Category Archives: Bad mood

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.

Can Being on a Committee Make You Overeat?

The neighborhood association meeting started out benignly enough, with a non-contentious minutes read and acceptance, followed by people chitchatting as the chairperson droned on about some street maintenance issue. Someone had placed bowls of snack food on the table, along with diet and non-diet sodas, but all were ignored. About 20 minutes into the meeting an agenda item launched agitated discussions with people talking over each other and, when they couldn’t be heard, muttering to themselves. Just as suddenly hands dipped into the bowls of pretzels, chips, nuts, and crackers and cups of soda poured and gulped. Some people were talking through mouthfuls of chips as they attempted to enter the conversation and others, who were shut out, stuffed more food in their mouths.

The committee meeting was a living poster for stress-induced eating.

What was a little surprising was that the gobbling of snacks occurred in public. We tend to assume that those among us who resort often or even infrequently, to emotional overeating, do so in private. The ice cream, cookies, chicken fingers, pork rinds, or doughnuts are usually eaten alone or in the company of people who are sympathetic and supportive of the problem driving the eating.  But the behavior of this group shows that if the provocation is sufficiently strong, the eating response may be immediate, even if embarrassingly visible to others.

This is not to say that people in groups don’t overeat. Watch people at a meal listening to a speaker as they eat. Their interest in their food increases in proportion to their boredom. If a speaker notices that the members of the lunch or dinner audience are attempting to eat the crumbs of the roll from the tablecloth, it’s very clear signal that he or she ought to wrap up the talk immediately.

But people at the committee meeting were not eating out of boredom; they were eating because of stress. Each member of the committee felt that he or she had to influence the outcome of the discussion, and many were afraid that the outcome would not be to their advantage.

Were they aware of how much they were eating? If they had been asked to fill out a food diary a few hours later, would they have reported eating three handfuls of pretzels or nuts, or drinking 10 ounces of soda? Probably not.

Did the eating influence the intensity of the discussion?  The act of putting food in one’s mouth may have been somewhat calming, just as giving a whining child pieces of breakfast cereal to eat has a distracting and calming effect. And obviously chewing somewhat dry food made it hard to shout out comments without spraying a fellow committee person with bits of pretzels or chips.

The mainly carbohydrate snacks would have had a calming effect—if the meeting had gone on long enough for the food to be digested and serotonin to be made. But that would have taken at least another half an hour, and the meeting broke up before then.

Stress associated with group interaction is usually overlooked among the many triggers inducing overeating. And there are unspoken rules about eating behavior in the corporate culture that probably deem any unrestrained eating at a meeting as unprofessional even when food is available? If someone at a lunch meeting begins to munch on several chocolate chip cookies brought in with the sandwiches, others will notice and wonder at his or her lack of control. There is stress most certainly, but if it generates overeating, it is usually done afterward, in private. I once had a client whose presentation to her team was so criticized that she went to a gourmet chocolate shop in the lobby of her office building, bought five pounds of chocolate and ate it all in her office (with the door closed).

The advice I gave her might, however, be useful to those attending future meetings of committees where emotional discomfort is inevitable: Eat proactively to reduce future stress. She was to eat a small, non-fat carbohydrate, such as half a plain bagel, 30-45 minutes before going into her meetings, so that the serotonin made after she consumed the carbohydrate would be a little calming.

If my fellow neighborhood association members had followed the same advice would there have been a quieter, more restrained discussion? If they had “armed” their brain with more serotonin before the meeting, would they have ignored the snacks on the table?

But of course there is another solution to the problem of committee meeting-induced overeating: stay home.

 

How To Stay Full In 2017 When You Are On A Diet

January can be depressing. The predictable cold, snow, ice, wind, and bills are accompanied by, for many, the need to go on a diet. It is hard to ignore the pounds you’ve accumulated since Thanksgiving, and even if you do try to disregard them, advertisements for weight-loss programs won’t allow you to.

Diets tend to be dismal, adding to January gloom, and they are often boring. If someone suggests that we have been all wrong in eating X and avoiding Y, then there is at least the possibility of talking about a novel approach to dieting. But, alas, a quick survey of the diet books appearing now indicates that most of them are still promoting low-or carbohydrate-free diets (ho-hum).

Promoting a low-carbohydrate weight-loss regimen while one is enduring the long hours of winter darkness seems somewhat counterproductive. Such diets exacerbate the toll the lack of sunlight takes on serotonin levels and the grumpy moods, excessive sleepiness, uncontrollable food cravings, and lack of motivation to exercise that may consequently follow. And most relevant for the dieter is the absence of a sense of satiety, or fullness, also conveyed by serotonin.

Eating carbohydrate is the only way the brain makes more serotonin, and a diet that denies or limits starchy carbs like potatoes, pasta, bread, cereals, rice, beans, lentils and corn meal will leave the brain serotonin deprived.  It is a better plan to wait until May or June to stop eating carbohydrates in order to lose weight. The days at this time of year are so long that serotonin levels are not affected by carbohydrate depletion.

But, New Year resolutions being what they are (here today, gone tomorrow), many people feel that they’d better grab onto their will power and start dieting immediately.

So if you can’t eat carbohydrates because the diet books tell you not to, then you might consider an extract from a magical fruit called Garcinia Cambogia. (The name sounds a new dance step.) If you missed hearing about this fruit whose extract not only melts away extra pounds but, based on pictures on the Internet, leaves dieters looking as if they have had head-to- foot plastic surgery, then here is the information.

The fruit is tropical, apparently shaped like a pumpkin but grows on a tree, not on the ground, and is also known as the Malabar tamarind. Its popularity as a promoter of weight loss has shifted on and off for the last 20 or more years and had a resurgence this past year. Its virtues were extolled by the television medical personality Dr. Oz a few months ago, and like dandelions after the rain, companies sprang up to sell a particular ingredient in the fruit. Carcinia Cambogia contains hydroxycitric acid, aka HCA. Rodent studies done many years ago suggested that HCA might cause weight loss by blocking chemical reactions in the body that transform glucose into fat.

Fat or triglycerides are composed of two parts: glycerol, which makes up the backbone of the molecule and three fatty acids. So if your body produces fewer fatty acids, then fewer fat molecules are produced. This is what HCA seems to accomplish. It decreases the conversion of glucose  (all carbohydrates are digested to glucose) to acetyl-CoA. Acetyl-CoA is the building block of fatty acids.Rat studies found that when a high carbohydrate diet was eaten, HCA prevented some of the glucose from being changed into fatty acids. Moreover, as a value added sort of feature, people claim that HCA gives them a feeling of fullness or satiety, so they eat less. Serotonin, the neurotransmitter responsible for satiety, is thought to be increased by HCA, but there is as of yet no evidence for this.

A couple of pesky problems are associated with using Garcinia to lose weight: cost and sketchy purity. It is not cheap. One company is selling the extract HCA at a cost of $50.00 for 60 caplets and since it is recommended that a dose be taken before each meal, the cost can add up. The quality of the preparation is inconsistent among brands. ConsumerLab.com analyzed the content of hydroxycitric acid in several supplements and found the actual amount far less than claimed on the package label. Moreover, the HCA seems effective only when a very high carbohydrate diet is eaten.

There is a much cheaper way to prevent the transformation of carbohydrates into fat, while increasing satiety. It’s simple….eat only moderate amounts of carbs so what is eaten is used for energy, not to build up the fat cells. And consume some of those carbs, such as a half a cup of oatmeal or a toasted English muffin, about a half an hour before meals. Serotonin will be made naturally, the appetite will be decreased naturally, and you will lose weight naturally. Stay on this plan and the weight will even stay off long after the snow has melted, and the rest of the New Year’s resolutions have been forgotten.

Is Mindless Eating Like a Dog Worrying a Bone?

One of our dinner guests, a thin older man who prided himself on his eating and exercise discipline, sat down next to a bowl of nuts and almost inhaled them. We were having cocktails before dinner, and as hostess I was paying more attention to whether there was a coaster under every glass and napkins next to the finger foods, more than to what our guest was eating. But his rapid almond-to-mouth movements caught my attention.

“Did you see how much Jake (not his real name) was eating?” my husband asked after everyone departed. “He is usually so deliberate and slow in his eating, but this evening he cleaned his plate almost before everyone had picked up his or her fork. “

We mused over his uncharacteristic behavior, and then one of us remembered a story he told later on in the evening about a possibly nasty legal situation he was facing with a neighbor.

“I don’t think he even knew what and how much he was eating,” I commented. “I suspect that if he had been asked what he had eaten for dinner, he would have no idea.“

Not paying attention to what, especially how much, we are eating is one of the unsolved causes of weight gain. Who has not munched on a sandwich or crunched baby carrots while staring at a cell phone? Peering at the screen while eating is so common that eventually restaurants will probably provide cell phone stands so the phone can be propped up while eating, thus relieving the necessity of eating with only one hand. However, the perils of attending to the cell phone screen rather than to your food on the plate is that everything on the plate is consumed (possibly even the toothpick holding the sandwich together) without the eater being aware of doing so. Have you ever eaten a large bag of popcorn in a movie theatre and found that your munching was faster or slower depending on what was on the screen in front of you? Your fingers were able to direct the popcorn to your mouth without much awareness of your part.

Psychologists and nutritionists tell us TO PAY ATTENTION to what we are eating. We are to look first at the food before biting into it and notice its texture, smell, and color, perhaps the same way we might look at a glass of wine. Then we are to chew slowly, savoring the release of flavors and how they change in the mouth. Finally we are allowed to swallow. I was at a workshop watching the facilitator demonstrate this with a strawberry. We all had several on our plates so we could practice along with her. One of the participants was so mesmerized by the slow motion consumption of the strawberry by the leader that she mindlessly munched on all the strawberries on her plate.

Of course, paying attention to what we are eating, and especially noticing when we are full so we don’t continue eating beyond fullness, is helpful in controlling our universal tendency to overeat.  But perhaps more important is noticing why we put our mouths on automatic pilot and eat and eat the way a dog gnaws and gnaws at a bone. The dog is probably not thinking much of anything except where the next bone might be coming from, but the automatic eater is, for sure, thinking of something other than the food.

Mindless eating should really be called “mind elsewhere” eating. Like the dog worrying a bone, or our dinner guest, the “mind elsewhere” eater is gnawing away at an unresolved, troublesome situation.  It is unlikely that the eating and the somewhat obsessive thinking will produce a solution at that moment, but is more likely to result in the consumption of excessive calories. (And, to my mild annoyance, probably no recollection of what the food tasted like.)

A dog owner will take away the bone when it is apparent that the dog should move on to something else.  As owners of our “elsewhere minds” we must take away our own bones. We must put away or move away from the food, set our forks down, determine how much we have already eaten, and halt the repetitive movement of either a utensil or a hand carrying food to the mouth.

Dogs usually sigh and then go to sleep when the bone is gone. We should learn from them. A few minutes of calmness, of allowing ourselves not to be consumed by the problem at hand, will bring our mind and our eating into harmony.  It will also bring the benefit of enjoying the food we are eating.

Are You Losing More Than Weight on a High Protein Diet?

Adherents of high-protein/low-or no-carbohydrate diets have, to some extent, hijacked the discussion of whether we should still be eating carbohydrates. Indeed, for some militant followers, carbs are seen as leading only to brain and body decay, and are to be avoided at all costs. Well, maybe it is time to reconsider this attitude.

Avoiding carbohydrates seemed like the logical response to poor insulin activity. Obesity often causes a decreased responsiveness to insulin and may result in Type 2 diabetes. But before the diabetes is confirmed, there are signs that the body requires more than normal amounts of insulin to push glucose in the cells. This is called insulin resistance or decreased insulin activity. “Well,” say the high-protein folk, “stop eating carbohydrates! No carbs, no glucose? No problem getting the glucose into your cells.”

What these high-protein adherents fail to mention is that the body can make its own glucose and only by following an exceedingly stringent no-carbohydrate diet does the body switch from its natural use of glucose to using fat for energy.  There are many side effects that come with a fat- burning (ketotic) diet:  dreadful breath, foggy brains and bad moods. But so what if one’s breath will kill mosquitoes? It is worth it so one does not have to worry about insulin and carbohydrates?  Eliminating fruits, vegetables, fiber, and dairy products, in short the foods that our bodies require for their nutrient contents, on such diet shouldn’t be a problem according to the non-carbohydrate folk.  Just take lots and lots of vitamin/mineral/fiber supplements.

There was only one problem with this approach. It apparently did not work.

A few weeks ago, researchers from Washington University in St. Louis published a study that is challenging the relationship between high protein and better insulin responsiveness. Bettina Mittendorfer and her colleagues divided 34 obese post-menopausal women into three groups: a non-dieting group, a dieting group that ate only the recommended daily amount of protein, and a third dieting group who followed a high-protein diet.

If the ‘high protein diet to improve insulin sensitivity’ proponents were correct, the women on the high protein diet should have shown the most benefit. They didn’t. In fact, there was no improvement among this group. Only the group whose diet contained carbohydrate showed improvement in insulin sensitivity; it increased by about 25-30%. And a side benefit assumed to be conferred by eating lots of protein while on a diet, i.e., no muscle loss? This did not happen either.

This study generated headlines, albeit brief about these unexpected results. However, Sargrad, Mozzoli and Boden reported similar results in the April 2005 journal American Dietetic Association. They found no improvement in fasting glucose levels or insulin sensitivity among dieters on a high-protein diet. Those on a high-carbohydrate diet did improve.

The absence of improvement of insulin sensitivity among the obese women on a high-protein diet is worrisome because they are already at risk for developing Type 2 diabetes. To bring glucose levels in the blood to normal levels, their beta cells in the pancreas have to produce abnormally high levels of insulin. Eventually diabetes can result.

What is also worrisome is that blunted insulin response affects the ability of a critical amino acid, tryptophan, to get into the brain. Tryptophan is the essential component of serotonin; too little or too inactive serotonin may result in depression, anxiety, inability to focus, or even fatigue. Insulin removes other amino acids from the blood that interfere with the ability of tryptophan to get into the brain. High-protein diets fill the blood with these interfering amino acids so that with such a diet, tryptophan levels in the brain may be lower than normal. Consequently, serotonin levels are lower. This may be one reason why there is a strong relationship between diabetes and depression.

The results of the Washington University study seem unfair. High-protein diets are no fun. The dieter can’t eat starchy carbs like popcorn, rice, or bread and must limit fruits and starchy vegetables like winter squash or potatoes. But this deprivation seems worthwhile if the result was an improvement in insulin sensitivity. But of course this did not happen.

The better option it seems is the natural one: Eat the amount of protein that corresponds to what the body needs but no more. Eat a variety of healthy fruits, vegetables, grains, and low-fat dairy products. And finally do physical activity, which in itself helps insulin shunt glucose into the cells so the body can use it for energy.

Not terribly exciting, nor the focus of television health talk shows or dinner table conversation….But it works.

Darkness In The Morning, Depression In The Afternoon

It is getting to be that time of year again. Suddenly, or at least it seems that way, the sun is rising later and setting earlier. Of course, this has been going on since the first day of summer, but it is noticeable now, in these early days of fall.

This decrease in light causes many of us to feel melancholy and makes it harder to wake up in the morning. We experience difficulty controlling our appetite, our grumpiness, our interest in being with other people, even our motivation to be engaged in work. Soon, these subtle changes will coalesce into a seasonal-type depression known as Seasonal Affective Disorder (“SAD”) or the Winter Blues.  Often the symptoms are bearable until late afternoon when moods darken along with an early sunset.

It is no surprise that the general population who suffer from SAD live in the northern tier of states. For example, it is estimated that 10% of people in northern New England suffer from SAD whereas only 2% of the population of Southern California or Florida experience these symptoms.

About 3/4 of SAD sufferers are women, but SAD affects men and children as well. Typically, people start to experience symptoms in their twenties, but they can occur at any age. Fibromyalgia patients and women who suffer from premenstrual symptoms may find their symptoms worsening during the months when they are experiencing SAD.

How daylight, or its absence, affects mood is understood in a general way, but specific mechanisms are still being explored. It is thought that a decrease in the intensity of sunlight affects signals in the brain that ultimately decrease the activity of the brain neurotransmitter serotonin. The excessive sleepiness associated with SAD may be associated with the sleep hormone melatonin, which normally disappears from the bloodstream with sunrise.

The first, and still the most common, therapy recommended for SAD is exposure to light delivered by a fluorescent light box. These boxes, called light or sun boxes, emit so-called full spectrum light minus UV emissions.  The light intensity ranges from 2,500 to 10,000 lux and one is supposed to sit about 1–2 feet away from the box for about 30 minutes early in the morning.

How bright is the light? The following chart compares the light emitted from the dimmest natural light source, i.e., bright moonlight, to daylight when the sky is cloudless. Sitting in front of the light box is like being outside on a cloudless day, but not exposed directly to bright sunlight.

Here’s a chart to provide an easy to understand illustration:

  • Bright moonlight = 1 lux
  • Candle light at 20 cm = 10-15 lux
  • Street light = 10-20 lux
  • Normal living room lighting = 100 lux
  • Office fluorescent light = 300-500 lux
  • Sunlight, 1 hour before sunset = 1000 lux
  • Daylight, cloudy sky = 5000 lux
  • Daylight, clear sky = 10,000-20.000 lux
  • Bright sunlight = > 20,000-100,000 lux
article continues after advertisement

It might be possible to achieve the same ‘lightening of the mood’ by walking or jogging outside in the morning, if one’s schedule and weather permit this. But the light boxes are not affected by weather, and for those whose work schedules make it impossible to spend 30 minutes outside when the sun is fully up, an indoor light box may be the only light therapy option.

But other therapies are also available: antidepressants, talk therapy, or a combination of both. Antidepressants work by increasing serotonin activity to compensate for the decreased activity of this brain chemical; an activity decrease attributed to decreased daylight. It is not clear how talk therapy can compensate for a late sunrise, but talk therapy’s benefit is that patients learn coping mechanisms so their family, work, and social relationships are not impaired by this seasonal depression.

Dietary interventions also assist in bringing mood, eating, sleep, and social activities back to normal. The persistent urge to eat carbohydrates, a diagnostic feature of SAD, is a clue that serotonin levels are low. Indeed, sometimes the need to eat carbohydrates is so overwhelming that other food groups are ignored, and junk carbohydrates are eaten instead. Unfortunately, many of these high-carbohydrate foods, e.g. cookies, ice cream, chips, french-fries, chocolate, piecrust, biscuits, etc., are also very high in fat, so satisfying the carbohydrate craving by eating these foods has negative consequences. Because of the high fat content, it takes a long time for the carbohydrate to be digested and which commences the body on the process of making new serotonin. In the meanwhile, the SAD carbohydrate craver continues to eat, and eat as well as feel depressed and angry and grouchy and tired.

The optimal way of increasing serotonin, decreasing the SAD moods, and preventing weight gain is to choose very low or non-fat carbohydrate foods, and eat them only in the amount necessary to increase serotonin. This amount is small, about 25 to 30 grams of carbohydrate. A cup of instant oatmeal or an English muffin with a teaspoon of jelly provides enough carbohydrate. The carbohydrate must be eaten before, or at least 2 hours after, protein is eaten. Eating protein prevents serotonin from being made. By the way, forget about eating dessert after a protein meal to make new serotonin. It won’t happen.

Physical activity of any kind is important to remove the sluggish, blah feeling of the winter blues. Blood flow to the brain and muscles is increased, body temperature increases and energy is renewed. Exercising outside in full sunlight when possible adds an extra boost to getting back a summer-like mood.

Like squirrels laying up a good supply of acorns for the winter, those of us who suffer from SAD or the winter blues must now make plans to combat this seasonal change in our mood and activity. Life is too short to put it on hold until the spring.

Can Antidepressants Turn You Into a Food Addict?

What is a food addiction? Having heard several people explain their inability to lose weight due to this problem, I searched out the answers on, where else? The Internet. It appears there are addictions, and there are addictions.  Apparently, being addicted to your grandmother’s strudel or your brother-in-law’s barbecue is one type of addiction to be put in the same category as your impulse to drive 40 miles to eat homemade ice cream, or a fresh-from-the-sea lobster roll.  But these are not real addictions because if they were, you would be driving to eat the ice cream daily, even when the temperature was colder than the treat.

Real food addictions, according to many so-called food addict experts, are more grim and relentless. If you are a food addict you are unable to stop eating sweet, sometimes starchy, high-fat carbohydrates. Indeed, simply by consuming these foods, if you are susceptible, you will be thrown into the abyss of food addiction. If you have the misfortune or mindlessness to eat some refined carbohydrates, say some jelly beans or a piece of birthday cake, you will be assaulted by uncontrollable urges to continue to eat. You may find yourself eating the entire birthday cake or leaving the party to search out more carbohydrates.  Eventually, unable to stuff any more food in your stomach, you will stop…but the longing and urge to continue to eat will remain.  Not only will you experience a constant craving for more food, especially sugary snacks, you will, according to some food addiction websites, suffer from  emotional, social and spiritual deterioration. (Curiously, television networks do not seem to realize the profound damage caused by eating sugar as evidenced by programs devoted to making incredibly decorated cakes, or people fighting over who makes the best cupcakes.)

The solution, or sobriety, if this word can be applied to the sugar and refined carbohydrate addict, requires a life-long total abstinence from these addictive foods. Organizations like Food Addicts Anonymous exist to help people recover from their addiction.

Is it possible that for some, eating cookies or a slice of bread causes them to become food addicts? Maybe. But it is also possible that the reasons driving a compulsion to eat are more complex, and have to do as much with psychological and physiological factors as swallowing a piece of bread. Binge eating disorder and bulimia, two eating disorders characterized by compulsive overeating, are associated with complex psychological problems, not a simple food addiction. Someone who weighs 750 pounds or more, and cannot stop compulsive eating needs solutions to lose weight far more complex than eliminating flour and sugar. Self-described chocoholics (people addicted to chocolate) usually manage to eat normal amounts of ordinary non-chocolate foods most of the time.

Are there reasons people may find themselves with a compulsion to eat sugary carbohydrates other than the random digestion of a sugar cube? Below are some situations that cause people to crave carbohydrates:

People treated with antidepressants and related medications report intense cravings for carbohydrates, especially sweet ones. Why the medications cause these cravings is not understood, but the cravings are recognized as a side effect of the medications, not a food addiction. When medications are stopped, the cravings disappear.

Women crave sugary carbohydrates toward the end of their menstrual cycle, right before menstruation begins, and for some it is all they want to eat. Their longing for these foods are so intense that a cartoonist named Boynton pictured a premenstrual woman saying ‘I could kill for chocolate.’

Is this an addiction? Doubtful, since women return to eating normally as soon as menstruation begins.

A decrease in hours of daylight characteristic of late fall and winter is associated with a type of depression known as Seasonal Affective Disorder. A milder form is simply called the, ‘Winter Blues.’ Typically, the mood change is accompanied by an almost insatiable need to eat sweet carbohydrates; indeed, this is one of the ways this depression is diagnosed.  But how can it be an addiction if it mysteriously disappears as soon as daylight increases, and is usually gone by late spring?

High-protein diets that forbid or limit carbohydrate consumption may cause a sugar addiction due to a decrease in brain serotonin levels. Serotonin, a neurotransmitter responsible for affective mood, appetite, and pain perception, is made only when the consumption of carbohydrates allows the brain to receive the tryptophan it needs to make new serotonin. Craving carbohydrates, like thirst when not enough water has been consumed, may be the signal sent to indicate that the brain needs to make serotonin.

Stress and carbohydrate consumption go together like peanut butter and chocolate. Studies in which people were given, covertly, carbohydrate or protein-containing beverages decreased their feelings of depression only after consuming the carbohydrates. This is probably due to an increase in serotonin production. People tend to self-medicate with carbohydrates to decrease the emotional discomfort of stress. If the stress doesn’t go away, neither does the carbohydrate consumption. Therefore a so-called food addiction may last as long as the stress. The best way to stop the overconsumption of carbohydrates, if indeed that is occurring, is to stop the stress.

Is that plausible, really?

Our bodies and minds can certainly exist without the consumption of sugary carbohydrates. But let’s wait until there is evidence from a placebo-controlled, double-blind studies (neither the subject nor researcher know what is being consumed) that eating a graham cracker, a pancake with a drizzle of maple syrup or their equivalent in sugar grams is generating a food addiction. The situations that cause a craving for sweet carbohydrates such as depression or PMS are difficult enough without the additional burden of worrying that a few gumdrops are going to turn these eaters into addicts.

Potatoes: Good for the Mood, but Do They Really Cause Lung Cancer?

Decades ago, while staying with friends in Stockholm, we were introduced to their version of a midnight snack: steamed new potatoes on a bed of fresh dill. Karin, a medical doctor with a doctoral degree, and Bengt, her equally well-educated medical doctor, Ph.D. husband and we ate these tiny potatoes after returning to their home following a concert. And despite the late June sun never quite setting, we were able to fall asleep quickly and rest soundly, probably because eating the potatoes increased the soothing, soporific events of serotonin.

Had we only known then what a recent research publication has claimed a few weeks ago, we would never have let a potato touch our lips. Obviously our hosts, despite their scientific credentials, were not aware that potato eaters may increase the risk of lung cancer. A study asserting that potatoes and other carbohydrates with a high glycemic index (“GI”), are a risk factor for cancer was still in the future. Indeed as we sat eating our deliciously tender, dill-flavored potatoes, their high glycemic index was of little concern to us. At that time, the only people concerned with the glycemic index of foods were diabetics and their health care givers, as the GI of foods was involved in determining to insulin requirements. Now it is impossible to escape this concept as the GI of foods seems to affect every aspect of our health (at least according to self-appointed nutritional experts).

GI refers to how the rise in sugar (or glucose) levels in the blood two hours after a particular carbohydrate in a specific quantity is eaten on an empty stomach. Foods that cause glucose levels to rise quickly are called high GI foods and include potatoes, white bread, Fruit Roll-Ups, white rice, and Gatorade. Foods bringing about a slower rise have a moderate GI: Snickers bars, ice cream, macaroni and cheese, chicken nuggets, peanut M&M’s. The foods associated with a slow rise in blood sugar levels, such as lentils, soybeans, peanuts, cashew nuts and prunes have a low GI.

This means is that the GI depends on high rapidly carbohydrates are digested. Adding fat, protein and/or fiber to a carbohydrate food will slow down its digestion and decrease the GI. This is why a Snickers bar or pizza loaded with melted cheese would have a much lower GI than bread or steamed rice.

Insulin is released as soon as glucose enters the circulation and pushes the glucose into the cells where it is used for energy. Diabetics sometimes have too low glucose levels and need to consume a food or beverage with a high GI to elevate their glucose levels quickly. Not doing so may cause them to become unconscious. Endurance athletes may also consume a high GI food during a sporting event because their muscles have run out of the energy producing glucose and they want the energy immediately, not at the end of the race. Sometimes, eating a high GI food has an almost immediate positive effect on mood the same as what we experienced with our midnight potato snack. Serotonin is made soon after glucose enters the bloodstream and its increased activity soothes and subdues stress, lowers anxiety and calms. When our clients in our weight management center worried about binge eating, we suggested they eat a rapidly digested carbohydrate similar to those eaten by endurance athletes to switch on serotonin’s ability to brake the appetite.

So what does all of this have to do with cancer? The unexpected finding from a study done at the University of Texas Anderson Cancer Center that there is a “49 percent increased risk of lung cancer among people who consume the most foods with a high GI, compared to people who consume foods with a lower GI…” (presumably people who eat Snickers bars rather than rice). Does this mean that diabetics, endurance athletes, and people seeking serotonin’s help in curbing their excessive food intake are more likely to get lung cancer?

Well as it turns out, unlikely if they were educated beyond high school. “Participants who had less than 12 years of education were 77 percent more likely to develop lung cancer than those in the lowest GI group,” according to the results. This means that our Swedish friends are probably not likely to develop lung cancer from their midnight snacks of potatoes, having had considerably more than 12 years of education. But it still leaves unanswered the question of why someone who out of necessity or choice has less education will be more vulnerable to this type of cancer? What else were they eating or not eating?

Few of us live solely on high glycemic index potatoes as did the Irish during the early 1800s. It has been estimated that by the middle of the 19th century, about one third of the entire population was totally dependent on the potato and in some regions, the potato was the only food eaten. Obviously diets must include large quantities of vegetables, fruits, high fiber carbohydrates, low fat dairy products and lean protein. But one effect of the study linking a high GI with lung cancer may be a move to include high fat ingredients in foods because that lowers the GI. Clearly the take-away message is not to replace sweet potatoes with Snickers bars or eat a stack of bacon, lettuce and tomato with mayonnaise without the bread. Let us hope that in the near future, the headlines of a study will announce, “Moderation in all that is eaten is the best way to good health.”

“Oprah, I Told You So!”

She wouldn’t remember. Why would she? It was at least 15 years ago since I appeared as the only guest on her afternoon television program, discussing the benefits of carbohydrates on mood and controlling appetite. After I wrote a book on how nutrients can influence mental performance and mood, one of her many producers asked me to be on her show. We discussed our mutual craving for carbohydrates in the afternoon, and when asked for snack suggestions that would be diet appropriate, I mentioned baked sweet potatoes, popcorn, and toast and jam. The sweet potatoes and bread appealed to her. She understood immediately the connection between eating carbohydrates, increased serotonin levels in the brain, a better mood and decreased appetite. (She is a very smart woman.)

But alas, my advice to her was soon lost, smothered under a steamroller marketing campaign to promote high-protein, low-carbohydrate diets.  A movement to tarnish carbohydrates as the cause of obesity, and extolling the virtues of eating only protein and fat as the path to thinness nirvana, started around that time with Dr. Atkins. (His high-fat, high-protein diet caused him to exit the world not too long afterward.) Soon the low-carbohydrate South Beach diet (with mouth-watering pictures of low carbohydrate foods) followed, and the nation was hooked on eliminating carbs from their diet. (Interestingly, despite the popularity of the South Beach diet elsewhere, South Beach itself is  filled  with  Italian restaurants serving pasta and pizza; an Italian bakery selling gigantic loaves of freshly baked, crusty bread is so crowded it is often hard to get in the door!) 

Soon after it became popular in our culture, not eating carbohydrates was praised as a way of returning to the pre-Stone Age menu of raw meat, occasional berries, and edible twigs known as the Paleolithic Diet. Fear that eating a piece of bread would turn one into a look-alike Tubby the Tuba, eliminated bread baskets from the kitchen table, and recipes for sandwiches using lettuce wraps rather than bread became popular.  It did not matter that eliminating bread, potatoes, rice and pasta in favor of beef, chicken, fish, and cheese drained the brain of serotonin, and left the dieter with a personality that ranged from grumpy to Attila the Hun. No matter that the satiety-producing effects of serotonin no longer could turn off appetite, and serotonin’s soothing aura could no longer help people to fall asleep naturally without sleep aids. No credence was paid to that after a low-carb diet, weight was gained quickly and efficiently as the brain pummeled the ex-dieter into now overeating carbohydrates in an attempt to replenish serotonin stores. No matter that the previous Weight Watchers point system was rigged against carbohydrates except fruit, which does not increase serotonin levels.

Now, finally, Oprah has squashed the bread phobia.  Certainly the instant increase in the worth of her stock in Weight Watchers, after she announced her 26 pound weight loss eating bread on their new diet plan, must convince some that their portfolio, if not their scale, will benefit from a return to carbohydrates.   

It is unclear whether those in the Weight Watchers organization understand the relationship between eating carbohydrates, an increase in brain serotonin, a decrease in appetite and an improvement in mood. Dieters are deliberately given few limitations on what foods to eat and avoid. (However, the new Smart Point System does allow food choices to be more flexible and less directed.)  Moreover, it is unlikely that information about how to eat carbohydrates in order to harness the power of serotonin is conveyed. Unless the carbohydrate snack such as rice cakes, popcorn, pretzels or baked potato is eaten with very little protein and fat, i.e. five or fewer grams of each… no serotonin will be made. Weight Watcher dieters are probably unaware that two pieces of bread stuffed with protein foods like turkey or tuna will not produce the satisfying satiety of eating carbohydrates alone. The program likely does not inform them that protein interferes with the synthesis of serotonin, nor tells them to eat carbohydrates at least 30 minutes before protein is eaten, or two-to-three hours afterwards. They may not be able to translate the small amount of carbohydrate necessary to turn on serotonin synthesis, about 25 grams, into Smart Points.  

No matter.  They will listen to Oprah. She is someone whose pronouncements change people’s lives, almost always, for the better. Her cry of, “I love bread!” may be one of those pronouncements.  If she can convince the carbohydrate-avoiders to start eating foods that produce the calming, soothing, mellowing, and appetite-reducing effects of serotonin, then who knows? Maybe the rest of us will be thinner and happier.

Winter & PMS Woes

“I hate winter. It’s not just the ice, the shoveling, too many snow days, and long traffic-congested commutes. What I really hate is that my PMS becomes unbearable. From November to April, I dread those days before my period comes because I turn into Attila the Hun!“ So stated a weight-loss client of mine. She is not alone.

Most women are not transformed into the 21st century version of a marauding barbarian when they have PMS—premenstrual syndrome—but they may feel that their lives are disrupted and moods out of control. PMS is linked to hormonal changes at the end of the menstrual cycle. The symptoms are numerous but most women do not, thankfully, experience more than a few. The most common are feeling depressed, angry, irritable, longing for sweet or salty fatty foods like ice cream, chocolate or chips. Often a foggy mental state that makes speaking coherently, or concentrating a difficult task, occurs. PMS affects women of childbearing age, from teenagers to women about to enter menopause (whose symptoms are very similar but last for months rather than days).

PMS arrives, often without warning, during the fourth week of the menstrual cycle and may last hours or days, retreating only when menstruation begins.  Changes in mood for no apparent reason, disturbed sleep and increased irritability are often the first signs that PMS is present, but also some women experience a dramatic increase in their carbohydrate craving.  A friend of mine who does the family grocery shopping once weekly, told me of coming home with bags of pasta, bread, cookies, crackers, ice cream, doughnuts and boxes of instant mashed potatoes and nothing else. When her husband helped her put away the food, he asked why she did not buy any milk, vegetables, chicken and fruit. “Because I bought what l wanted to eat,” she told him.  “I have PMS.”

Many of the PMS symptoms are similar to those of Seasonal Affective Disorder (SAD) or winter depression. People suffering from mood and appetite changes associated with diminished hours of daylight experience similar irritability, fatigue, depression, and carbohydrate cravings although they tend to sleep, if they can, many more hours. PMS, in contrast, often causes broken and unrestful sleep. Of course men also suffer from Seasonal Affective Disorder, and there is no age limit as to who may experience it.

Winter can worsen PMS; symptoms can last longer and be more severe. One explanation might be that many of the stresses associated with winter add to the stress of PMS:  prolonged commuting time; roofs sinking under the weight of snow; inability to exercise because sidewalks are too icy or weather too cold; and cabin fever that comes from not being able to escape the house over weekends. But there is probably a biological explanation as well as environmental discontent. Our research at MIT and that of a group from UCLA found insufficiently active serotonin underlying PMS symptoms. Decreased serotonin activity has also been linked to SAD. The diminished hours of winter sunlight further decreases serotonin activity, according to the research of Barbara Parry, thus exacerbating the moodiness, depression, anger distractibility and poor sleep of premenstrual syndrome.

Ironically, Parry and others who have discovered this relationship live in southern California, where the fluctuation in hours of daylight is much smaller than in the northern tier of states where differences in sunrise and sunset between July and January are dramatic.

Other than moving south, getting pregnant or becoming menopausal, there are not many options to ease the monthly mood swings. Parry’s research suggests phototherapy, which involves sitting in front of a so-called lightbox that emits the light spectrum of sunlight without the damaging ultraviolet rays. It is still unclear how exposure to sunlight interacts with serotonin to increase its activity, but positive changes in premenstrual mood are evidence that it is having an ameliorative effect.

The carbohydrate cravings experienced by women with PMS is a clue to another therapy. This one involves consuming a specific dose of carbohydrate once or twice a day to increase serotonin synthesis. The carbohydrate craving is real and measurable. Women with PMS eat about 1100 extra calories daily when they have PMS. The foods contributing these extra calories are sweet and starchy carbohydrates such as breads, pasta, cookies, chips, crackers, and candy.  We have studied the changes in mood, concentration, and cravings before and after premenstrual women consume a beverage containing either carbohydrate or a placebo. Statistically significant improvements were found after the carbohydrate drink, but not after beverages containing nutrients like protein that do not increase serotonin synthesis.

The carbohydrate acts like an edible mood elevator. Eating about 25 to 30 grams of any carbohydrate (except fructose) increases serotonin levels and activity, and subsequently takes the edge off many PMS symptoms.  Eating protein prevents this effect, as protein prevents serotonin from being made. It is best to eat a carbohydrate food like popcorn or oatmeal before eating protein, or two or three hours after a protein-containing meal.

If winter woes include a worsening of PMS, it may be necessary to eat a carbohydrate snack two or even three times a day. (Avoiding fat-containing snacks and limit the calories to about 120 per snack).  Relief comes soon after the carbohydrate is digested. This is another reason why eating low or fat-free carbohydrates are best. They are digested faster if they contain no fat.  From our research we know that the symptoms ease for about three hours.

So far the combination of phototherapy and carbohydrate consumption has not been tested against each of these therapies alone. But presumably eating a bowl of oatmeal while sitting in front of a light box should make even a gloomy winter PMS or SAD day brighter.