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9 Minute ReadFeature by David Levesley
It's the time of year for indulgence, but indulgences can sometimes become habits. Or worse. Dr Tamer Rezk points out how to spot something becoming a vice, and how to fight it.
At certain times of the year, moderation can go right out the window. That’s challenging enough in your average year, but increasingly intense if assorted pandemic pressures, quite fairly, pushed you into using indulgence as a means to cope.
On top of that, from the festivities of December we u-turn right into the intense asceticism of January, a spartan time of endless self-improvement that can create addictions of a different type: ‘clean’ eating, exercise, and things that seem virtuous until we do them too much.
Dr Tamer Rezk is a doctor, NIHR Clinical lecturer in Nephrology at the UCL Division of Medicine, and expert in the intersection of health and wellness. Here he shares his advice on how to manage your indulgences.
"There are some simple signals of when a habit isn’t good for you. Whether it's alcohol, smoking, making money, or looking attractive, you need to recognise whether you are getting enjoyment from them, or in fact those habits are controlling you.
"Doctors often see addiction as something that you don't have the control to stop. But really, addiction is when something obstructs your day to day living, or gets in the way of you becoming the best person you can be.
"Does your 'habit' affect your personal relationships? That might be when people withdraw from partners, family, friends, colleagues, or work, whether it's because they're in the office 18 hours a day obsessed with getting a promotion, or they're drinking two bottles of wine on their own every night and don't want to be in a social situation.
"And some addictions are not so obvious. If you’re going out to buy cocaine or heroin, you know that's not a good thing to do. But if you're spending three and a half hours in the gym, and every time you take off your top you think you look abhorrent, that's just as damaging a form of addiction. That's evidenced in the rates of eating disorders, body dysmorphia, and anorexia in both men and women."
"I've got patients who smoked 26 cigarettes a day until they were 85 or 90, and they ask 'Should I give up smoking, now I have this new cardiac condition?' And I say: Absolutely not. You should keep on doing what you've been doing for 60 years, because it serves you fine. But it'd be quite different if, by the age of 35, they couldn't walk up a flight of stairs. That is an addiction because it is cutting away your physical health, and much more subtly at your mental health too.
"In medicine we use cocaine as an anaesthetic, ketamine as a painkiller and anti-anxiety cure, morphine for pain relief, and cannabis in a whole host of divisions. The one thing we don't use is alcohol. We use it to sterilise equipment. That's worth thinking about.
"In California, where they've legalised cannabis, there's been a rising interest in psilocybin and other sorts of plant-based drugs. At the same time there has been a downtrend in the use of alcohol, particularly in people from the ages of 18 to 25. The very cohorts that were binge drinking are now looking at different substances, which come with their own set of health problems. As do traditional pharmaceuticals or painkillers. Even the WHO has declassified cannabis, saying its medicinal benefits outweigh its potential harms as a drug. There is a societal change: people are more well read, information is more easily accessible. Healthcare is much more in the consumers' hands.
"In all cases, one man's medicine is another man's poison. Give one man an antibiotic that cures their bacterial infection, but that same antibiotic might cause someone with a viral infection a life threatening reaction. If that's what happens with antibiotics, then it's entirely possible that happens with substances."
"There was an interesting study done in the US of college students intending to go into professional football, and they put them on two training programs. The students following one program were told to figure out, when they woke up, how they felt: how achy they were, how well fed they were, how well rested they were, what their mental performance was like. From there, they could then choose whether do a high intensity workout or a low intensity workout. The other group were just attached to certain days of prescriptive high intensity, or low intensity, exercise. The ones who listened to their bodies, and then responded to their training patterns, did much better than those who just followed a prescriptive algorithm.
"Whether it’s medicine or education, personalised approaches tend to be much more powerful, and intuition is a big part of it. It's hard to say that when someone has habits of overtraining, over eating or under eating; to pinpoint when something is an addiction, untreated mental health, anxiety or OCD. But nonetheless, personalising what you do - whether it's physical exercise, how many drinks you have, or your social life - with how you're feeling on a day to day basis, is a better way of intuiting your habit than just saying, ‘next year I'm going to go out twice a week on these days.’"
"Giving up an indulgence is a huge achievement. We all need to identify the habits we’ve fallen into – good and bad. If you've already identified a bad habit, a lot of the work is done. If you're still not sure, try and recognise: what is it that you start getting at the end of an experience?
"Once you've done something, do you feel liberated? Or do you feel constricted? So if you force yourself to get out on a Thursday night with your workmates, then stay out till 4am on a Friday, are you still getting any of the benefits? If not, it's pretty obvious that indulgence is not serving you. But you don’t have to give it up entirely: it might be you just go out less, or on different nights."
"What leads people to addiction - whether that's alcohol, drugs, sex, or co-dependency - tends to be childhood relationships, childhood traumas and childhood narratives about how to interact with your caregivers. Feeling validated, feeling loved, how to exchange emotion, love languages, all play a crucial part.
"Say to yourself: what are these relationships that I have? Most of us know when relationship dynamics demonstrate unhealthiness. A lot of people use substances to cope with relationships. When you're breaking a habit, the focus might be on staying away from something, but the underlying foundation of the bad habit is a product of relationships. Recognise if you're always reaching for a drink because you are unhappy at home, unhappy at work? Try to navigate and redefine those relationships, and break away if needed."
"You'll meet people who, for three years of their life, everything will be about going out every weekend. Then for three years after that, they'll get into a relationship and everything will be about their partner, because that will be the thing that they're addicted to, then they have a kid and the child will be the centre of their attention, and then it’s all about their career. This is cross addiction, and it’s important to talk about. Some people shift their needs from place to place.
"These people need to be okay with having some stillness and calmness. With not having your happiness stemming from something happening. For me, that was going to the gym. If I went to the gym every day, even if I was exhausted, even if I'd just finished a night shift, even if I didn't even want to go to the gym, then my day was better. It's a very powerful thing, because you do feel better. But it isn't a choice. It's what you need to do to just get by, and feel like the day is not collapsing around you. That's what I think addiction signifies."
"Try laying out what you eat over a 24 or 72 hour period. Then ask yourself the following:
"An example would be someone who is very sugar-focused. Whenever they're stressed, anxious or irritated, they reach for a tub of ice cream, eat half the tub, then feel guilty afterwards. Then there's the opposite side of the spectrum where eating can be just as disordered: when I was trying to put on muscle and going to the gym, I would force feed myself to eat chicken and sweet potato, sometimes to the point of feeling physically nauseous. I felt a duty to eat those macronutrients before I ate, I wasn't enjoying it whilst I ate them, and I felt nauseous afterwards. But I would tell myself 'well done, you've done the right thing.'
"Once you can elucidate how you're made to feel, then you can go back and say: how do I want to feel? So before you have that tub of ice cream, you want to feel that you can deal with the anxiety, the stress, the low mood without reaching for the ice cream. Realise ice cream is not going to solve that, because the emotion is not directly correlated to having low blood sugar.
"And the same applies to the guy who's trying to be a healthy gym goer, saying: how do I feel before? I feel anxious. I feel like I need to hit this macronutrient requirement. Why do I feel like that? What's going to happen if I don't?"
"Making a 10-15% change in your eating habits - that's not even what you eat, it's how quickly you eat, what portion you eat, what time in the day - can lead to a big difference.
"Take the ice cream example: if someone binges on ice cream at 10pm before going to sleep, let's move that two hours earlier to 8pm. And then say, well, if I'm going to have ice cream, I'm going to go for a compulsory 15 minute walk before bed. Which is what the Italians do: they have sugar, but then they'll walk it off.
"The gym goer, who thinks he has to eat chicken breast and sweet potato, can change that by saying 'I'm going to have the sweet potato because I like it, I'm going to have some of the chicken, but I'm going to have something next week that I wouldn't normally have.' That might be some yogurt, or something sweet. That person still eats the food, and part of what they planned, but they change their thought processes. You eat in a more balanced manner because you've made small changes."