Category Archives: Cravings

Can You Lose Weight If You Don’t Know How to Diet?

Our formerly thin, physically active friend had gained close to 80 pounds following two years of debilitating orthopedic problems that left him with chronic back pain. His previous constant exercise, which included tennis, skiing, long bike rides, hiking, and running had kept his weight normal, but became no longer possible. Now he was able to move only with the help of a back brace and two hiking sticks that he used as canes.

“I am trying to lose weight,” he told us, “but it is slow going.”

When we were guests at his home, it was obvious how physically impaired he was as well as how hard it was going to be for him to attain a weight that would help relieve his back pain. The one day he walked on his long hilly driveway to point out a particularly beautiful landscape, he paid for it in increased pain the next morning. Simply moving from living room to dining room was difficult for him. He talked about how he never needed to diet before he developed a back problem because his level of physical activity kept his appetite down and burned off excess calories. A review of the relationship between physical activity and weight change confirms his experience. (“The Role of Exercise and Physical Activity in Weight Loss and Maintenance,” Swift, D., Johannsen, N., Lavie, C., Earnest, C., Church, T Prog Cardiovasc Dis 2014, Jan-Feb; 56 (4): 441-447.)

Routine physical activity like the type my friend used to do slows, or even prevents weight gain, without any change in calorie intake. And the long duration of many of his physical activities may even have dampened his appetite according to a very recent study published in the Journal of Endocrinology. (“Acute effect of exercise intensity and duration on acylated ghrelin and hunger in men,” Broom, D., Miyashita, M., Wasse, L., Pulsford, R., King, J., Thackray, A., Stensel, D., J Endocrinol. 2017; 232 (3): 411-422.)  Now, however, the beneficial effect of exercise, when added to a reduced calorie diet on hastening weight loss is out of reach for him.

Told by his physician that a substantial weight loss might lessen his back pain has motivated him to decrease his calorie consumption. His strategy, as he told us, is to consume less than he had been eating.  But he has lost very little weight over the past few months of attempting to do just this.  His lack of success may be due to his inexperience in dieting. He doesn’t know how much he is eating, nor does he know whether what he is eating is particularly high or low in calories (he does know the difference, however, between salads and cake.)  Another family member, who has never had a weight problem and likes to cook dishes containing high calorie ingredients, prepares his food. Butter, heavy cream, and cheese are routinely added and her sweet tooth motivates her to bake or buy cakes, cookies, pies and other desserts that are offered to our friend.  Eating in restaurants for dinner (and occasionally both lunch and dinner) occurs frequently, and this adds to the uncertainty of how many calories are being consumed. Overly large restaurant portion sizes, and the habit of chefs to add butter or oil to food to keep them moist, also inadvertently boosts his calorie intake. And, unlike experienced dieters, he has not developed an eye for judging portion sizes and not eating the entire amount if it is too big.

None of this would matter if losing weight were for cosmetic rather than medical reasons. However, when weight loss is crucial to improving health, and, in his case, restoring lost freedom of movement and removing his pain? Dieting must be done with the same care and knowledge as any other intervention to improve health. The approach cannot be casual or haphazard, and would probably benefit from the professional services of a dietician or nutritionist. The type of diet must also be sustainable and balanced nutritionally for the many weeks it takes to lose the necessary weight. Many alleged quick weight-loss diets, so tempting because results after only a few weeks are supposedly so dramatic, often lead to weight gain as soon as the diet is over. (Remember the Oprah Winfrey’s famous fast weight-loss from a low calorie liquid diet, and the subsequent rapid regain several years ago?) Regaining weight is not an option when it may bring about a return of the medical problem like intolerable back pain. Thus the diet plan has to be malleable enough to change into a long-time maintenance program to keep the now lower weight stable.

Being honest with family and friends about how hard it is to lose weight and consequently asking for help will improve the chance of success. Imagine how much more weight our friend would have lost if his meals had been significantly lower in calories and size. Preparing meals at home that that could be made without the addition of fat-dense ingredients such as cheese would help reduce the calories he was eating. If others wanted to add more cheese to their dishes, for example, they could do so after the food was prepared.  His problem in reducing calorie intake in restaurants could be solved by either eating in establishments that served normal-size portions, or ordering appetizers for a main dish or splitting an entrée. The temptation to eat dessert would disappear if it were not on the table in front him.

Dieting is like any new activity. As it is with playing the piano, speaking a foreign language, or planting a successful garden, it has to be learned. Instruction is needed, along with patience, the willingness to practice and make mistakes, and encouragement from others. And like taking on any new activity, even small successes are worthy and worth striving for.

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.

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.

If Teens Eat According to Their Own Internal Clock, Maybe They Will Eat Better

Do any teens eat breakfast? Do they eat it at breakfast time? Possibly there are a few who manage to wake up on school days early enough to get breakfast, but given the choice of sleeping longer or facing a bowl of cereal and milk and toast, it would be the rare adolescent who opts for feeding over sleeping. Conversely, late in the evening, when their homework and/or social networking is complete and everyone else in the house is asleep, the teen may prowl the kitchen for something to eat, even the cereal or toast that was ignored that morning.

That the food intake of the contemporary American teen may be lacking in many nutrients considered essential for life is well known. And that their diet may leave them too thin or too fat, this is also well known. Studies have been done to see how parents cope with the resistance of their adolescent offspring to consuming a nutritionally balanced diet, one which when they were a few years younger, they willingly ate. They, the parents, are not very successful.

Nagging, bribery, coercion, feigning lack of concern or interest, and controlling the foods coming into the household have some effect; but the pushback from the teens can be strong. And once the adolescent can buy food from vending machines, convenience stores, or fast-food franchises? Parental control over food intake is weakened considerably. Parents may not even know what their teens are eating.  A 16-year-old relative told me that she ate only white bread, peanut butter, and honey for a month before her parents noticed. A friend’s daughter used to eat dinner in her room during school nights so she wasn’t wasting time eating dinner with her family, but could start on her homework. She prepared her own dinner, usually microwaved chicken nuggets, and never ate what her mother prepared.

Teens are like the proverbial horse: they can be led to water but can’t be forced to drink or…in the case of the teens, eat. However, when they are hungry, they will eat what is available.   Perhaps one solution to improving their nutrient intake is to only make available at home foods with some nutritional value. This means eliminating junk foods, e.g. chips, cookies, sugary drinks, candy, batter-coated fried foods, cheese dips, and fatty cold cuts.  At night when the teen is looking for something to eat, he or she will just have to settle for what is in the kitchen. If no sugary beverages are in the refrigerator, then the thirsty teen will have to settle for something that is healthful, e.g. milk, juice or water.

Their hunger will have to be satisfied with sandwiches made from lean proteins such as turkey breast, cold chicken, or tuna. It is possible that the desire to crunch on something will lead the teen to baby carrots rather than nacho chips. Even breakfast foods, so soundly rejected at breakfast, will seem tempting before bedtime. Cereal & milk, yogurt, fruit, or whole grain toast or waffles topped with peanut butter will seem satisfying to the hungry teen at 10 or 11pm, and they can claim that they did indeed eat breakfast that day.

Another solution, which does not yet exist, is to invent a food or beverage containing the nutrients teens should be consuming. Surveys among adolescent populations indicate that vitamin and mineral intake is below required levels due, no doubt, to an avoidance of the vegetables and fruits that contain these nutrients. To be sure, if all teens suddenly started to eat kale salads, grapefruit segments, and low-fat cottage cheese as consistently as they eat nachos, pizza and subs, they would not need any vitamin/mineral pills or nutrient-laden beverages. And, as the saying goes, “If pigs had wings, they would fly.“

But when I asked my 16-year-old relative whether teens would consume a food or beverage that contained most of the daily nutrient requirements, she was skeptical. “Most kids would not consider it cool. And besides, it would have to be really tasty.”

However, we have seen the power of marketing on changing almost every aspect of our lifestyle, and indeed the negative power it has on generating nutritionally poor food choices. Images of older teens enjoying life in some magical environment while drinking popular carbonated beverages are so enticing that one is tempted to believe that such beverages even erase credit card debt.

What will convince teens, and indeed adults, to consume formulated beverages or foods is the belief that doing so enhances athletic power, improves complexion and hair texture, increases cognition, or even removes stress. The effects must be more or less immediate, not something that will be of benefit 40 years in the future like improved bone strength or decreased cardiovascular disease. And if the beverage or food is available when the teen decides that now is the time to eat, then there is a chance that it will be consumed.

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
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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.

Will Sugar Take Away the New Baby Blues?

Eleanor, the daughter of a close friend, apologized for still wearing her maternity clothes when her mother and I went to her home to ooh and ahh over her adorable newborn.

“It’s crazy!” she said, pointing to her baggy pants and shirt. “In the two weeks since giving birth, I think I have gained 12 pounds. I can’t stop eating and I know it is not just because I am breast feeding. I don’t want any good stuff to eat, just doughnuts, cookies, ice cream and waffles drenched in syrup.”

When she left the room, her mother confided that her daughter had been very moody and complained of exhaustion, feeling overwhelmed, and worried that she would not be a good mother. “She is also so irritable…When I offered to take care of the baby so she could get out of the house, she told me to stop giving her advice!”

The mother then whispered, since she heard the daughter returning, “She must have the Baby Blues.”

Postpartum blues, or baby blues, are not the same as postpartum depression, although some of the symptoms are identical. The ‘blues’ affect about 80% of mothers during the first week after giving birth, and the symptoms peak between days three to five. The mood swings, food cravings, fatigue, and depression are blamed on a decrease in serotonin activity due to the new mother’s estrogen and progesterone levels readjusting. In some ways, the symptoms are similar to PMS, which occurs at the end of the menstrual cycle when hormone levels are shifting. The postpartum blues disappear about two weeks after childbirth, but the exhaustion and fogginess may continue much longer until the mom and baby sleep through the night.

Postpartum depression, in contrast to these postpartum blues, can last for months; the symptoms are much more severe and require medical/ psychiatric interventions. Women with postpartum depression are usually treated with SSRIs, the antidepressants that increase serotonin activity, along with talk therapy and assistance in taking care of the baby and the household.

Postpartum blues are not treated with antidepressants because of their temporary nature. But this doesn’t mean that the new mother has to suffer the unwelcome feelings of sadness, fatigue, lack of focus, not feeling like herself, anxiety, or irritability even for a few days. Sleep helps with all of these symptoms.  One does not have to be a nursing mom to feel the effects of too little sleep and when it goes on for days? The confusion and mood swings that follow can be very distressing.  Waking every two hours to nurse during the night, and then getting up in the morning to carry on the tasks of taking care of the rest of the family is sufficient reason to exacerbate these ‘ blues’.

Women in our culture are given little or no time off to rest from childbirth and the demands of a family and even work. Other cultures, such as the Chinese, insist that a woman be secluded for 30 days with little to do except keep warm, eating high fat, nourishing soups and stews to sustain nursing, and sleep when not feeding the baby. In our culture, the postpartum blues can be minimized by helping the new mom with her family and household tasks so she has time to sleep, making opportunities for her to leave the house, and participate in a healthy, non-baby-centric world… and when she feels physically able, to exercise.

Eleanor’s appetite for sweet carbohydrates led her to yet another quick and effective way of improving her postpartum blues.  The foods she consumed were acting like edible tranquilizers, because their consumption increased the level of the good mood chemical, serotonin.  She was eating sugary carbohydrates to increase serotonin activity, but starchy carbohydrates such as  instant oatmeal, a bag of popcorn, or baked potato are just as effective.  The path from eating carbohydrates (except fruit sugar) to more serotonin is a little complex, but the end result is that after the food is digested, more serotonin is made and the edge is taken off all those distressing symptoms.  Eleanor was probably eating larger quantities of carbohydrate than she needed to; about 30 grams (120 calories in a fat free food) would have been enough to raise serotonin levels for about three hours. Two or three small carbohydrate snacks during the day and evening would have made her feel less edgy and depressed.

One caveat: the carbohydrates must be eaten on an empty stomach or at least two hours after eating protein.  When protein foods are digested, their amino acid contents prevent serotonin from being made by preventing one amino acid, tryptophan, from getting into the brain.

Eleanor must of course make an effort to eat the nutrient packed foods her body needs to recover from giving birth and to nurse. A diet of cookies and brownies is incompatible with the nutritional demands of her body. But eating carbohydrates should, by increasing serotonin, decrease stress and induce calmness and tranquility. Which is exactly what the mother and infant need.

If They Can’t Eat Sugar, Let Them Eat Fat

Recently our government advised us to reduce our sugar intake as a way of decreasing obesity, Type 2 diabetes and a cluster of metabolic problems associated with consuming this nutritionally empty carbohydrate. No problem. Unless one were stranded in a hut in the middle of a 30 day blizzard, or floating on a raft in the middle of the Pacific Ocean, there is little reason to eat sugar except as a minimal flavoring agent.  As a simple carbohydrate, sugar provides 4 calories per gram, but so does any starchy carbohydrate and the latter always come packaged with nutrients as well as calories.

But even though the government, unlike Marie Antoinette, has told us not to eat cake (and by the way the cake she was referring to was the fermented starter used for making bread), our desire for sweet baked goods is as strong as ever.

The solution, according to an article in last week’s Saturday/Sunday section of the Wall Street Journal (April 9-10) is to eat pastries so loaded with fat they might melt if left in a warm place.

The recipes look luscious. The ingredients, however, seemed to come right out of a Paula Deen Food Network show. (Deen used to revel in adding almost pure fat ingredients such as heavy cream and egg yolk to every recipe, and became famous for her fried butter.) One example of the WSJ recipes, Strawberry Cream Cheese Fool, is a custard like dessert served with strawberries. Along with half a pound of cream cheese, the ingredient list included two cups of heavy cream and ½  cup of crème fraiche. There was sugar, in the form of frozen apple juice concentrate. Strawberries provided some vitamins.

A coconut chiffon cake recipe had somewhat less fat but contained a cup of full fat coconut milk, and 7 large eggs. More such cholesterol and fat elevating recipes were available in cookbooks from which the described recipes were taken.

Was it really the intention of the government that we substitute fat for sugar? An expert was quoted in the article affirming that sugar has no nutritional value. True. But at 9 calories per gram, fat not only has more than twice as many calories as sugar, it also elevates triglyceride and cholesterol levels in our bodies, and although some vitamins are fat soluble, it is not necessary to drink heavy cream to obtain these nutrients.  Moreover the weight gaining potential of fat is not to be underestimated.

We should be told that if we decrease our intake of sugar, we should not be compensating by increasing our consumption of fat. We should be told that if we eat a high fat diet, we change the population of bacteria living in our intestinal  tract and that this has negative health consequences.  When laboratory animals are fed diets high in saturated fat (butter, heavy cream) or unsaturated fat, (olive oil, avocado etc.) changes in their gut microbes occur depending on what they have eaten.  Animals eating the high saturated fat diet developed signs of elevated blood insulin and glucose levels, even after fasting, because of the type of bacteria residing in their gut.

A Scientific American article reports the research of Eugene Chang on the effect of consuming a high saturated fat diet. He has shown that changes in gut bacteria following consumption of high fat foods, especially dairy (heavy cream)  lead to the inflammatory responses associated with irritable bowel disease.  So why are recipes with enough fat to bring about a bacterial population exchange inside us being featured in a well-respected newspaper? Why is sugar being banned, but not bacon grease?  The answer is, in part, because of a spate of articles disputing the link between high cholesterol levels, fat intake, and heart disease.

‘Don’t believe the research linking lard with heart attacks and stroke,’ these articles claim. In other words, we should stop avoiding high fat foods; they are good for us. Full-fat food advocates dispute  decades worth of evidence amassed by the American Heart Association about prudent low fat food choices and must be delighted with these recipes in the WSJ.

So now how are we supposed to eat?

To some extent, it depends on your personal health history and your physician’s experience and advice. The empty calories in sugar should be avoided. If you have a family history of heart disease or stroke, you should ask you physician whether you can eat saturated fats with abandonment or caution.

But let’s be realistic. Maybe we shouldn’t even be concerned with whether desserts have too much sugar or fat.  Desserts were never meant to be eaten instead of a nutrient containing meal (unless you are seven years old and having a birthday celebration). When the government recommended eating less sugar, this expert nutrition panel, did not say, “Let them eat fat!” Obviously what they were hoping for is an increase in the consumption of vegetables, fruits, high fiber carbohydrates, low fat meat and dairy foods. If people want to eat dessert, they should…assuming that their weight and health allow them to. But let’s not fool ourselves into thinking that just because a pudding or cake has less sugar, it is as good for us as a salad or poached chicken breast.

Alcohol Withdrawal Mood Swings: Might Eating Carbs Help?

My generally genial and placid neighbor was heard complaining about the number of dogs in our building. His comments seem strange, seeing that he once had a dog himself and was often seen petting the dogs of other owners.

“Be tolerant of him,” whispered another neighbor. “He just stopped drinking and has the bad mood (link is external) that goes along with alcohol withdrawal.” My informant had been sober for more than 25 years, as he often told me, so I asked how long the grumpiness and irritability lasts. “Could last up to two years,” he replied. “But the anxiety, difficulty focusing, tiredness, insomnia? They usually begin to get better after a couple of months. It has a funny acronym,PAWS…That stands for Post Alcohol Withdrawal Symptoms. Some people have terrific sugar cravings along with it. I sure did, but even though my waistline expanded  from eating cookies and ice cream? It really helped my mood. Maybe I ought to take Fred ( the cranky neighbor) out for some waffles.”

A craving for sweet carbohydrates is not unusual for people during the early months of abstinence from alcohol.  AA meetings traditionally provide doughnuts and other sweetened carbohydrate snacks. Many rehab facilities, as well as on-line self-help sites talk about the perils of replacing an addiction to alcohol with a sugar addiction, because so many people crave sugar.

Obviously a post-drinking diet of jelly beans, PEEPS ( those yellow and green marshmallow animals) and chocolate kisses is dreadful for one’s teeth and weight, and does nothing to meet the very critical need for several vitamins.  Folate (link is external), as one example, is very much needed by the recovering alcoholic.  Alcohol, despite its potent effect on the brain, does absolutely nothing to nourish the body, and many alcoholics may be malnourished because they consume up to 50%, if not more, of their daily calories as alcohol.

The longing for carbohydrates (sugar is a simple carbohydrate) may be driven not by a sweet tooth but by the need to restore a sense of emotional balance, calmness, and tranquility during the turbulent weeks following abstinence.  Many studies have shown how prolonged and excessive alcohol intake effects (not in a good way) several neurotransmitters in the brain (link is external). Like a thief who trashes a house, excessive drinking leaves a brain in disorder, and the severe symptoms of acute alcohol withdrawal are testimony to the damage left by the drinking.

Serotonin is one of the neurotransmitters whose normal activity is affected both by alcohol consumption and its cessation. The many symptoms of PAWS read like the behaviors seen with inactive serotonin: inability to concentrate, anxiety, irritability, lack of motivation, obsessive thoughts, and depression, among others.

Is it possible that the craving for carbohydrates is an attempt by the alcoholic in recovery to increase serotonin activity, and diminish these many unpleasant moods and behaviors?

Previous research with volunteers whose moods indicated reduced serotonin activity, such as women with premenstrual syndrome and people suffering from winter depression, suggests that the answer might be yes. In both these cases the mood, focus and sleep changes are very similar to those described in PAWS, and reflect diminished serotonin activity.  Extensive research with women who suffer from mild to moderate PMS showed that a small ‘dose‘ of carbohydrates relieves many of the unpleasant symptoms soon after the carbohydrate is digested. Carbohydrate intake seems to have the same effect among those with winter depression.

But it is not necessary or desirable for the recovering alcoholic to eat sugar or sugary, fatty foods like doughnuts, ice cream, chocolate, and cookies in order to smooth out the mood swings. It is critically important that the food choices made by the recovering alcoholic help to restore depleted nutrients.  Many carbohydrate foods which will increase serotonin will do this:Sweet potatoes, oatmeal, brown rice, beans, whole grain waffles, vitamin fortified breakfast cereals, quinoa, lentils…these are but a few of the many complex carbohydrates that, once digested, will elevate serotonin levels.  Not much is needed. Thirty grams of carbohydrate is enough (which is equivalent to about 1 cup of multi-grain Cheerios).

When carbohydrate is eaten to increase serotonin, it must be eaten with little or no protein, as eating protein prevents serotonin from being made. This should be noted by those promoting high protein, low carbohydrate diets for people in recovery, because such diets will prevent serotonin activity from being restored.  Fat should be limited also because it delays digestion, thus delaying the time it will take until the recovering alcoholic feels some relief from depression, anxiety and lack of concentration.

Many critics of carbohydrate intake point out that even though people feel better after eating sugar, they then ‘crash’ and feel much worse.  What they fail to note is that after three hours of so, serotonin levels may drop again and the feelings experienced before eating the carbohydrate return. It is similar to what happens when a pain reliever wears off; the pain medication doesn’t cause the pain. It temporarily relieves it. No one would suggest not taking a pain medication, such as aspirin, because its effects wear off.  Once the pain disappears, the pain medication is no longer needed. And so when the alcoholic moves through the months following alcohol withdrawal and sees that the emotional discomfort has lessened, he or she may no longer need to use carbohydrates as often to feel better.

Months following alcohol withdrawal are tough, and not recovery is not helped by waves of anxiety, depression, irritability and other negative emotional states. Eating a sweet potato or bowl of rice or oatmeal might take the edge off these mood swings, and help the recovering alcoholic gets through yet another day of sobriety.

“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.