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Mine the complexities of treating food addiction

October 1, 2014
by James Greenblatt, MD
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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).