More on Set Point theories, compulsive eating, SSRIs, etc...

[MS]

More on Set Point theories, compulsive eating, SSRIs, etc...

I found this to be an entertaining discussion on some of these concepts. More anecdotal than scientific, but i think it encompasses a lot of good stuff. I have a strong feeling that a lot of the cravings induced by BB type diets are from similar chemical imbalances and that maybe dieting BBs should be considered to be suffering from a self-induced compulsive eating disorder!

Compulsive Eating

From http://www.t0.or.at/~ascharf/links/krentzmann/comp.eat.html

In 1995 the DSM-IV was published. This is the Diagnostic Services Manual 4th edition and is the basis for billing for psychiatric services as well as setting criteria for psychiatric diagnosing. In this edition all but 3 conditions were changed to reflect the view that all mental illness (or conditions) are based in the anatomy, physiology and biochemistry of the brain.

I have an evolving concept of the "Set-Point Thermostat". I believe that this is a structure or gland in the brain which sends out neurotransmitters (chemical messengers to other parts of the brain) to increase or decrease our eating behavior. A paper, about Leptin, has been published by the Rockefeller University Medical Center giving indirect evidence that this thermostat exists and is genetically programmed. The exact site and structure of the "Set-Point Thermostat" has not been proven but many of us believe that it is the hypothalamus.

We have many examples of this kind of feedback controls in the human body. The thyroid gland is controlled by the hypothalamus by a constant supply of TSH (Thyroid Stimulating Hormone) sent out by the hypothalamus (the master gland in the brain). When not enough thyroid hormone in the blood is detected, the hypothalamus increases the TSH and the thyroid gland releases more thyroid. When there is too much, such as when people take unnecessary thyroid during dieting, the supply of TSH is turned down so the level of thyroid in the blood remains at the "proper" level. "Proper" can sometimes be too high or too low and this causes hyper-thyroidism or hypo-thyroidism.

Another feedback loop is from the hypothalamus in the brain and the ovary. This controls the menstrual cycle by sending out several controlling hormones and stimulating or shuting off estrogen and progestrogen hormones and setting the timing for the release of the egg.

Like those two examples we now have had revealed the possible basis for a feedback loop involving the "Set-Point Thermostat" and our body fat cells. This is the recently discovered hormone Leptin. This was used to knock off 30% of a mouse's total body weight in 2 weeks. You can get lots of information from my web site at http://www.loop.com/~bkrentzman/. The original Rockefeller Press Release is linked from there.

In my theory the Leptin produced from the fat cells causes a Leptin level in our blood. When there is "enough" the appetite stimulation slows down and we crave less. When this "Set-Point Thermostat" does not detect "enough" Leptin, it sends out neurotransmitters demanding we eat more. This could be how people keep their weight steady at, any level, without trying.

I believe that it is the chemically resetting of the "Set-Point Thermostat" which produces the good results from the phentermine/fenfluramine medicines. Most of the cravings and strong urges to eat are relaxed. It's like getting a monkey off your back.

Thin people do not understand how we overweight FEEL, when we are compelled to eat, whether hungry or not. I ask them to hold their breath for 2 minutes and tell them "That is about how we feel". If I push away from the table I will feel something like that "forever". That is what they are asking us to do for the rest of our lives. Talk about cruel and unusual punishment.

Do people lose "All" their excess weight on the phentermine/fenfluramine medicines? Some do and some don't. Like everything else people differ from each other and live in different enviornments and families and socioeconomic situations. We also start out with different bodies. No two people will react the same and any one person will react differently at different ages.

How safe is the phentermine/fenfluramine course of therapy? There are pesky side effects to these medicines, like there are to all other medicines, even aspirin. By working closely with your doctor you can usually make adjustments to the doses of the medicines to work around any unpleasant side effects. Only rarely does someone, who is truly motivated, have to discontinue the medicines.

How long do I have to take these medicines? Since this is a chemical way of reseting the "Set-Point Thermostat", if the medicines are stopped without finding a way to make this change permanent, 95% of us will regain all the weight we lost. I plan to stay on these medicines until a better way is discovered. Many of the big drug companies are throwing big money into research since they have finally noticed the $30,000,000,000.00 market out there, mostly being serviced by modern day snake-oil salesmen.

More written below, between the reflected lines:
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>>>ONE cookie, ONE Candy bar. ONE bowl of cereal will not make much of an effect

>[Deleted] writes:

>>[Deleted], my good buddy, I have to disagree with you on this one!

>>Some of us, me included, are compulsive eaters - we have a disease as bad or worse than alcoholism - one bite of a cookie or one bite of a "Snickers" is as lethal for me as "Miller's Time" is to a drunk. One spoonful of "Heavenly Hash" could set me off on a three-day ice cream binge!

>This is an interesting thread. I'd like to know other's opinions. Having once been a compulsive over-eater and now no longer one, I tend to agree with [Deleted]. FOR ME (see, I can do it) the change took place when my view of food changed from good food/ bad food to food. [Deleted] accused me of simply changing the terms from good/bad to healthy/fat-laden but that is not quite true. I should perhaps change healthy to "nutrient laden" and then what I would be doing is describing the content of the food without labelling to "good" or "bad". Because we do need SOME fat in our diets as well as nutrients, fat-laden foods are not "bad" foods. (But I digress; sorry, this is one of my pet peeves).
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[BZK]-- I agree. There are no BAD foods. There is only a BAD DIET. Many of my patients come to me saying they have been "bad". I refuse to accept this self judgement. So long as we are not harming others I do not believe any of our acts are bad. Not even our decisions about food.

[BZK]-- Researchers have now identified at least 13 neurotransmitters in the brain which create a complex control system for eating. 2 of those are controling fat intake, 2 for carbohydrate intake levels and 2 for protein intake. The composition of the foods we eat are strongly influenced by this set of controling hormones. One of the others called cystokinin, created in the bowel wall when we eat and carried to the brain sites by the blood stream, helps influence when we cease eating. Serotonin, another brain chemical, is known to be involved with both depression and satiety (the feeling of contentment after eating). Prozac, Paxil and other Serotonin Reuptake Inhibitors are very close to Pondimin (fenfluramine) in action and a combination of these drugs may cause side effects from too much serotonin. Great caution must be taken when using combinations of these drugs. I have only been able to hint at how complex is the human beings control system governing eating behavior. Much more is already known and I am sure much more is still to come out of the research labs.
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>I think that the difference between alcohol and food is that alcohol has an addictive substance to it which the acloholic's body chemistry reacts to. I don't THINK food is the same, though recent medical research may be proving me wrong. One common thread among alcoholics is that they do not know when they have had enough to drink. One common thread among the obese seems to be that they, too, do not know when they have had enough to eat.

>>From my experience, I tend to think of compulisve over-eating as something >mentally controllable through changing one's relationship to food and through becoming more aware of the physical impact certain foods have on my body (increased body awareness, I suppose). One cookie does not make me feel ill. A dozen cookies do. This has always been the case, but before I got more in tune with my body, I either never drew the connection or chose to ignore it, going for the instant gratification.
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[BZK]-- I do not believe that there are any simple answers to the overeating problem. Wishing ourselves thin (i.e. "eating as something mentally controllable through changing one's relationship to food") just does not work. If it did I would have been thin somewhere in the 20 years of therapy, and dozens of diets and fasts I put myself through. Also the hypnosis treatments I went through would have worked. Hypnosis NEVER works on obesity. It is great to stop smoking, but not to control overeating.
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>Rambling on (sorry these thoughts aren't better organize), I was also deep in depression while a compulsive over-eater. When I pulled out of the depression I pulled out of the compulsive eating habit. And there is lots of medical evidence that chemical changes take place in the body during depression. I wonder if the chemical changes that happened when I came out of the depression might not have enabled me to feel full where before I was unable to.
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[BZK]-- Since lower levels of serotonin in the brain is known to be related to depression, and raising the serotonin levels is known to relieve both depression and urges to eat, then yes, there is lots of evidence that chemical changes could have enabled you to resist where before you were helpless and driven to eat.
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>Anyway, I've rambled long enough. But I'd like other people's opinions of compulsive eating. Is it a mental crutch or the ramifications of a chemical imbalance?
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[BZK]-- Since phentermine/fenfluramine has been shown to reduce binge eating in 18 of 19 people who were in a recent trial, I think there is good proof that it is chemical.

 

[SteelWeaver]

OMG there's so much, it's so huge, this is a HUGE topic! So many factors: genetic, social, chemical, psychological ...

I take it this was written before phen/fen proved to be dangerous.

Are these chemical imbalances really similar, though? Between lean/shredded hypocaloric BB dieters and obese, possibly diabetic, hypercaloric compulsive eaters? Does that mean that the compulsive over-eaters are getting the same "starving" signals that BB dieters get?

And would the persistence of these signals even after a hypercaloric state has been reinstated explain cravings experienced then?

 

[MS]

Yes, this was written before Phen-Fen was withdrawn, and before they realized that obese HUMANS mostly suffer from excess leptin (in the form of leptin resistance). But the physiology of the cravings are pretty similar IMHO. In the lean case there is an absolute lack of leptin/serotonin etc....whereas the obese person may have plenty of these hormones floating around, but the message can't get through=relative deficiency symptoms. It now appears that drugs that affect uptake and recycling of neurotransmitters (such as Phen-fen) may work in obese humans by increasing their sensitivity to these hormones through changes in neurotransmitter levels, receptors, reuptake transporters and possibly even uptake into the brain. Kinda like giving metformin to a type 2 diabetic to make them more sensitive to their own insulin, or giving them more insulin to increase the strength of the signal. Using the diabetic analogy, this is why I think that ketogenic diets work well for many obese people. It's kinda like decreasing your sugar intake instead of increasing your insulin levels. Over time, low carb diets will reduce chronic serotonergic signals, thus sensitizing the brain to 'normal' neurotransmitter levels. They will also often resensitize insulin receptors to the insulin signal, and leptin receptors to the leptin signal. Because low carb diets are also dopaminergic, many people like the wired, more alert feeling they get on these diets. But again, I suspect this is because they are suffering from relative serotonergic excess/dopamine deficiency and the desensitization that goes with chronically high carb high insulin diets.

Persistance of these "OMG I'm starving" signals is likely to continue in normal females until they have regained enough bodyfat to be reproductively viable. In other words, we're stuffed when it comes to staying chronically lean without some pretty strong pharmaceutical intervention. For me, it took about a year for my diet induced cravings to completely disappear after my last competition

 

[FitFossil]

...Because low carb diets are also dopaminergic, many people like the wired, more alert feeling they get on these diets. But again, I suspect this is because they are suffering from relative serotonergic excess/dopamine deficiency and the desensitization that goes with chronically high carb high insulin diets. ...

MS,

Can you tell me more about this, specifically how it relates to levels of brain neurotransmitters? For me, I find low carb diets impossible. They don't make me alert, they make me completely dopey, slow and stupid.

I'm already pretty certain I have a serotonin definciency (OCD, depression, eating disorder) and SSRI's work well for me. Does my reaction to low carbs say anything about my other neurotransmitters? The SSRI's have reduced my carb cravings/appetite considerably. Unfortunately they exacerbate my excessive daytime sleepiness, which a sleep study points to possible mild narcolepsy, though I'd need a different sleep study to confirm this.

I recently started taking Monafidal (Provigil), and this definitely helps, but I'm worried about long term usage. I believe it affects dopamine, so does that mean I'm deficient in that too? Is there anything I can do from a dietary standpoint to help this? I've read about Tyrosine, would that help? Thanks!

 

[MS]

FitFossil, this is a huge topic as I'm sure you can appreciate. Let me just say that at all ages, women in general respond better (from an anti-depression AND weight loss point of view) with SSRIs or carb-based diets, and men respond better to non-SSRIs and lowered carb diets (That last point is purely observational on my part). Men and women are not even close to the same when it comes to neurochemistry of dieting or depression.

In other words your statement "For me, I find low carb
diets impossible. They don't make me alert, they make me completely dopey, slow and stupid. " is more common for women than men.

It also fits with the known biological differences in terms of leptin setpoint theories, serotonergic fluctuations throughout a women's cycle, the dopaminergic activity of androgens etc.... As a gross generalization, men will prefer a dopaminergic rush (cocaine, amphets, ECA, ketosis, MAOIs, Bupropion, testosterone etc...) and women will prefer a serotonergic rush, or an anti-dopaminergic substance (SSRIs, chocolate, non-ketogenic diets, estrogenic compounds, sedatives etc...) more often. Of course there are always exceptions to these rules, and the exceptions prolly do reflect distinct and individual neurochemical imbalances.

Men are used to having more cholinergic stimulation. Their threshold for what feels 'good' is higher than a normal women's. Most antidepressants will have a long term impact on all major neurotransmitters, but a more distinct short term impact on specific neurotransmitters. It's the short term effects that seem to help with dieting, and the long term effects that assist with depression.

 

[PowerPrincess]

I'm already pretty certain I have a serotonin definciency (OCD, depression, eating disorder) and SSRI's work well for me. Does my reaction to low carbs say anything about my other neurotransmitters? The SSRI's have reduced my carb cravings/appetite considerably.

What exactly are SSRI's??? How do you get them and do you need to be tested for this type of serotonin definiciency or insulin resistence - what tests should you ask the doc for???

 

[starfish]

I'm not exactly sure how I feel about using SSRI's for competition dieting. I think that is the point being discussed, but I may be off.

SSRI's can cause weight gain in MANY people, more than they originally thought. They can also SLOW your basal metabolic rate and make you feel sluggish (hence less desire to work out and weight gain)

What are people thinking about? Using an SSRI for competition and then stopping or keep using it for the benefit? I would not use an SSRI for competition and stop cold turkey. TRUST ME!

 

[FitFossil]

What exactly are SSRI's??? How do you get them and do you need to be tested for this type of serotonin definiciency or insulin resistence - what tests should you ask the doc for???

SSRI's are selective serotonin reuptake inhibitors, a class of anti-depressants. They are prescribed by my doctor for OCD (obsessive-compusive disorder) and depression. I do NOT take them as a weight loss aid, that's just been a nice side effect.

Since SSRIs allow serotonin to circulate in the brain longer, I guess I'm less inclined to binge on carbs. Carbs cause the brain to produce serotonin, so carb-binging can be self-medicating for those with serotonin definciency.

For many people, SSRI's make them gain weight. They also have other unpleasant side-effects, so it's really not anything anyone would want to take unless they had a psychiatric need.

 

[FitFossil]

MS - thanks for answering my questions!

 

[SteelWeaver]

Persistance of these "OMG I'm starving" signals is likely to continue in normal females until they have regained enough bodyfat to be reproductively viable. In other words, we're stuffed when it comes to staying chronically lean without some pretty strong pharmaceutical intervention. For me, it took about a year for my diet induced cravings to completely disappear after my last competition

A YEAR!! Oh, NO!

So I wasn't imagining things when, despite being stuffed to the gills on chick peas, oatmeal, even yummy nutty bread and cafe lattes, I STILL wanted sugar, sugar, chocolates, cookies. And peanuts.

I wish there were some way to let my body know I'm not interested in babies, so it can dump all the baby-prep stuff.

"I'm not exactly sure how I feel about using SSRI's for competition dieting. I think that is the point being discussed, but I may be off. "

Yes, this is part of it - MS also mentioned it on another thread a few days ago. But I think she used the word "acute" as opposed to chronic use.

Somehow I think I prefer having regular high-carb refeeds to deal with the cravings.