“Next to Normal” is a Broadway musical dealing with the common, but rarely sung about, problems of mental illness and the impact this has on the family. Despite its theme, the musical is often very funny while being uncannily accurate in depicting the symptoms of bipolar disorder and how current therapies affect the patient. In one very long musical sequence, the patient, the mother of the family, is put on a variety of medications to stabilize her out-of-control mania. In scene after scene she comes back to tell her psychopharmacologist about the side effects of the various medications he is trying and their lack of efficacy. To my amazement, she sings that one medication took away her appetite and then made her gain 10 pounds. “ Did you hear that?” I whispered to my husband as people around us laughed. “They sing about weight gain from anti-depressants on stage but psychiatrists still won’t talk about it.”
As we left the theater, I felt hopeful that this hidden cause of obesity might finally become mainstream. If it could make its way into the lyrics of a popular play, then maybe weight gain due to antidepressants and drugs used for bipolar disorder might be recognized as contributing to the epidemic of obesity In fact, the only part of the song that did was not entirely accurate was the weight gain of l0 pounds. Of course, this was supposedly after only a few weeks of treatment. Many drugs, especially those used for bipolar disorder, can produce weight gains upwards of 70 pounds over six months or so.
One of the saddest aspects of medication-induced weight gain is that people who experience it were often a normal size before drug use and without any history of eating problems or obesity. In our weight-loss center at a Harvard University hospital, we saw many clients who not only had been thin but also had led physically active lives. They would tell us that they did not recognize their own bodies after several months on their medication. Not only were they unable to control their eating, they no longer could exercise as their extreme weight gain left them fatigued and often with back or leg pain. Their family and friends did not understand what was happening and these formerly thin people were subjected to unkind and sometimes abusive statements about their new size. A few became recluses because they could not bear people looking at them. One of our clients, in high school at the time, refused to go to school because of the way she looked. Her mother had to home-school her.
And yet, as we point out in our book, The Serotonin Power Diet, this does not have to occur. The side effect of chronic hunger produced by the medications can be aborted by getting the brain to make more serotonin. No one is sure how the weight-gaining medications affect food intake but serotonin’s role in turning off hunger has been known for at least 35 years. It would be ideal if a drug existed that turned serotonin into an appetite terminator but there isn’t any. The only safe and effective way to get serotonin to function more potently as an appetite suppressant is to make the brain manufacture more of this chemical. This is easy to do and it is too bad the Broadway show didn’t mention it. Serotonin is made when non-fruit, starchy or sweet carbohydrates are eaten. As long as the food is eaten without protein and with very little fat, serotonin is made within 20 minutes or so. And as soon as it is made, it acts to shut off further eating.
Clients in our hospital weight-loss center and our private practice were given a diet we have reproduced in our book. They were told to consume a carbohydrate drunk, which we had developed for the clinic. It allowed the brain to make serotonin very quickly. They were also allowed to substitute a carbohydrate food for the beverage, if they wished.
Weight loss was immediate and easy because the additional amount of serotonin seemed to diminish or remove entirely the need to eat all the time. Some of the clients had to stay on the weight-loss plan for many weeks because they had gained so much w eight from their medication. They all told us they wished their psychopharmacologist had told them about our diet when they first started gaining weight and not after their weight gain became a major side effect.
But who knows? Now that weight gain from antidepressants and mood stabilizers is put to music, maybe some songwriter will tell the audience about eating carbohydrates to lose weight.


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Television advertisements for highly caloric, yummy-looking foods have been around for so long that some of us avert our eyes when they appear so we won’t immediately give into the temptation to obtain the food. Otherwise, we would be phoning the local pizza place or raiding the freezer every time the commercials came on the screen.
Over the past several months I noticed something about the commercial breaks that may drive all of us to the kitchen to find something to eat even if the advertised product is not food. The time dedicated to showing commercials between segments of a network television show seem to be getting longer and longer. I noticed this when, during the commercials. I tried to take care of those last-minute household chores of the evening. To my astonishment, it was possible to get the coffee maker ready for morning breakfast on one break, brush my teeth for the allotted time on another and, if my dog was fast enough, take him out for a last minute “pee” break. But then once these tasks were completed, I was faced with the problem of what to do during the subsequent two or three minutes of advertisements. Going to the kitchen to find something to eat was always a possibility as was spending the time deciding whether I wanted to eat or not.
Eating to use up time is a chronic problem that many of us face. regardless of whether we are on a diet or simply trying to maintain our weight. When faced with large amounts of uncommitted time, such as on a rainy Sunday afternoon or during the evenings, it is too easy to spend the time walking back and forth from the kitchen. Often the best way to prevent this is to get out of the house or become so involved in an activity that the desire to snack is forgotten. In fact, diets will succeed only if the dieter can figure out how to spend the time he or she used to be spend eating doing something else.
It is easier to identify activities that use up several hours than it is to find something to do for three-minute intervals every ten minutes of a television show. Few people are going to run to the piano to practice a scale or put a few strokes of oil on a canvas during the commercials.
So I thought I would come up with a list of activities that can be done during the advertising interval and are far away from the kitchen.
1. Look up definitions of words whose meaning is a mystery to you. If you don’t have a dictionary, Google them.
2. Write a thank-you note or sign and address birthday, anniversary or other celebratory cards.
3. Check your appointment schedule for the next day. This is particularly important for people such as myself who write down meeting and other appointment dates but fail to open the calendar where they are written.
4. Scan the weather report in the newspaper so you can find somewhere in the world with worse weather than tomorrow’s forecast for where you live.
5. Check to see if your pet’s water bowl is filled.
6. Get down on the floor and do a minute’s worth of push-ups or abdominal crunches.
7. Stand on one foot during the commercial. With practice you might be able to do it for the full length of the advertising. This is a great way to improve your balance.
8. Go through the container where you keep your earrings and line up them up. Think about what to do about those missing a partner.
9. Fold clothes (this always has to be done).
10. Write down what you remember eating during the day and check to see if you consumed any vegetables, fruits or dairy. If not, program your cell phone or computer to remind you to do so tomorrow. This may take two commercial breaks to accomplish.
11. Empty your wastebaskets or yell at your kids to do it if it is their chore.
12. If you plan to travel to a foreign country, repeat an essential phrase in that country’s language like “where is the toilet?”
13. Check the thermostat and argue with your partner/spouse over the setting. This may take longer than the commercial break.
14. Floss your teeth, again. It’s impossible to do this enough.
15. Brush your cat or dog. Do not do this if animal is on bed unless you want fur on your pillow.
16. Watch the advertisements. Sometimes they are funny.

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Television advertisements for highly caloric, yummy-looking foods have been around for so long that some of us avert our eyes when they appear so we won’t immediately give into the temptation to obtain the food. Otherwise, we would be phoning the local pizza place or raiding the freezer every time the commercials came on the screen.
Over the past several months I noticed something about the commercial breaks that may drive all of us to the kitchen to find something to eat even if the advertised product is not food. The time dedicated to showing commercials between segments of a network television show seem to be getting longer and longer. I noticed this when, during the commercials. I tried to take care of those last-minute household chores of the evening. To my astonishment, it was possible to get the coffee maker ready for morning breakfast on one break, brush my teeth for the allotted time on another and, if my dog was fast enough, take him out for a last minute “pee” break. But then once these tasks were completed, I was faced with the problem of what to do during the subsequent two or three minutes of advertisements. Going to the kitchen to find something to eat was always a possibility as was spending the time deciding whether I wanted to eat or not.
Eating to use up time is a chronic problem that many of us face. regardless of whether we are on a diet or simply trying to maintain our weight. When faced with large amounts of uncommitted time, such as on a rainy Sunday afternoon or during the evenings, it is too easy to spend the time walking back and forth from the kitchen. Often the best way to prevent this is to get out of the house or become so involved in an activity that the desire to snack is forgotten. In fact, diets will succeed only if the dieter can figure out how to spend the time he or she used to be spend eating doing something else.
It is easier to identify activities that use up several hours than it is to find something to do for three-minute intervals every ten minutes of a television show. Few people are going to run to the piano to practice a scale or put a few strokes of oil on a canvas during the commercials.
So I thought I would come up with a list of activities that can be done during the advertising interval and are far away from the kitchen.
1. Look up definitions of words whose meaning is a mystery to you. If you don’t have a dictionary, Google them.
2. Write a thank-you note or sign and address birthday, anniversary or other celebratory cards.
3. Check your appointment schedule for the next day. This is particularly important for people such as myself who write down meeting and other appointment dates but fail to open the calendar where they are written.
4. Scan the weather report in the newspaper so you can find somewhere in the world with worse weather than tomorrow’s forecast for where you live.
5. Check to see if your pet’s water bowl is filled.
6. Get down on the floor and do a minute’s worth of push-ups or abdominal crunches.
7. Stand on one foot during the commercial. With practice you might be able to do it for the full length of the advertising. This is a great way to improve your balance.
8. Go through the container where you keep your earrings and line up them up. Think about what to do about those missing a partner.
9. Fold clothes (this always has to be done).
10. Write down what you remember eating during the day and check to see if you consumed any vegetables, fruits or dairy. If not, program your cell phone or computer to remind you to do so tomorrow. This may take two commercial breaks to accomplish.
11. Empty your wastebaskets or yell at your kids to do it if it is their chore.
12. If you plan to travel to a foreign country, repeat an essential phrase in that country’s language like “where is the toilet?”
13. Check the thermostat and argue with your partner/spouse over the setting. This may take longer than the commercial break.
14. Floss your teeth, again. It’s impossible to do this enough.
15. Brush your cat or dog. Do not do this if animal is on bed unless you want fur on your pillow.
16. Watch the advertisements. Sometimes they are funny.

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A research team from San Diego reported recently that people who are depressed eat more chocolate than non-depressed individuals. Although this news might surprise men, any woman who has experienced premenstrual syndrome takes this for granted. PMS and chocolate cravings go together like peanut butter and jelly or fireworks and the 4th of July. An editor of a woman’s magazine told me years ago that she always knew when she was premenstrual because she was unable to walk by a gourmet chocolate shop next to her office without going in and buying a large chocolate bar. “The crankiness, fatigue, confusion and depression come later on,” she told me. “The craving for chocolate is always there first. I remember once longing for a chocolate ice cream while sitting through a formal three-course dinner and after- dinner speaker. The food served at the meal did not tempt me at all but as soon as I could leave, I headed for the nearest ice cream shop. Sure enough, I was premenstrual.”
The association between chocolate craving and premenstrual syndrome has been known for decades and theories promoted to explain this relationship tended toward the fanciful or bizarre: hysterical personality, malfunction of the reproductive organs or water on the brain. Moreover, because doctors noted that the women eating the chocolate were bad-tempered, depressed or confused, they concluded that the chocolate was making them that way. As recently as 10 to15 years ago, chocolate-craving premenstrual women were told that eating chocolate, and indeed any sweet food, would make their moods worse and to eat only fruits, vegetables and lean protein. This advice can still be found in some women’s health and fitness magazines. Not only is it wrong but any premenstrual women who follows it will gnash her teeth over being denied her chocolate.
There is a good reason why women with PMS go out in a blizzard to get chocolate or eat a dinner of melted chocolate on a chocolate brownie sitting on chocolate ice cream. The chocolate was making them feel better, not worse.
The improvement in mood is due to chocolate’s substantial sugar content and, to a small extent, the caffeine-like ingredient is also contains. Because chocolate has a creamy texture, we are unaware of how much sugar it contains. But anybody who has accidentally mistaken baking chocolate for the eating kind knows the difference; baking chocolate is incredibly bitter. Sugar is a simple carbohydrate and when sugar of any carbohydrate, except that found in fruit, is eaten without protein, the body responds by making new serotonin in the brain. To be sure the flavor and mouth-feel of chocolate starts the eater on the road to a good mood. But the immediate sensations on the taste buds quickly disappear, whereas the relief from irritation, agitation and fatigue may last for a couple of hours.
Several years ago at the MIT clinical research center, we carried out some extremely complicated studies with premenstrual women to show scientifically that eating a brownie or even a bowl of starchy carbohydrate like cornflakes relieves that mood and eating disturbances of PMS. To begin with, we found that normal weight women may increase their calorie intake by more than 1100 calories a day when they are premenstrual compared to when they are in the first half of their menstrual cycle. And to no one’s surprise, these calories came from sweet and starchy snacks and starchy meal food, and not from chicken, fish or cottage cheese. We also found the anger, confusion, depression, anxiety and cravings of PMS became more tolerable after women consumed a beverage containing a mixture of carbohydrates. When they drank a beverage containing protein, there was no improvement in how they felt. They did not know what they were drinking and the two beverages tasted exactly the same.
For reasons we still don’t understand, hormonal changes associated with the menstrual cycle affect serotonin activity. This also may be true for women who are pre-menopausal. When our premenstrual volunteers ate carbohydrate, their brain cells made more serotonin and this chemical messenger brought the women back to feeling normal. An extra bonus was that they lost their intense cravings for carbohydrate so those who were trying to lose weight felt their appetite was under control.
Just to be sure that serotonin was the main actor in all this, we also carried out more studies with one of the antidepressant drugs that activated serotonin. We found that a short bout of treatment with the drug improved the moods of women who had severe PMS and this actually led to drug companies using some antidepressants for the extreme form of this disorder.
Obviously someone on a diet, or even not on a diet, cannot live on a meal plan consisting of chocolate Cheerios for breakfast, a chocolate bar between two slices of bread for dinner (they do eat this in Switzerland) and a bowl of hot fudge sauce for dinner when she has PMS.
But as long as portion control is monitored, fat is decreased as much as possible ( for example, fat-free fudge sauce) and a vitamin pill is taken, no real nutritional harm will come from a once-a-month indulgence in this wonderful mood food. However, all carbohydrates except fructose (fruit sugar) will produce the same beneficial effect on premenstrual mood. If you find that your mood is bearable in the early part of the day but intolerable by afternoon eat your protein, vegetables and dairy products for breakfast and lunch and switch to carbohydrates from 3 PM on. This way your nutritional and emotional needs will be met. And rather than dreading PMS, think about chocolate and look forward to it.


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The newspapers are filled with pictures of people sleeping on cots in airports waiting to get home. Days have passed since the volcano in Iceland erupted, stranding people on both sides of the Atlantic. In addition to stories of people washing their socks—and even their hair—in restroom sinks, there must be untold numbers of travelers running out of more than clean underwear.
Medications are an obvious problem. If you expected to be away only for a long weekend, you may not have taken the medications you need for an extended stay away from home. But there is one over-the-counter medication Are vitamins classified as medications? that you might not think of packing, even if you are not planning to spend your vacation in the airport. I’m referring to multi-vitamin pills. It is pretty obvious to anyone trying to eat before boarding a plane that most airport restaurants do not offer foods meeting the USDA standard of what you should be eating each day. Even though the ubiquitous fast-food hamburger, pizza and Chinese restaurants may be joined by a few places offering salads, grilled vegetables and non-fried protein like grilled chicken, whole grains, fresh fruits and vegetables and non-fat dairy products are not featured prominently on any airport restaurant menu.
Even assuming that your travel will not be limited to arriving and staying at an airport, you should still consider packing vitamin pills. Railroad stations and highway rest-stop restaurants echo the nutritional limitations of airport restaurants. Moreover, a steady diet of restaurant food during an extended business or pleasure trip may further restrict your access to a nutritionally adequate diet. This is especially true if you are traveling with children. For obvious reasons, restaurants offer “kid-friendly” menu options. These options may be friendly to your child’s taste buds but are often unfriendly toward good health.
Many years ago, when my husband was on a sabbatical, we took our kids to England and our first meal in London was breakfast. When our junior high school-aged kids saw a typical English breakfast—fried eggs and sausage swimming in lard, baked beans, warm mushy tomatoes and soggy toast—they were ready to go back on the plane.
It is less hard to get vegetables and fruit these days but these foods are certainly not served as often as French fries or chicken nuggets. In fact, one of the frustrating aspects of travel is the disconnect between what is in the supermarket or farm stands and what is served in restaurants. A farmer’s market in late spring or summer will offer countless local vegetables and fruits but try to find those fresh blueberries or recently picked lettuce in the restaurant a few blocks away! When we travel during those months, we try to stop at local farm stands whenever we can. If we are staying in a hotel, we store them in the refrigerated section of the mini-bar. Then we eat the fruit at breakfast or make a lunch out of fresh tomatoes, basil and local goat cheese and bread. But of course these nutritional pit stops are unavailable in the winter months or if the closest supermarket or farm stand is in the next state.
So vitamin pills are like nutritional travel insurance. You don’t expect volcanoes to erupt or lack of sunshine and citrus fruit to make you vulnerable to rickets and scurvy. But carrying a small bottle of pills with you will give you a sense of nutritional security. And we all hope the planes start flying before you use up your bottle.


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