I, like most people, like to indulge in a late-night snack every now and then. Succumbing to stomach rumbles that roll like Elton John's thunder under the covers, I shuffle to the kitchen in the dark and open the fridge. I am shrouded, icon-like, in light, just like Jesus. Instead of feeding the five thousand, though, in such moments I only care about feeding one person: Me.
We've all been there. God knows Nigella Lawson knows her way around a fridge in the wee small hours. For Nigella and I, though, nocturnal snacking is a decision rather than a need. If I go and make a sandwich at 2 AM it's because I fancy it, not because I fear I'll be far too hungry to fall back asleep again if I don't.
However, for those suffering from Night Eating Syndrome (NES)—an estimated two percent of the UK population—late night trips to the fridge are a compulsion. First observed in 1955 by Albert Stunkard, M.D., a professor of Psychiatry at the University of Pennsylvania, NES is classified in the most recent edition of Diagnostic and Statistical Manual of Mental Disorders under the "Other Specified Feeding or Eating Disorder" section. Not to be confused with Nocturnal Eating Syndrome, in which sufferers are asleep and have no recollection of the incident, those with NES are awake and very much aware of their late-night food endeavors.
NES sufferers typically have no appetite in the morning and don't eat breakfast, ending up taking in a paltry one third of their daily calorie intake by 6 PM compared to the average person, while the control group studies had consumed almost seventy five percent. Come evening, usually between 8 PM and 6 AM, those with NES can consume around half their total calorie intake for that day. That's a lot of eating in the dark.
Sufferers of NES are characterized by broken sleep and a belief that, unless they go and make themselves some cheese on toast or something, that they won't be able to sleep again. It is thought that those with NES tend to consume around 400 calories at one time, whereas binge eaters may take in up to 2000-3000 in an episode. That said, there does seem to be similar brain patterns at play, a temporary loss of control that may or may not precede a feeling of guilt and shame.
So what causes this nocturnal affliction? Hormones might have a lot to answer for. Research has shown that people with NES had significantly lower melatonin levels than those without it. Since melatonin levels rise during the night to help ensure steady, continuous sleep, a deficiency in it would suggest disrupted sleep patterns. Low levels of another hormone, leptin—the satiety hormone—was also found in those with NES, suggesting with reasonable clarity that hormone imbalance is muddying the water.
It may be genetic, too. New research has also suggested that NES may develop when the gene responsible for regulating and synchronising eating and sleeping patterns, PER1, is faulty. Using mice, they observed that when the gene was 'silenced', the mice were hurriedly stuffing sunflower seeds into their cheeks when they should have been sleeping.
As with any cognitive disorder, NES is almost certainly a product of multiple factors, and it's crucial that these results are not taken on their own. As Dr. Sheri Jacobson, psychotherapist and clinical director at Harley Therapy points out, "eating disorders are normally connected to emotional problems. They're rarely just an isolated problem. There are invariably some earlier emotional difficulties, often stemming from childhood."
Other theories that have been put forward the causes of NES bolster this opinion. One, put forward by Dr Stunkard—who first spotted the systems in 1955—is that those with NES may be practicing a form of self-medication because they are suffering from stress, depression, anxiety, or perhaps all three. Because of this, their snacks will usually be high in carbohydrates and sugar (think doughnuts, cakes, rounds of toast, chips) which naturally contain high levels of the feel good hormone, serotonin. Dr. Kelly Allison, assistant professor of psychology in psychiatry at the University of Pennsylvania says, "I think stress triggers it but you have to have a specific kind of make-up to respond in this way, and I think that's genetic."
Interestingly, in fifteen years of practice, Dr. Jacobson hasn't come across clinical representations of NES. "I've come across eating disorders of varying kinds which would sometimes have included eating in the night but it was part of a wider set of presenting issues around food". It seems that NES, just as with other eating disorders, has a stigma attached to it that could be preventing sufferers from seeking help. This is hardly surprising. In the past, the disorder has been scoffed at. Naysayers might think, Just stop eating cheese out the fridge at three in the morning, you swine, which is probably, just like telling a depressed person to "pull yourself together," about as useful as a chocolate teapot.
With any hope, the findings of this new research will pave the way for further investigation and help remove the dismissive cloud hovering over NES. Greed is one thing, but this appears to be quite another.