copyright vera ingrid tarman, 2010 dangerousliaisons: comfort and food by vera ingrid tarman md,...
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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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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%)
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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, 2010
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
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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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
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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?
Copyright Vera Ingrid Tarman, 2010
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)
Copyright Vera Ingrid Tarman, 2010
Standard TreatmentsStandard Treatments
High dose anti depressants High dose anti depressants (Zoloft)(Zoloft)
Mood stabilizers (Topimax)Mood stabilizers (Topimax) Naltrexone (Revia)Naltrexone (Revia)
Copyright Vera Ingrid Tarman, 2010
Standard TreatmentsStandard Treatments
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)
Copyright Vera Ingrid Tarman, 2010
Standard TreatmentsStandard Treatments
Behavioral:Behavioral:
Residential or community Residential or community basedbased
to to moderatemoderate food intake of all food intake of all foodsfoods
Copyright Vera Ingrid Tarman, 2010
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?
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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
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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. .
Copyright Vera Ingrid Tarman, 2010
Why do Alcoholics Love Why do Alcoholics Love Sugar?Sugar?
SubstitutionSubstitution!!
Alcohol AND Food, enhances:Alcohol AND Food, enhances:
EndorphinEndorphin DopamineDopamine SerotoninSerotonin
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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,
Copyright Vera Ingrid Tarman, 2010
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
Copyright Vera Ingrid Tarman, 2010
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