Dr. Mark Hyman – Must Read Article and Reflections on Our Meeting

Below is an article from Dr. Mark Hyman, MD. It is a powerful article, pretty much summarizing Dr. David Kessler’s End to Overeating in a more efficient and gripping way. If you have time, Dr. Kessler’s book is worth the read, but Dr. Hyman’s article covers the issue very well. I blogged about Dr. Kessler’s book several times, but this entry is most compelling: Ryan’s Mom Passed Away This Morning.

Before I post Dr. Hyman’s article I want to make a few comments about him. He is probably the most well-known functional medicine doctor in the country. He is a New York Times best-selling author of several books, rights regular columns for media and is on the talk show circuit. He is a medical celebrity.

You never know what you are going to get when you meet any doctor, let alone a celebrity. I had the opportunity to meet Dr. Hyman almost two weeks ago. My sister and I brought her son to Dr. Hyman. The baby has a deadly mitochondrial disease called Leigh’s Disease (see Help Us Help Nicky). My sister, her husband, and most importantly Nick, have met the challenge head on. Nick is a survivor and his parents have worked hard to navigate mainstream medicine and complementary medicine. Still, they were missing a major piece and that is where Dr. Hyman comes in.

When I contacted Dr. Hyman for help, he was amazingly easy to reach thanks to a caring and thoughtful staff. Even though he is not taking new patients, he quickly made an exception for Nick (that only took 15 minutes) and appointments were scheduled. A couple weeks later, off we went. For those who are following Nick’s story, I haven’t seen him in six months, and how big and strong he has gotten! I was amazed! He is beating all of the standard MD survival projections by a million miles.

My sister said that she has not met an MD like Dr. Hyman. He is the first to look her in the eye (for the entire two hours he met with us), and he asked many questions and listened to the answers. He was caring and thoughtful. Perhaps most importantly Dr. Hyman is a collaborator, which in my opinion is the sign of a true healer. There was no ego in the room as Dr. Hyman reached out to colleagues around the world, marshalling the resources he thought would help strengthen Nick.  His nutritionist is a collaborator as well (she knowledgeable of Nourishing Traditions foods and preparation and she is beginning to explore Dr. Natasha Campbell-McBride’s GAPS Diet), the nurses are outstanding and the office personnel are amazing. The entire experience exceeded our hopes, and I feel confident that Nick will be heading to a new level of health. Thanks to my sister’s drive for healing and incredible understanding of Nick’s very complicated disease, Nick is blazing new territory, and I am so grateful that Dr. Hyman is the next step.

Now for Dr. Hyman’s article. It is so good that I am going to paste it below as well as hyperlink it. Please share this post with anyone that you feel might benefit. Food can hurt and food can heal. To put it another way, with every bite you eat you determine how you will live. Ryan, Colson and I know it to be true because we have lived it.

Food Addiction: Could It Explain Why 70 Percent of Americans Are Fat?

Our government and food industry both encourage more "personal responsibility" when it comes to battling the obesity epidemic and its associated diseases. They say people should exercise more self-control, make better choices, avoid overeating, and reduce their intake of sugar-sweetened drinks and processed food. We are led to believe that there is no good food or bad food, that it's all a matter of balance. This sounds good in theory, except for one thing...

New discoveries in science prove that industrially processed, sugar-, fat- and salt-laden food -- food that is made in a plant rather than grown on a plant, as Michael Pollan would say -- is biologically addictive.

Imagine a foot-high pile of broccoli, or a giant bowl of apple slices. Do you know anyone who would binge broccoli or apples? On other hand, imagine a mountain of potato chips or a whole bag of cookies, or a pint of ice cream. Those are easy to imagining vanishing in an unconscious, reptilian brain eating frenzy. Broccoli is not addictive, but cookies, chips, or soda absolutely can become addictive drugs.

The "just say no" approach to drug addiction hasn't fared to well, and it won't work for our industrial food addiction, either. Tell a cocaine or heroin addict or an alcoholic to "just say no" after that first snort, shot, or drink. It's not that simple. There are specific biological mechanisms that drive addictive behavior. Nobody chooses to be a heroin addict, cokehead, or drunk. Nobody chooses to be fat, either. The behaviors arise out of primitive neurochemical reward centers in the brain that override normal willpower and overwhelm our ordinary biological signals that control hunger. Consider:

• Why do cigarette smokers continue to smoke even though they know smoking will give them cancer and heart disease?
• Why do less than 20 percent of alcoholics successfully quit drinking?
• Why do most addicts continue to use cocaine and heroin despite their lives being destroyed?
• Why does quitting caffeine lead to irritability and headaches?

It is because these substances are all biologically addictive.

Why is it so hard for obese people to lose weight despite the social stigma and health consequences such as high blood pressure, diabetes, heart disease, arthritis, and even cancer, even though they have an intense desire to lose weight? It is not because they want to be fat. It is because certain types of food are addictive.

Food made of sugar, fat, and salt can be addictive. Especially when combined in secret ways that the food industry will not share or make public. We are biologically wired to crave these foods and eat as much of them as possible. We all know about cravings, but what does the science tell us about food and addiction, and what are the legal and policy implications if a certain food is, in fact, addictive?

The Science and Nature of Food Addiction

Let's examine the research and the similarities between high-sugar, energy-dense, fatty and salty processed and junk food and cocaine, heroin, and nicotine. We'll start by reviewing the diagnostic criteria for substance dependence or addiction found in the bible of psychiatric diagnosis, the DSM-IV, and look at how that relates to food addiction:

• Substance is taken in larger amount and for longer period than intended (a classic symptom in people who habitually overeat).
• Persistent desire or repeated unsuccessful attempts to quit. (Consider the repeated attempts at diet so many overweight people go through.)
• Much time/activity is spent to obtain, use, or recover. (Those repeated attempts to lose weight take time.)
• Important social, occupational, or recreational activities given up or reduced. (I see this in many patients who are overweight or obese.)
• Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous). (Anyone who is sick and fat wants to lose weight, but without help few are capable of making the dietary changes that would lead to this outcome.)
• Tolerance (marked increase in amount; marked decrease in effect). (In other words you have to keep eating more and more just to feel "normal" or not experience withdrawal.)
• Characteristic withdrawal symptoms; substance taken to relieve withdrawal. (Many people undergo a "healing crisis" that has many of the same symptoms as withdrawal when removing certain foods from their diet.)

Few of us are free from this addictive pattern. If you examine your own behavior and relationship with sugar, in particular, you will likely find that your behavior around sugar and the biological effects of overconsumption of sugar match up perfectly. Many of the criteria above are likely to apply to you.

Researchers from Yale's Rudd Center for Food Policy and Obesity validated a "food addiction" scale.(i) Here are a few of the points on the scale that are used to determine if you have a food addiction. Does any of this sound familiar? If it does, you may be an "industrial food addict."

1. I find that when I start eating certain foods, I end up eating much more than I had planned.
2. Not eating certain types of food or cutting down on certain types of food is something I worry about.
3. I spend a lot of time feeling sluggish or lethargic from overeating.
4. There have been times when I consumed certain foods so often or in such large quantities that I spent time dealing with negative feelings from overeating instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities that I enjoy.
5. I kept consuming the same types of food or the same amount of food even though I was having emotional and/or physical problems.
6. Over time, I have found that I need to eat more and more to get the feeling I want, such as reduced negative emotions or increased pleasure.
7. I have had withdrawal symptoms when I cut down or stopped eating certain foods, including physical symptoms, agitation, or anxiety. (Please do not include withdrawal symptoms caused by cutting down on caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)
8. My behavior with respect to food and eating causes significant distress.
9. I experience significant problems in my ability to function effectively (daily routine, job/school, social activities, family activities, health difficulties) because of food and eating.

Based on these criteria and others, many of us, including most obese children, are "addicted" to industrial food.

Here are some of the scientific findings confirming that food can, indeed, be addictive(ii):

1. Sugar stimulates the brain's reward centers through the neurotransmitter dopamine, exactly like other addictive drugs.
2. Brain imagining (PET scans) shows that high-sugar and high-fat foods work just like heroin, opium, or morphine in the brain.(iii)
3. Brain imaging (PET scans) shows that obese people and drug addicts have lower numbers of dopamine receptors, making them more likely to crave things that boost dopamine.
4. Foods high in fat and sweets stimulate the release of the body's own opioids (chemicals like morphine) in the brain.
5. Drugs we use to block the brain's receptors for heroin and morphine (naltrexone) also reduce the consumption and preference for sweet, high-fat foods in both normal weight and obese binge eaters.
6. People (and rats) develop a tolerance to sugar -- they need more and more of the substance to satisfy themselves -- just like they do for drugs of abuse like alcohol or heroin.
7. Obese individuals continue to eat large amounts of unhealthy foods despite severe social and personal negative consequences, just like addicts or alcoholics.
8. Animals and humans experience "withdrawal" when suddenly cut off from sugar, just like addicts detoxifying from drugs.
9. Just like drugs, after an initial period of "enjoyment" of the food, the user no longer consumes them to get high but to feel normal.

Remember the movie Super Size Me, where Morgan Spurlock ate three super-sized meals from McDonald's every day? What struck me about that film was not that he gained 30 pounds or that his cholesterol went up, or even that he got a fatty liver. What was surprising was the portrait it painted of the addictive quality of the food he ate. At the beginning of the movie, when he ate his first supersized meal, he threw it up, just like a teenager who drinks too much alcohol at his first party. By the end of the movie, he only felt "well" when he ate that junk food. The rest of the time he felt depressed, exhausted, anxious, and irritable and lost his sex drive, just like an addict or smoker withdrawing from his drug. The food was clearly addictive.

This problems with food addiction are compounded by the fact that food manufacturers refuse to release any internal data on how they put ingredients together to maximize consumption of their food products, despite requests from researchers. In his book The End of Overeating, David Kessler, M.D., the former head of the Food and Drug Administration, describes the science of how food is made into drugs by the creation of hyperpalatable foods that lead to neuro-chemical addiction.

This binging leads to profound physiological consequences that drive up calorie consumption and lead to weight gain. In a Harvard study published in the Journal of the American Medical Association, overweight adolescents consumed an extra 500 calories a day when allowed to eat junk food as compared to days when they weren't allowed to eat junk food. They ate more because the food triggered cravings and addiction. Like an alcoholic after the first drink, once these kids started eating processed food full of the sugar, fat, and salt that triggered their brain's reward centers, they couldn't stop. They were like rats in a cage.(iv)

Stop and think about this for one minute. If you were to eat 500 more calories in a day, that would equal 182,500 calories a year. Let's see, if you have to eat an extra 3,500 calories to gain one pound, that's a yearly weight gain of 52 pounds!

If high-sugar, high-fat, calorie-rich, nutrient-poor, processed, fast, junk food is indeed addictive, what does that mean? How should that influence our approach to obesity? What implications does it have for government policies and regulation? Are there legal implications? If we are allowing and even promoting addictive substances in our children's diets, how should we handle that?

I can assure you, Big Food isn't going to make any changes voluntarily. They would rather ignore this science. They have three mantras about food.

1. It's all about choice. Choosing what you eat is about personal responsibility. Government regulation controlling how you market food or what foods you can eat leads to a nanny state, food "fascists," and interference with our civil liberties.
2. There are no good foods and bad foods. It's all about amount. So no specific foods can be blamed for the obesity epidemic.
3. Focus on education about exercise not diet. As long as you burn off those calories, it shouldn't matter what you eat.

Unfortunately, this is little more than propaganda from an industry interested in profit, not in nourishing the nation.

Do We Really Have a Choice About What We Eat?

The biggest sham in food industry strategy and government food policy is advocating and emphasizing individual choice and personal responsibility to solve our obesity and chronic disease epidemic. We are told that if people just didn't eat so much, exercised more, and took care of themselves, we would be fine. We don't need to change our policies or environment. We don't want the government telling us what to do. We want free choice.

But are your choices free, or is Big Food driving behavior through insidious marketing techniques?

The reality is that many people live in food deserts where they can't buy an apple or carrot, or live in communities that have no sidewalks or where it is unsafe to be out walking. We blame the fat person. But how can we blame a two-year-old for being fat? How much choice does he or she have?

We live in toxic food environment, a nutritional wasteland. School lunchrooms and vending machines overflow with junk food and "sports drinks." Most of us don't even know what we're eating. Fifty percent of meals are eaten outside the home, and most home-cooked meals are simply microwavable industrial food. Restaurants and chains provide no clear menu labeling. Did you know that a single order of Outback Steakhouse cheese fries is 2,900 calories, or that a Starbucks venti mocha latte is 508 calories?

Environmental factors (like advertising, lack of menu labeling, and others) and the addictive properties of "industrial food," when added together, override our normal biological or psychological control mechanisms. To pretend that changing this is beyond the scope of government responsibility or that creating policy to help manage such environmental factors would lead to a "nanny state" is simply an excuse for Big Food to continue its unethical practices. Here are some ways we can change our food environment:

• Build the real cost of industrial food into the price. Incude its impact on health care costs and lost productivity.
• Subsidize the production of fruits and vegetables. 80 percent of government subsidies presently go to soy and corn, which are used to create much of the junk food we consume. We need to rethink subsidies and provide more for smaller farmers and a broader array of fruits and vegetables.
• Incentivize supermarkets to open in poor communities. Poverty and obesity go hand in hand. One reason is the food deserts we see around the nation. Poor people have a right to high-quality food, too. We need to create ways to provide it to them.
• End food marketing to children. 50 other countries worldwide have done this, why haven't we?
• Change the school lunchroom. The national school lunch program in its present form is a travesty. Unless we want the next generation to be fatter and sicker than we are, we need better nutrition education and better food in our schools.
• Build community support programs with a new workforce of community health workers. These people would be able to support individuals in making better food choices.

We can alter the default conditions in the environment that foster and promote addictive behavior.(v) It's simply a matter of public and political will. If we don't, we will face an ongoing epidemic of obesity and illness across the nation. For more information on how we can manage the food crisis in this country, see the diet and nutrition section of drhyman.com.

To your good health,

Mark Hyman, M.D.

References

(i) Gearhardt, A.N., Corbin, W.R., and K.D. 2009. Brownell. Preliminary validation of the Yale Food Addiction Scale. Appetite. 52(2): 430-436.

(ii) Colantuoni, C., Schwenker, J., McCarthy, P., et al. 2001. Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. Neuroreport. 12(16): 3549-3552.

(iii) Volkow, N.D., Wang, G.J., Fowler, J.S., et al. 2002. "Nonhedonic" food motivation in humans involves dopamine in the dorsal striatum and methylphenidate amplifies this effect. Synapse. 44(3): 175-180.

(iv) Ebbeling CB, Sinclair KB, Pereira MA, Garcia-Lago E, Feldman HA, Ludwig DS. Compensation for energy intake from fast food among overweight and lean adolescents. JAMA. 2004 Jun 16;291(23):2828-2833.

(v) Brownell, K.D., Kersh, R., Ludwig. D.S., et al. 2010. Personal responsibility and obesity: A constructive approach to a controversial issue. Health Aff (Millwood). 29(3): 379-387.

Comments

[Maria Droujkova]

I still think it's about choice, but the choice is much more systemic than "just eat less" or "just avoid sugar." I would compare these naive slogans to the current attempts to choose a better curriculum (maybe with a bit more algebra in elementary? maybe with a few more/less tests?) for schools. Well, you can't change one variable in a system just a bit and cause big changes, not typically!

Cooking your own food, for example, causes systemic changes in how you eat. Such a choice affects what you can do on the daily basis, how you work and study, how your family is... But these big lifestyle choices are still choices. They just aren't simple, mundane, or quantitative choices! These are global, systemic, qualitative choices.

This reminds me of (very frustrating) conversations I have whenever people ask me to share some cool ideas from homeschoolers that they can use at school.