Pulses and 2 women’s binge eating went on their mind

What if the uncontrollable desire to eat rapidly large amounts of food is rooted in an impaired brain circuit? If that were the case, people who live with binge eating disorder — a psychiatric diagnosis The tremors of the Parkinson’s disease patient may not be to blame for overeating.

This question prompted doctors to try a new treatment different from any that had been made to help people with this common but under-reported eating disorder. least 3 percent The population has it, said Dr. Casey Halpern, a neurosurgeon at the University of Pennsylvania.

He and his colleagues decided to try deep brain stimulation, a method routinely used to reduce tremors in Parkinson’s patients. This involves placing electrodes in the brain to control abnormal signals. Wires attached to electrodes are placed under the scalp, where they are invisible and unobtrusive. For binge eating treatment, the device stimulates neurons only when the device detects a signal to initiate the binge.

pilot study, funded by the National Institutes of Health and published earlier this year in the journal Nature Medicine, covers two women and will be expanded in a few months to include four more people living with binge eating disorder Those who have lost weight after bariatric surgery. Before the treatment could be approved by the Food and Drug Administration, researchers would need to rigorously test the method in at least 100 people in several medical centers. Such a study would take many years to complete.

The two women whose devices were implanted a year ago will be followed for three years. They had the option of removing their devices after 12 months, but both wanted to keep them because they no longer felt the irresistible urge to binge.

One of them, 58-year-old Robin Baldwin of Citrus Heights, Calif., described himself as a “chunko kid” who had “always been growing up”. She tried a wide range of diets. Once he consumed only protein shake for a month.

In 2003 he bariatric surgery, which usually involves changing the digestive system so that the stomach is smaller and food is more difficult to digest. It has enabled many people to lose weight when other methods have failed. But for Ms. Baldwin, the weight she lost came back.

The study’s second patient, 48-year-old Lena Tolly, lives in Sacramento. She also tried a large number of diets and treatments for obesity. Her parents put her in a vegetarian camp for a month as she graduated from college. While there, she walked 10 miles a day.

In August 2005, Ms. Tolly had bariatric surgery. He lost 100 pounds, but the weight came back on.

“It must be more than willpower,” she said.

In her case – and in Ms. Baldwin’s case – it was. Their binge eating isn’t what most people call bingeing, as that’s when they sometimes start on a bag of chips or a gallon of ice cream and just keep going. Instead, their position is in the Diagnostic and Statistical Manual of Mental Disorders. This includes bingeing several times a week. Binges are almost accompanied by a feeling of being in another state in which they lose all control, quickly consuming large amounts of food. Many, embarrassed by their behavior, binge in secret. It is common to feel disgust and shame when the binge ends.

The study that Ms. Baldwin and Ms. Tolly participated in is part of a movement to use deep brain stimulation to treat a variety of disorders caused by problems with electrical signals in the brain. They include movement disorders and psychiatric conditions such as depression and obsessive compulsive disorder, said Dr. Edward Chang, professor of neurosurgery at the University of California, San Francisco, who was not involved in the binge eating study.

Researchers have found precise brain circuits, often in regions about a millimeter in diameter, that control the symptoms of some of these disorders. The discovery opens the way for the study of deep brain stimulation.

Dr. Halpern led the pilot experiment with Ms. Baldwin and Ms. Tolly. But first he and his colleagues started with mice that were obese. The animals were fed, but when the researchers put butter in their cages, they ate it, consuming more than 25 percent of their daily calories in an hour.

The area of ​​his brain that was active was the nucleus accumbens, a major center of the brain’s reward center located deep in the center of the brain. In rats, neurons in the nucleus accumbens became activated just before a binge. When the researchers used deep brain stimulation to silence those neurons, they were able to stop the mice from biting.

But can it work in humans?

The group of scientists began advertising to people who had regained all their weight after bariatric surgery, believing it might be due to binge eating disorder.

Ms. Baldwin and Ms. Tolly replied. Both did not realize that they had binge eating disorder. But binge eating is “really, really common in individuals attending for weight loss surgery,” said Lauren Brethoupt, a psychologist at Massachusetts General Hospital who studies eating disorders.

When Ms. Baldwin and Ms. Tolly visited Dr. Halpern, both weighed more than they had before the weight loss surgery.

As part of the study, researchers provided each woman with a 5,000-calorie feast of their favorite foods when they weren’t hungry. The women described specific emotional triggers that could set off a binge: thoughts for Ms. Tolly, her mother, who had recently died; And for Ms. Baldwin, thoughts about her work schedule and responsibilities at home. They agreed to allow the researchers to induce them to binge with those triggers as part of the study.

Researchers recorded electrical impulses in the women’s nucleus accumbens as they ate, determining which neurons were firing just before the binge and that those electrical impulses correlated with women feeling a loss of control. was. A direct brain may be able to interrupt excitatory signals and prevent women from bingeing.

After connecting the devices to the women’s brains, investigators told Ms. Baldwin and Ms. Tolly they would activate the devices sometime during the next few months, but would not tell them when. Both women said they knew immediately when the devices were activated. Suddenly, he no longer felt the urge to eat insatiable.

Now his weight is slowly decreasing. Both say that they are eating differently without thinking about it.

“It’s not self-control,” said Ms. Tolly. “I make better choices.” But she hasn’t started eating foods she never liked. “I’m not signing up for black.”

Ms. Baldwin said she has noticed a change in her eating preferences. She loved peanut butter and would find herself eating it from the jar with a spoon. Now she doesn’t yearn for it.

“I’d get into these habits like going to the pharmacy for a prescription, but I can get round to Ben and Jerry’s,” she said.

Once the device was activated, she said, “I can go to the pharmacy and not even think about ice cream.”

She also notices that her taste has changed. Now her favorite food is salty instead of sweet.

“It’s not that I don’t think about food at all,” said Ms. Baldwin. “But I’m no longer a craving person.”

But does this show that direct brain stimulation may be the answer for people with excessive bingeing?

Dr. Brethoupt is cautious.

“It’s just two people,” she said.