Faculty Disclosures. Vera Tarman, MD, Author:
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3 Faculty Disclosures Vera Tarman, MD, Author: Food Junkies: The Truth About Food Addiction (book) Dangerous Liaisons: Comfort and Food (DVD) Biology of Addiction, Biology of Recovery (DVDs)
4 Standard Treatments
5 OMA Health Prevention 2012 Recommendations Borrow from tobacco control strategies Increase taxes on junk foods, reduce taxes on healthy foods State health risks on packaging State health warning on retail displays Restrict advertising and sponsorship to children
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8 Standard Treatments Bariatric Surgery: Inhibit absorption of food (gastric bypass) Or obstruct food intake (lap band)? Intra - Gastric balloon or pump
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10 Standard Treatments: Medications Amphetamines Anti-Craving Psychotropic Hormone based drugs OTC / Herbal Supplements
11 Amphetamines Vyvanse (BED) Ritalin and Dexedrine Ephedrine FlenFluramine (Ponerax) Dexfenfuramne (Redux) Fen-Phen
12 Amphetamines: Mechanism of Action Appetite suppressant Increase body s metabolism
13 Amphetamines: Issues Significant (to 10%) weight loss Insomnia, anxiety Paranoia Cardiac tachycardia Heart valve defect
14 Hyperactivity
15 Fat Blockers Mechanism: Xenical (Orlistat) Blocks absorption of fat in small intestine by inhibiting pancreatic enzyme (Lipase) Issues: Less than 10% weight loss Fecal soiling Vitamin deficiencies
16 Xenical Side Effect!
17 Psychotropics
18 Psychotropics SSRIs (Prozac, Celexa) SSNRI s (Effexor) Wellbutrin Topiramate (Gaba-nergic) Meridia (off market) Belviq (2013)
19 Psychotropics: Mechanism of Action Treats self medicated eating Suppresses appetite
20 Psychotropics: Issues Sedation Less than 10% weight loss Or Weight gain Low libido Atypical mood reaction (suicidal ideation, psychosis)
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22 Craving Blockers ReVia (Naltrexone) Remonabant (off market) Campral (Acamprosate, Glutamate / Gabanergic) Baclofen (off label, Glutamate / Gabanergic)
23 Craving Blockers: Mechanism ReVia is an opiate blocker Rimonabant is an endocannaboinoid blocker Reduces cravings for opiates, alcohol and sugar Campral (Alcohol) and Baclofen (Cocaine) craving reducers
24 Craving Blockers: Issues Liver Disease Depression Fatigue Suicide
25 Combos Qsymia (2013) an Appetite suppressant mixed with Topiramate Contrave: Naltrexone with Burpropion
26 Combo s: Issues Birth defects Depression, anxiety Insomnia, paranoia? Decreased libido
27 Hormones Leptin Pramlintide (Symlin) Exenatide (Byetta) Saxenda Metformin Synthyroid
28 Hormones: Mechanism Leptin satiates gives feeling of fullness and diminishes reward potential Pancreatic enzymes delay gastric activity to make you feel fuller Metformin improves insulin resistance and curtails liver s production of glucose Synthyroid mimics thyroxin, the hormone that governs body metabolism
29 Hormones: Issues - Leptin Significant weight loss for Leptin insufficiency Injectable Not effective for Leptin resistance (most obesity is caused by too much leptin rather than not enough)
30 Obesity: Hyper-Leptinemia? Obesity causes Leptin resistance, so that the person does not feel satisfied/ full with high leptin levels Leptin diminishes dopamine so Leptin resistance leaves high desire for food
31 Pancreatic Enzymes Only available for diabetics Twice daily injections (meals) Can lead to Pancreatitis, thyroid cancer
32 Hormones: Issues Metformin (for diabetics) produces hypoglycemia Synthyroid Weight loss Insomnia, Diarrhea, Tremors Proptosis, osteoporosis Suppression of own ability to make it
33 Hyperthyroidism
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35 Standard Treatments Behavioral: Residential or community based to moderate food intake of all foods
36 Standard Treatments Diet and Exercise Usually starts with abstinence and leads to re-introduction and moderation of trigger foods Calories in / out Model
37 Metabolism?
38 Treatment for Addiction How would treatments differ if eating disorders were viewed as an Addiction?
39 Treatment for Addiction Abstinence of sugar and refined starches Ex: Leptin or Insulin resistance, paleo / raw food / real food plans 12 step / food addiction diets (FAA, Greysheet, Kay Sheppard)
40 Treatment for Addiction Treatment Centers for detox Nutritional / Dietary Paradigm Shift away from the Food Guides Community Supports: OA, FA, FAA Public awareness
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