title: Psychological and metabolic responses of carbohydrate craving obese patients to carbohydrate, fat and protein-rich meals.
abstract: BACKGROUND
  A defective central serotonergic neurotransmission has been suggested to result in the concomitant occurrence of an appetite disorder and a disturbed mood. This syndrome was termed carbohydrate carving (CC) obesity. Excessive consumption of carbohydrate-rich snacks would, through a plasma amino acid mediated mechanism, restore serotonergic neurotransmission and thereby relieve the symptoms of atypical depression.
  
  
  OBJECTIVE
  To test whether CC obese patients indeed exhibit symptoms of atypical depression, whether these symptoms can be alleviated by carbohydrate-rich snacks and whether they respond differently to the snacks than non-carbohydrate craving (NC) control subjects. Furthermore, we investigated whether differences between CC and NC patients could be related to peripheral metabolic differences.
  
  
  METHODS
  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/protein respectively) on three consecutive test days. Before and after snack administration mood and performance were tested and blood samples were obtained.
  
  
  METHODS
  9 CC and 17 NC obese patients, matched for sex, age and body mass index.
  
  
  METHODS
  Mood states (Profile of Mood States and Visual Analogue Scales) and performance (Bourdon-Wiersma cancellation test), serum glucose and insulin and plasma amino acid concentrations.
  
  
  RESULTS
  Before snack consumption, CC patients had slightly higher anger and fatigue scores and tended to have lower mood scores 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 patients to the snacks were similar.
  
  
  CONCLUSIONS
  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 carbohydrate craving.
authors.affiliation: Department of General Internal Medicine, Leiden University Hospital, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Toornvliet
authors.forename: H
authors.initials: H
authors.lastname: Pijl
authors.forename: J C
authors.initials: JC
authors.lastname: Tuinenburg
authors.forename: B M
authors.initials: BM
authors.lastname: Elte-de Wever
authors.forename: M S
authors.initials: MS
authors.lastname: Pieters
authors.forename: M
authors.initials: M
authors.lastname: Frölich
authors.forename: W
authors.initials: W
authors.lastname: Onkenhout
authors.forename: A E
authors.initials: AE
authors.lastname: Meinders
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology*; D000596:Amino Acids / Q000097:blood; D001066:Appetite; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D018592:Cross-Over Studies; D004040:Dietary Carbohydrates; D004041:Dietary Fats / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology* / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology*
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D007328:Insulin