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Vera Ingrid Tarman, MD  
Female
Toronto

Specialties: food addiction, Addiction, drug addiction

Interests: Addiction Medicine, Addiction

Addictions Unplugged
Founder & Medical Director
Toronto
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Binge Eating Disorder in the DSM 5: Good News or No News for the Food Addict?

Jan 25, 2013 - 6 comments
Tags:

binge eating disorder

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food addiction

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DSM-V

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Phil Werdell



Binge Eating Disorder in the DSM 5: Good News or No News for the Food Addict?

For those of us working in the field of food addiction, the DSM-1V (Diagnostic and Statistics Manual) has been a poor reflection of our clinical reality. The highly controversial DSM-V, expected to be released in May 2013, may not be much of an improvement for the food addict.

Food addiction is not a medically recognized diagnosis under the DSM-1V schema. This has left dire consequences for the food addict. Without official recognition, treatment for food addiction has not been funded by any insurance provider, nor has it been offered by any major health care provider: nutritionists, dieticians, physicians have not yet recognized its existence nor proposed our recommended treatment  (abstinence from triggering addictive foods) as a healthy solution.

We have not been alone in our discontent over this diagnosis tool of the American Psychiatric Association. There has been a great deal of advocacy towards reforming the DSV-1V, and there has been ongoing controversy over the proposed DSM-Vs anticipated changes. Advocates of various hitherto excluded disorders  (such as food addicts) have attempted to get their concerns included into the psychiatric cannons of treatment, while others have been  eager to challenge the overarching ambition of psychiatry to medicalize (with the implicit intention to treat with pharmaceuticals) much of normal behaviour.  

Those working in the eating disorders field have achieved landmark success in getting "Binge Eating Disorder" recognized as a clinical entity that exists apart from Anorexia or Bulimia. This diagnosis may now include persons who suffer from the uncontrollable urge to eat large amounts of food (usually in intermittent sessions) without having to include many of the weight restricting behaviours that bulimics or anorexics engage in, i.e. vomiting, over exercise, use of laxatives. Thus many of those who are obese can now get treatment, outside of bariatric surgery, that can be funded.  

Does this help the food addict? The big question is this: Are all food addicts also suffering from binge eating disorders? While there is likely a high degree of overlap in these two groups, indeed many food addicts binge eat when in active addiction, it is important to note that they are NOT necessarily suffering from the same condition of Binge Eating Disorder. They are not the same thing. They may appear to look the same on the outside: a person overeating a large amount of food without control - but the reasons behind this behaviour are fundamentally different. The food addict is dancing to a different drummer, though the tune may look the same.

The person who is suffering from a Binge Eating Disorder is responding to social and emotional psychological cues that have disinhibited the eating behaviour. Something has prompted the person, such as previous emotional trauma stemming from childhood, sexual abuse, or current environmental stresses, to over eat in an attempt to self medicate their emotional distress.

The food addict, alternatively, is responding to the cravings created by the physical quality of food itself.  If the food addict does not pick up the first taste of sugar (or any other their trigger foods), they may not need to over eat, regardless of emotional state - calm or distressed, emotional internal or external havoc.These states of mind do  not create the overpowering drive to overeat. Certainly emotions can trigger a person to want to eat, but the control is lost truly when the food has ignited the reward pathway in the limbic brain. It is not what is eating you (Binge Eating Disorder), but what you are eating (Food addiction) that is the problem.

This distinction is important. Treatment for a person suffering from the new Binge Eating Disorder category is to heal the depression, anxiety, post traumatic stress,  so that the person does not need to self medicate with food or abnormal eating behaviours. Treatments include cognitive therapy, mindfulness and medications. They are taught how to eat all foods moderately, in the hopes that they were join "normal society" once their psychological conditions have been addressed, even resolved. The food addict, on the other hand, will never eat a "normal diet" and while psychological issues are important to sustain long term recovery, the essential first treatment for the food addict is to stop the drug that is creating the loop of addictive eating: sugar, refined starches, other trigger foods. Treatment includes abstinence from the triggering foods, peer support to encourage ongoing vigilance, and often a spiritual dimension needs to be tapped into to maintain long term recovery.

Without a diagnosis of Food Addiction, nothing much has changed with the proposed changes for 2013. We will have many food addicts funnelled under the new categorization of Binge Eating disorder, and they will probably be given treatment that could ultimately undermine their recovery. Modified diets do not work for the food addict. Advances have been made but for food addiction, still more work needs to be done.

I would like to acknowledge the painstaking work of Phil Werdell (see foodaddictioninstititute.org) for his work in lobbying the APA for food addiction's inclusion into the new DSM-V. He is a true pioneer: far sighted, dedicated and persistent.

For  more information of food addiction, see addictionsunplugged.com

Why is an Addiction Doctor talking about Food Addiction?

Jul 11, 2012 - 1 comments

Why is an Addiction Doctor writing about food addiction? Shouldn't it be a specialist treating eating disorders?

In the last six years of working at Renascent, I have seen over 1000 new patients for substance abuse disorders each year. This is has given me a large sampling from which to draw out some clinical patterns of behaviour from people who struggle with addiction and who are in the early stages of recovery. It has struck me from the outset that the phenomenon of addiction spans many substances: People who are addicted to alcohol frequently go on to develop an addiction to opiates. People who are addicted to cocaine come back to treatment for a new (or latent) addiction to alcohol. People who use marijuana to avoid opiate use end up as alcoholics.

Over the years, I have seen some typical patterns. A person would come into treatment to be treated for their alcoholism. They  eat voracious amounts of food, usually to their horror, frequently gaining as much as 20 - 30 pounds in the three weeks of treatment. They find that they are eating candies incessantly, and cookies, muffins, bread, potatoes at each meal.  Many would exclaim that they never ate that way before and find that they can not stop even if they want to. After treatment, this pattern of over eating and binge eating continues. It is as if they can not stop. I know of one heroin addict who quit his drug, only to start eating two large tubs of ice cream each night, every night. He knew he was eating dangerously. He had high blood pressure, he was obese, he was depressed. He died 10 years later, not from a heroin overdose, but from diabetes and a heart attack.

There was also a smaller group who admitted that prior to their own drinking problem, they used to eat for comfort - bags of chips or cookie or jars of peanut butter each night.  They stopped eating in this way when they picked up their drug of choice - often in adolescence. Once in treatment, they stopped their drug, and discovered that the same pattern of eating reemerged. When told that they had to quit eating in this way, the typical response was that would be impossible. Most said that to not eat sugar was harder than to stop drinking or drugging. One recovered cocaine addict who attempted to stop, actually left the treatment, visibly upset. He felt that to stop eating his nightly regime of junk food might destabilize his recovery from cocaine addiction.

I concluded that many people who were addicted to any of the drugs I have mentioned, quickly develop a new addiction to food. The foods they became addicted to are almost always the sugars and carbs which we provide in abundance at the centre - we call it the 'cheap and cheerful' foods. They are cheap, and they are mood altering: they provide a surplus of neurochemicals, namely dopamine, serotonin, and endorphins. And they are 'drugs'; the refined hyper palatable foods that we serve (muffins, pastry, popcorn, juices, candy) are not natural real food. They are artificially constructed chemicals that the food industry has created so that we become addicted to eat more and more of them. The surplus of neurochemicals that result create a heightened sense of wellbeing that is the same as a drug intoxication. Look on a SPECT scan, a specialized radiological study of part of the brain, and you could not tell the difference between a sugar high and a cocaine high.

Another pattern that I discovered were the people who had once suffered from anorexic disorders coming into treatment for cocaine or crack addiction. They often admitted that they used crack as a form of inhibiting appetite i.e. the 'Jenny Crack' diet. When they started to gain weight, most said that they would choose to return to their drug use rather than relapse fully back to anorexic behaviours (which was always operating just under the surface) or worse to them, adopted uncontrollable bulimic behaviour. It was obvious to me that they were struggling with the same disease of compulsion and obsession, with just slightly different manifestations.

I maintain that the anorexic, while not eating, is experiencing a dopaminergic euphoria. She or he is experiencing an altered agitated 'high' as they obsess about food like any drug addict would over their drug of choice. We know that hunger creates dopamine - and the reward value of food heightens the hungrier a person becomes. This is the body's attempt to entice the person to eat, to nourish itself.  The anorexic does not eat food, but as he or she gets hungrier, she or he instead anticipates food - in the food preparation, in the food obsessions, in how she or he 'plays' (but does not eat) the food, - this is a dopamine high which builds and builds the hungrier the person gets. And, importantly, it stops the moment food enters the body. Anorexics resist food the same way as the drug addict resists withdrawal from their drug.

This understanding is important. While an eating disorder may be a dual diagnosis alongside an addiction for some, it is just as likely a possibility that it IS part of the addictive disorder itself. If the person is a food addict, rather than suffering from a true eating disorder, then the typical treatment used for eating disorders is not only not helpful (hence the high rate of recidivism and relapse in eating disorders), but actually dangerous. A modified food plan based on our Canadian food pyramid will actually undermine recovery from the addiction to the specific foods.

And since the phenomenon of addiction does not favour one drug over another ultimately, it may even undermine recovery from the addiction to other drugs latent in the person's history. Food can be  a drug, like any other, and can fuel the addictive cycle which impedes recovery and sobriety. If you are a recovered alcoholic and addict, and are still suffering from depression, anxiety, insomnia and cravings.... look to your diet.

Breaking Food Addiction: The Story of Amber

Jun 19, 2012 - 1 comments
Tags:

food addiction

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Obesity

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Eating disorders



Nearly 4 years ago today Amber W. was struggling with her weight. At the same time she was struggling to fit into a society that puts blame and shame on the obese. But an involvement with a 12 step program put her on a path to truth of self, recovery and eventually life changing weight loss.

“Prior to being introduced to 12 steps, my life was about food and the acquisition of it,” said Amber. Only 48 months ago Amber weighed nearly 320 lbs with a dress size of 26. Tired of fad diets and breaking self promises, she turned to the help of the well-known 12 steps for addiction and as she put it ‘got real’ about her food addiction. She found a long term solution for her food issues in understanding the science of addiction to food and by committing herself to the 12 steps of addiction recovery.

Both Amber and her colleague Dr. Vera Tarman agree that weight loss is only a result of the recovery process for the food addict. Amber went from sneaking food and staying away from public interactions to becoming an advocate for food addiction in the public eye, truly a real life success story.

“The process of surrendering to addiction is difficult for most people,” said Dr. Tarman, Canada’s foremost food addiction expert. “For those people like Amber who embrace the science behind food addiction and the need to change the way they think and act; the results of recovery can be remarkable.”

Today Amber has lost over 150 lbs and more importantly is totally committed to the recovery process, including abstinence from sugars and starch. “It’s one day at a time for me, like it is for most people recovering from addiction”, noted Amber. Amber has taken control of her life and her story is one of breaking through the denial of her addiction and developing a passion for living life to the fullest.
Amber W. is now a key figure in the drive to educate people about food addiction.

If you would like more information about food addiction and related issues, please check out my website at addictionsunplugged.com

Lap Band Surgery: Is it an Option for the Food Addict?

Jun 19, 2012 - 0 comments

Lab Band Surgery is currently touted as the best solution for morbid obesity (a BMI over over 40, and in some cases over 35). What is it exactly? Is it Safe?

Unlike a Gastric By-Pass, which is a much more significant surgery – where by a portion of the intestine is actually removed or rerouted – a Laparoscopic Adjustable Band Surgery is the procedure where by an inflatable, adjustable bio-compatible strap is wrapped around the stomach. Both are examples of Bariatric Surgery. The lap band curbs a person’sappetite and limits how much food he or she can eat, thereby leading to weight loss. In fact, the available stomach left to hold food is a pouch that will hold only one half cup of food. In contrast, a normal stomach will hold six cups of food.

Success rates are touted to be over 50% of weight loss in the first two years. This can range from 30 – over 100 lb. However, only about 40% of people were able to maintain their weight loss successfully at the five year mark. Those were were successful were the one who were compliant with the recommended diet and exercise plan.

What is not highlighted in the press surrounding lap band surgery is that success depends on following the appropriate food plan. This includes most often changing the types of food the patient has been in eating in the past, as well as the quantities of food. What is also not emphasized is that if the patient were to make these changes in diet and eating alone, much of the same weight lost after the procedure would have occured – even without the procedure! This begs the question of if such a surgery, which bring a high rate of complications with it – is even necessary.

What are the complications? These include everything from discomfort in eating ie difficulty swallowing, bloating and nausea. Other more general symptoms are discomfort, such as indigestion and constipation.
More serious complications can be the lap band slippage to actual erosion of the band into the stomach, so that the device needs to be removed. While surgeons have improved the techniques markedly over the years, most studies point to at least 30 % of people suffering surgical complications. 20 per cent of patients required repeat surgery to deal with the complications. A most recent Belgian study found that 39 per cent of their surgical candidates experienced serious complications and nearly 50 per cent had the band removed within 12 years.

Most surgeons will agree that lap band surgery is most successful if their food plan is recommended. The plan? The following are typical suggestions:

Avoid:
Sugar and sugary foods, including: high-calorie soft drinks, syrups, honey, jelly, jam, cakes, cookies, candy, ice-cream.
High-fat foods, including: chocolate, chips, pies, pastries, ice-cream, bacon, sausage, fried foods, cream soups, cream sauces.
High-calorie drinks, such as milkshakes, soda, beer, orange juice, apple juice, other fruit juices, whole milk.
Starchy and white flour foods, such as pasta, rice, and doughy breads.
Fats such as butter or oil should be restricted to 3 to 4 teaspoons per day.

If a person changes their diet to accommodate these recommendations, weight loss will be achieved. If the person is unable to follow through on these recommendations, with or without surgery – their food addiction will need to be addressed. Lab Band surgery will not address the underlying food addiction dynamic which may contribute to the inevitable and discouraging weight regain.

If you would like to find out more about food addiction and related issues, please check out my website: addictionsunplugged.com