Secrets of Serotonin

Part One
Moods, Impulses, Appetites, Aches
1
Are You Glad, Sad, or Mad?
Low moods, low energy, headaches, upset stomach, sleep problems, overeating, heavy drinking ... we all have our patterns for responding to the stress and strain of busy schedules and lives. One person may be creative, energetic, and productive for much of the year, yet sag through most of the winter, overeating and oversleeping, like a hibernating bear or a dormant plant. Another may have daily ebbs of energy and mood that can be relieved with a fast-food fix. Someone else may cope well with work and family pressures throughout the week, then get blinding migraines as soon as the weekend comes around.
For most, these mood and energy swings and stress-response patterns aren't disabling or disturbing enough to send us to a doctor or counselor for help. We may see them as inevitable, as just the way we are. Or as an inescapable by-product of high-pressure jobs and family responsibilities. In fact, these chronic, stress-induced problems can be minimized or even eliminated by relatively simple changes in how you eat, exercise, and organize your day.
Have you ever noticed how often these common complaints seem to be linked? A low or anxious mood is almost always accompanied by changes in eating and sleeping patterns. Stress or changes in your eatingand sleeping schedule can trigger a headache. Sometimes it isn't stress but the calendar, the weather, or the time of day that brings a sudden shift in energy, spirits, and motivation. Vast numbers of people hit their lows in the early morning or late afternoon, on cloudy days, during much of the winter, or, for women, during premenstrual days.
Although stress, weather, and season can all bring on a low mood, a headache, or an eating binge, the ultimate cause is internal and chemical. An essential natural substance called serotonin is one of the body's most powerful modulators of mood, appetite, sleep, and pain awareness. It is produced in the brains and nervous systems of humans and animals from specific nutrients in the foods we eat. Avoidable fluctuations in its availability to the brain can bring on depression, anxiety, binge eating, insomnia, headaches, and a host of other common everyday problems.
Many mood-enhancing drugs, from the antidepressant Prozac to the abused drug Ecstasy (MDMA), achieve their effects by increasing the brain's supply of serotonin. You can take nutrition and lifestyle steps to enhance your serotonin supply without drugs to get your mood, appetite, energy, and headache problems under control. You don't need to run ten miles a day or live on raw vegetables and skim milk. This is not a case of "the cure is worse than the disease." You can learn how to ward off your mood and energy lows by scheduling your meals and snacks and choosing mood-enhancing foods. Relaxing, low-impact exercise (for example, walking or cycling) can also help control or avoid stress reactions, such as anxiety and binge eating.
Interested? Read on! The first step is understanding why moods go up and down, and why negative moods so often bring on troubling changes in your sleeping and eating habits.
When Our Moods Just Don't Make Sense
Moods are different from emotions. We feel good when good things happen, bad when we experience something bad. We can feel glad or sad in response to a book, a movie, a newspaper article, a joke, or an insult, orsomething that happened to a friend. We can even feel happy or unhappy because of our thoughts, laughing at something we simply imagine, or frowning over an unpleasant memory.
But our moods often seem to be much more arbitrary, to have little to do with the good and the bad in our day-to-day lives. Moods are almost an internal weather system. A storm front rolls in out of nowhere, and suddenly we walk under a cloud, sullen, slow, and hard to please. Or irritable and anxious, getting angry or worried over trifles. When our mood shifts downward, often our emotional responses become muted or distorted as well. We don't laugh at jokes, we lose interest in normal activities and pleasures, and the little hassles and annoyances of daily life can seem not so little, maybe even unbearable.
Bad moods can come out of nowhere, but often they are surprisingly predictable. You might tend to feel bad in the mornings ("I hate to get up") or the late afternoons ("I just drag"), on overcast days, or for much of the winter. And for many people bad moods are accompanied by binge eating or drinking, or other impulse control problems, such as compulsive shopping or gambling.
The Bingeing Blues-Mood Goes Down, Eating Goes Up
Bingeing is not that wonderful dessert you can't pass up, or the four-star meal the company is paying for. Bingeing is out-of-control overeating and snacking--a compulsion to finish the box of cookies or half-gallon of ice cream when you only intended to have a bite or two. You aren't hungry, you know you've had enough, yet you can't stop. It may not be particularly good and you aren't really enjoying it, but for the minutes that you are working your mouth, chewing and swallowing, your stressed and depressed mood is miraculously better. Alcohol is also a common self-treatment for stress and anxiety. You hold yourself together all day, but need "more than a couple" to unwind in the evening.
Not everyone overeats or overdrinks in response to depression, anxiety, or stress. A substantial number of people lose their appetite along with their good humor, particularly if they are chronically depressed or anxious. They skip meals or push their food around their plate with little interest. However, in our "you can never be too thin" society, these individuals are less likely to complain or worry about the loss of weight they suffer during their depressed or stressed period. The association between negative mood and appetite is so common and so strong that a significant, unexplained weight loss or gain is considered one of the diagnostic signs and symptoms of depression.
The Stressed/Depressed Response
A sad or anxious mood can come out of nowhere, or it can be a response to stress, either a loss or setback of some kind, or more than your fair share of daily pressure. In either case, this misery usually has company. In addition to eating more or eating less, we often sleep more or less when our mood is down, and our mental and physical functioning both seem to suffer.
Negative Mood
Some people are very aware of their own moods; others don't realize that they've been irritable, uncooperative, or unresponsive until they are given that feedback. The range of feelings and behaviors that fit into the general category of "bad" or negative mood is fairly diverse: negativity about oneself or others; lack of pleasure and spontaneity; worry, anxiety, or fearfulness; obsessing about real or imaginary problems; irritability; and, of course, plain old depression.
Stressed/Depressed
Many people are more comfortable with saying that they are stressed, which sounds busy and important, than acknowledging that they might beanxious or depressed, which is still unfairly associated with weakness and mental illness. In reality, there is often not a great deal of difference between the two. Prolonged stress of any sort--physical exhaustion, physical danger, illness, emotional distress, or environmental stressors like inescapable noise--will produce signs and symptoms of depression in animals and humans. Often anxiety precedes or overlaps with the depression. Anxiety is a hyperalert response to threats and to stress, while depression is the body's way of shutting down in the presence of intolerable strain. For some people, the stress response seems to be more sensitive, more easily triggered--for reasons that have more to do with biology than personal character.
Mood Cycles
Everyone has up days and down days, but for many of us they fall into fairly predictable patterns. Our moods, in fact, often follow the course of the sun and the moon. A great many, if not most, people will notice that their mood deteriorates over the course of a series of overcast or stormy days. Some people are very sensitive to the effects of prolonged bad weather and suffer from what is now a well-recognized problem: seasonal affective disorder (SAD). As the hours of daylight diminish in late November and December, sufferers from SAD experience chronic depression, fatigue, overeating, and oversleeping.
Less obviously, many people have a daily mood cycle that they may relate to workplace stress or unhappiness in their job. While stress can certainly contribute, there is often a clear pattern that correlates with time of day rather than with specific events. The cycle varies, but most often sufferers will feel tired and depressed in the morning, perk up toward noon, drag in the late afternoon, then feel better again after dinner.
As for the lunar cycle, mood changes and food cravings are of course very common symptoms of premenstrual syndrome (PMS), and some women can mark the exact days on the calendar when they will be troubled by monthly attacks of bingeing, angry or tearful moods, or migraine.
Sleep
Everyone has been kept awake at night or has awakened in the middle of the night because of a nagging worry; it's annoying but natural and maybe even helpful. You might find a solution to your problem or at least make peace with it by mulling it over quietly. It's much more frustrating and puzzling to be kept awake or to wake up early when there is no specific worry or problem driving your insomnia. Some people find that stressed, depressed, or negative moods will make normal sleep almost unobtainable. They may get intolerably sleepy in the middle of the day, when they need to be alert, then lie sleepless much of the night--falling asleep late or waking much too early. Insomnia is very common in a world of irregular but always busy schedules. Oversleeping is also a possible response to negative mood, and just as annoying to people who complain that they are "sleeping their life away."
Eating
Do you ever eat when you're not hungry, but because you feel bad? Few people binge because they're happy. Cravings most often hit us when we are down. Boredom alone can do it. You watch impatiently as the flight attendants work their way down the aisle passing out snack packs containing such delicacies as stale, strangely tasteless pretzels and soggy, plastic-wrapped muffins. You aren't hungry, the cuisine is hardly wonderful, but eating helps to pass the time. Depression and anxiety can make us yearn for food as a comfort and a diversion--or make eating a difficult and joyless chore. People who binge may not be depressed or anxious on a regular (chronic) basis. However, many report that their episodes of bingeing tend to occur when they are stressed or upset. Eating relieves negative feelings, at least momentarily.
Concentration/Motivation/Activity Level
During periods of anxious or depressed mood, many people report that they are unable to concentrate or that they have problems with theirmemory, think more slowly, and lack their normal energy and resource-fulness. A loss of motivation may be a common factor behind the drop in mental and physical performance. Lowering brain serotonin levels does impair performance on tests of memory and decision making in both animals and humans. The effect on memory is likely indirect, resulting from the serotonin system's role in modifying the activity of another neurotransmitter, acetylcholine.
Pain Awareness
Many people develop headaches, back pain, or other muscle aches when they are tense, unhappy, or angry. People with chronic pain conditions are often aware that stress will bring on another headache or exacerbate the pain of a ruptured disc, arthritis, or fibromyalgia. A few people will experience stress or depression as physical pain, and will present their family doctor with symptoms that they fear are signs of cancer, heart attack, ulcer, or some other disease. Tests will not be able to identify a physical cause of their pain. Once dismissed as hypochondriacs or attention seekers, these individuals are now known to have a distinct way of responding to stress and depression.
You may be so used to some of these familiar stressed/depressed responses that they seem logical to you. "Eating makes me feel better" or "How can I even think of eating when everything is so awful." "Of course, I can't sleep--I'm too worried" or "Sure, I sleep half the day; there's nothing worth getting up for." These explanations and rationalizations do make sense so far as they go. But they do not tell the whole story.

Serotonin: The Mood-Appetite-Pain-Sleep Modulator
Decades of research have demonstrated a very strong link between mood, sleep, appetite, and pain awareness, and serotonin, a necessarybrain chemical. Normally, serotonin helps to regulate and balance these fundamental aspects of our health and well-being. Abnormalities in the amount of serotonin available to the brain have been linked with an impressive variety of disorders and everyday problems. These include:
• Depression
• Mood swings and mania
• Seasonal affective disorder (SAD)
• Premenstrual syndrome (PMS), especially moodiness and food cravings
• Anxiety
• Obsessive-compulsive behavior
• Eating disorders, particularly bulimia and binge eating, plus some forms of obesity
• Sleep disorders, especially insomnia
• Migraine and other types of headache
• Chronic abdominal pain, particularly irritable bowel syndrome (IBS)
• Heightened sensitivity to pain
• Irritability and aggression
• Poor impulse control
• Drug and alcohol abuse
These symptoms and medical conditions often show a great deal of overlap, pointing to a common underlying mechanism. For example, depression and alcoholism have been found to run in families, suggesting an inherited deficiency or instability in serotonin functioning. The same is true for migraine and depression. Studies of bulimia report that bulimics have a higher than average frequency of mood disorders (depression or anxiety) and substance abuse problems--and so do their family members. This symptom overlap is so common that it is often difficult for physicians and therapists to identify the primary or core problem with a patient who complains, for example, of poor sleep, poor appetite, and feeling keyed up or anxious.
Prozac and Company: The Serotonin-Active Drugs
Many of the drugs used to treat these common disorders are known to achieve their effects by acting on the serotonin system. Most antidepressants, including Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine), increase serotonin availability or activity. So does the weight-loss drug Meridia (sibutramine), and the antimigraine medications known as the triptans (sumatriptan, rizatriptan, and many others). What's more, many serotonin-active drugs developed to treat one serotonin-deficient condition are later found to be effective for others. For example, antidepressants are often used to prevent migraine and other forms of chronic headache. They sometimes prove effective for treating binge eating, bulimia, and alcohol abuse as well, problems for which there are few medical treatments available.
Millions of people are happier, healthier, and more productive as a result of serotonin-active medication. While medication is almost always the preferred treatment for severe or chronic mood, eating, and headache disorders, many people don't want to take medication, don't need to take medication, or don't wish to continue taking it for life. Among the millions who have been prescribed Prozac or another serotonin-active drug, only a minority will need to continue taking the drug beyond a few months, or a year or two at most.
What then? How do you avoid hitting another one of life's potholes and finding yourself in another period of depression, anxiety, chronic pain, or bingeing? If you are vulnerable to the mood-lowering effects of stress or season, you will want to do all you can to minimize the toll they take on your health and happiness.
The Serotonin-Friendly Lifestyle
Fortunately there are natural and healthy ways to help keep the brain well supplied with serotonin. An amino acid called tryptophan, which is found in a wide variety of foods, is essential for the production of serotonin by the brain and body. More attention to what you eat and when you eat it--particularly the timing of protein and carbohydrate intake--can do a lot to improve your mood at the times of day when you usually sag or drag.
Serotonin has a role in initiating movement, and movement appears to regulate serotonin in turn. The feel-good effects of a walk or other moderate exercise may be due to release of serotonin in the brain and nervous system. Experiments with animals suggest that the calming effect of chewing may well result from stimulating increased serotonin activity. Chapter 10 will suggest exercises and movement patterns you can use to enhance your body's serotonin functioning.
The effects of diet and exercise are more subtle and more moderate than those of the serotonin-active drugs. However, the simple lifestyle and nutrition changes recommended in this book have no side effects, only benefits! These natural alternatives should not be expected to replace drugs for individuals who really need them, and you should never stop taking a prescribed medication without consulting your doctor.
If your problems with mood, eating, or headache are not severe or disabling, you can learn to recognize and avoid fluctuations in serotonin levels that affect your moods and appetite. Migraine sufferers can reduce the frequency and severity of their headaches by avoiding foods and activities known to trigger migraines as well as selecting those that will raise the brain's supply of tryptophan.
The medical and nutritional information contained in this book can benefit you if:
• You have mild-to-moderate problems with mood, food, sleep, migraine, or IBS and would like to know natural and healthy approaches to their control.
• You are considering taking Prozac, Zoloft, Paxil, or another serotonin-active drug but want to know more about risks, benefits, and alternatives first.
• You are currently taking medication but want to know natural ways to supplement its effectiveness or to avoid a relapse when you go off your medication.
• Someone you care about suffers from one of the many medical conditions related to serotonin deficiencies.

Is It Really Serotonin?
People are complex, and so are their moods, motivations, and behavior, their personal problems, and their medical disorders. At any given moment, the one-word explanation for why you feel and act the way you do is just as likely to be "Susan," "Sunday," or "shopping" as "serotonin." But if your low mood or ill temper doesn't quite make sense to you, or if you tend to feel bad at certain times of the day, month, or year, then it is very likely that fluctuations in brain serotonin activity have a major role in how you feel.
Try answering these questions as honestly and thoughtfully as you can, to see if abnormalities or fluctuations in serotonin activity might be the key to your mood-food-sleep profile. The numbers in parenthesis after each choice are there to help you rate the severity of the symptom.
1. My moods get worse in the late fall or winter:____ no (0)
____ mild problems (1)
____ moderate (2)
____ hard to cope (3)
____ severe/disabling (4)

2. I have problems with overeating in the late fall or winter:____ no (0)
____ mild problems (1)
____ moderate (2)
____ hard to cope (3)
____ severe/disabling (4)

3. I sleep more and feel tired or listless during much of the winter:____ no (0)
____ mild problems (1)
____ moderate (2)
____ hard to cope (3)
____ severe/disabling (4)

4. Cloudy days make me feel depressed, irritable, or low on energy:____ no or rarely (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

5. I snack when I'm not hungry or eat more than I need:____ rarely (0)
____ occasionally, about once a week (1)
____ frequently, 2-4 times a week (2-3)
____ almost daily or daily (4)
____ several times each day (5)

6. My moods go up and down at predictable times of day:____ no or rarely (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

7. I binge-eat or -drink more than I should:____ rarely or never (0)
____ occasionally (2)
____ frequently (4)
____ almost daily or daily (5)

8. My eating habits change when I'm stressed or depressed:____ no or rarely (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

9. I sometimes get angry or tearful for no reason:____ no or rarely (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

10. I have food cravings and mood changes associated with PMS:____ no/not applicable (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

11. People identify me or I see myself as a moody person:____ no (0)
____ yes (3)

12. My weight goes up and down a lot over the course of a year:____ no, or only a 1-5 pound range (0)
____ yes, about a 5-10 pound range (1-2)
____ yes,10-15 pounds (3-4)
____ yes, more than 15 pounds (5)

13. My normal sleep patterns are disrupted when I'm stressed or depressed--producing excessive sleepiness, early morning awakening, or insomnia:____ no or rarely (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

14. My sleep patterns change in the winter:____ no or rarely (0)
____ occasionally/mildly (1)
____ frequently/moderately (2-3)
____ almost always/strongly (4)

15. I get migraines:____ no (0)
____ not me, but other(s) in my family (2)
____ yes (4)

16. I have frequent or severe headaches:____ no (0)
____ yes, frequent (1-2)
____ yes, severe (3)
____ yes, both frequent and severe (4-5)

17. I have frequent episodes of abdominal pain or irritable bowel syndrome:____ no (0)
____ yes, mildly, doesn't really bother me (1)
____ yes, moderately, sometimes bothers me (2-3)
____ yes, severely, has a negative impact on my life/activities (4)

If you scored yourself a 4 or 5 for several items, you should consult a health-care professional if you have not already done so. In addition to medication, behavioral therapy and stress reduction training can be very helpful in gaining understanding and control over these (seemingly) diverse mood, food, sleep, and pain problems. If any of your symptoms are severe or disabling, you should not expect that the health- and nutrition-oriented information provided in this book will offer you a cure. The serotonin-friendly lifestyle can supplement and enhance the effectiveness of medication or behavioral approaches, and hopefully give you a good basis for keeping your mood, food, or pain problems undercontrol in the future, if you are not one of those who require long-term medication use.
If you scored yourself 1 to 3 on several questions, that is a strong indicator of mild-to-moderate serotonin system deficiencies that can be addressed by nutritional and other lifestyle modifications. This book will help you understand your symptoms and spot the times and circumstances that put you at risk for mood drops, headache or abdominal pain attacks, insomnia, binge eating, or other serotonin-related problems. You will learn how to choose meals, snacks, and daily activities that will ward off the low points and the bad days--helping you maximize the time you spend at your peak of energy, productivity, and good spirits. No restrictive diets or elaborate exercise regimens will be required. Instead, the recommendations offered will guide you to select a wholesome variety of good foods and a level of physical activity that suits your health and preferences.
Quite likely, there is no one who can say "I never feel anxious, angry, or sad for no reason," "I never have trouble sleeping at night and staying alert during the day," and "I never binge or overeat." Our schedules and lifestyles conspire against it. More and more of us sit at a desk all day doing jobs that require a sustained level of concentration and effort that we just may not be able to give all day, every day. Overrefined sweet and fattening foods are always readily available to soothe anxiety and tension. There is caffeine to keep us up during the day, alcohol to bring us back down at night. We frequently disrupt our sleep schedule for shift-work, deadlines, or late-night entertainment. Slight inherited serotonin deficiencies can be greatly aggravated by a serotonin-unfriendly lifestyle--the kind most of us practice. Even if your moods, sleeping, and eating are only occasionally thrown out of kilter by your schedule, this book can help you avoid serotonin-related problems in how you work, eat, relax, and play.
If your mood-food-sleep-pain symptoms trouble you, if you would like to get better understanding of and control over them, read on! This book will help you by explaining how and why:
• Mood and impulse control problems arise from biochemical deficiencies, not weakness or lack of will power.
• Abnormalities in brain serotonin are believed to be a major underlying cause of both everyday and severe problems with migraine, IBS, moodiness, and bingeing.
• Biochemistry is not destiny! You can gain control over your mood-food problems through medication, lifestyle changes, or a combination of the two.
• Diet and physical activity impact the brain's production of serotonin.
• Exercise and repetitive physical movements can boost serotonin production.
• Small, simple changes in what you eat and when you eat can help stabilize your serotonin levels naturally.
• Serotonin-active drugs are often effective in treating anxiety, depression, headaches, IBS, and eating disorders--how they work, what they can do, and their risks and side effects.
Healthy foods and regular exercise will be recommended, but you don't have to diet or do strenuous workouts in order to achieve a more serotonin-friendly lifestyle. You only need to pay attention to the timing of your meals and snacks and to their relative protein and carbohydrate content. A simple Food-Mood-Activity Journal will help you prove to yourself that the balance and timing of your protein and carbohydrate intake do make a difference in how you feel, and so do certain types of physical activity. You may find, in fact, that your mood and motivation improve to the level that you are able to pay more attention to your health and fitness--getting more exercise and eating from hunger rather than stress. And that would be the best of all possible outcomes!

SECRETS OF SEROTONIN. Copyright © 1996, 2008 by Lynn Sonberg Book Associates.