DAY 6: What to expect as you withdrawal

“At the heart of conditioned hypereating lies the impulsive nature of the behavior. Because people with conditioned hypereating are so sensitive to food cues, they tend to make eating decisions on the spur of the moment. To compete with the chaotic nature of that behavior, we need to develop a set of rules to keep us from becoming aroused.”

            – David A. Kessler, MD, former U.S. Food and Drug Administration Commissioner

What Dr. Kessler (the former FDA Commissioner who took on Big Tobacco) refers to as “conditioned hypereating” is food addiction. He wrote The End of Overeating – a brilliant book in my estimation – in 2009, long before the medical community was calling it food addiction, but they’re one in the same certainly. Whatever we call it, the repercussions are the same and the pain is real. And as we’ve learned this first week, disengaging from the behavior is very difficult.

Knowing that, it’s critical that we are prepared for the active withdrawal phase of food addiction recovery.

Some tips for dealing with the symptoms of withdrawal from salt, sugar, and fat:

1. Stick to the eating plan. It’s there to provide structure, to make sure you don’t get ravenously hungry, to retrain your palate, and to begin to rewire our cue-urge-reward response circuitry that is currently out-of-whack. It absolutely works, but only if you actually follow it.
2. Never go more than 2-1/2 – 3 hours without eating to maintain blood sugar levels. The eating plan dictates that you eat at 7am, 10am, 12:30pm, 3:30pm, 6pm and 9pm on weekdays, and 8am, 11am, 1:30pm, 4pm, 6:30pm and 9pm on weekends. If you have to go over by a half hour or so because you’re in a meeting or commuting home or whatever, that’s fine. But plan ahead and take your food with you if you know you’ll be away much beyond the designated mealtime. I know it sounds rigid, but allowing blood sugar to dip too low, and experiencing the ravenous hunger that accompanies it, will make it next to impossible to stick to the eating plan. We’re not just trying to avoid uncontrollable hunger; we’re trying to avoid being aroused by food. The cues are strong enough anyway; don’t make it worse by letting yourself get impossibly hungry.
3. Don’t try to satisfy your sweet tooth with a bunch of fruit or artificial sweeteners. After the 28 days you will be able to reintroduce more fruit and even natural sweeteners (honey, molasses and pure maple syrup) back into your life, but for now stick to the eating plan as it is written. Remember: we’re retraining our palates. Even naturally sweet foods can derail that.
4. For now, absolutes are best. That is, for these 28 days, you must have blinders on. Your food is safe; the rest of the world’s food is not. The vast food choices that are available to us are a huge part of the problem. We need to narrow our food world – not forever, but for now – to choices that support our goal to get unhooked from salt, sugar, and fat. That’s the only way to unplug from the cue-urge-reward cycle.
5. Engage in “higher-level” thinking. Addictive behavior is a “bottom-up” drive; your brain’s neurons get fired up by a food cue, which stirs basic desire. You know from past experience that giving in to that impulse brings emotional reward (happiness, comfort). But all of this response happens on autopilot. Your brain is capable of going from cue to standing in line a Cinnabon in a nanosecond. Higher-level thinking is required to create space between craving and caving. By engaging those higher-level thoughts you actually activate the executive control part of your brain (prefrontal cortex), thus retraining your brain to respond differently to a food cue. Your executive control can tell you to “walk away.” And just like you became conditioned to give in to impulse, the more you engage your higher-thinking skills, the better you get at engaging executive control and the easier it becomes. I cannot stress enough: this is not willpower. This is rewiring your brain to interrupt the cue-urge-reward habit.
6. Know that urges pass. Have you ever been ravenously hungry and then something dramatic or urgent happens, refocusing your attention? Time passes and then you remember, “Oh yeah, I was starving 20 minutes ago, but now I’m not!” I’m not saying you should ignore true hunger, absolutely not! But I am saying that cravings, urges, that impulse to eat … it passes, like a wave going back out to sea. It may have felt like a tsunami when it hit you, but it will pass if you allow it to. And allowing it to pass while engaging those higher-level thinking skills strengthens your ability to let it pass the next time it happens. Which it will.
7. Don’t go bonkers on the cheat meals. They’re there to give you flexibility: go out to dinner with your family, have lunch with a friend (yes, you can swap the dinner cheat meal for a lunch if that’s more workable for you). But a cheat meal is not a double bacon cheeseburger. That’s a momentum-crushing lapse. A cheat meal is a bowl of turkey chili at Panera (it’s really good) or a plate of sushi. If you’re me, it’s going to include a beer. Yours might be accompanied by a nice merlot. The point is to give yourself some breathing room, but still exercise good judgment. The only person who get “cheated” on an all-out binge is you, so don’t do it.
8. You will have lapses. And that’s okay! Fortunately this is not heroin we’re talking about, it’s doughnuts (or cinnamon rolls, or mega meat pizza, or whatever). A fall is not an undoing; it’s a learning opportunity. There are no failures, only feedback. Learn from mistakes, don’t put yourself in that position again and move on.
9. Most importantly, understand your personal “why”. You must be able to answer the question: “Why is this important to me?” And, “Because it’s important to my husband/wife,” or “Because my doctor told me to lose weight,” won’t work. It can’t be somebody else’s agenda you’re fulfilling. You must know in your heart of hearts that this behavior  – at the risk of sounding melodramatic – is killing you, one bite at a time. And knowing that, you must want something better for yourself and be willing to do what you must do to get better.

Engaging higher-level thinking, wanting something better for yourself … these are pretty abstract things to hold onto when you’re faced with a birthday cake in the office break room. That’s why during these 28 days I ask that you stick to the meal plan rigidly. That firmness will remove the endless, “Should I have a piece or should I not???” dialogue that goes on in your head when you’re faced with a food cue. Even asking yourself the question leaves you extremely vulnerable to giving in.

For now, trust the process.

“Intervention begins with the knowledge that we have a moment of choice – but only a moment – to recognize what is about to happen and do something else instead.

The cornerstone of treatment for conditioned hypereating is developing the capacity to refuse the cue’s invitation to the brain in the first place. That refusal must come early, and it must be definitive.”

– David A. Kessler, MD, The End of Overeating, p. 182

More tomorrow. Until then, stay strong.