Do you find yourself frequently thinking about or wanting sweets?
Do you feel obligated to finish a whole bag of chips or package of cookies once you start?
Do you eat more than you want to?
Do you ever feel bad about yourself after eating something?
Confessions of an Ex-Sugar Fiend
Most of us are familiar with food addiction, which is just as real as addiction to cigarettes, cocaine, and alcohol.
Mine started in residency. First it was sugar. Then caffeine. I was driven by stress, fatigue, and the need for quick “food” and comfort in the face of long, grueling work hours. It started with the occasional Dunkin’ Munchkin that was ubiquitously available at morning meetings after overnights awake caring for sick patients in the cardiac ICU. I became fond of the chocolate ones.
I quickly progressed to peanut M&Ms – surely a gateway drug for many of us – because the combination of fat, protein, and sugar kept me awake and staved off hunger overnight. Energy bars fit in there now and then. And those little 100-calorie cookie packages stashed easily in my white coat pocket next to my stethoscope and patient notes. Pretty soon anything with sugar and fat was fair game and if it had salt that was even better. Junk stashes were available at pretty much every nurse’s station, staff meeting, and in resident conference rooms. The really nice nurses brought in homemade brownies and cookies and gave us first dibs before morning rounds.
I drew the limit at soft drinks and artificial colors and flavors. Well, except for the M&Ms.
About halfway into my first year of residency I started drinking coffee in the middle of the night. Just a half cup – so I could make it through the night and until noon the next day, taking care of patients, writing careful medical notes, and presenting patients on rounds until that 30-hour shift ended. I really hate the taste of coffee but I am super caffeine sensitive so it’s a great “drug” for me. To circumvent the taste I added sugar and a small amount of milk.
I gained 8 pounds in that year – all around my waist – and got sick more times than I had cumulatively in the decade prior. My periods became irregular with intense sugar cravings and PMS prior to them (how do you spell cranky and bitchy?) and for the first time in my life, during one particularly coffee-heavy month of frequent overnights on the oncology ICU where pagers go off three times a minute, I had menstrual cramps. I slept poorly even on my nights off, and in my early 40s got some zits.
On my days off I craved a muffin for breakfast instead of my previously typical healthy fare of a natural foods, protein-rich breakfast, and I wanted sweets every day – usually in the mid to late afternoon. Even when I didn’t eat them, I thought of them. And I started to really love lattes. In spite of 30 years of living and teaching a healthy lifestyle, becoming a doctor turned me into a sugar fiend! Ah, the ironies of the medical system. It takes healthy people and makes us sick at all points of entry!
An Unexpected Detox
Everything changed when I went to Haiti to practice medicine for a month. I don’t mean to sound glib or insensitive, given the poverty and attendant starvation in that country (please read my blogs about my experiences there), but I sometimes think of that month as my Haiti detox. I lost those 8 pounds, completely stopped craving sugar and carbs, slept easily for the first time in over a year in spite of being on a crinkly cot under mosquito netting in a malaria-ridden country, and came back home physically refreshed in spite of a grueling month of providing high-risk obstetric and general medical care in the poorest country in the Western hemisphere.
During that month food was sparse and simple, with only a rare sweet available when a visiting medical team came down to provide services and brought a bag of M+Ms or mini-Snickers bars to share. These were always completely scarfed up by sugar- deprived Americans within an hour of being opened because everyone wanted a taste break from the peanut butter on cardboard-dry white toast, chicken, goat, grapefruit and over-cooked cabbage and onions that constituted breakfast, lunch, and dinner.
In addition to lack of availability of non-food junk (I refuse to call that stuff junk food ‘cause it ain’t food), I shared a limited amount of food with a large number of people at every meal so portions were modest (though it was amazing how much some people managed to heap on their plates – a testament to what Americans think is a portion size). Meals were served at regular times, and I had only nuts as a snack in between. I went to bed at ten and woke up with the roosters (really, there were roosters everywhere) at 6:30 each morning. I was physically active and loved what I was doing. I also remembered to slow down and be grateful for every bite of food I had. Because as really awful as the food was from a culinary perspective, I still had food while most of my patients, and the people in the entire country ate less than 2 meals most days of their lives. I worked hard but life had a rhythm, my schedule was in balance with nature, and I was filled with purpose.
Nearly immediately upon my return home I was served a muffin from a local bakery. I actually spit my first bite out into my napkin – the taste was so unbearably sweet I couldn’t tolerate it. I couldn’t eat any sugar for about 6 months after my return. I had developed a sugar addiction in residency and it was cured. I also had renewed mindfulness about eating and a new level of food gratitude. However, eventually the prevalence of sugar in my environment and the stress began to creep back in – so I then had to consciously and intentionally say NO, and maintain healthy lifestyle habits that prevented the addiction and cravings from starting up again.
My experience points out two simple truths:
Stress leads to food addictions and our food environments perpetuate them.
Victims of Addiction
Did I say we are victims? Yes. I used that term deliberately.
Let’s take a closer look at this. Here are some of the characteristics of an addiction:
1. Obsession with (constantly thinks of) the object, activity, or substance
2. Seeking out or engaging in the behavior even though it is causing harm (physical problems, poor work or study performance)
3. Compulsively engaging in the activity, that is, doing it over and over even if you don’t want to and finding it difficult to stop
4. Upon cessation of the activity, withdrawal symptoms often occur. These can include irritability, craving, restlessness or depression.
5. Lack of sense of control as to when, how long, or how much the behavior will continue (Ate 10 cookies when she only wanted one, “Can’t stop”.)
6. Denying problems resulting from engagement in the behavior
7. Depression about the behavior
8. Low self-esteem associated with the behavior and anxiety over the perceived lack of control
Any of these strike a familiar chord?
BIG FOOD is no dummy. Entire research and development teams at major BIG FOOD companies thrive on creating non-food junk with just the right amount of sugar, salt, or fat (or all 3 rolled into one tasty package) to make us want more – and more – and more. Not only do these foods feed our biologically driven survival urges, they feed our brain’s pleasure centers. This is the very same neurological wiring that is activated in drug addiction!
Food addictions contribute to a host of medical problems. Seventy percent of Americans are overweight and nearly 1/3 of adults are now obese. Obesity is rapidly increasing amongst kids and teens, and along with its culprits, a western diet and lifestyle, is spreading through the world like a scourge. The good news is that unlike smallpox, the plague, and HIV, vaccinations and medications are not needed – lifestyle changes, for most of us, are the cure!
Almost daily in my clinical practice I hear a new patient say, “I am trying to control what I eat but I have no self-discipline,” “I try to eat well but then I just can’t control myself when there’s a bag of chips or M&M’s in front of me – I can’t stop at a few,” and the one that really gets me, “I’ve been a really bad girl lately…” As a result, many women struggle with loss of self-esteem due to perceived lack of self-control over the foods they are consuming. Many women beat themselves up emotionally on a daily basis over lost food battles.
Yet food addiction is not simply – or even mostly – a matter of self-discipline. “Non-food junk” is carefully and deliberately manufactured to manufacture addiction. Scientists and marketing teams work with multimillion-dollar budgets to provide exactly what our exhausted, over-extended nervous systems are craving: sugar, salt, and fat. Dr. David Kessler, former commissioner of the US Food and Drug Administration under Presidents George H. W. Bush and Bill Clinton, describes the manufacture of food addictions by the food industry elegantly in his book The End of Overeating, as does Pulitzer Prize-winning journalist Michael Moss in his book Salt, Sugar, Fat.
However, while the food industry may create an environment that is hostile to health by supplying us with a stash of salt, sugar, and fat at every checkout counter in the country, something much deeper is happening to drive our sense that we need or want salt, sugar, and fat – and this starts in our most primitive survival centers in the brain and our adrenal glands.
The Primitive Brain
Ready for some science? Human beings have a highly conserved stress response system. This means it’s ancient and has stuck with us throughout our evolution. It is called the hypothalamic-pituitary-adrenal axis (HPA axis) and is our primitive fear and stress response, elegantly orchestrated to modulate most of the biological functions needed to help us avoid, and should we be unable to avoid, survive a life-threatening emergency. You’ve probably heard it called the fight-or-flight response. Running away from a saber tooth tiger is a classic example given to describe it. The HPA axis connects 2 centers in our brain – the pituitary gland and the hypothalamus – with two tiny organs called the adrenal glands that sit atop our kidneys.
When this system gets activated because we are exposed to a threat, our sympathetic nervous system goes into red alert and we start pumping out a chemical called cortisol. This causes our blood sugar to go up so we can get energy to our muscles to run hard and fast, raises blood pressure to protect us from a potentially fatal hemorrhage should that tiger gouge us, and activates our immune system by sending out a bunch of inflammatory chemicals to protect us in case that gouge gets infected.
In ancient times, we’d outrun that tiger (or the guy running next to us!), make it to safety, and the red alert would be down-graded and our bodies would recover. But in our modern society we’re almost always under sustained psychological stress – hanging out somewhere between orange and red alert much of the time. We pump out massive amounts of blood sugar we don’t use up because we’re not physically running away from the stress – we’re sitting at desks pumping ourselves full of coffee to keep our energy up – and coffee adds to the stress response! We store extra sugar as abdominal fat (and cholesterol) because that’s what cortisol tells us to do. Too many of us have high blood pressure. Many of us struggle with either frequent colds and infections, or autoimmune conditions – flip sides of immune system dysregulation caused by stress. And finally, many of us are “tired and wired” – a result of chronic activation of the stress system. Over time, exposure to high levels of cortisol can also lead to depression.
Here’s the rub: stress hormones cause us to crave fat, sugar, and salt! These are the main substances our bodies need to fuel this system. Under stress, our bodies think these are survival foods. In fact, what we often call comfort foods, to our stressed-out nervous systems may actually seem to be “survival foods.” Ever been sooo stressed or sooo over hungry that you need to eat NOW? That low blood sugar feeling can actually cause you to experience anxiety! And what do you grab for? Something with some combination of sugar, fat, and or salt. Don’t kid yourself – even if you’re going for dark chocolate, sea salt, and caramel – it’s still sugar, salt, fat! These ingredients calm our anxiety because in the short run they reassure the primitive brain that all is safe.
So it’s not really just that the food industry is causing us to have these cravings. Actually, STRESS IS CAUSING US TO HAVE THESE CRAVINGS and the food industry just conveniently provides the fuel. The long-term consequences, however you look at it, are weight gain, abdominal obesity, type II diabetes, hormonal problems, increased heart disease and stroke, and earlier death.
It Doesn’t Have to Be This Way: How To Break the Addiction Pattern and Gain Food Freedom
We do not have to be slaves to food addictions – or to stress. The key lies in quieting the primitive stress response and resolving stress as quickly as possibly. If we keep our bodies and brains feeling safe, we don’t have to live in a constant state of overdrive! The sugar, fat, and salt become less interesting – and when we don’t feel we need them, we stop craving them.
What do we need to prevent stress overdrive? Really, we just need the human basics: good nutrition, adequate rest and sleep, love, and fulfillment. It all comes down to making a healthy lifestyle – which includes engaging in meaningful activities and healthy social connections – a priority. It is in our power and interest to release the unhealthy patterns and build the healthy ones that allow us to break free of food addictions.
Here are 7 essential solutions for overcoming food addiction:
- Practice stress reduction: Your entire being needs to know that you are not at a 4 Alarm Fire! Even 5 minutes of mindfulness meditation twice daily can calm your nervous system, help your cortisol levels return to normal, and transform your life. I practice a “quickie” meditation whenever I feel my stress level mounting. It goes like this: While inhaling deeply to the count of 4, say to yourself “I AM” and on the exhale to a count of 4 say “AT PEACE.” Rinse and repeat x 4.
- Practice mindfulness in food choices and while eating. To do this simply take a moment before you eat something to really check in with yourself, from a place of centeredness, whether this is optimal for you and what your body really needs right then. Eat only when you feel relaxed. Eat slowly so that you can enjoy and savor your meals. Food should be one of our great pleasures in life. Mindful eating can help you break free from the grip of food addictions and feel better about your choices so that you can enjoy eating once again.
- Keep your blood sugar balanced. Blood sugar balancing is a key to alleviating food cravings. Eat a healthy breakfast with a good quality protein every day. Eat only nutrient rich foods, emphasizing proteins, high quality fats, and vegetables. Sugar sends your body on a roller coaster ride of highs and lows. The lows (hypoglycemia) trigger your brain, which depends on sugar for energy, to think you are in a state of emergency and causes your stress response to get activated full tilt boogie. Stable blood sugar = stable stress hormones, smoother emotions, and healthy weight.
- Keep your fridge and pantry health friendly. Simple logic: If you only have healthy food choices, you’re more likely to eat well.
- Optimal nutrient intake will help with satiety. If your body isn’t getting the nutrients you need, you will crave more and more food as your body tries to get the nutrition you are really craving. This takes you back to points 2-4. Taking a good multivitamin and mineral can also provide missing ingredients for optimal health.
- Sleep well. This means getting 7-8 hours each night. Less than this also leads to activation of the stress response and increased cortisol levels. We’ve all experienced fatigue leading to sugar cravings. Back to the same vicious cycle of stress, cravings, weight gain and so on.
- Find ways to feel full other than food. Sometimes feelings of emptiness, sadness, loneliness or boredom can also activate our stress response and trigger hormones and chemicals in our brains that stimulate cravings – a need to fill ourselves. Since fat, sugar, and salt “feed” us when we are in a stress response, calming the anxiety that arises when we feel fight-or-flight feelings, or depression, these are what we tend to crave when we feel empty emotionally. Tending and mending the broken parts of us is part of becoming whole and healthy.
Herbal medicines called adaptogens, for example, ashwagandha, rhodiola, maitake and reishi mushrooms, and American ginseng are especially helpful for restoring adrenal health, healing burnout, regulating blood sugar, and nourishing the immune system. They can also help with “brain fog” and memory problems that also accompany stress, fatigue, and sugar cravings, and they boost mood naturally. They are safe except if you are pregnant, on SSRI antidepressants, or medications for your immune system. I like a formula called Stress Manager by Herb Pharm – a blend of the liquid extracts of Eleuthero root, Reishi fruiting body, Holy Basil leaf, Rhodiola root, and Schisandra berry. I also like Vital Adapt by Natura Health Products, and another by Planetary Formulas called Reishi Mushroom Supreme. Gaia Herbs makes an excellent formula called Adrenal Health, and there are many other adaptogen blends on the market. They need to be taken for at least 3-6 months to be effective.
Love your body. Love your food. Love your self. BREAK FREE! YES, YOU CAN!!! And hey, a square of dark chocolate now and then is perfectly healthy so cut yourself a break over that one!
And as always, feel free to share your tales and triumphs in the space below.
Due to enormous volumes of comments I cannot respond to all of them, but I do read every single one and love hearing from you!
Wishing you ease, peace, and freedom,
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