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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Dr. Bob on February 10, 2003, at 11:39:31
Hi, everyone,
I'm pleased to announce that John La Puma, MD, Medical Director of the Santa Barbara Institute for Medical Nutrition and Healthy Weight and formerly Clinical Associate Professor of Medicine here at the University of Chicago, has agreed to be our guest expert for a week (though 2/13). See his site, at:
If you have any questions *about obesity*, just post them here (but please put "La Puma: " at the beginning of the subject line to let me know it's for him). I'll be the intermediary and pass on selected questions.
As an interesting counterpoint, during this same week, Maureen P. Dymek, PhD, Assistant Professor of Psychiatry here at the University of Chicago, will be the guest expert on eating disorders at Psychological Babble. For more information, see:
http://www.dr-bob.org/babble/psycho/20030203/msgs/2572.html
Discussion about the how this works (or doesn't) is welcome, but should take place at Psycho-Babble Administration. Thanks,
Bob
PS1: The above site discusses commercial products and services -- and unapproved or investigational uses of products. The site was not supported by educational grants.
PS2: The participation of a guest expert is intended to provide information and not advice. His responses should *not* be considered diagnosis or treatment. He may suggest an option to consider, but do *not* infer that his professional opinion is that you personally should choose that option. What specifically to do for yourself or a loved one you should discuss with a knowledgeable professional in person.
Posted by babs on February 10, 2003, at 17:19:41
In reply to La Puma: Guest expert on obesity, posted by Dr. Bob on February 10, 2003, at 11:39:31
Dear Dr. La Puma- I have gained 60 pounds from the current med regime I am on. I am concerned because I don't eat enough to warrant gaining 60 pounds- maybe 20 would have been more like it. The drug that caused me to gain so much weight was risperdal. One of the problems is that it increases my appetite to the ppoint where I get hypoglycemic if I don't eat on time. I am very worried about developing diabetes as a result of this weight gain. Any suggestions?
Posted by missinglynxx on February 10, 2003, at 17:37:29
In reply to Re: La Puma: Guest expert on obesity, posted by babs on February 10, 2003, at 17:19:41
Dear Doctor LaPuma___--How are you doing? Would working out HEAVY duty 3 times a week for an extended period of time (with Weights and stairclimber at the gym )be as productive as working out less intense 6 times a week? Some days I have depression.
WOuld you consider this enuff exericise for someone who wants to gain Muscle Mass and NOT lose weight? which is quite common, Do you advocate the pyramid method of weights (upping the weight on each set and lowering the reps) thanx
Posted by Dr. Bob on February 11, 2003, at 14:02:25
In reply to Re: La Puma: Guest expert on obesity, posted by babs on February 10, 2003, at 17:19:41
Babs: All the atypicals" (Zyprexa, etc) can cause weight gain, and with it diabetes, hypertension, heart disease and dyslipidemia--you're right to be concerned.
Clozaril, Zyprexa, and Seroquel cause the most--and a few cases of extreme weight gain, such as yours, have been reported with Risperdal (risperidone). Geodon (ziprasidone) is the least likely to cause weight gain.
You may need to switch meds. You certainly may need to check a fasting blood sugar, and compare with your fasting blood sugar prior to therapy. All of these meds are associated with potential changes in glucose regulation...especially Clozaril, Zyprexa, and Seroquel, and again, Risperdal and Geodon seem less likely to cause diabetes.
Posted by Dr. Bob on February 11, 2003, at 14:03:49
In reply to Re: La Puma: Guest expert on obesity, posted by missinglynxx on February 10, 2003, at 17:37:29
missinglynxx:
Work out frequency and type depend on your goals: there is exercise to build stamina and exercise to build strength, and they are different, as you know. And then there's activity to socialize, decrease depression, improve insomnia, beat constipation, and feel better.
If you're trying to build muscle, your muscles need a break, and I favor 3x/week with increasing reps or increasing weights on each set. I don't favor reducing the number of reps if you're increasing weight: something needs to stay constant. The only way to build muscle is with frequent repetitions of lower than maximal weight: large weights just balloon out existing muscle cells; they don't create new ones.
If you're trying to build stamina, your body still needs a break, but you're not working to fatigue, so 5-6x/week is optimal. If you're working towards any of the other goals, non muscly goals, the latter is best.
Posted by Gabbix2 on February 11, 2003, at 16:13:58
In reply to Re: La Puma: Guest expert on obesity, posted by missinglynxx on February 10, 2003, at 17:37:29
I don't know if there is even a clear answer to this question. I've gained weight on a few anti-depressents which negates most any positive effect for me.
Recently I found Paxil very effective for my anxiety but gave it up entirely because of the weight gain which happened seemingly overnight.
Would going on a lower dose be of any significant help?
Thanks
Posted by NikkiT2 on February 11, 2003, at 16:38:57
In reply to Re: La Puma: Guest expert on obesity, posted by Gabbix2 on February 11, 2003, at 16:13:58
Hi Dr La Pluma.
Over the past 3 years I have gained nearly 80lbs. I have managed to lose 35 lbs since September, but I have suffered terrible nausea throughout the whole diet. If I get at all hungry I get nauseas, yet when I then eat I get nauseas. I recth heavily, and the slightest thing triggers a vomiting attack. I have been on anti-nauseants with little success.
I have been eating a 1000 cal diet, staying under 10gms fat a day. My diet is also vegetarian, and I probably eat too much carb's, but a vegetarian diet with no carbs seems almost impossible. Living on steamed green vegetables just isn't an option.
Can you give me some advice to help me continue with this diet?? And not feel so ill with it.
Oh, and I currently take Zyprexa, though I was also taking Effexor until last November.Thankyou
Nikki
Posted by johnj on February 11, 2003, at 17:22:16
In reply to Re: La Puma: Guest expert on obesity, posted by babs on February 10, 2003, at 17:19:41
Dear Dr. La Puma:
I have been on 50 mg of nortryptline, 22.5 mg of tranzene and 600 mg of lithobid(AD booster) and am unipolar depressive. When I first stared meds I could work out for a few months before having some sleep or relapse troubles. However, as of about a year ago (I am 37 year old male) I cannot work out without mood/sleep disturbance. I find myself starting to gain weight and workouts used to be my way of being proactive. I am not sure what med is causing the problem. I have hydrated well and even a slight aerobic or weight lifting regime causes dizziness, etc. It is like the side effects are increased. The only thing I can do is Yoga! So, my question is is there any way for me to find out i.e. a specialist, to see what causes the problem? I had a stress test a year ago and did just fine.
I am waiting to try cymbalta when it comes out in hopes of getting off the TCA. I would think if excercise helps depression, as it has in the past, why would it have this effect now? It has been very perplexing and frustrating. I have always had a fast resting heart beat so I don't know if it is cardo related or not. Any advice whould be much appreciated. Thank you
Johnj
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.
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
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
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!
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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