Carb addiction and withdrawal.

Assessment: Hunger and Disorganized Eating

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

 

 

 

 

 

 

 

 

 

 

 

 

Hunger and Disorganized Eating

Most patients and clinicians think of hunger as the physical pangs felt in the vicinity of the stomach (growling, moving, gurgling, constricting) combined with a desire to eat. We refer to this as physical or homeostatic hunger.

Many patients will deny that they ever feel physical hunger, and yet they find themselves eating in a manner that is inconsistent with their weight-management goals. These patients often refer to themselves as “emotional eaters" or “stress eaters" and commonly blame their lack of dietary control on abstract factors such as willpower, stress, depression, anxiety, boredom, and habit.

Emotional eating is the practice of consuming comfort foods or junk foods in response to feelings other than physical hunger. This can best be described as emotional or hedonistic hunger. We can call it appetite.

Emotional eating has a partially biological basis in that it appears to involve serotonin-releasing brain neurons — and the release of serotonin is controlled by food intake. Carbohydrate consumption in particular leads to the secretion of insulin, and the resultant insulin-mediated change in the body’s plasma tryptophan ratio increases the release of serotonin. Protein intake does not stimulate insulin production and consequently does not produce the same effect. Because serotonin release is also involved in functions such as falling asleep, sensitivity to pain, blood pressure regulation, and mood control, many patients learn to overeat carbohydrates (particularly snack foods like potato chips or pastries, which are rich in both carbohydrates and fats) to make themselves feel better. Such patients are, in effect, self-medicating with food. This tendency appears in patients who gain weight during stressful periods of life, in women with severe premenstrual syndrome, in patients with SAD or depression, and in patients who are trying to stop smoking. (Nicotine, like dietary carbohydrates, increases brain serotonin secretion, while nicotine withdrawal decreases it.)

Other central neurotransmitters like the endocannabinoid system and the dopaminergic system may also be involved in the impulse to ingest certain foods to improve mood or alleviate physical symptoms.

Interestingly, most patients report having a time of day at which they find it most challenging to maintain dietary control, and other times of day at which they have no difficulties whatsoever.

Based on anecdotal evidence from many patients, we wonder whether emotional eaters should be divided into primary and secondary sub-groups. The majority of self-proclaimed emotional eaters would fall into the secondary sub-group, who only tend to eat emotionally from mid-afternoon onwards. While these individuals may have a heightened physiologic response to carbohydrates and use food to self-medicate, the fact that they do not struggle with emotional eating in the mornings suggests that some other factor is needed to trigger their eating behaviours. Many of these secondary emotional eaters admit to skipping or having very light breakfasts, no mid-morning snack, and sometimes light lunches. We wonder whether or not it is possible that these secondary emotional eaters require the combination of an emotion with a physiologic mechanism such as increased ghrelin, generated as a result of their disordered eating patterns that combine synergistically to trigger binge behaviours.

Given the incredibly important role of eating in the evolutionary development of every organism, we are tempted to expand the definition of hunger to include not only overt physical symptoms, but also appetite-mediated food cravings and food compulsiveness that trigger behaviours such as binge eating, emotional eating, and night eating in predisposed individuals. These behaviours often involve a loss of restraint, and individuals with a predisposition to this type of temporal disinhibition may be manifesting heritable mechanisms that evolved to allow for excess intake during times when food was only intermittently available.

Primary emotional eaters, on the other hand, self-medicate with food all day long in response to emotions and stressors. Rarer than secondary emotional eaters, these individuals are often much more difficult to treat and may well benefit from counselling from a clinical psychologist.

 

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.