Orlistat is an FDA-approved drug for long-term treatment of obesity. It works by blocking the absorption of dietary fat. When taken with meals, it reduces the risk of obesity-related conditions like type 2 diabetes, hypertension, and dyslipidemia. Orlistat leads to greater weight loss than placebo when used along with lifestyle changes like diet and exercise. It also helps maintain weight loss and lessens weight regain over two years.
Carbohydrate;low intensity and high intensities physical activitiesSiham Gritly
The document discusses carbohydrate utilization during exercise. It states that carbohydrates should make up 60-70% of an athlete's daily energy intake to fuel exercise and prevent fatigue. Carbohydrates are used aerobically during endurance exercise and anaerobically during high-intensity exercise through glycogen stores in the liver and muscles. Insufficient carbohydrate intake can lead to hypoglycemia during long-duration exercise when glycogen runs low.
This document outlines Dr. Sahil Kumar's presentation on anti-obesity drugs. It begins with introducing the global rise of obesity and discusses mechanisms that control energy balance like leptin and the hypothalamus. Historical anti-obesity drugs are reviewed along with contemporary FDA-approved options like orlistat, lorcaserin, phentermine-topiramate, naltrexone-bupropion, and liraglutide. The document also explores future developments in anti-obesity drug research and development.
Are you Struggling to Control of your Diabetes and Weight?
People who are overweight or obese are more prone to developing Type 2 diabetes. Those who have Type 1 and Type 2 diabetes with weight problems struggle to control their blood sugar levels. Research shows that people with diabetes find it more difficult to lose weight than those without diabetes.
Weight loss significantly improves blood sugar control and also reduces the risk of getting complications from diabetes. However, whilst attempting to lose weight, people with diabetes find it hard to restrict their intake of food since eating less may trigger hypoglycaemia (low blood sugar). All these facts explain the need for specialist input in management of weight in people with diabetes.
This Slideshow gives you insight to Diabesity
For more information please visit
http://www.simplyweight.co.uk
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http://www.simplyweight.co.uk/articles/
Videos
http://www.simplyweight.co.uk/video/
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The document discusses evidence from studies on the effect of lifestyle modifications such as caloric restriction, physical activity, and weight loss on health outcomes. It summarizes key findings from several studies:
1) The Diabetes Prevention Program clinical trial found that intensive lifestyle intervention reduced the risk of developing type 2 diabetes by 58% compared to 31% for treatment with metformin.
2) Studies on caloric restriction in primates showed decreased fasting glucose and insulin levels as well as reduced risk of age-related diseases like diabetes and cardiovascular disease.
3) Physical activity has been shown to increase lifespan in animal models, and a study of over 1300 male rats found a 10% reduction in body weight led to a 13.5
Skeletal system (Healthy of Bones,Joints)& Yoga by Dr.Nutan PakhareDr.Nutan Pakhare
The document discusses the skeletal system, including its structures and functions. It describes the different types of bones and joints in the human body. It covers topics like bone tissue, cartilage, ligaments, tendons, and the role of the endocrine system in bone health. The document also discusses disorders like fractures, osteoporosis, and discusses how practices like yoga can benefit bone and joint health.
Obesity increases the risk of developing type 2 diabetes. Type 2 diabetes occurs when cells become resistant to insulin or the body does not produce enough insulin. Nearly 90% of people with type 2 diabetes are overweight or obese. Maintaining a healthy weight through a balanced diet and regular physical activity can help prevent or manage diabetes by reducing strain on the body's ability to regulate blood sugar levels. Medical nutrition therapy, such as modest weight loss through calorie reduction, can improve insulin resistance and diabetes symptoms.
Orlistat is an FDA-approved drug for long-term treatment of obesity. It works by blocking the absorption of dietary fat. When taken with meals, it reduces the risk of obesity-related conditions like type 2 diabetes, hypertension, and dyslipidemia. Orlistat leads to greater weight loss than placebo when used along with lifestyle changes like diet and exercise. It also helps maintain weight loss and lessens weight regain over two years.
Carbohydrate;low intensity and high intensities physical activitiesSiham Gritly
The document discusses carbohydrate utilization during exercise. It states that carbohydrates should make up 60-70% of an athlete's daily energy intake to fuel exercise and prevent fatigue. Carbohydrates are used aerobically during endurance exercise and anaerobically during high-intensity exercise through glycogen stores in the liver and muscles. Insufficient carbohydrate intake can lead to hypoglycemia during long-duration exercise when glycogen runs low.
This document outlines Dr. Sahil Kumar's presentation on anti-obesity drugs. It begins with introducing the global rise of obesity and discusses mechanisms that control energy balance like leptin and the hypothalamus. Historical anti-obesity drugs are reviewed along with contemporary FDA-approved options like orlistat, lorcaserin, phentermine-topiramate, naltrexone-bupropion, and liraglutide. The document also explores future developments in anti-obesity drug research and development.
Are you Struggling to Control of your Diabetes and Weight?
People who are overweight or obese are more prone to developing Type 2 diabetes. Those who have Type 1 and Type 2 diabetes with weight problems struggle to control their blood sugar levels. Research shows that people with diabetes find it more difficult to lose weight than those without diabetes.
Weight loss significantly improves blood sugar control and also reduces the risk of getting complications from diabetes. However, whilst attempting to lose weight, people with diabetes find it hard to restrict their intake of food since eating less may trigger hypoglycaemia (low blood sugar). All these facts explain the need for specialist input in management of weight in people with diabetes.
This Slideshow gives you insight to Diabesity
For more information please visit
http://www.simplyweight.co.uk
Articles
http://www.simplyweight.co.uk/articles/
Videos
http://www.simplyweight.co.uk/video/
Blogs
http://simplyweight.co.uk/blogs/
Forum
http://www.simplyweight.co.uk/forum/forum.php
Contact Us
http://www.simplyweight.co.uk/how-to-contact-us/
The document discusses evidence from studies on the effect of lifestyle modifications such as caloric restriction, physical activity, and weight loss on health outcomes. It summarizes key findings from several studies:
1) The Diabetes Prevention Program clinical trial found that intensive lifestyle intervention reduced the risk of developing type 2 diabetes by 58% compared to 31% for treatment with metformin.
2) Studies on caloric restriction in primates showed decreased fasting glucose and insulin levels as well as reduced risk of age-related diseases like diabetes and cardiovascular disease.
3) Physical activity has been shown to increase lifespan in animal models, and a study of over 1300 male rats found a 10% reduction in body weight led to a 13.5
Skeletal system (Healthy of Bones,Joints)& Yoga by Dr.Nutan PakhareDr.Nutan Pakhare
The document discusses the skeletal system, including its structures and functions. It describes the different types of bones and joints in the human body. It covers topics like bone tissue, cartilage, ligaments, tendons, and the role of the endocrine system in bone health. The document also discusses disorders like fractures, osteoporosis, and discusses how practices like yoga can benefit bone and joint health.
Obesity increases the risk of developing type 2 diabetes. Type 2 diabetes occurs when cells become resistant to insulin or the body does not produce enough insulin. Nearly 90% of people with type 2 diabetes are overweight or obese. Maintaining a healthy weight through a balanced diet and regular physical activity can help prevent or manage diabetes by reducing strain on the body's ability to regulate blood sugar levels. Medical nutrition therapy, such as modest weight loss through calorie reduction, can improve insulin resistance and diabetes symptoms.
This document discusses the clinical management of elderly patients with diabetes. It addresses several topics:
1. Elderly patients have a different pathophysiology compared to younger adults due to changes in muscle mass, adipose tissue, and vascular function.
2. Elderly patients face higher risks of vascular complications, functional decline, falls and fractures, cognitive impairment, and mortality compared to those without diabetes.
3. A comprehensive assessment of elderly patients with diabetes should consider medical, functional, cognitive, social, and other factors to determine individualized treatment goals that preserve quality of life.
4. The management of elderly diabetes patients should focus on preventing frailty and disability rather than only treating the disease itself. Integrated
Intermittent fasting is an Interventional strategy where in individuals are subjected to varying periods of fasting.
It doesn’t specify which foods you should eat but rather when you should eat them.
Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating.
It’s currently very popular in the health and fitness community.
Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
NFMNT Chapter 5 Overview of Body Systems and Medical Nutrition Therapy Interv...KellyGCDET
This document provides an overview of medical nutrition therapy interventions for various body systems and conditions, including the gastrointestinal tract, liver, kidneys, Alzheimer's disease, and developmental disabilities. It defines medical nutrition therapy and outlines objectives for identifying terminology, concepts, and utilizing therapy in care settings. It also details dietary modifications and considerations for specific diseases and disorders.
In the UK, rates of obesity have increased by 30% in women, 40% in men, and 50% in children within the last decade resulting in over 25% of adults classified as obese today.
Obesity, in particular central obesity, is the dominant risk factor for insulin resistance, metabolic syndrome and type II diabetes. Evidence supporting obesity as an inflammation condition continues to grow and this is directly linked to the development of insulin resistance.
This webinar discusses novel approaches for the treatment and prevention of the common morbidities associated with obesity, specifically insulin resistance and type II diabetes, through targeting obesity-induced inflammatory processes.
The document discusses doping in sport and performance enhancing drugs. It provides a timeline of banned substances in sport from ancient Greece to modern times. Key events discussed include the 1988 Olympics where Ben Johnson tested positive for steroids and the establishment of WADA in 1999. Specific performance enhancers like anabolic steroids, human growth hormone, EPO, and THG are defined. The BALCO scandal is summarized where many top athletes were linked to the lab. The document discusses views on whether performance enhancing drugs should be banned and debates around natural advantages in sport.
Medooc is a search engine for researching medical information.It has been built by medical
professionals to help others in the community to research and share credible health information.
Doctors, Physcials and medical professionals participate in Medooc.com on day to day basis to help each other.
For more information you can visit:-http://www.medooc.com/
The glycemic index (GI) is a value assigned to foods based on how much they raise blood glucose levels compared to an equivalent amount of pure glucose. The GI represents the total rise in blood sugar over 2 hours after eating a food. Low GI foods raise blood sugar slowly while high GI foods cause a rapid spike. Glycemic load (GL) takes into account both a food's GI and the amount of carbohydrates per serving to estimate its effect on blood glucose levels. Common foods are classified as having a low, moderate, or high GI or GL based on established cutoff values. The standard protocol for determining a food's GI involves measuring blood glucose responses in volunteers after consuming the food.
Glycemic Index vs. Glycemic Load: What's the Difference? - Johanna Burani, MS...Nutrition Works, LLC
What is the difference between glycemic index and glycemic load? What does each tell about a carbohydrate? Johanna Burani, MS, RD, CDE explains these differences and the calculations involved.
[Also available with narration at http://www.EatGoodCarbs.com]
Obesity in women by Dr. Sharda Jain presented on 17th August 14 at DMA Cente...Lifecare Centre
This document summarizes a presentation on obesity in women given by Dr. Sharda Jain and others. It discusses the increasing prevalence of obesity in women globally and in India. Unique aspects of medical history taking and physical examination in obese women are covered. The document reviews the medical issues associated with obesity like infertility, pregnancy complications, and increased risk of diseases. Lifestyle changes including diet and exercise as well as pharmacological and surgical options for obesity management are presented. Specific considerations for obesity and infertility treatment and pregnancy are also summarized.
Guidelines in Obesity management
By Dr. Usama Ragab Youssif
Obesity-related counseling should be offered to those with BMI ≥25 kg/m2
A 3% to 5% weight loss can result in meaningful reductions in triglycerides, blood glucose, hemoglobin A1c, and the risk of developing type 2 diabetes
Set an initial weight loss goal of 5% to 10% of current body weight over 6 mo
After 6 mo, focus on weight maintenance before attempting further weight loss
Participating in a weight loss program long-term can help improve weight maintenance
The document discusses the principles of yogic nutrition according to Ayurveda. Foods are categorized as sattvic, rajasic, or tamasic based on their qualities. Sattvic foods such as fruits and vegetables promote purity, health, and mental clarity. Rajasic foods like meat and spices overstimulate the mind and body. Tamasic foods which are stale or rotten cause lethargy. A yogic diet focuses on sattvic foods to nourish the body and calm the mind for spiritual practices.
This document defines obesity and discusses its types, causes, effects, and treatment. Obesity is diagnosed using BMI and occurs when excess body fat negatively impacts health. It has various types ranging from severe to super obesity. Its causes include lack of exercise, poor diet, genetics, and certain medical conditions. Obesity affects the body's systems and can increase risks of diabetes, heart disease, fatty liver, arthritis, and some cancers. Treatment focuses on healthy weight loss through diet, exercise, medication, and sometimes surgery.
Obesity is defined as excessive accumulation of body fat that occurs when caloric intake exceeds physiological needs. It can be caused by genetic, behavioral, social, and medical factors. Obesity is assessed by measuring body mass index (BMI), body fat percentage, and skin fold thickness. A BMI over 30 indicates obesity and is associated with increased risk of health complications like hypertension, diabetes, heart disease, and stroke. Obesity management involves dietary changes like reducing carbohydrate and fat intake while increasing protein and fiber, regular exercise, psychological counseling, medication, and sometimes surgery.
Metabolic syndrome is a group of conditions that increases the risk of heart disease, stroke, and diabetes. It is diagnosed when a person has at least 3 of the following: increased waist circumference, high blood pressure, high fasting blood sugar, low HDL cholesterol, or high triglycerides. Risk factors include excess weight around the middle, insulin resistance, age, race, family history of diabetes, and other medical conditions. Complications include diabetes and cardiovascular disease. Improving metabolic syndrome involves eating a healthy diet like DASH, increasing physical activity, losing weight, quitting smoking, and managing stress.
1) Metabolic syndrome is a cluster of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels that increase the risk of heart disease, stroke and diabetes.
2) It is becoming increasingly common globally, affecting nearly 1 in 5 adults. In India, prevalence rates are as high as 33.5% overall.
3) Lifestyle factors like unhealthy diet, physical inactivity and obesity are major contributors to metabolic syndrome. Initial treatment focuses on lifestyle modifications like diet changes, increased exercise and weight loss.
The document provides guidelines for diet and nutrition in managing diabetes mellitus (DM). It recommends a balanced diet with regular meals that includes carbohydrates, proteins, fats, and fibers in appropriate amounts based on an individual's needs and goals. Dietary education tools like food groups, food exchanges, carbohydrate counting and the glycemic index help patients understand healthy eating habits and self-manage their blood glucose levels. The overall goals are to maintain a healthy weight and lifestyle to prevent complications and symptoms of DM through nutritional modifications.
Rapid weight loss through crash diets or over-exercising can have serious health consequences like increased hunger, lowered metabolism, muscle loss, nutrient deficiencies, and yo-yo dieting. A healthy rate of weight loss is 1-2 pounds per week through moderate calorie reduction and exercise. This allows fat loss without triggering starvation responses or harming long-term health and weight maintenance.
Nutrition Therapy for the Addicted Brain (June 2016) by David Wiss MS RDNNutrition in Recovery
Registered Dietitian Nutritionist and addiction expert David Wiss discusses how nutrition can be used to combat substance use disorders. His focus is on brain chemistry, hormones, and gut health.
Incorporating Food Addiction into Disordered Eating: The Food and Weight Unit...Nutrition in Recovery
The document proposes a new model called the Food and Weight Unit Spectrum Model (FWUSM) to conceptualize and treat eating disorders that incorporates recent data on food addiction. It explores the relationship between eating disorders and addictions, noting similarities between processed foods high in sugar, fat and salt and addictive drugs in their ability to hijack the brain's reward system. Food addiction, as measured by the Yale Food Addiction Scale, has been found in a significant percentage of obese and binge eating disorder patients. The document suggests some eating disorders and obesity may be a form of addiction driven by alterations in dopamine and opioid neurotransmitter systems that regulate reward, motivation and hedonic aspects of eating. The proposed FWUSM aims to map
This document discusses the clinical management of elderly patients with diabetes. It addresses several topics:
1. Elderly patients have a different pathophysiology compared to younger adults due to changes in muscle mass, adipose tissue, and vascular function.
2. Elderly patients face higher risks of vascular complications, functional decline, falls and fractures, cognitive impairment, and mortality compared to those without diabetes.
3. A comprehensive assessment of elderly patients with diabetes should consider medical, functional, cognitive, social, and other factors to determine individualized treatment goals that preserve quality of life.
4. The management of elderly diabetes patients should focus on preventing frailty and disability rather than only treating the disease itself. Integrated
Intermittent fasting is an Interventional strategy where in individuals are subjected to varying periods of fasting.
It doesn’t specify which foods you should eat but rather when you should eat them.
Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating.
It’s currently very popular in the health and fitness community.
Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
NFMNT Chapter 5 Overview of Body Systems and Medical Nutrition Therapy Interv...KellyGCDET
This document provides an overview of medical nutrition therapy interventions for various body systems and conditions, including the gastrointestinal tract, liver, kidneys, Alzheimer's disease, and developmental disabilities. It defines medical nutrition therapy and outlines objectives for identifying terminology, concepts, and utilizing therapy in care settings. It also details dietary modifications and considerations for specific diseases and disorders.
In the UK, rates of obesity have increased by 30% in women, 40% in men, and 50% in children within the last decade resulting in over 25% of adults classified as obese today.
Obesity, in particular central obesity, is the dominant risk factor for insulin resistance, metabolic syndrome and type II diabetes. Evidence supporting obesity as an inflammation condition continues to grow and this is directly linked to the development of insulin resistance.
This webinar discusses novel approaches for the treatment and prevention of the common morbidities associated with obesity, specifically insulin resistance and type II diabetes, through targeting obesity-induced inflammatory processes.
The document discusses doping in sport and performance enhancing drugs. It provides a timeline of banned substances in sport from ancient Greece to modern times. Key events discussed include the 1988 Olympics where Ben Johnson tested positive for steroids and the establishment of WADA in 1999. Specific performance enhancers like anabolic steroids, human growth hormone, EPO, and THG are defined. The BALCO scandal is summarized where many top athletes were linked to the lab. The document discusses views on whether performance enhancing drugs should be banned and debates around natural advantages in sport.
Medooc is a search engine for researching medical information.It has been built by medical
professionals to help others in the community to research and share credible health information.
Doctors, Physcials and medical professionals participate in Medooc.com on day to day basis to help each other.
For more information you can visit:-http://www.medooc.com/
The glycemic index (GI) is a value assigned to foods based on how much they raise blood glucose levels compared to an equivalent amount of pure glucose. The GI represents the total rise in blood sugar over 2 hours after eating a food. Low GI foods raise blood sugar slowly while high GI foods cause a rapid spike. Glycemic load (GL) takes into account both a food's GI and the amount of carbohydrates per serving to estimate its effect on blood glucose levels. Common foods are classified as having a low, moderate, or high GI or GL based on established cutoff values. The standard protocol for determining a food's GI involves measuring blood glucose responses in volunteers after consuming the food.
Glycemic Index vs. Glycemic Load: What's the Difference? - Johanna Burani, MS...Nutrition Works, LLC
What is the difference between glycemic index and glycemic load? What does each tell about a carbohydrate? Johanna Burani, MS, RD, CDE explains these differences and the calculations involved.
[Also available with narration at http://www.EatGoodCarbs.com]
Obesity in women by Dr. Sharda Jain presented on 17th August 14 at DMA Cente...Lifecare Centre
This document summarizes a presentation on obesity in women given by Dr. Sharda Jain and others. It discusses the increasing prevalence of obesity in women globally and in India. Unique aspects of medical history taking and physical examination in obese women are covered. The document reviews the medical issues associated with obesity like infertility, pregnancy complications, and increased risk of diseases. Lifestyle changes including diet and exercise as well as pharmacological and surgical options for obesity management are presented. Specific considerations for obesity and infertility treatment and pregnancy are also summarized.
Guidelines in Obesity management
By Dr. Usama Ragab Youssif
Obesity-related counseling should be offered to those with BMI ≥25 kg/m2
A 3% to 5% weight loss can result in meaningful reductions in triglycerides, blood glucose, hemoglobin A1c, and the risk of developing type 2 diabetes
Set an initial weight loss goal of 5% to 10% of current body weight over 6 mo
After 6 mo, focus on weight maintenance before attempting further weight loss
Participating in a weight loss program long-term can help improve weight maintenance
The document discusses the principles of yogic nutrition according to Ayurveda. Foods are categorized as sattvic, rajasic, or tamasic based on their qualities. Sattvic foods such as fruits and vegetables promote purity, health, and mental clarity. Rajasic foods like meat and spices overstimulate the mind and body. Tamasic foods which are stale or rotten cause lethargy. A yogic diet focuses on sattvic foods to nourish the body and calm the mind for spiritual practices.
This document defines obesity and discusses its types, causes, effects, and treatment. Obesity is diagnosed using BMI and occurs when excess body fat negatively impacts health. It has various types ranging from severe to super obesity. Its causes include lack of exercise, poor diet, genetics, and certain medical conditions. Obesity affects the body's systems and can increase risks of diabetes, heart disease, fatty liver, arthritis, and some cancers. Treatment focuses on healthy weight loss through diet, exercise, medication, and sometimes surgery.
Obesity is defined as excessive accumulation of body fat that occurs when caloric intake exceeds physiological needs. It can be caused by genetic, behavioral, social, and medical factors. Obesity is assessed by measuring body mass index (BMI), body fat percentage, and skin fold thickness. A BMI over 30 indicates obesity and is associated with increased risk of health complications like hypertension, diabetes, heart disease, and stroke. Obesity management involves dietary changes like reducing carbohydrate and fat intake while increasing protein and fiber, regular exercise, psychological counseling, medication, and sometimes surgery.
Metabolic syndrome is a group of conditions that increases the risk of heart disease, stroke, and diabetes. It is diagnosed when a person has at least 3 of the following: increased waist circumference, high blood pressure, high fasting blood sugar, low HDL cholesterol, or high triglycerides. Risk factors include excess weight around the middle, insulin resistance, age, race, family history of diabetes, and other medical conditions. Complications include diabetes and cardiovascular disease. Improving metabolic syndrome involves eating a healthy diet like DASH, increasing physical activity, losing weight, quitting smoking, and managing stress.
1) Metabolic syndrome is a cluster of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels that increase the risk of heart disease, stroke and diabetes.
2) It is becoming increasingly common globally, affecting nearly 1 in 5 adults. In India, prevalence rates are as high as 33.5% overall.
3) Lifestyle factors like unhealthy diet, physical inactivity and obesity are major contributors to metabolic syndrome. Initial treatment focuses on lifestyle modifications like diet changes, increased exercise and weight loss.
The document provides guidelines for diet and nutrition in managing diabetes mellitus (DM). It recommends a balanced diet with regular meals that includes carbohydrates, proteins, fats, and fibers in appropriate amounts based on an individual's needs and goals. Dietary education tools like food groups, food exchanges, carbohydrate counting and the glycemic index help patients understand healthy eating habits and self-manage their blood glucose levels. The overall goals are to maintain a healthy weight and lifestyle to prevent complications and symptoms of DM through nutritional modifications.
Rapid weight loss through crash diets or over-exercising can have serious health consequences like increased hunger, lowered metabolism, muscle loss, nutrient deficiencies, and yo-yo dieting. A healthy rate of weight loss is 1-2 pounds per week through moderate calorie reduction and exercise. This allows fat loss without triggering starvation responses or harming long-term health and weight maintenance.
Nutrition Therapy for the Addicted Brain (June 2016) by David Wiss MS RDNNutrition in Recovery
Registered Dietitian Nutritionist and addiction expert David Wiss discusses how nutrition can be used to combat substance use disorders. His focus is on brain chemistry, hormones, and gut health.
Incorporating Food Addiction into Disordered Eating: The Food and Weight Unit...Nutrition in Recovery
The document proposes a new model called the Food and Weight Unit Spectrum Model (FWUSM) to conceptualize and treat eating disorders that incorporates recent data on food addiction. It explores the relationship between eating disorders and addictions, noting similarities between processed foods high in sugar, fat and salt and addictive drugs in their ability to hijack the brain's reward system. Food addiction, as measured by the Yale Food Addiction Scale, has been found in a significant percentage of obese and binge eating disorder patients. The document suggests some eating disorders and obesity may be a form of addiction driven by alterations in dopamine and opioid neurotransmitter systems that regulate reward, motivation and hedonic aspects of eating. The proposed FWUSM aims to map
Nutrition Interventions in Addiction Recovery: The Role of the Dietitian in S...Nutrition in Recovery
Are you curious about the connection between nutrition and drug addiction? David A. Wiss, MS, RDN, CPT reviews the literature, makes recommendations for medical nutrition therapy, and shares some suggestions to run groups in treatment facilities.
Nutrition in Recovery: The Role of the Dietitian in Addiction Treatment 2015Nutrition in Recovery
David Wiss MS RDN discusses the importance of nutrition in addiction recovery and the rationale for the Registered Dietitian Nutritionist to be a member of the treatment team. Topics include:
Food and Mood
Food Addiction
Disordered Eating
Hormones
Nutrition Therapy
Information and overview of important content of Harold Urschel's book: Healing the Addicted Brain: The Revolutionary, Science-Based Alcoholism and Addiction Recovery Program
This document provides an outline and slides from a university class on gambling. The class covers the history and trends of gambling, how gambling affects the brain, vulnerable populations like youth, and addiction and mental health connections. Regarding youth, the document notes that 6 in 10 Oregon teens have gambled, and surveys show teens who gamble are more likely to use substances like alcohol, cigarettes, and marijuana. However, the conclusion is that problem gambling is one component of broader problem behaviors in teens, and not the sole cause of other issues. The class aims to educate students on these various aspects of gambling.
1) Dopamine pathways in the brain are involved in reward, pleasure, and motivation. Drugs of abuse cause the release of dopamine in these pathways, particularly in the nucleus accumbens.
2) With prolonged drug use, changes occur in the brain that affect dopamine pathways and the prefrontal cortex. These changes can be both structural and functional.
3) Brain imaging studies have shown decreases in metabolism in the orbitofrontal cortex of cocaine abusers compared to controls. Studies have also shown that prolonged methamphetamine use suppresses the expression of the dopamine transporter.
Engage the rhythms of your brain.stephen dolleStephen Dolle
Stephen Dolle presents on engaging the rhythms of the brain through drumming. He discusses how drumming can benefit cognition, movement, sensory integration, socialization, language development, and induce trance-like brain wave entrainment states. Dolle also outlines his research on how syncopated drumming patterns can aid cognition while unsyncopated patterns can impair it. He proposes applications of drumming in education, healthcare, and community building.
FDA's David L. Daly July 2002 Response and Denial to include CNS shunts in ne...Stephen Dolle
The letter responds to a request to add CNS shunts to a postmarket surveillance list under Section 522 of the FDA. It apologizes for the delayed response. While CNS shunts meet the criteria of being a Class II implantable device, the FDA believes postmarket surveillance is not needed as issues are related to understanding the disease and improving device materials, not significant postmarket safety questions. The letter states postmarket surveillance would not provide benefit and manufacturers will not be required to conduct it for CNS shunts.
Patient Advocate Stephen Dolle's FDA Stamp Conference RecommendationsStephen Dolle
This is a paper of FDA STAMP Conference recommendations FDA patient advocate and CNS shunt user Stephen Dolle, which he wrote for this 1999 Conference in Bethesda, MD, a conference he was responsible for, yet was not invited to speak on panel, nor was his new solution oriented DiaCeph Test included in the conference. STAMP was held in part due to Dolle's 1996 FDA petition on anti siphon shunts, of which he was an affected user, and FDA upheld, but oddly withheld their Sept. 1998 ruling from the Federal Register. Dolle did everything he could possibly do to bring progress in CNS shunts, yet wasn't allowed.
You can read from his recommendations back in 1999 that he had a vision to bring progress in this area. Since 1999, CNS shunts have been plagued by widespread device failures, more notably programmable shunts.
CNS shunts users today face new risks from years of over use of CT scanning, which DiaCeph would have reduced. Some patients have had as many as 100 and 200.
I can be reached at contact[at]dollecommunications[dot]com and via my blog.
FDA STAMP Conference on CNS Shunts Agenda January 1999Stephen Dolle
Conference agenda for the 1999 STAMP Conference on CNS Shunts and anti siphon devices in Bethesda, MD, brought about by patient advocate Stephen Dolle and his efforts with a 1996 petition to FDA on anti siphon shunts. Dolle oddly was not invited to speak or be a panelist, or to have his new mHealth DiaCeph Test included in the conference. In the years since, CNS shunts have suffered significant medical device and design failures, most of which have not been reported to FDA, which Dolle attributes to the cover ups dating back to this conference. As of 2015, Dolle has undergone 12 shunt operations, with the majority of these caused by failing CNS shunts that were never reported to FDA. The more your know!
Addiction develops from behaviors driven by pain, shame, and secrets that provide temporary relief but do not cure the underlying issues. The addictive behaviors are like a tree with roots representing the causes of addiction such as abuse, trauma, genetics, loneliness, fear, shame, guilt and anger. As long as the root causes are not addressed, the addictive symptoms will return and potentially worsen over time. Recovery requires addressing the underlying causes that contribute to feeling stuck and fuel addictive patterns.
1. Addiction is a brain disease that affects the limbic brain's reward system and results in drug use becoming equated with survival.
2. Genetic factors determine vulnerability to addiction by influencing how individuals respond to drugs and experience pleasure and stress.
3. Addictive drugs and behaviors hijack the brain's natural reward pathway by flooding it with dopamine and strengthening drug-related memories through glutamate.
4. Chronic stress, drug cues, and relapse are all mediated by the brain's stress systems and the neurotransmitter CRF, which further weakens the reward system over time.
This document provides background information on nutrition and substance abuse. It summarizes 2011 survey data showing high rates of binge drinking, heavy drinking, illicit drug use, and substance abuse/dependence in the US population. For veterans receiving VA healthcare, over 60% of marginal costs are due to substance abuse and result from inpatient care. The document discusses how substance abuse can lead to both primary and secondary malnutrition by disrupting food intake and altering absorption, metabolism, and nutrient utilization. It notes the lack of research on illicit drug-induced malnourishment and challenges conducting such research. The purpose of the presented thesis is then stated as measuring attitudes, beliefs and behaviors around nutrition, health and self-care in veterans enrolled
This presentation is to test the animation of the powerpoint created by Presenter Media templates, to be used for educational purposes, not available for file download by others.
The document discusses how three neurotransmitters - dopamine, serotonin, and noradrenaline - play key roles in addiction. Dopamine is involved in reward pathways and addictive drugs mimic its effects, increasing risk of addiction to stimulants for those with excess dopamine. Serotonin regulates mood, and low levels increase risks of addiction to alcohol and opioids. Too much noradrenaline causes anxiety, raising risks of addiction to anti-anxiety drugs. Genetics and environmental stress can also influence addiction risks by impacting neurotransmitter balances. Treatment aims to stabilize neurotransmitter levels through medication or behavior changes.
This document summarizes the physiology of drug addiction. It begins by defining drugs and discussing drugs of abuse. It then describes the nervous system and components like neurons, neurotransmitters, and receptors. It explains how drugs act on receptors in the reward pathway in the brain, especially stimulating dopamine release in the nucleus accumbens. Repeated drug use can cause tolerance, dependence, and reward deficiency as the brain adapts. Addiction involves changes in neurobiology and loss of control over drug intake despite negative consequences.
Understanding and Addressing Food Addiction: A Science-Based Approach to Poli...Center on Addiction
Public health concerns about the escalating obesity epidemic and its far-reaching health consequences, coupled with a growing understanding of the shared features of addiction across its myriad forms, have prompted some scientists to explore the possibility that certain eating behaviors might best be explained through the lens of addiction.
The interest in applying an addiction framework to understanding certain eating behaviors and food-related disorders has grown in recent years. This is a result of a large body of research highlighting the considerable overlap in the characterizing symptoms, risk factors and underlying neurobiological characteristics between substance addiction and what can be thought of as food addiction. It also arises from an attempt to explore how certain types of addictive-like eating might account for pathology that cannot be explained within the context of the currently recognized eating disorders of anorexia nervosa, bulimia nervosa and binge eating disorder. The growing interest in food addiction is also partially a result of an increasing awareness that lessons learned with regard to policy, prevention and clinical practice in relation to addictive substances might fruitfully be applied to the realm of food addiction.
- The document discusses the relationship between nutrition, diet, and general and dental health. It explores topics like chronic health conditions linked to oral health, macronutrients and micronutrients that promote health, and providing nutritional guidance.
- Key points discussed include the role of fermentable carbohydrates in dental caries and periodontal diseases, common risk factors like sugar intake, and vitamin deficiencies. Data on conditions like heart disease, diabetes, and obesity in New Zealand are presented.
- Barriers to dental professionals providing dietary advice like time, knowledge, and confidence are examined based on past studies. The document advocates a holistic approach and collaborating with other health practitioners.
This document discusses the link between food allergies/intolerances and addiction, and the importance of nutrition in addiction recovery. It states that foods we crave can act like drugs by binding to receptor sites like endorphins. It also notes that failing to eat a nutritious diet can cause problems like fatigue and depression that make recovery more difficult. Several studies are cited showing that correcting biochemical imbalances through proper nutrition can positively impact behavior, recovery outcomes, and relapse prevention. The document advocates for allergy/intolerance testing through Allgenic to help patients identify and eliminate problem foods from their diets to aid the recovery process.
The pharmacists role in drug induced nutrient depletion n. jonesPASaskatchewan
This document discusses the role of pharmacists in addressing drug-induced nutrient depletions. It provides background on how certain medications can affect nutrient levels in the body by interfering with metabolic pathways. Specific examples are given of how statin drugs may deplete coenzyme Q10 and how acid-reducing medications can impact vitamin and mineral absorption. The document advocates for pharmacists to play a greater role in counseling patients on nutritional supplementation to remedy nutrient deficiencies caused by their medications.
This document discusses nutrition in geriatrics. It begins with definitions of key terms like nutrition, health, gerontology and balanced diet. It then classifies the elderly based on age and health status. The document outlines factors that can compromise nutritional status in the elderly like oral health issues, physiological changes, and medication side effects. It describes the major nutrients of carbohydrates, proteins, fats, vitamins and minerals. It provides details on specific vitamins like A, D, E, K, B1 and B2 and their oral manifestations when deficient. The goal is to promote adequate nutrition for health and well-being in the aging population.
This document discusses obesity, including its definition, classification, causes, health risks, diagnosis, and management. Obesity is defined as excess body fat accumulation that negatively impacts health, and is classified using body mass index (BMI), waist circumference, and waist-to-hip ratio. Causes include genetic, environmental, and behavioral factors. Health risks associated with obesity include increased risk of diabetes, cardiovascular disease, respiratory issues, cancers, and mental health conditions. Treatment involves lifestyle modifications focusing on diet and exercise, as well as potential medication options to help with weight loss.
The document discusses the development and applications of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale. It describes how the EdFED scale was developed through factor analysis and Mokken scaling to measure 6 items related to feeding behavioral problems in people with dementia. Studies have found the EdFED scale is stable across cultures and a good measure of feeding difficulty. Research has also shown that interventions like music during meals and Montessori-based activities can help alleviate feeding problems for those with dementia.
Sugar, the New Baddie on the Block
How can the addiction community help the obesity crisis and is sugar really an addiction? How do we currently treat binge eating and the CBT versus 12 step dilemna
How to get involved with Sweet Dreams as an affiliate partner
The document discusses whether overconsumption of food, particularly high calorie foods (HCFs) containing fat, sugar, and salt, can be considered an addiction. It reviews literature that HCFs act on the same brain pathways and induce many of the same physiological and behavioral effects as addictive drugs. Certain individuals may have a genetic predisposition that makes them more vulnerable to overconsuming HCFs and developing carbohydrate dependence. While food in general is not addictive, components of HCFs meet the criteria for addiction for some people by alleviating negative moods and causing weight gain through compulsive overconsumption and development of tolerance.
"Putting Dietary Guidelines for Americans to Work! Multifactorial Approaches ...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 2.2: Information and education for healthy food behaviours"
This document discusses opioid use disorders and their management. It begins with an introduction to opioids, their physiology and routes of administration. It then covers the etiology of opioid use disorders, including genetic and psychosocial factors. The key opioid related disorders according to DSM and ICD criteria are outlined. Clinical features of opioid effects and withdrawal are described. Management includes treatment of dependence, intoxication and withdrawal. Pharmacological approaches discussed are antagonist therapy using naltrexone and agonist therapy using methadone, buprenorphine and other agents.
This document provides an overview of topics to be covered in an introductory nutrition class from a functional medicine perspective. The class will cover nutrition basics including the six classes of nutrients and their absorption; functional imbalances related to digestion, detoxification and more; biochemical individuality and the importance of personalized nutrition approaches; and how functional medicine views food as containing elements to support health and vitality rather than just avoiding problems. The functional medicine model focuses on restoring health through addressing underlying imbalances.
This document provides an overview of nutrition, including factors that influence food choices, the nutrients in foods and the body, how nutrition research is conducted, establishing nutrient recommendations, nutrition assessment, and the relationship between diet and health. Some key points covered include the six classes of nutrients, how nutrients provide energy, establishing dietary reference intakes, stages of nutrient deficiency, national nutrition surveys, and risk factors for chronic diseases related to diet.
This document provides an outline and introduction for a seminar on eating disorders presented by Dr. Diptadhi Mukherjee and moderated by Dr. D.J. Chetia at LGBRIMH, Tezpur on 23/09/15. The seminar covered the history, epidemiology, etiology, nosology, differential diagnosis, comorbidity, complications, Indian scenario, and management of eating disorders. It discussed the main eating disorders of anorexia nervosa, bulimia nervosa, and binge eating disorder. The seminar emphasized the multifactorial nature of eating disorders and recommended a multidisciplinary treatment approach.
Thiamine Deficiency Disease, Dysautonomia, and High Calorie MalnutritionHormones Matter
This document discusses thiamine deficiency and its relationship to mitochondrial function. It begins by introducing the authors and their backgrounds in medicine and nutrition research. It then discusses how thiamine is an important cofactor for many mitochondrial enzymes involved in energy production. Thiamine deficiency can thus lead to mitochondrial dysfunction and reduced ATP production. The document argues that thiamine deficiency may be more common than recognized, as subtle metabolic disturbances are often missed, and notes several populations that are at high risk for deficiency. It questions common assumptions about the role of fortification in ensuring adequate nutrient intake.
Nutrigenetics: Possibilities and limitations in the treatment of overweight...Diana Gessner
1) The document discusses nutrigenetics and its potential role in treating overweight and obesity. It outlines several candidate genes associated with obesity like FTO and genes involved in the leptin/melanocortin pathway.
2) Large genome-wide studies have identified hundreds of genetic loci associated with obesity but genetics only accounts for a small percentage of BMI variation. Environmental factors are still the major driver of obesity.
3) While leptin therapy reduced weight in leptin-deficient individuals, it did not significantly reduce weight in common obesity cases. Further research is still needed to determine nutrigenetic approaches for obesity treatment and prevention.
National Food & Nutrition Policy: Balancing the Role of Research, Nutrition S...Corn Refiners Association
At Experimental Biology 2015, the Sponsored Satellite Program "National Food & Nutrition Policy: Balancing the Role of Research, Nutrition Science and Public Health" held in conjunction with the American Society for Nutrition's Scientific Session took place on April 1, 2015.
To watch the Dr. Lichtenstein video on slide 68 "Do Scripted Diets Work for Policy? What about Low-fat Diets?", please download the presentation first.
Similar to Nutrition Therapy for the Addicted Brain (September 2016) by David Wiss MS RDN (20)
David Wiss MS RDN walks you through research on childhood adversity and the various ways that trauma can become embedded into physiology and impact health, such as eating behavior.
"Nutrition Interventions Amidst an Opioid Crisis: The Emerging Role of the RD...Nutrition in Recovery
This presentation was given at the Food and Nutrition Conference and Expo (FNCE) on Sunday October 21, 2018 in Chicago. Here David Wiss MS RDN describes the impact of opioids on nutritional status and gastrointestinal health, identifies common disordered and dysfunctional eating patterns common to opioid-addicted populations, and describes nutrition therapy protocols for specific substances including opioids and for poly-substance abuse.
This presentation is an overview of our recent publication in the Appetite Journal. "Preclinical Evidence for the Addiction Potential of Highly Palatable Foods: Current Developments Related to Maternal Influence" by David Wiss, Kristin, Criscitelli, Mark Gold, and Nicole Avena.
Muscle Dysmorphia: What Happens when Body Image Collides with Exercise, Nutri...Nutrition in Recovery
Learn about the growing problem of Muscle Dysmorphic Disorder and how it relates to eating disorders. This presentation will focus on the male population who is in relentless pursuit of muscularity. For more information about the author David A. Wiss, MS, RDN, CPT visit his website at www.NutritionInRecovery.com
Learn about which sports supplements and ergogenic aids are effective! Registered Dietitian Nutritionist David Wiss MS RDN shares the latest research and his professional experience.
Beit T'shuvah Run to Save a Soul Los Angeles Marathon Nutrition GuidelinesNutrition in Recovery
David A. Wiss, MS, RDN, CPT, provides nutritional guidelines for marathoners who are in recovery from substance abuse. The recommendations are intended to be practical for individuals who live in treatment or sober living. 2014 will be Mr. Wiss' 5th LA Marathon as a coach for Beit T'shuvah.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. ASAM Disclosure of Relevant Financial Relationships
Content of Activity: “Nutrition Therapy for the Addicted Brain”
Date of Activity: September 10, 2016
Name Commercial
Interests
Relevant
Financial
Relationships:
What Was
Received
Relevant
Financial
Relationships:
For What Role
No Relevant
Financial
Relationships
with Any
Commercial
Interests
David Wiss MS
RDN
Nutrition in
Recovery,
Founder and
Owner
3. LECTURE OBJECTIVES
1. Discuss the impact of addictive substances on
nutritional status
2. Explore disordered and dysfunctional eating
patterns in addicted populations
3. Propose nutrition therapy guidelines for specific
substances and for poly-substance abuse
4. SECTIONS
1. Background
2. Food and Mood
3. Substance Use Disorders
4. Food Addiction
5. Disordered Eating
6. Hormones
7. Gut Microbiome
8. Nutrition Therapy
9. Conclusions
6. BACKGROUND
• Substance Use Disorders
(SUDs) assoc. w/ vitamin &
mineral deficiencies1-6
• What about altered neuro-
circuitry?
• Nutrition-related hormones?
• Leptin, ghrelin, insulin
• Gut microbiome?
• We need to know more!
1. Estevez, J. F. D., Estevez, F. D., Calzadilla, C. H., Rodriquez,
E. M. R., Romero, C. D., & Serra-Majem, L. (2004).
Application of linear discriminant analysis to the biochemical
and haematological differentiation of opiate addicts from
healthy subjects: A case-control study. European Journal of
Clinical Nutrition, 58, 449-455
2. Heathcote, J., & Taylor, K. B. (1981). Immunity and
nutrition in heroin addicts. Drug and alcohol dependence, 8,
245-255.
3. Hossain, K. J., Kamal, M. M., Ahsan, M, & Islam, S. N.
(2007). Serum antioxidant micromineral (Cu, Zn, Fe) status of
drug dependent subjects: Influence of illicit drugs and
lifestyle. Substance Abuse Treatment, Prevention, and Policy,
2(12). Retrieved from
http://www.substanceabusepolicy.com/content/2/1/12
4. Islam, S. K. N., Hoassain, K. J., & Ahsan, M. (2001). Serum
vitamin E, C, and A status of the drug addicts undergoing
detoxification: influence of drug habit, sexual practice and
lifestyle factors. European Journal of Clinical Nutrition, 55,
1022-1027.
5. Ross, L. J., Wilson, M., Banks, M., Rezannah, F., & Daglish,
M. (2012). Prevalence of malnutrition and nutritional risk
factors in patients undergoing alcohol and drug treatment.
Nutrition, 28, 738-743.
6. Saeland, M., Haugen, M., Eriksen, F. L., Wandel, M.,
Smehaugen, A., Bohmer, T., & Oshaug, A. (2011). High sugar
consumption and poor nutrient intake among drug addicts in
Oslo, Norway. British Journal of Nutrition, 105, 618-624.
7. NUTRITION AND DRUG ADDICTION
• Primary Malnutrition
• Displaced, reduced, compromised
food intake
• Secondary Malnutrition
• Alterations in:
• Absorption
• Metabolism
• Utilization
• Excretion
• Due to compromised health:
• Oral
• Gastrointestinal
• Circulatory
• Metabolic
• Neurological
Immune system
Inadequate response to disease
8. DRUG ADDICTION VS. ALCOHOL
• Negative effect of alcohol on
nutritional status well-described
• Protocols in place (i.e. thiamine)
• Illicit drug-induced malnourishment
largely unknown
• Primary or secondary?
• Poly-drug abuse
• Ethical/legal challenges with
controlled trial research
• Poor patient follow-up
Most data speculative,
underpowered, retrospective
9. ACADEMY OF NUTRITION AND DIETETICS
• Formerly the American Dietetic Association (ADA)
• Position paper (1990) supporting need for nutrition intervention in
treatment/recovery from addiction
• Registered Dietitians (RDs) essential members of the treatment team
• Nutrition care integrated into the protocol rather than “patched on”
• Nutrition professionals urged to “take aggressive action to ensure
involvement in treatment and recovery programs.”
American Dietetic Association (1990, September).
Position of the American Dietetic Association:
Nutrition intervention in treatment and recovery from
chemical dependency. Journal of the American Dietetic
Association, 90(9), 1274-1277.
10. CURRENT CLIMATE
…Little progress incorporating dietitians
into drug rehabilitation programs despite
continued explosion of drug abuse
• Lack of interest from RDs???
• Associated stigmas of drug abuse
• Difficulties conducting research on this
population
• Non-collaboration between public
and private sector
• Limited funding for new initiatives
11. SYSTEMS INFLUENCING FOOD INTAKE
• Homeostatic System
• Post-consummatory
• Post-absorptive
• Hedonic/Pleasure-Reward System
• Consummatory
• Interaction between homeostatic
and hedonic mechanisms
13. HEDONIC/PLEASURE-REWARD SYSTEM
• Brains response to rewarding
events essential for survival:
• Eating behavior
• Sexual behavior
• Associated pleasure influences
future behavior
• Ensures survival as a species
• Hedonic system
• Drawn toward pleasurable activities
• “Reward” (dopamine)
• Cognitive and emotional factors
14. INTERACTION BETWEEN HOMEOSTATIC AND
HEDONIC MECHANISMS
• Homeostatic
• Availability of fuel
• Hedonic
• Desire for and pursuit of food
• “Wanting”
Homeostatic signals
SHOULD provide feedback to
mesolimbic circuitry so that
one’s metabolic state will
ultimately influence the hedonic
value of food…
15. OVERFEEDING?
• Sufficient energy stores SHOULD
reduce brain’s response to
highly palatable food
• Higher fat stores SHOULD
decrease food intake and rev up
metabolism
• SHOULD suppress the drive to
overconsume food
• Modulate sensory properties
• Taste, odor
16. HEDONIC OVERRIDES HOMEOSTATIC
• Pleasurable effect of highly
palatable food very
MOTIVATING
• “Food Motivation”
• Contemporary food is
supercharging our reward
systems!
• Hedonic drive (once provided
evolutionary advantage) has
now transformed into a burden
18. FOOD & MOOD – Carbohydrates
• Carbohydrate ingestion:
• Insulin promotes the cellular
uptake of glucose & amino acids (AA)
(except for tryptophan)
• Tryptophan brain Leyse-Wallace, R. (2008). Linking
nutrition to mental health. Lincoln, NE:
iUniverse.
19. FOOD & MOOD – Carbohydrates
• Serotonin
• Feel calm, centered
• Recognition due to popularity of
SSRI anti-depressants
• Stress
• Depletes serotonin availability
• Carb cravings can be caused by
serotonin deficiency
• Serotonin reduces cravings for CHO
• You don’t have to take an
antidepressant to boost serotonin Leyse-Wallace, R. (2008). Linking nutrition to
mental health. Lincoln, NE: iUniverse.
20. FOOD & MOOD – Protein
• AAs are the building blocks of
neurotransmitters including:
• Serotonin
• Dopamine & Norepinephrine
• Acetylcholine (inhibitory/excitatory)
• Histamine (inflammatory response)
• Glycine (inhibitory) Dekker, T. (2000). Nutrition & recovery.
Canada: Centre for Addiction and Mental
Health.
21. DOPAMINE
• Catecholamine neurotransmitter
• Dopamine is the major brain
chemical involved in addiction
• Important in:
• Movement (muscle control)
• Motivation and attention
• Reward
• Well-being
23. FOOD & MOOD – Protein
• Dopamine and norepinephrine
are often associated with
alcohol / drug abuse
Low dopamine associated with
drug abuse…(receptor dysfunction)
What can mimic the reward one
gets from drug use?
24. FOOD & MOOD – Fat
• Essential fatty acids (EFAs):
• Linoleic (omega-6)
• Linolenic (omega-3) EPA, DHA
• Eicosanoid production
• Inflammatory processes
• Cell membrane integrity
• 55%-60% dry wt of brain is lipid
• 35% composed of PUFA Fortuna, J. L. (2009). Nutrition for the focused brain. Mason,
Ohio: Cengage Learning.
25. FOOD & MOOD – Fat
• Prevalence of depression lower as fish
consumption increases (omega-3)1
• Deficiencies alter fluidity in membranes
affecting neurotransmission
• Protective effect on bipolar, depression
Omega-3 & depression is controversial2
1. Leyse-Wallace, R. (2008). Linking
nutrition to mental health. Lincoln, NE:
iUniverse.
2. Bloch, M. H., & Hannestad, J. (2012).
Omega-3 fatty acids and the treatment of
depression: Systematic review and meta-
analysis. Molecular Psychiatry, 17(12),
1272-1282.
27. POLY-SUBSTANCE ABUSE
• 24-hr recalls of 20 F IV drug users
revealed > ½ of foods consumed not
classifiable into “food groups”1
• Preference for easily
ingested/digested foods (i.e. cereal)
• Difficulty w/ raw vegetables & meat
Digestive issues & preference for
hedonistic foods rich in sugar/salt/fat
1. Baptiste, F., & Hamelin, A. (2009). Drugs and
diet among women street sex workers and
injection drug users in Quebec city. Canadian
Journal of Urban Research, 18(2), 78-95.
28. POLY-SUBSTANCE ABUSE
• Added sugar 30% intake of drug
addicts in Norway (n=220)1
• Sugar & sugar-sweetened foods
preferred > 60% of respondents
• 70% vit. D deficiency
• Low levels of vit. C
• Elevated serum Cu
1. Saeland, M., Haugen, M., Eriksen, F. L.,
Wandel, M., Smehaugen, A., Bohmer, T., &
Oshaug, A. (2011). High sugar consumption and
poor nutrient intake among drug addicts in Oslo,
Norway. British Journal of Nutrition, 105, 618-
624.
29. OPIATES
• Infrequent eating, little interest in food
(appetite suppression)
• Reduced gastric motility1
• Delayed gastric emptying
• Impaired gastrin release
• Constipation while using
• Diarrhea while detoxing
• GI discomfort for several months
• Compromised gut health
Impaired absorption of AA, vit/min
1. White, R. (2012). Drugs and nutrition: How
side effects can influence nutritional intake.
Proceedings of the Nutrition Society, 69, 558-
564.
30.
31. OPIATES
• Quick, convenient, cheap,
sweet foods1
• Low fiber
• Easily digestible
• Calorically dense
Ice cream
• Fruit/vegetable
consumption generally low
1. Neale, J., Nettleton, S., Pickering, L., & Fischer, J. (2012).
Eating patterns among heroin users: a qualitative study with
implications for nutritional interventions. Addiction, 107, 635-
641.
32. OPIATES – TREATMENT RESEARCH
• Methadone-treated patients1,2
• Higher consumption of sweets
• Higher eagerness to consume
sweet foods
• Willingness to consume larger
quantities desired by controls1
• Qualitative research on heroin
users confirmed3
• Dysfunctional eating patterns
1. Nolan, L. J., & Scagnelli, L. M. (2007).
Preference for sweet foods and higher body mass
index in patients being treated in long-term
methadone maintenance. Substance Use and
Misuse, 42, 1555-1566.
2. Alves, D., Costa, A. F., Custodio, D., Natario, L.,
Ferro-Lebres, V., Andrade, F. (2011). Housing and
employment situation, body mass index and
dietary habits of heroin addicts in methadone
maintenance treatment. Heroin Addiction &
Related Clinical Problems, 13(1), 11-14.
3. Neale, J., Nettleton, S., Pickering, L., & Fischer,
J. (2012). Eating patterns among heroin users: a
qualitative study with implications for nutritional
interventions. Addiction, 107, 635-641.
33. COCAINE
• Reduced appetite, nausea
• Affinity for high-sugar food/drink1
• Addicts in detox prefer highest conc.
of sucrose solution offered
• Brain reward (dopamine)
• In large national sample, cocaine
users more likely to have BP than
heroin or meth2
CKD or CVD
1. Janowsky, D. S., Pucilowski, O., & Buyinza, M.
(2003). Preference for higher sucrose concentrations
in cocaine abusing-dependent patients. Journal of
Psychiatric Research, 37, 35-41.
2. Akkina, S. K., Ricardo, A. C., Patel, A., Das, A.,
Bazzano, L. A., Brecklin, C. ...Lash, J. P. (2012). Illicit
drug use, hypertension, and chronic kidney disease
in the US adult population. Translational Research,
160(6), 391-398.
34. COCAINE
• Low levels of omega-3 and omega-6
linked to relapse1
• May stem from increased anxiety
associated w/ low PUFA2
• Addiction stripping brain EFAs3
• Impaired utilization of AAs for NT
synthesis (serotonin, dopamine)
• Amino acid therapy???
1. Buydens-Branchey, L., Branchey, M., McMakin,
D. L., & Hibbeln, J. R. (2003). Polyunsaturated fatty
acid status and relapse vulnerability in cocaine
addicts. Psychiatry Research, 120, 29-35.
2. Buydens-Branchey, L., & Branchey, M. (2006).
N-3 polyunsaturated fatty acids decrease anxiety
feelings in a population of substance abusers.
Journal of Clinical Psychopharmacology, 26(6).
3. Grotzkyj-Giorgi, M. (2009). Nutrition and
addiction – can dietary changes assist with
recovery?. Drugs and Alcohol Today, 9(2), 24-28.
35. COCAINE – AMINO ACID THERAPY?
• N-acetylcysteine (NAC)
• Proposed pharmacological treatment for
relapse prevention1 (animal models)
• Evidence suggesting long-term efficacy of
therapeutic AA programs is lacking
• Need more controlled trials
• Increasing overall protein can promote NT
synthesis is less urgent manner
• Assuming addict is safe and food is available
Long-term sustainable behavior change
1. LaRowe, S. D., Myrick, H., Hedden,
S., Mardikian, P., Saladin, M., McRae,
A., ...Malcolm, R. (2007). Is cocaine
desire reduced by n-acetylcysteine?
American Journal of Psychiatry,
164(7), 1115-1117.
36. METHAMPHETAMINE
• > 40% meth users had dental/oral dz1
• Almost 60% had missing teeth
• IV users higher rates of dental dz compared
to smoking/snorting, and to other IV drugs2
• Altered Ca utilization?3
• High intake refined CHO, high calorie
carbonated beverages, increased acidity in
oral cavity, GI regurgitation/vomiting4
“Meth mouth”
1. Shetty, V., Mooney, L. J., Zigler, C.
M., Belin, T. R., Murphy, D., &
Rawson, R. (2010). The relationship
between methamphetamine use
and increased dental disease.
Journal of the American Dental
Association, 141(3), 307-318.
2. Laslett, A., Dietze, P., & Dwyer, R.
(2008). The oral health of street-
recruited injecting drug users:
Prevalence and correlates of
problem. Addiction, 103, 1821-
1825.
3. Sun, L., Li, H., Seufferheld, M .J.,
Walters Jr., K. R., Margam, V. M.,
Jannasch, A., ...Pittendrigh, B. R.
(2011). Systems-scale analysis
reveals pathways involved in
cellular response to
methamphetamine. Insights into
methamphetamine syndrome, 6(4),
e18215.
4. Hamamoto, D. T., & Rhodus, N. L.
(2009). Methamphetamine abuse
and dentistry. Oral Diseases, 15, 27-
37.
37. METHAMPHETAMINE
• Cessation and subsequent
improvements in nutrition and oral
hygiene 1st line of treatment
• Oral health affects capacity to consume
food, therefore…
• Potential impact all areas of nutrition
• Interventions must be realistic!
• Monitor/evaluate xerostomia, chewing
ability, and taste
Consumption of refined CHO
• Replace with fruits/vegetables
38. “SOCIAL DRUGS”
CAFFEINE & NICOTINE
• Used together for synergistic effects
• Caffeine as cue for nicotine
• Some treatment centers do not
allow “social drugs,” others allow
without any formal regulation
• Often used as a breakfast substitute
for individuals in recovery, which
may have adverse effects in the
afternoon1
1. Dekker, T. (2000). Nutrition and recovery.
Toronto, CAN: Centre for Addiction and Mental
Health.
39. CAFFEINE
• No longer just coffee, tea, chocolate
and sodas
• Energy drinks, pills
• Workout supplements (>300mg)
• “Caffeinism” 600-750 mg/day
• >1000 mg/day defined as toxic1
• DSM-5: >250 mg can be intoxicating
• Coffee/tea inhibits the absorption of
iron in food
• Affects duration/quality of sleep
1. Hilton, T. (2007). Pharmacological issues in the
management of people with mental illness and
problems with alcohol and illicit drug misuse.
Criminal Behavior and Mental Health, 17, 215-
224.
40. Yudko, E., & McNiece, S. I., (2014). Relationship between coffee use and
depression and anxiety in a population of adult polysubstance abusers.
Journal of Addiction Medicine, 8(6), 438-442.
• N = 69
• Mean age = 35
• Treatment center in rural Hawaii
• Racially diverse
• About half Pacific Islander
• Coffee use associated with
depression
• Beck Depression Inventory
• Direction of causality?
41. NICOTINE
Nicotine
• Increases metabolism1
• Acts as appetite suppressant1
• Compromises senses of taste and smell2
Smokers have tendency to choose
hyperpalatable snack foods, less likely to
enjoy the taste of fruits and vegetables
Smokers lower in plasma vitamin C
and total carotenoids, independent of
dietary intake3
Introducing the vape?
1. Novak, C. M., & Gavini, C. K. (2012). Smokeless
weight loss. Diabetes, 61, 776-777.
2. Hatcher, A. S. (2008). Nutrition and addictions.
Dallas, TX: Understanding Nutrition, PC.
3. Dekker, T. (2000). Nutrition and recovery. Toronto,
CAN: Centre for Addiction and Mental Health.
42. “SOCIAL DRUG” USE – THOUGHTS
• Caffeine and nicotine can impact one’s hunger/fullness cues and
lead to dysfunctional eating behavior
• Dietitians in treatment settings can help patients meet reduction or
cessation goals when ready
• By focusing on the benefits of improved physical health, patients will
be positioned to make informed choices about what they eat
• Strict avoidance of caffeine during early recovery may make
nutrition seem punitive vs. a helpful component of recovery
• “First things first” – complete avoidance may lead to relapse
• Nutrition education and counseling can become an effective
adjunctive approach towards caffeine/nicotine reduction/cessation
43. LET’S BE PRACTICAL – BIG PICTURE
• Caffeine, nicotine, and hyperpalatable food may have beneficial
functions in early recovery!
• First issue is always to get the individual past the immediate crisis…
• “Many of us have noticed a tendency to eat sweets and have found
this practice beneficial.” –AA Big Book, p. 134
• Prolonged abuse after abstinence achieved may contribute to:
• Comorbid conditions
• Compromised quality of life
• Decreased likelihood of long-term recovery
• Overall healthcare burden
44. LET’S BE CLEAR BEFORE MOVING ON…
The most substantial health burden
arising from drug addiction lies not in
the direct effects of intoxication but in
the secondary effects on physical health
Ersche, K. D., Stochl J., Woodward,
J. M., & Fletcher, P. C. (2013). The
skinny on cocaine. Insights into
eating behavior and body weight in
cocaine-dependent men. Appetite.
Advance online publication.
Retrieved from
http://dx.doi.org/10.1016/j.appet.2
46. “ADDICTION” – DSM-5???
• Non-Substance-Related
• Gambling
• Behavioral Addictions?
• Sex Addiction
• Exercise Addiction
• Shopping Addiction
• Gaming
Currently insufficient
evidence for diagnostic criteria
What about food???
Is it substance-related?
Behavioral?
Both?
47. THE CONTROVERSY OF FOOD ADDICTION
• Is overeating a behavioral problem
or a substance related problem?
• Does obesity stem from high-risk
people or high-risk foods?
• Abstinence from offending “drug
foods”?
• Risk factor for binge eating?
• Or abstinence from offending
behaviors?
• Classic ED treatment
48. CURRENT CLIMATE
• Eating disorder (ED) clinicians
uneasy about incorporating FA
• Classic EDs such as AN-R do not
resemble an addiction
• Education about FA will cause
those with restrictive EDs to
deepen into their ED
• Challenges the classic messages:
• “All foods fit”
• “Everything in moderation”
• “A calorie is a calorie”
• “Food is fuel”
Meanwhile…
Standard ED treatment is
associated with high rates of
relapse and poor long-term
remission rates1
1. Bergh, C., Callmar, M., Danemar, S., Holcke, M.,
Isberg, S., Leon, M., ...Sodersten, P. (2013). Effective
treatment of eating disorders: Results at multiple
sites. Behavioral Neuroscience, 127(6), 878-889.
49. MODERATION?
• Perceived (vs. defined)
• Self-serving biases
• Justify over-consumption
• Used to reduce self-conflict
• Very appealing message
• More part of the problem
than the solution
• Misinterpreted & misapplied
• Big Food loves “moderation” vanDellen, M. R., Isherwood, J. C., & Delose, J. E. (2016). How
do people define moderation? Appetite, 101, 156-162.
50. ACADEMY OF NUTRITION AND DIETETICS ON
FOOD ADDICTION
• “Total Diet Approach”1
• Rejects labeling foods as “good”
and “bad” because it is believed to
foster unhealthful eating behaviors
• Unless contraindicated by
extenuating circumstances
• “Sugar addiction present in
humans has not been proven”2
1. Academy of Nutrition and Dietetics (2013).
Position of the American Dietetic Association:
Total diet approach to communicating food and
nutrition information. Journal of the American
Dietetic Association, 113(2), 307-317.
2. Academy of Nutrition and Dietetics (2012).
Position of the Academy of Nutrition and
Dietetics: Use of nutritive and nonnutritive
sweeteners. Journal of the Academy of Nutrition
and Dietetics, 112(5), 739-758.
51. DEFINING ADDICTION & FOOD
American Society of Addiction
Medicine (ASAM) “addiction is a
primary, chronic disease of
brain reward, motivation,
memory, and related circuitry”
ASAM recognizes food as
having addictive potential
Food (Wikipedia) (Noun)
Any nutritious substance that
people or animals eat or drink,
or that plants absorb, in order to
maintain life and growth.
Food in it’s natural state is hardly
addictive…
But what about highly
concentrated by-
products of food?
aka processed food?
52. COCA LEAF VS. CRACK COCAINE
Coca Leaf
• Not highly
addictive
Powder Cocaine
• By-product
• Addictive
Crack Cocaine
• Further processed
• Wreaks havoc on
human brain
53. POPPY PLANT VS. HEROIN
Poppy Plant
• Not highly
addictive
Raw opium
• By-product
• Addictive
Heroin
• Further processed
• Highly Addictive
54. WHEAT PLANT VS. WHITE FLOUR
Wheat Plant
• Not addictive
Whole Wheat
Flour
• By-product
Refined White
Flour
• Further
Processed
• “Offensive”
55. SUGAR CANE VS. REFINED WHITE SUGAR
Sugar Cane
• Not addictive
Raw Sugar
• By-product
Refined Sugar
• Further Processed
• “Offensive”
56. CORN VS. HIGH FRUCTOSE CORN SYRUP (HFCS)
Corn
• Not addictive
Corn Syrup
• By-product
HFCS
• Further Processed
• “Offensive”
57. FOOD ADDICTION
• Highly processed foods that
share characteristics of abused
drugs1
• High dose, high concentration
• Rapid rate of absorption
• Most addictive combinations
typically contain1
• White flour, sugar, fat (e.g. cookie)
• Abundance of addictive food
assoc. w/ craving & compulsion2
1. Schulte, E. M., Avena, N. M., & Gearhardt, A.
N. (2015). Which foods may be addictive? The
roles of processing, fat content, and glycemic
load. PLoS ONE, 10(2).
2. Potenza, M. N., & Grilo, C. M. (2014). How
relevant is craving to obesity and its treatment?
Frontiers in Psychiatry, 5(164).
58. FOOD ADDICTION
• Drugs addicts share many
characteristics with
compulsive overeaters
• Brain imaging1
• Behavioral2
• “Reward” from substance
• Drugs/alcohol
• Hedonic food
• Highly palatable food
• Processed food w/ added
sugars/salt/fat
1. Volkow, N. D., & Wise, R. A. (2005). How can drug addiction help
us to understand obesity? Nature Neuroscience, 8(5), 555-560.
2. Davis, C., Curtis, C., Levitan, R. D., Carter, J. C., Kaplan, A. S., &
Kennedy, J. L. (2011). Evidence that 'food addiction' is a valid
phenotype of obesity. Appetite, 57, 711-717.
59. YALE FOOD ADDICTION SCALE (YFAS)
• Developed in 2008, both internally &
externally validated1
• Abnormal desire for sweet, salty, and
fatty foods documented in obese adults
using YFAS2
• Diagnostic scoring based on seven
symptoms in the DSM-IV-TR for
substance dependence
• Withdrawal
• Tolerance
• Use despite negative consequences
• Food addiction found in 57% of obese
BED patients3
1. Gearhardt, A. N., Corbin, W. R., & Brownell, K. D.
(2009). Preliminary validation of the Yale food addiction
scale. Appetite, 52, 430-436.
2. Davis, C., Curtis, C., Levitan, R. D., Carter, J. C., Kaplan,
A. S., & Kennedy, J. L. (2011). Evidence that ‘food
addiction’ is a valid phenotype of obesity. Appetite, (57),
711-717.
3. Gearhardt, A. N., White, M. A., Masheb, R. M.,
Morgan, P. T., Crosby, R. D., & Grilo, C. M. (2012). An
examination of the food addiction construct in obese
patients with binge eating disorder. International Journal
of Eating Disorders, 45, 657-663.
60. FOOD ADDICTION – CULPRITS
…Sugar, Salt, Fat + dynamic contrast
• The more multisensory the food the
more likely a person is to crave it
• Combining a cold food such as ice cream
with a warm sauce such as hot fudge, and
topping it off with smooth Reese’s peanut
butter cups and crunchy heath bar pieces
becomes irresistible
62. FOOD ADDICTION – CULPRITS
What is the
difference between a
baked potato and
French fries with
ketchup?
Fat…Salt…Sugar
63. Schulte, E. M., Avena, N. M., & Gearhardt, A. N. (2015).
Which foods may be addictive? The roles of processing, fat
content, and glycemic load. PLoS ONE, 10(2).
1. Chocolate
2. Ice Cream
3. French Fries
4. Pizza
5. Cookie
6. Chips
7. Cake
8. Popcorn (Buttered)
9. Cheeseburger
64. WHAT IS A “FOOD ENVIRONMENT”?
• Collection of physical, biological, and social
factors affecting eating habits/patterns
• Access to food
• “Food Deserts” convenience foods
• Resource limitations?
• Food availability at home (rehab)
• Environmental causes of overeating?
• Highly available “hyperpalatable” foods
a risk factor for food addiction in some
individuals?
• “Big Food” aka The Food Industry
created irresistible, yet toxic “Food
Environment”?
65. WITHDRAWAL – ANIMAL MODELS
• Rats w/ access to highly palatable
cafeteria diet for 40 days
• When taken off, they reject
standard chow!
• Chronic exposure to addictive
substances causes self-
administration of excess in
attempt to regain the same
hedonic level (subjective pleasure)
Cottone, P., Sabino, V., & Steardo, L. (2008).
Opioid-dependent anticipatory negative
contrast and binge-like eating in rats with
limited access to highly preferred food.
Neuropsychopharmacology, 33, 524-535.
66. BED vs. FOOD ADDICTION
Binge Eating Disorder
• Ate the whole box of
chocolates in one sitting
• Psychological/emotional
• DSM-5 clinical diagnosis,
insurance reimbursement
Food Addiction
• Ate the whole box over
several sittings
• Biological/neurochemical
• Not recognized or
reimbursable
There are more similarities than there are differences…
Obesity can exist without either one!
67. FOOD ADDICTION
• Reward-responsive phenotype
of obesity1
• Can exist without obesity2
• And without BED
• Food becomes less rewarding
and more habitual3
• Alterations in dopamine circuitry
• Low levels of DA transmission
linked w/ heightened
propensities towards substance
abuse in bulimic women4
1. Davis, Caroline (2013). Compulsive overeating
as an addictive behavior: Overlap between food
addiction and binge eating disorder. Current
Obesity Reports, 2, 171-178.
2. Eichen, D. M., Lent, M. R., Goldbacher, E., &
Foster, G. D. (2013). Exploration of "food
addiction" in overweight and obese treatment-
seeking adults. Appetite, 67, 22-24.
3. Guo, J., Simmons, W. K., Herscovitch, P., Martin,
A., & Hall, K. D. (2014). Striatal dopamine D2-like
receptor correlation with human obesity and
opportunistic eating behavior. Molecular
Psychiatry, 1-7.
4. Steiger, H., Thaler, L., Gauvin, L., Joober, R.,
Labbe, A., Israel, M., & Kucer, A. (2016). Epistatic
interactions involving DRD2, DRD4, and COMT
polymorphisms and risk of substance abuse in
women with binge-purge eating disturbances.
Journal of Psychiatric Research, 77, 8-14.
68. REWARD DEFICIENCY SYNDROME (RDS)
• Dysfunction of the
dopamine D2 (DAD2)
receptor in striatum
• Leading to substance-
seeking behavior
• Alcohol, drug
• Food
• Concept that unites:
• Addiction
• Compulsivity
• Impulsivity
Blum, K., Sheridan, P. J., Wood, R. C., Braverman, E. R., Chen, T. J. H., Cull, J.
G., & Comings, D. E. (1996). The D2 dopamine receptor gene as a
determinant of reward deficiency syndrome. Journal of the Royal Society of
Medicine, 89, 396- 400.
69. REWARD DEFICIENCY SYNDROME (RDS)
• Yet, recent meta-
analysis found no
support for link
between DAD2-
related RDS as
mechanism
underlying obesity
• A1 allele
• Novelty seeking
• Delay discounting
• Impulsivity
• Avoiding neg. cons.
Benton, D., Young, H. A. (2016). A meta-analysis of the relationship between brain
dopamine receptors and obesity: A matter of changes in behavior rather than food
addiction? International Journal of Obesity, 40, S12-S21.
70. BRAINS OF OBESE INDIVIDUALS
• Low inhibitory control
• Impaired prefrontal activity leading
to problems of impulse control1
• Low availability of DAD2 receptors
in NAc associated w/ reduced
activity in the prefrontal cortex1
• Contributing to impulsivity and poor
self-control
• “Reinforcement pathology” favors
unhealthy behaviors that
contribute to weight gain2
1. Carr, K., Daniel, T., Lin, H., & Epstein, L. (2011).
Reinforcement pathology and obesity. Current Drug Abuse
Reviews, 4(3), 190-196.
2. Volkow, N., Wang, G., Fowler, J., Tomasi, D., & Baler, R.
(2012). Food and drug reward: Overlapping circuits in human
obesity and addiction. Current Topics in Behavioral
Neurosciences, 11, 1-24.
71. REWARD SURFEIT THEORY
• Individuals w/ greater
reward region sensitivity to
food intake at elevated risk
for overeating
• Habitual intake of palatable
foods leads to hyper-
responsivity of attention
and reward valuation
Val-Laillet, D., Aarts, E., Weber, B., Ferrari, M.,
Quaresima, V., Stoeckel, L. E., …Stice, E. (2015).
Neuroimaging and neuromodulation approaches to study
eating behavior and prevent and treat eating disorders
and obesity. Neuroimage: Clinical, 8, 1-31.
72. WANTING VS. LIKING
Berridge, K. C., Robinson, T. E., &
Aldridge, J. W. (2009). Dissecting
components of reward: ‘liking’,
‘wanting’, and learning. Current
Opinion in Pharmacology, 9(1), 65-73.
http://ocw.mit.edu/courses/experimental-study-group/es-s10-drugs-and-the-brain-spring-2013/handouts/MITES_S10S13_addictionwk4.pdf
LEARNING:
Predictive associations and cognitions
74. CO-OCCURING SUBSTANCE USE DISORDER (SUD) &
EATING DISORDER (ED)
• HOT TOPIC (shortage of data!)
• Anorexia nervosa (AN) + AUD
• Alcohol use disorder (AUD) + AN
• Bulimia nervosa (BN) + AUD
• AUD + BN
• BN + SUD
• SUD + BN
• Binge eating disorder (BED) + SUD
• SUD + BED (often sub-threshold)
75. BACKGROUND
• Substance Use Disorders (SUD)
on the rise
• Eating Disorder (ED) + SUD
• SUD + ED
• Bidirectional associations1,2
• Most of the research conducted
on females with AN and bulimia
nervosa (BN)
• “Drunkorexia”3
1. Baker, J. H., Mitchell, K. S., Neale, M. C., & Kendler,
K. S. (2010). Eating disorder symptomatology and
substance use disorders: Prevalence and shared risk in
a population based twin sample. International Journal
of Eating Disorders, 43, 648-658.
2. Grilo. C. M., Levy, K. N., Becker, D. F., Edell, W. S., &
McGlashan, T. H. (1995). Eating disorders in female
inpatients with versus without substance use
disorders. Addictive Behaviors, 20(2), 255-260.
3. Hunt, T. K., & Forbush, K. T. (2016). Is "drunkorexia"
an eating disorder, substance use disorder, or both?
Eating Behaviors, 22, 40-45.
76. SUD/AUD + GASTRIC BYPASS
• New onset SUDs/AUDs in
the post-surgical period
(second year or later)
• Absorption rate
• Addiction transfer
1. Fowler, L., Ivezaj, V., & Saules, K. K. (2014). Problematic intake of
high-sugar/low-fat and high-glycemic index foods by bariatric patients
is associated with development of post-surgical new onset substance
use disorders. Eating Behaviors, 15, 505-508.
2. King, W. C., Chen, J., Mitchell, J. E., Kalarchian, M. A., Steffen, K. J.,
Engel, S. E., Courcoulas, A. P., Pories, W. J., & Yanovski, S. Z. (2012).
Prevalence of alcohol use disorders before and after bariatric surgery.
Journal of the American Medical Association, 307(23), E1-E10.
3. Wiedemann, A. A., Saules, K. K., Ivezaj, V. (2013). Emergence of
new onset substance use disorders among post-weight loss surgery
patients. Clinical Obesity, 3, 194-201.
77. SUD/AUD + GASTRIC BYPASS
• Post-RYGB1
• Lower appeal rating of
high-energy foods
• Yale Food Addiction
Scale (YFAS) scores
• Gut microbiota? 1. Scholtz, S., Goldstone, A. P., & le Roux, C. W. (2015). Changes in
reward after gastric bypass: the advantages and disadvantages. Current
Atherosclerosis Reports, 17(61).
78. SUD – DISORDERED EATING
• Women in SUD treatment1
• BED and sub-threshold BED
• Bulimia nervosa
• Men in SUD treatment2
• First 6 months
• Bingeing
• Use of food to satisfy drug cravings
• 7-36 months
• Weight concerns, distress about
efforts to lose weight
1. Czarlinksi, J. A., Aase, D. M., & Jason, L. A. (2012).
Eating disorders, normative eating self-efficacy and
body image self-efficacy: Women in recovery homes.
European Eating Disorders Review, 20, 190-195.
2. Cowan, J., & Devine, C. (2008). Food, eating, and
weight concerns of men in recovery from substance
addiction. Appetite, 50, 33-42.
79. NUTRITION & ADDICTION TREATMENT
• Disordered eating
• Drug abuse risk factor for EDs1
• Genetic and environmental2
• Increased sugar use over time3
• Alcohol linked to bingeing/purging4
1. Krahn, D. D. (1991). The relationship of
eating disorders and substance abuse. Journal
of Substance Abuse, 3(2), 239-253.
2. Munn-Chernoff, M. A., Duncan, A. E., Grant,
J. D., Wade, T. D., Agrawal, A., Bucholz, K. K., ...
Heath, A. C. (2013). A twin study of alcohol
dependence, binge eating, and compensatory
behaviors. Journal of Studies on Alcohol and
Drugs, 74, 664-673.
3. Levine, A. S., Kotz, C. M., & Gosnell, B. A.
(2003). Sugar and fats: The neurobiology of
preference [Special section]. Journal of
Nutrition, 831S-834S.
4. Fischer, S., Anderson, K. G., & Smith, G. T.
(2004). Coping with distress by eating or
drinking: Role of trait urgency and
expectancies. Psychology of Addictive
Behaviors, 18(3), 269-274.
80. BULIMIA NERVOSA (BN) + STIMULANTS
• 707 undergrads1
• Nonmedical prescription
stimulants
• Ritalin, Adderral, Concerta
• Used for appetite
suppression and weight loss
• Associated with greater ED
symptomatology
• Binge eating
• Purging
1. Kilwein, T. M., Goodman, E. L., Looby, A., & De Young, K. P.
(2016). Nonmedical prescription stimulant use for suppressing
appetite and controlling body weight is uniquely associated
with more severe eating disorder symptomatology.
International Journal of Eating Disorders, Advanced online
publication.
81. BN + ADDICTION
• Associated with the eating or
the compensatory behaviors?1
• DSM-5 purging disorder
• Overlap between BN + FA
• Nutritional approach?
• Reduced exposure to addictive
foods?1
• Liberalize the diet?
• Food restriction increases reward
sensitivity, promotes rebound
bingeing2
1. Muele, A., von Rezori, V., & Blechert, J. (2014). Food
addiction and bulimia nervosa. European Eating
Disorders Review. doi:10.1002/erv.2306
2. Avena, N., Murray, S., & Gold, M. S. (2013).
Comparing the effects of food restriction and
overeating on brain reward systems. Experimental
Gerontology, 48, 1062-1067.
82. Umberg, E. N., Shader, R. I., Hsu, G., & Greenblatt, D. J. (2012). From disordered
eating to addiction: The "food drug" in bulimia nervosa. Journal of Clinical
Pharmacology, 32, 376-389.
• BN should be separated into
two distinct sub-types!!!
• Hyporesponsive to reward
• Akin to AN
• Hypersensitive reward circuitry
• Akin to FA
83. BED + SUD
• Approximately one fourth
of BED patients have SUD1
• BED should be treated in a
way that acknowledges the
presence of a range of
binge eating phenotypes2
• Including co-occurring SUD1
1. Becker, D. F., & Grilo, C. M. (2015). Comorbidity of mood and
substance use disorders in patients with binge eating disorder:
Associations with personality disorder and eating disorder
pathology. Journal of Psychosomatic Research. Advance online
publication. Retrieved from
http://dx.doi.org/10.1016/j.psychores.2015.01.016
2. Marcus, M. D., & Wildes, J. E. (2014). Disordered eating in
obese individuals. Current opinion in psychiatry, 27(6), 443-
447.
84. DISORDERED EATING
• Body image issues often relevant to both
AUD/SUD patients
• Does not always imply presence of ED
• Early recovery is stressful!
• Craving, compulsivity
• Relapse risk
• Substance abuse linked to low distress
tolerance, leading to consumption of food1
• Night Eating Syndrome
1. Kozak, A. T., & Fought, A. (2011).
Beyond alcohol and drug addiction.
Does the negative trait of low
distress tolerance have an
association with overeating?
Appetite, 57, 578-581.
85. NIGHT EATING SYNDROME
• Severity associated with FA1
• Higher food tolerance
• Amount of food consumed
• Effect of consumed food
• Among psychiatric outpatients2
• Turkish sample:
• Depression
• Impulse control disorder
• Nicotine dependency
• Psych meds?
1. Nolan, L. J., & Geliebter, A. (2016). "Food
addiction" is associated with night eating
severity. Appetite, 98, 89-94.
2. Saracli, O., Atasoy, N., Akdemir, A., Guriz, O.,
Konuk, N., Sevincer, G. M., ...Atik, L. (2015). The
prevalence and clinical features of the night
eating syndrome in psychiatric out-patient
population. Comprehensive Psychiatry, 57, 79-
84.
88. HORMONES
• Neuronal & gut hormones
• “Cross-talk” via “Gut-brain axis”
• Gut peptides released from
enteroendocrine cells in
response to pre-absorptive
nutrients can reach brain1
• Indirectly
• Receptors in enteric nervous system
• Directly
• Systemic circulation or lymphatics
1. Bauer, P. V., Hamr, S. C., & Duca, F. A. (2015).
Regulation of energy balance by a gut-brain axis
and involvement of the gut microbiota. Cellular
and Molecular Life Sciences. doi:10.1007/s00018-
015-2083-z
89. GUT-BRAIN AXIS
• Stomach as 2nd Taste System
• “Sensing receptors”
• Mechanoreceptors: touch/pressure
• Chemoreceptors: chemical
• Thermoreceptors: temperature
• Osmoreceptors: osmotic pressure
• Wall of gut brain stem
• Neurohormonal stimuli
• Ghrelin (appetite stimulant)
• “Light” versions of food detected
by Gut-Brain Axis Witherly, S. A. (2007). Why humans like junk
food. Lincoln, NE: iUniverse
90. VENTRAL TEGMENTAL AREA (VTA)
• Contains dopamine neurons
that project to cortico-limbic
structures:
• Nucleus accumbens (pleasure)
• Medial prefrontal cortex
(cognition)
• Hippocampus (memory)
• Amygdala (emotional reactivity)
• Direct input from hypothalamus
• Governs several endocrine
processes (leptin, ghrelin)
91. HYPOTHALAMUS
• Regulates energy balance
• Altering energy intake &
expenditure
• Arcuate nucleus
• Integration site for neurological &
blood-borne signals
• Brain reward system (midbrain)
• Hedonic feeding (dopamine)
• Modulated by blood-borne signals
Bauer, P. V., Hamr, S. C., & Duca, F. A. (2015).
Regulation of energy balance by a gut-brain axis and
involvement of the gut microbiota. Cellular and
Molecular Life Sciences. doi:10.1007/s00018-015-
2083-z
92. LEPTIN
• Produced/secreted by adipose tissue
• Plasma leptin associated w/ fat mass
• Increases metabolic rate
• Initiates starvation response
• Decreases food intake
• Reward value of sucrose decreased
by leptin via reduction in dopamine
signaling1
1. De Araujo, I. E., Deisseroth, K.,
Domingos, A. I., Friedman, J.,
Gradinaru, V., & Ren, X. (2011). Leptin
regulates the reward value of nutrient.
Nature Neuroscience, 14, 1562-1568.
93. LEPTIN & CRAVING
• Leptin regulates homeostatic
center of hypothalamus
• Hedonic system1
• Subjective desires for food
• Food deprivation decreases
circulating leptin
• Contributing to preference for
highly palatable foods
• “Hunger is the best sauce”
• Leptin-dopamine interaction
• Bi-directional2
1. Schloegl, H., Percik, R., Hortsmann, A., Villringer, A., &
Stumvoll, M. (2011). Peptide hormones regulating
appetite - focus on neuroimaging studies in humans.
Diabetes/Metabolism Research and Reviews, 27, 104-112.
2. Leinninger, G. M. (2011). Lateral thinking about leptin:
A review of leptin action via the lateral hypothalamus.
Physiology and Behavior, 104(4), 572-581.
94. LEPTIN & CRAVING
• Leptin
• Inhibits signaling in nucleus
accumbens (VTA)
• Among smokers trying to quit1
• Higher leptin, greater craving
• Difficulty achieving abstinence
1. de Silva Gomes, A., Toffolo, M. C. F., van Keulen, H. V.,
e Silva, F. M. C., Ferreira, A. P., Luquetti, S. C. P. D., ...de
Aguiar, A. S. (2015). Influence of the leptin and cortisol
levels on craving and smoking cessation. Psychiatry
Research, 229, 126-132.
95. GHRELIN
• Stimulates appetite
• Decreases after eating
• Opposing effects with leptin
• Leptin counters ghrelin
• Stomach-derived
• Receptors identified in VTA,
hippocampus, amygdala1
• Sight of food elevates ghrelin2
• Non-obese healthy subjects
1. Dagher, A (2012). Hunger, hunger, and food addiction.
In Brownell, K. D., & Gold, M. S., Food and addiction
(131-137). New York, NY: Oxford University Press.
2. Schussler, P., Kluge, M., Yassouridis, A., Dresler, M.,
Uhr, M., & Steiger, A. (2012). Ghrelin levels increases
after pictures showing food. Obesity, 20, 1212-1217.
96. GHRELIN & VTA
• Ghrelin alters set point of
dopaminergic neurons1
• Anticipatory physiological
responses to scheduled meals2
• Opioid receptor pathways3
• Regulation of food incentive and
hedonics
• Motivational effects on feeding4
1. Dickson, S. L., Egecioglu, E., Landgren S.,
Skibicka, K. P., Engel, J. A., & Jerlhag (2011). The
role of central ghrelin system in reward from food
and chemical drugs. Molecular and Cellular
Endocrinology, 340, 80-87.
2. Pandit, R., Mercer, J. G., Overduin, J., la Fleur, S.
E., & Adan, R. A. H. (2012). Dietary factors affect
food reward and motivation to eat. Obesity Facts,
5, 221-242.
3. Kawahara, Y., Kaneko, F., Yamada, M.,
Kishikawa, Y., Kawahara, H., & Nishi, A. (2013).
Food reward-sensitive interaction of ghrelin and
opioid receptor pathways in mesolimbic
dopamine system. Neuropharmacology, 67, 395-
402.
4. Overduin, J., Figlewicz, D. P., Bennet-Jay, J.,
Kittleson, S., & Cummings, D. E. (2012). Ghrelin
increases motivation to eat, but does not alter
food palatability. The American Journal of
Physiology - Regulatory, Integrative and
Comparative Physiology, 303, R259-R269.
97. ALCOHOL & GHRELIN
• Rewarding properties of alcohol
require ghrelin1
• Ghrelin increases during withdrawal2
(changes in hunger?)
• Alcoholic beverage before a meal?
(stimulates appetite)
• Key role in alcohol-seeking behavior3
• Dopamine neurobiology
• Hyperghrelinemia related to
addiction?1 Innovative treatment?3
1. Jerlhag, E., Egecloglu, E.,
Landgren, S., Salome, N., Hellg, M.,
Moechars, D., ... Engel, J. A. (2009).
Requirement of central ghrelin
signaling for alcohol reward.
Proceedings of the National
Academy of Sciences, 106(27),
11318-11323.
2. Kraus, T., Reulbach, U., Bayerlein,
K., Mugele, B., Hillemacher, T.,
Sperling, W., ... Bleich, S. (2004).
Leptin is associated with craving in
females with alcoholism. Addiction
Biology, 9, 213-219.
3. Leggio, L., Ferrulli, A., Cardone, S.,
Nesci, A., Miceli, A., Malandrino, N.,
... Addolorato, G. (2011). Ghrelin
system in alcohol-dependent
subjects: Role of plasma ghrelin
levels in alcohol drinking and
craving. Addiction Biology, 17, 452-
464.
98. INSULIN
• Peptide hormone from pancreas
• Similarities to leptin:
• Anorexigenic
• Adiposity signal
• Attenuates food reward
• When low, drive for food intake
increases
• Works with dopamine to calibrate
reward associated with feeding1
• Depresses dopamine conc. in VTA,
which may suppress salience of
food once satiety is reached
1. Mebel, D. M., Wong, J. C. Y., Dong, Y. J., &
Borgland, S. L. (2012). Insulin in the ventral
tegmental area reduces hedonic feeding and
suppresses dopamine concentration via
increased reuptake. Behavioral Neuroscience, 36,
2336-2346.
99. ALCOHOL & INSULIN
• Sober alcoholics blunted
responses in insulin1
• Nervous system damage?
• First month of abstinence more
pleasure from sweetness2
• Decreased over time
• Those abstinent at six months
less likely to prefer max
sweetness than those not sober2
1. Umhau, J. C., Petrulis, S. G., Diaz, R., Riggs, P.
A., Biddison, J. R., & George, D. T.(2002). Long-
term abstinent alcoholics have a blunted blood
glucose response to 2-deoxy-d-glucose. Alcohol
and Alcoholism, 37(6), 586-90.
2. Krahn, D., Grossman, J., Henk, H., Mussey, M.,
Crosby, R., & Gosnell, B. (2006). Sweet intake,
sweet-liking, urges to eat, and weight change:
Relationship to alcohol dependence and
abstinence. Addictive Behaviors, 31, 622–631.
100. INSULIN & LEPTIN
• Insulin receptor signaling
pathway interferes with
leptin signaling
• Insulin blocks leptin
• Hyperinsulinemia contributes
to the pathogenesis of leptin
resistance1
• Interferes with leptin
extinguishing of dopamine
clearance in the nucleus
accumbens2 (addiction)
1. Kellerer, M., Lammers, R., Fritsche, A., Strack, V.,
Machicao, F., Borboni, P., Ullrich, A., & Haring, H. U.
(2001). Insulin inhibits leptin receptor signaling in
HEK293 cells at the level of janus kinase-2: A potential
mechanism for hyperinsulinaemia-associated leptin
resistance. Diabetologia, 44, 1125-1132.
2. Lustig, R. H. (2013, October). Sugar, hormones and
addiction. Symposium conducted at The Lifestyle
Intervention Conference, Las Vegas, NV.
101. Daws, L. C., Avison, M. J., Robertson, S. D., Niswender, K. D., Galli, A., & Saunders, C.
(2011). Insulin signaling and addiction. Neuropharmacology, 61(7), 1123-1128.
• Insulin receptors present in brain and midbrain dopamine
neurons
• Insulin-influenced dopamine transmission can affect the
ability of drugs to exert their neurochemical and behavioral
effects
• Interplay between insulin signaling and drug-induced
increases in extracellular dopamine may contribute to high
comorbidity of eating disorders and drug abuse
• Improvements in brain dopamine function by normalizing
or bypassing disruptions in insulin signaling might be
effective in treating addictions
102. COCAINE
• Ghrelin modulates
reinforcement and reward1
• Female crack users2
• Low leptin in early abstinence
• Increasing during
detoxification
• Improved diet, weight gain
1. Clifford, P. S., Rodriguez, J., Schul, D., Hughes, S.,
Kniffin, T., Hart, N., ... Martinez, J. (2012). Attenuation
of cocaine-induced locomotor sensitization in rats
sustaining genetic or pharmacologic antagonism of
ghrelin receptors. Addiction Biology, 17(6), 956-963.
2. Michaelides, M., Thanos, P. K., Kim, R., Cho, J.,
Ananth, M., Wang, G., & Volkow, N. D. (2012). PET
imaging predicts future body weight and cocaine
preference. Neuroimage, 59, 1508-1513.
103. Ersche, K. D., Stochl J., Woodward, J. M., & Fletcher, P. C. (2013). The skinny on
cocaine. Insights into eating behavior and body weight in cocaine-dependent men.
Appetite. Advance online publication. Retrieved from
http://dx.doi.org/10.1016/j.appet.2013.07.011
• Cocaine-dependent men reported increased food intake, specifically
foods high in fat and carbohydrate
• Trend towards lower levels of circulating leptin in the cocaine group,
directly interfering with metabolic processes
• Overeating in cocaine-dependent individuals pre-dates recovery,
with the effect masked by lack of weight gain
• Taken together, cocaine abuse results in imbalance between fat
intake and storage, leading to excessive weight gain during recovery
104. HORMONES – DISCUSSION
• Food and drugs compete for
overlapping reward mechanisms
• When substance abstinence has been
achieved, likely a compensatory
increased drive for food
• Ravenous “rebound appetite”
• Hypothalamus
105. HORMONES – DISCUSSION
• Normalizing disrupted leptin
signaling cascade may be
sufficient to decrease
motivation for food reward
• Weight gain during addiction
recovery should be
monitored/controlled in order
to counter associated hormonal
adaptions
• Exposure to highly palatable
107. BURNING QUESTIONS
• Why are so many of us drawn to foods that can
compromise our quality of life?
• Why do some of us reject foods that can heal us?
• Why are educational efforts alone often not
sufficient to produce sustainable behavior change?
• Why is it so challenging to develop a new
relationship to food?
Lack of willpower?
Food addiction?
Restrained eating? Dieting?
108. Over 90% of over 4,000 peer-reviewed articles
on PubMed published within last 5 years
In a human body, microbial cells
outnumber human cells by a scale of 10
112. DEFINITIONS
• Symbiosis
• Interdependence/cooperation
• Different species live together
• Not necessarily mutualism
• Commensal
• One benefits, other unaffected
• Pathogenic/Parasitic
• Cause or produce disease
• “Dysbiosis”
113. MICROBIOTA
• Bacteria
• Archea
• Protozoans
• Fungi
• Viruses
Share human space
Gut Microbiota
• “Hidden Organ”
Homeostasis or disease
114. INFLUENCES ON MICROBIAL POPULATION
• Genetics
• Pregnancy
• Via amniotic fluid?
• Birth delivery
• Breastfeeding vs. formula
• Antibiotic use
• Diet!!!!!
• Weight & metabolic state
Jayasinghe, T. N., Chiavaroli, V., Holland, D. J., Cutfield, W. S., &
O'Sullivan, J. M. (2016). The new era of treatment for obesity and
metabolic disorders: Evidence and expectations for gut microbiome
transplantation. Frontiers in Cellular and Infection Microbiology,
6(15).
Engen et al. (2015)
115. INFLUENCES ON MICROBIAL POPULATION
• Illness1
• Aging1
• Lifestyle1
• Living environment1
• Stress1
• Separation of animals
from mothers altered
microbiome2
• Maintained for
extended time
1. Zhang, Y., Li, S., Gan, R., Zhou, T., Xu, D., & Li, H. (2015). Impacts of gut
bacteria on human health and disease. International Journal of Molecular
Sciences, 16, 7493-7519.
2. Evrensel, A., Ceylan, M. E. (2015). The gut-brain axis: the missing link in
depression. Clinical Psychopharmacology and Neuroscience, 13(3), 239-244.
Konturek et al. (2015)
116. GUT MICROBIOTA – FUNCTIONS
• Regulating gut motility
• Digestion of cellulose (fiber)
• Fermenting unused energy
substrates
• Destroying toxins
• Biosynthesis:
• Vitamin K
• B-vitamins
• Amino Acids (lysine, threonine)
• Absorption of minerals
Konturak et al. (2015)
117. GUT MICROBIOTA – FUNCTIONS
• New insights:
• Disease development
• Brain health
• Attenuation
• Memory
• Learning Matsumoto, M., Kibe, R., Ooga, T., Aiba, Y., Sawaki, E., Koga, Y., & Benno, Y.
(2013). Cerebral low-molecular metabolites influenced by intestinal microbiota:
A pilot study. Frontiers in Systems Neuroscience, 7(9).
Althani et al. (2015)
118. SHORT CHAIN FATTY ACIDS (SCFA)
• From microbial mediated
degradation of dietary fiber
calories to the host
• Constitute approximately
10% of energy source in
healthy people1
• Microbiota in lean patients
produces larger amounts of
SCFAs1
1. Tilg, H., & Adolph, T. E. (2016). Influence of the human
intestinal microbiome on obesity and metabolic dysfunction.
Current Opinion in Pediatrics, 27(4).
Jesus Raposo et al. (2016)
119. SCFAs & IMMUNE SYSTEM
• Strengthen intestinal
epithelial barrier1
• Protection against toxins
• Gene regulation of anti-
inflammatory processes2
• Butyrate in particular3
• Suppression of pro-
inflammatory genes
1. Barlow, G., M., Yu, A., & Mathur, R. (2015). Role of the gut
microbiome in obesity and diabetes mellitus. American Society for
Parenteral and Enteral Nutrition. doi:10.1177/08845336156090896
2. Konturek, P. C., Haziri, D., Brzozowski, T., Hess, T., Heyman, S.,
Kwiecien, S., Konturek, S. J., & Koziel, J. (2015). Emerging role of fecal
microbial therapy in the treatment of gastrointestinal and extra-
gastrointestinal diseases. Journal of Physiology and Pharmacology,
66(4), 483-491.
3. Jesus Raposo, M. F., Morais, A. M. M. B., & Morais, R. M. S. C.
(2016). Emergent sources of prebiotics: Seaweeds and microalgae.
Marine Drugs, 14(27).
120. SCFAs & METABOLISM
• Promotion of increased
uptake of monosaccharides
• Storage of triglyceride
• Digestion of dietary fiber
• Synthesis of
hormonal precursors Jayasinghe, T. N., Chiavaroli, V., Holland, D. J., Cutfield, W. S., &
O'Sullivan, J. M. (2016). The new era of treatment for obesity
and metabolic disorders: Evidence and expectations for gut
microbiome transplantation. Frontiers in Cellular and Infection
Microbiology, 6(15).
121. SCFAs & HORMONES
• SCFAs as modulators of the
enteric neuroendocrine system
• Stimulate anorexigenic hormones1
• Glucagon-like peptide (GLP-1)2
• Secretion of peptide YY (PYY)2
• Increase synthesis of leptin1
1. Chakraborti, C. K. (2015). New-found link
between microbiota and obesity. World Journal
of Gastrointestinal Pathopsysiology, 6(4), 110-
119.
2. Belizario, J. E., & Napolitano, M. (2015).
Human microbiomes and their roles in dysbiosis,
common diseases, and novel therapeutic
approaches. Frontiers in Microbiology, 6(1050).
122. GUT DYSBIOSIS – General
• Microflora imbalanced
• Symbiotic relationship lost
• Inflammatory Bowel Disease1
• Irritable Bowel Syndrome1
• NAFLD1
• GI Malignancy1
• Autism2
• Crohn’s3
• Asthma3
• Allergies4
• Eczema4
• Diabetes4
• Obesity4
1. Parekh, P. J., Balart, L. A., & Johnson, D. A. (2015). The influence
of the gut microbiome on obesity, metabolic syndrome and
gastrointestinal disease. Clinical and Translational
Gastroenterology, 6(e91).
2. Zhang, Y., Li, S., Gan, R., Zhou, T., Xu, D., & Li, H. (2015). Impacts
of gut bacteria on human health and disease. International
Journal of Molecular Sciences, 16, 7493-7519.
3. Davenport, E. R., Cusanovich, D. A., Michelini, K., Barreiro, L. B.,
Ober, C., & Gilad, Y. (2015). Genome-wide association studies of
the human gut microbiota. Plos One, 10(11).
4. Villanueva-Millan, M. J., Perez-Matute, P., & Oteo, J. A. (2015).
Gut microbiota: A key player in health and disease. A review
focused on obesity. Journal of Physiology and Biochemistry.
doi:10.1007/s13105-015-0390-3
123. GUT DYSBIOSIS – General
• Reduction in diversity of
microorganisms1
• Healthy guts have higher
diversity
• Associated w/ high-fat, high-
sugar, and low-fiber diets2
• Compromised barrier function
• Altered glucose and lipid
metabolism3
1. Belizario, J. E., & Napolitano, M. (2015). Human microbiomes and
their roles in dysbiosis, common diseases, and novel therapeutic
approaches. Frontiers in Microbiology, 6(1050).
2. Scavuzzi, B. M., Miglioranza, L .H., Henrique, F. C., Paroschi, T. P.,
Lozovoy, M. A. B., Simao, A. N. C., & Dichi, I. (2015). The role of
probiotics on each component of the metabolic syndrome and other
cardiovascular risks. Expert Opinion on Therapeutic Targets, 19(8).
3. Principi, N., Esposito, S. (2016). Antibiotic administration and the
development of obesity in children. International Journal of
Antimicrobial Agents.
http://dx.doi.org/10.1016/j.ijantimicag.2015.12.017
124. “LEAKY GUT”
• Increased gut permeability
• Microbial translocation
• Metabolic endotoxemia
• Low-grade inflammation
• pro-inflammatory
cytokines and free radicals
• Inflammation in liver,
pancreas, brain
Konturek, P. C., Haziri, D., Brzozowski, T., Hess, T., Heyman, S.,
Kwiecien, S., Konturek, S. J., & Koziel, J. (2015). Emerging role
of fecal microbial therapy in the treatment of gastrointestinal
and extra-gastrointestinal diseases. Journal of Physiology and
Pharmacology, 66(4), 483-491.
Althani et al. (2015)
125. MICROBIOME & BRAIN
• Bi-directional communication!
• Pathways:1
• Autonomic nervous system
• Enteric nervous system
• Neuroendocrine system
• Immune system
• Via:
• Vagus nerve
• Spinal cord
• Circulatory system
• Inflammatory signaling molecules2
1. Foster, J. A., & Neufeld, K. M. (2013). Gut-brain axis:
How the microbiome influences anxiety and
depression. Trends in Neurosciences, 36(5), 305-312.
2. Gorky, J., & Schwaber, J. (2016). The role of the gut-
brain axis in alcohol use disorders. Progress in Neuro-
Psychopharmacology & Biological Psychiatry, 65, 234-
241.
Cryan et al. (2012)
126. BRAIN-GUT PATHWAYS
• Autonomic nervous system
• Sympathetic
• “Fight-or-flight”
• Parasympathetic
• Organ function, “rest and digest”
• Hypothalamic-pituitary
adrenal (HPA) axis
• Corticotrophin releasing factor
(CRF) directly acting on gut
Keightley, P. C., Koloski, N. A., & Talley, N. J. (2015).
Pathways in gut-brain communication: Evidence for distinct
gut-to-brain and brain-to-gut syndromes. Australian & New
Zealand Journal of Psychiatry, 49(3), 207-214.
Cryan et al. (2012)
127. BRAIN-GUT AXIS
• Anxiety and depression1
• sympathetic parasympathetic
• Regulates enteric nervous system
• Up-regulate HPA axis
• CRF & Cortisol
• Stress hormones
• Impair digestion
• IBD & IBS both associated w/
anxiety and depression2
1. Keightley, P. C., Koloski, N. A., & Talley, N. J.
(2015). Pathways in gut-brain communication:
Evidence for distinct gut-to-brain and brain-to-
gut syndromes. Australian & New Zealand
Journal of Psychiatry, 49(3), 207-214.
2. Lyte, M. (2013). Microbial endocrinology in
the microbiome-gut-brain axis: How bacterial
production and utilization of neurochemicals
influence behavior. PLOS Pathogens, 9(11).
128. GUT-BRAIN AXIS
• Functional GI disorders linked
to anxiety & depression
• Direction of causality?
• GI inflammation linked to
anxiety in mice1
• Is microbiota the link between
poor diet & depression?
• Can diet prevent depression?
• Does depression promote
“leaky gut”?2 vicious cycle
1. Foster, J. A., & Neufeld, K. M. (2013). Gut-brain
axis: How the microbiome influences anxiety and
depression. Trends in Neurosciences, 36(5), 305-312.
2. Klecolt-Glaser, J. K., Derry, H. M., Fagundes, C. P.
(2015). Inflammation: Depression fans the flames
and feasts on the heat. American Journal of
Psychiatry, 172(11), 1075-1091.
129. Skosnik, P. D., Cortes-Briones, J. A. (2016). Targeting the ecology within: The role of
the gut-brain axis and human microbiota in drug addiction. Medical Hypotheses, 93,
77-80.
• Potential links
between microbiota
and drug addiction:
• Stress
• HPA axis
• Depression
• Serotonin production
in the gut
• Dopamine
130. GUT BACTERIA & BEHAVIOR
• GABA
• Synthesized from MSG by
Lactobacillus & Bifidobacterium
• Norepinephrine
• Produced by Escherichia coli,
Bacillus, & Saccharomyces
• Serotonin
• Produced by Candida,
Streptococcus, & Escherichia
• Dopamine
• Produced by Bacillus & Serratia
Evrensel, A., Ceylan, M. E. (2015). The gut-brain axis: the
missing link in depression. Clinical Psychopharmacology
and Neuroscience, 13(3), 239-244.
More than 50% of
dopamine & vast majority
of serotonin (90%) have an
intestinal source
131. GUT & BEHAVIOR
• Other signaling neuro-active
molecules synthesized or
mimicked by gut microbiota:1
• Acetylcholine
• Histamine
• Melatonin
• All serve as clear implication
that gut bacteria influence
brain function & behavior
1. Petra, A., I., Panagiotidou, S., Hatziagelaki, E., Stewart,
J. M., Conti, P., & Theoharides, T. C. (2015). Gut-
microbiota-brain axis and its effect on neuropsychiatric
disorders with suspected immune dysregulation. Clinical
Therapeutics, 37(5), 984-995.
132. IN THE LAY PRESS…
http://www.theatlantic.com/health/archive/2014/08/your-gut-bacteria-want-you-to-eat-a-cupcake/378702/
133. CONCLUSIONS
• Microorganisms are competing for nutritional resources
• Evolutionary conflict between host & microbiota may lead to cravings
and cognitive conflict regarding food choice
• Exercising self-control over eating may be partly a matter of
suppressing microbial signals that originate in the gut
• Acquired taste may be due to acquisitions of microbes that benefit
from that food
134. Wasielewski, H., Alcock, J., & Aktipis, A. (2016). Resource conflict and cooperation
between human host and gut microbiota: Implications for nutrition and health.
Annals of the New York Academy of Sciences. doi:10.1111/nyas.13118
• Ecology principle: access to resources shapes nature of
interactions between organisms
• Mismatch between ancestral nutrition and modern diets
disrupts host-microbe resource sharing
• Genetic conflict: driver of metabolic disease and
malnutrition via resource competition
• Ongoing evolutionary arms race over access to
micronutrients and energy substrates
135. Wasielewski, H., Alcock, J., & Aktipis, A. (2016). Resource conflict and cooperation
between human host and gut microbiota: Implications for nutrition and health.
Annals of the New York Academy of Sciences. doi:10.1111/nyas.13118
• Sugar, iron: may lead to conflict over resources
• Zero-sum interaction (strictly competitive)
• Increased invasiveness and inflammation
• Iron: Neisseria meningtidis and Haemophilus influenzae
sequester iron using bacterial transferrin-binding protein A
• Explanation for red meat craving in some?
• Could Fe supplementation in children cause gut dysbiosis?
• Excess resource availability can escalate conflict by providing pathogens the
opportunity to proliferate and further influence human behavior
• Fiber: cooperation, low overlap in resource (nonzero-sum)
136. SWEETENERS – SUGAR
• Substrate conditioning1
• Loss of phylogenic diversity
• Dysbiosis
• “Western gut microbiome”
• Lower refined sugar intakes2
• Higher gene richness & diversity
in intestinal microbiota
1. Payne, A. N., Chassard, C., & Lacroix, C. (2012). Gut
microbial adaption to dietary consumption of fructose,
artificial sweeteners and sugar alcohols: Implications
for host-microbe interactions contributing to obesity.
Etiology and Pathophysiology, 13, 799-809.
2. Kobyliak, N., Conte, C., Cammarota, G., Haley, A. P.,
Styriak, I., Gaspar, L., ...Kruzliak, P. (2016). Probiotics in
prevention and treatment of obesity: A critical view.
Nutrition & Metabolism, 13(14).
Payne et al. (2012)
137. ARTIFICIAL SWEETENERS (AS)
• Interfere with gut microbiota1
• Beneficial bacteria
• Pass through SI, but enter LI
• Induce glucose intolerance1,2,3
• glycemic response after CHO
• Elevated fasting glucose (rats)
• “Metabolic derangements”2
• “Metabolic abnormalities”3
“…directly contributed to enhancing
the exact epidemic that they
themselves were intended to fight.”
1. Pepino, M. Y. (2015). Metabolic effects of non-
nutritive sweeteners. Physiology & Behavior.
http://dx.doi.org/10.1016/j.
physbeh.2015.06.024
2. Swithers, S. E. (2013). Artificial sweeteners
produce counterintuitive effect of inducing
metabolic derangements. Trends in
Endocrinology Metabolism, 24(9), 431-441.
3. Suez, J., Korem, T., Zeevi, D., Zilberman-
Schapira, G., Thaiss, C. A., Maza, O., ...Elinav, E.
(2014). Artificial sweeteners induce glucose
intolerance by altering the gut microbiome.
Nature. doi:10.1038/nature13793
139. GUT-LIVER AXIS
• Liver = largest immune organ
• Primary site for EtOH metabolism
• Responds to pathogen-derived
signals1
• Bile acids as communicators
• Modulates microbiome (and vice versa)
• Ex: conjugated bile acids secreted
into duodenum modified by
bacteria & sent back to liver2
• Chronic EtOH bile acid in stool3
• Cirrhotic bile acid in stool3
1. Szabo, G. (2015). Gut-liver axis in alcoholic liver
disease. Gastroenterology, 148(1), 30-36.
2. Hartmann, P., Seebauer, C. T., & Schnabl, B. (2015).
Alcoholic liver disease: The gut microbiome and liver
cross talk. Alcoholism: Clinical and Experimental
Research, 39(5), 763-775.
3. Kakiyama, G., Hylemon, P. B., Zhou, H., Pandak, W.
M., Heuman, D. M., Kang, D. J., ...Bajaj, J. S. (2014).
Colonic inflammation and secondary bile acids in
alcohol cirrhosis. American Journal of Physiology -
Gastrointestinal and Liver Physiology, 306, G929-G937
140. GUT-LIVER AXIS
• Intestinal oxidation of EtOH
• Acetaldehyde
• Alters intestinal permeability
• EtOH consumption
• Intestinal epithelial barrier
• Zinc deficiency?1
• Bacterial translocation
• Intestinal dysbiosis
Progression of
alcoholic liver disease (ALD)2
1. Zhong, W., McClain, C. J., Cave, M., Kang, Y. J., & Zhou, Z.
(2010). The role of zinc deficiency in alcohol-induced intestinal
barrier dysfunction. The American Journal of Physiology-
Gastrointestinal and Liver Physiology, 298, G625-G633.
2.Szabo, G. (2015). Gut-liver axis in alcoholic liver disease.
Gastroenterology, 148(1), 30-36. ‘
3. Llopis, M., Cassard, A. M., Wrzosek, L., Boschat, L., Bruneau,
A., Ferrere, G., …Perlemuter, G. (2016). Intestinal microbiota
contributes to individual susceptibility to alcoholic liver
disease. Gut, 65, 830-839.
142. ALCOHOL & GUT MICROBES
• Small intestinal bacterial
overgrowth (SIBO)1
• Also large intestine
• May explain GI symptoms
• Diarrhea
• Nausea
• Abdominal pain
• Impact nutrient absorption?
• B-vitamin deficiency?2
1. Hartmann, P., Seebauer, C. T., & Schnabl, B. (2015).
Alcoholic liver disease: The gut microbiome and liver cross
talk. Alcoholism: Clinical and Experimental Research, 39(5),
763-775.
2. Chen, P., & Schnabl, B. (2014). Host-microbiome
interactions in alcoholic liver disease. Gut and Liver, 8(3),
237-241.
Hartmann et al. (2015)
143. ALCOHOL & GUT LEAKINESS
• Persists into abstinence1
• Alcoholics with gut
leakiness2
• At 3 weeks sober, had higher
scores of:
• Depression
• Anxiety
• Alcohol craving
• Dysbiosis during abstinence
can be long-lasting
1. Mutlu, E. A., Gillevet, P. M., Rangwala, H., Sikaroodi, M.,
Naqvi, A., Engen, P. A., ...Keshavarzian, A. (2012). Colonic
microbiome is altered in alcoholism. American Journal of
Physiology- Gastrointestinal and Liver Physiology, 302,
G966-G978.
2. Leclercq, S., Matamoros, S., Cani, P. D., Neyrinck, A. M.,
Jamar, F., Starkel, P., ...Delzenne, N. M. (2014). Intestinal
permeability, gut-bacterial dysbiosis, and behavioral
markers of alcohol-dependence severity. Proceedings of
the National Academy of the Sciences. Retrieved from
www.pnas.org/cgi/doi/10.1073/pnas.1415174111
144. ALCOHOL WITHDRAWAL
• Decrease in protective colonies?1
• Increase in pathogenic colonies?1
• Inflammatory signaling
• Cytokine release
• Both correlated to depression and
alcohol craving2
• Gut dysbiosis
• Gut-Brain Axis
• Neuroinflammation1
• Amygdala (emotion)1
• Corticotropin releasing factor1
Withdrawal behavior/symptoms
1. Gorky, J., & Schwaber, J. (2016). The role of
the gut-brain axis in alcohol use disorders.
Progress in Neuro-Psychopharmacology &
Biological Psychiatry, 65, 234-241.
2. Leclercq, S., Matamoros, S., Cani, P. D.,
Neyrinck, A. M., Jamar, F., Starkel, P., ...Delzenne,
N. M. (2014). Intestinal permeability, gut-
bacterial dysbiosis, and behavioral markers of
alcohol-dependence severity. Proceedings of the
National Academy of the Sciences. Retrieved
from
www.pnas.org/cgi/doi/10.1073/pnas.141517411
Gorky & Schwaber (2016)
145. OPIATES & MICROBIOME
Animal Data: Morphine Treatment
• Gut epithelial barrier dysfunction1
• Disrupted tight junction organization
• Inflammation in small intestine
• potential pathogenic bacteria2
• Enterococcus faecalis 100x
• Decreased microbial diversity
• Bile acid metabolism greatly affected2
• Naltrexone (opioid receptor antagonist)
reversed effect on bile acid metabolism
1. Meng, J., Yu, H., Ma, J., Wang, J., Banerjee, S.,
Charboneau, R., ...Roy, S. (2013). Morphine
induces bacterial translocation in mice by
compromising intestinal barrier function in a
TLR-dependent manner. PloS One, 8(1), e54040.
2. Wang, F. (2015). Temporal modulation of gut
microbiome and metabolome by morphine.
(Doctoral dissertation).
Wang (2015)
146. WE NEED TO KNOW SO MUCH MORE!!!
• Exercise: Boosts microbial diversity!
• Smoking: Weight gain after quitting1
• Coffee & caffeine
• Illicit street drugs
• Medications, vaccines
• Dietary supps: Vit/min, functional fibers
• Antibiotics in meat! Pesticides
• GMOs
• Pasteurization & “food safety”
• Microwaves
• Cooked vs. raw
• Artificial colors/dyes/flavors
• Binders/thickeners
• Stabilizers/emulsifiers: Carrageenan
• Water, plastic bottles
• Pets & shared living space
• Plants
• Sexual partners
• Extended hospital visits
• Disinfectants/cleaning products
1. Begon, J. (2015). Smoking and digestive tract: A complex relationship. Part
2: Intestinal microbiota and cigarette smoking. Geneve: Medecine & Hygiene,
11(478), 1304-1306.
148. NUTRITION INTERVENTIONS – GOALS
• Primary goal is to support
recovery by any means necessary
• Complete abstinence from all illicit
mind-altering substances
• Nutrition therapy emphasizing
correction of nutrient deficiencies
• Lab data to warrant aggressive
interventions
149. NUTRITION INTERVENTIONS – GOALS
• Immediately bombarding an addict
entering treatment with pills and
other supplements may fail to
support behavioral aspects of
recovery
• If individuals begin using again,
efforts to correct nutritional
deficiencies are futile, and are
likely to redevelop!
150. SUPPLEMENTS VS. FOOD
• Supplements may give patients the idea that
as long as they take pills, they do not need to
improve their eating habits
• Street drugs exert tremendous strain on liver
supraphysiological doses of nutrients
may actually conflict with healing process
• Eating behavior FIRST, supplements SECOND
151. IDEAL TIMELINE – NUTRITION THERAPY
• 6 hours
• Complete diet liberalization
• Micronutrient supplementation
• 6 days
• Targeted nutrition education
• Diet liberalization (goal: improvement)
• 6 weeks
• Reduce intake of sugar and refined CHO
• 6 months
• Cessation of supplementation
152. SO WHAT ARE YOU SAYING?
• Liberalized diet including
abnormal amounts of sugar
during first weeks of abstinence
can assuage painful symptoms
of withdrawal
• Consumption behavior should
be monitored and eventually
sugar use should be reduced
• Assessed individually
153. NUTRITION INTERVENTIONS
• “Western Diet” – PROBLEM
• Low in fiber
• High in sugar and/or AS
• High in inflammatory fats
• Omega-6 and certain saturated fats
• Nutrition in Recovery – SOLUTION
• High in fiber
• Low in sugar, no AS
• High in anti-inflammatory omega-3s
• Lower in pro-inflammatory omega-6
Priority #1
Transitions are typically
gradual & progressive. Gut
will hardly allow for
anything else!
154. THE IMPORTANCE OF FIBER
• Gradual/progressive reintroduction
• Low fiber tolerance creates significant
barriers for nutrition therapy involving
fruits, vegetables, whole grains, beans
• Increase 2-4 g/week to meet recs:
• 38 g/day men, 25 g/day women
• Ages 14-50
Focus on improved gut health
• Optimal absorption of AAs, vits/mins
155. INTERVENTIONS – FIBER
• Get fiber from food, not from
fiber supplements!
• Fruits
• Vegetables – emphasize raw
• Whole grains
• Beans
• Nuts/seeds – emphasize raw
• Eat a wide range of plant foods
on a daily basis
• F or V with every meal/snack
Every time you eat:
Fiber
Fat
Protein
156. OPERATION: HEAL THE GUT!
• Gut-Brain Communication1
• Brain-Gut (Bi-Directional)
“Psychological treatments are
known to improve functional
gastrointestinal disorders, the next
wave of research may involve
preventative microbiological gut
based treatments for primary
psychological presentations…”
1. Keightley, P. C., Koloski, N. A., & Talley, N. J. (2015). Pathways in gut-
brain communication: Evidence for distinct gut-to-brain and brain-to-gut
syndromes. Australian & New Zealand Journal of Psychiatry, 49(3), 207-
214.
157. INTERVENTIONS – BEVERAGES
• Eliminate artificial sweeteners
• And artificial colors
• Stop consuming sweetened
beverages. Yes, all of them!
• Beverage list:
• Water
• Chia water
• Tea (unsweetened)
• Black coffee?
• Milk (organic only)
• Alt. milk? (unsweet, carrag. free)
Negative impact of (short-
term) artificial sweeteners
on gut microbiota
reversed w/in 2-8 weeks1
1. Suez, J., Zilberman-Schapira, G., Segal, E., & Elinav, E.
(2015). Non-caloric artificial sweeteners and the
microbiome: Findings and challenges. Gut Microbes.
Retrieved from
http://dx.doi.org/10.1080/19490976.2015.1017700
Fresh Juice???
158. INTERVENTIONS – GRAINS
• Reduce/eliminate refined grains
• White flour, white rice
• Processed cereals, etc.
• Only eat 100% whole grains
• Quinoa
• Brown rice
• Oats
• Buckwheat
• Farro
• Barley
• Ancient grains…
159. INTERVENTIONS – FATS
• Minimize exposure to omega-6
• Sunflower
• Corn
• Soybean
• Grapeseed
• Sesame
• Peanut
• Use nut oils instead:
• Almond, walnut, pistachio
Use avocado, coconut, olive oils
Most fat in our diets
should come from food
NOT from refined oils!
Eat these:
Nuts, seeds
Avocado, coconut, olives
Animal products
Organic dairy
160. INTERVENTIONS – ANIMAL PROTEIN
• Is human gut dysbiosis
linked to consistent
exposure to low dose
antibiotics from animal
agriculture? YES
• Look for:
• No Antibiotics
• Raised Without Antibiotics
• If we demand change, it
can totally happen
161. INTERVENTIONS – FERMENTED FOODS
• Kefir
• Unsweetened, organic, full-fat
• Other cultured dairy products
• Raw sauerkraut, raw kimchi
• Sodium can be very high
• Lots of commercial fermented
beverages, tonics, and foods
on the market (buyer beware)
162. OTHER RECS – NUTRITION THERAPY
• 50% of fruits and vegetables
should be raw
• Vs. cooked, canned, frozen, dried
• Minimal fruit juice
• Spotlight on fiber! “Zen Nutrient”1
• Gut bacteria
• Beans, nuts, seeds!
• Brazil nuts (Se)
1. Hoffinger, R. (2012). The recovery diet.
Avon, MA: Adams Media.
163. OTHER RECS – NUTRITION THERAPY
• Oily fish
• Plant-based omega-3’s
• Flax seeds, walnuts
• Chia seeds!
• Dairy choices (go organic!)
• Milk, yogurt, cottage cheese
• Low protein high-fat cheeses and
processed cheeses used sparingly
• Alternative milks
• Calcium, vitamin D
164. INTERVENTIONS – TIMING
• “Never hungry, never full”
• Eat every 2.5 - 4.5 hours
• Reduce potential for
hormonal extremes
• Avoid the “crash”
165. NUTRITION THERAPY – PROTOCOLS
Wiss, D. A., & Waterhous, T. S.
(2014). Nutrition therapy for
eating disorders, substance
use disorders, and addictions.
In Brewerton, T. D., & Dennis,
A. B., Eating disorders,
substance use disorders, and
addictions (pp. 509-532).
Heidelberg, Germany: Springer
Publishing.
166. RECS – POLY-SUBSTANCE ABUSE
INVOLVING ALCOHOL
• MVI (low metal)
• Additional B-vitamins primarily
thiamine (for EtOH)
• Omega-3 supplement DHA rich
• Diet rich in vits A, C, E, Se, Fe
• Probiotics if GI distress
167. RECS – OPIATES
• Liquid MVI (low metal)
• Additional vit. B6
• Additional calcium and vit. D
• Digestive enzymes, probiotics
• Fiber if constipated (chia!)
• Higher caloric needs?
• Diet rich in vits A, C, E, Se, Fe
168. RECS – COCAINE
• MVI (low metal)
• Omega-3 supp DHA rich
• Protein-rich diet
• Diet rich in vits A, C, E, Se, Fe
• Gradual weight gain1
• Not drastic/immediate
1. Ersche, K. D., Stochl, J., Woodward, J. M., &
Fletcher, P.C. (2013). The skinny on cocaine.
Insights into eating behavior and body weight
in cocaine-dependent men. Appetite. Advance
online publication. Retrieved from
http://dx.doi.org/10.1016/j.appet.2013.07.01
169. RECS – METHAMPHETAMINE
• MVI (low metal, no Fe)
• Omega-3 supp DHA rich
• Protein-rich diet
• Diet rich in vits A, C, E, Se
• Lower refined CHO intake
170. SUPPLEMENTATION
• Compromised GI function may create
barriers for absorption of vitamins
• Liquid forms useful
• Meal replacement drinks
• MVI w/ low metal content
• Antioxidant supps?
• Co-Q10, alpha lipoic acid, resveratrol,
flavonoid polyphenols
171. PROBIOTICS
• Effects highly strain dependent
• Reversal of behavior problems1
• Normalization of:1
• Immune response
• Norepinephrine levels in brain
• Gut-Brain axis
• Lactobacillus casei strain Shirota
relieves stress-associated
symptoms2
hypersecretion of cortisol
1. Evrensel, A., Ceylan, M. E. (2015). The gut-
brain axis: the missing link in depression. Clinical
Psychopharmacology and Neuroscience, 13(3),
239-244.
2. Takada, M., Nishida, K., Kataoka-Kato, A.,
Gondo, Y., Ishikawa, H., Suda, K., …Rokutan, K.
(2016). Probiotic Lactobacillus casei strain
Shirota relieves stress-associated symptoms by
modulating the gut-brain interaction in human
and animal models. Neurogastroenterology and
Motility, doi:10.1111/nmo.12804
“Live organisms that confer
a beneficial health effect on
host when administered in
proper amounts” – INTL def.
172. PROBIOTICS
• May be useful in:1
• Diarrhea
• Gastroenteritis
• IBS
• IBD
• Cancer
• Infant allergies
• Failure-to-thrive
• Hyperlipidemia
• Hepatic diseases
• H. pylori infections (ulcers)
• Mental health!!!
1. Scavuzzi, B. M., Miglioranza, L .H., Henrique, F. C., Paroschi, T. P.,
Lozovoy, M. A. B., Simao, A. N. C., & Dichi, I. (2015). The role of
probiotics on each component of the metabolic syndrome and other
cardiovascular risks. Expert Opinion on Therapeutic Targets, 19(8).
Malaguarna et al. (2015)
173. PROBIOTICS & RECOVERY
• Meta-analysis from 20161
• 5 separate clinical trials
• Probiotics associated with
significant reduction in
depression!!!
• Alcoholic hepatitis2
• 7 days of oral
supplementation with
cultured L. subtilis & L.
faecium associated with
restoration of bowel flora
1. Huang, R., Wang, K., & Hu, J. (2016). Effect of probiotics on
depression: A systematic review and meta-analysis of randomized
controlled trials. Nutrients, 8(483).
2. Han, S. H., Suk, K. T., Kim, D. J., Kim, M. Y., Baik, S. K., Kim, Y. D.,
...Kim, E. J. (2015). Effects of probiotics (cultured Lactobacillus
subtilis/Streptococcus faecium) in the treatment of alcoholic
hepatitis: randomized-controlled multicenter study. European
Journal of Gastroenterology & Hepatology, 27(11), 1300-1306.
174. PROBIOTICS – MECHANISMS
• Displacement of pathogens
• Competition with hostile bacteria
• Production of bacteriocins
• Alteration of microbial enzyme activities
• Inhibition of bacterial translocation
• Enhancement of mucosal barrier function
• Effects on Ca-dependent K channels
• In intestinal sensory neurons
• Induction of opioid and cannabinoid receptors
• In intestinal epithelial cells
• Modulation of the immune system
• Through signals on epithelial cells
• Increasing antibody levels
Bravo, J. A., Julio-Pieper, M., Forsythe, P.,
Kunze, W., Dinan, T. G., Bienenstock, J., &
Cryan, J. F. (2012). Communication between
gastrointestinal bacteria and the nervous
system. Current Opinion in Pharmacology,
12, 667-672.
175. OTHER CONSIDERATIONS FOR GUT
• Fish oil
• 2,000mg EPA + DHA
• Curcumin
• Or fresh turmeric
• Aloe vera
• Gelatinous/thick/fibrous
• Wheat grass with ginger
• 2 oz. shot!
• Peppermint oil (for IBS)
• 2-3 capsules between meals
180. SOURCES OF IRON
• Red meat
• Lentils
• Pumpkin seeds
• Kidney beans
181. SUMMARY – NUTRITION THERAPY
• Ideal macro breakdown
• 45-50% CHO
• 25-30% protein
• 20-30% fat
• Of CHO consumed:
• 75% (or more) unrefined
• Whole grain, fruits, vegetables
• Dairy (if tolerant)
• Some leeway for sugar and
refined grains in early recovery
182. SUMMARY – NUTRITION THERAPY
• Nutritional deficiency lowers
antioxidant potential of cells
• Increased potential for cell damage
• Increased need for antioxidant
vitamins A, C, E, selenium
• Higher protein needs than the
general population
• Promote neurotransmitter synthesis
183. WHAT ABOUT EXERCISE?
Lifestyle interventions involving both diet and exercise
• Exercise supported in treatment of mental illness1 with
profound impacts on cognitive abilities2
• Aerobic activity transforms not only body but mind2
• Exercise can help rebuild brain cells killed by alcohol-
ten min. of exercise could blunt an alcoholic’s craving2
• Other benefits:
• Increased self-esteem, self-efficacy
• Elevated mood
• Improved energy and concentration
• More relaxing sleep
• Relief of tension
• NORMALIZE HORMONES, improves microbiota
Integration of exercise along w/ nutrition
critical for full recovery from substance abuse
1. Forsyth, A., Deane, F. P., & Williams, P.
(2009). Dietitians and exercise physiologists in
primary care: Lifestyle Interventions for
patients with depression and/or anxiety.
Journal of Allied Health, 38(2), e-63-68
2. Ratey, J. J., & Hagerman, E. (2008). Spark.
New York, NY: Little, Brown and Company.
184. EXERCISE IN RECOVERY
• 15 minutes of brisk walking
reduces urge for sugary snacks
in overweight individuals1
• Benefits of exercise in alcohol
recovery2
• Provide pleasurable states
• Reduce depressive symptoms
• Increase self-efficacy
• Provide positive alternatives
• Decrease stress reactivity
• Decrease urges to drink
• Adjunctive treatment for SUD3
1. Ledochowski, L., Ruedl, G., Taylor, A. H., & Kopp, M.
(2015). Acute effects of brisk walking on sugary snack
cravings in overweight people, affect and responses to a
manipulated stress situation and to a sugary snack cue:
A crossover study. PLoS ONE, 10(3).
2. Brown, R. A., Abrantes, A. M., Read, J. P., Marcus, B.
H., Jakicic, J., Strong, D. R., ...Gordon, A. A. (2009).
Aerobic exercise for alcohol recovery: Rationale,
program description, and preliminary findings. Behavior
Modification, 33(2), 220-249.
3. Linke, S. E., & Ussher, M. (2015). Exercise-based
treatments for substance use disorders: Evidence,
theory, and practicality. The American Journal of Drug
and Alcohol Abuse, 41(1), 7-15.
185. EXERCISE PROTOCOLS
• Strength training
• GI tract is made of muscles
• Twice/week
• Cardio
• Outdoors whenever possible
• Twice/week
• Yoga
• Aids in digestion (parasympathetic
nervous system)
• Basically helps with EVERYTHING
• Twice/week
186. BIG PICTURE – GOALS
• Not necessarily weight loss
• Relapse prevention
• Disease prevention
• Focus on overall health
• Body, mind, spirit
• Behavior change & self-efficacy
• “Sanity restoration”
• “Recovery”
• Can be difficult to measure
Eventually developing a relationship
w/ food & exercise that is intuitive/personal
• Avoid “quick fix” whenever possible
187. BIG PICTURE – GOALS
• Cooking Classes
• Mandatory part of
treatment!
• Life Skills
• Grocery shopping
• Food safety
• Meal planning
• Kitchen cleaning
• Challenge the entitlement
189. FOOD ADDICTION
• Recent meta-analysis1
• 20% of all subjects tested for FA
met criteria
• No well-accepted treatment
• Abstinence from addictive food?
• Mindfulness? Intuitive Eating?
• Health at Every Size?
• Psychiatric interventions?
• Surgical interventions?
1. Pursey, K. M., Stanwell, P., Gearhardt, A. N.,
Collins, C. E., Burrows, T. L. (2014). The prevalence of
food addiction as assessed by the Yale food
addiction scale: A systematic review. Nutrients, 6,
4552-4590.
190. GOOD VS. BAD FOODS?
• As an eating disorder specialist,
this simplistic distinction can
cause more harm than good
• Cognitive distortion
• HOWEVER, we can start to
discern between:
• Real food vs. processed food
• Non-addictive vs. addictive food
• Gut healing vs. gut harming
• If it has the potential to promote
dysbiosis, think twice!
“Everyone knows how important
the brain is. We have all sorts of
educational protocols in place for
the brain.
But what about the second brain?
If the gut truly is the second brain,
we need educational protocols for
the gut.”
David Wiss MS RDN
Nutrition in Recovery
191. ABSTINENCE FROM OFFENDING FOODS???
• Some food addicts do benefit from restricting added
sugars, refined grains, fried foods…
• Beware of rebound bingeing
vs.
• Disordered thinking patterns
• “Orthorexia”
192. HOW TO END FOOD ADDICTION
Take Care of Yourself:
• Regular meals/snacks
• Plenty of water
• Minimal caffeine
• Daily exercise
• Something you enjoy
• Modulates reward pathway
• Sufficient quality sleep
• Support system
• Give up on perfectionism
193. HOW TO END FOOD ADDICTION
• Reconnect with food
• Intuitive Eating
• Attuned Eating
• Mindful Eating
• Stop multitasking at meals
• Only eat table
• Pay attention (non-judgmentally)
• Focus on each mouthful
• Chew and savor
• Put down cutlery between bites
• Quality not quantity
• Prepare your own food
194. INTERVENTIONS – “INTUITIVE EATING”
• Can we trust our body wisdom?
• Near gut homeostasis
• Low addictive symptomatology
• Hormonal milieu relatively stable
• Mindfulness training
YES – in sync with intuition
• Gut dysbiosis
• Addiction/withdrawal/craving
• Hormonal extremes
• Mindless eating
NO – addiction running the show
Guarner et al. (2003)
195. SUMMARY – BIG PICTURE
• Restoration of nutritional status in
SUD should look beyond
vitamin/mineral status and body
weight!
• Goals should include BEHAVIORS:
• Gut (HOT TOPIC!!!)
• Brain chemistry
• Hormones
Minimize spikes/drops in insulin
196. NUTRITIONAL TREATMENT
• Must consider biology:
• A calorie is NOT a calorie
• It is “about the food”
• Food industry continues to deny
responsibility, always stressing
individual responsibility for eating,
and pointing to lack of exercise
• Psychological interventions alone
are not sufficient
• Educational efforts alone are not
sufficient (just like drug addiction)
we need an intervention
197. TREATMENT-BASED EVIDENCE
• Most people report that eating less
“processed foods” & more “whole
foods” improves wellness & mood
• Impact more pronounced in some
• But we never really knew WHY...
UNTIL NOW?
• Many highly processed foods have
ingredients (emulsifiers) that
negatively impact gut microbiota!
198. THE ROLE OF THE DIETITIAN
• Dietary intake
• Nutritional needs
• Regular feeding patterns
• Healthy weight goal
• Food fears, restrictions, rules
• Feelings/emotions around food
• Medical nutrition therapy
199. WHAT IS YOUR FOOD PHILOSOPHY?
“All foods fit. But not all foods fit
for all people. And just because
the food industry manufactures
and sells it, does not mean we
have to include it.”
200. WHAT CAN THE RDN DO AS A MEMBER OF
THE TREATMENT TEAM?
Every patient who walks into substance abuse
treatment should be assessed by a dietitian!!!
• Screen for ED and other dysfunctional/disordered food behaviors
• Request nutrition-related labs for high-risk patients
• Run groups and offer individual counseling (Nutrition Therapy)
• Collect data and publish findings (that means YOU!)
• Develop educational curriculum, life skills experiential therapies
• Plan special events ex: Supermarket Tours
• Attend treatment planning and staff meetings
• Work w/ doctors/therapists/counselors to help achieve treatment goals
• Nutrition/exercise interventions to facilitate behavior change favorable to long-term
recovery and improved quality of life
• Audit the menu and suggest substitutions within the budget
• Food service and food safety improvements
• Work with the chef to improve the “food environment”
201. WHAT’S NEXT?
• RDN integrated member of the
treatment team!
• Individual counseling
• Educational groups
• Approves all food/beverage
• Meal/snack planning
• Supermarket tours & meal outings
• Treatment planning
SSRI = selective serotonin reuptake inhibitor (ex: Prozac)
Anyone eat in response to stress? What do you eat? (Probably not chicken breast)
“Self-medication with food”
CHO contributes to production of serotonin (drowsy)
Protein contributes to production of dopamine, norepinephrine (alert)
A major reason people take drugs is because they like what it does to their brain.
In the beginning it is to “feel good” and eventually it is to “feel better”.
Dopamine activity increases for drugs, food, sex, and other rewarding events.
Phenylalanine relatively widespread in food
Major brain chemical involved in addiction
Highly palatable foods, as well as sex and other rewarding events
GI discomfort includes both diarrhea and constipation
Easier to collect data from methadone patients
NAC reduced cocaine-seeking behavior in animal models
NAC appears to restore levels of glutamate in the nucleus accumbens, leading to reductions in drug-seeking behavior
Protein: meat, fish, dairy, nuts
Xerostomia = dry mouth
Probably because they do not want to piss off their sponsors.
Two words: No comment
OK two more: Professional Integrity
White flour rapid mouth meltdown, rapidly becomes sugar.
And for some people: refined grains
Dynamic Contrast
AN + AUD: Alcohol to impact hunger-fullness cues, adds empty calories
AUD + AN: Alcoholic anorexia
BN + AUD: use alcohol to induce vomiting
AUD + BN: other forms of purging (diuretics, laxatives, diet pills)
BN + SUD: stimulants such as meth for purging
SUD + BN: meth probably most common
BED + SUD: use drugs but real issue is food
SUD + BED: binge eat when no drugs around
Common for individuals recovering from SUD to experience additional psychiatric symptoms
More sensing receptors than oral cavity
Dieting causes a rise in ghrelin. Protective mechanism against starvation.
Brain AND gut have a memory of foods eaten in the past, including taste AND calories.
None of the male participants reported losing weight or appetite suppression as a reason for using cocaine (unlike many females)
Higher fat intake, less fat storage
Decreased plasma leptin with a high fat diet suggests an impaired energy balance (leptin inhibition). This imbalance is what leads to weight gain.
Dysfunctional eating predates beginning of use for many as well
Focusing on single vitamins and amino acids is futile
Not to mention hypervitaminosis
Beware of individuals who make outrageous claims related to the efficacy of vitamin and amino acid therapy.
Nutrition education should emphasize what to eat, not what not to eat.
6 months: assuming balanced diet
Nutrition should be introduced as a helpful rather than punitive part of the recovery process
Fiber supplements can be used to maintain gradual and progressive weekly increases if oral intake is poor
As always, increased water intake should accompany increased fiber with a goal of 2-3 L/day
Higher caloric needs for leptin restoration
Weight gain should be gradual as opposed to immediate.
Again, gradual weight gain compared to drastic.
It is unknown if copper-chelating agents would be useful intervention
Many patients with SUD have an aversion to processed foods because it acts on their brain similarly to drugs, leading to overconsumption
Ginger bread house “exposure therapy” not necessary