Hi {!firstname_fix}
Here is your weekly copy of our new online newsletter. I think you will be pleased.
Warmly,

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November 17, 2003

** Quote From Kathleen **

The reason people continue to stay dysfunctional is the other well meaning folks take away the logical consequences of behavior.

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** Testimonial for the Week**

There is a great deal of talk over on the parents list about reconciling how we were with our children *before*... It is hard to remember the failed promises and short tempers, the spiciness and la-la about our own parenting when sugar addiction is running.

I want to offer you some solace about how forgiving our children are. This is a poem my daughter wrote. I hope you love it as much as I do.

Kathleen


Mommy's Love

I remember running through the mud
with my new shoes when you told me not to

I remember cuddling up in the green chair
to listen to Watership Down

I remember hot dogs & rice, moths on the wall,
crawling in bed with mommy

Teaching me how to stop sucking my thumb
how to stop biting my nails
how to keep the nightmares away

Teaching me about my body
my imagination
my strengths and weaknesses

I remember waking on my birthday
to receive a beautiful amethyst ring

I remember driving together to Indiana
to experience my first conference

I remember how you flew me back
to be where I needed to be

Teaching me about the validity of my own decisions
about starting to heal from within
about different lifestyles and being truly loved

Teaching me about going where my heart is leading
about relationships and true commitment
about mommy's love

I remember seeing you hold my first son for the first time
you chanting, crying, loving him
in those first moments of life
like you have loved me all these years.

j. Blair

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** Your Last Diet: More Than What You Think**

Many of you have asked me what YLD is *really* about. The chats we do every week are just awesome. We all come away feeling filled up. And the scope of the chats is WAY beyond weight loss. Really, YLD is a place to learn and grow and feel great. Read this Thursday noon chat led by Patti and Sheila. Or come see the Index of all the chats I have done for the past year.

(Click on any word that is underlined to see its content. You will need Adobe Acrobat to read the Index. If you do not have it, it is easily downloadable from the Adobe site.)

You can get a lifetime membership to Your Last Diet Online with the wonderful support of a caring, compassionate community of people committed to healing.

http://www.radiantrecovery.com/YLD_signup.htm

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** Featured Product **

Making plans for the holiday? Take some shake.

Concerned the sound of the blender will wake your mother-in-law? Get a quiet mixer.

Driving a long way in the car with your kids? Take some cheese snacks.

Gee, we have something for everybody in our store

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** Science Tip **

Was There Really a Problem With Phen-Fen?
by Kathleen DesMaisons, Ph.D.

After the great flurry of concern about the impact of Phen-fen, a number of people wondered if the FDA should have taken the drug off of the market. Were the problems people reported really an effect of the drug, or were they simply a function of obesity?

Three new studies have recently been reported in the New England Journal of Medicine. All of them did an in-depth look at matched groups of obese subjects. All three concluded that there was a "significantly higher prevalence of cardiac valvular insufficiency" in the subjects who had been taking the drugs. Women taking the drugs had more problems with their heart valves. Taking phen-fen was risky. Many people did not understand what the drug actually did to their body chemistry. They were simply grateful for how it helped them to lose weight.

The two components, fenfluramine and phentermine, had been around for a long time, but it wasn't until around 1992 that they were put together in a patented combination.

Fenfluramine activates the release of additional serotonin which causes an increase in what is called satiety: feeling "full" or "satisfied." Many of us who have lower levels of serotonin keep eating because our satiety thermostat doesn't work properly. The higher levels of serotonin released by fenfluramine cranked up the satiety thermostat. But this effect was achieved at a price. The extra serotonin also had an effect on other tissue (like heart valves).

In addition, the brain downregulates in response to the extra serotonin. When the person stopped taking the drug, she could be more depressed than when she started. Fenfluramine was contraindicated for persons who were alcoholic, who often experienced paranoia, depression or psychosis. There was little discussion of these cautions.

The other half of Phen-fen, Phentermine, is actually one of the family of amphetamines. It, like "speed," increases the metabolism of your cells. It was clearly contraindicated for anyone with a history of drug abuse. Nothing was said about persons with an addictive biochemistry who did not use illicit drugs but had the same biochemical vulnerability. As the brain down regulated in response to the "speed" effects, the impact would diminish unless the dosage were increased.

The combination of these two drugs as Redux created major biochemical changes in the brain and other tissues. Those feelings of desperation and hopelessness -- which many folks felt when the drug was taken off the market -- were chemically very real. Many people were actually experiencing withdrawal and didn't know it. They were simply desperate to have the drug which helped them lose weight. "I don't care if it kills me, I am going to Europe to get it!"

Obesity is real, painful and devastating. We are desperate not to be fat. We want a solution, sometimes even at huge risk. I believe if we understand our bodies, and we understand what these drugs are trying to do, we can find solutions which give us results without the risk. Granted, doing it with food is slower and takes more work, but it sure keeps you safe!

Khan MA, et al., The prevalence of cardiac valvular insufficiency assessed by transthoracic echocardiography in obese patients treated with appetite-suppressant drugs. N. Engl. J. Med., 1998 Sep 10;339(11):713-8.

You can read any of these articles by going to PubMed.
Do a search by author by putting in the last name and initial like this - Panksepp, J.

http://www.ncbi.nlm.nih.gov/PubMed/

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** Featured Topic

What About All Those Other Food Plans?
by Kathleen DesMaisons, Ph.D.

“I am so confused about all these diets. I don't know what to do,” wrote one Potatoes Not Prozac reader. I can't blame her. Everyone's confused these days. There has been a major shift in the public's thinking about the “best' way to eat in the last ten years. For quite a while experts told you that low fat/high carbohydrate was the way to eat. Now other experts are saying high protein/low carbohydrate. Feels like a 180-degree turnaround. Who are you to believe?

Let's walk through the different stories of these experts and help you make sense of them. First, let's do an overview. During the Eighties, a growing consciousness about the need to pay attention to food started to emerge. At that time, the emphasis was on fat. You were told to reduce your fat intake in a major way. Pritikin and McDougall started the discussion. In 1990 Dean Ornish continued it with his groundbreaking work on heart health (1), then published Eat More, Weight Less in 1993. Ornish told us; “You can eat all the following foods whenever you feel hungry until you feel full,” and he included beans and legumes, fruits, grains and vegetables. Soon low-fat/no-fat foods-and their accompanying marketing campaigns-became the American way.

But these high-carbohydrate plans did not work for many of you. You were religiously eating pasta and bagels and getting fatter and feeling more out of control daily. Rumblings about the role of insulin in your weight and your health started to emerge. Atkins and his Dr. Atkins' New Diet Revolution resurfaced, Barry Sears published The Zone (1995), the Eades published Protein Power (1996) and the Hellers (2) picked up on Judith Wurtman's work at M.I.T. on serotonin and started talking about carbohydrate addiction in the Carbohydrate Addict's Diet. Finally, Sugar Busters (1995) proclaimed the evils of sugar.

It was at this point that I wrote Potatoes Not Prozac, and introduced my theory that sugar sensitivity was an underlying cause of carbohydrate craving. By encouraging people to go off of sugar but eat a nightly potato, my book may have seemed to add confusion to the story.

Still, you read the book and started to work the Potatoes Not Prozac plan. You began feeling steady and clear. You were free of cravings, your impulsivity had quieted. You lost weight, but not thirty pounds in thirty days. You started to wonder if maybe Dr. Atkins' New Diet Revolution or the Carbohydrate Addict's plan might be a better alternative to lose weight. Maybe potatoes weren't such a good idea. After all, Sugar Busters says no potatoes, potatoes are like sugar. Confusion, definitely.

Let's see if we can sort this out. Before starting your program, it is critical that you understand the context of its guidance. Once you do, you will start to sort out the issues and make informed and thoughtful choices about what to eat in order to get the results you want. My intention is to provide you with not only stability and weight loss, but also a lifestyle change that will eliminate food cravings, even out your mood swings, increase your self-esteem and give you a lifelong solution.

We'll start by taking a look at the power and limitations of each of these programs. I want you to be able to really understand and discern the reasoning behind each one. Let's make sure that the Potatoes Not Prozac plan is really the right destination for you.

The ‘Diet Revolution’

Robert Atkins has been a lone and persistent voice about the negative effects of insulin for more than twenty years. Many of us tried the Atkins diet back in the Seventies when his book Dr. Atkins' New Diet Revolution first appeared. Atkins says that hyperinsulinemia is the prime culprit in our being fat. High levels of insulin, he says, contribute not only to obesity, but also to high cholesterol, high triglycerides and diabetes. Atkins' solution is to shift to a low-carbohydrate, high-protein and high-fat diet.

He urges people to get themselves into a ketogenic state-one in which the body is burning its own stored fat as energy. He encourages people to shift from the use of carbohydrate fuel to the use of fat fuel. When this happens, the body throws off ketones. You can test your level of ketones (which Atkins claims is a measure of fat burning) with a dipstick easily obtained at the local pharmacy. Or you can learn to recognize the telltale acetone breath of ketosis and know you are on the right track.

Atkins' plan is very appealing. You can have steak, bacon, cheese, eggs, butter and cream. Staying away from desserts doesn't seem so bad in the face of the comfort of fat. And, most important to many of us, the Atkins plan promises dramatic results quickly. You lose weight. You lose weight fast. And you seem to feel terrific.

So what's the problem? Atkins is right on the money about insulin. High levels of insulin do affect your health. Insulin resistance is a significant variable in your weight loss equation. But ketosis is not the way to get there. Yes, you want your body to burn fat, but you want it to do that in a healthy way. Ketosis signifies that something is off balance. It is not a natural and healthy state to be in. In addition, higher fat levels contribute to insulin resistance, the very thing you are trying to heal.

The Atkins plan, done well, also creates a huge problem in your serotonin and beta-endorphin systems. If you follow Atkins to the letter, you will minimize your insulin production, which is his goal. But to make serotonin, your body requires insulin to move tryptophan (an amino acid from the protein you eat) from your bloodstream into your brain. If you don't have a carbohydrate-only insulin response to help tryptophan cross the blood-brain barrier, your serotonin level will drop. Your ability to “just say no” will drop dramatically. Your depression will return with a vengeance.

Six or eight weeks in, you will be one cranky puppy. And then you will try just a little something sweet and your cravings will awaken. The sleeping giant of your sugar addiction, now roused, will take you to the bakery, the ice cream store or the bar. You will feel wonderful with the “just a little” something, truly, truly wonderful: mellow, relaxed, hopeful and peaceful. So “just a little” more seems fine. Then you will wake up two weeks later to discover that you are in full-blown relapse. And you can't stop. Your impulse control mechanism, which is dependent upon serotonin, is shot. This is called rebound and you are in big trouble.

Now it's even more difficult to find your way back to success with the Atkins plan. The higher levels of fat you have been eating on the plan have actually made you more insulin-resistant, have disturbed your serotonin levels and set you up for serious beta-endorphin priming. The Atkins promise fails you.

Trying Out ‘The Zone’ and ‘Protein Power’

The Zone was more tempered in its instructions. “Balance,” Barry Sears said, “seek balance.” The formula 30-40-30 became a key word in our vocabulary as many of us worked hard to get Sears' ratios down at each meal. You were promised a slim body and high energy forever if you worked hard to master the formula. But many of us with scattered brains and impulsive behavior soon drifted away from the rigor Sears demanded. Your 30% carbohydrates could be jellybeans or white bagels. Even his special “Zone” bars have sugar in them. The thin ones who went to the gym every day anyway kept on counting and balancing. The rest went back to their couches and desks, still looking for a cure.

Protein Power, the book I consider the mother of The Zone, though it wasn't actually published until one year later, seemed more promising. Like Atkins, the Eades talked about the need to control insulin levels by shifting away from carbohydrates and moving toward protein and fat.

Protein Power seemed softer and more sensible than Atkins. While promising as dramatic results, it offered a plan that was workable. You felt better, lost weight, and kept working at it. But something was missing. Six to eight weeks into the plan, you started getting restless. You noticed carbohydrates wherever you went. Bagels and muffins started calling you again. Many of you slipped, had a few servings of your favorite comfort food-and found yourself sliding into a disaster of bread, cookies or ice cream. It made no sense to you that you fell off the program so quickly.

The Zone and Protein Power do leave you less vulnerable than the Atkins plan. The “balance” guides you with a healthier and more reasonable pattern. Keeping your fat level at 30 percent protects you from fat-induced insulin resistance. But both plans, done well, will also contribute to a problematic drop in serotonin. The clarity and focus you felt for six to eight weeks on the plan will start dissipating. The diet starts to seem “too restrictive” and once more you are on the prowl. This is low serotonin speaking, not low will power. You are craving carbohydrates, but in actuality, this is your brain needing serotonin.

‘Maybe I'm a Carbohydrate Addict’

Then you turned to the Hellers' Carbohydrate Addict's Diet, which put into words your underlying intuition that something more was going on for you than just trouble staying on a food plan. The term “carbohydrate addict” touched a nerve. You knew you felt like an addict around carbs or sweets. You might not have talked about it much, but in your heart and in your cells, you knew what it meant to feel helpless and out of control around carbs.

The Hellers repeated and expanded the story about the importance of insulin. They promised that if you had your carbs in a particular way and at a particular time of day, you could eat whatever you wanted. Their idea of a “reward meal” was thrilling. You knew you could do anything you had to during the day if at 6:10 p.m. you could get bread, wine, pasta and ice cream as your reward.

The Hellers also promised that your reward meal would help to take care of your serotonin level, which controls your feeling full. The reward meal would raise your serotonin, thus quieting your cravings and controlling your addiction. It was an awesome promise. Pay attention, be rigorous all day, then get a “reward.” You only had to wait until evening and then you would be fine. And you would lose weight, feel great and never have to diet again.

The problem is, your “reward meal” was a ticket to disaster. It reinforced the core of addictive thinking. Rather than quieting your cravings, you were simply cutting a deal. When you chose your favorite reward foods, you were priming your beta-endorphin level, leading it to expect, in fact to demand, more of the same. So the very thing you believed was the source of your comfort (the reward) was actually feeding your addiction and reinforcing your cravings.

The addiction part of your biochemistry is not about low serotonin, it is about beta-endorphin. The reward meal boosts your beta-endorphin level temporarily and, a short while later, sets off cravings. Eventually you slip off the plan. First, your reward meal continues beyond the allotted hour. Then the reward becomes a binge. Three weeks later, you wake up in shame, horror and confusion. You don't know what hit you. What happened? What happened was your beta-endorphin system getting dramatically out of balance.

At this point you may have tried Dean Ornish's program. It didn't last long. His admonition that “You can eat all the following foods [including bread and pasta--KD] whenever you feel hungry until you feel full” made no sense for your sugar-sensitive body and your addictive relationship to food. It didn't address the compulsive aspect of your eating, which you could no longer deny. In fact, it reinforced your interest in lots and lots of nonfat bread stuff.

Finally, you came to Sugar Busters. This was straight forward. “Just say no to sugar,” they said, reinforcing all the messages you have heard all your life. They told you that all white things were bad. Stop eating bad stuff was the message. Gamely, you tried it. But you dropped into headaches, irritability, and serious cranky. After all this experience, you began to sense that indeed, there might be more to the story than just saying “no” to sugars and carbohydrates. You knew that there is more to the story. Your body knew and had been telling you all along. And now your brain was following the clues you body had been sending. You wanted the rest of the story.

Looking at these different programs together, it is easy to see that none of them addresses all three biochemical systems that affect your emotional well being and your ability to stick to a food plan. If you don't understand and meet the needs of all three-blood sugar/insulin, serotonin and beta-endorphin-you will continue your lifelong struggle with food cravings and addiction.

Finally, Potatoes Not Prozac

Getting you working with all three biochemical systems was my goal in Potatoes Not Prozac, which slipped into this “diet” controversy in 1998 without much fanfare. The title was deceptive because the real story in the book was about sugar sensitivity. It was a story that said that your compulsive and sometimes addictive eating was a function of imbalanced brain and body chemistry. While Potatoes Not Prozac didn't address weight loss specifically, it outlined an intriguing concept. It suggested that your body overreacted to carbohydrates. You were carbohydrate sensitive. Sugar-sensitive. You produced more insulin than your thin or non-sugar-sensitive buddies. In addition, you also had a lower level of serotonin, which made you more vulnerable to depression, alcoholism and compulsive eating. Your lower serotonin also contributed to moodiness and impulsivity, and accounted for your inability to say no.

You began to find Potatoes Not Prozac an intriguing story. You were floored by how you resonated with its message. You felt as if the book was written for you personally. How could anyone know you this well? You were particularly intrigued by the new information about beta-endorphin. Beta-endorphin, as we have seen, contributes to craving in a major way. You learned you might have inherited a naturally low level of this brain chemical and that low level makes you love the total well-being you temporarily feel when you eat or drink alcohol, ice cream and breads.

Even more striking to you was the explanation that your beta-endorphin level affects your self-esteem. When your level is low (or you are in beta-endorphin withdrawal), you feel hopeless, fat, ugly and overwhelmed. When it is “high” (so to speak), you are confident, energetic and ready to take on the world. And while you had always noticed these dramatic changes in your mood and optimism, you had never before made the crystal-clear connection between what you ate and how you felt.

The Potatoes Not Prozac plan very quietly and very simply says, “Let's get to the heart of the story. Let's heal the problems that make you fat, make you impulsive and make you crazy.” It provides one simple, uncomplicated program to reduce your insulin, repair insulin resistance, increase your serotonin, and minimize your cravings by stopping the beta-endorphin priming. The Potatoes Not Prozac plan takes care of the whole package with a food plan that not only works but heals. It is a long-range solution, not a quick fix.

The plan is simple but deceptive. Mastering three meals a day at regular intervals is harder than it seems. Learning what and when to eat takes work and attention. Designing your own plan, knowing your own style and being in relationship to your body is a totally different approach. The Potatoes Not Prozac plan does not tell you what to do. It teaches you why you are the way you are. It provides a context of meaning for your body and your brain chemistry. It teaches you about being sugar sensitive and what you can do about it.

1 Dr. Dean Ornish's Program for Reversing Heart Disease
2 Authors of The Carbohydrate Addict's DietB

Here is one of our community member's reaction to having done Atkins:

After a disrupted childhood and depressive (and overweight) adolescence and early adulthood I had finally been feeling happy - reasonable weight, engaged to a great man, professional job I love - with lots of exercise, sports psychology and positive thinking backing me up. In fact in the last couple of years my life has been getting better and better.

So good, in fact, that I thought I'd go on a diet and try to lose those last 15 lb before the wedding. I went on Atkins and felt *so* good... for a while. Then I'd "lose my willpower" and end up bingeing on cookies and candy - junk food I hadn't touched for years. Worse, with the wedding coming up I panicked about gaining weight and started throwing up - I'd had bulimia in college and later in grad school and had finally taken an SSRI to combat it. But this time it was so fierce - the cravings and the impulse to purge were like nothing I'd ever felt before.

With the psychological skills I have built up over the past few years something in my head was saying "this isn't me, this just isn't me, I am happier than this - what is going on with me?". As part of the diet I had started keeping a food journal. One weekend in desperation I went through it to see if I could figure out what was going on. From the food journal I started to see patterns: I'd start on Atkins, and feel absolutely great for about 4-6 weeks. Then the cravings would start and then the bingeing and purging. But only every other day. For about a week. Then I'd renew my resolve and get back on the diet... I had repeated this cycle four times before I stepped back and recognised the pattern. I thought "there is something going on here, and it's not just low willpower."

I pulled out a big nutrition book I had and in the footnotes it mentioned that Atkins sometimes causes sugar cravings, possibly due to low serotonin. Ah ha! So I went to the biggest bookstore in town and trawled the diet aisle. I found your book and read the whole thing in one sitting - but, I must confess, alongside a big sugar binge, staying up until 4am!!

Everything matched exactly with what I had been noticing in myself. Apparently I had been loving Atkins because the low carbs bit was keeping my blood sugar even. But after about a month my serotonin levels were so depleted that I couldn't see straight. Finally my body would win and I would binge and purge repeatedly until my body scraped together enough serotonin for me to feel happy and confident again - and then I would give it another go, starting another low-serotonin cycle!!

So I changed priorities - from losing weight to upping my serotonin.

I can't tell you how relieved I am to see that it was all biochemical! In fact, I went back and reconstructed my diet and my moods over the past five years and it all fits the pattern. I was typically low-serotonin, either from eating carbs with too much fat (from binge eating), or from eating almost no protein (trying to be low fat), or or from eating no carbs (from Zone and Atkins). Since I had tried so many diets and none of them had worked for long I had thought that it must just be me.

Thanks for pulling the research together and writing the book - I now look forward to the rest of my life where healthy eating, steady energy levels and even-keeled emotions are as ordinary as brushing my teeth and going to the dentist twice a year - ie, something to be dilligent about, but really just a routine and inobtrusive part of my life, not the main game.

anonymous

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(c) Kathleen DesMaisons 2003 All Rights Reserved