Archive for June, 2012

A Physician’s Take on Health Insurance Reform

June 30, 2012

Blog # 64

With the recent Supreme Court decision to uphold the “Obama care” Affordable Care Act, we can expect some significant reforms in our health insurance system. This act will increase access for those who are uninsured, protect those who are insured from cancelling benefits if they become seriously ill, allow for children to stay on their parent’s plan until age 26, and allow coverage for pre-existing conditions. The law will also require insurance plans to cover out-of-pocket costs for many preventive care services that screen for problems at their earliest stages, such as colonoscopies and mammograms.

Even in light of these positive changes, the American health insurance situation is clearly problematic, fraught with deeply entrenched and highly complicated issues for which there are no simple solutions.  Even with Obama’s reforms, the current situation is neither healthy nor sustainable.  As a physician who “works in the trenches” and confronts many of these issues on a daily basis, I have a few ideas about improving health insurance. I certainly don’t have all the answers, but I know some givens and some of what must change in order for our system to remain viable.

As a general model, I use the “body as automobile” metaphor, extending this to the realm of health insurance.  The premise is simple—we need to maintain our automobiles to keep them healthy and running.  We fuel them properly, do routine preventative maintenance, drive them in the manner they were designed to be driven, keep them clean and treat them with respect.  We purchase automobile insurance in the event that we are involved in an accident that causes costly damage to our vehicle.  It is our choice whether we purchase a very basic insurance plan or a more complicated and fancier plan that offers more frills.

The following are some of my thoughts about necessary reforms to the system:

  • Establishing universal health insurance with a single-payer that has streamlined administration is an absolute necessity. This would serve to eliminate the ridiculous amount of red tape and bureaucratic waste in the current system.  The profit-based private insurance companies squander billions of dollars via inflated administrative costs, shareholder profits and the disgraceful eight-figure salaries of the CEOs. Our taxes should provide all citizens of the USA with a basic policy to insure against a serious medical illness. More extensive and sophisticated coverage should be available at a premium, similar to automobile insurance where deductibles and “bells and whistles” are variable.
  • The employer-based underwriting of medical insurance has to be terminated.  Why should one’s employer have the financial responsibility and burden for this?  This was an absurd and misdirected idea from the get go.  The concept that the employer provides health insurance is as ludicrous as the idea that the employer should provide automobile insurance.  It puts the USA at a competitive disadvantage, hinders employment, and thus puts a drag on the economy.
  • Just as automobile insurance does not pay for routine car maintenance, I do not believe that health insurance should pay for routine preventative maintenance—the purpose of this health insurance should be to protect us in the event we need surgery, develop a chronic disease, have a catastrophic medical occurrence, etc.  All of us need to have some “skin” in the game and expect that we will need to have some financial responsibilities for our medical care.  We willingly pay it for our automobiles, why not for ourselves?
  •  Dental care (and other ancillary health care) should be included under the domain of medical insurance—it is ridiculous that specific areas of our bodies are treated differently in terms of insurance.
  • The third party system engenders the concept of “other people’s money” paying for our expenses, which must change to a system of crystal-clear transparency and the thought process that it is “our money.” Patients, physicians and the payer all need to be in-the-know about the precise fees and charges for all medical expenses, and once this transparency exists it will help set up the necessary markets to allow for competition and for inflated medical charges to equilibrate.  This transparency needs to apply broadly to doctors’ offices, clinics, labs, imaging centers, ambulatory surgery centers, hospitals, etc.  Transparency will engender market competition, which will keep prices down.

I recently had some x-rays of my hand; I was in sticker shock when I saw the bill that was in excess of  $1000 for this series of films that took the technician 5 minutes and the radiologist a minute or so to read and dictate a report. My insurance company paid the bill, so although I was initially incensed at what I thought was an excessive charge, I was happy that it was covered by my insurance and soon didn’t give it another thought.


  • Meaningful tort reform needs to be established so doctors do not feel obligated to order medical tests on a “defensive” basis.  Many of the lab, imaging and other diagnostic tests we order are not medically necessary, but are done on a “covering-our-ass-in-this-litigious society-basis.”  After having spent time in court being grilled on the witness stand by a vicious plaintiff’s attorney with the following question: “Doctor, is it not your obligation to rule out the most serious possible cause of the patient’s presenting symptoms?”, I changed my entire philosophy of medical practice to be an extremely defensive physician.  Thus, a gamut of tests that are largely done to keep me and other doctors out of the courthouse.
  • Patients must take responsibility in shaping their own health destiny in terms of living a healthy lifestyle to avoid preventable chronic diseases that occur on the basis of tobacco, unhealthy eating, obesity and sedentary living.  An appropriate system needs to be established to “reward” non-smokers who maintain a healthy weight and exercise regularly and to “penalize” those who drive up the cost of the program by volitionally pursuing unhealthy lifestyle choices.  Much like speeding tickets or other infractions that jeopardize our safety and incur points that can result in a more costly automobile insurance policy, our health insurance policies have to incorporate risk into their premiums.  Once again, we need to have some skin in the game.
  • Patients need to understand that expensive diagnostic tests that are generally low-yield should not be ordered on whim for any mild symptom that presents itself.  I have countless patients who literally demand cat scans for frequently inconsequential reasons, yet I rarely try to argue against pursuing tests from the patient/consumer who is absolutely determined to have a test done.
  • Many physicians pursue diagnostic tests for a variety of reasons including: ready availability; habit; dogma; derivation of potentially helpful clinical information; reassurance; medical-legal documentation; and revenue to help offset the expensive cost of maintaining a medical practice.  Before any medical test is performed, there needs to be a discussion between the patient and physician regarding whether the test is absolutely necessary and if there are less costly alternatives.  Many tests are expensive, the additional information they provide does not make them cost-effective, and treatment could be rendered as effectively without the diagnostic information provided.
  • The payment system for physicians needs to be modified, precisely how I am not sure.  As in most things in life, there is a Bell curve among physician competence.  Most are good, but there are some outliers who are exceptional and some outliers who are less than proficient. For example, Dr. NOT-so-competent operates on patient X and because of ineptitude needs to repeat the operation two additional times before the situation is corrected.  Dr. Competent does the surgery once and achieves effective results.  The inequity of the system is that Dr. NOT-so-competent garners three surgical fees from the insurance system and Dr. Competent just one, while the patient of Dr. NOT-so-competent had to endure unnecessary procedures.  Something is just not right with this scenario!  A fair and equitable physician compensation system needs to be established in which lack of competence and unwarranted volumes of diagnostic testing are not rewarded.
  • An integrated electronic medical records system needs to be established.  What we have now is disintegrated and spotty, in its most rudimentary phases of development and not ready for Prime Time.  We need a system such that any medical doctor in the USA can access the records of any patient, and one that is integrated across hospitals, private practices, clinics, laboratories and imaging centers.  I’m not sure why information technology has been so late to come to medical practice in America, but it is an unfortunate situation that needs to be rectified.  Some brilliant software engineers from, let’s say, Apple need to come to the rescue with an intuitive, simple, universal and integrated system.
  • The cost of devices and pharmaceuticals in the USA is out-of-sight as compared to many other industrial nations, significantly jacking up the cost of medical care.  The establishment of some form of international co-op such that economic market forces could be brought to the world of pharmaceuticals and devices is in order.  If an identical product is available in Canada or Europe at much less expense than in the USA, we need to broaden and open the market to allow these to compete with the devices and drugs available domestically to bring their prices down.
  • Hospital expenses need to be kept in check.  Transparency is truly lacking in this domain. If you were to examine your hospital bill carefully you would likely be bewildered trying to understand it and flummoxed when you realized what the charges are.  There are many ways to cut the expenses of hospitals and I would start with reducing the billions of dollars that go to advertising and marketing and eliminating seven-figure executive compensation packages.

In summary, at the same time that many of us are true believers in capitalism and the free market, our sense of humanity, compassion and community should drive the necessity for universal health insurance to provide health care for those less fortunate than ourselves.   In addition to insuring all Americans, we need a system that provides high-quality medical care that will not impoverish the nation. We certainly do not want a health care system that runs like the Department of Motor Vehicles. We must continue to provide incentives so that the health care field attracts bright and talented individuals and so that research and development by the medical, pharmaceutical and device industries continues to promote innovation.

A nationalized, single-payer, bureaucracy-streamlined, taxpayer-financed, medical insurance system is imperative.  Patients must expect to have some financial responsibility as well as personal responsibility in terms of maintaining a healthy lifestyle—skin in the game—or else they will need to have increased financial liability for burdening the system. The employer-based system has to be terminated and the private health payers need to be melded into the nationalized system.  The economics underpinning the new system must be highly transparent and competitive markets need to be established to keep costs down.  Tort reform will mitigate the practice of defensive medicine.  An integrated, universal electronic medical records system needs to be established.  The current system of physician reimbursement must be revamped.  The expenses for devices and pharmaceuticals need to be brought down by opening competitive markets.  The end results of such reformation should be broad access to care for all U.S. citizens and significant cost savings.  Without some or all of this, the system is destined to crumble.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Available on Amazon Kindle


Coconut Oil: Friend or Foe?

June 23, 2012

Andrew Siegel, M.D.   Blog # 63


I previously expressed my opinion regarding coconut oil and other tropical oils in my book Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship With Food as well as in a few videos I have posted on YouTube:

“Even though they are not animal fats, tropical oils such as coconut oil, palm oil and palm kernel oil are so saturated that they behave like animal fats. Clearly, they are too saturated for our good health and are better suited for use in sun block and skin moisturizing lotions, which they are!  Beware of consuming any chemicals that are also products in moisturizers and cosmetics!”

I received a great deal of flack from the devout coconut worshipers, who are of the opinion that coconut and other tropical oils are nectar from heaven, super foods that have remarkable properties.  After all, Dr. Oz told his television audience that coconut oil has “superpowers.”  Internet guru Joseph Mercola stated that its benefits are “nearly miraculous,” and he aggressively promotes coconut oil on his website, where it is on sale for $65/gallon.

The strangest thing—the biggest paradox—is that coconut oil is beloved by the processed food industry, but at the same time is the lovechild of many members of the super-health conscious, organic community.   When it comes to coconut oil, these polar extreme factions—usually at odds with each other—share a great degree of admiration, esteem and regard for the same product. When a product is lauded by both the corporate powers that control our food industry as well as by individuals who are very health conscious, it begs the question: is this an amazing and overwhelming substance with wonderful medicinal properties and a miraculous panacea for a myriad of diseases or is it underwhelming rubbish, just another tropical oil laden with saturated fats?

So what is the real deal with coconut oil?  For many reasons—shelf life, heat stability, solid status at room temperature, etc.—it is a favorite of Big Food. It is also beloved by the cosmetics industry as coconut oil is a key ingredient commonly used in hair and skin products. Many food purists worship it as a sort of magical elixir. There are an abundance of Internet sites that extol the medical virtues of coconut oil, for example:  Extensive lists of purported medicinal benefits make it seem to be the holy grail of nutrition.  For example, the following is a bullet list of just the first 15 benefits (copied verbatim off the aforementioned website):

  • Kills viruses that cause influenza, herpes, measles, hepatitis C, SARS, AIDS, and other illnesses.
  • Kills bacteria that cause ulcers, throat infections, urinary tract infections, gum disease and cavities, pneumonia, and gonorrhea, and other diseases.
  • Kills fungi and yeasts that cause candidiasis, ringworm, athlete’s foot, thrush, diaper rash, and other infections.
  • Expels or kills tapeworms, lice, giardia, and other parasites.
  • Provides a nutritional source of quick energy.
  • Boosts energy and endurance, enhancing physical and athletic performance.
  • Improves digestion and absorption of other nutrients including vitamins, minerals, and amino acids.
  • Improves insulin secretion and utilization of blood glucose.
  • Relieves stress on pancreas and enzyme systems of the body.
  • Reduces symptoms associated with pancreatitis.
  • Helps relieve symptoms and reduce health risks associated with diabetes.
  • Reduces problems associated with malabsorption syndrome and cystic fibrosis.
  • Improves calcium and magnesium absorption and supports the development of strong bones and teeth.
  • Helps protect against osteoporosis.
  • Helps relieve symptoms associated with gallbladder disease.

Is this truth, fiction or somewhere in between?  As a physician, I have to conclude that many of these claims are simply not proven, and to scientifically demonstrate many of the claimed benefits would require long-term, highly complex studies that would be expensive and difficult, if not impossible to carry out.  Coconut oil just might be the greatest thing since the iPhone, but we do not have that information.  The jury is out and I do not believe they will be in for some time.

The coconut palm tree grows and bears coconuts all year round, producing a fruit that is potable, palatable, and portable. This fruit is a dietary staple for residents of tropical seashores like the Pacific islands where the coconut palm is native and plentiful. Coconut oil is edible oil extracted from the “meat” of mature coconuts.

Extracting the oil from the coconut involves a variety of physical methods including heating, milling, grating, pressing, centrifuging and expelling, and chemical methods such as hexane and enzymatic breakdown.  The product is ultimately refined to remove impurities.  Refined, bleached and deodorized coconut oil has the taste and scent of coconuts removed and is used for home cooking, commercial food processing, and for manufacturing by the cosmetic and pharmaceutical industries.

When refined and deodorized, coconut oil mixed with nonfat milk is often used as a substitute for whole milk. Other uses include imitation dairy products such as coffee creamers, soft-serve and frozen desserts, whipped toppings, milk shake mixes, chocolate milk, movie theatre popcorn oil, baked goods and snack foods.  Since coconut oil is solid, it can be used as a butter substitute for vegans. In addition to its use for nutritional purposes, coconut oil can be utilized as an unguent for the hair, an emollient for the body, a rust inhibitor for iron, and a fuel for lamps. Its first industrial use in Europe was as a lubricant in textile mills.

So what is truth and what is fiction with this oil derived from the coconut fruit?

The following are facts about coconut oil:

  • More than 90% of its fat is saturated fat as opposed to canola oil (7% saturated); olive oil (13% saturated); beef tallow (48% saturated); lard (43% saturated).  Saturated fats have all of their carbons “saturated” with hydrogen as opposed to unsaturated fats in which the carbons have double bonds.  The double bonds confer a bend to the molecule whereas the saturated fats tend to be straight.  The significance of this is that the saturated fats tend to be more densely packed together, making them solid at room temperature and raising the melting point.  Saturated fat is not considered healthy since it tends to promote fatty plaque accumulation in our arteries.
  • It is solid at room temperature—an oddity for a fat derived from a plant source—on the basis of the very high levels of saturated fat.
  • It is a durable product that is resistant to going rancid, a desirable feature for manufacturers of processed foods that want to prolong the shelf life of the product in question (also on the basis of the very high levels of saturated fat).
  • It is very heat-stable, making it very suitable for frying.
  • It is easily digested and is absorbed because of the low molecular weight of the fatty acids. The fatty acids in coconut oil are lauric, myristic, palmitic, oleic, caprylic, capric and stearic.
  • Coconut oil is unusual because it contains a high percentage of medium-chain triglycerides (MCT), whereas most oils consist entirely of long-chain triglycerides (LCTs). Coconut oil is 40% LCTs AND 60% MCTS. MCTs are composed of carbon chains of 6-10 links vs. LCTs, which are composed of 12-18 carbons. The shorter chains are more rapidly absorbed and readily metabolized as fuel as opposed to being stored as fat. That stated, no study has ever proven that coconut oil promotes weight loss.
  • Pure MCT oil that is specially formulated by extraction from coconut oil has been shown to result in increased weight loss in dieters as compared to liquid vegetable oil.
  • In Polynesia, where residents consume most of their fat as coconut fat from fresh coconuts, there does not appear to be an increased incidence of heart disease, despite the saturated fat content of coconuts.  That stated, Polynesia does not seem to be lacking in overweight individuals.  In fact, in the top ten countries that celebrate female obesity are the following: Tonga islands, the Fiji islands, Samoa, Tahiti, and Nauru.
  • As with dairy and meats, the following organizations recommend limiting consumption of significant amounts of coconut oil due to its high levels of saturated fat: USFDA; WHO; International College of Nutrition; ADA; AHA; U.S. Department of Health and Human Services; British National Health Service; Dieticians of Canada.

 Bottom Line:

Coconut oil is a natural product that is very high in saturated fat content, generally not such a good thing.  The high MCT content of coconut oil confers a nutritional and metabolic benefit. These effects seem to balance each other out.

Until studies prove otherwise (and I am not sure they ever will), I do not believe that coconut oil has magical and mystical properties that will cure or prevent the scourges of mankind.  I am a huge advocate of plant-origin fats—olives, avocados, nuts, etc.—as opposed to animal fats, but because of the high saturated fat content of tropical oils, I think it prudent to be moderate with intake of coconut oil, despite the predominance of MCTs.  As is the case with anything imputed with extraordinary powers and claims, it simply remains to be demonstrated.  Time usually will bear out truths and untruths, and I retain a healthy skepticism regarding anything that sounds too good to be true.  Coconut oil is probably neither friend nor foe, but just is.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Available on Amazon Kindle

“The Internet is a treasure trove of information and misinformation.

Everything with a grain of salt…no, a salt shaker.”


The Cambridge   World History of Food

Essentials of Food Science


June 15, 2012

Andrew Siegel, M.D.    Blog # 62


By juicing, I am not referring to the use of anabolic steroids, but the liquefaction of fruits, vegetables and whatever other components one would like to blend up into a healthy concoction.  Consuming fresh, raw vegetables and fruit converted into juice is a means of helping to maintain vitality and wellness.

Generally speaking, there are two kinds of juicers—those that separate the juice from the solid components (fiber), and those that blend the liquid juice components and the solid fiber component.  A carrot juicer, an example of the former, will separate the sweet carrot juice from the rough fiber that is discarded, yielding a sweet, delicious, carbohydrate-rich but fiber-poor drink.  An example of the latter is the Vitamix, which beats up into a liquid pulp all of the component ingredients, e.g., a smoothie with soy milk, bananas, apples, blueberries, spinach, celery, carrots and almonds.  This concoction is also sweet and delicious, but in addition to vitamins, minerals, trace elements, anti-oxidants and phyto-nutrients, retains the all-important fiber that provides us with numerous advantages and benefits.

Fiberrefers to the part of plant foods that our bodies are not capable of digesting.  It passes through our bodies relatively unscathed, providing no calories, and is one of our key protective measures against obesity. Fiber does all sorts of wonderful things for our bodies including: increases our satiety and fullness because of the bulk and volume of the insoluble matter; promotes intestinal motility and thus bowel regularity; slows carbohydrate absorption and the conversion of complex carbohydrates to simple sugars, thus modulating digestion and controlling blood glucose levels; and decreases the absorption of cholesterol.

Whenever nature provides us with a nutrient that is potentially harmful to our health, it usually limits access to that nutrient.  With sugar—potentially dangerous in high doses—nature has also included the antidote, fiber.  Juicers that separate the sweet juice from the pulpy fiber have allowed us to cheat nature by eliminating the safety mechanism.  For example, 12 ounces of carrot juice have approximately 120 calories of sugar; this is not necessarily bad unless you are carrying extra pounds that you are trying to eliminate.  Carrot juice is a delicious taste treat and better than drinking a can of soda, but is not very filling because of the absence of fiber and is a bolus of rapidly absorbed sugar that stimulates an insulin spike, which promotes storage as fat.  To get the same caloric load from carrots, you would have to eat about 4 average-sized carrots—something that not many people would necessarily do.  It would take a good deal of time and chewing effort and I would venture to say that those who desire a carrot as a snack would stop at one, maybe two at the most.  Nature’s unit is one carrot; with the juice, there is no such unit.  As opposed to the juice, the carrot is filling, the sugar absorption is slower and the insulin spike much less pronounced. The key point is that is that if you are going to juice, use juicers that retain the fiber.  You can still enjoy delicious, fulfilling—and incredibly healthy—drinks.

Juicing facts:

  • If you dislike the taste of vegetables, juicing with fruit added for sweetness will help you get an adequate daily intake of vegetables.  Very few of us consume the recommended 6-8 daily servings of vegetables, so juicing makes it easier to achieve this goal.
  • Juicing allows us to add a wider variety of vegetables to our diet than we would typically consume, as opposed to the habit that many of us have of eating virtually the same vegetables every day.
  • It is entirely possible to train our taste buds away from the fat-sugar-salt snack habit that so many of us have.  Eventually you can get to the point that you actually develop cravings for your juicing concoctions.
  • Raw juicing is of theoretical advantage since heating can sometimes damage or alter micronutrients.
  • Juicing facilitates absorption of nutrients since it mechanically “pre-digests” foods; the liquid slurry is much more easily absorbed than the intact components.
  • Retaining the pulp (fiber) is preferable and desirable.
  • Juicing makes for a great snack or meal supplement and a fabulous replenishing drink after a good workout.
  • Choose organic when possible.  You can use any combination of vegetables and fruits.  Using a variety of brightly colored fruits and vegetables will assure a broad range of nutrients and anti-oxidants.  Being creative can yield some great concoctions.  You can supplement with nuts, seeds, dried fruit, etc.
  • Juices are very perishable so it is best to consume them right away.
  • Citrus fruits can neutralize the bitter taste of dark, leafy green vegetables.
  • With devices like the Vitamix, in addition to juicing, you can also whip up smoothies, hummus, soups, nut butters, etc.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Now available on Amazon Kindle

Are You Addicted To Food?

June 9, 2012

Andrew Siegel, M.D. Blog # 61


The sudden thoughts of the substance will rise unbidden like bubbles in a toddler’s bath. The key is to just let the thoughts go—let them come as they will, but do not entertain them.
(Paraphrased from Infinite Jest by David Foster Wallace)

Food for thought: Why is it that cookies, ice cream, candy and cake are so addictive, yet Brussel sprouts are not?

Because eating is—for many of us, including myself—such a stimulating and pleasurable experience, it is easily and readily liable to over-indulgent behavior. A chemical dependence on food satisfies the criterion for an addiction. There are many addictions that humans can succumb to including alcohol, drugs, sex, gambling and eating. Unlike behaviors that involve habits that we can live without, food is unique in that we are all dependent upon it for our survival. So, we are all food addicts to some extent since without it we would not survive for very long. We are all physically dependent upon food, such that symptoms of withdrawal will occur if levels of blood of glucose fall and engender hunger and cravings. Additionally, because food can stimulate our pleasure centers, it can be thought of as a mood-altering drug leading to compulsive use.
And how easy it is for us to be compulsive abusers—addicts—of food. Food is relatively cheap, it is readily available, and we do not need a dealer or involvement in surreptitious business arrangements or clandestine meetings to get our supply. We don’t need to snort it, smoke it, or inject it into our veins. A food addiction is condoned by society and it is often pursued in the company of others in orgies of overindulgence.
Big Food has created an abundance of highly processed, attractively packaged foods laden with fat, sugar, and salt that are convenient fodder for our addiction. In contrast to wholesome, slow-digesting, unrefined foods that contain abundant fiber—which slows and regulates glucose absorption and leaves us feeling full and satisfied—these nutritionally void substances promote addiction. For example, enriched wheat flour (wheat grain strip-mined of bran and germ)—is a pulverized, super-fine, silky white powder that appears much like cocaine or heroin. This “pre-chewed,” “pre-digested,” melts-in-your-mouth, adult baby food is absorbed amazingly rapidly because of the fiber-stripping and refinement process, much akin to mainlining glucose into our bloodstream. And that is just the refined grain component— juice this up with the right combination of sweeteners and fats and you have ingested a fix—the physiological result of which is a sugar rush causing a rapid spike in insulin to get the sugar load into our cells. This quick fix of sugar is not particularly filling because of the absence of fiber—it is a short-lived satisfaction that begs for more consumption, establishing a vicious cycle. The result is a push in the direction of weight gain, insulin-resistance, obesity, diabetes and heart disease.
There are biochemical mechanisms that drive addictive behaviors no matter what the object of the addiction is, whether it is drugs, alcohol, sex, gambling, junk food, etc. After exposure, reward centers of the brain are stimulated to release a veritable pharmacy of pleasure-mediating chemicals that can override the normal mechanisms that would limit such behaviors. Food scientists employed for Big Food have mastered the art of concocting hyper-palatable foods consisting of highly processed fat, sugar and salt; these can lead to “hijacking” the brain via neurochemical addiction, engendering obesity for the individual and a public health crisis for society.

There are many features in common between addictive drugs including opiates and alcohol and fat-sugar-salt processed junk. Like addictive drugs, such foods cause the release of the neurotransmitter dopamine and endogenous opiates from brain reward centers. PET scan imaging demonstrates that these reward centers light up after eating such foods. Drug addicts and obese people actually have less dopamine receptors, making them more likely to crave the very items that release dopamine. Medications used for opiate addicts that block brain receptors have a collateral effect of reducing junk food consumption. Like drugs and alcohol, we develop a tolerance for fat-sugar-salt, requiring more and more to gratify ourselves. Additionally, like drugs and alcohol, we develop withdrawal symptoms when cut off from the object of our addiction. After an initial period of gratification, the user consumes it not to get “high,” but just to feel “normal.” Many fat-sugar-salt addicts continue to be a slave to their addiction, just as drug and alcoholic addicts do, despite their knowledge of its deleterious health consequences and their desire to end their addiction.

Common mechanisms likely underlie obesity and drug addiction. The Scripps Research Institute conducted a study, published in Nature Neuroscience by Paul Kenny and Paul Johnson, showing that compulsive eating shares the same addictive biochemical mechanism as does cocaine and heroin. Using laboratory rats fed high-calorie, high-fat foods, the development of obesity coincided with a progressively deteriorating chemical balance in parts of the brain that deal with reward and pleasure, confirming the addictive nature of junk foods. When offered healthy food alternatives, the rats in the study displayed no interest whatsoever and essentially starved! Conclusions of the study were that “over-consumption of highly pleasurable food triggers addiction-like neuro-adaptive responses in brain reward circuitries, driving the development of compulsive eating. ”

Bottom line: Habitual consumption of highly palatable calorie-dense foods—especially sugary, fatty, salty processed glop—prompts brain responses that can parallel drug addiction. The release of neurotransmitters including dopamine and endogenous opiates will make us consume more, sabotaging normal satiety signals and reinforcing future behavior.

Solutions to Food Addictions

• Understand the specific cues that trigger the craving for certain foods. Factors such as stress, fatigue, depression, mood swings, loneliness, boredom, feelings of deprivation, the need for immediate gratification, etc., beg for a convenient and immediate source of relief. Make an effort to deal with these cues in a less maladaptive way.
• Activity swapping is a means by which eating behavior that is driven by cravings is exchanged for an alternative behavior that has an equivalent soothing effect. This substitute activity for eating might be sleep, exercise, reading, phoning a friend, getting out of our home, taking a walk, bathing or showering, doing household work or errands—anything to get our minds off the craving. Distracting ourselves with alternative activities will allow the craving to float away. Exercise is a particularly great alternative that will burn calories instead of storing them, and is capable of releasing dopamine and endogenous opiates.
• Mind the specific trigger foods that drive overeating. The trigger could be the scent of food, an advertisement, the sight of someone else indulging, or even your own thoughts about food. As difficult as it may seem, try to avoid getting into situations that expose you to such trigger foods.
• Access control is a helpful strategy because of the simple reason that whatever is handy is readily eaten and whatever is not handy is not readily eaten. In other words, in sight leads to a greater chance of consumption, hungry or not! So keep trigger foods at bay.
• Vaccinate and inoculate—take a small piece, a teeny but satisfying taste, a vaccination if you will—a small dose that will preclude us from coming down with the disease— the obesity disease. There are some who have such a profound addiction to certain trigger foods that even a small exposure to that food can set off a cascading cycle that demands more and more of that particular food. For this subset of the population, total avoidance is the key, being similar to an alcoholic not being able to have even one drink. The food addict must simply practice abstinence. When liberated from addictive trigger foods, it is very possible to lose urges and desires for them.
• Food swapping is a very useful means of substituting a healthy, low-calorie food for an indulgence that is laden in calories, fat, sugar and salt. Find highly palatable healthy foods to substitute for the objects of your addiction—a juicy apple, a succulent peach, a handful of mixed nuts, etc.—that are capable of satisfying cravings. Try to get addicted to healthy foods!
• Oral alternatives. Eating is all about oral stimulation. Chewing gum, sucking candy or breath mints can provide low-calorie oral stimulation that is an alternative to eating.
• STOP before it gets out-of-control. The enemy of good is perfect. If we foul up, it is not the end of the world. It’s okay to lose a battle as long as we win the war. We are humans, subject to all the imperfections, weaknesses and foibles that are characteristic of our species. If we fall off the wagon, we can get back on without losing ground. When we think with a long-term perspective, we understand that a little detour off the pathway need not affect the outcome of our journey. To quote comedian Jeff Garlin: “Slip ups are speed bumps on the road to recovery.” We need to be aware and attentive, focused and mindful, and simply halt, stop and desist before matters get out of hand.

Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food
Now available on Amazon Kindle