Carbohydrates Addiction & Addition- Programs to lose Weight

If you’ve ever tried any weight-loss diet, you know how difficult (impossible, actually) it was to stick to it for a long period of time. Of course, for the first few days or weeks your resolve was high, and you were able to restrain your appetite and follow the diet and lose some weight. However, as the weeks went by, the effort to control your appetite became increasingly difficult. Your desire for more “forbidden” foods increased.

Finally, your food cravings became too much to resist. You found your resolve weakening until, eventually, you drifted back into your old patterns of eating, and soon you regained all the weight you’d lost plus more.

Does this pattern sound familiar? Don’t feel guilty—we’ve all been through it more than once. It’s the familiar “yo-yo” dieting pattern: Weight gain → dieting → partial weight loss → diet cheating → weight regain → even further weight gain → dieting again → repeat cycle.

This leads to a pattern of weight gain throughout life, a roller-coaster pattern of ups and downs, with the overall trend being progressive weight gain as the years go by.

Research shows that 85% of individuals who go on a weight-loss diet will regain all the weight they lose within one year. Almost 97% will weigh more in five years than they did when they started their diet. The reason is that their main problem isn’t overweight; their main problem is carbohydrate addiction. Failure to address carbohydrate addiction is the major reason most dieters regain all the weight they lose.

I often tell new patients that I really don’t treat overweight—I treat carbohydrate addiction. When the addiction is controlled, the excess body fat corrects itself.

Imagine someone with an alcohol addiction. He’s drinking uncontrollably and his health is suffering, his marriage is suffering and finally he is convicted of a DUI. He decides to admit himself into an alcohol rehab program.

For several weeks, while he’s in the rehab program, he doesn’t drink at all. His health improves, and his alcohol cravings are gone. Then, he’s discharged from the program.

There’s just one problem. Let’s imagine that while in rehab, no one tells him never to drink alcohol again after discharge. No one tells him that adding back even small amounts of alcohol will likely lead to an eventual return to uncontrollable drinking.

So, after discharge he thinks he can resume “social drinking”: just a beer here and there with his friends; just a glass of wine when out to dinner with his wife. But as the weeks go by, the beer and wine become more frequent.

Soon, the cravings for alcohol are back, and he’s drinking uncontrollably again. Once again, his health and marriage are suffering, and he’s driving while intoxicated.

See the parallels? The overweight person who is eating uncontrollably is like the drinking alcoholic. Going on a diet is like entering rehab. Then, beginning to add back extra sugars and starches into the diet at maintenance is like the alcoholic returning to social drinking—and then it’s just a matter of time until the dieter is back to uncontrollable eating and soon all the weight is regained.

Less than 10% of alcoholics can return to social drinking without eventual full relapse. In my experience, this statistic holds for us carbo-holics as well. Most of us can’t add back sugars and starches to our diet without eventually regaining all the weight we lost. This is what most diet plans (“eating rehab programs”) fail to tell us.

You can overcome carb addiction. You can live a life virtually free of significant sugar and starch in your diet. Like overcoming any addiction, it won’t be quick, simple or easy for most of us. But all of us can do it. And when you do, you’ll never have a problem with overweight again. Later chapters will discuss this in depth. In this chapter we will focus on the addictive effects of carbohydrates on the brain.

Appetite Regulation

First, let me admit right up front that scientists’ understanding of appetite regulation is still very limited. Only since the 1990s has this become an area of much research interest; furthermore, the circuits that control appetite are so complex that it will take many years for scientists to understand them. I will describe what we understand so far—and this helps explain why we can’t stick to any weight-loss diet without help.

An area of the mid-brain called the hypothalamus is most responsible for appetite control. Several recently discovered hormones that affect the hypothalamus are part of our appetite regulation system. One hormone, neuropeptide-Y, for example, stimulates the hypothalamus to increase appetite specifically for carbohydrates. Another hormone, ghrelin, may also stimulate appetite, and its level may increase during most weight-loss diets.

There are at least three likely causes of strong urges to eat carbohydrates. First, a chemical imbalance in a circuit from the frontal area of the cortex (behind the forehead) down to the mid-brain may cause irresistible urges (compulsions) to eat too often, or to eat very large quantities (bingeing). The imbalance probably involves a problem with the brain chemical serotonin in this circuit.

Second, problems in a circuit from the locus coeruleus area in the brainstem to the hypothalamus in the mid-brain can increase emotion-induced overeating of carbohydrates. This overeating occurs when we’re tense, bored, depressed, or nervous. This circuit runs on the brain chemical norepinephrine, which is similar to adrenalin.

Third, there is evidence that overweight individuals have reduced functioning in a circuit called the mesolimbic tract in the mid-brain that controls the sensation of pleasure. In these overweight individuals, a brain chemical in this circuit called dopamine lacks the normal number of receptors to which it can attach. This may cause overeating to compensate for a lack of normal sensations of pleasure.

There is evidence that carbohydrates are addictive, just like many street drugs. In both laboratory animals and in human subjects, stopping a high-carbohydrate diet results in mental and physical symptoms of drug withdrawal. These symptoms included anxiety and depression, and a severe mental preoccupation with getting more carbohydrates. Chemical changes in an area in the brain called the striatum probably encourage both drug and carbohydrate addiction.

A recent article in the scientific journal Obesity Research shows that the brain chemistry effects of high sugar intake are very similar to the effects of narcotics. As Dr. Richard Bernstein says in his book Diabetes Solution, “Carbohydrate addiction is just as real as drug addiction.”

Because of these addictive properties, it is very unpleasant to reduce your carbohydrate intake. You feel physically tense and restless, and preoccupied with thoughts about eating carbohydrates. Just as most addictions get worse over time, carb addiction also leads to a continuing increase in the average daily consumption of carbs as the months and years go by. Of course, this makes the addiction even stronger.

It is also possible that carbohydrate cravings are imprinted in our genetic code. Until 9000 years ago carbohydrates were scarce. All humans lived in hunter-gatherer bands with no farming. Their diet was mostly wild game, nuts, berries, and leafy vegetables. Potatoes and other carbohydrates were not common, but when available they provided quick energy and a stimulus to store fat for future times of food scarcity. To crave these carbohydrates was adaptive in that prehistoric environment.

Our genetic code has changed little in the past 9000 years, so it is likely we still have these inherited carbohydrate cravings.

Three Brain Components

The brain is organized as various circuits, much like a computer. Each circuit has a particular job or function. There are circuits that handle visual input from our eyes; circuits that handle auditory input from our ears; circuits that handle touch; circuits that handle signals from our inner organs, etc. There are also circuits that generate our feelings: appetite, sexual interest, anger, pleasure, anxiety or fear. The various brain circuits are linked together to perform smoothly and to coordinate our actions, feelings and thinking.

The brain’s circuits can be divided roughly into three groups: The brain stem group of circuits is the lowest part of the brain and controls our most basic physical functions: breathing, heartbeat, blood pressure, pain reflexes, and internal organs. We share this part of the brain with most other animals down to the level of reptiles.

The mid-brain (“limbic system”) group of circuits controls feelings: appetite, urges, mood, sleepiness, alertness, tension, anxiety, fear, sadness, excitement, etc. We share this part of the brain with many other animals, too.

At the top of the brain is the cortex group of circuits. This part of the brain controls our most “advanced” functions: intellect, planning, personality, language, speech, rational evaluation, goals, morals, ideas, etc. Mammals have the best-developed cortex, and humans have the very best developed cortex of all.

These three brain areas—brain stem, mid-brain, cortex—are linked together and, ideally, function together very smoothly. While each area of the brain controls certain functions, each area can also be influenced by—or even temporarily be controlled by—a different brain area. Their relationship is reciprocal: the cortex influences the brain stem or mid-brain when needed; the mid-brain can influence the cortex, and so on.

An example of this reciprocal influence is your ability to hold your breath when you want to. Normally, your brainstem regulates your breathing based on its genetic instructions, feedback from blood vessels about your blood oxygen level, feedback from muscles about your level of exertion, etc. Your brainstem keeps your breathing regulated smoothly so that you always have the oxygen you need. All this happens independently of your conscious (cortex function) thought.

However, your cortex can influence your brainstem when you decide to hold your breath. Then your cortex will override the other inputs to your brainstem and then you can voluntarily stop breathing for a brief time.

However, as you know, there are limits to how much your cortex can override your brainstem. After a few minutes (at most) of breath-holding your brain stem will generate cravings for air that your cortex cannot control and you will start to breathe even “against your will” (that is, against the control of your cortex). At that point, your brain-stem cravings have overridden your cortex and taken control of your behavior.

Every brain function is like this. It has its own internal control mechanism, and it can also be influenced by other parts of the brain, but only within limits. Each area can override attempts at control from other areas of the brain and return to its independent actions. Now let’s discuss how this involves eating.

The Power of the Mid-Brain

Compulsive eating, emotional tension, reduced numbers of dopamine “pleasure” receptors, carb addiction, and genetic programming of the human species—any or all of these factors may create strong biochemistry-based cravings for carbohydrates. As with all addictions, these cravings originate in our mid-brain—this is a key fact.

The mid-brain doesn’t care how overweight we are. It doesn’t care about our self-image (self-image is a cortex function). The mid-brain doesn’t care about our long-term health (rational concern is also a cortex function). It doesn’t care about the social effects of being overweight (another cortex function). The mid-brain only cares about satisfying its urges right now. It wants what it wants right now and without limit.

Our higher aspirations and desires for self-improvement, in contrast, originate in our cortex. The cortex creates our rational thoughts and logical analysis. The cortex is where we decide that we want to lose weight. The cortex is where we decide to go on a diet. Unfortunately, it’s not the cortex—but rather the mid-brain—that controls appetite and carbohydrate cravings.

So when we are overweight and put ourselves on a weight-loss diet we set up a conflict between our cortex and our mid-brain. The cortex tries to restrain the continuing urges and cravings to overeat carbohydrates generated by the mid-brain.

For a while, our cortex is successful and does restrain the appetites and cravings generated by our mid-brain. At first this might not even feel difficult, and we think that, finally, we will be able to stick to a diet forever. This early dieting phase is like the easy first few seconds of holding your breath (another example of your cortex restraining a “lower” but powerful part of your brain).

But as the days and weeks go by, your mid-brain continues to generate cravings and appetites for types of foods, and quantities of food, that are forbidden by your diet (forbidden by your cortex, that is). In fact, the longer those mid-brain food cravings are restrained, the stronger they get. Still, you think you can hold on and stick to your diet. This is like the second minute of holding your breath—it’s getting more difficult.

Finally, the cravings and appetites generated by your mid-brain become overwhelming—in fact, at this point they’re almost all you can think about. It becomes increasingly uncomfortable—even painful—to restrain your appetite. This is like the last few seconds that you can make yourself hold your breath.

At last you relapse into eating the way you did before you started the diet—the way your mid-brain wants you to eat. At this point your cortex has (once again) lost its dieting battle with your mid-brain. Exhausted, you decide to forget about dieting for a while. You probably even have a mini-binge on all those foods you’ve been resisting. This is like those first extra-deep breaths you take after you’ve held your breath for a couple of minutes.

But your cortex is still not happy with your weight and generates guilt and anxiety about it. Your cortex may generate rationalizations (excuses) about your weight to try to reduce the guilt and anxiety, but this is only partially successful. Eventually, your cortex will cause you to again go on a diet and repeat the cycle of struggling with your mid-brain—a struggle you are doomed to lose every time.

This cycle of: restraint → cravings → resisting cravings → stronger cravings → loss of restraint, is part of every type of addiction: from cigarettes, to alcohol, to cocaine to carbohydrates. So, frequent relapse is a feature of recovering from all addictions. For most individuals, the only way to stop this cycle is to reduce the intensity of the cravings.

Don’t Fight Your Mid-Brain—Change It

With extremely rare exceptions, no one with a significant weight problem can win this battle against his mid-brain. The cortex simply does not have enough long-term control of midbrain carbohydrate cravings.

Struggling against your mid-brain cravings is a losing proposition—so it’s not the solution to overweight. The solution to overweight is to change your mid-brain. We must reduce the midbrain’s production of cravings and excess appetite. That’s where modern medications can provide so much help, especially in the first few months of your diet until your mid-brain naturally reduces its cravings for carbs. (I’ll discuss medications in a later chapter.) With the mid-brain under control, it’s much easier for your cortex to regulate your eating according to your rational goals.

Using medications to reduce carb cravings is an important part of successful recovery from carb addiction, but it is only one part. Just as important is coping with the psychological aspects of addiction. I will discuss this in later chapters.

Food Addiction: More Concepts

Food addiction has four main components: carb cravings, oral activity, the stuffed feeling, and fear of hunger.

The most important component in relation to overweight is cravings for sugars and starches. This component is the primary focus of the weight-loss program described in this book. Overcoming only the carb addiction component is sufficient for most patients to get very close to their goal weight and size. However, it can also be helpful to understand the other three components.

Oral activity is habit-forming. From infancy on, chewing, sucking, and munching tend to be relaxing and pleasurable. And it doesn’t matter much whether the object of oral activity is edible—think of the baby’s pacifier, biting fingernails, chewing a toothpick, and so on. Of course, if carbohydrates are the object of oral activity, then you get two “highs” at once—doubly addictive.

The feeling of having the stomach over-stuffed is also addictively pleasurable for many individuals. Again, from infancy onward, it can be associated with feeling satisfied and secure. Over the past 40 years, as food portions at many meals have more than doubled, we’ve come to expect to feel stuffed when we finish eating. In fact, we’ve trained ourselves to use the stuffed feeling as the signal to stop eating, rather than the elimination of hunger as the signal to stop eating. If we don’t walk out of the restaurant feeling stuffed, we feel like we didn’t get our money’s worth.

The fear of hunger is the fourth component of food addiction. “If I don’t eat a lot now, I might get hungry later.” An exaggerated fear of hunger can make us feel that getting hungry would be like running out of air—fatal. Actually, if we go without food hunger begins to disappear. A well-known psychologist, Judith Beck, asks her weight-loss patients to go an entire day consuming nothing but water. She wants them to discover that hunger won’t disable them, that it’s ok to risk being hungry later by not overeating now—that they can even skip a meal if suitable food is not available.

Completely overcoming food addiction means overcoming all four of these components. Fortunately, a virtuous circle emerges in that working on controlling one component helps in controlling the others.

How to overcome these additional components of food addiction? Awareness and practice. Pay attention to what is driving your urge to eat and to keep eating. Are you actually hungry? If not, then ask yourself whether you’re wanting oral activity, wanting the stuffed feeling, or whether you’re afraid of getting hungry later. Then practice stopping eating right then. Do something else. Take a chance; risk a little frustration. Walk away from the food and see what happens. When ordering at a restaurant, ask for half the order to be brought to the table in a to-go container and eat it for lunch the next day.

With practice, you’ll find yourself eating less and less for any reason other than true hunger. With awareness and focus you can overcome all the components of food addiction.

Key Points