A VERY different way to address Binge Eating and Bulimia
Here is a link to an article on Binge Eating Disorder from WebMD; a very credible source of health related information. I believe they should update their information on binge eating in a way that will actually help the majority of people who suffer from these conditions. >>>Article <<<
For the longest time (I’ve been an RD specializing in medical nutrition therapy for over 34 years), binge eating and especially bulimia have been presented as psychological disorders. Bingeing and bulimia are different from occasionally going overboard at a meal or having several snacks at night; binge eaters feel compelled to start and finish a cake, a party sized bag of chips, plus a half gallon of ice cream in one evening and feel totally out of control and unable to stop. Binge-ers will crash after eating, bulimics will make sure to purge first (throw up, take laxatives, exercise for hours) to “rid” themselves of the food.
I would like to present a very different way of looking at bingeing.
The Binge Provoker:
Take notice that the foods people binge on are mainly carbohydrate based: pasta, bread, chips, cookies, cakes, pies, ice cream, pudding, pizza, fast food, etc are primarily made of carbohydrate.
Carbohydrate is the food our body uses for energy. When carb is ingested, blood glucose naturally rises and the pancreas should release the exact correct amount of insulin to return blood glucose to the normal range while helping to transport any excess blood glucose into the liver and muscle cells (to replenish glycogen stores) and into fat cells.
I am willing to state that about 40% of binge-ers and bulimics have normal insulin release. When they go on a carb bender, their insulin is released normally, they end up with normal blood glucose and excess glucose is replaced in the liver, muscles and stored as fat. Binge-ers will become appropriately fat and bulimics will use purging, laxatives, or exercise in an effort to burn off the excess fat.
The Missing Link
Missing from all articles on binge eating and bulimia is the fact that about 60% of teens and adults who suffer from these conditions do NOT produce and release a normal amount of insulin. Here’s what happens in the body of a person with normal insulin and then a person with excess insulin.
(For ease, I will call those with normal insulin people with Metabolism A or Met A. Those with excess insulin as having Metabolism B or Met B).
The Met A Binge-er: A person with normal insulin eats a piece of cake. Their blood glucose rises, insulin releases in the appropriate amount, blood glucose returns to normal the normal range, and any excess blood glucose is stored in the liver, muscles, and fat. As they stand in the kitchen, they may feel bored or anxious or tired or stressed, and they have another slice of cake….everything proceeds as above. Even without thinking, they do it again and again until the entire cake is gone. They are ashamed and angry with themselves. “How could they eat an entire cake?” They did not control their eating….but their body will process this cake normally. Perhaps there is a psychological backdrop to their compulsive eating in the face of normal insulin.
The Met B Binge-er: If a person is genetically predisposed to produce excess insulin in response to a rise in blood glucose, the scenario is MUCH different.
The person with Met B cuts a slice of cake and promises him/herself that will be it.
Blood glucose rises normally
But…their pancreas over-releases insulin
Excess insulin “opens” excess fat cells. When the blood glucose is normalized, the liver and muscles are refilled with glycogen, the excess fat cells have been opened. The “normal” blood glucose leaves the circulation and fills those extra opened fat cells. This leaves the person’s blood glucose LOW.
Low blood glucose sets off an alarm in the brain; after all, the brain runs on glucose. The brain signals the person to get more carb…QUICKLY…to normalize the blood sugar. The person feels compelled to have another piece of cake.
Sure enough, the next slice of cake causes their blood glucose to rise….but just as quickly, excess insulin is released. Excess fat cells are opened and blood glucose is once again rendered LOW.
MORE CAKE! This is a real compulsion driven by the brain screaming for more carbohydrate to normalize blood glucose.
After the cake is gone, the binge-er with uncontrolled Met B may open a bag of chips, finish it, and move onto ice cream.
Inside the body, blood glucose is on a wild roller coaster…up/down/down- too- low…and then up/down/down- too- low.
When the binge is over, the Met B person is exhausted, light headed, dizzy, perhaps nauseated, and cranky and usually falls into a “carb coma.” This is not a real coma…but it is a way to describe nearly passing out after eating in a binge due to excess insulin.
How do I know if my bingeing is due to excess insulin?
If you have a patient with bulimia or binge eating disorder, please have fasting lab work drawn. The following FASTING labs will show if they have uncontrolled Metabolism B:
Fasting glucose….If it’s over 85, consider Met B
Total cholesterol…over 200, consider Met B
LDL cholesterol…over 99, consider Met B
Triglycerides….over 99, consider Met B
Hemoglobin A1C….under 5.2 OR over 5.6, consider Met B
Fasting insulin…over 7, consider Met B
Vitamin D level…under 40, consider Met B
You will find that 60% of those with bulimia and binge eating disorder have labs that look like the illustrated uncontrolled Met B labs. For these people, the “help” will be more physical than psychological.
The dietary treatment and lifestyle for uncontrolled insulin, insulin resistance, uncontrolled Met B is found in the book The Metabolism Miracle by Diane Kress, RD CDE.
If you have “Metabolism B” give yourself an 8 week trial on the program. These 8 weeks are called Step 1. (It is a lifetime program, but they will feel remarkably better and in control after fewer than 3 weeks). If they like how they feel (and their labs and energy will all improve, too), this is the help they have been seeking. Once labs are normalized, if psychological treatment is warranted, the therapist will be working with a clean slate.
If you have normal fasting lab work (as it pertains to Met B), it is very probable that their condition has a psychological component.
In conclusion, you are most likely accustomed to reading that those with binge eating disorder have no self-control, low self-esteem, high stress related to hiding their binges, are physically inactive, and will eventually become obese.
The whole story is that the majority of binge eater have a physical condition that no amount of psychological intervention can help on its own..
Treating binge eating requires a combination of The Metabolism Miracle program AND psychological intervention.