This is an interview with on my teachers Bitten Jonsson, a forerunner in the food addiction field in Sweden. Bitten’s story is a truly captivating tale of what successful food addiction treatment can look like and the barriers we are facing to establishing treatment that is accessible through the public health system. Read the story of how Bitten set up the first food addiction treatment centre in Sweden that was so successful it had to close down.
Bitten is a registered nurse with a specialism in the diagnosis and relapse prevention of food addiction and biochemical repair. Together with journalist Pia Nordström she wrote the book Sugarbomb in 2004 and has updated it twice, in 2010 and 2016. Her second cookbook was released in March 2018. She is a board member of the Food Addiction Institute and a faculty member of the International School of Food Addiction Counsellors. She is on the expert panel of Diet Doctor and a strong advocate of the ketogenic diet to treat food addiction. Currently she is training the new generation of sugar addiction counsellors and her next training in English starts in autumn 2018. I asked Bitten a few questions to share her unique story with us.
What started your interest in food addiction?
I’m a recovering alcoholic since 27th of September 1985 and after seven sober years, in 1992, I quit smoking and started to binge like crazy on sugar products. I just couldn’t quit and it shocked me. How come I could quit alcohol and cigarettes but not chocolate and ice cream?
So, you consider yourself a food addict?
Yes, but I identify more as a sugar addict because I’ve never been into flour products and am also not a volume addict. Sugar, flour and volume are the most common aspects of food addiction for many, and I’m grateful that for me it’s ‘only’ sugar. Alcohol and sugar gave me the same rush. I started smoking and drinking in nursing school at the age of 19 and was hooked right away. But I was exposed to sugar at a much earlier age. With the knowledge I have today I know that my addiction started with sugar.
How did you get into professionally treating people with food addiction?
In 1992, I had the pleasure of working with this American lady from Parkside Medical Corporation in Chicago, who was training us here in Sweden to be alcohol and drugs counsellors. I told her about my struggle with sugar and she suggested I go to Chicago and meet Joan Ebbit and Patricia Devlin, some of the forerunners in the field of food addiction, or ‘food alcoholism’, as many called it at first. I also met food addiction counsellor Mary Foushi in Chicago in a workshop with addiction specialist Terry Gorski. My recovery and training in the field started in autumn of 1993 as a result of these meetings.
Today you are a pioneer in the area of biochemical repair. What is it and why is it important as part of food addiction treatment?
When we do SUGAR mapping (a tool I developed to diagnose sugar addiction), we usually see the first symptom of addiction between the ages of four and seven. The Australian neuroscientist Selena Bartlett has shown that long-term exposure to sugar and flour causes the same damage to our neurons as long-term exposure to alcohol. The early exposure most people experience is what gets us hooked for life. Today research shows how important our microbiome, our intestinal flora, is for both physical and mental health. People who are addicted to sugar and other food substances are malnourished as the junk food they eat doesn’t provide the nutrients the body needs. Instead it plays havoc with our biochemistry. When I started detoxing people I developed a simple way of screening several body chemistry systems (such as brain function, hormonal and digestive health) to see which are in need of repair in order for the patients to recover faster.
You set up a food addiction treatment centre in Sweden several years ago and it was very successful but is now closed. How did this happen?
I started a small local support group for food addiction in 1994. The word spread fast that there was a new way to look at loss of control over food and eating. More and more people contacted me and asked for help. In 1996 I started doing five day detox workshops. People wanted longer treatment so in 1996 I did a trial run with a six week in-house treatment with four patients, including a one year aftercare component. Even more people started calling for help. I had started negotiations with the local health authority, the County Council Regional Authority in Gavleborg, to get a contract, as most Swedes have no private insurance to cover the type of treatment I was offering. I got a trial contract with a promise that the local health system would pay for some of the patients. I was also granted authorisation from the National Board of Health and Welfare to run the treatment because I’m a registered nurse.
My treatment centre was the first of its kind and opened in 2000. I bought a small campus, trained 13 staff members, and toured Sweden to present our program. We admitted 202 patients between 2000 and 2005 for 4-6 week in-house treatment with a two year aftercare program. We also offered five day detox workshops for outpatient clients. Hundreds of people who could not be covered by the initial public health funding signed up as this was the more affordable option.
After five years of operation, in 2005, the County Council Regional Authority did a comprehensive review of our services. We had a recovery rate of 76%! We measured many parameters such as weight loss (or weight gain for anorexics), depression, the time of being drug free*, levels of physical activity, full blood screenings, digestive healing and overall wellbeing.
*I prefer using the term ‘drug free’ to ‘abstinent’. Sugar and flour are drugs just like any other psychoactive drug. Processes such as bingeing, starving and exercising are behaviours created by the addiction to cope with the damage the drug causes in our brain’s reward system. The drug is what came first and what needs to be removed to address all the other behaviours.
Our treatment method was based on that used by Capistrano By The Sea in Newport Beach, where I was in alcohol treatment in 1985. Their holistic approach was one of the very best in the US at the time. In my centre, we did detox from day one and went cold turkey on sugar and flour. But back then we didn’t yet know much about nutrition and what nutrients we needed to add to speed up the biochemical repair process. With experience and study, my food plans have evolved and I usually suggest ketogenic food plans to newcomers. Lowering insulin is extremely important to reduce cravings. My treatment was 12 step based and clients were taken to meetings in town. We used Terry Gorski’s relapse prevention therapy, which I adapted for sugar addiction. We had lectures every day about topics such as the science of addiction, emotional recovery, body image, and the 12 steps. I used my huge network of professionals to offer a range of classes such as cooking, exercise, yoga, spirituality, art therapy and taught families and medical professionals.
The 2005 evaluation showed excellent results. Why did the centre close?
We had a steady increase in patients and received more and more medical referrals from doctors all over Sweden as clients started saying that it had saved their lives. At the same time, there was a lot of resistance from the eating disorders and traditional medicine fields. My addiction-based approach, focusing on food addiction as a brain disease where we have to look at the biochemistry first and take away the drug, like in other addictions, was not a popular concept. In addition, my reference to the importance of spirituality and integrating the 12-step addiction recovery model was not well received by psychiatrists. I suspect they were not happy about losing clients whom they were prescribing medications to for years without success while we were getting pretty fast results.
In spring of 2005 we had about 375 referrals from doctors all over Sweden. However, politicians at the local level who were determining hospital budgets no longer wanted to pay for the treatment. I asked two of my largest referring medical doctors about this and got the same answer: ‘You’re doing too well. The word is out and so many patients want to be referred to you but the politicians don’t want to allocate the funds to cover all these people. If not everyone can access the treatment, it is unfair, so therefore no one will get it.’ As a result the County Council Regional Authority of Gavleborg didn’t extend our contract.
In September 2005 I closed our facility. It was a sad day, having to call around to all 375 waiting patients and having no help to offer them.
What did you learn from this experience?
So many people told me that I was way ahead of time. At age 66, I feel that I’m too old to start this kind of treatment centre again. I’ve been carrying a very heavy caseload. In 2012 I decided to start training professionals and have more counsellors working in this field. I couldn’t do it all on my own! In March of this year I started the sixth round of training and many students are now certified and have their own clinics. Many dream of starting a treatment centre and are seeking my advice. I’m telling them not to set up treatment centres yet. As long as traditional medicine will not accept food addiction no one will be willing to cover the cost of treatment. Yet treatment for food addiction is so labour-intensive and requires long-term support and it would be unaffordable for most clients.
Our clients will have to remain sick and suffering and continue to try solutions that don’t work for them, such as diets, surgery, exercise and medication. We know that food addiction is a chronic brain disease and have the method for treating it. But we don’t have the money to pay for it. As a result, treatment is now limited to more affordable 3-5 day workshops, online counselling programs, and Facebook support groups with thousands of members. We are referring patients to professionals all over the world and also to 12-step food programs.
What do you think is the biggest obstacle in food addiction treatment in the world today?
The biggest obstacle is the misconception of what we’re dealing with when we talk about food addiction. It’s like the story of the three blind men and an elephant. A huge industry is working hard to put more and more sugar into our food; a medical industry that wants people to consume pills, talk therapy and surgery; and a diet industry that advocates for eating drugs in moderation. There is a total lack of understanding of the difference of those people who are using food socially, those who are using it harmfully, and those who are addicted. There’s a lack of understanding that this is a chronic brain disease, and a lack of trained professionals to treat the enormous amounts of people who will come forward as this crisis compounds. And the crisis will compound, because the ever increasing manufactured edible substances we call food is making us sicker and fatter, and food addiction is on the rise.
What is your vision for food addiction treatment in 10 years from now?
Food addiction treatment should be part of the treatment of other addictions. Addiction is one disease and has many outlets. Food is one of them. Many people struggling with alcohol and drug addiction put the drugs down and then go to the food. Likewise, many food addicts are also alcoholics, smokers, gamblers and drug addicted. Addiction is the disease of the 21st century as we live in a world of overconsumption and instant gratification.
We need to educate the world with regards to how food addiction relates to obesity and lifestyle diseases such as diabetes and heart disease. We should also collaborate with the functional medicine world and embrace new nutritional knowledge, such as ketogenics. We need to look at the term ‘food addiction’ and get clear on it being a substance as well as a process / behavioural addiction. We need to collaborate with biochemical researchers and learn more of about brain processes that give rise to addictive eating. For example, we know that volume eating is caused by the lack of oxytocin. We need to learn how to increase oxytocin in a natural way to heal this. These are just some of the many issues we have to address.