Starting with Thanksgiving, the holidays bring continuous parties with feasts of food, which, for many of us, brings about many new years resolutions about dieting and exercise, but can be a serious issue for people with addictions for food – compulsive over-eating. Dr Inaba shares his thoughts.
Transcript (edited):
CNS: Hi and welcome once again to the CNS addiction pod cast, Im Howard LaMere here with Dr. Darryl Inaba. I found a few stories in the news about food addictions to follow up on our last conversation on the holiday blues.
Darryl: Yes this is the time when an addiction to food gets put to the test. The winter holidays Thanksgiving, Christmas and even New Years are all about food.
CNS: Through the whole period, all the parties and everything
Darryl: The holidays are a time when people consume massive amounts of calories in the form of fat and protein. When Dr. Nora Volkow, the head of National Institute on Drug Abuse, and Jack Wang first started looking at compulsions they started with food compulsions. They wanted to know why some people consume many more calories than other people and continue to eat despite suffering horrendous health consequences due to obesity. Her research showed that there were differences in the brains of compulsive over-eaters and obese people and those changes were actually brought about by extra consumption of food. These brain differences cause a person to be incapable of stopping consuming food. It also causes a person to over eat in response to stress, life problems and the holiday blues. The most comfortable way to get through a holiday when you are not very happy is to consume as much food as you can.
CNS: What about the so called comfort foods we all reach for when we dont feel good – like macaroni and cheese, for instance.
Darryl: And you know- they work. That is the whole thing with drug addiction as well. These substances and these practices work for a short period of time to relieve you of those uncomfortable symptoms youre having. Dr Nora Volkow and Jack Wangs research found that the relief was related to the same brain chemical involved with all drug addictions, dopamine. They determined there are less dopamine receptor sites or fewer dopamine concentrations or inappropriate dopamine activity at those receptor sites creating a need for people to seek more dopamine stimulation in order to feel satiated. The more they seek the less satiated they feel so they keep going – becoming chronic over eaters. Dopamine does two things. Excessive amounts of dopamine makes you want more, you want to continue an activity or continue using a drug. After continued use you deplete or down regulate receptors sites and your dopamine is dysfunctional. It is a vicious cycle creating a craving for more dopamine and escalates from there. Dr. Volkow first discovered this as part of her research of chronic obesity, food addiction and compulsive overeating as well as bulimia and other eating disorders. Then she looked at alcohol, cocaine, methamphetamine and noted that the brain abnormalities and anomalies she found with eating disorders, were present in alcoholism, cocaine, and heroin addiction. This is all inter-related so it is not surprising that we attempt to get through depressive times by satisfying ourselves with drugs or food or alcohol.
CNS: The body and the brain are trying to balance themselves but in the process they become more imbalanced.
Darryl: Yes, its sort of like what cocaine addicts used to call chasing the little green man. There is nothing like that first rush you get from that first rock or the first snort or first injection of cocaine. But because that rush is created by the release of excessive amounts of your brains own dopamine, its not the drug; its your own energy, stimulating, rewarding, and satiation chemical dopamine. However, every time you do the drug, youre depleting your natural stores and you end up chasing it. Every time you use, you feel less stimulated, or less euphoric or less satisfied and so you keep thinking you can get back to that first feeling by taking more and more. The more you take the more you deplete so you end up with a chase that goes after it- again and again.
CNS: A vicious cycle definitely. Has this shown up in the research because of better scanning, better, better scientific imagining techniques? Has this technology played a significant part in research and discovery?
Darryl: We are going through a revelation, a phenomenal age of discovery with regards to the brain. We didnt have these tools until the 1980s. Now imaging technology is exploding and we are able to view the brain with more than just an x-ray. Now abnormalities can be detected that indicate certain mental illnesses and drug addictions and perhaps ADHD and eating disorders. Functional MRI’s, Spec scans, and PETscans allow us to see a picture of the brain in operation so we can see differences in brain functionality. This technology is unraveling a lot of the mysteries connected to the reasons these conditions exist.
One of the things we must realize is that obesity, compulsive over-eating is partially inherited. Weve experimented with mice by placing them in the same environment, given them the same type of food and attention and have observed mice maintaining normal body shapes and sizes through out their life compared to other mice with different genetics that became obese. It is not because the obese mice are less able to control their appetites or have less will power its simply genetics. This suggests that over eating is part genetic, part other things in life. Imaging gives us the ability to see how the brain of a person who is a compulsive overeater looks and acts by comparison to someone of normal weight. It is the difference between feeling satiated, saying no I dont want dessert tonight, Im finished with the mashed potatoes, with the turkey and continuing to eat despite feeling full and despite the potential medical consequences.
CNS: Now I dont know if its just my perception or the medias perception but it seems like we have more weight issues in here in the US than in Europe and other countries. Is that true or is that just a perception?
Darryl: No I think it is true but I think that other countries are catching up. Actually the more modern a country becomes and the more they emulate our American quality of life – McDonalds moves in. I hate to pick on McDonalds but you know as Kentucky Fried Chicken and Arbys and all those places offering high fat, high sugar and low nutritional content move into other countries the population begins to look like us – so they are emulating us real good. I think our country has one of the highest instances of juvenile diabetes and juvenile nutritional problems, metabolic problems in the world and its partially due to these rich diets, to how our culture has been set up and how we tend to look toward food or drugs to comfort us.
CNS: Well if someone is grappling with this, how would they go about seeking help? It doesnt seem like we have the same kind of treatment modality for over eating as we do with drugs and alcohol.
Darryl: Well, its an amazing thing. As the effectiveness of treating alcoholism and other substance addictions has improved, treatment of all the other compulsions, the impulse control disorders are emulating those techniques. Dr. Nora Volkow believes that in the future were going to have better medications to help prevent a persons craving for food so they dont over eat. But for now we have 12 step programs for eating disorders.
The method used to determine whether or not a person has an eating disorder is the same method used for determining other addictions. It is called the CAGE Aide. CAGE is a simple way of self diagnosing a potential problem. The C stands for Cut down – have you ever tried to cut down, tried to diet, tried to stop your compulsive overeating. The A is anger. Are you irritated or angry when people suggest you diet or try to lose a little weight or try to be more healthy? The G is guilt; do you ever suffer guilt and shame? Do you feel remorseful that youre unable to control your weight, unable to control your eating? The E stands for eye opener. Do you need to get up in the morning and take that first hit in order to function? I dont know how that factors in because breakfast has always been important to me, its one of my favorite meals. But treatment professionals say if you wake up and the first thing that you think about when you get up is putting something into your mouth to eat it is a symptom. If a person has two of those CAGE symptoms, they probably have an eating problem. If you have one of those symptoms, you should really look at how youre doing with food and how youre doing with carbohydrates and things like that. Some of the available treatments include seeking out eating disorder clinics, and eating disorder physicians, looking in to different surgical techniques, but I think one of the strongest treatments is a twelve step system. Overeaters Anonymous the OA-H.O.W the GreySheeters offer an entire spectrum of different types of twelve steps targeted at helping people who are unable to control their eating. The OA-H.O.W people and GreySheeters view refined carbohydrates as a drug so they look at their intake of refined carbohydrates, bread and sugar and flour and things like that and actively make an effort to avoid them. Theres an OA here, 301, which addresses the fact that youre compulsively, behaviorally and emotionally attached to food. Since you have to eat, unlike taking drugs or alcohol which you dont need to stay alive, you do need to take in calories. OA 301 deals with being a compulsive overeater and teaches how to eat three balanced meals a day. The 3 is three balanced meals a day, the 0 stands for nothing in between, do not snack, do not take all those extra fries, or chips – nothing in between. The 1 stands for one day at a time. Taking in and dedicating yourself to that behavior, not for your whole life but just for today. And then for the next day, and the next. That has helped a lot of people. So there are treatments, clinics, special groups, twelve steps and better medication on the horizon.
In times past, people took methamphetamine or amphetamines. It was a strange thing; you lose a lot of weight because youre anorexic and you dont eat at first. As you keep taking higher and higher amounts of amphetamine, you gain tolerance and actually start to eat more. People who were given stimulants as diet aides actually gained more weight than where they started so it didnt work too well.
There are appetite enzymes like grailyn that researchers are trying to block through medication. I had high hopes for Rimonabant which was an actual THC antagonist developed to block the chemicals in marijuana. Of course everyone knows that one of the side effects of marijuana is munchies. Marijuana stimulates your eating. Well, if you can block the endo-cannabinoids that stimulate eating, maybe craving and hunger pains can be blocked too. I had great hopes for it, but people who were given the medication on an experimental basis became very depressed so they had to quit experimenting. There are other things in development. I am so happy that eating disorders are recognized as a difficult issue rather than an inability to control primitive eating desires. The differences in the brain, body and genetics allow us to address this as a medical disorder.
CNS: It is good to move that away from self deprecation.
Ok, wed love to hear from you with comments or questions about this topic or any on the subject of addiction and drug and alcohol use and abuse. Stop by our website, drop us an email, and if you have a question well try to get to it in a future program. Well continue looking at some of these issues around the holidays I think here in the next couple of weeks so tune back in again soon, Thank you Darryl, Happy Holidays!
Darryl: Hey, Happy Holidays to you!