THE NEW ZEALAND MEDICAL JOURNAL

Journal of the New Zealand Medical Association

NZMJ 27 February 2009, Vol 122 No 1290; ISSN 1175 8716 Page 133

URL: http://www.nzma.org.nz/journal/122-1290/3491/ ©NZMA

Carbohydrate withdrawal: is recognition the first step to

recovery?

Simon Thornley, Hayden McRobbie

In October 2008 we submitted a paper to a little-known medical journal proposing

that high glycaemic index (GI) carbohydrates may be more ‘rewarding’ than other

foods and that this may be responsible for the global rise in obesity observed globally

over the last 30 years.1 Our paper attracted little attention, until a British tabloid

published a story based on our article on 4 January 2009.2 Several television and radio

interviews followed.

After the publicity we received a number of emails from persons who identified with

the article. Some were relieved that the medical community had begun to consider

obesity as an addiction rather than primarily a metabolic problem associated with

imprudent food choices.

In the original article, I claimed that obese persons may experience a withdrawal

syndrome (after abstinence from high GI foods) with symptoms such as craving and

low mood, although I had little support for these claims in the medical literature.

Symptoms of carbohydrate withdrawal were thought to be similar to those associated

with other drug dependencies. The only description we had found of

food/carbohydrate withdrawal was reported by Atkins3 of an obese individual who

had made repeated unsuccessful attempts to reduce his weight and experienced

restlessness and tremors after short term abstinence from sugar. Sugar withdrawal has

also been induced in rodents.4

Email correspondence extracts from a 38-year-old woman from Wisconsin, USA,

received initially on the 1 of February 2009 (consent obtained for reproduction)

follow:

…For the first 3 weeks I cut all processed sugar and flour from my diet and suffered mood

swings with extreme tension and depression, even a sense of hopelessness at times, I had

horrible stomach pains, all my joints and muscles throbbed, and I had the shakes constantly. I

don't even know how to describe the horrible headaches that went along with all this. People

who knew me started thinking I was hiding a drug problem. The worst physical symptoms

have been gone for about 2 weeks now, and the cravings are finally starting to subside…I look

at birthday cake today and all I see is myself curled up in the foetal position crying in bed.

…The worst part of the addiction lasted 3 weeks. The first 3 days were normal, but then on

the fourth day the worst cravings began. All I could think about was ice cream, chocolate, and

cheesecake. The cravings started to subside after the third week, but once I started feeling

better I [thought] about food less. The shakes and the headaches really were the worst part!

Before her diet changed, she reported a weight of 124 kg (BMI 41.0 kg/m2), that

lowered to 114 kg (BMI 37.7 kg/m2) 6 weeks later. Similarly, her fasting venous

glucose dropped from 7 to 6 mmol/L and her total cholesterol changed from 5.7

mmol/L to 4.6 mmol/L over the same period.

NZMJ 27 February 2009, Vol 122 No 1290; ISSN 1175 8716 Page 134

URL: http://www.nzma.org.nz/journal/122-1290/3491/ ©NZMA

Although this case does not prove our hypothesis, it may explain why obese people

find it difficult to adhere to advice to reduce intake of refined carbohydrates. Her

description is similar to an opiate withdrawal syndrome (craving, aches and pains and

muscular spasm or twitching).5 The time course—worst in the first weeks and

resolving with continued abstinence within 4 weeks—again concurs with a

withdrawal syndrome.

Further work may indicate if these symptoms can be reliably measured and mapped

over time in obese subjects that limit their intake of high GI food. The magnitude of

health resource devoted to the treatment of obesity and its consequences6–8

argues that

such work be prioritised.

Simon Thornley Assistant Research Fellow

Section of Epidemiology and Biostatistics

University of Auckland (Tamaki Campus)

Auckland

sithor@woosh.co.nz

Hayden McRobbie Senior Lecturer

Auckland University of Technology

School of Public Health and Psychosocial Studies

Auckland

hayden.mcrobbie@inspiringlimited.com

References:

1. Thornley S, McRobbie H, Eyles H, et al. The obesity epidemic: is glycemic index the key to

unlocking a hidden addiction? Medical Hypotheses 2008;71(5):709–14.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN2-4T6KFHG-

4&_user=1626814&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000007718&

_version=1&_urlVersion=0&_userid=1626814&md5=74d293b034dfa5954a0d71aeae51c2f3

2. Burne J. Are you a carb addict? Daily Mail 2009 9 January 2009.

http://www.dailymail.co.uk/health/article-1106003/Are-carb-addict.html

3. Atkins R. Dr Atkins New Diet Revolution. London: Vermillion, 2003.

4. Grimm JW, Manaois M, Osincup D, et al. Naloxone attenuates incubated sucrose craving in

rats. Psychopharmacology 2007;194(4):537–44.

5. Farrell M. Opiate withdrawal. Addiction 1994;89(11):1471–5.

6. Tobias M, Turley M. Causes of death classified by risk and condition, New Zealand 1997.

Australian & New Zealand Journal of Public Health 2005;29(1):5–12.

7. Ni Mhurchu C, Turley M, Stefanogiannis N, et al. Mortality attributable to higher-than-

optimal body mass index in New Zealand. Public Health Nutrition 2005;8(4):402–8.

8. Turley M, Tobias M, Paul S. Non-fatal disease burden associated with excess body mass

index and waist circumference in New Zealand adults. Australian & New Zealand Journal of

Public Health 2006;30(3):231–7. Abstract at

http://www3.interscience.wiley.com/journal/118731429/abstract