Monthly Archives: August 2018

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

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

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

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

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

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

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

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

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

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

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

Salting Your Way to Health Problems

A few months ago we dined with friends in a restaurant featuring small plates of ‘interesting food’ that were meant to be shared by everyone at the table. For the first time ever in a restaurant, we sent back a few of the meal items. They were so salty we had to spit them out (discreetly). A review of the restaurant read after our visit confirmed our impression that the dominant seasoning came from the salt shaker.

The excessive salt content of this restaurant’s food was apparent to anyone with taste buds, but could not be avoided unless we left the restaurant hungry. However it was not alone in supplying more salt than our body needed or should  be given. Restaurant food in general is a major source of excessive salt content; so much so that the Center for Science in the Public Interest (“CSPI”) gives unwelcome prizes to the fast food chains whose dishes contain the most egregious amounts of NaCl. Two of the prize winners this year were Chili’s Crispy Fiery Pepper Crispers (6,240 mg of sodium ), and Applebee’s New England Fish & Chips/Hand Battered Fish Fry (4,500 mg of sodium). To put the salt content of these meals in perspective, the American Heart Association  says that we should consume no  2,300 milligrams a day, and ideally less.  And for those with high blood pressure, salt intake should not exceed 1,500 milligrams per day.

But you don’t have to be a patron of these notable restaurants to have your cells swim in salt. According to the Center for Disease Control, the average American, regardless of where he is eating, eats too much salt. We eat on average  according to their 2014 report, 3,400 mg of salt each day; about a thousand milligrams above the ‘highest’ amount we should be eating.

About 61 percent of the salt we consumed each day comes from processed foods and restaurant meals, according to Zerleen Quader, an analyst from the CDC. However the top five saltiest foods may not be the ones we would think of: they are soups, pizza, bread, luncheon meats, and sandwiches ( presumably because of the bread and the meat filling). Potato chips and other salty crunchy are close contenders .

While we are managing to eat too much of the mineral sodium (half of the salt molecule) we don’t eat enough potassium, a mineral  that we should be eating in much greater amounts than sodium. The consequences can be serious: the results of a major study published in the Archives of Internal Medicine showed  “…a significant increase in the risk of cardiovascular disease with higher ratios of sodium to potassium…”  We should be eating about 4700 mg of potassium and of course only 2300 g or less of sodium.  Most of us fail miserably in reaching this balance. According to their survey, of almost 3000 participants, less than 5% reached their potassium goals and only 13%  did not eat too much  sodium.

This study was based on information gathered more than ten years ago. Might our current emphasis on low carbohydrate, high protein diets make us even more vulnerable? Bananas for example, which are very high in potassium , would be eliminated on a Paleo or Keto diet, along with many other fruits and vegetables.

Changing sodium consumption behavior is difficult because unless we read food labels carefully, avoid most processed foods and restaurants, and rein in our tendency to use spices that have high sodium content, e.g. garlic or onion powder, soy sauce and condiments in general. Many contain MSG, which of course has sodium.

New York City is making it easier to identify high sodium foods by requiring a restaurant chain with 15 or more locations nationally to list sodium contents of their menu selections. And just a few months ago, Philadelphia passed a law that requires restaurants to mark menu items that contain 2300 mg of sodium or more.

High salt intake has been linked to hypertension (high blood pressure) for decades. A recently published study of nutrient intake among more than 46,000 men and women in Japan has shown that both sodium intake alone and the sodium to potassium ratio are linked to hypertension and the diseases that can result such as strokes.

But just as it is with those television infomercials always say, “Wait! There is more!” A press release from the Alzheimer’s Association International Conference this week announced a significant relationship between blood pressure, impaired cognition, and dementia.  Professor Jeff Williamson and his colleagues at Wake Forest School of Medicine found a decrease in the number of new cases of mild cognitive impairment and dementia among individuals with normal systolic blood pressure (systolic is the higher amount and normal readings are 120 and below). Many medications are available, the anti-hypertensives, to reduce  blood pressure to normal levels. However life style changes, most obviously cutting back on salt intake, would support the effect of the drugs on returning blood pressure to normal readings.

As a friend who loves salt told me, “ It is worth giving up salty foods so I can remember what I just ate.”

References

Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the trials of hypertension follow-up study Cook N, Obarzanek E, Cutler J et al    Arch Intern Med. 2009;169(1):32-40.

Relation of Dietary Sodium (Salt) to Blood Pressure and Its Possible Modulation by Other Dietary Factors The INTERMAP Study   Stamler J, Chan  Q, Daviglus M,  Dyer A, et al Hypertension. 2018;71:631-637.

Is the Gym the Place for Psychotherapy?

I was on the treadmill when the battery for my noise-canceling headphones died. As I took them off and hung them on the railing of the machine, I heard a personal trainer talking with some urgency to the woman walking on the machine next to me. She was in her late forties, more or less, and about forty pounds overweight. He questioned whether she had planned to cancel the training session because she had not lost any weight, and when she nodded in the affirmative, he went on for some minutes, describing her emotional problems and what she should do about them. The noise of the treadmills was not loud enough to block his voice. The trainee, a woman, was a little out of breath which may be why she did not respond to his lecture.

What to do?  “I really should not be hearing this,” I told myself.  As someone who has done weight counseling and clinical research, I know how important it is to protect the privacy of everyone with whom I have contact.  Having a therapeutic conversation with a client would be done in an office, and the information in my notes was protected against an invasion of privacy. And yet, this trainer was conversing in a sufficiently loud voice so that I, and perhaps someone on a nearby machine, could hear what he was saying. Should I have been hearing about her problems with her mother? Did I want to know what she eats when she is upset? I suppose we all would benefit from his advice to take better care of ourselves, but it was not necessary for me to hear that as a bystander.

Combining exercise and talk therapy is certainly a good idea, as it may amplify the benefits of both. Presumably both therapist and client are better off engaging in physical activity; we all sit more than we should.  And as a friend told me, you, the patient, know that your therapist isn’t sleeping while you are talking if you are walking together. Sometimes simply walking side by side with someone who is an empathetic listener makes it easier to talk about problems than sitting face to face. How many of us have taken a walk with a friend or family member to discuss a problem?

But the personal trainer is neither a friend nor a family member, much less a licensed therapist. Yet because his advice was being given in a professional capacity as a paid trainer, it is reasonable to assume it would be taken more seriously than if the advice came from a friend or another gym member on an adjacent treadmill.

It is very tempting to give advice even when it is outside the area of one’s expertise. I go to the gym; shouldn’t I be able to help a weight loss client plan a program of physical activity?  For example, when I see a client for a weight-loss consultation, I ask about the level of physical activity and usually suggest exercise as part of a weight-loss plan. Certainly I should be able to suggest even more: how much weight lifting should be done along with cardiovascular activity.  But I am not a certified personnel trainer and I would never give advice as to the kind of exercise that should be followed, beyond the obvious recommendation to walk. Instead, I recommend a consultation with a personal trainer or physical therapist to make sure that the physical activity is compatible with the client’s health, stamina and age.  Would I take the client to a gym to show her how to use the machines? Of course not.  I do spend time with clients helping them figure out when their schedules will permit them to exercise.  And once I discussed with a client what she could wear in the gym that would flatter her shape. (It is hard to find workout clothes in large sizes.)

However, I have overheard many trainers who have relatively little nutritional expertise giving advice about diets or nutritional supplements; sometimes their information is erroneous or based on little evidence that a particular supplement, for example, is safe and effective.  Too many times, I have been told that a friend is following the latest diet fad because his or her trainer recommended it.

Would we be taking financial advice from our trainer or listening to her about how to decorate our living room, buy a car, or deal with a troublesome teenager? Unlikely.  Would we take marital advice or suggestions on how to deal with an aging parent from the person who helps prepare our income tax?  Probably not. But as I kept glancing at the woman on the treadmill beside me, I wondered why she was allowing her trainer (and not a therapist) tell her how to handle the demands of her mother, or problems with her marriage. (I obviously heard too much.) Was it because she was a captive on the treadmill? Or maybe she believed that someone who is overseeing how your muscles are working is competent to advise her on her emotional state.

The trainer’s advice to exercise faithfully, eat frugally, and give her some time for herself are within the bounds of common sense; they are suggestions that any of us could give and receive.  But if he plans on continuing his gym psychotherapy, let him go through professional training and receive the credentials to do so. And then he should he want provide therapeutic consultations in the gym, go to a place where only the client is listening.