Dear Dr. Roach: My husband’s infidelity has just been discovered. It was unknown for 25 years. He is seeing a certified sex-addiction therapist. Do you really believe in sex addiction (which supposedly began with Internet porn)? Or was he just having the time of his life in massage parlours, strip clubs, escort clubs, etc.? If he truly has an addiction or sexual compulsive behaviour, I feel obligated to help him, but if this is just a bunch of nonsense, I feel a divorce is necessary.
A.P.
I can’t tell you about your husband, but I can tell you that there are people whose sexual behaviour persistently damages themselves, their finances and their relationships, and that they often feel powerless to stop it.
They have underlying psychological issues, especially mood disorders such as anxiety and depression.
One author stated that the disorder isn’t about sex, anymore than “an eating disorder is about food or pathological gambling is about money.” Internet porn is a common means for people who harm themselves this way, but it wasn’t the first and isn’t the only way.
I do feel that the term “addiction” is overused, and this is no exception. When we talk about addiction to alcohol, cocaine or opiates, there are changes in the brain that can be found by sophisticated testing.
These have not been found in people who are described as “sex addicts.” So I don’t think the terminology “sexual addiction” is accurate, even if some of the treatments are similar to those used for medication addiction.
Your point about whether your husband was “having the time of his life” is more important than you might have recognized. For people in whom sexual activity is really problematic, indulging in the activity doesn’t cause pleasure so much as it helps to relieve some of the underlying psychological suffering. I think your term “compulsion” may be appropriate.
While I couldn’t blame you for wanting to divorce your husband, I think speaking with your husband’s therapist (he would need to give permission) may give you some insight that could help you decide whether your compassion for him is deserved or misplaced.
Dear Dr. Roach: If a person eats a 2,000-calorie meal, how many calories, when digested, are absorbed by the body? I find it hard to believe that the body will absorb every single one of the 2,000 calories ingested. Please advise.
J.H.
Our bodies are very well adapted to extract energy out of the food we eat, but you are right that there is some energy left in food at the time it is excreted. Some chemical energy also is used by the bacteria in the gut. A little bit is lost in the urine. But in general, we absorb probably 90 per cent of the chemical energy stored in food.
A few factors can affect that number. Food that is cooked or processed tends to have calories that are more easily accessible and more absorbable.
This may be one reason that those who eat only raw foods tend to lose weight (another may be that they avoid highly calorie-dense foods).
There also are medical conditions that prevent us from absorbing food properly (lactose intolerance and celiac disease are two of the more common of the many causes of malabsorption).
In summary, calorie counts are imprecise, but still useful for comparing one food with another.
Email questions to ToYourGoodHealth@med.cornell.edu.