Effects of Eating Behavior on Mood: AReview of the Literature

Larry Christensen

(Accepted 14 September 1992)

The literature focusing on the use of food as a regulator of a negative mood state is reviewed.This literature reveals that individuals experiencing a negative mood state arising from dis-orders ranging from tobacco w/thdrawa/ to premenstrual symptoms make use of carbohy-drate ingestion, especially simple carbohydrates, to provide a temporary lifting of mood.However, other evidence suggests that some individuals may obtain a more permanent con-trol of their negative mood state by eliminating simple carbohydrates from their diet. Whilethe literature is consistent in demonstrating that carbohydrate consumption can alter a neg-ative mood state, the underlying mechanism mediating this relationship is unknown. © 1993by John Wiley & Sons, Inc.

FOOD AS A MOOD REGULATOR

Mood is a word that is frequently used interchangeably with other terms such as emo-tion (Thayer, 1989). Although there is considerable overlap, moods are generally con-sidered to differ from emotions in terms of their nonspecificity or pervasiveness (Morris& Reilly, 1987) and are frequently conceptualized along the dimensions of positive andnegative affect (Watson & Clark, 1991). A negative mood state is generally viewed asbeing aversive and something to be avoided whereas a positive mood state is desirableand something to be maintained. Given the aversive characteristics of negative moodsand the desirable characteristics of positive moods, it would seem logical that we wouldbe motivated to avoid or eliminate a negative mood state and to maintain a positivemood state.

Morris and Reilly (1987) proposed the idea that individuals may engage in a varietyof behaviors for the purpose of regulating their mood state. Their review of the litera-ture revealed that some evidence (e.g., Clark & Isen, 1982) existed indicating that indi-viduals regulate good moods by acting in such a manner as to maintain the positivemood. However, most studies have focused on the incentive for regulating negativemoods probably due to its aversive nature. Morris and Reilly's (1987) review of the self-regulatory literature revealed that a behavior such as alcohol consumption seems to be

Larry Christensen, Ph.D., is Professor of Psychology, Department of Psychology, Texas A&M University. Addressreprint requests to Dr. Christensen at TAMU Department of Psychology, College Station, TX 77843.

International Journal of Eating Disorders, Vol. 14, No. 2, 171-183 (1993)(c) 1993 by John Wiley & Sons, Inc. CCC 0276-3478/93/020171-13

171 Christensen

an effective mood enhancer. Other behaviors such as self-reward or exposure to rein-forcing events were of questionable value. One behavior that has been overlooked isthe self-rewarding mechanism of food consumption although this is perhaps the mostcommon form of indulgence.

During the past decade studies have documented that specific types of food tend tobe consumed more frequently during specific mood states. For example, Lyman (1982)found that subjects requested to imagine a variety of mood states perceived that thepreference for junk foods (foods with a value of -10 or less according to Jacobson's Nw-triiion Scoreboard; Jacobson, 1975) would increase during negative moods such as frus-tration and depression and that the preference for healthy foods would increase duringpositive moods such as happiness. Although such data suggest that the preference fordifferent foods varies with different emotions, they do not provide any indication as towhy an alteration in emotions may be accompanied by an alteration in preference forspecific foods. There is, however, a literature demonstrating that specific foods seem tobe consumed for the purpose of ameliorating a negative mood state. This paper presentsa review of the literature suggesting that food is frequently used in the self-regulationof negative mood.

In reviewing the literature, there are two approaches that emerge regarding the useof food as a mood regulator. Specific foods seem to be consumed by individuals af-flicted with one of several disorders in an attempt to provide some relief from the neg-ative affect accompanying that disorder. Other research has suggested that eliminationof specific foods is an effective technique for ameliorating a negative mood state. Eachapproach will be reviewed.

FOOD CONSUMPTION AND THE SELF-REGULATIONOF MOOD

Regulation of Tobacco Withdrawal Symptoms

It is well established that tobacco use is reinforcing and provides a strong motivationto continue self-administration. This reinforcement seems to come from the tobacco'sstimulant, relaxation, and stress countering effects (Russell, Peto, & Patel, 1974). Nico-tine, the major psychoactive element in tobacco, enhances cognition and psychomotorperformance (Mangan, 1982; Parrott & Winder, 1989; Hindmarch, Kerr, & Sherwood,1990). In spite of these seemingly positive effects, it has been well established that to-bacco use constitutes a health hazard prompting a desire in many to eliminate its use.

Although there are sufficient health, economic, and social factors (Gritz, 1980) moti-vating abstinence from tobacco use, it is generally believed that behaviors such as smok-ing are very difficult conditions to terminate. This difficulty seems to exist primarilyamong heavy users of tobacco such as smokers of at least one pack of cigarettes a day.Schachter (1982) reported that over 70% of heavy smokers and only 11.8% of light smok-ers had difficulty in quitting. The difficulty in quitting apparently stems from the expe-rience of withdrawal symptoms (Pederson & Lefcoe, 1976). The withdrawal symptomsrange from mild to severe dysphoria, tobacco cravings, mood changes, sleep distur-bances, fatigue, concentration difficulties, and increased appetite (Gritz, 1980; Myrsten,Elgerot, & Edgren, 1977). To combat the effect of these symptoms most individuals usesome substitute such as food, exercise, or nicotine gum (Pederson & Lefcoe, 1976).

Nicotine gum has been demonstrated to decrease most of the withdrawal symptoms

Effects of Eating 173

(Hughes, Gust, Skoog, Keenan, & Finwick, 1991). However, little if any attention hasbeen devoted to the effectiveness of exercise or food although there are some data in-dicating that the altered food preference accompanying cessation of tobacco use is mo-tivated by its effect on the withdrawal symptoms.

Investigation of the altered appetite accompanying cessation of tobacco use has beenstimulated by the repeated demonstration of a weight gain following smoking cessa-tion. Both animal (Grunberg, Bowen, Maycock, & Nespor, 1985; Grunberg, 1983) andhuman (Grunberg, 1985; Hall, McGee, Tunstall, Duffy, & Benowitz, 1989; Rodin, 1987)studies have demonstrated that the increased appetite and accompanying weight gainfollowing termination of tobacco use is due to an increased consumption of simple orrefined carbohydrates. This increased appetite for sugary foods could be due to the in-creased preference that quitters have for sweet tasting foods (Redington, 1983). How-ever, smoking does not alter the perceived intensity of taste suggesting that theresponsiveness of the taste buds are not altered (Redington, 1983). Additionally, quit-ters who did not gain weight demonstrated the same degree of preference for sweettasting foods as did those who gained weight indicating that it is the expression of thepreference and not the preference per se that is related to the increased caloric intakefrom sweets (Rodin, 1987).

Grunberg (1986) has suggested that the increased consumption of simple carbohy-drates represents an attempt to modulate and improve mood thereby diminishing theseverity of the withdrawal symptoms. This suggestion is supported by evidence (e.g.,Brzezinski et al., 1990; Rosenthal et al., 1989) indicating that carbohydrate intake im-proves mood and diminishes the severity of symptoms similar to many of those occur-ring from tobacco withdrawal.

Bowen, Spring, and Fox (1991) provide some evidence of the modulating effect thatcarbohydrate ingestion can have on tobacco withdrawal symptoms. Individuals smok-ing at least 15 cigarettes daily for 2 years were randomly assigned to a high-carbohydrate, low-protein diet plus 50 mg/kg/day of 1-tryptophan or a low-carbohydratediet plus placebo while participating in a behaviorally oriented smoking cessation treat-ment program. Results revealed that the high-carbohydrate plus 1-tryptophan group ex-perienced significantly less anxiety and less severe withdrawal symptoms than did thelow-carbohydrate plus placebo group. This suggests that the increased carbohydrate in-take characteristic of abstinent smokers represents a form of self-reward or self-medication to reduce the severity of the withdrawal symptoms and thereby regulatetheir mood through consumption of simple carbohydrates or sweets.

Alcohol Withdrawal

National surveys of drinking practices have revealed that approximately two thirdsof the U.S. population 18 years of age and older consume alcohol (National Institute onAlcohol Abuse and Alcoholism, 1987). The surgeon general's report on nutrition andhealth (U.S. Department of Health and Human Service, 1988) has identified the reduc-tion of alcohol intake as a primary dietary priority for public health action because it isa factor in several leading causes of death including cancer, stroke, unintentional in-jury, cirrhosis of the liver, chronic liver disease, and suicide. In addition to the healthissues, alcohol use contributes to public safety, family, and work-related problems (Mil-gram, 1990). Such issues have prompted a number of researchers to investigate the mo-tives for consuming alcohol.

Studies investigating the motivation to drink have generally revealed that light drink-

174 Christensen

ers and nonalcoholics consume alcoholic beverages for different reasons than do heavydrinkers and alcoholics. Light drinkers and nonalcoholics are more likely to consumealcohol for sociability reasons such as drinking to be friendly, to celebrate special occa-sions, or when eating a meal, etc. Heavy drinkers and alcoholics are more likely to con-sume alcohol for its drug or relief effect such as drinking to relieve feelings of tension,depression, loneliness, or to receive a lift and combat feelings of fatigue (Beckman &Bardsley, 1981; Graham, 1988; Cahalan, Cisin, & Crossley, 1969). This improvement inmood accompanying alcohol ingestion is accompanied by a more prolonged period ofincreased anxiety and depression (Pohorecky, 1981). However, the initial positive ef-fect and not the more prolonged negative experience is the one that is remembered(Tamerin & Mendelson, 1969). Consequently, it appears as though heavy drinkers andalcoholics are engaged in a form of self-regulation that involves the use of alcohol toimprove mood and a general state of well-being. It has even been theorized that thealcoholic drinks "from a state of pain in order to feel normal" (Milgram, 1990).

When heavy drinkers and alcoholics abstain, there is an increased desire or cravingfor alcohol probably because the dysphoric feelings are not relieved from alcohol con-sumption. To compensate, other substances such as coffee, candy, and sweet drinkshave been suggested as being used in the place of alcohol (Johnston, DeVries, & Hough-ton, 1966; Rosenfield & Stevenson, 1988; Mazdzienz, Goetz, Seanyck, DeVito, & Davis,1981). Verinis (1986) has demonstrated that a significant increase in coffee consumptionoccurs following abstinence from alcohol in recovering alcoholics. Rosenfield andStevenson (1988) have revealed that recovering alcoholic women consume more sweetand starchy foods during days in which they felt more distressed.

This increase in consumption of coffee and sweets during abstinence is reasonablegiven the mood altering effects that these substances can have. Caffeine is generallyregarded as a central nervous system stimulant (Rail, 1980) and often has stimulant andreinforcing effects (Griffiths, Bigelow, & Liebson, 1986) although it may also have de-pressant effects (Veleber & Templer, 1984). Graham (1988) has demonstrated that cof-fee is most likely to be consumed to provide a stimulant effect as well as relief from anegative mood state. Sweets or simple carbohydrates have been demonstrated to pro-vide a temporary elevation in energy levels (Thayer, 1987) as well as a decline in de-pression (Lieberman, Wurtman, & Chew, 1986b; Wurtman, Brzezinski, Wurtman, &Laferrere, 1989). These are the same types of symptoms for which alcohol was previ-ously consumed. Consequently, it appears as though caffeine and sweets may be sub-stituted for alcohol to regulate mood during periods of abstinence.

Bulimia

One of the primary diagnostic characteristics of bulimia includes binge eating or the" . . . rapid consumption of a large amount of food in a discrete period of time" (Amer-ican Psychiatric Association, 1987, p. 68). Binge eating can even be considered a defin-ing characteristic of this eating disorder. A number of studies have revealed that bingingepisodes revolve around the consumption of high fat and carbohydrate foods charac-teristic of many sweets and desserts. Rosen, Leitenberg, Fisher, and Khazam (1986) re-vealed that bulimic patients' binge eating episodes consisted of predominately snacksand desserts. Abraham and Beumont (1982) reported that binge foods were typicallyhigh in both fats and carbohydrates. Mitchell, Pyle, and Eckert (1981) revealed that thetypical binge eating episode involved consumption of high calorie foods such as icecream, candy, or doughnuts. This is similar to Leon, Carroll, Chernyk, and Finn's (1985)

Effects of Eating 175

results indicating that most females preferred to binge on pastries and other soft andeasily consumed high carbohydrate and fat foods.

It has been repeatedly demonstrated that one of the precipitating antecedents of abinging episode is a negative mood state. Schlundt, Johnson, and Jarrell (1985) revealedthat negative moods were predictive of binging whereas positive moods were associ-ated with a reduced probability of binging. Several studies (e.g., Johnson-Sabine, Wood,& Wakeling, 1984; Abraham & Beumont, 1982; Pyle, Mitchell, & Eckert, 1981; Green-berg, 1986) have revealed that both self-reports and measures of stress and depressionas well as symptoms of depression were predictive of binge eating in both an eatingdisordered and a college student population. Greenberg and Harvey (1987) have evendemonstrated that mood lability was the best predictor of binge eating among a non-depressed college sample.

The fact that negative moods precipitate binging episodes has led to the suggestionthat bulimics may be attempting to control or self-regulate their dysphoric mood withfood (e.g., Johnson & Larson, 1982), which would also suggest that the negative moodstate may not only precipitate but it may also maintain the binge eating. Abraham andBeumont (1982) revealed that 72% of their subjects stated that they were free of nega-tive mood states while binge eating. Fernstrom, Krowinski, and Kupfer (1987) and Sch-uman, Gitlin, and Fairbanks (1987) have revealed that depressed individuals increasetheir preference for carbohydrates, particularly sweets, during a depressive episode.Rosenthal et al. (1989) have demonstrated that consumption of carbohydrates can im-prove a depressed mood. To the extent that bulimics binge on carbohydrate-rich foods,such evidence suggests that the binging may represent a self-regulatory attempt to im-prove a dysphoric mood state through ingestion of food.

Seasonal Affective Disorders

Seasonal affective disorder (SAD) is a syndrome characterized by recurrent depres-sions occurring at the same time of the year (Rosenthal et al., 1984). The primary char-acteristic differentiating SAD from a nonseasonal affective disorder is carbohydratecravings or a specific hunger for carbohydrate-rich foods (Wurtman, 1984), althoughSAD patients also experience significantly more fatigue (Garvey, Wesner, & Godes,1988). Some SAD patients crave sweets and chocolates whereas other prefer starches(Rosenthal et al., 1984; Krauchi & Wirz-Justice, 1988). Rosenthal et al. (1989) demon-strated that SAD patients experienced an activation in mood and decline in fatigue fol-lowing consumption of a carbohydrate-rich meal. Such evidence, tentative as it is,suggests that SAD patients may be self-medicating or using carbohydrates to self-regulate their mood.

Obesity

Hopkinson and Bland (1982) reported that 74% of obese individuals experiencing tran-sient episodes of depression also crave carbohydrates, the compulsive eating ofcarbohydrate-rich foods as snacks in addition to regular caloric intake. This inability tocontrol carbohydrate consumption has been suggested as being one factor hinderingthe weight loss of the obese. Lieberman et al. (1986b) hypothesized that the carbohy-drate cravings of the obese may be due to postprandial changes in mood or the tran-sient episodes of depression they experienced. To test this hypothesis, carbohydrateand noncarbohydrate cravers completed a variety of mood indices prior to and follow-

176 Christensen

ing consumption of a carbohydrate-rich meal. The noncarbohydrate cravers experienceda significant increase in fatigue and depression. However, the carbohydrate cravers ex-perienced an improvement in mood or a decline in depression suggesting that the car-bohydrate snack may represent an attempt at self-medication or the self-regulation ofmood. During the transient dysphoric state, cravings for carbohydrates may emerge be-cause of their mood elevating characteristics.

PREMENSTRUAL SYNDROME

Premenstrual syndrome (PMS) is a term that refers to a "constellation of mood, be-havior, and/or physical symptoms which have a regular cyclical relationship to the lu-teal phase of the menstrual cycle, are present in most (if not all) cycles, and remit bythe end of the menstrual flow with a symptom-free interval of at least one week" (Har-rison, Rabkin, & Endicott, 1985). One of the primary symptomatic characteristics of PMSis carbohydrate cravings (Wurtman et al., 1989) although other symptoms such as fa-tigue and depression are also characteristic (Hallman, 1986). Studies (e.g., Lissner,Stevens, Levitsky, Rasmussen, & Stnipp, 1988) have revealed that caloric intake in-creases during the luteal phase of the menstrual cycle and this caloric intake is attainedfrom an increase in carbohydrate but not fat or protein consumption (Dalvit-McPhillips,1983) which is consistent with the demonstration of the carbohydrate cravings charac-teristic of PMS patients.

There are several studies that have related the carbohydrate cravings to alterations inmood. Smith and Sauder (1969) and Bancroft, Cook, and Williamson (1988) have re-vealed that feelings of depression are related to increased appetite and carbohydrateconsumption. Both-Orthman, Rubinow, Hoban, Malley, and Grover (1988) have dem-onstrated that feelings of depression account for most of the variance that exists be-tween mood, appetite, and carbohydrate cravings. These studies indicate that adysphoric mood is somehow related to the increased desire for and consumption ofcarbohydrates. Wurtman et al. (1989) revealed that consumption of carbohydrate-richfoods resulted in a lifting of the depression among PMS individuals experiencing de-pression during the luteal phase of the menstrual cycle. Such evidence suggests thatthe carbohydrate cravings and consumption represent an attempt at self-regulation ofthe dysphoric mood experienced by PMS patients.

ELIMINATION OF FOOD AS A MEANS OF SELF REGULATION

The idea that certain foods may produce a variety of emotional reactions and thatelimination of the offending foods would then counteract these emotional reactions hasa long history but, until recently, little scientific evidence. Mandell and Rose (1968), forexample, presented a case study of a woman experiencing a variety of emotional reac-tions that were believed to be due in part to reactions to a variety of foods. These in-vestigators reported that elimination of the offending foods resulted in an ameliorationof her emotional distress. King (1981) provided some of the initial scientific evidencedocumenting the fact that foods could cause an emotional reaction. Subjects presentingwith one or more psychological symptoms experienced an exacerbation of symptomssuch as depression and nervousness following sublingual administration of an allergen

Effects of Eating 177

extract but not to placebo. Such data suggest that elimination of the food containingthe allergen would at least ameliorate the severity of the symptoms.

More recently a series of studies have been conducted demonstrating the effective-ness of a simple carbohydrate and caffeine free diet in the amelioration of emotionaldistress. Christensen, Krietsch, White, and Stagner (1985) demonstrated that a caffeineand refined sucrose free diet resulted in a reduction of emotional distress and reintro-duction of these substances in a double-blind format resulted in a return of the dis-tress. Several additional studies (Christensen, Krietsch, & White, 1989; Krietsch,Christensen, & White, 1988) have replicated these findings providing confirmation ofthe efficacy of this dietary intervention for ameliorating emotional distress. In a subse-quent study Christensen and Burrows (1990) demonstrated that elimination of caffeineand refined sucrose from the diet was particularly effective in the amelioration of de-pression in a subsample of depressed individuals. Double-blind challenges revealed thatthe simple carbohydrate, refined sucrose, represented the most frequent contributor tothe depression of the sample subjects. Such data suggest that the dysphoric mood ofsome depressed individuals could be self-regulated by the avoidance of such foods. Un-fortunately, most of the sensitive individuals are not aware of the contribution of sim-ple carbohydrates or caffeine to their depression, which means that this mode of self-regulation must be demonstrated to them by either accidental discovery on their ownpart or from another individual such as a mental health professional.

This literature demonstrating that elimination of refined sucrose from the diet of de-pressed individuals can effectively ameliorate depression seems to be inconsistent withthe literature demonstrating that consumption of carbohydrates results in an improve-ment in mood. It appears to represent a contradiction because, on the surface, it wouldseem difficult for the consumption and elimination of a food substance to have a simi-lar effect. However, there is evidence indicating that this dual effect may not representa contradiction but have real substance. Thayer (1987) has demonstrated that the initialeffect of consumption of refined carbohydrates is an increase in energy but the longerterm effect is one of increased fatigue and a decline in energy. This finding of increasedfeelings of fatigue following carbohydrate ingestion is supported by Blouin et al. (1991)who revealed that feelings of fatigue as well as increased cravings for carbohydrate-richFoods increased following a 25-gm glucose load but only in bulimics and not controls.This would suggest that, for a distressed group of individuals, a vicious cycle may becreated where simple carbohydrates are consumed to obtain a temporary relief fromfeelings of dysphoria and fatigue. Following the temporary relief the carbohydrate con-sumption increases feelings of fatigue and dysphoria contributing to the developmentand maintenance of negative affect (Christensen, 1991). It may be, similar to the effectnoted with regard to alcohol consumption (Tamerin & Mendelson, 1969), that it is themore immediate mood elevating or energy enhancing effect that is remembered andnot the subsequent exacerbation and maintenance of negative affect that may accom-pany the carbohydrate ingestion.

POSSIBLE MECHANISM OF ACTION

The use of food to regulate mood has consistently indicated that carbohydrate con-sumption, particularly simple carbohydrates, results in a temporary reduction in nega-tive affect in individuals experiencing a variety of different types of emotional disorders.The most frequently proposed explanation for this carbohydrate-induced effect is the

178 Christensen

effect that carbohydrate ingestion has ori central serotonin synthesis and release (seeWurtman, Hefti, & Melamed, 1981a for a summary of this research). Animal researchhas demonstrated that consumption of a high-carbohydrate and low-protein meal stim-ulates the release of insulin from the pancreas. This insulin release in turn has the ef-fect of increasing the uptake of amino acids from plasma but it also causes nonesterifiedfatty acid molecules to dissociate from albumin and enter adiposites leaving albumin inan unbound state. Tryptophan has an affinity to bind loosely to albumin and whenin.sulin strips the fatty acid molecules from albumin, tryptophan binds to this protein,which spares tryptophan from being taken up by the peripheral cells. This sparing ac-tion increases the ratio of plasma tryptophan to the other large neutral amino acids(LNAA), valine, leucine, iosleucine, tyrosine, and phenylalanine, with which trypto-phan competes for transport across the blood-brain barrier. An increase in the plasmatryptophan/LNAA ratio facilitates the uptake of tryptophan into the brain (Femstrom& Wurtman, 1971), which increases the saturation of tryptophan hydroxylase, the en-zyme controlling the synthesis of serotonin (Carlsson & Lindqvist, 1978), resulting inan increased synthesis of serotonin.

There are a number of studies (e.g. Lieberman, Spring, & Garfield, 1986a) support-ing the hypothesis that carbohydrate consumption mediates its mood enhancing effectsthrough its indirect effect on central serotonin. Most of the supportive evidence comesfrom studies that demonstrate the effectiveness of fenfluramine, a drug that is believedto mediate its effect by causing a selective increase in serotonin-mediated neurotrans-mission, in ameliorating one or more of the symptoms, such as increased carbohydrateconsumption or cravings, accompanying a negative mood state. It is assumed, becausecarbohydrates enhance serotonergic neurotransmission, that if similar acting drugs in-fluence carbohydrate cravings, ingestion, or mood, such evidence also indicates thatthe effect mediated by the carbohydrate ingestion is also mediated by its influence oncentral serotonin.

There are several studies demonstrating the effectiveness of fenfluramine in moder-ating carbohydrate cravings and depression. O'Rourke, Wurtman, Wurtman, Chebli,and Gleason (1989) found that a 15-mg dose of d-fenfluramine reduced the carbohy-drate cravings of SAD patients. A 20-mg dose of d-1 fenfluramine reduced the carbohy-drate snacking among normal weight individuals as well as obese carbohydrate cravers(Wurtman et al., 1981b). Brzezinski et al. (1990) demonstrated that d-fenfluramine notonly relieves premenstrual depression but it also suppresses the carbohydrate cravingsand its concomitant increase in appetite and carbohydrate consumption in women withPMS.

Although several studies have indicated that fenfluramine alters carbohydrate inges-tion as well as carbohydrate cravings, such data should not be construed as represent-ing definitive evidence suggesting that the mood altering effect of carbohydrates ismediated by their influence on central serotonin. Spring, Wurtman, Gleason, Wurtman,and Kessler (1991), for example, speculated that the ameliorating effect of carbohydrateingestion on withdrawal symptoms in abstinent smokers was due to an attempt to el-evate brain serotonin. This hypothesis was tested by administering d-fenfluramine intwo 15-mg doses daily. However, d-fenfluramine not only failed to decrease the sever-ity of most withdrawal symptoms but even increased some symptoms prior to smokingcessation.

There is also evidence demonstrating that the alteration in plasma tryptophan/LNAAratios required for an increase in serotonin synthesis and release does not always occurfollowing carbohydrate ingestion even though mood is altered. Wurtman et al. (1989)did not find a difference in the amino acid profile of individuals with PMS versus con-

Effects of Eating 179

trol subjects following a carbohydrate-rich meal even though the PMS subjects obtainedan elevation in mood not found in controls. Rosenthal et al. (1989) assessed the ratio oftryptophan to the other LNAA in SAD and normal subjects and found no difference inthe two groups casting doubt on the speculation carbohydrates produce their mood al-tering effects in SAD patients by increasing synthesis and neurotransmission of seroto-nin. Caballero, Finer, and Wurtman (1988) revealed that neither a carbohydrate-richsnack nor supplemental tryptophan ingested 2 hours following a standard lunch, ele-vated the tryptophan-LNAA ratio in an obese sample whereas it did in a lean sample.It is the obese sample that receives the beneficial effect from carbohydrate ingestion.Such data reveal that one of the critical biochemical steps required for carbohydrate in-gestion to alter serotonin synthesis and neurotransmission (Wurtman et al., 1981a) ismissing suggesting that the mood altering effects resulting from carbohydrate inges-tion are probably mediated by a mechanism other than, or in addition to, the enhance-ment of serotonin synthesis or neurotransmission.

At the present time, the most accurate conclusion to draw is that the mechanism un-derlying carbohydrates apparent mood altering effect is unknown. This does not meanthat a role does not exist for the effect that carbohydrates may have on central seroto-nin. Rather, that this proposed mechanism provides an incomplete explanation.

SUMMARY OF THE SELF REGULATORY LITERATUREAND RESEARCH SUGGESTIONS

The literature relating to the self-regulation of mood has provided preliminary datasuggesting that individuals suffering from a variety of afflictions ranging from tobaccowithdrawal to premenstrual symptoms may be using food to assist in the regulation oftheir mood. This research consistently suggests that consumption of carbohydrates, par-ticularly simple carbohydrates, assists in the moderation of negative affect. It is impor-tant to be aware of the tentative nature of this proposed connection. At the presenttime there are few studies supporting such a connection although these studies are con-sistent in demonstrating a mood altering effect. These studies need to be replicated andextended before a more definitive conclusion can be reached regarding the self-regulating effects of carbohydrate ingestion. This review is designed to present the pro-posed connection as well as the currently available research to encourage the continuedinvestigation into this area to more definitively identify the role of food, and particu-larly carbohydrates, as a mood regulator.

The literature also demonstrates that consumption of carbohydrates can produce atemporary elevation in mood but elimination of the simple carbohydrate refined sucrosefrom the diet may result in a more permanent reduction. It has been suggested that acyclical effect may be encountered where simple carbohydrate consumption produces atemporary elevation in mood but the longer term effect is an exacerbation and mainte-nance of negative affect. Research needs to be conducted to determine if this cyclicaleffect occurs and whether carbohydrate ingestion or elimination of refined sucrose pro-duces the most effective and beneficial effect in terms of ameliorating a negative moodstate.

The most frequently proposed mechanism by which carbohydrates exert their moodaltering effect is through the influence that carbohydrates have on the synthesis andrelease of central serotonin. However, the literature supporting this speculation is in-consistent indicating that this proposed mechanism is not only tentative but probably

180 Christensen

not the primary route by which carbohydrates exert their mood altering effects. Thisindicates that there is a need for investigation into the mechanisms by which carbohy-drates exert their effect on mood.

SUMMARY

A literature is developing suggesting that individuals use food as a regulator of a neg-ative mood state. Individuals abstaining from use of tobacco as well as alcohol increasetheir consumption of carbohydrates to ameliorate the withdrawal symptoms. Bulimicsbinge during a negative mood state and report that the negative mood state lifts duringthe binge. Individuals with SAD, premenstrual symptoms, and the obese experiencinga transient depressive episode crave and increase their consumption of carbohydrates.This carbohydrate consumption is accompanied by an increase in energy and a liftingof depression.

A variety of studies from several different areas provide converging evidence thatindividuals make use of carbohydrates to provide a lifting of a negative mood state.Although the evidence is not definitive, there are repeated suggestions that the pri-mary carbohydrate consumed for this regulatory function is simple carbohydrates. Thereis also evidence indicating that eliminating simple carbohydrates from the diet may pro-duce a more permanent amelioration of a negative mood state suggesting that the con-sumption of simple carbohydrates may provide a temporary lifting of mood butingestion of this carbohydrate may have the longer term effect of contributing to thedevelopment and maintenance of the negative affect.

Although consistent evidence exists for the role of carbohydrates in the regulation ofmood, there is little evidence suggesting the underlying mechanism. It has been spec-ulated that the regulatory mechanism is the influence that carbohydrates have on cen-tral serotonin synthesis and release. However, the evidence supporting such acontention is inconsistent and indicates that this proposed mechanism provides an in-complete explanation.

REFERENCES

Abraham, S. F., & Beumont, P. J. V. (1982). How patients describe bulimia or binee eating. PsMcholoaical Med-icine, 12, 625-635. b y i,

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised).Washington, DC: Author.

Bancroft J., Cook, A., & Williamson, L. (1988). Food craving, mood and the menstrual cycle. PsychologicalMedicine, 18, 855-860.

Beckman, L. J., & Bardsley, P. E. (1981). The perceived determinants and consequences of alcohol consump-tion among young women heavy drinkers. The International Journal of the Addictions, 16, 75-88.

Blouin, A. G., Blouin, J. H., Braaten, J. T., Sarwar, G., Bushnik, T., & Walker, J. (1991). Physiological andpsychological responses to a glucose challenge in bulimia. International Journal of Eating Disorders 10285-296. J s

Both-Orthman, B., Rubinow, D. R., Hoban, M. C, Malley, J., & Grover, G. N. (1988). Menstrual cycle phase-related changes in appetite in patients with premenstrual syndrome and in control subjects. American lour-nal of Psychiatry, 145, 628-631.

Bowen, D. J., Spring, B., & Fox, E. (1991). Tryptophan and high-carbohydrate diets as adjuncts to smokingcessation therapy. Journal of Behavioral Medicine, 14, 97-111.

Brzezinski, A. A., Wurtman, J. J., Wurtman, R. J., Gleason, R., Greenfield, J., & Nader, T. (1990).d-fenfluramine suppresses the increased calorie and carbohydrate intakes and improves the mood ofwomen with premenstrual depression. Obstetrics and Gynecology, 76, 296-301.

Effects of Eating 181

Caballero, B., Finer, N., & Wurtman, R. J. (1988). Plasma amino adds and insulin levels in obesity: Responseto carbohydrate intake and tryptophan supplements. Metabolism, 37, 672-676.

Cahalan, D., Cisin, I. H., & Crossley, H. M. (1969). American drinking practices. New Jersey: Rutgers Centre ofAlcohol Studies.

Carlsson, A., Finer, N., & Wurtman, R. J. (1988). Plasma amino adds and insulin levels in obesity: Responseto carbohydrate intake and tryptophan supplements. Metabolism, 37, 672-676.

Carlsson, A., & Lindqvist, M. (1978). Dependence of S-HT and Catecholamine synthesis on precursor amino-add levels in rat brain. Naunyn Schnicdeberg's Archives Pharmacology, 303, 157-164.

Christensen, L. (1991). Issues in the design of studies investigating the behavioral' concomitants of" foods.Journal of Consulting and Clinical Psychology, 59, 874-882.

Christensen, L., & Burrows, R. (1990). Dietary treatment of depression. Behavior Therapy, 21, 183-193.Christensen, L., Krietsch, K., & White, B. (1989). Development, cross-validation, and assessment of the reli-

ability of the Christensen Dietary Distress Inventory. Canadian Journal of Behavioural Science, 21, 1-15.Christensen, L., Krietsch, K., White, B., & Stagner, B. (1985). Impact of a dietary change on emotional dis-

tress. Journal of Abnormal Psychology, 94, 565-579.Clark, M. S., & Isen, A. M. (1982). Toward understanding the relationship between feeling states and social

behavior. In A. Hastorf & A. M. Isen (Eds.), Cognitive social psychology (pp. 73-108). New York: Elsevier.Dalvit-McPhillips, S. P. (1983). The effect of the human menstrual cycle on nutrient intake. Physiology and

Behavior, 31, 209-212.Fernstrom, J. D., & Wurtman, R. ]. (1971). Brain serotonin content: Increase following ingestion of a carbo-

hydrate diet. Science, 178, 1023-1025.Fernstrom, M. H., Krowinski, R. L., & Kupfer, D. J. (1987). Appetite and food preference in depression:

Effects of imipramine treatment. Biological Psychiatry, 22, 529-539.Garvey, M. J., Wesner, R., & Godes, M. (1988). Comparison of seasonal and nonseasonal affective disorders.

American Journal of Psychiatry, 145, 100-102.Graham, K. (1988). Reasons for consumption and heavy caffeine use: Generalization of a model based on

alcohol research. Addictive Behaviors, 13, 209-214.Greenberg, B. R. (1986). Predictors of binge eating in bulimic and nonbulimic women. International Journal of

Eating Disorders, 5, 269-284.Greenberg, B. R., & Harvey, P. D. (1987). Affective lability versus depression as determinants of binge eat-

ing. Addictive Behaviors, 12, 357-361.Griffiths, R. R., Bigelow, G. E., & Liebson, I. A. (1986). Human coffee drinking: Reinfordng and physical

dependence produdng effects of caffeine. Journal of Pharmacology and Experimental Therapeutics, 239,416-425.

Gritz, E. R. (1980). Smoking behavior and tobacco abuse. In N. K. Mello (Ed.), Advances in substance abuse(Vol. 1, pp. 1-90). Greenwich, CT: JAI Press.

Grunberg, N. E. (1983). The effects of nicotine and dgarette smoking on food consumption and taste prefer-ences. Addictive Behaviors, 7, 317-331.

Grunberg, N. E. (1985). Nicotine, cigarette smoking, and body weight. British Journal of Addictions, 80, 369-377.Grunberg, N. E. (1986). Nicotine as a psychoactive drug: Appetite regulation. Psychopharmacology Bulletin, 22,

875-881.Grunberg, N. E., Bowen, D. J., Maycock, V. A., & Nespor, S. M. (1985). The importance of sweet taste and

caloric content in the effects of nicotine on specific food consumption. Psychopharmacology, 87, 198-203.Hall, S. M., McGee, R., Tunstall, C , Duffy, J., & Benowitz, N. (1989). Changes in food intake and activity

after quitting smoking. Journal of Consulting and Clinical Psychology, 57, 81-86.Hallman, J. (1986). The premenstrual syndrome-an equivalent of depression? Acta Psychiatry Scandinavia, 73,

403-411.Harrison, W. M., Rabkin, J. G., & Endicott, J. (1985). Psychiatric evaluation of premenstrual changes. Psycho-

somatics, 26, 789-799.Hindmarch, I., Kerr, J. S., & Sherwood, N. (1990). Effects of nicotine gum on psychomotor performance in

smokers and non-smokers. Psychopharmacology, 100, 535-541.Hopkinson, G., & Bland, R. C. (1982). Depressive symptoms in grossly obese women. Canadian Journal of

Psychiatry, 27, 213-215.Hughes, J. R., Gust, S. W., Skoog, K., Keenan, R. M., & Fenwick, J. W. (1991). Symptoms of tobacco with-

drawal. Archives of General Psychiatry, 48, 52-59.Jacobson, M. F. (1975). Nutrition Scoreboard. New York: Avon.Johnson, C , & Larson, R. (1982). Bulimia: An analysis of moods and behavior. Psychosomatic Medicine, 44,

341-351.Johnson-Sabine, E. C , Wood, K. H., & Wakeling, A. (1984). Mood changes in bulimia nervosa. British Jour-

nal of Psychiatry, 145, 512-516.Johnston, N. W., DeVries, J. C , & Houghton, M. I. (1966). The female alcoholic. Nursing Research, 15, 343-347.King, D. S. (1981). Can allergic exposure provoke psychological symptoms? A double-blind test. Biological

Psychiatry, 16, 3-18.Krauchi, K., & Wirz-Justice, A. (1988). The four seasons: Food intake frequency in seasonal affective disorder

in the course of a year. Psychiatric Research, 25, 323-338.

182 Christensen

Krietsch, K., Christensen, L., & White, B. (1988). Prevalence, presenting symptoms, and psychological char-acteristics of individuals experiencing a diet-related mood-disturbance. Behavior Therapy, 19, 593-604.

Leon, G. R., Carroll, K., Chemyk, B., & Finn, S. (1985). Binge eating and associated habit patterns withincollege student and identified bulimic populations. International Journal of Eating Disorders, 4, 43-57.

Lieberman, H. R., Spring, B. ]., & Garfield, G. S. (1986a). The behavioral effects of food constituents: Strat-egies used in studies of amino acids, protein, carbohydrate and caffeine. Nutrition Reviews, 44(Suppl.),61-69.

Lieberman, H. R., Wurtman, ]. J., & Chew, B. (1986b). Changes in mood after carbohydrate consumptionamong obese individuals. American Journal of Clinical Nutrition, 44, 772-778.

Lissner, L., Stevens, J., Levitsky, D. A., Rasmussen, K. M., & Strupp, B. J. (1988). Variation in energy intakeduring the menstrual cycle: Implications for food-intake research. American Journal of Clinical Nutrition, 48,956-962.

Lyman, B. (1982). The nutritional values and food group characteristics of foods preferred during variousemotions. Journal of Psychology, 112, 121-127.

Mandell, M., & Rose, G. J. (1968). May emotional reactions be precipitated by allergens? Connecticut Medicine32, 300-302.

Mangan, G. L. (1982). The effects of cigarette smoking on vigilance performance. Journal of General Psychiatry,106, 77-83.

Mazdzierz, G., Goetz, D., Semyck, R., DeVito, R., & Davis, W. (1981). Coffee consumption among alcohol-ics as a function of time in the hospital. International Journal of Addiction, 16, 253-262.

Milgram, G. G. (1990). The facts about drinking: Coping with alcohol use, abuse, and alcoholism. New York: Con-sumers Union.

Mitchell, J. E., Pyle, R. L., & Eckert, E. D. (1981). Frequency and duration of binge-eating episodes in pa-tients with bulimia. American Journal of Psychiatry, 138, 835-836.

Morris, W. N., & Reilly, N. P. (1987). Toward the self-regulation of mood: Theory and research. Motivationand Emotion, 11, 215-249.

Myrsten, A., Elgerot, A., & Edgren, B. (1977). Effects of abstinence from tobacco smoking on physiologicaland psychological arousal levels in habitual smokers. Psychosomatic Medicine, 39, 25-38.

National Institute on Alcohol Abuse and Alcoholism. (1987). Sixth special report to the U.S. congress on alcoholand health (DHHS Publication No. [ADM] 87-1519). Washington, DC: U.S. Government Printing Office.

O'Rourke, D., Wurtman, J. J., Wurtman, R. J., Chebli, R., & Gleason, R. (1989). Treatment of seasonal de-pression with d-fenfluramine. Journal of Clinical Psychiatry, 50, 343-347.

Parrott, A. C , & Winder, G. (1989). Nicotine chewing gum (2 mg, 4 mg) and cigarette smoking: Comparativeeffects upon vigilance and heart rate. Psychopharmacology, 97, 257-261.

Pederson, L. L., & Lefcoe, N. M. (1976). A psychological and behavioural comparison of ex-smokers andsmokers. Journal of Chronic Diseases, 29, 431-434.

Pohorecky, L. A. (1981). The interaction of alcohol and stress: A review. Neuroscience and Biobehavioral Re-views, 5, 209-229.

Pyle, R. L., Mitchell, J. E., & Eckert, E. D. (1981). Bulimia: A report of 34 cases. Journal of Clinical Psychiatry42, 60-64.

Rail, T. W. (1980). Central nervous system stimulants. In G. A. Goodman, L. S. Goodman, & A. Gilman(Eds.), The pharmacological basis of therapeutics (6th ed., pp. 592-607). New York: Macmillan.

Redington, K. (1983). Taste differences between cigarette smokers and nonsmokers. Pharmacology, Biochemis-try, and Behavior, 21, 203-208.

Rodin, J. (1987). Weight change following smoking cessation: The role of food intake and exercise. AddictiveBehaviors, 12, 303-317.

Rosen, J. C , Leitenberg, H., Fisher, C , & Khazam, C. (1986). Binge-eating episodes in bulimia nervosa: Theamount and type of food consumed. International Journal of Eating Disorders, 5, 255-267.

Rosenfield, S. N., & Stevenson, J. S. (1988). Perception of daily stress and oral coping behaviors in normal,overweight, and recovering alcoholic women. Research in Nursing and Health, 11, 165-174.

Rosenthal, N. E., Genhart, M. J., Caballero, B., Jacobsen, F. M., Skwerer, R. G., Coursey, R. D., Rogers, S.,& Spring, B. J. (1989). Psychobiological effects of carbohydrate- and protein-rich meals in patients withseasonal affective disorder and normal controls. Biological Psychiatry, 25, 1029—1040.

Rosenthal, N. E., Sack, D. A., Gillin, J. C , Lewy, A. J., Goodwin, F. K., Davenport, Y., Mueller, P. S.,Newsome, D. A., & Wehr, T. A. (1984). Seasonal affective disorder: A description of the syndrome andpreliminary findings with light therapy. Archives of General Psychiatry, 41, 72-80.

Russell, M. A. H., Peto, J., & Patel, U. A. (1974). The classification of smoking by factorial structure of mo-tives. Journal of the Royal Statistical Society, 137, 313-333.

Schachter, S. (1982). Recidivism and self-cure of smoking and obesity. American Psychologist, 37, 436-444.Schlundt, D. G., Johnson, W. G., & Jarrell, M. P. (1985). A naturalistic functional analysis of eating behavior

in bulimia and obesity. Advances in Behavior Research and Therapy, 7, 149-162.Schuman, M., Gitlin, M. J., & Fairbanks, L. (1987). Sweets, chocolate, and atypical depressive traits. Journal

of Nervous and Mental Disease, 175, 491-495.Smith, S. L., & Sauder, C. (1969). Food cravings, depression, and premenstrual problems. Psychosomatic Med-

icine, 21, 281-287.

Effects of Eating 183

Spring, B., Wurtman, J., Gleason, R., Wurtman, R., & Kessler, K. (1991). Weight gain and withdrawal symp-toms after smoking cessation: A preventive intervention using d-fenfluramine. Health Psychology, 10,216-223.

Tamerin, J. S., & Mendelson, J. H. (1969). The psychodynamics of chronic inebriation observation of alcohol-ics during the process of drinking in an experimental group setting. American Journal of Psychiatry, 125,886-889.

Thayer, R. E. (1987). Energy, tiredness, and tension effects of a sugar snack versus moderate exercise. Journalof Personality and Social Psychology, 52, 119-125.

Thayer, R. E. (1989). The biopsychology of mood and arousal. New York: Oxford University Press.U.S. Department of Health and Human Service. (1988). The surgeon general's report on nutrition and health (DHHS

Publication No. 88-50210). Washington, DC: U.S. Government Printing Office.Veleber, D., & Templer, D. (1984). Effects of caffeine on anxiety and depression. Journal of Abnormal Psychol-

ogy, 93, 120-122.Verinis, J. S. (1986). Caffeine use in the recovering alcoholic. Alcohol Health and Research World, 11, 64-79.Watson, D., & Clark, L. A. (1991). Self-versus peer ratings of specific emotional traits: Evidence of conver-

gent and discriminant validity. Journal of Personality and Social Psychology, 60, 927-940.Wurtman, J. J. (1984). The involvement of brain serotonin in excessive carbohydrate snacking by obese car-

bohydrate cravers. Journal of the American Dietetic Association, 84, 1004-1007.Wurtman, J. J., Brzezinski, A., Wurtman, R. J., & Laferrere, B. (1989). Effect of nutrient intake on premen-

strual depression. American Journal of Obstetrics and Gynecology, 161, 1228-1235.Wurtman, R. J., Hefti, F., & Melamed, E. (1981a). Precursor control of neurotransmitter synthesis. Pharmaco-

logical Reviews, 32, 315-335.Wurtman, J. J., Wurtman, R. J., Growdon, J. H., Henry, P., Lipscomb, A., & Zeisel, S. H. (1981b). Carbo-

hydrate craving in obese people: Suppression by treatments affecting serotoninergic transmission. Inter-national Journal of Eating Disorders, 1, 2-15.