Monthly Archives: October 2016

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
article continues after advertisement

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

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

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

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

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

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