A few days ago I was concluding a visit with a patient with thyroid disease, while her diabetic
husband, also my patient, looked on. They are a pleasant older couple I have known for
years, who are devotedly helping each other stay healthy. As they were leaving the exam room the
wife apologetically turned the subject to her husband mentioning he was having almost
daily â€œepisodesâ€ of weakness and confusion. “I hadnâ€™t changed his diabetic medication recently
so why should his blood sugar be an problem now”, I thought. A number of other unpleasant
possibilities immediately occurred to me. I inquired about signs of a possible stroke or heart
condition. If these other angles were unproductive I faced the choice of sending him to the
hospital for an evaluation. We quickly ran through a routine systems review. He had lost 10
lbs in the past month, the wife mentioned. â€œOh, no, cancerâ€ , was my first thought. His wife
explained that as a New Yearâ€™s resolution he enrolled in a commercial weight loss program for
diabetics. With relief, I knew we had the explanation of his disturbing new symptoms.
Most of my diabetic patients are on medication since they are unable to maintain good glucose
control with diet and exercise only. If they succeed however, in achieving weight loss then the
diabetes medication must be reduced to prevent undesirable hypoglycemia (low blood sugar).
Hypoglycemia is potentially dangerous because the brain cannot function properly resulting in
abnormal behavior, loss of muscle control and even unconsciousness. Imagine this occurring
while behind the wheel? Down here in Florida this is all too common.
Many commercial weight loss programs have started targeting Type 2 diabetics (adult onset)
with their TV ads. These programs are generally administered by people without any medical
background. They cannot advise medication changes (not that you would want them to) without
breaking the law by practicing medicine without a license. The result, as with my patient, is the
development of potentially serious complications of hypoglycemia.
In a previous blog https://www.metabolism.com/2010/10/17/injured-diabetic-diet , I worried that this type of problem could develop with commercial weight loss programs. I didnâ€™t expect to see evidence of it so soon and in my own exam room. If my patientâ€™s wife didnâ€™t stop and mention his new symptoms at the last moment
that day, I imagine a far worse outcome for her husband was possible.
Gary Pepper, M.D.
In a new book, The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain, the authors Judith J. Wurtman, PhD and Nina T. Frusztajer, MD, propose that eating carbs before a meal can actually help weight loss efforts. The connection between carb consumption and appetite suppression is due to a change in brain chemistry that occurs when carbs are eaten before a meal. Their theory is supported by independent research conducted by the authors.
I am intrigued by this new concept because until now I have always considered carbs an appetite stimulant because of their action to raise insulin levels which can then cause blood sugar levels to drop a few hours later, resulting in relative hypoglycemia (low blood sugar) which is a powerful trigger to more eating.
Thanks to the authors and their publisher we are able to provide an excerpt from the book The Serotonin Power Diet, and you can decide for yourself if this is an idea you would like to pursue.
Serotonin: What It is and Why It’s Important for Weight Loss
By Judith J. Wurtman, PhD and Nina T. Frusztajer, MD,
Authors of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain
Serotonin is nature’s own appetite suppressant. This powerful brain chemical curbs cravings and shuts off appetite. It makes you feel satisfied even if your stomach is not full. The result is eating less and losing weight.
A natural mood regulator, serotonin makes you feel emotionally stable, less anxious, more tranquil and even more focused and energetic.
Serotonin can be made only after sweet or starchy carbohydrates are eaten.
More than 30 years ago, extensive studies at MIT carried out by Richard Wurtman, M.D., showed that tryptophan, the building block of serotonin, could get into the brain only after sweet or starchy carbohydrates were eaten. Although tryptophan is an amino acid and found in all protein, eating protein prevents tryptophan from passing through a barrier from the blood into the brain. The reason is simply numbers: Tryptophan competes for an entry point into the brain with some other amino acids. There are more of those other amino acids in the blood than tryptophan after protein is eaten. So in the competition to get into the brain, tryptophan is at a total disadvantage and very little gets in after a protein meal like turkey or snack like yogurt.
But carbohydrates tip the odds in tryptophan’s favor. All carbohydrates (except fruit) are digested to glucose in the intestinal tract. When glucose enters the bloodstream, insulin is released and pushes nutrients such as amino acids into the cells of the heart, liver and other organs. As it does this, tryptophan stays behind in the bloodstream. Now there is more tryptophan in the blood than the competing amino acids. As the blood passes by the barrier into the brain, tryptophan can get in. The tryptophan is immediately converted to serotonin, and the soothing and appetite controlling effects of this brain chemical are soon felt.
Our studies with volunteers found that when people consumed a pre-meal carbohydrate drink that made more serotonin, they became less hungry and were able to control their calorie intake. Volunteers whose drinks contained protein — so that serotonin was not made — did not experience any decrease in their appetite.
Most of us have experienced the carbohydrate-serotonin effect on our appetite even though we were not aware of the connection. Have you ever munched on rolls or bread while waiting for the main course to be served in a restaurant? By the time dinner is served, twenty minutes or so after you ate the roll, your appetite has been downsized. “I don’t even feel that hungry” is a common response when the plate is put down on the table.
This blunting of appetite is not because you may have eaten 120 calories of roll. It is caused by new serotonin putting a brake on your appetite.
Successful weight loss depends on the power of serotonin to control food intake.
The carbohydrate-serotonin connection has a direct impact on our emotional state, too. Drugs that increase serotonin activity have been used for several decades as a therapy for mood disorders. However, our studies showed that natural changes in serotonin could have a profound impact on daily fluctuations in mood, energy levels and attention. In one of our early studies, we found that our volunteers became slightly depressed, anxious, tired, and irritable around 3 to 5 pm every day. At the same time, they experienced, in the words of one volunteer “a jaw-aching need to eat something sweet or starchy.” Several studies later, we were able to state that late afternoon seems to be a universal carbohydrate-craving time, and people who experience this craving use carbohydrates to “self-medicate” themselves. Carbohydrate cravers who consume a sweet or starchy snack are increasing serotonin naturally.
We carried out careful clinical studies to measure the effect of carbohydrates on mood and to make sure that the effect was not just due to taste or the effect of taking a break from work. Volunteers, all carbohydrate cravers, were given a carbohydrate or protein- containing food or drink that had identical tastes. Their moods, concentration and energy were measured before and after they consumed the test beverages. The carbohydrate serotonin-producing beverage improved their moods but the protein-containing beverage had no effect on either their mood or their appetite.
Eating carbohydrates allows serotonin to restore your good mood and increase your emotional energy.
Eating low or fat-free, protein-free carbohydrates in the correct amounts and at specific times potentiates serotonin’s ability to increase satiety. You will eat less, feel more satisfied and lose weight.
Here are five tips to get serotonin working for you:
Eat the carbohydrate on an empty stomach to avoid interference from protein from a previous meal or snack. Wait about 3 hours after a meal containing protein.
The carbohydrate food such as graham crackers or pretzels should contain between 25-35 grams of carbohydrate. The carbohydrate can be sweet or starchy. High-fiber carbohydrates take a long time to digest and are not recommended for a rapid improvement in mood or decrease in pre-meal appetite. Eat them as part of the daily food plan instead for their nutritional value.
The protein content of the snack should not exceed 4 grams.
To avoid eating too many calories and slowing down digestion, avoid snacks containing more than 3 grams of fat.
Do not continue to eat after you have consumed the correct amount of food. It will take about 20-40 minutes for you to feel the effect. Eating more carbohydrates during the interval is unnecessary and may cause weight gain.
Stress may increase your need for serotonin and make it harder to control food intake. Prevent this by shifting protein intake to the early part of the day; i.e. protein for breakfast and lunch and switching to carbohydrates by late afternoon. Eating a carbohydrate dinner with very little protein increases serotonin sufficiently to prevent after dinner nibbling. And the soothing effect of the serotonin prevents stress from interfering with sleep.
Boost Serotonin to switch off your appetite and turn on a good mood.
Â©2009 Judith J. Wurtman, PhD and Nina T. Frusztajer, MD, authors of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain
Judith J. Wurtman, PhD, co-author of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain, has discovered the connection between carbohydrate craving, serotonin, and emotional well-being in her MIT clinical studies. She received her PhD from George Washington University, is the founder of a Harvard University hospital weight-loss facility and counsels private weight management clients. She has written five books, including The Serotonin Solution, and more than 40 peer-reviewed articles for professional publications. She lives in Miami Beach, Florida.
Nina T. Frusztajer, MD, co-author of The Serotonin Power Diet: Eat Carbs — Nature’s Own Appetite Suppressant — to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain, counsels private weight management clients and is a practicing physician and certified professional life coach. She received her master’s degree in Nutrition from Columbia University and her medical degree from George Washington University. She lives in Boston, MA.
For more information, please visit www.SerotoninPowerDiet.com and Amazon.com.
Carb craving seems to be a major hurdle for people with metabolic disorders like diabetes and thyroid disease. Is this just a problem all people face or is there something more specific about metabolic disorders that draws people in the direction of carbs? It is clear that when “insulin resistance” is part of the medical picture that sudden drops in blood sugar that result from this, are most rapidly corrected by consuming sugars and carbs. This may explain part of the attraction.
In her recent book, Eat Your Way to Happiness, expert and author Elizabeth Somer offers readers excellent advice for dealing with cravings and carbs in general.
We thank Elizabeth and her publisher for permission to post this excerpt again:
10 Steps for a Carb Makeover
by Elizabeth Somer, M.A., R.D.,
Author of Eat Your Way to Happiness
If you are a carb craver, you need to treat yourself with a little kindness. It’s not your fault you can’t keep your fingers out of the cookie jar or the bag of chips. You can’t “will away” those cravings. They are hardwired in your head.
So work with your carb cravings. Make sure each meal contains at least one whole grain. Plan a quality-carb snack at your most craving-prone time of the day (typically midafternoon or late evening). To maximize your mood and minimize your weight, you need to take this quality-carb message seriously. That means tackling the issue with a 10-step plan.
Step #1. Purge the kitchen of all white flour. Open the cupboards and toss the junk. Throw out the obvious: the white rice, the instant mashed potatoes, any cracker or cookie made with anything but 100% whole grain (you are pretty much down to Triscuits and 100% Whole Wheat Fig Newtons), all potato chips, Pop-Tarts, boxes of bread crumbs, Pasta Roni, Hamburger Helper, cans of Chef Boyardi Ravioli, Costco muffins and such. Search the freezer for French fries, hash browns, breakfast foods made from processed grains or other high-calorie/low-quality items like Marie Callender’s frozen pasta entrees or pot pies.
Definitely toss your carb triggers, junk foods that you are powerless to resist. Remember, if you have to drive to the store to get ice cream, you will be much less likely to binge.
Then read labels on the rest. If wheat flour or enriched flour is in the top three ingredients on a label, you are holding a poor-quality carb. Toss it.
Okay, okay, if this cold-turkey approach is a bit over the top, then keep two or three junk carbs and toss the rest. But beware: these items may be “trigger” foods that tempt you to indulge. Also, keep in mind that this is not so much about “giving up” as it is giving to” your health, your mood, and your belly and thighs.
Step #2. Restock the kitchen with the 100% whole grains you like, such as 100% whole-wheat bread, old-fashioned oatmeal, Kashi Autumn Wheat Cereal or GoLean Cereal, Zoom hot cereal or instant brown rice. Experiment with new grains, like barley, millet, amaranth, whole-wheat couscous or bulgur.
If you can’t imagine your spouse or kids loving whole-wheat pasta or whole-wheat tortillas, then choose the next best thing. For example, try Aunt Jemima frozen Pancakes with Whole Grains, or tortillas or pastas made from blends of whole wheat and refined wheat, such as Ronzoni or Barilla whole-wheat blend pastas.
Step #3. Switch to quality carbs in recipes. For example, if a recipe calls for
white rice: use instant brown or wild rice, bulgur, millet or other whole grains
flour: use at least half whole-wheat flour
bread (such as French toast): use whole-grain bread
potatoes: use sweet potatoes, yams, squash and/or corn
Step #4. Plan snacks and bring grains with you. When packing your lunch and snacks for the day, make sandwiches with 100% whole-grain bread, use low-fat cheeses such as Cabot Vermont 50% Reduced Fat Cheese, and include other grains like 100% whole-grain crackers or air-popped popcorn.
Step #5. Create nonfood rewards. Praise yourself with a manicure, flowers, a game of golf on Saturday or a Netflix movie. Follow the “if . . . then” rule: if you steer clear of the junk, then you get the back rub, hour of alone time or bubble bath.
Step #6. Take time. Often we grab food before we even know whether we really want it. That knee-jerk reaction gets us into trouble. Take a 10-minute pause before diving into any snack, from popcorn to leftover doughnuts.
Step #7. Identify the craving. Is it for something crunchy or chewy? Cold, sweet or creamy? Once you have pinpointed exactly what you want, then find a low-calorie food that satisfies that craving. Luckily, the better you eat, the more your cravings for fatty or overly sweet carbs will dwindle.
Step #8. Eat breakfast. As discussed in Chapter 2, eat a nutritious breakfast and you are much more likely to resist junk-food temptations throughout the day.
Step #9. Keep hunger at bay. Eat small meals and snacks evenly distributed throughout the day. This helps keep serotonin levels (and other nerve chemicals like NPY) in the normal range.
Step #10. Out of sight, out of mind. Put another way, seeing is craving. Watch out for temptations at the mall, restaurants and friends’ houses. It is easy to overdo carbs when most of the ones offered to you are the low-quality ones. For example, studies at the University of Illinois found that people ate 45% more calories when there was a bread basket placed on the table in restaurants than when the waiter came by and offered them a slice from a basket. Ask that the tortilla chips be removed when dining at a Mexican restaurant and you will save yourself 300 unnecessary calories. Avoid the coffee shop with the display of muffins, scones and croissants.
The above is an excerpt from the book Eat Your Way to Happiness by Elizabeth Somer, M.A., R.D.. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.
Copyright Â© 2009 Elizabeth Somer, M.A., R.D., author of Eat Your Way to Happiness
Elizabeth Somer, M.A., R.D., author of Eat Your Way to Happiness, is a registered dietitian and author of several books, including 10 Habits That Mess Up a Woman’s Diet, Food & Mood and Age-Proof Your Body. She is a member of the editorial advisory board of Shape magazine and editor in chief of Nutrition Alert, a newsletter that summarizes the current research from more than 6,000 journals. She appears frequently on NBC’s Today and other national television shows.
For more information please visit www.EatYourWayToHappiness.com.