copyright vera ingrid tarman, 2010 dangerousliaisons: comfort and food by vera ingrid tarman md,...

Copyright Vera Ingrid Tarman, 2010

DANGEROUSDANGEROUSLIAISONS:LIAISONS:Comfort andComfort andFood Food

by Vera Ingrid by Vera Ingrid TarmanTarman MD, M.Sc. FCFP, CASAMMD, M.Sc. FCFP, CASAM

copyright 2011copyright 2011


ASAM definition ofASAM definition of AddictionAddiction

A primary chronic disease of brain A primary chronic disease of brain reward, motivation,memory and related reward, motivation,memory and related circuitry. circuitry.

Dysfunction in these circuits leads to Dysfunction in these circuits leads to characteristic biological, psychological, characteristic biological, psychological, social and spiritual manifestations.social and spiritual manifestations.

This is reflected in an individual This is reflected in an individual pathologically pursing reward and / or pathologically pursing reward and / or relief by substance use and other relief by substance use and other behavioursbehaviours


AddictionAddiction

Inability to consistently Inability to consistently AbstainAbstain Impairment in Impairment in BehaviouralBehavioural control control CravingCraving or increased 'hunger' for or increased 'hunger' for

drugs or rewarding experiencesdrugs or rewarding experiences DiminishedDiminished recognition of recognition of

significant problems with behaviour significant problems with behaviour @ relationships@ relationships

A dysfunctional A dysfunctional EmotionalEmotional response response


Quiz Quiz

Recent American and Canadian Recent American and Canadian statistics indicate thatstatistics indicate that

2 / 3 of the population are overweight 2 / 3 of the population are overweight (BMI of >25) or obese (BMI >30)(BMI of >25) or obese (BMI >30)

Rates of obesity have doubled from Rates of obesity have doubled from 1960s (13 % to 32%)1960s (13 % to 32%)


QuizQuiz

The death rate for eating disorders is The death rate for eating disorders is approximatelyapproximately

a)a) 5%,5%,

b)b) 20%.20%.

c)c) 50%,50%,

d)d) minimal, any figure is just a scare minimal, any figure is just a scare tactictactic


QuizQuiz

What is the increased risk of death for What is the increased risk of death for people suffering from obesity?people suffering from obesity?

a)a) 10%10%

b)b) 50%50%

c)c) 80%80%

d)d) No difference. Diabetes, hypertension No difference. Diabetes, hypertension occur in all weight groups occur in all weight groups


Food AddictionFood Addiction

What are the main foods that are What are the main foods that are currently viewed as addictivecurrently viewed as addictive

a)a)SugarsSugarsb)b)StarchesStarchesc)c)FatsFatsd)d)SaltsSaltse)e)Any binge foodAny binge foodf)f) All of the aboveAll of the above

Copyright Vera Ingrid Tarman, 2010Limbic: The nature reward pathway


Reward CenterReward Center

Reward system related to Reward system related to matters of survivalmatters of survival: :

sex sex foodfood safety safety companionship, love, joycompanionship, love, joy


NeurotransmittersNeurotransmitters

Neurotransmitters involved in the Neurotransmitters involved in the brain and reward pathway are…....brain and reward pathway are…....

a)a) SerotoninSerotonin

b)b) DopamineDopamine

c)c) EndorphinsEndorphins


Drugs and the Reward CenterDrugs and the Reward Center

Drugs ‘hijack’ the reward center, Drugs ‘hijack’ the reward center,

the traditional ‘rewards’ become the traditional ‘rewards’ become secondary secondary

as these are not as as these are not as intense and intense and concentratedconcentrated as drugs as drugs


foodsex

gambling


Food - RewardFood - Reward

Notice which foods enhance the Notice which foods enhance the rewardreward neurochemistry: neurochemistry:

SerotoninSerotonin: warm milk, pasta, : warm milk, pasta, potatoes, bananas, turkeypotatoes, bananas, turkey

DopamineDopamine: sugar, white starches: sugar, white starches OpiatesOpiates: chocolate, sugar, dairy, : chocolate, sugar, dairy,

spicesspices


Eating DisordersEating Disordersand Obesityand Obesity

The Big Clinical The Big Clinical Question:Question:

Are Eating Disorders and Are Eating Disorders and Obesity an Addiction? Obesity an Addiction?


Standard TreatmentsStandard Treatments

Medications: Medications:

Appetite suppressants Appetite suppressants (Dexedrine)(Dexedrine)

Hormone based drugs (Leptin)Hormone based drugs (Leptin) Fat Absorption drugs (Orlistat)Fat Absorption drugs (Orlistat)



High dose anti depressants High dose anti depressants (Zoloft)(Zoloft)

Mood stabilizers (Topimax)Mood stabilizers (Topimax) Naltrexone (Revia)Naltrexone (Revia)



Bariatric Surgery:Bariatric Surgery:

Inhibit absorption of food Inhibit absorption of food (gastric bypass)(gastric bypass)

Or obstruct food intake (lap Or obstruct food intake (lap band)band)



Behavioral:Behavioral:

Residential or community Residential or community basedbased

to to moderatemoderate food intake of all food intake of all foodsfoods


Treatment for AddictionTreatment for Addiction

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


Food Addiction


HungerHunger

HungerHunger releases the hormone releases the hormone gherlingherlin from the stomach which from the stomach which activates activates dopaminedopamine

This creates cravingsThis creates cravings Food cues i.e. smells, sights, Food cues i.e. smells, sights,

tastes also creates cravingstastes also creates cravings


Sugar Addiction?Sugar Addiction?Acts likeActs like a a DopamineDopamine

Some studies show that Some studies show that overweightoverweight people have a diminished dopamine people have a diminished dopamine response response

thus have more cravings thus have more cravings


Sugar Addiction?Sugar Addiction?

Sugar also releases our own Sugar also releases our own endorphinsendorphins

Fats have also been Fats have also been implicatedimplicated

relieves pain and gives a relieves pain and gives a sense of well beingsense of well being


Sugar WithdrawalSugar Withdrawal

After a few weeks of sugar After a few weeks of sugar binging, rats will show opiate binging, rats will show opiate withdrawal …withdrawal …

if given Naltrexoneif given Naltrexone


SatiationSatiation

The stomach also gives the The stomach also gives the feedback to stop eatingfeedback to stop eating

A A fullfull stomach releases the stomach releases the hormone hormone leptinleptin, leads to appetite , leads to appetite satiationsatiation

Prader – Willi SyndromePrader – Willi Syndrome


Dieting: Dieting: a Gateway to Drugs?a Gateway to Drugs?

During fasting, anticipatory During fasting, anticipatory dopamine is dopamine is not not selective for selective for food rewards food rewards

dieting increases the rewarding dieting increases the rewarding effects of most drugseffects of most drugs. .


Why do Alcoholics Love Why do Alcoholics Love Sugar?Sugar?

SubstitutionSubstitution!!

Alcohol AND Food, enhances:Alcohol AND Food, enhances:

EndorphinEndorphin DopamineDopamine SerotoninSerotonin


Gateway for DrugsGateway for Drugs

Cross sensitization occurs with Cross sensitization occurs with amphetamines amphetamines and and sugarsugar

when the rat are given when the rat are given amphetamines, amphetamines,


SummarySummary::Food AddictionFood Addiction

1.1.A Neurochemical excess of A Neurochemical excess of serotonin, dopamine and serotonin, dopamine and endorphinsendorphins

2.2. heightens reward heightens reward in the in the limbic brain limbic brain


Summary of Food AddictionSummary of Food Addiction

3. 3. Trigger Foods stimulate Trigger Foods stimulate excess excess neurochemicals. neurochemicals.

4.4. This is exaggerated when This is exaggerated when starving, starving, over eating and purgingover eating and purging

55. Binge. Binge of neurochemicals of neurochemicals over rideover ride the normal checks and balancesthe normal checks and balances


Summary of Food AddictionSummary of Food Addiction

6. Which fosters 6. Which fosters addictive addictive eatingeating behaviors behaviors

7. Gateway to substance 7. Gateway to substance useuse

copyright vera ingrid tarman, 2010 dangerousliaisons: comfort and food by vera ingrid tarman md,...

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