Eating Disorders, Addictions and Substance Use Disorders: Research, Clinical and Treatment Perspectives

Dr. Timothy Brewerton and Dr. Amy Baker Dennis have published an academic textbook "Eating Disorders, Addictions and Substance Use Disorders: Research, Clinical and Treatment Perspectives" and David A. Wiss, MS, RDN, CPT has contributed two chapters.

Find out more about the book and how to order it HERE

International Conference of Eating Disorders March 27-29, 2014 in New York City

Dr. Timothy Brewerton and Dr. Amy Baker Dennis have compiled an academic textbook titled "Eating Disorders, Addictions, and Substance Use Disorders: Research, Clinical, and Treatment Perspectives" which is currently in press through Springer Publishing. The aim of the textbook is to propose treatment modalities that address eating disorders and substance use disorders simultaneously, and is intended for both eating disorder and addiction professionals. Traditionally, these disorders have been addressed separately but experts are beginning to see a need to address them concurrently. David A. Wiss, MS, RDN, CPT, Registered Dietitian Nutritionist, is the primary contributor of a chapter titled "Nutrition Therapy for Eating Disorder, Substance Use Disorder, and Addictions" where the topic of Food Addiction is examined in connection to Binge Eating Disorder as well as substance abuse. Dr. Brewerton and Dr. Dennis will be conducting a workshop on topics related to co-occurring eating and substance use disorders and will be presenting new information at the International Conference on Eating Disorders March 27-29, 2014 in New York City. The Keynote Speaker at this highly acclaimed event is award-winning journalist Frank Bruni who will be discussing Food Addiction. The topic of Food Addiction has gained significant attention since the validation of the Yale Food Addiction Scale in 2008, and 2014 marks the year that Food Addiction becomes a widely accepted mainstream topic. 

Nutrition Therapy for Eating Disorders, Substance Use Disorders, and Addictions

David A. Wiss, MS, RDN, CPT, Registered Dietitian Nutritionist, owner of Nutrition In Recovery will discuss the importance of nutrition in addiction recovery with Dr. Ranae Norton on Wednesday, January 15 at 4:30pm PST.

For more information, click HERE

What is Nutrition In Recovery's Nutritional Approach to Binge Eating Disorder?

Binge Eating Disorder is now officially recognized as an eating disorder. More and more people are seeking treatment for this condition, which has been linked to Food Addiction.

Nutrition In Recovery owner David A. Wiss, MS, RDN, CPT specializes in the treatment of Binge Eating Disorder and Food Addiction. Find out more about his approach by clicking HERE

What Foods Have Addictive Potential?

Food in it's natural/unadulterated state is not addicting, while processed foods seem to cause problems for many people. Foods that have the most addictive potential include the following:

Refined grains

Added sugars

Artificial sweeteners

Added salts

Added fats (including refined oils)

Caffeine

Treatment for any addiction should involve abstinence for a period of time. While not possible to abstain from food, it is possible to abstain from highly concentrated by-products of food that are characterized by the aforementioned additives. Traditional eating disorder treatment typically ignores the impact of processed foods on the human brain, over-emphasizing the behavioral component of eating and the underlying issues, yet failing to address the importance of the substances ("food") that enter the human body. As the concept of food addiction gains popularity, I see a trend in people being willing to pay more for less ingredients. While this trend is not new, highly palatable foods will continue to be linked with dysfunctional eating behavior stemming from neural dysregulation. The transition towards abstinence from addictive food substances is best executed gradually as opposed to immediately. Once the brain is normalized ("recovery"), some foods with addictive potential can be handled by some individuals, in small doses. With respect to food addiction, the dose makes the poison. Meanwhile, failure to therapeutically address the underlying issues during treatment can lead to relapse into addictive eating, as is the case with any addiction. In conclusion, the food matters more than the food industry wants us to believe. We must identify and eliminate profitable and toxic substances that are masquerading as food.  

To learn more about Food Addiction, click HERE

Sugar, Salt, and Fat. What Drives Preference?

The taste system is a gatekeeper for food consumption. No natural poison is sweet. Sugar is one component of breast milk, which has been described as nature's perfect food. All humans have an affinity for sweet, which is rewarding to the human brain via dopaminergic pathways, with individual differences based on brain chemistry influencing substance-seeking behavior. Repeated exposure to sugar actually increases the desire to consume it, unlike the satiety response to most other foods. 

Unlike sugar, salt is non-caloric. Humans need salt to survive thus our desire for it is grounded in evolutionary history. Addiction to salt and variance in salt sensitivity is much less understood relative to sweet, savory, bitter, and sour. Babies do not enjoy salt until about 2 or 3 years of age. Cravings for salt are not inherent but have likely been created by the food industry, using sodium for its functional, flavor-enhancing, and preservative properties. 

Salt makes sugar taste sweeter, so very often these ingredients are used together to maximize the reward potential of foods. Low-sodium versions of food add more sugar, and sugar-free versions require more salt. Humans perceive a thrilling effect from the combination of sweet and salty, light and dark, and crunchy with silky, a concept known as dynamic contrast. The more multisensory the food is, the more likely the person is to crave it. The crunching of an Oreo creates a very novel effect that can release brain opioids and therefore stimulate reward. The trigeminal nerve hovers above and behind the mouth to differentiate between sandy and smooth, sensing variations in texture that are heavily influenced by fat content. 

Much like other addictions, it is likely that food addiction is determined by both genetic and environmental factors. Chronic exposure to sugar, salt, and fat during childhood is likely to have significant impact on adulthood preference since the developing brain of a child is marked by heightened excitement. The irresistible yet toxic food environment created by the food industry is likely to have the most significant effect. Meanwhile, the influence of genetics on personal preference for sugar vs. salt vs. fat is a topic that clearly warrants further investigation.   

Visit www.NutritionInRecovery.com for more info! 

Nutrition Interventions in Addiction Recovery

Malnutrition associated with substance abuse can be either primary or secondary. Primary malnutrition occurs when substance abuse displaces, reduces, or compromises food intake. Secondary malnutrition occurs when the substance of abuse causes alterations in the absorption, metabolism, utilization, and excretion of nutrients due to compromised oral, gastrointestinal, circulatory, metabolic, and neurological health. Malnutrition negatively impacts all body systems including the immune system, leading to an inadequate response to disease. While the harmful effect of alcohol on nutritional status has been well described, the mechanisms behind illicit drug-induced malnourishment remain largely unknown. It is difficult to differentiate between primary and secondary malnourishment within drug-addicted populations. In addition, there are ethical and legal challenges in conducting controlled trials using illicit substances, as well as difficulties with patient follow-up. Most of the data that links nutritional deficiencies to substance abuse is speculative, underpowered, and retrospective.

The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) published a position paper in 1990 supporting the need for nutrition intervention in treatment and recovery from chemical dependency. The paper promoted the concept that Registered Dietitians (RDs) are essential members of the treatment team and that nutrition care should be integrated into the protocol rather than “patched on.” Nutrition professionals were urged to “take aggressive action to ensure involvement in treatment and recovery programs." In the past 20 years, there has been little progress in incorporating dietitians into drug rehabilitation programs, despite the continued explosion of illicit drug abuse. The reasons for this are multifactorial and include: lack of interest from RDs, limited funding for new initiatives, non-collaboration between the public and private sector, difficulties conducting research on this population, and the associated stigmas of substance abuse.

Once sobriety has been achieved, altered biochemistry and dysfunctional behavior resulting from substance abuse often persists. The practice of making healthful food choices while abstinent from drugs and alcohol may be challenging in the early stages of recovery. Sobriety often creates new emotions, anxiety, and uncertainty. Patients often seek a predictable and comforting response from food, which can lead to overeating, relapse, compromised quality of life, and the development of chronic disease. Increased caloric intake and excessive consumption of sugar, salt, and fat often leads to obesity, diabetes, and hypertension, which in turn increases the risk for cardiovascular disease and the clinical burden associated with substance abuse. Recent findings suggest that even a remote history of substance abuse can negatively impact weight loss. Evidence to date indicates that individuals in recovery will benefit from learning new behaviors with respect to food and nutrition. There is also an increasing body of literature that suggests nutrition interventions in substance abuse treatment lead to improved outcomes, yet we need more investigators willing to conduct controlled trials. Please consider this topic for your Master's Thesis or Doctoral Dissertation.