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Old 09-12-2012, 01:16 PM   #1
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Default Another thing to consider with WLS

It seems some people who had food/eating addiction then got WLS end up changing to a new addition.

http://www.newscientist.com/article/...ddiction.html?

Really shows the importance of treating the whole situation the person is in, not just cutting then sending them on their way.
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Old 09-12-2012, 04:26 PM   #2
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I really don't feel like registering to yet another new site. Would you be kind enough to post the article itself here, Tad? Thanks.
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Old 09-13-2012, 06:05 AM   #3
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Doh! I forgot that it was behind a registration wall, here it comes, in three parts.

========================================

"GREG" was only 36 when the scales hit 180 kilograms. "I was an eater," he says. "I ate all day, every day because if I didn't feel full, I didn't feel right." As a result, Greg, a computer programmer, had a long list of ailments atypical of a man his age, including hypertension, diabetes, sleep apnea and back pain caused by his large belly pulling his pelvis forward, forcing him to walk with a cane. His doctor told him he might die at any moment.

So he underwent weight-loss surgery. Just a year later, he had lost half his body weight. Gone were diabetes, hypertension, sleep apnea and the cane. But something else had taken their place. Greg was addicted to painkillers. "It was an all day, every day obsession," he says, and just like before, "if I wasn't feeling the meds, I didn't feel right."

Greg is not the only person to have experienced such a switch after weight-loss surgery. Before her operation, "Molly" was a social drinker. Just over a year later, she now starts and ends each day with a tall glass of whiskey. "Stacy" can't stop buying scrapbooking materials. "Rose", in an otherwise happy 16-year marriage, cannot seem to stop having sex with strangers, meeting them in hotel rooms and parking lots between meetings at work. "I know this could ruin my marriage," she says, "but I can't get myself to stop. I don't know what my problem is."

It's a textbook sentence familiar to addiction counsellors all over the world: "I can't stop and I don't know why." After gastric bypass surgery, some people find themselves in the grip of addiction. Their existence lends strong support to a long-standing and controversial theory that could shake the foundations of addiction science. But it would also carry distinctly good news for a group of people who historically have been marginalised.

May 2013 will see the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a tool used to define, identify and diagnose psychiatric illnesses. One of the most contentious battles that has raged between its authors is over what types of addictions to include and whether they are about the substance or the behaviour.

This argument is almost as old as addiction research itself. From the field's beginnings in the early 20th century, two factions have been at war: those convinced that addiction is about an uncontrollable physiological response to a substance, a "disease" that needs to be treated under a medical model, and those who think it is simply a sign of weak moral character.

A host of experiments soon cast substance addiction into a medical light: it would have been hard to explain certain behaviours otherwise. "You see animals running across an electrified floor in order to get cocaine or you see people neglecting eating, sleeping and caring for their kids to stick a needle in their arm," says Keith Humphreys, a psychiatrist at Stanford University in California, and former senior White House drug-policy adviser. How else could you explain the neglect of one's own young in favour of a substance? "Evolutionarily, that doesn't make sense," he says. And so, most acute-addiction treatment hospitals use a disease model to treat patients.

Splitting hairs

But not all addictions were deemed equal. As food, sex and gambling addictions began to emerge, the world reluctantly accepted them. But when these were followed in the digital age by video-game, porn and internet addiction, the response was markedly less sympathetic. The argument for weak character and a lack of self-control rose again.

To resolve the disconnect, in the fourth edition of the DSM, published in 1994, the authors decided to classify behavioural addictions to food, gambling or sex as separate from chemical addictions to substances like alcohol, nicotine, caffeine and drugs.

Drawing this line defined addiction not as a single disease, but as a tangle of environmental, physical and situational factors. The lack of a cohesive picture of what addiction is has perhaps meant that treatments often are not as effective as they could be. The US National Institute on Drug Abuse in Bethesda, Maryland, estimates that relapse rates are between 40 and 60 per cent.

Addiction researchers have turned to neuroscience to understand the mechanisms underlying different addictions. But the more they have tried to tease apart substance and behavioural addiction, the more similarities they find. For one thing, the brains of people with addiction look similar whether the addiction is to a substance or to a behaviour. When the brains of addicts are scanned using functional magnetic resonance imaging (fMRI) while they are shown videos of the addictive behaviour or of people using their drug of choice, the same reward centres are activated, says Robert Malenka, a Stanford neuroscientist who studies addiction.
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Old 09-13-2012, 06:06 AM   #4
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The physical symptoms, including withdrawal, are also the same, says Nicole Avena, a neuroscientist who studies the neural and biochemical mechanisms of food addiction at Princeton University. In her research with animals, Avena has found that when rats have access to a very sweet or very fatty food, they will overeat it. Over time, they will need more and more of it, "chasing a high" the way a drug user might while gaining tolerance - one of the key markers of an addicted brain. Removing the food, she says, leads to signs of withdrawal including anxiety, distress and even tremors, much like what could be expected of someone in chemical drug withdrawal. "The brain circuitry activation when people are addicted to food looks very much like the brain circuitry activation when people are addicted to drugs," she says.

The similarities are so pronounced, in fact, that other mouse studies show that it is possible to swap one addiction for another. "If we take the rats that are addicted to food and then, instead of offering them the food to eat each day, we offer them drugs of abuse, the rats that have the history of addiction to food will more readily take the drugs," says Avena.

Taking this research any further would have hit a wall. After all, it would have been ethically impossible to design a study to test such a theory in humans. But then it accidentally happened anyway.

Weight-loss surgery provided a crop of perfect research subjects, a population of people whose surgical intervention had irrevocably cut them off from their original addiction, and who (according to pre-surgery screening) had never shown previous signs of any other addiction. Like Avena's rats, robbed of their preferred method of activating their brain's reward system, some of these former food addicts scrambled to find a new fix.

This, Avena theorises, is what happened to Greg. After Roux-en-Y surgery - the most common kind of weight-loss-surgery, which restricts the stomach to reduce the amount of calories a person can absorb - Greg lost almost 100 kilograms, but not because he lost interest in food. "I wanted to eat, but I couldn't," he says. "The surgery wouldn't let me. I could only get a couple of bites in at a time and that wasn't enough to make me feel good."

Addiction transfer

The surgery created a unique condition in which, no matter how much the addicted brain wanted to reach satisfaction via its established channels, it could no longer do so.

In the wake of this accidental experiment, researchers have started to see evidence of people switching to new ways to satiate their cravings. When the pills prescribed for Greg's continuing back pain gave him another outlet, he became addicted. He wasn't the only one. Last year, a study warned of a rise in narcotic addiction after weight-loss surgery(Obesity Surgery, vol 21, p 680). A previous study had found that, years after the surgery, some people seemed to spontaneously develop alcohol dependence (Surgery for Obesity and Related Diseases, vol 4, p 647).

Estimates of the prevalence of the transference of addiction are few, because researchers have only recently begun to focus on the topic, but in a study published last year, Eric Braverman of Weill Cornell Medical College in New York and Kenneth Blum of the University of Florida in Gainesville estimated the percentage at 5 to 30 per cent (Journal of Genetic Syndromes & Gene Therapy, S2, p 001).

Their study put an official label on a phenomenon, "addiction transfer", which has been anecdotally described for years.

As early as 2006, substance-abuse centres were reporting an increase in these kinds of cases after gastric surgery. At the Betty Ford Center in Rancho Mirage, California, people who'd had stomach surgery were checking in with new addictions. Addiction transfer was not unique to this group. According to The Wall Street Journal, the centre says that 25 per cent of people with alcoholism who relapse switch to a new drug, such as opiates. Like Greg, Molly and Stacy, some people are simply addicted to addiction. But why? Previously these individuals were dismissed as having addictive personalities. Recently, however, it has become clear that the reason may be genetic.

Addiction involves a complex set of factors and several areas of the brain, but if you had to pick one "smoking gun" it would be the neurotransmitter dopamine. Addictive substances cause the release of this chemical in the nucleus accumbens, part of the brain's reward system. "We only have one dopamine system, and it doesn't care what triggers it," says Avena.

But if we all have the same reward system, why can many people try addictive substances but only some go on to develop addiction? Gene-Jack Wang at the Brookhaven National Laboratory in Upton, New York, is one of a growing number of researchers who have begun to identify one particular culprit in the addicted brain.
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Old 09-13-2012, 06:07 AM   #5
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The brain has five different receptors for dopamine. One of these - known as the dopamine D2 receptor - is thought to act as a control system, limiting the levels of dopamine available to the brain (see "Dopamine brakes"). The fewer D2 receptors are present in your brain, Wang says, the more likely you are to become addicted.

This holds true across all types of addictions. Wang's team have compared chronic cocaine users, methamphetamine users, alcoholics, heroin users and morbidly obese people whose body mass index exceeds 40. All were shown to possess significantly fewer D2 receptors in their brains than people without these conditions.

The best way to test this correlation would be to find out what happens when the D2 receptors are missing entirely. In 2010, Paul Johnson and Paul Kenny of the Scripps Research Institute in Jupiter, Florida, did just that, genetically engineering mice without D2 receptors to find out whether their eating behaviour would change. The results were as they had suspected: mice lacking D2 receptors worked pathologically longer and harder to obtain food than their normal counterparts (Nature Neuroscience, vol 13, p 635).

But would the addiction transfer? Last year, David Lovinger at the US National Institutes of Health in Bethesda, Maryland, supplied D2-deficient mice with food and cocaine. Sure enough, the loss of D2 receptors rendered the mice far more sensitive to the effects of both.

That raised a question: did addiction burn away D2 receptors? Or did addicts never have the normal number of D2 receptors to begin with? Blum reasoned that the latter is the case. Two forms, or alleles, of the same gene, DRD2, play a role in the formation of D2 receptors. Back in 1990, Blum found that carriers of the A1 allele have about 30 per cent fewer D2 receptors than carriers of the A2 allele.

So if you carry the A1 allele, your dopamine system will contain fewer dopamine brakes. Intriguingly, the A1 allele has also been separately linked to obesity.

The genetic link is welcome news for those who have posited for years that addiction is a brain disease rather than a character flaw. "Addiction is a chronic, persistent relapsing illness not unlike diabetes, not unlike many cancers," says Malenka. In itself, the missing receptors are not a guarantee of addiction. Like asthma and diabetes, your predisposition is down to genetic luck but the manifestation is down to circumstance. "If you never take a drink, you will never be an alcoholic, regardless of your genes," says Humphreys.

Acceptance of this theory would mean an end to decades of philosophical hair-splitting between substance, food and video-game addictions.

Not everyone is convinced. "We need to be extremely careful about over-interpreting these clinical phenomena," says Paul Fletcher at the University of Cambridge. Although he does not contest the idea that some people transfer from addiction to addiction, Fletcher thinks their existence is compatible with more than one theory. For example, changes produced by the first substance could make the brain vulnerable to a second substance or behaviour. In Nature earlier this year, he asserted that there is little evidence in favour of a physical basis for food addiction.

But even if conclusive evidence pins it down, it may be a long time before the new findings are reflected in the DSM. "The DSM, in a lot of ways, is a political document," says Humphreys. "It influences how very large sums of money are going to be spent." Blurring the line could demean the term addiction, he says. "I don't want everything in life where people are lacking self-control to be labelled as an addiction."

Even if the DSM retains its fine-grained taxonomy, people in the grip of addiction may still benefit from the growing popularity of the theory that it is a single brain disorder with many different manifestations. Treatments are already being devised in line with the theory that all addiction is a single disease.

Attempts to design drugs to combat addiction on its own turf have met with some success. A recent study demonstrated that the synaptic changes that had occurred in rats as a result of cocaine use could be reversed by reducing the ability of the neurons responding to the cocaine to fire, nullifying the effects of the drug. In fact, Wang says trials are already testing the effects of a combination of Naltrexone, which has been approved to treat alcoholism, and Bupropion, which combats nicotine addiction, to treat obesity. These treatments further validate the notion that one addiction may be substituted for another.

Greg is going to outpatient counselling. But in the near future, he may have hope for a drug that can help.
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Old 09-13-2012, 05:10 PM   #6
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My therapist believes that everyone has an 'emotional plate' and that when their plate hasn't been filled during their developmental years, with good stuff, like self-esteem, confidence, and unconditional love, they are more prone to filling it with inappropriate and only temporarily satisfying (hence, needing to feed the addiction) things like drinking, drug abuse, gambling, promiscuity, and yes, food dysfunction. Certainly not all people, and absolutely not all fat people, but many.

If their primary needs aren't being met, their emotional plate not being filled, then WLS (or detox for other addictions) won't help because it requires emotional and psychological change AND a lot of support.
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Old 09-13-2012, 07:43 PM   #7
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Default Heh...You're gonna lose con-trol!

Quote:
Originally Posted by Tad View Post
It seems some people who had food/eating addiction then got WLS end up changing to a new addition.

http://www.newscientist.com/article/...ddiction.html?

Really shows the importance of treating the whole situation the person is in, not just cutting then sending them on their way.
You said addition...instead of addiction.
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Old 09-19-2012, 10:37 AM   #8
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This is why any surgical program worth a plugged nickel has a comprehensive screening process, which should include dietitians, social workers/psychologists and nurses/nurse practitioners, and emphasize to the patient that they need support before, during and especially after the surgery. If you have untreated or poorly-controlled mental pathologies, your chances of success are severely diminished.
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Old 09-20-2012, 08:43 PM   #9
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Quote:
Originally Posted by cakeboy View Post
This is why any surgical program worth a plugged nickel has a comprehensive screening process, which should include dietitians, social workers/psychologists and nurses/nurse practitioners, and emphasize to the patient that they need support before, during and especially after the surgery. If you have untreated or poorly-controlled mental pathologies, your chances of success are severely diminished.
Right.

Unfortunately for my brother, they missed his mental health disorders and he "out ate" his surgery several times, dying early from complications of diabetes. I, OTOH, as much as I love to eat, limit it to mere enjoyment and not self medication. I'd like to think this is why I've had success with my WLS.
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Old 09-20-2012, 09:29 PM   #10
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Quote:
Originally Posted by CastingPearls View Post
My therapist believes that everyone has an 'emotional plate' and that when their plate hasn't been filled during their developmental years, with good stuff, like self-esteem, confidence, and unconditional love, they are more prone to filling it with inappropriate and only temporarily satisfying (hence, needing to feed the addiction) things like drinking, drug abuse, gambling, promiscuity, and yes, food dysfunction. Certainly not all people, and absolutely not all fat people, but many.

If their primary needs aren't being met, their emotional plate not being filled, then WLS (or detox for other addictions) won't help because it requires emotional and psychological change AND a lot of support.
Not a bad way of thinking of it. I think it's even simpler than that: sometimes we get addicted to things that feel good, and the less we feel good without external things, the more likely we are to get the addiction.
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Old 09-26-2012, 10:10 AM   #11
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Quote:
Originally Posted by Yakatori View Post
Quote:
Originally Posted by Tad View Post
It seems some people who had food/eating addiction then got WLS end up changing to a new addition.

http://www.newscientist.com/article/...ddiction.html?

Really shows the importance of treating the whole situation the person is in, not just cutting then sending them on their way.
You said addition...instead of addiction.
I don't know, it seems like a strangely appropriate Freudian slip.
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