B r a i n - b a

B r a i n - b a

B r a i n - b a s e d Tr e a t m e n t For Binge Eating Nicole Siegfried, PhD, CEDS Chief Clinical Officer Tammy Beasley, RDN, CEDRD, CSSD Vice President of Clinical Nutrition Services The WAR Within Objectives Illustrate how the brain is activated during urges to binge. Understand the basic concepts of neuroplasticity

to create new neural pathways in the brain. Define and illustrate three keys points of reconnection to hunger and fullness Describe practical methods for both dietitians and therapists to unstick the repetitive behaviors and facilitate brain rewiring. The Mind and the Brain Brain: the physical organ that responds to our environment through chemical and electrical impulses. Mind: an embodied and relational process that regulates the flow of energy and information Dan Siegel Mind: the representation of your true self with the ability to focus attention

and make choices according to your values Jeffrey Schwartz on and Whats thehappening in the brain? brain INSULA What should I do? AMYGDALA

NUCLEUS ACCUMENSORBITOFRONTAL CORTEX Ok Eat it! I look fine YummyIts OK ! Im hungry. Tastes

good! CAUDATE NUCLEUS PARIETAL LOBE ANTERIOR CINGULATE CORTEX (ACC) (Hill, 2013) (Hill, 2017) Non-Eating Disorder Brain

INSULA What Should I do?! AMYGDALA NUCLEUS ACCUMBENS ORBITOFRONTAL CORTEX Whoa ! Yuk!

DONT EAT! Im HUGE! EEEK! I am not hungry And this tastes blah CAUDATE NUCLEUS PARIETAL LOBE ACC

(Hill,2017) 2013) (Hill, AN Brain INSULA AMYGDALA NUCLEUS ACCUMBENS ORBITOFRONTAL CORTEX What should

I do?! EAT! EAT! Im HUGE! All Good! GO!! Yummy ! That Tastes Delicious! CAUDATE NUCLEUS

PARIETAL LOBE ACC BN or BED Brain (Hill,2017; 2013)Kessler et al., (Hill, 2016; Matthes et al., 2009 Brain Reward Circuitry: Effects of Binge Eating Dopamine hormone is

released in response to pleasure signals (food) Dopamine circuits are associated with reward Brain will automate response to behavior if repeated often

Want it but do not have to like it PhD. Center for Bill Kelley, Cognitive Neuroscience at Dartmouth College Prediction and Reward If brain can predict reward, it will respond to the dopamine trigger This Photo by Unknown Author is licensed under CC BY-NC-ND Brain Reward Circuitry: Effects of Binge Eating

Evidence suggests that dopamine reward responses from acute food pleasure adjust over time; more required for same effect Evidence suggests brain reward circuitry is more active with sugarbased foods in hungry subjects vs. satiated subjects Schag et al., 2013; Kessler et al., 2016; Davis, 2015 The Binge Teaches the Brain That

The automated response to binge foods is physiologically learned and not simply failed willpower 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. Schag et al., 2013; Kessler et al., 2016; Davis, 2015 Cortisol Feeds the

Problem Stress triggers cortisol release Triggers release of more insulin which can cravings Decreases storage of glucose from blood to liver

Cortisol looks for stored glucose to feed stress Increases release of glucose from liver to blood Consequences of the binge/dieting cycle Binge eating episodes increase exponentially with the frequency of

dieting or restriction. More cortisol is produced by the stress response from dieting itself. Holmes et al. 2014; Tomiyama et al. 2010. The single most pervasive intersection between the distorted thoughts and the binge itself is SHAME. The brain

cannot rewire when it is emotionall y flooded This Photo by Unknown Author is licensed under CC BY-SA Neutralizing messages around food choices and body changes increase the brains

response flexibility This Photo by Unknown Author is licensed under CC BY-SA Our most important objective: Guide our clients to see a new way out of the binge/ restrict cycle through: A filter for shame reduction

A lens of selfcompassion A frame of hope urges, restriction and the brain How can new neural pathways in the brain be created?

Rewiring the Brain Neurogenesis Birth of new neurons Neuroplasticity Malleability of neural circuits Neural Darwinism Neural pruning Hebbs Law Fire together=wire together Quantum Zeno Effect Attention density

(Schwartz, 2016) Rewiring the Brain Self-Directed Neuroplasticity Rewiring or retraining your brain away from automatic behaviors to new behaviors (Schwartz, 2016) Rewiring the Brain by Rediscovering Hunger and Fullness

MEAL Fuel Balance TIMING Repetition Research on Meal Timing Adjusted mealtimes reset body clock Brain is the clock for sleep/ body temperature

Liver is clock for food metabolism Study: After 2 days of adjusted mealtimes, livers rhythm shifted 10 hours. Wehrens, SMT, et al. Current Biology. 2017. Research on Meal Timing Meal timing exerts a variable influence over human physiological rhythms, with notable changes occurring in aspects of glucose homeostasis.

Translation? A 5-hour delay between meals changed glucose balance but did NOT influence insulin balance the same way Reduced glucose without subsequent reduction in insulin creates insulin-produced hypoglycemia increasing sugar cravings Bottom line: Meal timing matters Flood Gate Analogy Flood Gate: Consistent meal/snack times

Restores and normalizes bodys appetite-based eating pattern Resets bodys metabolic clock Reduces insulin-produced hypoglycemia Serve as a flood gate to This Photo by Unknown Author is licensed under CC BY-NC

Rediscovering Hunger and Fullness FUEL Meal BALANCE Timing Repetition What IS Balance? Balance is defined as to bring to equilibrium, equal in value, including emotional stability. Balance is not only in the tangible food choices but also the intangible emotions

and judgment around food Research on Balance & Variety Better outcomes w/ increase in energy dense foods Fats Complex carbohydrates Proteins* Schebendach et al., JADA 2011 Decreased desire to binge or overeat

after consuming meals adequate in protein Herrin M, Larkin M. 2013 Longer thermic effects after eating meals with adequate protein compared to similar amounts of carbs or fats Li, Jia, et al. Nutrients 2016. Balance/Variety Requires Permission How do different fuel combinations

Feel in your body? Sustain your energy? Change your mood? Permission Requires Curiosity This Photo by Unknown Author is licensed under CC BY-NC-ND

Flood Gate Analogy Flood Gate: Balance of fuel groups Variety reduces cravings Choosing balance and variety requires permission Permission opens door to curiosity Curiosity reduces shame

and embraces both physical and emotional This Photo by Unknown Author is licensed under CC BY-NC-ND Rediscovering Hunger and Fullness Meal Fuel Balance Timing REPETITION Hunger and Fullness Analogies

A New Way to Drive This Photo by Unknown Author is licensed under CC BY-SA Flood Gate Analogy Flood Gate: Repetition and permission Restores confidence that change is possible Rewires by building a new pattern from

repetition itself This Photo by Unknown Author is licensed under CC BY-NC-ND Rewiring the Brain Step 1: RELABEL: The art of being aware Identify your thoughts and urges as uncomfortable sensations (Call it like it is!) Instead of I am huge! Or I must eat! Or I am sad!... I am having the thought I am having the urge I am having the feeling (Schwartz, 2016)

Rewiring the Brain Step 1: RELABEL (contd) This is mindfulness! Impartial spectator Curious detective (Schwartz, 2016) Rewiring the Brain Step 2: REATTRIBUTE: The different perspective This is my brain mis-firing

This is my brain trying to follow its well-worn path (Schwartz, 2016) Rewiring the Brain Step 3: REFOCUS: The power of attention Shift the gears yourself I am experiencing an automatic urge related to my eating disorder. I need to do another behavior. Opposite action 15 minute rule (Linehan, 1993; Schwartz, 2016)

Rewiring the Brain Step 4: REVALUE: The power of future Wise advocate Creating a life worth living the thought of being fat is coming and going and Im going to have a life anyway people live their lives in spite of their chronic pain, loss and other distressing experiences and I am right now going to live despite my thoughts.. they are not me.. and I am learning to tune them out and it takes time. (Schwartz, 2016) Rewiring the Brain

Step 4: REVALUE: The power of future Access gratitude Count your Blessings exercise Gratitude letters/gratitude phone calls Rewiring the Brain Step 4: REVALUE: The power of future Identify core values and values in action -- Values questionnaire -- Creating your life garden Career

Edu cati on Fa m Sp i r i t u al i

t y ily (Wilson, 2014) Conclusion Questions? References References Cell Press. "Delayed meal times reset body clocks." ScienceDaily. ScienceDaily, 1

June 2017. www.sciencedaily.com/releases/2017/06/170601124004.htm>. Davis C. The epidemiology and genetics of binge eating disorder. CNS Spectr. 2015; 20: 522-529. Donnelly, B.,Touyz, S., et al. (2018). Neuroimaging in bulimia nervosa and binge eating disorder: a systematic review. Journal of Eating Disorders, 6, 3. http://doi.org/10.1186/s40337-018-0187-1 Herrin, M, Larkin M. Nutrition Counseling in the Treatment of Eating Disorders.

Taylor & Francis, New York; 2013. Hill, L. (2018). A brain-based approach to eating disorder treatment. Retrieved from https://brainbasedeatingdisorders.org/etext Holmes, M. et al. Improving Prediction of Binge Episodes by Modelling Chronicity of Dietary Restriction. European Eating Disorders Review: 12 August 2014; https://doi.org/10.1002/erv.2315 Kelley B. (Center for Cognitive Neuroscience at Dartmouth College). How the

brain forms new habits: why willpower is not enough. Institute of Natural Resources Workshop, Huntsville, AL. February 2013. References References Kessler, R., Hutson, P., Herman, B., & Potenza, M. (2016). The neurobiological basis of binge eating disorder. Neuroscience Biobehavioral Review, 63, 223-238. Lask, B., & Frampton, I. (2011). Eating disorders and the brain. New York: Wiley.

Li, J, Armstrong, CLH, Campbell, WW. Effects of Dietary Protein Source and Quantity during Weight Loss on Appetite, Energy Expenditure, and CardioMetabolic Responses. Nutrients 2016, 8(2), 63; doi:10.3390/nu8020063 Linehan, M. M. (1993). Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. New York, NY, US: Guilford Press. Marek RJ, Ben-Porath DD, Federici A, et al. Targeting premeal anxiety in eating disordered clients and normal controls: a preliminary investigation into the use of mindful eating vs. distraction during food exposure. Int J

Eat Disord. 2013 Sep;46(6):582-5. doi: 10.1002/eat.22152. Epub 2013 Jun 5. Mathes, W., Brownley, K., Mo, X., & Bulik, C. (2009) The Biology of Binge Eating. Appetite, 52(3), 545553. References References Reiff DW, Reiff KKL. Eating Disorders: Nutrition Therapy in the Recovery Process, Aspen Publishers; 1997.

Schag K, et al. Food-related impulsivity in obesity and binge eating disorder- A systematic review. Obes Rev 2013;14: 477-495 Schebendach, JE, Mayer, LE, Devlin, MJ, et al. Food choice and diet variety in weight-restored patients with anorexia nervosa. J Am Diet Assoc. 2011 May; 111(5): 732-736. Schwartz, J. (2016). Brain lock: Free yourself from obsessivecompulsive behavior. New York: Harpers Collins.

Sherman, H, Genzer Y, Cohen R, et al. Timed high-fat diet resets circadian metabolism and prevents obesity. FASEB J. 2012 Aug;26(8):3493-502. doi: 10.1096/fj.12-208868. Epub 2012 May 16. Sophie M.T. Wehrens, S.C., Isherwood, C, et al. Meal Timing Regulates the Human Circadian System. Current Biology, 2017; DOI: 10.1016/j.cub.2017.04.059 References References Tchanturia, K. (2014). Cognitive remediation therapy for eating and weight disorders. London: Routledge.

Tomiyama, A. et al. Low Calorie Dieting Increases Cortisol. Psychosomatic Medicine 72 (4):357-64. Wilson, K. (2010). Things may go terribly horribly wrong. New York: New Harbinger.

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