The Antidepressant Diet

The connection between carbohydrates, serotonin, and antidepressant weight gain

The Pain of Being Obese versus The Emotional Pain of Dieting

People may be prevented from the emotionally healing benefits of serotonin.


Kara Curtis, an obese woman who was recently interviewed on NPR about her decades- long struggle with her weight, described how despite her commitment to daily exercise, her overeating prevented any weight loss. She described herself as being unable to resist buying and eating sugary food even though she knew, from the many diets she had followed, that she had to ignore those foods to stop gaining weight. Admitting to eating entire boxes of cookies, she blamed the availability of such foods as one factor in her inability to resist them in favor of healthy fruits and vegetables and revealed how helpless she felt in controlling her intake of junk food.

Ms. Curtis is special because she talked honestly about her weight and her conflict over losing it or accepting the way she looks. But her story is unfortunately familiar to the thousands of obese who have the same struggles with weight gain, diet failures and criticism from those who do not understand why they overeat.

When I heard the interview on the radio, I wanted to pick up the phone and say to her, "I understand why you can't stop overeating. The foods you crave and overeat comfort you and take anyway emotional pain and stressful feelings. They diminish your depressed mood and calm anxiety. Diets tell you to stop eating these foods but they don't tell you how to deal with the emotional distress that will follow. So of course you can't stay on a diet long enough to lose any substantial weight. The emotional pain of dieting is greater than the emotional pain of being obese."

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None of us escapes stress; it comes in all forms and can be caused as often by hormones (think PMS), lack of sleep, winter darkness and chronic pain, as by the seemingly infinite ways life has of causing problems. But Nature, in her wisdom, put into our brains a chemical capable of smoothing the emotions caused by stress. Unfortunately, people such as Ms. Curtis may be prevented from the emotionally healing benefit of this chemical because of their obesity and their diets.

Our brains contain a neurotransmitter, serotonin, which functions to restore emotional well-being. Serotonin is made when we eat non-fruit carbohydrates. Then insulin is secreted and an amino acid, tryptophan, gets into the brain. Once in the brain, tryptophan converts to serotonin and a sense of emotional well-being is felt. Studies of this process have shown that people of normal weight need eat only about 25 to 30 grams of a low-or fat free carbohydrate to bring about the changes that lead to serotonin being made. As long as the carbohydrate is low in fat (this speeds up digestion) and low in protein (protein prevents tryptophan from getting into the brain) this process can take as little as 20 minutes.

However, when people become obese, it is harder for their brains to make serotonin than it is for a normal weight individual. Insulin responsiveness is sluggish and tryptophan has a harder time getting into the brain. More carbohydrate may have to be eaten and the process may take longer. Instead of feeling emotional relief after eating ¾ of a cup of Cheerios, an obese person may have to eat twice as much and wait longer for the same sensation of emotional well-being.

But most diets would deny Ms. Curtis even the possibility of eating 1 ½ cups of Cheerios when she is upset. The dieter is usually told to limit or avoid carbohydrates or to eat them only when accompanied by protein. This, of course, will prevent tryptophan from getting into the brain and the desired effect of feeling better won't take place.

Moreover, eating as a way of alleviating emotional pain is considered counterproductive. The dieter is told that eating cookies and ice cream and other sugar-and fat-laden foods has caused her obesity, and the solution to obesity is to find some other solution to stress.

Thus, should anyone be surprised when the emotional need to eat, the need to feel comforted, trumps the need to follow a diet? Imagine a diet that prevents a migraine sufferer from taking medication. You are fine on the diet until the migraine begins. You would instinctively abandon the diet to take the medication. This is what happens to Ms. Curtis. Stress happens, comfort is required, carbohydrates are eaten and the diet is lost.

But this does not have to be the outcome. As we found in our many years of research at MIT, it is possible to consume therapeutic amounts of carbohydrate to increase serotonin and relieve emotional distress. If the carbohydrates are portion controlled, low-or fat-free, and eaten on a precise schedule, serotonin is made. The result is that stress is relieved; plus, the serotonin acts as a buffer against future stress. Ms. Curtis could not eat cookies on such a plan; they are too high in fat. But, along with portion- controlled meals, she could consume pretzels, popcorn, rice crackers, rice, sweet potatoes, whole-grain pasta and oatmeal. She would lose weight. Admittedly, her weight loss would be slow, no more than a pound or two a week, because such a diet plan includes calories from the foods needed to nourish her as well as calories from her serotonin-producing carbohydrates.

Weight loss without emotional pain. It can be achieved.

Judith Wurtman, Ph.D., is the co-author of The Serotonin Power Diet and the founder of a Harvard University hospital weight-loss facility.

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