PSYCHOLOGICAL AND METABOLIC RESPONSES OF CARBOHYDRATE CRAVING OBESE PATIENTS TO CARBOHYDRATE, FAT AND PROTEIN-RICH MEALS

RATIONALE: A defective central serotonergic neurotransmission has been suggested to result in the concomitant occurrence of an appetite diso rder and a disturbed mood. This syndrome was termed carbohydrate carvi ng (CC) obesity. Excessive consumption of carbohydrate-rich snacks wou ld, through a plasma amino acid mediated mechanism, restore serotonerg ic neurotransmission and thereby relieve the symptoms of atypical depr ession. OBJECTIVES: To test whether CC obese patients indeed exhibit s ymptoms of atypical depression, whether these symptoms can be alleviat ed by carbohydrate-rich snacks and whether they respond differently to the snacks than non-carbohydrate craving (NC) control subjects. Furth ermore, we investigated whether differences between CC and NC patients could be related to peripheral metabolic differences. DESIGN: Double blinded, randomized with cross-over. Patients received three types of snacks (100/0/0, 70/29/1 and 35/3/62 energy percent carbohydrate/fat/p rotein respectively) on three consecutive test days. Before and after snack administration mood and performance were tested and blood sample s were obtained. SUBJECTS: 9 CC and 17 NC obese patients, matched for sex, age and body mass index. MEASUREMENTS: Mood states (Profile of Mo od States and Visual Analogue Scales) and performance (Bourdon-Wiersma cancellation test), serum glucose and insulin and plasma amino acid c oncentrations. RESULTS: Before snack consumption, CC patients had slig htly higher anger and fatigue scores and tended to have lower mood sco res than NC patients. The efficiency of performance increased in both groups after all snacks. No other psychological effects of the snacks were registered. Psychological and metabolic responses of CC and NC pa tients to the snacks were similar. CONCLUSION: Although they may have a somewhat disturbed mood, CC obese patients do not improve their mood states through ingestion of a carbohydrate-rich snack. It seems, from a therapeutic point of view, useless to maintain the concept of carbo hydrate craving.