Hey there, it's Susan Peirce Thompson, and welcome to the Weekly Vlog.
So I have a fun one this week. I want to talk about three different topics and weave them together. Three stories I want to tell, three points I want to make that have each been up in my life this week, and I could separate them out and make them three different vlog topics, but they all relate to each other and they're all so alive in my consciousness right now. I just want to share it all with you in one vlog.
So I want to start by saying I've been working on a great project this week. I'm writing an academic book chapter on ultra-processed food addiction. The book is an academic book on weight loss, so it's a book cataloging the current state of the affairs when it comes to weight loss. And they reached out and invited me and a colleague to write a chapter on food addiction.
And it's an honor and a privilege and a big job. I mean, the chapter ultimately will probably end up being 20 pages, like full 8.5 by 11 pages, single-spaced, 10-point font, cited to the hilt. That's kind of the whole point of it, is that it's got to be the sort of repository for all the important studies and just really meticulously researched and cited. And I'm trying to write the thing in about a week, primarily in a week with another week to get all the references and copy-edit it and stuff. It's a big job. I'm doing pretty much nothing else.
And I'm in the section now on diagnosis. So I'm looking at the DSM-5 criteria for a substance use disorder. There are 11 criteria, and the research is very strong that food addiction, ultra-processed food addiction meets all these criteria in various people.
There are prevalence rates that have been determined. So most of the criteria are seen in about 20% of people in the general population, and the average person in the general population has 2.38 of these symptoms, of these 11 symptoms, which is interesting because to get a diagnosis of ultra-processed food addiction, you only need two symptoms of the 11. You might think, well, that's not many, but that's a mild diagnosis. So this is a new thing in the DSM-5 compared to the DSM-4 is they diagnose substance use disorders along a continuum. So a mild disorder, a mild case has two to three symptoms. A moderate case has four or five symptoms, and a severe case has six or more symptoms.
My guess is that a lot of people listening to this, not everybody of course, but a lot of people would have six or more symptoms. It's not that hard to do. I mean, one of the symptoms is just taking more than you intended to take, sometimes consuming more than you intended to take, losing control over how much you consume sometimes, which I think most people can relate to when it comes to food.
The second one is repeated attempts to cut back, failed attempts to cut back, or a persistent desire to cut back even if you're not actually trying again. I think a lot of people meet that criterion. I mean, that's the whole dieting industry is built on that.
And then the other criteria, go on and talk about hazardous use, which is weird to think of in terms of food, right? We're not on alcohol operating heavy machinery, but we kind of are, right? I think a lot of us have eaten in the car to a degree that we have to admit that it's hazardous, and yet we do it, we do it. We reach for that bag of something. We are juggling a beverage and food and whatever in the car in a way that is hazardous tolerance withdrawal.
And then a lot of things related to lack of ability to perform roles, emotional distress, avoidance of important activities because of the use.
But here's the point that I want to make. I noticed something in doing this writing that I'd never noticed before. It stood out to me. Okay, the average person has 2.38 of these symptoms, meaning most people have a substance use disorder when it comes to food, but they don't. And here's why. Because having two or three or six or whatever of these symptoms is not enough. It has to be a pattern of use that overall contributes to significant clinical impairment or distress, significant impairment or distress. And this is where most people don't qualify. So there are lots of people, more than 80% of people who have two or three symptoms don't meet that other benchmark for clinical impairment or distress, meaning they have tried to cut back, they lose control over how much they eat. Sometimes they eat dangerously in the car, maybe sometimes they don't go to the country club event or the wedding or the ball game or the beach because they don't like the way their body looks. So they're avoiding activities. So they meet several criteria, but they're not that distressed about it. They just don't care that much.
They're may be in denial about it or whatever. They just move on with their life. And you couldn't really look at their life and say, whoa, that's a non-functional human being. They're not fulfilling their role obligations, they're not functioning in life. They're going to work. So they're not distressed enough and they're not impaired enough. So that's really interesting. And the penny dropped for me when I realized how many people have what we rightly should call an addictive relationship with food or addiction-like eating, an addictive relationship with food, but they don't have food addiction. The food addiction would necessitate the clinically significant impairment or distress. So that kind of put puzzle pieces together for me a little bit. I've been looking at this ultra-processed food addiction construct and thinking, what if we find out that 60, 70% of the people have this? And the reality is we're not going to find that because just not enough people care enough is the truth, right? They're just, they're not kept up at night over it, right? So that's interesting. They're experiencing harm from it. They've got these symptoms, but yeah, but they're just going along with their lives.
So now the second story I want to tell has to do with someone I've been talking to a lot lately who's struggling. She is been trying to do this food thing for years on and off, on and off, on and off, on and off with her food. She's got 60, 70, 80 pounds to lose. I'm not sure exactly how much, but she's got a fair bit of weight to lose. But she's young enough that it's not impacting her health majorly. It's not like health is a big concern or a big driver here. She would like to look better for sure. The weight is something that bothers her better. From her perspective, she doesn't like the weight that she's carrying and she's incredibly distressed about it.
So she is in the other bucket. She's got clinically significant impairment or distress. As a matter of fact, just a month or two ago when I talked with her, she was telling me she couldn't function. She was non-functional, so profoundly significant impairment. She was declaring herself to be a non-functional human being, not able to shower, get to work, live life like she was not functional and huge amounts of distress. But she's not a 10 on the Susceptibility Scale. We just took the quiz with her a few days ago. She's an eight on the scale, and she's got a part of her that doesn't believe in food addiction. Maybe all of her. She really doesn't believe in food addiction. She thinks that it's a choice. She thinks that she should be able to just control it.
And I think some of that comes from she's got alcoholism in her family and she's watched family members just quit cold turkey, no program, no recovery efforts at all, and just become a dry drunk thereafter. And so a part of her just keeps thinking, if you had more moral fiber, if you had more willpower, you would just quit. You would just quit. But she can't seem to do it. And she tries to quit and she tries using various programs or tools or whatever, and she can't seem to do it. She can sometimes not even get a day. I think the most she ever gets is a month or two. And I mean, literally, she's been trying this for years, if not decades.
And the last time we talked, I reminded her that the science shows that it is an addiction and that the belief that she's choosing to eat these foods is erroneous. Now, I shot a vlog about this a while back, but there was this professor at NYU, Rodolfo Llinas who had graduate student stick electrodes into his brain, through his skull, into his brain and activate the part of the motor cortex that would make him flex his foot back. But the gig was that he was sitting there trying to point his toe at the same time, and he just wanted to know what would happen. The dude was hilarious. I love this guy. And he couldn't get ethics board approval to run this experiment on actual other human subjects, so we just did it on himself. So he's sitting there, and so he's going to try to point his toe, she's going to make his foot flex back with the electrode, and they go, 1, 2, 3, go, 1, 2, 3, go.
And they keep doing it over and over again, and he gets more and more horrified, and she doesn't know what's going on. He's clearly freaking out, and he just says, do it again, do it again, do it again. And he's just trying to flex his foot. Well, I forget now which way I said it, but what's happening is that at the crucial moment when she innervates the electrode and he's trying, let's just say I'm sorry if I got it the wrong way, but he's trying to flex his foot back and she's making it point forward.
His brain is telling him that he's changing his mind and deciding it, deciding to do it the other way at the critical moment that he's changing his mind. And he can't ever get it straight in his mind that he's not changing his mind. At the last second, and I explained this to her and I said, when you think you're choosing to eat that stuff, you're not actually choosing.
Just like we could agree that if there were $5 billion in a duffel bag, or I guess what would it take in cash, a mattress bag at the top of 40 flights of stairs waiting for you. If you could just hold your breath while climbing up those stairs, 40 flights, you could not actually hold your breath for five minutes and climb up 40 flights of stairs and get that duffle bag. You couldn't do it. And what would happen was along the way, you'd be debating in your brain, the debate would start, am I going to breathe? This is hard. When am I going to give up? I don't think I can make it. I should just breathe already. All of those thoughts are not really your thoughts in the fairest sense of the word. Your thoughts are, I better make it. I better make it. There's $5 billion up there. And at some point you would breathe and you would feel like you had chosen to breathe. But in the real sense of the word choice, you had not chosen to breathe right? You were capitulating to demands of your brain that then tricked you into thinking that you had chosen. I mean, put it in a more dire way, right? Your child is up there going to be killed. If you don't succeed, you still wouldn't succeed. And imagine what would be going on in your brain. You cannot imagine that you're choosing in any real sense of the word. So I explained all that to her, and I don't know if it's going to make any difference.
And this brings me to the third thing that I wanted to say, which is I was speaking to a group about a week ago, and what I ended up saying in part was just how grateful I am that I both want and like my Bright recovery. This Bright Line Eating way of life is something that I now deeply, deeply appreciate for its structure, for its rhythm, for the morning habit stack, for the mean evening habit stack, for the support systems, for everything about it that allows me to be the person that I most want to be. I both want to and like this program. And what's interesting is that in the addiction literature, there's a lot about wanting and liking when it comes to the drug because wanting and liking are separate when it comes to our drug of choice. What happens is initially when we're not in an addictive state, when addiction has not built up yet, we want a little bit of the sugar-flour foods a little bit, but then we eat them and we like them a lot.
There's a lot of liking that happens. And over time, as the brain wires for addiction, the wanting of it gets bigger and bigger and bigger, and the liking of it gets smaller and smaller and smaller, and in the way that the addiction literature completely confounds obesity with food addiction. And I hope one day it will not do this, but it does right now, it confounds the two. They've done studies on people with obesity and shown that someone living with chronic obesity wants ultra-processed foods, intensely wants the junk food, wants the sugar and the flour intensely. And then when they're eating it, FMRI studies show that the parts of the brain associated with liking it or enjoying it or receiving any pleasure or relaxation from it are muted. In other words, the satisfaction is never coming. So there's now a lot of wanting and no liking, meaning you're basically in hell.
Meaning that there's a yearning that never gets satisfied, an itch that literally can never be satisfied, can never be scratched. And I was thinking about the terms wanting and liking, because I think that when it comes to Bright Line Eating, a lot of people want to lose weight. A lot of people want to want this program, but when they learn what's involved, that it's more than just following a food plan or when they learn that it's about giving up sugar and flour or weighing and measuring food, they don't really want it, and they don't really like it when they do it. And then people grow to like it. Some people grow to like it, and some people grow to love it and want it like it and want it both. And what a gift that is, especially for people like my friend who don't have all the symptoms of addiction, but have the distress, have the impairment and the distress, and it makes their life miserable when they're not addressing this issue that they have.
And because they're not as bad a case as other people, or they don't have all the symptoms that other people have, or they don't binge, they've got no eating disorder symptoms, they think what they really have is a weight problem and a willpower problem. And my friend was telling me that intellectually, she just believes in intuitive eating more. The whole abstinence thing, the Bright Line thing, she's not on board with it. She doesn't agree with it as much. She's on board with it because another part of her knows that it's all that's going to work for her, but she doesn't believe in it really. She thinks that intuitive eating makes more sense. And to everyone out there who thinks that, I just have to tell you, I'm with you. I agree. I mean, it's not for nothing. That after 10 years of blissful recovery, not a cloud on the horizon in my right-sized body, tootling along, no cravings for sugar and flour, happily weighing and measuring my food, I went and found one of the most preeminent intuitive eating experts in the United States. Hired her as my personal coach and left weighing and measuring foods, started eating sugar and flour again, and did my best to eat it intuitively and moderately. And what happened was it drove me crazy. And within a month, I was spinning out of control. I was not stressed, and I was not eating emotionally. Everything in my life was great, and it was the food, the physiology of the food hitting my brain that started to activate those neural circuits again for addiction. And suddenly I couldn't stop again.
Sometimes, not always, not always. And this is something else my friend said, if I were really an addict, I wouldn't be able to stop for a day. And I said, oh, no, no, my dear. That's not the criterion. Every addict, pretty much, maybe not every, but most addicts, almost all addicts experience periods where they feel like they're regaining control, but they don't last, and they're never enough to fully do the job.
And that's what powerlessness is defined as. It's defined as ineffectual, meaning unable to produce the desired result on its own. So if you can't get peace with your weight and your food together as a package, your weight and your food together as a package on your own, that's powerlessness, that's addiction. And if it bothers you a bunch, that's clinically significant distress. If you don't care, then that's fine. Then you'll be one of the many millions of people who are out there eating what they want to eat. Maybe to our eyeballs having a problem. But who are we to judge, right? If they're not distressed about it, they have no problem because distress is required for a problem. Well, distress or impairment. So someone who is clinically impaired but not distressed, they still have a problem. You could look at someone and say, well, they can't function at all. So whether they know they have a problem or not, they have a problem.
Clinically significant impairment or distress, and what a gift it is. What a gift it is to be willing to work a potent enough program and to want to do it, and to doing it to put whatever degree of issue you've got to bed, to put it at ease, to put it at rest, to break free to live. Joyously, contentedly, and free. What a gift. Not everybody gets that gift. Some people battle with themselves over this for all of their dying days, living with clinical distress over it, maybe because they don't have enough symptoms to feel like they qualify, so they're not really willing and able to work a Bright Line Eating program that's powerful enough for what they need. Addiction is just a beast. It really is. And that's the Weekly Vlog. I'll see you next week.
