Binge Eating Disorder: New Approaches to Appetite Control

ice creamToday I attended a conference presented by Walden Behavioral Care on the topic of Binge Eating Disorder (BED). Dr. James Greenblatt, Chief Medical Officer at Walden and author of the book “Answers to Appetite Control:New Hope for Binge Eating and Weight Management”  spoke about the complicated interactions between our physiology and brain when it comes to binge eating.  There are specific criteria that define a diagnosis of BED and just one of the criteria includes “recurrent episodes of binge eating characterized by both of the following: (1) consuming an abnormally large amount of food in a short period of time compared to what others might eat in the same amount of time and under the same or similar circumstances, and (2) experiencing a loss of control over eating during the episode. Additionally, in BED there is “significant distress” about the binge eating.

Dr. Greenblatt stressed that some binge eaters experience cravings that are physiologically based, in other words, the cravings are a result of your biology rather than just the environment or a social trigger. In fact, some research showed that brain scans of those who scored higher on a “food addiction” rating scale were similar to those of drug addicts.  There was an elevated activation in the reward circuitry in response to food cues. Again, this does not mean that if you binge eat, you are “addicted” to food, but that everyone is different and some people have the physiology that makes it much harder (and it is not their fault).

In addition, disordered eating such as binge eating often co-exists with mood disorders such as bipolar disorder, anxiety disorders, depression and ADHD . In fact, ADHD has been linked to BED (apparently the act of chewing helps to decrease day dreaming brain waves and helps you pay attention). The odds of developing a binge eating disorder is 12 X greater in children with ADHD. Dr. Greenblatt stressed the importance of treating the mood disorder first before the binge eating could be addressed.

Another very important point was regarding the importance of protein. There are over 250 neurotransmitters that send impulses throughout our brains and affect our thoughts, feelings and behaviors, many of these directly affecting our appetite regulatory mechanisms. They are all derived from amino acids. Adequate protein intake is critical, often an issue for some. For example,  vegetarians and vegans may not get enough protein (especially if they are not educated on nutrition) and chronic dieters often have inadequate intakes. And, even if a person does consume adequate protein, it may not always be available, such as in the case of insufficient digestive enzymes or excessive antacid use.

Finally, there was mention of how for a small percentage of people, certain foods substances may contribute to food addiction and binge eating, such as high fructose corn syrup and MSG (he also discussed the gluten craze as well as casein but I may save that for another post!) This does not mean we need to cut out any foods  or that we should never eat them, it just is important to have balance in your life.

The importance of medication (such as mood stabilizers) in some cases was also  mentioned, as well as how medication was not helpful in other cases. The bottom line is that everyone is different, and it is very important to get evaluated by a professional. BED is a serious and debilitating eating disorder, but there is help.

If you are interested in the book which contains a wealth of information from Dr. Greenblatt, check out: 

Are You in Diet Jail?

Idiet jail first encountered the term “Diet Jail” in 1975. I was a biology major at Clark University in Worcester, Mass. I remember clearly working with the lab teacher who was doing his research on birds (he kind of looked like a cool woodpecker). He made me count bird chirps he had taped on a recorder. I decided I did not want to be a biology major because counting bird chirps was incredibly boring. So I met with my adviser who asked me what I was interested in. My best friend Joyce was a vegetarian and ate very interesting things such as yogurt with sunflower seeds and honey, and so I told him, I though vegetarianism was interesting. He told me I should be a dietitian. I did not know what that was, but anyway, I ended up transferring to the University of Connecticut to study nutrition. For my first nutrition class (Nutrition 101) I had to do a  report about fad diets and at the time there were many books out there on the market, including the Atkins Diet. But I found one called “The Psychologist’s Eat Anything Diet” by two psychologists, Dr. Pearson and his wife, also Dr. Pearson.  It changed my thinking in a way that lasted, well, forever. The authors were decades before their times in the strategies they were promoting, before we knew about mindful eating or how our bodies regulated themselves regarding calorie intake, fat, carbohydrate intake, etc. They described what they called “diet jail” where individuals who diet tend to “lock themselves up” in a jail where only the healthy foods exist. In other words, they tell themselves they are only going to eat healthy foods such as grilled chicken, vegetables, fruits, salad, etc until they lose the weight. So psychologically it is as if they “lock themselves up” in a world where only the healthy foods are available (or allowable). But outside the jail are all the other foods, the “bad” foods. The chips, cookies, ice cream, burgers, pizza, you get the picture. All the foods they have determined they are not allowed to eat (while they are on that diet). And so, most people can last a bit in Diet Jail. Yes, they get cravings, but they use their “willpower” and overcome them. Unfortunately, we now know our bodies send out very loud signals when we are not getting enough carbohydrate or fat (the foods that do not exist in Diet Jail!) and so eventually, our bodies drive our brains to give in. Add this physiological drive to an environmental trigger, such as walking into your friend’s home who just baked some homemade chocolate chip cookies, and things change. Your brain, which is triggered by the deficiency in your body, tells you to eat a cookie! It has just what you need, what you have been missing, that fat and carbohydrate! But you can’t have someone throw just one cookie into your jail cell, so you have to step out of the jail to get that one cookie…….the problem is, once you take that bite, your realize you are out there! Out of Diet Jail! And since you know you will go back in (you tell yourself that on Monday you will really start again!) you better eat while you are out here! So you decide to order pizza, and then have ice cream (a lot) because, heck, you are going to start again on Monday. Often a full blown binge results. Because you know this is just this one time. Soon you will be back on track. Back in Diet Jail. Until the next time.

As repetitive as this cycle is in so many people’s lives, they do not seem to stop. The next diet craze offers the next magic scheme. Weight is lost and then regained. Back then we did not know the physiological reasons people were driven to eat but now we do. We know if you restrict you will suffer from “disinhibition” or breaking out of Diet Jail.Often referred to as the “what the hell” effect. It is a very sad and draining cycle.

So why not take those bars down? Why not entertain the thought of changing what you have been doing that is not working? What if you were to start to believe that all foods are equal? No food is good, no food is bad, they all have a place in your life. Yes, we need certain nutrients to feel good, have energy, normal bowel movements, prevent disease, etc. So educate yourself (I will gladly help you!), experiment, enjoy your cultural traditions (yay. pasta fagioli!) but start paying attention to your body. Are you hungry? Are you full? Are you so confused that you might really want to get some help (such as from an eating disorder specialist?). Wherever you are, it is ok, just take some time to truly reflect on your patterns. My hope for you is to enjoy eating, be healthy, and take down those darn bars.

Feeling “Full”

boy with cake

Back in the day when I was young, I am guessing it was easier to know if you were “full”. These days I find many of my patients are very confused about this. Now that we know a lot more about the physiological contributors to feeling both hungry and full it is easy to figure out why back then people didn’t struggle as much.

So what are some of the contributors I am referring to? This topic is so complex that I am going to only focus on three:

(1) Balanced Meals: we now know there are messengers that respond to what we eat that communicate to our brain that we got what we needed. For instance, if we do not include adequate protein with our meals, our belly may feel “full” but our brain will tell us we are not satisfied because of a messenger called NPY (Neuropeptide Y). If we do not consume adequate carbohydrate our serotonin levels will fall and likely trigger a craving for something sweet later on. Back in the day, getting “three square meals” a day was the norm (and you were very lucky if you ever got a dessert, and that was probably on holidays and birthdays!). Today, things are different. Family meals barely exist as families tend to be busier, children tend to be glued to computers and video games, and family meals have fallen by the wayside. A typical “meal” for many teens I have seen is a package of Ramen Noodles (not much protein there, more snacking will be needed).

(2) “Sensory Satisfaction”: research has demonstrated that when you eat while distracted (such as while watching the TV or on the computer) you do not get an adequate release of dopamine which tells your brain you are satisfied and can stop eating. Need I say more? With one small TV in the home, 3 channels to choose from, and the remote not invented yet, back then we all ate at the table.

(3) Fitness: studies show that people who are active are more in tune with their hunger and fullness. In other words,one of their fullness messengers (called PYY) works better. Back in the day, there was no choice but to be active. There was nothing to do in the house, so kids played outside. We had to walk 2 miles to school and then back home, etc etc etc.

So, feeling “full”, a very normal physiological function is no longer that easy. Working on having balanced meals, shutting off the TV and sitting at the table sounds like simple advice, but more important than most people realize. And getting outside to play now that spring is here is a good idea too!!


Hunger and Food Insecurity

full frogOne topic I discuss often is the concept of hunger. It may sound like a simple thing. Either you are hungry or you are not, right? Well, unfortunately, for those who diet and restrict, or binge eat as a result of this, hunger is much more complicated.

Today I was fortunate to have the opportunity to volunteer at a soup kitchen. It was quite interesting to see the different kinds of people come in. Kids and elderly and families. What struck me was how some people came up a few times and took second and third plates, and I am talking full plates. I wondered how they could fit that much food in their tummy in one meal! Then it struck me. “Food Insecurity” was what I was seeing. The feeling that you will not get enough food. It is a scary feeling many of us have never experienced.

Unless you have dieted. Then, maybe, that feeling is there. With a self-imposed diet, restricting many foods, you get the same mind set that those who truly do not have enough food have. And so the answer is, to eat as much as you can when you have the opportunity. When you break your diet (and know that you will start again tomorrow). Very similar to the person who gets to have a good meal once per week when the other days of the week are not so good. It makes sense.

But the reality is, for those of use fortunate enough to be able to buy the foods we need, we never have to experience this feeling. You can always have what you want. So why overeat when you break your diet? If you don’t diet in the first place, and instead try to listen to your “true” hunger (typically a meal time or snack time when you have not eaten for a few hours) you are more likely to avoid getting into this mind-set. Listen to your body! Easier said than done, but keep trying!!

Habits: our brain’s fault

vegetable brain

We all have behaviors that we wish we could stop. Some people smoke and wish they never started. Some people want to start exercising yet they go straight to the couch the minute they walk in the door. Others want to eat healthy, yet just can’t drive by that fast food joint without going to that drive up window. You get the picture! What is going on here? Why is it so hard to change?

In all of these situations our brains have taken over to theoretically make life easier for us. In all of these situations a habit has been formed. Our brains have learned that when it gets a certain “trigger”, a “routine” follows that results in a “reward”. The first time we perform the behavior (walk in the door, take off our shoes, walk to the couch) our brains had to think through each step. But eventually, the step of walking through the door gets directly connected in our brains to the reward of sitting on the couch! We can already feel the reward! And that my friend, is a craving.  Our brain is now automatically wired.

How do we undo this unhealthy behavior? We need to start to rewire our brains! You can start with changing your routine. Instead of taking off your shoes, put on sneakers. Go outside instead of to the couch. Or take a different route home (bypassing your trigger). In time, the urges decrease (although the brain connections always remain, they are weakened, and your new healthier connections become strong).

So ask yourself: is there anything YOU do automatically, without thinking, that you wish you didn’t? What have you got to lose? Even just identifying your habits can be the first step to help you move into a healthier lifestyle.