Sugar Sugar Everywhere!!

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Antidepressants as Antioxidants

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Poor Glucose Tolerance Negatively Affects Mood

weight lossGlucose intolerance is a condition whereby the insulin receptor becomes desensitised to the action of insulin. This prevents insulin lowering blood glucose levels sufficiently in response to carbohydrate consumption, and as a result blood glucose control is diminished. Initially this can raise levels of blood glucose, but rebound hypoglycaemia can also occur whereby blood glucose levels fall too far. One of the main causes of poor glucose tolerance is the consumption of a low quality diet. In particular, the typical Western diet has been shown to lead to the development of insulin resistance and glucose intolerance. Large fluctuations in blood glucose levels can occur as a result of the development of glucose intolerance and this is common in those who regularly consume typical Western food. As the brain requires a consistent and continual supply of glucose for energy production, the fluctuations in blood glucose seen with glucose intolerance can cause significant mood changes, and this can lead to an increased risk of anxiety and depression.

anxiety depression

Those with better glucose tolerance have been shown to have better mood scores compared to those with poor glucose tolerance. Strategies to improve glucose tolerance are therefore a pivotal strategy in improving mood scores. One of the best ways to improve glucose tolerance is to consume a traditional diet. Traditional diets such as the Mediterranean diet have been shown to significantly improve glucose tolerance. This is because such diets supply all the essential nutrients, along with high amounts of plant based antioxidants and dietary fibre. These nutrients work together to improve insulin sensitivity, and this in turn improves glucose tolerance.

A number of studies have investigated the effects of glucose intolerance on mood. For example, in one study, researchers measured the glucose tolerance of a number of individuals and then assessed their mood with a Profile of Mood States questionnaire. Those subjects with a fasting blood glucose level below 6 mmol/L were considered to have better glucose tolerance compared to those who had a fasting blood glucose levels above 6 mmol/ L. The results of the study showed that those subjects with better blood tolerance had significantly better mood scores than those with poorer glucose tolerance. Individually, poorer blood glucose control was significantly associated with decreased energy and increased tiredness. When subjects with poorer glucose tolerance were fed carbohydrate, the energy levels and fatigue felt by the subjects increased with increasing carbohydrate content to the meal. Maintaining a good control over blood glucose levels may therefore be pivotal to maintaining a more stable and consistent mood state.

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Nabb, S. L. and Benton, D. 2006. The effect of the interaction between glucose tolerance and breakfasts varying in carbohydrate and fibre on mood and cognition. Nutritional Neuroscience. 9(3-4): 161-168
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High Glycaemic Diets Negatively Affect Mood

weight lossThe association between the food we eat and health is very well established. We are what we eat, and a low quality diet devoid of essential nutrients is unable to provide the individual with the correct chemicals required for optimal biochemical and physiological performance. With a low quality diet, over time, structural components in the body decay and become dysfunctional and this leads to disease. The brain, as with other structures is reliant on the provision of many nutrients that are only present in high quality diets. Consuming low quality diets therefore causes deterioration in the structure of the brain, and this leads to functional problems. In the short term, this can be seen in mood changes and over longer time spans, serious mental health problems such as anxiety and depression can develop. High glycaemic foods may lead to mood changes because they cause too much variability in blood sugar levels, and this destabilised the function of the brain, through fluctuations in energy levels.

Studies show that increasing consumption of dairy products, fibre, fruit and vegetables is associated with a reduced risk of developing depression. This may relate to the way these foods are able to stabilise blood glucose levels, and this may have beneficial effects on the function of the brain. For example, dairy and fibre can both decrease the speed at which carbohydrate foods are digested, and significantly slow the entry of glucose to the blood from the gut. As fruit and vegetables are rich in fibre, this also explains their beneficial glycaemic effects.

Consumption of sweetened soft drinks, refined foods, and cakes have all been shown to be associated with an increased risk of depression. This may be because they destabilise blood glucose levels. For example, one group of researchers assessed the effects of high and low glycaemic index energy restricted diets on the mood and cognitive performance of overweight adults over a period of 6 months. The researchers noted that the high glycaemic index diet resulted in a worsening of the mood over the course of the diet in comparison to the low glycaemic index diet. In particular, the depression score of the high glycaemic index diet was significantly higher than the low glycaemic index diet group. In another study, researchers also found that consumption of high glycaemic index foods were a risk factor for the development of depression in postmenopausal women. Incrementally increasing sugar intakes were associated with an increasing risk for the development of depression.

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Cheatham, R. A., Roberts, S. B., Das, S. K., Gilhooly, C. H., Golden, J. K., Hyatt, R., Lerner, D., Saltzman, E. and Lieberman, H. R. 2009. Long-term effects of provided low and high glycemic load low energy diets on mood and cognition. Physiology and behavior. 98(3): 374-379
Gangwisch, J. E., Hale, L., Garcia, L., Malaspina, D., Opler, M. G., Payne, M. E., Russom, R. C. and Lane, D. 2015. High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. The American Journal of Clinical Nutrition: 103846
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Panic Attacks: Possible Causes

weight lossAnxiety is a common disorder in the modern Western World, with estimates indicating that 7.3 % of people in the United States may be sufferers. A sudden and extreme (paroxysmal) form of anxiety is a panic attack. It has been estimated that between 1 and 2 % of the population of the United States may suffer regularly from panic attacks with 35 % of the population having had at least one panic attack. Panic attacks can be hugely debilitating for the individual, and sufferers have an increased risk of mortality, particularly from cardiovascular disease and suicide. Panic attacks can be provoked under experimental conditions and a number of triggers for panic attacks are known (see figure). However, despite this understanding about how they can be triggered, it is still not fully understood what the possible mechanisms might be. Also, there is some debate as to whether the pharmacologically stimulated panic attack is actually the same as one that might be experienced naturally during the course of daily living.

anxiety depression

Panic attacks can be induced experimentally in a number of ways. Of these, perhaps infusion of sodium lactate is perhaps the most well studied and consistent. There may be multiple triggers for panic attacks, and for each individual, the trigger might be different.

A number of theories have been suggested to explain the development of panic attacks experimentally. One of these theories suggests that low blood glucose levels are able to provoke the development of panic attacks. Low blood glucose levels are known to induce many symptoms in common with panic attacks including sweating, anxiety, increased heart rate and elevations in blood pressure. However, experiments have shown that low blood glucose alone is not enough to trigger panic attacks in certain individuals. Further, panic attacks can occur under circumstances when blood glucose levels are normal. Therefore peripheral falls in blood glucose may not be reflected by a concomitant fall in neuronal glucose levels. This suggests that the panic attacks that occur as a result of low blood glucose may induce other biochemical changes that then provoke the panic attack. This suggests that it is these biochemical changes per se and not the low blood sugar that may be the cause of the panic attacks.

anxiety depression

Consumption of sugar, high glycaemic index carbohydrates and poor glycaemic control may all be triggers for panic attacks. Avoiding alcohol and caffeine and maintaining adequate intakes of B vitamin, calcium and magnesium are also important.

Another promising theory of panic attacks is the lactate theory of panic attacks. This theory suggests that a raised level of lactate in the blood may trigger panic attacks. When glucose is metabolised, pyruvate can be formed. Under conditions of low oxygen in the cells, some of this pyruvate is converted to lactate. Alcohol, sugar, deficiencies of B vitamin, calcium and magnesium, caffeine and food allergies can all increase the production of lactate from pyruvate and this may provoke panic attacks. This theory is supported by experimental evidence that infusions of sodium lactate can induce panic attacks. The lactate theory of panic attacks suggests that changes to the lactate to pyruvate ratio causes pH changes in the brain which provokes anxiety. High glycaemic index carbohydrates are able to increase levels of blood lactate to a greater degree that low glycaemic index carbohydrates during exercise. In sensitive individuals this may be a contributory factor in the provocation of panic attacks.

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Nutt, D., and Lawson, C. 1992. Panic attacks. A neurochemical overview of models and mechanisms. The British Journal of Psychiatry. 160(2): 165-178
Carr, D. B. and Sheehan, D. V. 1984. Panic anxiety: a new biological model. Journal of Clinical Psychiatry. 45: 323-330
Stannard, S. R., Thompson, M. W. and Miller, J. C. B. 2000. The effect of glycemic index on plasma glucose and lactate levels during incremental exercise. International Journal of Sport Nutrition and Exercise Metabolism. 10(1): 51-61
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Blood Glucose Control Affects Mood

weight lossWith nutrition often the most obvious solutions to problems are overlooked. This is certainly the case with the link between blood glucose levels and mood. The brain is a highly complex organ, and one that uses a large amount of energy. This energy is supplied to the brain almost exclusively as glucose. The brain obtains its glucose, like all organs, from the blood. The amount of glucose in the blood can therefore dictate how the brain functions and this in turn can dictate mood. Because of the sensitivity of the brain to fluctuations of glucose in the blood, the body tries to maintain blood glucose levels within a narrow window. It does this using the hormones insulin and glucagon. Insulin is released following ingestion of food, and the purpose of this insulin release is to transport the newly delivered glucose from the blood into cells and thereby lower blood glucose. Between meals, glucagon is released, and the function of glucagon is to raise blood glucose levels by causing the breakdown and release of stored glucose in the liver.

Insulin and glucagon work together to keep blood glucose levels within a narrow window. In this regard, these two hormones make constant fine adjustments to maintain their homeostatic control over blood glucose levels. In normal healthy individuals, this antagonistic and sensitive hormonal control leads to a stable blood sugar level, and this provides a constant and consistent delivery of glucose to the organs, including the brain. However, if the blood glucose levels are allowed to become elevated or depressed either acutely or chronically, this can have a detrimental effect on the energy supply delivered to the brain. Such fluctuations in energy supply to the brain may be a possible contributory factor in the development of mood disorders. The Western diet is likely a significant factor that leads to poor blood sugar control, and consumption of the typical Western diet may cause detrimental effects to blood glucose levels because the diet contains too much refined sugar and starch, which is absent of its original fibre content.

anxiety depression

Refined carbohydrates can lead to addiction because they cause detrimental changes to neurochemistry. Sugar dependency, is a term used to describe the addictive behaviour displayed by rats fed highly refined sugar and starch.

In the short term, consumption of refined carbohydrate can lead to poor glycaemic control. The fibre present in unrefined sources of starch and sugar tends to reduce the rate that glucose is digested and absorbed to the blood. This facilitates a slow release of glucose to the blood, and this slow trickle of glucose is conductive to good blood sugar control because the correct amount of insulin can more easily be released to match the delivery of glucose. However, in the absence of fibre, too much glucose is delivered to the blood, and this tidal wave of glucose overwhelms the body. The blood sugar levels rise far too high, and in response the body tries to lower them by releasing large amounts of insulin. However, often too much insulin is released and this then forces the blood sugar levels to fall too far. In response the body stimulates the appetite of the individual in order to provide more glucose to raise levels. If more refined carbohydrates are consumed at this point, the cycle repeats and blood glucose levels rise and fall like a yoyo.

The fluctuations associated with consumption of refined carbohydrates can have a significant effect on mood. As blood sugar levels rise, energy levels also rise. It has been demonstrated that consumption of refined carbohydrates can lead to excitement and euphoria. High intakes of sugar can cause neurochemical changes in the brain. One of these changes is an increase in the production and release of the neurotransmitter dopamine and another can be an increase in the stimulation of opioid receptors. This response to sugar is similar to the response seen when addictive drugs are taken, and this explains the evidence that highly refined carbohydrate foods cause addiction in animals and humans. Such neurochemical changes have been termed ‘sugar dependence’ when they occur in experimental rats. This addictive property explains why those individuals under stress often turn to refined carbohydrate foods when they are under stress. Such neurochemical changes do not occur when unrefined carbohydrates are consumed.

anxiety depression

Poor glycaemic control may be a significant factor in the development of detrimental mood changes. Evidence suggests that high and low blood sugar can cause a number of mood changes including depression and anxiety.

Low blood sugar levels may also lead to detrimental changes to mood. As blood levels fall, the body responds with a number of hormonal changes that are aimed at increasing blood sugar levels and stabilising energy levels. One of these changes is the release of adrenaline. Evidence suggests that elevated levels of adrenaline are associated with anxiety, and may be a causative factor in the development of anxious behaviour. Certainly the symptoms of panic attacks, a severe form of anxiety, are very similar to the symptoms experienced when adrenaline is released. The release of adrenaline that can occurs with low blood sugar levels is associated with anger, frustration and aggression. Low blood sugar levels are also associated with lethargy and apathy and can even induce stupor and sleep. This explains the cycle of manic behaviour often seen in those with poor glycaemic control. As blood sugar levels rise, euphoria develops, only to be replaced with a tiredness and exhaustion as blood sugar levels once again fall.

If the Western diet is consumed chronically, insulin resistance can develop. Insulin resistance is a condition that desensitises the insulin receptor to the actions of insulin, and this causes insulin to  lose the ability to lower blood glucose levels. As a result blood sugar levels tend to remain elevated above their normal physiological levels, and insulin levels can also become elevated in response to this. Such chronically elevated levels of glucose are associated with detrimental changes to mood including depression. A number of studies have investigated the association between the elevated levels of blood sugar seen in those with type 1 and type 2 diabetes and depression. Generally, findings of such studies show that depression is associated with hyperglycaemia in patients with diabetes. In addition, studies also suggest that hyperglycemia in patients with diabetes is associated with anxiety. Chronically elevated levels of blood sugar may therefore have a significant detrimental effect on mood.

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Avena, N. M., Rada, P. and Hoebel, B. G. 2008. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews. 32(1): 20-39
Breggin, P. R. 1964. The psychophysiology of anxiety: with a review of the literature concerning adrenaline. The Journal of Nervous and Mental Disease. 139(6): 558-568
Lustman, P. J., Anderson, R. J., Freedland, K. E., De Groot, M., Carney, R. M. and Clouse, R. E. 2000. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes care. 23(7): 934-942
Anderson, R. J., Grigsby, A. B., Freedland, K. E., De Groot, M., McGill, J. B., Clouse, R. E. and Lustman, P. J. 2002. Anxiety and poor glycemic control: a meta-analytic review of the literature. The International Journal of Psychiatry in Medicine. 32(3): 235-247
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Kasani (Cichorium intybus): More Evidence of Liver Protection

weight lossKasani (Cichorium intybus), also known as chicory, is a perenial heraceous plant that contains a number of important phytochemical groups that show medicianl properties. Theses include sesquiterpene lactones (including lactucin, lactucopicrin, 8-desoxy lactucin, guaianolid glycosides, including chicoroisides B and C and sonchuside C), caffeic acid derivatives (including chiroric acid, chlorogenic acid, isochlorogenic acid, dicaffeoyl tartaric acid), inulin, sugars, proteins, hydroxycoumarins, flavonoids, alkaloids, steroids, terpenoids, oils, volatile compounds, coumarins, vitamins and polyynes. Some of these chemicals may be partly responsible for the hepatoprotective and gastrointestinal effects seen with kasani extracts. The roots and peel of kasani may be particularly high in inulin, which may have blood glucose modulating effects. Ethanol extract appear to be particularly high in inulin. The insulin sensitising effects of kasani, may also indirectly explain the beneficial effects on the liver.  

kasani liver chicory

In one study, mice administered carbon tetrachloride had a 100 % death rate. Coadministration of kasani reduced the death rate to 30 %, due to the beneficial effects kasani had on liver function. In cell culture studies, kasani seeds have been shown to reverse expression of protein markers of liver damage and to prevent liver injury in rats. Kasani is protective of paracetamol (acetaminophen), carbon tetrachloride and oxytetracycline induced liver damage in rodents.

When the liver becomes stressed, the expression of a number of enzymes can increase. As levels rise, these enzymes can spill over into the blood. As liver stress proceeds levels of enzymes such as alkaline phosphatase (ALP), glutamic oxaloacetic transaminase (GOT; also called aspartate transaminase (AST) or aspartate aminotransferase (ASAT)), alanine transaminase (ALT; also called alanine aminotransferase (ALAT)) and GPT (gamma glutamyl transpeptidase) increase in the blood. Kasani extracts can significantly reduce elevated levels of these enzyme markers of liver stress in experimental animals, suggesting that kasani extracts are having anti-stress effects on the liver. When the liver is stressed metabolic changes cause levels of blood proteins and the carrier protein albumin to fall. Kasani extracts are able to reverse these falling levels of protein and albumin, again suggesting that the extracts are having an antistress effect on the liver. Kasani therefore appears to be able to favourably modify liver function.

kasani chicory liver

Kasani also shows potent anti-inflammatory effects. As liver damage is associated with inflammation of hepatic tissue, these could also contribute to the hepatoprotective effects of the herb. Kasani extracts have been shown to inhibit the proinflammatory eicosanoid, prostaglandin E2 and tumour necrosis factor alpha (TNF-α). The down regulation of TNF-α may in turn cause a decrease in the proinflammatory enzyme cyclooxygenase-2 (COX-2). Kasani may also cause a direct downregulation of the proinflammatory cyclooxygenase (COX) enzyme. The sesquiterpene lactone guaianolide 8-deoxylactucin, present in high amounts in kasani, may be a direct inhibitor of COX-2 protein expression, further demonstrating the anti-inflammatory effects of kasani.

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Ziamajidi, N., Khaghani, S., Hassanzadeh, G., Vardasbi, S., Ahmadian, S., Nowrouzi, A., Ghaffari, S. M. and Abdirad, A. 2013. Amelioration by chicory seed extract of diabetes-and oleic acid-induced non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) via modulation of PPARα and SREBP-1. Food and Chemical Toxicology. 58: 198-209
Al-Snafi, A. E. 2016. Medical importance of Cichorium intybus – a review. IOSR Journal of Pharmacy. 6(3): 41-56
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Sweeteners Sweeteners Everywhere

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Stress: How Does It Cause Mood Changes?

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Kasani (Cichorium intybus) for Liver Protection

weight lossKasani (Cichorium intybus) is a herb that has traditionally been used as a general liver tonic in Ayurvedic medicine. The ability of kasani to protect the liver is well documented. For example in animals studies, extracts of kasani are able to prevent rats from thioacetamide induced hepatotoxicity. In this regard kasani was not as effective as silybum marianum, another liver protective herb, but both extracts were significantly able to inhibit liver cell damage. Extracts of kasani have also been shown to be protective of carbon tetrachloride induced toxicity in rats. The extracts were able to reduce levels of malonaldehyde in the liver, suggesting that the extracts can prevent free radical damage. This supports other evidence that kasani extract possess significant antioxidant effects due to the large number of antioxidant phytochemicals present in extracts. Over 100 compounds, many of which are antioxidants, have been isolated from kisani. Most of these are present in the roots in high concentrations, making the root medicinally active.

kasani chicory liver

Studies show that kasani extracts can improve insulin sensitivity and that this might be separate from its hepatoprotective effects. This ability to separately improve the liver function and improve peripheral insulin sensitivity may explain its significant effect on a number of health conditions and its use as a general health tonic. This relates to the large number of conditions that develop as a result of both liver damage and peripheral insulin resistance. One possibility is that the presence of inulin in the plant is a contributor to its blood glucose lowering effects.

Kasani may have other activity relating to its antioxidant and liver protective effects. For example, kasani extracts have been shown to have blood glucose lowering effects and this may make them a useful supplement for diabetics. One study has shown that leaf extracts of kasani were able to improve the insulin signal pathway and improve insulin sensitivity in diabetic rats. It was concluded that this was due to the presence of a caffeoyl derived phytochemical in the extract, and this suggested that the effect may be due to an antioxidant effect. In another study, a significant reduction in blood glucose was observed when extracts of kasani were administered to rats. In addition, the kasani produced significant triglyceride and cholesterol lowering effects. However, no increase in insulin secretion was observed, indicating that the blood glucose effect was likely from improvements in insulin sensitivity. Kasani is used as a traditional treatment for diabetes in Ayurvedic medicine, and these studies support its use in this role.

kasani chicory liver

Evidence suggests that kasani can increase the expression and activity of certain cytochrome P450 enzymes in the livers of pigs. This may explain some of the hepatoprotective effects of kasani, because cytochrome P450 are important phase 1 metabolising enzymes in the livers of all mammals.

kasani chicory

The roots, flowers, stems, leaves and seeds of kasani show health effects in humans and animals. These include antiviral, antioxidant, anti-inflammatory, diuretic, anti-dabetic and hepatoprotective effects. Over 100 individual chemical have been isolated from kasani. Most of these potentially medicinally active compounds have been isolated from the root.

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Madani, H., Talebolhosseini, M., Asgary, S. and Naderi, G. H. 2008. Hepatoprotective activity of Silybum marianum and Cichorium intybus against thioacetamide in rat. Pakistan Journal of Nutrition. 7(1): 172-176
Li, G. Y., Gao, H. Y., Huang, J., Lu, J., Gu, J. K. and Wang, J. H. 2014. Hepatoprotective effect of Cichorium intybus L., a traditional Uighur medicine, against carbon tetrachloride-induced hepatic fibrosis in rats. World Journal of Gastroenterology. 20(16): 4753-4760
Muthusamy, V. S., Saravanababu, C., Ramanathan, M., Raja, R. B., Sudhagar, S., Anand, S. and Lakshmi, B. S. 2010. Inhibition of protein tyrosine phosphatase 1B and regulation of insulin signalling markers by caffeoyl derivatives of chicory (Cichorium intybus) salad leaves. British Journal of Nutrition. 104(6): 813-823
Pushparaj, P. N., Low, H. K., Manikandan, J., Tan, B. K. H. and Tan, C. H. 2007. Anti-diabetic effects of Cichorium intybus in streptozotocin-induced diabetic rats. Journal of Ethnopharmacology. 111(2): 430-434
Azay-Milhau, J., Ferrare, K., Leroy, J., Aubaterre, J., Tournier, M., Lajoix, A. D. and Tousch, D. 2013. Antihyperglycemic effect of a natural chicoric acid extract of chicory (Cichorium intybus L.): a comparative in vitro study with the effects of caffeic and ferulic acids. Journal of Ethnopharmacology. 150(2): 755-760
Rasmussen, M. K., Zamaratskaia, G., & Ekstrand, B. 2011. In vivo effect of dried chicory root (Cichorium intybus L.) on xenobiotica metabolising cytochrome P450 enzymes in porcine liver. Toxicology Letters. 200(1): 88-91
Street, R. A., Sidana, J. and Prinsloo, G. 2013. Cichorium intybus: traditional uses, phytochemistry, pharmacology, and toxicology. Evidence-Based Complementary and Alternative Medicine. Article ID 579319, 13 pages
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