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 artificial 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 benefit 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 favors Behavioral techniques, with one example of a patient being from Psychodynamic treatment. The main message of this book is that the food addict needs to practice 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 benefit 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 focuses on the Cognitive Behavioral Techniques. Her practice is in downtown Toronto.
Katie Jay says
It’s not a question of what we should do, it’s a question of trying to heal ourselves in a sick, unsupportive society.
I’ve been sober 33 years and have suffered with an eating disorder/food addiction for longer than that. I was super morbidly obese for more than a decade. Most of the medical professionals I saw told me to lose weight, but none could tell me how to do that in a birthday-cake, stuff-your-emotions, you-deserve-a-break-today, why-can’t-you-just-take-one-bite culture.
People with eating disorders and addiction often are trauma survivors. Every time the amygdala is activated to signal us to fight, flight, or freeze; something needs to bring us back to chemical balance. Willpower, or being told to avoid sugar and starchy foods, doesn’t work long term without major education and support.
A person needs to be able to create an environment in which s/he can succeed. How many people have trouble getting family and friends to help create that environment, or even to understand our vulnerability and dire condition? Every time I’m invited to a family gathering I’m confronted with drunkenness and junk food. (Not to mention trauma memories.) We need to have black-belt self awareness, boundary-setting skills, and the ability to confront people and negotiate to get our needs met.
We give up family. Give up socializing with coworkers and neighbors. We have to avoid the lunchroom at work. We walk past the donuts at church or skip the fellowship time altogether.
We are judged harshly day in and day out. Even in the hospital I was shamed for being fat, and was then served sugars and starches.
I’ve done better than many in my healing (and have had several years-long reprieves), but even at that, I get knocked down from time to time. I am ever vigilant, and I will always have to be that way. And right now, that stinks.
Dr. Vera Tarman says
Thank you Katie
Yes, I agree completely. The unsupportive attitudes is what brings people down – makes it incredibly hard to eat well. Esp if food addicted, where even a ‘little taste’ to appease a friend can be a problem.
This is one of the reasons why I am so keen to make this an issue for public discussion – the ore people recognize that food can be an addiction, or at the very least, a very real disorder that ruins people’s lives – the more people may support it.
Thanks for your comments
Katie Jay says
Thank you for responding, Vera! I have spent a number of years teaching about what Kathleen Des Maisons calls carbohydrate sensitivity. And I do think she’s correct to call it that, but I also know it’s an addiction. I’m glad you’re offering the opportunities for discussion. It’s going to take a army! One of my clients recommended this site and I look forward to exploring it. Best regards 🙂