“I want you to increase your fat to 70-80% of your total food intake . . .” I stated, before I was cut off by a loud gasp, followed by a chortle. The 300 lbs male sitting on the exam table in front of me looked at me with a very skeptical smirk.
“You want me to eat fat to lose weight?!” he said after catching his breath. “You’re the first doctor who’s openly blown smoke up my a** . . . ,” chided the rotund 42 year old male shaking his index finger at me as we discussed weight loss treatments.
“Although that was standard medical treatment of the Royal Humane Society for drowning victims in 1774, . . . .” I responded. “No. I’m actually trying to help you lose weight by shifting the hormone signal in your body with food.” I replied as I recalled that the medical thought of the time was that a tobacco enema dried out the insides , warmed the body and increased the heart rate of the drowning patient. I informed my patient that the use of tobacco smoke enemas fell out of favor around 1811 when its use for drowning, typhoid, headache and stomach cramping was found to actually be cardio-toxic and ineffective.
“So, . . . blowing smoke into your rectum won’t help you lose weight, nor will it help you maintain ketosis. In fact, it might actually kill you.” I added with a smile.
Eating fat is, however, one of the keys to hormone manipulation used to fix the Habit-Loop Cycle of Obesity. So, how do we fix or alter the habit-loop of obesity discussed in the last two blog posts?
Four Part Habit-Loop of Obesity
The habit-cycle cycle of obesity consists of four parts:
- Hormone Response
In my last blog post, we discussed how the trigger and the response are driven by or focused on a craving that may or may not be consciously perceived. We also learned that breaking this habit-loop cycle takes willpower we talked about in my first article, and willpower can fatigue. It has a daily shelf-life.
Fixing habits and creating new powerful habits requires identifying the components of your individual habits. That means, first, identify the routine that occurs in a habit you want to change. We want to identify a habit that drives you to eat carbohydrates when you really rather wouldn’t. You’ve tried to stop, but you struggle and when fatigued, ignore your previous thoughts and imbibe on cookies.
Identify the Routine
Weight gain, fat entering and staying in the fat cells, is stimulated by the production of insulin. Many of us who are insulin resistant, produce 2-15 times the normal amount of insulin when we indulge in carbohydrates. That’s the master hormone part of weight gain. There are 29 other hormones that play a role in weight gain, however, turning them all on or off is driven by the routine you follow in your daily habits.
In my journey to understand my weight challenges, I found a pattern that was causing my middle to grow. After a long day at work and returning home to have dinner with the family, I would often sit down to work on my charts, billing codes, labs and dictation from that day. (Thanks to the wonders of the Affordable Care Act, this immense amount of work added 3-5 hours of “home work” to my already 10 hour day at the office, only to be completed late in the evenings.)
Even though I enjoyed a late low-carb dinner with my family when I got home, I’d find myself getting hungry 2-3 hours later. While working on charts and trying to “push through” the pile of work in front of me, I’d start getting “hungry” around 10 pm. I would find myself rummaging through the fridge and freezer looking for something to eat. The problem was that I would find myself eating things that I normally wouldn’t, and I’d even find myself finishing off the quart of ice-cream in the back of the freezer left over from a birthday. No matter how much I tried to avoid this behavior, I would frequently cave to cravings between 10 pm and 1 am. (Yes, I heard the gasps from the ketogenic blogosphere, but I’m human, too.) I knew that if I, an obesity specialist, was having these challenges, you probably are, too.
So, how does one change this kind of behavior? The solution is found in the habit-loop cycle.
I started drawing out the loop. Trigger –> Go to kitchen fridge/freezer —> Reward.
What is the Trigger?
I had to ask myself some questions. What is the Trigger or Cue?
Was it actually hunger? Boredom? Stress? Fatigue?
What is the Reward?
What was the reward? Was it actually food? Change of scenery? A temporary distraction? Energy from the food?
So, I had to experiment with my reward to find out. Rewards are powerful because they satisfy cravings. However, you and I are often not aware or conscious of the craving that actually drives our behavior or routine. As Charles Duhigg states, “Most cravings are hiding in plain site. . . They are obvious in retrospect, but incredibly hard to see when we are under their sway” (1).
To figure out which craving drives which reward, I had to run a few experiments on rewards. I asked my wife to make extra fat bombs and some of her low-carb cheese cake to have in the fridge.
The next few evenings I recorded what happened. When I felt the urge to get up and go eat, I ate a few fat bombs. But that didn’t take away the craving. I tried going out and walking around the back patio and petting the dogs for a bit. I tried drinking something different instead of my routine water, Diet Dr. Pepper or exogenous ketones. No matter what I did, some of the evenings I still found myself rummaging the back of the freezer for something sugary.
What Action Eliminated the Craving?
My point here was to see which of these activities took away the cravings. I wrote down how I felt after each activity, as well as what happened after I’d cheat late at night with ice cream or chocolate. Just the action of journaling how I felt, my thoughts, emotions or words that came to mind was the key. After waiting for 15 minutes, I wrote down three words or phrases that came to mind.
I found myself journaling: “Sleepy,” “Anxious,” “Tired,” “Still Hungry”
I found that eating something I should be avoiding, like ice cream, chocolate, or sweets (Even in a low-carb home you can still find some of these things), caused me to feel short term euphoria, more relaxed and suddenly more tired.
The brain will record the scribbled words as recollections attached to emotions. It is easier to see patterns if you will actually write it down with pen and paper. The goal is to isolate what you are actually craving. The words and emotions attached to those words will give you an idea about your cravings and the cue driving it.
Five Categories of Habitual Triggers
Scientists have shown that almost all habitual triggers fit into one of five categories:
- Emotional State
- Other People
- Immediately Preceding Action
So, in trying to identify the cue driving me to the back of the freezer, I write down five things that happen the moment the urge hits (I’ve included some of my actual notes in bold from my experiment):
- Where am I? – Sitting in front of my computer at my desk in my home office.
- What time is it? – 11:32 pm
- What is my emotional state? – Tired, anxious, and overwhelmed by the volume of work
- Who else is around? – No, one. Everyone else is in bed
- What action preceded the urge? – I looked at the clock while finishing a patient’s chart
I repeated these notes and the repetitive pattern I identified was that it was late (between 10 pm – 1am) and I felt very tired and anxious.
Look at the Pattern
I realized that I wasn’t actually hungry. I was exhausted, anxious & tired. My willpower was gone for the day. Eating the sugary food has always caused me to have a huge insulin surge and when that happened, I always got more sleepy. When I ate the sugary food, I got more tired – tired enough that I would start falling asleep at my desk and end up going to bed.
I found that the craving was not for sugar at all, but for sleep. The cue was not hunger or boredom, but for time of day coupled with the emotions of fatigue and stress. The combination of time of day with these emotions were the trigger that would kick in a routine of rummaging through the pantry or freezer for something sweet, leading to an insulin response (hormone) driving me to bed. This routine had has a negative aspect, it kicked me out of ketosis causing weight gain and further cravings for the next 72 hours.
Make a Plan
So, I wrote out my plan: Go to bed at 10 pm.
I actually found that I could get up earlier, exercise and my ability to focus in the morning was much more crisp, alert and I was more effective at getting my charting and labs done in the morning and throughout the day. I haven’t rummaged the pantry for the last month and I dropped the inch off my waist that had crept back over the last year.
Now, I realize that some habits are much more difficult to break. I expect that, but hopefully this will be a starting point for you and I to begin looking at some of the hundreds of habit-loops that affect us for good or bad throughout the day.
Sometime New Habits are Required Before Bad Ones Can Be Broken
Your ability to break some of the stronger habits occurs when you set other good habits (2, 3). Habits like regular daily exercise increase the likely-hood of changing or breaking other bad habits. People get better at regulating impulses and avoiding temptations when they strengthen willpower with habits like exercise. Research shows that simply establishing a habit of exercise actually increased peoples ability to drink less, smoke less, eat better, and learn more effectively (3).
The key to change is repetition of an activity, thought statement associated with physical or emotional feeling. The repetitive action of exercise 3-6 times per week when willpower is strong increases the emotion of excitement, joy and happiness. The combination of the repetitive action physically with the emotions experienced by the accomplishment actually strengthens willpower and allows for naturally identifying and changing the triggers and cravings of other habits (3, 4). It takes at least 3-4 weeks for people to experience the effects of forming a new habit, so be patient with yourself.
Using Hormones and Your Journal to Bridge the Habit-Loop Cycle Faster
This is where journaling and fat come into the equation. The ingestion of an increased amount of fat in the diet stimulates three hormones: GLP-1, Protein YY, and Oxyntomodulin. These three hormones suppress hunger cravings by turning down the effects of hunger hormones in the hypothalamus. When we use fat as a fuel and as a reward, we can change the cravings and the weight at the same time.
We now know that the use of hormone stimulus, emotion and repetition of an action allow for parallel learning about and expecting the reward in the basal ganglia. The basal ganglia is the region of the brain that streamlines complex learning. It is the part of the brain that allows you back up a car, or riding a bike without deeply thinking about steering, pedaling and balancing. Shifting the food type to predominantly fat and lowering the carbohydrates changes the hormones in the brain. When we add journaling, by physically writing and recording our emotions, the basal ganglia learns about this reward system faster (5).
If you are ready to change your life, feel more energy, have improved concentration, better sleep and lose weight, I want to help. I’ve created a 30 Day Keto Kickstart Challenge Program starting October 1st. Click on Kickstart Challenge to join this exclusive group of Ketonians as we use the principles in these articles to successfully improve health, lose weight and feel more energy.
And, to answer your burning question, “No! Adding tobacco smoke rectally . . . doesn’t help the habit-loop cycle.”
- Duhigg, Charles. The Power of Habit. Random House, New York. 2014. p. 290.
- Oaten M, Cheng K. Longitudinal Gains in Self-Regulation from Regular Physical Exercise. Journal of Health Psychology. 2006.; 11: p 717-733.
- Baumeister RP, Gailliot M, DeWall CN, Oaten M. Self-regulation and personality: How interventions increase regulatory success, and how depletion moderates the effects of traits on behavior. Journal of Personality. 2006; 74: p 1773–1801.
- Oaten M, Cheng K. “Improvements in Self-Control from Financial Monitoring,” Journal of Economic Psychology. 28 (2007): p 487-501.
- Brown J, et al., How the Basal Ganglia Use Parallel Excitatory and Inhibitory Learning Pathways to Selectively Respond to Unexpected Rewarding Cues. Journal of Neuroscience. 1999. Online OpenBU edition: https://open.bu.edu/bitstream/handle/2144/2228/99.011.pdf?sequence=1