James Greenblatt, MD
Historically, our relationship with food has rested on the balance of our need to eat and the availability of food: the biological imperative to eat—hunger, and the physical ability to satisfy that imperative. The interplay between hunger and being satisfied is “appetite.”
Appetite, at least in theory, is an internal guide that plots the path between when, what, and how much we should eat. Like all our physiological systems, our appetite is best suited for the world in which our long-ago ancestors lived, a world of feast and famine. When food was scarce, our appetite was “on low,” telling our bodies that little food was required. When food was plentiful, our appetite amped up, allowing us to take advantage of the relative bounty.
For most of us at the beginning of the 21st century, particularly those of us living in the United States, food is always plentiful. Our appetite, that trusty guide that served our ancestors so well in times past, is now out of sync with the reality of our lives. Rather than an aide in our survival, it has become a subversive enemy, undermining our good health and well-being. Your appetite may make you feel like you’re on a roller coaster ride of restricting, bingeing, and chronic self-blame. And while a roller coaster ride may be a thrill we seek out at an amusement park, it is not a pleasant or useful way to live. No one chooses a pattern of disordered eating that damages health, self-esteem, and personal relationships.
The roller coaster ride gets old. You’ve plunged through its jerks and twists a thousand times. First, you successfully resist cravings for several weeks. Then comes a momentary lapse in vigilance and once again your eating spins out of control. The needle on the scale that you watched descend just days ago inches back up again. A critical inner voice berates you for your lack of willpower and plays in your head like a broken record. This scenario seems hopeless.
No matter how many times you have ridden this roller coaster, there is good reason to hope that this time you WILL get your appetite under control. You have failed in the past because you—with the help of the medical profession and the food environment of our culture—have misplaced the blame for your disordered eating on a weak will or bad character. But the problem you struggle with is not a moral or a character weakness; it is a biochemical one. Recognizing that cravings for food come from deep within our biochemistry and outside our conscious control should lead us to see disordered eating through a different lens. And just as we have misdiagnosed the problem of binge eating and overeating in the past, until now we have missed finding effective, permanent solutions.
But things have changed, and you can change, too. We now have a much more accurate understanding of the complicated, neurochemical process of appetite. We now know that food cravings are the manifestations of a genetically based biochemical disorder that skews the body’s natural signals of hunger and satiety. It is not your fault!
As the problem we once attributed to laziness or lack of self-discipline is actually biochemical, so is the solution. Amino acids and related nutrients serve as the primary building blocks of the neurotransmitters andhormones that guide appetite and mood. When we understand this intricate relationship between amino acids, nutrient deficiencies, the nervous system and the foods we eat, we can use science to find a way off the roller coaster. This is the New Hope. By focusing on balancing individual biochemistry, it becomes possible to change how we eat and better understand emotional issues that may coexist with an eating problem.
Many professionals who work with disordered eating believe they must be entrenched in one camp or another: they must treat their patients with medications, or offer psychotherapy, or recommend nutritional supplements. I don’t believe there is just ONE answer to appetite control. Instead, I advocate a comprehensive approach that evolves from the field of integrative medicine and combines nutritional therapies, medications, psychotherapy, and other lifestyle changes as needed. It is dysregulation in the brain that causes the appetite to run wild. Consequently, my approach is designed to restore brain health, which will bring psychological freedom and physiological homeostasis, ending a frantic and tortured roller coaster ride.
The next “new” diet or therapy program is not the answer. Rather, solutions are possible by combining existing therapeutic modalities with the science of biochemistry. Only by using this multi-faceted approach will you be able to stop feeling shame, change your relationship with food and arouse a spirit of renewed hope.