Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert
Development and process

Does sugar affect the serotonin and glutamate in the brain?

I don’t know, but I think the answer is no. I can’t think of any pathway through which anything in sugar could affect the brain, other than perhaps providing more energy but that would be non-specific for a giving transmitter system.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Is there a link between substance abuse and sugar – like heroine addicts who load up on sugar if they can’t get their fix?

One of the main brain substances involved in reward and addiction is dopamine. Compulsive gamblers show a problem with low dopamine levels, as do people who abuse drugs. In the same way, binge eating behaviours seem to impact dopamine levels. Heavy sugar loading might also do that to. People always say “What’s wrong with me? I’m a sugar addict, I can’t say no.” It’s not true. Usually you are seeing somebody who had chronically avoided eating sweet things, cut out carbohydrates, cut out sugars, and then, when confronted with them, they can’t control themselves. I say it looks pretty normal to me.
-Howard Steiger, Ph. D., Mini-Psych School 2009

When anorexic people look at themselves in the mirror, do they see themselves as being fat?

That’s actually one of the myths about anorexia. People say “What is wrong with them? Don’t they see they are thin?” Sometimes, in extreme cases, people will actually distort their body image, but that’s really in the extreme and it’s often when people are so malnourished that their brains aren’t functioning properly anymore. What my patients teach me is that there is a terrible uncertainty: it’s like one moment they feel ok, one moment they might feel fat, and one moment they think they’re too thin. They never know, so it’s so easy to get pushed over the edge by something as simple as one or two French fries. The only metaphor I think of is to imagine if I took you up to the roof of a building and put you in the middle, so you knew you were pretty safe, and the edge was far. But now, I put on a blindfold, put you on the roof, and ask you to take a few steps. You can imagine that that would be a scary thing to do now. Somebody who has anorexia feels that way about weight in her body. She may know she’s thin, she just doesn’t know when fat starts. She never wants to go there.
-Howard Steiger, PhD, 2009

How do you compromise between looking good and being healthy?

There is a naturally accruing process which means we could all have hope. The process is this: as people age, they tend to gain some weight. As people age, body satisfaction goes down especially according to certain social norms of what a good body is. But the investment of having a good body image goes down too. And, it goes down faster than the satisfaction. If you are getting unhappy, get hope: eventually, it won’t matter!

There is another really important side of it too which is that we live in a society that is obsessed with the body. We all have the need to really do a soul search about the kind of values we attach to thinness. It really takes a search on the part of clinicians and parents and young kids, and some of the kinds of social efforts we can make to the things that you saw I was involved in. Eric Stice’s prevention programs, for instance, have people ask “Why is thinness such a big deal?” And, could you imagine a version of attractiveness that doesn’t come in a thin package? I can do that, and I’m sure you can all do that. But we have to sort of challenge our own beliefs.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Is it true that people with anorexia have high cholesterol?

Yes, it can be true. When this is the case, my patients are shocked. They say “I only eat a celery stalk or carrots and how come I have high cholesterol?” It’s actually because, when you are in a state of malnutrition, and that changes the way your body processes fat (its own fat) and you actually look like you have high cholesterol. It’s a bit like the way an alcoholic gets a fatty liver. The solution to it is paradoxically, you eat more, not the usual thing that we do to keep our cholesterol down.
-Howard Steiger, Ph. D., Mini-Psych School 2009

If I am happy with my body now as a teen, do I still have a risk to getting anorexia or bulimia when I am older?

I would like to think that if you really have a good solid kind of connection with your body image and solid values around it, then probably you protected from developing an eating disorder. I hope that you will not go through any experience that would shake that confidence you have or the ability you have to feel good about yourself even if you think your body isn’t perfect. Although, sometimes we do see development of eating disorders later in life, even though we think of them as things that happen to young people or adolescents. If I ask you to think about anorexia, what is your stereotype? Thirteen years old? Fourteen years old? You know that these are really disorders of adulthood, and around 28 is when we see the peak of eating disorders. And we even see them starting in women in their forties and fifties. But, yes, having a healthy body image when you are a kid is a very important fact. Related to that, there are really nice programs that foster prevention by taking teens and having them question the value they place on thinness and weight. It’s been shown that a very short program of that type substantially reduces the risk of people developing an eating disorder over the next three years. So, healthy attitudes are an important piece of the puzzle.
-Howard Steiger, PhD, 2009

What does repetitive dieting do to the brain?

When you diet, you mess up your brain. I always say to my patients that they should take an anti-antidepressant every time they diet. And they come back saying that they feel depressed and that their mood is unstable. And, they are taking an antidepressant; it is like a heavy smoker using cough syrup. You better off quitting smoking. Dieting negatively affects brain functions – there is no doubt about that.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Can you comment any relationship between cortisol and weight?

Cortisol is the brain stress hormone. And so it is modified by various things including dieting and stress. And cortisol is not only involved in stress regulation but actually has a lot to do with the way in which body fat is distributed, especially around the abdomen. So things that throw off the cortisol system can actually cause people to store fat in a unique way. Stress is one of those things. People who have eating disorder interestingly always have elevated cortisol. And it’s because they are often stressed. They are going through an emotional distress, but also starving is a stressor for your body. And so they put themselves in that state where whatever cortisol levels are supposed to regulate is now deregulated.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Are more men dissatisfied with their bodies too?

For men, it’s not the thin ideal, it’s the bulk ideal. They need to be strong, muscular and have six packs. This ideal sells protein shakes and all kinds of things. Even now there are cosmetics that men can buy. There’s money to be made in making men satisfied with themselves. And men then become targets. The industry pursues boys and it becomes an epidemic. But they aren’t always the target that girls are. However, they are going after little boys and making them feel like they should be unsatisfied about themselves.

- Mimi Israël, MD, FRCPC, Mini-Psych School 2013

Are we seeing eating disorders and body image problems in other cultures besides North Americans?

I just read a study showing that young women from the United Arab Emirates have become totally obsessed with their body image because they are being exposed to the same cultural ideals as we are and they also have their own pressures about identity and self-assertion. The study found that anorexia in that country is about 10 times the rate in Britain. So it’s clear that culture can protect you until our North American culture gets in your way. Nowadays, it’s quite hard not to be exposed to our culture.

- Mimi Israël, MD, FRCPC, Mini-Psych School 2013

What is the overall influence of social media on body image and how far can it go?

Social media could have a very big impact, and for the moment what I have read is not encouraging. The average girl spends about one and a half hours a day on Facebook or MySpace. Social media is really a means of social comparison. The peer pressure on these platforms is very high. You’re measured by how you look, how many friends you have, what your friends look like, and the pictures you post. Again, for vulnerable girls, this can put them at risk and can affect their self-esteem. They can feel pressure to live up to these ever-present standards.

- Mimi Israël, MD, FRCPC, Mini-Psych School 2013

How does dieting actually cause an increase in eating disorders?

It is very hard to lose weight. That’s because we all have a set point, or a weight that you’ll naturally be just by eating normally and following your hunger cues. If you exercise more, you might be hungrier; if you eat too much, you might be a little less hungry the next day. The body regulates itself naturally. When you diet, you’re forcing your body into an unnatural mode. It’s very hard to maintain the result because you’re fighting nature. And when you actually succeed for a week or two or a month to keep your weight down from unnatural tactics, your brain goes into starvation mode. It thinks, “What are you doing to me?” So when you start to eat normally, your body wants to store a little bit for the next time you pull a number like that.

- Mimi Israël, MD, FRCPC, Mini-Psych School 2013

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