Posts Tagged ‘addiction’

Reader Insight

With the permission of a reader of mine who has become a dear friend, I am posting part of one of her emails to me.  I find it to be very stirring and very true, and I think that the words of someone wrestling with food so intelligently and bravely right now might be a good perspective to add to mine on this blog.  She discusses what makes her binge, and why, and it’s enormously touching.  Moreover, we could all really learn from her radical and brilliant self-honesty.

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I thought about WHY did I want to eat. Was it because I was hungry? Was it because I had just “allowed” myself  that day and wanted to make the most of it as a treat? Or was it because I wanted to be distracted from a thought about myself or a void inside?

Usually when I binge, Stef, I think its the last two questions.  I’m getting better at learning how to handle the second to last one- the go crazy because I already screwed it up mentality- that’s all about willpower, and realizing that the real treat and the real spoiling of myself comes from getting to that goal weight that would make me so happy. It’s the last question I think is the hardest- the types of thoughts I’m trying to escape from are ones where I am disappointed in myself, or ones where I feel lonely (like I’ll never find someone to spend the rest of my life and will live alone forever), or thoughts about how I could be better at everything, or thoughts about how little progress I’ve made- I don’t need to describe more because we both know what those self-castigating thoughts (thriggers [purposeful misspelling lol] lets call them) are and how they get us going on a binge.  And we talked about it before and I knew that, but what I think I realized this week, is when you are in that moment, when you are reaching to eat something, and IN THAT MOMENT when you realize that you are doing it because you don’t want to think whatever you are thinking, or you want to run away from that loneliness inside- it is so hard to put it down. Not because you dont realize its not going to make you better- I’ve made that realization already- i know that it’s not going to make me feel better, and i know that probably in an hour and the next day its going to make me even feel worse but IN THAT MOMENT, it’s something to do, something to distract myself with, something to fill myself with. Something to keep me from being alone with my thoughts of self loathing and loneliness. And when you do decide to put it down, and when you do decide to not eat, you are alone with those thoughts. And that’s when it becomes something you actually know- that is when you actually realize that you were eating to not be alone with those thoughts, because being alone with those thoughts suck. At least it was something to do (like people turn to alcohol or drugs, the analogies weve made before to addictive substances).  It’s not until you actually let yourself be alone with those thoughts do you really understand that you were running away from being alone with them. And I know why- because it sucks to be alone with them. But I know thats the only way to heal.  Its the harder route, but in the long run makes me happier, and in the long war against self loathing, its beginning a small battle with those thoughts- giving yourself the opportunity to sift through them, to face them, instead of eating away from them.

Did any of that make sense? I hope it did. I was trying to convey something I think that’s been very powerful for me.  Realizing that 1) not only will eating not make it go away or make it better and will actually make it worse and make me hate myself more and that 2) being alone with these thoughts is what I was running away from, is what binging was doing for me.  The thoughts of feeling like I obsess too much on whats on the outside and that my inside is not good enough, or that I will be alone forever. Or that I feel like a failure in everything. Not always, many of the times I binged because I felt I needed to make the most of this “break” — which I think is more about dealing with willpower and arming myself with the knowledge that Im not depriving myself but actually doing better.

As you can see, I’m sifting through the WHYS of my binging so I can move forward with better armor and preparation as you suggested is best.  I’m reading this book called “the act of racing in the rain”- it’s absolutely amazing. I want to copy in a paragraph for you, but it will take too long. Basically the point of the paragraph is:  “that which you manifest is before you”– I’m explaining it horribly, but the idea is that you create your own destiny by the decisions you make and the way you react to things that are outside your control- by realizing the response to these actions are in your control.  I woke up this morning (the hardest part for me is the day after a bad day , I just want to make that bad day bad too and the cycle goes on) saying “that which you manifest is before you- it is in my hands to get to my goals or not, I can decide whether I’m going to make this day something that I want rather than something that is self sabotage”- and I am pushing and pushing every time a thought of laziness, post fruit from yesterday hunger pang comes, to remember my goal to get to Sunday with my break only lasting one day. And I WILL do it Stef, I’ll be dammed, but God willing, I will get there. Because I can decided whether I will or not, and I decide to do what I know I want for myself.

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She’s brilliant, isn’t she?  And strong and courageous, and making so much progress, and really doing well.  And getting through med school at the same time.  In any case, the greatest lesson I think we can learn from her is that running is not the answer.  Food as a distraction is not the answer.  Is it momentarily numbing?  Absolutely.  But it is a band-aid, and a bit of a scary one, at that.  One of those that pulls all of your tiny hairs out when you take it off.  Don’t let food be a band-aid.  If you need one, look elsewhere.  If you don’t need one, face your demons head on, and think about how to best deal with them, and approach the problem with as much patience, love, and positivity as you can muster.  And I promise, I promise: no matter the depth of your pain or your self-illusion, recognizing food as a distraction will help you walk away from it more easily.  Hell no, it won’t be easy.  But it will be easier, and you will be able to more clear-headedly think about your problems and how to fix their place in your life.

12

05 2011

The number one reason you should exercise

Exercise is lauded for a number of reasons in contemporary society, and for once the masses seem to have it right.   Exercise increases lean muscle mass (perhaps the best indicator of longevity), bone density, respiratory health, physical fitness ability, weight loss, insulin sensitivity, neuronal plasticity and memory, stress mitigation, ease of sleep, sexiness, stamina (!), confidence, energy, and loads more!   Three cheers for exercise, in almost any form.

However– the one effect I didn’t mention, while implicit in some of the characteristics I listed above– is increased dopamine levels.  Exercise, both of the aerobic walk-to-the-store and up-the-stairs type and of the anaerobic carry-a-piano-to-the-store and-up-the-stairs type, is strongly correlated with higher dopamine levels in the brain.  This happens both in rats and in humans, and we know this from decades of neuronal testing.  Moreover, we see the effects in every day life.  Recall that dopamine is a pleasure hormone, and closely tied to the production of the other primary pleasure hormone, serotonin.  Because exercise increases dopamine levels, it can put a bounce in our step, heavily relieve stress, contribute to catharsis, and generally make us feel more serene, empowered, and happy.  I recall a time just a few days ago when I was feeling unusually stressed and depressed about some choices I have to make for my future, so I made a conscious effort to exercise.  After 5 minutes of sprinting, I was feeling better.  After 15, I didn’t want to stop.  By 30, I felt great, and was heading home orders of magnitude less frazzled.

Recall, also, that I recently wrote a post about food addiction and brain chemistry.  Food, like other drugs such as alcohol, cocaine, and amphetamines, can create a conditioned dopamine response in the brain.   At first, we get a slight dopamine hit from eating.  Later, through habituation, we become addicted to this hit.  We need more, more and more food over time in order to receive the same amount of pleasure.  Suddenly we find that the foods we are eating are way more hedonistic, way less healthy, and in way bigger quantities than they were before.   Old, healthy habits don’t suffice.  And we find that we are, truly, addicted to food.

Exercise (so long as we don’t become addicted to this, too!) is the healthiest way to increase dopamine levels.  Feeling the need to binge?  To snack?  To graze?  Do 50 push ups.  Or six, whatever.  Go for a quick walk.  Jumping jacks.  Or do what I do: jump on a bike–stationary or not–and crank until you can hardly stand.  In the healthy, feel good sort of way.  I promise, boy oh boy, do I ever promise, that afterwards you’ll feel less like eating.  With increased dopamine from the exercise, you don’t need it as much from your typical sources.

Exercise also has the effect of making us feel like we’ve done something GOOD, made some decent progress, and therefore makes us want to keep up momentum.  I’ve talked about momentum before.  Momentum is psychologically important for weight loss and for maintaining healthy relationships for food.  Use exercise not just as a way to increase dopamine, but also as a way to increase your positivity, your momentum, and your confidence.

Exercise often, then, if you need to.  Daily.  Vary your routine so you don’t get bored.  Make sure that you always feel good after you exercise, and never exhausted, depressed, or anxious.  You want to be bouncy and happy!  And let that dopamine flow.  By constantly restoring dopamine levels, daily exercise can inhibit your need to eat on a day to day basis, huzzah!  And by kicking up dopamine when you really need it, spontaneous exercise can curb bingeing desires.  In both cases, you win. So be good to yourself, and use exercise intelligently.  Leave space in your schedule in case you need it, or make space if you have to!  Prioritize appropriately.  If you don’t do it often, give it a shot.  Just one!  Or two.  If you do it a lot and you like it, keep it up.  And keep it in your arsenal, if you need to use it against addiction problems.

Check out this comprehensive post by Mike T Nelson nutrition PhD about dopamine and movement.

16

03 2011

Rats binge on pure fat, but escape with sanity in tact

Since there’s very little human data out there, I’ve been doing a bit of digging on differences in bingeing behavior between carbohydrate- and fat- fed rats.  What I’ve managed to unearth is fairly striking.  Rats appear eager to binge on any kind of diet, but this frightening fact is offset by the fact that only high carbohydrate diets induce addiction-like symptoms.

Rats are made binge eaters by offering them highly palatable foods for only short periods of time (approximately two hours) throughout the day.  Regular lab chow is available for consumption the rest of the time.   What we find is that rats binge on three kinds of foods: high sugar chow, high fat (vegetable oil) chow, or a combination of both sugar and fat in the chow.  Rats that binge solely on sugar or solely on fat manage to maintain average body composition.  Here, rats self-restrict and normalize after their bingeing periods, simply by eating less of the normal chow. However, rats with daily access to a sweet-fat mixture gain weight.  This is what we witness with human beings.  It lines up with our knowledge of insulin release and fat storage.  Combining sugar and fat is the most insidious obesity-inducer of all.

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High sugar rats:

Rats are made sugar addicts by being provided with laboratory chow 100 percent of the time, but for a short period of time, approximately 2-4 hours, provided access to sucrose solutions.  When that sucrose window is removed from the rats’ daily routine, they demonstrate symptoms of opiate withdrawal.  These include horrific behaviors such as paw tremor and violent head shaking.   What worse, their symptoms and their frantic lever-pressing increases the longer they’ve gone without sugar.   They also, when forced to abstain from sugar, demonstrate a 9 percent increase in alcohol intake, demonstrating cross-links in substance abuse.  Sugar addiction can induce alcoholism.  Fascinating and scary, huh?

High fat rats:

Some literature suggests, moreover, that similar patterns emerge with high fat binges.  Teegarden and Bale demonstrated in one study that rats on both high fat, high carbohydrate, and mixed binge diets for 4 weeks, when removed from the diets, demonstrate severe anxiety and endure aversive environments to reach their preferred foods.   They conclude that dietary withdraw and changed habits induces the rats’ stress state, which in turn induces “dietary relapse.”  This data indicates that a stark change in eating habits, rather than the macronutrient ratios of the diet, is responsible for the extreme stress the rats display.   Neurochemically, this makes sense as well.  Both fat and sugar have strong effects on dopamine release, such that withdraw from a conditioned, pleasurable diet negatively effects the rats.

What we ultimately find, however, is that rats love fat, and do in fact binge on fat, but never experience symptoms of addiction or withdraw on a high fat diet. This lines up with my own experiences bingeing, and with those with whom I’ve conversed about fat binges.  It is in fact totally possible, and totally satisfying, but not quite as demonic as sugar.  The rats in this study were fed high fat diets, removed from the opportunity to binge, and then observed for addict-like behavior.  None emerged.  (!)  They also showed no sign of opiate dependency.   Moreover, most remarkable part, in my opinion, is that rats fed both a 100 percent fat diet and a 45 percent fat diet demonstrated no signs of addiction or withdraw. What we learn here is that fat has a neurochemical stabilizing effect on the brain.  While definitely pleasurable to binge on fat, it is not what induces addiction symptoms.  In rats.  In humans, too, I’d bet.  Loads.

Why do signs of opiate-like withdrawal emerge with sugar but not fat bingeing?
The relative lack of opiate-like withdrawal behavior after fat bingeing demonstrates the importance of opioid systems in differenetiating sugars and fats and their subsequent effects on behavior.  Both sugar and fat effect dopamine signalling in similar ways, but opioids are another question entirely.  You can read more about it here, but in brief: based on some recent data and neurochemical processes, it seems as though the lack of opiate-like withdrawal signs in fate-bingeing rats may be caused by fat-induced peptide activation, which can inhibit opioid transmission.  In essence, fat likely interferes with opioid processes and effects in the brain.

The authors of this study conclude with the same caveat that I do.  “Although we have not noted signs of opiate-like withdrawal in fat-bingeing rats, that does not mean that excessive fat intake cannot produce addictive-like behaviors.  Withdrawal is not a necessary criterion for drug craving, just as food deprivation is not necessary for food craving.”

Sugar is the big demon here, but fat is not well understood, and it can still be a part of an unhealthy diet or disordered eating style.  I have personally binged on just fat before (ever had 1000 plus calories of coconut?  Pork Rinds? Macademia nuts?  Bad. News. Bears.)   I do know, and I do feel, the satiating effects of fat.  I think about food far, far less when there is fat in my diet, and honestly, the types of cravings I feel now are orders of magnitude less than the cravings I felt on my 100 percent carbohydrate diet (can you believe I did that?  Oh my god.)   What’s more, keeping the carbs away, even ones as innocuous as vegetables, helps, too.  Recall that the rats experienced the same phenomenon.  Mixing sugar and fat was the worst combination for them, inducing both weight gain and symptoms of withdrawal.

It’s really nice to have this rat model, and to see our physiological responses validated.  As complicated as our decisions and our lives are, we have comrades in mere rats, and we are all victims here.  Cheer up, compadre!  Eat some avocado and fuck the lollipops and we’re on the road!   We’re not all the way there, to this destination of perfect mental and physical health, but we’re certainly walking and enjoying the stroll, which is all we could possibly ask for. 

Huzzah!

10

03 2011

Food addiction: Harder to kick than cocaine?

I’ve heard people debate it before.  I’ve felt it, before.  And I’ve heard Robb Wolf discuss it before.  And the general consensus is that food is an addictive substance.  Eating can be a positively reinforced habit that our brains constantly crave.  The worse part, however, is that we can never go “cold turkey” off of food.   With each meal we are forced to recondition the habit.   “Relapse” constantly threatens us.  This makes food, science is beginning to show, more difficult to kick than hard drugs.  Yikes.

Research shows that all drugs—alcohol, nicotine, cocaine, heroin, and foods, particularly sweet foods—are habit forming in like ways.  They overstimulate the brain’s reward system, which creates a vicious cycle of dopamine supply and demand.

This “reward system” consists of a circuit of neurons that run through the ventral tegmental area, the nucleus accumbens and the prefrontal cortex in the brain.  It is normally activated when an animal does things–such as eating or sex–that help it to survive. This activity increases levels of pleasure-related hormones such as dopamine and serotonin.  This is natural, and this is awesome.   What is not awesome is when drugs overactivate the circuit, and dopamine levels soar.  Dopamine receptors get blown out, such that we are now forced to conduct our lives with a malfunctioning dopamine system (this is the same thing ecstasy does to our serotonin receptors).  We learn to mitigate this “deficiency” with whatever drug caused it in the first place.  One whole banana cream pie, please.

This also means that addictions worsen over time.  What may start out as an innocent habit, such as always going to the fridge when you get home from work, some day may not feel like enough.  So instead of having a salad at that time, now you crave fruit.  Or cheese.  Or fruit cheesecake (mmm).  And in a year you’re coming home and used to downing a big gulp and a whole bag of chips.  These things happen to us, and they happen so slowly that we never notice until we try to stop and realize that we can’t.

Because, as I mentioned above, food is a constant in our lives.  It isn’t going away.  We need to de-condition the pleasure response, and we need to kick certain foods to the curb for good, but it’s very tricky business, staying alive and healthy and doing so at the same time.  After someone dependent on a substance stops using it, it often takes time for depleted dopamine receptors to return to baseline levels.  I find that my need to eat decreases with how often I eat, and I suspect that this is because my brain has adjusted to more normal dopamine levels during that time period.  I also find that my need to eat decreases drastically when I don’t eat carbohydrates, something I’ve discussed before, and is definitely worth keeping in mind.

To quit an addictive cycle, low dopamine levels must be tolerated, but only for a given period of time.  For mice addicted to cocaine, it can take two days to regain normalized levels.  For rats in one study on food addiction, it took two weeks.

Yikes.

To gauge just how much the quantity of dopamine receptors had affected these rats’ eating behavior, Kenny and Johnson of the Scripps Research Institute of Florida inserted a virus into the brains of a test group of the animals to knock out some dopamine receptors. The researchers found that– rather than gradually increasing reward thresholds and accompanying overeating behavior— the dopamine deficient rats took to overeating immediately when given access to a high-fat, high carbohydrate diet.

So the researchers designed an experiment to try to draw a human parallel with the rats, training them to expect an electric shock when they saw a certain light cue. Unlike their plain old chow-fed counterparts (a mix of sprouts and vegetable oils and other crap), obese rats accustomed to food rewards would keep right on gorging even when they knew a shock was coming.

But these are rats!, you protest.  Does the same apply to humans?

You bet your sweet ass it does.

Gene-Jack Wang and Nora Volkow of the Brookhaven National Laboratory discovered that obese people share that dopamine deficiency with many cocaine and alcohol abusers. Their study injected 20 volunteers–10 obese subjects and 10 control subjects– with a radioactive chemical tag designed to bind to dopamine receptors in the brain. Then they scanned these individuals using positron emission tomography and counted the numbers of receptors they saw. The obese subjects not only had fewer dopamine receptors than did the normal-weight subjects, but the number of receptors was lower for patients who were heavier.  With increasing weight, and presumably increasingly “unhealthy” diets, dopamine levels decreased.  People who are conditioned to get dopamine from foods need more and more as their addictions worsen.

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There is a lot of discussion in the scientific community about genetics, and how it plays a role in chemical addiction.  While true that some people are more susceptible than others, I don’t really fucking care.  Two rats in the whole study above abstained from bingeing.  Two. Fuck those two.  We’re all susceptible.  The lesson here isn’t that science is going to find some miracle to cure addiction (though of course we’ve all got our fingers crossed) or even that it’s going to be able to tell us who is most susceptible to the addiction demon, but rather that we’ve all got to be careful.

And we have just got to forgive ourselves if we find that we have food addictions or habits.   Food can never (and should never) be eliminated from our lives, so we are forced to confront disordered behaviors while continually interacting with our demons.  It’s hard as shit, and if you hate yourself for struggling I will come right to your house and shake you.  Depression and feelings of self-loathing decrease dopamine levels, so every time you have negative feelings about yourself you are only helping the monster.

Yuck.

Addiction is nasty, but it’s not unconquerable.  Long roads and enduring positivity are the names of the game.  Breathe.  Love.  Breathe.  Love.

Mmmmm.

07

03 2011

The psychology of making changes

I can think of few things in the world more full of positive changes than the paleo movement.   Objectivity compels me to nitpick the movement and to do things like log onto paleo hacks and ask: “Are there any anti-paleo testimonials out there?”…and still come up with nothing.  Or at least very little, and nothing conclusive.  I just typed a few searches such as: “paleo sucks testimonial,” “tried paleo failed,” “didn’t like paleo,” and “fuck paleo” into my google search bar, and didn’t get any results, either.  It seems as though most failures with the paleo diet have to do with incomplete compliance, or not giving paleo guidelines enough time (though honestly you don’t need all that much) to work their magic.

But getting started can be a doozy.  Changes always are.  And even maintaining the diet, for people who have struggled psychologically with food and other lifestyle habits, is also a doozy.  DO NOT FEAR.  Psychologists have come to a pretty solid understanding of how people go about making big changes in their lives.  Each recommendation varies in specificity and number–for example, AA uses twelve steps, whereas Dr. Phil uses seven (which are you going to trust?)–but they are, in essence, the same.  An awareness of these steps can help us understand and better live our own journeys.

These steps were crafted and are today mostly used for overcoming addiction.  In the paleo movement, this is relevant for a variety of substances, including: foods we have conditioned responses to, caffeine, alcohol, artificial sweeteners or carbohydrates.  However, it is helpful for a whole range of situations and problems, such that I consider them steps for “making changes” rather than just addictions.  Some things we might want to change: our diets, our sloth, control over our health, compulsive behaviors, negative thought patterns, and, in general, bad habits.  Always a grazer?  Never run out of excuses to avoid exercising?   Still counting calories and obsessively measuring your intake?  These problems, while not officially addictions, are still Monsters with a capital M, and it takes a very certain willpower and process to get over them.

They say the stages of change in overcoming substance addiction are:

1) Precontemplation: not yet acknowledging there is a problem

Remember a point in your life in which you swam in excuses?  Still think you might?  Denial is a mightily powerful demon.  Any human being can rationalize any situation, and it is so fucking hard to step back and be honest with ourselves.  But we must.  If we live in fear of the truth, we’ll never improve, and we’ll never feel at peace with ourselves.  I know that just about everyone in good health or even seeking good health has passed this stage, but it is easy to be here without knowing it, and it’s easy to slide back into it.

What’s the easiest explanation for your current predicament?  Is it that the combination of eating a tomato, an egg, and a slice of eggplant yesterday inflamed your gut, activated your immune system, and gave you acne? Or is it actually that you ate a whole block of cheese, but you just can’t admit it because you love. cheese. so. much?   Consistently feeling really tired in the mornings?  It’s probably your compulsive exercise habits, and not the fact that old Snoopy Snoop woke you up once in the middle of the night.

Look at everything in your life with an honest gaze.  There are other ways to live, but not if you want to optimize your physical and mental health.

2) Contemplation: acknowledging that there is a problem, but not yet ready or willing to make a change

Okay, so I know that being a vegetarian is unhealthy, but I am unwilling to start eating animals.  What do I do?  Do I ignore my failing health, or do I continually do research, look for ways to sustainably eat meat, try eating meat even though historically I haven’t liked it?  Push myself through that process?  Yes, you’ve got to.  The thing is–this is a very transitory stage.  I’m willing to bet that once we’re past denial, we might float here for a while, but facts are facts and we are inevitably pulled along to their logical conclusions.

3) Preparation/Determination: getting ready to change behavior

Go go go!  Get information.  Prepare thyself.  And most importantly, learn to embrace yourself.  Your addiction, your compulsions, your habits–they are an inherent part of you.  They always have been, and even when you are healed, they will continue to be.  This is a constant battle, but it gets easier over time.  Accept this stuff into your heart, and let it settle there peaceably, and move forward with a positive attitude.  Progress is made in increments, not in leaps, and your ability to have patience with yourself and with others is vital to your success.  Breathe. Love. Accept. Give yourself a hug.

4) Action/Willpower: changing behaviors

Kick into gear!  This is the beginning.  Don’t let it scare you, Just. Do. It.  Even if it’s something you’re unsure about– for example, the paleo diet!– give it your all.  If you half ass it, you’re not going to know what a miracle a real change can be.  Trust me, and trust yourself, and trust the information you’ve gathered.  Trust the process.  Don’t cut your calories to 800 because you think the paleo recommendations just won’t work.  Trust!  Do yourself a giant favor.  You’ve prepared yourself thoroughly.  You know the risks and the benefits and the rules and all of that.  Step into the ocean, and keep walking forward.  When the sandbar drops off, you’ll swim.  Water might get in your ears, and it might scare the shit out of you, but it’s not a shark.  You’re going to be okay.  Grab onto a life raft and keep on swimming.

5) Maintenance: maintaining the behavior change

It’s not always easy.   Not at all.  Real step backs will occur– your ears will fill up with water from time to time– but we can’t let the idea of sharks scare us away.  Swim swim swim!  You have a paleo community, you have your family, you have me! Rely on the information you’ve gathered and the people around you, and continue to forgive yourself for lapses.  You will find that, while difficulties occur, momentum is the name of the game.  Get a few hard won battles under your belt, and all the sudden you’re a veteran.  This is awesome.  And you can do it.

6) Relapse: returning to old behaviors and abandoning new changes

Yikes.  I’ve said it before.  The name of the game is momentum.  The other name is trust.  Just because you’ve relapsed doesn’t mean you’ve failed.  You’re wrestling with a Monster.  These things happen.  But did Odysseus give up when the cyclops had him in his grip?  Did Ron Weasley give up when the troll knocked Hermione unconscious?  Hell no.  They were heroes because they pressed on against doubt and failure, and what can we all aspire to be, but heroes of our own lives?

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All this said, I am no psychologist.  I’ve only read some books, gotten a B+ in Intro Psychology, and spent a lot of time around people making (or not making) changes.  I really believe that these phenomena exist for everyone in various degrees, and I really do think that being aware of them helps push us in the right direction.  I suggest that you check out other resources online about making changes.  For example, I jest, but I also acknowledge that Dr. Phil has a pretty good set of recommendations.   He discusses acknowledging your purpose, thinking rational thoughts, using alternative coping skills, identifying danger zones, being accountable, having a support system, and rewarding yourself.  These are all incredibly important things, and I hope you pursue them, if you’re trying to jump start change in your life.

Good luck with your changes and your optimal health.  Make me a resource.  If you want.  Please.  I can hold you accountable to just about anything.



24

02 2011