We are still not entirely sure of the effects of the oxytocin...as much as I would like to believe that the reduced appetite we observed in him was a genuine reflection of a truly reduced appetite and not due to extra food snuck on the side, I cannot verify it for certain. I told him that if HO Monster was tricking us by continuing to sneak food during the time it appeared he had a reduced appetite, I needed him to tell me. I even told him that if HO Monster was actually sneaking food, I didn't want to waste my time with oxytocin- that there may be other treatments to try... in truth, I wouldn't give up on oxytocin that easily but I wanted to see if he would give up his charade if I presented him with the option to quit and try something else. I have approached him on a few occasions and have used my very best detective and psychologist skills but I know that it is not easy to ascertain it from Sasha when he may have been "under the influence" of his evil twin, HO Monster.
For what it's worth, Sasha staunchly maintains his position that the oxytocin DID help him reduce his appetite for a period of time and that during this period of time (however long, we don't know), he did NOT engage in any extra food sneaking. He said that everything went awry when his appetite was triggered for chocolate, starting him on the vicious cycle of the wanting more, eating more, acquiring more, etc. Interestingly, he told me that while he was acquiring and eating chocolate in secret, he had little to no cravings to seek other foods. For example, he could have finished eating the food in his lunch or dinner or even tried to sneak other foods when he had the chance, but he said that he didn't have the desire to do so. Before oxytocin, Sasha would sneak any and all palatable food he could get including nuts, cheese, salami, peanut butter, etc. Could it be that the oxytocin was able to decrease his appetite for non-sugary food? Could this be because the other food was not as tempting or palatable to him as chocolate? What was so special about chocolate?
Well, to all of you chocoholics out there, you know why chocolate is so special! I am fond of chocolate too but I think that certain people have a particular passion for it that goes beyond fondness. In grad school I can recall learning about phenylethylamine, a chemical contained in chocolate that gives us the feeling of being in love- there is good reason why chocolate is often given to lovers on Valentine's Day! Chocolate also contains tryptophan, a precursor to serotonin, the well known neurotransmitter responsible for our feelings of well being. Besides having some of these alluring ingredients, chocolate of course tastes good and contains sugar and fat. Well, fat is allowed in Sasha's low carb food plan but it does NOT permit sugar. All of this has made me wonder if his narrow focus on chocolate may be an indication of sugar addiction.
First of all, is it possible to be a sugar addict? We often think of addiction as pertaining to substances like alcohol or cocaine but sugar...? Let's first look at the definition of addiction. The DSM describes addiction as a problematic pattern of use of an intoxicating substance leading to:
A) Clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period-
1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
8. Recurrent use of the substance in situations in which it is physically hazardous.
9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
B) Tolerance, as defined by either of the following:
1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
2. A markedly diminished effect with continued use of the same amount of the substance.
C) Withdrawal, as manifested by either of the following:
1. The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).
2. The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
For Sasha, sugar is not a benign substance. As a hyperinsulin secreter, his body produces very high levels of insulin in response to glucose in his body. His ingestion of carbs/sugars causes insulin resistance, putting him at high risk of developing Diabetes Mellitus 2. Sugar also causes him to have very high triglycerides and this puts him at risk for developing acute pancreatitis and other types metabolic and cardiac diseases. From what I have observed with the very large cache of chocolate, the persistent lying which has eroded our relationship with him, his risky behavior of eloping from the house in the wee hours of the morning without our knowing, weight gain and dangerous electrolyte imbalance, and the loss of time and quality of life due to the fatigue caused by steep insulin crashes... all of these make me think that he definitely has met the criteria under section A.
As for (B) building tolerance, I am unable to say for certain if he was consuming increasingly greater amounts of chocolate in order to attain the same "high" since I do not know how much he was consuming. I can only guess by his large supply that the more he ate, the more he felt he needed to eat. In regards to (C) withdrawal from sugar, the literature reports increased cravings and anxiety as observed in animal studies where rats are intermittently exposed to sugar and then deprived. These rats also exhibited signs of passivity in a physical activity of escape (swimming, climbing) compared to control group rats. Those rats who had intermittent exposure and then forced withdrawal (compared to control group rats with no exposure/withdrawal from sugar) were observed to choose floating behaviors more than their counterparts who engaged in more swimming and climbing behaviors. The authors concluded that the rats who were withdrawing from sugar showed signs of behavioral depression.
The authors (Avena et al.) of this review article sum up their findings about sugar addiction in their conclusion:
"From an evolutionary perspective, it is in the best interest of humans to have an inherent desire for food for survival. However, this desire may go awry, and certain people, including some obese and bulimic patients in particular, may develop an unhealthy dependence on palatable food that interferes with well-being. The concept of “food addiction” materialized in the diet industry on the basis of subjective reports, clinical accounts and case studies described in self-help books. The rise in obesity, coupled with the emergence of scientific findings of parallels between drugs of abuse and palatable foods has given credibility to this idea. The reviewed evidence supports the theory that, in some circumstances, intermittent access to sugar can lead to behavior and neurochemical changes that resemble the effects of a substance of abuse. According to the evidence in rats, intermittent access to sugar and chow is capable of producing a “dependency”. This was operationally defined by tests for bingeing, withdrawal, craving and cross-sensitization to amphetamine and alcohol. The correspondence to some people with binge eating disorder or bulimia is striking, but whether or not it is a good idea to call this a “food addiction” in people is both a scientific and societal question that has yet to be answered. What this review demonstrates is that rats with intermittent access to food and 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. In the aggregrate, this is evidence that sugar can be addictive."
To read the full review article, please click on this link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/
If I had to translate these animal study findings to Sasha, I would say that the tolerance was exhibited by his high chocolate consumption (presumably, increased consumption) and that his anxiety may have been exhibited by his irritable mood and arguments with me and his camp directors over the last few weeks. His withdrawal may been demonstrated by his increased fatigue and day time somnolence. Although we attributed his fatigue to his needing more thyroid or corticosteroids, we can see now that his large chocolate consumption was probably also playing an important role in his excessive fatigue!
It is hard to know for certain the exact role of the chocolate in relationship to his oxytocin. I can only surmise that the oxytocin has been effective to a degree in reducing his appetite for the time he was not binging on chocolate and other sugary foods (if we believe Sasha's self-reports). It is also apparent to me that oxytocin has not been effective in eliminating his strong cravings for sugar/chocolate. It is also likely that the sugar contained in the chocolate acts as a powerfully seductive substance that he resists with extreme difficulty (at best) or is unable to resist once exposed (at worst).
For now, we will take heed of HO Monster's favorite food and try to keep it away from him as best we can... Sasha has expressed appreciation for the increased security in our home and we will be doing intermittent searches of his room, backpack, pockets, and other possible hiding places. The Kitchen Bitch will likely be making a reappearance but it cannot be helped, for now. All I know is that she wants to send a very loud and clear message to HO Monster:
"Stop messing with Sasha and the oxytocin experiment or you will face the wrath of the Kitchen Bitch!"
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