Copyright Vera Ingrid Tarman, 2010 DANGEROUSLIAISONS: Comfort and Food by Vera Ingrid Tarman MD, M.Sc. FCFP, CASAM copyright 2011

Copyright Vera Ingrid Tarman, 2010 ASAM definition of Addiction A primary chronic disease of brain reward, motivation,memory and related circuitry. A primary chronic disease of brain reward, motivation,memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursing reward and / or relief by substance use and other behaviours This is reflected in an individual pathologically pursing reward and / or relief by substance use and other behaviours

Copyright Vera Ingrid Tarman, 2010 Addiction Inability to consistently Abstain Inability to consistently Abstain Impairment in Behavioural control Impairment in Behavioural control Craving or increased 'hunger' for drugs or rewarding experiences Craving or increased 'hunger' for drugs or rewarding experiences Diminished recognition of significant problems with relationships Diminished recognition of significant problems with relationships A dysfunctional Emotional response A dysfunctional Emotional response

Copyright Vera Ingrid Tarman, 2010 Quiz Recent American and Canadian statistics indicate that  2 / 3 of the population are overweight (BMI of >25) or obese (BMI >30)  Rates of obesity have doubled from 1960s (13 % to 32%)

Copyright Vera Ingrid Tarman, 2010

Quiz The death rate for eating disorders is approximately a) 5%, b) 20%. c) 50%, d) minimal, any figure is just a scare tactic

Copyright Vera Ingrid Tarman, 2010 Quiz What is the increased risk of death for people suffering from obesity? a) 10% b) 50% c) 80% d) No difference. Diabetes, hypertension occur in all weight groups

Copyright Vera Ingrid Tarman, 2010

Food Addiction What are the main foods that are currently viewed as addictive a) Sugars b) Starches c) Fats d) Salts e) Any binge food f) All of the above

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

Copyright Vera Ingrid Tarman, 2010 Reward Center  Reward system related to matters of survival:  sex  food  safety  companionship, love, joy

Copyright Vera Ingrid Tarman, 2010 Neurotransmitters Neurotransmitters involved in the brain and reward pathway are….... a) Serotonin b) Dopamine c) Endorphins

Copyright Vera Ingrid Tarman, 2010

Drugs and the Reward Center  Drugs ‘hijack’ the reward center,  the traditional ‘rewards’ become secondary  as these are not as intense and concentrated as drugs

Copyright Vera Ingrid Tarman, 2010 food sex gambling

Copyright Vera Ingrid Tarman, 2010

Food - Reward Notice which foods enhance the reward neurochemistry:  Serotonin: warm milk, pasta, potatoes, bananas, turkey  Dopamine: sugar, white starches  Opiates: chocolate, sugar, dairy, spices

Copyright Vera Ingrid Tarman, 2010 Eating Disorders and Obesity The Big Clinical Question:  Are Eating Disorders and Obesity an Addiction?

Copyright Vera Ingrid Tarman, 2010 Standard Treatments Medications:  Appetite suppressants (Dexedrine)  Hormone based drugs (Leptin)  Fat Absorption drugs (Orlistat)

Copyright Vera Ingrid Tarman, 2010 Standard Treatments  High dose anti depressants (Zoloft)  Mood stabilizers (Topimax)  Naltrexone (Revia)

Copyright Vera Ingrid Tarman, 2010 Standard Treatments Bariatric Surgery:  Inhibit absorption of food (gastric bypass)  Or obstruct food intake (lap band)

Copyright Vera Ingrid Tarman, 2010 Standard Treatments Behavioral:  Residential or community based  to moderate food intake of all foods

Copyright Vera Ingrid Tarman, 2010 Treatment for Addiction  How would treatments differ if eating disorders were viewed as an Addiction?

Copyright Vera Ingrid Tarman, 2010

Food Addiction

Copyright Vera Ingrid Tarman, 2010 Hunger  Hunger releases the hormone gherlin from the stomach which activates dopamine  This creates cravings  Food cues i.e. smells, sights, tastes also creates cravings

Copyright Vera Ingrid Tarman, 2010 Sugar Addiction? Acts like a Dopamine  Some studies show that overweight people have a diminished dopamine response  thus have more cravings

Copyright Vera Ingrid Tarman, 2010 Sugar Addiction?  Sugar also releases our own endorphins  Fats have also been implicated  relieves pain and gives a sense of well being

Copyright Vera Ingrid Tarman, 2010 Sugar Withdrawal  After a few weeks of sugar binging, rats will show opiate withdrawal …  if given Naltrexone

Copyright Vera Ingrid Tarman, 2010 Satiation  The stomach also gives the feedback to stop eating  A full stomach releases the hormone leptin, leads to appetite satiation  Prader – Willi Syndrome

Copyright Vera Ingrid Tarman, 2010 Dieting: a Gateway to Drugs?  During fasting, anticipatory dopamine is not selective for food rewards  dieting increases the rewarding effects of most drugs.

Copyright Vera Ingrid Tarman, 2010 Why do Alcoholics Love Sugar? Substitution ! Alcohol AND Food, enhances:  Endorphin  Dopamine  Serotonin

Copyright Vera Ingrid Tarman, 2010 Gateway for Drugs  Cross sensitization occurs with amphetamines and sugar  when the rat are given amphetamines,

Copyright Vera Ingrid Tarman, 2010 Summary : Food Addiction 1. A Neurochemical excess of serotonin, dopamine and endorphins 2. heightens reward in the limbic brain

Copyright Vera Ingrid Tarman, 2010 Summary of Food Addiction 3. Trigger Foods stimulate excess neurochemicals. 4. This is exaggerated when starving, over eating and purging 5. Binge of neurochemicals over ride the normal checks and balances

Copyright Vera Ingrid Tarman, 2010 Summary of Food Addiction 6. Which fosters addictive eating behaviors 7. Gateway to substance use 7. Gateway to substance use