Toronto Medical Rounds in Addiction: Food Addiction: Is it Real? Why does it Matter?

Copyright Vera Ingrid Tarman 2015

Food Addiction:
Does it Exist?
Why Do We Care?
by Vera Ingrid
Tarman
MD, M.Sc. FCFP, CASAM
copyright 2015

Quiz
What is the estimate of Ontario girls (age 12
– 18) engaged in severely problematic
food and weight management behavior?
a) 3%
b) 10%
c) 25%
d) 50%

Obesity and
Food Addiction
Does Food Addiction Exist?
Why Do We Care?

Or….is it an
Eating Disorder?
NOS: Compulsive Overeating
Bulimia
Binge Eating Disorder

Eating Disorders?
Food Addiction?
The Diagnosis ….
…. Determines the
Solution
(maybe the answer!)

Are You a Food Addict?
10 / 20 Questions from Food Addicts in Recovery Anonymous
1. Have you ever wanted to stop eating and found
you just couldn‘t?
2. Do you think about food or your weight
constantly?
3. Do you find yourself attempting one diet after
another with no lasting success?
4. Do you binge and then “get rid of the binge”
through vomiting, exercise, laxatives?
5. Do you eat differently in private? Do you eat in
secret?

Are You a Food Addict?
6. Do you eat large quantities of food at one
time? Or do you restrict?
7. Do you hide your food to make sure you
have ‘enough’?
8. Have you ever stolen other people’s food?
9. Have you ever discarded food only to eat
it later?
10. Have you ever felt hopeless about your
eating behavior?

Yale Food Addiction Scale
(sample)
IN THE PAST 12 MONTHS:
1) I find that when I start eating certain
foods, I end up eating much more than I
had planned
2) Not eating certain types of food or cutting
down on certain types of food is
something I worry about.

Estimated Prevalence of Food Addiction (Yale FAS)

ASAM definition of
Addiction
A primary chronic disease of brain
reward, motivation, memory and related
circuitry.
Dysfunction in these circuits leads to
characteristic biological, psychological,
social and spiritual manifestations.
This is reflected in an individual
pathologically pursing reward and / or
relief by substance use and other behaviours
Copyright
Vera Ingrid Tarman 2011

Addiction
Inability to consistently Abstain
Impairment in Behavioural control
Craving or increased 'hunger' for drugs or
rewarding experiences
Diminished recognition of significant
problems with behaviour @ relationships
A dysfunctional Emotional response
Copyright
Vera Ingrid Tarman 2011

Food Addiction:
The Theory
 Normal Hunger and Satiety
 Limbic / Reward Pathway
 Neurochemistry: dopamine,
serotonin, endorphins

Hunger
 Hunger releases the hormone
gherlin from the stomach which
activates dopamine
 This creates hunger and cravings
 Food cues i.e. smells, sights, tastes
also creates cravings

Satiation
 The stomach also gives the feedback
to stop eating
 A full stomach releases the hormone
leptin, leads to appetite satiation
 Prader – Willi Syndrome

Weight Loss and Hormones
 Recent research shows that almost
immediately after weight loss, Leptin
falls 2/3, and Gherlin increase, thus
person is hungrier
 One year later, Leptin was still lower by
1/3 (still hungry)
 Hormones normalized when the person
regained their weight

Obesity: Hyper-Leptinemia?
 Obesity causes Leptin resistance,
so that the person does not feel
satisfied/ full (even though leptin
levels are high)
 Leptin diminishes dopamine so
if Leptin resistant, pleasure of food
remains high

Limbic: The nature reward pathway

Food Reward
 The brain reward pathway
(dopamine) makes us desire food
 To protect against famine, the brain
reinforces excessive food intake

Food Reward Hijacked
 Our modern diet contains sugars,
refined carbohydrates

Food Reward Hijacked
 Energy Rich Foods = high dopamine
= drug of abuse

food
sex
gambling

Food - Reward
Notice which foods enhance the reward
neurochemistry:
 Serotonin: warm milk, pasta, potatoes,
bananas, turkey
 Dopamine: sugar, white starches
 Endorphins: chocolate, sugar, dairy,
spices

Sugar Addiction?
Acts like a Dopamine
 Some studies show that overweight
people have a diminished dopamine
response
 thus have more cravings

Obese subjects have decreased DA

OA Survey
 80% of OA members surveyed had blood
relatives who identified as alcoholic
 40% of female alcoholics had a history of
an eating disorder

Dopamine Receptor Availability

Sugar Addiction?
Sugar also releases our own
endorphins
Fats have also been implicated
relieves pain and gives a sense of
well being

Sugar Addiction?
Pain Relief like an Opiate
Sugar is an effective analgesic
for infants
analgesic effect is lost at 18
months of age

Sugar Withdrawal
 Withdrawal occurs if food restriction
(a diet) lasts more than 24 hours
 Withdrawal can take the form of
irritability, cravings, anxiety

Sugar Withdrawal
 After a few weeks of sugar binging,
rats will show opiate withdrawal …
 if given the opiate (and alcohol)
antagonist: Naltrexone

Dieting:
a Gateway to Drugs?
 During fasting, anticipatory
dopamine is not selective for food
 dieting increases the rewarding
effects of most drugs.

Alcohol and Sugar:
Gateways?
 Rats with a history of sugar binging
 were found to increase alcohol intake

Gateway for Drugs
 Cross sensitization occurs with
amphetamines and sugar
 when the rat are given
amphetamines……

Gateway for Drugs
hyperactivity occurs 10 days later
with sugar alone

Saccharine
 Even Saccharine is thought to create a
withdrawal syndrome similar to sugar,
 In one study, rats preferred saccharine
over cocaine

Food Addiction:
The Clinical Picture

Food Addiction
(Werdell)
Obesity (Normal eaters)
Emotional / Psychological
Eater (Eating Disorders)
Food Addiction

Stages of Food Addiction
(Werdell)
Early Stage
Mid Stage
Late Stage
Final Stage

Standard Treatments
Bariatric Surgery:
Inhibit absorption of food (gastric
bypass)
Or obstruct food intake (lap band)

Standard Treatments
Medications:
Appetite suppressants
(Ephedrine, Dexedrine)
Fat Absorption drugs (Orlistat)
Hormone based drugs (Leptin,
Metformin, Eltroxin)

Standard Treatments
High dose anti depressants
(Zoloft, Wellbutrin)
Mood stabilizers (Topimax)
Craving Blockers (Naltrexone,
Remonabant)

Standard Treatments
Behavioral:
Residential or community based
to moderate food intake of all
foods

Treatment for Addiction
How would treatments differ if
eating disorders were viewed as
an Addiction?

Treatment Centers needed
Nutritional / Dietary Paradigm
Shift away from the Canada Food
Guide
Community Supports: OA, FA,
FAA
Public awareness

Abstinence of sugar and
refined starches
Leptin and Insulin Resistance
diets ie low carb / high fat?
Nutritional Supplements?

Toronto Medical Rounds in Addiction: Food Addiction: Is it Real? Why does it Matter?

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Toronto Medical Rounds in Addiction: Food Addiction: Is it Real? Why does it Matter?