Tag: food coma

Food Coma @MSTrust conference

After my food coma blog post and survey in January, I was asked by the MS Trust to talk about food coma at their annual conference in Hinckley. It is always great to speak at this meeting. The audience is always very enthusiastic and I have had a lot of questions after my presentation. I used my talk to discuss some of the science and issues around excess sugar consumption.

I suspect that my food coma observation and our audit will lead to a reassessment and a change in the dietary advice we give pwMS. As I have said before there is no MS diet and I would sum up my dietary advice as follows.

Eat real food, avoid processed and particularly ultra-processed foods. Eat local and seasonal produce. As eat socially; a lot of eating is about rituals around social interactions. Finally, eat mindfully; be aware of the impact your diet is having on others.

You can download my presentation from my SlideShare site.

CoI: nothing to declare for this lecture

Sugar crash

My recent blog post on food coma (14-Jan-2019) not only uncovered another hidden symptom in MSers but has led us to start exploring this phenomenon in our patients and, hopefully, to some evidence-based advice on how to manage the problem. 

In our short web survey on food coma, I was surprised to find that 86% of MSers report this phenomenon with 28 of the 81 respondents (35%) reporting their food coma as being severe or severe-and-incapacitating. When exploring the science I was surprised to uncover that insulin, the hormone that the pancreas releases in response to carbohydrates or sugar, is one of the main mediators of food coma. How could this be when my mother always used to accuse me of having a sugar rush as a child? A sugar rush is a so-called period of hyperactivity that occurs after ingesting too much sugar in a short period of time. 

I was therefore not surprised to read the following well-done metanalysis debunking this piece of dogma. On the contrary, sugar does not cause a sugar rush, but a sugar crash, another term for food coma. 

This and other evidence keeps mounting against sugar and the sugar industry. There seems to be very little reason for anyone to consume sugar or processed carbohydrates in any form. This is why nutritionists have started to refer to processed carbohydrates as empty calories.

So I am going to repeat myself again if you want to select a diet that is healthy for you can I suggest a real-food diet low in carbohydrates, i.e. free of all processed carbohydrates. This means you may need to get most of your calories from fats and proteins. The carbohydrates you eat on the real-food diet will be unprocessed with a low glycaemic index. As a result of this diet, you will keep your insulin levels low and hence you will reduce your postprandial hypersomnolence or ‘food coma’. 

Keeping your insulin levels low will have other positive effects on your health; i.e. it will help you maintain a healthy weight, counteract insulin resistance and hence your chances of developing the metabolic syndrome (insulin resistance, diabetes, hypertension, hyperlipidaemia and obesity) and it should reduce your risk of developing common cancers.

What is there to lose? How easy is it to stick to the real-food diet? You tell me. 

Mantantzis et al. Sugar rush or sugar crash? A meta-analysis of carbohydrate effects on mood. Neurosci Biobehav Rev. 2019 Jun;101:45-67. 

The effect of carbohydrate (CHO) consumption on mood is much debated, with researchers reporting both mood improvements and decrements following CHO ingestion. As global consumption of sugar-sweetened products has sharply increased in recent years, examining the validity of claims of an association between CHOs and mood is of high importance. We conducted a systematic review and meta-analysis to evaluate the relationship between acute CHO ingestion and mood. We examined the time-course of CHO-mood interactions and considered the role of moderator variables potentially affecting the CHO-mood relationship. Analysis of 176 effect sizes (31 studies, 1259 participants) revealed no positive effect of CHOs on any aspect of mood at any time-point following their consumption. However, CHO administration was associated with higher levels of fatigue and less alertness compared with placebo within the first-hour post-ingestion. These findings challenge the idea that CHOs can improve mood, and might be used to increase the public’s awareness that the ‘sugar rush’ is a myth, inform health policies to decrease sugar consumption, and promote healthier alternatives.

Food coma: does it affect you?

This post explains why eating may exacerbate MS-related fatigue and what you can do to counteract it.

Do you suffer from food coma or excessive sleepiness and fatigue after eating a meal?

For ‘normal people’, we call this phenomenon postprandial somnolence or the siesta syndrome. Others refer to it as the ‘food coma’. It is my anecdotal experience that people with MS, in particular, people with more advanced MS, are particularly sensitive to postprandial sleepiness and fatigue. Why?

Postprandial somnolence (PPS) is a normal state of drowsiness or lassitude following a meal. PPS is a real phenomenon and has two components: (1) a state of perceived low energy related to activation of the parasympathetic nervous system in response to expansion of the stomach and duodenum from a meal. In general, the parasympathetic system slows everything down.  (2) A specific state of sleepiness, which is triggered by the hormone cholecystokinin (CCK) that is released in response to eating and changes in the firing and activation of specific brain regions. The reflexes responsible for PPS are referred to as neurohormonal modulation of sleep through the coupling of digestion and the brain. The signals from the gut to the brain travel via the vagus nerve.

My index patient is so affected by PPS that she now only eats one meal a day; her evening meal. She does this quite late so that she can crash and sleep about an hour after eating. She is a professional and needs to be functional during the day and finds if she eats anything substantial in the day she simply can’t work because of her overwhelming desire to sleep. We have tried caffeine, modafinil and amantadine to counteract PPS, but they only had a small effect in counteracting her PPS and allowing her to work productivel. Other patients reporting this have noticed some benefit from stimulants. Interestingly, my index patient, like a few others, finds carbohydrate-rich foods particularly potent at inducing ‘food coma’

Physiologists think that not all foodstuffs are made equal when it comes to causing PPS and it appears that glucose, or sugar, induced insulin is one of the drivers of this behavioural response. I suspect this why people who fast or eat very low carbohydrate or ketogenic diets describe heightened alertness and an ability to concentrate for much longer periods of time.

The reason for doing this post is to find out how common PPS is in the MS population and to give you some simple advice to counteract it. If you suffer from PPS can I suggest you review your diet and see if you identify ways to modify your eating habits and/or diets to coounteract PPS?

  1. You could adopt the above extreme solution and only eat one meal per day. Clearly, this not for everyone and is very difficult to implement. I say this, but many of my Muslim patients report feeling so much better during Ramadan when they essentially practice this type of eating pattern.
  2. You could reduce your meal size and cut out any carbohydrates from your daytime meals. You may find this difficult because it takes time for your metabolism to become optimised for ketosis. If any of you are interested in the science of ketosis I have written a Medium post on ketogenic and low-carbohydrate diets.
  3. Some of my patients find micro-meals helpful, i.e. instead of large meals you eat multiple small snacks during the day.
  4. The judicious use of stimulants. I tend to recommend caffeine, followed by modafinil and them amantadine. Please note you should probably not take stimulants later than about 3-4 pm as they have a long half-life and can cause insomnia.
  5. Some of my patients have also reported that exercise has helped them deal with PPS. I am not sure how exercise works except by possibly lowering glucose and insulin levels and improving insulin sensitivity. The latter will reduce hyperinsulinaemia that will not only cause PPS, but is an impotant driver and component of the metabolic syndrome.

Please note that PPS will be worse if you suffer from a sleep disorder and suffer from daytime sleepiness. Most pwMS have a sleep disorder so there is little point in focusing on PPS and ignoring the elephant in the room.

If you have a few minutes to spare can you please complete this survey and let us know if you come across any other effective treatments to manage your PPS.