According to the New York Times, researchers[1] have found that when people with anorexia nervosa think about eating low fat foods, the part of the brain responsible for habit formation and addiction is engaged, which is the opposite for non-Anorexic individuals. In other words the researchers demonstrate that restricting may actually be more of a bad habit, aka and addiction, than a conscious choice.
This represents a shift in thinking, in that we often credit the Anorexic with “super willpower” when it comes to resisting the foods that most people would find tempting. It turns out that they are not depriving themselves but are actually experiencing a reward for restricting; a reward that I believe they have consciously programed into their psyche. I have speculated for many years, based upon observations of how patients justify restricting, (which defies reason from any objective point of view) that they are addicted to restricting. Now there is neurological evidence to back up these clinical observations.
Using functional magnetic resonance imaging — which tracks activity in the brain in real time — the researchers monitored 21 women with anorexia nervosa and 21 healthy individuals while they made a series of choices about what food to eat. As expected, individuals with anorexia nervosa consistently chose more low-fat foods and in so doing activated receptors in the brain. But the real news has to do with the part of the brain, called the dorsal striatum, that lit up at the sight of carrots for those suffering from Anorexia. This part of the brain is associated with habit formation and/or addiction.
If we think of restricting as an addiction, and we understand that addiction is a conditioned response to a stimulus, it changes the focus of treatment. I believe that this research helps to explain why a clean eating approach to treatment for Anorexia succeeds where traditional treatment fails. When I use the term “clean eating” I am referring to eating foods that are free of toxins, loaded with nutrients and antioxidants and have a healing effect on the body and the brain. In my experience, it is much easier for Anorexic patients to switch from low fat to clean foods than it is for them to switch from low fat foods to processed or fast foods, which is what they are expected to do in most treatment programs.
The traditional model of treatment is “moderation” meaning that the goal is for the individual to be able to eat everything and anything without fear. Here is a quote from the director of a very successful residential treatment center that I interviewed a few years ago. “If she isn’t able to eat a Big Mac, fries and a Coke without fear, she isn’t ready to leave our program!” While I am onboard with the no fear part, there are simply some foods we should not eat and fast foods are the best example.
Fast foods are polluted with excitatory neurotoxins, denatured proteins, trans fats and carcinogenic food additives that have been scientifically shown to damage the parts of the brain regulating eating behavior. They have also been shown to be the primary reason for the current obesity epidemic in the U.S.. Despite the evidence pointing to the damage that such foods are doing, the “all foods in moderation” approach is staunchly defended by residential treatment centers and the National Eating Disorder’s Association.
The assumption such groups make is that it is counter productive to encourage the individual with Anorexia to avoid any food, no matter how bad the food is. While this may have been true 35 years ago when food in the U.S. was of a better quality and therefore safer, it is no longer true. The U.S. is currently the unhealthiest wealthiest country in the developed world, with the most obese population and one of the lowest infant survival rates, despite having more food, better medical technology and significantly more resources. Clearly something is amiss and the common denominator is the food.
It is my belief that most people want to be healthy and that those suffering from Anorexia are no exception. Indeed, in my experience, they are often foodies beneath a cloak of starvation. But like many of us, they have been victims of the demonization of fat that began in the 80’s. Simultaneously, they have also fallen prey to the relentless pursuit of thinness in our society. The drive to be thin in a society where obesity is a national epidemic puts pressure on even the youngest members of our society. Researchers have found that little girls start to worry about being fat at age 3. Given that Anorexia is proliferating, affecting younger and younger children, more men and older women than ever before, I believe there is a connection between the two extremes that is driving some of the disordered thinking when it comes to eating.
Resisting “unhealthy” food is much harder now than it was in the past, because food today is actually designed to cause overeating and addiction. In the face of these intense pressures to be thin while surrounded by foods that are designed to make you overeat them, what’s a girl to do?
Train herself to resist. That is what makes this research so interesting. I have been observing this behavior for many years and describe it as more like self-inflicted brain washing. The dialogue in the head of the anorexic never stops, constantly finding and broadcasting evidence that food, especially food containing fat, sugar, calories, salt, (what ever she deems to be unsafe) is the enemy. This inner voice screams at her that if she eats one bite of that chicken breast, she will never be able to stop and she will end up obese, which will result in public humiliation and/or abandonment by everyone that matters in her life. Whereas this thinking used to be completely irrational, back when food was just food, it is no longer as irrational as it sounds.
These thoughts/fears are so powerful and so present, that they become associated with danger, and in that sense are punishing. Relief and therefore, reward, comes in the form of restricting. In treatment, I can demonstrate, quite convincingly, that clean food is safe and that you can eat as much of it as you want and not worry about gaining unwanted or unneeded weight. Many of my patients get that right away, making the transition to clean eating fairly easy. The earlier they begin treatment, the easier it is to make this transition, as there is a progression from being afraid of foods with fat (salt, sugar, calories) to being afraid of all food the longer they have the disorder.
Another component to consider when it comes to stimulus and response, or conditioning, and this may be the most important thing for some people, I find that the majority of my patients have developed food sensitivities that make eating grains, dairy or highly processed foods physically uncomfortable. In many cases, the food sensitivities may have led to an aversion to food, and ultimately to restricting. The restricting often gets rewarded with weight loss and the attention most people receive when they lose a lot of weight.
In contrast, clean food doesn’t cause bloating, constipation or allergic reactions of any kind. It feels good in you. If you are gluten and dairy intolerant, eating pizza may taste good, but it doesn’t feel good. Finally, not only does clean food feel good, it tastes really good!
Using language and behavioral techniques, along with solid data on the healing role that clean food plays in weight and wellness, I am able to help patients form a new conditioned response to food, except this time it is a conditioned response to clean food that gets rewarded and not to restricting. The bottom line is that it is much easier to convince a patient suffering from Anorexia to eat an organic scrambled egg with sour dough toast than it is to convince her or him to eat an Egg McMuffin.
The most common response I get from recovered patients is that they learned to “trust” food again. Eventually eating clean food becomes habitual and not something that occupies the majority of your thoughts day in and day out. When this happens the individual no longer needs to condition a negative response to food and a positive response to restricting. In other words these individuals can reclaim their lives.
[1]The findings appear in the journal of Nature Neuroscience. Columbia University Medical Center, New York State Psychiatric Institute, the Mortimer B. Zuckerman Mind Brain Behavior Institute, and New York University
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