This document discusses a case study of a 38-year-old woman who experienced withdrawal symptoms when cutting out processed sugars and flour from her diet for 3 weeks. Her symptoms included mood swings, depression, headaches, muscle and joint pain, and shakes. After 3 weeks, her cravings started to subside and her symptoms improved. The authors argue this case provides an example of carbohydrate withdrawal that is similar to opiate withdrawal, and shows why reducing refined carbohydrates can be difficult for obese people due to addictive properties. Further research is needed to study carbohydrate withdrawal in obese subjects limiting high glycemic index foods.

1. THE NEW ZEALAND
MEDICAL JOURNAL
Journal of the New Zealand Medical Association
NZMJ 27 February 2009, Vol 122 No 1290; ISSN 1175 8716 Page 133
URL: http://www.nzma.org.nz/journal/122-1290/3491/ ©NZMA
Carbohydrate withdrawal: is recognition the first step to
recovery?
Simon Thornley, Hayden McRobbie
In October 2008 we submitted a paper to a little-known medical journal proposing
that high glycaemic index (GI) carbohydrates may be more ‘rewarding’ than other
foods and that this may be responsible for the global rise in obesity observed globally
over the last 30 years.1
Our paper attracted little attention, until a British tabloid
published a story based on our article on 4 January 2009.2
Several television and radio
interviews followed.
After the publicity we received a number of emails from persons who identified with
the article. Some were relieved that the medical community had begun to consider
obesity as an addiction rather than primarily a metabolic problem associated with
imprudent food choices.
In the original article, I claimed that obese persons may experience a withdrawal
syndrome (after abstinence from high GI foods) with symptoms such as craving and
low mood, although I had little support for these claims in the medical literature.
Symptoms of carbohydrate withdrawal were thought to be similar to those associated
with other drug dependencies. The only description we had found of
food/carbohydrate withdrawal was reported by Atkins3
of an obese individual who
had made repeated unsuccessful attempts to reduce his weight and experienced
restlessness and tremors after short term abstinence from sugar. Sugar withdrawal has
also been induced in rodents.4
Email correspondence extracts from a 38-year-old woman from Wisconsin, USA,
received initially on the 1 of February 2009 (consent obtained for reproduction)
follow:
…For the first 3 weeks I cut all processed sugar and flour from my diet and suffered mood
swings with extreme tension and depression, even a sense of hopelessness at times, I had
horrible stomach pains, all my joints and muscles throbbed, and I had the shakes constantly. I
don't even know how to describe the horrible headaches that went along with all this. People
who knew me started thinking I was hiding a drug problem. The worst physical symptoms
have been gone for about 2 weeks now, and the cravings are finally starting to subside…I look
at birthday cake today and all I see is myself curled up in the foetal position crying in bed.
…The worst part of the addiction lasted 3 weeks. The first 3 days were normal, but then on
the fourth day the worst cravings began. All I could think about was ice cream, chocolate, and
cheesecake. The cravings started to subside after the third week, but once I started feeling
better I [thought] about food less. The shakes and the headaches really were the worst part!
Before her diet changed, she reported a weight of 124 kg (BMI 41.0 kg/m2
), that
lowered to 114 kg (BMI 37.7 kg/m2
) 6 weeks later. Similarly, her fasting venous
glucose dropped from 7 to 6 mmol/L and her total cholesterol changed from 5.7
mmol/L to 4.6 mmol/L over the same period.

2. NZMJ 27 February 2009, Vol 122 No 1290; ISSN 1175 8716 Page 134
URL: http://www.nzma.org.nz/journal/122-1290/3491/ ©NZMA
Although this case does not prove our hypothesis, it may explain why obese people
find it difficult to adhere to advice to reduce intake of refined carbohydrates. Her
description is similar to an opiate withdrawal syndrome (craving, aches and pains and
muscular spasm or twitching).5
The time course—worst in the first weeks and
resolving with continued abstinence within 4 weeks—again concurs with a
withdrawal syndrome.
Further work may indicate if these symptoms can be reliably measured and mapped
over time in obese subjects that limit their intake of high GI food. The magnitude of
health resource devoted to the treatment of obesity and its consequences6–8
argues that
such work be prioritised.
Simon Thornley
Assistant Research Fellow
Section of Epidemiology and Biostatistics
University of Auckland (Tamaki Campus)
Auckland
sithor@woosh.co.nz
Hayden McRobbie
Senior Lecturer
Auckland University of Technology
School of Public Health and Psychosocial Studies
Auckland
hayden.mcrobbie@inspiringlimited.com
References:
1. Thornley S, McRobbie H, Eyles H, et al. The obesity epidemic: is glycemic index the key to
unlocking a hidden addiction? Medical Hypotheses 2008;71(5):709–14.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN2-4T6KFHG-
4&_user=1626814&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000007718&
_version=1&_urlVersion=0&_userid=1626814&md5=74d293b034dfa5954a0d71aeae51c2f3
2. Burne J. Are you a carb addict? Daily Mail 2009 9 January 2009.
http://www.dailymail.co.uk/health/article-1106003/Are-carb-addict.html
3. Atkins R. Dr Atkins New Diet Revolution. London: Vermillion, 2003.
4. Grimm JW, Manaois M, Osincup D, et al. Naloxone attenuates incubated sucrose craving in
rats. Psychopharmacology 2007;194(4):537–44.
5. Farrell M. Opiate withdrawal. Addiction 1994;89(11):1471–5.
6. Tobias M, Turley M. Causes of death classified by risk and condition, New Zealand 1997.
Australian & New Zealand Journal of Public Health 2005;29(1):5–12.
7. Ni Mhurchu C, Turley M, Stefanogiannis N, et al. Mortality attributable to higher-than-
optimal body mass index in New Zealand. Public Health Nutrition 2005;8(4):402–8.
8. Turley M, Tobias M, Paul S. Non-fatal disease burden associated with excess body mass
index and waist circumference in New Zealand adults. Australian & New Zealand Journal of
Public Health 2006;30(3):231–7. Abstract at
http://www3.interscience.wiley.com/journal/118731429/abstract