Psycho-Babble Medication Thread 140430

Shown: posts 9 to 33 of 35. Go back in thread:

 

Re: La Puma: Dexadrine and weight gain

Posted by zenclear on February 11, 2003, at 17:41:47

In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31

I have ADD and take a low dose of Dexadrine: typically, 5-10 mg/day. I have always been a good shape (middle-aged female), and exercise is part of my life (moderate weight training and regular cardio). But since taking dexadrine (for about a year and half), I have gained about 10-15 pounds that I cannot take off. My diet is pretty good.

Before Dexadrine, I took Adderall and Ritalin, alternately, but I cannot tolerate those medds anymore. Dexadrine is my best solution.

Is it possible that the Dexadrine is related to my weight gain? Perhaps because it's centrally but not peripherally active?

I would really like to be at the weight that I feel best at, which preceded my use of Dexadrine. Any ideas? Many thanks.

 

La Puma: low carb when on meds?

Posted by jflange on February 11, 2003, at 22:44:19

In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31

Dear Dr. La Pluma:

I realize that the low carb diet is a bit faddish at the moment and has hyper-politicized the food pyramid, but I have noticed, both anecdotally and in the press, that in fact it does seem to help people lose weight and gain related health benefits.
And so I wanted to ask you your opinion on this matter:
Given that many of us on this site have struggled with our weight - both apart from our meds but especially on them - and given the fact that in an above message you mentioned that a number of psychotropic meds "are associated with potential changes in glucose regulation" I would think it is safe to assume that adhering to a low carb (aka: diabetic) diet is the smartest course of action to combat med-related weight gain. Would you agree?

Granted, one would probably want to eat more of the fish fats rather than the copius bacon called for in the Atkins induction-diet..... Still, such a modified diet is easier to handle than having to change meds because of weight gain!!!
Curious,
jflange

 

La Puma: Amino Acids and Weight..

Posted by jay on February 12, 2003, at 10:52:34

In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31

Dr:

Can you and do you recommend individual amino acids to be taken in supplement form, which can both be good for weight control as well as mental health? There seems to be a link between the two, and I have had a 'small' amount of success with help with weight with a prescription product here in Canada, which is L-tryptophan. I did start to feel a bit unhealthy after being on this singular product for quite some time (my doctor assured me it would have nothing to do with contamination, as this was a prescription grade product), and hence have avoided amino acids. Any comments please? Thanks,

Jay

 

Re: La Puma: Amino Acids and Weight..

Posted by noa on February 12, 2003, at 17:15:25

In reply to La Puma: Amino Acids and Weight.., posted by jay on February 12, 2003, at 10:52:34

Dr. La Puma,

I have always had weight issues, but they got much worse on medications. I have been on Effexor for about 7 years. My current cocktail is effexor xr, serzone, adderall xr, cytomel, and synthroid, glucophage xr, and a small amount of lorazepam at night. I have noticed that since being on effexor, I have gained a lot of weight in my middle, whereas before it was mostly in my hips, etc. I used to have a small waste and pear shape, with most weight in hips and thighs. Now the weight is everywhere, and I am much heavier than before medication. I also noticed that my cravings for sugary foods, including chocolate increased dramatically since being on effexor. These cravings were not a regular occurence for me before that.

I saw an endocrinologist for the hypothyroidism, and he noticed the signs of insulin resistance, and had me tested. He prescribed the glucophage xr, which I continue to take. I think the glucophage helps to limit, somewhat, further weight gain, but I still have the sugar and chocolate cravings. When I first started taking the glucophage, I was also exercising regularly (has been hard to get myself to do so in past 6 months or more). With the glucophage and exercise, I was able to lose some weight at a good pace, without having to make much change in diet. But that leveled off, and without exercising, I have put most of the weight back on. This weight is about 75 more pounds than before medication.

Do you suppose there is a connection between the effexor and the sugar/chocolate cravings, and does effexor alter how my body uses insulin to metabolize sugar? How about the serzone?

Thanks!

 

La Puma: Nardil and Obesity » Dr. Bob

Posted by jumpy on February 12, 2003, at 22:01:27

In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31

Dr La Puma,

I have severe depression and anxiety. After over 25 combination trials of medication, therapy, exercise and ECT, only nardil provides some relief. Unforunately, I gain about 30lbs and meet criteria for obesity on nardil. I think it might be related to hypoglyemia and carbohydrate cravings nardil induces (blood glucose is between 65 and 70). I often awake at 3 or 4 AM with low blood sugar and must eat high carbohydrate meal stop the hunger pains. Traditional remedies do not help such as exercise and reduced calorie diets. Do have any suggestions on how to lose weight on nardil? Would glucagon or glucophage be helpful?

Thank you,

Jumpy

 

Re: La Puma: low carb when on meds?

Posted by drjohnlapumamd on February 12, 2003, at 22:10:04

In reply to La Puma: low carb when on meds?, posted by jflange on February 11, 2003, at 22:44:19

Gee---there's a lot here. But I'll try.
A moderately low carb approach (30-45% of calories) works in diabetics because their insulin doesn't work well, and because there is often some degree of insuling resistance. Not all carbs are created or metabolized equally, however. What's important is glycemic load, not glycemic index, as the latter is a research tool that has gotcha-appeal popularized by the Sugar Busters people first, and man-handled by others later.

Glycemic load is the glycemic index of a carb multiplied by the number of grams of carbs ingested. Glycemic index is calculated, in the laboratory, as your blood sugar response to 100 grams of any particular food, administered in isolation. But we don't eat foods in isolation--we usually eat them with other foods. Adding fat to any particular carb will modify its glycemic index, and ultimately, its glycemic load---and your insulin and cortisol responses.

Enough pathophys. If you have gained weight, especially around the middle, and have an elevated waist to hip ratio (over 0.8 in women, and 1.0 in men), there's a good chance you have metabolic syndrome if your blood pressure or triglycerides or blood sugar is also high. And metabolic syndrome patients are often insulin resistant and do in fact benefit from lower carb intakes.

However, the rest of Atkins (and Somers and Heller and Schwarzbein and others) is likely to be atherogenic---i.e., cause vascular disease, include heart attacks, stroke, impotence and premature wrinkling of the skin. Protein should not come primarily from animal sources, as they suggest, but from fish and vegetable sources. Fat should be unsaturated not saturated or hydrogentated---nothing makes your cholesterol levels go up faster than weight gain, saturaged and trans fats.

So, yes, lower carb than we have been eating seems right---no one ever lost weight and kept it off with sugar or Snackwells or Twinkies. But don't reverse the mistake of the 80s and substitute fat for sugar...it's just as lethal.

 

Re: La Puma: Amino Acids and Weight..

Posted by drjohnlapumamd on February 12, 2003, at 22:19:15

In reply to La Puma: Amino Acids and Weight.., posted by jay on February 12, 2003, at 10:52:34

Hmmm. I'd be careful here. The boondoggle with tryptophan many years ago now was in fact due to contamination. You're right to seek pharmaceutical grade supplements. Make sure it says USP or DSVP or NSF on the label---that means that they meet those standards of purity, dissolution and composition. It's not clear to me that manufacturers can produce contaminant-free L-tryptophan. And the interaction with other drugs is well known---SSRIs, phenothiazines, sedatives, MAO inhibitors. I'd stay away.

Single amino acids are very appealing, because they are the building blocks of protein, and higher protein intakes, within limits, do help in athletes building muscle. But there's no evidence they help with weight loss. At all.

L-tryptophan is a precursor of serotonin and is also converted to nicotinic acid and nicotinamide). L-tryptophan has sedative effects. In addition, the contamination you refer to is not necessarily gone---the contaminant 1,1'-ethylidenebis [L-tryptophan] (EBT) was cited, but other chemical contaminants are possible, and some cases of eosinophilia myalgia syndrome (EMS) were not linked to the contaminant; cases of chronic B-cell lymphocytic leukemia were also linked.

Best of luck.

 

Re: La Puma: Dexadrine and weight gain

Posted by Carlos C on February 13, 2003, at 6:30:34

In reply to Re: La Puma: Dexadrine and weight gain, posted by zenclear on February 11, 2003, at 17:41:47

> I have ADD and take a low dose of Dexadrine: typically, 5-10 mg/day. I have always been a good shape (middle-aged female), and exercise is part of my life (moderate weight training and regular cardio). But since taking dexadrine (for about a year and half), I have gained about 10-15 pounds that I cannot take off. My diet is pretty good.
>
> Before Dexadrine, I took Adderall and Ritalin, alternately, but I cannot tolerate those medds anymore. Dexadrine is my best solution.
>
> Is it possible that the Dexadrine is related to my weight gain? Perhaps because it's centrally but not peripherally active?
>
> I would really like to be at the weight that I feel best at, which preceded my use of Dexadrine. Any ideas? Many thanks.

Dexedrine is a CNS stimulant. I don't see how you can gain weight from something that speeds up your metabolism and surpressed apetite. Dexedrine has be presribed to aid in treating obesity.

But than again we all have different reactions.

 

La Puma: PCOS, weight gain and depression

Posted by whitman on February 13, 2003, at 8:00:37

In reply to Re: La Puma: low carb when on meds?, posted by drjohnlapumamd on February 12, 2003, at 22:10:04

I was diagnosed with polycystic ovarian syndrome years ago. It was recently mentioned to me that could be a cause of depression and I know it is a cause of weight gain, I am about 50lbs. overweight. Is it true that this can cause a sugar imbalance, and if so is there good treatment for this? Thank you.

 

Re: La Puma: Sugarbusters et al

Posted by Dinah on February 13, 2003, at 9:26:14

In reply to Re: La Puma: low carb when on meds?, posted by drjohnlapumamd on February 12, 2003, at 22:10:04

I have high triglycerides and was just below pre-diabetic on my glucose fasting test. My fasting blood sugar is a wee bit high. Not diabetic yet. So I obviously have some glucose tolerance problems. My doctor has suggested Sugarbusters to me, but I find that when I go on a low carb diet I get angry and agitated enough to spit nails. My husband has begged me never to try again (before the doctor recommendation of course). I admit to using foods (especially pastas and breads) as a mood stabilizer. How do I keep my moods steady without carbohydrates? It's hard to care about long term health benefits when you're having trouble making it through today.

 

Re: La Puma: Sugarbusters et al

Posted by Dinah on February 13, 2003, at 9:53:36

In reply to Re: La Puma: Sugarbusters et al, posted by Dinah on February 13, 2003, at 9:26:14

Oops, I meant my levels were just one point below prediabetic on my glucose tolerance test.

 

Re: La Puma: Guest expert on obesity

Posted by lereto on February 13, 2003, at 11:00:27

In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31

Hello Dr. Lapuma:

Whenever I see a discussion of obesity I feel justified to "weigh in" as I have lost 140 lbs over the past 4 1/2 years.

What I have to say won't be true for everyone, so take what you need and leave the rest. However, I, in addition to, or as a result of my chronic depression and anxiety, am a compulsive overeater. I have found relief from this compulsion through working the 12 steps of Overeaters Anonymous. I currently am working with a dietician who developed my food plan, taking me out of the food business. I plan my food and call it into my sponsor daily. I am of the opinion that if one is a compulsive overeater, it doesn't matter what "diet" one follows, the compulsion will eventually over rule the desire to follow it. By abstaining from compulsive overeating through working the OA program, almost any healthy and appropriate food plan will result in weight loss (physical recovery), as well as emotional and spiritual recovery. My two cents.

 

Re: La Puma: Dexadrine and weight gain

Posted by stjames on February 13, 2003, at 12:10:39

In reply to Re: La Puma: Dexadrine and weight gain, posted by Carlos C on February 13, 2003, at 6:30:34

I don't see how you can gain weight from something that speeds up your metabolism and surpressed apetite. Dexedrine has be presribed to aid in treating obesity.

All stims have proven only to have short term
effects on weight. Over time appetite surpression
goes away.

 

Re: La Puma: Dexadrine and weight gain

Posted by zenclear on February 13, 2003, at 13:41:14

In reply to Re: La Puma: Dexadrine and weight gain, posted by stjames on February 13, 2003, at 12:10:39

I'd like Dr La Puma's response, thank you very much.

Receptor modification, insulin sensitivity, reduced physical activity (due to med effects of countering hyperactivity), rebound fatigue, et al, may account for these changes. But I'd like to hear a doc comment on them, as they are underdiscussed in regard to adult use of stimulants.

 

Re: La Puma: Dexadrine and weight gain

Posted by stjames on February 13, 2003, at 13:57:07

In reply to Re: La Puma: Dexadrine and weight gain, posted by zenclear on February 13, 2003, at 13:41:14

I was not talking to you, I was responding to carlos

 

Re: La Puma: Guest expert on obesity

Posted by zenclear on February 13, 2003, at 17:43:53

In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31

Has our Guest Expert left? According to the notice, today's the last day.

 

Re: La Puma: Dexadrine and weight gain

Posted by Carlos C on February 13, 2003, at 21:07:06

In reply to Re: La Puma: Dexadrine and weight gain, posted by stjames on February 13, 2003, at 12:10:39

> I don't see how you can gain weight from something that speeds up your metabolism and surpressed apetite. Dexedrine has be presribed to aid in treating obesity.
>
> All stims have proven only to have short term
> effects on weight. Over time appetite
> surpression goes away.

This is true, and I agree. I myself have experienced tolerance build-up from stimulants. Most ampethamines have little to no stimulant effects anymore.

Although I was uninformed of La Pumas history with amphetamines or need for them so I was generalizing.

 

Re: La Puma: Dexadrine and weight gain

Posted by drjohnlapumamd on February 13, 2003, at 23:17:34

In reply to Re: La Puma: Dexadrine and weight gain, posted by zenclear on February 13, 2003, at 13:41:14

I wrote an extensive reply to this last night, but somehow it vaporized.
As you know, weight gain on dexedrine is paradoxical, and I'm unaware of reports of this, or changes in insulin sensitivity with amphetamine administration. However, amphetamine-life signals act at several central nervous system (CNS) sites and the pathways converge on the hypothalamus, which influences food intake. There are examples of genetic obesity which suggest that the balance between the pathways causeing weight gain and those causing weight loss in ihe hypothalamus is a delicate one, and that those pathways converge.

But my suspicion, given your history of weight consciousness, is that it is something else, other than the dexedrine---a drop off in the intensity or duration of exercise/activity is the most likely culprit. To fight this, I'd look at a pedometer, perhaps held by or buddied with a friend, to self-monitor and make you more accountable for duration (especially) of activity.


 

Re: La Puma: Sugarbusters et al

Posted by drjohnlapumamd on February 13, 2003, at 23:24:48

In reply to Re: La Puma: Sugarbusters et al, posted by Dinah on February 13, 2003, at 9:26:14

I also wrote an extensive reply to this, now gone! But here is the more succinct version:

1. Try omega-3 fatty acid supplements or reducing alchohol intake to drop your triglycerides: both are very effective.
2. Sugar Busters is not a diet I'd recommend--too much saturated and trans fat. Plus, it's atherogenic.
3. There are better pastas and breeads now, some of which are specifically lower carb and generally higher protein: look for soy protein added pastas (from ADM); lower carb tortillas (from Santa Rosa); and higher fiber pastas and breads, which are more filling than lower ones
4. Some carbs are not nutritional, and should be limited or eliminated: other people's baked goods, buns, pastries, cookies, cakes, donuts, candies
5. Adding healthy fat to carbs lowers the glycemic index of any carb: so snack on nuts instead of chips. Have guacomole as an appetizer, not bread or tortillas by themselves, and definitely not flour tortillas. Eat grains that begin with whole wheat or whole oat. Try cereals (look for Hi Lo at Trader Joe's, or Heart2Heart (6 g of carbs, and delicious) from Kashi.

I think you can have your carbs and eat them too.
Good luck!

 

Re: La Puma: Dexadrine and weight gain » drjohnlapumamd

Posted by zenclear on February 13, 2003, at 23:48:29

In reply to Re: La Puma: Dexadrine and weight gain, posted by drjohnlapumamd on February 13, 2003, at 23:17:34

Thank you for your reply! I only wish your first one had not vaporized.

 

Re:Thank you. That was very useful (and gave hope) (nm) » drjohnlapumamd

Posted by Dinah on February 14, 2003, at 7:44:53

In reply to Re: La Puma: Sugarbusters et al, posted by drjohnlapumamd on February 13, 2003, at 23:24:48

 

Re: healthy carbs » Dinah

Posted by IsoM on February 14, 2003, at 11:56:16

In reply to Re:Thank you. That was very useful (and gave hope) (nm) » drjohnlapumamd, posted by Dinah on February 14, 2003, at 7:44:53

Dinah, can I make a suggestion?

Try to steer clear of stores that sell the wrong sort of foods. If you'd rather not, then make sure you avoid the aisles where the junk foods are concentrated. Avoid the areas in a mall where the concession fast food stands are located. If you don't go near those places, you're less likely to buy those foods & if you don't have them in your cupboards at home, you can't eat them, right?

Treat yourself to a bread machine if you don't know how to make bread or don't have the time. If you make your own bread & buns, you won't need to buy them. Once you get eating your own, you'll never want to eat store-bought again. And it'll very nicely satisfy your carb cravings while improving your diet at the same time.

I love my carbs & always have!!! But perhaps one of the reasons I don't gain weight from them is what's in them. I've always made my own breads (& now pastas) that have lots of protein in them. I include soy flour (50% protein!), milk, eggs, wheat germ, & extra gluten in almost all my breads. When I make pasta, I include eggs & soy flour too. I originally did so as a means of adding more protein to my diet when I was young & poor, & couldn't afford much high protein foods like meat, eggs, & cheese. Now I wouldn't go back.

Don't know if you still have my email addy, but if you want, you can email me & I'll send you a simple recipe for the bread. I don't use recipes when I cook but I can pay attention to how much I add when I make bread (today) & come up with the amounts for you.

 

La Puma: You Forgot My Question

Posted by jumpy on February 14, 2003, at 19:06:54

In reply to La Puma: Nardil and Obesity » Dr. Bob, posted by jumpy on February 12, 2003, at 22:01:27

Did you forget my question? Thanks, Jumpy

> Dr La Puma,
>
> I have severe depression and anxiety. After over 25 combination trials of medication, therapy, exercise and ECT, only nardil provides some relief. Unforunately, I gain about 30lbs and meet criteria for obesity on nardil. I think it might be related to hypoglyemia and carbohydrate cravings nardil induces (blood glucose is between 65 and 70). I often awake at 3 or 4 AM with low blood sugar and must eat high carbohydrate meal stop the hunger pains. Traditional remedies do not help such as exercise and reduced calorie diets. Do have any suggestions on how to lose weight on nardil? Would glucagon or glucophage be helpful?
>
> Thank you,
>
> Jumpy

 

La Puma: Willpower

Posted by sjb on February 15, 2003, at 6:37:02

In reply to Re: La Puma: Sugarbusters et al, posted by drjohnlapumamd on February 13, 2003, at 23:24:48

Doctor,

I agree with what you said and know all this stuff, but how do you advise uncontrollable cravings for the crap? In my case, cookies, baked goods, etc. I know it's not healthy, but I get these overwhelming "GOT TO HAVE IT AND STUFF MY FACE WITH IT" and give in time and time again. The result of course, is weight gain, lethargy, and in my case, suicide thoughts 'cause I hate myself for not being able to control what I eat. I used to be a marathon runner and could get away with some of these binges, but my last bought of sinking depression left me without the energy or motivation to run. I'm working out but not enough to compensate. I want to eat the foods you recommend and always have them around, but end up driving to bakeries, etc to get my "fix". I've tried taking walks, calling friends, all kinds of therapy, been hospitalized, etc, OA, 30 different medications, nothing has helped!!!

 

Re: La Puma: Willpower-- » sjb

Posted by lereto on February 15, 2003, at 7:19:13

In reply to La Puma: Willpower, posted by sjb on February 15, 2003, at 6:37:02

I think Dr. La Puma has left the building. SJB, I can relate so much to what you describe. The pain and the misery of it. It is classic compulsive overeating, and doctors really don't have an answer for it. Neither do the countless weight loss programs and books and supplements on the market. You say you tried OA, but for how long? Did you get a sponsor? Did you go to a dietician? Did you use the tools? Work the steps? It's a whole different way of doing things and sometimes takes a while to catch on to. Your story sounds so much like mine and as I said above, I have lost 140 lbs. in the program. Believe me, willpower wasn't involved. OA is always there for you whenever you are ready to go to any lengths necessary to put down the food. Good luck to you!

> Doctor,
>
> I agree with what you said and know all this stuff, but how do you advise uncontrollable cravings for the crap? In my case, cookies, baked goods, etc. I know it's not healthy, but I get these overwhelming "GOT TO HAVE IT AND STUFF MY FACE WITH IT" and give in time and time again. The result of course, is weight gain, lethargy, and in my case, suicide thoughts 'cause I hate myself for not being able to control what I eat. I used to be a marathon runner and could get away with some of these binges, but my last bought of sinking depression left me without the energy or motivation to run. I'm working out but not enough to compensate. I want to eat the foods you recommend and always have them around, but end up driving to bakeries, etc to get my "fix". I've tried taking walks, calling friends, all kinds of therapy, been hospitalized, etc, OA, 30 different medications, nothing has helped!!!


Go forward in thread:


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.