Most, if not all, medications have the potential to cause side effects. These may range from annoying, such as feeling slightly tired to fatal (toxic chemotherapeutic agents). However, we usually don’t think of obesity as a side effect of taking medicine. But it can be. Antidepressants, anti–anxiety drugs, mood stabilizers and antipsychotic drugs (used for bipolar disorder and schizophrenia) are linked with moderate to dramatic increases in weight.
“I gained 25 pounds on my antidepressant in just three months,” a new client told me. “I ate and ate. Since I am in my office all day, I did most of my eating at home. I had always been thin but within a few weeks on the drug, I ballooned up so quickly. And the worse thing about was, I didn’t care. The drug took away all my feelings of anxiety, or guilt, or horror at what I was doing. I just felt as if I was on a cloud watching myself stuff cookies and chocolate into my mouth.” When I asked her why and when she realized that she had gained weight, she told me it occurred when not one piece of clothing in her closet fit.
Another wrote to me in despair because her doctor told her that she had to go back on an antidepressant she had taken several years earlier. She had gained forty pounds but managed to lose it after going off the drug. Now she was being told to take it again and as she told me, “I feel as if a judge has just condemned me to obesity. It is so unfair. I worked so hard to lose the weight I gained the last time and now I am doomed to gain it all back.”
Weight gain as a side effect is not limited to drugs used to treat brain-based emotional disorders. A drug to treat fibromyalgia has recently been approved and it is the first (although several others may appear soon) to help people with this chronic disorder. The drug does help with the pain and other symptoms but like the antidepressants, it is already known to cause substantial weight gain. This is a particular hardship for people who already may have difficulty moving because of pain from the disorder. Gaining weight may make physical activity even more painful.
There is nothing mysterious about why weight is gained. Ask anyone who has had this annoying side effect. More food is eaten on meds than off. “It doesn’t matter how big my dinner is,” a client told me. “I still want to eat as soon as I get up from the table. My head keeps telling me to put food in my mouth.”
One theory is that the antidepressants and other drugs that cause this overeating are doing something to the neurotransmitter histamine (neurotransmitters are chemicals which transmit messages from one brain cell to another). Some allergy drugs (the anti –histamines) block histamine. Several years ago some scientists observed that anti-histamines are associated with overeating. Perhaps, the theory goes, antidepressants, mood stabilizers, and drugs for the pain of fibromyalgia might change histamine activity so that a feeling of wanting to eat never goes away.
Fortunately serotonin, the brain’s “feel good” neurotransmitter, also acts as a brake against the overeating caused by the drugs. If you think of these drugs as a car going too fast down a street, the serotonin, which slows down the eating and causes it to stop, acts as a speed bump. And the easiest way to provoke this “serotonin-speed bump” is simply to eat a therapeutic amount of carbohydrate so serotonin is made.
Recently I learned about a new drug that causes weight gain from an e-mail sent to me from someone who had bought our book, The Serotonin Power Diet. The sender has Parkinson’s disease and is taking a medication that increases the activity of another brain neurotransmitter, dopamine. The symptoms of her disease are caused by inadequate amounts of dopamine and medications that increase dopamine’s activity have been available for several decades. One side effect of medications for Parkinson disease has been compulsive activity such as gambling. However, this writer told me that she binges compulsively. She really did not want to overeat but felt driven to do so and gained a substantial amount of weight. At her suggestion, I read comments about the side effects of this drug and found others reporting similar abnormal eating behavior. She told me that she gained weight on two nationally known weight-loss systems and her second nutritionist (the first had given up on her) was having no success in controlling her eating.
As the medication is helping her control her illness, she is obviously going to stay with it. There is a good chance that increasing serotonin will put a brake on her bingeing as it does with other types of overeating. But the verdict is not yet in as she has just started on the diet.
Weight gain does not have to be the unavoidable side effect of medications which treat brain based illnesses. As long as we can depend on serotonin to shut off overeating, we can enjoy the benefits of medications that help pain, anxiety, and depression and restore us to a state of well-being.
| permalink | related link |
( 3 / 100 )Several days ago, many newspapers reported the results of a two-year weight-loss study published in the New England Journal of Medicine. The study, which took place in Tel Aviv, followed males and a handful of women for 24 months to see which of three kinds of diet program would produce the most effective weight loss. The three diets were low fat (similar to the American Heart Association diet), a somewhat healthier version of the Atkins (the participants were kosher and did not eat bacon, ham or pork or add cheese or butter to their meat products), and the Mediterranean diet (this used much more olive oil and fiber than either of the other two diets). The participants had similar and comprehensive support from dieticians and even their spouses were educated on how to help the dieters follow the program at home.
The participants were all obese; they had a body-mass index (BMI) around 31. To give you some idea of what these means in pounds, a woman who is 5’5” would have to weigh 185 pounds and a man of 5’11” would have to weight 225 pounds to have a BMI of 31. None were morbidly obese but they had to lose at least 50 pounds or more to get back in the normal weight category.
The study has generated an enormous amount of discussion on various blogs. One that I checked posted almost 200 messages from people proclaiming support or criticism for either the low-fat, low-carb or Mediterranean diet based on the success or failures of the subjects. Indeed, some of the exchanges were quite heated as the writers shared their own experiences.
So what is all the fuss about? Was one of the diets so effective that the participants attained their goal weight? Did another diet leave the participants heavier than before? Should we throw away every diet plan that exists and go with the winner of this study?
The results might surprise you.
The biggest weight loss was seen on the modified Atkins diet—but this was true only of the men. The few women (about 10% of the sample) did best on the Mediterranean diet. And the results were as follows (drum roll, please):
In two years the group as a whole lost about 6.6 pounds on the low-fat diet, 8.8 pounds on the Mediterranean diet and 9.4 pounds on the modified Atkins diet (or low carb).
Most of the weight was lost in the first 6 months. During the remaining 18 months, participants either gained back some weight, leveled out, or both.
Any weight loss is good and what this study shows is that with a really good monitoring and support system, it is possible to lose weight and keep it off. There was a significant difference in the effectiveness of the different diet plans although the differences are tiny when you consider how much weight the participants really had to lose.
Did the study answer the question what is the best type of diet? Yes and No.
For men, the low-carb, modified Atkins diet did work best. Many men have been able to lose considerable amounts of weight following a relatively high-fat, high-protein diet.
But the study did not answer these questions: What is the best kind of diet for emotional overeaters who do so because they need to use food to feel better? And what about people whose brains force them to overeat because they are taking medications that affect their food control system?
None of the diets were designed to use carbohydrates to improve mood, curtail appetite or halt the effect of medications that cause overeating. Exercise was not a major component of the weight-loss program, nor was counseling to identify triggers that caused weight to be gained initially.
The best kind of diet is one that allows you to lose weight steadily, makes you feel comfortable while doing so, motivates you to become more fit and gives you the chance to figure out how to prevent yourself from gaining back the weight when the diet is over.
And that diet is really a way of life.
| permalink | related link |
( 3.1 / 19 )Have you noticed how difficult it is to eat while you are laughing? Unlike talking and crying, it is almost impossible to chew and laugh at the same time. This came to mind when I received an e-mail from a friend who had gone to see this summer’s funny movie, “You Don’t Mess with the Zohan.” She writes:
“You know I am always complaining about how hard it is to go to the movies and not munch on nachos and cheese, a tub of popcorn or one of those gigantic boxes of candy. So until I lose my weight and, I hope, my desire to eat these foods, I have been avoiding the big screen. But my husband dragged me to the Zohan movie and promised me that I would not miss munching my way through the story. He was right. I laughed so hard that my stomach hurt afterward. I was so busy laughing that I never thought about munching. If I could laugh my way through every meal, I would be skinny by next week.”
She is right about laughter taking away the desire to eat. Her letter made me think back upon countless dinners with friends in which we would sit around the table telling funny stories. If the stories started before dessert, the food would be forgotten while we would hang on the sometimes interminable stories with the absurd endings.
One of the problems with going on a diet, or trying not to gain back lost weight, is that we often forget to laugh. This may be especially true when people go on diets that decrease their brain comfort chemical, serotonin. A dear friend e-mailed me yesterday saying that his wife was put on a high-protein, low-carbohydrate diet and is now very grumpy. She was a very funny woman, full of sparkle and a way of turning every day events into a vehicle for amusing stories. Now, according to my friend, she rarely laughs and has turned into a glass half-empty sort of person. “Sally has lost her sense of humor along with her weight,” complained my friend. “I told her that a few bowls of pasta might restore her good humor without the weight but she only snapped at me.” Privately I am afraid he is in for a long humorless summer as her lack of carbohydrate is decreasing her brain’s level of serotonin, and her good mood will continue to suffer.
Perhaps the next generation of weight-loss books, support groups and diet foods by mail order will provide humorous books, comedy DVD’s and stand-up comedians to help the dieter. Wouldn’t it be fun to go to a Weight Watcher’s meeting and spend an hour laughing instead of hearing, once again, what to do with leftovers? Instead of reading lists of calories and vitamins and minerals on a package of diet food, how about reading a funny cartoon instead? When you feel like a treat because you are bored or disappointed or feeling tired, how about taking out a book like Plato and the Platypus (a book of philosophy and the funniest jokes I have ever read) and indulging in one or two of the funny stories?
It has been said that laughter is the best medicine. It seems to be the best way to also lose weight.
| permalink | related link |
( 3.2 / 13 )Even though clothes sometimes come with a label saying ”One size fits all” or as a friend says, “One size fits no one,” the same cannot be said of a diet plan.
The Serotonin Power Diet, however, does fit everyone’s brain by making sure that you are making sufficient serotonin to keep your moods steady and appetites under control. But Nina, my co-author, and myself believe that the foods on the plan are suggestions, not demands, and certainly not engraved on a stone tablet. Sure, we want the dieter to eat some protein for breakfast along with toast or cereal. And we do insist that protein be eaten at lunch time as well. The dinner for the first two weeks of the program is basically carbohydrates and vegetables in order to boost serotonin, through that meal as well as the snack that precedes and follows it. But we realize that the foods we suggest as protein or carbohydrate foods or the vegetables and fruits listed on the page may or may not be acceptable to the dieter. Moreover, the portion sizes that may be work for a woman who wants to lose 40 pounds may be too small for someone who has to lose 240 pounds and is hungry at the start of the diet. For her, we suggest following the men’s diet until she finds it is too much food.
Recently, a woman in Australia wrote to us asking about snack foods, since many of the foods we suggested were not available in her supermarket. (I suspect, though, that she had access to some foods, like kangaroo, which we had not listed as a protein option.) After a few e- mails, we were able to work out some substitutes that seemed similar to some of the snacks on our American list.
Then there are vegans. They do not eat any animal products, including eggs and dairy products. Breakfasts of cottage cheese and lunches of grilled chicken breast won’t work for them, so it was necessary to see what soy or bean-based foods might work as substitutes. And we recommend calcium supplements in case the foods they did eat are not rich enough in that critical mineral.
But most of our queries are not so much about the food itself as how to fit the diet into the dieter’s lifestyle. And this is probably the most difficult aspect of following a diet. Food lists, recipes, menu suggestions, and food shopping and preparation tips may simply not work for the dieter who works a midnight to 8 AM shift, or for someone traveling from city to city or even from office to office within the same city. One client said that she would be happy to eat a hot lunch but could do so only by giving up her day job. “I am always in the car because I work as a visiting nurse,” she wrote us. “On occasion I may be able to stop the car and eat my lunch by a park. But there is no place I can get a hot lunch on my route and nowhere to heat up food I bring with me. Can I eat a sandwich for lunch? If I am driving to a client at least I can manage to eat and drive.”
Obviously the answer was yes—with the suggestion to pack a lot of napkins.
Another client who worked the midnight shift had a problem following the diet because the hospital cafeteria was closed, vending machines were useless as a source of nutritious foods and often her break time was spent catching up on computer entries. This is what we worked out:
Sleep: 9 AM to 4 PM
Breakfast: 5 PM
Lunch: 9 PM (this was her big meal because she could eat it at home. She ate about 5 ounces of protein with 1 cup of rice, potato, or pasta, along with vegetables.)
Work: 11 AM
First snack: 1am She loved cherry Twizzlers.
Dinner: around 2 AM. It was quiet then and she could microwave a potato or some hot cereal and fruit
Second snack: 5-6 AM. She usually ate graham crackers and had her fruit at this time. It was important that she eat a snack before leaving for home an hour later so she would not be tempted to stop for some fast food breakfast on the way home.
She arrived home at 8 AM and we told her to eat an English muffin or some toast and juice if she felt hungry. But the snack satisfied her and relaxed her enough so she was able to sleep soon thereafter.
It is important to make your diet fit into your life rather than the other way around. After all, the diet and all the changes in eating and exercise that it brings into your life should, ideally, continue after you have lost the weight you want to lose. Obviously you don’t have to diet any longer. However, all those pesky logistical problems that caused you to reach for fast food, or lunch on a diet Coke and a large bagel, are going to return unless you have figured out, during the diet, how to make those life style changes stick.
This may be why diet spas, diet foods in a box or pouch, or daily monitoring of what you are eating really doesn’t work in the long run. You have to work out the best way to eat the foods that you need for physical and emotional nourishment while juggling and balancing the sometimes overwhelming demands of daily life. And if you make a mistake, so what? You can start all over again tomorrow.
| permalink | related link |
( 3.2 / 18 )One of the stories about the effects of high gas prices mentioned the increase in candy bar sales at gas stations. Apparently after paying upwards of $40.00 for gas (and sometimes much more) people pay another dollar for a candy bar. It is unclear whether the reasons are: a) What is an extra dollar?
b) I need a treat after the shock of filling the tank or c) I guess I will be doing a lot of walking so I can afford the calories.
Whatever the reason, it is interesting that despite all the negatives written about candy, people still eat sweet snacks. I was thinking about this today during my town’s 4th of July parade. It is a tradition for the people on the floats, along with the guys driving the fire engines and police cars, to throw wrapped candy at the spectators. Tiny Tootsie Rolls were the most abundant but some other wrapped candies were also thrown. We were sitting on the sidewalk next to a group of kids and most of the candy was thrown in their direction. However, all the adults around us scrambled to get their share as the pieces landed around them. Pretty soon, the whole street was happily munching away. Fortunately, there was no float hauling the “wicked witch of the low carb world” to warn us of the perils of eating something with sugar in it.
What is amazing is that there still are many people who believe that eating anything with sugar will be devastating to their health, both physical and mental. They regard a miniature Tootsie Roll, or a dollop of ketchup, with horror. “ It has sugar, sugar is bad for you, I never eat anything with sugar,” they will cry.
Obviously, a diet loaded with sugar is bad because sugary foods usually lack the vitamins, minerals and protein that nourish us. They also tend to be low in fiber and high in fat. Think of cookies, doughnuts, chocolate bars, brownies, ice cream and sheet cake with frosting. They may be more appealing than broiled halibut, Brussels sprouts and brown rice but contain nowhere near the nutrient value. Indeed, they have just about no nutrient value at all.
But sugar is not without its virtues. To begin with, sugary foods taste good. That is why having a Tootsie Roll thrown at parade watchers rather than a turnip is so appealing. Sugary foods are also treats. Treats are not a steady diet; they are foods dolled out for special occasions or after certain chores or tasks are completed. Birthday cakes tend to be sweet, as do wedding cakes.
Sugar does the same thing for the brain as starchy foods. When eaten, it gets the brain to produce the brain chemical serotonin. And serotonin helps us feel better, calmer, more focused and, just as important, less hungry.
We hear all the time from nutrition people and health professionals that we should eat a variety of foods and eat everything in moderation, from wine to wieners. And it should be the same with something containing sugar. A small piece of candy at a parade, or a small candy bar when you fill up the car (and if you walk more, you will fill it up less often), is certainly not overdoing the sugary snacks. And if it makes you feel less grouchy about fuel prices, it might be worth it.
| permalink | related link |
( 3 / 43 )Next
Categories
