Compulsive Overeating Conference with
Dr. Matthew Keene

Bob M is the moderator.

BEGINNING

Bob M: Good evening everyone. I'm Bob McMillan, moderator of tonight's conference. Thank you for visiting our website and chatrooms. Our guest tonight is a psychiatrist, eating disorders expert, and author of the book "Chocolate is My Krytonite: Feeding Your Feelings/How to Survive the Forces of Food". He's Dr. Matthew Keene. We'll be discussing why people binge/compulsively overeat and what you can do about it. And, in a few minutes, we'll open the floor for your personal questions for Dr. Keene. Good evening Dr. Keene and welcome to the Concerned Counseling website. Could you please tell us a bit more about your expertise and how you came to write this book?

Dr. Keene: Welcome to our guests. Hello everyone. I went to medical school at Georgetown University, trained at the Cleveland Clinic and am board certified in psychiatry/neurology and addiction psychiatry. My first job out of medical school was working with compulsive overeaters. It has been so rewarding that I have continued my work.

Bob M: You've done a lot of research on the subject of compulsive overeating. What are the most important factors that lead someone to binge eat?

Dr. Keene: I think it is a combination of the genes God gave you combined with poor feelings management.

Bob M: Can you explain what you mean by "poor feelings management"?

Dr. Keene: I am not using the word "poor" as a derogatory term. I think we are conditioned from birth to associate food with comfort. Think about it...as infants the only way we could express ourselves was to cry. What we really wanted was mom and dad to comfort us. But they always brought that secret weapon, formula. We will talk later, how formula and more importantly, other processed carbos, can alter the physiology of a compulsive overeater. For now, it is important to understand that compulsive overeaters often use food to deal with uncomfortable emotions. Our goal is to teach them healthier ways of expression.

Bob M: You mentioned genetic factors and some psychological issues, can a person be simply "addicted" to food?

Dr. Keene: That is exactly what I am saying!!! It has been estimated that 18 million Americans are addicted to the most powerful drug known to man....food. Certain foods, like any other addictive substance, can powerfully alter body chemistry in certain people. The chemical that is of importance in this process is Serotonin.

Bob M: Just to clarify for everyone here, what is Serotonin and what role does it play in our body chemistry?

Dr. Keene: Serotonin is our happy juice. Or more technically, it is a brain chemical that creates a feeling of satisfaction. Not just emotional satisfaction, but physical as well. As it turns out, compulsive overeaters have been found to have Serotonin levels that are 4 times lower than normal. So if your happy juice isn't at the right level, you have a tendency to feel depressed, irritable, anxious etc. Our bodies are pretty sophisticated and can sense this. But it is not like it can tell you to go to the Jiffy Lube and say you're a quart low of Serotoin. Instead it looks for other methods....food, alcohol, etc. In fact, just two slices of bread with jelly can boost Serotonin by 450%. Imagine what an entire binge can do.

Bob M: For those of you just coming in...welcome. We're discussing the causes of Compulsive Overeating/Bingeing and what can be done in terms of treatment. Our guest is Dr. Matthew Keene, psychiatrist, eating disorders expert and author of the book "Chocolate is My Kryptonite: Feeding your Feelings/How to Survive the Forces of Food." Two things I want to make sure we all understand: 1) Are you saying, yes there are psychological factors leading to compulsive overeating, but an overeater's Serotonin levels are the major cause of overeating? 2) If we fix the serontonin levels, will that be the main answer towards making a significant recovery?

Dr. Keene: Not necessarily. Stabilizing Serotonin is essential to recovery, but if you continue to have a psychological mindset to use food as a coping tool, recovery will remain elusive. That is why it is important to address both biology and psychology for any long-term recovery.

Bob M: One last question from me, then onto some audience questions. Can a person make a "full recovery" from compulsive overeating"?

Dr. Keene: Absolutely! The disease of compulsive overeating can't necessarily be cured, but it can be put into complete remission.

Bob M: Here are some audience questions:

Mer512: I know what I am doing when I start a binge. I know how I will feel afterwards and yet I don't stop myself. I know that I am comforting myself and temporarily it works, but I also know how I will hate myself later and yet I do it. Should I just give up?

Dr. Keene: Of course not. All of the feelings that you are describing can be dealt with in time and with proper treatment. It is normal to feel out of control when the bingeing is out of control. But when you begin to understand the disease and how to eat properly, combined with improved feelings management, success is at hand.

Bob M: As we proceed through the conference tonight, Dr. Keene is going to give us a "meal plan for the rest of your life". Here's the next question:

Flyaway: Are there certain categories of food that contribute more to a boost in the Serotonin level?

Dr. Keene: Absolutely! All processed carbs, including breads and pastas will give a temporary boost in serotonin, but the key word is "temporary". The boost lasts an hour or so. Then comes the calories, the weight gain, the guilt, and shame, and worse still, serotonin levels plunge downward, even further than before you ate the carbs. So in the long run, if not treated, binge eating becomes progressively worse.

Sue MR: So no more carbs?

Dr. Keene: No. Whole complex carbs are the most important treatment to overcoming overeating. It is the processed carbs that are deadly. Take a look at alcohol. We would all agree it is addictive. But what is alcohol, but the ultimate processed carb. It is liquid sugar with a kick!! For some compulsive overeaters, sugar, bread, junk food, etc. can be just as addictive. Unfortunately, society is yet to recognize this.

turtle31: What can be done about the Serotonin levels? What specific foods are high in it?

Dr. Keene: The solution is not to eat foods that boost serotonin through the roof, but instead eat foods that will create stable serotnin levels throughout the day. We do this by combining the right amount of lean protein with whole complex carbs. These foods will stabilize Serotonin. As importantly, since whole foods take longer to digest, you feel full longer and crave less. Finally, you begin to fill up on vitamins and minerals and bran instead of empty calories.

Bob M: Some examples of whole complex carbs, please.

Dr. Keene: Good question. Just about everything that God gave us. Fruits, veggies, whole grain, etc. Unfortunately, we live in a society that has processed our foods beyond recognition. So initially it seems difficult to obtain high quality food. But when you realize that to treat this disease effectively that it doesn't require rocket science, but a return to basics, it is actually quite easy to treat.

Bob M: I received a couple of messages on Dr. Keene's book. It's called "Chocolate is My Kyptonite". You can purchase it from our online bookstore, or just click on this link now. Dr. Keene, before we continue on, there are also some audience questions on what exactly constitutes "compulsive overeating". How much food do you have to take in, and in what frequency, to be considered a "compulsive overeater"?

Dr. Keene: There are diagnostic criteria that professionals use to identify compulsive overeating. Unfortunately, it is almost too easy to meet the diagnosis. You just have to answer "yes" to these 3 questions:

1. Do you eat large amounts of food in a short period of time?
2. Do you have trouble stopping at one bite?
3. Does this happen twice or more per week?

I think in the 90's, we would all meet this. That is why I include the following two points.

1. Do you crave processed carbs? I think this is imperative to accurately pinpoint those who may have a Serotonin deficiency.
2. Is overeating causing you some sort of physical, emotional, or social harm?

I don't think it is fair to diagnose someone with an eating disorder if there are no recognizable consequences.

Bes: I feel like I can't control my eating because I always feel hungry. How can I stop feeling hungry?

Dr. Keene: Again, Serotonin is our satisfaction chemical. Until you are able to stabilize Serotonin, you will likely to continue to feel hungry. The "Menu for Life Plan" outlined in the book is one way to stabilize Serotonin. But there are others as well. For example, people who exercise have 50% more available Serotonin than couch potatoes, and I am not talking marathon running or step aerobics. Somehow, we have become convinced that loud music and lycra burn calories. It doesn't. A simple walking program is a great start.

Bob M: Don't worry, we are not going to let you leave tonight before giving us a few parts of the menu plan. :) Here are a few audience comments, some reaction to what's being said:

Kim4: I don't feel like I eat because of "hunger"...that makes it even harder to stop the binge!!

Stever: But boy, fruits have so many fat calories in the glucose. I hate to eat to many of them. I'd rather just not eat anything at all.

mulan: Dr. Keene - bread? I don't think Dr. Judith Wurthman will agree with this either.

Dr. Keene: Let me respond to a few of the comments. Fruits contain fructose not glucose, and fructose does not have the same derogatory affect on serotinon as does glucose. Next, you are right. Breads may not be unhealthy for all compulsive overeaters though. It is important to identify your own personal trigger foods.

cricket: If these foods give a boost, then why after eating them do I feel very tired. It can affect me in as little as 15 minutes, and I become incredibly sleepy.

Dr. Keene: Serotonin is a calming chemical. Any foods that artificially boost it too high can make you feel too calm, i.e. sleepy.

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.

Dr.Tucker-Ladd: How do you teach "feeling management"?

Dr. Keene: It is a combination of improving coping skills through teaching increased expressiveness, assertiveness, boosting body image, and lifting self esteem. And I think there are a number of self-help books, including mine, which can teach you these skills without necessarily going through intensive psychotherapy. However, many compulsive overeaters may have some deeply rooted issues, such as sexual abuse, that require individual therapy.

BobM: Dr. Tucker-Ladd is going to be our guest tomorrow night. We'll be talking about: How effective are self-help techniques and what ones can be used to improve your life. We start all our conferences at 6p Pacific, 8 p.m. CST, 9 EST.

willowbear: Bob, did Dr. Keene talk about taking serotonin supplements? I see them in the health food stores all the time. Are they for real or a rip-off?

Dr. Keene: Nobody knows for sure yet. I assume you are referring to the herbal remedies offered. As I have said, some of my patients swear by St. John's Wort, while others wouldn't touch it with a ten foot pole. There is good data to support St. John's Wort for treating depression, but not a single study has looked at whether if works for eating disorders.

Bob M: What about diet pills? Are they ever useful when it comes to compulsive overeating?

Dr. Keene: I don't think so. Diet pills treat a symptom, weight, not the disease.

Marsh: I've heard the meds only have a short term effect on the binging. What is your opinion?

Dr. Keene: Medicines have a short term effect in promoting weight loss. They appear to work better towards eliminating binge episodes. But again, you need to treat the right person with the right medicine and not assume that everyone needs pills to treat a disease that can often be treated with better feelings and better feeding.

Bob M: We have many people who visit our site, who go from eating disorder to eating disorder. From anorexia, to bulimia, onto compulsive overeating and back again or in combination. We are constantly being told, diets and weight loss programs are one of the key ingredients to the start of an eating disorder. Should someone who's been an overeater for a long time be concerned that by going on a "program," it could lead to anorexia or bulimia?

Dr. Keene: Let me answer this in several parts. Firstly, I think bulimia is often an evolution of compulsive overeating. Compulsive overeaters gain more and more weight until purging seems like a viable alternative. The same serotonin defects that exist in compulsive overeaters also exist in bulimics. I think true anorexia likely affects a different part of the brain. There is a condition known as bulexeremia that is best treated by combining treatment approaches for both anorexia and bulimia. I agree that diets and society's notion that rail thin beauty is the cultural ideal contributes to all eating disorders. That's why I prefer treating compulsive overeating as a disease with a meal plan for life versus diets which have a 98% failure.

wasted: Are serotonin levels different in anorexics as opposed to binge eaters?

Dr. Keene: Yes, anorexia really is a much more neurologically, chemically, as well as emotionally complicated illness.

Bry: You mentioned your eating program. It takes energy and commitment. How does one with binge eating get to the point that they can follow a program?

Dr. Keene: I think like any addiction, people need to get to the point in their life where making a major lifestyle change seems to be a priority. This is obviously a very personal matter. I think it is important to mention again the issue of relapses. Success is almost always preceded by failed attempts. In other words, to be a bit cliché..if at first you don't succeed...etc etc.

BobM: I want to thank Dr. Keene for being our guest tonight and for staying late to answer extra questions. It's entitled "Chocolate is My Kryptonite: Feeding your Feelings/How to Survive the Forces of Food". Tomorrow night, Dr. Tucker- Ladd joins us for a discussion on the effectiveness of self-help and the techniques that may work best for you. We will be dealing with a variety of mental health issues. Thank you again Dr. Keene and to everyone in the audience for coming tonight.

Dr. Keene: Thank you for having me.

Kim4: Please express my "thanks" to Dr. Keene...it was great!

willowbear: Thank you Dr.Keene. It was very informative!!!!thanks Bob

Flyaway: Bob, thank you for this conference. It was very good. Thank you very much for your helpful information, Dr. Keene

Bob M: Good Night

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