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Inspiring Success on the Road to Recovery

Wednesday, April 1, 2015

Alcohol Addiction ≠ Sugar Addiction?

By Dr. Ravi Chandiramani 

If you’re anything like me, you’re sick and tired of the media and so called “experts” throwing around the term addiction so haphazardly these days. Of course, qualifying as an addiction requires meeting an established set of criteria that point to significant dysfunction, unmanageability and collateral damage and of course, continued use in spite of all of it.

Of all the newest addictions floating out there today, I wanted to focus on one in particular, “sugar addiction.” 

You may have heard this term recently, especially as cities like New York continue to wage war against fast food and the First Lady of the U.S. remains vigilant in her campaign against childhood obesity. I’m interested partially because it is rife with controversy but equally, because I believe sugar addiction to be feasible physiologically.

Craving the Sweet Stuff
For years, we have known that a very strong correlation exists between alcohol-dependent individuals and a preference for foods with a high sucrose concentration. Research suggests there may be a biological connection between having a sweet tooth and an alcohol abuse problem. Individuals studied who reported drinking more alcohol on occasion and having more alcohol-related problems also had problems with controlling how many sweets they ate. These study participants were more likely to report urges to eat sweets and craving sweet stuff, especially when they were nervous or depressed. They believed eating sweets made them feel better. Sound familiar?

Another study of more than 300 children found those with a heightened preference for sugary foods and beverages were more likely to have a family history of alcoholism. These children were also more likely to have a family history of depression, which as we are well aware, is yet another risk factor for alcohol abuse. The biological children of alcoholic fathers seem to be particularly vulnerable to have a strong sweet preference, which in some predisposed individuals, may manifest as an eating disorder.

The fact is — the neurobiological pathways governing reward for drugs of abuse and sugar (sucrose) involve similar neural receptors, neurotransmitters, and regions of the brain. Tasting something sweet leads to the activation our brain’s happy place triggering the same reward mechanism that we now know is hijacked by addiction.
The question that has yet to be answered definitively is, can sugar be a substance of abuse and lead to a natural form of addiction? The problem appears to lie in the generality of the term, “sugar addiction,” given that natural and not so natural forms of sugar exist. People seem to be more comfortable with the notion of sugar addiction as a subtype of the larger, more accepted diagnosis of “food addiction.” 

If the research above doesn’t convince you the two maladaptive processes are similar in etiology, consider the vast volume of work spanning decades linking alcohol dependence and hypoglycemia. In fact, Bill W. himself experienced symptoms of hypoglycemia long after he had given up the booze.

In the 70s, endocrinologist John Tintera similarly found his alcoholic patients were significantly more likely to experience symptoms of hypoglycemia for years after they had stopped drinking. Since both of their times, many respected scientists and physicians have corroborated this finding noting that the vast majority of alcoholics are hypoglycemic, and this physiological problem is frequently misdiagnosed as a co-occurring psychological disorder. The consensus appears to be that until the underlying hypoglycemic physiologic disorder is corrected, symptoms will continue and the alcoholic is effectively at risk of relapse.

The prevalence of blood sugar dysregulation in alcoholics isn’t so far-fetched when you understand that the body responds to dietary refined sugars or alcohol sugars, both nutrient poor and calorie rich, and both rapidly converted to blood sugar, in a similar fashion. In response to a rapid rise in blood sugar from either of these sources, the pancreas, doing what it’s supposed to do, releases insulin. The essential purpose of insulin is to direct blood glucose from the blood stream into the cells, where it can be utilized for energy production. If this process is too efficient or as is more commonly the case in the alcoholic hypoglycemic, hypersensitive, the adrenal glands kick in and release epinephrine which, in turn, causes an emergency release of stored sugar (glycogen) from the liver into the blood to counteract the effects of insulin. This release of epinephrine causes transient symptoms that many alcoholics can recall as well, namely jitteriness, hot flashes, sweating, tremor, etc. This counteractive mechanism works well to prevent hypoglycemia until the adrenal glands get burnt out from repetitive stress, in which case, they are no longer able to counteract the effects of insulin to prevent hypoglycemia.

The Temporary High
In the classic scenario, the alcoholic responds to the unopposed hypoglycemia by bingeing on refined sugar, essentially self-medicating against the unpleasant symptoms associated with hypoglycemia, namely irritability, depression, aggressiveness, insomnia, fatigue, restlessness, confusion, desire to drink, nervousness, forgetfulness, inability to concentrate. The temporary sense of well-being afforded by the candy, soda, and other junk food items is just that…short lived and eventually, for some alcoholics, relapse on their medicine of choice is inevitable.

I frequently provide the lesson this way to patients and their loved ones alike— if you or your loved one was the first one in the bar stool at the beginning of happy hour and the last one off that stool when happy hour ended and that’s the way it was for years, you have trained your brain to expect a bolus of rapidly absorbable sugar between 4 and 6 p.m. 
Then you come to treatment and no one tells you that your brain is going to force you to seek out refined sugar between 4 and 6 p.m., so you do and the same pleasure pathway activated by booze stays activated by junk food, it never gets a chance to take a breather. You go home and find yourself buying junk food to stock your home and eat more junk food at work and everyone around you who’s in the know says, “we’ll at least they aren’t drinking.” 

The problem is — for some of you, it won’t stop there....the junk food will lead you back to booze. That’s just the facts and that’s why you have to go to nutrition class, and that’s why you can’t buy that crap or have your family bring it to you, and that’s why we have a gluten-free option at every meal and that’s why I would be remiss if I didn’t tell you my happy hour story. 

Get it? Good. Welcome to The Sundance Center.

So how does the alcoholic hypoglycemic correct this underlying blood sugar dysregulation without bingeing on refined sugars or worse, relapsing on alcohol?
This is where naturopathic medicine and therapeutic nutrition prove their value in the comprehensive medical management of these patients. The primary categories of recommendation follow.

Dietary Recommendations
It’s all about the balance. One of the biggest causative factors in hypoglycemia is that refined sugars/simple carbohydrates tend to be consumed without an appropriate balance of fat and protein. As a result, the sugar is rapidly absorbed inducing the process described above. Adding fat and/or protein slows down the whole process by a factor of 2-4. That is to say, adding protein allows the stomach to delay emptying and therefore, absorbing sugar over several hours while the protein component of the meal is digested. Adding fat delays the process even further; spreading it out over up to 4 hours versus the one hour or less it takes for a purely simple carbohydrate meal to be absorbed to become blood sugar. The slower the rate of dumping of sugar into the blood, the better insulin production can track the blood sugar level, resulting in a more stable blood sugar - lower peaks and shallower troughs.
In addition to the above, there is some evidence that hypoglycemia can be worsened by the presence of undiagnosed food sensitivities such as those to dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. 
Incorporating foods high in B-vitamins and iron, as well as those that are antioxidant - rich such as berries and other darkly-colored fruits and vegetables may be of additional benefit. 

Obviously refined sugar needs to be eliminated but complex carbohydrates also translate into blood sugar fairly quickly, so simply replacing your white rice and white bread with whole wheat bread and brown rice may not cut it, although a marked improvement. Instead, limit your intake of all carbohydrates, and always balance your carbs with protein to slow the conversion of dietary carbohydrate into blood sugar. Protein, fresh vegetables, and sea vegetables do not have this effect on blood sugar. Additionally, portion control is important and eating smaller, more frequent meals does actually help in stabilizing blood sugar by retraining the pancreas to modulate the release of insulin in response to lower levels of blood sugar.

There are a handful of supplements that are effective in helping to restore normal blood sugar regulation. Many of these nutrients are required in the normal metabolism of dietary carbohydrates. 

If you don’t have a history of digestive disorders, soluble fiber, such as flaxseed and pure oat bran, can slow the rate at which dietary sugars enter the blood and help regulate blood sugars throughout the day. When used for this purpose, they are best consumed before meals. 

A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium. If you are taking blood pressure medication or other heart medication, speak to your doctor before taking magnesium. Magnesium can interfere with certain medications, including some antibiotics and biphosphate medication.

Omega-3 fatty acids, such as fish oil, have a myriad of benefits including helping to decrease inflammation and help with immunity. Because they have a known blood thinning effect, anyone taking blood thinning medications should speak to their doctor before taking omega-3 fatty acids. These fats are sensitive to light and heat and are especially prone to rancidification so store in a cool, dark place when possible.

Vitamin C and alpha-lipoic acid (ALA) for extra antioxidant support.

Chromium, for blood sugar regulation. People with liver or kidney issues or history of psychiatric issues should talk to their doctor before starting chromium supplements.

Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Many acidophilus products may need refrigeration so make sure and read your labels closely. It may be best to refrigerate these regardless of what the label says.

Some botanicals/herbs may also be of benefit. The following may be consumed as a capsule containing powdered freeze dried plant material or alternatively, teas may be prepared from the leaves of the plants. Holy basil plants are even available at several health food stores.

Green tea (Camellia sinensis), for antioxidant effects. Caffeine free products are available.

Holy basil (Ocimum sanctum), for stress balance.. Holy basil may slow blood clotting and therefore increase the effect of blood-thinning medicines, such as warfarin (Coumadin).

Exercise for 30 minutes daily if possible at least 5 days a week. As you learn how to control your blood sugar and manage your diet, you will be able to tolerate higher intensity exercise. Until then, you may have to take it low and slow.

Bill W. along with many others recognized this as one of the protracted consequences of prolonged alcohol abuse as well as one of the many paths leading to relapse. As with many other chronic diseases, the best strategy is often the one that integrates fundamental lifestyle changes with evidence-based medical management. 

For my money, any approach that does not consider the key role lifestyle factors play in either supporting continued use or promoting abstinence-based recovery, is incomplete. This is the low hanging fruit. It doesn’t make it any easier to change but it must be addressed, and formally at that, if the alcoholic/addict is to be best armed to take on lifelong recovery.

Also interesting to consider this whole sweet tooth-alcohol abuse correlation in the context of being a semi-new parent which I am. Given my alcohol-loving, high sweet-tooth prevalence having family history, and in light of the findings of the research mentioned above, it is even more important to educate my girls about healthful eating habits early so that they understand the dangers of refined sugars when consumed frequently and in excess. Education, simple but effective.

Until next time….Stay Sweet Together AZ Readers!

Dr. Ravi Chandiramani is a graduate of Bastyr University. His unique approach treating chemical dependency and co-occurring psychological disorders has been refined over a decade of direct clinical experience with recovering addicts and alcoholics.  Dr. Chandiramani’s work has provided the foundation for a new field of medicine, Integrative Addiction Medicine (IAM). IAM effectively combines evidence-based addiction medicine protocols with the nurturing and rebuilding modalities inherent to the practice of naturopathic medicine. Over 5000 chemically dependent patients have been successfully treated using the IAM model. Dr. Chandiramani serves as Medical Director of Sundance Center, Arizona and Journey Healing Center, Utah. For more information call 877-974-1038 or visit www.sundancecenter.com.

Behind the Curtain

By Sarah Jenkins, MC, LPC

When I was a child, the Wicked Witch of the West terrified me. Her green complexion, haunting expression, and persecutory finger pointed at Dorothy and her friends. I would cower behind a pillow as she slithered into the center of my television screen, her cackle echoing in my ears as a taunting reminder that I shouldn’t watch The Wizard of Oz. The Wicked Witch of the West — she always got to me. 

Until, one day, she just didn’t. I grew up. 

I could look at her image without terror. In fact, I could appreciate my younger self’s fears, and know that they were appropriate at the time, but not anymore. 
Funny enough, what did become somewhat disturbing about The Wizard of Oz actually changed when I became an adult. Not because it was frightening, or scary, but rather that the realness of it would become ever present in my work my work with trauma survivors. 

One of the most poignant moments is when Dorothy and her friends find themselves standing in front of the ever-powerful wizard, with his thunderous voice and intimidating presence.

That is, until Toto pulls back the curtain. 

A cacophony of sounds, levers, and mechanical functions echo in their ears, as they witness a mere man standing there, bellowing “Pay no attention to that man behind the curtain!” through his mechanical contraption. 
And so they are faced with the truth, what’s real. For what stands before them, behind the curtain, is a mere mortal like themselves, a vulnerable soul who conceals himself behind his curtain of illusion. 

I see this every day in my practice, working with complex trauma. The curtain I ask clients to pull back has a certain sound and feel to it. It has the energy of what might be mistakenly perceived as “avoidance” or “resistance.” But for me, these words are not supportive, for they do not avail themselves to what is actually happening. The seemingly impenetrable curtain my clients conceal themselves behind is an unconscious dissociative pattern, one that has truly materialized over many, many years. 
And, unlike my fear of the Wicked Witch of the West that I eventually just grew up and out of as an adult, this dissociative curtain doesn’t grow up, it actually continues to do its job exactly as it was supposed to when it was first created. It doesn’t grow up, even though the adult has chronologically. The curtain still “handles” the traumatic material that stands behind it and the truth that may be too painful to bear looking at. The truth that it did happen, and was painful.
  • “I don’t want to think about it.” 
  • “I don’t want to feel that.” 
  • “I don’t think that really impacted my life that much.”
  • “I can’t stand it.” 
  • “It’s not that big of a deal, really.”

Yes, You Do Work With Complex Trauma and Dissociation
Really, that is dissociation, and perhaps surprises you. Here’s why, the fact is most clients, and even therapists seek me out for consultation, tend to think of the word dissociation, and automatically assume it means either Dissociative Identity Disorder, once known as Multiple Personality Disorder. “I’m not like Sybil.” “I don’t have Multiple Personality Disorder.” Or, in the case of those I consult for, “Well, I don’t have any clients with DID.” Or, “I don’t work with dissociation.” “I don’t have clients who dissociate.” “I don’t work with complex trauma.” 

Therein lies the problem 
Therapists, even experienced trauma therapists, may only think of dissociation along the more complex end of the continuum or in contrast, just don’t think of it at all. They might assume dissociation is not an issue, or it does not exist in their clients. Yes, dissociation can include feeling out of your body, watching yourself from the other side of the room. Yes, dissociation can even show up as Dissociative Identify Disorder, but that’s not all. Contrary to popular opinion, dissociation is there; it is just doing its job very well and not easily seen. 

To find it would mean to expose painful traumatic to the adult self who wants to get away from it.

The dissociative pattern, that curtain is the very thing that creates therapeutic impasses, is labeled as resistance, and creates a parallel process of frustration for the client and the therapist. “Well, this _____ we are working on, it won’t budge.” “We aren’t getting anywhere.” “We both feel stuck.” 

Therapists meet me at various events, come to my consultation meetings, and discuss cases what they are “stuck” with. What I find is what they may label as “resistance” is instead the dissociation that stands between the client and what is really contributing to the client’s symptoms. So, in a parallel process, the therapist may not know that the dissociative pattern, the curtain, is in place. They just may not be hearing or seeing it. 

You name it; whatever thought or action feels like it is a “block” is actually doing what it does because it ensured the client’s survival some time in the past. The curtain IS what keeps the adult self from exploring the traumatic material and its associated behaviors and feelings. Those experiences are and were too painful to look at, to know were real, to feel, to remember and be present with— just as it was back then when that dissociative pattern was established in the first place.

The Curtain’s Language
The dissociative curtain is often revealed in the language chosen to describe the reaction to the traumatic material. I see it all of the time. Those seeking to heal from trauma may say or express behaviorally “I don’t want to talk about it” or “its no big deal,” or “I feel numb” or “I just feel stuck in ______ feeling all of the time,” “I can’t think about it,” or “I can’t let it go.” 

The actual truth about the curtain is these dissociative patterns, cognitive errors and defense driven behaviors were created to survive what occurred in the past. It HAD to not feel real. It HAD to be something to not think about. It HAD to be no big deal. It HAD to be my fault.
Though the curtain is in place, it does not mean the traumatic material really isn’t there, it means it is coming out “sideways.” The challenge is in day-to-day life, the defense driven traumatic material “pushes through.” Essentially, traumatic material doesn’t necessarily “know,” that the present is not the past. That traumatic material, those sensations, feelings, painful experiences, cognitive errors, behaviors from back then continue as parts of the self that “show up” now as the long list of “symptoms” and bring folks to therapy in the first place. The “adult” keeps tries to keep it at bay, and the pattern of dissociation expands because the traumatic material feels too overwhelming. 

Meanwhile, the adult self becomes more fearful of the traumatic material. In response, the dissociative patterns must grow and grow stronger and stronger because the traumatic material becomes “too much” for the adult self to handle without dissociation. Thus, over time, if not explored and gradually, consciously, and mindfully, the defense driven parts of the self associated with the traumatic material become more invasive, driving the long list of symptoms. The curtain prevails, as do the symptoms. And, around and around we go. 

EMDR Preparation
As an EMDR consultant, and an EMDR therapist for 14 + years, I can tell you this increased flooding and dissociative pattern, the ever increasing fear of the traumatic material by the adult self even occur with highly effective trauma therapies like EMDR. For, without addressing these dissociative patterns and parts of the self that hold the traumatic material, first, and as part of EMDR preparation, the client can becoming continually “stuck” in a flooded state with traumatic material both in and between sessions. The bottom line is — the dissociative curtain will unconsciously do its job and feel even more needed. And the pattern continues. The client gets more frustrated with why the symptoms don’t change, and the therapist feels more stuck about “why the EMDR is budging it.” The dissociative curtain gets stronger because the adult’s self’s fears of the material may increase as oppose to decrease.

It is truly possible to heal from trauma, even with this dissociative curtain in place. It is also possible to do so through the power of EMDR therapy. Nevertheless, it also means a deep layer of trauma preparation work beforehand. And, whether you are doing EMDR, or any other kind of trauma therapy work either as a client, or as a therapist, it is imperative that these dissociative curtains be explored before trauma processing. As all EMDR therapists know, it is necessary the client be able to process fragmented and maladaptively stored traumatic material. We must do so at a tolerable level, whereby the dissociative curtain does not have to repeatedly appear because the adult self is becoming ever more fearful of the traumatic material. 

If you are a therapist overwhelmed with challenging cases, baffled by why a client destabilizes, or even feel “stuck” not knowing why a client’s trauma “just won’t move,” help is out there. In addition to the availability of consultation from me, you are invited to join two events that I am sponsoring; a comprehensive workshop and a practicum offered by Kathleen Martin, LCSW, an EMDRIA Approved Consultant and Trainer. Kathy specializes in working with complex trauma and dissociation in her private practice in Rochester, NY. “Mastering the Treatment of Complex Trauma: Transforming Theory into Practice” is available for all licensed clinicians to attend and The Power of EMDR: A Practicum for 
Personal and Professional Development is open to EMDR therapists. 

Sarah Jenkins, MC, LPC is an EMDRIA/HAP Approved EMDR Consultant, Certified EMDR therapist, and Equine Assisted Therapist who specializes in treating complex trauma. 
Sarah has conducted numerous workshops, presentations, and seminars for a variety of corporations and federally funded organizations. She provides consultation for therapists both nationally and internationally who seek to increase their confidence in working with complex trauma.

Sarah’s experience includes having served as a clinical supervisor for a grant funded EMDR trauma treatment program and as an adjunct faculty member for the University of Phoenix and Arizona State University. She is also the author of several thought provoking books on trauma recovery including “When Horses Hear the Unspeakable: A Guide To Trauma Informed Equine Therapy.” Information about Sarah’s practice can be found at www.dragonflyinternationaltherapy.com

Hidden Gem in the Desert

By Irene Mit

Nestled deep in the Foothills of Tucson, lies Taste Of Peace, a safe, sober living home for women over 18 years of age. Many of them come for help and healing from alcoholism, substance abuse, trauma, and self-harming behaviors. 

Taste Of Peace offers panoramic, majestic views of nature’s beauty and peace and is a beautiful, 
spacious home in secure surroundings, but most importantly, women can find safety, anonymity, with a focus on personalized recovery.

At a big brown rustic table every evening dinner is the social event of the day where positive thoughts are shared like the traditional family dinner used to be.

The house styled in a mixture of Southwestern and Modern offers amenities such as cardio equipment, large beds with pillow top mattresses, walk-in closets and private baths. The view thru the huge windows or from one of the porches is breathtaking. Residents are taken on outings, have movie nights, meetings together and more.

In an interview with Leilonne Neylon, co-founder and director she said, “Taste Of Peace is more than a halfway house. It is about learning to live happily and successfully free from addiction, emotional attachments to trauma, and other unhealthy behaviors. Women are taught to love and respect themselves and others; to pursue their individual dreams and rid themselves of what is holding them back.”

Taste Of Peace was not founded for profit. Rather, Taste Of Peace, is for the purpose of providing women a safe, sober home to live in while they work their individual recovery.” 

The decision to open is connected with Leilonne Neylon’s life. She is recovering from alcoholism, trauma, and PTSD and has devoted her life to helping other women live the fulfilling life that she has found in recovery.

It has become more apparent to referring practitioners, as well as clients and families that women who come to Taste Of Peace sickly and downtrodden, experience remarkable improvement in a relatively short span of time. Neylon attributed the transformations to “hyperpersonalized care, attention and direction received throughout the stay. The individualized care helps women transition to independence with a strong recovery foundation and support network.” She also emphasized that 

Taste Of Peace only accepts women willing to do the work necessary to change their lives; those who are serious about life-long recovery.

For instance on a cold December evening, a woman named Maria walked through the front door of Taste of Peace. Her therapist recommended she move in to ensure safety and support while furthering her recovery. Maria had spent over 45 days in rehab, and arrived with a bag full of medications. She was scared, traumatized and confused.

Maria is an journalist recovering from depression, trauma, anxiety and PTSD. She is also living with bipolar and ADHD. Initially, she barely spoke except when spoken to, and when she did, she could scarcely be heard.  She tried to isolate. Two months later her story is quite different. Maria is now full of laughter, is no longer reliant medications, no longer isolates, she participates. 
Maria’s success is the result of the environment provided — the individual working formula for each resident’s recovery.

Another resident Annie, said: “I would describe Taste Of Peace as a safe haven for women who are recovering from addiction and trauma. This is an environment for women to overcome their problems as well as learn new tools and coping skills; to transition out of their past and be able to see the beauty inside each and every one of them. While living here, the staff works with each individual’s needs to ensure we receive the care we need.” My stay has been a success. Before I arrived, I was broken. I have lived in difficult circumstances since childhood and the stress led me towards my addictions because I did not have the right coping skills I needed in order to handle physical and emotional abuse. I finally had the opportunity to wake up every morning feeling safe, as well as supported. Throughout the day I attend Intensive Outpatient treatment and 12 step meetings. Living here I feel whole again. I have the biggest support system now and I know I’m not alone anymore! Taste Of Peace has saved my life and I know for a fact that it will help save every woman who comes in with willingness.”

Taste Of Peace with all it offers is a true gem and definitely a place to consider solidifying one’s own sobriety, or as often is the case for a woman who has been lost and is now working to get back on track, when home is not the best place to accomplish this. Once having spent a fair amount of time at Taste Of Peace, women are ready to return home or establish their lives on solid footing.
For more information visit http://toparizona.us