The Connections Between the Brain and Urges to Binge and Purge
By Tammy Beasley, RDN, CEDRD, CSSD
“I did it again. And again! I can’t seem to control my bingeing no matter how hard I try. What is wrong with me?” Listening to a client who wants to recover from bulimia or binge eating disorder tell you the same thing shared in the last session can feel discouraging for both of you. The desire to recover is strong but the body and brain seem to be resisting. And each repeated behavior increases feelings of shame and hopelessness that things can or will ever change. Hunger and fullness signals, the body’s built-in fuel gauge, no longer seem to communicate correctly or effectively. Science has told us that an eating disorder can distort and confuse the brain and stomach’s ability to translate hunger and fullness messages. Science also tells us that as the brain and stomach heal, the body can relearn how to hear and trust those messages again, not only through nutritional rehabilitation itself but also by creating new behavior pathways that reduce the urges over time.
Current research is teaching us new layers of understanding about the interconnectedness of the brain, the gut and the urges entangled within both. The brain has less capability of creating new pathways to handle familiar urges when it is being flooded under a swell of emotions triggered by shame and hopelessness. Consider a natural disaster like flooding and the impact that flood gates can have on protecting the land and community. These flood gates, built over time as a counter-response to repeated flood patterns, hold back the rush of water and open opportunities for the community to take different routes to safety. Likewise, when the brain is flooded under a wave of emotions, it is very difficult to interrupt, slow down, or even see another way out of the familiar binge/purge cycle. However, if that same cycle is slowed down by a “flood gate” and the brain can then emotionally engage in a new way within a safe space, a fresh pathway begins to develop and alternatively create new patterns that strengthen recovery and gradually restore trust in the fuel gauge signals. If the shame and judgment that surrounds those urge cycles can also be simultaneously disrupted, the body can learn to embrace both physical and emotional urges as equally powerful opportunities to write another healing chapter in the recovery journey.
A starting place for creating new brain pathways to respond to the binge/purge, or binge/restrict, cycle is understanding the physiological changes created by the binge cycle and its influence on the inevitable emotional cycle that follows. Shame is the single most pervasive trigger that intersects all physiological and emotional responses to the binge cycle. Therefore, the most important objective is to begin seeing hunger and fullness signals, or lack thereof, through a filter for shame reduction. Observing hunger and fullness through a lens of self-compassion and a frame of hope neutralizes shame. How is this possible? The first step is making sense of the science occurring within the body. Understanding the physiological responses that can occur both before, during and after a binge helps reduce the “surprise factor,” begin a neutral and renewing conversation with the body and open the door to curiosity instead of judgment.
An array of hormones and neurotransmitters carry messages back and forth between the brain and gut. The scope of this conversation centers on the physiological responses to dopamine and insulin, specifically within the context of learned responses that can be “rewired” by the brain. Dopamine, a hormone released in response to pleasure received from activities like eating, is associated with reward, and evidence supports that the brain begins automating its response to a behavior if it is repeated, or “rewarded”, often. If the brain can predict a reward, it can respond to the dopamine trigger in the presence of or simply by seeing the binge foods. Evidence also suggests that brain reward circuitry is more active when sugary foods are consumed in hungry subjects as compared to subjects who are satisfied, and not hungry. The key message to embrace in the early stages of breaking the binge cycle’s hold on the brain is two-fold: 1) awareness that this “automated” response to binge foods as physiologically “learned” and can be “un-learned” over time reduces the shame triggered by assumptions that willpower has failed, and 2) periods of restriction as “punishment” for a binge can lower blood sugar levels and subsequently increase the desire for sugary-based binge foods in a hungry state.
In addition to dopamine, insulin regulation is progressively imbalanced over time with repetitive binge/purge, or binge/restrict cycles. Taste buds initiate the digestion and absorption process and are the first to signal the brain that glucose is on its way. The brain in turn tells the pancreas to prepare for the glucose load by releasing insulin, which serves as the key to cell doors to allow the glucose to enter and be used for energy. If the binge carries a large amount of sugar-based foods, the body adapts by producing large amounts of insulin just after eating, which in turn can potentially increase appetite for more. If the binge is then purged before all the foods consumed can be digested and absorbed, the body responds with insulin-produced hypoglycemia because of the presence of too much insulin in comparison to the glucose actually absorbed. The key message to embrace in this early stage of breaking the binge cycle’s hold on the brain is also two-fold: 1) awareness of this learned response and subsequent imbalance of insulin/blood sugar regulation can and will adjust over time, and 2) hunger and cravings can be intense in the early stages and will normalize alongside the insulin/blood-sugar balance. Knowing these inevitable, learned physiological responses ahead of time removes the “surprise factor” when experiencing them and helps reduce shame triggers sparked by feelings of body betrayal and “failed willpower.” Just as these patterns have been learned by the brain, new pathways can also be learned. Understanding these hormonal influences is one of the flood gates that can hold back the emotional deluge and allow space and time for new thoughts and patterns to develop.
The next phase is discovering and practicing three steps to reconnect to hunger and fullness, using these steps as flood gates holding back the force of emotional flooding to allow a safe space for new pathways to develop. The first step is meal timing. Research supports the body’s ability to reset the “clock” for food metabolism. In a 2017 research report in Current Biology (Wehrens, SMT, et al.), “meal timing exerts a variable influence over human physiological rhythms, with notable changes occurring in aspects of glucose homeostasis.” However, this same study notes that only “plasma glucose, but not insulin or triglyceride, rhythms are delayed by late meals.” Translation? A 5-hour delay between meals changed the rhythm of glucose homeostasis, or balance, but did not seem to influence insulin balance in the same way. This discovery seems to reflect the insulin-produced hypoglycemia phenomenon and further strengthens the role of timing of meals and snacks as a “flood gate” for new brain pathways. This flood gate is defined by a breakfast meal within a few hours of rising and from that point forward, consuming food every 3 to 4 hours. In the early stages, the hunger and fullness signals remain distorted and most likely will not coincide with the timing of meals and snacks. However, remaining consistent with this meal timing flood gate allows space for the body, brain and gut to heal and new pathways to be created. Similar to syncing meals and snacks with a new time zone when flying to another country even if not experiencing hunger cues that match, the body can readjust its hunger and fullness to these new patterns over time.
The second step is fuel, or food, balance. Saying “fuel” in place of “food” is a conscious choice that also serves as a flood gate to hold back the emotional meanings attached to food created by disordered eating thoughts and beliefs. Fuel implies a more neutral description and active purpose that can help diffuse anxiety and fear that may be triggered by the word “food”. Even if for a moment, reducing negative emotions by changing the language used can be a powerful tool that strengthens the new brain pathway. Every time “fuel” is used, the flood gate holds a little longer and the safe space can be explored a little deeper. The fuel choices made for each meal and snack are uniquely varied for each person and offer opportunities to experiment with how different combinations of fuel choices physically and emotionally feel. Research supports both variety and use of energy dense foods like proteins as associated with reduced eating disorder behaviors and recidivism. Meals adequate in protein have been shown to decrease the desire to binge and produce longer thermic effects. Translation here? Protein produces more heat when it is digested, which can lead to longer satiety and subsequently decrease the desire to binge by supporting more stable blood sugar levels. This step requires permission to choose and consume a variety of fuels in a variety of combinations. Permission embraces curiosity, not perfection. Staying curious about how different choices feel in the body, sustain energy, and change moods broadens the definition of balance. Defined as “to bring to equilibrium, to move in rhythm to and from; equal in value,” also includes “mental steadiness or emotional stability.” Therefore, balance is not only in the tangible fuel choices but also the intangible emotions and judgment around eating itself. The flood gate of fuel balance offers unlimited opportunities to hold back the emotional flooding with each different combination and try out the new pathways that are beginning to develop.
Fuel balance naturally leads to the third step, repetition. It is the repetition of meal timing and fuel balance, growing from an attitude of curious permission before, during and after eating, that strengthens the flood gates to hold on a little longer each time. A consistently fueled body is not nearly as vulnerable to physiological triggers. When physical cravings are reduced, emotional triggers are more clearly recognized. These emotional cravings do not have to open the gates and release the emotional flooding, nor do they represent failure to create new brain pathways. In fact, these same emotional cravings can support new pathways when used as opportunities to practice curiosity and embrace self-compassion for what is needed in that very moment. Emotional cravings are as real as physical cravings, and the healing comes in being able to differentiate the two and learn from both equally, without shame. Both can be embraced in recovery and reveal an opportunity to balance and restore trust in both food and body again.
Using intentionally focused effort and shifting attention to something meaningful within either scenario immerses the mind into something other than the binge or craving itself. As the mind repeats this shifted attention and the body repeats this new behavior pattern, both supported by flood gates of awareness, meal timing, fuel balance and repetition, the habitual emotional flooding is held back. Over time, the brain is emotionally engaged in a healing way as the focus and patterns are held more frequently and for longer periods of time. This fresh pathway can strengthen recovery as the urge to binge lessens and trust in both food and body is gradually restored.
About the author:
Tammy Beasley has been practicing as a registered, licensed dietitian/nutritionist for over thirty-two years, of which the last 27 have been specialized in the field of eating disorders. Her experience includes inpatient treatment programs and opening and managing several outpatient nutrition programs for clients with eating disorders in both Alabama and Florida; however, most of her experience has been in private practice until joining Castlewood Treatment Centers in 2015. She was recently promoted to Vice President of Clinical Nutrition Services, working closely with the Clinical Leadership Team to ensure that the nutrition programming blends both evidence-based science and cutting-edge practice. Tammy was the first registered dietitian to become certified with the International Association of Eating Disorder Professionals (iaedp) in 1993, and served on the Certification Committee for nine years, stepping into the role of Director from 2013-2017. During her tenure, the Commission on Dietetic Registration approved the CEDRD Certification for RDs in the field of eating disorders. Due to her work in this field, Tammy received the Excellence in Practice in Eating Disorders award from Behavioral Health Nutrition practice group of the Academy of Nutrition and Dietetics in 2016. Tammy enjoys translating evidence-based science into practical and insightful messages for clients to begin healing their relationship with food and body and for clinicians to incorporate into their own practices.
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