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

1. Copyright Vera Ingrid Tarman 2015

3. Copyright Vera Ingrid Tarman 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%

7. Copyright Vera Ingrid Tarman 2015 Obesity and Food Addiction Does Food Addiction Exist? Why Do We Care?

8. Copyright Vera Ingrid Tarman 2015 Or….is it an Eating Disorder? NOS: Compulsive Overeating Bulimia Binge Eating Disorder

9. Copyright Vera Ingrid Tarman 2015 Eating Disorders? Food Addiction? The Diagnosis …. …. Determines the Solution (maybe the answer!)

12. Copyright Vera Ingrid Tarman 2015 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?

13. Copyright Vera Ingrid Tarman 2015 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?

14. Copyright Vera Ingrid Tarman 2015 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.

15. Copyright Vera Ingrid Tarman 2015 Estimated Prevalence of Food Addiction (Yale FAS)

16. Copyright Vera Ingrid Tarman 2015 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

17. Copyright Vera Ingrid Tarman 2015 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

18. Copyright Vera Ingrid Tarman 2015 Food Addiction: The Theory  Normal Hunger and Satiety  Limbic / Reward Pathway  Neurochemistry: dopamine, serotonin, endorphins

20. Copyright Vera Ingrid Tarman 2015 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

21. Copyright Vera Ingrid Tarman 2015 Satiation  The stomach also gives the feedback to stop eating  A full stomach releases the hormone leptin, leads to appetite satiation  Prader – Willi Syndrome

23. Copyright Vera Ingrid Tarman 2015 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

24. Copyright Vera Ingrid Tarman 2015 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

25. Copyright Vera Ingrid Tarman 2015 Limbic: The nature reward pathway

26. Copyright Vera Ingrid Tarman 2015 Food Reward  The brain reward pathway (dopamine) makes us desire food  To protect against famine, the brain reinforces excessive food intake

27. Copyright Vera Ingrid Tarman 2015 Food Reward Hijacked  Our modern diet contains sugars, refined carbohydrates

28. Copyright Vera Ingrid Tarman 2015 Food Reward Hijacked  Energy Rich Foods = high dopamine = drug of abuse

29. Copyright Vera Ingrid Tarman 2015 food sex gambling

30. Copyright Vera Ingrid Tarman 2015 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

31. Copyright Vera Ingrid Tarman 2015 Sugar Addiction? Acts like a Dopamine  Some studies show that overweight people have a diminished dopamine response  thus have more cravings

32. Copyright Vera Ingrid Tarman 2015 Obese subjects have decreased DA

33. Copyright Vera Ingrid Tarman 2015 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

34. Copyright Vera Ingrid Tarman 2015 Dopamine Receptor Availability

35. Copyright Vera Ingrid Tarman 2015 Sugar Addiction? Sugar also releases our own endorphins Fats have also been implicated relieves pain and gives a sense of well being

36. Copyright Vera Ingrid Tarman 2015 Sugar Addiction? Pain Relief like an Opiate Sugar is an effective analgesic for infants analgesic effect is lost at 18 months of age

37. Copyright Vera Ingrid Tarman 2015 Sugar Withdrawal  Withdrawal occurs if food restriction (a diet) lasts more than 24 hours  Withdrawal can take the form of irritability, cravings, anxiety

38. Copyright Vera Ingrid Tarman 2015 Sugar Withdrawal  After a few weeks of sugar binging, rats will show opiate withdrawal …  if given the opiate (and alcohol) antagonist: Naltrexone

39. Copyright Vera Ingrid Tarman 2015 Dieting: a Gateway to Drugs?  During fasting, anticipatory dopamine is not selective for food  dieting increases the rewarding effects of most drugs.

40. Copyright Vera Ingrid Tarman 2015 Alcohol and Sugar: Gateways?  Rats with a history of sugar binging  were found to increase alcohol intake

41. Copyright Vera Ingrid Tarman 2015 Gateway for Drugs  Cross sensitization occurs with amphetamines and sugar  when the rat are given amphetamines……

42. Copyright Vera Ingrid Tarman 2015 Gateway for Drugs hyperactivity occurs 10 days later with sugar alone

43. Copyright Vera Ingrid Tarman 2015 Saccharine  Even Saccharine is thought to create a withdrawal syndrome similar to sugar,  In one study, rats preferred saccharine over cocaine

44. Copyright Vera Ingrid Tarman 2015 Food Addiction: The Clinical Picture

45. Copyright Vera Ingrid Tarman 2015 Food Addiction (Werdell) Obesity (Normal eaters) Emotional / Psychological Eater (Eating Disorders) Food Addiction

46. Copyright Vera Ingrid Tarman 2015 Stages of Food Addiction (Werdell) Early Stage Mid Stage Late Stage Final Stage

48. Copyright Vera Ingrid Tarman 2015 Standard Treatments Bariatric Surgery: Inhibit absorption of food (gastric bypass) Or obstruct food intake (lap band)

49. Copyright Vera Ingrid Tarman 2015 Standard Treatments Medications: Appetite suppressants (Ephedrine, Dexedrine) Fat Absorption drugs (Orlistat) Hormone based drugs (Leptin, Metformin, Eltroxin)

50. Copyright Vera Ingrid Tarman 2015 Standard Treatments High dose anti depressants (Zoloft, Wellbutrin) Mood stabilizers (Topimax) Craving Blockers (Naltrexone, Remonabant)

51. Copyright Vera Ingrid Tarman 2015 Standard Treatments Behavioral: Residential or community based to moderate food intake of all foods

52. Copyright Vera Ingrid Tarman 2015 Treatment for Addiction How would treatments differ if eating disorders were viewed as an Addiction?

53. Copyright Vera Ingrid Tarman 2015 Treatment for Addiction Treatment Centers needed Nutritional / Dietary Paradigm Shift away from the Canada Food Guide Community Supports: OA, FA, FAA Public awareness

54. Copyright Vera Ingrid Tarman 2015 Treatment for Addiction 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?

Women's College Hospital

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