New Hope for Binge Eaters

That box of chocolate chip cookies you never should have purchased in the first place is sitting there on your kitchen table, luring you, taunting. Your period is due in two or three days and you feel grumpy, depressed, bloated.

You’re agonizing. “Just a…couple/two, three at the most” you think, knowing you’ll actually feel emotionally and physically better in a few minutes. And suddenly, half the box is gone. Horrified and ashamed, you put the box out of sight. But the next day, after a blow-up with a co-worker, it crosses your mind that at least you’ve got the cookies at home. And maybe you can do better at the health club next week.

If you’re like most people who have binge eating tendencies, you tell virtually no one, including your physician or psychotherapist. For this reason, an accurate estimate of people struggling with binge eating isn’t known. Since most binge eaters are overweight and currently almost 70% of US citizens are either overweight or obese, we can safely guess the number of binge eaters is (sorry for this) huge.

A group of characteristics separates binge eating from plain old unhealthful overeating. If any of these sound familiar, you may have some binge tendencies.

• Frequent episodes of eating what others would consider an abnormally large amount of food, like half a box of cookies or a whole container of Ben and Jerry’s.
• Often feeling you’re unable to control what or how much you’re eating.
• Eating much faster than usual.
• Eating until you’re uncomfortably full.
• Eating a large amount of food, even when you’re not actually hungry.
• Eating alone because you’re embarrassed by the quantity of food you’re eating.
• Feelings of disgust, depression, or guilt after overeating.
• Fluctuations in weight.
• Feelings of low self-esteem.
• Loss of sexual desire.
• Frequent dieting.

Self-medicating with food

Over the past few years, researchers in the field began to understand that binge eaters basically use food to self-medicate the symptoms of anxiety and depression. With this knowledge, treatment was aimed at solving the depression and anxiety, rather than using appetite suppressants to quell cravings.

What seemed most logical was a combination of psychotherapy, especially cognitive behavioral therapy (CBT) along with an antidepressant to increase the stress-buffering neurotransmitter serotonin.

CBT, when you find a therapist trained in it, is helpful. But the SSRI antidepressants (like Prozac, Lexapro, and Zoloft) often carry weight gain as a side effect, so something in this  drug treatment was missing.

Enter glutamate

The newest research takes a hard look at a second brain chemical called glutamate. It’s classified as an “excitatory” neurotransmitter, since a certain amount of glutamate is needed for mental focus and concentration. Not having enough glutamate (or having a problem with the glutamate receptors in your brain so that the amount you do have doesn’t work as well as it should) is linked to such apparently unrelated conditions as adult attention deficit disorder, Parkinson’s disease, multiple sclerosis, and addictive behaviors.

Having too much glutamate isn’t good either. Again, the conditions seem unrelated and will remain so until we can uncover more. Fibromyalgia, familial tremor, and autism are all associated with excessive glutamine mechanisms.

The prescription drug Campral (acamprosate) is FDA-approved for alcohol addiction and works by raising glutamate levels in the brain. Psychiatrists are virtually the only prescribers of Campral, and some also prescribe it “off-label” for patients with serious binge-eating disorders. If you click through you’ll see that, as with virtually any prescription drug, Campral comes with side effects.

Boost glutamate without taking meds

There are also non-prescription ways to gently raise your brain’s glutamate level, and while research is limited, the results are promising:

• L-Glutamine is an amino acid that increases levels of glutamate and is especially useful for sugar and alcohol cravings. Dr. Andrew Weil’s website points out that glutamine has been used for alcohol cravings since the 1950s. The usual dose is 500 mg three times daily. It’s available in our apothecary.
• N-acetyl cysteine is an amino acid that works in the body as a precursor for the antioxidant glutathione. It seems to act by balancing out glutamate levels, and it’s currently used by nutritionally oriented psychiatrists as an add-on to prescription meds for obsessive-compulsive disorder (OCD). Binge eating really can be viewed as one of the OCDs. The most interesting recent use of N-acetyl cysteine is for trichotillomania, an OCD condition in which the patient obsessively plucks out her hair. The usual dose for obsessive behavior is 1,200 mg twice daily. Find it here.
• Black cohosh is a popular herb for the low estrogen that occurs before and during menopause. It’s also known by herbalists to reduce food cravings. Recent research has shown that women with low levels of estrogen at any time in their lives have more issues with binge eating than the rest of the population. If you’re having menstrual cycles, signs of low estrogen include scanty or irregular periods and mood issues during your PMS week. One recently published study using mice found that a form of estrogen that went directly to the serotonin receptors in the brain produced a drop in binge-eating behavior. You might be thinking you’re not a mouse, but in fact biochemically the mouse brain is spookily very much like our own. The researchers expressed reluctance to prescribe estrogen as a long-term treatment for binge eating because of its side effects, but this study does shed light on just why the estrogen-like herb black cohosh helps reduce food cravings and binge eating. The usual dose of black cohosh is one capsule daily.
• The acupuncture and herbs of Traditional Chinese Medicine have long been proven helpful for virtually any addictive or compulsive behavior, including binge eating and tobacco or alcohol addiction. When conventional Western scientists attempt to uncover how these therapies work, neurotransmitter adjustments are the common denominator.

I think you’ll agree that what’s happening behind the scenes with your binge eating tendencies is a lot more complicated than you may have considered. Just realize there’s hope. If you’ve got an issue with binge eating that you’ve been reluctant to confront, consider scheduling with us at WholeHealth Chicago. We’ve got two Cognitive Behavior Therapists (Dr. Janet Chandler and Dr. Meghan Roekle), three nutritionists (Marla Feingold, Seanna Tully, and Marcy Kirshenbaum), and three practitioners of Traditional Chinese Medicine (Mari Stecker, Cindy Kudelka, and Helen Strietelmeier).

Be well,
David Edelberg, MD