcher in an article entitled, “Is Food Addictive? Is food addiction a valid and useful concept?” It’s an excellent article if you’re interested in a more thorough examination from both a neuroscience and clinical perspective.
Food Addiction Theory
Proponents of the term food addiction often cite four similarities between food and other addictive substances.
1. Food shares common drug pathways in the brain.
2. Food can activate reward neurons.
3. When consumed, dopamine receptors are altered.
4. Anticipation of eating activates brain regions seen in drug abuse.
Limitations of the Food Addiction Theory
While the concept of food addiction is extremely compelling, there are a number of reasons to exercise caution in its application. First, there is no actual definition of an addictive food. Researchers have yet to categorize which elements are addictive, identify if the term refers to one or many addictive substances, or characterize which features interact with individual vulnerabilities. “Although arguments have been made that certain aspects of eating in obesity are ‘addictive,’ we would caution against less stringent applications of an addiction model as these risk losing the explanatory power and the neurobiological grounding of the model.”
Second, there is very little research that supports the food addiction model. Much of the research has been done on animals. The outcomes of these studies contain elements that seem promising, while the results of the limited human studies are largely conflicting. The authors state that “the potential role of FA in the obesity epidemic … has acquired much currency with relatively little supporting it.” They go on to say that “… food addiction is unlikely to be a causal pathway in the majority of people with obesity.”
Third, the food addiction theory fails to consider other viable explanations for neurobiological phenomena. At RDN Evelyn Tribole’s April 2013 “Intuitive Eating Training” event in Salt Lake City, she suggested four limitations to the food addiction model to consider:
- Pavlovian conditioning
- Food is meant to be rewarding
- Restrained eating increases the hedonic value of the food
- Hunger increases neural activation
Clinical Suggestions for the RDN
As nutrition experts, RDNs are perfectly positioned to stay current on the latest food addiction research and interpret those findings for their clients. Given the fact that the research on food addiction is in its infancy, RDNs should stay tuned for new information. And in the interim, consider alternative approaches to help clients reduce compulsive and binge eating. Intuitive Eating, a program developed by two RDNs, is one such method that has garnered significant research in the past few years. For a listing of all the research, click here.
Food addiction is a hot topic right now. I’m currently working on a blog post on food addiction for The Academy of Nutrition and Dietetics and look forward to sharing it with you after its release. But in the interim I thought I’d give you a taste by sharing with you some intriguing research. The proponents of the food addiction theory like to compare the neurological responses to food with the neurological responses to other addictive substances. The only trouble is that there are a lot of holes in the research that need to get filled before we buy that theory outright. (More detail to come in my forthcoming post.)
So being the neuroscience geek that I am, I started digging into the literature and discovered something important. There is a MAJOR component missing in the food addiction research (including the Yale Food Addiction Scale, a tool used for research as well as in clinical settings). It doesn’t account for caloric restriction and restrained eating.
What does this mean you might ask?! It means that we see a hyper-response in the reward region of the brain when we haven’t been eating enough (i.e. dieting or starving ourselves). This happens in response to seeing pictures of food, thinking about eating, as well as actually consuming food. Turns out that most people who feel that they are food addicts have an incredibly complicated history of dieting and disordered eating. It only makes sense that their brain response is extra active when they “give in” and eat a forbidden food…and then feel out of control while eating.
Perhaps what we are seeing in the neuroimaging is a HEALTHY response to food in a starved state and not an indicator of addiction at all. Needless to say, the food addiction research is in its infancy and there are a lot of unanswered questions. But the current research does seem to point to another solution that could prevent unnecessary weight gain, decrease food obsession and diminish compulsive overeating- END dieting.
Perhaps you’re a skeptic? Take some time to browse the research below; and this is only a sampling!
Research Studies to Consider
Ciampolini M et al. Sustained self-regulation of energy intake. Loss of weight in overweight subjects. Maintenance of weight in normal-weight subjects, Nutrition and Metabolism, vol. 7, article 4, 2010. [ Free full text.]
Heileson J.L., & R. Cole (2011). Assessing Motivation for Eating and Intuitive Eating in Military Service Members. Journal of the American Dietetic Association, 111 (9 Supplement), Page A26.
Intuitive Eating was associated with lower body mass index levels in 100 active military troops.
K H Pietiläinen, S E Saarni, J Kaprio and A Rissanen (2011). Does dieting make you fat? A twin study. International Journal of Obesity.
Madden C.E., Leong, S.L., Gray A., and Horwath C.C. ( 2012). Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. Public Health Nutrition. Mar 23:1-8. [Epub ahead of print].
Stice E, et al. Caloric deprivation increases responsivity of attention and reward brain regions to intake, anticipated intake, and images of palatable foods. NeuroImage 67 (2013): 322-330.
Women with high Intuitive Eating Scale (IES) scores had significantly lower body mass index, which suggests that people who eat in response to hunger and satiety cues, have unconditional permission to eat, and cope with feelings without food, are less likely to engage in eating behaviors that lead to weight gain.
Ziauddeen H and Fletcher PC. Pro v Con Reviews: Is Food Addictive? Is food addiction a valid and useful concept? Obesity Reviews (2013): 14 (19-28).
You've certainly heard the term "clean eating." As you think about those words, what images, feelings, and connotations get conjured up? What does the term "clean eating" mean to you?
Toby Amidor, RD and media-savvy nutrition expert recently wrote about clean eating in an article in Today's Dietitian a few months ago. She explained that clean eating "encourages the consumption of more fruits, vegetables, whole grains, and lean meats with fewer sugary high-calorie beverages and saturated fatty food." That sounds reasonable, right? I'm a dietitian, of course I'm in support of eating foods that nourish the body and support health.
BUT...I'm also incredibly interested in the power of semantics and the power of the meaning that gets all wrapped up in our eating habits. Sometimes people ask me how I can stand talking about food all day long. Even some of my therapist buddies ask if I ever get bored. And the answer is no! And that's because food habits are layered with all sorts of meaning. And part of my job is to help my clients untangle the layers of meaning when need be. If the way we eat gets too wrapped up with our identity, our eating habits may lead to exaggerated feelings of guilt, shame, anxiety, depression, and even self-hatred. And these feeling further distance our connection to the physical experience of eating. It probably goes without saying, that feeling this way over the long-term isn't good for our health.
When it comes to eating, my job is to help neutralize the harmful feelings of judgment and shame while deepening physical connection and awareness.
You may be asking yourself, what does this have to do with the notion of "clean eating?" Perhaps nothing for some of you. But for others, it may be highly problematic. The word clean carries with it the idea of being good, worthy, and virtuous. And the antithesis of clean is dirty, bad, or naughty. If you find that you are constantly feeling guilty about your food habits, these terms might be more harmful than helpful. Creating some distance from the semantic notions of "clean" and "good" might be useful. Instead, you could focus on the physical experience of how certain foods feel in your body during and after a meal.
One way to do this is to try a one day journaling experiment. You'll be recording three pieces of information. First, you'll make a note of what and how much you ate. Second, write down any inner commentary on what you ate (ie "that was bad I should haven't had that"). And finally you'll indicate how that food tasted and the way it felt physically in your body after (ie tasted yummy but noticed feeling gassy and bloated after).
This simple practice is intended to help you separate your physical experience from the narrative in your mind. If this concept resonates for you, give it a try. See what it's like to create some space from the judgement and "shoulds" of eating while discovering what types of foods allow you to feel your best. Your body and your brain just might thank you for it!
Picture Source As many of my clients can attest, I am endlessly fascinated by the field of neuroscience and the useful applications it has in my own work. Perhaps you’re aware but it wasn’t until the 21st century that neuroplasticity, the idea that our brains continue to change and adapt through adulthood rather than ending in adolescents, garnered universal acceptance. Norman Doidge, MD brought the concept of neuroplasticity to lay audiences with his book “The Brain That Changes Itself.” I highly recommend it! One of the most famous phrases of the concept of neuroplasticity is “neurons that fire together, wire together.”
So what does neuroplasticity have to do with nutrition? A lot! And for the purposes of this blog post, I’m going to talk about it in the context of negative calorie foods. Negative calorie foods are those foods which are purported to burn more calories through digestion than they actually contain. It’s perhaps one of the longest standing urban nutrition myths. J People like to imagine that eating these foods is actually a calorie-burning activity. It’s surprisingly common for people to appease their emotional hunger with these so-called negative calorie foods. You've heard the rationale, “why does it matter if I nosh on carrot sticks and celery when I’m bored? They don’t have many calories, so they aren’t going to make me fat.” Or how about this one “I can eat as much broccoli as I want, it doesn’t have any points.”
So what is so wrong about eating foods when you aren’t hungry if they have little or no calories?
My answer: calorie or no calorie, the neurons that fire together wire together! If you are genuinely hungry and respond by eating, it’s no problem at all. But if you are munching out of boredom, procrastination, anxiety, or any other emotional need you may be headed for trouble. Over time you are fusing that emotional state with the behavioral reaction to eat. The calorie count is a moot point if you are fusing certain emotional states with eating*. The goal is to fuse eating with the physical cue for hunger (most of the time) and learn how to deal with your emotions directly.
So the next time you feel bored, anxious, or prone to procrastination, AND you aren’t hungry- take a stretch break, step outside, or cuddle up with your pet before reaching for something to nibble.
Interested in other ideas to soothe yourself without food? Check out Susan Alber’s book. She has 50.
So what do you think? Is eating low-cal foods to tame emotions problematic or benign? I'd love to hear your thoughts.
I know we just wrapped up Valentine’s Day. But the holiday really does get me thinking about love. And this year I thought a lot about loving ourselves. I know that sound cheezy but please keep reading. I actually think learning excellent self-love takes a lot of work. And I also think it can be quite confusing because really loving ourselves sometimes means doing things that might not feel great in the moment. Sometimes, love just doesn’t feel like it!
I think children are the best example of what I hope to describe. Think about the kind of melting down and tantrum throwing that happens when they are over-tired. Clearly, what they need most in that moment is sleep. But when Mom or Dad initiate the bed time ritual, most kids don’t acquiesce by saying “you’re right, I’m throwing these crazy tantrums because I’m over tired, it’s probably for the best that I head to bed now.” No! They kick and scream in the hopes of staying up later.
As adults, we often revert back to our child-like selves. We say yes to things we really ought to be saying no to. And say no when what we truly mean is yes! Here are some examples that might sound familiar:
- I’m not hungry but I need a break from this project. Time for a cookie!
- I’m starving but according to my diet I don’t have any more points left so I guess I won’t eat.
- I’m exhausted and sleep-deprived but don’t have time for more sleep, I’ll just have an extra snack to boost my energy levels.
- My neighbor asked me for help on this fundraiser and I agreed even though I’m already feeling overwhelmed with my PTA commitment.
- I really love going out for a walk and getting some fresh air but find myself distracted on Facebook every evening instead.
But as adults, part of REALLY taking care of ourselves is refining our ability to find “true refuge.” I believe that requires learning to say yes or no when we need to most…and then sitting with the discomfort that might follow. If you’re not used to identifying and meeting your true needs this may feel tough and uncomfortable at first. But I promise that it starts to feel really empowering! Not only do you feel better because your actual needs are getting met but you also don’t have to deal with the residual feelings of guilt, shame, and disappointment that comes up when you hide in your “false refuge.”
Have you had an experience about self-love you’d like to share? I’d love to hear it!
This past weekend, we had a major storm out here in New England. In fact, I’ve never seen so much snow at once! As I was watching Facebook, my inbox, and news reports I was intrigued with everyone’s efforts to prepare for the upcoming deluge. In fact, I found it incredibly interesting. Many people headed to the grocery store and stock piled their cupboards, fridges, and freezers (along with grabbing cash and filling up their gas tanks).
I think this behavior has such relevance to the world of nutrition. When we fear impending famine, we stock pile “just in case.” How many of you repeat this pattern with your diets? If you have ever participated in a “diet” than you have repeated it even if you don’t know it! Creating a famine by cutting out certain foods or food groups actually triggers a natural and healthy survival mechanism to feast. This survival mechanism causes us to think obsessively and crave those forbidden items. And as many of you know from experience, when we are both psychologically and physically restricted we don’t just crave moderate amounts of those items, we yearn for COPIOUS amounts of them. And before you know it, a terrible pattern has emerged… Famine (even with the best of intentions) has set you up for feasting.
I intentionally held off on writing a "New Year's Blog Post" this year. I think everyone gets inundated with them and I wasn't so sure that I had anything that I really wanted to contribute. But now that it's the end of the month I feel like it's an opportunity for a little quiet reflection.
I believe in living a life based on specific values that are important to me. In fact, there is a "newish" type of therapy called "ACT" which stands for Acceptance and Commitment Therapy. "ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility."
This speaks to the work I try so hard to do with my clients. In fact ACT nicely parallels the messaging of intuitive eating. I believe that when we listen and make changes based on our own internal compass (which takes a lot of honest listening!) we are much happier and the changes we make are more sustainable. When our actions align with our belief system (rather than someone else's) this decreases stress and actually becomes empowering.
So I would like to challenge each of you to take this opportunity to learn something about yourself. It will only take a few minutes.
1. Take out a scratch sheet of paper.
2. Make a list of 10 things you value. If you need some inspiration, there is a list of over 400 values listed here.
3. If you made specific goals this year, compare those goals to your values. Do they align?
4. Compare your daily actions with your values. Do they align?
Sometimes we have to make dramatic changes in our lives when we become more clear about our values. But if I could give each of you a gift, it would be the gift of living in alignment with your core values. Just as the definition of ACT states, it brings more vitality and meaning to our lives. And when it comes to health, isn't that what we're all after?
I'd love to hear about your core values and what you are doing to better align your life with those values. Anyone brave enough to share? It is anonymous! :)
This past weekend I was giving a workshop on Intuitive Eating/Intuitive Living with my colleague and friend Amber Barke. During the workshop we were discussing the very challenging topic of self-acceptance and I shared this blog post, which I wrote just over a year ago. I thought I'd re-post it, as the message seems relevant, particularly around this time of year. Enjoy.
My client, whom we'll call Sally, was telling me how she's been reading up on all sorts of positive body image blogs. You know, blogs that encourage you to love yourself and accept yourself as you are right now. And that was just all too far from reality for her to be able to swallow. She told me "I can't love my body. I can't stand living in it. I don't feel good physically in my body. Why would I accept something that makes me so miserable?"
And I understood what Sally was saying. Often, people confuse self-acceptance with stagnation. Staying miserable, learning to put up with something you hate. Many people wrongly assume that they'll never change if they accept themselves (not to mention love themselves!) as they are right now. But it turns out that isn't true.
ACCEPTING SOMETHING DOESN'T MEAN YOU HAVE TO LIKE IT. The reality is that self-acceptance FACILITATES CHANGE. Acceptance can be defined as "the act of assenting or believing." Once we come to truly accept where we are at in life, what works for us, and what doesn't, we are then able to make decisions based on that reality. Here are a couple of diagrams to show what I mean.
Cycle of Non-Acceptance
Cycle of Acceptance
I share this message with you as a new year is about to begin because it's a time that you might be thinking about setting goals and contemplating how you'd like to improve upon this past year. So you just might want to consider adding self-love and self-acceptance to the top of your list. Ironically, it just might help you accomplish everything else you had in mind.
I'm going to leave you with a quote from a fabulous book that I stumbled upon while researching this blog post. The quote relates to accepting your body as it is right now.
How can you begin to learn the lesson of acceptance? By recognizing that what is, just is, and that the key to unlocking the prison of self-judgment lies in your own mind. You can either continue to fight against your body's reality by complaining bitterly and immersing yourself in self-deprecation, or you can make the very subtle but powerful mental shift into acceptance. Either way, the reality remains the same. Acceptance or rejection of your body only carries weight in your mind; your perception has no bearing on how your body actually looks, so why not choose the ease of acceptance rather than the pain of rejection? The choice is yours. "
Found in "If Life is a Game, These are the Rules" by Cherie Carter-Scott PhD
Have you had an experience with self-acceptance? Please share it!
Recovery cannot simply be described as the reverse of these thoughts and subsequent behaviors, nor is it simply subjective. To sidestep semantic debates, the ever-peppy positive psychologists have coined the term “subjective well-being” or SWB (1). It is typically thought of as analogous to happiness but easily applied to the recovery process. One of the most important components of high SWB is having a sense of purpose (2). Thus, in recovery, our bodies become something more! They become purposeful.
Our bodies allow us to see sunsets, hug children, listen to music, go to school, pursue dreams, help others, and any number of amazing things (3). With purpose, we step outside of ourselves and become a part of something bigger. It's down right spiritual if you think about it! With purpose, recovery takes on a whole new light. It becomes easier to follow a meal plan and change behaviors. As the old saying goes, it is easy to endure the how, when you know the why.
Purpose is unique to the individual and may take time to discover or create. However, we all have “signature strengths” which can be used “in the service of something larger than yourself” (4). In many ways, recovery gives a person an opportunity to explore the endless possibilities presented by those two very vague descriptors of purpose. Isn’t it exciting? Maybe a little stressful, but very, very exciting. As an eating disorder therapist, I get the biggest thrill out of seeing people find out that they are so much more than their eating disorder. If you are struggling, please believe that there something else out there, and luckily, there are dozens of professionals in the area waiting to help you discover the rest of your life!
2.Seligman, M. (2002). Authentic Happiness. New York: Free Press.
3. Frankl, V.E. (1985). Man’s search for meaning. New York City: Simon and Schuster, Inc.
4. Matousek, M. (March, 2004). Choose happiness. O: The Oprah Magazine, 5(3), 190-197
I don’t often use a lot of self-disclosure on my blog. In fact, the last time I shared something personal was July 2011 when I talked about my body image. But after finishing my dinner tonight I had a little conversation with myself that I wanted to share.
I love chocolate…like, a lot. I especially love German chocolate. Ok, to be more specific I LOVE Milka Schoko and Keks and I love the Butter Biscuit by Rittersport. As luck would have it, Trader Joe’s sells those Rittersport bars at a very reasonable price. I typically have at least one back up bar in my treat bowl at home. (Yes, another reveal, I have a treat bowl at home.)
So I came home tonight after a very full day at work. In fact, it was an unusually full day. I sat down to a meal that was just what I needed on a cold, rainy evening. I was tired and hungry and couldn’t wait to eat. After I finished my meal I started to think about my Butter Biscuit waiting for me in the treat bowl. I got all excited knowing that it was just what I wanted to finish my meal. I broke off a line of chocolate and noticed that I was eating it with tremendous delight. The chocolate was making me quite happy, quite warm and fuzzy, and I noticed the stress of my day begin to dissipate.
And that’s when I started to think about the difference between eating WITH emotion and emotional eating. I talk about emotional eating most days with my clients and I can assure you that there is a difference! Emotional eating has a few particular qualities:
- It is used to cover up, diminish, numb or avoid challenging emotions.
- It happens with great speed and little pleasure. It goes in the mouth and down the hatch before you can savor a single bite.
- It leaves you feeling physically unwell after you have eaten.
- It creates disconnection with yourself.
- It is often followed by guilt, remorse, and shame.
Now what I described above is light years away from eating WITH emotion! Eating WITH emotion includes getting super excited to eat a meal you love or try a new restaurant you’ve heard friends raving about. Eating WITH emotion is eating things that are super yummy and satisfying. Eating WITH emotion leaves you feeling physically satisfied and content and emotionally balanced or even happy!
Not every snack is going to be the zen experience I described earlier. Not every meal will send you to Cloud 9. BUT, I truly believe that experiences of eating WITH emotion are vital to our health and well-being.
So when was the last time you ate WITH emotion? What did you eat? And if you haven’t lately, what’s stopping you? Hop to it, your body will thank you. J