Excerpt: 'The Hunger Fix' The following is excerpted from "The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction" by Pam Peeke, MD, MPH, FACP, with Mariska van Aalst, new from Rodale. Chapter 1: The Dopamine Made Me Do It! "There is nothing better than a friend, unless it is a friend with chocolate." -- Anonymous We all have one. At least one. A little darling. A best friend. A helper, a life raft. An entrenched habit that's so comfortable, it feels like a hug or an island of calm. A fix. A fix starts simply enough. You think about doing something that you like to do -- drink a mojito, or check your iPhone, or get it on with your boyfriend or girlfriend -- and that thought lights up an entire dopamine-driven reward pathway in your brain. You feel a rush of pleasure. You start thinking about when and how you are going to do that thing: Is it happy hour yet? Can I sneak a peek at my e-mail during this meeting? Will he or she be around tonight? When are we going to connect? Your brain becomes consumed by the drive to satisfy that urge. You try, but you just can't get it out of your head. You give in. And then, as soon as you satisfy the raging hunger, bingo: You feel another rush. Your brain says, "Yeah! This is amazing. Bring it on. I want more. You need your fix. Most of the time, this neurological process is a good thing. Nature wants humans to stick around, so she uses this system to reward us for doing things that will ensure our survival -- eating food, bonding with loved ones, having sex, making babies. Preferably as often as possible. As a result, everything we do -- from the time we wake up until we collapse into bed -- is driven by reward. We're either getting reward in the short term (enjoying an hourlong massage) or in the long term (earning a college degree after studying for 4 years). The reward can also be to avoid pain. I learned that as a little girl who didn't like to brush her teeth. After suffering through a cavity, I soon learned that my real reward was never seeing that dentist again. This same reward system drives us to learn, to create, to innovate, to pursue our goals. But as a medical doctor specializing in metabolism and weight management, logging thousands of hours a year to educate the public about behavioral change, I've seen firsthand how the dopamine rush cuts both ways. The tremendous high you get from a run in the park or a hike to the top of a mountain can be powerful enough to change your life. But that healthy high occupies the same pathways, and can easily become confused with, the dopamine hit from a snort of cocaine or a puff of a cigarette. Clearly, not all rewards are created equal -- and some can kill you. In the past few years, I've started to see a growing manifestation of this double-edged sword in my own medical practice. More and more men and women are coming into my office desperate to find an answer to the same questions: Why can't I stop thinking about food? How can a cookie or plate of pasta or bag of chocolates have this kind of hold on me? I feel like a junkie! As I listen to people's tortured stories of unbearable cravings, yo-yo dieting, weight obsession, and emotion-driven stress eating, I've seen a pattern emerge. Their pleas for help are no longer your standard "Gosh, I'd love to drop 10 pounds before the reunion" fare. Instead, these entreaties have become eerily similar to the cries for help from my patients with hard-core drug or alcohol addictions: I just need that sugar fix every afternoon. If I don't get it, I'll go crazy with withdrawal. I need a dose of pizza. Those Tostitos and dip are like crack to me -- once I start, I just can't stop. I started to realize that in more and more of my patients, these cravings are the result of a reward system gone awry. I had also reviewed the new science that shows the mere anticipation of that food-related dopamine high will cause the reward centers of the brain to light up like Times Square on New Year's Eve -- the same as brain scans of cocaine addicts eager for their next fix. It doesn't take much to trigger this cascade of brain chemicals: A casually mentioned word, a picture in a magazine or on TV, or a smell from a bakery is all it takes to awaken the desperate cravings. That same insatiable drive for reward keeps all addicts pressing the dopamine accelerator, overriding their brain's normal "satisfaction" signals. These dopamine-driven moments of pleasure start to accumulate. With constant practice, they progress to habits, carving deep neural pathways in the brain. With every repetition of the cycle, those pathways get stronger and healthier alternatives get pruned out to make way for these new, ultra-rewarding but unhealthy habits. A walk in the neighborhood with your best friend begins to pale in comparison with sitting in front of the TV and bingeing on bags of your favorite chips. This False Fix becomes the default, setting up a domino effect, constantly reinforcing itself. See if this sounds familiar: Eat in bed, stay up too late, get rotten sleep. Feel like hell in the morning, reach for sugary, caffeinated foods to stay awake. Mindlessly seek the numbing of "just one more [candy/chip/cookie]." A glass of wine at dinner becomes three, and maybe even take a sleeping pill before bed to get "a good night's rest." Without fully realizing it, many people have created a life of continuous, comfortable opportunities to "dope up" in front of the computer, in the doorway of the fridge, and on the couch. They are driven to repeatedly score hits of what I call "False Fixes" -- anything (like food) that leads to short-term reward in association with self-destructive behavior, followed by feelings of guilt, shame, and defeat. In contrast, Healthy Fixes are productive, positive habits associated with feelings of pride, happiness, and achievement: the enjoyment of tasty, delicious whole foods, gardening on a sunny day, or taking a long walk with your best friend. When False Fixes prevail, Healthy Fixes are tossed aside. The seductive lies of the False Fixes now occupy center stage. In pursuit of each False Fix, you create self-defeating habits to support your habit. You start to set up rituals surrounding your bingeing. And voilÃ , you're ensnared in your own endless vicious False Fixâseeking cycle.