Journal of the New Zealand Medical Association

Carbohydrate withdrawal: is recognition t...
Although this case does not prove our hypothesis, it may explain why obese people
find it difficult to adhere to advice to...
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carbohydrate withdrawal


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This is a description of a woman who described severe carbohydrate withdrawal after restricting intake of sugar and white flour

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carbohydrate withdrawal

  1. 1. THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association 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. NZMJ 27 February 2009, Vol 122 No 1290; ISSN 1175 8716 Page 133 URL: ©NZMA
  2. 2. 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 Hayden McRobbie Senior Lecturer Auckland University of Technology School of Public Health and Psychosocial Studies Auckland 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. 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. 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 NZMJ 27 February 2009, Vol 122 No 1290; ISSN 1175 8716 Page 134 URL: ©NZMA