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Does Food Addiction Require Abstinence?



food junkiesRecently, I had the opportunity of meeting Vera Tarman, a Toronto addiction physician, who is also a self-proclaimed “food addict” and author of the book, “Food Junkies: The Truth About Food Addiction“.

It is fair to say that talking to Tarman and reading her book (of which she happily gave me a copy) has definitely given me food for thought.

To start with, her book “Food Junkies” is not a typical diet book or even a treatment guide to food addiction.

Rather, it is a rather compelling treatise in support of the┬áexistence of ┬áa discrete and definable subset of obese (and non-obese) individuals who may well be considered “food addicts” and for whom the only viable treatment is complete abstinence from their respective trigger foods.

To put things simply, Tarman (and her co-author Philip Werdell) describes three categories of “eaters” (the following words my attempt at paraphrasing the central ideas as I understand them):

Normal Eaters: this is by far the largest group of individuals with obesity, who may overeat for no other reason than that they like food, are surrounded by food, pay little attention to food, let themselves go hungry, have food pushed on them, and/or really don’t obsess or worry about food at all. Normal eaters can learn to control their eating through education and coaching and by changing the circumstances that foster poor willpower: better sleep, stress management, improving social skills, changing their personal food environment, etc.

People with Eating Disorders: for┬áthis group of individuals, obesity is not the primary problem, rather it is just another symptom of the underlying emotional disturbances that drives their “pathological” eating behaviour. The “spectrum” of these disorders ranges from rather mild “emotional eating” to full blown “binge eating syndrome”. The primary driver of their overeating┬áis psychological (e.g. trauma, grief, abuse, etc.). Once the psychological problem is identified and resolved (or managed, e.g. though cognitive behavioural therapy), they can gain control over their eating behaviour, which in turn can help them control their weight problem.

Food Addicts: this group of individuals is literally┬á”addicted” to certain foods (usually foods high in sugar, flour, fat and/or salt) in the same manner that a drug addict would be considered addicted to their drug, with the same clinical signs that range from denial and loss of control, to physical symptoms on “withdrawal” and relapse that can be prompted by minimal exposure, even years after being “clean” or “sober”.

According to Tarnan and Werdel, this grouping has important implications for clinical management.

While a “normal eater” and someone with an “eating disorder” can eventually learn to practice “moderation”, this is virtually impossible for the true addict – the only viable strategy for them is complete and lifelong abstinence (best coupled with a 12 steps program or something similar).

For the true “food addict”, no amount of education, psychological counselling or attempt at “moderation” will ever lead to success. Any attempt to get the “food addict” to learn how to “use” their “drug” in moderation will be as futile as trying to get a drug addict to learn how to use alcohol or heroin (or any other drug) in moderation (the vast majority will fail).

As to how the “food addict” can practice abstinence, the Food Junkie acknowledges that this is difficult but achievable. Obviously, the goal will be to completely eliminate and abstain from the “trigger foods”, which will vary from individual to individual (and people may well bounce around from one food to the next). Nevertheless, a good place to start is probably with foods that contain sugar, flour, are highly processed, high in fat or otherwise “addictive”.

For some it may mean a low-carb, for others a paleolithic diet, or simply a fruit and vegetable-based high protein diet with some fat thrown in for satiety – here Food Junkies discusses the various options, while acknowledging that there is no hard and┬áfast rule – only, that it can be achieved (a point that the authors illustrate using their own stories and those of their patients).

All of this said, the authors are the first to acknowledge that there is much about food addiction that we don not yet know or fully understand.

For one, making the diagnosis is anything but easy – often, this “diagnosis” can ┬áonly be made when all attempts at “moderation”, despite best efforts, fail.

The authors also accept that we do not know the prevalence of true food addiction – only, that it may be higher than we think.

If nothing else, the book is a quick and fascinating read for anyone interested in the issue – patient or professional.

It certainly has got me thinking about whether or not “abstinence” may indeed be a viable approach for some of my patients.

For anyone, who has questions regarding this concept, Dr. Tarman has kindly agreed to address these in a subsequent guest post on these pages – so please send me your comments/questions.

@DrSharma
Edmonton, AB

 

20 Comments

  1. Dr. Sharma, I’m so happy to hear you’re opening up to the possibility that addiction may be real and that abstinence, for some, is the only answer. I happen to be one of those people and I’ve done it all including bariatric surgery and abstinence from sugar and flour is the only thing that’s worked. I also have BED (Binge Eating Disorder); however, I find it odd that abstinence is such a challenge for main stream medicine to accept. NO, it’s not everyone, but it’s just a continuum really from emotional eater to BED to addiction.
    Most people can drink alcohol without a dependency forming, but not everyone. If you are someone with that problem, as I am post bariatric surgery, and you keep being told it’s all about getting therapy, learning coping behaviours etc. without ever looking at the food what sense does that make?
    The food industry knows what it’s doing! They’re just turning dials to get the exact right bliss point I believe Michael Moss called it in his book Salt, Sugar, Fat.
    Is it really that crazy that it might be the food? Really?
    Thank you for keeping an open mind and considering abstinence as one of the tools you use to work with people who suffer with obesity, Dr. Sharma!
    Robin

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  2. I read the Macleans article on this book with interest. Health care providers often give messages about moderation, portion size, and “all foods can fit.” For many people, trying to completely avoid foods can lead to overindulging or cravings. This book is evidence that for some individuals, avoiding some foods is the most helpful strategy.

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  3. Being obese from childhood and eventually finding out I have certain trigger foods, I think it’s possible to have a food addiction. I was in a residential bariatric program where I learned this about myself and began to figure out what would work to help me gain control. Unfortunately, there were a few people in the program who had more severe addition behaviors who would have been better served if they were treated as addicts instead of just fat people who needed to be put on a diet. Sadly, two of them died during the time I was there.

    In my own case, anything high carb, like bread, pasta and most sweets (milk chocolate in particular) triggers binge eating for me. Once I cut out all the triggering foods and started eating low carb, I was able to get my eating under control with no more binging. A bonus: weight loss, better mobility and better numbers on all my health markers.

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  4. I never thought of myself as a “food addict”, but I do probably fit into that category.

    I follow the “Bariatric Food Pyramid” used by people who have had bariatric surgery. I haven’t had surgery, so I eat larger servings than they do. The diet is satisfying and successful, though much slower than with surgery (So far lost 35 pounds in 9 1/2 months.) It’s similar to the diets you describe.

    In the last 9 months I have gone way off plan three times.

    For my birthday, I had cake and ice cream and chocolates, thinking I’d get back on track after the party. The next day I was starving. I ate more, I ate more sweets, and I got hungrier and hungrier. It took me 2 weeks of white-knuckle effort to get back to being comfortable on my diet.

    Same thing happened for a family event – eating treats, getting really hungry, and taking a week to recover.

    On Dec 25, I decided to have one day only of special holiday food, chocolates and dessert. On Dec 26 I was “starving” again, and the Christmas goodies I had avoided suddenly seemed irresistible. I gained 10 lbs in all, and it took me a month to lose that weight. Finally , Feb 10, I’m comfortable on my diet again, and slowly losing weight.

    I ‘m not going to do that again. For Valentine’s I’ve asked my husband for No Chocolates!! It’s not just the extra calories I’m worried about, I know chocolates would just set off my cravings and hunger.

    On the topic of addiction, I wonder what you think about Robert Lustig on the metabolism of fructose.
    Robert Lustig – Bad Sugars: Addictive and Hazardous to your Health:
    https://www.youtube.com/watch?v=aXlL7yWtAAg
    Lustig has other YouTube videos.
    It seems interesting to me, but I have no way of knowing if his description of metabolic reactions is accurate.

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  5. I’m definitely a thin person with food addiction, according to this definition. The loss of control is terrifying. The most frustrating part to me is people who insist that “everything in moderation” is the only way to go, despite the very clear evidence that this simply does not work at all for me. It’s exhausting to try to explain to people that no, I’m not being unreasonable, no, I’m not going to rebound binge from “depriving myself,” no I REALLY CANNOT have “just one” cookie, no it really is easier and in fact necessary for me to abstain. People get very defensive and judgmental because they think that when I say “moderation doesn’t work for me” I’m somehow judging their choices or trying to take their treats away from them. I’m not! If moderation works for them, great! Frankly, I’m jealous because I would love to have a cookie now and again without devolving into a two-day food bender followed by another day or so of insane withdrawal depression. I wasted way too much time trying to force myself into the “moderation” model and I’m so glad I eventually said screw it, I’m going to do what works for me regardless of what is supposed to work according to the “experts.”

    My trigger foods have also fluctuated over time, as Tarnan points out. Sadly this tends to be in the direction of more things I’m triggered by. 🙁 Also, I’ve noticed that some trigger foods aren’t even the typical “processed foods” – a big one for me is any kind of nut butter, even if it’s literally just nuts ground into a paste with no added salt. It doesn’t get much more unprocessed than that, and yet it’s a huge trigger for me.

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  6. I am maintaining a 60-pound weight loss over the last decade, 40 pounds of it stabilized over the last two years, with a 12-step approach. The “phenomenon of craving” described in *Alcoholics Anonymous* surely applies to me, and I have abstained completely from my main trigger foods for a year now–cookies, cake, pie, ice cream, chips, and high-fat combo foods like cheesy starchy casseroles and batter-fried foods and such, as well as most refined-white-flour items. This, along with the daily “spiritual fitness” required for 12-step recovery, has given me a measure of peace. But I am discovering that I need to draw my lines a bit differently and include other refined carbs, particularly in combination with fat. Cold cereals are becoming a problem for me, and lower-fat crackers, and perhaps even whole-grain refined flour items, and so forth.

    This is a complex malady but not impossible–it takes a lot of willingness, as well as the hope that comes from seeing the results of recovery efforts. Interestingly, alcohol is not a problem for me–and the analogy of alcohol to my problem foods helps me appreciate my own problem as well as that of alcoholics (and drug addicts, etc.). I still have dozens of pounds to lose, but I have a program to deal with my problem when nothing else would deal with it before.

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  7. Hi there,

    I am surprised that, like many other addictions, 12-step support groups are not mentioned. I have been abstinent from my binge foods for almost 4 years, and blessed with a large amount of weight loss (from Obesity category 4 to overweight). The blessing is that, with my support group and it’s steps, I am able to be sane around food. My kids can eat my binge foods, and I don’t want a bite. My relationships with my family and the rest of the world have improved as well.

    While we don’t promote Overeaters Anonymous like “weigh and pays” are, hopefully there can be solace some someone who has trouble putting down their drug of choice.

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  8. For me, this is a meta-issue, not just about food addiction, but about what we understand about addiction in general. Scientific study seems to be suggesting that addiction has little to do with the object of addiction and everything to do with social and psychological and “brain” matters. One classic example is of Vietnam veterans who developed severe heroin addictions in Vietnam but, once at home in a less stressful environment, surrounded by loved ones, etc., they were able to fairly quickly end their addictions. I know innumerable alcoholics who were able to moderate their drinking when they realized that their drinking was causing them harm. I recommend the work of Dr. Carl Hart at Columbia University for a more scientific AND sociological understanding of addiction.

    So frankly, I don’t accept the idea of a food product with magical properties. I think the mind is very, very powerful. If you had asked me ten years ago whether I was addicted to sugar and/or chocolate, I would have said yes, absolutely, so much so that I refused to submit to the notion that I needed to abstain from eating them. But post-bariatric surgery, a constant case of “dumping” every time I eat more than a tiny amount of sugar has turned me into a very moderate eater who is completely satisfied by a bite-size peppermint patty or one Oreo cookie. A little shock therapy? Yes. I decided I preferred foregoing chocolate to avoid barfing. It’s a subtle mind-body interaction. I’m not sure where the psychology gives way to physical response, but I am cautious about throwing the word “addiction” around when referring to food, or anything else, for that matter.

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  9. Hi,

    I have a question for Dr. Tarman: does the addiction ever stop jumping?

    A bit of bakground: after losing weight (calorie restriction) I started having out-of-control eating episodes. Not quite binge eating, but close. Some foods were definitely triggers: desserts, cold cereals, candies, snack foods. So I stopped buying and eating those foods. Then I started overeating and obsessing about cheese. So I quit cheese. Then peanut butter. Etc. That’s what I mean by the addiction jumping. It seemed like I would never get to the end of it.

    In your experience, do people ever find a way to eat that leaves them comfortable? Or will a person always get triggered, no matter how many foods they eliminate? Does weight loss change the picture?

    Thanks.

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  10. This is one reason why I think the word we should use to describe excess adiposity is “obesities” in the plural. I think if this idea might help diminish the judgment and humiliation that people who can just “moderate,” with some effort, heap onto people who cannot, even though they go to Herculean extremes.

    There are people who can maintain a reasonable level of health and weight stability through paleo, through vegetarianism, through general moderation, through whatever, and people who cannot. For some people everything proves elusive (and they do try everything!)

    This is just so sad that we cannot admit how complicated weight-loss maintenance is and how nascent our knowledge.

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  11. Hi Valerie
    You are describing a phenomenon that many food addicts experience. As with gambling or other process addictions, sometimes it is just the anticipation of the food (or activity) that gives the rush – dopamine is after all the neurochemical of desire… and for food addicts who have travelled down many roads, desire can switch to pretty much anything. A person can be desirous / addictive to just quantities of food – even carrots!
    This is why trigger foods can switch or as you say ‘jump’. In the addiction field, this is called substitution and happens all the time. Witness cigarettes for food, marijuana for alcohol etc.
    You are also illustrating why food addiction really can not be dealt with alone – if you had a mentor / food coach who was helping you, this jumping would be easier to deal with.

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  12. Thank you for your responses! I was surprised to hear that so many people who support the idea of food abstinence, because as you say, Debra, there are many ‘obesities’ and not all are food addicts.
    I will be writing a guest post on food abstinence – the pros for food addicts and the cons – if not food addicted.

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  13. I missed another question – about Dr Lustig’s work. Some excellent videos have been mentioned -‘ sugar the bitter truth’ gives a nice explanation of the metabolism of frutose and how it creates the same damaging effects as alcohol on the liver. I believe his explanation of metabolism is sound and his warning should be heeded!

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  14. I am a food addict. I am pleased that this subject has been written about so well by Dr. Tarman and Mr. Werdell. Thank you, Dr. Sharma for your excellent article.

    Like so many others, I was morbidly obese from a young girl until I began to treat my food addiction. I gained and lost hundreds of pounds following too many diets to mention. I was great at losing weight. I finally went to treatment in 1986 and 1990 and have been free from bingeing and restricting for over 25 years. And, it was not easy. I found it required letting go of the substance that was my “everything.” Sugar (and sugar, flour, fat combinations) and high volume were my drugs.

    I have had to completely put down my addictive foods and weigh and measure every thing I eat exception. That means every meal of every day. Bondage? No! Crazy? No … certainly not compared to how CRAZY I was when I was in the food. Now I am free. I am free of 195+ pounds for over 22 years. I am free of physical craving and mental obsession (as described in common 12-Step literature).

    It is ONLY through treating myself as a food addict and a spiritual program that I have been able to maintain freedom from this insidious disease. There is a treatment that works.

    Thank you for the work you are doing to help save lives.

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  15. Thanks for your time, Dr. Tarman.

    However, I still don’t know if the jumping ever stops (in your experience). Do you just keep abstaining from whichever new food becomes a problem? Or do you deal with it differently?

    Also, I am pretty sure that most addicts quit in their own, no matter what 12 steppers like to say about it (for instance, all ex-smokers I know have stopped on their own). But if I had a mentor, what advice would he give me to deal with the jumping problem?

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  16. Hi Valerie

    Yes, it is my experience that jumping does stop or at least diminish – though the impulse to jump again I think often rears its head. I think a variety of techniques can be used:

    1) stop – since some foods are very triggering – processed food has been manufactured to be addictive – so chips can lead to ice cream – and so on.

    2) portion control of healthy foods (if the problem persists once your diet is cleaned of processed foods) ie point system of WW.

    3) learn to recognize the impulse and deal with it ie mindfulness or any number of relapse prevention tools (call someone, write, distraction).

    If the impulse to jump stays stronger than ever – I would question what is keeping up that impulse (regardless of the landing spot – candy, carrots, nuts). In addiction circles, we ask if the person is self-medicating their distress ie hungry, angry, lonely, tired. Here is where addiction doctor claims that addiction is not just a physical condition but a psychological one, and even a spiritual one.

    You may be right that there are many people who quit their own drug habit ie smoking. This is partly because the societal expectation and support to quit has helped many people in the last years – showing that support is pretty important to success. Sadly, until we have respect for the addictive nature of food, we do not have this support round food yet.

    As well, people who quit smoking etc often jump – right to food. It is often the last landing point. My book has many examples of people who have been able to quit nicotine, cocaine, alcohol – but not food. There is something about the fact that the reward center of our brain was actually designed to enjoy food specifically (nicotine, alcohol etc only hijack this system) – that makes it harder to resist it lures once the addiction (physical changes to the reward pathway) has been established.

    Frankly, I do not know many addicts who have truly quit on their own (and not just jumped to something else or are still obsessing struggling, wishing they could smoke, drink, eat…). I admit, my practice is biased towards the people who continuously struggle. But I do know many people who have quieted their urges and few of those have done it on their own. They have tried unsuccessfully.

    It isn’t only 12 steppers who say you need others to stay sober – it is weight watchers, and other diet programs that have now attached support groups attached to their programs. People using apps to count calories are encouraged to join the on-line support that comes with their web program (ie myfitnesspal).

    A mentor’s advice? The jumping problem is a nice description of the addictive drive, and you can’t beat it on your own – or you would already have done so. Find support where you are most comfortable and then build the external necessary changes into your daily life (ie clear the fridge of tempting foods, don’t go to buffets, tell friends not to offer you a piece of cake etc) that will buffer the urges when they come – and they will, at your most vulnerable moments. It is those moments, when you are drowning in your ‘need’ that you need a hand to steady you or pull you out.

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  17. I don’t know whether I have been clinically obese, but have been up and down over the years. I’ve recently been diagnosed with rheumatoid arthritis and thought I should lose 20 to 30 lbs. to help my joints. My knees were swollen. I researched a lot and found that inflammation can aggravate many conditions. I researched foods and found that wheat, rye, barley, etc. and sugar causes inflammation. Up to this point I was having major sugar cravings. Couldn’t stop. Also had 3 days a month where no matter how much I ate I couldn’t get full. Decided to stop eating bread and other grains. In a matter of 6 weeks my knees went back to normal size and the sugar cravings were gone! I had realized before that when I ate bread I then craved sugar. I can now have a piece of chocolate and then stop. It’s amazing! It really helps to find out what your triggers are. I’ve lost 2 inches off my waist and 9 lbs. My joint pains have subsided to almost nothing. I’m losing weight slowly, which is okay. I make coconut flour bread and I love it and muffins. I’m so happy I just want to share this with everyone in case it can help.

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  18. One comment wrote: “For my birthday, I had cake and ice cream and chocolates, thinking IÔÇÖd get back on track after the party. The next day I was starving. I ate more, I ate more sweets, and I got hungrier and hungrier.”

    This happens to me a lot. I have always thought it was just emotional eating and bad habits, or both, but when I really think about it, it is the one “cheat” day that so many say is “ok” that leads into to a full out binge. The HUNGER is real, I get so hungry after one indulgent “cheat” meal, legitimate, pit of my stomach, hungry. I really don’t understand this link but if abstinence will prevent it, then that’s probably the best option.

    I have no idea if I am a food addict (or some combination of all 3?), but there may be reasons I refer to myself as “falling off the wagon” or being a “carb addict”.

    I also know that there have been times when being ‘deprived’ a certain craving can lead to some extremely angry behavior, bordering on rage, with crying, yelling, etc.

    Either way, I do not think “cheat day” is a good strategy for me. I may have to accept that certain foods must be cut out of my life permanently, or at least until I have a lot more control over my eating. (not just after reaching my goal weight)

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  19. Hi Blue:
    If you are not sure that you are a food addict – here are 20 questions to ask yourself. Keep in mind, this is NOT diagnostic, but if you can relate to more than a few of these, I suggest you check my book out or go on-line for more info on the subject. You might be quite surprised at how helpful some of the info is (food addiction.org, addictionsunplugged.com) – in light of what you have described:

    1. Have you ever wanted to stop eating and found you just couldnÔÇÖt?
    2. Do you think about food or your weight constantly?
    3. Do you find yourself attempting one diet or food plan after another, with no lasting success?
    4. Do you binge and then ÔÇ£get rid of the bingeÔÇØ through vomiting, exercise, laxatives, or other forms of purging?
    5. Do you eat differently in private than you do in front of other people?
    6. Has a doctor or family member ever approached you with concern about your eating habits or weight?
    7. Do you eat large quantities of food at one time (binge)?
    8. Is your weight problem due to your ÔÇ£nibblingÔÇØ all day long?
    9. Do you eat to escape from your feelings?
    10. Do you eat when youÔÇÖre not hungry?
    11. Have you ever discarded food, only to retrieve and eat it later?
    12. Do you eat in secret?
    13. Do you fast or severely restrict your food intake?
    14. Have you ever stolen other peopleÔÇÖs food?
    15. Have you ever hidden food to make sure you have ÔÇ£enough?ÔÇØ
    16. Do you feel driven to exercise excessively to control your weight?
    17. Do you obsessively calculate the calories youÔÇÖve burned against the calories youÔÇÖve eaten?
    18. Do you frequently feel guilty or ashamed about what youÔÇÖve eaten?
    19. Are you waiting for your life to begin ÔÇ£when you lose the weight?ÔÇØ
    20. Do you feel hopeless about your relationship with food?
    Copyright ┬® 2000-2010 Food Addicts in Recovery Anonymous

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  20. Thank you! I will be blogging about my key take aways after reading the book, my experiences and sharing what I’ve learned over the last 40 years trying to moderate sugars and grains.
    Trying to moderate was miserable and painful – physically and emotionally.

    Now 3 years in recovery mode, the next 40 years (age 49 now) will be the best yet. I use a Paleo-ish food template, modified for auto-immune disease in 1997. 70 pounds and binge urges fewer. Now that I can’t ignore my 23nme geneotype (FTO, extra ghrelin, etc) I’m super glad that science and mainstream medical is catching up.

    Thank you for talking about this topic. I know it will help many. Onward!

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