Are Kids Born, or Made Into, Emotional Overeaters?

Anyone who has eaten when frustrated, angry, bored, worried, exhausted, lonely, or depressed—but not hungry—has engaged in emotional eating
(So that makes most of us.)  And for most, the food eaten is less likely to be steamed broccoli, poached chicken breast, or fat-free yogurt and far more likely to be a member of the so-called carbohydrate junk food family.

We know this from studies carried out at the MIT clinical research center about 25 years ago. Emotional overeaters were offered a choice between protein snacks like miniature meatballs or luncheon meat and carbohydrate snacks like cookies and crackers. The choice was always the carbohydrate foods. The predictable choice of carbohydrates led to research confirming that the carbohydrates were chosen not from taste (the meatballs were delicious but ignored) but because eating crackers or cookies led to an increase in the mood-soothing activity of serotonin. Our conclusion, reinforced by many subsequent psychological studies, was that people used carbohydrates as a form of self-medication.

But how did we learn to do this? And indeed, did we learn to do this, or is medicating with food something we are born with?

Infants don’t eat to make their bad moods go away. They eat to make their hunger go away.   And infants don’t eat when they are not hungry.  Theoretically infants, especially those who are breastfed, do not overeat since it is almost impossible to get infants to swallow more milk when they are done feeding. The mouth closes, the head is turned away, and often sleep takes over.

So how does an infant who self-regulates her food intake turn into an emotional overeater? Some pediatric obesity researchers such as Savage, Birch, Marini, et. al.1 suggest that it is the mother’s fault. Mothers who interpret every sign of their infant’s distress as hunger will feed their infants too often. The baby may not eat but eventually, so the researchers surmise, the baby associates feeling bored, lonely, wet, annoyed or whatever emotions babies feel with being offered food.

This association seems to be strengthened when parents offer treats to the now older child to soothe her. Blisssett, Haycraft and Farrow measured cookie and chocolate consumption among preschool children when they were stressed in a research setting. Children whose mothers often gave them snacks to comfort them ate more sweet snacks than children whose mothers did not offer them snacks when they were upset.

Is this how it begins? The child grows up and, when experiencing the predictable stresses of childhood, adolescence and adulthood, turns to food as a means of coping?

But there is much unanswered about this assumption, i.e. that children will turn into emotional overeating adults because they were given treats as children to help them overcome distress, boredom, or anger.

Do children growing up in cultures where food is scarce become emotional eaters? They may worry as adults about not having enough food and hoard food or overeat because they learned as children that food is not always available. But is this emotional overeating?

Do all children in a family become emotional overeaters in response to being given comfort food while growing up? Often some children in a family overeat sweet or starchy junk food and others reject these items. What makes Sally, but not Sam, reach for cookies when experiencing a negative mood state? Why doesn’t Sam also use food to feel better?

Do children, and indeed adults feel comforted if given any food when upset or only specific foods? The answer is obvious, at least in our culture.  Foods offered and eaten in times of stress tend to be tasty, sweet or starchy and often high in fat (cookies, chocolate, ice cream).  If, theoretically, a toddler was always offered a piece of broccoli or spoonful of cottage cheese after bumping his head or feeling confined in a stroller, would he grow up and reach for the same foods when upset? Probably not, but this is testable. If a child grows up in a community where it is common to eat hot chili peppers or munch on dried seaweed or snack on avocado, then would these be comfort foods?

Are children nurtured from early infancy in a daycare center where meal and snack times are regulated and not dependent on a child’s mood less likely to become emotional overeaters?

Might children who are denied so-called tasty junk food because of their adverse effect on weight and health, feel compelled to eat such foods when they are old enough to get the food themselves? And might they overeat such foods to compensate for the years they were denied such treats?

Clearly much research has to be done before we understand whether an emotional overeater is born or made that way.  Answers may come from studies in which self-defined emotional overeaters are given covertly a food that they tend to eat when stressed, and a food that is never eaten  (crackers versus cottage cheese). Measurements of their emotional state before and following eating are measured. If the emotional overeater shows an improvement in mood to one or the other test food, then the change must have come about because of some change in the brain regulation of mood, and not because of taste or the anticipation that the food will help the mood.

And perhaps, eventually, we can find what in the food gives the child or adult an emotional hug, so we can strip away the calories and leave just the good feeling behind.

Strolling: Good for the Mind as Well as the Body

Walking has become the default mode of exercise. If going outside to walk is not convenient, then a walking treadmill is available for year-round use. You will get nowhere, but you will use up calories. We are exhorted to walk to lose weight, to avoid gaining weight, to refresh our minds, to unstiffen our muscles.  As someone whose steps per day are counted by an app on my cell phone, I am pleased when my daily walking miles increase. “Look at all the calories I am using up!“ I think when a congratulatory computer-generated message appears on the phone.

But before walking was reserved for burning calories, it used to be the predominant way of reaching a destination. Those who still depend on walking, rather than a car or public transportation, often find it a more efficient and cost-effective way of getting somewhere.  When the roads are clogged with traffic, it is a delight to realize that walking to a destination is faster than driving.  And in some situations like a mall, museum or zoo, walking is the only option other than a wheelchair. Tour buses get drive a sightseeing group to the ancient castle or botanical garden, but seeing it requires legs not wheels.

However, there is an aspect to walking that seems to have been forgotten or disregarded in an attempt to make more people move more. Walking is good for the mind, for thinking, daydreaming, and becoming aware of the details of our environment.  Indeed, those who meditate sometimes do a walking meditation in which the body, breathing, and mind become one. Usually too impatient to contemplate anything but a robust pace while walking, recently I have been forced to slow down because of my dog. He is almost blind due to a genetic problem associated with his breed. Fortunately, his hound genes allow him to sniff his way through the world as if there are eyes at the end of his nose; but his pace is about 90% slower than when he could see.  As I am at the other end of the leash, I too have slowed down my pace. 

Our walks have now become a stroll, a leisurely perambulation around the neighborhood. But as the number of miles we used to cover diminishes to a few blocks, moving slowly has the positive effect of increasing my awareness of the surroundings: There are fewer ducks in the pond today; the yellow leaves of the birch tree highlighted by the sun look painted; that trash can needs to be emptied; the moon is almost full tonight; the leaves on the sidewalk crunch delightfully when I scuff through them. Casual conversations with other walkers occur frequently, as I stop to allow the dog to smell his way to the next tree. But the best aspect of these leisurely strolls is giving me the time and privacy to think, to indulge in memories, even to daydream.     

A constant complaint of our over-committed lives is the absence of time to restore and renew ourselves.  We must always get to the next thing on our list. One of my friends jokingly told me that as she is lowered into her grave, she will toss out her ‘to -do’ list. Strolling gives us permission to forget the list, to stop temporarily multi-tasking and strategizing about how much we can accomplish over the next 24 hours. Ambling gives us the respite from the constant demands upon us. It gives us time to indulge in our private selves without having to worry about how we present ourselves to the world.  Strolling, if we think about it, should even make us aware and grateful that we can walk and see and hear.

Exercise is important; indeed, it is essential to good mental and physical health. But as my dog has taught me, sometimes a gentle walk can truly enhance our well-being.    

Lactose Intolerance: Can It Cause Weight Gain and Weak Bones?

I hadn’t seen my neighbor for several weeks, but we’d just met again while walking our dogs.  When I commented on how well she looked, she patted her mid-section and said, ”I finally got rid of my big stomach.” (that she had a large stomach was not apparent in our previous encounters.)  When I murmured something to that effect, she went into a long discourse on how she managed to vanquish her perceived girth by radically changing her diet.  She told me, “I cut out all dairy and carbohydrates, and I eat only protein and vegetables. But it’s strange. I haven’t lost any weight. I just lost the bloating.”

My nutritional antennae went up when she mentioned her dietary changes.  Further questioning revealed that she really hadn’t stopped eating carbohydrates, and had enjoyed an excellent pasta dish the previous night at a local restaurant.  But no dairy products had been eaten for weeks. “And as soon as I stopped putting milk on my cereal, and cut out yogurt and cottage cheese, my bloating stopped,” she proclaimed, patting her flatter stomach. “So obviously the dairy products were making me fat.”

As our dogs settled down on the grass, we continued talking. “ So maybe you have lactose intolerance,” I suggested. “That would account for the bloating after you eat dairy. “

She was unaware that as people age, the enzyme lactase that breaks down lactose, the sugar naturally found in milk, disappears or becomes much less active. Consuming milk and sometimes other dairy products such as ice cream, yogurt, cottage cheese, cheese and even butter (it contains milk solids) causes gas, bloating and diarrhea. This is due to bacteria in the intestine interacting with the undigested milk sugar. The intestinal discomfort is accompanied by cosmetic discomfort; skirts or pants strain to fit over a bloated stomach, and the abdomen may not retract to a flatter shape until all the lactose has been expelled.

“You can get lactose-free dairy products,” I told her. “Also, often the bacteria in yogurt have already broken down some of the sugar, so regular yogurt may not cause bloating. And you can take pills that contain the enzyme lactase. You chew them right before eating any dairy products. “

“Well, maybe I do have lactose intolerance… but it doesn’t matter,” she responded. “Why go back to eating dairy? I drink almond milk and eat broccoli. “ She bent down to pick up her dog who was eating grass. “I get all the calcium I need. “

I felt as if I was making a nutritional nuisance out of myself, but asked anyway, “ Didn’t your doctor tell you a few months ago that you may be developing osteoporosis? You were worried that calcium in supplements was not being absorbed as well as calcium in food. Are you sure you are getting enough calcium now?”  Her dog started barking, and she looked as if she was going to bark at me so, letting our dogs pull us in opposite directions, we parted company. But as I walked home, I wondered whether she could get enough calcium from almond milk and broccoli. She needed to get about 1200 mg of calcium daily.

She was right about the almond milk. Eight ounces of calcium-fortified milk contains as much of this mineral as cow’s milk: 300 mg.  But would she drink 4 glasses a day?  Yogurt has 400 mg of calcium, but because eating it supposedly made her fat, it was not on her allowable food list.  What else could or would she eat? Canned salmon or sardines with bones? Probably not, or only rarely. Vegetables? She said she ate broccoli.  Could vegetables provide the calcium she needed?

Broccoli is not a good option, unless she eats a bucket full.  A cup contains at most about 65 mg of calcium. Steamed kale, bok choy, turnip greens, and spinach are good sources (a relative term as they contain only about 100 g per cup of calcium) but there is a problem. These dark leafy vegetables have a pesky substance called oxalic acid that attaches to the calcium, and prevents the mineral from being absorbed from the intestine into the circulation. In fact, oxalic acid can even prevent the calcium in milk or yogurt from getting into the blood stream if these dairy products are eaten along with dark leafy vegetables.

What about orange juice? Calcium-fortified OJ is as good a source of calcium as milk, and has about the same number of calories as whole milk. But will my friend, worried about the size of her tummy, fret about the calories?

Maybe she could swallow 2 tablespoons of blackstrap molasses every day (400 mg). And she could eat chickpeas, black-eyed peas, soybeans, tofu processed with calcium sulfate, figs, and instant oatmeal fortified with calcium.

Bones are an excellent calcium source, but I suspect only her dog chewed on those. (These cook down in the canning process of sardines and salmon to boost calcium.)

So it seems that dairy products are the best natural sources of this essential mineral. But will my friend be willing to try lactose-free dairy products and/or the lactase containing pills so she can consume them? Maybe so, if her stomach remains flat.  Perhaps it will require another   walk with our dogs to convince her.

If We Celebrated Thanksgiving in July, Would We Gain Less Weight?

Weight gain season has started: first Halloween, then Thanksgiving, and finally the Christmas/New Year holidays. The trick-or-treat candy has been barely put away (in our stomachs) when the recipes for Thanksgiving dinner are pulled from the drawers, or torn out of the November magazines. Even those among us who rarely cook begin to fantasize about a perfectly cooked turkey, moist dressing, gooey sweet potato casserole (will last year’s marshmallows still be edible?) and pies…How many pies should we bake? Surely not just one. What will our guests think? And as the days grow colder, wetter, windier, and darker, we fantasize about spending an entire day focused on eating. No need to exercise. The gyms are closed on Thanksgiving anyway (at least most of them), and who wants to go outside for a walk when it is so cold and/or so dark?

So begins the season of real weight gain.

What makes Thanksgiving so fraught with weight-gaining potential is its position on the calendar. Presumably when President Lincoln picked the fourth Thursday in November as a day of national Thanksgiving, he could not have known that the holiday would be altered into a day of national overeating due, to some extent, it being plopped in one of the darkest months of the year. It wasn’t until more than a hundred years later that scientists linked the short days of late fall with a winter depression causing significant overeating. Nor was President Lincoln concerned, skinny as he was, that the feasting on Thanksgiving was a prelude to weeks of overeating associated with December holidays. Indeed, for a country in the middle of a civil war, obesity was not something anyone worried about, nor was anyone in the position to spend much time in festive parties.

But just consider the impact on our food intake and weight if Thanksgiving were moved to the warmer, sunnier months like June, July or August. The benefits are obvious:

1. Menus would not be filled with butter and cream-infused carbohydrate dishes like mashed potatoes and creamed onions;
2. Stuffing soaked in the melted fat of the turkey would be incompatible with the warm temperatures of a late June afternoon;
3. Vegetables might come from the farmer’s market and reflect what was harvested that day, rather than limited to what was harvested weeks earlier, or shipped from a country a continent away;
4. Desserts could include really fresh fruit whose tastes do not have to be enhanced by large amounts of sugar, or baked in piecrust made with copious amounts of butter or lard;
5. Long hours of daylight would allow outdoor activities before and after the meal, such as a lengthy walk after dinner instead of lying on a couch; and
6. Wearing bulky clothes to disguise large figures would not be possible, thus adding a bit of restraint to indulging in more than two servings.

Were Thanksgiving moved to another date not bookended by holidays characterized by overeating, there would be time to diet or exercise off the pounds that might be added by the meal. But coming as it does at the time of the year when we think wistfully of the joys of overeating and then hibernating until spring, it seems easier to ‘go with the flow’ and continue to overeat until January ads for diet programs make us get on a scale.

When the Pilgrims celebrated the first Thanksgiving in October (by the way), they did feast for three days on foods provided mainly by their Native Americans neighbors. They did not have to worry about overindulging a couple of months later at Christmas, as they did not celebrate this holiday. Moreover, they were worried that their food supply would not last through the winter, and so were very careful about how much they were eating. Death from hunger, not obesity, was their constant worry.

It is unlikely that Thanksgiving will be moved to another time of the year, regardless of the benefits that would confer on those of us struggling to maintain our weight. But if we, like Governor Bradford and President Lincoln, focus on the reasons for the holiday rather than the recipes, we might emerge with our weight intact.

 

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.

Will Preventing Male Baldness Cause Depression?

The symptoms sounded like a case of a male PMS: swelling in the hands or feet, swelling or tenderness in the breasts, dizziness, weakness, fatigue, cravings for carbohydrates, weight gain, depression, confusion, cold sweats, and sexual dysfunction. These are some of the side effects of a medication used to treat male pattern baldness. Finasteride, the generic name of the drug, was originally used to treat benign prostatic enlargement. During early clinical trials, however, researchers noticed that the volunteers were growing hair. It seemed too good to be true: finally, a solution to reverse age-related male baldness. The drug, known by the trade names Propecia and Proscar, seemed to be an effective treatment for the restoration of hair among men suffering from male baldness.

Finasteride’s effect on decreasing hair loss is related to its effect on a testosterone-like compound, dihydrotestosterone (DHT). DHT is an active form of testosterone and is responsible for prostate enlargement and the destruction of hair follicles on the top (but not the sides) of the scalp. Finasteride belongs to a group of compounds that inhibits, or slows this conversion of testosterone to DHT, thus making it an effective drug to slow prostate growth and, happily for many men, slow hair loss.

But unfortunately, getting a full head of hair comes with potential physiological and emotional costs. Soon after it was introduced to prevent male-patterned baldness, especially among young men (it works better among a younger population), anecdotal reports of depression and even suicidal thinking began to circulate. Even more disturbing, these critical changes in mood seem persistent even after the drug was discontinued. A small study to investigate the validity of these side effects was carried out by Dr. Michael Irwig of the George Washington University in Washington D.C.  He measured the moods of young men, average age 31, who had been treating their baldness with Propecia for an average of slightly more than two years. These men had developed persistent sexual dysfunction that continued for at least three months after they stopped taking the drug. He found 75 percent of those who had used the drug had symptoms of depression compared with 10 percent of controls who never took the drug. Over 30 percent reported having suicidal thoughts compared to only one from a control group. Were these young men depressed because they were experiencing sexual dysfunction or the converse? The study did not answer that question.

An increase in appetite, especially for sugary carbohydrates, and weight gain were two additional side effects that lasted well beyond discontinuing the drug. This was also unexpected, but reported as a side effect often enough to make the FDA add them to the list of side effects. And according to stories by men who used Finasteride, the weight does not come off after they stop using the drug. As one disgruntled user said,”I would rather be thin and bald than the way I am now, fat and hairy.”

What seems to be the link between Finasteride and depression? By altering the synthesis of the testosterone-like substance, it might be affecting two possible neurotransmitters in the brain involved with depression and anxiety. One is gamma-aminobutyric acid, commonly known as GABA, and the other is serotonin. Interestingly, serotonin activity also decreases when estrogen levels decline at the end of the menstrual cycle, and the resulting depression, anxiety, fatigue and overeating characterize PMS.

Evidence that the Finasteride-associated depression may be related to a change in serotonin activity comes mainly from animal studies looking at the effect of testosterone on certain serotonin receptors. But a hint that serotonin may be involved can also be found in reports of intense carbohydrate craving from men who have used the drug. PMS and Seasonal Affective Disorder (severe winter depression) are each characterized by carbohydrate cravings, depression, and decreased serotonin activity. And the consumption of carbohydrate by these groups seems to relieve their depression, anxiety and fatigue because of the resulting increase in brain serotonin synthesis.

Might men suffering from Finasteride-related mood changes also benefit from eating carbohydrates? Were they to consume 25-30 grams of a starchy, very low-protein carbohydrate snack two or three times a day, on an empty stomach, they will be increasing serotonin synthesis. The resulting improvement in mood may not dispel their depression entirely (after all, a cup of oatmeal is not an antidepressant), but at least will make it easier to cope with their negative moods and the possibility that they will now lose their hair.

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.

Using Up Calories By Being Inefficient

The App that records my walking distance read 3 miles, but I had not left our apartment except for a quick trip to a nearby grocery store.

How could I have walked three miles inside?

I knew how. We had just moved, and the aftermath of unpacking had left me with only a vague idea of where anything was now stored. Back and forth I walked, searching for laundry detergent, trash bags, my cell phone, and my cell phone charger. Accustomed as I had been to a kitchen small enough to have everything I needed available without moving more than a few inches, now the larger and poorly laid out kitchen had me roaming around substantial distances to bring pots, plates, silverware, and salt shakers to the same place. I felt like a laboratory rat in a maze, figuring out, with many failures, how to set a path that would get me whatever stuff I was looking for.

But, on the positive side, all this wandering was burning up calories. Simply searching for my cell phone (which I stopped doing when I finally stuffed it into a fanny pack that did not leave my waist) was probably using up a few hundred calories, and searching for stuff that I thought I had unpacked (where was it?) used up considerably more. If one thing marked this week, it was efficiently using up calories by being helplessly inefficient.

Efficiency is essential in our overcommitted, insufficient time world.  We expect contemporary technology to ensure that what has to be done is done in a timely fashion, without too many errors. We are annoyed and often angry when others who are inefficient slow us down. Think of how impatient we get in a supermarket checkout line when the person in front of us can’t figure out how to use the credit card machine.

But perhaps an overlooked cause among many, for the unfortunate fattening of our nation, is that we have fewer and fewer ways of using calories by being inefficient. We shop online; it saves time and is very efficient, but then we spend less time walking to and in stores. We go to big box food stores with gigantic shopping carts and buy enough staples, from paper towels to toothbrushes, so we don’t have to ‘waste time’ running off to the local drug store or supermarket when we run out. Everything that can be delivered is: who wants to spend time even getting in and out of a car to pick up dry cleaning or a pizza?

Children are also delivered, to school, to home, and to various activities by bus or car. Do children walk anywhere these days? It would take too long, and maybe even reduce the time they spend sitting in front of their computer screens. We drive to our health club or yoga or Pilates classes. Walking there is out of the question. It’s just too inefficient.

A few years ago a middle management positioned woman told me that her company abolished cubicles and assigned desks. “See this,” she said pointing to an overstuffed computer bag/brief case. “This contains everything I need. I just carry it to any available desk when I come into work.“ She never has to get up from her chair to find anything. She never walks to someone else’s desk to talk, since no one is ever in the same place from day to day. Instead, she texts or emails messages to her colleagues. She never walks to the copy machine since everything that has to be copied is sent electronically to the copy ‘worker.’ It’s very efficient. It is also a little fattening? Perhaps.

It is too late to build inefficiency into our work situation, and anyway who would want the frustration, delays, and extra costs associated with this?  But maybe we can rejoice, rather than grumble when we forget something in the car and have to go back to get it. Maybe we can look positively on our inefficiency when we have to go back to the supermarket because we have a year’s supply of toothpaste, but forgot to buy milk. Maybe we can lose our cell phones more often, and praise ourselves for using up some extra calories when we finally find it. And maybe that will help, a little, to avoid gaining weight.

Why Is It So Hard To Lose Weight After Antidepressants?

Side effects from medications are common, although usually not severe enough to halt treatment. Anyone who has listened, perhaps unwillingly, to a recital of side effects associated with a television advertisement for a medication is aware of the number of health problems that might arise while taking that particular drug.  But unless the side effect is death (the announcer always seems to mumble at this point), one assumes most of these adverse events go away when the medication is no longer taken.

Weight gain is a common side effect associated with most medications prescribed for depression, and/or anxiety, or the pain of fibromyalgia. We know that the weight is gained for the same reason weight is usually gained: more calories are consumed than needed by the body for energy. But even though most of the people gaining weight as a side effect of antidepressants and related medications may become overweight or even obese, they differ from the typical overweight or obese individual. The latter group struggle with their weight, often because of a lifestyle of eating too much, exercising too little, and in many cases using food to deflect emotional issues. But people whose obesity is a side effect of their medication never had a problem maintaining a normal weight and fit body prior to treatment.  To them gaining weight was as much of a shock and disruption to their body as losing hair is to a patient on chemotherapy.

They’d never dieted. Why would they? They never needed to.

Antidepressants, mood stabilizers, and atypical antipsychotic drugs seem to alter appetite by inhibiting serotonin-based regulation of the appetite function.  A persistent need to eat remains after the stomach is full of food, along with cravings for carbohydrate snacks. Sometimes the ravenous need to eat interferes with sleep, and leads to waking up in the middle of the night to eat.  Medication-associated fatigue frequently accompanies the overeating side effects, so the motivation, and indeed the ability, to exercise off the extra calories becomes difficult or impossible.

All this is well known, and even if a prescribing physician may not mention weight gain as a side effect, countless studies have confirmed it to be so.

So if weight gain is caused by the medication, then weight loss should follow its discontinuation.

And it does for most people. Once the medication is out of the body, normal appetite returns, fatigue diminishes, and the patient returns to eating and exercising normally. Increasing serotonin level and activity prior to meals diminishes any lingering inability to feel full after eating or an inability to control snacking.  Consuming small amounts of fat-free, low-protein carbohydrate foods such as oatmeal an hour before mealtime or as an afternoon snack increases serotonin sufficiently to resume normal appetite control. Returning to a vigorous workout schedule once the side effect of fatigue disappears accelerates weight loss.

But not everyone is able to lose the weight even months after the medication is stopped.

And no one knows why.

Formerly pre-treatment, thin/fit individuals are horrified to find that the 15 or 25 or 50 pounds they gained on their medication is hanging around like a relative who won’t leave the guest room.  Diets are tried and discarded for lack of success. Aerobic and strength-training workouts are increased in frequency and duration.  Yet the pounds stay on.

The result is a feeling of despair and desperation: “No matter what I do I cannot lose weight.” It is as if someone who loses her hair while undergoing chemotherapy learns that she will be bald the rest of her life. Patients who have become obese due to their medication believe their bodies will be permanently changed. They believe they will never return to the slim bodies they had before their medications, and grudgingly and often angrily resign themselves to accept being overweight or obese.

Some suggest that water retention may be responsible for the increased weight, but once the medication is out of the body, the excess water should be lost. Others point to some muscle loss before and during the early stages of treatment when depression has led to weeks of inactivity. However, rebuilding muscle mass doesn’t seem to produce any significant weight loss. It is possible that metabolic rate decreased as a result of treatment, and therefore is slowing weight loss. But studies on thyroid function with patients who were treated with Zoloft or Prozac did not show any functional change in thyroid hormones. So at this point, there is little to offer someone who has tried to lose the medication-associated weight by dieting and exercising, and is failing.

Is the weight finally lost, many months or even years after the antidepressants or related drugs are out of the body?  Are the extra pounds still attached to the body five or ten years later?

No one knows. There are no long-term studies following patients after they discontinue treatment to see if weight is lost and, if so, what produced the weight loss. Interestingly, there are many studies showing that after a weight-loss diet is over, people’s weight eventually returns to the heavier pre-diet weight or ‘set-point’.  Perhaps it is time to see whether people whose weight is a consequence of antidepressant treatment will also return to their weight ‘set-point’. If this turns out to be the case, it will certainly lessen the depressed feeling so many patients experience when they don’t believe their weight will ever come off.