When I was invited to attend the Food Addiction and Obesity Summit in Brainbridge, Washington in 2009 I had no idea that it would change my life forever. This conference intrigued my curiosity for research and shaped my approach to treating binge eating disorder, obesity, eating disorders and addiction.
The Summit invited 1/3 researchers and scientists, 1/3 medical doctors and 1/3 healthcare clinicians who work with patients with eating disorders. See a list of presenters here. At the end of each day, participants broke into small groups keeping the same ratio of scientists, doctors and clinicians to discuss the findings of the day’s presentations. The conclusions and recommendations from these breakout sessions were featured in the summit proceedings. It was amazing to watch the process as each member discussed similar results within their own disciplines. The researcher presented his results, the medical doctor and clinicians discussed similar results in their patients, and the scientists explained how these human behaviors and symptoms were mimicked in their trials with animals.The combined research, experience and knowledge provided so much more awareness about how refined foods are causing food addictions and our obesity epidemic.
Throughout the years I have received criticism from other professionals who don’t subscribe to the addiction philosophy. They believe everything in moderation is ok. In my many years of treating people with disordered eating I know for a fact that not all people can drink alcohol in moderation and I believe there are some people who have a similar problem with some foods. Throughout the years I have treated some patients who cannot have just one of their binge foods without succumbing to the cravings for more food. I have given research articles to my Registered Dietitians and shared in social media about this to no avail. They rejected the information in part because of the research published in the Nutritional journals reputing the fact that sugar could be addictive for some people. I investigated further and found that big corporations, who had a lot to lose, funded the published nutritional research they were reading.
Michele Simon, president of Eat, Drink, Politics, an industry watchdog-consulting group, published an exposé of the close financial relationships between food and beverage companies and the Academy of Nutrition and Dietetics (AND) formerly known as the American Dietetic Association.
The Academy of Nutrition and Dietetics have more than 72,000 members, the largest professional organization for nutrition in the world. Most members hold credentials as Registered Dietitians (RDs). A closer look at some of the leading Nutritional journals show that major food corporations fund the parent companies of these journals. The Academy of Nutrition and Dietetics partners and sponsors include Coca-Cola, Pepsi, Hershey, General Mills, Kellogg’s, Mars, and Truvia®, to name a few.
Major food corporations not only fund the research studies, they also sponsor their conferences and provide continuing education units to AND members. I am concerned about big corporations that sponsor scientific studies when there are such conflicting interests. How does the journal deal with research papers suggesting that consuming some of their sponsors’ products may be harmful to ones’ health if they are receiving funds from these big corporations?
The ramifications of eliminating highly processed foods are staggering. Can you imagine going into a grocery store and there were no processed foods? The store would have empty isles except around the perimeter. The convenience stores would be empty. The cost to major manufacturers of processed foods is beyond comprehension. Most Americans are not even aware of the impact these highly processed; sugar dense foods are having on their emotional, mental and physical health. Awareness is the key to changing our mindset in America. Other countries are ahead of us in promoting healthy eating. How did we get so far behind? The answer is, consumption of these foods are a big business with huge profits! The industry refers to their profit makers as having a high “crave ability factor.”
There is a new textbook that was just published titled Fructose, High Fructose Corn Syrup, Sucrose and Health. This textbook shows scientific studies thatagain say that sugar is not a problem. The textbook’s editor, James M. Rippe, MD is Founder and Director of the Rippe Lifestyle Institute. If you check the Integrity In Science website it states “The various divisions of Rippe Lifestyle Institute work with a diverse group of clients and research sponsors from Fortune 500 companies. Among these sponsors are Kellogg Company, General Mills, and various pharmaceutical companies.” Most people would not check this out.
The Summit speakers were pioneers in their field with years of research behind them. These Scientists and Researchers validated a phenomenon that those working with eating disordered patients or people in recovery from overeating and food addictions have known for years.
There has been some exciting work that has come out of the 2009 Food Addiction and Obesity Summit. Dr. Mark Gold and Kelly Brownell, PhD., wrote and published the Food Addiction Handbook, a great resource for professionals. There were many other books that were influenced by this mindshare including Diets Don’t Work® by Rebecca Cooper, The Fat Switch by Dr Richard Johnson, and many research publications by Dr. Gene-Jack Wang, Eric Stice, PhD., Elliott Blass, PhD. and Jeffrey Grimm, PhD. Of special interest was Serge Ahmen, PhD. a Scientist from the University of Bordeaux, France,whose research showed that sugar can be more addictive than cocaine.
The movie Fed Up (#FedUpMovie) was just released and many of the people from the 2009 conference were featured in this documentary. The movie exposes how our food supply is destroying our nation and the big corporate money of lobbyists is preventing our government from doing anything about it. It is time to wake up, if it is not too late already.
We the people need to take action! This is our last hope for a prosperous, healthy future for the next generation. Those of us who grew up in the 60’s and 70’s thought we would make a difference in our world. We may have got sidetracked along the way, but now it is time to make our difference and leave this world a better place. You can start with taking the sugar challenge to see if you may have a problem, then help your loved ones and neighbors. Learn more about this yourself. A good place to start is www.sugarawareness.com where you can find research and other people’s’ experience with this addiction and recovery. If you need help please call 800-711-2062.
“I identified in 1990 the first gene in alcohol addiction. Specifically, we found the A1 allele (the minor form) of the D2 dopamine receptor (DRD2) gene to be associated with addiction. We researched the brain characteristics of the subjects who had the DRD2 A1 allele. To do that, we carried out a pharmacological study on the brains of deceased individuals who had or did not have the A1 allele. What we found was that subjects with the A1 allele, regardless of whether they were that of alcoholics or controls, had fewer D2 dopamine receptors than those who lacked this allele. To compensate for this deficiency state, individuals used their addictive substance to release brain dopamine and activate their few dopamine receptors, which would activate their brain dopamine reward or pleasure system. Some foods significantly increases brain dopamine levels.” — Ernest Noble, MD, PhD.
Consumption of high volumes of natural rewards like foods that are high fat/sugar dense increase Delta FOSB proteins that effects the brain reward system and enhances motivation for more (binge-eating, craving). ΔFosB is a highly stable protein which produce lasting changes in gene expression. Dr. Eric Nestler of the Mt. Sinai School of Medicine on NIMH radio.
Low functioning of the dopamine reward circulatory may cause individuals to overeat to compensate for this low reward deficit, which through conditioning produces greater anticipatory food reward and heightened development of the somatosensory cortex. STICE, SPOOR, BOHON, VELDHUIZEN, AND SMALL. Relation of Reward From Food Intake and Anticipated Food Intake to Obesity: A Functional Magnetic Resonance Imaging Study. Journal of Abnormal Psychology 2008, Vol. 117, No. 4, 924-935.
Ingestion of different nutrients, such as fats vs. sugars, normally prodces different effects on physiology, the brain, and behavior. However, they do share certain neural pathways for reinforcement of behavior including the dopamine system. When these nutrients are consumed in the form of binges, this can release excessive dopamine that causes compensatory changes that are comparable to the effects of drugs of abuse. Nicole M. Avena, Pedro Rada, Bartley G. Hoebel, 2008. Sugar vs. Fat Bingeing: Notable Differences in Addictive-like Behaviors; Department of Psychology, Princeton University.
PET scans reveal that obese subjects show a reduction in dopamine receptor availability that is associated with the body weight of the subject. Wang, G.J., Volkow, N.D., Thanos, P.K., Fowler, J.S., 2004b. Similarity between obesity and drug addiction as assessed by neurofunctional imaging. Journal of Addictive Diseases 23, 39-53.
The decrease in dopamine receptors in obese subjects is similar in magnitude to the reductions reported in drug-dependent subjects. Wang, G.J., Volkow, N.D., Logan, J., Pappas, N.R., Wong, C.T., Zhu, W., Netusil, N., Fowler, J.S., 2001. Brain dopamine and obesity. Lancet, no.9253, 354-357.
The involvement of the dopamine system in reward and reinforcement has led to the hypothesis that alterations on dopamine activity in obese subjects disposes them excessive use of food. Exposure to especially palatable foods, such as cake and ice cream, activates several brain regions including the anterior insula and right orbitofrontal cortex (Wang et al., 2004a), which may underlie the motivation to procure food. Rolls, E.T., 2006. Brain mechanisms underlying flavour and appetite. Philosophical Transactions of the Royal Society of London Series B — Biological Sciences 361, 1123-1136.
Volkow published a study in which her team found that obese people who have fewer dopamine receptors also have less activity in their prefrontal cortex. N. D. Volkow, “Inverse Association Between BMI and Prefrontal Metabolic Activity in Healthy Adults,” Obesity 17, no. 1 (2008), 60–65. doi:10.1038/oby.2008.469.
Drugs of abuse can alter dopamine and opioid receptors in the mesolimbic regions of the brain. N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 28.
The cumulative effect of all this sensory stimuli (about sugar, fat and salt – and combinations of them) amp up the neurons, getting them to fire more. The message to eat becomes stronger, motivating the eater to act more vigorously in pursuit of the stimulus.” Kessler, The End of Overeating: Taking Control of the Insatiable American Appetite, Rodale, New York, 2009
Food and Emotions
Children who ate more junk food (processed, refined, sweets, soda, and snacks) in the first years of life demonstrated more internalizing behaviors, such as worry, sadness, crying, and anxiety. They also exhibited more externalizing behaviors, such as aggression, tantrums, and hyperactivity. Moms who ate more of these foods while pregnant had children with higher levels of externalizing behaviors, independent of the children’s diets. Jacka FN, Ystrom E, Brantsaeter AL, et al. Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. J Am Acad Child Adolesc Psychiatry. 2013;52:1038-1047.
A 2012 study of nearly 9000 Spanish adults found that participants who frequently consumed fast food were 40% more likely to develop depression than those who did not. Sánchez-Villegas A, Toledo E, de Irala J, Ruiz-Canela M, Pla-Vidal J, Martínez-González MA. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr. 2012;15:424-432
Dietary patterns characterized by higher intakes of processed or fried foods, refined grains, and sugary were associated with increased depression and anxiety in both Australian and Norwegian adults. Jacka FN, Pasco JA, Mykletun A, et al. Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010;167:305-311. Jacka FN, Mykletun A, Berk M, Bjelland I, Tell G. The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health Study. Psychosom Med. 2011;73:483-490.
Unhealthy diets were associated with poorer mental health in more than 3000 adolescents aged 11-18 years. Investigators found that those whose diets were higher in snack and processed foods scored significantly worse on the Pediatric Quality of Life Inventory. Jacka FN, Ystrom E, Brantsaeter AL, et al. Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. J Am Acad Child Adolesc Psychiatry. 2013;52:1038-1047.
Binge Eating Disorder
The subset of BED patients classified as having YFAS “food addiction” appear to represent a more disturbed variant characterized by greater eating disorder psychopathology and associated pathology. Classification of “food addiction” was met by 57% of BED patients who had significantly higher levels of depression, negative affect, emotion dysregulation, eating disorder psychopathology, and lower self-esteem. Gearhardt AN, White MA, Masheb RM, Morgan PT, Crosby RD, Grilo CM. An examination of the food addiction construct in obese patients with binge eating disorder. Int J Eat Disord. 2012 Jul;45(5):657-63. doi: 10.1002/eat.20957. Epub 2011 Aug 30.
There is increasing evidence that disruption of energy homeostasis can affect the reward circuitry and that overconsumption of rewarding food can lead to changes in the reward circuitry that result in compulsive food intake akin to the phenotype seen with addiction. Volkow ND, Wang GJ, Tomasi D, Baler RD. The Addictive Dimensionality of Obesity. Biol Psychiatry. 2013 Jan 29. pii: S0006-3223(13)00011-5. doi: 10.1016/j.biopsych.2012.12.020.
Yale University researchers used functional MRI (fMRI) studies to prove that both lean and obese women who test positive for addictive behavior around food show the exact same pattern of neural activity as a chronic drug abuser: very high levels of anticipation of their drug of choice—in this case, a chocolate milk shake—but very low levels of satisfaction after consuming them. A. Gearhardt et al., “Neural Correlates of Food Addiction,” Archives of General Psychiatry 68, no. 8 (August 2011):808–16. Published electronically April 4, 2011.
Kenney demonstrated that overconsumption of palatable food triggers addiction-like neuroadaptive responses in brain reward circuits and drives the development of compulsive eating. Common hedonic mechanisms may therefore underlie obesity and drug addiction. P. Johnson and P. J. Kenny, “Dopamine D2 Receptors in Addiction-Like Reward Dysfunction and Compulsive Eating in Obese Rats,” Nature Neuroscience 13, no. 5 (2010):635–41.
People were 30 to 40 percent more likely to be obese if they had addiction in the family. For women, the chance was 50 percent greater. R. Grucza et al., “The Emerging Link Between Alcoholism Link and Obesity in the US,” Archives of General Psychiatry 67, no. 12 (2010):1301–8.
The overall enhancement of consummatory behaviors (both ethanol and water) suggests that RYGB may facilitate alcohol consumption, which in vulnerable individuals could lead to abuse and addiction. Thanos PK, Subrize M, Delis F, Cooney RN, Culnan D, Sun M, Wang GJ, Volkow ND, Hajnal A. Gastric bypass increases ethanol and water consumption in diet-induced obese rats. Obes Surg. 2012 Dec;22(12):1884-92. doi: 10.1007/s11695-012-0749-2.
Numorous studies have found that sensitization to one drug can lead subsequent increased intake of another drug or substance. Ellgren et al., 2007; Henningfield et al., 1990; Hubbell et al., 1993; Liguori et al., 1997; Nicols et al., 1991; Piazza et al., 1989; Vezina et al., 2002; Volpicelli et al., 1991.
Somatic signs of withdrawal, such as teeth chattering, forepaw tremor, and head shakes are observed in rats that have had sugar eliminated from their diet. Colantuoni, C., Rada, P., McCarthy, J., Patten, C., Avena, N.M., Chadeayne, A., Hoebel, B.G., 2002. Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence. Obesity Research 10, 478-488.
These animals are also anxious, as measured by reduced time spent on the exposed arm of an elevated plus-maze. Colantuoni, C., Rada, P., McCarthy, J., Patten, C., Avena, N.M., Chadeayne, A., Hoebel, B.G., 2002. Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence. Obesity Research 10, 478-488.
Behavioral depression has also been found following naloxone administration in intermittent sugar-fed rats. N.M. Avena, Rada, Hoebel, (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 26.
Screening for food addiction has the potential to identify people with eating difficulties that seriously compromise weight management efforts. Corsica JA, Pelchat ML. Food addiction: true or false? Curr Opin Gastroenterol. 2010 Mar;26(2):165-9. doi: 10.1097/MOG.0b013e328336528d.
Signs of aggressive behavior have been found in response to removing a diet that involves intermittent sugar access. Galic, M.A., Persinger, M.A., 2002. Voluminous sucrose consumption in female rats: increased “nipiness” during periods of sucrose removal and possible oestrus periodicity. Psychological Reports 90, 58-60.
If a drug becomes available again, animals will take more than they did prior to abstinence (i.e., the “deprivation effect”) Sinclair, J.D., Senter, R.J., 1968. Development of an alcohol-deprivation effects in rats. Quarterly Journal of Studies on Alcohol 29, 863-867.
Exposure to especially palatable foods, such as cake and ice cream, activates several brain regions including the anterior insula and right orbitofrontal cortex which may underlie the motivation to procure food. Avena, N.M., Rada, P., Hoebel, B.G., 2008. Evidence for sugar addiction; Behabiorial and neurochemical effects of intermittent, excessive sugar intake. Neuroscience Biobehavioral Review 32(1), 20-39.
Craving-related changes in fMRI signal have been identified in response to palatable foods, similar to drug craving. Pelchat, M.L., Johnson, A., Chan, R., Valdez, J., Ragland, J.D., 2004. Images of desire: food craving activation during fMRI. Neuroimage 23, 1486-1493.
Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake. Gearhardt, A.N., Yokum, S., Orr, P.T., Stice, E., Corbin, W.R., & Brownell, K.D. (2011). The neural correlates of food addiction. Archives of General Psychiatry, 68, 808-816. doi:10.1001/archgenpsychiatry.2011.32.
Although there exist important differences between foods and addictive drugs, ignoring analogous neural and behavioral effects of foods and drugs of abuse may result in increased food-related disease and associated social and economic burdens. Public health interventions that have been effective in reducing the impact of addictive drugs may have a role in targeting obesity and related diseases. Gearhardt AN, Grilo CM, DiLeone RJ, Brownell KD, Potenza MN (2011). Can food be addictive? Public health and policy implications. Addiction. 2011 Jul;106(7):1208-12. doi: 10.1111/j.1360-0443.2010.03301.x. Epub 2011 Feb 14.
You can download the Yale Food Addiction Scale at http://www.yaleruddcenter.org/resources/upload/docs/what/addiction/FoodAddictionScale09.pdf
Substance Use Disorder and Eating Disorders
National Center on Addiction and Substance Abuse at Columbia University (CASA), 2003 published the first comprehensive examination of the link between chemical dependency and eating disorders, which indicated that roughly one-half of individuals with eating disorders abuse alcohol or drugs, compared to 9 percent of the general population. Up to 35 percent of substance abusers have eating disorders, compared to 3 percent of the general population. (I believe the numbers are much higher in other research. The report is also outdated.)
- During puberty, a healthy girl will gain anywhere from 20-50 lbs.
- 45% of elementary age children report wanting to be thinner.
- 50% of girls ages 12-14 say they are unhappy because they “feel fat”
- 80% of women in the US report being dissatisfied with their appearance
- 86% of sufferers report onset by age 20 and 33% between ages 11-15
- 40-60% of High School girls in the US are dieting on any given day
- Over 66% of the population of America is overweight. Nearly one-quarter are obese.
- 8-11 million people in the U.S. have eating disorders.
- 35% of “normal dieters” progress to eating disorders
- Anorexia Nervosa has the highest mortality rate of any mental illness
- 60% of women who abuse substances also have an eating disorder.
- 25% of Eating Disorder sufferers are men.
- Thirty percent of post-bariatric patients develop substance addiction.
- Eating disorder patients can fully recover
- Early intervention and a supportive family or loved ones are factors that seem to improve the chances of recovery
Research has uncovered neurobiological and behavioral similarities between substance dependence and excess consumption of highly processed foods. These findings have led to the theory that food addiction may play a role in obesity and disordered eating. Gearhardt AN, Corbin WR. The role of food addiction in clinical research. Curr Pharm Des. 2011;17(12):1140-2.
There are several biological similarities between dependence of palatable food and drug dependence including cravings and loss of control. Fortuna JL. The obesity epidemic and food addiction: clinical similarities to drug dependence. J Psychoact Drugs. 2012;44 (1):56–63.
In the model of sucrose binging, behavioral components of addiction are demonstrated and related to neurochemical changes that also occur with addictive drugs. Evidence supports the hypothesis that rats can become dependent and “addicted” to sucrose. Avena NM. The study of food addiction using animal models of binge eating. Appetite. 2010 Dec;55(3):734-7. doi: 10.1016/j.appet.2010.09.010. Epub 2010 Sep 16.
This review demonstrates that rats with intermittent access to a sugar solution can show both a constellation of behaviors and parallel brain changes that are characteristic of rats that voluntarily self-administer addictive drugs. This is evidence that under some circumstances sugar can be addictive. N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews p32.
Several studies have correlated the rise in the incidence of obesity with an increase in sugar consumption. Bray et al., 1992; Elliott et al., 2002; Howard and Wylie-Rosett, 2002; Ludwig et al., (2001). N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 31.
Evidence for experimental research on animals has unearthed deep commonalities between overconsumption of sugars and drug addiction. Volkow ND, Wise RA (2005) How can drug addiction help us understand obesity? National Neuroscience 8, 555-60.; Kelley AE (2004) Memory and addiction; shared neural circuitry and molecular mechanisms. Neuron 44: 161-79; Levine AS, Kotz CM, Gosnell BA (2003) Sugars: hedonic aspects, neuroregulation, and energy balance. American Journal of Clinical Nutrition 78, 834S-842S.
Both sweet tastes and drugs of abuse stimulate dopamine signaling in the ventral striatum, a brain signaling pathway critically involved in reward processing and learning. Koob, G.F., Le Moal, M., (2006) The neurobiology of addiction. San Diego: Academic Press. 490 p; Wise RA (2004) Dopamine, learning and motivation. National Review of Neuroscience 5, 483-94.
Our findings clearly demonstrate that intense sweetness can surpass cocaine reward, even in drug-sensitized and addicted individuals. Citation; Lenoir M, Serre F. Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.000069.
We speculate that the addictive potential of the intense sweetness results from an inborn hypersensitivity to sweet taste. In most mammals, including rats and humans, sweet receptors evolved in ancestral environments poor in sugars and are thus not adapted to high concentrations of sweet taste. The super normal stimulation of these receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a super normal reward signal in the brain, with the potential to override self-control mechanisms and thus to lead to addiction. Citation; Lenoir M, Serre F, Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698
Sugar intake may lead to an increased number of and/or affinity for opioid receptors, which in turn leads to further ingestion of sugar and may contribute to obesity. Fullerton, D.T., Getto, C.J., Swift, W.J., Carlson, I.H., 1985. Sugar, opioids, and binge eating. Brain Research Bulletin 14, 673-680.
Sugar “withdrawal” upsets dopamine/acetylcholine balance in the accumbens. N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 28.
Recent findings using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in humans have supported the idea that aberrant eating behaviors, including those observed in obesity, may have similarities to drug dependence. Craving-related changes in fMRI signal have been identified in response to palatable foods, similar to drug craving. Pelchat, M.L., Johnson, A., Chan, R., Valdez, J., Ragland, J.D., 2004. Images of desire: food craving activation during fMRI. Neuroimage 23, 1486-1493.
Sugar access repeatedly releases dopamine in response to the taste of sugar, may be important for understanding the bingeing behaviors associated with bulimia. Dopamine has been implicated in bulimia by comparing it to hypothalamic self-stimulation, which also releases dopamine without calories. (Hoebel et al., 1992).
Certain functional markers of genes regulating dopamine signaling in the brain striatal area were associated with binge eating disorder (BED) and eating-related sub-phenotypes of BED. Results support the view that BED may have its causal origins in a hyper- responsiveness to rewarding stimuli such as highly palatable food. Davis C, Levitan RD, Yilmaz Z, et al. Binge eating disorder and the dopamine D2 receptor: Genotypes and sub-phenotypes. Prog Neuropsychopharmacol Bio Psychiatry. 2012;38:328–35.
Some refined ingredients, such as sugars, are progressively more viewed, by laypeople and scientists alike, as addictive substances and their chronic overconsumption as food addiction. Once a controversial concept, food addiction is now considered as serious as other forms of addiction, including cocaine or heroin addiction. In addition, there is growing evidence linking increased sugar availability and consumption, particularly in infants, to the current worldwide obesity epidemic. Despite the focus on sugar addiction, some of the main conclusions drawn can be generalized to other types of food addiction. Serge H. Ahmed Ph.D., Dr. Nicole M. Avena, Dr. Kent C. Berridge, Dr. Ashley N. Gearhardt, Dr. Karine Guillem. (2013). Food Addiction. Neuroscience in the 21st Century, pp 2833-2857.
The overall similarities in behavior and brain adaptation with sugar bingeing and drug intake support the theory that some eating disorders, such as bulimia, may have properties of an “addiction” in certain individuals. Davis and Claridge, (1998); Gillman and Lichtigfeld, (1986); Heubner, (1993); Marrazzi and Luby, (1986, 1990); Mercer and Holder, (1997); Riva et al., (2006). N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 31.
Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal whereas children in the high-sugar condition consumed significantly more and almost twice the amount of refined sugar in total. Harris, J.L., Schwartz, M.B., Ustjanauskas, A., Ohri-Vachaspati, P., & Brownell, K.D. (2010). Effects of serving high-sugar cereals on children’s breakfast-eating behavior. Pediatrics, 127, 71- 6. Epub 2010 Dec 13.
Sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet make it a primary culprit of this worldwide health crisis. University of California, San Francisco (UCSF) (2012, February 1). Societal control of sugar essential to ease public health burden, experts urge. ScienceDaily. Retrieved October 15, 2012, from http://www.sciencedaily.com /releases/2012/02/120201135312.htm
Dr. Yvonne Sanders-Butler started the first “Sugar Free Zone” elementary school in the United States. She eliminated all the high fat/high sugar foods from the cafeteria menus, refused to allow soft drinks in the school’s vending machines and instead allowed only water and healthy fruit juices to be sold. She also added a fitness program that incorporates nutrition and exercise into class lesson plans.
The result: a 28% drop in disciplinary referrals, a 23% drop in counseling referrals and higher test scores. The kids say they have more energy and feel much better. There are also less illness related absences.
SEE the Keys Semi-Starvation Experiment, 1950 showing the long-term effects of restricting food and the creation of eating disorder behaviors. You can also read the blog about this study at http://www.rebeccacooper.com/the-keys-semi-starvation-study/.
Cyclic binging and food deprivation may produce alterations in opioid receptors, which help perpetuate bingeing behavior. In support, appetite dysfunctions in the form of binge eating and self-starvation can stimulate endogenous opioid activity. Aravich, P.F., Rieg, T.S., Lauterio, T.J., Doerries, L.E., 1993. Betaendorphin and dynorphin abnormalities in rats subjected to exercise and restricted feeding; relationship to anorexia nervosa? Brain Research 622, 1-8.
Bulimia and Binge Eating
Bulimics often restrict intake early in the day and then binge later in the evening, usually on sweet food. Gendall, K.A., Sullivan, P.E., Joyce, P.R., Carter, F.A., Bulik, C.M., 1997. The nutrient intake of women with bulimia nervosa. International Journal of Eating Disorders 21, 115-127.
Bulimic patients have increased opioid receptor binding in the insula compared with controls, which correlates with recent bingeing behavior. Bencherif, B., Guarda, A.S., Colantuoni. C., Ravert, H.T., Dannals, R.F., Frost, J.J., 2005. Regional mu-opioid receptor binding in insular cortex is decreased in bulimia nervosa and correlates inversely with fasting behavior. Journal of Nuclear Medicine 46, 1349-1351.
Acetylcholine is normally important for the satiation process. Hoebel, B.G., Rada, P., Mark, G.P., Pothos, E., 1999. Neural systems for reinforcement and inhibition of behavior: Relevance to eating, addiction, and depression. In: Kahneman, D., et al. (Eds.), Wellbeing: the Foundations of Hedonic Psychology. Russell Sage Foundation, New York, 558-572.
By purging, one eliminates the acetylcholine response that opposes dopamine. Thus when “bingeing” on sugar is accompanied by purging, the behavior is reinforced by dopamine without acetylcholine, which is more like taking a drug and less like normal eating. N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 29.
The behavioral signs of drug withdrawal are usually accompanied by alterations in dopamine/ acetylcholine balance. During withdrawal, dopamine decreases while acetylcholine is increased. This imbalance has been shown during chemically induced withdrawal with several drugs of abuse, including morphine, nicotine and alcohol. Rada, P., Avena, N.M., Hoebel, B.G., 2005b. Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience 134, 737-744.
Bulimic patients have low central dopamine activity as reflected in the analysis of dopamine metabolites in the spinal fluid, which also indicates a role for dopamine in their abnormal responses to food. Jimerson, D.C., Lesem, M.D., Kaye, W.H., Brewerton, T.D., (1992) Low serotonin and dopamine metabolite concentrations in cerebrospinal fluid from bulimic patients with frequent binge episodes. Archives of General Psychiatry 49, 132-138.
We have shown that purging leaves dopamine unopposed by satiety-associated acetylcholine in the accumbens. This neurochemical state may be conducive to exaggerated binge eating. Moreover, the findings that intermittent sugar intake cross sensitizes with amphetamine and fosters alcohol intake may be related to the co-morbidity between bulimia and substance abuse. Holderness, C.C., Brooks-Gunn, J., Warren, M.P., 1994. Co-morbidity of eating disorders and substance abuse review of the literature. International Journal of Eating Disorder 16, 1-34.
The overall similarities in behavior and brain adaptation with sugar bingeing and drug intake support the theory that some eating disorders, such as bulimia, may have properties of an “addiction” in certain individuals. Davis and Claridge, (1998); Gillman and Lichtigfeld, (1986); Heubner, (1993); Marrazzi and Luby, (1986, 1990); Mercer and Holder, (1997); Riva et al., (2006). N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 31.
High Corn Fructose
High Corn Fructose now represents more than 40% of caloric sweeteners added to foods and beverages. It is the sole caloric sweetener in soft drinks in the United States. The increased use of high-fructose corn syrup in the United States mirrors the rapid increase in obesity. Bray, Nielsen, Popkin (April 2004) Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. American Journal of Clinical Nutrition, Vol. 791, No. 4, 537-543.
Fructose is a unique sweetener that has different metabolic effects on the body than glucose or sucrose. Fructose is absorbed further down the intestine, and whereas circulating glucose releases insulin from the pancreas, fructose stimulates insulin syntheses but does not release it. Insulin modifies food intake by inhibiting eating and by increasing leptin release, which also can inhibit food intake. Meals of high-fructose corn syrup can reduce circulating insulin and leptin levels, contributing to increased body weight. Fructose intake might not result in the degree of satiety that would normally ensue with an equally caloric meal of glucose or sucrose. Based on our results showing that sweet taste is sufficient to elicit the repeated release of dopamine, we hypothesize that any sweet taste consumed in a binge-like manner is a candidate for producing signs of dependence. N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 28.
Meals of high-fructose corn syrup can reduce circulating insulin and leptin levels, contributing to increased body weight. Elliot, S.S., Keim, N.L., Stern, J.S., Teff, K., Havel, P.J., 2002. Fructose, weight gain, and the insulin resistance syndrome. American Journal of Clinical Nutrition 76, 911-922.
Bingeing on sugar can cause dopamine sensitization and opioid dependency, with withdrawal symptoms and long lasting aftereffects. Bingeing on sucrose does not cause obesity; the rats compensate for the added calories by eating less lab chow. But, if the sugar is high-fructose corn syrup, then the animals do gain excess weight. N.M. Avena, Rada, Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 31.
Greater anticipated reward form food intake increases risk for overeating. Pelchat, M. L., Johnson. A., Chan, R., Valdez, J., & Ragland, J. D. (2004). Images of desire: food-craving activation during fMRI. NeuroImage, 23, 1486-1493: Roefs, A., Herman, C.P., MacLeod, C. M., Smulders, F. T., & Jansen, A. (2005). At first sight: How do restrained eaters evaluate high-fat palatable foods? Appetite, 44, 103-114.
Anticipated reward from food is a stronger determinant of caloric intake than the reward experienced when the food is actually consumed. STICE, SPOOR, BOHON, VELDHUIZEN, AND SMALL. Relation of Reward From Food Intake and Anticipated Food Intake to Obesity: A Functional Magnetic Resonance Imaging Study. Journal of Abnormal Psychology 2008, Vol. 117, No. 4, 924-935.
With functional MRI’s obese patients showed greater activation in the primary gustatory cortex and in the somatosensory cortex and anterior cingulate in response to our measure of anticipatory food reward compared with lean participants. STICE, SPOOR, BOHON, VELDHUIZEN, AND SMALL. Relation of Reward From Food Intake and Anticipated Food Intake to Obesity; A Functional Magnetic Resonance Imaging Study. Journal of Abnormal Psychology 2008, Vol. 117, No. 4, 924-935.
A mantra of the food and beverage industry is that “there is no bad food.” Brownell, K.D., & Koplan, J.P. (2011). Front-of-package nutrition labeling – an abuse of trust by the food industry? New England Journal of Medicine, 364, 2373-2375.
Sugar Awareness Scale
Download at www.SugarAwareness.com
Note from Rebecca:
Thank you for attending my workshop. I hope you enjoy researching some of the information I presented. I am always interested in new research on this topic. I would very much appreciate you sharing your research, findings, comments, questions and opinions with me personally by commenting at www.RebeccaCooper.com/contact.
I have many more forms, charts and questionnaires that can be downloaded free from www.DietsDontWork.org. You can also buy my books, workbooks, CDs, DVD’s, and obtain the PDF download of the Diets Don’t Work® book at www.DietsDontWork.org.
The Diets Don’t Work® book is available as an eBook and Kindle on
Please visit www.SugarAwareness.com to record your experiences and beliefs about sugar consumption and/or see what others are saying about their experiences with sugar.
If you want a free eating disorder assessment call 800-711-2062. To get information about eating disorders and treatment options go to www.RebeccasHouse.org.
Many Blessings, Rebecca
P.S. I would also like to give you my free e-Pub, “Living Diet-Free” by clicking the red box on www.RebeccaCooper.com/links.
Most people have no idea what it is really like to suffer with an eating disorder. They think it is the need to be skinny. They think the person with bulimia nervosa could quit if they really wanted to. “Just don’t do that” is a phrase repeated by family members, friends and some therapists. There is so much misunderstanding of this complex disorder that I am going to bring you into the mind of a person in the depths of the disorder. You will never view the disorder in the same way after reading this. If you relate to this story know it is common to many more people than you realize. But most important I want you to know that with help even this person recovered . . . fully.
The way I learned to deal with my feelings was not to feel. One of the ways I learned to do this was to think of something different. For instance, I looked forward to getting some candy from the little store on my way home from school. I would get a cola soft drink and a frosted pastry or candy. I always felt better when I ate that. Little did I know that I was opening a floodgate of addiction with this newly learned coping behavior.
I gained weight and decided to go on a diet. I would go for days eating nothing or very little. I lost a lot of weight, but no one said anything about it. Then there were days when I had to eat. Once I did, I could not quit. Eventually I progressed from anorexia to binge eating to bulimia and finally to anything that would make me numb. I never realized that someday my life as a bulimic would overshadow everything.
The first thought that comes to me upon awakening is what I did last night. I check my stomach to make sure my pelvic bones are the highest point and my stomach is concave. They aren’t. I use the bathroom and then weigh myself. This is the first of several times I will be stepping on the scale today. But the morning brings the most important weigh-in. This will be the lowest weight of the day and it determines the course of events to follow. Some people read their horoscope. I read my scale. The number on the scale is in direct proportion to how I will feel today.
I clean up the mess from last night. There are scrambled eggs spilled on the stove top, an empty cereal box sitting on the counter, and on the kitchen table I see an empty carton of pecan ice cream, an empty potato chip bag and empty cans of diet cola. As I am cleaning the stove top, I promise myself that today will be different. I am sick and tired of living life like this.
I look at the clock and see that the cleaning took longer than I thought. My anxiety mounts with every moment, along with beating myself up. “I’m always late… I can’t do anything right… I’ll probably get fired… I’m not good at my job… I’ll never amount to anything.” The last phrase is from childhood but it is Me telling myself this now.
Before I get into the shower, I weigh myself and check my body in the full-length mirror. I feel disgusted. My thighs are touching and my stomach is sticking out. I try to rationalize that it is that time of month and that’s what is wrong with my stomach, although I rarely have a monthly cycle. The doctor said my lack of periods is because of my hormones being out of balance, but I have so many more symptoms. My hair is getting so thin, my nails are brittle, and my skin is so dry. I’m tired all the time and there are times when I faint, especially after throwing up. I get so shaky that it’s hard to put my mascara on.
I put on my makeup carefully, avoiding looking into my eyes. When I do look into my eyes, I feel such loathing and disgust. I hate myself. I dress impeccably. I have always tried to look pretty. People tell me I am beautiful, but I don’t believe them. In fact, many people compliment me on the shape of my green eyes. If they only knew.
I feel anxious about getting to work on time and doing a good job today. I look at the clock in the car and see that I am already late. On the way to work, I make up a story to tell my boss about why I am late again
When I get to work, I try to get to my desk unnoticed. Someone brought donuts today. I decide to have one. It tastes so good. This is the best part of my day so far. I savor the sweetness. I try to make it last but the donut disappears too fast. I’ll have another one, I think, trying to recapture that sensation I feel with the first bite. But it doesn’t taste like that. I keep thinking the next bite will do the trick. The second donut disappears faster than the first. What have I done? I will gain a lot of weight from eating two donuts. I must get rid of it.
I go to the bathroom but someone is in there too. I wait for them to leave, but as they leave someone else enters. I can’t wait much longer. The calories are already dispersing into my fat cells and I have been away from my desk too long. I vomit as I flush the toilet hoping the sound will cover up my purging. I clean up and look into my blurry red eyes. It looks like I have been crying and I have broken a blood vessel in my eye. I check my stomach in the mirror and it looks bigger.
I go back to my desk and start looking for the eye drops in my purse. I keep looking and realize I forgot what I was looking for. I remember, find it and then get back to my work. I am making modifications to a software program. I write some code, then get stuck. My self-talk takes over. “Who are you trying to fool? You don’t know what you’re doing. You will never get this done in time.” I think about the donuts. That will make me feel better. I go into the break room and eat one, then another and another. I make sure no one sees me. I feel like I am in a different place, zoned out and calm at last. Someone comes in and asks where the donuts are. I answer that everyone must have liked them because I was finishing the last one. I can’t get to the bathroom soon enough. I feel like a trapped rat and I must get away to my safe place of empting my stomach
I go home for lunch. I don’t want anyone to see how much I eat. When I do go to lunch with my co-workers, I can usually manage eating very little (and then binge afterwards). However, sometimes I can’t control my eating when I’m out to lunch with them. I hear comments like “How do you stay so skinny eating so much?” I feel like I want to hide under the table and become invisible. I promise myself that I will not eat with them again. It is much safer going to the take-out window and ordering as if it’s for the whole office, but I eat it all. I even buy extra drinks to make it look like the order is for more than one person. I eat in my car on the way home and continue the feast in my kitchen. I wash it all down with diet cola and end with ice cream. Ice cream makes the food easier to come up.
I clean up the mess again, weigh myself, apply some more makeup and eyedrops, and then hurry back to work. I’m late again.
I am working on my software program when my boss comes and tells me that if I am late again there will be consequences. I think of stopping at the bakery and ordering six chocolate chip cookies and six more with nuts. I work through the afternoon feeling anxious and fearful, but know that I can get some relief when I get to the bakery.
After work I drive in a daze to the bakery. I get my cookies and I decide I will eat one in the car. After eating it, I see that it was just what I was looking for. My mind clears of all negative self-talk, my anxiety is abiding, and my fear is gone. Right now is all there is and nothing else matters at this moment. I have another cookie and another. I suddenly realize that I have eaten the last one. If I had noticed that it was the last one, I would have savored it more. I am still in the parking lot. I can’t go in again and get more cookies.
I decide I will go to the grocery store and get some food to take home. I get chips, an apple pie, more cookies, ice cream and paper towels to camouflage the contents of my cart. I throw in a loaf of bread just to make it look like a normal shopper’s cart. Besides, I can make toast and sandwiches with the bread. As I am checking out, I see the clerk looking at my items. I try not to notice. I wonder if anyone else knows what I’m doing? I will shop at a different store tomorrow.
I eat the chips on the way home. I take my groceries into my place filled with anticipation about feeling numb again. I vomit away the cookies and potato chips after drinking a diet cola and then weigh myself. I am gaining weight.
I take off my suit and change into my large food-stained T-shirt. I am happy to see that I have not stained my suit. I turn on the TV. It doesn’t really matter what’s on. I just need the noise to divert my attention from feeling anything. I half-listen as I fix a piece of apple pie with ice cream on top. It is so good. I start mentally beating myself up about all the bad things I think I have done and for who I am.
I can’t believe this has been my day again. Am I possessed or something? I eat enough for three people. Maybe I have multiple personality disorder. Maybe it is a demon possession. I can’t stop this even though I want to stop.
The phone rings and I ignore it. The answering machine picks it up. I hope they do not leave a message because then I will feel bad if I don’t call them back. I just want to be left alone. The voice on the machine is asking me where I am. Oh no, I was supposed to go to therapy this evening. She will be so mad. I can’t make appointments with anyone because I never know when I will be available and not busy with my eating disorder.
I start thinking of a story to tell my therapist. “My sister got sick and I had to take her to the hospital.” That will probably suffice for missing my appointment. I could never tell her what I was really doing.
Someone knocks at my door. I wonder who it could be. I tiptoe to the door to look through the peephole and see a man I dated a few times. I hope he doesn’t smell the food or hear the TV and think I’m home. He is a nice guy but he questioned me about being sick at the restaurant again. I told him it must be the flu, but when it happened again he looked at me funny. He might know. I can never see him again. He leaves after a while and then I vomit. It takes a lot of trying to get all the food out. I weigh myself and see the scale still is heavier. I try again but nothing comes up. When I finish, I am lightheaded. I hope I don’t faint again. People will be asking me about the bruises. I feel shaky. I fight off the urge to get more food and lie down on the bed.
I guess I fell asleep because I awoke at 2:00 am in a sweat. I was craving my favorite brand of donuts. The one store that would be open is on the other side of town. It is in a rough area. But the more I think of the donuts, the less I care about my safety. I throw on some sweat pants and a jacket over my stained T-shirt. I drive to the donut shop and it is open. What a relief! I get a dozen glazed donuts and a large diet cola. There are two drunken guys walking by and they start yelling at me to come over and talk to them. I get in the car and drive off as fast as I can. When I am a safe distance away, I open the carton of donuts. They are still warm. I put one into my mouth and everything is OK again
I get home and finish the rest of the donuts, get rid of them by vomiting, weigh myself and go to bed. I have to get up in an hour to get ready for work. I fall asleep fast and the next thing I know it is 10:00 am. I was supposed to be at work at nine o’clock. Anxiety washes over me. What now?
My trip to Savannah to be on TV is another adventure. I still love the south. People are so nice here and seem to be more centered than the hustle and bustle of California. It’s funny that I say that because I have carved out a sanctuary for myself right in my back yard that I become more centered in the mornings. It is true that it matters less of where you are physically than it does mentally, emotionally and spiritually.
Maybe it is just easier when I am away from the daily routines and stresses of everyday life. Maybe it is because I realize how important it is for me to be centered when I am trying to bring awareness to the devastating illness of eating disorders. I can’t believe I actually will get in front of the cameras and the nervousness goes away as I focus of the importance of the message. Even if one person hears something that gives them pause to reevaluate their relationship with food and them Self it is worth it.
Having such a mission is exciting. I never imagined that the worse thing I encountered in my life would also become my greatest gift. If I did not know first hand how crippling eating disorders were I would not be so passionate about helping others to avoid these pitfalls.
The general public does not even know what an eating disorder is. They think it is someone starving them Self to be thin or someone who should just say ‘No’ to the food. They think they just need to quit eating so much, go on a diet, exercise more or stop the disordered eating behaviors. What’s more disturbing is that so many people whose lives are so compromised by disordered eating do not even know they have a problem. Some people have lived their life struggling with their weight, diets, body image and obsessive thinking about these things that they think it is normal. Eating disorder awareness is where alcohol and substance abuse was 20 years ago.
When I first started working with patients with disordered eating fifteen years ago I worked with people who were having problems with yo-yo dieting. That is why I wrote the book, Diets Don’t Work. By that time I had years of recovery from an eating disorder myself. I listened to these patients with a different ear than most therapists. My patients were describing the self-hatred, loss of control, obsessive thinking, and suppressing feelings and stress with food. They described how this was affecting their relationships with their families and their Self. They described not being truly available to those around them because of always thinking about losing weight, finding the right diet or beating them Self up because they had once more slipped with their diet.
The statistics are that 66% of Americans are overweight and 1/3 of these people are obese. Most of our health care cost is associated with the results of disordered eating. People are spending 60 billion dollars a year on diets, weight loss programs, diet foods, pills and products but as a nation we are more over weight than any time in history. Eating disorders are skyrocketing. We keep trying the same thing over and over again expecting different results. This is insanity. We keep looking for an external solution to an internal problem.
I am going to Atlanta tomorrow to speak at a conference for mental health professionals about recognizing disordered eating, understanding the neurochemistry changes that exacerbate eating disorders and how to treat this disorder. Again I am so fortunate to have this opportunity. There are so many excellent professionals who have not been able to obtain treatment information or even be aware of this disorder in their patients. I hope I can ignite the desire to learn more about eating disorders so they can help so many more people than I can alone.
Three hours later we docked in Montevideo. Now surely I will find my tour. I frantically looked for tour signs but again there were none. I showed a uniformed man my ticket. He pointed to a bus. Again no one spoke English around me, but there was a tour director who described everything in three different languages and one of the languages was English.
People got off and on the bus at different locations. I was given a schedule of pick ups and where the stops were. I finally got off the bus two stops before the arrival back at the docks. This brought back memories of when I was a child living with my grandmother in Huntington, West Virginia.
My sister, Rhonda and I had gone to live with my grandparents when I was 6 years old and Rhonda was four. I was about 14 years old when I learned I could walk about one-half mile to a bus stop. I bought a token that I could use all day. I would get on one bus after another with no clear destination in mind. I was on an adventure! Sometimes I would drag my little sister with me but she didn’t seem to enjoy it as much as I did. We always found our way back home to our stop. What possessed me with this spirit of adventure even then?
I remember once my sister, a couple of friends, and me was trekking along the banks of the Ohio River and came upon an old canoe. I was always the leader of these excursions and suggested we take the canoe out on the Ohio river. We got a few feet from shore and the canoe started filling with water. Everyone jumped out of the boat and started making their way back to shore, but not me. I said, ”I am the captain of this ship and I will go down with it.” I forgot to mention that I could not swim. The current in the Ohio River can be pretty swift. The canoe sank and I was able to dog paddle back to shore.
I would take my sister on hikes up in the hills beside our house. My grandparents lived with the Ohio River on one side and forested hills on the other. It was a great neighborhood. I didn’t know at the time, but we were very poor. There were other people across the street that had bigger more beautiful homes, but it did not seem to matter much where you lived, at least not in my eyes. Some of my friends lived there and some had small houses like we did.
On these hikes there were times when we would come upon a snake or fall off a cliff, but for the most part we just enjoyed the beauty of the mountains. There was a meadow that was so beautiful in the spring when it would turn into a field of flowers. There was a big rock just at the opening of the meadow. Rhonda and I would sit on that rock enjoying the warmth of the rock and the sun and talk about how pretty it was. There were no houses within miles. We had packed our lunch and would eat it there sometimes. We would be gone all day, but always made it back home before nightfall.
During my stop in Montevideo, I though I should get some money exchanged. I found an exchange place and gave the guy sixty US dollars. He gave me pesos. I didn’t realize it at the time but these pesos were a little different then the pesos I had been getting in Argentina. Since I was able to put my lunch on a credit card I didn’t use my pesos. Later when I got back to the hotel no one would accept these pesos. They were Uruguay pesos, not Argentina pesos. I was told that it would better to get the peso exchanged at the international airport. I did remember to do this at the Atlanta airport were I went through customs for my arrival back to the states. They told me the pesos were worth six-teen dollars. I asked, “How could that be because I had exchanged the pesos for sixty dollars.” He said’ “You got taken.” I still have the Uruguay pesos if anyone is interested.
At 7:30pm I got back on the ship to Argentina. I wondered how I would get back to the hotel when we landed at eleven o’clock at night. I guess the only official tour had been the bus ride around the town in Montevideo. I had given up on meeting anyone or someone directing me to the right location. I hoped I make it back to the hotel.