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Sugar, fat, food and addiction: New approaches to the public health crisis A FABResearch conference – July 2014 |
Food and Addiction – an overview – Dr Alex Richardson Appetite, Satiety and the Obesity Crisis: Why can't people just say 'no' to over eating? – Professor Jason Halford Sugar, Hormones and Addiction – Professor Robert Lustig Nutrition and Substance Abuse: Getting the fats right – Captain Joseph Hibbeln The Role of Food and Diet in 'Addictive' Disorders – Dr Alex Richardson Addicted to Antisocial Behaviour – Dr Bernard Gesch Psychosis and addiction: Nutritional Interventions in Mental Health – Kevin Williamson How a public health policy addressing the crisis could be implemented.
Food and Addiction – an overviewDr Alex Richardson, Senior Research Fellow at the Centre for Evidence Based Intervention, University of Oxford. Founder Director FABResearch Abundant evidence now links modern, western-style diets, rich in highly processed, refined foods, not only to physical health problems such as obesity, type II diabetes, cardiovascular disease and cancer but to mental health disorders such as ADHD, anxiety, depression and psychosis. But public health messages remained confused and anti-fat, often preferring sugar to a high fat diet; there is little understanding that what damages the body also damages the brain. Yet the scale of the mental health crisis facing the world is now massive. Mental health care, which cost £77 billion in 2007 had risen to £105 billion by 2010 while across Europe the figures are even more mind boggling. 38% of Europeans now have a diagnosable mental disorder, from anxiety to dementia. In 2010 €798 billion was spent on addiction across Europe and if you include the figures for alcohol and nicotine addiction that rises to €350 billion, substance use disorders accounting for much of that bill. But what is addiction? And what are seen as addictive substances? Not just alcohol, drugs and cigarettes but how about coffee, healthy energy drinks, prescription medicines, food? When discussing addiction nutrition is still largely ignored. Yet there are 39 essential nutrients that we all need to function, including fats, yet many are lacking in most diets and very few people get them all. But nutrient deficiencies stunt neural networks. A child whose mother was nutritionally inadequate may have 50% fewer neural synapses than a child whose mother was properly nourished. And malnutrition in early life can affect both physical and mental outcomes throughout life. Modern 'high fat' diets are almost always high in Omega 6 fatty acids and also high in sugar. The brain is 60% fat – but fat is not a single substance – it is the type of fat that matters.
Appetite, Satiety and the Obesity Crisis: Why can't people just say 'no' to over eating?Professor Jason Halford, Reader in Appetite and Obesity, Psychological Sciences, University of Liverpool Why do people overeat? Is it biological? Environmental? Or the expression of appetite? Hunger is a response to a physiological need but we rarely experience genuine hunger; what we perceive as hunger pangs are habituation cues. Wanting. We want a food because we like it, both consciously and unconsciously. Satiation and satiety. Eating is brought to an end because we are full and hunger is suppressed so we have no further need to eat. But... Many energy dense foods are very palatable, so we are tempted to eat more regardless of whether we are hungry or full. Palatable foods also delay the physical feeling of fullness. High carbohydrate foods are more satiating than most high fat foods although that does depend on the fat concerned. Overeating means consuming an excessive volume of energy dense foods. Sugar does reduce post meal appetite but its effects are very transient so the person is hungry again very soon after the meal. This effect is particularly noticeable with fizzy drinks where any satiety effect is extremely short lived. Obese people: Advertising, especially to children, is extremely potent. The new regulations have had little real effect as, instead of promoting the foods, advertisers just promote their brands. Research suggests that:
Sugar, Hormones and Addiction.Professor Robert Lustig, Division of Pediatric Endocrinology, University of California, San Francisco Addiction makes a nonsense of personal responsibility. The balance in the addicted brain is off centre so that it cannot activate rational/responsible responses. The lay public believe that food, and especially sugar, is addictive. Dopamine. • When you get a pleasurable feeling dopamine is released producing a feeling of reward – but this is short lived (around one hour). It should be controlled by the frontal cortex which indicates satiety – you have had enough. Leptins and insulin • The hormone leptin originates in the fat cells. Leptin 'takes its lead' from insulin so if one does not work, nor does the other. Every obese person has a problem in one or other of these areas. For example: Similarly, if the insulin signal is disrupted the dopamine 'reward pathway' is also disrupted. So the child who is 'insulin resistant' (whose brain cannot 'see' the insulin) thinks that it is starving so it will continue to eat to try to get a 'reward' response. Insulin suppression? • The more insulin that is released into the system, the more the obese person will eat and the more weight will be gained. Fast foods and addiction Fast foods are made up of salt, sugar, fat and caffeine. • Salt. Salt is habituating but it is relatively easy to retrain the palate so it is not addictive. Sugar releases opioids and dopamines in the brain – in the same way as alcohol, which is sugar based. Consumption patters are similar: bingeing – withdrawal – craving – bingeing. But addiction to any substance up-regulates the dopamine pathways and that dopamine up-regulation will persist and will transfer to another substance especially if it follows similar pathways – such as sugar and morphine. In rats, for example, sucrose causes anxiety. If the rats are deprived of sucrose for three weeks, they are still addicted when they are given access to the sugar once more, and that addiction has spread to other substances. The jury is still out on whether humans can be 'addicted' to sugar but sugar is definitely 'abused'. What to do about it? 1982–2012
Nutrition and substance abuse: Getting the fats rightCaptain Joseph Hibbeln, Acting Chief, Section on Nutritional Neurosciences, NAAAA, NIH Chronic alcohol abuse can alter brain function thus creating dependence. (For general information Captain Hibbeln characterised 5% of the population as 'dependent drinkers', 20% at risk of dependency, 35% as responsible drinkers and 40% as abstainers.) Alcohol consumption releases dopamine so it feels good – 'reward'. The prefrontal cortex should be able to exert control but cues from memory can induce cravings. If these are satisfied more dopamine is released thus creating a habit. Withdrawal activates stress and the stress hormone, cortisol, so you drink more in order to produce more dopamine so as to feel better. But overuse desensitises the dopamine receptors, so you need more alcohol to achieve a lesser result in terms of satisfaction. Instead of happy you become depressed, miserable, irritable. Change from Omega 3 to Omega 6 fatty acids Fat consumption affects the membranes which are the base for signalling. Enzymes will digest whatever they are offered so if the diet is high in Omega 6 fatty acids rather than Omega 3s, that is what the enzymes will digest. But, excess Omega 6 can: Alcohol, and possibly smoking, also depletes DHA (docosahexaenoic acid from Omega 3) from the brain. If that is all that is available, the DHA will be replaced with Omega 6 fatty acids. In an ideal diet (the original Mediterranean diet) there would be an equal intake of Omega 3 and Omega 6 fatty acids. In the early part of the 20th century, calorific intake from Omega 6 fatty acids was negligible; now 8–10% of calories comes from Omega 6 fatty acids. Can dietary intake of Omega 3 fatty acids redress this situation? Captain Hibbeln quoted one case of an aggressive alcoholic (who was drinking up to 2 litres of spirits and beers per day) whose drinking pattern was dramatically altered over the course of 21 days by elevating his levels of Omega 3s. He also quoted work that his group had done on the ALSPAC study (an ongoing study following a large group of mothers and children in the Bristol are from their birth in the early 1990s). This showed that the children of meat eating mothers had a lower risk of alcohol, cannabis and smoking problems in their early to mid 20s, while the children of vegetarian mothers with a high consumption of pulses and soya proteins (Omega 6 fatty acids) had a higher risk of substance abuse problems. Consumption of fish, fruits and vegetable and socio economic factors did not appear to be relevant. Captain Hibbeln pointed out that our consumption of Omega 6 fatty acids, though our use of vegetable oils, shortenings and animal feed (all fed corn or soya), had increased from 5% to 30% of our diet and asked, therefore, whether it was not just sugar but fats that were affecting out brains?
The Role of food and diet in 'addictive' disordersDr Alex Richardson, Senior Research Fellow at the Centre for Evidence Based Intervention, University of Oxford. Founder Director FABResearch Many different psychological disorders are associated with addictive features, including neurodevelopmental conditions such as ADHD, autism, schizophrenia, anxiety and mood disorders. Substantial evidence shows that nutrition and diet can play a signifcant role in the etiology and management of these conditions, yet it is all but ignored in current professional practice. Anxiety underlies most addictive behaviours. Long chain Omega 3 fatty acids are biologically useful and are essential for brain function: DHA for brain structure; EPA for signalling, blood flow and as an anti-inflammatory. Omega 3s affect control mechanisms and dopamine pathways. The ideal percentage of EPA for a child is 8–12% but a standard Western child gets only 2.46%. Addiction and substance abuse is the single biggest contributor to mental ill health. There are known to be addictive opiods and peptides in dairy products and gluten so could food cravings in food allergy and intolerance be related to an addictive pathway?
Addicted to antisocial behaviour.Dr Bernard Gesch FRSA, Department if Physiology and Genetics, University of Oxford. Criminal justice assumes that the criminal exercises free will when he/she commits a crime. It is impossible to exercise free will without using the brain to assess the situation and make a rational decision as to what action you will take. But if the brain is poorly nourished, how can it work properly and take rational and well balanced decisions? (Within the criminal justice system itself it is recognised that decision making is related to our ability to metabolise energy in the brain. For example, the severity of sentencing has been shown to correlate with how long it was since the judge's last refreshment break.) Social factors are extremely relevant in criminal behaviour but so is poor nutrition but while the former is very visible, the latter is not and is therefore ignored. For 200 years we have been experimenting with our diets but at no point has there been any examination of what effect these experiments might have, or have had, on the brain. Points of relevance: • 2006. The WHO recognised that good nutritional status could be connected with a reduction in violent behaviour. • The reduction in lead contamination worldwide between 1964 and 2004 is now accepted as crucial in the dramatic crop in violent crime worldwide during those years. • Lead is known to be a potent nutrient antagonist pushing out calcium and iron and reducing brain size. • Malnutrition in pregnancy affects the foetus, as was shown in the subsequent aggression levels shown my the children of mothers who suffered the Dutch 'hunger winter' during WWII. • The exercise of will power is very energy expensive. There is a strong link between offending and hyploglycaemia (low blood sugar). • 9 out of 13 young offenders have vitamin and mineral levels below the Lower Reference Nutrient Intakes • Criminals rarely look healthy. Indeed many show signs of conditions such as scurvy and pellagra, both severe deficiency syndromes. • US studies have shown a 34% reduction in violence between the active and placebo groups on nutritional supplementation. Similar studies in the UK showed a 24% reduction, in Holland a 34% reduction. None of these studies used mega doses of vitamins, merely the recommended daily amounts – and did not include any dietary manipulation. • The nutritional approach ignores, colour, creed, background and circumstances; it is applicable to everyone.
Psychosis and addiction: Nutritional interventions in Mental HealthKevin Williamson, Senior Nutritionist, Rotherham Early Intervention Psychosis team, Doncaster and South Humber Healthcare Trust Following on from Professor Malcolm Peet's work in Rotherham, Kevin Williamson's team offer nutritional assessment and support as part of their routine care to clients suffering their first episode of psychosis – basing their interventions on the convincing evidence of the connection between the nutrients we consume and the way we think, feel and behave. This nutritional intervention is delivered along with medication and psychological and social interventions as appropriate. Although NICE Guidelines for the treatment of both alcohol abuse and psychosis (there is a long established connection between the two) do not mention food or nutrition, schizophrenic patients consume more caffeine, higher levels of fat and sugar and smoke more. The Rotherham service interventions involve: Kevin then described two cases in one of which their intervention had been successful, in the other of which it had not! To take the latter first: 1. 23-year-old male who had suffered trauma and physical abuse and who was a heavy substance user. He refused to consider any dietary change.... 2. 37-year-old male, suffering his first episode of psychosis. He did not sleep and was a substance abuser. He was consuming 70–80g of fat per day and around 2,000 calories per day but no fish.
July 2014
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