Monthly Archives: September 2016

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.

Too Little Potassium May Lead To Big Problems

My friend, who is undergoing chemotherapy, was admitted to the hospital because of an infection but blood tests revealed another very serious problem. Her potassium levels were extremely low and, despite getting potassium intravenously, the unfortunate effects became apparent very quickly. Her heart began beating abnormally, her blood pressure shot up, and even though she was given a drug to prevent blood clots, one found its way to her brain. Consequently, she suffered a stroke. The infection was soon gone, but the effects of her low potassium remained many days later.

Potassium is one of those minerals that we usually don’t think about. If one eats a healthy diet with lots of vegetables and fruit, then potassium levels are usually within the range of what the body needs, about 4700 mg a day. But surveys of potassium intake in the U.S. population indicate that as whole, we don’t get enough of this mineral. Indeed, the average intake is 2640 mg a day, and that level has remained unchanged for decades.

“So what?” might be one’s response to this data. “I feel fine!”

Perhaps we should not be so complacent about whether we are getting enough of this mineral. Most of us, I hope, will not have to endure the toll of chemotherapy on the body and experience the side effects that can reduce potassium levels. My friend had mouth sores that prevented her from eating for days, along with gastrointestinal side effects, thus causing a significant loss of potassium from her body.

But also consider these other factors:

• A gastro-intestinal infection that causes prolonged dehydration may reduce potassium levels so much that it is necessary to get medical attention and potassium supplementation;

• Going on a high protein, low or carbohydrate-free diet can also drastically lower potassium levels because, as the body loses water due to diminished stores of carbohydrate, the body is also losing potassium. And it is almost impossible for such a diet to restore potassium because foods rich in this mineral — i.e. potatoes and bananas — contain carbohydrate and cannot be eaten. The effects of potassium loss on these so-called ketogenic diets is known as keto-flu. Followers of such diets feel ‘wasted’ and totally exhausted with flu-like symptoms. Since potassium is needed for normal muscle function including the heart (a muscle) experiencing such fatigue should be a sign to balance eating critically important nutrients with weight loss on an extreme diet;

• Prolonged fasting or cleanses and extremely limited food intake after bariatric surgery may also lead to low potassium. Post-surgery, bariatric patients are usually given potassium supplements;

• Alcoholics may have dangerously low potassium levels;

• Athletes engaging in prolonged strenuous exercise associated with excessive sweating also lose significant amounts of potassium;

• Medicines such as diuretics cause potassium loss (as does laxative abuse);

If potassium levels are marginally low to begin with, a further decrease may, as with my friend, generate potentially dangerous side effects. (Hypokalaemia, the term for low potassium, is defined as potassium blood levels below 3.5 mmol/L. If potassium is among the items measured when you have a blood test, the computer will list the potassium level as mmol/L and note if your level is below normal. ) However, an adequate potassium intake and blood levels are important for all of us, even if we are not strenuous athletes, recovering from bariatric surgery, following a carbohydrate-free diet or receiving chemotherapy. Too little potassium may lead to elevated blood pressure, kidney stones, and/or bone loss. Conversely, obtaining enough potassium in the diet may reduce the risk and severity of these conditions.

Consuming enough potassium is not hard, or at least should not be hard, if one is willing to eat vegetables and fruit every day. Bananas are high in potassium (everyone seems to know this). But for banana haters, there are many more options, some with considerably more potassium than bananas.

Here are a few high potassium foods: sweet and white potatoes, white beans, plain yogurt, milk, halibut, cod and tuna, winter squash, spinach, peaches, papaya, raisins, prunes, oranges, soybeans, tomatoes, melon, beef, peanut butter, and turkey (dark meat). There are many more foods with moderate potassium contents, mostly vegetables like mushrooms, Brussels sprouts, cooked zucchini, avocado, carrots, asparagus, and broccoli.

Let’s face it. Conversations about potassium are boring. People might boast about their good and bad cholesterol levels but I, for one, have never heard anyone boast about his or her potassium levels. In fact, potassium is usually only mentioned when someone needs to take a supplement and complains about the size of the pill, which is enormous. But, as the saga of my friend’s many medical problems indicate, we cannot be blasé and disinterested in our potassium levels. The potential health risks are too high. Eating enough of the foods on the list (and the list was not at all comprehensive) to meet the daily requirement should be given a high priority when planning meals or choosing what to eat at a restaurant.

When your mother told you to eat your vegetables, she was right.

Dividing a Daschund: Cementing a Friendship

This blog is for all caretakers and friends who look out for one another.

Simon, our long-haired dachshund, runs to Mary Lou’s apartment and makes low, moaning sounds of anticipation as we wait for her to come to the door. Once in her arms, he licks every inch of her face and then runs to her kitchen.

 “Simon, you know there won’t be any treats!” I call after him. Mary Lou, slender herself, is strict about getting Simon’s weight under control, but it’s a hopeless goal.

 Mary Lou and I hug. We have not seen each other since she left for Palm Beach and we, South Beach last fall. Now it is May, and Mary Lou’s turn to have the dog.  I hand her Simon’s heartworm and tick prevention pills, his leash and harness, and take the elevator to our apartment. I miss the dog already. He won’t return to our bed (literally) until next fall. 

 It is right and fitting that Mary Lou and her husband have Simon for six months. They own half of him, although which half it is, after almost 14 years, is still contested.  We bought Simon together, not long after Frieda, my wire-haired dachshund, died.

 Mary Lou and I became friends almost 30 years ago when we moved the same month into a new condominium building in Boston.  My husband and I were traveling frequently for work, and she offered to care for Frieda. Their condo became the dog’s second home, and Frieda spent so time at their medical supply company that her picture appeared on the cover of the company catalogue.

Frieda died at 16, and after we stopped grieving, Mary Lou and I agreed that it hurt too much to get another dog. Six weeks later we bought Simon. The breeder, named Jenn, was so fussy that she interviewed me on the phone before allowing us to visit. So we decided not to tell her that we were going to buy and share the dog. Our story was that I wanted a dog and Mary Lou was helping me find one.  It was a wise decision. I doubt that Jenn would have tolerated the dog being shared like a lawn mower. The puppy, whom we named Simon, seemed unconcerned. 

Sharing the puppy was the only way we managed to live through the two years it took to housebreak him. Like many of his breed, it mattered little to him that our carpets were not grass. “You take him; I am out of pee cleaner!” became a common refrain during the frequent hand-overs.  

Our somewhat erratic sharing of Simon eventually became fixed by season.  Mary Lou and her husband became snowbirds, and as their Florida apartment did not allow dogs, Simon lived with us from November to early May. We followed the snowbird migration a few years later living in a building littered with dogs.  

Dividing two dogs has cemented our friendship. Like an old married couple, we kvetch over the same things, share private details about our lives, comfort  each other, gossip ( too much),  and occasionally go hiking.  

We also get lost. Often.

There was the time we hiked with Simon on Blue Hill, a nearby 630 foot nano-mountain, and could not find our way back to our car.  Using an out of date map, (we didn’t know) and following a trail marked with barely visible dots (the trail had been abandoned) we were certain that the three of us would become a newspaper headline when our bodies were discovered. We were rescued by a hiker who pointed out our stupidity as she pointed us in the right direction.  

That was our last hike. But the reason was not our phobia about getting lost again. Simon is almost blind. He has a genetic disease similar to macronnuclear disintegration.  He walks slowly, his nose acting as a built in white cane, scanning the space around him for obstacles. He manages well enough in familiarly scented areas but rock strewn hiking paths, typical of those on Blue Hill, are no longer possible.

And the other reason is that Mary Lou has cancer. The double whammy of her treatment protocol, radiation and chemotherapy, is stilling her normally active life.  So the three of sit together in the library of our building, which is a social space for residents. Our armchairs are close enough so that Simon’s head is on one lap and his tail on the other. (He is a very long dog). We each rub him and talk and laugh and gossip and sometimes cry because that is what friends do. And our love for Simon and our love for each other passes through his furry body to each of our hands and our hearts and our memories.