Harm reduction
Dr. Eric Westman: What am I doing when I tell someone to just put a big bowl of sugar-free Jello in the fridge, let it set, and have as much of that as you want? There are no carbs in it, so you don’t get the sugar. You just get the sweet taste that mimics the sugar. What is that called, in addiction?
Dr. Vera Tarman: It’s called harm reduction. It’s like methadone or Suboxone to help the person get off the opiate. In that early stage, if that keeps the person in the game, I would say do it.
Dr. Eric Westman: In those first few days, I’ve heard the darndest stories about using tools that aren’t sugar. It’s about getting people away from sugar, even to the point of avoidance. If you would always purchase whatever at the ball game that was carbs, don’t go to the ball game for a few weeks.
Dr. Vera Tarman: Exactly. That’s actually one of the tools. Don’t go to the ball game. I’m going to use myself as an example. I used to go to the movies all the time. I love movies. Then I realized what I really loved was the big tub of popcorn that I used to have. I’d have mine, and I’d have my partner’s because she wasn’t going to eat it all. When I stopped doing that stuff, suddenly my interest in movies was not that strong. Or when I went to a movie, all I could think about was the popcorn that I couldn’t have. So I stopped going for two or three years. Now I can go. You have to apply some tools and recognize your situation. It’s like having respect for this thing that’s happened. This thing, meaning this addiction that’s within, and you will work your way through it. You have to treat it with respect and compassion. If using a big bowl of Jello does it for the first few days, or even the first month, do it. It’ll get you over. Obviously, you don’t want to be eating that kind of sweetener because that’s going to trigger the desire for sweetness. We want to actually get beyond the desire for sweetness so that just having the sweetness of a vegetable is enough. Just having the pleasure of food without enhanced sweetness will be enough. It will be eventually.
Dr. Eric Westman: Having grown up loving candy bars, I will still have sweet things, but they, in no way, have sugar in them. I’ve come to that peace myself by allowing for these other sweeteners. I know a lot of zealots say don’t have them, but I stay within the realm of sugar-free sweets.
Dr. Vera Tarman: What you’re doing is really important. When you go into early-stage food addiction treatment, often there are some pretty rigid rules about what to do. That might be appropriate for the first month or so. It’s really a good idea to work with the person. That’s why we say you should have a coach or a sponsor or somebody that you’re working with to tailor it to you. What will eventually happen is that you say, “Okay, I want to have a little bit of sweet once in a while. I know that if I contain it, I can manage this.” Somebody else may not be able to manage it, or maybe you can manage jello, but there’s no way you could manage a particular keto treat.
Prevalence of food addiction
Dr. Eric Westman: How common is food addiction?
Dr. Vera Tarman: Because we don’t have a definition that’s clinically accepted, we don’t have a lot of research yet. We have some research, and I’m going to tell you what the statistics are there. But we don’t have enough. We need to have more people talking about it.
Ashley Gearhart is probably the person who’s done the most research on prevalence because she’s actually the one who came up with medical tools called the Yale Food Inventory that will diagnose food addiction. She came up with that scale and has been using it across various populations to figure out what the prevalence is. The prevalence of food addiction is around 11 to 14 percent, which to give context is about the same amount as alcoholism. How many alcoholics do we have in American society and Canadian society? About 10 to 12 percent. Food addiction may be a little bit more, according to her scale. If you look at specific populations, like the obese population, people who have had bariatric surgery, or people with mental issues, then we’re looking at higher numbers like 20 to 30 percent. If you’re looking at particularly obese populations, this is not her work anymore. But we have numbers anywhere between 30 and 50 percent. This means that somebody who’s overweight has a 40 to 50 percent chance of being a food addict. But in the general population, I think the number we’re going to land on is around 13 to 14 percent.
Dr. Eric Tarman: That’s interesting, that’s also the current prevalence of cigarette smoking. Twenty years ago when I was in the tobacco cessation world, the prevalence was 30 percent. That’s come down over time, but it’s taken decades. I hope and I wonder if that’s going to happen with sugar over the next few years.
Dr. Vera Tarman: I’m a little cynical, and I wonder if, in fact, those smokers are now my eaters.
Predispositions to food addiction
Dr. Eric Westman: Is there some way to predict who’s going to become a food addict?
Dr. Vera Tarman: There are some predispositions. There is a genetic predisposition. If you look at your family, are there other people who are obese? Obesity is not just from food addiction. There are all sorts of other reasons, so the person might not be a food addict, but if they’re eating processed foods, high-carb foods, and they’re gaining weight. Most likely, that’s the case. If we’re looking at previous family history, let’s be aware that obesity is a phenomenon of this generation. Since the ‘70s and ‘80s, we’ve seen a really sharp rise. That’s a sharp rise in the food industry. If somebody was obese before that, chances are they might have had an issue with food.
If you are obese, you are definitely going to predispose your children to obesity. If you’re eating particular foods, processed foods, even while you’re pregnant, Dr. Nicole Avina talks about this at great length. You’re predisposing your child to becoming a food addict. They will have a preference for those foods, which is, basically setting the groundwork for food addiction.
If you look in your family and there’s a history of alcoholism, that is a predisposition for food addiction. When we’ve studied alcoholism, we’ve studied what’s called dopamine D2 receptor abnormalities, and those dopamine abnormalities in alcohol are also evident in food addicts. It would then make sense that other addictions, like cocaine or opiates, may also have a dopamine D2 receptor abnormality.
A second predisposition is if you live in 2023! If you live and eat the foods of today, it’s eventually going to happen if you continue to eat processed foods in excess without caution. It’s the same as if you live in a society where people are drinking all the time, kids are drinking all the time, and they’re going to become alcoholics. The level of exposure makes addiction inevitable because addiction is really just a natural response to an abnormal environment. Genetics is just that some people respond more quickly than others.
Then, there are also social norms. We call certain things “food,” and we call the behaviors around them, like Christmas, Easter and Halloween, “normal behavior” to be giving kids all this stuff. The only way I could say it is, it’s like giving our children cigarettes. And then on Halloween saying, “This is Happy Smoke Day, and you get to smoke as much as you want.” It’s just absurd, but we have normalized it so that it’s okay.
Processed food
Dr. Eric Westman: And it’s important to keep in mind that we’re not just talking about sugar as the element. People come to me with an addiction to bread. What is it about bread?
Dr. Vera Tarman: Let’s consider the makeup of processed food. What is bread but a grain that’s been processed? When you have normal foods like vegetables and meats and fats, it takes a fair amount of time for the body to metabolize that food. Whatever sugar is in there, is processed within the context of all the other food. And it’s done at a pace that the body can manage. When you overwhelm it with huge amounts of sugar, the body can’t keep up. You essentially remove the body’s ability to act in a responsible manner. It’s a neurochemical hit that the body has to respond to because it’s too much, and it’s damaging.
Bread is a grain that’s been processed and it is metabolized into sugar. Food should take at least two hours to break down, but bread takes about 10 minutes before it becomes sugar. If you eat bread, you’re getting this wallop of sugar that your body and brain can’t manage. Essentially, it goes into defensive mode. Then, you start to see the pattern of addiction, which is actually tolerance.
Fruit addictions
Dr. Eric Westman: Recently one of my patients said, “But fruit is good for you.” Can you be addicted to fruit?
Dr. Vera Tarman: You can. Fruit, in and of itself, is not a problem. But, we’re talking less sweet fruit from a hundred years ago. The food industry has made fruit almost a drug in and of itself. If a person is eating the fruit of yesterday, how much could they realistically eat in a day? Probably one or two pieces of fruit, maybe over the course of the day or two. After that, they’re going to feel bloated and uncomfortable. The fiber and everything else would stop them. That amount of fructose in the liver and brain aren’t going to cause any damage. But if you have fruit in the form of fruit juice or alcohol, you’re getting way too much. Is fruit okay? Yes, in extreme moderation. In today’s society, people are bombarded with sugar and their liver and brain is now ill. In other words, they are addicted. Sometimes the body can’t manage one or two pieces of fruit because they’ve become insulin-resistant. Even one piece of fruit is no longer okay. It might have been okay when they were five or ten years old and they weren’t damaged, but now it may not be okay. That’s why we have to individualize our food plans.
Addiction is any time you eat something or do something despite negative consequences, and you do it anyway. That’s the dynamic of addiction. Normally, fruits shouldn’t do that, but they do today.
Treating food addiction
Dr. Eric Westman: How do you look at treating somebody with food addiction?
Dr. Vera Tarman: You want to acknowledge that there’s a condition that exists. The person eats something, and they want more of it. They want more of it because they’ve developed a tolerance, and this whole phenomenon that we call addiction. It’s like an itch. Once you start scratching a little bit of an itch, it gets itchier, and then you scratch it harder, and it gets even itchier. So you shouldn’t have scratched it the first time because it just got worse. That’s the dynamic of addiction, in a metaphor. What you would want to do is you don’t scratch the itch.
When you notice the desire, “I want something sweet,” don’t give in to it because it’s only going to make you want the sweet more often. What do we call that? Abstinence. If a person is trying to quit smoking, and they think, “You know what, I want a cigarette,” they should say no, they’re not going to have one because if they have one, they’re just going to want more. If you’ve quit for a few days, and then you think, “You know what, I’ve actually not had a cigarette for a few days, I’ll have a puff,” but we all know what’s going to happen. The person’s gonna start smoking again. Same thing with food. You have to be abstinent. You can use methods of harm reduction – for smoking you have patches or gum, and for eating, you could have a bowl of sugar-free Jello. You can do that, but eventually, you also want to get off of that stuff.
Because abstinence is so hard, what you want to do is get support and tools. One of the tools is getting trigger foods out of the house, not having it around, not going to the movie or bar, or an event where you know there will be a lot of food and alcohol. Protect yourself while you are in withdrawal by getting rid of all the triggers. These are all actions you wouldn’t take if you didn’t think this was an addiction. That’s why I say you first need to acknowledge that it’s an addiction. Then, you can remove the triggers and get support as well.
The importance of support
Dr. Eric Westman: How important is support? If you have never tried this, know that without support, you’re really not going to have much of a chance.
Dr. Vera Tarman: No, it’s so important. Part of it is because we live in a society where it’s ubiquitous. It’s like smoking used to be. It’s ubiquitous. Everywhere you look, there’s food or there are triggers or cues or temptations. Every minute of the day it’s there. Then, you’ve got your mind, TV, the internet, and all sorts of reminders that there’s this drug that you could take right now. You could take it the whole day. You could eat and binge and nibble the whole day. We’ve got this onslaught, and how do we stop that? We have to buffer and protect ourselves. I can’t do that myself because I am under the barrage of temptation. I need somebody to hang on to; I need to have a community of people. Certainly, one person, whom we might call a coach, who you can call and say, “I’m having trouble. This is what I’m going to do.” Somebody who is regularly there to help you buffer the outside world, as it were. I call it, making it a bubble.
At a treatment center, a person goes in for 28 days, and often people will say it’s just the group who carries it. They build a buffer around them. They say, “I don’t want to leave the treatment center,” by the end because they’re protected there. Well, you need to do that in a community outside all the time, which can be virtually or in person. COVID and isolation were a real problem because they broke down a lot of those connections, but it didn’t break down the invitation to eat all the time because there was this big joke about stuff that you make, COVID recipes. How do you bear isolation? Eat.
Adapt Your Life
Dr. Eric Westman: Well, so there’s hope, and I am happy to now switch gears to something that you can do if you’re watching, and that’s to join us at the Adapt Your Life Academy in an upcoming class. Tell us a little bit about the class that’s coming up.
Dr. Vera Tarman: The class is two things. The sugar and food addiction class gives the foundations for understanding what addiction is, how food is addictive, and what your triggers are if you identify yourself as addicted. It also helps you understand what the next steps are. It gives all that information that is not out there in the larger world. It’s not out there, certainly not. I mean, I’m speaking medically, but also clinically. We know you’ll get this voice in the public, but you won’t get this from a lot of doctors.
The other thing that we’re offering is a support group, like the Sugar-Free Challenge coming up soon. The main focus of that challenge is to say, if you are ready, now is the time. We’re going to give you that support, the very support that we were talking about. You’re going to get the information in the course, but you’re going to get the support that is, I think, critical. I personally would not have been able to do it without support. Most people can lose weight, but can they stay off it for 10, 20, or 30 years? They can’t unless they have some level of support, and we’re going to introduce that as well.
Dr. Eric Westman: You had a residential program where people got off. What did you learn from that experience?
Dr. Vera Tarman: There were people that were in a treatment center for drugs and alcohol and then we had the food addiction as part of that. The people who were sitting with food addiction felt exactly the same. It was the same language and there was a sense of unity. The person struggling with food addiction felt as bad as the person with another drug or alcohol addiction.
It was very successful and much quicker than I thought. I was surprised at how many people felt really good after seven days. With some drugs, it takes a lot longer. For some people, it did take longer, but it was actually once they got over the hump, people were like saying, “I can’t believe how much energy I have, and I don’t feel deprived. I don’t feel like I want that stuff anymore.” I used to be a smoker. When I see a cigarette now, I think, “Oh, it stinks. I don’t want that stuff.” Can you imagine having that reaction with food? I don’t want that anymore. That’s how I feel.
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