Why Willpower Fails: The Psychology of Food, Cravings, and Weight

18:00Dr. Mark Hyman:Rose liposomal DIMM is designed to actually absorb so your body can use it. If you've been told your hormones are, quote, normal, but something that still feels off, estrogen metabolism is worth looking at. So go to ronutrition.com and use the code HYMED for 20 % off site-wide. That's H-Y-M-E-N at R-H-O-nutrition.com. So 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?

18:36Dr. Rachel Goldman:Yeah. And I think the reason people can't distinguish the two today is because everybody's go, go, go again, right? 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 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.

19:14Dr. Rachel Goldman: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.

19:54Dr. Rachel Goldman:There is a craving you are having and it is a 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 going to 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 at bariatric surgery department, I was describing this in a support group. And it was actually a little girl there with her mom. And 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?

20:31Dr. Rachel Goldman:Because she knew she's not hungry. She's just opening and closing. 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 going to fill you differently. 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.

21:16Dr. Rachel Goldman:Maybe you're physiologically satisfied, but it was boring. You're probably going to want something else.

21:21Dr. Mark Hyman:Yeah, it'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. I also mentioned something really important, Rachel, that I want to 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 the 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 at fast food places.

22:00Dr. Mark Hyman:He goes to the drive-thru and he's a big Whopper or whatever. I don't even know what they're called. these places like Burger King or something. The guy said, I really can't change my behavior in this way. I just need you to help me, whatever he wanted help with. And my friend Mark Davis said, well, you can have the 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 five breaths and I want you to consciously and mindfully enjoy every bite. Please enjoy it. and the patient comes back to him and says, I did it and I tasted it and it was disgusting and I couldn't eat it.

22:47Dr. Mark Hyman:And I think most of us just don't pay attention when we eat 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 I think 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 find other ways to sort of address the feelings we're having? Because ultimately, if you keep doing with food, it's a problem. And stress plays a big role.

23:24Dr. Mark Hyman:I think also, I want to talk to you a little bit about stress because I know I personally, when I'm stressed and like everybody else, I get stressed 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 like, I want ice cream. And I'm like, oh, damn, I don't have any ice cream in the freezer. I just have frozen strawberries.

24:00Dr. Rachel Goldman:So I'm curious, what did you do in that situation?

24:02Dr. Mark Hyman:I had some dark chocolate because it was a little, 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 pine ice cream, which I would have, you know, and it 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.

24:38Dr. Mark Hyman: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.

25:13Dr. Rachel Goldman: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.

25:48Dr. Rachel Goldman:And like everything we talked about before with emotional eating and like taking that pause and checking 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 going to wake up and your body is going to need something different.

26:26Dr. Rachel Goldman:You're going to 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?

27:02Dr. Rachel Goldman: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.

27:20Dr. Mark Hyman:I think this is important. You talk about this coping toolbox and health behaviors. But I think 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 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. And I'll just tell you a quick example.

28:01Dr. Mark Hyman:I had someone go to one of my workshops. It was like a week-long workshop where we remove sugar, process food, and 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 I think I'm going to have a problem I said okay well let's just see how it goes I'm here you know like 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.

28:43Dr. Mark Hyman:And the second day she's like, I don't know what happened. Like all my cravings are gone. I don't want sugar. And so 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 we 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 do we deal with people who are just overwhelmed with these constant cravings and desire and stress-related eating?

29:24Dr. Rachel Goldman: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 you're talking about and that I'm talking about. Because you're absolutely right. You can't white knuckle your way to this. 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.

30:00Dr. Rachel Goldman:I try. It doesn't work. I'm a failure. but actually kind of the GLP ones 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, you know, pointing us in this direction of really proving that it's not about willpower, right? It is about biology because if you, like, 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, you know, it's hard, obviously, to do the behaviors.

30:39Dr. Rachel Goldman:But by doing what you did, similarly to GLP ones, if the GLP ones, 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 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.

31:23Dr. Mark Hyman:By doing what? Through like stress reduction techniques or what?

31:27Dr. Rachel Goldman:This was actually TDCS, transcranial direct current stimulation.

31:31Dr. Mark Hyman: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?

31:45Dr. Rachel Goldman: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 might be a piece of it but it's more complicated than that.

31:57Dr. Mark Hyman: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. If it worked, everybody would be skinny, right? It's like, oh yeah, sure. It 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.

32:34Dr. Mark Hyman: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 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, did a lot of work in this area. He did an interesting study. I call it the milkshake study where he took two different milkshakes. One was a higher glycemic milkshake.

33:08Dr. Mark Hyman:One was a lower glycemic milkshake. Another was 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 different milkshakes on different days. So they didn't know which milkshake they were getting.

33:40Dr. Mark Hyman:So they were, in a sense, their own control. So the one, when they had the regular milkshake, they were fine, there 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, cocaine, all this addiction stuff is actually triggering this biological addiction, which is quite amazing.

34:13Dr. Mark Hyman: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 not having control of yourself. 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 you talk about like this sort of coping toolbox concept.

34:52Dr. Rachel Goldman: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 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? First, 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.

35:27Dr. Rachel Goldman: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, 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 going to 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.

36:03Dr. Rachel Goldman:We know that lifestyle is so important. So thinking what's in my control 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 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, you know, again, bringing up the idea that stress management is so important and how we manage stress because life happens.

36:40Dr. Rachel Goldman:We all experience stress all day, every day. Even me, a psychologist, you, a medical doctor, like, you know, stress is happening. But it's how we manage it. You know, we can't eliminate it, unfortunately. But it's how we manage it, 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.

37:19Dr. Rachel Goldman:I don't like to classify that one as healthy or unhealthy, because 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.

37:55Dr. Rachel Goldman: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, 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.

38:25Dr. Mark Hyman: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 diet for 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. But if you use your diaphragm, you can't intentionally move that muscle, which is diaphragm is a muscle, that activates this relaxation response.

39:03Dr. Mark Hyman:And it's so important because people shallow breathe, they don't take deep breaths, they don't really properly oxygenate. And it's such an easy access point that you can just take five, You know, take five breaths into the count of five, out to the count of five. You can even hold for five at the bottom if you want. But like basically just do that for five breaths and you're going to be amazing. It's also something I should guess people do before eating. Because before eating, if they do five breaths before eating every meal, it resets their nervous system so they're not eating under stress.

39:38Dr. Rachel Goldman: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 really be intentional. Take that mindful breath. Take that moment to intentionally breathe. It's going to 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. And so, yes, it's literally within, with all my clients, I teach diaphragmatic breathing within like the first two sessions because I really truly believe it is so powerful.

40:21Dr. Mark Hyman: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 culture. 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. And I think people have this phenomenon, 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.

40:58Dr. Mark Hyman:And it's not healthy. So can you explain what that's about?

41:03Dr. Rachel Goldman: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 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.

41:54Dr. Rachel Goldman:And I think many people are kind of experiencing something like that now, just as you had just said, like, it's like about, well, you know, you have to be all organic, or I need to be all this, or, you know, I need to be clean, you know, 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 this flexible thinking, that's when it becomes problematic. And it can be quite problematic, just like an eating disorder or disordered eating can be.

42:27Dr. Mark Hyman:Interesting. So how do you advise people to sort of work with that? 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 five times and they like, you know, take out this, put in that, don't eat this, like that whole thing. How do you deal with that?

42:44Dr. Rachel Goldman:So, I mean, I think, you know, everything kind of falls on a continuum and you have the two extremes, right? But 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. You know, talk to your medical doctor, see a therapist, because that's kind of, you know, I always say that's kind of where it becomes tricky, right?

43:19Dr. Rachel Goldman: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, you know, 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.

43:53Dr. Rachel Goldman: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.

44:03Dr. Mark Hyman:Yeah, I think that's, that's true. I I think I definitely am focused on healthy eating. It's guided my life, my work, my career. 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 a Ritz cracker or a Cheeto. Like, it's just not going to happen, right? So I don't know if that's considered orthorexia, but that's kind of a hard line for me. Other than that, like, you know, 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.

44:40Dr. Mark Hyman: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, regular dairy, it's not sheep or goat, I'll get stomach issues, I'll get acne, I'll get congestion. And sometimes 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 it's, you know, it's, people don't understand that their biology can quickly shift, and you can kind of break these cycles 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 kind of have more control over eating, it actually kind of makes you feel ultimately less in control?

45:26Dr. Rachel Goldman:Yeah. So, you know, often what happens is, especially people that have kind of been restricting their whole life are 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. 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.

46:04Dr. Rachel Goldman:But it becomes this vicious cycle. And 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 and 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 heartnorexia, 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.

46:35Dr. Mark Hyman:And I don't eat the whole point. I'll have like a scoop.

46:38Dr. Rachel Goldman:You're probably very mindful.

46:40Dr. Mark Hyman:Whether I'm having a demanding week, pushing myself through a tough workout, or simply trying to keep up with everything on my plate, I know my body is constantly getting asked to respond and to recover. And that's why I think resilience is one of the most important markers of long-term help. And one of the best tools I found for that, both personally and clinically, is infrared sauna use. I think of it the same way I think about exercise. It's a beneficial stressor. You're sending your body to adapt, to recover, to come back stronger. And that's one reason I make time for regular sunlight and sauna sessions.

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48:11Dr. Mark Hyman:Get your first box at Zootopia.fish and use the code HYMAN for free shipping. Before we begin, I'd like to note that today's conversation explores one perspective of an area of medicine that continues to be actively debated. And while we discuss emerging evidence and critiques of current psychiatric practice, treatment decisions, especially involving antidepressants or other prescription medications, should always be made in consultation with your health care provider. The views expressed by my guest are her own and reflect her interpretation of the available evidence. My goal in hosting conversations like this is to explore different perspectives, to examine the science, to encourage thoughtful discussion, not to provide individualized medical advice.

48:50Dr. Mark Hyman:So if you're currently taking medication, please don't stop or change your treatment based on this conversation alone. Instead, use this episode as a starting point for an informed conversation with your healthcare team. My hope is that these discussions encourage curiosity, critical thinking, and shared decision-making between patients and their clinicians. So before we wrap up, if you found today's conversation on Lyme disease helpful, be sure to check out my upcoming conversation with one of the world's leading Lyme experts, Dr. Richard Horowitz. We go beyond Lyme disease itself to explore why so many people remain chronically ill.

49:22Dr. Mark Hyman:We explore his groundbreaking M-Sense framework for understanding chronic disease. and we also look at the biggest drivers of chronic inflammation and what it really takes to help the body heal. So be sure to check it out this Wednesday. Here's a preview. If you enjoyed today's episode, don't miss my upcoming conversation with Lyme disease expert, Dr. Richard Horowitz. We dive into why so many people stay sick and we look at the hidden drivers of chronic illness and a whole new way of thinking about inflammation and recovery and healing. It drops this Wednesday. And until then, here's a preview of what's to come.

49:55Dr. Mark Hyman:Yeah, well, the thing is, you know, I have been through periods of 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 seven in the morning. And I would literally have like a Drupal Espresso. I would have probably half a pint of ice cream and a giant chocolate chip cookie, and I'd go to work.

50:21Dr. Rachel Goldman:But you were in survival mode, right?

50:24Dr. Mark Hyman:Yeah, yeah. And, you know, I'd be exhausted. I'd be two 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 was the apple turnover.

50:35Dr. Rachel Goldman:You're like, it has apple.

50:36Dr. Mark Hyman:Probably not apples, but maybe it has apples. I don't know. Apple-like substances. I remember being in that state of like really craving and then 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'm like, give me that. Even if I know, like obviously this is what I do for a living. I know that's not my best interest, but I will often do it when I'm having that.

51:09Dr. Mark Hyman:Because I think sleep is another big trigger that people don't realize. So there's a lot of biological triggers for appetite and dysregulation.

51:16Dr. Rachel Goldman: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 going to 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.

51:51Dr. Rachel Goldman:Do I want to eat it? Okay, 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 what we need.

52:26Dr. Rachel Goldman:But really in that situation, we need to go back to sleep, but that's not always possible. So the other one is the answer in the moment.

52:34Dr. Mark Hyman:Yeah. I mean, it's the thing. When you put it on the fridge, what do I need? What am I feeling? And what do I need? Well, I'm tired. I need sleep. It's not like I'm tired. I to eat a cookie.

52:43Dr. Rachel Goldman:Exactly. Right.

52:45Dr. Mark Hyman: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 not be obsessed and be over-restricted, but also, you know, not be binging and eating stuff that's bad for you. Like how do you help people resolve that?

53:03Dr. Rachel Goldman: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.

53:38Dr. Rachel Goldman:I mean, I have two young kids at home, Like my life looks different today than it did 10 years ago. So kind of accepting that what maybe worked in the past isn't going to 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.

54:16Dr. Rachel Goldman:We're not bad for eating ice cream. You know, 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 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 like a certain weight or a certain food means you're good, quote, good. Like 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. Like those should be separate, right?

54:59Dr. Rachel Goldman:Like 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 exercise 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.

55:13Dr. Mark Hyman:Yeah, I think it's important. I think people don't understand how to do that. So that'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 like being hungry or wanting some food.

55:34Dr. Rachel Goldman:So to just clarify, also food noise is not like 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, right? Like 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, you know, 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.

56:16Dr. Rachel Goldman:What's the next thing I'm eating? When is the next time I'm eating? What am I eating? Did I eat enough? You know, am I going to need more? You know, 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, people are like, oh my gosh, I'm not thinking about food as much. I'm able to enjoy it. 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.

57:01Dr. Rachel Goldman:That when dinner time came with her family, she couldn't eat because she ate so much while she was picking. 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. Yeah.

57:27Dr. Mark Hyman:I mean, this whole GLP-1 revolution has certainly kind of shaken this all up because people have been wandering around their lives with these food cravings and food noise and this constant chatter in their head, when they take the shot, it goes away. So can you explain that and what happens to people's psychology when they experience that?

57:51Dr. Rachel Goldman: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, like I'm always curious, like, well, what are you going to do with that time now? Right? And oftentimes that's when the cognitive behavior therapy can start working, right? 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?

58:33Dr. Rachel Goldman: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. I think that, and wow, it's literally like this aha moment for so many people.

58:53Dr. Mark Hyman:When I think about GLP-1s, it sort of challenges our old orthodoxy about weight and it's all about discipline or calories or just trying harder. How do you think it's changed the landscape of people and their relationship to food in that way?

59:09Dr. Rachel Goldman:I mean, I think it's changed so much. Something that I often see 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 one. 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.

59:47Dr. Rachel Goldman:And it's like, oh my God, it's working. Something's working. right and again i think that again is the evidence that we're not talking about a willpower ratio

59:57Dr. Mark Hyman: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 when you're overriding these massive hormonal biological signals and i think you know the the this is important um but you know when people take you up you want 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 that bridge?

1:00:35Dr. Mark Hyman:So people often will stop, jump your ones after a year, they'll gain back the weight. Sometimes they try to reduce it and they end up in the same place. So how do you think about that?

1:00:46Dr. Rachel Goldman: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 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, right? 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, you know, it's just like the bariatric surgery, like somebody can be super successful with losing weight with surgery.

1:01:23Dr. Rachel Goldman:And then all of a sudden, you know, 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.

1:01:58Dr. Rachel Goldman:And this is where we often hear people say, I lost all the weight, but why am I not happy? Right? 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 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 part of a bigger picture. But oftentimes people just think, just if I lose weight, I'll be happy, right? Or just like, I need to lose weight to go on a date. I need to lose weight to take the vacation. But we often see that that's 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

1:02:56Dr. Mark Hyman: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?

1:03:13Dr. Rachel Goldman:So 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 ourself 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.

1:03:50Dr. Rachel Goldman: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 going to 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 of like, oh, well, that felt good. I was able to do it. Oh, I could do it a little bit more.

1:04:26Dr. Rachel Goldman: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?

1:04:39Dr. Mark Hyman:You know, I think a lot of this is in your book, When Life Happens, the mindset shift you need to manage trust, 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 have the support and resource. So given everything you know, and the work you do with patients and sort of the content you produce, what are the resources that people should look toward to help them with this? I mean, obviously your book, your website, drrachelnyc.com. What other resources are there available for people to really learn about all this?

1:05:13Dr. Rachel Goldman: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, you know, 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?

1:05:49Dr. Rachel Goldman: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?

1:06:21Dr. Rachel Goldman:But really, there's so many resources out there that I think, you know, it's brave to ask for help. And a lot of people are scared to. But, you know, 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.

1:06:42Dr. Mark Hyman:Yeah, I think 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.

1:07:16Dr. Mark Hyman: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 to food. And 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 you 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.

1:07:42Dr. Rachel Goldman:Of course. Thank you so much.

1:07:44Dr. Mark Hyman:If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more Thank you so much again for tuning in. We'll see you next time on the dr. Hyman show This podcast is separate from my clinical practice at the ultra wellness center My work at Cleveland Clinic and function health where I am chief medical officer This podcast represents my opinions and my guests opinions Neither myself nor the podcast endorses the views or statements of my guests This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.

1:08:29Dr. Mark Hyman:This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public.

1:09:01Dr. Mark Hyman:So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.