I was looking at my acne patient intently after she had stated all her problems. There was a pretty and well-dressed girl with fluent communication yet consistently fidgeting with her fingers as she spoke to me. She seemed to constantly touch her face as she spoke – almost as if she were embarrassed with her acne at age 30. She seemed slightly overweight but not obese and after I asked her about her eating habits – it seemed that she was more in favour of eating the yummy breads that are flooded in the market these days. 

“The bread is all made of multiple grains and not maida!” she added factually, “And I eat them with fibre and protein all the time!” 

I smiled at her and asked, “Do you think food addiction exists? Is there something called carbohydrate addiction according to you?”

Her fidgeting increased and she stared back at me clueless. 

“Yes,” I said, “there is something called the Binge eating disorder (BED) which may be an outcome of carbohydrate addiction”.  

Randolph proposed the concept of ‘food addiction’ nearly 50 years ago. Food addiction is the development of food sensitivity due to a failure of the individual to ‘normally’ adapt to particular foods. He also pointed out that two important aspects of food addiction were the ‘size of the dose’ and the ‘frequency of use’. 

It was Kemp who coined the specific term ‘carbohydrate addiction’ for a condition that many of the obese exhibit (or near obese or overweight may exhibit). He recognised that people who were obese preferred to select foods high in carbohydrates; milk, bread, refined sugars, cereal grains, and legumes.

“But cereal grains and legumes are healthy, aren’t they?” she claimed with utter disbelief. 

“They are, but when eaten in a certain way and proportion,” I said. 

If one looks at Randolph’s statement, the proportion of the food and the frequency of its use matter a lot. I get a lot of patients with acne and many other skin diseases as well, who claim that they eat “ghar ka khana – home-cooked food”. But when I ask them about when they eat these: The commonest answer is “When I get back from work by 10 pm.” Therein lies the beauty of nutritional science. It is when and how much you eat this home-cooked food that matters. 

For me, eating disorders (BED), or even carbohydrate addictions do not exist for no reason. 

When one eats foods rich in carbohydrates, especially simple carbohydrates like sugar, there is a surge of insulin that leads to gratification. But because the surge is quick, it also equally rapidly falls down – leading to a ‘need’ to feel better often. And this need ‘to feel better’ stems from an inherent lack of knowledge on how to deal with your harmful emotions. 

All our actions are aimed at feeling better, aren’t they? Ask yourself how you feel when you have a piece of broccoli or spinach and when you have that juicy piece of garlic bread. The answer is obvious. 

Also, with the food industry booming, foods are being created to get you addicted. When have you had just one piece of Pringles and stopped? Hard, isn’t it? And let me be honest, it is hard for me too. So as someone who still suffers from the occasional acne, I too have had to ‘de-addict’ myself from this addiction. 

How did I or how does one go about it? 

The easiest way out is behavioural modification. Try to consciously eat healthy and restrict calories. Reward your dopamine centre (the feel-good hormone) with one cheat day. Although all this may work for some time – it is difficult to stick to it. Because we forget the basic underlying issue – the need to feel good – which broccoli does not do or a cheat day does not suffice. Therein lies the importance of applying Emodermatology (EmoD) where you use Rational Emotive Behaviour Therapy (REBT). 

EmoD helps us to change negative and harmful emotions that cause binging or craving in the first place. This is done by using one simple formula: A +B =C. 

Dr Albert Ellis, who introduced REBT, defines A as the activating factor in your life (could be family issues, work issues, and moralistic issues), B as the belief system (your unmoved and concrete opinions about all the things that matter to you), and C as the consequences that occur in the form of physical diseases (acne or carbohydrate addiction or any other disease), emotional (panic attacks), or Behavioural (OCD’s or neurotic behaviour). 

But of course, acne or even carbohydrate addiction (C) is the physical manifestation of A + B.

And in order to change this C, reduce acne or reduce cravings, we need to address our activating factors and revisit our belief systems that are the true reason for our C’s. 

A is not equal to C. 

A + B = C

The common notion that a particular event or person or boss caused my negative emotion or disease does not stand true. It is only when my belief systems (thoughts) are added to the situation is when I manifest the C. 

See what I am getting at? Acne and carb craving and thoughts are all interrelated. 

Eating without awareness or eating wrongly despite awareness is a consequence of the way your thoughts are. And this again leads to acne as well. 

With eating without awareness, there is an increased level of glucose and thereby a surge of insulin. This increases sebum production and changes the way testosterone works (in simple words) and its causes. And the funniest part is that this acne further leads to negative emotions (self-doubt, lack of confidence, anxiety) that further leads to eating issues and adds to the acne. A vicious cycle it is indeed!

I added further, “and there is an enzyme called Desnutrin in your fat cell that is lowered thereby leading to raised insulin levels…” 

She seemed to get lost in her thoughts and I thus concluded my explanation. 

“You said you still suffer from acne?” she asked curiously. 

“Yes, I do. Not as severe as it used to be in my teenage years. But you know the beauty of such acne that I suffer from?” I asked her. 

“How is there beauty in acne?” she almost shrieked. 

“I see it as my body’s way of communicating to me that somewhere my inherent B’s that I add to my A’s may be causing my acne. My acne teaches me to not eat mindlessly which may happen when I am in stress. I do love bread too, you know.” I smiled back. 

Acne or carbohydrate addiction is connected with your thoughts. A lot of hormonal changes are happening in your body as you think of a negative thought. Understanding who you are by asking yourself those ‘difficult’ questions will help you give sustainable solutions to your acne. 

And of course, a dermatologist will help you in the process! 

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