Anorexia/Eating Disorders/Night Time Eating

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QUESTION: Dear Dr Pritchard

I am a 30 year old woman and all my life I have had a problem with night time eating (waking up and eating). As a result, together with other lifestyle factors,  I had always battled with my weight until this year and I have finally reached my goal weight. However, I have found that the night time eating has started again and I have gained a kilogram in the 2 months so I am quite concerned, as I put a lot of effort into following a very balanced calorie controlled diet plan throughout the day and I fear regaining the weight I battled so hard to lose. I am not starving myself  and eat 5 small meals a day using the Weight Watchers propoints model. I have always suffered from mild insomnia too and  I am not sure if the 2 are linked?

Would this be classified as Night Eating Disorder? And if it is, the suggested treatments/lifestyle changes that I have encountered thus far are restructuring calorie allocation throughout the day (which I plan to try), and possibly taking melatonin supplements. I take no other form of sleep aids and the only medication I take is Mebeverine for IBS. I also have no allergies to medications. Would you suggest trying these? I have been on SSRIís in the past I didnít find them to be of much benefit and am able to manage my stress and anxiety levels with yoga and exercise quite comfortably now.

I just feel a bit helpless as I donít seem to have any control over the night time eating and donít really know if this is an area that many people are familiar with.

Thank you in advance

ANSWER: Hi Julianna,

I am so sorry you are going through this. I need a bit more information from you before I can help you.

Night eating syndrome includes morning anorexia (you're not hungry in the morning so you don't eat), increased appetite in the evening (from not eating enough all day), and insomnia. Patients can have complete or partial amnesia for eating during the night.

It sounds like you have the insomnia part, but I'm not sure about the morning anorexia and increased appetite in the evening as you say you eat 5 small meals a day. Are you hungry when you eat these meals? Do you remember eating at night?

Insomnia is very integrally linked to night time eating. It has to do with the stress response. When we don't get enough sleep, our body enters the stress response, otherwise known as the  General Adaptation Syndrome. Cortisol and adrenaline are released into the bloodstream to meet the perceived threat or danger; blood is rerouted to our arms and legs so we can flight or flee. It's a fabulous system that works well when we actually need to fight or flee. Unfortunately, most of the time we don't.

More importantly - in your case - is what lack of sleep does to our emotions and our digestive system. When we are under stress, our bodies crave high carbohydrate, high fat foods because our bodies think they need extra energy to fight or flee from a nonexistent threat.

It sounds like you do suffer from stress and anxiety, which can contribute to night time eating as your body is likely in a stress response pattern when you go to sleep.

Okay, so onto your question. Should you take melatonin? Maybe. I would try a few other things first.

1) Do some sort of relaxation right before bed. When do you do your yoga practice? Is it vigorous or restorative? I suggest trying some restorative yoga or meditating before bed.

2) How do you feel at night time? Are you tense? Anxious? Is your mind going 100 miles an hour? If so, then you might want to think about getting back on SSRIs or trying Tryptophan to calm you down so you can sleep.

3) If you are not anxious before bed, are doing relaxation exercises, and still can't sleep, then you can try melatonin. Keep in mind that melatonin does not work for everyone. While the body does utilize the hormone melatonin to induce sleep, if the supplement you are taking is not recognized by the body as melatonin, then you'll just end up with expensive urine! Make sure you get all supplements from a reputable brand as supplements are not regulated by the FDA. Manufacturers can claim just about anything on a supplement bottle and get away with it....

I hope this helps. If you would like some more information on night eating syndrome or anything else, please don't hesitate to ask. Good luck!


---------- FOLLOW-UP ----------

QUESTION: Dr Pritchard,

Thank you so much for your detailed response. It has been very informative and helpful. Just to follow up with regard to the night time eating, I don't really have the morning anorexia. There are mornings where I don't eat out of guilt as I feel I have snacked 'in my sleep'. And with reference to the amnesia, I often physically feel the effects of having  have eaten at night and then have to think back and try to remember what I ate. Most of the time I can recall however it isn't always a clear memory.

And in the evenings I find I do feel hungrier and want to eat more. Most of the time I manage to space out my calories but this is not always the case and I do occasionally overeat slightly.

With regard to the second issue of the melatonin, I do not feel anxious in the evening as a general rule. I do of course encounter stressful periods which may affect my sleep but I am usually quite calm when I go to bed and even when I experience an insomnia episode I am not anxious, just wide awake. The yoga I do is restorative and I do it in the evenings. I will definitely try to meditate before going to bed though and if that doesn't work I will chat to my pharmacist about recommending a trusted brand of Melatonin supplements.  

Thank you again for your help
Julianna

Answer
Hi Julianna,

That sounds like a good plan. For future reference, here are the symptoms of NES:

- Has trouble falling asleep or staying asleep. Wakes frequently and then often eats.
- Foods ingested are often carbohydrates: sugary and starch.
- Behavior is not like binge eating which is done in relatively short episodes. Night-eating syndrome involves continual eating throughout evening hours.
- This eating produces guilt and shame, not enjoyment.
- 1-2% of adults in the general population have this problem, but research suggests that about 6% of people who seek treatment for obesity have NES. Another study suggests that more than a quarter (27%) of people who are overweight by at least 100 pounds have the problem.
- It seems likely that a combination of biological, genetic, and emotional factors contribute to the problem. Stress appears to be a cause or trigger of NES, and stress-reduction programs, including mental health therapy, seem to help.
- The heavy preference for carbohydrates, which trigger the brain to produce so-called "feel-good" neurochemicals, suggests that night eating may be an unconscious attempt to self-medicate mood problems.
- NES may run in families. At this time is appears to respond to treatment with the SSRI sertraline (Zoloft).
- Treatment should include meal plans that distribute intake more evenly throughout the day so that you are not so vulnerable to caloric loading in the evening.

Here are a few good websites with information on supplements. They are based in the U.S., but hopefully similar brands exist in the UK and much of the information is generic anyway.

http://ods.od.nih.gov/Health_Information/Health_Information.aspx  
http://www.fda.gov/Food/DietarySupplements/default.htm  
http://www.usp.org/USPVerified/  
http://www.consumerlab.com/    

Good luck!

Anorexia/Eating Disorders

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Mary Pritchard

Expertise

I can answer questions about the psychology of eating, disordered eating attitudes and behaviors such as drive for thinness, drive for muscularity, binge eating, body dysmorphia, dieting, excessive/obsessive exercise, and body dissatisfaction. I can also answer questions about anorexia and bulimia.

Experience

I have a PhD in Psychology and teach courses in the Psychology of Health and the Psychology of Eating. I have been conducting research on disordered eating and exercise behaviors for 15 years.

Organizations
Midwestern psychological association, rocky mountain psychological association

Publications
Over 50 peer-reviewed journal articles in journals such as Eating Behaviors, Eating Disorders, and Eating and Weight Disorders

Education/Credentials
PhD in Psychology from the University of Denver

Awards and Honors
30 teaching awards, have received funding to conduct my research from academic institutions and state and local government

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