Monthly Archives: January 2015

Starting Antidepressants? About the Weight Gain…

Like hair loss during chemotherapy, weight gain while on antidepressants is not, fortunately, inevitable. And like hair loss, gaining weight should not be justification for refusing treatment with these drugs, as they may be very effective for a variety of mental disturbances, fibromyalgia, and even menopausal hot flushes. Unfortunately, for those who find themselves gaining weight within weeks of starting on their antidepressants or mood stabilizers, losing this weight is much harder than growing back hair after its loss from chemotherapy. Many find themselves struggling to dislodge from 15 or 50 pound months following the end of antidepressant treatment.

Recently, an email arrived from someone who found herself 35 pounds heavier six months after starting on a commonly used antidepressant. She wondered if it was too late to lose weight. Would those 35 pounds be a permanent side effect? Would she ever be able to go back to her original, normal weight?

My answer to her question, “It is never too late to lose weight!” was, I hope, reassuring, but I asked myself why she was not told to notice changes in her appetite and physical activity as she started on the drug. The signs are well-known by now: a new and persistent craving for carbohydrate, a sense of not feeling satisfied after the completion of a meal, increase in between-meal nibbling and possibly decreased physical activity due to fatigue. Had she been weighed before starting the treatment? Was there any record of her biweekly or monthly change in weight? Was she told to weigh herself since her physician may not have had a scale in the office? Was she asked if she is eating more and moving less? None of these measures may have prevented some weight from being gained, but if she and her physician were alerted to changes leading to the first five-pound weight gain, steps to halt additional gain might have been recommended.

As any dieter knows, as more and more weight is gained, the motivation and optimism that it can be shed disappears. After a certain point, a feeling of hopelessness in controlling the weight gain may make the dieter give up entirely. He or she concedes an inability to fit into clothes that were worn several weeks earlier and goes back into the larger pre-diet sizes still in the closet. Exercise programs are abandoned as it becomes more difficult to move those extra pounds.Eventually, when the weight gain becomes cosmetically or medically disastrous, he or she concedes that it is time to (finally) start dieting again.

But the previously normal weight person, now fat from the medication, doesn’t know any of this. Many of these weight gainers never dieted before starting on their antidepressant. Unlike the typical obese individual, their eating was controlled, emotional upheavals did not lead them to consume quarts of gourmet ice cream, and they did not feel compelled to eat even when full because there was still food on the plate. Physical activity was a part of their daily life. It was natural to take the stairs, or walk instead of drive, or go to the gym regularly. And their clothing size was stable.

Indeed, does it even require saying that when such individuals are started on a treatment, which may take away their control over eating and desire to exercise, some advice on how to deal with the weight gaining side effects should be offered? And soon, before much weight is gained?

Happily, doing something to stop antidepressant induced weight gain is easy.You and your doctor should keep track of changes in your eating, exercise, and even sleep, seeing that sleep disturbances also influence eating and activity. Typically, early signs of eating-going-out-of control include feeling strangely unsatisfied after eating an amount of food that from pre-drug treatment was more than enough to satisfy you. This may be accompanied by a new or increased desire to munch on sweet or starchy carbohydrates, urges to snack frequently during the day, or even awakening to do so during the night. is These appetite changes are stoppable. Normally, serotonin, acting on certain receptors on brain cells, produces a sense of satiation or fullness. It is the feeling that ‘I am satisfied, I really don’t want to eat anymore,‘ and analogous to the feeling we have when, after drinking enough water, our thirst is relieved. For reasons still not understood, antidepressants and related drugs, the mood stabilizers, may interfere with serotonin’s ability to bring about this sense of satisfaction. However it is not necessary to know how the drugs interfere with this function in order to do something about it.

The simple solution is to consume, on a relatively empty stomach, a small amount of carbohydrate, perhaps two or even three times a day. Doing so increases the brain’s production of serotonin. And from our clinical and research experience at MIT and a Harvard University associated psychiatric hospital, we found that increasing serotonin seemed to halt the relentless need to snack and the uncomfortable feeling of never feeing full after eating. Our weight management center at the hospital was able to help people successfully lose weight even though many were on two or three drugs, each with weight-gaining side effects. Serotonin also seemed to promote better sleep.

The amount of non-fruit carbohydrate that has to be eaten is really small, about ¾ of a cup of Cheerios, a cup of oatmeal, 6 small graham cracker squares or a slice of bakery-made multigrain bread. These and other nonfat (or very low-fat) carbohydrate foods should provide about 25 grams of carbohydrate (food labels have this information), and contain less than 2 or 3 grams of protein. Protein prevents an amino acid tryptophan from getting into the brain (even though protein contains tryptophan) and making new serotonin.

Exercise is also crucial to preventing weight gain. Your physician may not mention it so it is up to you to find a way to move: walk, take classes at a health club or Y, get a dog that is not house broken, and/or start some muscle building workouts. Tiredness may be a side effect of your medication but you will feel less, rather than more, tired after exercising. Strange but true.

And if you don’t have one, buy a scale. And if you feel generous, buy one for your doctor’s office as well.


Might the Fat Gene Make You Fat If You Were Born After 1942 and Received Penicillin as a Baby?

Born before 1942? If you were and also carry the gene for obesity, relax. The gene won’t make you fat. Born after 1943? Yes, the gene might have a definite impact on your size. A study using information from The Framingham Heart study looked at the link between the FTO gene for obesity and actual weight. The Framingham Heart study is an ongoing research project, started in the middle of the last century to monitor the health of people living in and around Framingham, a town about 30 miles from Boston. The study has been going on for so long that the adult children of the original participants and their children are part of the study. Although many of the original participants have died, their records are available so their health status for example, their weight, can be compared with measurements made on their children and grandchildren.

Researchers at the Massachusetts General Hospital in Boston wanted to see if people with the FTO gene became obese; what they found was unexpected. According to James Rosenquist, lead author on the study published in the Proceedings of the National Academy of Sciences, it depended on birth year. Those with the fat gene born before 1942 did not become obese. Those born after 1942 were likely to be fat. This is true even among siblings from the same family born before and after 1942. For the almost-baby-boomers and beyond, there was a strong relationship between having the fat gene and being fat.

The reasons for the difference pre and post 1942? It’s easy to find them. Packaged cake mixes, electric typewriters and then computers, TV remote controls, extension lines for the phone, drive-in services (so no walking is required to eat or bank), shopping malls, too much fast food, microwaves, clothes dryers, vending machines, super-sized portions, power lawn mowers and snow blowers, cheap food, automation, etc., etc., etc. The authors lump the reasons into one blame, and it’s technology, which arguably does cover just about everything, excluding too large food portions, too little time to exercise, and inadequate sleep.

However, there is one factor that they did not mention, probably because the research is new and has been carried out on mice, but not people. That factor is penicillin, and its effect on the intestinal tract.

Our intestinal tract is inhabited by trillions of microbes, a fact few of us think about until we have a tummy ache. But there are scientists who believe that some of those trillions of microbes might affect whether or not we become fat. It is not clear how these microbes influence how much fat ends up in fat cells, or whether metabolism is speeded up or slowed down, but something seems to be going on. In a recent article in the December 25 issue of the New England Journal of Medicine, a rather startling discovery was reported. Scientists could make baby male mice quite fat simply by giving their mothers while pregnant and then nursing, low doses of penicillin. The antibiotic altered the intestinal microbes of the baby mice which in turn changed their metabolism and how their bodies responded to food. The mice became so obese as adults, they looked like mouse pillows with a head, a tail and a cushion-like body. The power of the penicillin-exposed microbes to turn skinny mice into candidates for Weight Watchers was confirmed when the microbes were given to germ-free mice and those mice gained fat and weight at a rapid rate.

So what does this have do with the fat gene and birth date? Probably nothing. But consider this. Something may have happened in 1940s to make it more likely that babies born with the fat gene would indeed become fat. And that was, for the first time ever, the easy availability of penicillin.

The military had access to penicillin during the Second World War but the rest of the country did not. Production of penicillin was limited until early 1944. In 1943, 21 billion units of the drug were produced in the United States. One year later, the number jumped to 1,663 billion units and then to more than 6.8 trillion units in 1945. Unlike the earlier years, distribution of the antibiotic was no longer restricted and everyone had access to it. Production continued to rise so by 1949, the annual production of penicillin in the U.S. was 133,229 billion units per year and it was now cheap.

So here we have one study that says something happened after 1942 to increase the likelihood of being fat if one has the obesity gene. We have another study, done with mice (so its relevance may be limited), that says changing the microbes in the gut with low doses of penicillin may cause obesity. And from 1944 on, penicillin rapidly became available to everyone.

Coincidence? It will take much more research to know. But it does turn research on obesity in a new direction. If the fat gene slows down metabolism for example, and if antibiotic altered microbes in our intestinal tract also slows metabolism (or increases the absorption of fat), it may explain why some people seem to gain weight so much more easily than others. Now if only researchers can discover how to alter our intestinal microbes so we can lose weight!

How Many Pounds Did You Get for Christmas?

How can anyone not gain weight during the holiday season? Starting with the national binge day, Thanksgiving, the country seems to be in a whirlwind of feasting and drinking. Or at least it seems that way… Stores typically selling shoes or sheets now feature shelves full of imported cakes, candies, nuts, jams, processed meats and cheeses all seemingly encased in hard to remove plastic wrap, as well as fancy liquors whose bottles resembling perfume jars. Going into a home goods store the other day in search of a potato grater (mine seems to have disappeared), I had to avert my eyes from these food displays, feeling my blood cholesterol rising simply by walking past them. Healthy recipes featured on the Food Network, morning television shows and magazines will not appear until the beginning of the new year. Kale salads and quinoa somehow do not have the same appeal as sugar-coated pecans, pork roast wrapped with bacon, the ubiquitous sausage, egg and cheese casseroles, or spinach pureed with heavy cream. And as with the menu for Thanksgiving, the holiday tables, be they set for dinner or a party, must have more food than could possibly be consumed by the guests.

Eating special foods on holidays, and indeed eating much more than normal on holidays, is a very old tradition. The meals were special in large part because they were so different from the sparse and often nutritionally inadequate foods people ate during the rest of the year. Protein-rich foods such as meat, chicken, lamb, pork, and even eggs were simply too costly. Oftentimes foods such as eggs and cheese were sold, rather than eaten, so there would be money to buy the less expensive flour, corn, potatoes, beans and rice. Sweetening agents like honey and sugar were also excessively expensive and thus reserved for celebratory occasions. Fruits such as oranges and bananas, which for us are affordable and available throughout the year, were so rare that an orange took on the status of a Christmas gift.

In the countless books by people surviving in environments isolated by geography, weather, and war, Christmas day was usually a time for eating special foods hoarded for the occasion and made even more precious by previous deprivation. In diary kept by the explorer, Ernest Shackleton during his 1902 trip to the Antarctica with Captains Scott and Edward Wilson, he writes of the chronic hunger all of them experienced, and then records what he managed to make for Christmas:

Christmas breakfast:- a pannikin of seal’s liver, with bacon mixed with biscuits. Each; topped up with a spoonful of blackberry jam; then I set the camera, and we took our photographs with the Union Jack flying and our sledge flags, – I arranged this by connecting a piece of rope line to the lever. Then four hours march. Had a hot lunch. I was cook:- Bovril, chocolate and Plasmon biscuit, two spoonfuls of jam each – Grand!

Then another three hours march and we camped for the night. I was cook and took thirty-five minutes to cook two pannikins of N.A.O. ration and biscuit for the hoosh, boiled the plum pudding, and made cocoa. I must of coarse own up that I boiled the plum pudding in the water I boiled the cocoa in, for economys sake, but I think it was fairly quick time. The other two chaps did not know about the plum pudding. It only weighed six oz. And I had stowed away in my socks (clean ones) in my sleeping bag, with a little piece of holly. It was a glorious surprise to them – that plum pudding, when I produced it. They immediately got our emergency allowance of brandy so as to set it on fire in proper style. [1]

Shackleton saved food from the men’s daily intake so that there could be a special Christmas feast, even if the foods of the “feast” were meager and calorically inadequate. They did eat excessively, but of course they did so only because they typically were consuming so little. In contrast, because most of us are so well fed daily, (unless we are on a diet) in order for us to view a Christmas, Thanksgiving or any other celebratory meal as special, the meal must contain an excessive quantity and variety of food and drink. And alas for many the consequence of this overindulgence is taking home the gift of unwanted pounds.

For the homesteader trying to survive a brutal prairie winter or the sweat shop laborer earning barely enough to pay the rent, if in the unlikely event weight had been gained at a holiday meal, it was lost quickly. Once the holiday was over, people went back to their barely-calorically-adequate and unvaried diets. In her book 97 Orchard St about the lives of tenement dwellers in New York City in the late 19th century, Jane Ziegelman relates how some families eat as their only food for weeks a soup made out of potatoes, onions, and carrots along with stale bread (cheaper than fresh). Others lived on a soup made from lima beans, barley and a chunk of potatoes. No-one kept those pounds from the December feast season for long.

Alas, not so today. Typically by the first of the year, the pounds gathering on our bellies and hips from Thanksgiving are still around by the time we move into the New Year. Some of us attempt to dispose of these pounds by adopting the soups and meager diets of our great grandparents; others with cleanses of lemon juice and water, dinners of charred meat, and copious quantities of green leaves sprinkled with vinegar.

It makes no sense, this going from excessive feasting to self-imposed famine. How much better to make the excesses of the holidays those of generosity and friendship; these are “pounds” that one will gladly take into the new year.