Introduction
Dr. Eric Westman: It is my great pleasure to have Dr. Vera Tarman with me today. We are going to be talking about sugar and food addiction – is it real? What is it? What can you do about it? Dr. Tarman is the medical director of one of Canada’s largest treatment centers for substance abuse. She’s internationally renowned for her work on food addiction and sugar addiction and author of the book “Food Junkies: Recovery from Food Addiction,” as well as co-host of the popular podcast “Food Junkies.” Dr. Tarman is highly respected in her field and has given talks at international meetings but has also lived the food addiction life herself. As a recovering food addict, I understand that you’ve lost and maintained over a hundred-pound weight loss, is that right?
Dr. Vera Tarman: That’s right.
Dr. Eric Westman: That’s fantastic. You have academic and real-life credibility. It is my pleasure to have you here. I’ve learned so much from you over the last few years. I want to thank you before we get into this because there was a niche or an element that I didn’t quite understand as a keto doctor, a medical doctor. Although my history in tobacco cessation primed me for this, you helped me blend these two worlds that I thought were not linked, but they really are for so many people. Thank you.
Defining food addiction
Dr. Eric Westman: What is food addiction? How do you define it? Is it really a thing?
Dr. Vera Tarman: Thank you, back to you. I was really delighted when you were interested in the subject of food addiction a few years ago when we initially made contact. I discovered that the keto movement was using a food addiction-friendly plan, and I was trying my best to get people to accept a food addiction plan with so much resistance. I stumbled upon you and a community of people who are doing it happily. I thought, how are you able to get people to do something that I couldn’t do? It’s a happy marriage as far as I’m concerned.
The definition of food addiction is actually even controversial within the community itself. We’re struggling. Should we call it sugar addiction? Almost everybody agrees that sugar is addictive. The research is there. There’s more and more research showing that that’s the case. It’s hard to argue that. Should we expand and just call it food addiction? We haven’t landed on a term that we’re happy with at this point. Probably the one that we’re the most likely to settle on is “processed food addiction”. There are more and more murmurs about processed food addiction.
It’s not just sugar; it’s flour and processed oils. It’s processed foods, not just sugar. It’s not only sugar, but a larger umbrella of processed foods. Personally, I still like the term “food addiction” because it makes for an even larger umbrella, which might include foods that are not processed, like dairy and nuts. It opens up the concept that there are trigger foods that can even be healthy and also food behaviors like restricting, overeating, and volume addiction. It opens up the umbrella much larger, but likely we will settle on the concept of processed food addiction. Let’s, for the purposes of our talk today, use my definition, which is food addiction because it opens up so many more possibilities.
Are you a food addict?
Dr. Eric Westman: What would the practical reality of that definition be for someone here? How do you know if you are a food addict?
Dr. Vera Tarman: One thing I want to say before we get into ‘how do you know,’ [if you’re a food addict,] is, why we don’t even think about it. It’s not in the DSM-5. It’s not in the clinical mindset of most positions, especially obesity physicians. You’d think it would be, but it’s not. It’s not in the mindset of general practitioners or people who are dealing with the eating disorder community. Part of that is because it hasn’t been acknowledged on the clinical level. It’s definitely been acknowledged in the popular internet experience; people are talking about it amongst themselves. But clinically, it’s not really being acknowledged. You and I are using this word “addiction,” so we have to borrow from the addiction community and the addiction literature, because we can’t use the food literature. We can’t use the obesity literature. They’re not having this conversation.
When I want to define what sugar, food or processed food addiction is, it’s whatever that thing we’re talking about is that we’re addicted to. What are the behaviors that we expect? This would be for any addiction, including cigarettes. We’re looking for specific addictive behaviors. Let me give you the medical terminology first of all, and then we’ll look at the actual specifics. The medical definition of addiction is just any neuropsychological, social, or behavioral disorder that is characterized by compulsive maladaptive behaviors (we’ll touch on those soon,) that a patient is unable to control or stop, despite harmful consequences. There are three elements to that.
What does compulsive maladaptive behavior mean? It means that you’re behaving around food in a way that is compulsive and maladaptive. It’s a problem. Consider these questions:
- Do you eat more than you intend to? You plan to eat only a little bit, but you end up eating the whole thing.
- Do you eat in a way that you don’t want other people to know? In other words, you’ll eat privately or you’ll lie. You won’t say, “You know what, I eat really well,” but you don’t tell people about what happens when you get home at night and you’re alone. Even to the point of when you’re sleeping. When people are “night eating,” they’re not eating their celery sticks, their steak bits, or bacon bits.
- Has your doctor told you that you’re diabetic? You’ve been told that you have to stop eating whatever refined food. You may even realize, “Yes, I have a problem here. Here are the maladaptiveness, the negative consequences.” But you can’t stop. Often what happens is when people try to stop, it becomes like this game of deprivation. “I’m going to have this now; I’m going to stop.”
- Are you obsessing about food to the point where that is the mental landscape? You’re thinking about that food or you’re thinking about the consequences, the negative consequences; “I’m going to gain weight.” That becomes the mental chatter in your mind all the time. Are you thinking about food all the time?
- Are you craving particular foods that you wish you didn’t? Are you trying to stop? Are you lying about your food, embarrassed about it, or feel shame?
These are all the behaviors that are associated with any addiction. Alcohol fits perfectly into this as well, but food does, for sure. Usually, you don’t worry about it until you have negative consequences because there are negative consequences. The above are some of the questions to ask yourself; there are more. Do you lie about it? Do you eat in secret? Do you eat foods that you threw away because you said, “I have got to get rid of this,” and then sneak up later and eat that food again? Are you willing to drive across the city to get that favorite treat that you want because the local store doesn’t have it? Are you willing to go to lengths that you would not do for a celery stick? These are behaviors that are out of the norm around food.
Self blame for perpetuating the problem
Dr. Eric Westman: Why do people blame themselves? What part of addiction is it in our brain that we blame ourselves?
Dr. Vera Tarman: If I can make another analogy, this is like a person who has Tourette’s. Tourette’s is where a person has twitches or they bark or make funny sounds or something like that. If you say to them, “Hey, can you stop that because it’s bothersome,” they could actually stop. They could hold still and not twitch. But they can’t stop the urge. There’s a mental thing that’s going on that’s building and building and building, and the moment that you turn away, they’re going to start twitching because they need to get it out of themselves.
People will say, “I should just stop eating and behave myself.” Well, yes, you can because you can voluntarily pick this thing up and drink or eat and not, but you can’t stop the desire. Once that’s in your mind, it’s triggering something in your brain, which is the whole concept of addiction. That thing is beyond your control. It’s in a part of your brain, just like the Tourette’s person, that you can control the voluntariness of it, but it’s very short-lived, and that urge, that craving, will trump; it will overpower because it’s in a part of the brain that overpowers voluntary choice. When people say, “You should just stop,” it’s because they don’t have that urge and that need that’s as powerful as the person who’s suffering. You have to have compassion. You have a disorder; you have something going on in the brain that has been miswired, and that’s not your fault. If anybody’s fault, it’s the food industry which has tapped into that and has exaggerated that.
Similarities between food addiction with other addictions
Dr. Eric Westman: A lot of doctors come with the logic that you should just put down the food, step back from the table and they don’t get it. We’re in a medical world that doesn’t understand. Most obesity doctors don’t understand this. At the OMA (Obesity Medicine Association), one of my colleagues came up to me and said, that’s the first time you ever said “addiction,” “food addiction”. I didn’t realize so much time had passed. I feel like I’ve talked about this forever now, but there was probably a time when I didn’t really understand the degree to which food is so similar to other addictions. You have dealt with other addictions. How is food addiction similar or different from what people perceive as “hardcore” addictions
Dr. Vera Tarman: That is a really eye-opening experience for me working in the field of addiction. I’ll give you a great example. I work in a treatment center as a resident, so I get to see people come in for a month and then live there. They will come in and be coming off of drugs like crystal meth, alcohol (serious alcohol, like seizures if they stop), and cocaine. Actually, we’re seeing more and more people with cannabis as well, believe it or not, because it’s becoming so prevalent now. Some of these drugs are pretty serious. I think about crystal meth as being one of the most potent drugs that can bring a person down, so they lose their functionality within two or three years. Fentanyl addiction is also serious, which is an opiate addiction.
Fentanyl and crystal meth are the most potent drugs in their category. When people come in, they’re detoxing from that drug. What inevitably happens is they say, “I can’t understand why I am eating so much now.” If you’re coming off a stimulant, yes, you want to eat a lot because you haven’t been eating, and there’s an urge to eat for the first two or three days. But we’re talking about the third week, fourth week, and they’re eating unhealthy food. I’m not going to say that the treatment centers necessarily provide good food, but they’re not giving candy bars and such. They do have a vending machine in their center, where people constantly get soda, chips, and whatnot. Often, what I’ve seen over the months, when I see them in follow-up, their bellies are getting bigger, and they’re gaining weight. Initially, they were happy because they thought, “Wow, I’m gaining weight. That’s good.” But then they realize it’s all around their center, which we know is visceral obesity and not good. They start to realize, “I better stop eating this way.” And they can’t.
The telling thing for me is that I hear people saying over and over again, “This is harder to quit than alcohol.” When I heard people saying, “This is harder to quit than crystal meth,” that just floored me the first time I heard that. Crystal meth is so powerful that people beg on the street, asking for money, even when they haven’t eaten. You might decide, “Let’s hope they’re not going to use it for drugs; they’re going to use it for food because they need it.” But they will still use it for the drug, despite needing that extra 10 or 20 bucks, whatever you gave them.
When we see someone addicted to something that potent, and the person says, “Sugar was harder,” why do we not see that?
Dr. Eric Westman: Some things that strike me are that it’s legal and easy to get.
Dr. Vera Tarman: Exactly, how can it be bad? We call it food when it’s not food; it’s a food product. It’s not a food. Otherwise, the person wouldn’t be addicted to it with the potency of crystal meth. We get a whiff of how potent it is only when a person is actually trying to stop. If you say to the person, “Just for tonight, I don’t want you to have your special treat,” their reaction may be adverse. Don’t you have this when you’re presenting your keto plan? When you present, they come to you, and you’re saying, “I’ve got a solution. Here’s a diet plan, and I want you to follow it.” Isn’t the first reaction, “You’re kidding? You want me to stop eating all these carbs?”
Dr. Eric Westman: People cry!
Dr, Vera Tarman: Exactly. Yes, that’s it. The level of crying probably reflects the level of addiction. That’s where you get a whiff of the problem when you ask the person to stop, even for that meal or that day. Once we start talking the language of addiction, we start to recognize what we see clinically. The person cries or has some reaction, and you give them some hope. They’re going to come back, and I’m sure you’ve had the experience where people are relapsing. They come back and say, “I tried. I lost weight, but I’m eating it again. I don’t know how to stop. I had cravings.”
Dr. Eric Westman: The hallmark of withdrawal syndrome is that you do have cravings for the substance.
Dr. Vera Tarman: Absolutely. Doctors often don’t want to ask somebody to stop because they say the patient will feel deprived and then they’ll binge and use more, which is true, that will happen. What you have to do is help the person through that period because what they’re going through is withdrawal. The deprivation the person feels that night or the next few days is part of the withdrawal. It’s an enhanced need to feel normal again because you’re not taking your drug. The alcoholic, when they don’t take their drug, they get shaky, sweaty, and agitated. The person quitting smoking doesn’t take their drug, they just think about that cigarette and get antsy, feeling deprived, yes. But because we normalize food, we say, “We shouldn’t do that to people.” What we’ve got to do instead is say, “This is post-acute withdrawal. It lasts between three days, sometimes up to two or three weeks depending on the person. After that, It’s over. It’s not like this is going to be life. You’ve got to get through this actual withdrawal process.
Dr. Eric Westman: All you really need to know is that this is an issue, and you’ll be able to solve it.
As a last note, please don’t blame yourself if you’re in this addictive hurricane. There’s help, and we want to help you get over this if you need our help. Watch the full video here.