THE LINK BETWEEN ADHD AND EATING DISORDERS

As human beings we find creative ways to decrease our emotional, physical, and spiritual pain. Some people use alcohol and other drugs to ease the pain and frustration of their ADHD symptoms. Eating in ways that are not good for us, but temporarily make us feel better is also a form of self-medicating. Self-medicating is when we use substances and behaviors to change how we feel. The problem with self-medicating is that it initially works, but soon leads to a host of new problems.

Some compulsive overeaters are shocked to realize they have finished a carton of ice cream or a king-size tub of theater popcorn. They were not consciously aware of how much they were eating. Eating puts them into a pleasant trance like state that is a respite from their often active and chaotic ADHD brain. If your brain is not quick to contain your impulses, you may eat without thinking.

Eating foods high in sugar and carbohydrates can temporarily calm ADHD physical and mental restlessness. The consumption of these types of  food can help some with ADHD, to focus better while reading, studying, watching television or movies. This focus, however, is short lasting and inevitably followed by a crash in energy and focus.

Although we don’t think of food as a drug, it can be used as one. We have to eat, but eating too much or too little of certain types of food has consequences. Since there is no way to totally abstain from food, eating disorders are extremely hard to recover from. You may have to abstain from certain foods, perhaps those containing sugar, because they trigger a compulsion for more, yet everywhere you look you see and smell these foods.

Why Food?

Food is legal. It is a culturally acceptable way to comfort yourself. For some people with ADHD food is the first substance that helped them feel calm. Children with ADHD will often seek out foods rich with sugar and refined carbohydrates such as candy, cookies, cakes, and pasta. People who compulsively overeat, binge, or binge and purge also eat these types of foods.

It is no accident that binge food is usually high in sugars and carbohydrates, especially when you take into consideration how the ADHD brain is slow to absorb glucose. In one of the Zametkin PET scan studies, results indicated that “Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls…” (Zametkin). Other research has also confirmed slower glucose metabolism in ADHD adults with and without hyperactivity. This suggests that the binge eater is using these foods to change his or her neurochemistry.

Sugar Craving and Hyperactivity

Researchers have searched for the connection between sugar and hyperactivity. Some studies have reported that sugar causes hyperactivity in children. When these studies have been duplicated, however, the results were not always consistent. The idea that sugar causes hyperactivity is relatively new in our culture, and has not been passed on from previous generations. This is why grandparents are often miffed when they are told not to give their grandchild any sugar. They haven’t had the experience of sugar causing hyperactivity.

What if we have been looking at the question backward? What if ADHD hyperactivity actually causes people to crave sweets? If the ADHD brain is slower to absorb glucose, it would make sense the body would find a way to increase the supply of glucose to the brain as quickly as possible.

I have worked with many ADHD adults who are addicted to sugar, especially chocolate which also contains caffeine. They find that eating sugar helps them stay alert, calm, and focused. Prior to ADHD treatment many report drinking 6-12 sugar sodas, several cups of coffee with sugar, and constantly nibbling on candy and sweets throughout the day. It is impossible to sort out what is pure sugar craving when it is mixed with the stimulating effects of caffeine on the ADHD brain.

Neurotransmitter Connection

There are several neurotransmitters that we recognize are increased by the use of sugar. Dopamine, Serotonin and Norepinephrine are the primary players that we know of at this point. As research continues we will most likely see that even more neurotransmitters play a part in the relationship between sugar and ADHD.

Dopamine

Dopamine activates and motivates, improves focus and concentration, and gives you a sense of well being. It is believed that people with ADHD have difficulty utilizing dopamine. Dopamine is also believed to activate the pleasure or reward center of the brain.  Most ADHD medications work on establishing dopamine balance in the brain.

Researchers have located dopamine receptor sites, or places on the neuron that receive dopamine. They have also located defects on genes that determine how the dopamine receptor sites operate. For example, you may have inherited a genetic defect that tells the dopamine receptors to reabsorb the dopamine in the synaptic junction. This means that less dopamine is able to travel the neuron highway to the area of the brain where it is needed.

Serotonin

Serotonin is a neurotransmitter that has been associated with symptoms of depression. Serotonin helps regulate sleep, sexual energy, mood, impulses and appetite. Low levels of serotonin can cause us to feel irritable, anxious, and depressed. One way to temporarily increase our serotonin level is to eat foods that are high in sugar and carbohydrates. Our attempts to change our neurochemistry are short lived, however, and we have to eat more and more to maintain a feeling of wellbeing. Medications such as Prozac, Paxil and Zoloft work to regulate serotonin. These medications are frequently helpful when used in combination with ADHD and eating disorder treatment. Proper levels of serotonin can also help improve impulse control, giving the person time to think before they eat.

Compulsive Overeating

Most of us overeat at times. We may eat for sheer enjoyment even if we’re not hungry, or we may eat more than we intend at a dinner party or celebration. But for some, overeating becomes a compulsion they cannot stop. Compulsive overeaters lose control of their ability to stop eating. They use food to alter their feelings rather than satisfy hunger. Compulsive overeaters tend to crave foods high in carbohydrates, sugars, and salt.

Binge Eating

Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Buying the food and finding the time and place to binge in secret creates a level of risk and excitement that the ADHD brain craves. Large amounts of foods high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse control problems that contribute to binge eating and Bulimia.

Bulimia

Bulimia is binge eating accompanied by purging. The bulimic experiences the rush of planning the binge, which can be very stimulating for the person with ADHD. In addition, the bulimic may be stimulated by the satiation binging provides; then, he or she adds an additional dimension to the process: the relief of purging. Many bulimics report entering an altered state of consciousness, experiencing feelings of calmness and euphoria after they vomit. This cleansing provides relief, which is short lived, and so the bulimic is soon binging again.

Anorexia

Our culture is obsessed with thinness. “Food is OK, but don’t gain weight.” No wonder so many adolescent boys and girls, as well as women and men, become imprisoned in binge and purge cycles, chronic dieting, and anorexia nervosa. Anorexia can be deadly. People with anorexia have lost their ability to eat in a healthy way. Self-starvation is characterized by loss of control. They are obsessed with thoughts of food, body image, and diet. Anorectics can also use laxatives, diuretics, enemas, and compulsive exercise to maintain their distorted image of thinness.

As we learn more about ADHD, we discover that people manifest ADHD traits differently. Obsessing on food, exercise, and thinness gives the anorectic a way to focus their chaotic ADHD brain. They become over focused on thoughts and behaviors that related to food. Frequently these people will only become aware of their high level of activity, distractibility, and impulsiveness after they have been in recovery for anorexia. Self-starvation curtails hyperactivity.

Distractibility and being spaced out are characteristics of both anorexia and bulimia, whether or not they’re accompanied by ADHD. In each case the inability to concentrate or focus results because the brain is not being properly nourished. For people with ADHD, however, there is a history of attention difficulties that predates the eating disorder. Their concentration, impulse problems, and activity level may not improve when their eating disorder is treated. As a matter of fact, their ADHD traits can get worse once they are no longer self-medicating with food, or organizing their lives around food and exercise. If you are someone who has struggled with eating disorders, and suspect you may have ADHD, it is important to get an evaluation. Both your eating disorders and your ADHD must be treated.

Treatment for ADHD and Eating Disorders

It can be difficult if not impossible to stabilize your eating without treating your ADHD. On the other hand, you may be getting help for your ADHD, yet suffering from life threatening eating disorders. It is tricky to stabilize binge eating, bulimia, and anorexia while also treating ADHD. The important thing is to find professionals with experience in treating ADHD and eating disorders, and to make sure you are being treated comprehensively. You may have to educate your healthcare professional on your coexisting conditions. You may also have to work with more than one professional, one to treat your ADHD and another to treat your eating disorders. Recovering takes time. Be patient with yourself as you journey toward a healthier life.

A comprehensive treatment program includes:

  • Eating disorder assessment by an eating disorder specialist
  • Evaluation for and treatment of ADHD
  • A complete physical examination
  • Work with a nutritionist if possible
  • Exercise programs if you are able
  • Participate in groups such as Overeaters Anonymous, Weight Watchers
  • Therapy and support groups for eating disorders
  • Medication when warranted to treat ADHD, eating disorder, and other coexisting conditions
  • Identify trigger foods, and abstain from them
  • Therapy or coaching that helps you adapt to your ADHD

Medication

You may need medication to treat your ADHD and eating disorder at the neurotransmitter level. Even if you feel embarrassed talking about your eating problems, don’t let it keep you from getting help. Explain to your doctor how your ADHD affects your daily life. Tell him or her the details of your eating problems. It’s the only way you can get the help you need.

If you have abused prescription or street amphetamines, or over-the-counter appetite suppressants, you may not be a good candidate for amphetamine-based medication such as Adderall and Dexedrine. (Ritalin and Concerta are not amphetamines.) This doesn’t mean you absolutely can’t take amphetamines to treat your ADHD. Be honest with your doctor about your history of amphetamine abuse. It’s your decision to take stimulant medication, and depends on your history of abuse and where you are in your addiction recovery. The few people I know who have developed tolerance to and abused stimulant medication had histories of abusing prescribed and street amphetamines. There are non-stimulant medications such as Wellbutrin and Strattera that treat ADHD.

Keep Yourself Stimulated

Many people with ADHD need high levels of novelty and stimulus in their daily lives. Take responsibility for living a life that is stimulating. Boredom can trigger eating problems. Don’t just be open to new opportunities – create them. You might be more willing to travel, try a new sport, or find a hobby when you accept that being stimulated is an essential part of treating your eating problems.

 

References

Zametkin, Nordahl, Gross, King, Semple, Rumsey, Hamburger, and Cohen, “Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset,” {The New England Journal of Medicine}, 30 (1990).

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