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I feel the need to apologize for the boring/academic-sounding title to this post. If you searched Google expecting a list of PubMed entries on this subject and landed here, I expect you might be mildly disappointed, but don’t go yet!  What follows is my opinion on why we can’t apply traditional addiction interventions and techniques to the problem of excessive food intake based on almost twenty years of personal and clinical experience as a holistic health coach and nutritionist. I hope you’ll stick around and let me know what you think of my ideas.

I wear two hats in this conversation; one as a holistic nutritionist that’s interested in healing people’s guts, reducing inflammation, helping them lose extra weight and reversing chronic disease with holistic health practices. The other is as a wellness coach that has witnessed myself and my clients struggle with food, what to eat, what not to eat, decades of dieting, food restriction and the significant emotional turmoil associated with it.  I think I have a unique perspective with a foot in both camps that I’d like to share here.

Should we be calling it “food addiction”?

First off, I have to tell you that I dislike the terms “food addict” and “food addiction”.  I’m not even fond of the term “substance abuse” in the context of food.  Most of our research, education and conversations surrounding the topic of addiction in general, use terms like “substance abuse”, “substance use disorder”, “substance abuser”, “addict” or “user”.  The concept of addiction as a disease or illness is still very prevalent in the medical and addiction communities, even though more progressive social workers and mental health professionals are actively discouraging that perception in favour of a social, biological and psychological model of substance use disorders.

My approach as a health coach has always been holistic, meaning I consider physical mental, emotional and spiritual elements in any intervention I may recommend for my clients.  Therefore, my perspective on addiction of any kind is also influenced by that whole-being approach. That perspective is amplified further still when we’re considering “addiction” to food. I feel that labeling someone as being a “food addict” or having the disease of “food addiction” is not helpful in any way and is more likely to do harm and keep people stuck in a mindset that one is “uncurable or diseased”.

What if this is NORMAL?

 
I prefer to view any struggle we may have with eating too much food as a normal reaction to our modern lives and our modern food environment. That potential for struggle is exacerbated for some people by social, biological and psychological factors that we’ll discuss later.

In my view (and in the view of obesity researcher Stefan Guyenet and biochemist Robb Wolf to name a couple of experts in this field), we’re naturally wired to eat as much food as possible as an evolutionary guiding principle.  That natural inclination gets amplified by the calorie-dense, nutrient-void super tasty food in our modern food environment that we’re surrounded by all the time.  In fact, there’s evidence that the hyper-palatable foods in our modern environment damage parts of the brain and wreak havoc on our feedback systems that would tell us when we’ve had enough to eat. These modern hyper-palatable foods are nothing like the natural, unprocessed foods that we evolved eating and they have a negative effect on our brains.  Food that’s devoid of nutrients and fiber just doesn’t satisfy hunger in the same way as natural foods. That’s why you can eat an entire pizza and still want a bowl of ice cream for dessert. That’s actually a NORMAL reaction to these foods, not food addiction.

Next, we have to consider that these hyper-palatable foods also cause huge hits of feel-good brain chemicals that act a lot like drugs and make us crave them. You won’t get a dopamine hit from eating nuts and berries, but you can get it eating a bag of chips or a chocolate sundae.  When food has the capability to cause surges of those brain chemicals, it’s pretty natural that we would want to eat too much of it, especially given that life really sucks sometimes and we’re just looking for a way to feel better.

Humans have been using substances to make us feel good for as long as there have been humans, so it makes sense that we’d start using food in this way now that it’s morphed into something that acts more like a drug than it ever has in human history. 

It’s a fact that modern processed foods like refined sugar, grains, salt, flavor enhancers and fats have the power to cause surges in brain chemicals and feel-good hormones that we didn’t evolve to face, and I agree, that’s a problem we need to address. I also agree that some people are more prone to being impacted by those chemical surges and may even be more prone to the brain damage those foods can cause that impact our satiation feedback loops for a variety of reasons (but that doesn’t mean they’re diseased).

That said, some researchers suggest that these hyper-palatable foods are even more addictive than drugs like cocaine and consumption of them inevitably leads to addiction and major issues for all people. There are a number of “food addiction” experts that feel that abstinence from hyper-palatable or “trigger foods” is the only solution, but I disagree. I’ll explain why later.

So, yes, the foods are a problem and yes, sometimes our genetics is a problem and yes, sometimes our psychological conditioning plays a role but our society is a problem too.  When we feel excluded, stressed, unloved and need to feel better, reaching for a “feel-good substance” of some type is pretty natural.  It’s also pretty natural to use feel-good substances to celebrate or enhance life even when things are good.  Whether that’s alcohol and/or recreational drugs at a party or a holiday dinner followed by apple pie, we use substances to make life more fun. You get the drift.  It’s fairly normal and we’ve been doing that forever.

Just as a side-note that I’ll reflect on later, addiction is often defined as a use or misuse of a substance or behavior that is causing long-term, serious consequences in someone’s life.

Why abstinence?

Abstinence in the “addiction treatment” model means a person no longer uses the “substance of abuse” and finds healthier coping strategies so their life is no longer negatively impacted by their “substance abuse disorder”.

Don’t get me wrong, addiction is serious and crippling.  It destroys people. It destroys families. It costs millions of dollars in health care, justice system and a myriad of other associated costs. I’m not trying to minimize any of that and I agree that someone with an alcohol, cocaine, opioid or other serious life-threatening addiction would be well-served by abstinence. 

But I’m sure you can see why I have difficulty applying that approach to chocolate cake and I’m not alone.

There are plenty of people in the food addiction world that don’t have a problem with that at all.  In fact, I’m in the minority.  Most programs, books and professionals teach people that they are “food addicts” and they simply can’t eat their “foods of abuse” ever again if they want to be free and healthy.  That means they have foods that are just completely off-limits to them and to achieve “sobriety” they can never again eat sugar, refined wheat, chocolate, cake, donuts, cookies or basically anything else that’s a “trigger food” for them.  They’re also taught they could have a “volume addiction” and they should weigh and measure every meal they eat, including when they go out to restaurants (yep, that means pulling your digital scale out of your purse at a restaurant, weighing your meal and asking the server to pack up the rest immediately so you don’t fall off the wagon.)

Many of these programs (such as Overeater’s Anonymous) use the 12-step addiction recovery model which teaches people that they have a disease and they need to turn to a higher power to help them “recover” and they’ll need support from their peers and sponsors for the rest of their lives.

It works…kinda

Okay, so I get it. This approach has worked for people all over the world that suffer with debilitating, life-destroying substance misuse issues.  I can totally understand why someone that has struggled with constant thoughts and desire for hyper-palatable, brain-chemical-stimulating foods would try this approach, especially since historically nothing else has been available to them.  If you’re one of them, please know that I’m not judging you. I get it. You’re suffering and this works to some degree.  But I’m willing to bet that it has come with it’s own version of debilitation and suffering.  I’m willing to bet that holiday dinners, family BBQ’s, baseball games and birthday’s aren’t as much fun as they used to be if you can even attend them at all.  I’m willing to bet you feel like you’re white-knuckling your food intake sometimes.  I’m willing to bet that the donuts in the breakroom at the office are a hellish reminder that “you’re an addict” and even if you feel like you’re “in recovery”, you’re convinced that you’re broken and this is going to be a battle every day for the rest of your life.  Even worse, it feels as though your “substance of abuse” is harder to overcome because you still have to eat, which means you have to stare down your “substance” multiple times per day! Imagine an alcoholic having to go to the liquor store every week and having to see, smell and face and their “substance” to get to the “healthier” options.  That’s what a “food addict” has to do every time they step foot inside a grocery store! Not to mention, society doesn’t understand it as well as they understand alcohol or drug dependency. Hell, your best friends and relatives might try to tempt you with your substance of abuse on a regular basis because they don’t get it! They might even get angry with you and think you’re being overly dramatic! If you’ve been in the “food abstinence is the only way” camp for a while, I’m sure you can relate to some of that!

Personally, I don’t want people walking around thinking and saying “I’m a food addict”,  “I’m in recovery”, “I can’t eat those foods” and trying to come to terms with navigating this world with that perspective. It’s just SO HEAVY and I honestly think there’s a better way, but it’s not a simple fix.

I personally believe that abstinence does more harm than good.  Constant deprivation leads to obsession and social isolation. Self-identifying as diseased or as an addict focuses our attention on the problem rather than on the solution. Food addiction treatment often puts too much focus on body weight and requires weighing and measuring of all foods.

It sets people up for repeated failures, low self-esteem and a lifetime of suffering. In my opinion, the risk to benefit ratio of using a traditional addiction treatment model with food is heavy on the risks and light on the benefits.  For starters, food is only a very mild mood-altering substance with a much lower potential for serious damaging effects in a person’s life. No one gets physically high on food. People don’t typically lose their jobs, partners and friends as a result of food misuse like they often do with hard drug use. They don’t end up homeless, they rarely have serious co-existing mental health conditions and they don’t resort to criminal activities to fund their substance use.

Yes, long-term health consequences are a real risk and the psychological pain of being overweight in a society that overvalues thinness (don’t get me started there) is damaging for sure, but when you weigh those risks against the deprivation, social isolation and psychological impacts of abstaining from certain foods, I don’t think they make a good case for abstinence.  I just think there’s a better way.  

When is abstinence a good idea?

Now, before I get into my harm-reduction model, I have to give a nod to the power of short-term abstinence for a number of reasons. 

Number one, it’s important to recognize that our modern food environment does cause those changes to the brain we were talking about earlier and that can create something that looks and feels a lot like typical addiction that I prefer to refer to as brain “hijacking”. When someone is “hijacked by food” they don’t have the control around food they’d like to have and they’re constantly dealing with cravings despite trying to eat healthier foods.  Fortunately, short-term abstinence from hyper-palatable foods allows the brain to up-regulate dopamine receptors and get some balance back in our natural dopamine uptake and that reduces those cravings for the vast majority of people and gives them a feeling of normalcy. Most of my clients report that this happens within five days. This is one of the major reasons that I feel we can’t compare foods, even the most processed, most hyper-palatable foods on the planet to things like heroin, meth, cocaine or even alcohol.  Most people’s brains recover from food hijacking fairly quickly, they don’t get the DT’s, they don’t have serious withdrawal, it’s not life-threatening in any way.  In my personal and clinical experience, it’s a bit grey and unpleasant for a few days if you don’t have tools to help cope with that, but it’s relatively painless compared to the withdrawal from heavy-hitting drugs.  It always feels a lot harder to do before you actually do it, but almost everyone reports that it really wasn’t that hard to quit eating sugar and other hyper-palatable foods as long as they had a plan and knew what to eat instead. No one needs methadone to get off sugar.

Number two, as a holistic nutritionist I recognize that the standard North American diet is full of preservatives, chemicals and foods that contribute to inflammation, damaged gut linings, microbiome imbalance and nutrient deficiencies.  The foods that contribute to ill health and disease also have a large degree of crossover with the ones that can hijack our brains. The reality is, we all need to be eating a healthier diet made up of whole, unprocessed foods and minimizing our intake of hyper-palatable, inflammatory, nutrient-void food that do great harm to our long-term health.

For these reasons, I do highly recommend that everyone spend at least forty days eating a whole-food, anti-inflammatory diet as a health practice at least once in their lifetime and preferably once or twice a year.  Removing ALL the foods that contribute to inflammation is necessary to allow the body to heal.  It’s not enough to simply reduce sugar, grains, damaged fats and dairy*.  Once the body is in an inflammatory state, even a small amount of inflammatory food will keep it inflamed.  I like to think of it like trying to heal a wound when you keep picking the scab off. You have to let things be and give your body only nourishing, anti-inflammatory foods for a period of time to let things heal. That means removing ALL sources of processed sugar, grains, damaged, processed fats and dairy foods for a short period of time.  After 40-90 days of a whole-food, anti-inflammatory diet, most (not all, but that’s another story) people can withstand a bit of inflammatory food now and then without causing major damage.  I encourage an 80/20 split.  If I can shift a client into eating an ancestral diet, full of nutrient-dense, unprocessed foods 80% of the time, then I encourage them to have “healthy indulgences” 20% of the time to avoid feelings of deprivation, social isolation and other psychological issues.

So, that’s my version of abstinence.  I see it as necessary to reset brain chemistry and reduce inflammation and reverse disease processes associated with a long-term, poor-quality diet.  It’s been used in holistic medicine for decades and is often referred to as an elimination diet.

After forty days of abstinence I teach my clients how to re-introduce the healthiest versions of the potentially inflammatory foods we’ve removed and see how their body reacts.  This helps them get to know themselves and how their unique body responds to certain foods.  In cases where more healing is necessary, such as auto-immunity or microbiome issues, I would recommend removing certain foods on a longer-term basis until healing is achieved.  For example, if someone has non-celiac gluten sensitivity and they’re still eating gluten every other day (or even once a week), the intestinal lining never gets a chance to fully heal and a leaky intestinal lining leads to major problems, not the least of which is auto-immunity.  That’s not good.   So, that’s definitely a case for longer-term abstinence of gluten-containing foods that I can support.

By the same token, if a client has a genetic predisposition for celiac disease, I think it would be pretty unwise to continue eating gluten since we don’t know exactly what contributes to the full manifestation of the disease, but on-going gluten intake is certainly a factor.

Baring a major health problem that we’re trying to heal or avoid, abstinence is a recipe for disaster. Telling someone they can’t have a certain food, often makes them want it even more and that’s a problem I encounter with my forty day resets as well.  Most people can handle short-term food restriction when they have a good reason for it.  I bank on the fact that they are going to feel so amazing when they eat well for forty days that they’ll find a new level of motivation to stick with a healthier diet. I’m never disappointed. My clients are often pleasantly surprised at how good they feel and that experience can be transformative.

It’s from this vantage point that I teach my clients about the power of food to make them feel healthy, nourished and in control or to make them feel lousy, hijacked and constantly craving more.

So, after I’ve helped a client with a period of short-term abstinence from those inflammatory foods that tend also to be hi-jackers, I teach them my harm-reduction strategies.

*a note about dairy: many people can tolerate dairy just fine, especially raw, organic, full-fat dairy, but a damaged gut can lead to difficulties with dairy in the form of silent immune responses and inflammation. In order to heal that, dairy must be removed for a period of time and re-introduced to see it’s effect on the individual. Heritage plays a big role with dairy as well. If your ancestors ate dairy, there seems to be a better possibility that dairy is an appropriate food for you.

What is Harm Reduction?

 Harm-reduction is a term used in mainstream addiction treatment to describe interventions that allow for continued use of the addictive substance or behavior while minimizing potential risks. Providing sterile needles for those addicted to injectable drugs to reduce the risks of disease transmission or infection is a prime example. Harm-reduction strategies are commonly an important first step towards recovery, defined in the substance-abuse world as abstinence. In my model, I propose learning and using harm-reduction strategies on a permanent basis rather than as a step towards complete abstinence.

Obviously, food is not heroin, but overuse or abuse does come with risks. Long-term health risks are the most common and most obvious. My motto is “if you don’t have your health, nothing else matters”.  My goal for myself and my clients is “maximal life enjoyment” and we just can’t do that if we’re not healthy on all levels, physically, socially, psychologically and spiritually. That’s a major motivator for all of my work.  By the same token, it’s pretty hard to have maximal life enjoyment if you’re constantly doing internal battle with food cravings, feeling like a failure and feeling like your body is unacceptable.  My harm-reduction strategies involve mitigating the risks when we eat foods that create a burden on our bodies as well as understanding and managing food-hijacking and learning how to recover quickly from food indulgences so they don’t become more frequent than our bodies can handle so we can be healthy on ALL levels.

I like to use the hill analogy to explain my model.

Imagine a steep hill with a narrow trail along the top. When we’re in control of our food intake and not hijacked by food we’re walking along this trail at the top of the hill. The view from up here is beautiful. The walking is easy and we often feel that we can walk here indefinitely. We feel healthy, strong and happy up here.  This is what abstinence feels like, which is why it’s so appealing to those in the food addiction world. It’s powerful to experience what it’s like to be free from food cravings and I do encourage everyone to experience this vantage point and to live here most of the time.

Next, imagine that you eat something that hijacks your brain and pulls you a couple of steps down the hill. Okay, no big deal. You’re only a few steps away and you probably still feel pretty good.  Maybe your stomach hurts a bit because you ate something your body can’t digest all that well, or maybe you get a headache and your joints hurt.  Those are fairly normal reactions to inflammatory foods. The worst part is that you may find yourself craving more of that hyper-palatable food later that day and the next day and the next and before you know it, you’re tumbling down the side of that hill into what the food addiction model would call a “relapse”. This is what we want to avoid.

So, in my model, we walk along the top of the hill most of the time and occasionally we make a conscious choice to take a step or two off the side of the hill with a “healthy indulgence” and then we implement strategies that will get us “unhijacked” in the hours and days after to a) minimize the impacts of the inflammatory food and b) get us back on the trail at the top of the hill to minimize the long-term risks of an unhealthy diet.

I don’t mean “everything in moderation”!

I’d like to point out here, that this concept is not the same as the “everything in moderation” mantra typically spouted by mainstream nutrition experts. That idea is WAY too simplistic in my opinion. We have to consider the nuance here. Some foods have a lot of potential to mess us up. It’s smart to operate from that understanding and recognize that the food industry is doing everything in their power to make food more and more addictive.  The idea that we should be able to eat anything in moderation only applies to those that aren’t susceptible to hijacking, eating foods that aren’t designed to make us overeat. In fact, to this end, I recommend all my clients read The End of Overeating, a great book that highlights how the food industry strives to make foods we can’t resist and encourages us to overeat for their own profit. I prefer it when my clients get very clear about the risk to benefit ratio of eating certain foods and it becomes easy for them to make choices that support their health the vast majority of the time, but if and when they want to eat the occasional piece of cake, I want them to recognize the benefits in doing so and do it with full consciousness and enjoy every morsel.  

The reality is, most people have the potential to get hijacked by the foods in our modern environment and the more palatable and addictive those foods get, the more people will be affected. For reasons that aren’t yet well understood, there seems to be an “addictability spectrum”, which means some people are more likely to have addiction issues.  It’s highly likely that social, psychological, environmental and biological factors all play a role in where we sit on that spectrum.

If we look at potential food hijacking through the lens of the social, biological and psychological model of addiction, I think it becomes even easier to understand why I recommend harm-reduction strategies as the best approach.

Social eating is a thing…

Socially, dealing with foods that can hijack us is a challenge.  During a short-term period of abstinence I recommend that my clients avoid social eating if at all possible. It’s just easier if you’re making all of your own food and you don’t have to navigate the world of restaurants and other people’s cooking while you’re learning about whole-food nutrition, trying to get your brain reset and reducing inflammation levels.  Avoiding social eating becomes unreasonable in the context of everyday life, so I help my clients develop strategies to engage socially without feeling like an alcoholic at an open bar.  I’ve seen it argued that addiction is about disconnection. That makes a lot of sense to me and from a deeper, spiritual perspective; I believe this to be a major root of addiction. So, how can we effectively deal with “food addiction” if we lose one of the common and not-so-unhealthy ways that we connect with others over a good meal?  That doesn’t mean we have to eat the bread, drink the wine, eat the cheese dip and eat the chocolate cake…but it also doesn’t mean we tell our loved ones that we can’t eat with them without whipping out our digital scales and refusing to eat the food they’ve lovingly prepared for us. That’s a recipe for disconnection if I ever heard one. When you go in to situations like this knowing that there’s a potential for hijacking, you can take steps to prevent it and you can take steps to get unhijacked immediately afterwards and it doesn’t have to be a big, hairy deal. Remember, it’s not heroin.

Genetics are a thing…

Biologically, we know that addictability is highly genetic.  Now, I’m a big believer that genetics may load the gun, but lifestyle pulls the trigger, so a genetic pre-disposition is not a guarantee that you’ll develop issues.  One’s potential to get addicted is usually pretty obvious and most of the people I work with are fully aware that they have an addictive nature.  I want my clients that rank high on that addictability spectrum to understand that they aren’t diseased or damaged.  Even if they’re genetically prone to addiction, that’s just part of who they are, it’s not a flaw or a personal failing.  We all have genetic “weaknesses”; it’s normal! Some of us are more prone to getting hijacked, some of us are more prone to getting diabetes, some of us are more prone to getting Alzheimer’s, that’s life, but we can make the most of our genetics by minimizing risks where we can and making peace with the things we can’t change. 

In the world of genetics, environment refers to the chemical soup our cells are bathed in   and this plays a very big role in whether our genes are turned “on” or turned “off”. Purely environmental factors might include nutrition, pharmaceutical and illicit drugs, chemical pollution, sleep and exercise, but social and psychological factors impact that environment as well.  Our stress levels, our emotions, our belief systems and our connection to others and the world around us all play a role in that genetic expression. We may not be able to do much about the blueprints but we do have some control over whether or not we build according to the plans.

Wiring and psychology is definitely a thing..

I’ve spent the better part of the last twenty years pulling apart the psychological factors related to food hijacking and overeating. I could probably give you a list as long as my arm of psychological reasons that I, and my clients have issues with food. One of those is hard-wired evolutionary psychology to eat as much food as we can when it’s available because, you know, we could hit a famine any second now. Another big one is how we learn that sweet, fatty, salty, tasty foods cause a release of feel-good chemicals in the brain and we get conditioned to reach for food anytime we need a “hit”.  Those are pretty common to most people. Then there are the more personal reasons. For example, if you wanted to get your share of potato chips in my childhood home you had to scarf those puppies down as fast as humanly possible. FOMO anyone?   If you’ve ever been offered a cookie to help you cope with a scraped knee, guess what?…you learned that cookies are a solution to pain. If you were taught that “food is love”, you’re probably dealing with a belief system about food that doesn’t serve you very well.  Most of the time, we come by this stuff pretty honestly, and it’s no one’s fault, but it has to be re-wired in order to neutralize the psychological elements of addiction.

So, if the goal is physical, social, psychological and spiritual health, it just makes sense to navigate our modern food environment by doing the least harm possible without creating the social isolation and psychological stress that comes with total abstinence and the label “food addict”.  The reality is that we can have excellent, robust health even if we occasionally get hijacked by food. Health is defined by what we do consistently, not what we do occasionally.

Emotional eating isn’t that bad!

I’ll even go so far as to say that eating food PURELY for emotional reasons is OKAY sometimes.  Using food as an emotional coping tool isn’t going to cause major damage to a person’s health, if anything it may improve it when they do it consciously and know how to get unhijacked the next day versus living in deprivation.  The difference between someone that uses food to deal with their emotions sometimes and someone that can’t control their food intake at all lies in the social, psychological and biological factors we discussed above, most of which we can learn to manage, because, again, food isn’t as powerful as heroin.

My harm-reduction strategies have worked for me to maintain a healthy, fit body for the last fifteen years and they work for my clients as well. When I teach people how to approach the foods in our modern world, how to understand their effects and what to do stay healthy without being afraid of them, they feel empowered and back in control without feeling like they’re “an addict”. I believe that’s a healthier, more holistic and less stressful way to live in our modern food environment.