June 7, 1997
It sounds like a joke. Someone suffers a stroke -- or a brain tumor or a traumatic head injury -- and is suddenly transformed into a gustatory hedonist.
Indeed, Zurich neuropsychologist Marianne Regard wouldn’t have believed it if she hadn’t stumbled across the first signs of this "gourmand syndrome" herself, 8 years ago. Since then, she and Geneva University neurologist Theodor Landis have tallied 36 Swiss patients who, after sustaining sudden-onset damage to the brain -- usually in the right frontal region -- developed a preoccupation with fine foods.
This is no simple, newfound appreciation of gourmet fare, she and Landis report in the May Neurology, but an intense, consuming passion for food -- addictionlike cravings for their taste, an inordinate interest in their appearance, a savoring of trips to shop for ingredients, and delight in the memory of particular restaurant experiences.
What their findings don’t indicate, Landis says, is the site of some specialized food center in the brain. Instead, he and others argue, gourmand syndrome and a host of seemingly unrelated passions may serve as a window into the brain -- both in terms of diagnosing injury and in understanding its normal function. In fact, neurologist Jeffrey Cummings of the University of California, Los Angeles suspects such behavioral fallout of brain injury may be fairly common but largely overlooked, precisely because neither the patient nor the physician tends to view the change as negative.
The first victim of gourmand syndrome -- or beneficiary, as the case may be -- was a political journalist who had never been particularly concerned about what he ate. He amiably consumed whatever his wife put before him. When he occasionally ate out, he exhibited no particular preference for one type of food over another.
Following a stroke, however, he at once began carping about the hospital’s meals and reported thinking of little but good-tasting food prepared and served in a nice restaurant.
In time, Regard asked the patient to record his thoughts each day. It was in going over them that she realized his interest in food had developed into an obsession. His diary was riddled with observations, like "it is time for a real hearty dinner, e.g., a good sausage with hash browns; or some spaghetti bolognese; or risotto and a breaded cutlet, nicely decorated; or a scallop of game in cream sauce with spätzle [a starchy, pasta-like side dish]."
Now describing himself as a connoisseur, he lamented being "dried up here, just like in the desert. Where is the next oasis, with date trees and lamb roast or couscous and mint tea, the Moroccan way -- real fresh?"
Four months later, when the man was fit to return to work, his old job awaited him. However, the preoccupation with food had overtaken his once-consuming enthusiasm for politics. So he resigned his job as a political reporter and became a columnist on fine dining. His food fixation even carried into his personal life, Regard and Landis report. For instance, his family found that the only way to pique his interest was to talk about food. Moreover, the Swiss scientists note, the man’s "desires for meals prepared at home became more precise and exotic."
What first suggested that the journalist’s case wasn’t a fluke, Regard says, was the finding soon thereafter of another patient who, following a stroke, also began waxing rhapsodic about food. Until then, the man had been concerned about his looks and tennis but never about what he ate. Immediately after the stroke, however, this businessman became consumed by food -- to the point of frequently initiating discussions of food fantasies.
Most of the newfound gourmands that Regard and Landis studied had other cognitive changes after their brain injury -- especially visual-spatial problems. Fully 26 of the patients also had impaired memory, and several, including the journalist, had a weakening on the left side of their bodies.
Behavioral changes also emerged. For instance, the businessman suddenly began making inappropriate sexual advances. Others became overly talkative, newly aggressive, more ambitious, or emotionally unstable. Landis now suspects gourmand syndrome "is just one aspect, probably, of a much broader disturbance of impulse control."
Cummings also subscribes to that interpretation. "Many processes of the brain are balances between inhibitions and excitations," he says. "So if a lesion or degenerative process were situated such that it affected primarily the inhibition of a process, then what you’re going to have is an enhancement of that process."
So why doesn’t he see gourmand syndrome in Los Angeles? In fact, he quips, "restaurants are full of these patients. But U.S. neurologists can’t afford to go to the higher-class restaurants. So we don’t discover them the way the Swiss do." He jokes that "it’s all a kind of managed-care issue."
More seriously, he argues that "we tend to see what we look for. And who would have thought to ask this sort of question" about a lusting after food?
Occasionally, however, a particular patient’s behavior stands out enough to arouse curiosity. That’s what happened to a coworker of Cummings, neurologist Bruce Miller, who had been following patients with progressive dementias that stemmed primarily from degenerative changes on the right side of the brain.
He ran across a 56-year-old businessman with no previous interest in art who suddenly began rendering increasingly detailed drawings and paintings of images that he visualized during the "open" and "closed" periods of his developing dementia. The closed periods corresponded to agitated, unhappy phases when lights and sounds brought him pain and discomfort. During open periods, these same stimuli triggered creativity.
Over the decade that his artistic skills were building, the man’s dementia became increasingly obtrusive -- with him changing clothes in parking lots, shoplifting, and insulting strangers.
The dramatic enhancement of artistic skills in this otherwise increasingly dysfunctional individual suggested that the brain damage played a role. Miller set about asking every new patient with frontal temporal degeneration about whether he or she had experienced a similar artistic epiphany -- and turned up four or five more such newly emerging artists.
Such studies, Cummings says, prompt the speculation that "there are likely inhibitory processes that, when affected -- by strokes, as in gourmand syndrome, or degeneration, as in our work -- allow us some type of heightened sensitivity. And that heightened sensitivity may be in the visual domain, as in painters, or in the gustatory domain, as with the gourmand syndrome."
Regard cautions that such diminished inhibitions may also emerge in less socially acceptable addictions or cravings. For instance, several years back, her team probed the neurological status of 21 "pathological" gamblers who had been referred to them by area psychiatrists.
After subjecting these individuals to a battery of neurological and cognitive tests, they found that fully two-thirds had abnormal electroencephalograms, suggesting temporal-frontal lobe abnormalities. In neuropsychological tests, more than half exhibited a range of other cognitive problems that affected, among other things, memory and conceptual thinking. Though the researchers did not conduct brain scans on these gamblers to map the low-grade brain injury suggested by many of the tests, they did learn that two-thirds of them had sustained head injuries, usually in childhood.
Regard’s team concluded that in some individuals, a gambling addiction "in some so-called organically normal subjects" may trace to "minimal brain damage, mostly due to head trauma," affecting their frontal lobe region.
The development of compulsive behavior after head trauma or other conditions may therefore signal latent brain injury that might otherwise go unnoticed. Indeed, Regard told Science News Online, gourmand syndrome and other behavioral changes may have diagnostic significance. "They may sometimes be the only things that you can observe -- put your finger on -- to indicate where in the brain damage might be."
The trick, Regard says, is to recognize these changes when they’re not dangerous, objectionable, disabling -- or even something that the patient considers a problem.
Cummings agrees. He says it’s easy to miss or misinterpret brain damage "in patients who undergo changes that they see as improving their lives."
Miller, B.L. . . . J.L. Cummings, et al. 1996. Enhanced artistic creativity with temporal lobe degeneration. Lancet 348(Dec. 21/28):1744.
Regard, M., and T. Landis. 1997. "Gourmand syndrome": Eating passion associated with right anterior lesions. Neurology 48(May):1185.
Stegmann, M., M. Regard, T. Landis, et al. 1991. Pathological gambling: neuropsychological and EEG findings. Journal of Clinical and Experimental Neuropsychology 13:37.
Baker, L. 1995. Food addiction traced to trauma-induced changes in the brain. Addiction Letter 11(October):3.
Raloff, J. 1997. Patients savor this brain disorder. Science News 151(June 7):348.
Raloff, J. 1996. Prescription-strength chocolate. Science News Online (Oct. 12).
Raloff, J. 1995. Coming: Drug therapy for chocoholics? Science News 147(June 17):374.
Marianne Regard
University Hospital
Department of Neurology
CH-6091 Zurich
Switzerland
This week's Food for Thought is prepared by Janet Raloff, senior editor of Science News.
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