Eating and Ecstasy: Fluctuations in calorific intake following weekend use of MDMA

John Turner

University of East London, Psychology, Romford Road, Stratford, London, E15 4LZ, UK. Phone no: +44 (0)208 223 4462 Fax no: +44 (0)208 223 4937

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The first thing to emphasise is that all studies of human behaviour in drug user populations are extremely flawed. There is a large gap between the animal work and the human work, and there are so many things that cannot be calculated in people who use illicit substances. For any given drug, it is often not known how much they have actually taken, when it was taken and even if they have taken what they think they have.

The following studies, therefore, are flawed but there is possibly an important finding to come out of this work. The study does not actually lead to any definite conclusions but it raises some new questions and possibilities for future research into health and behavioural effects of MDMA. The first is that we should be broadening the way in which we explore the behavioural effects of ecstasy or MDMA. Most of the work in psychology and psychiatry is increasingly concentrating on the neurotoxicity question; of whether or not there are long-term negative cognitive and mental health consequences of using MDMA¹. This current study is slightly removed from that area, and looks more at acute effects of what happens when somebody takes ecstasy at the weekend. The other flaw in the whole area of psychology and ecstasy research is that the terms ecstasy and MDMA tend to be used interchangeably. Ecstasy is not or is very rarely pure MDMA.

This study is derived from three areas. It is a very small study that looks at people’s dietary intake after they have taken MDMA/Ecstasy. The study arose after some students at the University of East London were writing (in their projects/essays) that MDMA may have originally been developed as some kind of appetite suppressant (Erik Fromberg pointed out in this session that there is no truth in this common myth). A more accurate point is that 5HT (5-hydroxytryptamine or serotonin, a neurotransmitter) is involved in the regulation of carbohydrate intake and a range of behaviours such as sexual behaviours, sleep, eating behaviour as well as cognitive and mood regulation. The third and final area that raised some important questions, was the fact that weight loss has been reported amongst ecstasy users. This appeared to be well understood amongst users and support groups. Indeed, in 1995 Lifeline, a UK organisation which provides harm reduction information to clubbers, produced a leaflet about ‘the E plan diet’². This stressed the need to be careful in using MDMA/Ecstasy because the combination of dance and this potentially anorexic drug could lead to significant weight loss. The emphasis here was, however, more on over-exercising after MDMA/Ecstasy, rather than a direct effect on appetite. This study aimed to look more at this latter possibility.

Study 1

The study began with 30 people but many dropped out, as the method was quite demanding on a participant's time. The final groups were 9 regular MDMA/Ecstasy users and 10 alcohol user controls. Everything they were eating and drinking was self-monitored and recorded for 14 days. To gain as many details as possible, and as accurately as possible, people were shown how to weigh foods or give estimates as to how much something weighed, and how to record how much of it they ate. Basically, we wanted a record of their daily intake for one week following weekend usage of MDMA/Ecstasy, and then for a week when they had not taken the drug. Some of the subjects did the study the other way around. The separate group of non-MDMA users (alcohol controls) were people who had never tried ecstasy but were also clubbers. This control group was made up of people who were going out clubbing but were using alcohol as their main drug. The people were asked to report back what other drugs they had taken as well and for some reason the MDMA/Ecstasy people just took Ecstasy, but that is not the norm.

Results

It was found that for up to six days after taking ecstasy, the subjects' calorie intake was (statistically) significantly down (see Figure 1; intake of user and alcohol groups over the week following weekend use). The average was 500 to 600 calories down (see Table 1; overall mean calorie intake in the two groups), but there were some people who were taking in 1,200 calories a day less than usual. That may not necessarily be a huge reduction if it is done for just one or two weeks, but if this kind of effect is happening week after week then that could perhaps lead to some deterioration of health. The excessive exercise that is involved in clubbing could be additive to any weight loss and health outcomes. Finally, the control groups results should be noted. The alcohol data shows no difference in the week that they had been out and had binged on alcohol and clubbed, and the week that they had not (see Figure 1 and Table 1). This indicates that the effects in the MDMA/Ecstasy group were not simply an extended hangover from clubbing (because the control group were also out clubbing); the effect is a more specific MDMA/Ecstasy hangover.

Figure 1: Daily total calorie intake in MDMA-user and alcohol (control) groups – during week after use (‘On’) and week after non-use (‘Off’)

Table 1: Mean total calories (and standard deviations) per day in ‘on’ and ‘off’ drug weeks.

Conclusion

There was not a desperately low calorific intake for the MDMA/Ecstasy users but some individuals were taking in as little as 500 calories a day. These effects were enduring for five or six days after they had taken the drug at the weekend. All these effects were significant (p<0.05).

Study 2

One of the immediate concerns was that this (results from study 1) could be an amphetamine effect. Amphetamines have been known to cause weight loss and reduction in appetite for some time, so we wanted to do a repeat study looking at people after they had taken amphetamine. We did a self-reported study where about 75 regular users of alcohol, amphetamine and MDMA/Ecstasy were recruited. These people were asked to rate the changes in their eating behaviour themselves, such as whether they thought they ate less after they had taken MDMA, alcohol and so on.

Study 2: Results & Conclusion

The data basically confirmed what was found in the data of study 1: that in individuals’ opinions they did think they ate less. They were not as hungry when they had taken MDMA/Ecstasy at the weekend compared to how they felt when they had drunk alcohol. They reported that the effect on appetite was more or less the same as when they had just taken amphetamine so it could be that it is an amphetamine effect that we are looking at (in both studies).

Overall Conclusions

We can conclude rather tentatively from these very small (and very flawed) studies that MDMA/Ecstasy use may suppress appetite, and may do so for five to six days after use.

This is something that needs to be explored further because it indicates a very easy way to help regular users of the drug to maintain their health. If this is a definite finding that can be reproduced, then it is the kind of finding that translates quite quickly and easily into documentation. Users could be advised for example, to eat more in the week after taking MDMA/Ecstasy, and that they may notice that their appetite is suppressed which could be due to amphetamine adulteration of tablets or the MDMA itself (or both!). The original group of nine people were just taking MDMA/Ecstasy, but there is often an amphetamine mix in tablets which may suggest serious implications for health and physical and mental well-being in regular users.

There is literature from psychology research into effects of diet on behaviour which may also be relevant here. This interestingly shows that manipulating people’s carbohydrate intake can alter performance on cognitive tests and in self-reporting their mood. People who do not eat very well tend to have lower moods and are a little bit ‘rusty’ (impaired) when performing some cognitive tests³. Perhaps this brings in a whole new confounding variable for the other groups of researchers who are saying that deficits in cognitive tests are an indication of neurotoxic damage. It is a possibility that we are dealing with a group of people who are not eating very well. This research does indicate that we do need to look at the other behaviours that the 5HT system controls. Too much emphasis on looking for cognitive problems or possible depression and clinical problems in MDMA/Ecstasy users could be distorting the way research is going. The other problem is that many studies of possible neurotoxic effects are being conducted by psychologists, psychiatrists and medical schools. This raises an important question as to what kind of people take part in studies when they know they are going to be assessed at a medical school or by a psychiatrist. It may well be a bias in the research that they are identifying people with problems because the people with problems are interested in that kind of research.

Selected References

1. Ricaurte, G. (1999) Studies of MDMA ('ecstasy') neurotoxicity in animals: implications for humans. Club Health 2000 Conference Plenary Session; November 12^th 1999, Amsterdam
2. Claire and Jose in 'The E-plan diet' (leaflet). Lifeline Publications, Manchester, UK; 1995
3. Green, M.W., Rogers, P.J., Elliman, N.A. and Gatenby, S.J. (1994) Impairment of cognitive performance associated with dieting and high-levels of dietary restraint. Physiology & Behavior, vol.55, no.3, pp.447-452