Cupcakes or Cocaine – Relapse Rates

One of the ideas that has been popping around my head lately is the idea of relapse rates in dieting. We have all heard that a high percentage of people who go on diets end up failing – especially in the long term. Hell if this wasn’t the case why would we be blogging right here right now. But why does this happen?

People who have never dieted tend to believe it is a lack of willpower. To a certain degree I guess they are right. But perhaps the high failure rate is not because of willpower but more because its an addiction. So I thought why not do a little bit of background work and look at the statistics for relapse rates for different addictions. Below is a list of relapse rates ranked from highest to lowest with the number representing the percentage of people who try to give up that addiction and then fail. I consider a diet an attempt to break food addiction.

Food: 95%

Cocaine: 90%

Alcohol: 90%

Smoking – 90%

Heroin – 82%

Im not trying to start  a war of ‘my addiction is worse than yours’ here. There are obviously a lot of factors at play here. But what I want to highlight is the fact that relapse rates are similar for all addictions including dieting. I don’t think this is a coincidence! Is it that surprising that so many dieters fail when you look at it in the light of addiction?

Prison of Boredom

So here I am sitting at home twiddling my thumbs, and watching lots of stuff on the internet. Fifa world cup, Doctor Who and a whole bunch of other geeky stuff. The reason is that I am bored out of my brains. I decided when I started this that I was going to be really strict on myself. So I wont eat tasty delicious junk food, and I won’t let myself have a little bit of alcohol either. At this stage I don’t trust myself. But a consequence of these rules is I have locked myself into a prison of boredom. I can’t go out socialising because that would mean either having eating temptation or alcohol temptation. Arggghhh. When your in a new country and hardly know anyone this kind of sucks.

I think one of the biggest problems with giving up any kind of addiction is the boredom. Once upon a time I could escape this by eating something. Even if it was just for five minutes it was nice to have a break from my head. Now that five minute relief break is gone. But I think thats the point. I think that a large part of addiction revolves around the ‘addict’ wanting to escape from reality. So when you have to face it it can get draining and tough. Now that I have come this far I really need to start thinking of other things I can do that doesn’t involve going out and eating or drinking. Something that is healthy and good for me. Yes like exercise! Because at the moment Im spending a lot of time on the internet and I don’t want that to become a new form of escape.

Meals

Breakfast: Milk

Lunch: Half Roast Chicken, Cabbage Stew

Snack: Almonds

Dinner: Half Roast Chicken, Cabbage Stew

Snack: Almonds

Macronutrients

Fat 49% (Sat 12%, Poly 11%, Mono 26%).

Carbohydrates 18% (132g)

Protein 32%

When You Start Thinking Addict

I cycled down to 2500 calories today, and so was feeling hungry all day. But especially in the evening. The sad thing is I know its not real hunger. That is what has changed since I have started seeing my hunger as an addiction to food. Before this I pretty much believed in the ‘set point’ theory. That you are meant to weigh what you weigh, and any efforts to deviate from that will put you in a war against your body.  So I thought that when I went on a diet I was only going to get more and more hungry as time passed. This made it hard to motivate myself not to eat because I felt that this hunger, this never ending desire to eat something, was never going to leave and only get stronger. Deep down I still believe this to a certain extent. I think it has been brainwashed into my head.

But my perspective is changing. When you see these cravings as some desperate attempt from that little addict inside your head to get a ‘hit’, then it becomes hard to give in to those cravings. This is because the longer you abstain from junk food the less cravings you will get as time passes. So if you eat some junk food its like an ex smoker having a cigarette. Your undoing all that hard work. However, there is light at the end of the tunnel. This hunger that I feel is TEMPORARY. I just need to tough it out for this moment in time!

But its hard. These thoughts occurred to me tonight as I sat there constantly thinking about eating sugary foods. I desperately want to tell you, and me, to go get stuffed then head down the road and stuff my face with ice cream. I really do want to do that. But I know that if I do then I have given in to this addict. That my life will never get better. That I am just trapping myself into the same patterns. As much I know this it still really sucks. Because I really really WANT to tell you to get stuffed.

Meals

Lunch: 6 x Eggs, Spinach, Tomato

Dinner: 2 x Round Eye Steaks, Cabbage

Late Snack: Cabbage, Canned Tomatoes

Macronutrients

Fat 54% (sat 13%, poly 8%, mono 33%)

Carbohydrates 13% (91g)

Protein 33%

So I stuck to around 2500 calories. I was under this limit (and under 50g of carbs) but I was really really hungry this evening. I was going crazy. Funnily enough I seemed to satisfy the cravings in my head with the thought of some cabbage with tomatoes. No olive oil, no meat, nothing else. So I had that and it pushed me to 2600 calories and 91g carbs. But thats alright as my calories are below maintenance and my carbs are still below 100g. Once again my nutrients were through the roof.

Protein

No Junk Food Today!

Ok quick post today. Went to the meeting today and did my talk. All went well. Today I brought some almonds with me so I wouldn’t have to eat the carb nightmare. But today they actually served fish and vegetables. So I had that instead, then the nuts later. Here is what I had.

Meal

Breakfast - 2 x beef steaks (I loaded up because I thought I was having a small lunch)

Lunch - cod, fish kebab, roast potatoes, salad, seafood chowder

Afternoon Snack – almonds

Dinner – 5 x chicken drumsticks, canned tomatoes, onion

Macronutrients

Fat 54% (sat 11%, poly 10%, mono 27%)

Carbohydrates 15% (156g)

Protein 31%

Well my calories were too high sitting at 3900, and I think my maintenance is 3500. But I am still relieved that I avoided any of the junk food and sort of stuck with paleo. I could have had cheesecake!! Also my carbs were too high at 156g. But tomorrow I am cycling back down again and so will keep my calories under 3000, and my carbs below 50g until I get down to 117 kg, when I will cycle back up for a few days. The good news is that all my nutrients were completely over the RDA limits.

The Goldilocks Principle – Stages of Food Addiction

Dopamine is an important neurotransmitter that is thought to mediate reward responses to foods, and drives a person to consume more foods. When neuroscientists scanned the brains of obese individuals, viewing images of desirable food, they found greater activity in brain regions rich in dopamine receptors. These same regions are also activated by drugs. However, another group of researchers believe that there is decreased reward activity in the brains of obese individuals. In these individuals overeating acts as a compensatory strategy to normalise the reward deficit. In other words, they eat more to feel normal.

A recent study supports both these theories showing that they are not mutually exclusive, and used brain imaging and genetics data to prove it. Using fMRI the researchers scanned the brains of adolescent girls with differing BMIs while they viewed pictures of appetizing foods and imagined eating junk food. They also genotyped these girls to determine whether they possessed variants of two genes that have been linked with lower dopamine activity. They followed the girls for one year and then checked their BMI. Overall, they found that adolescent girls with greater BMI showed increased reward activation in response to food images. They found that girls with greater reward activation gained more weight. However, the genetic data also showed that girls whose brains had a lower reward response to foods also gained more weight. It would seem that there may be two types of obesity – those who are overly sensitive to food and those who are under sensitive. They propose the Goldilocks priniciple – too much or too little reward system activation may lead to weight gain.

I think I would like to add my opinion on this. Research has also shown that if you are a healthy weight, and are more sensitive to rewards, the heavier you tend to be. I believe that initially, whether your rat or human, the more sensitive you are to food rewards the more likely you are to consume these foods again and again. So at the start you get a huge hit from eating this junk food and want more! This is why oversensitivity to food rewards is found in heavier normal weight people as it is at the initial stages of the addiction process. As you continue to become more addicted, and eat more junk food, your dopamine system begins to shut down reducing the number of dopamine receptors and thus decreasing your sensitivity to a food reward. Thus, you need to eat more and more junk food to compensate (this mechanism has been shown in rats). By this stage you have entered into stage II of the addiction process, and are likely to be obese. This would explain the above pattern. Unfortunately, if this is true, and this pattern is not broken, an addicted individual is destined to become more obese and to enjoy food less and less as time goes by.

Relapse I

Before I start I suggest anyone reading this go and read my post on how junk food can trigger addiction. If you read that, and don’t walk away thinking junk food is like cocaine, then good day to you sir!!!

I didn’t blog yesterday because I am in the midst of preparing a talk for a very important meeting tomorrow. I won’t bore you, but it is basically about getting some funding to do environmental monitoring of some freshwater ecosystems here. So when it comes to funding I get stressed. Needless to say I was up late last night writing the talk, which I give tomorrow. I only post now because I have finished it. I also didn’t write yesterday because there was nothing much to report. Same day as the last one. Getting hungry in the evenings (which apparently is a tell tale sign of food addiction) but thats about it.

Today I woke up and had some eggs for breakfast. Then I went to the workshop. Now I assumed since this was at a fancy hotel that my options for food would not be strictly limited. I intended on having some sort of salad. Well bad luck for me. There was the choice of carbs, more carbs, or high carb foods. Nothing existed without carbs. I couldn’t even have the insides of sandwiches as there wasn’t much. By this stage my stomach was rumbling and I knew I needed to stay awake and eat something.

I contemplated leaving and getting some food elsewhere but no one else did, and in these types of meetings its all about contacts!!! Going out for lunch by yourself is a big no no!!! So I stayed and I ate some small sandwiches, a pasta salad and some apple juice. I really did feel my hands were tied. Yes I could have been more gungho and simply starved myself. But let me tell you that my ability to not eat carby foods is via a thin shred of willpower. To not eat AT ALL was too much, and lets say I had a controlled explosion.

I feel bad because up to this point I have been perfect. Also, I feel bad because this is similar to doing a line of coke. In other words I have undone all my efforts. I can expect massive hunger now. But I can’t get too caught up in that thinking otherwise I really will unravel. I just have to soldier on and remind myself that everyone has a relapse every now and then. In this case it was a pretty minor incident as I did not have that much, and I did not go into a bigger binge because I had stuffed up.

So here is the damage.

Meals

Breakfast: Two Fried Eggs

Lunch: Assorted Sandwich mix, pasta salad, apple juice

Dinner: 2 X Pork Steaks, Asparagus, Almonds

Macronutrients

Fat 49% (sat 13%, poly 11%, mono 21%)

Carbohydrates 27% (177g)

Protein 24%

All in all its not that terrible. I have had 2600 calories of food. My nutrients were lower than normal and I was deficient in Vitamin C, Calcium, Magnesium and Potassium. Could have been worse!

Junk Food Triggers Addiction

Recently, scientists have shown that the same molecular mechanims that drive people into drug addiction are behind the compulsion to overeat, pushing people into obesity. They found that in rats the development of obesity coincides with a progressively deteriorating chemical balance in reward brain circuits. As these pleasure centers in the brain become less and less responsive, rats develop compulsive overeating habits consuming larger quantities of high-calorie food eventually leading to obesity. Scarily, the exact same changes occur in the brains of rats that overconsume heroin or cocaine, and are thought to play an important role in the development of compulsive drug use.

In later studies the researchers showed how eating behaviour changes in ‘addicted’ rats when they have access to high-calorie food. Animals completely lost control over their eating behaviour, the primary hallmark of addiction. They continued to overeat even when they knew they would receive an electric shock. This shows how motivated (addicted) they were to consume palatable food. Control rats that were fed a normal diet decided to not eat rather than receive an electric shock.

Addicted rats were fed a diet that was modeled after the type that was thought to contribute to obesity – easy to obtain high calorie and processed foods like sausage, bacon and cheesecake. Rats always went for the worst type of food consuming double the number of calories as control rats. Rats began to bulk up dramatically soon after the experiments begun. When junk food was removed and they were placed on a nutritious diet (the salad bar option) the rats refused to eat. Not only that this hunger strike lasted for two weeks!!!!

The rats that showed the biggest ‘crash’ in brain reward circuits were the same that showed the biggest food preference for junk food. It was these same rats that kept on eating even when they anticipated being shocked. The authors believe that the reward pathways in the brain were so overstimulated that the system basically turned it itself off, adapting to the new reality of addiction, and it doesn’t matter whether its cocaine or cupcakes. When the animal overstimulates its brain pleasure centers with highly palatable food, the systems adapt by decreasing their activity. However, now the animal requires constant stimulation from palatable food to avoid entering a persistent state of negative reward (could be defined as punishment in my book). In other words not eating junk foods makes the rat feel depressed.

After showing that obese rats had clear addiction-like food seeking behaviors, researchers investigated the underlying molecular mechanisms that may explain these changes. They focused on a particular receptor in the brain known to play an important role in vulnerability to drug addiction and obesity – the dopamine D2 receptor. The D2 receptor responds to dopamine, a neurotransmitter that is released in the brain by pleasurable experiences like food or sex or drugs like cocaine. In cocaine abuse, for example, the drug alters the flow of dopamine by blocking its retrieval, flooding the brain and overstimulating the receptors, something that eventually leads to physical changes in the way the brain responds to the drug. The new study shows that the same thing happens in junk food addiction.

In addition, levels of the D2 dopamine receptors were significantly reduced in the brains of the obese animals, similar to previous reports of what happens in human drug addicts. Remarkably, when the scientists knocked down the receptor using a specialized virus, the development of addiction-like eating was dramatically accelerated. The day after the dopamine receptors were knocked out in normal rats they began to show the same compulsive eating behaviours as those rats that had been overeating for several weeks.

The Need For Hypervigilance

In yesterdays post ‘Missing Sugar‘ I received two comments from Cheryl and Chris that suggested I should not be starting my day off with a carby breakfast. I still think that by today’s standards some plain greek yogurt and berries is not terribly high in carbs. BUT I do know that evidence shows that if you eat carbs for breakfast then you will burn carbs throughout the day, and this may lead to greater cravings for carbs later. I took their point and so today I did not start my day with a high carb breakfast. In addition, as opposed to what I said last night, I will not leave my carbs in the range of 100-150g, but rather will keep them under 100g as I orginally intended. I think this was a case of cognitive dissonance. I had eaten over 100 g so tried to justify it.

So I guess the big question on everybody’s mind is did I get hungry later than usual after the low carb breakfast? The answer is yes. The hunger pangs didn’t kick in until about 4 or 5pm. I was feeling fantastic. I had kept my carbs well below 100g, I had managed to curb my hunger for two hours, and I had lost another kilogram. Oh I lost another kilogram!! Anyway, I started to feel that my eating was under control and I couldn’t quite believe it. Maybe this time eh?

You might notice I am using past tense………as if something sinister happened later. Well lets just say when I found myself standing in the kitchen hacking off bits of fat from the steak I cooked for tomorrows lunch I realised that something was wrong. Just so you know I did NOT actually put any of the food into my mouth. As I stood there I suddenly came too, and realised that this was addictive behaviour. I quickly went for a walk and when I came back the cravings had subsided enough for me to put the steak in the fridge and leave it there.

This was like a warning sign for me. I cannot let this false sense of security let me be anything but hypervigilant. I cannot let my guard down for one second otherwise it will be like coming too at a murder scene and not knowing what happened. But rather than a dead body it will be empty ice cream containers everywhere. What I did find interesting about the ‘steak incident’ was I really tuned in on the fat. I saw the big succulent juicy pieces of fat and and just lost it. Maybe my body was just trying to get as much calories as it could. Or maybe not. If I have anymore fat cravings I will let you know. The major difference, however, is I only crave fat when I physcially see it whereas carbs are always on my mind.

This evening my hunger levels have been stronger than yesterday but weaker than the day before. I can’t explain it but their is a feeling in my gut that just wants something sweet. That other foods just seems so mundane. I feel so bored with food and so empty. The thought of meat now is putting me off eating. I just want something sweet. Which seems ironic considering that just over an hour ago I was standing in the kitchen with a knife tearing into an innocent steak. I had lowered my carbs today so maybe my addiction for sugar is kicking in a bit more?  Thoughts anyone?

Today was a good day though. My calories were at 3000, and for the first time since I started my carbs were under 100g, and I lost another kilo. All my nutrients except calcium and potassium were well over the RDA. But if you look at it over a week it seems as though I am getting enough nutrients each day.

Meals

Late Breakfast/Early Lunch: Pork, Spinach, Tomatoes, Olive oil

Afternoon Snack: Almonds

Dinner: Steak, Asparagus, Olive Oil + Cod Liver Oil

Late Evening Snack: Berries

Macronutrients

Fat: 68% (sat 13%, poly 9%, mono 43%)

Carbohydrates: 10% (77g)

Protein: 23%

Success Story – Breaking Sugar Addiction

I just received an excellent comment from someone who just found my blog, but has broken her obsessive eating behaviours. It was such a well thought out comment I didn’t want it to go unnoticed hidden away in the comments section. So I decided to pay the respect that it clearly deserves and post it. Denise thank you for your comment (and I hope you don’t mind me doing this since I never asked).

I found your previous blog yesterday and am touched by your struggle. I was tempted to comment then but decided that since we had just met, I should get to know you better, so I’ve done some reading and when you popped up in my RSS reader today and I read your post, I thought perhaps now I can offer something constructive.

I have been where you are and have come out the other side. Here is my story: the first time I did Atkins (late 1990′s) I lost a lot of weight and felt great. Then I was brainwashed by the low-fat, healthy-whole-grain-and-fruit South Beach-style propaganda and over several years gained it all back except 1 lb. In January 2009, in complete desperation, I started Atkins Induction. I also, at that time, stopped eating everything that tasted sweet. The “Induction Flu” only lasted a couple of days, and then I felt fantastic. Except for some digestive issues, the cause of which I couldn’t exactly pin down. My personal trainer, who has celiac disease, suggested that perhaps gluten might be an issue, and after resisting that idea for a while, I decided to stop eating grains for 2 weeks (telling myself I can do anything for 2 weeks, then when it didn’t work, I could go back to my beloved Ezekial bread and Miller Lite). In 3 days I felt like a fog had lifted, one I had no idea was even there. Dammit!

It has been a year and a half since I gave up sweets (yes, that means sugar, fruit, artificial sweeteners, anything that tastes sweet), and a year since I stopped eating grain.

Do I miss them? No, actually. I don’t have any cravings and can happily pass up all the things I used to be addicted to. Here is why: I feel good. I want to continue to feel good. And I know that any time I want to feel like crap I can get back on the sugar-starch-cravings roller coaster, and I don’t want to do that. I don’t want to go through withdrawal again. Ever. And I’ve already proven to myself that’s what happens when I eat even just a small amount of sugar or starch. I’m sure you can figure out how I know this.

My digestive issues have resolved and I’ve lost 40 lbs. in the last year and a half, and am still losing slowly (very slowly) and figure I have about 40 lbs. to go to be at what I’m thinking would be a good goal weight.

The most interesting thing I’ve discovered is that in giving up sugar and starch, the “emotional eating” went with it. Speaking strictly for myself, I have concluded that it was not emotional eating, it was addiction, a very physical addiction to sugar and starch. Because it went away when I quit eating them. Here’s what also went away: being obsessed with food and thinking about the next thing I was going to eat even while I was eating; lusting after food; the horrible, shaky, lightheaded feeling that I was starving and absolutely, positively MUST eat something, anything, right this very minute or I am going to DIE; being unable to stop eating although I was uncomfortably full, even “stuffed”. All that is gone along with the sugar and starch. I am not saying it will work this way for anyone else, but what do you have to lose?

The longer I go on this path the better I feel. I absolutely do not need carbohydrates in my diet, although I do love my vegetables (non-starchy, of course), usually cooked using Paula Deen’s method: a pound of veggies (especially nice for French-cut green beans or any kind of greens), a half a pound of bacon, and a stick of butter. Add enough chicken broth so they don’t burn, and cook them until they’re as done as you like them.

I apologize for the length of this comment, but I wanted to share what has worked for me and perhaps, give you a bit of hope.

Great story of hope. Thank you.

Missing Sugar

I weighed myself today. I don’t know why. I guess I wanted to know I wasn’t gaining weight. I have lost 2 KG since I started this a few days ago. Probably mostly water. But I think that I may be losing weight too fast. This time round Im really cautious of not physiologically shocking my body. In some ways I think I shouldn’t even be trying to lose weight, rather I should be maintaining weight and working through my food issues. But I know that the motivation for me is to be healthy and to lose weight. When I do that it will help motivate me. So since I have decided to diet I want to do this slowly. I don’t want to force my body into thinking its starving. At least I want to minimise physiological cravings as much as possible so I can deal with the addiction. I find it really hard to say that – addiction. I rewrote that sentence a few times even though I wanted to say addiction. I almost feel embarrassed to say it. I guess I don’t want people to think Im crazy for thinking this.

At exactly 2:40 pm today the hunger started to kick in, and after that it progressively got stronger. It was similar to when I gave up smoking. I could feel my heart beating in my veins and I felt very tense. I also began obsessing about food. Particularly lemonade. I guess my body just wants the quickest hit it can get from sugar, and what could be better than sugar in liquid form. I also knew it was going to get worse as the day went on. In order to counteract this I decided that I would lift my calorie limit to 3000. The reason behind this is the hope that it will prevent the currently rapid rate of weight loss, which may be partly causing this massive hunger. It seemed to work. My need for food disappeared, and I was left with a strong want for food. I WANTED to go and get some lemonade, but I didn’t need it. It made the obsessive food thoughts more manageable.

So I am left with this feeling of simply missing carb-laden food. I just want to have carbs for no other reason than I just want to have carbs. I miss the way it makes me feel, I miss the taste and I miss the excitement of having it. I feel like something is missing now. Weirdly, I feel I have lost a piece of me or something that I could always rely on to make me happy. I guess this truly is the addict talking. Its similar to when I gave up smoking and I just missed smoking. I wanted that hit again. Also, I am having similar thoughts as to yesterday. That little addict inside my head is trying to convince me I am going to fail. That when I lose more weight I will actually be too hungry, and there will be nothing I can do about it. That its not about addiction at all. That I am wrong, and I will fail, and will be fat for life. That little addict is trying to break me so it gets its fix. I hope it is not right because honestly Im not sure.

Ok so here is my eating for today. As I said I brought my limit up and had 3000 calories. Im hoping that this will maintain my weight for the next few days and then I will drop it again until I lose another half a kilo, and then bring the calories back up again. I am hoping that by cycling my calories like this that my hunger levels will be kept at bay. Since I increased my calories, and my carbs always seem to be sitting in between 100 and 150 g of carbs anyway, I decided to keep it that way. This carb intake may be too high, and so if the cravings become intense at 3000 calories I will begin to progressively reduce the carbs down in an effort to diminish hunger levels. Today my nutrients were looking really good with most been well over 200% of the RDA with no shortfalls.

Meals

Breakfast: Berries, Yogurt

Lunch: Pork Steak, Canned Tomatoes, Spanish Onion, Celery

Late Afternoon Snack: Pork Steak, Spinach, Olive Oil

Dinner: Salmon, Asparagus, Almonds

Macronutrients

Fat 56% (Sat 12%, Poly 9%, Mono 32%)

Carbohydrates 18% (149g)

Protein 26%

By the way never be afraid to make comment. I freaking love people commenting!