Binge eating disorder is an eating disorder that is characterised by a person eating a very large volume of food very rapidly, in a negative and uncontrolled way, often in secret and at night. Unlike Bulimia Nervosa, this is not followed by calorie compensation. Therefore, many patients, not all, are obese. Some may be anorexia-binge subtype and so maintain a healthy weight. Obesity is also an eating disorder, providing it is not caused by medical causes (such as hypothyroidism). Binge eating can affect people of all ages and ethnicities and is the most common eating disorder and puts an individual at high risk of heart disease, type II diabetes, osteoarthritis, gout, kidney and liver disease and infertility.
Unlike overeating, when you consciously choose to eat more, binge eating is not in response to genuine hunger (after say, a run) or indulgent desire for more of a delicacy that is not usually on offer (at say Christmas). Binge eating is also not one-off comfort eating (where you eat to get the Dopamine high from fat and sugar that cheers you up temporarily and then you return to normal eating,) as it happens consistently over a sustained period. Diagnosis requires continuous episodes over an average of three months to a year.
Binge eating can come after a period of dietary restriction (dieting) or a fast, where the caveman brain is in scarcity mode (with energy deficit) and denied sufficient nutrition and then, in premeditated defence against further famine, wishes to hoard calories. It can also come after a period of intense stress, where the gut gastric motility is slowed by the flight and fight adrenaline and cortisol stress mechanism, and then returns into full action causing extreme hunger. This hunger seems bottomless and is why binge eaters often feel the eating “relieves tension” following a period of stress. Overeating consistently can also cause binges as one can eat past hunger and fullness satiety signals (from body chemicals called Leptin and Ghrelin), which can make it hard to recognise when full. A binge can also come when feeling negative emotions (such as after grief, breakups) as the low Dopamine and Serotonin, brain happiness and pleasure chemicals, are increased in response to consumption of high fat and sugar foods. The binge causes a massive surge of these chemicals. Dopamine also is used as a reward neurotransmitter, and therefore cycles of binges can develop as Dopamine helps to cement habit formation. If you learn that a binge eases tension, causes a surge of Dopamine, you are likely to repeat the behaviour.
Following a binge, dark feelings of worthlessness and guilt are often present in Binge eating disorder. There is high risk of suicidal ideation or self-harm. This is another reason it differs from overeating, as in overeating you feel positive pleasure and satisfaction from indulging in the delicious food you have chosen to eat. In binge eating, where weight is so entwined with self-worth, there are instead dark and negative feelings of guilt and self-hatred following an episode. Therefore, binge eating is often regarded as another form of self-harm.
- Evidence of binge eating with food missing from cupboards, wrappers present and larger food bills.
- Eating small meals in front of people and yet gaining weight. Constantly dieting.
- Hoarding food in strange places.
- Feeling extremely hot (food is needed for thermodynamics and excess nutrition will provide excess energy which will cause hot flushes, sweating and feeling hot).
- After a binge, the heart rate may increase (tachycardia).
- Feeling tired and lethargic as it takes substantial amounts of energy to break down all the surplus nutrition. This is why people feel tired after a big meal. Also, large peaks in blood sugar levels from excess dietary sugar and fat cause large peaks in Insulin, the blood sugar regulating hormone, reducing blood sugar. This can make a person tired.
- Binge eaters may steal food (as food and money behaviours are often very entwined with eating disorders. Anorexic behaviour is often linked to hoarding or saving money, with a fear of spending money, as they “don’t deserve it,” on self and food, and with binge mentalities and behaviours the opposite).
- An all or nothing approach to food, “I have had chocolate so I might as well have the whole bar,” with black and white flawed thinking (treated with Cognitive behavioural therapy- CBT to encourage a person to question their thoughts and see thoughts as not facts).
- Unable to stop eating once started negatively. The “I might as well eat and eat and never stop as I am so fat and worthless” mentality. Food as self-punishment or self-sabotage.
- Wearing baggy clothes to hide the body.
- Withdrawal from usual friends and activities.
- A history of anorexia or other eating disorders or trauma.
- Thoughts about self-harm or suicide. Feelings of guilt and self-loathing after a binge episode.
- Tiredness: Energy deficit is a huge cause of binges. This is why they often happen at night, when tired and energy low. Even if sufficiently energy-satisfied after a balanced and nutritious meal, if sleep and rest are not achieved, the body will still send out signals to increase energy, with increased appetite hormone Ghrelin. Tiredness also decreases levels of the satiety signal, Leptin. This is why you often have a bottomless appetite when tired. The best thing to do is have a nutritious meal, have a hot bath to help lower your body temperature and help you sleep, and go to bed, rest, and sleep.
- Sugar and sweeteners: a diet high in dietary simple sugars and sweeteners is often associated with binge eating. This is because simple sugars (such as Glucose, Sucrose, Fructose) cause spikes in the hormone Insulin. Insulin lowers blood sugar and therefore causes energy deficit, increasing hunger. Simple sugar causes quick but short acting energy. Complex sugars (such as those from high fibre fruit and vegetables) cause slow acting yet long lasting energy. Protein and fats can also provide more long-term energy. Sweeteners are up to 1000x sweeter than sugar. They can change the taste buds and Dopamine response to sugar, making it harder to get pleasure from sweet things. Sugar is not addictive, but the more you have of it, the more of it you need to get the same pleasure response as the brain and palate adapts to diet. Sweeteners make sweet things taste less sweet and bitter things (like vegetables) taste less appealing. Therefore, this makes people have a stronger craving for highly palatable quick sugar high simple sugars.
- Dieting: when you diet or fast you cause an energy deficit. Skipping meals makes you hungry. The brain goes into famine mode. This can result in a scarcity complex, where the caveman brain will attempt to hoard food as it is worried about future famine, resulting in a binge. You also can crave what you deny yourself and flawed black-and-white thinking patterns (CBT) can emerge where a person can feel “oh I broke my food rule, I had one and now I might as well have the whole jar.” When in energy deficit, the blood sugar is low, and this puts the brain into stress mode, making you hyper and energetic (the premise behind intermittent fasting) but is not sustainable, as this stress mode long term, causes cycles of binges as when the stress goes, and you return to normal meals, the appetite returns with extreme hunger in an attempt to rebalance the energy deficit.
- Overeating: if you constantly overeat, your body starts to no longer recognise the satiety signals Leptin and PYY (polypeptide hormone YY). Therefore, sticking to three meals a day and three snacks can help the body relearn when to send out Ghrelin and Insulin hormones, in a controlled and ordered way, helping you relearn when you are hungry and stop when you are full.
- A diet low in fat and protein: protein is needed to make key neurotransmitters. A diet low in dietary protein will affect mood, causing mood swings. Protein also takes longer to break down than carbohydrates, and therefore will make you feel full and satisfied for longer. It also slows down the breakdown of simple sugars in the bloodstream, helping to control your blood sugar levels. Fats also take longer to break down and help regulate fullness and blood sugar levels. They are also needed to absorb many key fat-soluble vitamins and minerals (such as vitamin K, A, D, E) and therefore a fat free or low-fat diet will make you feel more hungry, tired and can cause vitamin deficiencies. Some fats, Omega-3’s, are also essential in helping regulate key mood hormones and can help regulate cognition (our ability to think rationally) and omega-6 levels.
- Loneliness: sociability and the company of others, raises Dopamine and Oxytocin, the pleasure and warmth brain chemicals. Extended periods of isolation (such as seen during the pandemic) cause decreased Oxytocin brain chemical. Oxytocin helps to reduce Cortisol neurotransmitter, reducing the stress response and therefore hugging (or stroking animals and pets), kissing, conversation and sex are good stress reduction techniques.
- Menstruation and Menopause: binge eating in women is common when a woman is menstruating or going through perimenopause. This is because Oestrogen is a mood stabiliser which regulates Serotonin, the happiness brain chemical. Therefore, pre-menstrual tension (PMT) or pre-menstrual syndrome (PMS) can cause mood swings and low mood. In menopause, Oestrogen levels deplete, which can cause depletions in mood. This recalibrates post-menopause, but it is the fluctuations in Oestrogen levels in menstruation and menopause, that put an individual at risk of binge eating.
- Anger: anger is an emotion that causes a stress response. Feelings defensive, frustrated or threatened trigger the flight or fight response.
- Illness: some illnesses (of course it depends on the exact cause), such as colds and flus (or covid) put the body into stress response and take it out of balance (homeostasis). The body focuses on fighting the cause of disease, and so deprioritises all non-essential mechanisms such as digestion, slowing down gastric emptying (so you feel fuller for longer). As the rate of digestion (breaking down food for energy, vitamins and minerals, salts, and water) impacts appetite, illness can reduce your hunger. However, it also requires more energy to fight an infection, and so you may find you crave plain foods, often high in simple sugars, when unwell. Nausea reduces appetite and then once it has gone you often feel extreme hunger. Illness also impacts Serotonin and Dopamine levels, and can make you feel tired and lethargic, making it harder to feel good and think rationally, putting people more at risk of binge eating when low, or when recovered and appetite returns.
- High fibre diet: this is essential, both as fibre containing foods are complex carbohydrates in fruit and vegetables which help provide a long-lasting energy supply which prevents the energy lows which can trigger binges. Also, fibre is prebiotic, and therefore feeds the gut microbiota. The gut microbiota is the layer of so-called friendly bacteria which line the gut. They help reduce gut inflammation and food allergy, increase the immune system, improve heart health and work via the gut-brain-access to improve mental health. This is because the small-chain-fatty-acids such as Butyrate produced from the gut microbiota help regulate Serotonin and Melatonin, the sleep and mood brain chemicals, and therefore improve mood and sleep.
- Mood supporting foods: foods high in Tryptophan include dairy, nuts and seeds, turkey, oats, and fish. Tryptophan is the precursor for Serotonin and low levels of Tryptophan are associated with mood disorders. B12 rich foods also regulate energy metabolism and so play a role in vitality and mood. It can be found in fortified milks and cereals, eggs, fish such as salmon and tuna, chicken, beef, yoghurt, and cheese. Magnesium also helps mood. It is a mineral important for bone structure and energy metabolism. It also helps regulate Melatonin (the sleep pattern regulator) and therefore helps you sleep and feel calmer. It is found in green vegetables (it helps make the green pigment in plants), seeds (especially almonds), tofu, dairy products, and meat. Studies have also shown it can help regulate the stress response, reducing fight or flight.
- Foods which support immunity: these include those high in vitamin C which supports the immune system, our defence against illness. It is found in fruits such as citrus fruits, peppers, potatoes, tomatoes, broccoli, cabbage, Brussel sprouts and cauliflower. We need iron to absorb Vitamin C, and for energy (anaemia from low iron causes fatigue and mental fog) and it can be acquired from supplements or from iron rich foods including seafood, meat, peas, beans, and green leafy vegetables such as kale and spinach. Vitamins A, in fish oils, melon, milk and eggs and leafy green vegetables and vitamin E, in almonds, peanuts, sunflower seeds and avocado and vitamin D, in cod liver oil, salmon, tuna, egg yolk, and fortified cereals and milks, are also immunostimulants. Garlic is also a natural antibacterial and antiviral and studies show echinacea and turmeric also support immunity.
- Nutrition for sleep support: sleep plays a massive role in eating disorders as it helps to regulate sleep. A diet too high in carbohydrates will provide surplus energy at night, keeping a person awake. A diet too low in carbohydrates will make it harder for a person to sleep and stay asleep as carbohydrates are needed for energy for the brain. The purpose of sleep is to process information from the day and regulate emotions, and therefore a lack of sleep can result in less emotional control and more anxiety and mood swings. Sleep is regulated by Melatonin, which sets our circadian rhythms (sleep patterns). Foods high in Melatonin include eggs, fish, and nuts. Magnesium also plays a role in Melatonin production. Alcohol makes it easier to get to sleep but stops a person entering a phase of sleep called rapid eye movement (REM) sleep, and therefore causes restless, shallow sleep. A lack of sleep makes a person more irrational, emotionally sensitive, and more easily stressed and so more likely to be triggered into using eating disordered behaviours. Sleep helps improve resilience to stressors and regulate appetite and blood sugar levels, reducing appetite.
Both nutritional support and psychological support are needed to address binge eating. Nutritional support should prevent the energy deficit (even if an overweight, diet cannot meet energy demands, increasing appetite), that can trigger a binge episode and psychological support is required to address the underlying emotions. CBT, cognitive behavioural therapy, can be used to encourage an eating disorder sufferer to question their thoughts and not see them as facts and separate their weight from their self-worth. Additionally new coping strategies for challenging situations must be developed for developing distress tolerance, for example locking the kitchen at night, going for a walk round the block if you feel the urge to binge or having a hot bath or listening to music and surfing the feelings until they pass.
Technical reviewer: Alice Benskin, MSc Personalised Nutrition