Obesely Speaking

The brain and obesity

Christmas Cookie Blue

Inside the holiday binge-eating brain

The Hanukkah candles are all gone, and the jingle bells are starting to ring. But obesely speaking, what we need for Christmas Santa just can’t bring. It’s the season when love and connectivity with family and friends is craved the most. Humans are a social species so when that is missing anguish abounds. We have an innate aversion to loneliness, which is not a lack of company, but an absence of kind. The holidays, like young children and high-powered cameras, are painfully truthful and mortifyingly indelicate. For compulsive overeaters the “season to be jolly” is the season to be bingeing, psychologically distressed, and feeling out of control.     

 Compulsive overeaters usually start bingeing on Thanksgiving and don’t stop until New Year’s Day—when we start our annual New Year’s Resolution Diets. That’s partly because the holidays are a time when binge eating is not only socially acceptable, it’s expected and encouraged. Of course, it’s not called binge eating. It’s called “celebration,” which is a bit like referring to dead people as “the late so-and-so.” They’re not late; they’re not coming. It’s not like they’re caught in traffic, or stuck at the office. So why do we call them late? We do it because we’re humans, and we’ve loved dancing around the truth and Maypoles since the Druids. Holiday binge eating is not celebratory. It’s is a multifaceted, complex, socially encouraged pathological behavior. For normal eaters, holiday bingeing is circumstantial and not problematic, per se; for compulsive overeaters it’s a reoccurring nightmare.

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 I define holiday binge eating as inconspicuous, episodic, excessive food consumption that is not driven by hunger or metabolic necessity. Normally, binge eating is secretive. Holiday binge eating is socially sanctioned, so it becomes inconspicuous because everyone’s doing it and encouraging it. “Oh just have one little bite, it won’t hurt you.” That’s as untrue as “one size fits all.” One bite can lead to a large weight gain over the holidays.

Compulsive Overeating And Holiday Bingeing: A Biological Basis For Concern

In animal research, delicious foods that are preferred over normal foods are called “palatable foods.” The human equivalent would be our rich, delicious, calorie-dense, holiday foods. Researchers found that when animals are given palatable foods, they will binge. Palatable foods causing bingeing in animals, tells us that bingeing is an innate human tendency.

For example, a single morsel of high-sugar and high-fat palatable food triggers binge eating in rats. Likewise, it only takes that “one bite can’t hurt you” of a rich dessert to trigger binge eating in compulsive overeaters. Substance dependence studies in humans and animals have shown this same outcome. Thus, holiday foods are more dangerous to compulsive overeaters than normal eaters because of our addictive relationship with them. Normal eaters don’t have an addictive relationship with food. Hence, they might have a few rich desserts, like a non-alcoholic might have a glass of champagne. For the compulsive overeater and the alcoholic, that’s just not a viable option.  

Consuming palatable foods also intervenes on some of the psychological and physiological consequences of stress. The neurochemical pathways involved in this are like those activated by addictive behavior. Eating those special holiday foods results in dopamine release and endogenous opioid peptides binding in the central nervous system (makes your brain do its “happy dance”). Holiday binge and compulsive eating, like drug addiction, causes guilt, self-loathing, and psychological distress. There is consistent and considerable co-morbidity between compulsive overeating and substance abuse. Hence, the predisposition for compulsively overeating voluminous amounts of food, suggests an underlying neurobiological process similar to addiction. 

As if this isn’t ugly enough, it gets uglier. The absence of palatable foods and food restriction in rats increases their tendency to binge when palatable foods are present. So, you know what that means. If a compulsive overeater is on a diet before the holidays, which we always are, when the holidays roll around and they break out the goodies, which we haven’t been eating, it flips the binge switch. Oh falalalala—just the ornament my Christmas tree needed.

Environmental and physiological stress plays a vital role in binge eating. For example, rats that have been on calorie restrictive diets do not eat more food once they’re satiated. However, when the rats are stressed out and given access to regular chow and palatable food, they compulsively overeat the palatable food. So let’s connect these yuletide dots. Even when we’re full, we are inspired to eat compulsively, if we encounter holiday foods during physical or environmental stress.  Considering excess weight is physiologically stressful, and being overweight in society is  psychologically stressful, this story is not getting any prettier, anytime soon.    

On a related note, compulsive overeaters, compared to normal eaters, are much more likely to have been abused as children. Both animal and human studies associate early life trauma with hippocampal and hypothalamic remodeling. This means when these regions were developing, their environments caused adaptive structural changes that affect how well they work. For example, hippocampal remodeling affects perception in compulsive overeaters. Compulsive overeaters are prone to misread social cues, misinterpret situations, and have inappropriate reactions, resulting in downward synergies. We also perceive aversive stimuli more intensely, and subsequently, take longer to habituate. This further increases our stress level. The more stress, the more vulnerable we are to the pathophysiology of stress regulation, a part of which, in compulsive overeaters, is self-medicating with preferred foods. Additionally, hypothalamic remodeling causes breaches in crucial signaling processes in appetite control and energy balance that encourage the reward-driven brain (I want to eat it) to override repletion (I’ve had too much to eat).

Holiday Dread, Palatable Foods, and Compulsive Overeating

John Wayne Gacy's Last Meal
Mortality salience (knowing you’re going to die) sheds some additional light on yet another holiday challenge for compulsive overeaters. A study that looked at the last meals of 247 death row inmates found that the average last meal was 2,756 calories, and contained 2.5 times the daily-recommended serving of protein and fat. The most frequent requests were calorie dense meat, fried food, and desserts, approximately 84%, 68%, and 66%, respectively. Almost every inmate ordered multiple cartons of ice cream with either two or three types of cake or pie for their last meal. This supports the theory that rich, fatty foods are used to combat stress. What could be more stressful than awaiting execution on death row?

A dreaded work or family holiday event could seem just as stressful to the brain. Dreading impending death by lethal injection is understandably terrifying. But to the brain, so is being overweight at a party with weight Nazis nibbling on celery hearts because they had a huge gust of wind for breakfast. There is no comparing the two when you think about it. However, the brain regions that regulate this type of stress are subcortical and sub cortices, do not, and cannot, think or distinguish between real and perceived threat.  

Compulsive Holiday Binge Eating: A Neurobiological Perspective

The neurobiology and associated behavior of compulsive overeating and holiday binge eating is like drug addiction. No surprise there, because most likely many of the antecedents of drug addiction and compulsive overeating are the same. Palatable holiday foods and narcotics utilize the same reward pathways in the brain. Also, drug and food stimuli cause the same type of conditioned gene expression and neuronal plasticity in the mesolimbic-cortical pathway (reward circuitry) and regions associated with learning and memory, e.g., the ventral striatum, where habit formation occurs. Dopamine and endogenous opioids are implicated in adaptations to reward circuitry in compulsive overeating, as well as drug usage. 

The Beatles were still together, and I had Beatle wig, when researchers first linked hedonic eating and the nucleus accumbens. So, palatable holiday foods increasing binding status of opioids receptors, in reward pathways, is old news. However, animal studies, demonstrating how stress further exacerbates this, are “fresh”, as the rappers say. My personal experience totally supports this. Put a Honeybaked holiday ham in front me when I am stressed out, and see what you get.  I assure you, I will be on it like a Republican on an Obama scandal. 

Where there is pleasure there is dopamine. Dopaminergic neurons in the various reward areas of the brain are activated by preferred foods. Repetition of eating preferred foods to mitigate stress has been linked to alterations in dopaminergic pathways. This further asserts the addictive nature of compulsive eating and bingeing. So considering that dopamine and endogenous opioid systems are involved in reward, and considering compulsive overeating alters reward pathways, compulsive overeaters probably respond differently to the reward-value of food. This is evidenced in studies examining taste, flavor, and fat preferences. So, again, the take home message for compulsive overeaters is that holiday foods do not affect us the same way they affect normal eaters. We’re dealing with an addiction and the drug of choice. So, in essence, for compulsive overeaters, rich, calorie-dense holiday foods are not holiday treats for us. They are crack, and we have to treat it accordingly. “One little bite” will seriously harm us, just like one little line will harm a cocaine addict. 

Also, we have to be wary of environmental cues. Learned associations between places and rewarding foods trigger compulsive overeating and especially holiday bingeing. Sentiment is a large part of the holidays. Going to specific places and participating in specific activities is how we establish personal holiday traditions. Cue-elicited condition response is one of main contributors to relapse in substance abuse. Compulsive overeating mirrors this. For example, rats quickly learn to associate palatable foods with specific environments. They also spend more time food seeking in those environments because it is reinforcing. This is because of opioid activation. This indicates reward-motivated behavior rather than metabolic-motivated behavior. For compulsive overeaters, sadly this means our holiday traditions involving palatable food and associated environments and events are treacherous.    

Additionally, sensory cues, such as smell and sound have triggered drug and food seeking behaviors in rats. For compulsive overeaters, the holidays are full of sounds (Christmas carols, bells, etc.) and smells that may serve as sensory cues for some compulsive overeaters.  Humans are also susceptible to visual cues—gingerbread items, Christmas cookies, candy canes and pictures of holiday feasts on tastefully-appointed tables are omnipresent. Put another log on the neural holiday inferno. 

Jingle Bells -from Obesely Speaking
So, as my friend, Lynn, would say, “the news is grim”. Squelching compulsive overeating, as a conditioned response to holiday food cues, is not easy. Eating is not like substance dependence, or alcoholism in this regard. You can’t just quit eating and being around food because food is necessary to sustain life.  Hence, food cues are ubiquitous. Binge eating is also instinctual and tethered to human survival because the ancients' feast-or-famine circumstances.  Likewise, when the holidays roll around we can’t lock ourselves in a vault with a case of celery and a Richard Simmons' “Sweating To The Oldies” CD because we’re compulsive overeaters. It’s like having a dog with a biting history. You can’t extinguish it like a cigarette; you can't pretend the chance of it biting again doesn’t exist; and you certainly can’t let it go unleashed. You have to understand the beast as best you can, be vigilant, diligent, persistent, responsible and loving to manage it successfully. We are who we are, and we have to honor that by embracing our assets and liabilities, triumphs and tragedies, personal angels and private demons, 24/7/365. So obesely speaking… let the jingle bells ring!  What we need for Christmas, are gifts that we can bring. Pa-rump-pa-pum-pm... Remain fabulous and phenomenal.

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Selected References

Adam, T. C., & Epel, E. S. (2007). Stress, eating and the reward system. Physiol Behav, 91(4), 449-458.

Artiga, A. I., Viana, J. B., Maldonado, C. R., Chandler-Laney, P. C., Oswald, K. D., & Boggiano, M. M. (2007). Body composition and endocrine status of long-term stress-induced binge-eating rats. Physiol Behav, 91(4), 424-431.

Berthoud, H. R., & Morrison, C. (2008). The brain, appetite, and obesity. Annu Rev Psychol, 59, 55-92.

Boggiano, M. M., Chandler, P. C., Viana, J. B., Oswald, K. D., Maldonado, C. R., & Wauford, P. K. (2005). Combined dieting and stress evoke exaggerated responses to opioids in binge-eating rats. Behav Neurosci, 119(5), 1207-1214.

Colantuoni, C., Schwenker, J., McCarthy, J., Rada, P., Ladenheim, B., Cadet, J. L., et al. (2001). Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. Neuroreport, 12(16), 3549-3552.

Goodman, A. (2008). Neurobiology of addiction. An integrative review. Biochem Pharmacol, 75(1), 266-322.

Kelley, A. E., Baldo, B. A., Pratt, W. E., & Will, M. J. (2005). Corticostriatal-hypothalamic circuitry and food motivation: integration of energy, action and reward. Physiol Behav, 86(5), 773-795.

Kelley, A. E., Will, M. J., Steininger, T. L., Zhang, M., & Haber, S. N. (2003). Restricted daily consumption of a highly palatable food (chocolate Ensure(R)) alters striatal enkephalin gene expression. Eur J Neurosci, 18(9), 2592-2598.

McEwen, B. S. (2006). Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci, 8(4), 367-381.

Wansink, B., Kniffin, K. M., & Shimizu, M. Death row nutrition. Curious conclusions of last meals. Appetite, 59(3), 837-843.

Zheng, H., Lenard, N. R., Shin, A. C., & Berthoud, H. R. (2009). Appetite control and energy balance regulation in the modern world: reward-driven brain overrides repletion signals. Int J Obes (Lond), 33 Suppl 2, S8-13.

 

Billi Gordon, Ph.D., is  Co-Investigator in the  Ingestive Behaviors & Obesity Program, Center for the Neurobiology of Stress, David Geffen School of Medicine at UCLA.

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