by Vivian Chow , MD
I was given the opportunity to read and comment on this book when a colleague had to abandon the review. At first, I was a bit skeptical of the notion of food as an addiction. Junkies are addicted to heroin, crack, cigarettes, and alcohol. How could someone be addicted to food?
Then I recalled a grossly obese patient of mine. My 50-something patient is the child of two alcoholics, and has never been able to stay on a diet long enough to lose more than 20 pounds (9 kilograms). I would have appreciated any advice to help treat this patient.
This book is very readable, with plenty of case histories and personal anecdotes. At only 199 pages of actual material, it was also a quick read. The authors are both food addicts, and successfully convey what their struggles feel like and how they cope. Dr. Tarman has a specialty in addiction medicine, which gives credibility to her explanations and treatment suggestions. As a medical practitioner, she also provides lots of references and re- search.
The first part of this book is spent answer- ing my question “How could someone be addicted to food?” I like that Tarman uses sound scientific reasoning to explain how sugar can be addictive. She goes through a general description of addiction, starting with our “happy” neurochemicals namely serotonin, dopamine, and endorphins—and explains exactly what “rewards” they produce. Serotonin makes us feel safe and content, dopamine gives us a natural high, as when we are excited about an upcoming event, and endorphins are natural pain relievers. She then goes on to explain how addiction develops in relation to consuming unnatural substances that are more intense and more concentrated than natural substances (e.g., alcohol vs. fermented fruit), and
which provide a “quick x” of the re- wards that these neurochemicals provide. The addict, of course, is constantly seek- ing these rewards and needs higher and higher doses of the drug of choice in order to achieve the same high. The other side of addiction is that an addict who stops using his or her drug of choice, goes through unpleasant withdrawal symptoms. In the case of sugar, it is now so re- ned (e.g., high-fructose corn syrup) that it creates an articial high, and when consumed in huge quantities (not uncommon in jumbo-sized soft drinks, for example), it can produce withdrawal symptoms. Ac- cording to Tarman, these include “snappy moods, insomnia, tremors, nausea, aching muscles and a mental fog” (p. 70).
Tarman does not try to paint every over- weight or eating-disordered person as a food addict. She makes a clear distinction between a true food addict and an emotional eater. The true addict is chemically dependent on food, whereas the emotion- al eater is eating to “treat” a negative emotion. She also makes clear that the treatments for the two problems are completely different. Emotional eaters can bene t from an eating disorder program and psychotherapy to recognize their triggers and deal with them in a positive manner. Food addicts, on the other hand, are advised to follow typical addiction treatments, including the Alcoholics Anonymous model. Of the limited information on psychotherapy, most favours Behavioural techniques, with one example of a patient bene ing from Psychodynamic treatment. The main message of this book is that the food addict needs to practise abstinence from trigger foods, which usually include sugar and starch.
This book is really geared for the food ad- dict or anyone who suspects they might be one. A big chunk of the book is spent proving the existence of food addiction
and how to make the diagnosis, with relatively less emphasis on treatment. In spite of its limitations, though, I would recommend this book to all medical practitioners, especially psychotherapists. We all have binge eaters in our practices, and some of them could be food addicts. I think it’s worthwhile to distinguish one set from the other. Any patient that does not bene t from typical eating disorder treatments could have a food addiction.
In the case of my grossly obese patient, I now believe that I truly am dealing with a food addict. This is partly supported by a strong family history of addiction. Moreover, after losing the proverbial 20 pounds on the Atkins diet, (only proteins and vegetables in the first stage, followed by the reintroduction of starchy trigger foods in the second stage), my patient promptly re -gained the lost weight and then some when a stressful life event led to a relapse. I have strongly urged this patient to avoid all sugary and starchy foods for life. We’ll see how it goes.
Conflict of Interest: None reported.
Vivian Chow switched from Family Practice to Psychotherapy in 2002 and focusses on the Cognitive Behavioural Techniques. Her practice is in downtown Toronto.