The Real Reason You Can't Stop Eating (It's Not Willpower)

That this is not just a matter of being weak-willed or not having willpower. Our brains and our microbiome have all been hijacked by the food industry.

So I think the first thing is to acknowledge that it's not your fault and then to focus on what's in your control. So obviously there are some health behaviors that are in our control. We know that lifestyle is so important. And what can I do about this now? You know, I think there's a difference between why me, why is this happening to me, which isn't gonna get us anywhere, As opposed to, now what's in my control? What can I do? What is an action I could take to move one step closer to reaching whatever goal it is that somebody has?

Welcome, Rachel, to the Dr. Hyman Show. So good to have you here.

Thank you so much. I'm honored to be here with you today.

Okay, your work's really important because it covers an area about food that often doesn't get discussed, which is not what to eat or what's good or bad to eat, but more about our relationship to food, the psychology of eating and nourishing ourselves, and the challenges that a lot of people face, uh, around their relationship to food. And often people have a very dysfunctional relationship to food, and, and often people are struggling with cravings, with food noise, with just dysregulation. And that's why we see, you know, 75% of Americans overweight. We see people struggling to lose weight. We see this craze of GLP-1 drugs that have taken off that are Exploding because people are looking for a way to kind of interrupt this cycle of addiction and craving and food noise and also emotional eating. And I mean, I've done that for sure. You know, like I'm stressed, tired, I'm like, oh God, I just want a pint of ice cream right now. Give me a pint of Chunky Monkey, I'll be good. You know, I kind of want to kind of talk about how even though we know more about nutrition than ever before, like why is changing the way we eat So difficult. Like, what are we missing about food noise, about cravings, about willpower? And what have we got wrong about it? And how do we need to rethink our whole relationship to food? And we'll sort of get into the details of it, but I want you to kind of give us the lay of the land here.

Yeah, and you're right. I mean, so many people struggle with their relationship with food, their relationship with their body, as well as emotional eating. I'm actually glad that you mentioned that you've done it before because We've all participated in emotional eating before. And I know we'll dive into more of kind of when it— why it matters, when it matters, and what to do about it. But I think what's really important to just bring up is that knowing what to eat isn't the problem, like you said, right? But being able to do it consistently is 2 different things, right? Like, we know what to do. Knowing what to eat and being able to do it consistently are 2 different things. And I think that's really important to remember because people know what to eat. There's not an information problem. There's not a lack of knowledge out there, but it's how to do the behavior change. And it's not just simply willpower, right? There's so much more to it and it's so much more complex than that. And I think that's what people are missing is that. And then I know we're going to dive into it so much more.

People feel like often This sort of not just poor relationship to food, but to their bodies. And it's kind of this vicious cycle. And then why do people feel so uncomfortable in their bodies? Why are they like, you know, even though there's maybe nothing obviously wrong with them, why do they feel kind of not cool?

Right. And it's unfortunate. I, you know, so many individuals struggle with body image. And but if we think about it, it makes sense. Society has told us for years or rather all the time, that we should— should, I put in air quotes— that we should look a certain way, right? It's whatever media is showing us, whatever the celebrities are showing us. And we are thrown these messages at a very young age. And eventually, when we hear the same message over and over and over again, we begin to internalize it.

Mm-hmm.

And we compare ourselves to others, and then we think we're not good enough if we don't look like maybe what the celebrity looks like or what the influencer looks like. So it is, it's so challenging and difficult for individuals today, especially, but always with body image because of the messages that we are given. And those messages could be obviously at home also, but then there's the media, the magazines, the social media, and everything else as well.

It's basically this set of messages from our culture and society that kind of make us kind of have a distorted relationship. You know, we get early messages from our family, oh, don't eat that, or you're going to make you fat, or wow, you're getting a little weight, or comments. Like, there's all these comments. You talk a lot about like not actually commenting on people's bodies, even if they're good or, or not. You know what, can you talk about that?

Yeah, so the thing with making comments is that we never know what somebody is going through. solely by looking at them and their appearance. So if somebody were to compliment somebody's, say, weight loss or the way that they look, and maybe they're participating in an unharmful— I'm sorry, maybe they're participating in a harmful behavior or an unhelpful behavior to get that body to look that way or to look a certain way, what we're really doing is reinforcing that negative behavior. So because we don't know what people are doing, I always just say, don't comment, right? Somebody could be struggling with an illness and maybe trying to gain weight, yet somebody is commenting on their losing weight. So because we don't know, it's better, safer to just not comment. I often say, if you know the person is trying to lose weight, you know they're doing it in a healthy way, you know, sure, maybe you wanna compliment something or make a comment, but there's also so many other things we can be complimenting people. That's not their body. You know, like, oh, you look radiant, or, oh, I love your new jacket. You know, there's other things we can be complimenting and commenting on.

You know, you have this sort of interesting way of framing things, talking about your thoughts, emotions, behaviors, and how, you know, they kind of shape how we eat or how we care for ourselves. Can you kind of unpack that for us in terms of your exploration with your patients and working with people?

Yeah, so I do what's called cognitive behavior therapy. And the most basic example of that, or like the basic theory, is that our thoughts, emotions, and behaviors are all linked. So the way I like to think about it and explain it is if you wake up with a certain thought, that thought is going to influence how you feel, and that's then going to lead to a certain behavior or an action. And then it becomes a cycle. And then so that action, you have a feeling, you have a thought, and it keeps going. So, for instance, if we talk about with body image, if somebody were to wake up and they look in the mirror and they think to themselves, I hate my legs, right there, that one thought, the way that you just spoke to yourself, is going to make you feel a certain way, which is probably then going to lead to maybe you wearing something different, maybe you even go back to bed, maybe you don't show up in the world that day, like going to work and other things. But one thought can literally change the course of our day. So I really like to remind people to be super mindful of the way that they're talking to themselves because we all have these automatic thoughts. But it's acknowledging that the thought can influence how we feel and our behaviors.

And so how do you get people to kind of shift from that?

Yeah, so the first step is just to identify and acknowledge that this is an unhelpful thought. And I like to think of it as, how do you know if it's an unhelpful thought? Well, how does it make you feel? If it's making you feel good, if it's motivating you, if it's encouraging you, inspiring you, great. Maybe that's working for you. But if it makes you not feel good about yourself, or you don't feel good, or you're discouraged by it, I would classify that as an unhelpful thought. There's many— we call them cognitive distortions in psychology. But I like to think of them just as unhelpful thoughts. And there's very common ones like all-or-nothing thinking is one, should statements, jumping to conclusions, catastrophizing. Those are some of the common ones. So the first step is to acknowledge, oh, I'm an all-or-nothing thinker, for instance.

I just see this one cookie. That means I can eat the whole bag, right?

Exactly. That's the best example. I use that one all the time. So that's an all-or-nothing thinker, right? Or if I don't have an hour to go to the gym, I'm not going to go at all. When we know something is better than nothing. So, you know, the unhelpful thoughts are more rigid. I like to think of the helpful thoughts tend to be a little more flexible, more neutral. They don't feel as bad. So when we identify them, we then have a few options or a few choices. We can sit with it because thoughts are actually temporary. Thoughts are not facts. They're going to pass. So if somebody wants to just sit with it and be like, this is just a thought. It's not a fact, and let it go. That works for some people. For others, I think we need to tweak the thought. I like the word tweak because change can feel so overwhelming for people.

Mm-hmm.

But we could just tweak the thought by like shifting a word, for instance. So if somebody's like, well, I don't have an hour, I'm not gonna go to the gym at all, I would actually challenge that and say, okay, where is the evidence That you shouldn't go to the gym at all? Where's the evidence that you need a full hour? Can you do something in 20 minutes? Is something better than nothing? So, you examine the evidence.

I can do jumping jacks for a minute.

Exactly. Something, right? But you examine the evidence, you challenge it, and then you can tweak it. So, maybe the new thought or the reframed thought is, I don't have an hour, but I have 20 minutes and something is better than nothing. Now, that statement feels so much better And then it's probably gonna get you to move your body for 20 minutes as opposed to, I don't have an hour, I'm not gonna do anything at all. And that's probably gonna lead to a lot of, I should have gone to the gym, I should have woken up early, all these guilt-like statements and feelings and shame. And that's gonna again lead to a different behavior.

Yeah.

You talk about this phenomenon. I think I, you know, I, it kind of reminded me, um, on Viktor Frankl, cuz you talk about this pause and this that you can take between thinking something and doing something. You know, and Viktor Frankl said, you know, between stimulus and response there is a pause, and in that pause lies a choice, and in that choice lies your freedom. And I kind of— it felt like— I don't know if that's where you got it from, but it's certainly something that I, I've anchored to. And I think it's, it's something that, you know, is, is like you get the impulse to eat a cookie, it's like you do eat the cookie. It's like, and it's like there's no pause in between those 2 things. And I think I used to tell my patients to put something on the fridge, which is a little Post-it note that says, what am I feeling? What do I need? So what am I feeling? I'm feeling, I'm feeling, you know, angry. I need to go yell at somebody, not eat a cookie. You know, like, what am I feeling? I feel lonely. I need to call a friend. What do I need? Not to eat another half a sheet cake, you know, like, Right. or a pint of ice cream. And I think it's just that pause, like, what am I feeling? What do I need? And often we medicate our feelings. And this is something that I think we as a culture do really badly. We train our kids to be rewarded with food. So sugar is the reward for anything. And so it's sort of like a trigger for, oh, if I'm feeling anything, I need food. And I think that's a big problem. So how do you help people integrate this concept, this framework of this pause, and what you call the 10-minute window before eating? And like, what's happening? And what you That's what people should be asking themselves when they're kind of going to the fridge or going to the pantry and trying to grab something.

Yeah, and I love the example that you just gave because I tend to explain it to my clients in a very similar way. That one day, maybe it was your parents, maybe it was just you at home, that you felt stressed or angry or upset. And that one day you went to go soothe yourself, maybe with the ice cream or the cookie, maybe because you grew up with your parent giving it to you, right? But what happens is that one time has now built an association. So it's like, oh, I'm emotional, I'm stressed, I'm upset, I'm angry, I grab the sugar, I grab the ice cream, I grab the cookie. And then what actually happens over time is it becomes an automatic behavior. And a lot of people don't even realize, right? It's like a mindless eating. It's a mindless impulsive act that people are grabbing that. So I actually truly believe that until we understand the why, People aren't going to change. And I know psychology is only one piece of the puzzle. I kind of joke that CBT, we can't CBT our way out of everything. There's so much biology going on.

CBT is cognitive behavioral therapy, right?

But I think the first step is for people to understand why this is happening. And I actually do something very similar to what you said. I encourage people to stop and pause and to check in with themselves. And actually ask similar questions. So, what you had said, what's going on right now? How am I feeling? What do I need? And is this going to solve the problem? Most of the time, it's not. It just feels good in the moment. It's like a temporary fix. It's like a band-aid, right? And that pause breaks the cycle. So, I love that you said put the Post-it note on the refrigerator because I tell my clients to do the same thing but with the word stop or pause. But that pause allows you to take that breath, turn inward, because I think we live in a society that we are go, go, go, go all the time, that the automatic behavior is just grab and go. But then we grab and go and then we feel bad. And it's the thought that follows the behavior that ends up being the vicious cycle. So I often say, if you really want the cookie, have the cookie, because it's not about the cookie. It's the thought that follows the behavior that matters more. Because if you sit down and accept, I'm gonna eat a cookie, you're gonna eat it, you're gonna enjoy it. It's not gonna be impulsive. You're not gonna feel out of control. You're not gonna feel— it's not gonna be mindless eating. And you might just say, oh, that was a good cookie, and I go on with my day. But if you impulsively grab the cookie, eat over the counter, mindlessly eat, the thought that follows most of the time Is what did I do? I shouldn't have done that. I feel guilty. I feel ashamed. And that becomes a vicious cycle. So it's not about the cookie. It's about the thought.

Yeah.

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So, so how do we, how do we kind of frame the whole concept of emotional eating versus like an emotional hunger versus physical hunger, because I think people often can't distinguish the two and they kind of get mixed up. So, you know, how can you kind of unpack that for us?

Yeah. And I think the reason people can't distinguish the two today is because everybody's go, go, go again, right? There's, there's that part of it, kind of the fast world that we're living in. And unfortunately, I think a lot of people have gone through life dieting, right? And dieting, on a diet, off a diet, you kind of lose that sense, that internal clock, that internal understanding of what is fullness, how, you know, how do I feel, that check-in. So it's so easy to just grab food in a way and not— like, I hear this all the time from my clients, I don't know when I'm hungry anymore. My body never tells me I'm hungry. My client's like, I'm not hungry, I don't eat. I'm like, well, That's part of the problem. We have to pause and turn inward and ask ourselves some questions like, when is the last time I ate? Was it whole foods? Was it filling? Was it nutrient-dense? Did it really fill me up psychologically, emotionally, physiologically? Because there is that difference. And usually, the way I like to think of it and describe it is, because nobody knows anymore unless they're really doing the work we're talking about, if you are opening and closing a refrigerator or a cabinet and searching for something, you are emotionally hungry. There is a craving you are having, and it is an emotional void that you are trying to fill. But if you open the refrigerator and you see a bowl of fruit sitting there, and you are actually physiologically hungry, you're gonna eat the fruit. That's what's available to you. So I think that's a really good sign I remember years ago when I worked in bariatric surgery department, I was describing this in a support group. And there was actually a little girl there with her mom. And then they came back the following week and the mom said, ever since my daughter heard you say that, every time I open and close the cabinets, my daughter says, mom, are you sure you're not just bored? Because she knew, you know, she's not hungry, she's just opening and closing.

Yeah.

So I think, You know, again, but the awareness is the first step, right? You have to be able to be like, oh, I do that. Okay, why do you do that? And what's going on? Did you eat enough to feel physiologically full? You know, I often say, if you ate an hour ago, you might be physiologically full, but what did you eat, right? Did you eat only carbs? Did you eat protein, fiber, whole foods? You know, like, what you eat does matter. It's gonna fill you differently. And, and if the food is really boring, like for somebody that's been on a diet their whole life, if the food's really boring, you're actually also probably not going to be emotionally satisfied. Maybe you're physiologically satisfied, but it was boring. You're probably going to want something else.

Yeah, that's interesting. I think that's true. And I think I also think of this concept of like, don't think about like what you're eating, think about what's eating you. And I think that's often what's driving your food behavior. You mentioned something really important, Rachel, that I wanna double-click on, which is mindful eating. You sort of quickly jumped over that. I had a friend of mine, Mark David, who's also a nutritional psychologist, who told me this story of a patient he had where he was refusing, he was a very busy executive, he worked very hard, he only kind of ate, you know, At fast food places, he like goes for the drive through and he like eats a big Whopper or whatever. I don't know what. I don't even know what they what they're called. These places like Burger King or something. The guy said, "I really can't change my behavior in this way." Like I just need you to help me.

Da da da.

Whatever he wanted help with. And my my my friend Mark Davis said, "Well, you can you can have the you know big Whopper or whatever that you want. But what I want you to do is I want you to go inside." Buy it. I want you to sit down. I want you to take like 5 breaths, and I want you to consciously and mindfully enjoy every bite. Please enjoy it. And, uh, the patient comes back to him and says, I did it and I tasted it and it was disgusting.

Exactly.

And I couldn't eat it. And I, I think, you know, most of us just don't pay attention when we eat, and, and we don't enjoy the food. We don't taste the food. We don't let it nourish us. And So we're constantly feeding like this emptiness, which is more emotional emptiness. And, and I think that's, that's a really important thing for people to think about. And how do we sort of figure out what is eating us, not just what we're eating, and how do we navigate those emotional issues that are driving us to eat and, and find other ways to sort of address the feelings we're having? Because ultimately, if you keep doing it with food, it's a problem. And, you know, stress plays a big role, I think, also. But I want to talk to you a little bit about stress because I know personally when I'm stressed, And like everybody else, I get stressed. Uh, and I'm like looking for something to make me feel better. And sometimes it's Netflix. Sometimes it's what's in the fridge or the pantry. Now, the problem with my house is I don't keep anything in there that is a problem. And, you know, like, I don't know, a few nights ago, so I was stressed about something. I'm like, I want ice cream. And I'm like, Oh, Oh damn, I don't have any ice cream in the freezer. I just have frozen strawberries.

So I'm curious, what did you do in that situation?

I had some dark chocolate because it was a little— I get— I said I have like dark chocolate in the house. I had like a square of dark chocolate and it kind of helped. But I didn't go for the pint of ice cream, which I would have, you know, had a tough situation the other day. So I think, like, you know, part of it is like understanding how to regulate your nervous system. Part of it is like not keeping things around you that make it easy to misbehave. You know, like if there was something bad in the fridge, I would eat it. So maybe you can talk a little bit about stress, how that plays a role in hunger, appetite, emotional eating, and our ability to even make healthy decisions about food. Because I think most people don't connect the idea that stress is really driving a lot of bad food behavior. People also don't know, and this is really important from a medical perspective, that every one of your fat cells is innervated by your nervous system, and your brain is literally speaking to your fat cells. And when you are stressed, your body is in a storage mode. It's not in a metabolic mode. It's like you're just basically trying to survive. So I think it's important to understand that it's not just psychological, it's also physiologically affecting your metabolism.

Yeah, and I love that you said that because whenever my clients are stressed, and they're going through a really stressful time, so not just like the daily stressors, but like a major life change, a big stressor, I actually tell them, if they're trying to lose weight, I tell them, your goal right now is not weight loss, right? Because your body and that stress is kind of working against you, and your goal is to just maintain your health behaviors as best as you can, exactly like you just said, like you're in survival mode, and sometimes survival mode is okay. But that chronic stress, the stress that keeps building up, can become problematic. And like everything we talked about before with emotional eating and like taking that pause and checking in with yourself and asking yourself those questions, what I often tell people is when you are stressed, emotional, or tired, it is so much harder. It's like your body and your brain have to work on overtime to even get to that point of being able to pause and check in with yourself. So it's like stress is getting in the way of us doing what we need to do on so many levels, but it's all related because if you had poor sleep last night, you're also gonna wake up and your body is going to need something different. You're gonna be craving something different. So all of our health behaviors are related. And when I say health behaviors, I also mean our stress management tools. Like, to me, that's a health behavior. Like, how are you managing your stress throughout the day? But if you are stressed, if you are tired, if you're not eating properly and fueling your body, if you're dehydrated, if you're not moving your body, all of those things are connected and it's going to make all of what we're talking about more challenging. It's not impossible, but it's more challenging. And that's where I like to remind people, like, let's just choose one health behavior to start with first, right? Like, if you're not sleeping well, let's get you sleeping better because then you're going to wake up Feeling differently, having different thoughts. You're going to choose a different food for breakfast, you know, all of those things. So just choosing one of those health behaviors is going to impact everything. And then once we get that under control, we can maybe move on to another health behavior.

I think this is important. You talk about it's a coping toolbox and health behaviors. But I think, you know, one of the things I want to sort of dive into is willpower. People think they need to use willpower. I would be interested to hear your perspective on this because from my perspective, it's biology. And when, when I take people and I help them shift their diet in ways that change their hormones, their neurochemistry, their microbiome, like medical things, that they literally stop having to use willpower and they can use science, not willpower, to regulate their appetite and behavior.

Right.

And I'll just tell you a quick example. I had a, you know, I had someone go to one of my workshops who it was really, it was like a week-long workshop where we remove sugar, processed food, and, you know, refined carbs and all the starchy stuff that people are addicted to. And she's like, look, Dr. Hyman, I have been addicted to sugar my whole life. I crave it all the time. I don't really think that I can handle this. I don't know what to do. Um, I think I'm gonna have a problem. I said, okay, well, let's just see how it goes. I'm here, you know, like, and, and you tell me how you're doing, but just follow the exact program of food that you're going to get, which is designed to regulate your hormones, your neurochemistry, your immune system, your microbiome. And she's— the second day, she's like, I don't know what happened, like, all my cravings are gone. I don't want sugar. I'm like— and so I was I was trying to teach the group that it's not willpower that you have to focus on because you can't white-knuckle your way to lose weight. It's impossible. You might win for a day or two, but you will fall apart after a while. So can you kind of help us understand this sort of willpower issue and how people can navigate it? And what are the tools that people can use to reset that? And also how to— You know, how do we deal with, you know, people who are just overwhelmed with these constant, you know, cravings and desire and stress-related eating?

Yeah. And I think if more people understood that it's not about willpower, I think they would be able to start making some of the smaller changes that, like, you're talking about and that I'm talking about. Because you're absolutely right, you can't white-knuckle your way to this. And but the problem is, because people think it is willpower, They don't move forward because it just keeps them stuck exactly where they are because they try again and again and it doesn't work. Or like you said, it starts for a short time. So that cycle is our thought cycle, right? It's like, oh, it must just be me. It's just my willpower. I try, it doesn't work. I'm a failure. But actually, kind of the GLP-1s and what they're doing to food noise and for helping people lose weight as well as even some brain imaging studies, which I've even done some years ago, I think is pointing us in this direction of really proving that it's not about willpower, right? It is about biology. Because if you can change, like what you did in that workshop, if you can change somebody's cravings and they're not having cravings anymore, right? By simply— not simply, but it's hard obviously to do the behaviors. But by doing what you did, similarly to GLP-1s, if the GLP-1s, like all my clients, like, I don't understand. Like, I don't have cravings anymore. The food noise is gone. Or I like to think of it as it's decreased, right? That is evidence that there is something else going on. It's not willpower. It's biology. It's the chemicals in our brain. It's everything else interacting. So then, we can stop blaming ourselves, right? Like, I did brain imaging studies. years ago. And it actually, you know, we were able to modulate the activity in the brain and decrease food cravings. Like, literally, with an individual sitting there looking at images, like food images, and their food cravings decreased when we were able to activate a certain part of the brain.

By doing what? Through, like, stress reduction techniques or what?

This was actually tDCS, transcranial direct current stimulation.

Like transcranial magnetic stimulation, yeah.

But like that even, like, I mean, that leaves us with this question of if it was just willpower, how could we do that just by changing or like activating a certain part of the brain, right? That's evidence for people to be like, hold on, there's something else going on here. And it's so complex as we know, but willpower, it might be a piece of it, but it's more complicated than that.

I think this is so important what you're saying because Most people judge themselves. I'm just weak. I have no willpower. I can't control myself. What's wrong with me? I'm bad. I'm this. I'm that. And this is negative self-talk, and it's reinforced by society and by the messages. Just eat less. I mean, doctors do it. Just eat less, exercise more. That's how you lose weight. That's nonsense. Like, it's just if it worked, everybody'd be skinny, right? It's like, oh yeah, sure. Eat less, exercise more. It's not doesn't work. And it's really about understanding how to sort of change your biology through the quality of the food you're eating. Focus on what you're eating. You don't really have to worry about how much because your cravings will go away. And I think that's something I know as a doctor, but as a psychologist, I think it's really important that people sort of understand this. And I think people really, really struggle. And I think, you know, people don't understand how certain foods hijack their system. So it's like once you start— You get hijacked. David Ludwig, who's a friend and colleague of mine who's at Harvard, done a lot of work in this area. He did an interesting study. I call it the milkshake study where he took 2 different milkshakes. One was a higher glycemic milkshake. One was a lower glycemic milkshake. In other words, one raised the blood sugar more, one raised it less. They both had the same amount of calories, same amount of protein, same amount of fat, same amount of carbohydrate. Same amount of fiber. They tasted the same. The only difference was they swapped out a very rapidly acting carbohydrate for a very slow absorbing carbohydrate. And when they did brain imaging and blood work, it was fascinating. The brain imaging on the group that had— and it was basically the same people would do this different milkshakes on different days, so they didn't know which milkshake they were getting.

Yeah.

So they were, in a sense, their own control. So the one when they had the regular milkshake they were fine. That was a low glycemic one. When they had the high glycemic one, their insulin went up, their triglycerides went up, their cholesterol went up, their blood sugar went up, but their brain also lit up because they look at functional MRIs. Their brain lit up in the part of the brain, the nucleus accumbens, which is the addiction center of the brain where dopamine hits. And so it's basically where heroin and cocaine, all this addictive stuff is like actually triggering this biological addiction, which is quite— Quite amazing. I think so. People need to understand that we have the science, just like your brain imaging studies, like his brain imaging studies, that this is not just a matter of being weak-willed or not having willpower or being a bad person or, you know, not having control of yourself. There are— it's like the Body Snatchers. Our brains and our microbiome and our hormones and our transmitters have all been hijacked by the food industry in ways that are sort of invisible to us. And then we blame ourselves. So maybe you can kind of talk a little bit more about that and how people kind of can start to reset things and how the— and you talk about like this sort of coping toolbox concept.

And I'm so glad that you brought all of that up because again, I think the first step is understanding that it's not our fault, right? That there is more to it. It's biology, it's the food system, it's everything else that's going on. Because again, our thoughts, emotions, and behaviors are linked. So if people keep trying and they keep failing, in essence, they're going to play that blame game, right? Like, what's wrong with me? I'm a failure. They're looking at what everybody else is doing. Why can they do it and not me? For us, we don't know everybody's whole story. We don't know everybody's medical history and all of those things, but there's so much more to it. So I think just to kind of take a pause for a moment and for anyone listening, like, it is not your fault. There is so much more going on here. And that's the first step. And then the question is, you know, I like to focus on what's in our control. So if this isn't my fault, for instance, because of biology and the food industry and everything else, what is in my control, right? What is one thing I can do today that's gonna help me feel better and move forward? So I think the first thing is to acknowledge that it's not your fault and then to focus on what's in your control. So obviously there are some health behaviors that are in our control. We know that lifestyle is so important. So thinking, what's in my control and what can I do about this now? I think there's a difference between why me? Why is this happening to me? Which isn't going to get us anywhere, as opposed to, okay, this is the fact. It's my biology. I know this now. And now, what's in my control? What can I do? What is an action I could take to move one step closer to reaching whatever goal it is that somebody has? And oftentimes, that's where I bring up my coping toolbox. And I think, again, bringing up the idea that stress management is so important and how we manage stress, because life happens. We all experience stress all day, every day. Even me, a psychologist, you, a medical doctor, stress is happening. But it's how we manage it. We can't eliminate it, unfortunately, but it's how we manage it. It's how we respond to it as opposed to react. And again, that question of what is in my control? And then choosing something that I can do instead, right? I could choose to react or I could choose to respond. And when we respond, there's healthy and less healthy coping mechanisms that we can use. You know, we talked about emotional eating, for instance. Eating is a coping mechanism for many people. I don't like to classify that one as healthy or unhealthy 'cause I think many people do it. But if it's your only coping mechanism, if it's the only tool in your toolbox, It can be problematic, just like drinking, drugs, all of those other things. Like, if it is your only coping tool, it's definitely problematic, right? We want to have a toolbox full of tools that we can pull from when we need them. So other ones, I always like to just give a few examples. Like, I'm a runner. Getting outside and moving your body, even if you're not a runner, walking, moving your body, getting to the gym, stretching, any kind of movement is a great coping tool. But we can't always go out for a run when we're feeling stressed. I always joke like, I'm about to go on stage to give a speaking engagement. If I'm feeling stressed, I can't just be like, see ya. Not feasible and not realistic. So we also have to be realistic, right? So in addition to having some of these other coping tools in our toolbox, I always think we should have something internal that you don't need anybody else for, or nobody needs to know you're doing it. So that could be like a breathing exercise, meditation, mindfulness, a relaxation technique as well.

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Yeah, it's important. It's important. Like, you need the skills, and it's like, it's a life skill to learn how to regulate your nervous system. Most people don't know how to do it. It's— your breath is always available to you. It's immediate. It works. And your diaphragm— the way it works is your diaphragm, when you expand your diaphragm, it activates your vagus nerve. Your vagus nerve is your relaxation parasympathetic system. And so you're literally physiologically— like, you can raise your arm intentionally, right? But you can't intentionally relax.

Right.

But if you use your diaphragm, you can intentionally move that muscle, which is— diaphragm's a muscle that activates this relaxation response. And it's, it's so important because people shallow breathe, they don't take deep breaths, they don't You know, really properly oxygenate. And then it just— it's such an easy access point that you can just— I call it take 5. You know, take 5 breaths into the count of 5, out to the count of 5. You can even hold for 5 at the bottom if you want. But like, basically just do that for 5 breaths and you're gonna be amazing. Um, it's also something I suggest people do before eating. Before eating, if they do 5 breaths before eating every meal, it resets their nervous system so they're not eating under stress.

Exactly. And I like to remind people, you know, like when you're feeling really stressed, like maybe you're doing some of these things all the time, but be more intentional about it, right? So like really be intentional. Take that mindful breath, take that moment to intentionally breathe. It's gonna do everything like you just said. And then what actually happens is that pause, that breath, allows you to respond because it automatically just lowered everything. So then again, we can respond instead of react. And that's where that pause comes in, that's where that breath comes in. So yes, it's literally within— with all my clients, I teach diaphragmatic breathing within like the first 2 sessions because I really truly believe it is so powerful.

I think it is. It's like an easy access point. I want to talk about the flip side of things. And it's kind of popular in our And it's kind of like I've seen little jokes on YouTube and memes about it. But basically, it's people who are into really restrictive eating. I'm gluten-free. I'm dairy-free.

I'm this.

I'm that. You know, like, and I think people have this phenomenon that it's called orthorexia, which means ortho means to straighten or correct, and they're constantly obsessed with what they're eating, but in a kind of a negative way. And people kind of restrict food or they have a bad relationship with food that's out of fear and it's not healthy. So can you explain what that's about?

Yeah. So it's interesting because it's actually— the term was coined several years ago, but people are just hearing more about it today. And I actually think the reason is because of social media that we're seeing more of these. I like to classify it as disordered eating in a way, disordered eating behaviors or thoughts. But the difference between orthorexia and anorexia, let's say, is that with orthorexia, the goal is actually not weight loss. It's actually to become healthier. So it's a, you know, a very common goal that a lot of people have, but it's when it becomes obsessive, it becomes a preoccupation, it ends up ruling somebody's life and taking control of their life, is when it becomes problematic and when it becomes that term orthorexia or, again, disordered eating thoughts or behaviors. And I think many people are kind of experiencing something like that now, just as you had just said. It's like about, well, you have to be all organic, or I need to be all this, or I need to be clean, eating clean. Again, that's fine, but when it starts controlling our lives, When we're not as flexible with our thinking, again, going back to that rigid thinking versus flexible thinking, that's when it becomes problematic. And it can be quite problematic, just like an eating disorder or disordered eating can be.

Interesting. So how do you advise people to sort of work with that? How do you— how do you— you know, what do you advise people who are stuck in this cycle where they're like kind of obsessed about every ingredient and they go to the restaurant, they change the menu 5 times, And they're like, take out this, put in that, don't eat this, I can't eat that, that whole thing. How do you deal with that?

I mean, I think everything kind of falls on a continuum and you have the 2 extremes, right? So I would first say, if it is impacting with your daily functioning, if it is getting in the way of you doing things, like maybe you're at the point where you're not even socializing because you don't want to go out and you don't know what ingredients are in the food. So if you're on that extreme, I would say it's time to seek professional help. Talk to your medical doctor, see a therapist, because that's kind of— I always say that's kind of where it becomes tricky, right? The line is blurred. But once it starts impacting with your daily functioning or it's causing you distress. And then I would say maybe you're hearing this and you're like, oh, I kind of do that. So I would ask yourself, is it getting in the way of you enjoying your life? Is it ruling your life? You know, again, if it's working for you and it's not so rigid and extreme, maybe it's okay. But I would say follow up with your medical providers, get your labs tested, you know, because obviously being so restrictive and rigid can also cause certain nutrient deficiencies and other problems. So you do want to make sure that you're healthy in other ways. But is it impacting with your daily functioning? I would say is, is kind of a key question.

Yeah, I think that's, that's true. I mean, I, I, you know, I think I, I definitely, um, and focus on healthy eating. It's got to be my life, my work, my career, um, and I, and I, and I am committed to it. I am obsessed with not eating any ultra-processed food. Like, I will not do that. Like, you can't get me to eat a Snickers bar or Ritz cracker or a Cheeto. Like, it's just not going to happen, right? So I don't know if that's going considered orthorexia, but that's kind of a hard line for me. Other than that, will I eat cake? Will I eat ice cream? If it's made from real ingredients and real food that I recognize and know where the source is, yeah, I'll eat it. And I think if there's foods that I know cause me problems, then I won't. If I know a food is, for example, dairy, if I eat regular dairy, it's not sheep or I'll get stomach issues, I'll get acne, I'll get congestion. And, you know, sometimes, you know, I'll eat ice cream and I'll have to make that choice, but I know what I'm doing and I kind of limit it. But I think, I think it's, you know, it's, um, people don't understand that, that, that their biology can quickly shift and you can kind of break these cycles of, of, um, of hunger and cravings. You talk about something in particular called the restriction-binge cycle. Can you Explain that and why, you know, when you try to have more control over eating, it actually kind of makes you feel ultimately less in control.

Yeah. So, you know, often what happens is, especially people that have kind of been restricting their whole life or on or off diets, what happens is they're restricting for so long or they're restricting certain foods that then there's this moment that kind of breaks and then they binge on it or they overeat it. Right. And then, but again, because our thoughts, emotions, and behaviors are linked, maybe they overeat or binge, and then there's that shame, that guilt, the why did I do it? I shouldn't have done that. I'm so bad.

Mm-hmm.

And then that leads to, oh, now I have to restrict again. Or they go to the gym for X amount of hours, or unfortunately, you know, purging in other ways. But it becomes this vicious cycle. And the, the key actually is to not restrict. I mean, I love actually that you said that you eat ice cream and that you mentioned Ben& Jerry's before because— and to be honest, that's like, I'm not diagnosing you or not, but I would say you don't have orthorexia. You do not because you just described a more flexible thought process. You have flexible thinking. You're like, if I really want the ice cream, I'm going to eat it. Maybe I'm not going to feel so great the next day, but you're not not letting yourself.

And I don't eat the whole pint.

Right. You're probably very mindful.

Yeah. Well, the thing is, you know, I have been through periods in my life where I'm not like this. Like, I used to be working in the ER when I was in my 30s. I had to be up all night. I would go to work at 11 o'clock at night. I'd literally have to drive to work at 10. I'd be there at 11. I'd work till 7 in the morning. And I would literally have like a quadruple espresso. I would have probably half a pint of ice cream. And a giant chocolate chip cookie, and I'd go to work.

But you were in survival mode, right?

Yeah, yeah. And, uh, you know, I'd be exhausted. I'd be 2 in the morning. The only thing open in the hospital was McDonald's. I would go get a— well, I thought it was like a healthy thing, it was the apple turnover, which—

You're like, it has apple?

Probably not apples, but maybe it had apples. I don't know, apple-like substances. I remember being in that state of like really craving, and then can also be with fatigue and lack of sleep. That's another big trigger, and people don't realize that many people are sleep deprived. And when you're sleep deprived, even now when I'm sleep deprived, I want more sugar and I want more carbs. I want pasta, I want rice, I want potatoes, I want sugar. And I, I'm like, give me that. Even if I know, like, obviously I— this is what I do for a living. I know that's not my best interest, but I will, I will often do it when I'm having that. Because I think Sleep is another big trigger that people don't realize. So there's a lot of biological triggers for appetite dysregulation.

Yeah, it's so true. And I think the important thing to remember is knowing ourselves. You know, like you had mentioned, if you eat certain foods, you know you're not going to feel good, right? But sometimes in the moment, that's what you really want. But again, it goes back to that pause, because I think people, if more people can slow down, And be like, okay, if I eat this, how am I gonna feel afterwards? Making that full mind-body connection. I think that's going to also help with the behavior change, right? It's that acknowledgement of, oh, when I eat that, I feel like crap, right? And then we have a choice to make. Do I wanna eat it? Okay, maybe, maybe you do, and it is what it is for the day. Or sometimes you're like, you know what, that's just not a good idea for me today, right? But if we can pause long enough to turn inward, And be like, what is my body telling me? What do I really need right now? That's, you know, that's going to help us determine the next step. And oftentimes, as we said before, we just go, go, go. We grab the food, we're exhausted, we grab the cookie, we grab the espresso, and we think that's the answer. But it's not. It's our body telling us we need something, and that's what it's telling us we— what we need. But really, in that situation, we need to go back to sleep. But that's not always possible. So the other one is is the answer in the moment.

Yeah, I mean, it's the thing. What do we put on the fridge? What do I need? What am I feeling and what do I need? Well, I'm I'm tired. I need sleep. It's not like I'm tired. I need a cookie.

Exactly right.

Let's let's talk about how do you create a healthy relationship with food as you're counseling people and people are struggling with trying to understand how to have a healthy balance with what they're eating and. be obsessed and not be over-restrictive, but also, you know, not be binging and eating stuff that's bad for you. Like, how do you help people resolve that?

Yeah, and it's a lot. Even as you were saying all that, I was like, oh my gosh, if somebody is listening, they're probably like, oh my God, where do I even begin? Right? And I think the first step is understanding that we don't have to change everything right now, right? And I like to just meet people exactly where they are right now. So, to, again, kind of pause and be like, okay, what's going on in my life right now? And understanding that what you and your body need today is most likely different than it was years ago, right? As we age, hormones change, bodies change, our needs change. Also, different phases of life. I mean, I have 2 young kids at home. My life looks different today than it did 10 years ago. So, kind of accepting that what maybe worked in the past isn't gonna work exactly the same. Like, yes, we know our health behaviors, the structure, the routine lifestyle is still so important, but it becomes a little bit more challenging as those things continue. So we can just start by meeting the person where they are. And then I also actually really like to help people disassociate their worth from their body weight. or from the food that they eat. Because we're not bad for eating a cookie. We're not bad for eating ice cream. We might feel bad. We might not feel good. But I think that's a really good place to start, is to start identifying really what is— what identifies us, what defines us, what helps define our self-worth beyond all of those other things. Because society has been telling us for years, skinny equals healthy. Well, we know that's not true, right? Or, a certain weight or a certain food means you're good, quote, good. I hear this all the time from people like, oh, I got my run in today. I was good, so I can go eat whatever. Those should be separate, right? If you want to eat the ice cream, eat the ice cream, but it should have nothing to do with the fact that you moved your body and exercised or whatever it was. So, I think kind of being able to understand that and kind of start disassociating that is really an important step.

Yeah, I think it's important. I think people don't understand how to do that. So, it's really helpful. I kind of want to talk about the whole GLP-1 phenomena, food noise, and what's going on here because I think we're hearing the term food noise. I want to know how you define it and how it's sort of different. than just being hungry or wanting some food.

So to just clarify also, food noise is not a clinical diagnosis or a clinical term in the diagnosis at this point. But it's interesting because we now have a name for what I think many of my patients have been experiencing for years. We didn't have a name for it. And when we have a name for it, it's easier to talk about, it's easier to study, it's easier to kind of have a solution as well or figure out how to manage it. But my definition of food noise is intrusive preoccupation or intrusive thoughts related to food. And the best way to describe it is what I hear from my clients, which is I'm constantly thinking about food. What's the next thing I'm eating? When is the next time I'm eating? What am I eating? Did I eat enough? Am I going to need more? Again, kind of these like Very intrusive thoughts that are difficult to quiet. And I like to think of food noise as like volume, because many people have that food noise that's very loud. It's taking up so much mental space. And then when it gets a little quieter, perhaps from a GLP-1, you know, people are like, oh my gosh, like, I'm not thinking about food as much. I'm able to enjoy it. Like, I have a client who actually told me, Before she was on a GLP-1, she would cook dinner and all she could do was pick on the food while she was eating, even if she wasn't hungry, because of how loud the food noise was. That when dinnertime came with her family, she couldn't eat because she ate so much while she was picking.

She ate so much, yeah.

And now she's like, she actually enjoys cooking again because she's not thinking about the next thing. She's like, all right, dinner will be later. I'm preparing food. And it's kind of separate. In that way. So it's literally just like lowering those constant, you know, intrusive thoughts around food and eating.

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Yeah, I mean, it's quite incredible. I mean, my clients come back and again, I don't want to just describe it as like, Poof, it's gone. Because for some people, it's just quieter. They might still have it, but it's not as loud. It's not taking over their life. But the way that they describe it is like, wow, I have so much more time. I have so much more mental space. And in that mental space, I'm always curious, well, what are you going to do with that time now? And oftentimes, that's when the cognitive behavior therapy can start working. It's like somebody couldn't take— like, their brain is so consumed with what the food is and the eating that there's no more space for the work, right? So when that food noise, when that chatter gets a little quieter, is when actually I see that the relationship with food, the relationship with body, the thought work actually starts clicking. It's like, oh.

Yeah.

Oh yeah. Like, I think that, and wow, You know, it's literally like this aha moment for so many people.

When we think about GLP-1s, you know, it kind of, it sort of challenges our old orthodoxy about weight and about, you know, it's all about discipline or calories or just trying harder. How do you, how do you think it's changed the landscape of people and their relationship to food in that way?

I mean, I think it's changed so much. You know, something that I often see and and share is that I've noticed that it's given my clients hope who have lost hope. And that's because of that willpower piece, right? Like, people have literally lost hope. People would come to me and be like, I've tried everything. I just can't seem to do it. What is wrong with me? And then they go on the GLP-1. They're still doing all the things they were trying to do before. You know, they were exercising, they were trying to eat less, they were trying to eat healthier. But now they're on the medication, which is a tool, a treatment option. And it's like, oh my God, my, you know, like it's working, something's working, right? And again, I think that again is the evidence that we're not talking about a willpower issue, that we're talking about biology.

It's biology, not, it's not psychology in some ways. And I think we try to, you know, white-knuckle the psychology, but it's not possible when you're overriding these massive hormonal hormonal biological signals. And I think, you know, the, the, the— this is important. Um, but, but even, you know, when people take GLP-1 medications, they can change your, your food cravings, they can help you with weight, but it doesn't necessarily automatically change someone's relationship to food, how they relate to food, how they think about food, body image, their coping skills. So how do you sort of work with them psychologically to kind of create So people often will stop. Some people, after a year, they'll gain back the weight. You know, sometimes, you know, they try to reduce it and they end up in the same place. So how do you, you know, how do you think about that?

Yeah, and it's complex, right? Because, again, food and eating and everything we're talking about is so much more than just what we're putting in our bodies. And there is, you know, the psychology, there's the stress, the sleep, all the health behaviors We don't live in a bubble. So, I think if we lived in a bubble and we took the medication and we didn't have stress and we didn't have sleep-deprived nights and all these other things, it would be easier, right? But that's not reality. So, it's just like with bariatric surgery. Somebody can be super successful with losing weight with surgery and then all of a sudden, It doesn't mean that they're happier. It doesn't mean that everything in their life changed just because they lost weight, or maybe they regain the weight or have weight recurrence because of the stress and the sleep deprivation and the biology and all these other things. So I think people tend to forget that as humans, we are so much more complex than just the biology, right? We do live in a society that is sending us these messages, and if we don't change some of those other things or work on the relationship and work on those thoughts. We might still be stuck exactly where we are, and this is where we often hear people say, "I lost all the weight, but why am I not happy?" Right? And and I often like to ask them, like, "Well, you know, let's dig a little deeper. What was going on?

Right?

Were you happy because you were living in an old, you know, a bigger body, or were you unhappy because of your relationship and this and that?" So weight loss isn't the answer. Right? It's it's it's part of a bigger picture, but oftentimes people just think just if I lose weight, I'll be happy, right? Or just like you know, I need to lose weight to to go on a date. I need to lose weight to take the vacation. But we often see that that's you know not necessarily the answer again because of the psychology, right? If you've lived in a certain body and had a certain routine and these certain automatic behaviors and habits your whole life. It's not just going to poof change. You know, there's, there's a psychology of it. There's the emotions, the thoughts, the feelings, and we need to talk about all of that and work on that.

Yeah.

So you kind of, you can fix the biology, but then there's, you still are left with what's, what's going on in your head. Yeah. You kind of sort of talk about the idea that knowledge and willpower aren't really enough. You know, what actually helps someone build a healthy relationship with food for the long term?

So I actually I actually think it all boils down to our thoughts, you know, with the biology. Like, not forgetting the biology and not forgetting everything we just talked about, but our thoughts literally can keep us stuck where we are. So if we can tweak our thoughts in a way to work for us— again, like I said before, we can't CBT our way out of it, out of biology. But if we can tweak our thoughts and be kinder to ourselves and speak to ourselves like the way we would speak to a friend, for instance. It's a great place to start. And we have to just start somewhere, right? Like, we can acknowledge and accept that there's biology here that I can't change. But I can control, I can help change the way that I talk to myself to feel a little better. And if I'm a little kinder to myself, and maybe you, quote, allow yourself the cookie, for instance, or to maybe only work out for 20 minutes instead of not at all, right? Like tweaking those unhelpful thoughts, it's gonna move us one step closer. And that's how we start building confidence, right? I think people think that you're just born with confidence and that's the way it is. But we have to take action in order to build confidence. So we do something and like, oh, wow, that felt good. I was able to do it. Oh, I could do it a little bit more. Oh, I could try something else. So if we just take that step back and be like, okay, if it's not about willpower, What is in my control? What can I tweak knowing that biology is at play here?

You know, I think a lot of this is in your book, When Life Happens, the mindset shift you need to manage stress, build confidence, and break free, right? And it just came out. And I think, you know, I think it's important for people to have this important resource. So given everything you know and the work you do with patients and sort of the content you produce. What, what are the resources that people should look toward to help them with this? I mean, obviously your book, your website, drachelnyc.com. What, what other resources are there available for people to really learn about all this?

Yeah, thank you. So I think, you know, if you're struggling with any of the things that we talked about, you know, seeking help can be a great first step. And often people are like, well, when do I know if I need to seek help? And I often say if that question popped into your head, then it's time to seek help, right? At least to make the consult, have the conversation. So there's therapists, psychologists. I also think like you and your podcast and all of your books are a great resource as well. And there's so much information out there, but the problem is knowing who the expert is and maybe like who the influencer is, right? And like, so be mindful. of the information you're consuming and make sure that you're getting it from experts. But I think if somebody's struggling with eating disorders, for instance, there's eating disorder associations, there's the Mental Health Coalition that has amazing resources as well. And I always say, like, I'm happy to connect with people and point them in the right direction and give them resources, referrals, and recommendations in terms of who to reach out to. I actually— somebody was like, I can't believe you put your email address on, like, the first page of your book. And I was like, why wouldn't I? But really, there's so many resources out there that I think it's brave to ask for help, and a lot of people are scared to. But the key is just to ask for help because help is available, and then to understand where you are and maybe which direction you need to go to take that first step.

Yeah, I think it's important. It's such an important conversation because I think people have often a very dysregulated disordered relationship to food. It's not just about what they're eating or what they should be eating or shouldn't be eating, which is a lot of what I talk about, but it's more about the relationship and the psychology of eating, which is something that doesn't get talked about enough. And also some of the misguided information about why we behave the way we do and a lot of the self-talk, the self-blame, the self-harm in a sense that happens from people's negative relationship to food. So having a positive relationship to food is important. I know a lot of people over the years have told me when they sit down to eat, it's a very stressful experience for them because they have such a dysfunctional relationship with food. And it's, it's a really important part of your life to kind of regulate and get set. And then sometimes it's fixing first your biology and then kind of leaning into the psychological aspects of it. And I think all of it's important. And I think your work is really important. I encourage people to check out your book, check out your website. And learn more about what you're doing. And thank you for your contribution to this whole field.

Of course. Thank you so much.

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