Mine the complexities of treating food addiction

Treating food addiction is like trying to solve a Rubik’s Cube puzzle. You need to think several steps ahead, anything you do will affect something else, each encounter is different, and the overall experience is complex and challenging.

In most cases, individuals with food addiction or other forms of disordered eating have co-occurring disorders. One study found that about 80% of patients with binge-eating disorder and 95% of patients with bulimia met criteria for at least one other diagnosis. Researchers have found that up to three-quarters of people with eating disorders also have depression, 10% have bipolar disorder, and 40% show signs of obsessive-compulsive disorder (OCD). In addition, 15 to 40% of patients with eating disorders struggle with substance abuse.

Treatment of food addiction is difficult, but it’s exponentially more difficult when other disorders are involved, as they all must be treated concurrently. Medical, behavioral, psychological and nutritional issues also must be addressed. Different patients respond to different treatments. Much also depends on the stage of the patient’s disorder and the patient’s body chemistry.

Food addiction has similarities to drug addiction. When some individuals digest excessive quantities of sugar and fat, they experience a high, followed by withdrawal and cravings—similar to what is experienced when ingesting opiate drugs.

When a person is addicted to food, his or her body chemistry is out of balance. The New Hope Model of treatment that I have used with thousands of patients adapts to the individual, based on the person’s unique body chemistry, to restore balance and break the addictive cycle of binging. The course of treatment can be described along a five-step process.

Step 1: Address co-occurring disorders.

A team of professionals conducts a complete physical and psychiatric evaluation, including an inventory of drug and alcohol use. It is essential to identify the interplay among disorders. For example, a patient with depression may use food to self-medicate, while a patient with a family history of alcoholism may binge and purge. If the patient is to recover, all disorders must be diagnosed and treated concurrently.

Psychiatric disorders or genetic predispositions will hijack efforts to control appetite until they are successfully treated. Stabilizing the patient is of primary importance initially.

Sometimes treating food addiction can help with treatment of other disorders. For example, depression and binge-eating disorder result from imbalances in neurotransmitters. Restoring serotonin, a neurotransmitter linked to satisfaction, leads to emotional satisfaction and a sense of fullness after a meal.

Step 2: Conduct tests.

Disordered eating is usually caused by a deficiency of several nutrients. Yet few psychiatrists look at lab tests to assess health when they're treating eating disorders.

Most deficiencies are not evident from standard examinations. The nutritional assessment for disordered eating includes the tests on the list at the end of this article. Additional tests may be recommended, based on symptoms and screening results.

How does testing help? As one example, when amino acid precursors are in short supply, levels of corresponding neurotransmitters also may be low, and this can lead to loss of appetite control. All peptides, neurotransmitters and hormones involved in appetite are produced from amino acids obtained from a person’s diet. For example, serotonin, the “master appetite controller,” is manufactured from the amino acid tryptophan, while dopamine and norepinephrine come from phenylalanine.

As another example, adrenal glands are responsible for responses to stress, so measuring adrenal hormones such as cortisol indicates how the patient deals with stress. Cortisol can stimulate cravings for sugar, and tends to make cells resistant to insulin.

Step 3: Prescribe nutritional supplements.

Since disordered eating is often related to biochemical imbalances, treatment should incorporate biochemical interventions. To control appetite, the patient must experience fullness, rather than continue to crave more. Amino acids can help, as they form the molecular basis for neurotransmitters and neuropeptides, the keys to appetite control.1,2,3 Cravings decline in many patients soon after they begin taking amino acid supplements.

Low amino acid levels can result in abnormally low neurotransmitter and neuropeptide levels. When levels of the neurotransmitters serotonin, dopamine and norepinephrine are low, appetite disturbances may develop. Amino acid supplements are often the most important factor for optimizing appetite control, decreasing binging and sugar cravings, improving mood and diminishing anxiety.

But other supplements are also important. B vitamins affect mood and appetite regulation; B6 is a factor in serotonin synthesis. Inositol enhances insulin sensitivity and may be effective for treating depression. Low folate levels are linked to depression. Chromium improves insulin function and may ease depression, carbohydrate cravings and weight gain. Magnesium fights insulin resistance and depression. Zinc affects hormones and peptides that regulate the appetite; too little zinc is related to depression and anorexia. A deficiency or imbalance in essential fatty acids can contribute to depression, obesity and diabetes.

Once biochemical balance is restored, symptoms of food addiction often diminish or even disappear.

Step 4: Medicate, if necessary.

For some, medication or a combination of medications is also needed—especially when disordered eating co-exists with psychiatric conditions such as depression, anxiety or attention-deficit/hyperactivity disorder (ADHD).

Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), help decrease cravings and anxiety associated with binging and purging by blocking the reuptake of serotonin and increasing its availability in the brain. Topiramate (Topamax) helps normalize the neural systems involved in appetite regulation. Zonisamide (Zonegran) increases serotonin and dopamine. Stimulants can be useful for disordered eating patients struggling with ADHD. For patients who do not respond to other drugs, naltrexone can reduce cravings associated with foods.

Medications are not an easy fix, but can be part of an integrative approach to rebuild a healthy relationship with food.

Step 5: Make lifestyle changes.

Regular exercise and healthy eating should, of course, be among the lifestyle changes patients make as they seek to gain control over their appetite. But what else is needed? Eating regular meals is also important. Dieting, fasting, skipping meals, eliminating entire food groups, or purging has an effect opposite from that intended—it slows the calorie-burning rate and increases hunger. Eating meals on a reasonable schedule regulates metabolism and digestion.

Mindful eating also is important. It occurs when the patient devotes full attention to and is aware of all aspects of eating, including smells, tastes, thoughts and feelings.

Follow these steps and you’ll find that food addiction has one more similarity to a Rubik’s Cube puzzle: With persistence and the right approach, success can be achieved.

James Greenblatt, MD, is the Chief Medical Officer of Walden Behavioral Care in Waltham, Mass., and is the author of the book Answers to Appetite Control, which outlines the New Hope Model for Treating Food Addiction.

References

1. Kim M, Park J, Namkoong C, et al. Anti-obesity effects of alpha-lipoic acid mediated by suppression of hypothalamic AMP-activated protein kinase. Nat Med 2004;10:727-33.

2. Anton SD, Morrison CD, Cefalu WT, et al. Effects of chromium picolinate on food intake and satiety. Diabetes Technol Ther 2008;10:405-12.

3. Rondanelli M, Klersy C, Iadarola P, et al. Satiety and amino-acid profile in overweight women after a new treatment using a natural plant extract sublingual spray formulation. Int J Obes 2009;33:1174-82.

Pivotal tests

Laboratory testing for binge eating and food addiction includes tests for:

• Amino acids

• Celiac disease screening

• Complete Blood Count (CBC) with differential

• Comprehensive Chemistry Panel

• Copper level

• CoQ10 enzyme

• Cortisol: Adrenal Stress Test

• C-Reactive Protein (CRP)

• DHEA-S

• Essential fatty acids

• Estrogen and progesterone

• Folate and vitamin B12

• Food allergies

• Homocysteine

• Iron and ferritin

• Lipid panel (cholesterol, triglycerides)

• Magnesium

• Methylmalonic acid

• Thyroid function test

• Trace minerals

• Uric acid

• Urinary organic acids

• Urinary peptides