Using mindfulness to kick my sugar habit.

I’m on day 6 of no sugar. I want to eat all the time. Previously (in 2019) I had been in a decent rhythm of time restricted eating (skipping breakfast and waiting until lunch to eat), but this week with the sugar withdrawal it feels more urgent and I’ve been eating a lot of healthy food (overeating healthy food) as my brain and body try to adjust. 

I’ve been incorporating mindfulness over the past 2 months in order to help me effect change in my eating habit loops, because until this year I have managed my weight by white knuckling — forcing myself to adhere to a food plan and then periodically giving in and indulging my sweet tooth before resisting again. But this way of dealing with food has left me feeling like I am still addicted to sugar (as I confessed last week), and has not helped me to decondition my brain — a brain that has had 40+ years of repeated strengthening of this basic habit loop: feel a feeling or urge (trigger), eat sugary treats (behavior), numb the bad feeling or bolster the good one (reward)... repeat. I want more than anything to break this habit loop. To decondition my brain from expecting a sugary reward every time I feel something, every time a certain time of day arises. But how?

In order to decondition yourself from automatic behaviors/habits, you have to first NOTICE the behaviors, and notice the rewards (or results) of those behaviors: what did you get from it? It’s harder to decondition a rewarding habit or addiction (one that lights up the reward centers in the brain) if you haven’t started paying attention to the negative results you’re getting from that habit in addition to the immediate rewards. You have to start really feeling disenchanted with your results at a gut level to truly want to change. How many times have you told yourself you needed to lose weight on an intellectual level, but not really felt truly committed? This intellectual wanting leads to a temporary change in behavior through forcing it, and an inevitable backslide back into the behavior of overeating. Wanting something is not the same as committing to something. So, in order to really build commitment, it helps to start paying attention to the negative consequences of the actions you are trying to change. Even before you actually try to make the change, first just notice what result you are getting from engaging in the behavior. So for example, if you want to stop drinking, first you start paying attention to how you behave in ways you wish you hadn’t when you’ve been drinking, how crappy your body feels after you drink too much, how it affects your sleep negatively, how it gives you heartburn, and how lethargic, dehydrated and headachey you feel the following day. Noticing all of those effects and feelings can help really make you want to stop drinking on a gut level. This builds disenchantment with what you had previously felt was rewarding. Giving in to your cravings when you are in the early stages of change doesn’t mean you are a failure — it means you are learning, and giving in to urges can be an amazing teacher when you are open minded and aware.

For me, you must know by now that my substance of choice is sugar. Previously I had always felt somewhat out of control when I let myself eat it, but I had never really paid attention to its effects — to how I felt physically or emotionally — during or after eating a big pile of sweets. Instead, I just felt an urge to eat sweets, often urgently, and did it out of habit. Now that I am using mindfulness to help me kick my habit, I am much more aware of what sugar is giving me. Last week when I was binging on sugar, I paid attention to how I felt. And it was really eye-opening. After feeling an urge and deciding to eat sweets, I felt a surge of excitement and happiness. Good ole’ dopamine exploding in my brain in anticipation of the reward. Buying the sweets was like visiting Disney World. The first few bites were amazing. An explosion of deliciousness in my mouth and happiness in my head. Then, interestingly, I just wolfed down the rest of it rapidly and mindlessly, as if I was afraid I’d catch myself. (Quick! Eat it all before she changes her mind!) It was fascinating. After the first few delicious mindful bites (which probably amounted to 200 or 300 calories), the remaining 2000 or so calories was just numbing. I noticed that my reward after that initial exciting dopamine surge was an escape into mindlessness, a peaceful calm feeling. But soon thereafter I felt physically hot, and felt my heart pounding out of my chest- the relatively immediate effects of the excess sugar. Then the delayed effects. My low back, which has been bad for 2 years (a herniated disc and degenerative disease) was screaming. I’d had problems with very mild pain before, but never this significant (it made it hard for me to even sleep). And I realized the only thing different in my life was that I’d been binging on sweets. It turns out that sugar increases inflammation and might affect things like joint pain. Additionally, my sleep quality was total crap. I was running unusually hot at night and was super restless, tossing and turning. Oh, and I felt terribly listless and fatigued all weekend - like a lethargy monster had gotten hold of me and all I wanted to do was lie around and watch TV. Totally unlike my usual busy self. So I was consciously aware that I’d gained 5 pounds, my back hurt, I felt lethargic and just completely crappy, and the only thing that could explain all of those horrible feelings in my body and spirit was sugar. How had I never connected these things before?!

I am now, as I mentioned, on day 6 of no sugar. I have the urge to eat constantly, but my back feels back to baseline, I don’t feel hot all the time, I’ve had no pounding heartbeat, I am sleeping more soundly again, and my energy level feels back to normal. Sure, I’m tired toward the end of the day, but I don’t feel like a blobby Jabba the Hutt anymore. There hasn’t been a magical transformation — I don’t suddenly feel peace around food — but I sure do feel better than I did. I am committed to staying off sugar for the long haul, a minimum of 6 weeks and maybe indefinitely. In the meantime, I am working on getting through the first few weeks of sugar withdrawal and letting myself overeat healthy food as I adjust, even when I am not physically hungry. I’m being kind to myself an accepting that I want to eat a lot right now as part of the process. Paying attention as much as possible along the way. Practicing feeling the feelings, feeling the urges, and curiously noticing how they feel in my body. Allowing them to be there with an open mind and heart, rather than contracting into myself and resisting them or distracting myself away from them. Noticing they don’t kill me. Noticing. Deconditioning. Mindfully.

I’m a sugar addict.

I’m a weight loss “success story,” weighing more than 150 pounds less than my highest weight and currently maintaining a normal BMI. But I don’t FEEL successful. Because I am still obsessed with food. With sweets, to be exact. When I spoke with Gina Kolata of The New York Times a few years ago, I described my experience of weight maintenance as me having to have an “iron grip” on my diet. I told her that my weight fluctuates because each time I relax my guard, the pounds return. Today I’m 55 pounds lighter than I was that day that they photographed me with a 4-day-old Graham, and the truth is, I STILL feel like I have no control — whenever I “relax” and eat what I want, I regain. Since early December when I restarted sugar binging on Graham’s birthday cupcakes and Christmas cookies, I’ve been telling myself I’ll stop eating sugar “tomorrow” and having one last sugar fix today. This past week alone I ate 3 slices of yellow cake, Valentine’s chocolates from 2 separate heart shaped boxes, gelato (several times), two microwave mug brownies (yes, I know how to make a single serve brownie in my microwave using sugar, flour, cocoa powder, and oil) and icing-coated cookies. I have gained 5 pounds or so since Thanksgiving as a consequence, and am now up to 150 pounds this morning. I have really noticed recently more than ever that my behavior around sugary foods is akin to an alcoholic or a drug addict: I experience cravings for my substance, I have made repeated attempts to control or quit using my substance but have been unsuccessful, I’ve started to use larger amounts, and spend an inordinate amount of time thinking about when and where I will get my next fix. I continue to use it despite negative consequences. I have a lot of mental chatter surrounding sweets and feel powerless against them, trying to avoid sugar for a few days (and seeing my weight start to drop again), only to ultimately give in to my primitive brain and eat it again – just “one last time.”

I’ve been calling myself a sugar addict for a few years now, but only recently have I really started to look into this phenomenon as a scientifically proven disorder. Although food addiction is not yet included in the gold standard manual called the Diagnostic and Statistical Manual of Mental Disorders (the most recently published edition being the DSM-5), it has been widely proven in the scientific literature to exist. A year ago, I cut all added sugars and flour out of my diet for a full 6 weeks. The first few weeks were rough and required a lot of willpower and white-knuckling, but by the end, I felt a sense of peace around food that I had maybe never felt. Like, no cravings. Even when I was around sweets, I could see them and not feel compelled to eat them. One of my residents at work even went so far as to ask me to “at least smell” his homemade brownies when I refused to eat one or just taste one (at 8am, by the way!)… and I smelled the brownies, but didn’t feel that irresistible urge to eat one. It was perhaps the most peaceful I’ve ever felt. I ended up going back on sugar over Mother’s Day weekend 2019, and since then have been fluctuating between white knuckling and avoiding sugar vs. feeling out of control and eating sugar seemingly against my will. It’s like, once I’ve made the decision to eat a sweet treat, my prefrontal cortex (the part of my brain with executive function, planning abilities, and self control) goes offline and my primitive brain takes over. Like I’m not even there.

In “Food Junkies,” Dr. Vera Tarman compares food addicts to drug addicts and says, “{addicts} often refer to their drug as their lover or best friend.” (I flash back to the book I’m writing: in my intro to the chapter I wrote about my month on a very low carbohydrate ketogenic diet, I described my trepidation about losing sugar, which I described as a secret lover with whom I had continued trysts.)
“To a food addict, eating even just a little bit of sugar, or any other trigger food, will set off the phenomenon of cravings that leaves her wanting even more. Just one cookie is enough to act as a trigger. Like a lit match to kindling, it inflames a highly volatile reward pathway. It’s just waiting to be set ablaze — an inferno that consumes willpower and makes it impossible to rationally moderate portions after that first taste.”

Yeah, that’s me. So. Now I am in the middle of an existential crisis: do I keep living this way, which allows me to eat sugar periodically and barely maintain my normal weight by losing and regaining and losing and regaining (and suffer with the mental angst that goes along with that), or do I give up sweets forever and practice abstinence to really address my addiction (and maybe even consequently achieve my dream goal weight of 135)? It probably seems obvious, but to an addict in the throes of a passionate tryst, the thought of losing my secret lover forever is almost unthinkable. Especially when that substance is one that is available all around me all the time, cheap and socially acceptable, and even pushed on me by well meaning friends and family. My prefrontal cortex wants me to be abstinent, but my primitive brain wants what it wants, and wants it now. The question of my life: Who will win this battle?

How The Biggest Loser sets viewers up for failure

#BiggestLoser #weightloss #obesity #TRE

@kimymami @chefdombells @phinally.me

I had a new patient come to see me for the first time last week. She had class 2 obesity (her body mass index, or BMI, was between 35 and 39.9) and told me that she had been struggling with weight loss and needed my help. She said that she had been emphasizing whole foods and cut out processed carbohydrates, was doing time restricted eating (TRE) with an 8-hour calorie intake window each day (fasting for the remaining 16 hours), and trying to exercise more. “But,” she lamented, “I’m not losing any weight.” When I pulled up the graph of her body weights taken at our medical center over the last year, it turned about that she had actually lost almost 20 pounds in that time! When I showed her these very real and amazingly positive results, she expressed disappointment and brought up The Biggest Loser. Watching the show had informed her expectations about her own weight loss, and she felt that she was failing because she had “only” lost 20 pounds. She wanted to give up.

{sigh}

Watching episode #2 of the show this week, I found myself feeling more and more disenchanted. Not that I was exactly enchanted last week, but I am finding that the show is still really missing the mark when it comes to responsibly teaching the contestants — and viewers — about weight loss and weight maintenance. I find myself falling in love with and rooting for the contestants (how much do I delight in Kim Emami Davis??!) and angrily judging the show all at the same time. As the players stood up again and weighed themselves one by one, the soundtrack switched to mournful music when players lost “only” 5-7 pounds in one week. When Domenico lost 7 pounds (2.27%), he said that he was afraid he was going home and said, “you know, I’m not proud of that number.” When Kim lost 5 pounds (2.16%) she was visibly disappointed: “uh, not great.” Similar negative reaction with silence instead of celebratory music for the weight loss achieved by Phi (6 pounds, 1.71%), who at least – thank goodness – said that she was proud of those 6 pounds! 

It is 100% understandable why the contestants react negatively to those (awesome) weight loss numbers… because they are competing to remain on the show the longest, to lose the most amount of weight in the shortest amount of time, and to win $100,000. I do not blame the contestants in the least. I blame the producers of the show for setting up a situate in which a person with obesity would express disappointment in a 5 pounds weight loss. Showing those negative reactions to 5 or 7 pounds (extreme amounts for a single week!) to viewers at home who struggle to lose 1 or 2 pounds in a week can be, in my humble opinion, harmful. It creates unrealistic expectations for weight loss, and makes it much more likely for regular people to be disappointed in their own weight losses and subsequently give up efforts at improving their own health. I can’t speak to how the current 2020 season of the show was filmed, but during my own tenure as a position on season four and five, I know for a fact that some “weeks“ were actually filmed over the course of up to 14 days but still referred to a a single week, and that contestantswould not only exercise for hours and hours and hours every day (or possible for regular working people who aren’t professionals athletes), but would also intentionally dehydrate themselves right before weigh-ins to boost their weight loss even more. There’s just no way that the average viewer can drop that much weight that quickly without extreme fasting and exercising. 

I’ve said before that I have mixed feelings about the show. I think it’s wonderful that many people feel inspired by it, that it shows that people with obesity are not lazy and can exercise just as hard as anyone else, and the emotional hurt that many of us go through. I always, 100%, support each and every contestant and the effort they made or are making. I fear that the show does harm, though, in perpetuating the idea that a one-week weight loss of 5 pounds is anything short of excessive. Please, anyone out there who watches the show, and even those who don’t, know that a weight loss of a single pound (in someone who is trying to lose weight) is an achievement to be celebrated! After all, a weight loss of 100 pounds can be achieved by losing just ONE pound. A hundred times.

With love, 

Jen

Where the new #BiggestLoser missed the mark.

The premiere of The Biggest Loser on January 28 felt all too familiar, and if it was any indication of the season to come, I have serious doubts that this new version is actually the kindler/gentler bastion of holistic health promised by the network and the show’s host. There were claims in advance that this season will be more about getting healthy than losing weight, yet the show’s formula is the same: hold a massive cash prize ($100,000) over the contestants’ heads to motivate them to produce the greatest weight loss in a fixed amount of time. That is one big carrot, and whether or not they encourage sleep or talk about their feelings, people will do what they have to do to win such a big prize. 

Beyond that elephant in the room, the season premiere had its obvious missteps (nicely pointed out by my friend @NicoleisNik Nicole Michalek), such as continuing to require body-conscious people to expose their half-naked bodies in front of the world during weigh-ins, and forcing contestants to exercise to the point of vomiting. (This might make for good TV, but only serves to reinforce their negative feelings about exercise through conditioning. After all, anyone whose parents caught them smoking as kids and were forced to chain smoke cigarettes until they puked, or who threw up violently after too many tequila shots, knows the power of vomiting on one’s desire to repeat the same behavior that caused the vomiting.) There were a few more subtle statements that I took issue with, as well. Here are my top three:

1.     When @MyTrainerBob Bob Harper said, “literally, you are what you eat when it comes to your cholesterol issues,” that was wrong. There is a wide variety in individual response to a low fat vs. high fat diet (with many people, my husband @KevinBMarvel included, actually improving their cholesterol and lipid profiles on a very high fat low carb diet), and the consumption of dietary cholesterol does not necessarily equal increased blood cholesterol levels. That said, other people do improve their lipid profiles on a low fat diet — it’s complicated and nuanced. So my best advice is to check your own detailed lipid profiles before and after adopting any lifestyle intervention to see how it affects your unique genetics and physiology. 

2.     When 47 year old contestant @coachjim2020 “Coach” Jim DiBattista was told by Bob that he has type 2 diabetes, he had an emotional outpouring of shame and regret: “People have diabetes — like real, type 1 diabetes — like, they don’t have a choice. They’re genetically built that way. I did this to myself. I ate myself into a sickness.” My heart broke for him and for all of the viewers watching this show who have type 2 diabetes and are wrongly blaming themselves. Type 2 diabetes has a strong genetic component, and although it is absolutely a weight-related condition in that your risk of developing the disease rises as your weight rises (and weight loss can cure it in many), there are also countless people of normal weight who suffer with the disease. In fact, a study

that was just published last month examined almost 5 million Americans and found that there was a high rate of diabetes in normal weight people. It varied greatly based on race/ethnicity, with normal-weight whites having the lowest prevalence (5%) and normal-weight Hawaiians and Pacific Islanders having the highest prevalence (a whopping 18%). A diagnosis of type 2 diabetes is not your “fault,” just as obesity is not your fault: our brains evolved to predispose us to overeat highly rewarding (calorie dense foods), some people are more genetically predisposed than others, and our environment in this modern era (with abundant processed foods engineered to get us to overeat them and technology making physical movement almost obsolete) is worsening that predisposition. That said, once someone realizes that their quality life and their health could be impacted for the better by doing the long hard work of making informed choices and changing their lifestyle to lose weight and eat fewer processed carbohydrates, they can often melt way the type 2 diabetes in addition to the body fat.

3.     Trainer @ericafitlove Erica Lugo wasn’t exactly accurate when she claimed that high intensity interval training (#HIIT) is the best for weight loss: “when you spike your heart rate up and then back down it kinda tricks your body ‘cause it never gets used to the same tempo so it’s awesome for losing weight and burning fat.” Ok, again, this is complicated, and I am by no means saying that HIIT isn’t good for weight loss. But it’s not “tricking” your body, and it’s not necessarily better than traditional moderate intensity continuous exercise. First, note that energy consumed (diet) has a much greater impact on weight loss than does energy expended (exercise) in study after study, at least in the real world where the amount of exercise we’re talking about is realistic for most working adults (when contestants on the Biggest Loser or professional athletes work out for 5 hours a day, that’s an entirely different story). Even our own research found that the amount of weight loss during the Biggest Loser competition was significantly correlated with calories eaten and not with calories burned (whereas 6 years later the exercise became more related to successful maintenance of weight loss). Indeed, one of my most successful weight loss patients today is a veteran who is disabled enough that he rides everywhere in a scooter, but has lost almost 100 pounds by changing his diet. So please, those of you out there who can’t be as active as the professional athletes also known as Biggest Loser contestants, don’t think that you can’t change your life! That said, regular exercise can help marginally boost weight loss beyond what you’d achieve with diet alone, and there have been many scientific studies of different types of exercise and their effect on weight loss. Deciding which exercise method is best depends on how you compare them. A large meta-analysis comparing moderate-intensity continuous training compared with high-intensity interval training found that the two types of exercise produce no difference in body fat percentage reduction (though HIIT in the specific form of intermittent sprints may produce greater absolute fat mass reduction – meaning more pounds of fat lost — than moderate continuous exercise). Another study found that overweight and obese adults had similar rates of adherence to and enjoyment of HIIT vs. moderate-intensity continuous training, but did not lose weight with either intervention over the 8 weeks of the study (more evidence that diet is more impactful than exercise for weight loss!). Interestingly, the HIIT group had greater drops in LDL cholesterol and (as expected) greater increases in VO2 max, a measure of peak aerobic exercise capacity, but conversely, had increases is blood inflammatory markers (interleukin-6 and C-reactive protein). Moderate intensity continuous exercise actually improved inflammatory markers in participants. Another study found that belly fat reductions in young obese women were comparable between moderate continuous exercise and HIIT when work-equivalent training sessions were conducted. How to interepret this? If you spend 30 minutes doing a HIIT workout one day and 30 minutes walking quickly the next day, you’ll burn more calories and lose more weight with the HIIT workout — but that’s intuitive, because your work is greater. If you compare a work-equivalent (calorie-burning equivalent) HIIT workout of 15 minutes to say 30 minutes of fast walking, you’ll burn the same calories and lose the same amount of fat. So HIIT allows you to be more efficient if you’re pressed for time and trying to condense your calorie burning into a shorter session, but not necessarily better if you’ve got time to do a proper moderate-intensity workout. There are other benefits to HIIT workouts and I am a fan of them, but technically they may not be better than moderate continuous exercise specifically for burning fat when you compare equivalent work loads. A great overview of other studies and how HIIT isn’t necessarily the magic bullet that Erica Lugo claimed was written here last year.

Despite my reservations, I’ll be watching the show again next week, and will try to come back here to discuss other topics and/or clarify issues as I see them arise. I’m disappointed that the premiere of the show had many of the problems that plagued the original series, but hopeful that the 12 brave folks who signed up to lose weight on TV for our viewing pleasure are living their best lives right now and happy that they participated in the show. I know that being on the show changed my own life in ways I couldn’t have predicted, and I wouldn’t change a thing about my own involvement. Cheers to my BL brethren!