Thursday, September 3, 2015

Is sugar your personal crack?

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“Sugar is my personal crack," Abby declared,.

She started treatment to address her "sugar addiction" and she also wanted to stop thinking about food, all day, every day.   She was “obsessed” with sugar and hated that she had no willpower (or so she thought).

Abby often baked cookies with her young daughter, and sent the child out of the kitchen on some pretext so she could eat cookie dough alone.  She hated herself for doing this but couldn't stop.

Abby was going through a painful divorce and also felt stuck in an unsatisfying job.  Food both comforted and distracted her from her problems. 

She didn’t have enough sweetness in her life, literally and figuratively.  Sugar was her primary source of relief.

Like Abby, people who lack pleasurable activities in their lives may be overly reliant on food for enjoyment.  Therefore, the more fun they have in their lives, the less they need food for that purpose.

Abby worked through the pain of her divorce, changed jobs and took up new hobbies.  Baking cookies became something fun to do with her daughter, not an exercise in willpower.

Eventually she could bake cookies without bingeing on cookie dough.  She could even eat it in moderation.

A recovered alcoholic cannot have just one drink.  A meth or heroin addict cannot stop at one hit.  

How was it possible for Abby to have just one bite of cookie dough?

People who feel powerless over sugar and white flour often consider themselves food addicts.  But is food addiction real?

Some studies (Gearhardt et al, 2009, Volkow 2013) make a case for the reward theory of food addiction, which correlates certain foods with increased dopamine levels.  Dopamine is the chemical that mediates pleasure and motivation in our brains.  The theory of food addiction is this: 

Sugar and other foods activate the release of dopamine.  People eat sugar, get a dopamine rush and feel better, then eat increasing amounts to get the same experience they previously felt with less.  Food addiction theory also points to changes in the brain as evidence of substance addiction. 

Sounds reasonable, right?  

But, wait.  There is more to the story.  

Sugar does change our brains, as do certain drugs.  In fact, any activity involving pleasure does so, including sex, exercise and spending time with friends.   One study (Salimpoor 2011) proved that listening to music had the same impact on the brain as cocaine. 

Psychotherapy also changes the brain and can be more effective than medication (Mayo-Wilson, et al, 2015).   Relationships with other people also have a direct impact on our brains (Schore, 2010, Cozolino, 2006, 2014).

Binge behavior actually decreases show that bingeing behavior decreased when people were asked to eat their “forbidden” foods as part of their treatment (Kristeller 2011, Smitham 2008).  When given permission to eat these “addictive” foods, people ate less instead of more, the opposite of what food addiction theory would expect.

This highlights the importance of unconscious psychological motivations with regard to bingeing.  Although recent studies (Ziauddeen et al, 2012, 2013) refute food addiction, the science may not matter to someone who feels addicted, like Abby, for whom sugar was crack. 

The reason is this:

We have brains, the physical control structure of our bodies, but we also have minds.  

Our brains do not operate alone, nor do our minds function independently of our brains.   

Research that focuses exclusively on the brain as the primary source of the behavior ignores the powerful influences of the unconscious mind, as well as the familial, social, cultural and other influences that impact our brain.   

 People turn to food for a reason – for comfort, to alleviate anxiety, to distract from painful or upsetting thoughts, to sleep, symbolically fill a void, or calm down.

Eating is a way of managing difficult internal states.   It’s the mind’s way of protecting itself.

For Abby, cookie dough provided a rush of brain-based pleasure.  Focusing on food also distracted from her helplessness over the divorce and career problems, which had to do with her mind.

“But nothing is bothering me.”

People who overeat without any underlying emotional issue may not be consciously aware of what is upsetting them.  

This was the case with another patient, Jillian.  While watching TV after a good day, she suddenly started craving ice cream. 

“Nothing was bothering me,” she said.  “I’m obviously addicted to Chunky Monkey.”

As it turned out, Jillian was watching a TV show about a difficult relationship between sisters, which activated anxiety about her own problems with her sisters.  Before that anxiety reached conscious awareness, she turned to ice cream for relief.

Food addiction vs. eating addiction

Jillian ate to protect herself from painful affects.  Her “addiction” was to the behavior of eating, not the substance of ice cream – it could be considered an eating addiction, not a food addiction.  

When she learned to recognize her triggers and cultivated new ways of relating to herself, she stopped craving ice cream. 

Whether or not the term “addiction” is used, the first step to changing behavior is to identify what’s going on inside, then cultivating new ways of responding to difficult emotions and conflicts. 

If you automatically turn to food when you’re upset, you can learn new ways to support and soothe yourself.  When that happens, you stop using food to cope.

It takes time, but it is possible - if you put your mind to it.


References:

Cozolino, L. (2006, 2014).  The neuroscience of human relationships: attachment and the developing brain.  New York, NY:  W.W. Norton & Company, Inc.

Gearhardt A.N. et al. (2009) Preliminary validation of the Yale Food Addiction Scale. Appetite (52):430-436.

Hebebrand, J. et al.  (2014) “Eating addiction”, rather than “food addiction” better captures addictive-like eating behavior.  Neuroscience & Biobehavioral Reviews, Volume 47: 295-306.

Kristeller JL, & Wolever RQ (2011). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Jan 2011; Eating disorders, 19 (1), 49-61.

Salimpoor VN.  (2011) Anatomically distinct dopamine release during anticipation and experience of peak emotion to music.  Nature NEUROSCIENCE: 14 (2): 257-262.

Schore AN. (2010).  Attachment and the regulation of the right brain. Attachment &
Human Development; 2: 23-47.

Smitham.L. (2008) Evaluating an Intuitive Eating Program for Binge Eating Disorder: A Benchmarking Study.University of Notre Dame, 26 November 2008.

Volkow ND, Wang GJ, Tomasi D, & Baler RD (2013). The Addictive Dimensionality of Obesity. Biological psychiatry PMID

Ziauddeen H., Farooqi I. S., Fletcher P. C. (2012). Obesity and the brain: how convincing is the addiction model?. Nat. Rev. Neuroscience 13: 279–286.

Ziauddeen, H., Fletcher, P.C., (2013).  Is food addiction a valid and useful concept? Obesity Reviews, Volume 14, Issue 1, 19-28.

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