I’m a GP — this is how I stopped binge eating

Her first book, What Your Doctor Eats — evidence-based, practical — “summarises everything I want my patients to know to prevent, treat or even reverse disease”. (It’s hard to cram all the latest science on how to achieve sustainable weight loss, improve your cholesterol, blood pressure, blood sugar, and general physical and mental health into ten-minute appointments.) And it lists delectable recipes from her mouthwatering Instagram account @whatyourdoctoreats.

• How much sugar are you really eating?

Reading this, one might imagine that her path to nutritional wisdom and wellbeing ran smooth. Not quite. Stokholm moved to the UK aged 19 to train as a doctor. At medical school she cooked from scratch because it was cheap. But on qualifying, that changed. Deciding, “I’m a busy doctor, I shouldn’t have to cook,” she bought “fancy ready-made meals”, ate ultra-processed foods (UFPs) at the Devon hospital where she worked and “lived off” artificially sweetened cordials instead of water. “Within a couple of months, I’d jumped two dress sizes.”

It got worse. “I became more and more hungry because of all the ultra-processed foods damaging my microbiome,” she says. She became trapped in a binge-restrict cycle. The extra virgin olive oil she had always loved became verboten. She would ignore her appetite, then snap and “gorge”. Her next obsession involved following the (bad) advice of YouTube “fitfluencers”. High-protein chocolate bars and kale smoothies became staples. Her hormonal acne “exploded” and she developed IBS, fatigue, brain fog, insomnia and depression.

Realising that “diet culture is terrible”, Stokholm abandoned it for “intuitive eating”. But at that point, intuition didn’t work because by then her appetite was ruled by a range of undesirable factors, from the addictive nature of UPFs to high background insulin levels. “Suddenly I gained ten kilos,” she says.

How did she transform her health? “The biggest change that I made to my own lifestyle was that I started to cook my own food,” Stokholm says. Her Instagram posts are inspiring. Her meals look beautiful, are no-fuss and, unlike some recipe-writing doctors, she understands flavours. Plus she’s not a perfectionist. “I’m much more interested in making food exciting and fun.”

Stokholm’s guide to eating well — for life

1. Binge eating? Stop restricting calories

There’s still a focus on restriction of calories to lose weight. But “food is more than a calorie”, she says. We can’t “calculate” how much to eat — bad news for people who weigh out food and count their “macros”. Many factors influence how much energy we get from food, from our genes to its form (eg whole almond v almond butter — if it’s “pre-chewed” by a machine, “you can absorb all the fat and fast”), to when we eat it (and what with) and our biology. Plus, if your body senses that you’re not consuming enough calories it fights back, perceiving the situation as a famine. It slows your metabolism, drastically drops your levels of the hormone leptin, increasing appetite, and furiously spikes ghrelin, your hunger hormone.

“It forces you to binge eat,” Stokholm says. “People think that’s a character flaw, but it’s actually an evolutionary mechanism.”

2. Eat a filling meal (and ditch that smoothie habit)

Many people purposely don’t eat enough to satisfy their hunger, Stokholm says. “You pat yourself on the back for resisting the urge to feel full.” But in our evolution “that’s not how we behaved and it’s not how our biology is designed. You are supposed to experience satiety.” If you don’t eat to “stimulate your fullness mechanisms” — with fibre, protein and fat in every meal — “you’re going to feel hungry”. The first step in stimulating your satiety mechanisms is chewing. But protein shakes and breakfast smoothies are simply swallowed, so you miss that important cue, Stokholm says. “If you don’t want to stimulate your appetite, I wouldn’t have the smoothie.”

Second, “the stomach needs to be stretched. That will stimulate more satiety mechanisms.” Again, soft UPFs, smoothies and flavoured drinks don’t do this, whereas fibre-rich food does. And it sits in the stomach for longer. In your gut, the first “stop eating” sign is triggered by fat. “Don’t be scared of healthy fats — nuts, seeds, oily fish, Evoo [extra virgin olive oil], fermented dairy,” she says. Then the mechanism gets to work, responding to fibre, protein and fat. Further down, there’s another fullness mechanism stimulated by protein. “That’s why eating a high-protein meal will keep you full for much longer.”

3. Understanding insulin is key to health

Key to managing our weight — and health — is understanding the hormone insulin. When insulin is in the blood, you’re in energy “storage” mode, Stokholm says. Only when it drops can you use your fat stores. But many of us eat and live in ways that mean we frequently have higher insulin levels, so we’re constantly in energy storage mode. Over time this can lead to insulin resistance — a build-up of glucose in the bloodstream. It’s the root cause of “all the things we’re most likely to die from — strokes, heart disease, dementia, type 2 diabetes”.

While many people with obesity have higher insulin levels, she says, “a lot of people who appear to have a healthy weight are insulin-resistant”. When Stokholm’s blood sugar was erratic (she often felt faint and “sugar hangovers” left her hungry and lethargic), she wore a continuous blood glucose monitor for two weeks to learn how foods affected her. She discovered “even 100 per cent fermented rye bread spikes my blood sugar quite a lot”. She still eats bread, but “it’s not my main carbohydrate. I try to mix things up,” opting for quinoa, bulgur wheat, pearl barley, spelt, coloured rice, beans, legumes and different varieties of potato.

4. Time-restricted eating improves metabolic flexibility

“Most people have a huge eating window. They’ll start very early in the morning and they’ll keep eating right until before they go to bed,” Stokholm says. Consequently, their insulin stays high for too long. Stokholm advocates TRE (time-restricted eating) “so you let your insulin fall during the day”. Her eating window is midday to 8pm. However, “you get the same metabolic benefits from a ten-hour eating window as you do from eight”. So, you could have breakfast at 8am, and “nothing crosses your lips past 6pm”. Stokholm eats at predictable times — if your body knows when to expect food, it will spike ghrelin at the appropriate hour.

But, she warns, “this will only work if you’re appropriately stimulating your fullness mechanisms”. Metabolic flexibility essentially means that when you run out of glycogen, your body can access your fat stores for energy. For some, that happens overnight if they haven’t eaten for 12 hours; for others, it takes longer. Stokholm says, “If you have very high insulin levels, you’re dependent on glucose,” so becoming metabolically flexible can take weeks. But if you let your insulin fall by consistent TRE, you’ll eventually “flip the metabolic switch”.

5. Stick to black coffee or green tea between meals

Between meals, Stokholm doesn’t graze, snack, chew gum or drink anything artificially sweetened or sugary — because doing so signals to the body that food is coming. “Your pancreas will release more insulin each time you are exposed to flavour,” she says, “turning that fat-storing switch to on mode all day.” In other words, even if something doesn’t contain calories, swirling a sweet taste in your mouth can spike insulin, just from the taste alone. “If you spike your insulin but you don’t have any calories coming in, that can then cause a paradoxical blood sugar dip.” She explains how the brain and body then think, “Oh no, we’re running out,” so they shoot up ghrelin, resulting in “hanger”. What doesn’t spike insulin? Anything bitter, like black coffee, black tea, green tea or plain water.

6. If you’re a high-achiever, beware of the effect of stress on your weight

We think we have lousy willpower if we can’t stop eating when full or not hungry, “but actually it’s much more complicated than that”, Stokholm says. “If you’ve got chronic stress — and therefore raised cortisol — it tickles your hedonic appetite pathways and makes you not just hungry, it makes you pine for food.”

Say you’re confronted by a tiger, she says. “Cortisol suddenly releases your blood sugar so you can run away. But if you let it bubble away long term, you’re constantly letting your blood sugar be a bit too high.” It pushes up your background insulin, she says, adding: “And through that you store more fat, become more resistant to insulin, and it becomes a vicious cycle.” It’s common, Stokholm says, “especially with high-achievers”. And raised cortisol is often “the missing puzzle piece” when their weight and health is a struggle.

7. No need to eat ‘breakfast food’ for breakfast

Stokholm doesn’t eat much “breakfast food”. Instead she’ll have a bowl of giant Greek beans, roasted squash, olives, pickled red onions, feta and jarred artichoke hearts with extra virgin olive oil. Or cannellini beans with radishes, pea shoots, fennel, cucumber, avocado, jarred artichoke, fresh mint, extra virgin olive oil, a squeeze of lemon juice, plus leftover potato and tinned mackerel. “I often don’t distinguish what I eat at different meals any more. My ‘breakfast’ is often just leftovers.” Too often, her patients choose breakfasts that spike their blood sugar — sweet, simple carbohydrates, very little fibre, little protein or fat — then soon feel hungry. Keep it savoury “with a decent portion of protein and plenty of fat,” she advises. Swap cereal for eggs, salmon and tofu. For a bit of sweetness, have full fat Greek yoghurt with nuts, seeds and berries, which are “very low sugar compared to other fruits”. Stokholm eats about two portions of fruit daily and always after meals to lessen the glucose spike.

8. Be a microbiome enthusiast

If you feed your microbiome food that it loves, like prebiotics — found in asparagus, bananas, oats, rye and mushrooms — Stokholm says the microorganisms “will produce medicines that will bring your blood sugar down”. A well-fed microbiome also produces more satiety hormones, she adds, which can directly alter your cravings too, since if you eat more plants “you support the bacteria that like to feed off those plants, and they’ll signal to your brain: eat more of this”.

Stokholm always has a “nice crunchy salad with vinaigrette” before dinner. The fibre helps to stabilise blood sugar and “entertains” her gut bugs. She’s a big fan of asking “What can I add to this?” Try seeds, pesto, tahini or salsa.

Does this sound too holy? Stokholm’s approach simply celebrates good food. And if you want pudding? Have it and enjoy — just not every day. And while she doesn’t generally drink much alcohol, if on holiday or celebrating she’ll “easily” exceed the recommended 14 weekly units. “I don’t overthink it. Not everything I do is for my health,” she says. “Life is to be lived.”

What Your Doctor Eats by Dr Camilla Stokholm (Ebury, £16.99). To order a copy go to timesbookshop.co.uk. Free UK standard P&P on orders over £25. Special discount available for Times+ members.