Category Archives: Advice on how to Lose Weight

Asking Why You Can’t Lose Weight After Your Medication?

The media is glutted with advertisements for weight loss: after all, this is January. And it is assumed that by denying calories and increasing physical activity, some weight will be lost by March at the very least. This assumption is based on the belief that the weight was gained because excess calories were consumed, and physical activity minimized.

But what if you were thin, fit, ate healthful foods, loved to exercise, and never been on a diet? Then sometime in 2016 you started on antidepressants for a variety of reasons: depression, anxiety, grief, fibromyalgia, or menopausal hot flushes. The medication helped, but there was a problem. Six weeks or so after starting treatment your clothes started to become tight. You no longer were satisfied with normal portions, but started eating larger amounts at meals. And, horrors of horrors, you could not stop snacking. Your physical activity decreased because the medication made you tired.  You ended up 23 pounds heavier at the end of 2016 than you were the beginning of last year.

So now you are off your medications, and you try one of the various weight-loss programs advertised. But weeks go by and you have lost practically nothing, even though you follow the plan exactly and exercise. Your distress is like someone who became bald during chemotherapy, and months later is still hairless.  You assume that like everyone else who is trying to lose weight in January, you should be successful. In fact more so, because unlike other dieters, you never had an overeating problem until you started taking antidepressants!

Help will not come from the people who develop the diet plans because the regimens are for the ordinary obese individual who gained weight the traditional way. Help won’t come from weight-loss support groups for the same reason. And so far no department of psychiatry has a weight-loss program for its patients who have gained weight on their medications, even though such programs are sorely needed.

So you alone are going to have to figure out how to lose the weight the medications caused you to gain.

Here’s what you need to know: Some medications stay stored in the body for some time after they have been discontinued. You can determine whether the medications are still affecting your appetite and physical activity even though you have stopped taking them; simply ask yourself if you are eating larger portions than you did before you started on the medication.

If you were craving and eating sugary, high-fat snacks when you were on the meds (cookies, cake, ice cream) do you still have these cravings?

Do you find it hard to feel satisfied even when you are eating enough food to make your stomach feel full?

Is your body still fatigued from the meds, or even from a residual depression? Does this make it hard to exercise with the same intensity and duration you had before you went on the medication?

Do you think you have lost muscle mass?

If you detect a lingering effect of your medication on your appetite and physical activity, then consider this one possible reason why it is so hard to lose weight.

Forget what the advertisements for weight-loss programs promise. They are not directed toward people whose appetite control and ability to exercise have been hijacked by their medications.

Instead, give yourself more time to lose your weight. If carbohydrate cravings persist, satisfy them with fat-free, healthy carbohydrates like steamed rice, oatmeal, whole grain pasta, polenta (an Italian version of grits, but without the cheese and butter), popcorn, pretzels, and whole grain bread. You need to eat only 30 grams of such carbohydrate on an empty stomach two or three times a day to take away your cravings, and increase your sense of being full.

And you may have to increase gradually your workout time and intensity since your body may not be able to jump into the type of exercise you did so easily before you took the antidepressants.

Be patient. Eventually the residual medication should leave your body, your control of appetite and ability to exercise will return, and you will lose weight.

But, if none of the above applies to you, seek medical advice. Before meeting with your health provider, accumulate data to show that your inability to lose weight is, a) not your imagination, b) not due to overeating and not admitting it, and c) not related to a sedentary lifestyle.

Keep a food log and exercise log. If possible, use apps that will do it for you and allow you to print out the results. The results will look more impressive than some pieces of paper covered with food stains or sweat. Allow at least three or four weeks of record keeping before presenting them to your physician. That is a long enough period of time to lose one or two pounds and if you have lost none, you can make a convincing case for something being wrong. At the very least, the health care provider should investigate possible reasons for the weight refusing to be lost.

Enough people have experienced difficulty in losing weight after they discontinued their antidepressants to make this a not rare occurrence. So far there has been mainly silence from both the psychiatric and obesity communities in response in part because of the belief that it should be possible to lose weight after the drugs are stopped. Presenting evidence that pounds gained during treatment are not lost with dieting after treatment is stopped, may indeed generate research to find a solution to this unwelcome side effect of antidepressants.

How To Stay Full In 2017 When You Are On A Diet

January can be depressing. The predictable cold, snow, ice, wind, and bills are accompanied by, for many, the need to go on a diet. It is hard to ignore the pounds you’ve accumulated since Thanksgiving, and even if you do try to disregard them, advertisements for weight-loss programs won’t allow you to.

Diets tend to be dismal, adding to January gloom, and they are often boring. If someone suggests that we have been all wrong in eating X and avoiding Y, then there is at least the possibility of talking about a novel approach to dieting. But, alas, a quick survey of the diet books appearing now indicates that most of them are still promoting low-or carbohydrate-free diets (ho-hum).

Promoting a low-carbohydrate weight-loss regimen while one is enduring the long hours of winter darkness seems somewhat counterproductive. Such diets exacerbate the toll the lack of sunlight takes on serotonin levels and the grumpy moods, excessive sleepiness, uncontrollable food cravings, and lack of motivation to exercise that may consequently follow. And most relevant for the dieter is the absence of a sense of satiety, or fullness, also conveyed by serotonin.

Eating carbohydrate is the only way the brain makes more serotonin, and a diet that denies or limits starchy carbs like potatoes, pasta, bread, cereals, rice, beans, lentils and corn meal will leave the brain serotonin deprived.  It is a better plan to wait until May or June to stop eating carbohydrates in order to lose weight. The days at this time of year are so long that serotonin levels are not affected by carbohydrate depletion.

But, New Year resolutions being what they are (here today, gone tomorrow), many people feel that they’d better grab onto their will power and start dieting immediately.

So if you can’t eat carbohydrates because the diet books tell you not to, then you might consider an extract from a magical fruit called Garcinia Cambogia. (The name sounds a new dance step.) If you missed hearing about this fruit whose extract not only melts away extra pounds but, based on pictures on the Internet, leaves dieters looking as if they have had head-to- foot plastic surgery, then here is the information.

The fruit is tropical, apparently shaped like a pumpkin but grows on a tree, not on the ground, and is also known as the Malabar tamarind. Its popularity as a promoter of weight loss has shifted on and off for the last 20 or more years and had a resurgence this past year. Its virtues were extolled by the television medical personality Dr. Oz a few months ago, and like dandelions after the rain, companies sprang up to sell a particular ingredient in the fruit. Carcinia Cambogia contains hydroxycitric acid, aka HCA. Rodent studies done many years ago suggested that HCA might cause weight loss by blocking chemical reactions in the body that transform glucose into fat.

Fat or triglycerides are composed of two parts: glycerol, which makes up the backbone of the molecule and three fatty acids. So if your body produces fewer fatty acids, then fewer fat molecules are produced. This is what HCA seems to accomplish. It decreases the conversion of glucose  (all carbohydrates are digested to glucose) to acetyl-CoA. Acetyl-CoA is the building block of fatty acids.Rat studies found that when a high carbohydrate diet was eaten, HCA prevented some of the glucose from being changed into fatty acids. Moreover, as a value added sort of feature, people claim that HCA gives them a feeling of fullness or satiety, so they eat less. Serotonin, the neurotransmitter responsible for satiety, is thought to be increased by HCA, but there is as of yet no evidence for this.

A couple of pesky problems are associated with using Garcinia to lose weight: cost and sketchy purity. It is not cheap. One company is selling the extract HCA at a cost of $50.00 for 60 caplets and since it is recommended that a dose be taken before each meal, the cost can add up. The quality of the preparation is inconsistent among brands. ConsumerLab.com analyzed the content of hydroxycitric acid in several supplements and found the actual amount far less than claimed on the package label. Moreover, the HCA seems effective only when a very high carbohydrate diet is eaten.

There is a much cheaper way to prevent the transformation of carbohydrates into fat, while increasing satiety. It’s simple….eat only moderate amounts of carbs so what is eaten is used for energy, not to build up the fat cells. And consume some of those carbs, such as a half a cup of oatmeal or a toasted English muffin, about a half an hour before meals. Serotonin will be made naturally, the appetite will be decreased naturally, and you will lose weight naturally. Stay on this plan and the weight will even stay off long after the snow has melted, and the rest of the New Year’s resolutions have been forgotten.

Strolling: Good for the Mind as Well as the Body

Walking has become the default mode of exercise. If going outside to walk is not convenient, then a walking treadmill is available for year-round use. You will get nowhere, but you will use up calories. We are exhorted to walk to lose weight, to avoid gaining weight, to refresh our minds, to unstiffen our muscles.  As someone whose steps per day are counted by an app on my cell phone, I am pleased when my daily walking miles increase. “Look at all the calories I am using up!“ I think when a congratulatory computer-generated message appears on the phone.

But before walking was reserved for burning calories, it used to be the predominant way of reaching a destination. Those who still depend on walking, rather than a car or public transportation, often find it a more efficient and cost-effective way of getting somewhere.  When the roads are clogged with traffic, it is a delight to realize that walking to a destination is faster than driving.  And in some situations like a mall, museum or zoo, walking is the only option other than a wheelchair. Tour buses get drive a sightseeing group to the ancient castle or botanical garden, but seeing it requires legs not wheels.

However, there is an aspect to walking that seems to have been forgotten or disregarded in an attempt to make more people move more. Walking is good for the mind, for thinking, daydreaming, and becoming aware of the details of our environment.  Indeed, those who meditate sometimes do a walking meditation in which the body, breathing, and mind become one. Usually too impatient to contemplate anything but a robust pace while walking, recently I have been forced to slow down because of my dog. He is almost blind due to a genetic problem associated with his breed. Fortunately, his hound genes allow him to sniff his way through the world as if there are eyes at the end of his nose; but his pace is about 90% slower than when he could see.  As I am at the other end of the leash, I too have slowed down my pace. 

Our walks have now become a stroll, a leisurely perambulation around the neighborhood. But as the number of miles we used to cover diminishes to a few blocks, moving slowly has the positive effect of increasing my awareness of the surroundings: There are fewer ducks in the pond today; the yellow leaves of the birch tree highlighted by the sun look painted; that trash can needs to be emptied; the moon is almost full tonight; the leaves on the sidewalk crunch delightfully when I scuff through them. Casual conversations with other walkers occur frequently, as I stop to allow the dog to smell his way to the next tree. But the best aspect of these leisurely strolls is giving me the time and privacy to think, to indulge in memories, even to daydream.     

A constant complaint of our over-committed lives is the absence of time to restore and renew ourselves.  We must always get to the next thing on our list. One of my friends jokingly told me that as she is lowered into her grave, she will toss out her ‘to -do’ list. Strolling gives us permission to forget the list, to stop temporarily multi-tasking and strategizing about how much we can accomplish over the next 24 hours. Ambling gives us the respite from the constant demands upon us. It gives us time to indulge in our private selves without having to worry about how we present ourselves to the world.  Strolling, if we think about it, should even make us aware and grateful that we can walk and see and hear.

Exercise is important; indeed, it is essential to good mental and physical health. But as my dog has taught me, sometimes a gentle walk can truly enhance our well-being.    

Lactose Intolerance: Can It Cause Weight Gain and Weak Bones?

I hadn’t seen my neighbor for several weeks, but we’d just met again while walking our dogs.  When I commented on how well she looked, she patted her mid-section and said, ”I finally got rid of my big stomach.” (that she had a large stomach was not apparent in our previous encounters.)  When I murmured something to that effect, she went into a long discourse on how she managed to vanquish her perceived girth by radically changing her diet.  She told me, “I cut out all dairy and carbohydrates, and I eat only protein and vegetables. But it’s strange. I haven’t lost any weight. I just lost the bloating.”

My nutritional antennae went up when she mentioned her dietary changes.  Further questioning revealed that she really hadn’t stopped eating carbohydrates, and had enjoyed an excellent pasta dish the previous night at a local restaurant.  But no dairy products had been eaten for weeks. “And as soon as I stopped putting milk on my cereal, and cut out yogurt and cottage cheese, my bloating stopped,” she proclaimed, patting her flatter stomach. “So obviously the dairy products were making me fat.”

As our dogs settled down on the grass, we continued talking. “ So maybe you have lactose intolerance,” I suggested. “That would account for the bloating after you eat dairy. “

She was unaware that as people age, the enzyme lactase that breaks down lactose, the sugar naturally found in milk, disappears or becomes much less active. Consuming milk and sometimes other dairy products such as ice cream, yogurt, cottage cheese, cheese and even butter (it contains milk solids) causes gas, bloating and diarrhea. This is due to bacteria in the intestine interacting with the undigested milk sugar. The intestinal discomfort is accompanied by cosmetic discomfort; skirts or pants strain to fit over a bloated stomach, and the abdomen may not retract to a flatter shape until all the lactose has been expelled.

“You can get lactose-free dairy products,” I told her. “Also, often the bacteria in yogurt have already broken down some of the sugar, so regular yogurt may not cause bloating. And you can take pills that contain the enzyme lactase. You chew them right before eating any dairy products. “

“Well, maybe I do have lactose intolerance… but it doesn’t matter,” she responded. “Why go back to eating dairy? I drink almond milk and eat broccoli. “ She bent down to pick up her dog who was eating grass. “I get all the calcium I need. “

I felt as if I was making a nutritional nuisance out of myself, but asked anyway, “ Didn’t your doctor tell you a few months ago that you may be developing osteoporosis? You were worried that calcium in supplements was not being absorbed as well as calcium in food. Are you sure you are getting enough calcium now?”  Her dog started barking, and she looked as if she was going to bark at me so, letting our dogs pull us in opposite directions, we parted company. But as I walked home, I wondered whether she could get enough calcium from almond milk and broccoli. She needed to get about 1200 mg of calcium daily.

She was right about the almond milk. Eight ounces of calcium-fortified milk contains as much of this mineral as cow’s milk: 300 mg.  But would she drink 4 glasses a day?  Yogurt has 400 mg of calcium, but because eating it supposedly made her fat, it was not on her allowable food list.  What else could or would she eat? Canned salmon or sardines with bones? Probably not, or only rarely. Vegetables? She said she ate broccoli.  Could vegetables provide the calcium she needed?

Broccoli is not a good option, unless she eats a bucket full.  A cup contains at most about 65 mg of calcium. Steamed kale, bok choy, turnip greens, and spinach are good sources (a relative term as they contain only about 100 g per cup of calcium) but there is a problem. These dark leafy vegetables have a pesky substance called oxalic acid that attaches to the calcium, and prevents the mineral from being absorbed from the intestine into the circulation. In fact, oxalic acid can even prevent the calcium in milk or yogurt from getting into the blood stream if these dairy products are eaten along with dark leafy vegetables.

What about orange juice? Calcium-fortified OJ is as good a source of calcium as milk, and has about the same number of calories as whole milk. But will my friend, worried about the size of her tummy, fret about the calories?

Maybe she could swallow 2 tablespoons of blackstrap molasses every day (400 mg). And she could eat chickpeas, black-eyed peas, soybeans, tofu processed with calcium sulfate, figs, and instant oatmeal fortified with calcium.

Bones are an excellent calcium source, but I suspect only her dog chewed on those. (These cook down in the canning process of sardines and salmon to boost calcium.)

So it seems that dairy products are the best natural sources of this essential mineral. But will my friend be willing to try lactose-free dairy products and/or the lactase containing pills so she can consume them? Maybe so, if her stomach remains flat.  Perhaps it will require another   walk with our dogs to convince her.

If We Celebrated Thanksgiving in July, Would We Gain Less Weight?

Weight gain season has started: first Halloween, then Thanksgiving, and finally the Christmas/New Year holidays. The trick-or-treat candy has been barely put away (in our stomachs) when the recipes for Thanksgiving dinner are pulled from the drawers, or torn out of the November magazines. Even those among us who rarely cook begin to fantasize about a perfectly cooked turkey, moist dressing, gooey sweet potato casserole (will last year’s marshmallows still be edible?) and pies…How many pies should we bake? Surely not just one. What will our guests think? And as the days grow colder, wetter, windier, and darker, we fantasize about spending an entire day focused on eating. No need to exercise. The gyms are closed on Thanksgiving anyway (at least most of them), and who wants to go outside for a walk when it is so cold and/or so dark?

So begins the season of real weight gain.

What makes Thanksgiving so fraught with weight-gaining potential is its position on the calendar. Presumably when President Lincoln picked the fourth Thursday in November as a day of national Thanksgiving, he could not have known that the holiday would be altered into a day of national overeating due, to some extent, it being plopped in one of the darkest months of the year. It wasn’t until more than a hundred years later that scientists linked the short days of late fall with a winter depression causing significant overeating. Nor was President Lincoln concerned, skinny as he was, that the feasting on Thanksgiving was a prelude to weeks of overeating associated with December holidays. Indeed, for a country in the middle of a civil war, obesity was not something anyone worried about, nor was anyone in the position to spend much time in festive parties.

But just consider the impact on our food intake and weight if Thanksgiving were moved to the warmer, sunnier months like June, July or August. The benefits are obvious:

1. Menus would not be filled with butter and cream-infused carbohydrate dishes like mashed potatoes and creamed onions;
2. Stuffing soaked in the melted fat of the turkey would be incompatible with the warm temperatures of a late June afternoon;
3. Vegetables might come from the farmer’s market and reflect what was harvested that day, rather than limited to what was harvested weeks earlier, or shipped from a country a continent away;
4. Desserts could include really fresh fruit whose tastes do not have to be enhanced by large amounts of sugar, or baked in piecrust made with copious amounts of butter or lard;
5. Long hours of daylight would allow outdoor activities before and after the meal, such as a lengthy walk after dinner instead of lying on a couch; and
6. Wearing bulky clothes to disguise large figures would not be possible, thus adding a bit of restraint to indulging in more than two servings.

Were Thanksgiving moved to another date not bookended by holidays characterized by overeating, there would be time to diet or exercise off the pounds that might be added by the meal. But coming as it does at the time of the year when we think wistfully of the joys of overeating and then hibernating until spring, it seems easier to ‘go with the flow’ and continue to overeat until January ads for diet programs make us get on a scale.

When the Pilgrims celebrated the first Thanksgiving in October (by the way), they did feast for three days on foods provided mainly by their Native Americans neighbors. They did not have to worry about overindulging a couple of months later at Christmas, as they did not celebrate this holiday. Moreover, they were worried that their food supply would not last through the winter, and so were very careful about how much they were eating. Death from hunger, not obesity, was their constant worry.

It is unlikely that Thanksgiving will be moved to another time of the year, regardless of the benefits that would confer on those of us struggling to maintain our weight. But if we, like Governor Bradford and President Lincoln, focus on the reasons for the holiday rather than the recipes, we might emerge with our weight intact.

 

Are You Losing More Than Weight on a High Protein Diet?

Adherents of high-protein/low-or no-carbohydrate diets have, to some extent, hijacked the discussion of whether we should still be eating carbohydrates. Indeed, for some militant followers, carbs are seen as leading only to brain and body decay, and are to be avoided at all costs. Well, maybe it is time to reconsider this attitude.

Avoiding carbohydrates seemed like the logical response to poor insulin activity. Obesity often causes a decreased responsiveness to insulin and may result in Type 2 diabetes. But before the diabetes is confirmed, there are signs that the body requires more than normal amounts of insulin to push glucose in the cells. This is called insulin resistance or decreased insulin activity. “Well,” say the high-protein folk, “stop eating carbohydrates! No carbs, no glucose? No problem getting the glucose into your cells.”

What these high-protein adherents fail to mention is that the body can make its own glucose and only by following an exceedingly stringent no-carbohydrate diet does the body switch from its natural use of glucose to using fat for energy.  There are many side effects that come with a fat- burning (ketotic) diet:  dreadful breath, foggy brains and bad moods. But so what if one’s breath will kill mosquitoes? It is worth it so one does not have to worry about insulin and carbohydrates?  Eliminating fruits, vegetables, fiber, and dairy products, in short the foods that our bodies require for their nutrient contents, on such diet shouldn’t be a problem according to the non-carbohydrate folk.  Just take lots and lots of vitamin/mineral/fiber supplements.

There was only one problem with this approach. It apparently did not work.

A few weeks ago, researchers from Washington University in St. Louis published a study that is challenging the relationship between high protein and better insulin responsiveness. Bettina Mittendorfer and her colleagues divided 34 obese post-menopausal women into three groups: a non-dieting group, a dieting group that ate only the recommended daily amount of protein, and a third dieting group who followed a high-protein diet.

If the ‘high protein diet to improve insulin sensitivity’ proponents were correct, the women on the high protein diet should have shown the most benefit. They didn’t. In fact, there was no improvement among this group. Only the group whose diet contained carbohydrate showed improvement in insulin sensitivity; it increased by about 25-30%. And a side benefit assumed to be conferred by eating lots of protein while on a diet, i.e., no muscle loss? This did not happen either.

This study generated headlines, albeit brief about these unexpected results. However, Sargrad, Mozzoli and Boden reported similar results in the April 2005 journal American Dietetic Association. They found no improvement in fasting glucose levels or insulin sensitivity among dieters on a high-protein diet. Those on a high-carbohydrate diet did improve.

The absence of improvement of insulin sensitivity among the obese women on a high-protein diet is worrisome because they are already at risk for developing Type 2 diabetes. To bring glucose levels in the blood to normal levels, their beta cells in the pancreas have to produce abnormally high levels of insulin. Eventually diabetes can result.

What is also worrisome is that blunted insulin response affects the ability of a critical amino acid, tryptophan, to get into the brain. Tryptophan is the essential component of serotonin; too little or too inactive serotonin may result in depression, anxiety, inability to focus, or even fatigue. Insulin removes other amino acids from the blood that interfere with the ability of tryptophan to get into the brain. High-protein diets fill the blood with these interfering amino acids so that with such a diet, tryptophan levels in the brain may be lower than normal. Consequently, serotonin levels are lower. This may be one reason why there is a strong relationship between diabetes and depression.

The results of the Washington University study seem unfair. High-protein diets are no fun. The dieter can’t eat starchy carbs like popcorn, rice, or bread and must limit fruits and starchy vegetables like winter squash or potatoes. But this deprivation seems worthwhile if the result was an improvement in insulin sensitivity. But of course this did not happen.

The better option it seems is the natural one: Eat the amount of protein that corresponds to what the body needs but no more. Eat a variety of healthy fruits, vegetables, grains, and low-fat dairy products. And finally do physical activity, which in itself helps insulin shunt glucose into the cells so the body can use it for energy.

Not terribly exciting, nor the focus of television health talk shows or dinner table conversation….But it works.

Using Up Calories By Being Inefficient

The App that records my walking distance read 3 miles, but I had not left our apartment except for a quick trip to a nearby grocery store.

How could I have walked three miles inside?

I knew how. We had just moved, and the aftermath of unpacking had left me with only a vague idea of where anything was now stored. Back and forth I walked, searching for laundry detergent, trash bags, my cell phone, and my cell phone charger. Accustomed as I had been to a kitchen small enough to have everything I needed available without moving more than a few inches, now the larger and poorly laid out kitchen had me roaming around substantial distances to bring pots, plates, silverware, and salt shakers to the same place. I felt like a laboratory rat in a maze, figuring out, with many failures, how to set a path that would get me whatever stuff I was looking for.

But, on the positive side, all this wandering was burning up calories. Simply searching for my cell phone (which I stopped doing when I finally stuffed it into a fanny pack that did not leave my waist) was probably using up a few hundred calories, and searching for stuff that I thought I had unpacked (where was it?) used up considerably more. If one thing marked this week, it was efficiently using up calories by being helplessly inefficient.

Efficiency is essential in our overcommitted, insufficient time world.  We expect contemporary technology to ensure that what has to be done is done in a timely fashion, without too many errors. We are annoyed and often angry when others who are inefficient slow us down. Think of how impatient we get in a supermarket checkout line when the person in front of us can’t figure out how to use the credit card machine.

But perhaps an overlooked cause among many, for the unfortunate fattening of our nation, is that we have fewer and fewer ways of using calories by being inefficient. We shop online; it saves time and is very efficient, but then we spend less time walking to and in stores. We go to big box food stores with gigantic shopping carts and buy enough staples, from paper towels to toothbrushes, so we don’t have to ‘waste time’ running off to the local drug store or supermarket when we run out. Everything that can be delivered is: who wants to spend time even getting in and out of a car to pick up dry cleaning or a pizza?

Children are also delivered, to school, to home, and to various activities by bus or car. Do children walk anywhere these days? It would take too long, and maybe even reduce the time they spend sitting in front of their computer screens. We drive to our health club or yoga or Pilates classes. Walking there is out of the question. It’s just too inefficient.

A few years ago a middle management positioned woman told me that her company abolished cubicles and assigned desks. “See this,” she said pointing to an overstuffed computer bag/brief case. “This contains everything I need. I just carry it to any available desk when I come into work.“ She never has to get up from her chair to find anything. She never walks to someone else’s desk to talk, since no one is ever in the same place from day to day. Instead, she texts or emails messages to her colleagues. She never walks to the copy machine since everything that has to be copied is sent electronically to the copy ‘worker.’ It’s very efficient. It is also a little fattening? Perhaps.

It is too late to build inefficiency into our work situation, and anyway who would want the frustration, delays, and extra costs associated with this?  But maybe we can rejoice, rather than grumble when we forget something in the car and have to go back to get it. Maybe we can look positively on our inefficiency when we have to go back to the supermarket because we have a year’s supply of toothpaste, but forgot to buy milk. Maybe we can lose our cell phones more often, and praise ourselves for using up some extra calories when we finally find it. And maybe that will help, a little, to avoid gaining weight.

Why Is It So Hard To Lose Weight After Antidepressants?

Side effects from medications are common, although usually not severe enough to halt treatment. Anyone who has listened, perhaps unwillingly, to a recital of side effects associated with a television advertisement for a medication is aware of the number of health problems that might arise while taking that particular drug.  But unless the side effect is death (the announcer always seems to mumble at this point), one assumes most of these adverse events go away when the medication is no longer taken.

Weight gain is a common side effect associated with most medications prescribed for depression, and/or anxiety, or the pain of fibromyalgia. We know that the weight is gained for the same reason weight is usually gained: more calories are consumed than needed by the body for energy. But even though most of the people gaining weight as a side effect of antidepressants and related medications may become overweight or even obese, they differ from the typical overweight or obese individual. The latter group struggle with their weight, often because of a lifestyle of eating too much, exercising too little, and in many cases using food to deflect emotional issues. But people whose obesity is a side effect of their medication never had a problem maintaining a normal weight and fit body prior to treatment.  To them gaining weight was as much of a shock and disruption to their body as losing hair is to a patient on chemotherapy.

They’d never dieted. Why would they? They never needed to.

Antidepressants, mood stabilizers, and atypical antipsychotic drugs seem to alter appetite by inhibiting serotonin-based regulation of the appetite function.  A persistent need to eat remains after the stomach is full of food, along with cravings for carbohydrate snacks. Sometimes the ravenous need to eat interferes with sleep, and leads to waking up in the middle of the night to eat.  Medication-associated fatigue frequently accompanies the overeating side effects, so the motivation, and indeed the ability, to exercise off the extra calories becomes difficult or impossible.

All this is well known, and even if a prescribing physician may not mention weight gain as a side effect, countless studies have confirmed it to be so.

So if weight gain is caused by the medication, then weight loss should follow its discontinuation.

And it does for most people. Once the medication is out of the body, normal appetite returns, fatigue diminishes, and the patient returns to eating and exercising normally. Increasing serotonin level and activity prior to meals diminishes any lingering inability to feel full after eating or an inability to control snacking.  Consuming small amounts of fat-free, low-protein carbohydrate foods such as oatmeal an hour before mealtime or as an afternoon snack increases serotonin sufficiently to resume normal appetite control. Returning to a vigorous workout schedule once the side effect of fatigue disappears accelerates weight loss.

But not everyone is able to lose the weight even months after the medication is stopped.

And no one knows why.

Formerly pre-treatment, thin/fit individuals are horrified to find that the 15 or 25 or 50 pounds they gained on their medication is hanging around like a relative who won’t leave the guest room.  Diets are tried and discarded for lack of success. Aerobic and strength-training workouts are increased in frequency and duration.  Yet the pounds stay on.

The result is a feeling of despair and desperation: “No matter what I do I cannot lose weight.” It is as if someone who loses her hair while undergoing chemotherapy learns that she will be bald the rest of her life. Patients who have become obese due to their medication believe their bodies will be permanently changed. They believe they will never return to the slim bodies they had before their medications, and grudgingly and often angrily resign themselves to accept being overweight or obese.

Some suggest that water retention may be responsible for the increased weight, but once the medication is out of the body, the excess water should be lost. Others point to some muscle loss before and during the early stages of treatment when depression has led to weeks of inactivity. However, rebuilding muscle mass doesn’t seem to produce any significant weight loss. It is possible that metabolic rate decreased as a result of treatment, and therefore is slowing weight loss. But studies on thyroid function with patients who were treated with Zoloft or Prozac did not show any functional change in thyroid hormones. So at this point, there is little to offer someone who has tried to lose the medication-associated weight by dieting and exercising, and is failing.

Is the weight finally lost, many months or even years after the antidepressants or related drugs are out of the body?  Are the extra pounds still attached to the body five or ten years later?

No one knows. There are no long-term studies following patients after they discontinue treatment to see if weight is lost and, if so, what produced the weight loss. Interestingly, there are many studies showing that after a weight-loss diet is over, people’s weight eventually returns to the heavier pre-diet weight or ‘set-point’.  Perhaps it is time to see whether people whose weight is a consequence of antidepressant treatment will also return to their weight ‘set-point’. If this turns out to be the case, it will certainly lessen the depressed feeling so many patients experience when they don’t believe their weight will ever come off.

Will Sugar Take Away the New Baby Blues?

Eleanor, the daughter of a close friend, apologized for still wearing her maternity clothes when her mother and I went to her home to ooh and ahh over her adorable newborn.

“It’s crazy!” she said, pointing to her baggy pants and shirt. “In the two weeks since giving birth, I think I have gained 12 pounds. I can’t stop eating and I know it is not just because I am breast feeding. I don’t want any good stuff to eat, just doughnuts, cookies, ice cream and waffles drenched in syrup.”

When she left the room, her mother confided that her daughter had been very moody and complained of exhaustion, feeling overwhelmed, and worried that she would not be a good mother. “She is also so irritable…When I offered to take care of the baby so she could get out of the house, she told me to stop giving her advice!”

The mother then whispered, since she heard the daughter returning, “She must have the Baby Blues.”

Postpartum blues, or baby blues, are not the same as postpartum depression, although some of the symptoms are identical. The ‘blues’ affect about 80% of mothers during the first week after giving birth, and the symptoms peak between days three to five. The mood swings, food cravings, fatigue, and depression are blamed on a decrease in serotonin activity due to the new mother’s estrogen and progesterone levels readjusting. In some ways, the symptoms are similar to PMS, which occurs at the end of the menstrual cycle when hormone levels are shifting. The postpartum blues disappear about two weeks after childbirth, but the exhaustion and fogginess may continue much longer until the mom and baby sleep through the night.

Postpartum depression, in contrast to these postpartum blues, can last for months; the symptoms are much more severe and require medical/ psychiatric interventions. Women with postpartum depression are usually treated with SSRIs, the antidepressants that increase serotonin activity, along with talk therapy and assistance in taking care of the baby and the household.

Postpartum blues are not treated with antidepressants because of their temporary nature. But this doesn’t mean that the new mother has to suffer the unwelcome feelings of sadness, fatigue, lack of focus, not feeling like herself, anxiety, or irritability even for a few days. Sleep helps with all of these symptoms.  One does not have to be a nursing mom to feel the effects of too little sleep and when it goes on for days? The confusion and mood swings that follow can be very distressing.  Waking every two hours to nurse during the night, and then getting up in the morning to carry on the tasks of taking care of the rest of the family is sufficient reason to exacerbate these ‘ blues’.

Women in our culture are given little or no time off to rest from childbirth and the demands of a family and even work. Other cultures, such as the Chinese, insist that a woman be secluded for 30 days with little to do except keep warm, eating high fat, nourishing soups and stews to sustain nursing, and sleep when not feeding the baby. In our culture, the postpartum blues can be minimized by helping the new mom with her family and household tasks so she has time to sleep, making opportunities for her to leave the house, and participate in a healthy, non-baby-centric world… and when she feels physically able, to exercise.

Eleanor’s appetite for sweet carbohydrates led her to yet another quick and effective way of improving her postpartum blues.  The foods she consumed were acting like edible tranquilizers, because their consumption increased the level of the good mood chemical, serotonin.  She was eating sugary carbohydrates to increase serotonin activity, but starchy carbohydrates such as  instant oatmeal, a bag of popcorn, or baked potato are just as effective.  The path from eating carbohydrates (except fruit sugar) to more serotonin is a little complex, but the end result is that after the food is digested, more serotonin is made and the edge is taken off all those distressing symptoms.  Eleanor was probably eating larger quantities of carbohydrate than she needed to; about 30 grams (120 calories in a fat free food) would have been enough to raise serotonin levels for about three hours. Two or three small carbohydrate snacks during the day and evening would have made her feel less edgy and depressed.

One caveat: the carbohydrates must be eaten on an empty stomach or at least two hours after eating protein.  When protein foods are digested, their amino acid contents prevent serotonin from being made by preventing one amino acid, tryptophan, from getting into the brain.

Eleanor must of course make an effort to eat the nutrient packed foods her body needs to recover from giving birth and to nurse. A diet of cookies and brownies is incompatible with the nutritional demands of her body. But eating carbohydrates should, by increasing serotonin, decrease stress and induce calmness and tranquility. Which is exactly what the mother and infant need.

Are Baby Boomers Becoming the Walking Disabled?

We were at a museum in the Berkshires whose overflow parking lot was about a 12- minute walk to the entrance. The couple we were with were somewhat dubious about whether they could walk that far. They did, but, after a couple of hours strolling very slowly throughout the museum, asked if they could ride back to the parking lot on the museum’s golf cart.  They were not sick, and neither have any disabilities that would have prevented them from walking further….the weather not too hot to make being outside for long unpleasant. But they were not young and gradually, almost imperceptively, over the years they had decreased the amount of time and distance they could walk. So to them? The additional 8th of a mile to the car was more than their stamina and legs could handle.

Mary (not her real name) mentioned that she had started to record her daily steps and some days was managing to approach 5,000. Her goal was to double that amount, but she admitted that she was so unaccustomed to walking that she tired easily.

Unfortunately, our friends are not unique. As people age beyond their sixties, many are losing the ability to walk for more than a couple of blocks. If they cannot walk a quarter of a mile, seven blocks, without assistance, their lack of mobility is termed walking disabled.

The consequences of being walking disabled have been studied by Dr. Thomas Gill, professor of medicine at Yale School of Medicine. He and his associates followed about 640 people age 70 and older for 12 years and assessed their ability to carry out what is called activities of daily life. Their results, published in the January 2012 Annals of Internal Medicine, found that as people lost the ability to walk, they lost their independence, too. If the inability to walk follows an inability to drive, the effects on quality of life are obvious.

How does someone who can no longer drive and no longer walk more than a block or two manage to go anywhere? The supermarket, library, pharmacy, movies, restaurants, shops,  a local park, museums, and concerts are all out of reach. Even public transportation such as buses that can be boarded by someone with a walker are inaccessible if an individual can’t walk to the bus stop or do errands when reaching a destination. As Dr. Gill points out, the effect is social isolation, dependence on family and friends, and often depression and possibly cognitive decline due to lack of conversation and contact with others.  The walking disabled become shut-ins and, in a sense, shut away from the kinds of casual contact that those of us who are able to walk take for granted.

But physical immobility need not be an inevitable aspect of aging.

The proliferation of devices and apps that measure walking distance or steps should allow everyone to learn just how active or sedentary they are. Day-to-day variations are averaged into weekly totals, and these data are stored so the wannabe walker has a record of steps or miles walked over a long period of time. Variations can occur, of course, because of weather (too hot or cold, rain, ice, or snow) or other factors  such as lack of time.  But daily variations eventually smooth out and offer a good record for the individual, as well as a medical care provider, of average daily activity and how much it changes over time. For example, if Mary continues her walking regimen, she should find herself walking further simply because her increased muscle strength and stamina will allow her to go longer distances without getting tired.

But what caused Mary, an otherwise healthy individual, to be unable to walk to the parking lot from the museum, a distance that presumably was considered close enough for most visitors to cover without needing transportation?

One answer is the national attitude toward walking: why walk if you can drive? Why have sidewalks in suburban communities if everyone drives or is driven? Why enable anyone to walk across a highway to get to a shopping mall if everyone drives to it? Why have children walk to school when they can be bused or driven or eventually drive themselves? Why get out of the car to go to the bank when you can go to a drive-through teller?

A few days ago in the gym I watched a television program featuring prospective house buyers.  A woman, in her early forties, was shown what seemed to be a lovely property and told that a beach was a mile away. She said, “I am not going to walk a mile to the beach. It is much too far.”

“Really, lady…” I wanted to say, “If you can’t walk a mile when you are in your forties, you may not be able to walk around the block 30 years later.”

Fortunately, attitudes are changing.

Urban planners are developing walkable cities and towns. Properties located in walkable areas are considered desirable, not just because the sidewalks and parks provide opportunities for exercise but, just as important, they provide the opportunity to connect with neighbors and with the community. Walking groups are becoming popular now, so someone for whom walking is a boring solitary activity can interact with others in a moving vertical social group. For people like Mary, it is possible to regain the ability to walk long distances by walking in a pool or on a treadmill. Treadmills allow the emerging walker adjust the time and speed and obtain an accurate display of distance. Walking in a park or on sidewalks with available benches upon which to rest, in case of fatigue, removes the fear of not having the energy to get back home.

Changing the walking disabled into the walking enabled may take time, but doing so has benefits far beyond walking to a parking lot.