The Instinct Diet

Food Cravings – Can you cure yourself?

Susan B. Roberts, Ph.D. — Fri, 15 May 2009 21:26:10 +0000

Chocolate. Chips. Ice-cream. French fries. In my research program at Tufts University most volunteers for our weight loss studies report substantial food cravings for foods like these. There isn't one single food that they all crave, because tastes are different, but craved foods all have one unique hallmark: they are all calorie-dense and typically contain twice as many calories per ounce as other foods. Surprisingly, carbs don't seem to be the important key. The craved foods reported by our volunteers usually contain a mixture of carbs and fat with a little protein thrown in for good measure. Think of the human species as being calorieholics rather than carboholics and you have it about right.

Many people feel bad about being unable to control themselves in the face of their got-to-have-it foods, but, in fact food cravings are completely normal. About 90% of women and 50% of men experience uncontrollable urges to eat particular foods several times a month, and they usually end up giving in... So today's blog is all about the emerging science in this important area and what lessons we can draw now to help with weight control.

Neurologically, the sensation of craving is considered to be a sensation of "need" that we experience as a "have to have it" feeling, arising out of dopamine and b-endorphin circuits in the ventral striatum and other midbrain areas, and is distinct from hedonic pleasure, which is just about loving the taste of food. For example, you may love the taste of fresh ripe raspberries but probably don't crave them. A craving for salty snacks or chocolate, on the other hand, may be enough to drive you out to find at 24 hour store at 10pm.
Typically we have triggers that set us off, such as hunger, stress, particular places, and of course the sight and smell of the item in questions. Because making neuronal connections between disparate pieces of information is the way our brain keeps us grounded in the experience of life, once we learn to eat high calorie treats when other things are going on (like hunger, or baseball games), just experiencing that other event again is often all it takes to set off the crave again and again.

It probably isn't a coincidence that most craved foods are snacks, because probably the real beginning point for cravings is the link our brain creates between the taste of the food in our mouth and its postingestive effects in the body-and of course it will be easier for our brain to link up the taste and digestion for foods that are eaten individually.

Here is how it seems to work based on studies in animals. Say you start having a donut midmorning when you pick up a coffee. Your food brain learns that the taste of donuts fixes the somewhat unsatisfied feeling you have at that time because you get a huge rush of calories into your bloodstream shortly after finishing the last bite. So the next time you get hungry or have a coffee or it is midmorning again you think of donuts! And then later on even thinking about donuts at other times can trigger the neurological chain of events that makes you hungry, and your addiction-circuits ramp up the pressure by giving you sensations of need as well. It all adds up to a craving that is truly hard to ignore. But again, as shown in research in animals, if we could feed you some donuts that were identical in taste to the high-cal stuff, pretty soon you would lose your craving for the taste because your brain would relearn that this flavor actually isn't highly caloric. In psychological terms you would have deconditioned your taste preference for donuts, because the reduced calorie content resulted in weaker postingestive effects.

How do we translate all this good theory into some practical help? Some easy but surprisingly effective treatment options seem to be emerging out of research:

1. Be really vigilant about controlling hunger because hunger (and lack of satiety) is a contributor to cravings. Eating high satiety foods at every meal and snack is one of the important factors here as I discussed in a previous blog (http://blogs.psychologytoday.com/blog/the-instinct-diet/200902/th...). Whatever you eat, though, hunger control isn't just about what you eat but when you eat it, and in particular having regular meals and snacks with nothing in between and nothing after dinner is also a big help. It takes a few days to get used to not eating at other times, but people adopting the technique for weight loss say it is hugely beneficial and actually not that hard once they get over the first few days.

2. Keep your eyes and nose under control. Avoid looking at and smelling tempting foods, not only to stop cravings once they've started but also to avoid triggering them in the first place. Deliberately look away when you come across foods that are out of bounds. And if you start to smell them, breathe through your mouth!

3. Change your recipes. This is really helpful also. If a taste you crave now comes with fewer calories, more fiber and more bulk, you can still enjoy it, but after a while your brain can "dissociate" this food trigger from the feeling of need and make it a less urgent sensation.

4. Eat craved foods wisely or not at all while you give the above techniques a few weeks to go to work. If craving for a particular food is very hard to control, give up that food for now before trying it again. Some people find it helpful to simply think of a troublesome food-say, cupcakes-as being "not food" or "garbage" or "not a food that I eat." If you decide to bring back a craved food, eat only reasonable, calorie-controlled portions in the middle of satisfying meals, never first or last and never alone.

Finally, there is Forehead Tapping for if you find yourself with a craving and don't want to give in. It's a proven help for cravings developed in Australia, and the theory behind this it is that working memory is small, so it is possible to displace craving thoughts with other mental activities, in this case a simple exercise that can be done anywhere. Just place the five fingers of one hand on your forehead, spaced apart. Tap each finger in turn at intervals of one second while watching each one carefully as it taps. Keep repeating the exercise until the craving sensation disappears! Alternatively, tell yourself "Not today" or "Hold on" and wait 15 to 20 minutes while you distract yourself by calling a supportive friend, drinking a full glass of water, chewing a piece of sugar-free gum, brushing your teeth, going for a walk or meditating. Keep a record of whatever thoughts and feelings you have leading up to cravings so you can recognize (and avoid) particular behavior chains that are a problem for you.

Will it work for you? There are no randomized controlled trials yet for the effectiveness of craving treatment, but in a group of people being tracked who are using my Instinct Diet menus to lose weight, 90% report that cravings completely disappear. While research studies have a chance to provide hard numbers on craving reduction, you may wish to get started with some of these ideas on your own and see how much healthy changes can help.

Susan B. Roberts, PhD is professor of Nutrition and professor of Psychiatry at Tufts University, Boston, MA, and also author of The Instinct Diet (Workman, 2008). A group of users of the diet in Boston have lost an average of 16 pounds of weight and 2 clothing sizes while on the 8-week program, and 90% report a complete elimination of food cravings. For more information on The Instinct Diet see www.InstinctDiet.com.

Plateaus: Why they happen, and how to get through them

Susan B. Roberts, Ph.D. — Mon, 02 Mar 2009 19:27:40 +0000

Today's topic is something that nearly ever dieter I have ever met is consumed by: what causes those dreaded plateaus, and how to get through them so you can keep losing weight.

If you read official publications on weight loss, as I do given my job as professor of Nutrition and diet researcher, it would be easy to get the impression that governments thinks most overweight people are a bunch of slackers who just need to be more responsible. You are told to follow the guidelines, avoid quick fixes that don't work, eat anything in small amounts, watch calories, limit discretionary foods to certain amounts - and not doing all this is necessarily the cause of weight gain and failure to lose weight. Easy!

The view from dieter's world is completely different. Here, slacking off doesn't enter into it. People are working enormously hard to lose weigh and pretty much every experienced dieter has a failed diet or two in their past. They are intimately familiar with the stress and despondency of getting nowhere, and the horror of pounds creeping back on despite good intentions. Perhaps the most compelling topic of all is the dreaded plateau - that weight that you just can't seem to break through when dieting, no matter what you do.

So how to deal with this very real, very tough problem?

First of all the basics. When we talk about plateaus we are talking about weight loss - or rather lack of it - but weight is really just a surrogate for what we truly want , which is fat loss. Unfortunately, weight and fat loss don't run in close parallel, especially at the beginning of a diet when body water balance is altered by the new foods you are eating. Even after you have been dieting a while, weight can go up and down by 3 pounds between one day and the next because of changes in hydration and water balance, and menstrual cycle hormones make water change even more than this in some women. So the 1-2 pounds of fat that is all most people can lose per week is genuinely hard to see in among the noise of daily changes in water weight . This is all true for any diet, but especially for those plans that are much lower in sodium than your regular food or are ketogenic (i.e. less than 50 grams of carb per day), because they can make you temporarily lose as much as 10 pounds of water in the first week, even if fat loss is negligible.

More basics - the only way to lose actual fat is to get calorie intake lower than calorie expenditure. This doesn't mean you simply can simply cut calories any old how and expect to lose weight easily (nobody would be fat if this was true!). As I started to talk about in my previous blog, eating hunger-suppressing foods at each meal and snack is an important element of success for most people. But the reason you do that is to make it possible to cut calories, because calories are the bottom line.

And real plateaus do happen. If say, you cut your calorie intake in half and kept it there, you would lose huge amounts of weight over many months. But eventually, your calorie requirements would decrease because your now-smaller body would require less energy to schlep it around, and so eventually you would plateau because your new smaller body would only need half as many calories as it did originally. However, based on my experience in research studies where we measure calorie requirements and study plateaus, usually true plateaus don't happen for 6 months or more of dieting. If weight seems to be stuck after 2, 3 or 4 weeks of dieting, more probably you lost a lot of water early on that is making it hard to see fat loss, and/or calories have crept up so you are no longer making the cut you think you are.

Here are some questions to help you work out whether your plateau is a real stall or not, and if so how to get through it.

1. Are you sure you have really reached a plateau?
Hopes for rapid weight loss get fed by the sharp decrease in weight you may have seen in the first week or two of dieting and by unscrupulous books and advertising promising you more weight loss than the amount of fat it is possible for the human body to lose. Its an unfortunate fact that the human body maxes out at about 2 pounds of fat loss a week, and that is if you go at dieting really actively. So if you have 20 pounds of real fat to get rid of, it is a job that will take a minimum of 10 weeks, and even successful dieters can take 20 or 30 weeks at a slower but still good pace. Some diets definitely cause faster weight loss, but that's just water loss - either inadvertent or deliberate. The trouble here is that 0.5-2 pounds of real fat loss a week is good success but gets lost in day-to-day weights that go up and down. The solution? Buy in for the long haul, and then choose one of two good ways to track weight. Either weigh yourself just once a week and not worry unless every 2 weeks you don't drop at least a pound; or weigh yourself daily, don't fuss about individual ups and downs, and keep an eye on whether your 'best' day weighs in less each week - if your best weight keeps going down, all is well.

2. Are you eating more than you think?
This is another really common cause of plateaus. You start your diet with great determination but then over time (especially on really strict plans) you change a few things here and there to make it easier. And maybe you had a dinner out one night with friends, and it turned out they had booked into your favorite Indian - you did your best but know it wasn't perfect. Or work was really busy, and you had a breakfast meeting and a working dinner so couldn't stick exactly to your plan. Every change adds calories, often hundreds of them, and what seems like small things add up surprisingly fast, because good food on the table tricks your brain into thinking you are eating less than you are. The end result is you really are dieting most of the last week, but those few occasions when control slipped took away all forward progress.

The solution? Get demanding and make it work! No question, we have a terrible environment that makes weight control harder. But almost everyone can take more control that they do. The fact that the environment works against you isn't a cause to give in, it is all the more reason for you to take control and not feel apologetic. One of my current Instinct dieters recently spend 4 days at a vendor show out of town and every night was brought a selection of pizza, tacos, pretzels, soda and other diet-breakers for dinner each night while she was supporting her product. Her solution? The first night she simply went hungry and ate things she had brought with her back in her room. The next evenings she took along a healthy low calorie salmon and steamed veggie dinner she ordered at the hotel restaurant - and arrived back home at the end of the week with her diet intact and weight lower than ever. Another of my dieters with a demanding job and home life carries 2 apples with her whenever she goes out, and has already lost more weight than she had hoped to lose by next summer. There are so many ways you can prevent exceptions becoming routine, it all starts with thinking ahead and being ready to advocate for yourself, and can be just what it takes to keep weight coming down.

3. Are you using a diet plan that isn't cutting calories enough?
Sometimes premature plateaus are real and happen because you are not cutting calories enough. Women with low calorie requirements (those who are, say, less than 5'4" tall or over 50 years of age) often have to cut calories to 1200 a day to lose weight effectively, and many diet plans only go down to 1400 or 1600. So you do lose weight for a week or two because of the water loss of changing to a low sodium meals, but then weight stalls because calories are just not low enough. I'm not suggesting you go hungry here, but finding a lower calorie plan that is also carefully designed to cut hunger may be what it takes to jump start weight loss in this case.

If you found this blog helpful please share with everyone you who know who diets! Next time I will be talking about cravings and how to keep them in line.

Susan B. Roberts, PhD is professor of Nutrition and professor of Psychiatry at Tufts University, Boston, MA, and also author of The Instinct Diet. For more information on The Instinct Diet visit www.InstinctDiet.com.

The Instinct Diet

Susan B. Roberts, Ph.D. — Wed, 11 Feb 2009 22:07:21 +0000

"I almost die for food, and let me have it!"
As You Like It by William Shakespeare

How do we lose weight and keep it off? This is a big, big topic, and one that I'll be covering piece by piece in this blog.

So let me first tell you who I am and why this topic is mine. In my professional life I'm a professor of nutrition and a professor of psychiatry at Tufts University and have spent the last 17 years doing research on weight loss and how to make it work for real people in the real world. On a personal level, I was an overweight kid, had a mother who loved us with food, and was 55 pounds overweight in my 30's after a difficult pregnancy. Researching weight has been my way to bring all the pieces of my life together. Like many people who struggle with control over what they eat, I've gained and lost, and gained and lost again, so I know the struggle up close. But I also know how to win on a personal level - I've been weight stable for the last 15 years, and with the help of things I've learned in my research program have achieved this without giving up the wonderful pleasures of food, comfort food and all the rest.

I also love food - I was a chef in a French bistro and worked as a private chef as well, before becoming a researcher - and think that good food, comfort food and all the rest are legitimate, normal pleasures which should not be made hostage to weight control - indeed I believe that we can't win our personal battle with weight unless we enjoy what we eat and stay satisfied. I'm also the author of the just-published The Instinct Diet, which has been endorsed by more leading obesity scientists than any diet book ever-including researchers who've never before been able to agree on the same recommendations.

People who struggle with their weight report that the main reasons they give up on a diet are because they miss eating foods they love, they are hungry all or most of the time, and then hit a plateau and can't get any further. So the central challenge in weight control is this: how do we cut calories while staying satisfied and eating things we enjoy? If we can do this, there is no reason we can't gain permanent control over our weight!

So let's start with hunger control. I know that most everyone thinks that they have other problems as well, but in my experience really good hunger control 24/7 makes it much easier to deal with just about every other issue (such as emotional eating and craving, which I will cover in a future blog). In psychiatric terms of peeling the onion, hunger control is the outside layer - you can't uncover other stuff until you get rid of it. And the good news here is that the diet wars of past years really are over. Really! Research studies are showing quite conclusively that there isn't just one way to deal with hunger, there are at least 4 ways to put together a meal or snack to get satisfied on fewer calories. Eating the right foods isn't the only way to control hunger (more on this later), but all of the following items are great for hunger control, and if you include 2 or more of these in each meal and each snack you will probably notice a rapid improvement in how satisfied you feel:

• High fiber foods (such as high fiber cereals, legumes, green vegetables);
• High protein foods (such as lean proteins like chicken breast, white fish, tofu);
• High volume foods (such as green salads and vegetable or bean soups);
• Low glycemic index carbs (such as legumes, again, and also wheat berries, barley, low carb breads, and non-starchy fruits).

What if you don't like these things? Practice (especially when you are hungry) and some good recipes are the key to growing enjoyment. Here is my favorite after-dinner cure for both hunger and late-night munchies. Think of it as the best diet medicine rather than an indulgent dessert, and enjoy!

Chocolate Cereal Dessert
½ cup very high fiber cereal such as Original Fiber One, All Bran Extra Fiber or Trader Joe's High Fiber Cereal
1 square (10 grams) chocolate of your choice
1% milk to serve, about 1/3 cup
Optional: 2 drops mint essence, or a handful of frozen raspberries

Place the chocolate on top of the cereal and microwave until the chocolate just melts, about 30 seconds. Mix the cereal and chocolate together really well. Add the milk and serve (preferably while you put your feet up and relax).

Dr. Susan Roberts is professor of nutrition and professor of psychiatry at Tufts University and author of The Instinct Diet.