April 2014 ISSUE

 

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After Hour Food Spooks
For some people, late-night snacking is more than a bad habit; it’s pathology. Raiding the refrigerator before you fall asleep may be a symptom of a bigger problem than impulse control.
If your favorite late-night companion is peanut butter then maybe your social life isn’t the only thing that needs attention. Carbohydrate-rich peanut
butter is the preferred first choice in comfort foods for those who suffer from nocturnal eating syndrome.

Overeating in the evening, lack of daytime appetite, and insomnia are classic symptoms of this serious, frequently untreated clinical illness, which is believed to affect 1.5 percent of the world’s population.

Dr. Albert J. Stunkard of the University of Pennsylvania first diagnosed this highly complex ailment in 1955. Multi-faceted, nocturnal eating syndrome has numerous behavioral and hormonal components.

“People with nocturnal eating syndrome often have insomnia,” comments Dr. Michel A Cramer Bornemann of the Minnesota Regional Sleep Disorders Center in Minneapolis (www.hcmc.org).

“Many have difficulty initiating sleep or maintaining sleep, and when you’re having difficulty with good quality sleep you’re going to do things that comfort you. There may be a predisposition, but you need the trigger in order to fully express the syndrome. An individual who is prone to insomnia may embark on a crash diet, and late at night their defenses break down, they lose impulse control and polish off a big chocolate cake. They actually discover it improves their insomnia, and then develop this conditioned response to eat at night. So it’s certainly possible that in some cases it can be a very strong conditioned response reflective of other underlying issues. Or it could be these individuals have an abnormality in the hypothalamic pituitary adrenal axis, and so they’re predisposed to it, and then later in life they develop insomnia, so now you have two triggers together, resulting in the onset of nocturnal eating syndrome.”

Subjects tested for nocturnal eating syndrome at the University Hospital in Tromso, Norway exhibited hormonal imbalances that accounted for the ailment’s principal symptoms. Abnormal levels of three key regulatory hormones, melatonin, leptin and cortisol, were discovered, enough in each case to disrupt circadian rhythms (the body’s 24-hour biologic cycle).

This, in addition to evidence of problems with the hypothalamic pituitary adrenal axis, has given rise to the possibility of a genetic predisposition to nocturnal eating syndrome.

Stress, obesity, depression, hormonal imbalance, insomnia, anxiety, and a skewed biological cycle may all be contributory factors for this condition, which slowly and quietly establishes itself, and then becomes firmly entrenched, in a pattern of behavior usually only professional assistance can break.

Since night-eaters routinely ingest carbohydrate-loaded foods like peanut butter, it’s theorized that they are subconsciously attempting to raise serotonin levels to induce sleep. Yet even after a half century of study, nocturnal eating syndrome continues to perplex researchers.

When Dr. Kelly C. Allison, a close colleague of Dr. Stunkard’s at the University of Pennsylvania School of Medicine’s Weight and Eating Disorders Program (www.med.upenn.edu/weight/nighteating.shtml), conducted tests for hormonal imbalance, the results surprised her:

“We tried to replicate the neuroendocrine findings from [Tromso] where they found elevated levels of cortisol and attenuated nighttime responses of melatonin and leptin. We had 15 obese women with night eating syndrome and 14 obese control women in the hospital for three days. We could not replicate the findings with cortisol, leptin, or melatonin… The differences we did find in our study were most likely results of the night eating syndrome, not causes. These differences were: elevated insulin and a trend for elevated glucose at night and lower levels of ghrelin (an appetite stimulating hormone) during the night. TSH was also elevated in the night eaters, which could be influenced by their disrupted sleeping patterns.”

If there’s been one constant it’s the behavioral or psychological component that accompanies the disorder. Dr. Stunkard has observed that night-eaters become increasingly depressed as the day unfolds, and are usually at their worst by evening. The deeper their depression, the greater their anxiety, the more they eat, almost as if self-medicating.

Dr. Allison has been exposed to a variety of cases, each with its own unique characteristics.

“My impression from patients is that it is individual to the person; some people were always horrible sleepers, and they began to eat to put themselves back to sleep at some point. For others, they were never breakfast eaters, but then the circadian delay in their eating became more pronounced with nocturnal ingestions. We do know that for about 70 per cent of people with night eating syndrome that they can relate the onset to a stressful event or stressful period in their lives.”

According to Dr. Allison, night eating syndrome may be characterized by a delay in the daily or circadian pattern of eating.

“It seems that night-eaters have similar bedtime and morning get-up times as control subjects, both at home and in an inpatient study. However, their eating schedule is delayed, which seems to disrupt their sleep. Therefore, it seems the eating and sleeping patterns of night-eaters is desynchronized. This could mean that nocturnal eating syndrome is primarily an eating disorder that disrupts sleep, or it could mean that these folks have a primary problem with insomnia and sleep maintenance, and that their eating cycle has become delayed in service of putting themselves back to sleep. I lean toward thinking the first is generally true, but I’ve also seen patients for whom the second explanation seems to be a better fit, so we can only speculate on that point at the moment.”

Light on Sleep, Heavy on Mayo:

The comfort that food provides is often enough to deter people with nocturnal eating syndrome from seeking help. If you exhibit the following traits, you may be suffering from this destructive ailment:
  • You routinely skip breakfast.
  • Have little appetite during the day.
  • Feel tense, anxious or depressed.
  • Consume at least 50 per cent of your daily food intake throughout the evening.
  • Predominantly eat carbohydrates, and exhibit a craving for peanut butter.
  • Suffer from insomnia.
  • For more information see: Overcoming Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle by Dr Kelly C. Allison, Dr. Albert J. Stunkard and Sara L. Thier (available at Amazon.com).
Insomniacs have a tendency to make matters worse.

“People search for ways to improve their sleep and develop this conditioned response to eat comfort foods. So there can be a simple behavioral-based mechanism for the expression of it. Many individuals with insomnia develop a behavior that actually further perpetuates or facilitates insomnia They have a glass of wine or shot of whiskey every night and before you know it, it becomes routine. The problem is that alcohol diminishes deep sleep. It may help to initiate sleep in the first couple of hours, but it deteriorates deep sleep, making people more susceptible to nighttime awakenings. It’s now causing insomnia in the second half of sleep, which wasn’t a problem before,” says Dr. Cramer Bornemann.

“People trade one problem for another and by the time they come to a sleep center, they’ve developed such a strong conditioned response with inappropriate behaviors that it becomes very hard to recondition and remove that element, regardless if it’s alcohol, eating or watching television. Most people with insomnia
Before attempting any exercise or diet modification, always consult a fitness or medical professional.
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