You may be wondering how an activity can bring about brain-chemistry changes if no addictive substance as such is ingested. The explanation lies in a better understanding of the relationship between body, mind and biochemistry.
The power of our thoughts and feelings
All our thoughts, feelings and actions affect brain chemistry; and brain chemistry affects our thoughts, feelings and actions. You have no doubt heard about the ‘power of positive thinking’. There is also power in negative thinking. Happy thoughts cause a release of chemicals in the body. So do angry thoughts, sad thoughts and worry thoughts. Were you ever in physical or emotional pain and then smiled because of something sweet your child or pet did and then realised that your pain was diminished? Were you ever feeling great and then happened to think about some disturbing situation that caused you to feel tired or perhaps develop a headache? These are examples of the power of our thoughts and feelings.
Our thoughts and actions
Even more powerful than thoughts and feelings are our actions. Think about a time when your child or pet did something amusing and you laughed out loud. How did you feel? A full body laugh changes your brain chemistry for 45 minutes. We refer to these as endogenous (inner) opioids because the release of this brain neurotransmitterA neurotransmitter is a chemical messenger that carries signals between body cells. They are various types of neurotransmitters which play a major role in everyday… is not triggered by something you consume; it comes from within.
There are activities that change our biochemistry so much that we want to do them over and over. Some people get a biochemical response from shoplifting or inappropriate sex that is equal to, or greater than, a heroin injection. Nature has given us natural substances in the brain to give us pleasure and a sense of reward, and to mediate pain. These neurotransmitters work to give pleasure as well as relieve physical as well as emotional pain. People born with the inability to feel good will look for ways to stimulate the release of these chemicals.
The neurotransmitters that are released from risk-taking or sex are metabolised through the same dopamineDopamine is a neurotransmitter (chemical messenger) found within the brain. It has a variety of influences on brain function including playing a role in regulating… pathway as cocaine, heroin or alcohol. And if the person has a reward deficit that predisposes to addiction, the activity that works will be repeated as often as necessary to get the desired reward. For the person predisposed to addiction the chosen activity will rapidly go from self-medication to addiction.
Work addiction is fairly common in our society because overworking is applauded and rewarded. And the painful consequences of overworking may not be as apparent or recognised as activities that do not have the same kind of social payoff. But work addiction is not the same as the compulsion to achieve. Some people get their biochemical payoff from the act of working whereas others get it from the accomplishment that results.
Risk-taking and gambling addiction are much the same. That is one of the reasons that this is such a difficult behaviour to control – it just changes forms. For some people gambling addiction takes the form of shoplifting or other behaviours that carry a risk of getting caught. The euphoria of shoplifting does not lie in the item taken but in the mood-altering event of taking it. If the item were free, it would not bring the same pleasure.
Case Study: Ben
Ben developed an addiction to casino gambling. His family and friends were quite astonished by this behaviour because even gambling on cards was not customary for him. A friend talked him into going to the casino the first time, where he discovered a game that was a combination of skill and luck; and the challenge of it hooked him immediately. He won, and it was exhilarating. He went back the next night – and the next. It was not long before he found himself thinking about and anticipating going again. Before long he was leaving work during the day (he was self-employed) and neglecting his business. He was winning, and the euphoria of that was beyond anything he had ever experienced with any kind of substance he had ever used. When he began losing, he was sure that the next time he would make it back.
It was not until his wife threatened to leave him that he went to Gamblers Anonymous and, with a great struggle, gave up the casino. However, the craving was intense and he was soon satisfying it with cars. He started buying cars – Porches, Lamborghinis and Aston Martins – and driving them at 120 miles an hour. He got caught and found himself in trouble with the law. That is when he realised that he had not stopped gambling; it had just taken another form.
N-acetyl cysteine may help reduce gambling and other addictions
Recent research indicates that supplementation with N-acetyl cysteine (NAC) may reduce addictive behaviour in compulsive gamblers as well as individuals with other addictions.
NAC is thought to restore extra-cellular concentrations of the chemical glutamate, which is often associated with good feelings of reward in the brain. This led researchers to believe NAC could have a promising role to play in minimising addictive behaviour. The researchers enrolled 27 pathological gamblers (12 women) in an eight-week trial of NAC. The first part of the study was an open trial where subjects each consumed daily doses of NAC. In this part of the study, 16 of the 27 subjects (59.3 per cent) reported that they experienced less urges to gamble. The effective dose of NAC ranged from 1,100mg to 1,700mg per day.
Of those 16 subjects, 13 went on to participate in a double-blind, randomised, placebo-controlled trial of NAC. Of those subjects given NAC, 83.3 per cent experienced a reduced compulsion to gamble compared with only 28.6 per cent of those assigned to a placebo.
The study authors concluded, ‘The efficacy of NAC lends support to the hypothesis that pharmacological manipulation of the glutamate system might target core symptoms of reward-seeking addictive behaviours such as gambling. Larger, longer, placebo-controlled, double-blind studies are warranted.’
Similar studies of NAC have shown it can curb drug addictions in animals. However, the researchers of the current study believe their study was the first to look at the effects of a glutamate-modulating agent in pathological gamblers. The researchers are currently investigating whether NAC could help methamphetamine users to give up.
The role of low serotonin
An addiction can overcome reason. In sex addiction the person – even someone who is high achieving – may risk everything of value to him or herself in order to satisfy their need for out-of-bounds sexual activity. People who are sexually promiscuous are consistently found to have low brain serotoninSerotonin is a hormone found naturally in the brain and digestive tract. It is often referred to as the ‘happy hormone’ as it influences mood…. levels. Through sexual activity such a person is probably attempting to change his brain chemistry, by temporarily increasing serotonin levels.
Addiction and food
Food addiction is a combination of mood-altering substances and mood-altering behaviours. Certain foods are mood altering: allergies to milk and glutenGluten is a protein found in the cereals wheat, rye and barley. Obvious sources of gluten in the diet are bread, pasta, breakfast cereals and… grains change brain chemistry and result in morphine-like substances in the blood and brain called exomorphines. But failure to eat (anorexia) and purging (bulimia) are mood-altering activities. Karen Carpenter, the singer from The Carpenters, who died as a result of anorexia and bulimia, once said that she got high from the feeling of an empty stomach. Excessive dieting that does not reach the level of anorexia can be mood altering and addictive.
Understanding eating disorders
Eating disorders are complex mental-health conditions characterised by a ‘definite disturbance of eating habits or weight-control behaviour’ . As many as 1.15 million people may be affected by eating disorders in the UK, with important consequences for physical and mental health. Eating disorders rank fifteenth among the top 20 causes of disability in women with an average length of recovery of five to six years.
Anorexia nervosa and bulimia nervosa are probably the best known of the conditions. Although both involve restricted food intake, anorexia is characterised by extreme weight loss, whereas bulimia is characterised by episodes of binge eating and purging to control weight. There is also a further category: ‘eating disorder not otherwise specified’ (EDNOS), a catch-all term for situations where an individual has many of the features of an eating disorder but they are either not severe enough or do not last for long enough to justify a diagnosis of anorexia or bulimia. Many people with eating problems probably fall into this category.
Eating disorders frequently feature in the media and are surrounded by many myths, having been described as slimming diseases, developmental teenage fads, an attempt to avoid growing up, an obsession with food and weight and so on. Anorexia nervosa was first described as a separate disorder by Dr William Gull in 1874. It has the highest mortality rate for any psychiatric condition, from the effects of starvation or from suicide. Bulimia nervosa was first categorised as a distinct condition by Dr Gerald Russell in 1979. It is perhaps the most common of the disorders, although it may also be the easiest to hide.
Biochemical and physiological imbalances
People with eating disorders often eat nutrient-poor food, skip meals or eat very erratically. This may result in a number of underlying biochemical and physiological imbalances that can contribute to many of the symptoms associated with the conditions. The following are important areas to consider:
Blood sugar imbalance and insulin resistance
Dieting, skipping meals and bingeing on foods high in sugar and refined carbohydrates can lead to low blood sugar levels, cravings and desensitisation of cells to insulinInsulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood…. (Johnson et al., 1994).
When neurotransmitters are present in sufficient amounts, mood and emotions are stable; when they are depleted, or ‘out of balance’, however, individuals may overeat (particularly sweet and starchy foods) or starve, simply to try to manage their mood.
In eating disorders there may be a particular link to disturbed serotonin metabolismMetabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it…. Serotonin is a neurotransmitter that plays a role in controlling carbohydrateCarbohydrates are the primary source of energy for the body as they can be broken down into glucose (sugar) more readily than either protein or… intake, promoting sleep and managing impulsive and obsessional behaviours. It is made from tryptophan, an amino acid found in foods such as milk, cottage cheese, poultry, turkey and chicken, eggs, red meats, soya beans, tofu and almonds. Vitamin B6, zincWhat it does: Component of over 200 enzymes in the body, essential for growth, important for healing, controls hormones, aids ability to cope with stress… and insulin are also needed for serotonin production. Dieting has been shown to deplete levels of tryptophan very quickly, particularly in women. Vomiting suppresses serotonin levels as the body loses the essential nutrients required for serotonin production, and altered serotonin function may persist even after recovery from anorexia and bulimia nervosa. Low serotonin may also give rise to some of the personality traits commonly seen with bulimia e.g. depression, impulsiveness, irritability and mood swings.
An eating disorder places considerable stress on the body and on the adrenal glands that produce stress hormones. Adrenal stress can also disrupt the production of other hormones particularly in the thyroid and the ovaries. Where the diet is low in grade-1 proteinProteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of… – for example, in some vegetarian and vegan diets – the risk of adrenal fatigue may be greater because of a lack of amino acidsAmino acids are commonly known as the building blocks of protein. There are 20 standard amino acids from which almost all proteins are made. Nine… and nutritional co-factors for hormone production. Vegetarianism is more common in those with eating disorders (particularly anorexia nervosa) than in the general population and may often justifiably be considered part of the pathology of the conditions.
Food intolerances and addictions
Certain foods may have a mood-altering effect in some people. Sugar may affect neurotransmitters such as serotonin and dopamine and the release of endorphins. In 2002 it was demonstrated that rats tended to binge eat when given food and sugar-water after food deprivation for 12 hours. In addition, the rats showed signs of withdrawal-like anxiety when researchers blocked their brains’ opioid system. Also in 2002, it was demonstrated that just the sight or smell of food can spike levels of the neurotransmitter dopamine even if the study subjects did not eat the food and hence had no pleasure associated with it.
Incomplete digestion of proteins, such as casein and gluten, may stimulate the production of opioid peptides that can contribute to an ‘addictive’ sensation and result in food cravings. The consumption of highly palatable sweet foods and alcohol can also stimulate endogenous opioid peptide activity and promote analgesia, possibly reinforcing an individual’s preference for such foods.
Deficiency of essential fatty acids (EFAs)
People with eating disorders frequently avoid fatThere are many different types of fats; polyunsaturated, monounsaturated, hydrogenated, saturated and trans fat. The body requires good fats (polyunsaturated and monounsaturated) in order to… in their diet. However, low-fat diets have been associated with endocrine disruption and depression.
Low zinc status
In the 1970s, a number of researchers noticed that the symptoms of anorexia were similar in some respects to those of zinc deficiency, giving rise to a hypothesis that zinc supplementation might be useful for treating anorexia and possibly also bulimia. A number of small trials have been carried out to supplement zinc for patients with anorexia as they started to eat and gain weight, with some improvements in weight gain, mood, emotional state and menstrual function. The researchers therefore concluded that individuals with anorexia and bulimia might have zinc deficiency. However, the complexity of treating eating disorders indicates that low zinc status is clearly neither the whole story nor the root cause of the conditions, and the administration of single supplements is not recommended (NICE, 2004).
The gastrointestinal effects of starvation and binge eating may result in symptoms such as constipation, early satiety and bloating. There may also be disturbances in satiety mechanisms normally controlled by cholecystokinin (CCK), grelin, neuropeptide Y (NpY), serotonin, leptin, and endorphins secondary to disturbed eating patterns and weight loss.
Optimum nutrition for eating disorders
There have always been differing views as to whether nutritional approaches or psychological treatments hold the key to successful recovery from an eating disorder. Although more research is needed into the efficacy of nutritional approaches, there is recognition that the disorders do have nutrition-related aspects and that combining both physical and psychological treatment approaches may improve the chance of recovery.
Nutritional approaches to eating disorders can be useful for:
Focusing on the quality of food and nutrient intake to rebalance physiology and biochemistry and improve mental and emotional health.
Providing appropriate nutrition education and support to help people change their behaviour with food.
Teaching people about energy balance, body-weight regulation and the physical consequences of purging behaviours.
Helping people to give up compulsive dieting and weighing.
Addressing concerns regarding longer-term complications such as infertility and osteoporosis.
Supporting the delivery of psychological treatments and the use of any medication.
However, it is vital to remember that eating disorders are complex mental-health conditions with potentially serious complications. Care must include psychological treatments, regular medical monitoring, and possibly medication. Nutritional counselling should not be offered as a sole treatment, although it may be part of a multi-disciplinary approach. Hospitalisation should be considered for those people who do not respond to outpatient treatment, if weight is very unstable or extremely low or if there are serious physical complications or a risk of suicide.
(This section on Understanding Eating Disorders is reproduced with the kind permission of Jane Nodder, a nutritional therapist specialising in eating disorders.)
Join the Conversation on our Facebook Page