Compulsive Overeating with Dr. Matthew Keene - Compulsive Overeating Conference

Written by HealthyPlace.com Staff Writer

OceanFree: I usually go for periods of time when I don't eat. I went through a few months that I was a compulsive eater and I gained about 20 lbs. What could be the reason for the drastic change in the eating pattern?

Dr. Keene: Compulsive overeating like many illnesses will wax and wane. It is not uncommon to go weeks or months without bingeing only to return to the binge cycle when either your physiology or your stressors change.

turtle31: Then what can we do to prevent reoccurrences?

Dr. Keene: Relapse is a part of any addiction. It is important not to beat yourself up if a relapse occurs. I think that the "one day at a time" approach that overeaters anonymous uses makes good sense. But sometimes it has to be more than one day at a time. It has to be one meal at a time.

Bob M:Do antidepressants work in helping treat compulsive overeating? Or any other medications for that matter?

Dr. Keene:Great question. I really believe that changing your eating habits, combined with improved feeling management can help the majority of compulsive overeaters. But like any other disease, once you have exhausted the conservative approach, medication can be useful. Antidepressants that stabilize serotonin are helpful only if you target the right person with the right dose. In these cases, proper use can result in significant and sustained improvement. The key is, not to necessarily target weight, but to target bingeing.

Bob M: And some specific names of these medications that might prove helpful?

Dr. Keene: Where do I begin? Medicines like Phen Fen and Meridia boost serotonin, but at the expense of significant risk. Herbal medicines like St. Johns Wort and 5HTP are reported to boost serotonin, but there aren't any good and true scientific studies to support this. Although I do have several patients who report good results with herbal meds. So that leaves us with the only medicines that have actually been studied to reduce binge eating: Prozac, Zoloft, and Paxil (throw fruits and vegetables at me, if you wish). But if you target the right person and not try and use a "one size fits all" approach, people treated with these medicines will have great success.

BC: What do you think about the nondieting approach? After years of restricting and binging, will eating "normally" (i.e. eating when you are physically hungry, stopping when you are full) help to boost your metabolism and stabilize your weight?

Dr. Keene:They will for some people, but others may need to subscribe to more of an abstinence model. The key is not to let anyone, including me, lump you into one approach. I think there is an "ideal" and a "real" abstinence. If you try and follow a completely abstinent food plan, you will have great difficulty succeeding. Some can do it, but quite frankly most can't. That is why I think it is important that everyone develops a list of their own personal trigger foods. That is, foods that invariably lead to a binge. Focus your attention on refraining from these foods and success becomes a whole lot easier.

Bob M:I also want to ask about another program that suggests: if you are a compulsive overeater, then bring all the foods you love and crave into the house and eat as much as you want. Eventually, the theory goes, you will become so tired of them, they won't attract you anymore and that's when you begin to control your compulsions. What do you think of that?

Dr. Keene:To me that is like giving a cocaine addict all the crack that he/she wants and expecting them to improve. That type of treatment, flooding or implosion, works well with anxiety disorders, not with addiction/compulsive overeating.

Diana: Is there any time schedule to putting compulsive overeating in "remission"?

Dr. Keene:Most studies suggest that it takes upwards of 6 months for the behavioral and physiologic changes to take root.

Bob M:I promised everyone we'd get to this. Can you please give us your "food plan for the rest of our lives"?

Dr. Keene:Obviously I can't provide a diagram of the food plan via the chatroom. So, here are the basics:

Bob M:As Dr. Keene is answering that, his book is entitled Chocolate is My Kryptonite.

Dr. Keene: 4 meals per day...(as our body will maintain peak metabolic efficiency if it has food about every 5 hours). Each meal combines the right amount of protein with complex carbs to best stabilize serotonin. The "meal plan for life" is divided into two phases: a weight-loss phase and a maintenance phase. In the weight-loss phase, caloric intake is low enough that people will lose 6-12 lbs. per month. But, since it emphasizes whole foods, people can lose weight without craving or suffering. It also has additional health benefits such as lowered cholesterol, improved mood, improved sugar balance. It is actually a very good food plan for diabetics according to our endocrinologist.

SueMR: My doc believes in "metabolic fitness". If your blood sugar and cholesterol are normal, then one shouldn't worry too much about the weight.

Dr. Keene:That is true if you are physically healthy. But if binge eating is causing social or emotional problems, then perfect health isn't so grand.

Bry: I've been told lowering calories can be problematic in that it fools the body into thinking its starving and messes up the serotonin levels.

Dr. Keene:If you lower the calories too much, like I believe the Adkins plan does, you are absolutely right. In fact, food plans that are too protein heavy, even if they are low in calories, will actually lower serotonin.