I recently received a "less than nice" letter telling me I don't understand what it's like to be an "emotional eater." The email took me by surprise, because nothing could be further from the truth. If anyone understands, I do, as I suffered from bulimia for YEARS, so much so that it almost killed me. Just this week I was asked to be a volunteer speaker on behalf of the National Eating Disorder Association, and that invitation along with the "emotional eater" email inspired me to write a blog on Food and Mood.
My painful journey with bulimia began when I was a senior in high school. I started binging and purging, because I thought it would be an easy way to drop weight, which would ultimately make me faster on the soccer field. I was a big-time soccer player, but every once in a while, someone would say “You’re a little slow” or “You need to pick up speed,” and instead of doing the smart things, like eating healthy and sprint workouts, I fell into the deadly trap of bulimia. It was an innocuous beginning and I didn't think much of it when I casually went to the bathroom after eating lunch, stuck my finger down my throat and made myself vomit. NEVER did I think that moment would trigger years of a horrific relationship with food.
When I started my plebe year at West Point, my binging and purging increased in frequency, probably because we had public weigh-ins. All of us cadets, wearing gym uniforms and light blue, flimsy flip-flops, would nervously line up behind a scale at 5 AM. Then each of us would step on the scale while one upperclassman would weigh us and call out our weight to another upperclassman who’d record it on a piece of paper. The public weigh-in sessions only exacerbated my fear of gaining weight, which continued to fuel my cycle of binging and purging. Plus, the worst thing a female cadet at West Point can be is fat.
The highly addictive component innate to bulimia, but often not discussed in the literature, was also extremely difficult to overcome. As a bulimic, I felt like a drug addict. But worse than being a drug addict is that a bulimic is addicted to food, something you can't give up or shun. Even on days when I wanted to stop or on days when I didn’t have the urge to binge and purge after eating, I’d do it anyways, because I was addicted to the way it felt. It's as if my body expected to vomit after every time I ate and my physiology craved it. Purging felt like such a release, a catharsis and simply calming. I wasn't just throwing up food, but a bad day, an argument, muffled emotions, a lack of control, insecurities,.. etc. It was TOTAL emotional eating. Of course, after about 10 minutes, I’d feel utterly fatigued, useless and more often than not, would climb into bed and sleep.
Why am I writing about my bulimia days? Because my eating became so dysfunctional that it began to take a humongous toll on my mood. I was sluggish, moody, dehydrated and became more and more socially withdrawn. Even my grades started to suffer, and I felt like my abilities to concentrate and memorize had faded away. People thought I was depressed and suggested I see a counselor, but because I felt ashamed about bulimia, I suffered silently and didn’t get help. I was even prescribed antidepressants for my “depression,” which only made me more miserable. On some days, I even contemplated suicide. I remember being in tears on my graduation day from West Point, which should have been one of the happiest days of my life, but I was crying, because I felt like I had lost all control over my eating and knew bulimia was ruining my life.
When I finally got help for my eating disorder and began to eat healthy meals again ( and keep them down), my mood improved tremendously. I was more energetic, engaged in activities, able to concentrate, no longer fatigued and happier overall. Though many people labeled me a depressive and though I demonstrated many symptoms of depression, I know now that many of my symptoms were a direct result, or at least exacerbated, by my eating disorder. My body was starving for the right nutrients, so of course my mood was suffering. Food IS mood. Today, my experiences with bulimia and depression remind me to always evaluate and reevaluate the foods I am or am not eating when I start to feel sluggish, depressed, irritated or anxious. If our diet is off, everything will be off, including our moods, and no amount of antidepressant, or any pill for that matter, can correct a problem that starts with a poor diet. Many times it’s a food problem, not a pill problem.
Many experts suggest particular foods for preventing depression, and a lot of the recommended foods are ones that increase serotonin production. Of course, this is because it’s hypothesized that low levels of serotonin cause depression. I want to stress that the popular serotonin hypothesis is just that- a hypothesis. It has not been proven. There are other theories for depression, including a problem with neuroplasticity, or how a brain responds to stress( internal and external stimuli), and there’s also the vascular theory that suggest ischemic changes in the brain create depressive symptoms. It’s good to keep these alternative theories in mind when someone tells you to eat something that boosts your serotonin levels. That said, here are some top foods that increase serotonin levels in the brain: oats, brown rice, broccoli, spinach, cauliflower, whole wheat pasta, cottage cheese, nuts, turkey, fish, chicken and eggs.
Experts also recommend eating a diet high in omega-three fatty acids, since low levels of omega-three fatty acids have been implicated in depression. (I’ll write about more about the omega-three theory in a later blog). You can also supplement with omega- three fatty acids, but good food-containing sources are flax seed, flax seed oil, fish, nuts (especially walnuts), oregano, grape leaves and spinach.
If you feel irritable and anxiety-like symptoms, you may want to reduce your caffeine intake, since caffeine can stimulate our nervous systems to the point of exacerbating our irritability and anxiety. A lot of caffeine can also dehydrate a person, and dehydration alone can make someone feel sluggish and depressed. Personally, I love my cup of coffee and would feel extremely irritable and sluggish without it, so that’s why I strongly feel one’s consumption of a particular amount of coffee ( or not) should be a personal choice. Different people have different sensitivities to caffeine, so not everyone will respond the same way to coffee. I always find my 2 cups of coffee in the morning are the exact jolt I need to start my day. With coffee, I’m much more energetic, engaged, focused and dare I say, happier? Without it, well, without it, no one would want to be around me for very long. Also, my blood pressure runs very low, which is possibly another reason I’m a huge caffeine fan.
Also, There are a couple of studies that indicate coffee may help fight depression. One study, conducted by the Harvard School of Public Health, analyzed 50,739 women and discovered that depression was 20% less likely in women who drank four or more cups of coffee per day. Another study conducted by the Institute of Public Health and Clinical Nutrition in Finland, concluded that coffee consumption may reduce the risk of depression in Finnish men. Since caffeine has a wide list of pros and cons, I’d recommend charting how you feel after each cup of coffee you drink for 2 weeks or so. Write down how you feel after drinking coffee to help decide if you should be drinking it at all, and, if so, if you need to cut back or perhaps even drink more. Ask yourself and write down answers to sample questions, such as the following: Do you feel more irritable? More alert? More anxious? Less sluggish? Are you focusing better or worse? Your answers to those questions will help you weigh the pros and cons and be a helpful self-assessment for how to adjust your caffeine consumption.
Low Vitamin B12 levels have also been implicated in depression. Vitamin B12 is a crucial vitamin and involved in the metabolism of all of our cells, our brains and our nervous systems’ health. If you’re concerned with your B12 level, my best advice would be to have your level checked by your doctor. You can purchase Vitamin B12 as a supplement, but you can also obtain it from meats, fish, poultry, milk and eggs in your diet. (Vegetarians, take note!)
I’d also recommend eliminating or cutting back on artificial sweeteners, such as aspartame, though this is a controversial topic and recommendation. Of course, if you struggle with sugar control or diabetes, this may not be an option, and like with any health choice, you have to weigh the pros and cons. On a personal note, I eliminated artificial sweeteners from my diet and feel it has improved my mood and lessened my frequency of mood swings, but that doesn’t mean the same is true for you. There’s an abundance of controversial literature about aspartame’s safety, and whether or not it contributes to certain diseases, headaches, obesity, cancer and even speculation that if exposed to heat, it produces formaldehyde, which is toxic to our bodies. I’m not sure if any of that is true or all of that is true. In fact, most of the scientific literature supports that aspartame is safe. The reason I eliminated aspartame from my diet was because of a paper I read when I was simultaneously suffering from depression, looking for alternative cures and chewing a lot of sugar-free gum and drinking a lot of diet soda. The paper, by Dr. Ralph Walton, a psychiatrist and medical director of Safe Harbor Behavioral Health, is title, “Adverse Reactions to Aspartame:Double-Blind Challenge in Patients from a Vulnerable Population” and published in Biological Psychiatry in 1993, which shows that people with mood disorders are hypersensitive to aspartame. The study’s findings sparked my interest, so I read another paper by Dr. Walton in which he describes a female, depressed patient whom he was treating with the antidepressant, imipramine. After 11 years of doing well on imipramine, the female patient suffered a seizure and manic episode. The only recent change in her life was a switch from using regular sugar to aspartame. When Dr. Walton asked her to eliminate aspartame from her diet, the patient recovered and was successfully treated with imipramine once again. In the paper, Dr. Walton makes reference that he’s observed many psychiatric patients who seem to do worse if aspartame is part of their diet. It seems to aggravate depression and even trigger manic phases. Of course, these are merely case studies and not randomized controlled trials, but it was enough for me to give up aspartame and see if it made a difference. I felt better after giving up aspartame, and in addition, I felt less bloated and didn’t have as many food cravings, so, overall, it was a great diet decision for me. According to Walton’s paper, aspartame can impair absorption of L-tryptophan, which is a precursor to serotonin. The phenylalanine portion of the aspartame molecule serves as a precursor to the norepinephrine-dopamine synthetic pathway, and aspartame may also inhibit acetylcholinesterase, an enzyme which breaks down acetylcholine, an active neurotransmitter in the brain.
Daily fluctuations in blood sugar can have a great impact on one’s mood. For example, too little sugar can create hypoglycemia, making you feel sluggish, depressed or tired. Too much sugar can create hyperglycemia and make you feel overly anxious, irritable and jittery. When it comes to your blood sugar, the goal should be stability. The best way to achieve stability is to eat a balanced diet, for example a protein along with a complex carbohydrate, as protein causes blood sugar levels to rise more slowly than carbohydrates. A great chart to follow for stabilizing blood sugars is the glycemic index, which ranks foods on how fast they raise blood sugar levels. If you decide to use the glycemic index, remember that “lower is better.” Foods that have a higher glycemic index raise your blood sugars faster and foods that have a lower glycemic index raise blood sugars more slowly. Also, avoid high-sugar foods that have the potential to raise your blood sugar to the point of being on a “sugar high,” only to crash to very low levels in an hour or two. High sugary foods will only sabotage your efforts for preserving a good, healthy mood.
Avoid perfluorinated compounds, found in many non-stick cooking ware and prepackaged food items, such as pizza boxes or microwavable popcorn bags. The reason many companies package foods in boxes containing perfluorinated compounds (PFCS) is because they are highly stable molecules and water-resistant. PFCS have been implicated in a variety of mental ailments, most lately the impulsivity seen in kids diagnosed with ADHD. If you’re going to cook, it’s best to go with cast iron or stainless steel pans.
I also want to mention food allergies and irritable bowel syndrome, because if what you’re eating is aggravating your gut, your mood will also become aggravated. Both your mind and body can’t function optimally if your source of energy is torturing you rather than nourishing you.
If you think you have a food allergy, my best advice is to 1) either go to your doctor and get an allergy test or 2) keep a chart ( similar to the caffeine chart I mentioned earlier) and write down everything you eat and if what you eat aggravates your gut, causes cramps, diarrhea and so on. You might note specific edible culprits that you should eliminate from your diet. Irritable Bowel Syndrome ( IBS) is one of the most common primary care complaints, yet no one knows exactly what causes it or how to treat it. Many people, mostly women, complain of cramps, constipation and diarrhea upon eating, which in itself can cause someone to become stressed, moody or depressed. Antidepressants and anti-anxiety medication have both been prescribed to treat IBS, because experts speculate IBS is the result of a faulty “mind-body” connection as well as stress. Since stress is usually involved in IBS, I recommend all IBS sufferers tweak their food hygiene practices so as to reduce stress. Here’s a list that may be helpful:
1) When possible, eat in a stress- free environment and do what you can to make your environment stress free.
1) Do you best to find a stress-free, calm, peaceful place to eat
2) Don’t argue and eat
3) Don’t try to solve stress work or family problems when you eat
4) Don’t take stressful phone calls while you eat
5) Think about positive and calming things
2) Practice Mindful Eating
1) “Order Arms” while you eat. This is something I had to do during my cadet basic training at West Point, and magically I have a use for it again! Use your eating utensil to pick up a piece of food, put it in your mouth, drop the fork or spoon back down on the table (“Ordering Arms”) and chew slowly. This will help you from shoveling food into your mouth and concentrate on what you are chewing.
2) Practice the “5 senses” routine while you’re chewing. While you’re peacefully chewing your food, ask yourself what it tastes like, smells like, feels like, and what it sounds like when you chew it. Obviously admire the looks of your food before you put it in your mouth! ;) This exercise will help get you in the moment and focused on enjoying your delicious meal rather than stressful thoughts or situations.
3) Be grateful when you eat. Always give thanks, whether out loud or silently, for the food you are eating. Instilling a sense of appreciation and gratitude in yourself is helpful for promoting a positive psychological state and therefore a reduced stress state, which may help prevent any eating issue exacerbated by stress.
And please don’t forget “common sense” when creating your mood-boosting diet plan. It’s truly amazing how people ignore common sense when it comes to dieting, which is why I’m mentioning it. So, just to refresh:
1) Avoid processed foods as much as possible, as they have been implicated in a variety of mental and physical ailments.
2) Avoid foods with added sugar
3) Try not to skip meals
4) Avoid yoyo dieting plans (If it sounds too good to be true, it is.)
5) Avoid excessive alcohol use (An important one, since we have a tendency to want to drink more when we’re feeling sad!)
6) Get an optimal number of calories into your system. Not too high and not too low.
The bottom line with choosing what foods to eat or not to eat to maintain a good mood is a very personal and individualized choice.
We have to take into account food allergies, food preferences, meal time hygiene, meal preparation time, the availability to certain foods, the amount of time a person has to eat and when exactly a person is hungry. ALL of those things vary from person to person which is why it’s so important to monitor our diets, diet habits and how one feels after eating a particular food. For example, I know someone who can’t stand the sight of fish. I certainly wouldn’t advise him to eat fish for its omega-three fatty acids. Another person I know has a severe gluten allergy. I wouldn’t tell her to eat many of the complex carbohydrates that contain gluten. Another person has zero time to cook, so I wouldn’t ask him to prepare a “mood-enhancing” meal rich in serotonin, magnesium and omega-threes. Because so many variables are involved in determining a person’s diet for maintaining an optimal mood, each person needs to be aware of those variables and keep a record of them. In short, each person needs to be his or her own scientist. Get a little self-reliant and do an experiment. If you want an optimal diet for YOU, you have to figure out what works for YOU.
I challenge you to create and maintain a food chart for the next 2 weeks. In one column, write down what you ate. Write down how long it took you to prepare the meal, or if you bought it, write down from where. Write down how long you had to eat. Document how you feel right after you eat, and then document how you feel an hour or two after you eat. Are you tired? Energized? Satiated? Bloated? Having stomach pains? Also describe the environment in which you ate. Was it stressful? Relaxing? Did you eat too fast? Too slow? Make a note of it and make observations, so at the end of your 2-3 week experiment, you will be able to notice trends or changes that you need to make in order to improve your diet, diet habits and subsequently, your mood. Yes, this project is YOUR self-reliant, scientific , self-experiment, but if you make a chart, it’s also a great tool to present to a therapist, wellness coach, significant other or trusted friend to help you navigate your way to an optimal diet plan!
P.S.: Today's dose of Nature therapy. I took this photo while jogging in Ibiza, a really beautiful place you all should visit if you can. :)