A good nutritional diet and addiction recovery go hand-in-hand. People forget that stress and depression mostly start in the brain, in the mind. So a good and healthy diet will help solve some brain inflammation and other negative things. To learn more about nutritional diets, join your host Tim Westbrook and his guest Kristin Kirkpatrick, MS, RDN. Kristin is a senior fellow at Meadows Behavioral Healthcare. She is the creator of their fuel well nutrition program. She is also the lead dietician and manager of the wellness nutrition services at Cleveland Clinic. Learn how nutrition helps addiction recovery. Learn why fish and plant-based foods are critical to your health. All of that and more in today’s episode.
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How Nutrition Helps Addiction Recovery With Kristin Kirkpatrick
I’m here with Kristin Kirkpatrick, who is a Senior Fellow at the Meadows Behavioral Health and creator of their Fuel Well nutrition program. She is the lead dietician and manager of the Wellness Nutrition Services at the Cleveland Clinic. She’s also a Bestselling Author, Experienced Presenter, and Award-winning Dietician. She has also contributed to national publications, including The New York Times, Wall Street Journal, TIME, Runners World, Oprah, Martha Stewart Living, Food Network, Women’s Health, and The Huffington Post, to name a few. She’s also on Dr. Oz’s Medical Advisory Board. Kristin and I will talk about nutrition and wellness as it relates to addiction recovery.
Kristin, welcome to the show.
Thank you, Tim. I’m so excited to be here because I feel like the topic that you’re covering is so important, and you hit the nail on the head. People probably see therapy in a vacuum. I like to change one thing. I know that’s the way my patients look at nutrition, and there’s so much more we have to change.
Stop doing drugs. When people talk about, “Can I take a pill to stop drinking?” I was like, “Recovery is so much more than that, and life can be so much better on the other side of recovery, but you got to do everything.” It’s like baking a cake. You can’t bake a cake with 1 or 2 ingredients. You got to put all the ingredients in for the cake to come out and taste good.
It’s so important because you have to do some work to get on the other side. I’m sure this is true, especially because you’ve lived it and I’ve lived it from a nutrition perspective and then see patients. If you can get to that other side, it’s wonderful. A lot of my patients are like, “Here’s all the reasons I can’t do it, all the barriers, the big wave that I can’t get over,” but if you can get over that wave, you’d never go back to the other side of the ocean.
It’s hard to see what’s on the other side if you’ve never experienced it. If they’ve never experienced it, they don’t even know it’s possible. One of the things that many people say in an AA meeting is I’m a grateful recovering alcoholic. If you’re a newcomer, I know when I was a newcomer, I’m like, “What are they talking about?” This is a fate worse than death to be a grateful recovering alcoholic. I’m one of those people that says, “I’m a grateful recovering alcoholic because my life is amazing now. It wouldn’t be the way it is now if I didn’t go through what I went through.”
In all my years of practice, I like to think about what are the most impactful statements that patients have made to me. I think this has always remained at number one. I had a patient that I was helping with sugar addiction. She didn’t have a weight problem. On the outside, her life looked perfect. She’s a complete sugar addict. We worked together for a very long amount of time. On our last session, when she finally felt she got on the other end, she said to me, “I never realized how bad I felt until I felt good.” It was interesting that her norm was feeling bad. She didn’t think there was any other way to feel because she had been so used to feeling the one way for so many years that it’s how people feel, and then she felt good and realized, “I’ve wasted all these years feeling like crap.”
I had some comprehensive blood work done back in December 2020. I’ve had comprehensive blood work in the past, but I had this comprehensive blood work done. Dr. Rebecca Miller said, “Your thyroid’s not functioning 100%.” I was like, “What does that mean?” She said, “You’re probably tired.” I was like, “I feel okay.” To your point, that was my norm. My norm was I needed eight hours of sleep. I wasn’t totally alive and awake. She said, “You watch in 90 days after I put you on this thyroid medication, you’re going to feel a lot better.”
Sure enough, 90 days later, I’m going, “I feel so much better.” I have so much more energy. I don’t need as much sleep as I thought I needed. I need six hours of sleep. I don’t need eight hours of sleep. It’s crazy. People get used to living and feeling a certain way until they get to feel what it’s like on the other side. Once they’re on the other side of it, they’re like, “This is so much better.” What is an RDN?
It’s a Registered Dietician Nutritionist. Let me tell you why that designation was changed by the Academy and credentialing for registered dieticians years ago. This brings up an interesting point. Most of the consumers of the community, whoever you speak with, see someone who will call themselves a nutritionist and then say, “You’re a nutritionist. I’m going to go and see you.” Legally, anyone can call themselves a nutritionist whether you have the training, you don’t have the training, or whatever it is.You can't just take a drug and expect to be fixed. Click To Tweet
To become a registered dietician, you have to go through all the schooling, an internship, sit for an exam and then keep up CEU’s. The Academy changed it from Registered Dietician to Registered Dietician Nutritionist because people did not recognize the fact that every registered dietician is also a nutritionist, but every nutritionist is not a registered dietician. That’s why we changed the labeling of how we have our credentialing behind our names. It’s a little fun fact.
It’s great because it’s like, “We have a nutrition expert on staff. Who’s that?”
How do you define expert? I’m biased. I know people that will say that they’re like a wellness or nutrition expert. It’s because they’ve read a few books and that’s the title they give. If you’re looking at your population base, you have people that are struggling with addiction, have type two diabetes, heart disease, and renal failure, that’s where a nutritionist is not going to be a nutritionist or however you want to look at that. It might not be as helpful because we’re delving more into the medical points of some of these things.
What gives you the right to claim you are an expert on nutrition and wellness, which we covered a little bit? Beyond the education, the credentialing, and all the other stuff that you went through, do you have anything else to add?
There are some nutrition certification programs, but as a consumer, you do have to look very carefully. You have to look at what’s the educational background. Do I care about that? To speak, quite frankly, you might spend less money on someone who has a certification in nutrition than you might a registered dietician. There are all these things. You also have to look at your overall goals and things like that. What gives you the right? It’s like, “We could go down the rabbit hole on that one on a lot of different things now.”
What specific incident inspired you to be so passionate about nutrition and wellness? Where were you? What happened? Who were you with?
For me, it was more about who I was. You used to be a different person before you were sober. I used to be a different person before I changed my relationship with food. As a teenager, I was obese. I went to my annual exam with my mom. I had blood work done. My physician told my mom, “It looks like she’s like maybe insulin resistant. She’s got to see a dietician. She got to lose weight.” I went to go see this dietician. She was very nice. Here I walk in this obese kid, very unsure of themselves. She was perfect by my means, perfect body and bubbly. Everything was perfect.
She said, “What do you think you’re doing wrong?” I said, “I probably shouldn’t eat the cookies that I’m eating in the middle of the night. I do that. I overeat like here and here.” She’s like, “Let’s start with this. Let’s stop eating the cookies in the middle of the night.” I feel like at that young age, you can’t take a drug and be fixed. This person didn’t recognize the fact that I wasn’t eating the cookies just to eat the cookies. There were much deeper meanings of why I was making a choice.
She didn’t understand that we had to delve into those meetings before I could even change the habit. I think behavior change is so critical and difficult. Diet is the one thing that is non-negotiable. We can choose not to exercise, manage stress, but we can’t choose to eat because the diet is associated with survival. Over time, if you stop eating, you will die. If you’re in the forest and you have lack of food, you will die.
For me, it was more about the perspective of I want to get into this because I feel like I can understand when someone who was overweight or addicted to food says to me, “I had a sleeve of Oreos last night. Don’t hate me. I have a sleeve of Oreos.” My answer back to them is like, “No, don’t hate yourself. That’s a normal reaction to some stimulus that you had. You medicated with food. Let’s get back to why you medicated with food to begin with.”
What I hear was when the person you spoke with said, “Stop eating the Debbie’s Nutty Bars.” You were addicted to these Debbie’s Nutty Bars? What I think about is the people that are successful at staying clean and sober are the people that are focused on living a new life. Not the people that are focused on stopping the drinking and the drugs. It’s like, “I can’t have a drink, shoot up, or smoke a cigarette now.” It’s the same thing with food and nutrition, “I can’t eat a cookie or a sleeve of donuts.” If you’re focused on not eating a sleeve of donuts, that’s temporary. It’s not sustainable. Would you agree with that?
I totally agree with that. Along the lines of what you were saying is when I’m seeing patients or when they come in and they tell me what their goal is, for many of my patients, their goal is, “I want to feel better. I want better at better mental health,” but still a huge chunk of my base is weight loss. Whatever the goal is, I always tell them that I need three whys on the motivations to do this. Only one of them can be vanity-related and vanity is totally fine. We all want to look good in clothes. I want to look better on my jeans, whatever the case may be, but two of them can be vanity-related. I want to not develop Alzheimer’s as my mother did. I want to live longer than my siblings did.
I want to get on the ground and play with my grandkids. It’s those motivating factors that we know are more to lead to sustainable action. You’re the expert here, but I would assume the why is as important. I shouldn’t drink so much. It’s ruining my relationships and it’s ruining my health, but what’s the why? What’s the motivating factor that keeps you from drinking in 30, 60 and 600 days? I think once we can identify the why, we’ve got a good motivating factor of why we have to make that change to get to it.
Does anyone not come up with a good enough why for you?
That’s why I always give them the give me for the vanity. If your why is, “I want to get back into my prom dress or my wedding dress.” We’re all driven in different directions and molded from where we started in our childhood in terms of food and what we were taught in our childhood. I would never want to judge my why. I think most people have whys that make sense to them. My role is to support that but to help them get over the finish line based on the rationale they gave me. If their why is a little bit BS, it will come out over time. I didn’t want it that bad. If it’s not one that I think is good, I think that will be revealed by the patient and to the patient within a matter of days.
I think that’s like BJ Fogg’s Behavior Change Model, Motivation, Ability and Prompt. It’s like, “What’s their level of motivation? Why are they motivated to change? Their ability, how easy is it to change the behavior?” Maybe in the short run, the ability is a little bit easier, but then once they’re triggered, at an event, in an environment where there’s lots of junk food. They’re at a festival, fair or something like that, it gets a little bit harder and their motivation is not high enough. There’s no way that they’re going to be able to stay on the path.
I think that speaks very well to what we were discussing at the beginning of this talk, which is looking at that vacuum. It’s not about stopping to eat something. There was a study that came out in Jama years ago. The title of the study said that “Obesity and bad eating habits were contagious.” Essentially, were where you chose to be could impact your ability to be able to lose weight or if we don’t even look at weight in this calculation, talk about healthy eating. If you are in an environment where healthy eating is not supported or condoned, you’re more likely to make bad decisions.
If you’re with people that aren’t supporting that, we’re talking about different things but we’re talking about the same thing and that’s behavior change. As you probably know, someone can tell you until they’re blue in the face like, “Of course, I support your effort. I want you to eat healthier and I’m so happy for you.” When you go out to dinner to be like, “One bite is not going to kill you.” We have to look at those places and look at, “What’s my circle. Who is my tribe? Is my tribe truly supportive of me to help me reach that finish line?”
You are the average of the five people that you spend the most time with. That’s in every area, exercise, fitness, food, recovery, work, how much money you make. That rings true in all different areas for the most part.
Can I steal that line in a future presentation, Tim, because I love it?Success is not short-term. Success is being able to do something long-term. Click To Tweet
It’s all yours. Take it. In our homes, we provide all the food. The reason we provide all the food is that environment is so important. If I’m the one providing all of the food and the food is all good, high quality, organic, whenever we can, we purchased another pasture-raised cow. Based upon the last interview that we did, we talked about grass-fed versus grass-finished. We purchased another cow from a ranch up in Wickenburg.
It’s pasture-raised. It’s an amazing thing that we do. If I provide the food, as opposed to the standard sober living home or the average sober living home, where most people buy their food. You end up with a refrigerator full of hot pockets, frozen burritos and top ramen, and everybody steals each other’s food. That’s a huge problem. I like to have some control over the environment. To your point, the environment always wins.
That’s why what the Meadows did with fuel well is so groundbreaking. They looked at what do we do good. They do therapy in addiction and trauma good. What can we improve? That’s where our relationship began and now, they do their food good as well. We have to look at what are the keys to success? If they come to me after three months and they’re like, “I’m eating so good. I’m one of your success stories.” I tell them to come back to me in five years and tell me you’re still eating good then you’re a success.
Success is not short-term. It’s being able to do something long-term. I think for the Meadows to take the process of what they do in an amazing manner and then transfer it to now, let’s feed people in the right way is incredible. I commend you for saying, “I’m going to provide my food because if I don’t, there’s no real credibility to you and having any conversation about diet.” For you to tell people like, “It’s important that we get off of sugar and we start eating more nutrient-dense.” I’ll see everyone at lunch and lunch is crap, then no one is going to listen to you.
I liked what you said about the patient that comes to you and says, “I’m doing well after a year.” Your response is, “Come back to me in five years.” I remember when I celebrated five years of recovery from alcohol and drugs, people said, “Congratulations, you’re no longer a newcomer.” I was like, “What are you talking about? I’ve been around forever.” I think it’s with everything. It takes five years.
If you’re still sober in five years, then we’ve got something to celebrate. I think the statistics are people that make it to one year of sobriety are 67% are going to make it to five years. People that make it to five years are 85% likely to stay sober for the rest of their lives. I don’t know how true is but they sound good to me.
In some ways, when you’re in front of the five years, it could be so overwhelming. Five years seems like forever, but then one year is not. One-year flies by. Even to that, what’s been a little bit concerning to me is looking at the people that have done great for five years-plus and then went back to a bad habit during the pandemic. I think that has changed things as well. I’m not even talking about, “Yes, we have seen about a 30-pound average weight gain during the pandemic,” but I’m talking about there are more processed foods being purchased. There’s more food being consumed as a way to cope as a way to manage stress. That has increased. I think that what that has taught me is that you can be at five years and be awesome and I’m so proud of you, but something major can break even the most resilient patients. I’ve seen that in the past several months while we’ve all gone through this together as a nation.
You’ve got the isolation, which is the opposite of human connection. People are isolated. They get triggered. Their depression and anxiety increase. The result is that they’re more likely to act out on food, sex, drugs, and alcohol. That’s happened and we’ve seen it happen.
We have surveys that have shown it too. I remember when our governor said that he was going to close down the liquor stores. I remember it was almost comical how this occurred. It turned out to be this breaking news in the Denver area, looking at these people making a mad dash for the liquor stores, the lines down on the sidewalk, and within a span of two hours, he reversed it, and he said, “We’re not going to close down the liquor stores.” I was like, “What a testament of human behavior in a time that was very stressful obviously, but also full of a million different unknowns.” We still have a lot of unknowns, but back then, it was even more. I feel like how interesting to see the mindsets of how people are reacting to this.
You started talking about the Fuel Well Program. Let’s talk about the Fuel Well Program you designed for the patients at the Meadows along with what diet is recommended for an addict early in recovery?
For the Meadows Fuel Well Program, our goal is patients, visitors, and guests. Even though it was something I thought of, I’ll tell you they had an amazing team that I worked with, including their chefs, to be able to come up with how it is implemented. When you look at the top foods that we know are associated in the field of Nutritional Psychiatry in relation to helping with addictive disorders or trauma, things like that, we have to go more clinical and go back to the brain.
When we look at things like depression, for example, we know that there are inflammatory factors associated with depression. If we can reduce inflammation, as we have seen in multiple studies, we can help with some of those factors and that can help with depression as well, amongst other things. What are some of the biggies? I think getting more omega-3 fatty acids is critical. Those are one of the main things that we’ve seen in terms of mental health outcomes and some of the trials that we’ve seen.
If someone is like, “I hate fish. That’s not happening,” we can look at Omega-3 supplementation. I do think the marine base is critical. Looking at EPA and DHA, which is what a salmon has within it as opposed to ALA. It’s still great, alpha-linoleic acid in the plants, walnuts, chia, things like that. If I were to say, “Here’s my pie in the sky, I would go the marine base.” That’s critical.
On that note, you said salmon, what about other fish? Does it matter? Is salmon the best? What about halibut, mackerel, trout or tuna?
They’re all great. Let’s say that number one, you want to find fish that has low mercury. How has mercury determined in a fish, the age and the size. Tuna is huge and it’s got a lot of surface area. The more surface area you have on a fish, the more likely they can absorb more mercury, which is why tuna is a high mercury food despite the fact that it also has Omega-3 fatty acids. The reason why things like sardines are so fabulous is because they’re so tiny. You’re going to get virtually no mercury. There’s that component and it has Omega-3 fatty acids.
I think from the Omega-3 perspective, wild salmon, lake trout, small amounts of tuna are fine. Those are all great options to think about. A lot of people don’t like sardines, but sardines are another great option. When you’re thinking of Omega-3s, if we get out of the fish world, which is obviously the marine base, then we go back into that plant world, walnuts, chia seed, flaxseed, things like that. If you look at the general dietary guidelines, the recommendation is probably about at least two servings of fatty fish a week.
A serving is probably like your fist. That’s what a serving looks like. I think the most important components are low mercury and wild. The thought process is, “I want the wild salmon, but I can’t afford it because when it’s fresh, it’s expensive.” Maybe you look at a canned version and determine how do I utilize canned salmon within my diet?
Speaking to mercury, let’s say someone eats a can of tuna every single day. What potentially could happen with high amounts of mercury?
You can definitely get mercury toxicity. There’s no doubt about that. I’ve seen that probably not a huge amount of my patients, but I am an integrative medicine. We do tend to see patients that are more likely to have things like heavy metal toxicity. Mercury would be one of them. If you have too much mercury, that could affect your brain and everything else. I think that’s something to think about.
I once had this patient, this is so interesting, but it speaks to the mercury. I couldn’t figure out what was going on with this person’s symptoms. We were thinking mercury because of the fact that it went along with what we knew in the literature related to mercury toxicity and behavior. This guy had no mercury in his diet. What we later discovered was that he’s a huge fisherman constantly had the hook in his mouth while he was doing everything else to get the line. He was fishing daily.Eating too much of anything isn't a great idea. Click To Tweet
The mercury was there. We were right, but it wasn’t coming from diets. The thing is that sometimes you have to go and look. We need an integrative or functional. I’m not a functional dietician. I’m integrative, but a functional approach would also be warranted for things like that to determine, “Am I having too much?” I don’t know if you remember, but I think it was Jeremy Piven.
He was public about this. He had this huge sushi habit and then he was like, “I found out that I have mercury toxicity.” I think with tuna, two servings a week is probably fine. If you’re pregnant less than that. We can take that discussion of tuna and related to other places like getting too much of anything is probably not a great idea. Let’s eat real food and small amounts of it.
Folate is going to be found in green leafy greens. It’s also going to be found in beans and legumes. The folate discussion is good because it gets to the discussion of gut microbiota. We have found again in Nutritional Psychiatry that the gut is a huge driver of mental health. If we have good gut microbiota, which we know is determined by what we call microbial diversity, we’re more likely to have better outcomes with mental health.
Leafy greens are great for guts. Beans and legumes are great for the gut because of the fact that it’s got fiber. Having a higher fiber diet is impactful as is having whole grains, things like that. You can find folate in that as well. I think the one thing I brought up the last time I spoke on your show and I definitely speak about it at the Meadows is cautioning your patients that you see if they feel, “I have brain fog,” things like that to consider doing a little bit of nutrigenomics testing to determine if they have what’s called an MTHFR deficiency.
If you have an MTHFR deficiency, which is genetic, it does not allow the process of folate to enter the brain. MTHFR is like the chaperone that says, “I’ll take you up through the blood-brain barrier and we’ll put all your folate up in the brain.” What happens is folate enters to go to the brain and there’s no chaperone. You don’t have it. You have that deficiency. It’s like, “What do I do? I’ll go back.” When we have MTHFR deficiencies, for the most part, as a dietician, I’m always recommending whole foods.
We know that is the most powerful, but with individuals with those certain genetic variants, we also have to look at what’s called the methylated folate, which is a folate supplement with that methyl group or chaperone already attached. That’s over the counter. That is not a prescription, but it’s definitely worth talking to your physician, whatever your patients are to say, “I’m thinking I want to get this MTHFR check to see if maybe if I have folate from leafy greens, it’s great, but maybe it’s going to be better if I get it through methylated folate.”
How does a person know if their gut microbiota is in good condition or in good working order?
Clinically, you got a poop test to see what your microorganisms look like. For the most part, where we see associations with that is heavy alcohol use will disrupt a good microbiota. If you’re tired, stressed, there are so many things that can point to, “Let’s look at your gut health.” What I tell my patients is, “Instead of giving me a sample of your poop, why don’t we work towards a good, healthy microbiome?” We know the science of how to do that. We can make it as simple as possible. We can look at components such as let’s get more color in the diet. More color means you’re eating more plants. It also means you’re eating a diverse number of plants. That gives you more nutrients and things like that from that perspective.
It will be interesting to see if we have studies that will come out in the next few years because one of the detriments of a good microbiome is excessive cleanliness. Though we have chilled out a little bit, you can’t walk any place without seeing five bottles of hand sanitizer at the cash register. We are definitely hand sanitizing a lot more than usual, and that’s taking away our good bacteria and our bad. It’d be interesting to see if we have data years from now to show if it did help the gut microbiome?
Obviously, we still need to do it. We need to protect ourselves, but the gut microbiome has an impact on immunity as well. Looking at folate and those types of things, more fruits, more vegetables, looking at gut health, those are the main components. We can go to what I would call the negative aspects of conversation, so less sugar and less refined grains. If you can cut those two out of your diet, your microbiome is going to be so much healthier.
We’ve got salmon, Omega-3s, folate, Vitamin D, foods with color, plants, veggies, so forth. What else?
I’ll mention Vitamin D again because I didn’t say it yet. Vitamin D that’s where you’re definitely looking at a supplement. For your patients, go and find out what your level is, number one. You could go to Target, get a Vitamin D supplement. 2,000 International Units is probably going to be the norm of the measurement and that’s fine, but maybe you’re not warranted for that. Maybe you need to take 5,000 International Units a day to get your levels up.
We know that Vitamin D is very closely tied to depression. I always say, go find out your levels. Once you find out your levels, work with your physician or your dietician to determine the dose. Obviously, this also impacts where you live. I’ll never forget, Tim. I was doing a presentation in Scottsdale. I’m not from Scottsdale and I made a statement, I was like, “No one in this room probably has Vitamin D deficiency.” They’re like, “We probably all do because we stay in the air conditioner all day.”
Walk around Scottsdale in the summer, nobody has a tan. The only people that have tan are people that went somewhere else.
For someone like me, I’m not from Arizona. That was a real eye-opener. Everyone’s Vitamin D here was great. The way we get Vitamin D from food is very inefficient. It has to convert from a form that the body doesn’t understand to a form the body does understand, and that’s a very disjointed process. That’s why you could eat salmon until you’re blue in the face. You could be drinking bottles of Cod liver oil. It probably won’t have a huge impact on your Vitamin D level. It’s the UV rays of the sun.
We don’t want everyone hanging out with the UV rays, we supplement that route. I think the last thing I would say with that is again, have your patients work with their clinicians, whoever they’re working with, to find a reputable brand. Branding in supplements is very important. Sometimes you do get what you pay for. Getting something high quality would be something I would look at as an important factor of that.
Those are the big ones. You and I could talk for an hour about the gut and hit all those foods. It depends on where you look at it. Obviously, with your gut microbiota, if we look at the data, we do know that obese states typically lead to negative gut microbiota. We know that stress can lead to the negative gut microbiota, poor microbiota. People could consider doing things like taking probiotics, things like that, getting more fermented foods in that could help, Sauerkraut pickles, things like that. The reason that people are calling the gut the second brain is because we recognize how much of the body it controls. That’s powerful.
How important is having a healthy gut microbiota to someone in recovery from addiction?
It’s very important because if you don’t have a good microbiome, then you’re going to fall back into some of those same things that perhaps brought you to addiction to begin with. Not being able to manage stress, feeling like crap and wanting to get out of that state of, “I feel like crap, I need something to get me to feel good again.”
At a high level, it’s important because as you go through addiction and recovery, and coming from someone who’s not a mental health expert, I feel like you said it in the first line of this show, everything has to recover in order for you to keep that addiction from rearing its ugly head. To get out of an addiction treatment program, and then the second you pull out of the place you go to McDonald’s, talk about going back to bad habits, even though that bad habit might not be drugs or alcohol.Get more color in your diet. More color means you're eating more plants. Click To Tweet
All of the things that you mentioned, all the types of foods, what’s the main goal or what’s the benefit of eating those foods? I think of two things, inflammation and brain fog.
If we take brain fog to a greater degree, it generalizes better mental. When you’re fueling better, you’re feeling better. It’s not something that’s a nice thing to think of and say, “That makes sense.” We have data and science now over decades worth to prove that. From that perspective those are some of the benefits. From the patient perspective, that can be overwhelming. It’s like, “Here I am. I’m going to your treatment center, Tim. I have to stop taking drugs or alcohol. I have to tap into what my childhood was like. I got to figure that out and the trauma and everything associated, and you want me to eat more vegetables to out of your mind? I can’t make all those changes.”
A baby steps approach for diet is important and the semantics of it. As we go through treatment, think about what it looks like once you’re out of here. Once you get home, what do you want your fridge to look like? That’s going to make a difference into your success and ability to maintain good mental health status, and then take that baby steps from there. I’ve had plenty of patients that will come to me and I’ll say, “Why are you here now? Why do you want to work with me?” “I want to improve my eating habits and live longer. I’m not giving up bacon.” “Don’t give up bacon then. That’s fine.” Let’s not kill ourselves for what we have to give up. Let’s look at what we can add. We can still keep some of those other things in.
Why is it that someone might crave a bowl of ice cream, a piece of pie or a candy bar, but they don’t crave a plate full of broccoli?
It’s because of the hyper-palatability of it. We have something in the food industry called hyper-palatable foods. Those are foods that do two things. They open up neurotransmitters that make us feel calm and relaxed. That’s number one. They also hijack areas in the brain that make it impossible for our normal digestive enzymes to come out and say, “You were done eating.” I think about when I was a kid and watching Sesame Street, and I would see the commercial with that guy with the Lay’s potato chip bag. I don’t know if you remember that commercial, Tim, but the guy was a devil.
You know never would they run that campaign now because it’s true. You can’t have just one. That’s the thing when you’re eating things that are very hyper-palatable, it’s very difficult to stop either because your brain is hijacked into not getting those symbols of, “I’m full.” You don’t get that fullness response or you’re feeling great during it. That’s very different from broccoli. That’s the physiological approach. If we look at the mental approach, I think I said this on your show last time, I don’t know about you, but when I fell off my bike as a kid, my mother never ran up to me and said like, “It’s going to be okay. We’re going to go inside. We’re going to have a big bowl of broccoli.”
When we look at where we have adapted as humans and our diet, it is not physiological. It is learned behavior. We have learned at a very early age that when something bad happens, food will soothe it. It’s hard to get out of that mind frame. We are offered certain things in childhood that make us happy, that reward us, whatever words you want to use.
Once we become adults, we seek out those same foods to get the same response that warmed our hearts when we were a child. That’s one of the reasons why broccoli, things like that, plants don’t give you those high of serotonin, norepinephrine, and dopamine. Some plants do some lentils and things, but not to the impact that other processed foods can.
Broccoli is nourishment. It’s what your body needs, but it doesn’t do anything. It doesn’t give you a high or make you amped up.
When you’re not stressed, your mind is not, “I want to avoid getting heart disease 50 years from now.” Your mind is, “Feel good now.” Broccoli isn’t going to do it.
Is there a different type of nutrition program for a person with an eating disorder versus an alcoholic or a drug addict in recovery?
I don’t know much about eating disorders because eating disorders are all mental health. Not so much diet. I’ve had plenty of patients that have come to me and said, “My daughter, my son, I would like them to come see you because I think they have an eating disorder.” I don’t see those patients. I would send them to the Meadows. I would send them to places that have that expertise. I don’t have that. It’s hard for me to comment on that.
Why do addicts early in recovery have sugar cravings? Myself, for example, when I first got clean and sober, I’m eating cake, pie, ice cream, and Jolly Ranchers. I gained twenty pounds. Why is that?
It is replacing one addiction for another. That’s probably the simplest way to look at it. Looking at the fact that having things that are high in sugar do make you feel good. That feeling doesn’t last. We’ve seen it as well. For example, bariatric patients go through bariatric surgery. They lose weight. They are no longer addicted to food and become addicted to sex. We’ve seen addiction trading in some of these things because now I can’t eat food. I’m not allowed to. I can’t feed that addiction. I’m going to do it in another manner.
For whatever reason, sex pain seems to be the one that we’re seeing the highest percentages of as well as seeing the latest amount of data. That’s what it boils down to. I can’t have alcohol or I can’t have a drug and both those things maybe feel on top of the world. What else is going to make me feel on top of the world that no one’s going to yell at me for having, and that’s a big bag of gummy bears?
Where’s the solution? When someone’s in pain, irritable, discontent, what’s going to give me some fulfillment? What’s going to make me feel better? What’s going to give me some relief, cake, pie, ice cream, candy, gambling, Facebook, TikTok?
We see addictive properties in the data with sugar. We don’t see addictive properties as much in salt, but I also think it’s also where you lie. For some people, the cake and the ice cream and all those things are going to be critical to feeling good, but for other people, that is going to be that bag of potato chips. It depends on are you more on the salt factor or are you more on the sweet factor? Where are you going to be? Is a baguette with butter going to make you feel better than a bag of gummy bears? For some people, the answer is absolutely yes. For me, it is. I’d much rather have the baguette with butter than the gummy bears.
I used to be a salt person. I would more want the chips, pizza, or something like that, as opposed to the candy, the cake or the pie, but I’ve changed. I like sweets more these days.
I’ve seen that as well. I’ve seen change on both. I don’t know what the mechanism is. My only thought process is at some point, you probably had more of the other and that then fueled the ability to want more and to crave more.
What’s your opinion on intermittent fasting for a person in recovery?The gut acts as your second brain. Click To Tweet
I love intermittent fasting as long as that person in recovery is not also working through disordered eating as well or diagnosed eating disorder. For the person that doesn’t have that as coming along with them in recovery, that intermittent fasting is good. I think it taps into how we are supposed to eat as a species. We are not supposed to eat around the clock yet. We do because we live in an environment where that is not only fostered but encouraged. There are so many studies on intermittent fasting that show the benefit that it’s hard to argue against. Let’s limit our eating hours to eight hours a day. I think we can all benefit from something like that.
Give your gut a rest.
We eat around the clock again because we can and it’s encouraged. We’re hit by marketing. When you go home and you drive home, count how many fastfood restaurants you’re going to pass, a lot.
Even for someone who works out on a regular basis, they say you should eat every 2 or 3 hours or something like that. What ends up happening is that you spend all your time eating or thinking about food. I think about food all the time.
There was an interesting study that came out of Duke. It’s fascinating. It showed that our metabolism doesn’t change from 20 to 60. When I say we, I’m also referring to me, 45-year-old woman. It’s my metabolism. That’s why I don’t fit into my wedding dress. I got married at 29. Studies show that it doesn’t change at all between 20 and 60. The other interesting component is not to say we shouldn’t exercise. We should. There are so many cardiovascular vascular benefits and mental health benefits, but to exercise for the goal of weight loss, this study and others that this author did show that it’s not going to make any difference.
What exercise does is it makes you more hungry. A lot of my patient base makes them more willing to eat more like, “I’ll have that pizza. I ran five miles now.” They’re still over-fueling. They still haven’t met that nice equilibrium. Never would I say to someone don’t exercise. I love to exercise, but don’t count on exercise to be your key for weight loss and weight management.
I used to think that I always needed to eat because I didn’t want to lose weight. I don’t want to get too skinny. I think I need to eat all the time. I’ve realized like I don’t need to eat all the time. I’ve started intermittent fasting. I stopped eating 3 or 4 hours before I go to sleep at night. I used to think that I needed to eat because I would wake up in the middle of the night. I’ve learned to embrace being hungry. That’s one of the best things I ever learned. We don’t need to eat all the time. I’ve got plenty of fuel. Food is fuel. I heard you say that the last time we spoke. The last thing you need right before you go to bed is fuel.
You’re going to sleep. Let’s say you deplete your glycogen stores during sleep. You’re not going to die. Your body is going to tap into fat. That’s fuel number two that go into. From that perspective, the body is incredible. It goes through major metabolic adaptation for the sake of survival. I think like when you’re feeling hungry and you’re about to go to sleep, you’re not going to die during the night. Your body is going to keep you alive and all the systems are still going to work.
Is there a question that you’ve always wanted to be asked, but the interviewer never got around to it?
One of the questions that I don’t get asked enough, but I get asked not by interviewers but constantly by my patients is, what’s the best diet out there? There are many diets. There’s so much information and no one likes my answer. It’s totally non-sexy. The best diet out there is the one that’s nutrient-dense, fits within your environment and when you can sleep in. For everyone, that’s going to be different. I have patients that hate intermittent fasting. I have patients that do awesome with keto.
Others say, “I can’t sustain keto.” We go back to this measure of success, whether you’re an alcoholic or you’re a food addict and look at, “Success is not measured within three months.” What diet can you stick to? To most people, if you look at the studies, it boils down to the basics, eat more plants, listen to your hunger, intermittent fast, go back to the basics.
What I’ve heard you say in the past is to eat whole foods.
Eat whole foods at least 90% of the time. A lot of clinicians will say, “Make it an 80/20.” I think people are better than that. I think you can go 90/10, still have that Oreo and ice cream if you want to have it. If you’re going to have ice cream, have real ice cream, enjoy it. Don’t feel shameful about it. Part of changing how we look at food and nutrition is also related to part of how we look at changing our relationship with food. Food cannot be entertainment or the mental health that we’re looking for or the drug. Once we change the semantics and look at it as fuel, we’ll be in a much better place.
Food is fuel, that’s it. When you go out to dinner with a bunch of friends, that’s entertainment.
You’re distracted when you go out to dinner. There are studies on this. Think about how much we eat out to dinner related to, “I am sitting alone at my kitchen table.” It’s a huge difference.
What’s the definition of whole food or real food?
I steal mine from Michael Pollan. He still has the best one out there and he defines food as something that comes from nature, is fed from nature, and will eventually rot. That is food. When you have your meat from that pasture-raised grass-finished cow, you are eating food, but if you go out to dinner, you and Tim get a cheeseburger that’s factory-made. It’s coming from KFO lots, the cows are eating grain, they’re not eating any grass, and they’re not eating from nature, now you’re no longer food. That’s the best definition of food because it takes us back to the most primal way of eating. It’s something that is coming from nature, a plant or an animal, but fed from nature is critical. Obviously, the eventually rot portion of it is having to do with the fact that it’s void of preservatives, additives, or things like that.
Kristin, I appreciate you so much. Tell people where they can find you or how they can find you or how they can learn more about you?
Thank you so much, Kristin. I appreciate you so much.
- Meadows Behavioral Health
- Cleveland Clinic
- Kristin Kirkpatrick
- BJ Fogg’s Behavior Change Model
- Meadows Fuel Well Program
- Show – Past episode
- Metabolism changes with age, just when you might think
- @FuelWellwithKrissy – Instagram
About Kristin Kirkpatric MS, RDN
Kristin Kirkpatrick MS, RDN is a Senior Fellow at Meadows Behavioral Health and creator of their Fuel Well nutrition program, she is the lead dietitian and manager of the Wellness Nutrition Services at the Cleveland Clinic. She is also a bestselling author, experienced presenter, and award-winning dietitian. She has also contributed to national publications including The New York Times, Wall Street Journal, TIME, Runners World, Oprah, Martha Stewart Living, Food Network, Women’s Health, and The Huffington Post just to name a few. She is also on Dr. Oz’s medical advisory board.