Episode Sixty Nine Summary
- What are food cravings? Food cravings are an intense desire to eat particular foods and they have got multiple causes. Both our physiology and our psychology play a critical role.
- Physiological cravings - these can be caused by iron deficiency, Bacteroides, and dopamine.
- Iron deficiency - when severe, this causes something called pica, which is cravings for what are usually non-food related things, for example ice and dirt. Iron deficiency can be due to pregnancy.
- Bacteroides - these are a phylum of bacteria that live in the gut microbiome, which send signals to our brain for sugar as this is their fuel source. Hence, by reducing the balance of Bacteroides, sugar cravings will reduce.
- Dopamine - this is one of the main reward systems in our brain. We get a dopamine hit from eating food, particularly sweet foods and those that are high in carbohydrates. The processed food industry creates hyperpalatable foods that are custom designed to give us a maximum dopamine hit, meaning they cause the maximum amount of cravings and the maximum amount of pleasure.
- Other factors that contribute to cravings - certain hormonal patterns, what is going on with the metabolic factors within our body, insulin, our blood sugar, the hunger hormone ghrelin, and the satiety hormone leptin, also play significant roles, and the various health of our metabolic hormones can make cravings more or less intense, as can stress and sleep deprivation.
- Dealing with cravings - there are many tools to deal with cravings and there is no one size fits all approach. Behavioural tools, cognitive tools, relaxation, meditation, hypnotherapy, and medication can all be used. Ideally, multiple tools should be used for the best chance of success.
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How to manage food cravings
Dr Mary Barson: Hello, my lovely listeners. I'm Dr Mary Barson.
Dr Lucy Burns: And I'm Dr Lucy Burns. Welcome to this episode of Real Health and Weight Loss.
Dr Mary Barson: Hello, lovely listeners. Welcome to this podcast and I am of course joined by my fabulous colleague and friend, Dr Lucy Burns. How are you, Lucy?
Dr Lucy Burns: I'm very well Dr Mary, very well indeed. I'm pleased to report that I have completely let go of all the nuts in my life. For a while anyway. I may bring them back at some stage, but at this stage, they've gone, which is helpful for me.
Dr Mary Barson: That's good, so embracing more helpful choices versus unhelpful.
Dr Lucy Burns: Absolutely. And interestingly, I've re-established my process of boiling a dozen eggs at the start of each week. I used to do that frequently and then it just fell off the wayside. So I'm back, boiling. Sunday night, boil a dozen eggs, make sure I label them because that's, that has been like a little joke in our house. “Mom, label the eggs!” “Sorry”. Yes, label the boiled eggs, and that process is extremely helpful for me.
Dr Mary Barson: So, you've got this delicious real food ready to go whenever you need a meal, or you need a good whack of very healthy fats and proteins. That is a beautiful segue and introduction to what we are talking about today, which is cravings. Food cravings specifically. What are they? Why do we get them? And how do we make them go away? Or how do we deal with them, rather than forcing them to go away.
Dr Lucy Burns: Absolutely, and I think you've hit the nail on the head there with the idea of forcing them away. But when you try and force something away, basically you give it your focus. And we know that when you give something your focus or your attention, it intensifies.
Dr Mary Barson: Push it away, it'll push back.
Dr Lucy Burns: Yep. Or don't think about the elephant in the room. And what are we all thinking about? The elephant in the room. Don't think about that itchy elbow you've got. Aww. Anyway, let's get on in and dive into what exactly cravings are.
Dr Mary Barson: I love this. So, cravings are actually slightly difficult to define, but they are basically an intense feeling, an intense desire, in the case of food, to eat particular foods, and they've got multiple causes. Our emotions and psychology play a significant role. We've got physiological causes of cravings, psychological causes of cravings, our gut bacteria get in on it as well. Our body can detect certain deficiencies and can make us crave certain foods if it detects we've got certain nutrient deficiencies. And a key player in all of this as well is the processed food industry that makes hyperpalatable foods that are scientifically designed and constructed to hijack our brains and to hijack the reward systems within our brain and to make us crave them intensely.
Dr Lucy Burns: Absolutely. So let's talk physiological or physical cravings if you like. So it's well known that iron deficiency, severe iron deficiency, causes something called pica. Pica is cravings for usually not food related products. So, and the classic is ice, and in fact, this happened to my young vegetarian when she was iron deficient. She started eating all this ice. It can also weirdly cause people to eat dirt. Dirt is another pica that's associated with iron deficiency. So it is always important that if there's cravings that are unexplained, that particularly for unusual foods, that you're a) Not pregnant and the pregnancy cravings come related to that iron, that's that, where that story's come from. But be that you're not iron deficient, so that that would be my first point of call if someone has intense cravings, just check your iron levels. The second thing that we know that is part of your physiology is your microbiome. You know, well we've talked about microbiome in the gut health podcasts before, which we will put in the link back to in the show notes, so that you can go and listen to those if you haven't already listened. But there is a phylum of bacteria called Bacteroides. Now this class of bacteria are associated with obesity and one of the ways they do this, they've got multiple ways, sneaky little buggers, is that they can send signals to our brain for sugar. They use sugar as their fuel, they love it. Without it, they die off. So you can imagine as a species, in order to keep themselves alive, they send signals via your enteric plexus, up through your vagal nerve to the gut, to eat sugar. So by denying them their fuel, they do actually die off. And part of the reason that sugar cravings reduce is reducing this balance of Bacteroides.
Dr Mary Barson: It's fascinating, isn't it, that these microbes communicate with our brain like this? I love it.
Dr Lucy Burns: I know, I know. Which is weird, because every now and then, and I'm sure this has happened to people, you're not thinking about anything and then a thought just pops in to go and get peanut butter or go and get a spoonful of Nutella or something. And I often think, “Ooh, that'll be Bacteroides just rearing their ugly heads”. So yeah, I do, it is totally weird. But the third physiological cause of cravings is, is dopamine. And Mares I know we've talked about this a lot, but would you just like to explain that briefly and how that works?
Dr Mary Barson: Yeah, so dopamine is one of the main reward systems in our brain. It's a fabulous evolutionary system that has evolved to make us want to keep doing things that would increase our chances of survival. So we can get a big dopamine hit with sex, for example, which is extremely good for the survival of our species. But on a more personal level, we can get a dopamine hit from eating food, which obviously from an evolutionary point of view was essential to survival. And viewed with an evolutionary lens, certain foods would give us more of a dopamine hit. Certain foods would be more pleasurable than others, more addictive than others, and we as a species would be obliged to seek these out more than others, and that was sweet foods in particular. Also foods that are pretty high in fat to an extent, but definitely the foods that are high in carbohydrates, because from an evolutionary standpoint, they were harder to come by. So it was all based around seasonal fruit, maybe a bit of honey here and there, and these foods were excellent ways for us to gain fat, and for us to survive. So all food gives us a dopamine hit and some foods give us more of a dopamine hit than others, which is okay in Palaeolithic times when we're living a hunter gatherer life, but can be pretty destructive to our health in a modern environment, particularly when you then insert the processed food industry, who create these hyperpalatable foods that are custom designed to give us a maximum dopamine hit, which means that they cause the maximum amount of cravings and the maximum amount of pleasure as well. And hyperpalatable foods and related products totally hijack this natural, delicate system of hormones and neurotransmitters within our brain. And stopping eating hyperpalatable, highly processed sugary foods, although it can be uncomfortable for a few days as the cravings take a little while to settle down, settle down they do, and then our brain chemistry can normalise, and we can start to get the normal little bouts of dopamine hits with our food that we were supposed to get.
Dr Lucy Burns: Exactly. And it goes back to that podcast we did a couple of weeks ago where we talk about reducing processed sugary foods, or processed high carb foods, increases your joy of normal food.
Dr Mary Barson: It's not just our gut bacteria and the processed food industry that contributes to our cravings, to intense desires to eat certain foods. Certain hormonal patterns, what is going on with the metabolic factors within our body, insulin, our blood sugar, the hunger hormone ghrelin, and the satiety or I'm feeling full hormone, leptin, also play significant roles, and the various health of our metabolic hormones can make cravings more or less intense, as well as stress. When we're stressed, we get activation of our hypothalamus pituitary adrenal axis, we get increased glucocorticoids in our system, we get increased adrenaline and noradrenaline, and this actually increases particularly our carbohydrate cravings. So does sleep deprivation. It's all a sort of complicated biochemical, hormonal, and neurotransmitter sort of mix within our brain that contributes to these physical cravings, and it almost always has a very significant psychological overlay as well.
Dr Lucy Burns: Absolutely. And it's interesting, because I think like lots of things, it's not like everyone has the same intensity of cravings. You know, some people, and we've talked a lot about this, some people's cravings for wine is much bigger than other people's cravings for wine. I can have half a bottle of wine or half a glass of wine and leave the rest, and I couldn't care less about it. Other people would find that very difficult. And that's, you know, I don't even understand the reasoning for that, but it's just fact. So, it's important to recognise that there are some people out there who have very, very, very intense cravings, which can sometimes result in binge eating disorder, which is separate. It's a psychiatric disorder that is completely different to just people who are perhaps letting go of processed food, feel uncomfortable for a few days, and suddenly they find that their cravings have gone. So I would always encourage if anybody has binge eating disorder, or thinks they have binge eating disorder, go and talk to your doctor about it. You may need an assessment by a psychiatrist, but there is absolutely treatment out there. Again, it's holistic. It's not a one, one size fits all, or a one, one pill for one person sort of thing. But yeah, I think that's important to just pay acknowledgement to.
Dr Mary Barson: Mmm, extremely important. Dr Lucy, you and I spend much of our professional life helping people deal with their cravings. And we have a broad framework that we could use. We use many, many tools, and some people are going to find some tools more useful than others. But broadly speaking, the tools that we give people, that we teach people, that we empower people with, come into these general categories. We've got sort of behavioural tools that people can use, things that they can do to help reduce cravings, to make them less likely, to deal with them when they're there. We've got the cognitive tools, the changes in thoughts that we encourage people to make. We use a lot, a lot of relaxation, meditation and guided meditation and hypnotherapy with our beautiful people, as we are both medical hypnotherapists. And then also, there is I think it'd be worth at least mentioning, medication. I mean that's, people have to see a doctor to get medication, but it's probably worth knowing that there are some medications out there that can be useful to deal with intense food cravings.
Dr Lucy Burns: Absolutely, and if we, you know we use a similar framework when we're dealing with smoking cessation. You can just use one of those tools if you want to, but to increase your likelihood of success, the more tools you use the better.
Dr Mary Barson: So, behavioural strategies to deal with cravings. Well, getting the food that you crave, that you don't want to eat, out of your line of sight is a just, really sensible thing to do. Because those cues, those visual cues to seeing the biscuits, Tim Tams, chocolate, ice cream, bread even, can make the cravings more intense. So if ever you can, just get the high carb junk, the hyperpalatable foods, out of your house is definitely the first step. If you can't get it out of the house, and there may be many reasons why you can't, try and quarantine it into one little area, to its own shelf, to its own box, somewhere where it is out of your line of sight. That's, that's a really simple behavioural thing that we can all do.
Dr Lucy Burns: Absolutely. And it's super helpful.
Dr Mary Barson: And it's like you say, Dr Lucy: “You make the right thing easy and the wrong thing hard”. So just reducing your access to this food.
Dr Lucy Burns: So there's a few other things, Dr Mary, apart from just hiding the you know, said object out of view. What are some other techniques that are well documented to be helpful?
Dr Mary Barson: Yeah, so when the cravings come on, really helpful techniques are the same techniques that we've used for decades and decades and decades with people who are quitting smoking, which is an incredibly noble health goal, to quit smoking. And these things really work. So we call them the five Ds. The first one is delay. You get the craving, you really, really want to eat the chocolate. Just tell yourself, “Oh, I just won't have it now. I could have it later”. You know, just, just have that thought. And then you know, the craving will pass, and you won't have had the chocolate or the cigarette. The other one is distract. Distract yourself with something. Just go do some work, go play with your kid, do something else to distract yourself from the craving, because the craving will pass. This is key to all of it. They don't sort of grow and grow and grow and grow and grow and grow and grow to the point where you know, you'll commit some heinous crime to get the chocolate. It will go away. Drink water, that's another thing. Oral soothing as well, by putting something in your mouth. Drink water. A cup of tea, we love a cup of tea at Real Life Medicine.
Dr Lucy Burns: A fancy cup of tea.
Dr Mary Barson: Very fond of a fancy cup of tea. So you can make yourself a fancy cup of tea. Have a drink is a really great way to deal with cravings as they come. And deep breathing. This also ties into the relaxation, which we also talk about. But just lovely deep breaths, you engage your parasympathetic nervous system, that relaxation part of your nervous system, a lovely way to ground yourself in the moment while the craving passes. And then discuss. Just call a friend. We've got support groups with our beautiful members, and this is sort of one of the things that they are really well designed to help with, is you can phone a friend, you can get some help, a support person, anyone at all. You can go on to your favourite Facebook group and ask for help with cravings. Having a discussion about it is also really, really useful to draw on other people's wealth of experience, and support. So that's the five Ds, which I think rounds off much of the behavioural things that can be really helpful when dealing with cravings. Next is the cognitive.
Dr Lucy Burns: So the cognitive therapy. So cognitive just means thinking. So it's your thought therapy, which is again, one of our favourite things to do. Cognitive reframing is just a fancy way to say change your thoughts. So there's a couple of ways that you can think about cravings. Now, one of the things that I like to do, because I like the idea of getting comfortable with being uncomfortable. So whenever I have a craving for something and I am “surfing the urge”, as the phrase goes, I also remind myself that this is training for being uncomfortable. This is an opportunity to do some extra training, and we all know that the more you train, the better you get. So if, the more you surf the urges, then the better you are at surfing them, and it just sort of creates this, a bit like sleep begets sleep, the more you surf the urges, the easier they become, the less they're there, the less you need to surf them. So it's wonderful. There's a couple of other strategies I like to look at. And one is to work out you know, because sometimes people don't know if they're having a craving or if they're hungry. So you know, we often talk about egg hungry or chop hungry. Most people don't crave eggs, and most people don't crave chops, frequently. They don't elicit the same dopamine response that chocolate doughnuts and bread rolls do, remembering that bread flour is just savoury sugar. So if you're not sure, you can ask yourself, “Am I chop hungry? Or am I egg hungry”? And if the answer is yes, well then go and eat a chop or an egg or something equally nutritious in that protein and fat combo. But if the answer is, “Nah, I don't want an egg”, well you're not actually hungry. So it's a craving, it's a psychological craving, a yearning, a desire for something. So then again, you think about well, “What is it that's happening for me? Why is this here? Am I here? Is it coming because I need soothing? Am I craving this food to numb an emotion?” Maybe you're not even aware that you're experiencing the emotion. Brains are complex things and sometimes there's things underlying them that unless you stop and take some time out and develop some awareness, you may not really be thinking about it. So the classic of course is that you know something happens to you, you have an altercation with somebody, you know, a bad day at work and you are then craving ice cream, or you're craving biscuits, or you're craving a glass of wine. You are often doing that to soothe. So working out, “Am I just, do I need soothing? In which case, is eating ice cream actually going to help me, really? Is that really what I need? No, I need soothing”. And how can we soothe well, as Mary talked about? One of my favourite soothing techniques is a fancy cup of tea. I sit down, I will take some time for myself. I will hold, put my hand on my chest, “Lucy, it's alright, you're okay”. I do this sort of little, sort of gentle rubbing, that touch. Touch is a very soothing technique. Beautiful cup of tea, that oral sort of soothing with the cup and the fanciness of it all, and then that craving passes. So recognising that you don't have to act on an urge is also something that for a lot of us, we've never done. We get cravings and we just, as people go, “I caved”. We give into them. What happens then is that you don't necessarily feel like you can trust yourself, and people often use that phrase, “I can't trust myself”. But every single time you surf an urge you are building trust, so that you know that you have the ability to do it. And while it doesn't have to be perfect, the more times you surf the urges, the more trust you build with yourself. It's a wonderful, wonderful, just tool to know that is there for you. So I think they would be my top sort of cognitive thoughts. So first of all, if it's there, good, ace, yay, I'm training for discomfort. Woohoo, good. You turn a craving into something that you don't need to dread. It becomes a challenge. The second thing is what is this craving trying to tell me? What do I need? And you ask yourself with loving kindness, “What do I need Lucy? Aww, I'm so mad. This happened. Okay, I understand”. Hear the self-talk, it's very gentle. When you do surf an urge, really, really bang on about it in your brain about how bloomin awesome you are. Because again, your brain, it's looking for feedback. And you go, “Oh my god, I did it. It's gone, the urge is gone. I'm so amazing. Hurray”. And give yourself that positive feedback.
Dr Mary Barson: I love those cognitive strategies.
Dr Lucy Burns: Wonderful. What's next on your list Mares?
Dr Mary Barson: Next on my list is we teach relaxation as a tool to deal with psychological cravings and also to deal with emotional eating and non hungry eating that you touched on then with the cognitive strategies. So relaxation is a strategy you can use in the moment, while you know, the urge, the intense desire is crashing over you. You can use deep breathing as a grounding technique right then and there to just surf it and let it pass. And relaxation is also a very powerful tool to use regularly when you're not necessarily feeling the cravings, to reduce stress, because stress increases food cravings. To help you sleep. Sleep deprivation increases cravings. And also to create some mental space in your brain, where you can employ all of those cognitive strategies. And we also use hypnotherapy, guided hypnotherapy, with our clients all the time in our 12 Week Mind and Body Rebalance Program and in our Inner Circle Membership Program. We are always giving our members new and different guided hypnosis, many of which implant very powerful guided imagery that helps reduce and stop the cravings from coming in the first place. For those listening at home, meditation, or regular relaxation, helps you in so many ways. It is pleiotropic, as we like to say, has many, many benefits. And you can start reaping these benefits, even with just 10 imperfect minutes a day. It's a really, really useful strategy that we have talked about many, many times, and I think I'll leave it there other than just stressing again, that it's fabulous, and a really, really accessible tool that we can all use. So Lucy, that leaves our final category, where medication, which we don't use a lot, but it is there and I think for the sake of completeness, it might be useful to tell our beautiful listeners a bit about the medications that are available.
Dr Lucy Burns: Absolutely. And you know, I preface this with if you just take the medication and do nothing else, you are unlikely to have success, as we've seen many, many times with smoking cessation. People that just take medication, or just use the patches, their success is by far and away reduced compared to using all the techniques. But I also know that there are some people that do use all the techniques and still have some difficulty. So there's a couple of things that I use from time to time. So there is a medication in Australia. It's called Contrave, and it's a combination of two medications, one of which is used for smoking cessation and the other one is used for opiate withdrawal. They're both at lower doses then they would be as a solo medication and for some people, they're really helpful. Now again, it's quite an expensive medication and it's a bit, seems to be that there are some people that respond really well and for other people, it doesn't do anything. So like anything, if you try it and it's unhelpful, then don't keep trying it, just you know, put that away as I didn't respond to it. The other medication that I've seen used successfully is for people who have the formal diagnosis of binge eating disorder, and it can only be prescribed by a psychiatrist. It's off label, which means it's not what it's usually used for and it's a medication called Vyvanse. It has had really helpful effects for people that are, have as I said, diagnosed by a psychiatrist, binge eating disorder. The third medication that is used as a weight loss medication, again off label at the moment, is a medication called Ozempic and it's an injectable. It's certainly very helpful for hunger and satiety. And the tricky thing about cravings is cravings are always worse if you're actually hungry. So I guess we should probably caveat, all of our things with making sure, and this was where the egg and the chop business came in, that working out are you actually hungry? Because if you're hungry, well you need to eat, you know. Do not fear food. You have to honour your hunger. But if you're not hungry, and you've still got a craving, Ozempic's probably not going to help you that much in that department, it's really more about managing your hunger. Which look, in our experience, low carb real food does. But again, for other people it is just an extra tool. There's no, it's not that you've given in. There's no shame in requiring medications. But just be aware that they're one thing that needs to be part of a whole package.
Dr Mary Barson: And they can only be prescribed by a doctor with a, you know, individualised medical consultation.
Dr Lucy Burns: Correct. And like everything, all medications come with side effects, so you need to be fully informed of the pros and cons before you make a decision. So, I think lovely listeners, we've given you sort of big framework with some practical strategies. You know, definitely for both Mary and I, the key for our cravings has been low carb real food. Following it with all of the, you know, mind management, relaxation, gut health, and making sure we get sleep. Like it's, I know we always bang on about you know, doing all the things, but honestly, we all need to do all the things. We don't have to do all the things perfectly all the time, but all the things we need to be doing.
Dr Mary Barson: That's right, and all of the things are pleiotropic.
Dr Lucy Burns: Yes.
Dr Mary Barson: They've got multiple benefits and they all work together and fit together so that you're living your best, most healthy, most fabulous life.
Dr Lucy Burns: Which is I guess why we called this podcast Real Health and Weight Loss. It's not just about being thin at all. In fact, that's kind of down our priority. It really is about using the tools, the strategies, to develop really, really good health.
Dr Mary Barson: Have a fabulous day everybody. Hope you're going off and living your best most healthy life and we'll see you again soon.
Dr Lucy Burns: Bye for now. So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr Lucy Burns.
Dr Mary Barson: And I'm Dr Mary Barson. We're from Real Life Medicine. To contact us please visit https://www.rlmedicine.com
Dr Lucy Burns: And until next time, thanks for listening. The information shared on the real health and weight loss podcast, including show notes and links provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.