Category Archives: Bad mood

Can You Laugh Off a Few Pounds?

Most of us have a friend who, if invited to dinner, will make us laugh so much with an unending stream of funny stories that the food will get cold and neglected. The jokes may start soon after hunger has been dulled sufficiently to slow down eating and, if the jokes are well presented, laughter will prevent many from continuing to eat.  And indeed, what one remembers after this type of dining experience is not the food (regardless of how good it is) but the shared experiences of laughter.

Many people have tried to define the effects of laughing on the brain, attempted to analyze how structure of jokes activates laughter (there is a linguistic basis for this) and even have measured physiological responses to laughter. But it is not necessary to know what neurotransmitters in the brain are involved in the laughing response to know that it makes you feel better. The feeling may not last any longer than it takes to forget the punch line, but there is a sense of contentment after a good laugh, a feeling of relief because even if it is only for a few minutes, any negative emotions we are harboring seem silenced by the sounds of laughter we are making.

The idea that laughing releases tension is well understood by therapists who study the effect of laughter on behavior and mood. Moreover, even though we can laugh privately at something funny in a book or in a New Yorker cartoon, laughing is acknowledged as a way we communicate with others in the few minutes we all perceive the world of the funny story the same way. Indeed, if someone in a group mutters, “Why is that funny?” others view him or her temporarily as an outsider to a shared understanding of the story.

Laugh therapy has been used to reduce anxiety and depression among patients confronting illnesses like cancer and chronic diseases that have no apparent cure. Laughter is used as a tool to help people with social anxiety, according to Aaron O’Banion and Justin Bashore, who write about this on their website, Social Anxiety Institute.

Doctors rarely, if ever, prescribe laughter as a remedy for disease but one man, Norman Cousins, proved that it could be a powerful tool. Cousins, the editor-in-chief of the Saturday Review, developed a painful connective tissue disease with a very small chance of recovery.  His own treatment plan included watching reruns of humorous television programs and movies. His book, The Anatomy of an Illness, published in l979 after he recovered from his disease, described how, “…ten minutes of belly laughter allowed him two hours of pain-free sleep.” Of course, as some critics pointed out, he may have been misdiagnosed and whatever he had could have gotten better without the laughter, but the effect of laughing was immediate and the results, no pain, easily noticed.

Inducing laughter for therapeutic reasons, such as decreasing anxiety, is not left to the telling of jokes or watching a stand-up comedian. There are therapeutic laughter meet-up groups, laughter yoga (known as Hasya yoga) and laughter clubs. The objective is put an individual through a series of breathing and moving exercises that mimic, to some extent, the body movements when one is laughing. And sometimes laughing is induced just by having two people sit, stare at one another, and then force a laugh. It works as anyone who has giggled in response to someone else giggling knows.

It seems obvious that laughing should somehow find its way into a weight-loss program, especially for those whose excessive food intake is the primary, indeed only, pleasure they have. Eating is commonly done to reduce tension and anxiety, as a pleasurable way of reducing boredom, loneliness, the tedium of work or household tasks, and as a source of comfort that never fails. If laughter can decrease the negative moods often associated with overeating, the effect may be a painless, and indeed enjoyable, way of losing weight.

Laugh It Off! Weight Loss for the Fun of It by Katie Namrevo was published 14 years ago and describes the effect of laughing on the weight loss of the author. Unfortunately, her book has not spawned the equivalent of national weight-loss laughing groups that, unlike Weight Watchers, would allow clients to tell jokes rather than sad stories about how they overate the previous week. Moreover, might laughter therapy be used to relieve the intense loneliness of a morbidly obese shut-in individual who finds pleasure only when eating? If Norman Cousins could experience a few hours of reduced physical pain, might laughing also bring about a few hours of relief from emotional pain? Consider what might happen if someone attempting to lose weight was told that a meal could be consumed only after the individual watched 10 or 15 minutes of a funny movie or video or listened to a recording of a very funny writer like David Sedaris. What if an exercise-averse individual were told that a yoga group was focusing on movements related to laughter? A weight-loss group might be more fun if the attendees laughed together instead of describing events in which they overate, or the reasons they were provoked into doing so.

All of us, regardless of our weight, probably don’t spend enough time laughing. And yet, all of us have had the experience of repeating to ourselves a joke or funny observation we may have heard recently, just because it brings a smile to our face. Doing so makes us feel good. And feeling good is an effective way to support weight loss.

References

“Effects of laughter therapy on anxiety, stress, depression and quality of life in cancer patients,” Demir, M. J., Cancer Sci Ther 2015 7: 272-273.

An Afternoon Starbucks’ Drink May Be Great for Your Mood, but a Disaster for Your Weight

A full-page advertisement for an Ultra Caramel Frappuccino stopped me from turning the page in a magazine I was reading. The picture of this drink caused my mouth to water, and was one of several Starbucks drinks they are featuring to entice morning customers back into their stores for afternoon refreshment.  Hidden in small letters at the bottom of the page is the phrase “Find Your Happy.” Perhaps it refers to happy taste buds after drinking one of the Frappuccinos.  And for many, this may be the result. Moreover, I suspect that the marketing people at Starbucks who came up with the campaign did not know that an afternoon drink combining caffeine and carbohydrate are satisfying a need rooted in our brains, not our taste buds.

Collette Reitz describes how many of us feel around 3 or 4 pm when she writes on Elite Daily’s May 2018 web site”…you can’t decide what to order at Starbucks because you are craving both a giant piece of cake and a caffeine boost.“ What Ms. Reitz is describing is the phenomenon of a, “…universal afternoon carbohydrate craving and afternoon lack of caffeine fatigue.”

The flagging energy and blah feelings experienced around 3 or 4 pm is largely due in part to caffeine levels that have been declining since morning, when many of us drink our coffee or other caffeinated drinks. They can be quite low by mid-afternoon unless a caffeinated beverage was consumed with lunch.  But most of the mood changes in the afternoon seem to be associated with decreasing brain levels of serotonin. We don’t know why there should be a change in the level of this neurotransmitter, but its effects can be seen in the craving for carbohydrates along with the distractibility, grumpiness, irritability and restlessness many experience between 3 and 5 pm.

We discovered this in studies carried out at MIT almost thirty years ago with people who self-identified as carbohydrate cravers. At first we believed people were eating carbohydrates in the afternoon because they wanted something pleasurable to munch on when they took a break from work. But it turned that eating the carbohydrates was a kind of self-medication. Our subjects told us how they couldn’t concentrate or became irritable with their kids, or felt depressed or angry late in the afternoon. They said they needed to eat carbs at that time. They weren’t hungry, but they found it impossible not to eat a sweet or starchy snack and when they did so they felt better.

We tested their claim that eating a carbohydrate in the afternoon positively affected their moods by giving them a drinks containing carbohydrate or protein, and measuring their moods before and after the drinks. They didn’t know what was in the drinks. It turned out that the carbohydrate drink reversed their bad moods but the protein drink had no effect.   (“Changes in Mood after Carbohydrate Consumption may influence Snack Choices of Obese Individuals,” Leiberman, H.J., Wurtman, J., and Chew, B., Am. J. Clin. Nutr. 45:772-778, 1986)

Further tests in which they received either a drug that increased serotonin activity, or a placebo showed that when serotonin was more active, their carbohydrate craving disappeared.( D-fenfluramine selectively suppresses carbohydrate snacking by obese subjects.Wurtman, J.J., Wurtman, R.J., Mark, S., Tsay, R., Gilbert, W., Growdon, J. Int. J. Eating Disorders, 4(1):89-99, 1985.)

So it appeared that somehow serotonin was signaling them to eat carbohydrates. Why? The reason was actually discovered years earlier, also at MIT. Serotonin is made after insulin is released and changes the pattern of amino acids in the blood. When insulin does this, a particular amino acid, tryptophan, gets into the brain and instantly is converted to serotonin. Insulin is secreted only after sweet or starchy carbohydrates (with the exception of fructose) are eaten.  (“Brain serotonin content: physiological dependence on plasma tryptophan levels,” Fernstrom, J., and Wurtman, R., Science, 173:149-152, 1971) Perhaps the lack of serotonin sent a signal in the form of carbohydrate craving just as thirst is a signal that the body needs water.

Starbucks’ “afternoon made” drinks may be the solution to this serotonin-generated afternoon mood and energy slump. But it is also a problem. The heavily advertised Frappuccino contains so many calories that the elevation in energy and mood may be costly in added pounds.  A grande size of the Ultra Caramel Frappuccino contains 420 calories, 19 grams of fat, 59 grams of carbs and 5 grams of protein. The grande size Triple Mocha Frappuccino has 400 calories, 18 grams of fat, 55 grams of carbs and 5 grams of protein. One does not need to consume 55 grams of carbohydrate and 400 calories to increase serotonin levels. Twenty-five to thirty grams is sufficient and if the snack is very low in fat or fat-free like some breakfast cereals the calories rarely exceed 130. Moreover, the fat content of the drinks may actually have a negative impact on mood. Feeling logy or foggy or just tired after eating a load of fat is not uncommon. Drinking 18 or 19 grams of fat puts a “ball of fat” in your stomach, and when digested rarely leads to increased mental or physical energy. I would not want to have a surgical procedure if my doctor just finished drinking a Frappuccino. To add fat to the fire, as it were, the fat drastically slows down digestion so the beneficial effects of caffeine and carbohydrate on energy and mood take longer to be experienced.

Starbucks offers other options that refresh and rejuvenate with many fewer calories. Mango Dragon Fruit Lemonade has 110 calories and 26 grams of carbohydrate. Strawberry acai lemonade has a similar nutrient profile. Other low-calorie drinks such as lemonade do not have quite enough carbohydrate to activate serotonin synthesis in the tall size, but would if ordered in the next larger size.

Will you find your “happy” in these afternoon drinks? Yes—but only if your mood goes up without your weight doing the same.

Too Little of a Good Thing: Carbohydrates

I was in charge of refreshments at a reception held for a guest lecturer and, aware of some of the attendees’ dietary limitations, selected gluten-free, sugar-free, dairy-free, and vegan cookies, as well as a large bowl of seasonal fruits.

“I am on the keto diet,” several of the guests told me as they avoided the cookies and fruit.

Where had I been?

I did not realize that the ketogenic diet had reappeared with such popularity, although I knew it never had really gone away since the days of Dr. Atkins. A few minutes on the internet made apparent the ubiquity of a diet that forces the body to switch from using glucose to fatty acids for energy. The diet seems to appeal to those who believe that total abstinence from sweet and starchy foods is the only way to control calorie intake. It also appeals to those who feel that carbohydrates are the source of physical and cognitive distress.

That adherence to such a diet has side effects ranging from unpleasant to worrisome is a small price to pay for those who follow a carbohydrate-free eating plan. Who cares about bad breath, constipation, “keto brain” (inability to concentrate and remember), difficulty sustaining strenuous exercise, and dangerously low electrolyte levels? As long as the weight comes off, it is worth it. Or so the thinking goes.

What happens after the diet ends can be dealt with after the diet ends, and if it seems impossible to maintain weight loss, well, why not go right back on the carbohydrate-free diet? Long-term effects? No one knows, so it could be good (or bad).

When someone is in ketosis, the body uses fat as a back-up energy system. Normally and naturally the body depends on glucose for all its energy needs. The glucose comes into the body as the end product of digestion of all carbohydrates, whether sucrose or brown rice, and is converted through a series of biochemical reactions into energy. In ketosis, the body uses fatty acids as its energy source. Once the body adapts to this alternate source of energy, it seems to run more or less the same (except for muscles which work longer and harder when using glucoose, the natural source of energy.) Exercise physiologists tell us that there is so little stored glucose in muscle on a carbohydrate-free diet, that muscles may fail to sustain strenuous movement after a few minutes of intense exercise. This means muscles used to sprint after a dog darting into the street, or a toddler about to climb up the rungs of a bookcase, will run out of energy reserves very quickly.

However, the body has a way of getting around the lack of carbohydrates for its glucose source by making its own. Certain amino acids in the protein we eat are converted to glucose in a process call gluconeogenesis. This occurs in the liver and kidneys and, according to advice given to wannabe ketotics, must be prevented. According to one Internet site, “Perfect Keto,” one should eat a specific ratio of fat to protein, because if too much protein and too little fat are consumed, the body will use the amino acids in protein as a source of self-made glucose. To prevent this, one should eat a very high fat diet, and only moderate amounts of protein, namely 75% fat, 20% protein, and a tiny amount of carbohydrate, 5%.

You will know whether or not you have achieved your goal of ketosis by testing levels of ketone bodies in your urine, blood or breath. Ketone bodies are three substances (acetoacetate, beta-hydroxybutyrate, and acetone) that the liver produces from fatty acids during periods of fasting, starvation, and very low or zero carbohydrate diets.

Although we tend to associate a carbohydrate-free or extremely low carbohydrate diet with dieting, it has long been seen as an effective treatment for controlling intractable pediatric epilepsy. Indeed, it is so important that the epileptic child not deviate from this diet that nutritional products have been developed containing flavored protein/fat liquid supplements that function as meal substitutes.

Moreover, avoiding carbohydrates used to be, prior to the availability of insulin, the only way someone with diabetes could handle this disease. And minimizing carbohydrate intake not only from sugary foods, but vegetables such as winter squash, corn on the cob, and carrots may help maintain a normal fasting blood sugar level.

Is it worth putting the body through a major physiological readjustment in order to lose weight?  What about the effect of carbohydrate deprivation on mood? Will there be any rebound eating of carbohydrates once the diet is switched back to including some carbohydrates? A definitive study comparing weight loss among 609 participants who were on a low carbohydrate or low-fat diet over a 12 month period was published this past winter in the Journal of the American Medical Association. The study did not support claims that avoiding carbohydrate produces a better weight-loss outcome. The difference in weight loss between the two groups was about l ½ pounds.

But perhaps the low carbohydrate diet is better for mood. Certainly anecdotal reports of the benefits of eliminating or drastically reducing carbohydrate intake would have you believe that clearer, sharper, focused, energetic minds result.  Here, also, the claim was not borne out by results of another twelve month study comparing  a low-fat and low-carbohydrate diet.

That moods improve among those in the study not denied carbohydrate is not surprising, assuming that some of the mood effects such as energy, focus, calmness and a sense of well-being are associated with normal serotonin activity. The absence of carbohydrate over prolonged periods of time prevents the amino acid tryptophan from entering the brain where it is converted to serotonin. The result: a decrease in serotonin levels and the risk of mood changes associated with too little of this neurotransmitter.

What happens if and when carbohydrates are added back into the diet? Diminished serotonin levels may make the dieter vulnerable to overeating this food group.

Next time I am asked to bring refreshments, I will be sure to include some pork rinds.

References

“Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion,”  The DIETFITS Randomized Clinical Trial,  Gardner, C., Trepanowski, J., DelGobbo, L., et al,  JAMA 2018; 319:667-679

Long-term effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive  Function .Brinkeworth, G, Buckley J, Noakes, M,  Arch Intern Med 2009 :169; 1880-1873

“Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis,” Jenkins. T., Nguyen, J., Polglaze, K.,, et al, Nutrients 2016 8(1): 56.

Night Eating Syndrome: Is It Just Sleep That Is Disturbed?

Waking up in the middle of the night is an annoying event that most of us experience. Usually we are able to fall asleep again quickly, perhaps after drinking some water and/or making a trip to the bathroom. But for some, waking up is a signal to go into the kitchen and eat: a bowl of cereal, a peanut butter sandwich, or a dish of ice cream. And unhappily, going back to bed after the night time snack does not ensure that the remainder of the night will be restful. Waking may occur once again, or even several times during the rest of the night, and is always accompanied by eating. The next morning, the night time eater has no appetite for breakfast and may not eat for hours.

When the pattern of awakening and eating occurs regularly, it is defined as a type of eating disorder called Night Eating Syndrome (“NES”) described first by Albert Stunkard in l955. Dr. Stunkard was a professor of psychiatry at the University of Pennsylvania when he first put forth the criteria for diagnosing this poorly understood behavior. Simply eating leftover pie or pizza at midnight is not sufficient to meet the diagnosis, because people with NES consume about 25% of their total daily calories after the evening meal. The food can be consumed in the evening before sleep and/or during nocturnal awakenings. Those with NES suffer from insomnia at least four or five times a week and believe that they will not be able to go back to sleep unless they eat. Finally, if they have mood disturbances like depression and anxiety, their moods will worsen as the evening progresses.

Interestingly, as Stunkard points out in a paper he wrote on the subject almost fifty years later, people who engage in frequent night time eating are not necessarily obese, although it is a risk factor for obesity. Because they are unlikely to eat during the early part of the day, (skipping breakfast and delaying lunch) their total daily intake may be appropriate. On the other hand, many who are seeking help for their obesity often fail to report nighttime eating episodes. Plus, they are rarely asked about it, so it is not known to what extent this type of eating contributes to weight gain.

The inability to sleep through the night, or to do so with only infrequent awakenings of short duration, is certainly associated with NES, but is it the cause? Many people have insomnia, but they do not eat their way through every period of nighttime wakefulness. If the food eaten helps put the eater back to sleep, this would explain their seeking food once they wake up. But it is hard to find studies that test whether the foods chosen in order to put the insomniac to sleep actually work. Moreover, in a study that examined sleep cycles of NES subjects and controls, no difference was found in the duration of sleep, although the former did awaken earlier in the night and more often.

Perhaps the syndrome is not caused by disordered sleep, but by something else. Current research suggests someone with NES is not eating to go back to sleep, but rather waking up because of hunger. The “hunger” hormone ghrelin, which normally is secreted during the day when we normally feel hungry, seems to peak late in the evening and into the night in NES sufferers. Thus they may be awakening because of ghrelin-potentiated hunger.

A solution has been to reset the pattern of ghrelin secretion back to normal by exposing the patient to light very early in the morning. Anyone who has traveled east across enough time zones to feel out of sync and out of sorts during the first couple of days, knows the feeling of being forced to sleep and eat on another time zone’s timetable. It is hard to be hungry for breakfast when it is only 3 am back home, and it is hard to find food when you wake up hungry at 2 am because it is now 7 pm back home. If you stay in the new time zone long enough, your eating and sleeping hormones adjust. This is what researchers hope to accomplish for the night eaters using bright lights to make ghrelin levels high during daylight rather than at night.

Melatonin is also being tried because some studies have found that this sleep hormone is not as high as it should be in the late evening, and perhaps this is why it is so easy for the night eaters to wake up. There is a time-released melatonin preparation containing the low recommended dose of melatonin (0.3 mg); whether it might prevent frequent awakenings has not yet been tested. Anxiety and depression are also linked with NES, but it is unclear if they are the cause or consequence of disrupted sleep.

It is not unusual to wake up at 3 am and be assaulted with the worries that were successfully repressed 12 hours earlier. If one were prone to depression and anxiety, would these mood disorders cause sleep disturbances leading to frequent awakenings or, if awake, prevent the individual from falling back asleep unless something is eaten? Stunkard recommended antidepressants that increase serotonin activity to decrease anxiety and depression and calm the individual back into sleep. But a remedy that would help the sleep, as well as hunger and mood disturbances, is more simple and natural: a cup of low-fat, mildly sweet breakfast cereal eaten upon nighttime awakening. The carbohydrate will increase serotonin thus inducing relaxation, satiety and a more tranquil mood.

If the cereal is in a cup by the bed, it can be eaten without leaving it (as long as there are no crumbs.)

References

“The night-eating syndrome; a pattern of food intake among certain obese patients,” Stunkard, A.J.; Grace, W.; Wolff, H.,The American Journal of Medicine. 1955: 19: 78–86

“Two forms of disordered eating in obesity: binge eating and night eating,” Stunkard, A. and Allison, K.. Int J Obes Relat Metab Disord 2003, 27: 1-12

“Circadian eating and sleeping patterns in the night eating syndrome,” O”Reardon, J., Ringel, B., Dinges, D., et al, Obes Res. 2004; 12:1789-96

If Your Valentine Sweetheart is on a Diet, Should You Gift Chocolates?

Valentine ‘s Day is a sweet (pun intended) holiday. It comes in the middle of the winter doldrums; Christmas is long past and spring is nowhere to be seen. But the problem is that it also comes about six weeks into the weight-loss program many started after New Year’s Day.

“Give something to show your love,” we are told in a doughnut shop advertisement featuring heart- shaped pink doughnuts covered with white icing and pink sprinkles. Shelves in gourmet chocolate stores are filled with pinky-red, heart-shaped boxes decorated with tiny flowers; the boxes contain melt-in-your-mouth creamy chocolate that should be guaranteed to melt the heart of the recipient.  Russell Stover chocolates that are filed with hidden flavors revealed only when bitten into are waiting to be bought and sent to the relatives who remember the candy with fondness. M&M’s sport pink chocolate shells, while heart-shaped sugar candies waiting to cause instant tooth decay call to the drug store shopper who came in only looking for shampoo.

Not to be left out, bakeries feature several-layered heart-shaped cakes to be consumed with a glass or two of champagne.

To be sure, commercial romance for Valentine’s Day is not limited to food. Flowers are a welcome brightness in the gloom of early February and jewelry, especially diamond engagement rings, do not contain calories. Gifts of self-indulgence that the recipient may not get for her or himself, such as a massage, spa treatments, pedicures, and/or manicures, are also calorie-free and thoughtful.

However, sweet foods, especially chocolate, seem to be the most persistent symbol of romantic thoughts or intentions. Perhaps because for centuries chocolate has been considered an aphrodisiac. There is no scientific evidence for this, and even if it were true, there would be no reason to assume that chocolate consumed on Valentine’s Day has a greater impact on sexual arousal than if it were consumed on any other day. Perhaps if chocolate is wrapped in a heart-shaped box, it has more of an impact; nonetheless, this certainly has not been tested.

Giving a gift of chocolate also has its perils. What if the message it conveys has less to do with romantic intentions and more to do with the body image of the recipient? Give a pound of chocolate to someone skinny and it may convey the thought, “You need to gain some weight.”  Present that heart-shaped box to a chubby recipient and it can unintentionally convey the thought that, “You are fat already, so what difference does another pound of chocolate make?” instead of, “I like you the way you are.” Can you give chocolate to someone in the older generation who may be overweight, developing diabetes, or dealing with orthopedic problems because of excess weight?

Then there is the dieter. The continuing popularity of low or zero carbohydrate diets puts chocolate on the forbidden food list. The butterfat would be fine, and the more expensive the chocolate, the more butterfat it contains. But the sugar content that makes chocolate edible (otherwise it would taste like bitter cooking chocolate) would ruin the diet of anyone who is following a ketogenic diet in which fat, not carbohydrate, is used by the brain and body for energy.

But for those who are counting calories or the equivalent in food exchanges, there is good news. Small amounts of chocolate have fewer calories than they seem to have, given their luxurious taste and mouthfeel. A quick scan of Godiva, a popular gourmet brand of chocolate, reveals a lower calorie count for their chocolate than one would assume. Admittedly the actual pieces of chocolate are not large, maybe one or two bites. Still, you can eat four dark chocolate truffles for about 180 calories, and three pieces of assorted Belgian chocolates for 190 calories. A Lindt chocolate ball has 75 calories. To put this in perspective, a glass of champagne has 95 calories, an eight-ounce serving of fat-free yogurt around 80-90 calories, and 10 almonds, 70 calories. So certainly presenting your Valentine gift of chocolate to a dieter should not be a problem; one or two pieces of chocolate will not retard weight loss or cause the diet to fail.

But of course that is the problem. You can’t buy prepackaged chocolates wrapped in the colors of Valentine’s Day in amounts smaller than twenty or so pieces. Thus the recipient has to confront the problem of how to manage the consumption of the rest of the chocolate after February 14.  A highly disciplined dieter will be able to restrict consumption of a luscious piece of chocolate to one or possibly two a day. But this kind of restriction is not easy to accomplish, especially in the middle of the diet. And the romantic associations with the chocolate will be quickly dissipated when the dieter finds a “gift” of pounds after devouring the rest of the package.

One solution is to buy only one or two pieces of gourmet chocolate from the store; the chocolate can be boxed in the same fancy wrapping as would be used for a larger amount. But in this time of online rather than in person shopping, locating such shops and having the time to go to one seems much too inconvenient. Moreover, the dieter may misinterpret intentions behind the gift thinking that the giver:

1) Is cheap;

2) Thinks I am fat;

3) Thinks I will gobble everything in a bigger box; and therefore

4) Wants me to stay fat.

Maybe people should stick to flowers or diamonds.

 

 

 

Is the US Becoming More Obese Because of Medication?

Despite a blizzard of weight-loss programs, touting novel fat-reducing foods, and innovative exercise devices, the country is getting fatter and fatter. The Centers for Disease Control and Prevention reports that nearly 4 in 10 U.S adults, according to their body mass index, can be classified as obese. Obesity is not evenly distributed among the states. The losers; i.e. the thinnest states, are Colorado, Hawaii, Massachusetts, and D.C. The gainer is West Virginia where almost 40% of adults are obese.

We have been becoming heavier for so many decades that we forget how thin we were as a country 80 or more years ago. It is only when viewing newsreels of the first half of the 20th century in which most adults look extremely thin that you realize what we now consider thin was considered normal weight back then.

The same old reasons are brought out yearly to explain why we, and indeed the rest of the world, is getting fatter: junk food, sugary drinks, dependence on motorized transport rather than our two feet, humongous restaurant portions, intestinal flora that make our bodies store fat, too much time on electronic devices, and too little time in the gym.

Might our growing obesity be related to the weight gain after smoking withdrawal? Weight gain is common among ex-smokers, and studies as reported by the National Bureau of Economic Research (Sharon Begley, “Gut Check”) suggest that it may be 11-12 pounds on average. But a close examination of who gains the most weight indicates that smokers with the lowest BMI are most likely to gain the most, and 11 or 12 pounds is not enough weight gain to make them obese.

Could medications used to treat mental disorders be another, mostly overlooked cause of national weight gain? That psychotropic drugs—the medications used to treat depression, anxiety, bipolar disorderschizophrenia and other mental diseases—cause weight gain is established. Sometimes the weight gain is only a few pounds, stops after a month or two, and is lost as soon as the treatment ends. But many drugs cause substantial weight gain because the patient experiences a relentless urge to eat. Moreover, to the chagrin, indeed horror of some patients, stopping the medications does not always cause weight loss even with dieting and exercise.

Data on the use of psychotropic drugs comes from a 2013 Medical Expenditure Panel Survey discussed in a Scientific American article by Sara Miller.  One in six Americans is taking a psychotropic drug, although not all are being prescribed for mental illness. There have also been many studies showing that depression itself is linked to future obesity. A common depression, Seasonal Affective Disorder, is diagnosed in part by the overeating and weight gain of patients during the increased darkness of winter. Often the depression of PMS and pre-menopause is accompanied by overeating and weight gain as well.

Yet in the list of causes for our increasing girth, reasons such as genes, inflammation, bad gut bacteria and bread are more likely to be found than the weight-gaining potential of depression and the drugs that treat it.

Where are the weight-loss programs specifically designed to help those whose overeating is caused by lack of sunlight, or hormones affecting appetite control centers in the brain, or drugs that hijack control over satiety? Where are the support services for those who are embarrassed to go to the gym because their medications have turned their formerly fit and slim body into a much heavier one?  Recently someone who has been struggling to lose the weight gained on her medication for obsessive-compulsive disorder told me that her dietician put her on a low- carbohydrate diet. “I was craving carbohydrates all the time,” she told me, “so the dietician figured the easiest way to take care of that problem was to remove them from my diet. She did not realize that my medication had caused the cravings even though I told her. And since I couldn’t stop my drugs, I just craved bread and pasta so much on her diet that I began to binge.”

 

This story is typical in that this patient was not seen as needing specialized weight-loss help because her weight gain was the result of a drug, and not related to emotional issuesor an inability to make healthy food choices. Moreover, the dietician’s advice to remove carbohydrates showed lack of knowledge on the effect of eating carbohydrates on serotonin synthesis. Serotonin levels drop when carbohydrates are not consumed and often lead to a worsening of the obsessive-compulsive disorder, depression, or other mental disorders.

How long is it going to be before weight-loss professionals acknowledge that many of the obese in the United States are that way because of their medications? How long will it be before thought, labor, and money are put into programs to address their special needs?

Will 2018 bring about needed innovations in weight-loss therapy for these individuals, or will we just become fatter?

Does Running Holiday Errands Count as Exercise?

“I‘m exhausted!” a friend told me when I bumped into her at the supermarket. “I spent the entire weekend running around doing errands.”

“Sounds like a good way of getting exercise and errands done at the same time,” I replied, knowing what the response would be. “Well, obviously I am not running,” she retorted. “But fighting the traffic in the mall parking lot and standing in line every store is so tiring. I don’t have the energy even to get to the gym.”

Holiday preparations, with its multitude of obligations and looming deadline of December 25th, seem to cause a frenzy of multitasking and soak up scarce free time. Even before Thanksgiving leftovers are consumed, the holiday to-do list is made and the running begins.

There is a high mental and physical cost to transforming ordinary life into one characterized by holiday decorations, buying and wrapping presents, sending cards, cooking, entertaining, hosting company and/or traveling. Since these tasks are added to those normally carried out each day, such as going to work, caring for family and social activities, the result is that time normally spent preparing and eating meals and exercising is drastically decreased. Indeed, going to the gym, a yoga class, or for a run seems like an indulgence done at the cost of cramming even more holiday obligations into remaining hours of the day or week. And for some, like my friend, the fatigue that comes with probably too little sleep, too much stress, too much shopping in malls with recirculated air, and too much waiting in traffic…it all makes sitting on a couch rather than on an exercycle seem like the only option at the end of the day.

Weight gain during the holiday season is so common that right after New Year’s Day, dieting kicks in. Gaining five pounds or more from Thanksgiving to the next year is not unusual, and holiday food and drink are major contributors to increased calorie intake. But even without the eggnog, sugar cookies, mayonnaise, sour cream or melted cheese dips, and fruit cake, weight would probably be gained. Lack of time leads to food court dining, fast food drive-ins, pizza, or nibbling all day on nutritionally weak snacks. Steamed vegetables, grilled fish and large salads are for January, not for December with its endless errands.

Frequent exercise classes or solitary workout routines followed by a shower, hair drying, and make-up applying is not compatible with a mind-set of counting down to Christmas.  And for those who exercise at home rather than at a health club, the convenience of having a piece of exercise equipment nearby is often ignored, because household tasks call more loudly than 30 minutes on the treadmill.

The approach to getting through the next few weeks without compromising sleep, weight, emotional well-being and fitness?

Schedule time to keep the body and mood healthy. You are not running a toy workshop in the North Pole and setting up a sleigh (rather than Amazon) delivery system by Dec 24. Which is to say that if there is a choice between getting enough sleep, or eating a salad, lean protein and high fiber carbohydrate, or taking a brisk walk or an exercise class, or making another dash to the mall, or baking one more batch of cookies? Choose exercise you want to do. Study after study has shown the positive and immediately impact that exercise has on decreasing stress and improving mood and cognition. Over the long term? Exercise can improve general health, decrease risks from heart disease, and perhaps even neurological diseases like Alzheimer’s.  A fatigued, stiff, grumpy body dragged to the gym unwillingly will not be the same after exercising. Paradoxically, the fatigue seems to lift….probably because increased blood flow oxygenates the muscles and brain. Stiffness from sitting in a car or standing in line goes away as the heat from the exercise makes the muscles more limber. Grumpiness disappears as well. People do not scowl at themselves in a health club; they may grunt or groan from the difficulty of their particular exercise, but somehow nasty moods go away (except if there are no towels when you leave the shower).

But the best part of literally (not figuratively) running or doing any other form of physical activity is that you are doing something for yourself. You are the beneficiary. You are the one who feels better, more energetic, less irritable or worried. The time you spend in exercise belongs to you.

Giving yourself the pre-holiday gift of time to take care of yourself is not something that is done easily. Guilt and anxiety over what has to be done, and what might not get done, may interfere with your healthy intentions: “I will make that salad or take a walk after I do (fill in the blank),” you say to yourself.

Putting your need for healthy food, exercise and sleep at the top of the long to-do list is hard. And yet, what better gift can you give to your family and friends than a cheerful, not sleepy, energetic, and unstressed you?

Feeding Your Guests to Decrease Their Stress

“I am reluctant to have friends over for dinner,” my neighbor confided in me recently. “By the time we are finished with the main course, everyone at the table is arguing about politics or sports. Once I had two guests get so upset that they stopped talking to each other for almost a year. “

“Maybe it is what you serve,” I responded.

She looked offended.

“No,” I said quickly, “You misunderstood…your food is delicious. I wasn’t criticizing your cooking. But maybe you could alter the menu to decrease their agitation. “

Usually contentious dinners are limited to family occasions, most notably holiday celebrations when relatives who may not like each other are forced to eat at the same table. Avoidance of either the relative, or avoidance of topics offensive to said relative, is the strategy many take when forced to attend such gatherings. But having friends over for dinner used to mean assembling people who enjoyed each other’s company, with the presumed mutual goal of a pleasant evening of food and conversation. Now it seems that the conversation may have to be limited to traffic, weather and vacation travel, unless all the guests have exactly the same political views and love of the same sports teams.

But why resort to such vetting of the guests or the topics?  A better option is to feed the guests in such a way that they become mellow, patient with the opinions of others and, in general, agreeable.

Years ago, in a book I co-authored called Managing Your Mind and Mood with Food, I described the culinary strategy of the CEO of a large French pharmaceutical company. The research department often invited scientific consultants to discuss and evaluate research on new drugs. One of the CEO’s associates told me that the lunch menu was designed to induce a state of benign drowsiness in the scientists so they would be agreeable to anything the company might discuss in the afternoon session. Having been witness to the aftermath of some of these meals, I can attest to the success of the strategy.

This being Paris, the meal contained different wines for each course including brandy with coffee. There was always an appetizer, main course, salad, cheese course and then, unusual for Paris, an elegant cake or elaborate pastry, sometimes with ice cream.  Sauces rich in butter, cream and possibly egg yolks were poured over the entrée and sometimes the vegetables as well. The cheeses were 95% or higher in fat and the desserts sweet enough to make one welcome the mild bitterness of the tiny cups of espresso. (There certainly was not enough caffeine in those tiny cups to counteract the soporific effects of the meal.) Interestingly, the host the CEO drank only water, and nibbled at the food.

An American host would need a sizable kitchen staff to prepare such meals. Fortunately, altering the mood of the guests so they also become tranquil and agreeable can be accomplished with much less effort and food.

To do so requires knowing only two facts about food and mood: carbohydrates consumed with little or no protein will make serotonin, and leave most people feeling relaxed. Fat, which can be consumed with protein, carbohydrate or both, may make the diners mentally fatigued and sometimes even a little befuddled. Befuddled is not a good state for scientists or dinner guests to be in, so it is probably best to use carbohydrates to alter mood rather than bacon, butter, egg yolks, cream and high-fat cheeses. Curiously, our American habit of serving appetizers of cheese and crackers may inadvertently potentiate mellower moods because of the combination of fat (cheese) and carbohydrate (crackers). The wine or other drinks will (usually) add to the relaxation effect.

Perhaps the ideal sequence of foods to produce happy, enjoyable guests is to be found in Italian homes. Carbohydrate, as in pasta and sometimes polenta, is usually served a first course. The amount is small, unlike American-size portions, but certainly contains at least the 30 grams of carbohydrate that must be consumed in order for serotonin to be made.  Because the pasta is eaten first, the eater benefits not only from the mood-soothing effects of serotonin but, in a value added sort of way, the beginnings of satiety as well.  This means that when the small portion of protein is served as a second course, it will not be viewed as too small, because the eater is already feeling a little full. Bread and wine accompanies the meal, and presumably even if arguments occur at the dinner table, there is enough serotonin being made to keep the arguments from becoming contentious.

Alas, our American avoidance of carbohydrates, and this incorrect insistence that eating copious amounts of protein may have the opposite effect on our temperament. Eating protein inhibits serotonin from being made because it prevents the amino acid tryptophan from getting into the brain (tryptophan being this from which serotonin is made.) Is it possible that our moods are deteriorating because we are not eating enough carbohydrates?

Eating carbohydrates to improve the group mood does not have to be restricted to your dinner guests. There are work environments so stressful that, as one employee told me; it feels as if her flight or fight responses are going off and on all day. “I am sure it is not healthy to be working in such a stressful culture where people think it is all right to continually shout, demand, berate, and insult those beneath them, “ she told me.

Would carbohydrates help? Apparently, no one in that volatile office touches them because not being fat is mandatory (unspoken), and everyone is convinced that eating a piece of bread will cause them to gain weight. What they don’t realize is that eating a piece of bread or a cup of breakfast cereal might make them a little less abrasive, and perhaps a little kinder. And that is a good thing.

Are You Merely Exhausted or Unrelentingly Exhausted?

My neighbor was sitting on the park bench watching her twin five year-old granddaughters feed bread to the ducks. After the obligatory remarks about the cuteness of the pair, I asked her how her weekend was. “Exhausting!” was her immediate response, “The twins stayed with us and I am bone tired. I may never get up from the bench!”

She did look exhausted, but we both knew that once the parents took the girls home, she would relax and by the next day feel, if not entirely rested, much better than today. She is one of the lucky ones. Her exhaustion is situational and an inevitable (but reversible) consequence of incessant care of two very active little girls.

Many of us can relate to her fatigue. We take upon ourselves too much to do both physically and mentally, and feel exhausted when our bodies and minds no longer can deal with yet another task. Sometimes we continue to do too much despite fatigue, because there is no other choice. Too long hours at work because of staffing problems, twenty-four hour care for a sick or elderly relative, a home renovation deadline that has passed: all kinds of situations cause tiredness. But eventually there comes a time when we can rest our bodies and minds and have our energy restored to us.

But what if the fatigue never goes away? What if the body feels weighted down with sleepiness, getting out of bed is a major accomplishment, or cutting through the mental fog seems an impossibility? What if instead of reversible weariness, the exhaustion is unrelenting?

According to a National Health Interview Survey about six years ago, more than 15% of women and 10% of men suffered from fatigue or exhaustion. Some reasons may be situational, such as excessive physical activity, lack of sleep because of insomnia, jet lag or shift work, medications that induce drowsiness like antihistamines and antidepressants, and excessive fat and alcohol intake. Some of these, such as shift work or constantly changing time zones because of work (like pilots and flight attendants experience), may be difficult to avoid and certainly diminish the quality of life.

Worse yet are medical conditions associated with unrelenting exhaustion: acute liver failure, anemia, chemotherapy and radiation, chronic fatigue syndrome, concussion, major depression, chronic infection, diabetes, underactive thyroid (hypothyroidism), multiple sclerosis, chronic kidney disease, fibromyalgia, stroke, drugs for hypertension, epilepsy, chronic stress, and major depression.

Some of these conditions, such as underactive thyroid, anemia and well-controlled diabetes, are correctable. And often the exhaustion will diminish as the body heals, for example, from a concussion or stroke (although it may take months for the post-stroke fatigue to disappear.)
The reason for the severe exhaustion is sometimes obvious and treatable, or disappears with recovery from the illness or treatment. Iron deficiency anemia responds to iron supplementation unless there is an underlying cause for loss of blood. Too low or high blood sugar in the diabetic that causes fatigue may require more intense monitoring of food intake and insulin dosing. Chemotherapy and radiation is usually of a limited duration, and people recover from concussions and infections.

But there don’t seem to be effective ways of overcoming the mental fog and intense tiredness of multiple sclerosis, major depression, chronic fatigue syndrome and other medical conditions, in large part because no one really knows what causes these symptoms. What causes cognitive sharpness to retreat into dullness? What causes well-nourished, developed muscles to feel too weighed down to move? How can a mental illness manifest itself in fatigue so great it is hard to get out of bed?

Because there is so much unknown about why fatigue seems to accompany illnesses from allergies to strokes, it is easy to point to available nutritional villains as the reason. Dairy products, gluten, fruits and vegetables belonging to the nightshade family like tomatoes, potatoes, peppers and gooseberries supposedly cause significant fatigue. Refined carbohydrates, saturated fats, and caffeine are also to be avoided. Conversely, foods that, not surprisingly, resemble those comprising a nutritionally sound diet, are recommended to fight fatigue: lean protein, fruit, vegetables, high-fiber foods, and low-fat dairy products. Of course, these food groups must be eaten not just for their supposed fatigue-fighting capacity, but also for the maintenance of general good health. Keeping hydrated is also very important.  However, there is little evidence that following a nutritionally sensible diet will alleviate the all-encompassing exhaustion associated with certain diseases.

Physical activity is recommended, although it should be low impact and of short duration. It seems counter-intuitive that using energy to exercise restores energy to the chronically tired, but it does seem to decrease fatigue. In fact, research showed athletes suffered from unrelenting exhaustion when they were not allowed to exercise for several weeks.

When exhaustion lingers, as it often does after a stroke or in chronic fatigue syndrome, the most usable advice is to accommodate to it. Frugality in using energy seems to be the most workable solution. Like budgeting one’s money, energy should be spent only on necessary activities. Simple things like sitting rather than standing to prepare a meal, consolidating errands, and avoiding unnecessary movements are helpful. Programming rest stops into the day’s routine and decreasing non-obligatory commitments are also important.  Meditation is thought to be helpful, as is simply sitting in a quiet room. When exhaustion includes a decrease in cognitive function, the so-called mental fog, it may be necessary to ask others to do the tasks, like paying bills, that seem impossible to carry out.

My friend’s exhaustion disappeared after a day without the grandchildren. Let us hope that research will make unrelenting exhaustion soon disappear as quickly.

Are Corporate Shut-In’s as Vulnerable to Vitamin D Deficiency as Nursing Home Residents?

I live near a nursing home and regularly see the staff coming in and out during their shift change when I walk past. What I have not seen, despite the warm, sunny weather, are residents sitting outside in the garden, or being pushed in a wheelchair.

This is not surprising. Few nursing homes have the sufficient staff to permit taking residents outside, and so rely on visitors to do so. The residents themselves often prefer to stay inside. An elderly aunt of mine always had an excuse as to why she did not want me to take her out when I visited. I wanted to take her for a stroll in her wheelchair, but she preferred staying in.

One consequence of being a “shut-in” in a nursing home has been noted for years: a significant decrease in vitamin D levels because of the absence of exposure to sunlight.  The predictable osteoporosis, bone breakage from falls, and decreased mobility affects quality of life, making many unable to move independently, and so is linked to increased mortality. Vitamin D supplementation is strongly recommended, and shown in many studies to be effective in reducing this vitamin deficiency effects on bone strength.

But what about the staff? The nursing staff who leave the residence early in the morning, sometimes just as the sun rises, are going home to sleep. They will be back the next evening, but even though their time off is during the day? The need to rest for at least 7 hours of sleep and the necessity of managing their daily obligations leaves little time for outside exposure to sunlight. This, of course, is especially true during the short hours of daylight during the late fall and winter. Depression has a high incidence among shift workers, and their failure to be exposed to sufficient sunlight has been suggested as one possible cause.

Those who work a traditional daytime shift should not be vulnerable to vitamin D deficiency due to the absence of sunlight, but is this really true? The reality is that many are stuck in their offices from sunrise to moonrise and later. Exposure to the sun is limited to weekends and, in some employment situations, such as law associates (recent graduates from law school) priority to work supersedes any weekend plans (including going outside.) These employees could be described as ‘corporate shut-ins.’ They may be tethered to the “clock” that is tracking their billable hours, and like a galley slave chained to his oars, will not be released until their supervisor (task master) permits time off. Whatever leisure time they have is spent carrying out the essential tasks necessary for their daily life such as buying food, doing laundry, paying bills, and maybe cleaning their apartments.

As we have seen, clinicians are worried (and rightly so) about the low vitamin D levels of nursing home residents, at home elderly shut-ins, and anyone else who is unable to obtain regular exposure to sunlight.  But look in vain for concern about corporate shut-ins who don’t see the sun from Sunday to Saturday during the months of year when daylight is scarce.  According to Dr. Barbara Gilchrest, who discussed vitamin D status at a recent American Academy of Dermatology meeting in Orlando, sun and diet should be enough to supply adequate levels of this essential nutrient for most patients. But can her advice be applied to those whose exposure to sun is severely limited, and whose diet lacks vitamin D fortified foods?

In an ideal work setting, shift workers would be advised on how to eat to minimize the health problems associated with their work schedule such as obesity, high blood pressure, diabetes and depression. Taking vitamin D supplements or finding time during the day to go outside and get some sunshine might be suggested. Much of this advice, however, comes not from the workplace or health care providers, but from anecdotal reports posted on Internet sites by those who also do this type of work.

But even less advice is given to daytime employees whose work hours are long and who may go days without any time off. They will not find bottles of vitamin D on their desk, nor will their supervisors encourage them to go outside during lunch to get some sun. Indeed, they are encouraged not to leave the building. And the meals provided in these organizations so they can work late are probably not planned to ensure that they consume vitamin D fortified foods.

We know already the long-term health consequences of nursing home residents who are shut-ins and get no sun exposure. So too, we know the long-term health consequences of shift workers who rarely see the sun.

We do not yet know the long-term health consequences of the corporate shut-in, the Silicon Valley twenty-four hour programmer, the investment banker who works during Asian, European and American time zones, or the surgical resident who arrives at the hospital at 5:30 AM and leaves at midnight. They, like the nursing home resident, have too little exposure to the sun. Do we have to wait until this generation of workers ages into the nursing home before we start to worry about their vitamin D status?

Research Cites Supportive Available Upon Request.