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with Pamela Peeke, MD, MPH, FACP

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Tuesday, October 16, 2012

Food and Addiction: Hand Over the Chocolate and Nobody Gets Hurt

By Pamela Peeke, MD

Pam, Katie, and Shayla

For years I have listened to my patients referring to their eating problems using a drug vernacular. “I need another hit,” they would say, “Withdrawal is killing me,” or “I need to score some more.” In the back of my mind and those of my colleagues, we collectively wondered if there was an addiction going on here.

At that time in history, there were some compelling research studies that suggested a food and addiction link. But all of us needed more. I waited somewhat impatiently until there was finally a critical mass of data from neuroscientists. When there was finally enough excellent, credible published information, I did what I’d planned for so long — write a book, translating this groundbreaking new science into practical tips and tools to help people who were hooked on certain foods and felt helpless, hopeless, and defeated about it. When I launched The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction I must have hit a nerve. Within five days of launch, the book became a bestseller. All I cared about was that people could benefit from knowing that, as many have shared, “I’m not crazy — there’s something real going on in my brain”. For that matter, at the Weight of the Nation conference in Washington, D.C., last May, Kathleen Sebelius, Secretary of Health and Human Services, stated in her keynote address, “Obesity can be caused by any combination of factors. For some it’s an addiction like smoking.” That was a first from such a high-ranking government official.

Food addiction is real.

Capsule Summary of the Science: The first chunk of new science presented in the book—based on NIH research by Dr. Nora Volkow, Director of the National Institute of Drug Abuse — was possible through the use of unique brain scans (PET and functional MRI’s) enabling scientists to  peer into the brain and identify changes that occur when someone is actively addicted to anything—from alcohol to drugs to food. Scans show damage and impairment in both the reward center as well as what I call the “smarty pants” part of the brain, or the prefrontal cortex (PFC). Tap your forehead. Right behind it lies the PFC. It provides you with executive function—planning, organizing, creating, and reining in impulses. It helps power up your willpower as well as your won’t power. If it is dysfunctional, moderation becomes a moot point.

Food is meant to be palatable, rewarding, and pleasurable. Our reward system secretes rivers of the pleasure brain chemical dopamine when we are cued up to find our favorite foods as well as when we’re consuming them. Dopamine drives us to love the smoothness of fat, and consuming it helps us survive in times of famine. That primal reward and survival system has been working beautifully for thousands of years.

 

Then something happened: we changed up the food supply. To feed a large population, food had to be manufactured, frequently with added sugar, fat, and salt to enhance taste. Your primal brain was overexposed to the 24/7 availability of the sugary/fatty/salty food combos—the “hyperpalatables”. Most brains were overwhelmed with this daily tsunami of reward and pleasure. Consuming these kinds of foods left people feeling out of control leading to overeating. As a result, the brain’s primal survival mechanism kicked in. It drove down the number of dopamine receptors so that you didn’t feel this overload of reward and were no longer over-stimulated. That’s the good news. The bad news is that now you can’t feel the usual pleasure with one serving of a certain food, and suddenly you need more and more. Before you knew it, your buttons were popping and fitting into your jeans became mission impossible.

 

The bottom line is that the sugary/fatty/salty combos hijack your reward center and impair the part of your brain that is supposed to help you be focused, stay vigilant, and rein in the urge to splurge. The end result is that you cave to the crave every time. That’s the vicious cycle of addictive eating.

 

Physical-Mental Changes: In the study of food addiction, biology meets psychology. They are inextricably intertwined. In all addictions, there are organic brain changes as well as conditioned behavioral responses that both have to be addressed in prevention and treatment. We’re saying goodbye to the days when we assume this is only about willpower. That’s one component, but based upon the new scientific findings, healing the organic damage must be integrated into any intervention.

Who’s affected? Yale University researchers created a validated science-based quiz to see if you have an issue with food and addiction. Take a moment to check it out here. People of all sizes and ages can be affected. Experts predict that after rigorous population sampling is conducted, the majority of overweight and obese people will be found to be food addicted to some degree. Folks who are cross addicted (have more than one addictive habit such as food and smoking) tend to have a more pronounced experience and during treatment, need to really hone their vigilance and focus to stay on track through recovery.

What This Means to You: This new research is a game-changer. No longer will people be foisted into a one-size-fits-all approach to weight management and wellbeing. Instead, we have now discovered a new category of folks, those with an issue with food and addiction, who need a more customized and individualized approach to their problem. What’s that going to entail?

You have to do direct battle with the hyperpalatables. Identify which foods and beverages lead you to lose control. As with any addiction, you have to go through a withdrawal, and then enter a lifelong recovery. I use my trademark three pillars: Mind, Mouth, Muscle to power you through the process. You’ll be changing up entrenched lifestyle habits as well as healing your brain’s reward and PFC centers.

Join Shayla on Her Journey: I was thinking about the best way to share this science with WebMD readers. The answer is to make it real. When I appeared on one talk show, I was asked to work with an extraordinary young woman, Shayla, who has a profound food addiction, especially to sugar. Watch the show and pay particular attention to her segment and the video of Shayla at home surrounded by her chosen hyperpalatables. It has been an honor to work with her as she has courageously taken herself on, detoxing while living her rich and full life as a mother, spouse, mental health professional, and part-time college student. Beginning this week, follow her experiences as she strives for progress, not perfection, and tackles the daily challenges of coming clean and staying that way. I’ll also be introducing other wonderful men and women who are looking for support in their journeys. Check out our Diet Community Discussion Group and help support your fellow WebMD members. Whether you have already achieved your health and wellness goals or are beginning or somewhere on the journey, everyone wins. It’s through sharing that the lessons come alive and become meaningful and relevant to your life.

We look forward to vibrant and terrific communication on the blog and the exchange.

 

Posted by: Pamela Peeke, MD at 1:00 am

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