Nutrition: Food Cravings
Interview with Dr. Neal Barnard, Author, President of the Physicians Committee for Responsible Medicine
Monday, August 11, 2003; 10:00 AM
link to transcript
Anyone who has had a late night urge for sweets suspects that their cravings are physically addictive, but other foods can be just as tempting. Dairy products, meats and sugars release opiate-like substances that trigger our senses and tempt us over and over and over.
Dr. Barnard is a nutrition expert, an adjunct associate professor of medicine at the George Washington University School of Medicine and the president of the Physicians Committee for Responsible Medicine.
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
washingtonpost.com: Good morning and thank you for joining us Dr. Barnard. When it comes to food cravings, what are the best ways to get "unhooked" from unhealthy foods? Dr. Neal Barnard: Thanks for including me in this program. Our approach to "bad" food habits is altered when we recognize that, for many people, they are more like addictions than off-hand choices. For some people, sugar or chocolate are insistent, daily needs. That can be true of women somewhat more often than men. While men may have a sweet tooth, a great many are especially hooked on what we might euphemistically call savories: meat and cheese. That, despite the evidence that these foods increase risk of heart attack, certain forms of cancer (e.g., colon, breast) and other illnesses.
Washington, D.C.: I have given up dairy products and switched to a vegetarian diet, but am concerned about not getting enough calcium. My family has a history of osteoporosis. What do you recommend?
Dr. Neal Barnard: First, a further word about the previous question. If food habits are like addictions, it is often easier to set them aside completely than to tease yourself with small amounts of them on a daily basis. Rather like smoking--it's hard to cut down, but easier, over the long run, to actually quit. So our efforts are devoted to helping people ease through the transition. As for osteoporosis, the latest data from Harvard's Nurses' Health Study show that dairy does not prevent osteoporosis. It has no positive effect whatsoever. Bone loss is aggravated by diets rich in animal protein and sodium and poor in vegetables and fruits, and by a lack of physical exercise and sunlight. You do need calcium, but green leafy vegetables and beans are the most healthful sources. Fortified juices have plenty, too.
Falls Church, Va.: How do you recommend that one conquer an addiction to sugar?
Dr. Neal Barnard: The key is to take a short break. If you haven't had chocolate for 3 weeks, you miss it less than if you had it yesterday. It often helps to start with some substitutes. For example, maple syrup is as caloric as sugar, but it's much more flavorful, so you'll use less. Fruit is less sweet, but you'll find varieties that are enjoyable. And when you're ready to take a break, do it for 3 weeks. If the cravings are premenstrual, we have a special approach for that. It involves using a low-fat, high-fiber, vegan diet to moderate estrogen levels. If you do it for the full 4 weeks or your cycle, you'll find it can reduce cramps, PMS, and, for some people, cravings.
Harrisburg, Pa.: What do you know about this new drug Pfizer is working on that reduces food cravings? The bushmen have been using it for generations, so it appears to work. Is it being tested now? Have you heard what the tests indicate as to how well; it works and whether there are side effects?
Dr. Neal Barnard: Sorry, I don't have any useful information on it.
Tysonís Corner, Va.: Doctor, is there a physiological reason for sugar cravings/addiction (i.e., is it due to a lack of a certain brain chemical(s), is it caused by the way our brains are "wired")? Is there a genetic predisposition to sugar addiction just as there is to alcoholism?
Dr. Neal Barnard: Yes, evidence suggests that there is indeed a physiological reason for it. Here is the short version of what you'll read in Breaking the Food Seduction.
Certain foods appear to stimulate the release of opiate chemicals within the brain. These are chemical cousins of morphine and heroin. The are not as strong as illegal drugs, but appear to be strong enough to keep us coming back, especially when we are stressed, tire, angry, or alone.
Not every food does this. The groups that do are sugar (and sugar-fat mixtures, such as butter cookies, as well as foods that produce sugar rapidly), chocolate, cheese, and meat. Let me share some of the evidence for this. In emergency rooms, doctors use the drug naloxone to block opiate receptors. So when a person has overdosed on heroin, naloxone can save their life. If we give it to a seriously addicted chocoholic--a person who really binges on it--chocolate is much less attractive. This suggests that chocolate's attraction is not just its taste, but rather its effect on the brain. The same has been found for sugary foods, cheese, and meat.
And cheese has a special property. Its protein, casein, breaks apart in your digestive tract to produce casomorphins--mild opiates. Researchers are now teasing apart the actions of these chemicals. But suffice it to say, some people are really hooked on cheese, despite its enormous load of cholesterol and fat.
Elmira, N.Y.: what is the best way to lose your fat stomach?
Dr. Neal Barnard: We recently completed a study comparing the weight-loss effect of two diets: A "moderate" chicken and fish diet vs. a low-fat, vegan (pure vegetarian) diet. The vegan diet led to faster weight loss. That is apparently because it is higher in fiber and much lower in fat, so it's naturally low in calories. For details on this sort of eating pattern, you might check www.pcrm.org
, or the recipes in Breaking the Food Seduction. It does require learning some new tastes, but all the "side effects" are good ones: weight loss, reduced cholesterol, improved diabetes, reduced need for medication, etc.
Potomac, Md.: What is the issue with trans fat? Before they put it on the nutrition facts, how do we avoid it?
Dr. Neal Barnard: Trans fats are not currently listed as such on labels. Look instead for the words "partially hydrogenated vegetable oil". They are as bad as butter, from the standpoint of cholesterol-augmenting effects. They are in some margarines, pastries, and some potato chips.
Bethany Beach, DE: How do you feel about excess use of
sugar substitutes such as Equal?
My wife uses at least 19 -15 packets daily
Dr. Neal Barnard: Some people do report feeling hooked on artificial sweeteners. We've seen this with aspartame (NutraSweet), and have speculated that it may relate to its content of phenylalanine, which is the amino acid that is toxic to the brain in children born with PKU. Toxicologists are still fighting about whether aspartame is safe or whether it is responsible for the many reports of headaches and seizures that have come in to the FDA.
Columbus, OH: My sugar cravings intensified after I stopped eating red meat. Are the cravings related?
Dr. Neal Barnard: It sounds like you're referring to what some people call the substitution of one addiction for another. People breaking free from alcohol often find themselves seeking out sugar, too. It is odd to think of meat as "addicting" but there are many people who feel they really cannot give it up, even after they have had a heart attack or a relative has developed colon or breast cancer (two forms of the disease linked to meat consumption). However, you may find that health food stores have the "methadone" you need, in the form of meat substitutes--hot dogs, deli slices, and burgers made of soy or wheat derivatives. They are really excellent now, esp. for kids who want a healthy lunch in their brown bags, but one that looks the same as what the other kids are eating.
Falls Church, Va: Doctor, many of your suggestions for conquering cravings, etc. suggest using a high fiber diet. What do you suggest for those of us who cannot eat a high fiber diet due to IBD?
Dr. Neal Barnard: It is important to sort out which kinds of fiber you can tolerate and which ones you cannot. Wheat, for example, is difficult for some people, while brown rice is rarely a problem. Also, be sure to cook beans and green vegetables adequately. There are no "al dente" beans. If you are still using other irritating foods, such as dairy, you'll want to avoid them.
Silver Spring, Md: What is your reaction to people who call you the "food cops"?
Dr. Neal Barnard: Our job is to provide information that people can use to make decisions for themselves. So many people do not realize, for example, that dairy consumption is linked to prostate cancer (as evidenced by 2 recent and very large Harvard studies, among others), or that having just 2 20-ounce sodas a day adds fully 500 calories to your diet.
If you understand the risks and want to take them, that's up to you. However, we have a responsibility to our children to try to not pass our risky habits along to them. They have enough risks as it is.
washingtonpost.com: If you would like to meet Dr. Neal Barnard in person and discuss food cravings, he will be at the Barnes and Noble bookstore located at 3651 Jefferson Davis Highway at 7:30 p.m. tomorrow, Tuesday, August 12, signing copies of his new book "Breaking the Food Seduction."
Poughkeepsie, NY: Recent data from Yale-New Haven Medical Center, Obesity Research Center, includes a notion that there is no neuropsychological evidence for carbohydrates causing an addiction. How do you reconcile your claims with this research.
Dr. Neal Barnard: Carbohydrate addiction is, for most people, a myth. As you'll see in "Breaking the Food Seduction", I hold that the only carbohydrates people are potentially addicted to sugar itself or foods that produce sugar rapidly. That group includes:
white bread, but not rye or pumpernickel
baking potatoes, but not yams or sweet potatoes
typical breakfast cereals, but not old-fasioned oatmeal
Beans, yams, and bananas have plenty of carbohydrate, but you never saw anyone race down to the 7-Eleven for a late-night bean binge.
BTW, we should stop the "carbophobia" that has spread in recent months. Keep in mind that the thinnest people on the planet--Asians and vegetarians--eat rice and other complex carbohydrates as daily staples, and they are much thinner than typical Americans. For details on carbohydrates and issues related to the Atkins diet, you may wish to check AtkinsDietAlert.org.
Arlington, Va.: How would you respond to the people that say that eating as you recommend is very very difficult for the average person to sustain forever? It seems to me that everything in moderation (some things in severe moderation) coupled with a regular exercise program is really the best way to sustain a healthy lifestyle.
Dr. Neal Barnard: We studied this in detail. It turns out that, when it comes to anything that is addicting or a really persistent habit, "moderation" is typically more difficult than simply avoiding a problem food. We have studied individuals on vegan diets and found that they lose their interest in meats, etc. On the other hand, people trying to measure out tiny meat portions (as recommended by "moderate" diets) usually find it as frustrating as a smoker being allowed to have just a half a cigarette.
But you need to find the recipes that appeal to you. We have put many of them on www.pcrm.org
Rockville, Md.: My son will only eat "junk food". I have to force him to eat or even try any fruit or vegetables. He is overweight and I am concerned for his health. Do you have any suggestions on help him learn to eat a more healthy diet?
Dr. Neal Barnard: If you son is very young, that it's up to you to take a measure of control and only bring healthful foods into the home. Small children will often not eat broccoli or spinach, because, to them, these foods are bitter-tasting. Don't arm-wrestle them. Instead, serve the vegetables they do like--corn, carrots, peas, green beans, etc. Kids love baked beans, spaghetti with tomato sauce, and bean burritos. For picnics, serve veggie hot dogs and veggie burgers, instead of the meaty varieties. Dump the sodas, and serve water.
Washington, D.C.: I absolutely love Chinese food. It has to be more than just the flavor. Is it because of the salt and sodium in it?
Dr. Neal Barnard: You might see if it has the same attraction if you ask that it be prepared without MSG. The combination of spices in Chinese foods is appealing, but we have no evidence yet that they have an addicting potential. Luckily, the "vegetable" section of the menu has many healthful items: tofu dishes, mixed vegetables, etc. Serve them on top of rice, and, if consumed frequently enough, you may be as slim as individuals living in rural China. Don't forget to walk and ride your bike, too. The unhealthy foods of the Western world are matched by our unhealthy (lack of) exercise habits.
Rockville, MD: You mentioned that dairy products have no effect on osteoporosis? Always one more new study!;!; As a postmenopausal female with multiple risk factors for bone loss, besides calcium supplements and weight-bearing exercise, what guidance is there for appropriate nutrition while dieting and maintaining weight loss.
Dr. Neal Barnard: It if far more than one new study. The great bulk of evidence shows that, for both children and adults, milk consumption does not improve bone integrity. It is important to separate marketing from science. While the dairy industry has aggressively promoted its products as a hedge against osteoporosis, they have not proven effective. The 12-year data from Harvard showed that milk-drinking women had no protection at all, and the 18-year data showed the same thing.
Keep in mind that osteoporosis is not a condition of inadequate calcium intake, for the most part. It is a condition of overly rapid calcium loss. The factors that accelerate the passage of calcium from the bones into the blood and that otherwise impair bone health are:
sodium (salt--as in canned goods and snack foods)
animal protein (meat, poultry, fish, eggs, and dairy)
lack of exercise
lack of sunlight (for vitamin D)
You do need calcium, but there is little evidence of any benefit for getting more than 500 mg per day. You can get much more than that in greens, beans, and, if you like, fortified juices.
Washington, D.C.: How does exercise fit in to this? What about claims that some people can get addicted to running or weight-lifting, for example -- are those 'good' addictions?
Dr. Neal Barnard: For some, exercise is indeed habit-forming--that's the good side of the endorphins. Don't fight it.
Washington, D.C.: Is addiction to chocolate related to any vitamin deficiency?
Dr. Neal Barnard: No. Nor is it related to magnesium deficiency, an oral personality, a bad childhood, or "being a woman." It is an opiate effect, triggered, so far as we can tell, by the taste of chocolate on the tongue, and augmented by chocolate's other mild drug effects: caffeine, Theo bromine, and phenyl ethylamine, among others. Chocolate isn't a drug--it might be thought of as the whole drugstore in a brown wrapper.
Denver, Colo.: Dr. Barnard, what is your opinion on snacking? I know the newer conventional wisdom is to eat smaller meals throughout the day, but my cravings seem actually to be less of a problem when I eat larger meals and do NOT snack. (though it's very hard to do.) Thoughts?
Dr. Neal Barnard: Multiple small meals helps maintain a more level blood sugar and has a marginally positive effect on cholesterol. But if it is not helpful to you, don't try to maintain it. Same for breakfast: As I've described in Breaking the Food Seduction, most people do much better by having breakfast, and they snack less than if they skip breakfast. But some people just cannot bring themselves to eat breakfast, so there is little value in forcing the issue.
DC: Salt! I crave salt! I put it on everything, I mean everything. I choose meals based on whether I can put salt on it. I even pour it in my hands and eat it by itself. I've never known anyone to do this. Is it physical? It seems to be more than the taste, I just.....WANT it so much!
Dr. Neal Barnard: Okay, let me offer a very useful tip:
Your taste buds have what I think of as "taste thermostats". You've experienced this if you switched from whole milk to skim. At first, skim tastes awful. But soon, it seems fine, and then you can no longer drink whole milk--it seems much too thick. It is as if your taste buds reset their preferences for fat based on the foods they've been exposed to for the previous six to seven days.
The same is true for salt and for sugar. If you go low salt, your foods will be unpalatable the first week; they'll be better the second week, and perfectly fine the third week.
This is why I use a 3-week time frame, and why we use a complete-exclusion plan for problem foods during that time.
Saarbruecken, Germany: My diet has never been what anyone would call healthy, mostly because I hate nearly all vegetables (they taste 'metallic' and 'bitter' to me). So what I would like to know is if anyone could tell me how I developed a Massive Craving for all things corn (except the real thing of course) - corn cereals, corn snacks - especially corn tortilla chips. I finally weaned myself away a bit, sadly by finding other junky type things, but at least I don't eat as much of them. I'm afraid the corn monster will come back - any advice? Dr. Neal Barnard: Corn itself won't hurt you, assuming it is not a trigger for arthritis. (For more details on that, see my earlier book, Foods That Fight Pain.)
Corn flakes release sugars rather quickly into the blood. Corn chips are a vehicle for grease, as are potato chips. But corn itself is fine.
Tysonís Corner, Va.: Have you or a loved one ever had a food addiction and how did you/they conquer it?
Dr. Neal Barnard: That's why I wrote Breaking the Food Seduction. In our research studies, we help people to make massive changes in their eating habits. So many of them have paid an enormous price for these habits, physically and psychologically. We have found that taking a short break helps, and we support you through that by helping you plan out what to eat instead, what breakfasts will hold cravings at bay, what foods will help you avoid blood-sugar swings, etc.
In my own life, I grew up in Fargo, ND, and come from a long line of cattle ranchers. We ate the most unhealthful diet you can imagine. And I wandered into cheese, chocolate, sugar, etc., not to mention a cigarette addiction in medical school and residency (all interns and resident live on black coffee and cigarettes.) Breaking free is very doable.
I quit smoking and now follow a totally vegan diet, and the benefits are enormous--low cholesterol, a trim waistline, and, if you have diabetes or hypertension, you may be able to reduce or eliminate your medications. Our cancer classes (202-686-2210, ext. 318) help cancer survivors learn how to prepare low-fat, vegetable-rich, vegan diets, too, based on evidence that these foods may be helpful for survival, as well.
Laurel, Md.: When you talk about chocolate addictive, is this coca addictive? For what I understand chocolate is made from coca, sugar and butter. Without the other substance, chocolate won't test as 'chocolate', will test bitter as coca.
Dr. Neal Barnard: The maximal appeal comes from a roughly 50:50 mixture of sugar and cocoa butter. In Breaking the Food Seduction, you'll see a recipe using cocoa powder (which has the cocoa butter removed) in a dip for strawberries, etc. You mix the cocoa powder with soymilk, thicken it with cornstarch and add a bit of a sweetener, and it works wonderfully.
Fairfax, VA: Dr. Barnard: How has your personal commitment to a vegan diet, which is the main agenda for Physicians for Responsible Nutrition, affected how you present your claims about sugar and transfat addiction? Do you also believe in addictions to meat, cheese, etc?
Dr. Neal Barnard: In 1990, when Dean Ornish presented data showing that vegetarian diets could be used in programs to reverse heart disease, this idea seemed quite radical. But today, it has become mainstream. So certainly our interest in vegan diets has translated into many thousands of people trying them out for many conditions. But it is important to go further and to recognize that there are other issues, too. Sugar and chocolate present problems of their own, as we have discussed in detail today.
By the way, if anyone would like to become more familiar with the Physicians Committee for Responsible Medicine, please visit www.pcrm.org
San Jose, CA: Hi - I'm wondering why after an evening of imbibing in a few alcoholic drinks, the following day I crave salty fattening foods. Any thoughts?
Dr. Neal Barnard: More common is the desire to rebound with sugar. Alcohol lowers blood sugar for some people. Also, alcohol is gradually metabolized to aldehydes, which are stimulants that cause early-morning awakening and may drive your sleepless self to head to the store for junk food.
washingtonpost.com: Unfortunately, that is all the time we have for today, we would like to thank Dr. Neal Barnard for joining us in this mornings chat. Dr. Barnard, if there is one piece of advice you could give to those who have food craving and want to overcome them, what would it be? Dr. Neal Barnard: Forget blame and guilt. Let's break some old habits and learn some new ones. If you're skeptical, just give it a couple of weeks' try, and you'll see that it's much easier than you'd imagined. If you're in the Washington area, I hope you'll join me at the Barnes and Noble, 3651 Jefferson Davis Hwy, in Alexandria, tomorrow (Tuesday) night at 7:30 PM. We'll talk about how to break free, and I'll be signing copies of Breaking the Food Seduction.