The Food/Mood Connection
Controlling Emotional Eating
Kirsten Rokke, PhD
Daniel G. Amen, MD
Amen Clinics, Inc.
Even though you want to stop eating you can’t.
Even though you know the rules to healthy eating you don’t.
Even though you would love to have a smaller waist size you don’t engage in the behaviors to make it happen. Why? Is there one reason or many?
These were the questions Bob sought to answer when he came to our clinic. Bob, was a 56- year- old business executive, a member of his local church, and the chairman of the board of a nationwide organization. He was known to be self-disciplined, a go-getter, and passionate about helping others. What most people didn’t know was that Bob often felt depressed and anxious and struggled with an increasing weight problem. He felt constantly hungry and spent inordinate time each day searching for something to eat. This hunt usually ended by him eating a large portion of pasta, a whole 12 piece pizza, or a 1/2 gallon of ice cream. In addition to gaining weight, he felt an overwhelming sense of fatigue and was becoming unable to concentrate or focus on his duties at work. He was no longer able to participate in the various sports activities that he once so enjoyed.
In examining Bob’s situation we found that he was facing several very difficult business decisions, as well as a marriage in crisis. Together these stressors often work to deplete a person’s serotonin reserves, and as such may play an important a role in depression and eating behavior. Carbohydrate loading has been found by researchers to increase, at least short term, serotonin levels. As a result when Bob ate carbohydrates he actually felt better! It is this type of behavior that is commonly labeled “emotional eating”. We get stressed, our serotonin levels drop, we then feel depressed, or sad…so we eat and we feel better (in the short term). It does not take much thinking to figure out why some people feel that they can’t seem to stop eating. They eat, because they feel better when they do.
We suggested for Bob to go into therapy with his wife and to reduce his stress levels by making some changes at work. He was prescribed a serotonin reuptake inhibitor (SSRI) to boost serotonin levels, and asked to engage in regular activities to strengthen his cardiovascular system several times a week. We also introduced him to healthier eating choices, including the use of a protein shake two times a day, one for breakfast and one for a mid afternoon snack, in addition he was given a wide spectrum multivitamin and mineral supplement. These were accompanied by a balanced Omega -3 essential fatty acid product. These nutritional suggestions were designed to help Bob regain control over his battle with depression and overeating. After implementing his program the biggest change was seen in Bob’s ability to regain his ability concentrate and focus on his job. This change significantly helped Bob regain confidence in his own ability to productively organize his life and his priorities.
Low Blood Sugar and Food Allergies
We wish it was this easy every time someone comes in with complaints similar to Bob’s. However, people with similar problems are not always so easy to untangle. They might be depressed, anxious, tired, and overweight just like Bob, but the common root of their problems might be quite different. Such was the situation of John, a 48 -year -old commercial realtor whose job involved frequent public appearances. Due to several recent bouts with panic attacks and nagging sense of depression he began seeing a counselor. After months of therapy with no change in his situation he came to our clinic on the prompting of his wife, who we had successfully treated for food allergies a few years earlier.
John’s daily dietary pattern reveled he depended on to three cups of coffee in the morning to get going and that his breakfast usually consisted of cereal and orange juice. During the day, he kept himself awake by drinking coffee and munching on carbohydrates such as donuts and cookies. Knowing that panic attacks can be caused by rapid drops in blood sugar, we tested John for hypoglycemia. In addition, because we knew that food allergies and low cortisol levels may also contribute to anxiety and depression we tested John for these as well. John’s test result revealed a low fasting sugar level indicating a possible inability to maintain an adequate sugar levels throughout the night. This night time drop in blood sugar may be one of the reason why John frequently woke up during the night. This pattern is one we often see in clients who are on a diet high in simple carbohydrate or in someone who has an erratic eating pattern. In both cases the person relies on cortisol to mobilize sugar from various storage depots, such as the liver and the muscles, in order to maintain normal blood sugar during the day. Eventually these types of eating patterns exhaust the adrenal glands and greatly reduce their ability to produce adequate levels of cortisol. This condition may even be exacerbated if other emotional or physical challenges are present and require an additional response by the adrenal glands. The adrenals inability to produce adequate levels of cortisol may be one of the primary reasons why John was so tired in the morning and why he relied on his coffee to get going. It was therefore not a surprise when his cortisol test came showing very low levels of cortisol in the morning -a time of the day when cortisol levels should be at their highest. John also tested positive for food allergies. He was allergic to dairy, corn , wheat plus several other food. John was put on a wheat, dairy and corn free diet and was instructed to eat meals every 3 hours. Each meal was designed to contain protein, complex carbohydrates and fat. He was also instructed to have a snack before he went to bed.
Johns’ dietary protocol suggested scrambled eggs with a gluten free toast for ,breakfast, a snack in the mid -morning consisting of nuts /or a piece of fruit. For lunch he was instructed to eat a salad with meat. In the event he didn’t have time for lunch we suggested he make himself a rice based protein shake. His afternoon snack consisted of another rice or soy based protein shake or a piece of fruit. On the days he went to the gym he was instructed to have a protein shake about an hour before his work-out. This would give him more energy and stamina to finish his work-out routine, To compliment his dietary protocol John was given a daily multi-vitamin package that included 2 Omega 3 essential fatty acid capsule and an herbal supplement consisting of Licorice Root and other herbs that would support his cortisol production. In a matter of weeks John’s panic attacks had subsided, he felt more energetic and was once again able to perform at his job. It was hard for John to believe that his panic attacks were caused by such a “simple thing” as food allergies, and an unstable blood sugar level. So, it took him a few times going off and on the program to experience the return of his panic attacks and tiredness before he finally submitted to the fact that his body did better when he ate the right foods regularly, avoided the wrong foods for him, and took his supplements.
Comparing these 2 cases, while Bob’s problems were mostly related to the emotional stressors in his life, while John’s panic attacks, tiredness and erratic (carbohydrate driven) eating pattern was more related to his faulty sugar metabolism, low cortisol levels, and food allergies. These metabolic issues may well have been the reason why counseling was unsuccessful in helping him deal with his panic attacks.
When Susan came into our clinic we were drawn to her engaging personality and outgoing nature. This 33 year old woman had come to our clinic she was sick and tired of how she felt. She was 50 pounds overweight and just never felt good. When asking her about diet she admitted that she lived on cereal, breads, ice-cream, peanut butter, and chocolate. When asked why she ate such a limited array of foods she responded: “I’m a picky eater. I have always been a picky eater. I eat when I’m bored. I eat when I am happy. I eat when I am depressed. Anytime I feel anything I eat. And when I go on a diet where I can’t eat my favorite foods I can only stand it for a couple of days. I just can’t live without my cereal. “I feel like there is something inside of me that drives me to eat”. In describing her relationship to food in this way Susan was describing an attachment beyond a simple emotional eating pattern. Susan was describing an addiction to the foods.
Much research has gone into finding out why people become addicted to certain foods, and recent studies suggest one of the reasons may be related to an enzyme called DPP IV or Dipeptidyl peptidase, an enzyme that help break down wheat and dairy in the digestive tract. If a person is deficient in this enzyme the body, by mistake, may produce beta endorphins, which are substances very similar to morphine. Beta endorphins have the same effect on the body as real morphine and may help explain why some people get addicted to wheat and diary products. Another explanation for food addictions may be found in the antigen-antibody theory that simply states you are often allergic to the food you crave. Ask anyone who loves bread or cheese to stop eating them. They may say it will be easy to stop, however, they often have trouble following through on their promises. Regardless of the biological reason behind certain food addictions, we know that when we take people off wheat and milk they often suffer withdrawal symptoms. While difficult, those who struggle with this problem who have been willing to live a life free of bread and diary will tell you that the pleasure of eating these foods pales in comparison to the misery they experience when eating them.
Overweight, lethargic and food addicted Susan was encouraged abstain from the food she craved (bread, pasta and ice cream). She was also encouraged to eat 5-6 small meals a day meals all consisting of a protein, complex carbohydrates, and fat. She was warned about the possible initial withdrawal effects. She was encouraged to begin therapy to help deal with some of the issues that are common to those struggling with addiction. We suggested she get a personal trainer and to get back into the gym for both cardiovascular and weight bearing exercise three to four times week. Susan responded, as most people do who follow through with our program, she lost weight, felt stronger, less tired, and was better able to deal with her anxiety.
In order to identify the reasons underlying a client’s eating problems we have developed a simple psychological-nutritional road map. Information to build the map comes from a three part questionnaire that includes the following:
Part I : Questions to unmask or identify emotional stressors within the context of family, marriage, relationship and or any work related problems or challenges. If these exist and they are causing mental anguish and stress, we encourage the client seek counseling and the possible use of medication according. See Dr. Amen’s book, Change Your Brain, Change Your Life.
Part II : Take a thorough dietary history and record what the client typically eats during a 4-7 day period. Ask what foods she or he craves. If we see a limited use of food choices, i.e., very few vegetables and fruits, foods containing a high amount of simple carbohydrates, and very few sources of protein, we will often check (1) a client’s vitamin and mineral status or (2) inquire into possible food addictions.
Part III: This is a physical symptom questionnaire that inquires about headaches, sinus problems, digestive complaints, joint and muscle pain, energy levels, sleeping patterns and various emotional states such as fatigue, anxiety, and panic attacks.
If we see any complaints in this category, we seek to rule-out the following:
Food allergies or food sensitivities
Using these and other test results we put together a personalized program (or map) that includes a daily meal plan and a supplement protocol.
Each client is encouraged to commit to follow-up sessions once a month by phone or by scheduling a 30 minute visit. These follow-up visits often continue for over a year, in order to ensure that we can quickly address any issues that they may encounter along the way. These visits also help us modify a client’s program to meet their changing need. Mid-course modifications are often needed when we deal with a client who is losing weight. Caloric intake will change during the course of the treatment as muscle mass increases and metabolic systems become more efficient. Some may also need to have their medications checked.
Follow-up visits also become a way of staying accountable and keeping in touch during a process that for many is novel and not necessarily easy. Clients that maintain an active relationship with a local counselor during this process often have an increased chance to complete the program and reach their psychological and health related goals.
Over time, we have had great success with this these interventions and encourage all mental health providers to familiarize themselves with the symptoms surrounding the “food-mood” connection. Similar to Bob, John and Susan, many clients may present with complaints commonly found within a psychological diagnostic model, but may also require an intervention above and beyond standard psychological care.
The national cost of depression and obesity exceeds 150 billion dollars a year. Although staggering in its immensity, this cost does not reflect the emotional and physical toll that both of these conditions extract from those whose lives are shadowed by them. No amount of funding can repay or compensate someone for lost dreams, a broken relationship, or a life not lived to its fullest.
Previously, therapists have developed a good working relationship with a local psychiatrist to optimize a client’s med management. Following this model, we encourage current therapists to develop a productive relationship with a highly skilled nutritionist or nutritionally oriented professional, in order to support a clients nutritional requirements. We would also encourage therapists to become familiar with the issues surrounding the “Mood-Food” connection by investigating in books such as “Making A Good Brain Great” by Dr. Amen; “The Food/Mood Connection“ by Dr. Gary Null; and “Food and Mood” by Elizabeth Somer. Should you desire further information about our work at the Amen Clinics go to www.amenclinics.com
Kirsten Rokke, PhD, Nutritionist
Daniel G. Amen, MD is the Medical Director and CEO of Amen Clinics, Inc and author of 20 books including Making A Good Brain Great and Change Your Brain, Change Your Life.