CHANGE YOUR BRAIN, CHANGE YOUR WEIGHT

THE CRAVING SOLUTION,
USE YOUR BRAIN TO INCREASE YOUR WILLPOWER AND CALM THE
URGES THAT PREVENT YOU FROM ACHIEVING YOUR GOALS.

From craving
is born grief, from craving is born fear. For one freed from craving, there's no grief--so
how fear?--buddha.

I had been good all day. I had a protein-fruit shake for breakfast; a spinach salad
with turkey, blueberries, and walnuts for lunch; and sweet red bell pepper and apple
slices with a little almond butter in the afternoon. All seemed right with my relationship
with food, until I went to the Los Angeles Lakers basketball game. I know how to eat
when I am away from home. But this night my brother bought a huge caramel apple with
peanuts. I find that I now have total focus, not on the game, but on the sticky, gooey,
sweet apple.

Our grandfather was a candy maker and some of my best memories are standing
on a stool at the stove with him when I was a little boy making and then, of course, eating
candy. Sweets have always been an emotional food for me. I am named after my
grandfather, and he was my best friend growing up. Yet, I know how tired and foggy a
sugar load makes me feel twenty to thirty minutes later.

Nonetheless, I am still totally focused on my brother's caramel apple. I try not to
look at it, but the urge to look, sort of like when you are next to a very pretty woman,
nudges me in that direction. The memories of the sweet taste try to hijack my brain.
Dopamine, the pleasure and motivation brain chemical, pushes on an area in my brain
called the nucleus accumbens, in the basal ganglia, which drives me toward asking for a
piece, or heck, just getting up and buying an apple of my own. My prefrontal cortex, the
brain's brake, fights back. Eating well earlier that day has given me a good blood sugar
level, which helps to protect me against my urges. "I'll be back," I tell my brother, and I
take a brief walk to reset my brain, let him finish the apple, and get my mind back on the
game.

I come from a family of not only candy makers but also amazing cooks and
overweight people. My brother, whom I adore, is at least one hundred pounds
overweight. My grandfather, also overweight, had a heart attack in his sixties. If I was not
focused on taking care of my brain, eating well, and exercise, I would, for sure, be
overweight too. I am grateful for my neuroscience background, because it shows me how
to maintain control over my urges.

In this chapter, I will share with you what I have learned on how to have the
willpower to control your cravings to stay on track toward your goals of having a healthy
brain and a vibrant body.

THE CIRCUITRY OF CONTROL.

Understanding the brain circuits of willpower and self-control is an important step
in gaining mastery of your brain and body. There are centers in the brain responsible for
focus, judgment, and impulse control (the prefrontal cortex, in the front third of the
brain). There is also a pleasure and motivation center, called the nucleus accumbens,
which is part of the basal ganglia, large structures deep in the brain. The nucleus
accumbens provides the passion and motivation that is one of the main drivers of
behavior.

Additionally, the brain has emotional memory centers that trigger behavior.
According to my friend, addiction specialist Mark Laaser, Ph.D., "the arousal
template" in the emotional memory centers underlies many behaviors that get out of
control. It is important to understand where you were and how old you were when you
experienced your first pleasurable or arousing experience, such as standing at the stove
making fudge with my grandfather when I was four years old. This intense, emotionally
pleasurable experience often lays the neural tracks for later addictions, even if the
experience happened as early as age two or three. The first experience gets locked into
the brain, and when you get older, you seek to repeat the experience because it was the
way you had the initial arousal or pleasurable experience, like the first time you tasted
fudge, had sex, fell in love, or used cocaine. Understanding the triggers for emotional
eating, smoking, or drinking can be very helpful to breaking addictions.

Four neurotransmitters are also important to mention here.

Dopamine is often thought of as the pleasure, motivation, and drive chemical in
the brain. Cocaine and stimulants like Ritalin boost dopamine in the brain. Dopamine is
often associated with "saliency," or the relative importance of something. At the moment
I saw the caramel apple, it became much more salient or important in my mind.

Serotonin is thought of as the happy, antiworry, flexibility chemical. Most of the
current antidepressants work on this neurotransmitter. When serotonin levels are low,
people tend to suffer with anxiety, depression, and obsessive thinking.

GABA is an inhibitory neurotransmitter that calms or helps to relax the brain.
Endorphins are the brain's own natural pleasure and painkilling chemicals.

The relative strength and weakness of each of these brain areas and each of these
neurotransmitters goes a long way in determining how much control we have over
ourselves and how well we are able to stick to our plans, even around caramel apples
with peanuts at the Lakers game. They all work together symphonically to give us
beautiful control over our lives. When they are out of balance, the noise can be very
irritating.

BRAIN AREAS INVOLVED WITH CRAVING AND WILLPOWER.
Prefrontal cortex (PFC)--focus, judgment, and impulse control
Basal ganglia (nucleus accumbens)--pleasure and motivation center
Deep limbic (emotional memory centers)--triggers of behavior.

BRAIN CHEMICALS INVOLVED WITH CRAVING AND WILLPOWER
Dopamine--motivation, saliency, drive, stimulant
Serotonin--happiness, antiworrying, calming
GABA--inhibitory, calming, relaxing.

Endorphins--pleasure and painkilling properties
In a healthy brain, there is good judgment and emotional control by a competent
prefrontal cortex (PFC), but also plenty of emotion and drive from the deep limbic
system to stay on track and get things done. Figure 2.1 shows a healthy self-control
circuit. Healthy dopamine levels can drive passion, especially in the context of good
activity in the PFC, which acts as the reins or the brake so you do not get out of control.
Low levels of dopamine are associated with certain problems that rob us of motivation,
such as Parkinson's disease, some forms of depression, and ADD. Addictions occur when
the drive circuits hijack the brain and take over control.

When these chemicals and brain areas are in balance, we can be focused and goal
oriented and have control over our cravings; we can walk away from caramel apples,
chocolate cake, the bag of chips, French fries, and the myriad of other unhealthy choices.
When these chemicals and brain areas are troubled (Figure 2.2), we often get off track
and can do serious damage to ourselves.

For example, having low activity in the PFC from a head injury, poor sleep,
persistent drug or alcohol use, or inheriting ADD, makes it more likely you will have
impulse-control problems and poor self-supervision. Even though the goal would be to
stop drinking, hold the cigarettes, or maintain a healthy weight, you do not have the
willpower (or the PFC power) to say no on a regular basis.

In the healthy self-control circuit, the prefrontal cortex (PFC) is strong and there
is good balance between the chemical dopamine and the basal ganglia (BG) and limbic or
emotional circuits in the brain. In the addicted circuit, the PFC is weak, so it has little
control over unbridled passions that drive behaviors. Addiction actually changes the brain
in a negative way, making it harder to apply the brakes to harmful behaviors. In the
nonaddicted brain, the PFC is constantly assessing the value of incoming information and
the appropriateness of the planned response, applying the brakes or inhibitory control as
needed. In the addicted brain, this control circuit becomes impaired through drug abuse,
ADD, sleep deprivation, or a brain injury, losing much of its inhibitory power over the
circuits that drive response to stimuli deemed salient.

I once treated a forty-two-year-old woman who failed six alcohol treatment
programs. Her impulse control was virtually zero. She could not be given a prescription
for any medication because she would take them all at once. When I asked her initially if
she had ever had a brain injury, she said no. But when I pushed her, she remembered that
she had been kicked in the head by a horse when she was ten years old. Her brain SPECT
scan showed severe PFC damage (Image 2.1). She had virtually no supervisor in her
head. Comedian Dudley Moore once said that, "The best car safety device is a rearview
mirror with a cop in it." The PFC acts like the cop in your head, and when it shows this
level of damage, most people are in serious trouble. If I did not address the damaged
PFC, she would never be well. Giving her a medication to enhance PFC function was
very helpful to her.

If you have suffered an emotional trauma or you are under a lot of stress, the feel-
good chemicals, such as serotonin and GABA, may be depleted and your emotional or
limbic brain may become excessively active, making you feel sad. This makes you eat or
drink in an attempt to calm your limbic brain. MIT researchers demonstrated that simple
carbohydrates, such as cookies or candy, boost serotonin levels. Many people
unknowingly use these substances as a way to medicate their underlying negative
feelings. But as with cocaine, over time these substances lose their effectiveness, and
people engage in the corresponding behaviors not so much for the high or good feelings
as for the attempt to prevent the terrible feelings of withdrawal.

Image 2.1: Brain Injury from Horse Kick.

Marked decreased PFC
Likewise, if you have engaged in excessive amounts of pleasure or used cocaine
or too many excessively pleasurable foods, your brain may have been exposed to too
much dopamine. Over time, it becomes numb to it, and it takes more and more to get the
same pleasurable response. Keeping these brain chemicals and systems in balance is
critical to maintaining focus and control over your cravings.
Anything that decreases activity to the brain, especially to the PFC, robs you of
good judgment and self-control. Head injuries are obvious. Protect your brain. Poor sleep
has been associated with overall decreased brain activity. Strive to get at least seven
hours a night (see Chapter 10, "The Sleep Solution").
REGAINING CONTROL--BALANCE YOUR BRAIN SYSTEMS
1. Boost Your Prefrontal Cortex
To gain control over willpower and cravings, it is critical to strengthen your PFC.
To do so:
Treat any PFC problems that may exist, such as ADD, toxic exposure, or brain
trauma. (See Chapter 15, "The Brain Health Solution.")
Get good sleep--at least seven hours, more is better--to maintain adequate PFC
blood flow.
Maintain a healthy blood sugar level by eating frequent smaller meals. In a 2007
article by Matthew Gailliot and Roy Baumeister, the authors outline the critical nature of
blood sugar levels and self-control. They write that self-control failures are more likely to
occur when blood sugar is low. Low blood sugar levels can make you feel hungry,
irritable, or anxious--all of which make you more likely to make poor choices. Many
everyday behaviors can cause dips in blood sugar levels, including drinking alcohol,
skipping meals, and consuming sugary snacks or beverages, which causes an initial spike
in blood sugar then a crash about thirty minutes later.

Keeping glucose levels even throughout the day improves self-control. Several
studies have examined the relationship between glucose and smoking cessation, and the
majority of these studies have found that healthy glucose levels increase the likelihood of
successfully quitting smoking. Coping with stress requires self-control because it requires
that people make a concerted effort to control their attention, thoughts, and emotions.
People with healthy blood sugar levels are therefore also able to manage stress more
effectively than others. Maintaining your blood sugar levels with complex carbohydrates,
lean protein, and healthy fat will significantly cut down on your cravings.

Exercise to boost blood flow to the brain. Table tennis is a great choice. One
study from Japan showed that ten minutes of table tennis boosted activity in the PFC.
Practice meditation--numerous studies have found that it boosts activity and blood
flow to the PFC.

Create focused, written goals. The PFC is involved in planning and forethought. It
needs clear direction. I have my patients do an exercise called the One-Page Miracle
(OPM) because it makes such a dramatic difference in the lives of those who practice it.
Here are the steps: On a piece of paper, write down the specific goals you have for your
life, including your health, relationships, work, and money. There's a reason why your
OPM includes more than just your physical goals. As you will learn throughout this book,
your relationships, career, and financial situation--and the stress they can cause--all affect
your body and your willpower.Take your time with this exercise. Keep the paper with
you so you can jot down ideas and goals as they come to you. After you complete your
initial draft, place it somewhere where you are sure to see it every day, such as on the
refrigerator, on your bathroom mirror, or on your desk at work. This way, on a daily
basis, you will be focusing on what's important to you. When you are focused on what
you want, it makes it much easier to match your behavior to make it happen. Ask yourself
every day, Is my behavior today getting me what I want? Your mind is powerful and it
makes happen what it sees. Focus and meditate on what you want. You will find that your
willpower goes up dramatically. Here is an example.

TAMARA'S ONE-PAGE MIRACLE.

What Do I Want for My Life?RELATIONSHIPS--to be connected to those I
loveSpouse/Significant other: to maintain a close, kind, caring, loving partnership with
my husband. I want him to know how much I care about him. Family: to be a firm, kind,
positive, predictable presence in my children's lives. I want to help them develop into
happy, responsible people. To continue to keep close contact with my parents, to provide
support and love. Friends: to take time to maintain and nurture my relationships with my
siblings WORK--to be my best at work, while maintaining a balanced life. Specifically,
for my work activities to focus on taking care of my current projects, doing activities
targeted at obtaining new clients, and giving back to the community by doing some
charity work each month. I will focus on my goals at work and not get distracted by
things not directly related to my goals.MONEY--to be responsible and thoughtful and
help our resources growShort-term: to be thoughtful of how our money is spent, to
ensure it is directly related to our family's and my needs and goals Long-term: to save 10
percent of everything I earn. I pay myself and my family before other things. I'll put this
money away each month in a pension plan for retirement. HEALTH--to be the healthiest
person I can beWeight: to lose thirty pounds so my body mass index (BMI) will be in the
normal range Fitness: to exercise for at least thirty minutes three days a week and to start
taking martial arts lessons. I promise no head injuries here. Nutrition: to eat breakfast
every day so I don't get really hungry until lunchtime. To prepare a sack lunch at least
three days a week so I'm not tempted to go to the fast-food restaurant across from work.
To eliminate diet sodas and reduce the amount of sugar I eat. To take a multivitamin and
fish oil every day. Physical health: to lower my blood pressure and cholesterol levels
Emotional health: to meditate for ten minutes every day to help me calm stress.

MY ONE-PAGE MIRACLE.

What Do I Want for My Life?
Along the same lines, having a clearly written set of rules also helps to boost the
PFC.
For example, one of my rules is to stay away from mayonnaise. I like it, but not
enough to make it worth the calories. Here is an example of some helpful rules.
I treat my body with respect.
I read my One-Page Miracle daily.
I look for ways to optimize my nutrition.
I eat breakfast every day.
I eat frequently enough during the day so that I do not get hungry or a low blood
sugar level.
I get seven to eight hours of sleep at night whenever possible.
I exercise three or four times a week.
I do not poison my body with toxins such as nicotine or my mind with persistent
negative thoughts.
If I break a rule, I will not dwell on it and give up on the rest of the rules. I will be
kind and forgiving.

No more than twelve rules. I once had a patient with obsessive-compulsive
disorder who made up 108 rules.

Willpower is like a muscle. The more you use it, the stronger it gets. This is why
good parenting is essential to helping children develop self-control. If we gave in to our
six-year-old every time she wanted something, we would raise a spoiled, demanding
child. By saying no, I teach her to be able to say no to herself. To develop willpower, you
need to do the same thing for yourself. Practice saying no to the things that are not good
for you, and over time, you will find it easier to do.

Long-term potentiation (LTP) is a very important concept. When nerve cell
connections become strengthened, they are said to be potentiated. Whenever we learn
something new, our brains make new connections. At first the connections are weak,
which is why we do not remember new things unless we practice them over time.
Practicing a behavior, such as saying no to the caramel apple, actually strengthens the
willpower circuits in the brain. LTP occurs when nerve cell circuits are strengthened,
practiced, and behaviors become almost automatic. Whenever you give in to the caramel
apple, it weakens willpower and makes it more likely you will not have any. You have to
practice willpower, and your brain will make it easier for you.

ACTION STEPT improve your willpower, you have to practice it.

2. Balance the Pleasure Centers and Calm Anxiety.

As mentioned, the basal ganglia are large structures deep in the brain. They are
involved with pleasure and motivation. When the basal ganglia are healthy, we feel
happy and motivated. When they work too hard, we can be anxious or overly driven.
When they are low in activity, we may feel low or unmotivated. Here are some ways to
balance your pleasure centers.

Be careful with too much technology. In Dr. Archibald Hart's book Thrilled to
Death, he suggests that the evolution of technology in our society is wearing out our
brain's pleasure centers. I believe it is having a very negative effect on our relationships
and our bodies. With the onslaught of video games, text messaging, cell phones,
Facebook, and Twitter, as well as online dating, pornography, and gambling, our pleasure
centers are being worn out. Pretty soon, we will not be able to feel anything at all. As I
mentioned above, our pleasure centers deep within the brain operate on a chemical called
dopamine, which is the same chemical that cocaine stimulates and one of the main
chemicals of new love. Whenever a little bit of dopamine is released, we feel pleasure. If
dopamine is released too often or too strongly, we become desensitized to it and it takes
more and more excitement to get the same response. More and more, I see people coming
into our offices complaining about their partner or children being addicted to new
technology. Christina and Harold were having big problems in their relationship.
Christina wanted more time with Harold, but he spent hours hooked on his video games.
He became angry when she asked him to stop playing so much, and when he told her to
stop nagging him, she moved out. Subsequently Harold became depressed and came to
see us. This couple played out the same pattern I have seen with many other types of
addictions--she didn't want to leave, but she didn't know what else to do.ACTION
STEP Work to keep your pleasure centers healthy. Be careful with the high-excitement
activities, limit video games, and stop ALWAYS being on your computer.As a society,
we have unleashed massive amounts of technology on the population with virtually no
study on what it all does to developing brains or to our families. We need to be more
careful. Stop it. In a study sponsored by Hewlett-Packard, people who were addicted to
their cell phones or their computers lost ten IQ points over a year. Find natural sources of
pleasure, such as nature, a great conversation, and long, loving eye contact.

Use relaxation techniques to help balance and calm this part of the brain.
Engage in meaningful activities that give you motivation without putting you in
overdrive.

Use supplements to calm anxiety and balance the pleasure centers. These include
vitamin B6, magnesium, and N-acetyl-cysteine (NAC). See Appendix C, "The
Supplement Solution," for more information.

3. Calm Your Brain's Emotional Centers and Eliminate Your Triggers.

Emotional stresses and depression decrease willpower. If you have unresolved
emotional issues, it is essential to understand and work through them, otherwise they will
hijack your brain. Here are six tips to help get your emotions under control.
Talk about what bothers you to someone close or a therapist. Talking about issues
can help get them out of your head. If there has been past trauma, one of the
psychotherapies I often recommend is called EMDR (eye movement desensitization and
reprocessing). It is fast and very powerful. You can learn more about it at
www.emdria.org.

When you are upset, journal rather than eat, drink, or light up. Studies show that
writing down your bothersome thoughts and feelings can have a healing effect.
Write down five things you are grateful for every day. Our research suggests that
focusing on gratitude helps to calm the deep limbic or emotional areas of the brain and
enhances the judgment centers.

Exercise. It not only boosts PFC activity, it also calms the limbic brain by
boosting serotonin, the feel-good chemical.

Correct the ANTs, or automatic negative thoughts (see Chapter 13, "The ANT
Solution"). You do not have to believe every thought that goes through your head.
Whenever you feel sad, mad, or nervous, write down the thoughts that are bothering you
and talk back to them.

Try the supplement SAMe to help calm this area of the brain and boost the PFC.
See Appendix C, "The Supplement Solution," for more information.

REGAINING CONTROL--BALANCE YOUR BRAIN CHEMISTRY.

Beyond brain-system balancing, it is also important to balance the chemicals that
drive behavior.
1. Dopamine.

Dopamine is the chemical of motivation, saliency, drive, and stimulation. It is the
chemical that both cocaine and Ritalin stimulate in the brain. Low levels are associated
with low motivation, low energy, poor concentration, impulse-control problems, some
forms of depression, Parkinson's disease, and ADD. You can boost dopamine levels by:
Doing intense physical exercise.
Eating a protein-rich meal.
Working at a job or organization that is exciting or deeply meaningful.
Being wary of excitement-seeking behaviors, which may wear out your pleasure
centers, deplete dopamine, and make you feel numb or unable to feel pleasure.

Taking natural supplements, such as L-tyrosine or SAMe. See Appendix C, "The
Supplement Solution," for more information.

2. Serotonin
Serotonin is the chemical of feeling peaceful, happy, and flexible. When it is low,
people suffer with some forms of depression, along with anxiety, obsessive thinking
(such as about the caramel apple), or compulsive behaviors. You boost serotonin by
Engaging in physical exercise, which allows the serotonin precursor L-
tryptophan, a relatively small molecule, greater access to the brain.
Practicing willpower. Giving in to obsessive behaviors solidifies them in the brain
and establishes nerve tracks to make them more automatic. Practicing willpower actually
does the opposite and has been found to change the brain, much like serotonin
medications, such as Prozac.
Taking supplements, such as 5-hydroxytryptophan (5-HTP), L-tryptophan,
inositol, or St. John's wort. Good scientific evidence supports 5-HTP's usefulness for
helping people lose weight. Inositol is a natural chemical found in the brain that is
reported to help neurons use serotonin more efficiently. St. John's wort comes from the
flowers of the Saint-John's-wort plant and seems to increase serotonin availability in the
brain. See Appendix C, "The Supplement Solution," for more information.

3. GABA.

GABA, or gamma-aminobutyric acid, is an amino acid that helps to regulate brain
excitability and calms overfiring in the brain. GABA and GABA enhancers, such as the
anticonvulsant gabapentin and L-theanine (found in green tea), function to inhibit the
excessive firing of neurons, which results in a feeling of calm and more self-control. Low
levels of GABA have been found in many psychiatric disorders, including anxiety and
some forms of depression. Rather than overeat or drink or use drugs to calm your anxiety,
natural ways to boost GABA may help. I often recommend GABA supplements.
Glycine is also an inhibitory neurotransmitter, which means it calms brain
activity. It is an important protein in the brain, and recent studies have demonstrated its
effectiveness in the treatment of obsessive-compulsive disorder and in reducing pain.
L-theanine, one of the components of green tea, has also been shown to boost
GABA, while at the same time helping with concentration and mental alertness.

4. Endorphins.
Endorphins are chemicals linked to feeling pleasure and eliminating pain. They
are the body's own natural morphine or heroinlike substances. These substances are
heavily involved in addiction and the loss of control. Natural ways to boost endorphins
include the following:
Exercise, which is why some people feel a runner's high when they exercise
intensely.
Acupuncture, which has been found to be effective for a number of pain
syndromes. Its positive painkilling effect can be blocked by using endorphin-blocking
drugs, such as naltrexone.
Hypnosis, which has been shown to be helpful in pain syndromes.
The craving solution involves balancing the brain areas and chemistry of pleasure
and control. It involves using your PFC as the master controller and making sure there is
a bridle on the pleasure and emotional centers to help them guide you to where you want
to go.

The Craving Solution
Will power Robbers.
Willpower Boosters.

Any brain problems Brain health Brain trauma.
Focusing on brain protection Poor sleep Adequate sleep (at least seven hours) Low blood
sugar Frequent small meals with at least some protein to maintain healthy blood sugar
Poor diet Enriched diet Alcohol Freedom from alcohol ADHD Clearly focused, written
goals (see One-Page Miracle) Some forms of depression Journaling when sad or anxious
Anxiety Meditation for relaxation and to boost the PFC Negative thinking Killing the
ANTs (automatic negative thoughts) Focusing on problems and fears Gratitude practice
Bad habits, giving in Practicing willpower Too much pleasure Being careful with too
much pleasure or too much technology Artificial forms of pleasure Finding natural
sources of pleasure Negative or meaningless behaviors Engaging in positive and
meaningful activities Social isolation Social support Being in denial about problems
Effectively treating any brain problems Lack of exercise Exercise Denial of feelings
Understanding emotional triggers Decreasing cravings with B6, magnesium, and NAC
Boosting dopamine (L-tyrosine, DL-phenylalanine, SAMe) Boosting serotonin (5-HTP,
L-tryptophan, inositol, St. John's wort) Boosting GABA (GABA, glycine, L-theanine)
Boosting endorphins (exercise, acupuncture, hypnosis).
3
THE WEIGHT SOLUTION.

USE YOUR BRAIN TO ACHIEVE YOUR OPTIMAL WEIGHTI am what I ate ...
and I'm frightened.--BILL COSBY.

Rebecca, forty-four, couldn't stop herself from eating, especially at night. She
thought about food constantly throughout the day. The thoughts haunted her, even though
she did not want to have them. Over eight years, she had gained nearly ten pounds per
year and was now eighty pounds overweight despite trying many diets and going to
multiple weight-loss clinics. She hated how she looked and was thoroughly disgusted
with herself. The Atkins diet--very high protein and low carbohydrate--made her irritable
and emotional. Diet pills made her anxious. She felt as though she needed a glass--or two
or three--of alcohol at night to settle her worries, but the extra calories were certainly not
helping her weight problem. She came to our clinics because she was starting to have
marital problems, in part because her husband was upset about her weight, and also
because she had trouble letting go of hurts, held grudges, and worried incessantly.
Rick, thirty-seven, was growing larger by the year. At five feet eight inches tall,
he was over 250 pounds. As a highly successful salesman for a large West Coast liquor
company, he was always on the run and attended many fancy dinners and sporting events.
His wife was starting to complain about his weight, which made him angry. Why doesn't
she just love me the way I am? he thought, even though she married him when he was
nearly seventy-five pounds lighter a decade earlier. Growing up, Rick had problems with
focus and impulsivity. He barely finished his first year of college when he found a job in
the liquor industry that he loved. Rick brought his son to our clinic for school-related
problems, much like the problems Rick had experienced in school. After he saw how
much better his son was on treatment, Rick decided to get an evaluation as well.
Cherrie, fifty-two, had been bulimic as a teenager, and the hidden truth for her
was that she still had bouts of bingeing and purging, especially during times of stress.
Cherrie was chronically thirty pounds overweight and hated how she looked. She would
not undress in front of her husband and found that she often picked on him as a way to
not have to have sex or be seen naked. Her own thoughts were extremely negative, and
she vacillated between being obsessive about her work and housekeeping to being
overwhelmed and disorganized. Cherrie grew up in an alcoholic home and had trouble
talking about her feelings and trusting others.
She had tried a number of diet programs without success, until the fen-phen craze
of the 1990s. On fen-phen, a combination of medications that increased the
neurotransmitters serotonin (fenfluramine) and dopamine (phentermine), she did
amazingly well, losing the unwanted pounds and feeling more emotionally stable than at
any other time in her life. When the fen-phen was pulled from the market because
fenfluramine was associated with a deadly illness called pulmonary hypertension, Cherrie
relapsed and went back to her emotional roller coaster and lack of success at losing and
keeping off weight. Cherrie came to see us on the advice of her sister, whom we were
seeing for issues of depression.
Jerry, sixty-two, was baffled by his weight problem. As a child, he was fit,
athletic, energetic, and loved being outside in the sun. He was raised in Southern
California and made the most of the beach, surfing, and volleyball. In his thirties, still in
great shape, he got a new job in the Northwest as a supervisor at Boeing. He loved his
job, the new responsibility, and the income, but over time he noticed that particularly in
the winter, his mood and energy would lag, and he started to gain weight despite trying to
work out. Over time, he retained more of the weight he gained in the winter than what he
could manage to lose in the summer. His weight gain and loss was like a yo-yo that was
losing steam. He also complained of many more aches and pains. He came to our
Northwest clinic to get a handle on his moods and weight.
Connie, twenty-eight, seemed to be constantly eating. She munched on the way to
work, at work, on the way home, and late into the night. She found that when she tried to
go without eating for a few hours, she felt anxious and nervous. She often felt a sense of
dread and was often waiting for something bad to happen. She frequently complained of
an irritable bowel, sore muscles, and headaches. Marijuana helped to calm her down in
college, but it also gave her the munchies, so she used it only sporadically. Her weight
continued to creep up; when she reached 165 pounds on her five-foot-two-inch frame, she
knew something needed to be done. She came to our clinic because her family had
complained about her level of anxiety and irritability.
Camille, sixty-four, could not keep on any weight. Two years before seeing us,
she had gone through a difficult divorce, and the year before, her mother died. Camille
had lost twenty-five pounds during that time and now none of her clothes fit. She had felt
as if her whole system was in hyperdrive. She had trouble sleeping, her thoughts seemed
to race, she had diarrhea, and both her heart rate and blood pressure were up. She came to
our clinics to help calm her mind and body and put back on some weight.

ONE SIZE DOES NOTFIT EVERYONE.

Rebecca, Rick, Cherrie, Jerry, Connie, and Camille all struggled with their
weight. Yet they all had very different clinical presentations and brain patterns.
Rebecca was a compulsive overeater. She couldn't stop thinking about food. Her
brain SPECT study showed too much activity in the front part of her brain (in an area
called the anterior cingulate gyrus), likely due to low levels of the neurotransmitter
serotonin. On a rational weight-loss program plus a regimen of 5-HTP to boost serotonin
levels in her brain, she lost weight, felt much happier, was more relaxed, and got along
better with her husband.

Rick was an impulsive overeater. He also had trouble controlling his behavior.
His brain SPECT scan showed too little activity in his prefrontal cortex, likely due to low
dopamine levels, so he had trouble supervising his own behavior. Like his son, he was
also diagnosed with ADD. On treatment to boost his dopamine levels, he felt more
focused and in better control of his impulses. Over the first year, he lost thirty-five
pounds and was getting along better with his wife and child.

Cherrie was an impulsive-compulsive overeater. Cherrie had features of both
impulsivity (the bulimia) and compulsivity (manifested by the repetitive negative
thoughts and rigid behavior). Her brain SPECT scan showed areas in her prefrontal
cortex that were both overactive and underactive, likely due to low serotonin and
dopamine levels. In my research, I discovered that this pattern is common in children and
grandchildren of alcoholics. On treatment to raise both serotonin and dopamine levels,
she felt much more emotionally balanced and consistently lost weight.
Jerry was a SAD or emotional overeater. He struggled with his mood and
weight, but only after he moved to a place where he got little sunlight. He suffered from
seasonal affective disorder (SAD), which has been associated with low vitamin D levels,
and his brain SPECT study showed increased activity in his emotional or limbic brain and
decreased activity in his PFC. On a combination of vitamin D, bright light therapy, and
SAMe, he did much better, experienced fewer pain symptoms, and returned to his
premove weight over a two-year period.
Connie was an anxious overeater. She medicated her underlying anxiety with
food. Her brain SPECT study showed increased activity in her basal ganglia, an area
often associated with anxiety. By calming her anxiety with relaxation techniques and a
combination of B 6, magnesium, and GABA, she stopped the constant grazing, felt more
relaxed and more in control of her emotions and behavior. She lost twenty pounds over
the next year and noticed a boost in her energy.
Camille was on adrenaline overload. This was causing her to waste away. The
chronic intense stress from her divorce and the recent loss of her mother reset her brain
and body to an overactive state. Her brain SPECT study showed overall increased activity
in the deep centers of her brain, a pattern on SPECT we call the diamond pattern because
of the hyperactivity of the different structures we see. On treatments to calm her brain--
including a form of psychotherapy called EMDR for people who have been emotionally
traumatized, plus phosphatidylserine, B 6, magnesium, and GABA--she was able to
sleep, quiet her mind, and come back to a normal weight.

WHY MOST WEIGHT-MANAGEMENT APPROACHES DO NOT WORK.

Weight-loss pills, clinics, books, programs, and cookbooks are everywhere you
look. Why are there so many different approaches to weight loss and weight
management? Why do they generally have such poor results? Why are people constantly
searching for the next idea and the next fix? The problem with the whole notion of weight
management is that one treatment, one program, or one method is advertised to work for
everyone. Based on our brain imaging work with tens of thousands of patients, the
premise for most weight-management programs that promote a single path or prescription
is ridiculous. First, you need to know about your own individual brain and then target the
interventions in a way that fits your own specific needs.
Looking at the descriptions below and taking the brief questionnaire in Appendix
B, plus the extended online version at www.amenclinics.com/my-brain-health/online-
tests-calculators/cyb-questionnaire, you will get an idea about how your own brain works
and what specific needs you may have. Then, based on your answers, you will be better
able to target the treatment interventions. Of course, you should do this in consultation
with your own health-care provider.

SUMMARY OF THE AMEN CLINICS: SIX TYPES OF WEIGHT-
MANAGEMENT ISSUES.

Type 1: The Compulsive Overeater.

People with this type have trouble shifting their attention and tend to get stuck on
thoughts of food or compulsive eating behaviors. They may also get stuck on anxious or
depressing thoughts. The basic mechanism of this type is that they tend to get stuck or
locked into one course of action. They tend to have trouble seeing options and want to
have things their way. They struggle with cognitive inflexibility. This type is also
associated with worry, holding grudges, and having problems with oppositional or
argumentative behavior. Nighttime-eating syndrome, where people tend to gorge at night
and not be hungry early in the day, usually fits this pattern.
The most common brain SPECT finding in this type is increased anterior
cingulate gyrus activity, which is most commonly caused by low brain serotonin levels.
High-protein diets, diet pills, and stimulants, such as Ritalin, usually make this type
worse. Interventions to boost serotonin in the brain are generally the most helpful. From a
supplement standpoint (see Appendix C), 5-HTP, L-tryptophan, St. John's wort, and the
B vitamin inositol are helpful, as are the serotonin-enhancing medications, such as
Prozac, Zoloft, and Lexapro. In fact, 5-HTP has good scientific evidence that it helps
with weight loss, and in my experience, I have found that it works best for this type.
ACTION STEP Behavioral interventions that boost serotonin to help
compulsive overeaters:
Exercise to allow more of the serotonin precursor, L-tryptophan, to get into the
brain.
If you get a negative or food-oriented thought in your head more than three times,
get up and go do something to distract yourself.
Make a list of ten things you can do instead of eating so you can distract yourself.
People with this type always do better with choices, rather than edicts. Do not tell
them where you are going to eat or what they are going to eat; give them choices.
Avoid automatically opposing others or saying no, even to yourself.
If you have trouble sleeping, try a glass of warm milk with a teaspoon of vanilla
and a few drops of stevia.

Type 2: The Impulsive Overeater.

People with this type struggle with impulsivity and trouble controlling their
behavior, even though nearly every day they intend to eat well. "I am going to start my
diet tomorrow" is their common mantra. This type results from too little activity in the
brain's PFC. The PFC acts as the brain's supervisor. It helps with executive functions,
such as attention span, forethought, impulse control, organization, motivation, and
planning. When the PFC is underactive, people complain of being inattentive, distracted,
bored, off task, and impulsive. This type is often seen in conjunction with ADD, which is
associated with long-standing issues of short attention span, distractibility,
disorganization, restlessness, and impulsivity.

Research published in the July 2008 issue of Pediatrics found that children and
adolescents with ADD who do not currently take medications are at 1.5 times the risk of
being overweight than non-ADD children. These individuals are more likely to be
impulsive overeaters. On the other hand, those taking medication for ADD had 1.6 times
more risk of being underweight compared to children without ADD, which is a side
effect of their medication, which decreases appetite.

Impulsive overeaters may also be the result of some form of toxic exposure, a
near-drowning accident, a brain injury to the front part of the brain, or a brain infection,
such as chronic fatigue syndrome. The most common brain SPECT finding in this type is
decreased activity in the PFC, which is most commonly associated with low brain
dopamine levels. High-carbohydrate diets and serotonin-enhancing medications, such as
Prozac, Zoloft, or Lexapro, or supplements, such as 5-HTP, usually make this type worse.
Interventions to boost dopamine in the brain are generally the most helpful. From a
supplement standpoint, green tea and rhodiola are helpful, as are stimulant medications,
such as phentermine, Adderall, and Ritalin, which are commonly used to treat
ADD.ACTION STEPBehavioral interventions that boost dopamine to help
impulsive overeaters:
Exercise, which helps increase blood flow and dopamine in the brain--especially
doing an exercise you love.
Clear focus--make a list of weight and health goals displayed where you can see it
every day.
Outside supervision--someone you trust checking in with you on a regular basis to
help you stay focused.
Avoid impulsively saying yes to offers for more food or drink and practice saying,
"No, thank you, I'm full."

Type 3: The Impulsive-Compulsive Overeater.

People with this type have a combination of both impulsive and compulsive
features. The brain SPECT scans tend to show low activity in the PFC (associated with
impulsivity, likely due to low dopamine levels) and high activity in the anterior cingulate
gyrus (associated with compulsivity and low serotonin levels). This pattern is common in
the children or grandchildren of alcoholics. People with this mixed type tend to have
done very well emotionally and behaviorally on the fen-phen combination, which raised
both dopamine and serotonin in the brain.
Using serotonin or dopamine interventions by themselves usually makes the
problem worse. For example, using a serotonin medication or supplement helps to calm
the compulsions but makes the impulsivity worse. Using a dopamine medication or
supplement helps to lessen the impulsivity but increases the compulsive behaviors.
Treatments to raise dopamine and serotonin together, with either a combination of
supplements, such as green tea and 5-HTP, or medications, such as Prozac and Ritalin,
have worked the best in my experience.

ACTION STEP Behavioral interventions that boost both serotonin and
dopamine to help impulsive-compulsive overeaters:
Exercise.
Set goals.
Avoid automatically opposing others or saying no, even to yourself.
Avoid impulsively saying yes.
Have options.
Distract yourself if you get a thought stuck in your head.

Type 4: The SAD or Emotional Overeater.
People with this type often eat to medicate underlying feelings of boredom,
loneliness, or depression. Their symptoms can range from winter blues to mild chronic
sadness (termed dysthymia) to more serious depressions. Other symptoms may include a
loss of interest in usually pleasurable activities; decreased libido; periods of crying;
feelings of guilt, helplessness, hopelessness, or worthlessness; sleep and appetite
changes; low energy levels; suicidal thoughts; and low self-esteem. The SPECT findings
that correlate with this type are markedly increased activity in the deep limbic areas of
the brain and decreased PFC activity.
When this type occurs in the winter, it is usually in more northern climates, where
there is often a deficiency in sunlight and vitamin D levels. Low vitamin D levels have
been associated with depression, memory problems, obesity, heart disease, and immune
suppression. In recent years, there is an increase in vitamin D deficiencies even in
southern and western states in the summer. There are two reasons for this: People are
wearing sunscreen more than ever, so they are not being exposed to the sun even when
they are outside, and they are spending more and more time indoors on their computers or
watching TV. Some researchers believe nearly half of the U.S. population suffers from a
vitamin D deficiency. I screen all of my patients for it by ordering a 25-hydroxy vitamin
D level. To treat SAD or emotional overeaters, check vitamin D levels and correct them
when low by taking a vitamin D supplement. Bright light therapy may be helpful to
correct vitamin D problems, help with mood states, and help people lose weight.
There is evidence that bright light therapy might also enhance the effectiveness of
physical activity for weight loss. In studies, it significantly reduced the binge-eating
episodes in people with bulimia and is an effective treatment for SAD. Research studies
have also shown it to be more effective than Prozac for these patients. Using bright light
therapy in the workplace was effective in improving mood, energy, alertness, and
productivity.ACTION STEPBehavioral interventions that boost mood to help SAD
or emotional overeaters:
Exercise to increase blood flow and multiple neurotransmitters in the brain.
Kill the ANTs (automatic negative thoughts) that steal your happiness.
Write down five things you are grateful for every day (this has been shown to
increase your level of happiness in just three weeks).
Volunteer to help others, which helps to get you outside of yourself and less
focused on your own internal problems.
Surround yourself with great smells, such as lavender.
Try melatonin to help you sleep.
Work to improve your relationships.
Also, make sure to check your DHEA blood levels. DHEA is a master hormone
that has been found to be low in many people with depression and obesity.
Supplementing with DHEA has good scientific evidence that it is helpful for weight loss
in certain patients. Another helpful treatment for emotional overeaters is the natural
supplement SAMe, in dosages of 400 to 1,600 mg. Be careful with SAMe if you have
ever experienced a manic episode, and take it early in the day as it has energizing
properties and may interfere with sleep. I like the medication Wellbutrin for this type,
which has been shown to have weight-reducing properties.

Type 5: The Anxious Overeater.

People with this type tend to use food to medicate underlying feelings of anxiety,
tension, nervousness, and fear. They tend to feel uncomfortable in their own skin. They
may be plagued by feelings of panic, fear, and self-doubt, and suffer physical symptoms
of anxiety as well, such as muscle tension, nail biting, headaches, abdominal pain, heart
palpitations, shortness of breath, and sore muscles. It is as if they have an overload of
tension and emotion. People with this type tend to predict the worst and look to the future
with fear. They may be excessively shy, easily startled, and freeze in emotionally charged
situations. The SPECT finding in this type is increased activity in the basal ganglia,
which is commonly caused by low levels of the calming neurotransmitter GABA.
Interventions to boost GABA, by using B6, magnesium, and GABA, are generally
the most helpful. From a medication standpoint, the anticonvulsant Topamax has strong
evidence that it is helpful for weight loss, and in my experience, it is especially helpful
for this type. Relaxation therapies can also be helpful to calm this part of the brain.
ACTION STEPBehavioral interventions that boost GABA and calm the brain to
help anxious overeaters:
Exercise.
Try relaxation exercises, such as: meditation prayer hypnosis deep
diaphragmatic breathing exercises hand-warming techniques
Kill the anxious ANTs.
For sleep, try self-hypnosis, kava kava, or valerian root.

Type 6: The Adrenaline-Overload Anorexic.
For most people, excess stress leads to weight gain. But some people have trouble
keeping a healthy weight on their bodies when they're under a lot of stress. The stress
causes them to go into an emotional overload state, and they start to waste away.
Typically, these people's thoughts often go too fast, they tend to have trouble sleeping,
they may experience diarrhea, and they often complain of memory problems. Their brain
SPECT studies show overall increased activity, especially in the deep centers of their
brains, similar to what I see with post-traumatic stress syndrome.
Treatments to calm the brain are generally the most helpful, including EMDR--
eye movement desensitization and reprocessing (see www.emdria.org for more
information)--hypnosis, and cognitive therapy. The supplements phosphatidylserine (PS),
B 6, magnesium, and GABA are also helpful to calm the stress. There are not any current
medications I use to help people gain weight. Any medications I prescribe depend on
what other factors may be contributing to the current stress. ACTION STEPBehavioral
interventions--the same as those recommended for anxious overeaters--that boost
GABA and calm the brain to help adrenaline overload anorexics:
Exercise.
Try relaxation exercises, such as: meditation prayer hypnosis deep
diaphragmatic breathing hand-warming techniques
Kill the anxious ANTs.
For sleep, try self-hypnosis, kava kava, or valerian root.
Knowing your brain type is essential to the Weight Solution and getting the right
help for yourself. For any weight solution to be effective, it must be centered on your
particular brain, your particular problems, and your particular needs. Any program that
gives you a one-size-fits-all approach is destined to fail.
Do You Have More Than One Type?
Having more than one type is common, and it just means that you may need a
combination of interventions. Type 3 Impulsive-Compulsive Overeaters is actually a
combination of Type 1 Compulsive Overeater and Type 2 Impulsive Overeater. It is
common to have Type 1 mixed with Type 4 SAD or emotional overeater or with Type 5
Anxious Overeater. In those cases, we may mix 5-HTP for Type 1 with SAMe for Type 4
or GABA with Type 5. Again, it is always smart to discuss these options with your
health-care provider. If he or she does not know much about natural treatments, consult a
naturopath or a physician trained in integrative medicine or natural treatments.

WEIGHT CONTINUES TO BE A RISING PROBLEM.
Our poor eating habits are making us one of the fattest nations on the planet. More
than half of American women have a waistline greater than thirty-five inches, while half
of their male counterparts measure in at more than forty inches around the belly. Obesity
is becoming an epidemic with a devastating impact on our health and our brains.
Research from 2005 and 2006 indicates that fully one-third of adult men and more than
35 percent of adult women in the United States are obese. About six million people are
considered to have morbid obesity, which is defined as being at least 100 pounds
overweight. Obesity is determined by a person's body mass index (BMI), which is a ratio
of their weight and height.

Body Mass Index (BMI) Categories.
Underweight:
Normal weight: 18.5-24.9.
Overweight: 25-29.9.
Obese: 30 or higher.
Morbid obesity: 40 or higher.
Sources: National Institutes of Health and American Society for Metabolic &
Bariatric Surgery.
Here are the steps to calculate your BMI: weight in pounds x 703/height in
inches.
Multiply your weight in pounds times 703.
Multiply your height (in inches) times your height (in inches).
Divide the number in step 1 by the number in step 2 to get your BMI.
For example: If you weigh 148 pounds and you are five feet six inches tall, the
calculation would look like this:
148 pounds x 703 = 104,044.
66 x 66 = 4,356.
104,044/4,356 = 23.9 BMI (normal).
Or, if you weigh 260 pounds and you are five feet six inches tall, the calculation
would look like this:
260 pounds x 703 = 182,780.
66 x 66 = 4,356.
3.182,780/4,356 = 42.0 BMI (morbidly obese).

Morbid obesity is associated with more than thirty medical conditions and
diseases, including type 2 diabetes, heart disease, and high blood pressure, as well as
brain-related conditions, such as stroke, chronic headaches, sleep apnea, and Alzheimer's
disease. These diseases can devastate a person's life. Diabetes is a disease that occurs
when blood sugar levels in the body aren't right. The high blood sugar level causes small
blood vessels in the body to become fragile and break, which can lead to terrible
consequences. I have a friend who is diabetic, and due to the disease, he has lost his sight
and has had to have both of his legs amputated. If you have a disease such as diabetes or
heart disease, it is even more important for you to eat right in order to prevent or delay
progression of the disease. Obesity is also associated with significantly longer hospital
stays for comparable conditions. Ultimately, obesity puts you at increased risk for death.
A review of several long-term studies on obesity and longevity found that the risk of
death rises as weight increases above normal weights.
People who are obese or overweight also have smaller brains than lean people,
according to new research in the journal Human Brain Mapping. Scientists used brain
scans to determine the amount of brain tissue in ninety-four people over the age of
seventy. They found that obese individuals had 8 percent less brain tissue and their brains
looked sixteen years older than the brains of people at normal weights. Overweight
people had 4 percent less brain tissue and their brains appeared eight years older.
The loss of tissue occurred in several important areas of the brain. In obese
people, losses affected the frontal lobes, anterior cingulate gyrus, hippocampus, temporal
lobes, and basal ganglia. In the overweight crowd, brain loss occurred in the basal
ganglia, corona radiata (white matter that speeds communication between different areas
of the brain), and parietal lobe. Overall, the loss of brain tissue puts overweight and obese
people at increased risk for Alzheimer's disease, dementia, and other brain disorders.
As if we needed more proof that gaining weight is bad for our health, researchers
at the University of Pittsburgh used brain imaging to examine the effects of increases in
BMI on forty-eight otherwise healthy postmenopausal women. They found that women
whose BMI went up following menopause were more likely to have a reduction in gray
matter.
What is even worse is that our kids are becoming overweight or obese at an
alarming rate. Studies show that a whopping 34 percent of children and teens are either
currently overweight or at risk of becoming overweight, and more than 16 percent of kids
ages two to nineteen are obese. Among younger children, obesity is skyrocketing. This is
putting our children at greater risk for a variety of diseases and conditions that negatively
affect brain function.
If you are overweight or love someone who is overweight, it is important to think
of this as a life-threatening problem. Mind-set here is critical. Some anxiety, or brain
alarm, is often necessary for people to take the actions needed to be healthy. I think it is
also important to treat obesity like a chronic disease, because it is. And we need to think
about being on healthy diets for life, not just for a few months to fit into a wedding dress
or a suit for a special occasion.
When it comes to the brain, size matters. A smaller brain means reduced brain
function, which can affect every aspect of your life--your relationships, your career, and
your mood.

FAT IS MORE THAN JUST FAT.

I remember the first day of my anatomy dissection lab in medical school like it
was yesterday. Some of my fellow students had weak stomachs and had to get the mop.
Even before the vomit, there was a smell in the room unlike anything most of us had ever
experienced. Some of the students were nervous. I was excited and fascinated. Anatomy
and neuroanatomy were my favorite subjects. Irma was the woman who donated her
cadaver so that my colleagues and I could become skilled physicians. Irma and I spent
many, many hours together. I remember when I cut through her skin how amazed I was
to see the bright yellow, greasy layer of fat below. I had no idea at the time that fat was
anything more than, well, fat. Since that day in the fall of 1978, fat has taken on a whole
new meaning. The fat on your body is not just an energy-storage reservoir; it is a living,
biologically active, toxin-storing, hormone-producing factory, and more fat is definitely
not better.

Fat produces the hormone leptin, which usually turns off your appetite.
Unfortunately, when people are overweight, the brain becomes sensitized to leptin, and it
no longer has a positive effect on curbing hunger cravings. Fat cells also produce the
hormone adiponectin, which also helps to turn off appetite and increases fat burning. As
fat stores increase, adiponectin levels drop, and the process of burning fat as fuel actually
becomes less efficient. In addition, fat cells pump out immune-system chemicals called
cytokines, which increase the risk of cardiovascular disease, insulin resistance, and high
blood sugar, diabetes, and low-level chronic inflammation.

Inflammation is at the heart of many chronic illnesses. The level of fat on your
body, especially abdominal fat, is also directly linked with higher total cholesterol and
LDL (bad) cholesterol and lower HDL (good) cholesterol. Together, insulin resistance,
high blood sugar, excess abdominal fat, unfavorable cholesterol and triglyceride levels,
and high blood pressure constitute the metabolic syndrome, a major risk factor for heart
disease, stroke, depression, and Alzheimer's disease.
In recent years, it has been found that fat stores toxic materials, so that the more
fat on your body, the more toxins you have. The more animal fat you eat, the more toxins
you have as well. Also, fat tends to increase the amount of estrogen in your body,
especially if you are male. Fat cells store estrogen. They contain an enzyme that converts
several other steroid hormones to estrogen. Having increased estrogen makes it difficult
to lose fat. Estrogen binds with a receptor on the surface of fat cells, which promotes the
growth and division of fat cells, especially in your butt and thighs.

THIRTEEN THINGS ALL OF US SHOULD DO TO MAINTAIN A
HEALTHY WEIGHT.

Know your type(s).
Get a complete physical and focus on having healthy vitamin D, DHEA, and
thyroid levels.
Know your BMI and caloric need numbers.
Know the approximate number of calories you eat a day by keeping a food journal
and calorie log and work on getting "high-quality calories in versus high-quality energy
out."
Exercise four or five times a week, starting with walking fast and light strength
training.
Optimize your hormone levels.
Get great sleep.
Use simple stress-management techniques.
Stop believing every negative thought that goes through your brain.
Use hypnosis to help keep you slim.
Take supplements to keep your brain healthy.
Using the advice in this book, keep your brain young and active in order to lose
ten pounds.

Take control of your weight and do not let other people make you fat.
1. Know your type(s). From the more than 55,000 scans we have performed at
the Amen Clinics, it is clear that not everyone with the same problem, such as obesity or
depression, has the same brain pattern. The descriptions above and the questionnaire in
Appendix B or at www.amenclinics.com/my-brain-health/online-tests-calculators/cyb-
questionnaire will help you know your type or types.

2. Get a complete physical. Not the five-minute type, but a real physical where
you spend time talking to your doctor about your health. Medical problems, such as being
on certain medications or having a low or suboptimal thyroid, vitamin D, DHEA, or
testosterone levels, or being depressed or anxious, can seriously sabotage any attempt to
lose, maintain, or be at your ideal weight.

3. Know your BMI and daily caloric need numbers. This is critical. The basic
principle of weight loss or weight gain is about energy balance. The BMI formula is
given above. The Harris Benedict Formula is commonly used to help people understand
the approximate number of calories a day they need to maintain their current weight. This
is a key number for you to understand, because it will serve as a guide to help you lose or
gain weight.

To find out your basic calorie needs without any exercise, your resting basal
metabolic rate (BMR), fill out the following equation on yourself:Women: 655 + (4.35 x
weight in pounds) + (4.7 x height in inches)--(4.7 x age in years)Men: 66 + (6.23 x
weight in pounds) + (12.7 x height in inches)--(6.8 x age in years)Take that number and
multiply it by the appropriate number below.1.2--if you are sedentary (little or no
exercise)1.375--if you are lightly active (light exercise/sports 1 to 3 days/week)1.55--if
you are moderately active (moderate exercise/sports 3 to 5 days/week)1.75--if you are
very active (hard exercise/sports 6 or 7 days a week)1.9--if you are extra active (very
hard exercise/sports and a physical job or strength training twice a day).
The total is the number of calories a day you need to maintain your current
weight. Put this number where you can see it. This number helps to give you control over
your health.

4. Know the approximate number of calories you eat a day by keeping a food
journal and calorie log and work on getting " high-quality calories in versus high-
quality energy out." People lie to themselves constantly about their food intake. They
underestimate the number of calories they eat and subsequently, through ignorance or
denial, ruin their brains and their bodies. I am not suggesting you count every calorie for
the rest of your life, but I am suggesting that you use your brain to become educated
about the calories and nutrition you put in your body, and then take control over them.
ACTION STEPRemember that it is the little decisions about food that you make every
day that often determine whether you are fat or trim. See the list of "100 Ways to Leave
Your Blubber" for tips on cutting calories at www.amenclinics.com/my-brain-
health/brain-health-club/100-ways-to-leave-your-blubber/.

New York State recently passed a law making restaurants put the calories of their
offerings on the menu. I love it! Why? It allows people to be informed consumers, to use
their thoughtful brains rather than just impulsively ordering something because it looks
good when their blood sugar and willpower are low. For example, when you look at the
calories and fat in a Caesar salad, you realize it is not a healthy choice. Or, take one
Cinnabon; it has 730 calories. My daily caloric intake needed to maintain my current
weight is about 2,100 calories. If I have one Cinnabon a day, it fills more than 33 percent
of my caloric needs with virtually no nutrition. Just knowing this fact will make me reach
for a banana.
Likewise, knowing the calorie content of what you eat can help you make small
adjustments that will make a big difference. Take having a Venti Peppermint White
Chocolate Mocha at Starbucks. If you have them make it with whole milk and whipped
cream, it is 700 calories! If you get a tall size of the same drink with nonfat milk and no
whipped cream, it is only 320 calories, less than half.
To really know your calorie intake without cheating, keep a food journal where
you write down absolutely everything you put in your mouth. Get a small weight scale
and measure your portions of food. I can promise you that your idea of a serving will
almost certainly vary substantially from what the food manufacturer puts on the label.
Some of you may be thinking this is too much work. Yet I promise you it is worth the
effort.
In our high school course Making a Good Brain Great, we have a lesson on
nutrition. We teach the students that people gain weight when they eat more calories than
they burn.Calories in versus calories out.Calories in = what you eat.Calories out = level
of exercise.
The average male teen burns about 2,500 calories a day, while the average female
teen burns about 2,000 calories a day. If you eat more calories than you burn, you gain
weight. If you eat fewer calories than you burn, you lose weight. Calories are key.1
pound (lb) = 3,500 calories (cals)1 lb weight gain = eat 3,500 cals more than burn1 lb
weight loss = eat 3,500 cals less than burnFor example, if you eat 500 extra cals a day
(about one cheeseburger), you will gain a pound a week
You need to know approximately how many calories you eat on a regular basis,
otherwise they can seriously get away from you.
You cannot change what you do not measure.
In one of the laboratory exercises for the high school course, we have students
write down the foods they typically order from their favorite fast-food restaurants and
then have them go online to www.chowbaby.com to find the nutritional value of those
meals. Most students are shocked by what they are putting in their bodies. When my son-
in-law Jesse did this exercise (he helped me develop the course and did his master's thesis
showing that it is highly effective in helping teens develop pro-social attitudes), he found
out that for lunch alone he was eating almost 100 percent of his daily allotted calories.
This knowledge encouraged him to make some simple adjustments that have helped him
stay within his allotted calories and maintain a healthier weight.
You typically hear doctors talk about "calories in" versus "calories out." To be
brain healthy, we must significantly upgrade this concept and think of " high-quality
calories in" versus " high-quality energy out." For example, having 300 calories from Red
Vines licorice or 730 calories from one Cinnabon is not the same as 500 calories from a
piece of wild Alaskan Copper River Salmon, grilled veggies, and a sweet potato. I
consider Red Vines and Cinnabon antinutrition, while the wild salmon, veggies, and a
sweet potato are nutrition powerhouses. Likewise, "calories out" can come through taking
supplements, such as caffeine or ephedra, to rev your metabolism and increase your stress
hormones and anxiety and insomnia, or they can come from coordination exercises that
burn calories and boost brain function. Aim for "high-quality calories in" versus "high-
quality energy out"!
5. Exercise four or five times a week. One of the best exercises is walking fast.
Walk like you are late, with periodic one-minute bursts of high-intensity walking or
running. Some studies have shown that exercise can be as effective as antidepressant
medications. The usual side effects of exercise are more energy and a healthier body. See
Chapter 5, "The Exercise Solution," for more information. Coordination exercises, such
as dance or table tennis, are also great for your brain and body.
6. Optimize your hormone levels. Much more information on this topic is found
in Chapter 7, "The Hormone Solution." For now, let's look at three essential weight-
management hormones: insulin, leptin, and ghrelin.
Insulin is produced by the pancreas and is considered a storage hormone. It gets
stimulated primarily in response to a rise in blood sugar. Its function is to take nutrients
from the bloodstream and store them in the body's cells. Insulin increases the uptake of
glucose into the liver and muscles for storage as a substance called glycogen, and it also
helps store excess glucose in fat cells. Since insulin is a storage hormone and not a
mobilizing hormone, it also stops the body from mobilizing and using fat as a fuel source.
Too much insulin stops fat burning. To maintain a healthy weight and burn fat
adequately, it is important to keep insulin properly balanced.ACTION STEPFour tips
to keep your insulin levels balanced:
Have frequent small meals throughout the day rather than a few large meals.
Larger meals tend to cause a greater insulin response.
Control your carbohydrate intake. The more carbohydrates in a meal, the greater
the insulin response.
Emphasize more low-density carbohydrates and fewer high-density ones. The
low-density carbohydrates, such as broccoli, cauliflower, green beans, and carrots, have
more fiber and fewer carbohydrates than high-density carbohydrates, such as bread,
pasta, rice, and cereals.
Glucose-balancing agents--such as chromium, alpha-lipoic acid, cinnamon, and
ginseng--may help. Chromium is a micronutrient (meaning that the human body doesn't
need very much of it) that enhances the action of insulin and is involved in the
metabolism of carbohydrates, fat, and protein. Alpha-lipoic acid is an antioxidant that
may lower blood glucose levels.
ACTION STEP.
Ways to boost leptin levels without causing leptin resistance:
* Improve your sleeping habits.
* Avoid excess sugar and bad fats.
* Exercise regularly.
* Take supplements, such as melatonin and omega-3 fatty acids.
Leptin is a hormone produced by fat cells that tells your body it is full. The more
fat cells you have on your body, the more leptin you tend to have. Leptin works on the
brain's hypothalamus to reduce your appetite when fat stores are high. When fat stores are
low, such as after dieting, leptin levels are diminished, which causes a spike in appetite
and sabotages weight loss. Leptin has been described as an antistarvation hormone
because low levels lead to increased hunger. In the past, leptin was described as an
antiobesity hormone, but researchers have since discovered that obese people, who
produce large amounts of leptin, are often resistant to its effect in a similar way that some
people are resistant to insulin. Leptin resistance may also result from over eating, as the
hypothalamus becomes desensitized to its effects so you never know when you are full.
Poor sleep also decreases leptin levels, which is interesting because many overweight
people suffer from sleep apnea, a condition where people snore loudly, stop breathing
frequently during sleep, and are chronically tired during the day. The lack of oxygen from
sleep apnea is likely involved in lowering leptin levels. Poor sleep also impairs melatonin
production, which can also lower leptin levels.

Ghrelin is a hormone secreted by the stomach that tells your brain you are hungry.
I think of ghrelin as gremlins that force you to eat. In one study, when people were given
ghrelin injections and then offered a buffet meal, they ate 30 percent more than they
normally would! One of the main reasons it is thought that people tend to put weight back
on after a diet is that ghrelin levels increase during dieting. This results in uncontrolled
hunger and subsequent overeating. Naturally reducing ghrelin, keeping the gremlins
away, is essential to maintaining a healthy weight. The substance peptide YY3-36 or
PYY3-36, which is also produced in the stomach, blunts the effects of ghrelin. PYY3-36
is increased by having frequent small meals.ACTION STEPTo stimulate the secretion of
PYY3-36 in your stomach and help keep hunger at bay, eat with the acronym CRON
(calorie restricted but optimally nutritious) in mind. For example, eating a 500-calorie
spinach-and-salmon salad will keep you feeling full much longer than a 700-calorie
cinnamon roll.ACTION STEPPay attention to Chapter 13, "The ANT Solution," to clean
up the ANTs that are stealing your happiness and increasing your waistline.
7. Get great sleep. For all of the brain types, being sleep deprived ultimately will
make you fat and less intelligent. See Chapter 10 for more information.
8. Use simple stress-management techniques. Chronic, unrelenting stress upsets
everything in your body, from your weight to your immune system to your memory. See
Chapter 11 for more information.
9. Stop believing every negative thought that goes through your brain. People
with weight issues typically are infested with a lot of ANTs. See Chapter 13 for more
information. For many, these negative thinking patterns are one of the primary sources of
worry, stress, depression, and anxiety, which often contribute to overeating or erratic
eating.
A former professional football player who came to see us as part of a brain
imaging study I am conducting on retired NFL athletes was six feet two inches and
struggled at a weight of 365 pounds. When I asked him about it, he said, "I have no
control over food." I asked, "Is that really true?" He said, "No, it isn't really true." I told
him, "By saying or thinking that thought, I have no control over food, you just gave
yourself permission to have no control over food and eat whatever you want."
In the same way, I was recently at dinner with a friend who was morbidly obese
and ordered a large plate of nachos smothered in cheese. His wife was trying to get him
on a healthy food plan, but he said, "I don't like any of that rabbit food." I responded by
asking him what he meant. He said, "You know, all those vegetables and fruits." I told
him that his way of thinking was giving himself permission to eat anything he wanted,
and was going to kill him. "I don't like paying taxes," I said, "but I do it because I know
there are consequences if I don't." Pay attention to your thoughts. They can help keep you
on track toward your goals or completely give you permission to fail.
10. Use hypnosis to help keep you slim. When I was an intern at the Walter
Reed Army Medical Center in Washington, D.C., one of my favorite teachers was the
noted psychologist Harold Wain. He was the president of the American Society for
Clinical Hypnosis and the chief of our Consultation-Liaison Service, the group of
psychologists and psychiatrists who helped patients on medical wards who had
psychiatric issues. Harold was a wonderful teacher. When he would use hypnosis for
weight loss, he would help patients take their time to savor their food and drink. To
patients in a trance he could describe drinking a cup of coffee in such a seductive way
that it made them think drinking was as pleasurable as sex. He pointed out that people
typically inhale their food and take little time to actually enjoy it. By using a simple,
descriptive hypnotic technique, he could get people to slow down, feel full faster, and
really start to enjoy the energy they put into their bodies.
I have personally been using hypnosis in my practice with patients for thirty
years. To use it effectively for weight loss, it needs to be used in combination with a
responsible weight-management program. There is also significant scientific evidence
that suggests that hypnosis can be a powerful aid to weight loss. In one scientific review
comparing a series of weight-loss studies with and without hypnosis, it was found that
adding hypnosis significantly improved weight loss. The average post-treatment weight
loss was 6.0 pounds without hypnosis and 11.83 pounds with hypnosis, nearly double. In
a further follow-up period, the mean weight loss was 6.03 pounds without hypnosis and
14.88 pounds with hypnosis. The benefits of hypnosis increased over time.
Hypnosis can help people learn positive eating behaviors and create healthy long-
term patterns of food intake. Some common hypnotic suggestions I give to patients
include "feel full faster ... eat more slowly ... savor and enjoy each bite of your food ...
visualize yourself at your ideal weight and body ... see the behaviors you need to do to
get the body you want."
In addition, hypnosis has been found to be helpful to decrease stress, anxiety,
insomnia, pain, and negative thinking patterns, all conditions that increase the potential
for weight gain. Brain imaging studies have also shown that hypnosis boosts overall
blood flow to the brain, which, as you will see below, helps to keep the brain young and
may help you burn more calories. On our website (www.amenclinics.com), you can find
a series of hypnosis CDs and downloads that I have created for you.
11. Take supplements to keep your brain healthy. Taking nutritional
supplements can make a big difference in your efforts to reach your ideal weight. To all
of my patients, I recommend taking a daily multiple vitamin/mineral supplement. Studies
have reported that they help prevent chronic illness. In addition, people with weight-
management issues often are not eating healthy diets and have vitamin and nutrient
deficiencies.
I also recommend fish oil. Increased blood levels of omega-3 fatty acids from fish
or fish oil have been recently linked to a lower incidence of obesity. Research results
reported in the British Journal of Nutrition indicate that overweight and obese people
have blood levels of omega-3 fatty acids that are lower than those of people with a
healthy weight.
A considerable number of studies already support the benefits of the omega-3
fatty acids for heart, skin, eye, joint, brain, and mood health. In this particular study,
researchers recruited 124 people of varying weights: 21 were classified as having a
healthy weight, according to their body mass index (BMI); 40 were classed as
overweight; and 63 were obese. People who consumed omega-3 supplements were
excluded from the study. Blood samples were taken after the subjects fasted for at least
ten hours. Researchers reported an inverse relationship between total omega-3 blood
levels with BMI, the subjects' waist size, and their hip circumference. The researchers
suggested that a diet rich in omega-3 fatty acids or omega-3 supplementation may play an
important role in preventing weight gain and improving weight loss when used in
combination with a structured weight-loss program.
Results from animal studies suggested that omega-3s may increase the production
of heat by burning energy (thermogenesis). Another study suggested a role of omega-3s
in boosting the feeling of fullness after a meal, and may help regulate the levels of hunger
hormones like ghrelin and leptin, which impact appetite.
In addition, I recommend a craving supplement containing chromium picolinate,
N-acetyl-cysteine, L-glutamine, and vitamin D and DHEA if levels of these are low. (See
more about these supplements in Appendix C, "The Supplement Solution," and on our
website: www.amenclinics.com.) Then, depending on your brain type, choose the
supplements, if needed or desired, that best fit your brain. See the table at the end of this
chapter.
I only consider recommending medication or surgery for weight loss if nothing
else is working. People who have mild to moderate weight issues are often able to get a
handle on the problem through natural means, but sometimes medications--especially
those targeted to your type--or even surgery may be needed to save your life. The
medications for each type are listed in the Summary Table of the Six Types of Weight-
Management Issues at the end of this chapter. Obesity is a life-threatening problem, and
sometimes lifesaving means are necessary. My friend Anthony Davis, a College Football
Hall of Fame running back from USC, had bariatric surgery with great success.
There are several new weight-loss treatments currently being studied. For
example, scientists are working on developing drug treatments that target abdominal fat.
Another breakthrough technique involves brain surgery to treat obesity. Called deep brain
stimulation, it delivers electricity to specific areas of the brain and has proved successful
in eliminating or reducing tremors and tics in people with epilepsy, Parkinson's disease,
and other neurological conditions. It has also been found to be useful in resistant
depression and obsessive-compulsive disorder.
12. Using the advice in this book, keep your brain young and active in order
to lose ten pounds. The brain uses 20 to 30 percent of the calories you consume each
day. It is the major energy consumer in your body. Based on tens of thousands of brain
scans that we have performed at the Amen Clinics, we have seen that the brain becomes
dramatically less active as we age. In Image 3.1, you can see that the activity of the PFC
peaks around age ten and then becomes less and less active. This happens in part because
nerve cells are being wrapped with the white fatty substance myelin, which helps them
work more efficiently, and brain connections that are not being used are pruned away.
But this also happens because later in life there is overall decreased blood flow to the
brain, which contributes to aging. This finding has also been reported by other
researchers and may be one of the reasons why people need fewer calories with age.

This graph shows increased
activity in the prefrontal cortex early in life, but dramatic decreased activity after age ten
over the life span.
One way to lose ten pounds is to keep your brain young, healthy, and always
challenged. By encouraging a youthful activity pattern and continually learning new
things, you will keep your brain active, which will help you better manage your weight.
So, learning a language or a musical instrument, playing bridge, or learning a new dance
step all contribute to keeping your brain young.
13. Take control of your weight and do not let other people make you fat. My
heritage is Lebanese. Like many cultures, Lebanese gatherings are often centered around
and focused on food--usually tasty, high-calorie foods such as baklava, butter cookies,
and rice fried in butter topped with tomatoes, green beans, and lamb. Too often, well-
meaning, sweet people sabotage your efforts to maintain a healthy weight. "Eat this ... try
that... this is so amazing, you need to try just a bite ... you are too skinny, eat more ...
here, have more or we will have to throw it away." Your own lack of focus, anxiety, and
desire to please others allows these people to contribute to your early demise.
I see these interactions nearly everywhere I go. We were in Subway for lunch on a
recent vacation and the store had run out of the little toys that come with the children's
meal for our five-year-old. The clerk asked me if he could replace it with a cookie. I said,
"No. Let's do an apple."
I was once at a store with a friend who asked me if I wanted an ice cream cone. I
told her, "No."
She said, "Are you sure?"
"As sure as I can be," I replied.
When she came back, she had an ice cream cone for me.
"What part of no did you not understand?"
"The ice cream was on sale. I would get two cones for five dollars," she said
innocently.
"Toss it or give it to the poor," I replied with a smile. "I get to have control over
what goes into my body."
She didn't believe I would turn it down, but never disrespected my wishes again
when it came to food.
Other people, at home, at parties, or in restaurants, often sabotage our efforts at
health. Most of the times the behavior is innocent. Some of the time, it is because they
feel uncomfortable being overweight and they would like you to join them. It is critical, if
you want to be healthy, for you to be in control. Here are five ways to deal with people
who, unknowingly or not, try to make you fat:
Be focused on your health goals. Before you go to a restaurant, party, or family
gathering, know the approximate number of calories you want to spend on yourself.
Practice saying no, nicely at first: "No, thank you, I am full."
If the other person persists, add a little more detail: "No, thank you, I am on a
special program, and it is really working for me."
If the other person is still persistent, pause, look them in the eye, and smile. Say
something like, "Why do you want me to eat more than I want to?" That usually gets their
attention. I was recently at the house of a friend who was very persistent. She asked me
six times if I wanted something to eat. When I finally smiled and said, "Why do you want
me to eat more than I want to?" she replied, "I am sorry, I just wanted to help." She then
realized she was not being helpful, but irritating, and stopped.
Be persistent. We train other people how to treat us. When we just give in to their
offers for food--so that they can feel helpful and important, or so we do not feel anxious--
we train them to invade our health. When we are firm and kind, most people get the
message and respect our wishes. Additionally, it may give you an opportunity to tell them
about the exciting new information you are learning in this book.

IS FAT CONTAGIOUS?

A study published in the New England Journal of Medicine shows that one of the
strongest associations in the spread of obesity is whom you spend time with. It is not a
new virus that has been discovered, but the social and behavioral influence of your
friends. The study was conducted using information gathered from more than twelve
thousand people who had participated in a multigenerational heart study collected from
1971 to 2003. The study showed that if a subject had a friend who became obese, he had
a 57 percent higher chance of becoming obese himself. That went up to a 171 percent
higher chance if both friends identified each other as very close friends. Friendship was
apparently the strongest correlation, and it didn't matter how far away geographically the
friends were. Distance did not have a notable influence on the results. Sibling influence
was also ranked high, with a 40 percent greater chance of becoming obese if another
sibling was obese.
The study highlights the social network effect on health issues and makes an
important point: Our health is heavily influenced by many factors, not the least of which
are the role models around us. Whom you spend time with matters to the health of your
brain and your body. This powerful influence works both ways, it seems, as the study's
authors also stated that the same network effect showed up between friends who were
losing weight. Health-conscious friends improve their health and their friends' health as
well. By taking the information in this book seriously, you can influence your whole
network of friends and family.
If you lead the way to better health in your circle of friends, your friends may also
benefit. The author of the study said, "People are connected, and so their health is
connected."

The Weight Solution.
Weight Boosters.
Weight Trimmers.
Thoughtless eating Restricted and optimally
nutritious calories Low vitamin D level Adequate vitamin D Compulsive eating Thought-
stopping techniques SAD eating Finding healthier ways to be happy Anxious eating Deep
relaxation Adrenaline overload Dealing with emotional issues Only one diet tried
Tailoring the plan to your type Low thyroid Optimal thyroid Ignorance/lying to self on
calories consumed Knowledge and honesty Low blood sugar, which leads to impulsivity
Consistent blood sugar Insomnia or low sleep Adequate sleep, at least seven hours/night
Negative thinking, i.e., "I have no control" Honest, optimistic thinking, i.e., "I do have
control" Sluggish brain Active brain Lack of exercise Physical activity at least four or
five times a week Being unaware of calorie content Counting calories Hormonal
imbalances Balanced hormones Chronic stress Stress-management techniques
See www.amenclinics.com/my-brain-health/brain-health-club/100-ways-to-leave-
your-blubber/ for "100 Ways to Leave Your Blubber."