Introduction
Eric Westman: It is my great pleasure to interview people from whom I’ve learned so much and worked with through the years. Today, I interview Dr. Vera Tarman.
We have an overlap in our work. You’re more of an addictionologist, and I’m, maybe a carb addictionologist. Assuming the viewer knows nothing about the past and hasn’t seen any of our interviews before, how did you get into the food addiction and sugar addiction world? I always find it very interesting to hear about your experience with what people call “hardcore” addictions. Hopefully, by the end of this, people will realize that sugar is just as hardcore as any of these other ones.
Getting into the food addiction and sugar addiction world
Dr. Vera Tarman: I was like many young women in my early university years, struggling with my weight. I always lost weight and gained it back again, lost weight, and gained it back again. I just didn’t understand why that was happening because I’d have the “perfect diet” that would allow me to lose weight, but then something would happen and I would slip back into my old ways despite knowing they weren’t helpful. Without control, I’d eat foods that were not good for me and then gain weight.
It wasn’t until I got into the addiction field that I started to understand. Initially, I was a family doctor. I worked mainly with HIV patients during the HIV crisis. When that settled in the late ’90s, thanks to the medications that were introduced, the protease inhibitors that virtually saved people’s lives, I switched back to family medicine. Given the neighborhood I was living in, which was downtown Toronto, where there were a lot of drugs, I wanted to learn more about the patients I was seeing, so I got into addiction medicine.
It took a number of years in addiction medicine, learning the concepts of addiction, which we’ll be talking about, such as the inability to stop using a substance despite negative consequences, using it to my detriment, and wanting to stop but not being able to, before I clued in, this is the same way that I behaved with food for years. It wasn’t until I came across Nora Volkow, who is the Director of the American Society of Addiction Medicine, that I started to realize the extent of this. She published a document on food addiction and sugar addiction, showing it to be as powerful as cocaine. I thought, yes, it is, and she has the research to prove it.
Since 1996 or 1998 I’ve been on the bandwagon. First of all, convincing myself, because I thought one day, I have to treat this like any other addiction that I’m treating my patients for, the way that I’m eating sugar and ultra-processed foods, and then I’ll get better. And I did.
It was a matter of second-guessing myself because, in society, nobody buys this concept of addiction. I would talk myself out of it, saying, “You’re pushing the envelope. Nora doesn’t know what she’s talking about.” But it is that black and white. Once I convinced myself that this was doable, I started to speak to more people and discovered I wasn’t the only one. The more people I spoke to, the more they said, “This is my experience, too,” which motivated me to get on the bandwagon and talk about this more publicly.
At the same time, I was meeting others, and more research was coming out. Right now in 2024, there’s been a spike in research on food addiction, so it’s finally reaching that tipping point.
Dr. Eric Westman: It seems like it takes forever. I remember those days. I was in the nicotine area. I worked with the inventor of the nicotine patch, Dr. Jed Rose, in Durham, North Carolina. He needed an MD to be part of his research team, to screen patients and to be on the forums, so I got involved in one of the first nicotine patch clinical trials ever. It was a patch that was made in Korea, I think, and then they brought it over in the early ’90s. I remember going to nicotine meetings, and Nora Volkow was very vocal about this. NIH studies were now starting to be done on nicotine. I thought it started with animals preferring sugar over cocaine. It’s kind of crazy that it takes going to a mouse to see what’s going on in a human. That’s just the NIH way. Dr. Jed Rose, who is an inventor and a PhD I worked with for over 10 years, introduced me to the idea of addiction generally, but then also that it’s not just nicotine in a cigarette. It’s the taste, the smoke, all these other things going on, which still applies now that we talk about sugar and food, and the wrapping of the sugar around the fruit and the starches.
It takes 10, 15, 20 years for scientific discoveries to start making it into the clinical world and clinical research. I had forgotten that you had a personal experience. My similar experience is that I needed something practical for my patients who were having trouble losing weight. Two of my patients actually lost weight in front of me, and I asked them how they did it. That’s how I got introduced to the interesting, novel idea that just cutting carbs might help you lose weight.
It occurred to me at the time that this was like smoking cessation. It was like a cold turkey method, at least the method I learned, of cutting all the carbs in one day, not unlike the old-time honored quit smoking cold turkey method for quitting cigarettes. People can now get help for nicotine addiction, and some medications can be helpful. A lot of people did it on their own. I’d be interested in your experience with people quitting substances. Some people can say, ‘I put the pack of cigarettes on the table and I quit.’ In some people’s brains, they can just quit, and for other folks, it’s harder.
Tell us a bit about your history with the HIV and drug community, because most people think of that as a real hardcore addiction, and we’re just talking about food.
History with the HIV and drug community
Dr. Vera Tarman: I’m the medical director of a treatment center where I’m treating people with drugs and alcohol. That’s mainly alcohol, cocaine, opiates, and, to some degree, cannabis. There was a period just before COVID when we had a food addiction program, thanks to a donor who said that she would like to fund something, and we got something running. It was the same program and the same type of people that came to that program with the same type of results. That’s where I could see that it was just as hardcore and just as difficult.
I think food addiction or sugar addiction, or carb addiction in general, is harder to quit because it’s not supported by society and it’s so ubiquitous. It’s the same way that people will say, “I could quit my cocaine, but I can’t quit smoking,” because they smoke. How many times, when you’re a smoker, are you smoking in a day, doing that repetitive reinforcement model? Twenty times a day, thirty times a day? The same thing with food. How many times a day does somebody pick up a snack? Especially when they are food addicts, they’re virtually snacking the whole day to some degree. It’s low-grade, but it’s built into everything and every day.
Dr. Eric Westman: Someone might be told to have multiple snacks throughout the day, especially from the health provider. It defies explanation. Even with diabetes, you need to have something to raise your blood glucose multiple times a day.
Dr. Vera Tarman: It’s so convincing that it’s not as morbid or as mortal as other addictions because you don’t die of tobacco addiction tomorrow; you die in 15, 20 years when you get cancer or something like emphysema. Same with food addiction. You don’t die right away; you die through metabolic disease and obesity in 15 years or so. It’s easy to convince yourself that it’s not as bad as an opiate addiction, where you can virtually die tomorrow, or an alcohol addiction, where you die of an accident or an overdose.
On that level, it seems like it’s not as bad as hardcore, but it is as hardcore. It just takes longer, and that’s what we’re battling with, that this is a low-grade issue. More people in society die of tobacco and food addiction. That’s why we often compare tobacco and food together. More people die of tobacco and food than they do of alcohol and opiates. Those are more dramatic, but by numbers, by statistics, epidemiologically, many more people die of these two conditions.
Dr. Eric Westman: Is the rock bottom for sugar addiction losing a job tomorrow?
Dr. Vera Tarman: It’s not losing a job, but you know what it is? It’s a gradual loss because the person will, when you’re in food addiction mode, cancel something because you’d rather stay at home. Not with your bottle of wine, because that would be the alcoholic, but with your tub of ice cream and with your foodie friends, possibly, and watch Netflix. I’d rather do this than go out and do the social stuff. Now that I’ve eaten so much, I don’t feel well. I’m going to call in sick. I’m going to call and cancel something. You don’t lose your job, but you do start to lose some of the same things, again, but it’s slower.
Dr. Eric Westman: The common thing I hear is, “I didn’t want to be social or go out because I was embarrassed about how I look.” The unintended consequence of this addiction is weight gain.
Dr. Vera Tarman: There’s the feeling sick, the physical stuff, and then there are the consequences afterward. We have lots of people who get diabetes, and the doctor says, “You have to stop eating sugar” and the person can’t stop.
Dr. Eric Westman: Fortunately, in the medical world, diabetologists have come up with medicines that can control blood sugar and help someone lose weight. The problem is that a lot of these medicines cause side effects, and they’re not available to everyone. Lifestyle changes are much more accessible.
How do you convince someone, if they don’t think this is all that serious, that sugar is addictive?
Is Sugar Addictive?
Dr. Vera Tarman: That’s education. That’s the courses we do and the videos we do, it’s all about education. You’ve got to get the buy-in first because we are battling big sugar or the food industry, which will not support our contention, and we’re battling the medical industry. It’s hard to get through to the medical world, which will acknowledge lifestyle changes but not potent enough lifestyle changes. Anything even remotely low-carb is already suspicious.
With any addiction, you can’t force the person to do it; they have to come to it. Usually, they’ve hit rock bottom, they’ve reached some level where they cannot stand how they’re living, and they’ve tried everything, or they’ve tried it and failed.
Dr. Eric Westman: How would someone realize that they have a sugar or carb addiction? What would someone notice?
Noticing a sugar or carb addiction
Dr. Vera Tarman: I don’t know if they come to the realization when they walk into your office or my office. They come in saying, “I don’t know what to do. I’m in a weight stall, or I’m gaining weight, and I’m doing everything.” When you start probing with questions, it’ll be, “I follow a diet, but I keep slipping off,” like my experience when I was younger. We both know that when a person’s weight goes down when it goes up again, it’s likely to go up a little bit more than the first time around. I think we both know, too, that it gets harder and harder to lose weight once you’ve lost weight. It’s almost like the body doesn’t want to let go of that.
Eventually, the person just says, “I’ve done it.” Unfortunately, I would like to say it usually happens when a person comes in and defeatedly says, “I don’t know what to do.” What’s happened with the new medications like the Ozempic or GLP-1s is where now there’s another solution. We have to wait for that wave to pass until we can get back on board with, “Come on, let’s get to what the real problem is. These are all just Band-Aid solutions.” We’re going to be patient and get through at some point.
Blaming oneself
Dr. Eric Westman: It may be a reflection of the clients or patients that I have, but a lot of them blame themselves. What I hear is, “I don’t have self-control.” I’ll then probe, “What religion were you raised with?” Like the shame and guilt and the self-blame. I know maybe that sets the stage for the quick saying, “It’s my problem, and it’s with me.”
Dr. Vera Tarman: It’s also the food industry that gives that message because it says, “Just moderate. Coca-Cola fits into a healthy lifestyle. You just have to not have as much as you’re having.” It’s implied that we should have control.
Dr. Eric Westman: Are there different levels of addiction?
Are there different levels of addiction
Dr. Vera Tarman: One of your questions earlier on which I didn’t get to, was what do you do when the person comes in? I’m going to suggest, “Let’s look at the foods,” and we have to remove those foods. Usually, the person is terrified by that. It is like me telling an alcoholic, “You have to stop drinking,” and they say, “Can I just learn how to cut down a little bit?” The problem is the person can’t, because addiction is the thing that’s in the way.
Dr. Eric Westman: I see that all the time, where people get terrified with the idea of dropping fruit and rice and potatoes. Tell me a little about that. If someone gets afraid of the answer, that should tell you that this is not rational.
Dr. Vera Terman: Absolutely. I think anybody will admit that food is pleasurable. It gives comfort, and I don’t know if people realize how much they rely on that comfort. Now, I’m taking away their main coping mechanism to deal with life. It’s like, “How will I get through life, but how will I get through the rest of the day? How will I be able to sleep at night?” You ask the alcoholic who uses their bottle of wine to pass out at night and chill after a busy day, “How will I stop if I stop drinking? What should I do?” That’s the same reaction that people will have, but they may not realize it. They just feel, “Oh my gosh,” and you’re right, if you see that kind of reaction, it’s a sign that there’s a stronger attachment to that food than food is meant to be.
Food is meant to be pleasurable while you’re eating, while you’re hungry, and then when you’re full, it’s pleasurable, but it’s not as pleasurable anymore because it’s built into the hormonal mechanisms that we won’t enjoy the food as much at the end of the meal as we did at the beginning. It’s the ghrelin-leptin complex working on our behalf. When that doesn’t work anymore, something else is going on, and that’s the concept of addiction.
Dr. Eric Westman: Clearly, advertisers and companies know if they put a picture of a cigarette and a smoker, people are going to want to smoke. If you’re someone who watches an ice cream or Coca-Cola commercial and it tugs at you, is that normal?
Dr. Vera Tarman: That’s done intentionally. All of us have probably had the experience of walking by a shop, and you smell the delicious bread or the delicious pastry that’s in there, luring you in. You had no idea about that until you walked into that cloud of chemicals wafting in the air. That’s an intentional lure, and that’s exactly how our reward circuitry works. Somebody is very clever in the food industry – they’re called food engineers – luring us in with those kinds of tools. Once you put the glasses of addiction on, you see that for what it is, and hopefully, that will make you aware and maybe a little bit angry – somebody’s making a lot of money off my illness.
Dr. Eric Westman: Does it help in any theoretical way to turn that emotion against oneself toward a company? The anger against oneself, of course, is another way of thinking about depression, and I’m repeatedly seeing people have trouble with addiction, emotional eating, and mental illness, with depression and anxiety. How does it overlap with mental illness?
How does this overlap with mental illness
Dr. Vera Tarman: Any drug at all, if a person is an alcoholic or a cocaine addict, is messing with the same neurochemicals as our moods in general are. Anybody who struggles with an addiction, and that includes sugar, is dealing with a topsy-turvy, messed-up neurocircuitry. Of course, the person is going to be anxious, depressed, or bipolar, just throw in ADHD, throw in the diagnosis, and it’ll probably fit. Not to say that those conditions don’t exist; they have their own pattern. Often, it’s the same people, but you can enhance or create a condition by being in an addiction. It’s a good idea to resolve the addiction first. That’s why a lot of psychiatrists will say that before we get to managing this condition, we have to get rid of the offending substance that is messing everything up, muddling the picture. It’s a contaminated diagnosis. We have to clear up the addiction, let things settle where they do, and then we’ve got something to work with because it’s all the same neurochemistry.
If a person is feeling bad about themselves, putting shame on top of their experience, that’s making things worse, which is why we often encourage people to say, “It’s not your fault.” It’s how we’re wired. Some people are more genetically predestined to get a carb addiction, or a sugar addiction, than others. Everybody is game for it, but some more quickly than others. That’s not our fault. Then, if we didn’t know better and we thought, like so many of us, especially people in the vegetarian and vegan world, were eating all sorts of healthy carbs but only carbs, not knowing why they’re not doing well because they’re carb-sensitive, essentially carb-allergic. Then, that’s not their fault either; that’s lack of education. When you are in a depressed, self-loathing mode, it’s not going to help the addiction at all. Addiction is all about recognizing it and then feeling good about the recovery changes that you’re making. You won’t make changes permanently in a negative state.
Dr. Eric Westman: One of the important first steps is to get more recognition about addiction among healthcare professionals. I know you work hard, you were at a meeting recently. Tell me a little about that meeting.
International Food Addiction Consensus Conference
Dr. Vera Tarman: The meeting was in the UK, and it was called the International Food Addiction Consensus Conference. It was an attempt to gather people who are prominent in the food addiction field on various levels. Dr. Nicole Avena, Dr. Robert Lustig, he’s the pediatric endocrinologist who’s speaking about what sugar is doing to our children and to society, Michael Moss, and Chris Van Tulleken, who wrote Ultra-Processed People. Getting people in the same room to say, “Food addiction exists.” One of the things that we have not yet determined, and here’s where the consensus comes in, is what should we call this? Should we call it carb addiction? Should we call it sugar addiction? Should we call it ultra-processed food addiction, or just food addiction in general?
I like the terminology of just “food addiction”, as it’s an umbrella term that captures them all. I’m okay with what we came up with, which was “ultra-processed food addiction,” because ultra-processed food addiction is the entry point for most people. If we didn’t have ultra-processed food, which we didn’t, like 200 years ago, there was much less of this problem. And although carbohydrates have been developed, it’s been the refined, ultra-processed nature of them that makes them so damaging and so addictive. The goal of that day was to come up with something that we could present to the ICD and the DSM-5 committee because we want to get this condition acknowledged in the medical world. It still isn’t, and part of the problem has been that we haven’t been able to define what we’re actually talking about because we want to be talking about the same thing. Then, what solutions do we have that are different from what already exists, which is eating disorders? We can talk about that in a few minutes, the differences, so that they are different.
Dr. Eric Westman: Really important work, because the ICD and the DSM are the organizations that allow doctors to code and to bill for things. I’m curious, how was the discussion to leave in sugar or to take sugar out? I bet it was a more political than scientific discussion.
Political versus scientific discussion
Dr. Vera Tarman: The whole thing is actually political, to some degree, because the food industry is involved, and everybody has their own points of view that they’re trying to push. I don’t think we focused so much on sugar addiction as promoting the concept of ultra-processed food addiction, which includes sugar, because, we’re not talking about the sugar in fruit, we’re not talking about the sugar even in corn as it is, corn on the cob. That can be a problem, but for most people, if they just eat unrefined, non-processed food, they’re not likely to have a problem. We can talk about the stages of food addiction next if you like, but it was mainly to agree on this concept of ultra-processed food addiction with the understanding that sugar addiction was included.
Different stages of addiction
Dr. Eric Westman: What are the different stages?
Dr. Vera Tarman: What I wanted to talk about in that conference was the concept of abstinence, or as you said, cold turkey. I believe that’s the most effective way. I know that it’s the most terrifying way, and if we want to make people comfortable coming into our practice and not running out the door we may say, “Let’s make it easier and adopt a softer touch,” which you might call harm reduction.
The concept of harm reduction in the food addiction world is becoming quite prevalent as it is in the whole addiction world. “Let’s reduce some harm; let’s make it a little bit more palatable for you,” and then, ultimately, when you’re ready, we’ll move to the next step, which is complete abstinence. I wanted to speak in my talk about, “Okay, that’s fine, we have a harm reduction model but I don’t want to lose sight of the goal, which is abstinence if you want to be free of the cravings,” because if you’re in a harm reduction model, you’re still eating something that’s feeding the cravings and therefore you’re not completely at peace. Let’s not lose sight of the goal that if you’re ready to go to peace, there is something called abstinence. In other words, cold turkey. You may not jump into the water right away, but eventually, you want to get in the water. That’s what I wanted to talk about.
As a way of explaining why that was important, I wanted to have it in the literature written somewhere, this idea that there are stages of neuro-adaptation that happen so that when a person is exposed to any drug, including sugar, it’s pleasurable, it’s comforting, it’s nice. There is that, and we could call that “recreational use,” “early stage,” if you will, or pre-food addiction.
If you expose yourself, even if you have a cigarette once in a while, you’re not a smoker if you are only having it once in a while, where you might have seen that in the past in religious traditions where they would smoke the pipe or something like that. That’s all they did; they’re not smokers now. They’re not thinking about it in between pipe smokes; it’s just there once in a while.
Then when you adopt a pattern of regularity and you’re actually making the brain make changes to adapt to that change, then the more you adapt, the more you want that substance. So, there’s a next stage, which is earlier or middle stage, and you might still be able to stop there, which is why cold turkeying may not be necessary but if you continue to stay in that flow, eventually, you will become so neuro-adapted that there’s no going back, and so abstinence becomes the only mechanism for success.
That would be like a person who is, they might be pre-diabetic, and while they’re pre-diabetic if they stop, their sugars are normal, and they’re good, and maybe they can have a little bit of sugar, no problem once in a while, but if they’ve become diabetic, their sugars can become normal, but they’re not normal anymore. They’re diabetic in remission, and I want to say that food addiction becomes a condition that you can seek remission only, you don’t seek a cure.
Abstinence is that there’s a line that you cross in all addiction, where a person will say, “I have to stop drinking, stop smoking, because if I have one, I will be a pack-a-day smoker again, or I’ll be having the two-fer on the weekend again. I just can’t have one.” It’s the same with sugar, you just can’t have one. You cross a line, and I wanted to talk about that line that is part of this addiction model, which is around the middle stage.
Dr. Eric Westman: Thoughts that come to mind are the variability that is seen with addiction in the tobacco world. Back in the day, we called them “chippers,” the people who could just have a cigarette now and then and didn’t get the full-blown pack-a-day, two or four packs a day.
Dr. Vera Tarman: They were a small group, weren’t they?
Signs of sugar addiction
Dr. Eric Westman: Yes. Whether it was worth telling them to stop smoking or not was up for debate. The political will of the government was that there should be no tolerance at all. But back to sugar. So someone is trying to give up, go “warm chicken,” as it was called, that was a friend who ran the Duke smoking cessation clinic. It was the brand fading, brand switching, nicotine fading idea. If someone tries to get rid of sugar and starch, what are the hallmarks of addiction that you might notice if someone is addicted to this stuff?
Dr. Vera Tarman: If they’ve already tried, then they’re already going to be able to give me some history about how they are. You could say, “We can do the warm chicken, or maybe we need to do the cold turkey because the warm chicken just prolongs the agony if you are a food addict. If you’re not, then great.” So you might want to do a trial, but you have to think about how much agony you want to prolong.
The cardinal feature of food addiction would be if you have a strong craving for the substance. Like I said, we like food. That’s built into us. And we love sweet food or energy-dense food. It’s, “I have a preference; I like it.” Also, by the time I’m filling up, the preference goes away. I don’t want more of that delicious whatever-it-is because I’m full. When that is lost, our intuitive sense of when we’re full is ignored, and we still have this sense, it’s like an itch, it’s like a mental, “I still want a bit more just to feel something.” That’s not an appetite. That’s why there’s no use in looking at appetite-suppressing drugs or medications because it’s not about appetite; it’s about craving.
If you have that sense of craving, which is like a false hunger or a different type of hunger, that would be the first cardinal feature. Are you eating outside of your normal hunger zone? If you’re snacking throughout the day, guaranteed you are, you’re definitely feeding something that’s not hunger. If you’re feeding something that’s not hunger, that’s probably dopamine, which is in the reward circuitry, in other words, addiction focus.
The second thing would be if you’re not able to control it anymore because you realize, “I’m having a little too much, and I keep needing more to get the same effect.” We call that tolerance. We have cravings, and then we have tolerance, where the person wants more. Not that they want it, but they want more because they’re not getting the same effect as they had the last time they had it. If you’re becoming tolerant, and when you realize, “I had a whole bag of something rather than just a row of cookies, I better cut back again,” and you find that you can’t cut back, that would be the third sign. Or if you can’t stop because the fourth thing is you’re now developing consequences, and this relates to what I said at the very beginning: you’re using a substance despite negative consequences.
Now you’re gaining weight. Everybody has that weight of, “If I reach that level, then I’ll stop.” When you reach that level, you can’t stop. Then it’ll be up the ante a little bit more, and, “Instead of 200 pounds, I’ll stop at 210 pounds.” And eventually, when it’s 350 pounds, you say, “I’ve got to stop, and I can’t stop.” Despite adverse consequences, diabetes or weight gain, you still can’t stop. If you can check off all of these marks, this is a strong indication that you’re looking at addiction, because it’s no longer a matter of just, “I think I’ve had enough, I’m going to stop and move on.” There is no kind of mental state like that.
A food or meal plan without ultra-processed foods
Dr. Eric Westman: Recently, someone told me that her husband wanted her to go back to eating carbs because she was irritable. The irritability in there, or the hungry, you’re just unsettled. The brain adapts to what it’s given for food and for addictive substances.
It’s remarkable, though, that some people, when they turn off the substance, get better almost immediately, and then for others, it lingers on. What does a food plan or meal plan look like without the ultra-processed foods, and how could someone kick this just by food alone?
Dr. Vera Tarman: If you want to do cold turkey, let’s go there first, then an extreme low-carb plan would be the best solution. You don’t have to think about it, you just follow that principle. I know you, Eric, have the under 30 grams of carbs a day. If you don’t want to go that far, maybe under 50 grams. If you’re doing something low-carb, you’re already knocking out the ultra-processed foods because they’re all highly full of carbs.
Other ultra-processed foods like ultra-processed oils and protein bars and others have no sugar, they’re still ultra-processed food. If you want to get a first principle, that would be it: just cut it out.
Other alternatives
Dr. Eric Westman: The language has changed through the years; now “keto” is used as a term to designate low-carb. I’m glad you mentioned these keto junk foods that are out there. If you hear “keto” and tried it, but it didn’t work, or you had trouble, find a method that has been tried and true. Our method came about 150 years ago, before there were ketone gummies, for example.
The keto low-carb, under 20 or 30 total grams – not net – per day is the method that we teach, which works great for some, not great for others. What would other alternatives be?
Dr. Vera Tarman: That would be the first hardcore cold turkey. If you want to go a little easier, it’s still hardcore, it’s just to avoid ultra-processed food.
That would mean if you need to eat carbohydrates, you might eat a lot of vegetables. It will work out to probably 50 or 60 grams of carbs. If you’ve lived on a diet of ultra-processed food most of your life, unfortunately, so many of our children are doing that, they’re going to find having unrefined, unprocessed food, even if it’s roasted brussels sprouts and carrots, are fairly healthy, they’re going to find that hardcore. Just avoiding processed foods would be a really good plan as well.
Mine would be two approaches. This is an alternative approach. I don’t know if it’s easier or harder. Avoid sugar, definitely liquid sugar, definitely get rid of pop and alcohol, and avoid any added sugar as number one.
Then you have to find, after that, what are the foods that still appeal to you, like bread, for example. Usually it’s refined carbohydrates. If you follow a food addiction plan, you’re going to find that your food plan becomes lower and lower in carbs because more foods that are addictive are in the carb variety, as we become very carb-sensitive.
There might be some proteins, like cheeses, which become addictive for people. It’s not just the carbohydrates. Get rid of the sugar, mostly the refined carbohydrates, and then look for trigger foods that might be in the proteins and fat variety and remove them.
You want to stop the compulsion, that false hunger, that itch that you’re trying to scratch. That’s the goal. When you find that, you’re going to be what we call “food serene.” Then you will eat appropriately – your two or three meals a day, with no snacking in between.
We do want to have some level of fasting. It may not be a full 14-hour fast, but we want to have some time when the body is repairing itself, at least four hours, six hours is even better, in between meals. If you’re eating the right foods, you’ll be able to do that happily.
Dr. Eric Westman: I hear this all the time: “I can’t have sugar ever again?”
Dr. Vera Tarman: That depends. I hadn’t heard the term “chipper,” but if you are a chipper in the food variety, if you are in the early stage of food addiction, you might be able to. In the addiction world, we have what’s called the Big Book, and in the Big Book, it says, “Go out and experiment.”
So go out and see if you can have just a little bit of sugar if you did not check off all those boxes that I mentioned earlier. Once you’ve crossed that line that I talked about, there is no going back. Usually, the person knows. They’ll ask the question, “Can I not have it?” It’s usually their addict asking that question. They know this is dangerous. It’s like, “Why would I have one cigarette?”
First of all, if I haven’t smoked for a long time, it’s going to feel disgusting. If I’m starting to acclimatize to it, where it feels good again, now I’m back in the addiction. It’s usually a warning question. I will say that when a person says to you, “How will I stop? Are you really telling me I can never have sugar again?” We always say in the addiction world, “Don’t think about the future, just look at today. Do you need sugar today?” And the person will likely say, “No, not today.” Just look at today. The addict works on the future, that addict’s mind.
The addicts mind
Dr. Eric Westman: Tell me more about that.
Dr. Vera Tarman: The addict mind. As you make that neuroadaptation and go through the different stages of food addiction, it’s like a second personality develops. It’s along the same lines as a person who has a level of anxiety or depression that develops. When a person has been depressed once or anxious once, they might get out of it, but it’s always there. It’s almost like in remission, and when something bad happens, they’re back to that anxiety. It’s like there’s a pre-programmed way of thinking about food addiction, with many mental issues. It hasn’t gone away, it’s just quiet.
There’s one person in the field, Bitten Jonsson, who calls it the “Red Dog”. I just call it the addict mind. It’s very clever and quiet. If I feed it anything, for example, I go out, and I smell the beautiful smell of bread baking, or, the smell of toast. I’m thinking, “Oh my gosh,” and if I think about it more, it’s like I’m feeding that quiet, sleeping dog inside of me that’s going, “I can smell it,” it’s a very primal instinct, smell, and a lot of these things are very primal. They’re even without my recognizing cravings. I see something; I don’t even recognize that I’ve seen it, and it wakes up this quiet, idling dog inside that now is perking its head. It’s smelling, it’s seeing, and now I’ve got to tell it to settle down. In therapy, we encourage you to see it that way. It isn’t obviously, but it feels that way.
Dr. Eric Westman: I’ve had some people follow me for 15 years in a weight loss clinic because they’re worried that the weight is going to come back tomorrow. They’re down a couple of hundred pounds, but they’re worried that it’s all going to come right back.
Dr. Vera Tarman: Are they afraid they’re going to stop what they’re doing or just out of control?
Hope
Dr. Eric Westman: It’s that kind of irrational anxiety. I said, if your weight goes up 10 pounds, you get right back here. They want to know they can come back. I think part of it is the safety, the haven. Would you say that there’s hope?
Dr. Vera Tarman: Absolutely, because I’m in this field, I get to see the hope, too. We see in the world out there – the larger world, not our world – that so many people lose weight, they gain it back, and now we’ve got the drugs that are snapping those people away, and now they’re losing the weight. I’m just waiting for them to eventually develop tolerance to that medication and then they’re going to gain it back.
That’s the world out there, but in our world, in my world, where people say, “You’re right, addiction fits,” and then they follow all the therapeutic guides because when you adopt the addiction modality, you’ve got a ton of tools you didn’t have that those doctors out there in that other world don’t have, things like “One day at a time,” things like support. There are just multiple tools that exist. Once they apply those tools, I’ve seen many people losing 100, 200 pounds, 10, 15 years later, still maintaining that weight loss.
They may have gained 5 or 10 pounds; they may not have lost completely because often you dip down, and then you go up a bit, but the sum total is substantial, like 100, or 200 pounds, and you maintain that loss for years. I’ve seen many people like that, and they’re not white-knuckling it. They’re not going, “Oh my gosh, I lost 100 pounds, I hate this.” They’re like, “I’m good.” Yes, there’s that irrational fear that tomorrow might not be good, but right now, that day, they like their food, they like their weight, and they don’t hate themselves anymore. We’re talking about people that have a lot of hope.
Unfortunately, they’re not out in society that much because we’re not being listened to. That’s why we’re doing talks like this because we want to say there is hope. You may not see it, but once you’re in that world, you will see it.
The Adapt Your Life Academy Course
Dr. Eric Westman: I’m excited to announce that the course at Adapt Your Life Academy that you worked with us to create and give awareness and opportunity for people to learn more, the course is now open for enrollment.
If someone was going to join the Adapt Life Academy course that you wrote, what would they learn from this course?
Dr. Vera Tarman: I’ll give you a few pointers about things that you’ll learn, a lot of what we’ve talked about today, but in much greater detail.
Number one: why your self-destructive behaviors around food are not your fault. This isn’t your fault; there is actually a condition that’s called food addiction or ultra-processed food addiction, whatever you want to call it, there is an addiction, and I lay that out very specifically.
I always start with the food environment itself, and how specific foods are engineered. The ultra-processed foods literally have food engineers that make these foods addictive and take over our minds as they do. I talk about that. I talk about the specifics, like the role of hormones and the neurochemistry. We mentioned a little bit about insulin and ghrelin. I talk in greater detail about that, and then also about the neurochemistry, mainly about dopamine, so about the mechanics of the addiction itself to show you that it isn’t your fault. This is something that’s actually being hijacked for us.
Then I move on to talk about the concept of, remember I talked about false hunger and real hunger, this idea about enjoying something and wanting something, that those are two different things. Then breaking down some of the experiences themselves and how you can make those things work for you, like when we are eating processed food or an addictive food, in general, most of the time we’re eating it, but we’re not really enjoying it. We want it, and we want more of it. That’s not joy. It’s actually quite uncomfortable. So I will talk about what’s happening there.
I talk about something that’s really important, which is the difference between food addiction and eating disorders because they’re confused in the larger public. They’re confused in the medical world. If you go to your doctor and they’re not aware of this whole world, they’re going to say, “I think you have a binging disorder,” or, “You have bulimia,” or something like that. Then they’ll give you treatment for that, which is not the same treatment as what we suggest. You want to know the difference, and I talk about that.
I talk about, as I did a little bit here today, the stages of food addiction and why that’s important. if you are, quote, a “chipper” and early stage, you may not need to be in total abstinence. Then, when you really do need to be, I’ll make that distinction.
I talk about some of the recovery food plans that we talked about today and the principle behind them. Essentially, you’re looking for the addictive nature, and we’re not looking at weight loss. Weight loss will follow, but that’s not the focus.
Finally, I talk about the importance of social support so that you want to have the benefit of understanding this. You have a plan, but you can’t do this yourself because the thing about addiction is it’s in a part of the brain that is easily manipulated. I might have the best of intentions when I go out there in the world, but I will get manipulated and swayed by the larger forces, i.e., the food industry and the messaging, and friends and family, and I’ll lose my goal. I need to have a support group that will buffer all the messaging, which is not in my favor. A support group is really important. It’s important in any addiction, including food addiction.
Finally, I want to really emphasize, and I talk about it too, that there is hope. There’s hope because once you have the diagnosis, we give you the tools in the course. We talk about relapse prevention so that you can be part of that 5 or 10% of the population that will lose their weight and keep it off. Then the bonus is you keep it off while feeling happy and content.
Dr. Eric Westman: It’s been a pleasure to see the number of people taking the course and have improvements. I’m teaching more people online now than in my clinic at Duke just because of the sheer volume that can be achieved online. Thank you for creating the course. Check out Dr. Tarman’s course at Adapt Your Life Academy.
You can view the full video here.