Thursday, February 21, 2013

Brightening the Lights

Recently, I've been learning more about the brain's reward system pathway. I don't want to go too deeply into it because, frankly, even people who know a little about it get frustrated and irritated when I go deep into the details. It's pretty dense stuff, and only those who want to know the science very well need to know about it. So, I'm going to speak in general terms, and entertain questions about details should my readers want more concrete answers.

What I've learned recently enhances what I talked about in the previous several posts, and it has mainly applied to substance use and abuse. In particular, I've learned a thing or two about how drugs that affect the parts of your brain that experience pleasure mess up your ability to take joy in anything else. The woman who was teaching the class I was sitting in on told us a story which, after hearing it, ran a bell very strongly with my experience with food.

This woman has a PhD, is a registered nurse, and a practicing licensed therapist as well as a teacher at a private graduate school. One can conclude she has a lot of practical as well as book-oriented knowledge. She told us about a client that she had who had spent several years using cocaine. Prior to his cocaine use, he used to enjoy music greatly. After using cocaine, music no longer could offer him the same joy, not even long after he'd stopped using the drug.

What had happened to this man was that the parts of his brain that were stimulated by the drug were the same ones that allowed him to take pleasure in other things. By abusing the drug to hyper-stimulate those areas, he changed the way they experienced the world forever. That's right. Forever. They were permanently changed such that nothing would ever give him pleasure in the same way again.

The reason this story really hit home with me was that, when I started changing my relationship with food, I wrote about how my life was changing. In this post (12th paragraph), "I should note that there is very much an aspect of this which is “duller” than things used to be. That is, the lights were more brilliant and the colors were brighter when food was fully centralized". This was a reflection of the fact that food was the thing that lit up the pleasure centers in my brain in a way nothing else could.

A lifetime of using food for comfort has almost certainly altered my brain's reward pathways just as those in the cocaine addict were altered. The highs were rarely as high for me as they were when I was fully invested in partaking in food with not restriction. However, I do believe that there is a difference between what happened to me and what happened to the cocaine addict. He was damaged and can't be repaired. I am damaged and am in the process of being repaired.

It continues to be a long and complex  path. Due to the psychological processing I've done, I can never regard food as the end all and be all of pleasure. The "buzz" I got from it died and I can't honestly say that anything has replaced it in intensity. I can say that things have slowly gotten better as I've tried to replace that pleasure with other types of pleasure, but it's more about collecting little bits of thing to enjoy then one whopper that delivered it's payload of joy in one sitting.

I don't know about the biology for certain, but I'd be shocked if people like me didn't see their reward pathways light up like a Christmas tree from food and provide dim lighting from other sources of pleasure. I think that this could be part of the complex picture of why people who lose weight regain. Just as the cocaine addict goes back to the drug because life becomes dim and joyless without it, the addicted eater may similarly find that the lights need some brightening when they try to abandon their drug of choice.

I know that it has taken me years to decouple destructive pleasure seeking in food and it's still there to some extent (as my last few posts illustrate) and similarly has taken years to elevate other pleasures to a meaningful status in terms of my response. I'm not saying every fat person does this, but I do think that for those of us who became fat as children and continue to be fat as adults, there's a good chance that our brains are built around this way of deriving pleasure from our world.

Sunday, February 3, 2013

"Methadone" for your food addiction - part 2

If you haven't read the previous post, this one won't make much sense so I encourage you to give it a read before reading this. This post is about a rough "plan" for those who are food addicted (likely due to biochemical imbalances) and is a follow-up to the previous one.

I think that the approach to food that we are encouraged to take in life comes basically from the perspective of a person who does not have an emotional dependence on food. I've written before about how people who have a roughly healthy relationship with food (which is not to be confused with a "healthy" diet) aren't dealing with food the same way that someone who does not does. They see the choices as indulgence or deprivation. Those with a dependence on food see the choice as suffering or not suffering. And I'm telling you that that suffering is not just some sort of childish "I want to enjoy food". It is real psychological pain which is not dissimilar from physical pain on a chemical level. People who aren't biochemically oriented to be dependent on food do not experience such suffering while depriving themselves.

So, I've been pondering this situation rather deeply and I think that there needs to be a radically different approach toward food for people who have such issues. This is a rough plan, but one which I think would function better for most people with such issues than the absolutism that they are generally presented with.

Step 1:
The most essential aspect would be to reframe the role food plays in your life as not simply one in which it provides sustenance, but one in which it actually can regarded as medicinal. Enjoying food is a matter of psychological survival. You aren't just eating a candy bar to indulge your desire for sweets, you are lighting up a chemical center in your brain which shines into a darkness created by some part that needs that brightness.

It is imperative to abandon guilt over eating food for pleasure. If you are dealing with an imbalance by creating endorphins by eating, you're going to sabotage the impact of that by creating more stress for yourself due to eating guilt. Berating yourself, feeling bad, punishing yourself only creates a stronger loop in which you need to medicate more by eating more. 

Step 2:
Knowing that food pleasure is an essential part of "medicating" your condition, you need to incorporate it in the least destructive and most productive fashion. It doesn't have to be "all or nothing".

For me, a big part of this has been eating small treats throughout the day and mindful eating. I eat sweet food for breakfast most of the time, but in far smaller portions than most people. I would never eat more than half of a bakery-size muffin, and generally eat my own homemade sugar-free muffins which are under 250 calories. I also eat small "desserts". I finish off lunch with a small cookie or a tiny bite-size candy bar that I eat slowly and think about. This is a type of "dosing" throughout the day which does not have a big impact on weight. Eating mindfully increases the chance that my brain's pleasure centers will light up from a much more limited experience.

Step 3:
Map out your eating to suit your psychology and biology. For me, I realize that I need to eat small amounts 5-7 times a day. This generally includes a very small breakfast, fruit between lunch and breakfast, lunch, tea time, dinner, and some snack in the evening about an hour before bed. Small portions and careful attention to a balance of nutrition with "treats" has helped me maintain at my current level for over a year now.

Step 4:
Refine portions and types of food to reduce overall calorie consumption without sacrificing pleasure. This means finding enjoyment in less, and this is by no means easy. I'm no stranger to the pleasure extracted from mindlessly eating food until I reach the bottom of the bag, especially high carbohydrate foods which do the best job biochemically of addressing HPA axis imbalances.

One of the things about being in America now which has "helped" to some extent is that there are many more food options which are lower calorie that I can use to fulfill my needs. No, they are not the best choices in many cases, but mine is an imperfect situation. Personally, I'd rather eat sugar-free gelatin with low-fat whipped cream an hour before bed as a palliative than to take an anti-depressant or anti-anxiety medication. Both have toxic elements (the gelatin has artificial sweeteners and food additives), but one provides balance by adding endorphins to my brain, the other messes with neurotransmitters in a far more complex and omnidirectional fashion. 

Step 5:
Deeply internalize the idea that this is not a "pass/fail" situation. Sometimes, you're going to eat a lot because that's all that will "do". The goal is to manage as best you can, not be perfect. Also, understand that you may never be thin. It may not be in the cards, but it is better to weigh 250 lbs. than 350 lbs. (or, in my case, it's better to weigh 180 lbs. than 380 lbs.).

Step 6:
Augment the manner in which you try to work with any biochemical imbalance with other actions which also create endogenous opiates. This is difficult if you have a disability or difficulty moving (as I did when I started losing weight), but this would include exercise, sex, engaging in creative behavior (true creative inspiration releases endorphins), laughing, and engaging social behavior (as opposed to empty or stressful socialization). Diversify your life to actively incorporate these alternatives. You may not be able to exercise, but you can schedule phone calls with friends or watch a comedy on T.V. Don't just "let" these things happen. Plan them in actively. They are not distractions. They are ways to correct a chemical imbalance.

As a last thought, I'm going to say, unless you have a medical issue, don't give up carbs. For people who have the sort of issue I'm talking about, carbs really play a role. The only caveat I'd add is to consume them with some fats and protein to try and slow absorption and the blood sugar impact. You want to get the benefits without the blood sugar spikes.

This is by no means a full "plan", but just an outline. Obviously, therapy would be a critical aspect of any attempt to deal with an issue that is psychological in nature. As my readers know, I have been analyzing and conditioning myself now for 4 years. Only now do I have a notion of why what has worked for me has worked so well whereas other attempts have failed. The way in which I have eaten may have, coincidentally, addressed an underlying issue which I knew stemmed from my upbringing. It wasn't merely all a mindset though. It was a very likely a chemical issue which will never go away.

"Methadone" for your food addiction - part 1

In my previous post, I talked about how I believe brain changes related to stress can result in food addiction for some people. When I say "food addiction", I don't mean psychological, but actual biochemical addiction. The neurochemical imbalances that result from early life stress (not trauma, folks, but negative stress which is chronic and of a particular type) prime some people to become compulsive eaters. This eating actually alters their brain chemistry in a way which restores a greater sense of psychological well-being by regulating parts of the brain which are not functioning in a manner which offers psychological well-being.

Before I get too far, let me say that I am not for a moment asserting that all fat people are in this situation nor that all people who suffer such stress become compulsive eaters. I can say that there is a very high probability that all people who experience such stressors in childhood have an imbalance of some sort to greater or lesser degrees depending on their particular biological vulnerability. Those who are most damaged  may deal with the imbalance in various ways. We all know that some people are prone to various addictions more than others. It could be alcohol. It could be drugs. It could be sex. It could be workaholism. Or, it could be food.

Since this blog is about me and my weight, and I have a strong sense that I am addicted to food and am a compulsive eater and that this is, in part, due to biochemical imbalances in my brain due to early life stress, I'm going to focus on this point. A lot of people talk about "how" you became something which is a problem is less important than what you do about it, but what I'm going to talk about points out the critical nature of knowing the "why".

If I assume that I have an imbalance which I'm addressing through food, then it becomes exponentially harder to restrict eating. Beyond the normal biochemical pressures that come along with blood sugar changes, the cellular push-back when you lower energy levels, starvation reactions, and changes in hormone levels that come along with eating less food, I also have to deal with the fact that I'm going to suffer psychological problems as a result of restriction. There are various ways in which to manage this which I will consider.

One is that you can take medications to handle the imbalance. As I mentioned in my previous post, this is hardly a good answer for people with weight issues because most of those types of drugs carry the side effects of metabolic syndrome/thyroid problems which result in weight gain. Also, personally, I'm not a fan of introducing toxins (and all medications are a form of poison) into my body if I can find another way of managing.

Another solution is to transfer the problem to another behavior or addiction. I'm certain that I worked with this aspect of my overeating when I first lost large amounts of weight in college by exercising 90 minutes a day. High amounts of exercise will produce the same endogenous opiates (e.g., endorphins) that help with neurochemcial dysfunction that overeating can produce. The problem is, and I learned this later as I got older, you cannot keep it up either due to time constraints, life circumstances, or injury. Exercising to keep up the "happy chemicals" in your brain is not a permanent solution.

You can also simply transfer your addiction to another equivalent addiction if such a one exists, but clearly this is also a poor choice. Taking drugs or drinking alcohol may, if you are so biochemically oriented, work for you. However, substituting one destructive behavior for another would not be a viable option.

What I have realized, and this is what has been working for me, is that you can choose to do the methadone equivalent of managing your diet and lifestyle. For those who don't know, methadone is a drug used to ween people off of more severe opiate addictions, especially heroin. The drug is given to people to soften withdrawal and allow them to transition away from drugs. Of course, when it comes to food, full withdrawal is never possible. We need to eat or we will die, so it's not as if you can simply walk away from your addiction.

I have been pondering the fact that people like me may simply need to approach how they eat from multiple perspectives that include the very important idea that food pleasure functions as an essential palliative for them. It isn't a weakness. It isn't a character flaw. It's part of a loop of chemical action in which some part of their brain (likely the HPA axis that I mentioned in the previous post) has become dysfunctional and certain types of eating restores a balance. The balance cannot be "fixed" permanently. It can only be dealt with through the ingestion of substances, whether it be food, illegal drugs, alcohol, or prescription medication.

In my next post, I will outline what I believe is a viable plan for people who suffer from this issue as I believe I do.

Friday, February 1, 2013

This Is Why You're Fat

The title of this post should more properly be, "this is possibly one reason why you're fat," or, perhaps more accurately, "this is probably one of the biggest reasons why I'm fat." However, I can't make a nod to that web site which shows food monstrosities by choosing such accurate titles, so there it is. The truth is that I try hard not to speak for anyone but myself, so I'll just say that I've learned a few things which have the potential to explain a lot and that I hope they shed some light on things for others as well.

This is going to be a hard post to write, not because it is going to be emotionally charged, but because it's going to almost certainly blind people with science. One of the hardest things for people to abandon when they think about psychology is the idea that it is inextricably linked to biology, and biology, my friends, is where weight issues live. The reason for this difficulty, at least in my opinion, is that we are mired in the idea of Cartesian dualism. We believe that somehow the mind exists apart from the body. Even when we imagine ourselves as scientifically minded modern thinkers, we continue to believe that mind can triumph over matter and that we can accomplish anything if we just "try hard enough." Quite often, our notions do not match our scientific understanding because we staunchly refuse to believe that a strong will cannot overcome all.

Getting back to baffling you with science, I've been studying the brain as of late. It's a topic which I've touched on before in this blog, but not in intricate detail. I strongly believe that the physical nature of our mind as expressed through how pathways are laid out in the brain is created by experience. We sometimes come into this world somewhat broken and sometimes we are broken by what happens to us. Lately, I've been learning a thing or two about just how one can be broken by childhood stress, and that can happen in such a way as to affect the rest of your life.

One of the many aspects of the brain that I've been studying has been something called the HPA Axis. For those who care, this is the hypothalamic-pituitary-adrenal axis. You don't have to understand it, but just believe me when I say that it is an important part of your brain when it comes to stress management and anxiety. When you are a child, if you experience the wrong kind of stress, and I don't mean abuse or serious trauma, your HPA Axis can become compromised in such a way as to create a high likelihood of a variety of disorders.

The HPA Axis is responsible for handling stress hormones and there is a "loop" of activity which handles a negative stimulation, activation of bodily systems to handle the stress of it, and then puts an end to that activation. I'm massively oversimplifying here, but anyone who wants to learn more knows how to do a Google search or ten and can get more details.

The bottom line is that early childhood issues such as insecure attachment to parents, chronic unresolved stress, neglect (even moderate), etc. can create issues in this area of the brain. There are multiple potential consequences including the potential to suffer anxiety disorders and depression. This is, in simplistic terms, due to over-activity in the HPA axis. Another, and this is a theory, but it's a plausible one, is that you can become a compulsive eater.

The way this works is that imbalances in the HPA axis which result in over-activity (from stress) can be slowed down by eating comfort food. Food that is high in carbohydrates in particular can produce more endogenous opiods (e.g., endorphins) and stimulate reward pathways. You can, quite literally, become addicted to food.

Here is the thing, once the HPA Axis is screwed up due to childhood experience, it cannot be made normal again. There is nothing you can do to repair the balance to what it should have been had you not had the stressors that created the imbalance. You can try to replace your food addiction and find something else to stimulate the same pathways such that you slow down the over-activity, but you will never be normal like other people.

The possibilities for replacement are hardly numerous, but they do have some effect. Drugs for depression or anxiety may help as they can have an impact on the HPA Axis, though some of them carry greater risks than overeating. Exercise, which also produces endorphins, can also be of help, though the levels you may need cannot necessarily be consistently sustained throughout the day and if you need consistent "medicating" to combat the imbalances, then it isn't enough to merely work out once a day, not to mention hard exercising can be side-lined at any time by physical injury.

This information came as a breath of fresh air to me, though it is also somewhat difficult to live with. The reason I believe I have been able to lose weight this time (and under circumstances in which I could not exercise) was because I kept eating food for pleasure. I eat small portions about 5 or 6 times a day, and I "treat" myself in small ways often. I trade off on portion sizes of healthy food at times to eat things I enjoy. I think I do this because of this imbalance in my brain which was brought on by my very hard upbringing.

The reason this is a breath of fresh air is that it validates the fact that I can't simply be a food puritan as people think I "should" be in a way which makes sense scientifically and emotionally. I eat to survive psychologically as well as biologically, and I have a richer understanding of why that is the case for me when it is not the case for others. I don't just "love food". I am not weak willed. I'm biologically messed up in a way that I didn't have anything to do with.

That is not to say that eating is my only "medication", nor that I may not be able to correct at least some of this biochemical imbalance through other means (such as cognitive rewiring techniques, exercise, and all of the other things I've talked about in this blog). However, I do feel I have a fundamental problem which cannot be addressed in the way in which society dictates. By knowing this, I can "manage" my problem by allowing portion-controlled access to comfort food as well as engage in continued management of stress and my outlook on life.

It is imperative that I not self-judge (as so many would have me do), but treat this as as much of an "illness" as any physical one. Sure, I could go to a psychiatrist and pop some pills, but those pills (and trust me that I know this well) are just as likely to bring on weight gain through other issues (metabolic disturbances, thyroid problems) as my self-medicating with small amounts of comfort food. However, I also need to be aware that I am constantly at risk, especially when I am stressed and depressed as I have been.

I'm talking about this because, if I have any readers out there who are also compulsive eaters (and I remain one, though that state is often in remission relative to what it once was), I want you to know that you may have an HPA axis problem as well and that you are not simply lacking in willpower and self-control. You may be struggling to deal with an imbalance and have a bona fide biological addiction to food which is little different than the addiction that anxiety sufferers experience when they are taking benzodiazepines (a highly addictive anti-anxiety drug that is very difficult to wean people off of). You can manage this by moderating your consumption of food and managing frequency as well as managing stress and exercising, but chances are that any sort of super strict diet of deprivation will almost certainly fail you.