DrClydeWilson's NUTRITION BLOG

Our sense of self that can overcome food addiction is in the brain's cortical midline

Food addiction is associated with dopamine and natural opioids in the emotion center of the brain, the limbic system.  Tested therapeutic methods for overcoming addiction (such as 12-step facilitation therapy or cognitive behavioral therapy) show that the key component to lasting success is a change in self-perception, meaning the development of a better self-image.  Positive feelings (about ourselves or anything else) lead to dopamine and opioid release, reducing our need for food to carry out that function.  This raises the question of how to address our self-perception to overcome food (such as sugar) addiction.  A first step is to scientifically define the “self” so we can figure out what parts of the brain are involved and how they interact with limbic system, where addiction resides.

There are 3 main types of self that are represented in our brain*.  First, we have a proto- or physical self, made up of sensory perception and motor control.  This is a rudimentary self that takes information from and interacts with the environment.  It does not require consciousness.  Our proto-self resides in the sensory and motor cortex, which runs from our left ear to our right ear in an arch along the outer part of our brain.  Second, we have a core or mental self, which fundamentally determines who we are, meaning what is and is not a part of us.  Our core self distinguishes unknown things from the house we grew up in, friends and family, and seeing ourselves (such as in a picture).  Our core self resides in the cortical midline structures, running from the front straight through to the back of our brain, and has strong connections with the limbic system.  We also have a narrative self that resides on the left and right sides of our frontal lobes (under the temples) where we have higher-order intellectual thought relevant to ourselves.  The narrative self also has strong connections to the limbic system. 

Clyde’s Thoughts:  Our proto- or physical self follows the laws of cause and effect in the more classical sense, interacting with the limbic system only through the thalamus where emotions help regulate perception of things external to the mind.  Our narrative self includes our conscious deliberations about what we want to do and how badly we think we want to do those things, which is our willpower.  Addiction can overcome even the strongest of willpowers, so this cannot be the only target.  Our core self reacts emotionally to distinguish what is part of our self and what is not.  The strong emotional component makes the core self the target for overcoming addiction.

Clyde’s Advice:  If your willpower is enough to overcome a food addiction, target your self-image by thinking about what contributes to and what takes away from how you see yourself.  Trauma and social isolation are two of the main things that can take away from a positive sense of self.  Addressing any such issues will directly address the limbic system where addiction resides.  Scientific studies show that all credible types of addiction therapy are equally effective, probably because they all share the common element of raising self-image.

The Bottom Line:  Eating better is not just about knowing what is healthy and having a strong willpower to follow through, because addiction can overcome both of these advantages.  To fight fire with fire, overcome addiction by achieving dopamine and opioid release from having a higher self-image.  Raising self-image generally means addressing issues of past trauma and/or feelings of isolation.

*References: 

“Self-referential processing in our brain—A meta-analysis of imaging studies on the self”, Northoff G et al., NeuroImage 31 2006 440. Research paper quality score: A

“Psychopathology and pathophysiology of the self in depression—Neuropsychiatric hypothesis”, Northoff G, J Affective Disorders 104 2007 1. Research paper quality score: C

Solving food addiction: From self-destructive to truthful self-nurturing

There are many barriers to healthy eating in our environment, such as social pressures and a low availability of convenient healthy foods.  There are also many barriers within ourselves, such as habit and low expectations of one’s ability to improve.  Food addiction, whether it is to sugar, fats, or eating in general, can be one of the most powerful internal barriers.  Addiction stems from changes in nerve signaling in the emotion portion of our brain.  We start off “liking” something, which escalates to “cravings”, and ultimately to an excessive (meaning life-interfering) dependence.  Addiction repeatedly overpowers a conscious decision to start living healthier, leading to feelings of defeat and loss of self-esteem.  However, scientific studies have shown that significant improvements can come from fighting fire with fire.  Compared to trying to overpower addiction with willpower alone, psychological approaches address our emotional perspective, which comes from the same place in our brain as addiction.  In a meta-analysis of rehabilitation research for alcohol, opioid and cocaine addiction, all the methods considered (12-step facilitation therapy, cognitive behavioral therapy, motivational enhancement, psychodynamic psychotherapy and family therapy) provided relatively similar benefits*.  While one method may be better than others for a specific individual, the evidence does not support any one method being superior for people overall.  So in general, the specific method of addressing addiction is less important than the common principles underlying all of the methods.  Based on a review of the literature**, the core factors found to contribute to long-term success against addiction, regardless of therapeutic method, are as follows:

1.  Motivation:  A realization that one’s condition is in conflict with important long-standing values and goals.  This is the starting point to seeking true change.

2.  Initial Success:  This enables further change.

3.  Identity revision:  A change in how one sees oneself (a new vision of ones identity as a healthier person), or seeing oneself in a new light, is the key to sustained success.

4.  Acceptance of addiction:  The new vision of ones identity must include an acceptance of one’s permanent addiction.  Addiction does not go away despite successful behavior change.  Self-observation and emotional self-awareness are a lifelong necessity.

5. Planning:  Strategies must be implemented to avoid re-triggering events, such as surrounding oneself with healthy food in the home, or ordering a salad in a restaurant even if no one else does. 

6. Re-enforcement:  The rewards of changed behavior re-enforce the new vision of oneself, which re-enforces the changed behavior in a cyclical pattern of empowerment.

Clyde’s Thoughts:  There are 2 core elements serving as the foundation of the 6 factors for success against addiction:  A nutrition plan (or just nutrition common sense) to provide the results in steps 2 and 5, and a the development of a new sense of identity that includes both the acceptance of ones addiction (steps 1 and 4) and the confidence to succeed (steps 3 and 6). 

Why a nutrition plan or nutrition knowledge is probably not the main barrier to healthier eating in America:  If you ask people to describe a healthy diet, the vast majority will mention natural foods (such as vegetables) as being good, and chips or sweets (manufactured foods) as being not so good.  This is consistent with the advice of top nutrition experts, such as Michael Pollen (“Eat Food.  Not too much.  Mostly plants.”) and Marion Nestle (“Eat less, move more, eat lots of fruits and vegetables…go easy on the junk foods”).  So if the fundamentals of healthy eating are so simple to understand, why is it so hard to accomplish?  Put differently, if we don’t even need a nutrition plan or a diet to follow because we already have enough nutrition common sense to guide us, why are so many people hurting themselves with eating patterns they know are not good for them?  A main reason is that our propensity for calories, fats and sugar can develop into cravings and addiction, which require more than just a nutrition plan to overcome.

Seeing oneself in a new light:  That a shift in how one sees oneself is the cornerstone of overcoming addiction** was determined by grounded formal theory***, which is a process of systematically comparing data from qualitative papers on a topic not amenable to objective numerical measurements.  The implication of this result is that a person who has difficulty making nutritional changes should assess how they see themselves, in particular focusing on whether they could potentially be in denial about addictive behavior (self-destructive self-nurturing), and their level of confidence at achieving and maintaining their goals of being a healthy person (truthful self-nurturing). 

Clyde’s Advice:  If you are having a hard time sticking to your nutritional commitments, consider that the problem might have more to do with your reflex response to desirable foods than any shortage of your understanding of nutrition.  If an honest self-appraisal of your habits indicates a problem you cannot easily overcome, consider addressing the problem by assessing how you see yourself; are you accepting of the idea that you might suffer from an addiction, and do you see yourself as being capable of real change?  Surround yourself with positive re-enforcements to avoid re-triggering, such as healthy foods and like-minded individuals.  Seek help as necessary with one or more sessions of any legitimate type of therapy.

The Bottom Line:  If you want to turn the corner on addiction, focusing on seeing yourself in a new light might be critical to your success, where your new perspective includes a strong sense of self-confidence and an acceptance of addiction as a life-long issue requiring on-going self-awareness.  A supportive environment and any legitimate form of therapy will help significantly.

References:

*”Three lessons for improving addiction treatment from a meta-analytical study”, Berglund M, Addiction, 100 2005 742. Research paper quality score: A.

**”Identity shifts as turning points in health behavior change”, Kearney MH and O’Sullivan J, Western J Nursing Res, 25 2003 134. Research paper quality score: B.

***”Discovering grounded formal theory”, Kearney MH, Research in Nursing and Health, 21 1998 179. Research paper quality score: 3.

Many think healthier eating will only help OTHER people

A person’s attitude (perceived consequences) about nutrition is a main predictor of eating habits.  But how much we think eating healthy will benefit us can be very different from how much we think it will benefit others.  This was clearly shown in a study* looking at the perceived benefits of produce (fruits and vegetables) for reducing cancer risk in 1,649 randomly-selected phone interviewees who ate fewer than the government recommended 5 servings of produce per day and who thought that produce can provide a cancer-reduction benefit in general.  Although not eating enough produce themselves, over half (55.3%) thought they could NOT reduce their own personal cancer risk with better nutrition, while only 6.8% of this same group thought others couldn’t benefit, and listed things that others could do.  In other words, when a person does not have a healthy diet, they are almost 10 times more likely to think that better nutrition can’t help them compared to others, and they are willing to list pieces of advice for others that they would not themselves follow because it can only help other people.

Clyde’s Thoughts:  The complexity of the human mind is beyond its own comprehension.  Not only do we have opposing emotional and intellectual nutritional interests (e.g. cake as opposed to salad), but these interests are mixed together so that our intellect can believe two opposing things at the same time (e.g. I should eat cake but other people should eat salad).  What this means is that knowledge is not enough, and even belief is not enough.  We need our belief to extend to ourselves, and we need an environment that does not make it difficult to achieve a healthy eating pattern.

Clyde’s Advice:  Remember that research results are done with humans and therefore usually apply to all humans.  And you are a human.  Know the basics about nutrition, and give that knowledge a chance to improve your life by taking action.

The Bottom Line:  Act on what you learn about nutrition.  Anything less is an academic exercise.  The most important step towards taking action is to pre-plan.  If you think ahead before you shop for groceries, follow a recipe in the kitchen, or order food, you will be able to improve your diet dramatically just using your own common sense.

*Reference:  “Lack of acknowledgment of fruit and vegetable recommendations among nonadherent individuals: Associations with information processing and cancer cognitions” Cerully JL et al., 11 2006 103.  Research paper quality score: 2

Attitude is a main predictor of eating habits

Ideally, life should be long and lived to its fullest.  We can then experience and share more with family and friends.  Achieving this goal is a natural instinct, but is re-enforced in childhood (attachment theory) and is psychosocially influenced as an adult, meaning that our environment impacts our attitude and behavior, particularly when we form habits while young.  Nutrition plays a key role in allowing us to live life to its fullest because it provides the fuel and building blocks for our body, which is the vehicle within which we experience and share our lives.  The psychosocial link with nutrition habits has been directly measured in adolescents*, separating out the following components:

·   Attitude, based on perceived consequences (e.g. fruit tastes good, breakfast improves mental focus, etc)

·   The perceived habits of parents

·   Whether family and friends are personally supportive of eating healthier

·   The availability of healthy foods

·   Self efficacy, i.e. whether or not it is easy (at a personal level) to eat healthy

Of these parameters, ONLY ATTITUDE had an actual impact on how adolescents ate.  And it positively correlated with every healthy eating habit measured (eating more fruit, eating breakfast, and limiting the amount of fatty snacks).  But there were some other interesting findings:  Mothers were perceived to practice healthy eating twice as much as fathers.  Adolescents think that family and friends have only a marginal interest in their eating habits.  They do not perceive their environment as being very supportive of healthy eating.  And students generally found it easy to practice good nutrition habits, but few had an intention to eat more fruits (even though they ate only 0.9 pieces of fruit per day) or to limit fatty snacks.  The lack of intent to eat breakfast was the strongest of all the measured unhealthy eating practices.  The authors of this paper conclude that interventions to promote healthy eating for adolescents need to include ways of creating positive attitudes on healthy eating i.e. opinions about perceived outcome. 

Clyde’s Thoughts:  Each of us has two sides to our inner conversation about healthy habits, whether it concerns taking the time to sleep enough, exercising regularly, or eating better.  Our inner adult tells us to do what improves our quality of life so that we can live life to its fullest and so we can be there more each day and for more years for our loved ones.  But the kid in us wants immediate gratification and sometimes wins out, postponing healthy actions indefinitely.  To improve our chances of taking action, we need to be honest with ourselves about whether or not we think following a healthier pattern will actually make us healthier.  This point is more important than any other measured psychological factor, including how easy it is for us to schedule healthy habits into our lives, or how much the environment keeps us from being healthy.

Clyde’s Advice:  Tell yourself every day that IT MATTERS what you put into your body.  If that has no effect on your habits, tell it to yourself before each major meal.  I think this every time I consume something, which is why I won’t eat cake or drink soda that I don’t really like.  If it is my favorite chocolate mousse cake or a quality root beer float, I enjoy it with absolutely no guilt.  But I won’t waste calories on sweets that don’t taste that good, and most of the time my meals are healthy.  Just taking a moment a few times per day to think about the fact that IT MATTERS can make a huge difference. 

The Bottom Line:  Eating healthy takes more than an intention to eat better or an understanding of nutrition.  You have to have a positive attitude about what it can do for you.

*Reference:  “Why do adolescents eat what they eat?  Personal and social environmental predictors of fruit, snack and breakfast consumption among 12-14-year-old Dutch students.”  Martens MK et al., Public Health Nutr 8 2005 1265.  Research paper quality: 1.5

How we view ourselves affects how we view our environment, which affects how we eat

Eating an unhealthy diet is a high-risk behavior.  It offers a dopamine reward-response, is addictive, and has inevitable drawbacks that literally outweigh the rewards.  Unfortunately, wanting to eat healthy is not usually enough to actually achieve nutritional health.  We live in an environment that makes it difficult to eat right.  Whether it is us or what surrounds us that is the biggest factor in making us bigger is a matter open to debate, but a recent review of the literature provides us some insight*:

·   Our perception of healthy food availability affects how we eat more than actual availability

·   Healthy food is more available than is often perceived, including in areas of lower economic status

·   Our perception of our environment is affected by our psychological state and sense of self (e.g. depression and how healthy we perceive ourselves to be)

·   Because social education on how to eat healthy has had only limited beneficial results, it may be more effective to address how we perceive of our environment (and ourselves)

·   Children have healthier habits when they perceive their parents as being more strict and involved in general (which is a perception of their environment), not when parents are strict just with health habits

·   Specific child-feeding practices by parents can have negative effects, such as encouraging eating beyond satiety and using food as a reward

The authors of the review conclude that our social environment has a greater impact on how we eat than our physical environment (i.e. the availability of healthy foods), and that to succeed with improving the nutritional health of society we may need to shift from educating the public to a paradigm of health protection by the government.  Such an approach has proven beneficial with the development of laws designed to protect us from infectious disease, unsafe driving, and second-hand smoke.

Clyde’s Thoughts:  A health protection program would presumably include tougher food labeling and advertising laws, as well as more restrictions as to where certain types of foods can be sold (e.g. in schools and hospitals).  Perhaps a higher tax on foods that increase the disease and health-care cost burden on society would make sense as well.  However, laws cannot be our only defense against toxic eating patterns.  As is the case in the relatively ineffective drug war, there needs to be a reduction in demand for high-risk behavior and eating.  We demonstrate our demand for healthy foods very simply by purchasing them.  To understand what purchases to make, we have to understand what foods and what type of diets truly are healthy (as opposed to fad diets that masquerade as being healthy).  This means that public nutrition education should always be one of the cornerstones of helping the public to eat healthier.

When I travel in Europe and in North America, it is difficult to eat healthy no matter how hard I try because of both low availability of healthy food and because of social barriers.  My friends and family like to eat unhealthy food, a lot of it, and late at night.  It is an uphill battle to avoid the pattern of “Night-Time Eating Syndrome” when I want to spend time with them, even though I teach nutrition and am very motivated to follow my own healthy advice. 

Working with and teaching many people over the years, as well as my experiences in my own life, have convinced me that knowing what is healthy is not enough.  We do need a healthier environment to succeed as a society.  That will require that the food industry continues to see increased demand for healthier foods, and that more protections are put in place by government.  Nutrition education for the public is extremely helpful in terms of motivation, but our environment has to enable our will to act.  In the meanwhile, we need tools to cope with an environment that is not always in our best interest.  I am developing a set of such tools in writing my current book, but below are some simple guidelines you can put to immediate use.

Clyde’s Advice

1.  Set up a healthy nutrition environment in your home.  Just using your own common sense in the grocery store will go a long way (in fact most of the way) towards getting you to eat healthy.

2.  When not at home, eat as healthy as you can by ordering using the same common sense you used with groceries, or bring healthy food and snacks with you.  If you like unhealthy foods, pick a couple days each week when you splurge, but make healthy habits the norm so that splurging does not become a high-risk behavior.

3.  Once you have done your best and have your food, enjoy it.  Don’t worry if it did not end up being as healthy as you had hoped.  Eat and be happy.  Food is for enjoyment too, not just to provide for your body.  If you want to continue to improve, go ahead and make more changes moving forward, but don’t take away from your enjoyment with guilt.  Nutrition should support our lives, not dominate it.

The Bottom Line:  Stop and think for a few moments every time you purchase, order, or grab some food.  Those few moments will either help you make a better choice, or help you move towards such choices in the future, making a huge difference in your potential quality of life and life span.

*Reference:  “Environmental determinants of healthy eating: in need of a theory and evidence.”  Brug J et al., Proc Nutr Society 67 2008 307.  Review paper scientific quality score: B (although based on all the scientific evidence, this evidence is at this time somewhat inconsistent and scant).