Walden Conference Focuses on Treatment of Binge Eating Disorder

Millions of Americans have a compulsion to binge that resembles an addiction to drugs or alcohol, but it often can be effectively treated with nutritional supplements and other forms of therapy, according to James Greenblatt, M.D., chief medical officer of Walden Behavioral Care.

Speaking at “Binge Eating Disorder: Medical, Nutritional & Psychotherapeutic Interventions,” a half-day conference sponsored by the Walden Center for Education and Research, Inc. at Maneeley’s Banquet Facility in South Windsor, Dr. Greenblatt said binge eating disorder is the most common eating disorder, affecting 2.6% of the adult population. That’s more than bulimia and anorexia combined, which affect about 1.5% of the population.

For binge eaters, binging has an intoxicating effect, like alcohol or cocaine, according to Dr. Greenblatt, while efforts at withdrawal result in physical cravings that make it difficult to resist overeating.

Dr. Greenblatt said the chemistry of appetite helps explain binge eating disorder. Neurotransmitters in the brain contribute to regulating appetite, coordinating a balance between hunger and satiety, telling us when to stop eating. There are 250 or so known neurotransmitters, include many protein-based cutokines, hormones and peptides that contribute to appetite regulation.

Those who have binge eating disorder typically either do not have enough protein in their diet, which is derived from foods such as chicken, fish and eggs, or they have a deficiency of amino acids and do not adequately digest protein.

“Intake, digestion and absorption of protein are critical,” according to Dr. Greenblatt.

Even someone with a healthy diet that’s high in protein can become obese, though, if there is not enough acid in their stomach to digest the protein. Amino acids are typically low among vegetarians, chronic dieters, those who have a diet low in protein, heavy users of antacids and individuals who are under a great deal of stress.

“Stress causes the ‘fight or flight’ response,” Dr. Greenblatt said. “The digestive system shuts off.”

Nutrition and Binge Eating Disorder

One reason binge eating disorder has become so common in the United States is because of our diet. For example, studies show that sugar is addictive and may play a role in binge eating disorder and obesity. Withdrawal from sugar among those who are addicted results in irritability and a compulsive need for sugar.

Sugar or high-fructose corn syrup and the food additive monosodium glutamate (MSG) are found in almost all foods, and can cause cravings and addiction. Gluten from wheat and dairy products also can cause addiction-like symptoms and can affect a person’s ability to control food intake. While the movement toward a gluten-free diet has gotten “a little out of control,” many people have celiac disease and for them eating gluten can other health issues, including depression and anxiety.

While Dr. Greenblatt said he’s long been an advocate for treating disorders without drugs whenever it’s appropriate to do so, for those with binge eating disorder, a short-term prescription to one or more drugs is often necessary to enable a binge eater to break the pattern of binging.

The U.S. Food and Drug Administration recently approved the use of Vyvanse for binge eating disorder and Dr. Greenblatt said it can be effective in many cases. However, he added that Vyvanse “is the only approved drug, but it’s not the only one that works.”

Topamax can also be very effective, he said, and, taken in low doses, it doesn’t typically have significant side effects. Naltrexone, which is also used for alcohol dependency, has proven to be effective when combined with psychotherapy. A study has also found that using a nasal spray can reduce the amount of time obese women spend binging.

Medication is typically prescribed along with a combination of therapies, including nutritional counseling and psychotherapy, according to Dr. Greenblatt.

Therapeutic Interventions

Laurel Watt-Aldredge, Psy.D., a licensed psychologist with a private practice in Holliston, Mass., discussed, “Therapeutic Interventions for the Treatment of Binge Eating Disorder,” at the conference.

While a variety of therapeutic approaches may be used to treat binge eating disorder, the starting point for any patient is a readiness to change. When a patient to ready to change, motivational interviewing may be used to determine why the individual is seeking change.

Cognitive behavioral therapy (CBT) typically follows and includes a functional analysis, a review of patient beliefs, identification of a dietary restriction cycle and cognitive awareness. Dialectical behavior therapy (DBT) is also used to help patients accept their emotions and avoid negative feelings. Together, CBT and DBT can help those with binge eating disorder to increase emotional awareness, develop the skills need to manage their emotions, clarify the role that stress plays, expand stress management practices and improve emotional tolerance.