Episode 8 Shownotes - Weight Loss For Cancer Patients

You are listening to Best Life After Cancer, Episode 8.

Hi, and welcome back. It’s such a pleasure to get to spend time with you every week. I always look forwards to sharing my thoughts and knowledge with you – I feel really honored that you are spending this time with me and wanting to hear what I have to say. I’d love to hear your thoughts, as well, and you can interact with me on the Best Life After Cancer MD facebook page to ask questions or leave comments. It is a way you can let me know what you are struggling with, and then I can answer there or or in the form of a future podcast! For many cancer patients, I find that weight gain is a real challenge after treatment ends. I think for some, this is partly due to hormonal changes including cortisol, or the stress hormone, partly medication based, and partly due to wanting comfort, and eating to feel better. Last week, we did some work on physical aspect of weight loss, reviewing some of the hormones that affect it, and the two most important are elevated cortisol and insulin. We also discussed how intermittent fasting helps reduce your body’s weight set point, or the weight your body thinks it should be at. This week, as promised, we are going to talk about the emotional aspect of it, because when you start to change what you eat, it will cause cravings and urges. Without tools to help with these, you will quickly slide back into eating whatever it is you want. Urges are still challenging for me, even after a long time working on them. I gave up alcohol entirely for June, and have been doing well with that, but this weekend, we saw my parents, and I dropped right into my habit of snacking while we hang out. For sure, I get it. For some of us, this work is harder than it does for those that it is easier. This allowing urges translates into so many other aspects of life, and once we master it here, it will apply so many other places, where you can use those skills to elevate your life. Even if you are not struggling with weight, if there are other places in life where you have urges to do things that aren’t productive, these techniques can help to learn to deal with them.

This week, we will talk through what allowing urges looks like. I have talked about what I recommend, which is using your planning brain, or prefrontal cortex, to plan what to eat 24 hours in advance. Our prefrontal cortex is the part of the brain that only humans have. It is the part that allows us to make future plans with forethought, not just from instinct, and is what allows us to delay gratification to do things that are hard, like going school, where it might not be fun in the moment, but we can see the future benefits. When you plan ahead, and get to the next day, the primitive brain will start up with wanting what you always eat. This might feel like a compulsion, and it is really uncomfortable to resist it. When we resist it, the more we push it away or crush it down, the bigger it becomes. This happens in part because your primitive brain thinks that flour and sugar are necessary for our survival, because they give us a huge rush of dopamine. Dopamine is something that evolved to help us prioritize things that helped us survive. Foods that gave a lot of dopamine were ones that had more calories, and when we found them, and ate them, we learned that they tasted good AND gave our bodies lots of fuel, so we ate them again and again. In modern day, and our brain still thinks these foods are important, and unfortunately, when we process foods and concentrate sugar, they give us MUCH more dopamine than foods in nature. Because of this, we concentrate the response in the brain which really leads to significant OVERDESIRE for these foods. It teaches our brain to believe that concentrated foods are much more important to eat than they really are. The more we do something, the more we practice it, the better a brain gets at doing just that. Eventually, the pathway to eat is so ingrained that it happens with no conscious thought at all, which is why we feel out of control, and sometimes even that we are eating against our will. The good news, though, is that our brains have neuroplasticity. What that term means for laymen, is that we can change the pathways it uses with time and effort. This requires reducing the rewards from food and working on new thoughts at the same time. Here might be a good place for me to discuss the difference between physical hunger and emotional hunger. When we have physical hunger, it comes in waves, and gets stronger for a bit, and then subsides. Often, it starts with an empty feeling in the stomach, and you may notice your stomach growling. If you don’t eat right away, this will subside in 10 minutes or so, and then come back in a bit. This process happens with much less discomfort when your insulin levels are not chronically high and you are fat adapted. I dedicated the last podcast to this, so I will not go into that any more today. Cravings are desire for a particular type of food, and may come with sugar and flour withdrawal. Emotional hunger is when we feel hunger that starts in our brains, and travels to our body. This may be due a desire not to feel some emotion that is uncomfortable. It may be due to withdrawal from the flour and sugar. It may be a habit. It used to be that every day, I drove by this Starbucks, and have a latte in the morning, so when I saw the Starbucks, I was trained to feel an urge for the latte. I never had lattes in the afternoon, so when I went by the same Starbucks in the afternoon, it did not trigger the same urge. I still have the urge every day, and every day, I work on allowing it, not being surprised, annoyed or upset. I just allow it to be there, and don’t give in to it, and am slowly making it better. Now, my brain says, hey, a latte? And I either say, well, yes, I planned one for you yesterday, so we are going to stop, or no, not on the plan for today. We can think about it tonight, and maybe put it on the schedule for tomorrow. Interestingly, I think that thought for me is now on autopilot, and I am not even aware of the whole conversation. Part of my brain says “Latte?” The other part says “Sorry, not planned”. The first part say “Oh, ok”, and we are done and past Starbucks, and it all almost goes on in the background while I listen to a podcast. Before, the discussion was up front and I missed part of the podcast while this suddenly took the front seat in my brain.

Back to having made a plan for the next day. You need to be prepared – this is almost a perfect storm of events that will make it really challenging to follow your plan. When you start restricting food, especially if you give up flour and sugar, your brain will begin to have dopamine withdrawal, which will produce significant cravings. Your body doesn’t want to use its fat stores, so you will feel increasing hunger. Somewhere around this time as well, all the stuff that you have been using food to avoid thinking about will start to come up. For instance, years ago, you may have been bored at work, and this led to having a midmorning snack. You might not even know this snack is to avoid boredom, because your brain put that thought on autopilot. But when you stop, oh, that thought definitely comes back, and now you have ghrelin hormone, which is time programmed to make you feel hungry at certain times, a trained thought that your primitive brain wants to keep because it is easy of midmorning is time for a snack, and boredom, which also feels uncomfortable. It is no surprise that most people can’t overcome the habit with all of that going on! When you read what you have planned, your primitive brain will start with suggestions and then demands that you eat things not on the plan. Interestingly, our primitive brains can’t move our bodies. Only the prefrontal cortex can. So, it can demand, but it physically can’t force you to eat anything. Here is where you have an urge. It may feel like it is forcing you into the kitchen. You can respond in one of 3 ways. You can resist it, you can avoid it, or you can allow it. If you resist it, that is shoving it down, and it keeps popping up like a beach ball held underwater. But unlike a beachball, it grows every time it pops back up. Imagine a beach ball that every time it was exposed to air grew by 10%. Eventually, you couldn’t push it back underwater any more, and then it has to stay on the surface, and it is giant, and you can’t do anything about it. The same is true for urges, if you force them down or resist them, they grow, and eventually, your willpower runs out, and you eat the food. Avoiding it may be by drinking alcohol, shopping, binging on Netflix, and may allow you to avoid the urge, but makes it very challenging to get anything else done in life. Drinking alcohol is a problem, because it suppresses the PFC, which leads to us having more problems dealing with urges, so alcohol almost always comes with eating the food at some point. Even just distracting yourself may count as avoiding, because it doesn’t have you process the urges. Finally you can allow the urge and process it, after which it will subside and eventually go away. This is hard to describe, but it feels to me like trying to put myself into the center of the urge, and seeing and feeling it and almost wrapping my arms around it, and welcoming it in. When I do this, I describe how it feels, where it is, and watch if it gets bigger or smaller, and notice to myself – oh, I’m having an urge. It can only hurt me if I try to chase it away. Let me open the door, and welcome it in instead. I often find they go away in 5 minutes or so. Often, they come back each time I see or smell the thing I wanted, and I notice, allow, and move on. Each of these counts as a completed urge. We can also notice the thoughts that caused the urge. I have two thoughts that I use when I see something I want. I see something, and think “I want that” or “it looks delicious”. Depending on what it is, I change that thought to “I want and don’t want that. I want it for the minute, but don’t want it for the next 4 hours, when it will make me feel sluggish, and bad that I gave in”. I may also think “it looks delicious, but it never tastes as good as I think it will”. This really is true once you get off the flour and sugar, and your tastes acclimate a little. We can thing of thoughts that create things we don’t want as thought errors, just like a processing error in a computer. Thought errors create unwanted desire and unwanted actions, because our thoughts create our feelings, which drive our actions. Some thought errors that I have uncovered in my work: Breakfast is the most important meal. This led to me eating breakfast even if I wasn’t hungry. Another common one for me was If I don’t eat it now, I will never get to, or it will be gone. Interestingly, this led to me being super protective of leftovers if we went to a Thai place about 45 minutes from our house. Tell about kids eating my leftovers, getting mad, etc. This is also such a common thought for me when we have a food in the house we normally don’t. Tell about strawberry shortcake, apple cider donuts. Another thought I often had was it isn’t fair that they can eat what they want and not gain. I should be able to as well. This thought always made me feel like a victim, and led to eating from that. One bite won’t matter – for many people, this is thought is like a gateway drug of food – one bite opens the floodgates, and for so many people, it leads to a binge. They might not even have been aware of the first thought of just one bite won’t hurt. Every celebration requires food and drink. This is so prevalent in our society. Talk a bit.
All urges are caused by thoughts, but initially they are an unconscious loop. The best way to attack this is to begin to collect allowed urges. There are 3 ways I have done this. The first is with an urge jar. You get a jar – it can be cheap, a sauce jar that you soak the label off, or beautiful and special – whichever appeals to you more. You collect 100 items – it can be the glass beads from a craft store that you put in with flowers, or shells you collected in the past, or pennies. You keep them in a bag and every time you allow an urge, you put one in the jar. Many coaches believe this gets much easier after 100, so that is why we start with this many. Another way I have done this is just with a list. I write numbers 1-100 in my food journal, and then just document them. The benefit of this is that you can rate them on a scale of 1-10 in strength, the time it took to subside, and what the urge was for. I have done an urge jar in my bullet journal, where I draw a gumball machine, and color in a gumball for each urge. To date, I have not found a virtual urge jar, but I am sure someone will make an app for that any moment! Until someone creates that, you could also just note it in your notes app. Allowing urges helps on many fronts. It allows you to become more aware, both of the urge, what it feels like, how long it takes to pass, and ultimately, it allows you to identify the thoughts causing them, so you can work on that aspect of it. Each allowed urge takes away some fiber of that ingrained pathway in your head, and weakens it a bit, while building a new pathway. A common question is whether you need to start over if you allowed 10 urges, and then ate to make an urge go away. The answer is no. You should evaluate why you couldn’t allow that urge – if it just got too hard, it may be that you are still resisting them, and you ran out of willpower. That will help you to see that you need to work more on your skill of allowing them. It may be that you let habit take over, in which case, you may need to work on your mindfulness or awareness in what you are doing in the moment.

Ok – the review for this week. Overeating is the cause of being overweight. In part, it can be due to physical factors like hormones, including insulin, cortisol, and ghrelin. It can be due in part to physical cravings, which are learned and reinforced by what we eat. It can be due to buffering to avoid emotional discomfort. It can also be due to overdesire from eating foods that give huge dopamine hits, leading to a learned reward which propagates the pathway. We need to manage our hormones, change our diet and allow the urges to eat what is not planned. Allowing urges, instead of resisting or avoiding, looks like leaning into them, and letting them be there. It takes work to rewire your brain, and collecting 100 urges can help with a kickstart of the rewiring process.

Next week, we will continue this weight loss month with work on making an eating protocol, and more work on how to stick to the plan! Thanks for joining me today!