ADHD medication to help with binge eating

A study found that ADHD medication may be an effective treatment for binge eating disorders.

A drug approved for the treatment of attention deficit-hyperactivity disorder (ADHD), lisdexamfetamine dimesylate, cuts the number of binge eating days in people with binge eating disorder, according to a study published in JAMA Psychiatry^[1].

There is currently no approved medicine for binge-eating disorder, an eating disorder characterized by recurrent episodes of excessive food consumption, a sense of loss of control and psychological distress, and being overweight or obese.

Guidance from the UK’s National Institute for Health and Care Excellence, published in 2004, recommends that patients follow an evidenced-based self-help programme as a first step or a trial course of a selective serotonin reuptake inhibitor. Patients may also be offered a course of cognitive behavioural therapy (CBT), which has been shown to have an impact on binge eating behaviour, it says.

In this study, researchers from the Lindner Center of HOPE in Mason, Ohio, compared 11 weeks of treatment with 30mg/day, 50mg/day or 70mg/day lisdexamfetamine (marketed at Elvanse in Europe and as Vyvanse in the United States) with placebo in a randomised trial including 260 adults with moderate to severe binge-eating disorder.

The number of binge eating days per week decreased in the 50mg/day and 70 mg/day treatment groups compared with placebo – log-transformed binge eating days per week decreased with the 50-mg/day (least squares [LS] mean [SE] change, −1.49 [0.066]; P = .008) and 70-mg/d (LS mean [SE] change, −1.57 [0.067]; P < .001) but not in the 30 mg/day group (LS mean [SE] change, −1.24 [0.067]; P = .88).

Fewer patients also achieved four-week binge eating cessation in the placebo group (21.3%) compared with the 50 mg/day (42.2%) and 70 mg/day (50%) treatment groups.

Patients who took lisdexamfetamine also lost weight over the 11 weeks: the mean (SD) change in body weight was −3.1kg (3.64) for 30mg/day, −4.9kg (4.43) for 50mg/day, and −4.9kg (3.93) for 70mg/day (P < .001). The weight of patients in the placebo group remained unchanged at −0.1kg (3.09).

The authors say their findings support the need for further assessment of lisdexamfetamine as a treatment option for decreasing binge eating behaviour in adults with moderate to severe binge-eating disorder. “Confirmation of these findings in ongoing clinical trials may result in improved pharmacologic treatment for moderate to severe binge-eating disorder,” they say.

“Increased efficacy with increasing dosages of lisdexamfetamine suggests a dose-response relationship” was involved, they add, and “the lisdexamfetamine safety profile was generally consistent with findings in adults with ADHD”.

Susan Ringwood, chief executive officer of Beat, the charity that supports and campaigns on behalf of people with eating disorders, says: “We know how important it is for people to get evidence-based psychological treatment for their eating disorder, and that pharmacological treatment is not sufficient by itself. This study seems to be saying that because it isn’t easy to access CBT and other evidence-based psychological treatments, these drugs are an alternative.”

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Study: Genes link circadian clock to eating schedule

A study found that specific genes link a person's circadian clock to their eating schedule.

For most people, the urge to eat a meal or snack comes at a few, predictable times during the waking part of the day. But for those with a rare syndrome, hunger comes at unwanted hours, interrupts sleep and causes overeating.

Now, Salk scientists have discovered a pair of genes that normally keeps eating schedules in sync with daily sleep rhythms, and, when mutated, may play a role in so-called night eating syndrome. In mice with mutations in one of the genes, eating patterns are shifted, leading to unusual mealtimes and weight gain. The results were published in this month's Cell Reports.

"We really never expected that we would be able to decouple the sleep-wake cycle and the eating cycle, especially with a simple mutation," says senior study author Satchidananda Panda, an associate professor in Salk's Regulatory Biology Laboratory. "It opens up a whole lot of future questions about how these cycles are regulated."

More than a decade ago, researchers discovered that individuals with an inherited sleep disorder often carry a particular mutation in a protein called PER2. The mutation is in an area of the protein that can be phosphorylated -- the ability to bond with a phosphate chemical that changes the protein's function. Humans have three PER, or period, genes, all thought to play a role in the daily circadian clock and all containing the same phosphorylation spot.

The Salk scientists joined forces with a Chinese team led by Ying Xu of Nanjing University to test whether mutations in the equivalent area of PER1 would have the same effect as those in PER2 that caused the sleep disorder. So they bred mice to lack the mouse period genes, and added in a human PER1 or PER2 with a mutation in the phosphorylation site. As expected, mice with a mutated PER2 had sleep defects, dozing off earlier than usual. The same wasn't true for PER1 mutations though.

"In the mice without PER1, there was no obvious defect in their sleep-wake cycles," says Panda. "Instead, when we looked at their metabolism, we suddenly saw drastic changes."

Mice with the PER1 phosphorylation defects ate earlier than other mice -- causing them to wake up and snack before their sleep cycle was over -- and ate more food throughout their normal waking period. When the researchers looked at the molecular details of the PER1 protein, they found that the mutated PER1 led to lower protein levels during the sleeping period, higher levels during the waking period, and a faster degradation of protein whenever it was produced by cells.

Panda and his colleagues hypothesize that normally, PER1 and PER2 are kept synchronized since they have identical phosphorylation sites -- they are turned on and off at the same times, keeping sleep and eating cycles aligned. But a mutation in one of the genes could break this link, and cause off-cycle eating or sleeping.

"For a long time, people discounted night eating syndrome as not real," says Panda. "These results in mice suggest that it could actually be a genetic basis for the syndrome." The researchers haven't yet tested, however, whether any humans with night eating syndrome have mutations in PER1.

When Panda and Xu's team restricted access to food, providing it only at the mice's normal meal times, they found that even with a genetic mutation in PER1, mice could maintain a normal weight. Over a 10-week follow-up, these mice -- with a PER1 mutation but timed access to food -- showed no differences to control animals. This tells the researchers that the weight gain caused by PER1 is entirely caused by meal mistiming, not other metabolic defects.

Next, they hope to study exactly how PER1 controls appetite and eating behavior -- whether its molecular actions work through the liver, fat cells, brain or other organs.

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Childhood sleep issues could signal eating disorders

A study that looked at what may signal a child may eventually develop an eating disorder found that sleep problems during early childhood was the only signal found.

Researchers, clinicians, and sufferers are often interested in finding out what leads to eating disorders, what causes them, and how we can predict them (if at all). A recent research study done in Norway and published by the Journal of Eating Disorders sought to do just that.

Researchers used results from a 15-year-long longitudinal community study to investigate risk factors from early childhood (before age 5) for adolescent eating problems. The study began with 921 mothers completing questionnaires regarding their 1 ½ year old child. 784 mothers completed questionnaires at age 2 ½ and 737 at age 4 ½. When the children were 16 years old, 373 mothers also completed a questionnaire about eating problems called the Eating Attitudes Test.

The study looked at several possible risk factors from early childhood including picky eating in early childhood, sleep problems, internalizing problems, shyness, and emotionality. Interestingly, the only risk factor that was associated with the development of eating problems in adolescent was early childhood sleep problems.

Although this does not mean that sleep problems cause eating disorders, it may mean that there is some type of psychological or biological problem that results in both sleep problems in early childhood and eating problems in adolescence. However, given that this is the only study to show a such a correlation, the results must be duplicated before anyone begins to worry about a sleepless two-year-old developing an eating disorder at age 16.

Interestingly, picky eating in early childhood was not correlated with the development of eating disorders late in life (much to the relief of toddler parents everywhere).

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Study: Autistic traits seen in anorexic girls

A study shows that anorexic girls show some signs of autism. This could have treatment implications to help those with anorexia with treatment.

Scientists studying girls with the eating disorder anorexia have found they show a mild echo of the characteristics of autism - a finding which could point to new ways of helping anorexics overcome their illness.

A study by the leading autism expert Simon Baron-Cohen at Cambridge University's Autism Research Centre found that compared to typical girls, those with anorexia have an above-average number of autistic traits.

They were also found to have an above-average interest in systems and order, and below-average scores in empathy - a profile similar, but less pronounced, to that seen in people with autism, suggesting the two disorders may have common underlying features, Baron-Cohen said.

"Traditionally, anorexia has been viewed purely as an eating disorder. This is quite reasonable, since the girls' dangerously low weight and their risk of malnutrition or even death has to be the highest priority," he said.

"But this new research is suggesting that underlying the surface behavior, the mind of a person with anorexia may share a lot with the mind of a person with autism. In both conditions, there is a strong interest in systems. In girls with anorexia, they have latched onto a system that concerns body weight, shape, and food intake."

People with autism have varying levels of impairment across three main areas - social interaction and empathy or understanding, repetitive behavior and interests, and language and communication.

Cohen noted that autism and anorexia share certain features, such as rigid attitudes and behaviors, a tendency to be very self-focused, and a fascination with detail. Both disorders also share similar differences in the structure and function of brain regions involved in social perception.

OVERLOOKED

As many as one in 50 school age children in the United States are diagnosed with autism. In Europe experts say the rate is around one in 100 children. Most cases are diagnosed in boys.

But Bonnie Auyeung, who worked with Baron-Cohen on this latest research, said its findings suggested a proportion of females with autism may be being overlooked or misdiagnosed because doctors see them first with anorexia.

The study, published in the BioMed Central journal Molecular Autism, tested how 66 girls aged 12 to 18 with anorexia but without autism scored on tests to measure autistic traits.

The researchers compared them to more than 1,600 typical teenagers in the same age range, measuring their autistic traits using a score called the Autism Spectrum Quotient (AQ), their "systemising" using the Systemising Quotient (SQ), and their empathy using the Empathy Quotient (EQ).

They found that compared to typical girls on the AQ, five times more girls with anorexia scored in the range where people with autism score. On tests of empathy and systemising, girls with anorexia had a higher SQ, and a reduced EQ, a profile the researchers said parallels that seen in autism.

Tony Jaffa, who co-led the study, said acknowledging that some anorexic patients may also have a higher than normal number of autistic traits and a love of systems offers specialists new ideas for ways to treat people with the eating disorder.

"Shifting their interest away from body weight and dieting on to a different but equally systematic topic may be helpful," he said. "(And) recognizing that some patients with anorexia may also need help with social skills and communication, and with adapting to change, also gives us a new treatment angle."

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Rare sleep disorder causes woman to eat 2,500 calories while asleep

An interesting article about a sleep disorder causing a woman to eat 2,500 calories in her sleep.

Lesley Cusack, 55, has Nocturnal Sleep-Related Eating Disorder. She said that she only finds out what she’s eaten at night when she looks through the leftovers and trash in the morning.

Csack, who is from Warrington, Cheshire in the UK, binge-eats, chops up food, and tries to cook it while sleeping. She also says she’s tried to eat paint, Vaseline and washing powder. She’s even broken some teeth and bruised herself while trying to cook while sleeping.

"I tend to find opened tins of things or packets and I’ve no idea whether I’ve eaten some of them cold or not,” she said.

‘I’ve found soup in pans, but also in bowls. It all can get rather messy. I’ve put alarms on my doors in the hope it will wake me up. I simply turn it off in my sleep. I’m trying to lose weight but it’s a constant battle. I can follow a diet to the letter but it goes to pot at night,” she added.

"One weekend, I came down to find the cake slice covered in butter. I’d used it while making cheese sandwiches"

"The worst things that I know I’ve eaten are emulsion paint, Vaseline, cough syrup, raw potatoes and soap powder. The night I ate paint was the only time I’ve ever woken up. I can still remember standing in the kitchen touching my mouth and being very confused,” she said.

Due to her night eating, Cusack has gained weight and now weighs about 230 lbs. As a result, she eats fruits and salads during the day and joined a diet club.

Cusack’s doctors have not been able to find an explanation, but Cusack believes she has Nocturnal Sleep-Related Eating Disorder (NSRED).

"I had started to find bits of mess downstairs, but I didn’t realize it was me. It was a while before I worked it out, but when I did, I felt very embarrassed and guilty,” she said.

"There were times when I felt extremely depressed through trying to hide it,” she added.

Cusack, a retired department store manager and divorced mother of three, says she only recently told her family of her disorder. The turning point was the realization that she was going outside to raid the freezer in her shed.

"I was terrified at the thought of leaving the door open or having an accident outside," she said.

"Using the cooker, kettle and sharp knives means it’s only a matter of time before something more serious happens,” she added.

Cusack lives alone.

"My bedding and night clothes are constantly getting stained and need washing. I’m always finding a trail of food leading downstairs,” she said.

‘"The disturbed nights, waking exhausted with stomach cramp, feeling sick and finding food in the bed has become almost normal,” she added.

Dr. Paul Reading, President of the British Sleep Society, said that cases like Cusack’s are rare but not unknown.

"A proportion of adult sleep-walkers will eat and even cook during apparent sleep, often consuming foods they would not normally enjoy," he said.

"Weight gain and guilt are common consequences."

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10 Health Conditions That Disrupt Your Sleep

This article outlines ten common health conditions that may negatively impact your sleep.

Having problems going to sleep or staying asleep? A health condition could be to blame. Research suggests that sleep disturbances such as insomnia are rooted in certain medical conditions.

“We’re finding that both the quantity and quality of sleep a person gets can be linked to a number of health issues and diseases,” says James Wellman, MD, medical director of the Sleep Disorders Center of Georgia in Augusta. Sleep problems may be caused by physical, emotional, or hormonal conditions — everything from asthma to depression to menopause. Here are the most common culprits.

Depression: Sleep problems and depression are common bedfellows. Some research shows that 90 per cent of people with depression experience troubled sleep. “In low-grade depression, insomnia is often the most prominent symptom,” says Dr. Wellman. Waking up too early in the morning is a hallmark of serious depression. Other depression-related sleep problems include difficulty falling asleep and sleeping excessively. Anxiety (persistent worrying and uneasiness) can also leave you wide awake due to the inability to relax. Appropriate medications can help ease depression and anxiety, as well as the resulting sleep problems.

Menopause: As a woman’s periods start to end, insomnia may begin. According to the National Sleep Foundation, 61 per cent of menopausal women have sleep problems. One possible reason: Progesterone levels drop off during menopause. “Progesterone is a sleep-promoting hormone,” says Wellman. Changing levels of estrogen during menopause can also cause sleep disruptions by bringing on hot flashes, sudden waves of intense body heat, and sweating.

Diabetes: Diabetics often find restful sleep elusive due to blood sugar fluctuations, night sweats, and the need to urinate frequently during the night. Insomnia can also increase the risk of developing diabetes. In a recent study involving 1,741 adults, people who slept less than six hours were more likely to develop type 2 diabetes than those who got more sleep.

Musculoskeletal Disorders: The intense pain of arthritis can make drifting off to dreamland difficult. Plus, arthritis patients who must shift positions during the night often find it hard to fall asleep again. A pain reliever before bed can help ease sleep-stealing arthritis pain. Fibromyalgia, a condition characterized by painful ligaments and tendons, has also been linked with sleep disturbances, as well as next-day fatigue.

Cardiovascular Disease: Two common cardiovascular conditions, coronary artery disease and congestive heart failure, have been linked to sleep problems. In coronary artery disease, fluctuations in circadian rhythms can cause chest pain, an irregular heartbeat, or even a heart attack while sleeping. Congestive heart failure prevents the heart from pumping enough blood to reach all parts of the body. As a result, extra fluid accumulates around the lungs while you are lying down, causing you to wake up during the night. Using pillows to elevate the upper body can help.

Asthma: People with asthma often have sleep disturbances because of breathing difficulties, wheezing, and coughing, says Wellman. Asthma symptoms are usually worse at night due to night time changes in functioning that constrict the airway, increasing the risk of asthma attacks during the night. Some of the medications used to treat asthma can also cause insomnia and fragmented sleep.

Heartburn Or GERD: In heartburn or gastroesophageal reflux disease (GERD), acidic juices in the stomach flow back into the esophagus, causing irritation and painful burning sensations. This can make it difficult to fall asleep and stay asleep. Lying down often worsens the condition. Avoiding big meals, coffee, and alcohol in the evening may help relieve heartburn and bring on a restful night’s sleep.

Eating Disorders: “Anorexia has been found to interrupt normal sleep patterns, possibly due to malnutrition and excessive weight loss,” says Wellman. Research suggests that anorexics get more non-REM sleep and less REM sleep than people of normal weight, resulting in next-day tiredness. Bulimia is often characterized by eating binges and purges during the night, interfering with a good night’s sleep.

Kidney Disease: Kidney disease prevents the kidneys from filtering wastes from the blood, which can lead to insomnia or restless legs syndrome. Dialysis or even a kidney transplant doesn’t always result in normal sleep, says Wellman. Researchers aren’t sure why.

Thyroid Disease: An overactive thyroid gland (hyperthyroidism) can cause sleep-busting night sweats, while an underactive thyroid gland (hypothyroidism) brings on excessive daytime sleepiness. Both of these thyroid conditions can be diagnosed with a simple blood test and easily treated with medications.

When sleep problems are due to a medical problem or physical condition, treating the condition will often resolve the insomnia and ease sleep disturbances, says Wellman. See your doctor for an evaluation, and you may find that your insomnia does a disappearing act. If not, the next step is to make an appointment with a sleep specialist.

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