Emotional eating, Part 3

Now getting back to my current issue…

I am currently bouncing between 152 and 157 these days — a range I’m not particularly satisfied with. While my long-shot goal is 130-140 lbs, my current (and realistic) goal is 140-145 lbs. All I need is to fit in my pants. I don’t have money to buy new ones and the current ones I have in rotation are either uncomfortable or too dressy (read: formerly a corporate America drone).

Why am I having such a hard time? Well, other than the fact that I don’t get much cardio in, I’m also terrible about controlling my diet. (I’ve been playing the Wii religiously for about 30-60+ mins each day but it doesn’t seem to be doing much for the scale.)

dessertI indulge myself in anything I want: cupcakes; cake batter ice cream; pound cake topped with vanilla ice cream, strawberries laden in syrup, drizzled with caramel and decorated with whipped cream on the sides. I’m trying to teach myself discipline, but an undisciplined person trying to teach herself discipline is a recipe for failure.

But I’m trying.

I’ve been successful at times. For a while I was addicted to cinnamon buns sold at UPenn bookstore’s cafe. They were (and probably still are) absolutely delicious. Somehow — and I don’t know how I talked myself into this — I looked at them one day and said, “You know, those are disgusting. They’re topped with all that icing. That huge bun underneath the icing is nothing but carbs and does you no good. You don’t like it anymore. Don’t eat it.”

I haven’t touched a cinnamon bun since.

It’s strange how I’ve been able to use that psychology on some food items but not on others. Let me tell you, how I’d love to give up my addiction to cakes and cupcakes. I can’t eat chocolate but I find  plenty of other things to take its place: strawberry shortcakes, strawberry sundaes, the Strawberry-Banana Rendezvous with cake batter ice cream from Cold Stone Creamery, carrot cakes, and Krispy Kreme donuts drenched in its original glaze icing. You can probably tell now why I can’t seem to dip below 150 lbs.

I want to stop. But each night, the ice cream place down the street beckons my name. Every morning, the bakery’s aroma wafts across the street and into the windows of my apartment, taunting me to defy the scale one more time for a temporary delight. There’s a diner that has dessert that is so good, I need to avoid eating there or else it becomes a requirement to indulge in after my entreé.

I’ve tried eating strawberries and grapes — natural sweets that should satisfy my sweet tooth. Grapes seem to make me hungrier and strawberries alone just don’t seem to cut it. I have tiny dessert cups used for individual shortcake servings but I’ve decided recently to cut them out to save calories.

I guess that it doesn’t help that I’m addicted to calorie-counting.

Goya riceI’m also trying to rid myself of my carb addiction. People from the Caribbean are notorious for their staples of rice and beans. As a product of Caribbean parents, I simply cannot live without rice. I can easily forgo meat if I can get my hands on some good rice and beans.

I don’t mind most veggies but trying to incorporate them into every single meal is incredibly difficult for me. And a house salad for lunch satisfies my hunger like a sip of water… that is to say, not at all.

So I’m currently faced with a dilemma. I need to stop eating so much and eat the right kind of food so I can lose weight. Because I lack discipline and feel hopeless and discouraged, I continue to overeat (American portions are larger than necessary) and indulge in dessert each night, continuing my slow trend toward weight gain.

My mental health suffered much less when I was 140 lbs. I looked good and felt good. There’s something to the saying that the physical contributes to the spiritual, mental, and emotional well-being. Mind, body, and soul — they truly are all connected.

Emotional eating, Part 2

Seeing the scale at 180 scared me into action somehow. I thought of my father who died of a heart attack and remembered that I had a history of high cholesterol running through my family. I decided I had to do something so I didn’t drop dead of a myocardial infarction at 23.

  • gymBob and I joined a gym. We went 1-2 times a week for about 30 minutes, which — for a variety of reasons — was a disaster so this consistency didn’t last long. But it helped short-term. We mostly did circuit training and about 20 minutes of cardio. We also had a
    personal trainer for a while. It’s expensive and we haven’t been able to afford one since, but it was definitely worth the money. I dropped 5 lbs.
  • I stopped drinking soda. Everyone in my family will tell you that I was ADDICTED to soda. However, I knew the carbonation made me bloated.
    • I slowly weaned myself off of regular soda, forcing myself to like the significantly inferior diet products.
    • Crystal Light On-the-GoIn due time, I tired of diet drinks and became hooked on Crystal Light On-the-Go packets and forced myself to drink water regularly. This change resulted in an additional loss of 5 lbs. For whatever reason, the CL packets soon became too sweet for my sweet tooth and I stopped using them.
    • While I drink mostly water, I somehow picked up a daily habit of drinking coffee and lattés along the way. I usually make my own coffee but often order my lattés at coffee shops or cafés. I initially didn’t care about drinking whole milk but I soon learned that the calories can quickly add up between the vanilla shots and 16 oz. of milk.
    • Now, I ask for sugar-free vanilla lattés with skim milk. (These are called “skinny lattés” at Starbucks.) I always hated skim milk but forced myself to get used to it if I really wanted the pounds
      to continue to peel off. I still get my caffeine fix but for significantly less calories. Depending on the size I get, my latté can vary from 90-175 calories. Not bad when a regular vanilla latté is easily 300.
  • I began eating Lean Cuisine or Healthy Choice for lunch. This is something that’s since dropped out of my diet but I need to reincorporate because it’s offered me the most results. I limited myself to LC or HC only and fought off any other hunger urges if I could. These pre-made frozen meals led to another 5-lb weight loss. (NOTE: The sodium counts on some of these meals are ridiculous, negating the healthy benefits of the low-calorie count, and causing increased hunger. Check the Nutritional Information for products that contain — on average — 600 mg or less of sodium. I’ve found that more than that can be counterproductive. Healthy Choice is pretty good about keeping the sodium milligrams around 500 or less.)
  • walkingI began commuting to the city and walked from the train station to work for a total of 20-30 minutes round-trip. I skipped walking during severe heatwaves and rain. The bus to the train station from my job wasn’t very reliable so I often ended up walking for at least 10 minutes during the day. Or more if I walked somewhere (usually by myself at a faster pace) for lunch. I lost 5 more pounds.
  • I ended up in the psych hospital. This is NOT recommended. I didn’t like much of the food so I hardly ate anything. I was also started on Effexor XR, of which weight loss was a side effect. I dropped a good 10 lbs in 7 days as a result of this. By this point, I was down to 150 — my “Freshman 15” weight.
  • Since my body was getting used to the 20-30 minute work walks, I began working out at the gym at least 2-3 days a week for at least 30 minutes. I attempted to do a minimum of 20 minutes of cardio and 10 minutes of strength training or vice versa. I maintained a weight between 140-145 lbs for more than a year.

I haven’t been able to crack 139 on the scale for whatever reason and my goal is for a weight maintenance of 130-135 lbs. The BMI scale recommends that I weigh 110-125 lbs for my height.  Considering that my 26-year-old body is significantly different than my 16-year-old body, I’m not going to shoot for anything less than 130. I think to do so at this point in my life would be unrealistic. Besides, I wouldn’t want to be that skinny again anyway. 110 lbs on a 16-year-old looks vastly different on a 26-year-old  or a 36-year-old or a… you get the point. I’ve made 130 my minimum — a goal I’m sure I’ll be happy with if I’m able to attain it. Even if I bounced between 130 and 140 lbs, I wouldn’t mind as long as I didn’t regain my Freshman 15 weight. But I’m a work in progress.

Emotional eating: Part 1

I waver on whether I should attend the CCEF conference on Addiction in November. I have my own addiction that I’m dealing with and it’s ruining my mental health like nothing else right now.

Food.

Especially sweets.

donutsI’ve been keeping a record of everything I eat and while most of it is not terribly bad, it’s either the portion sizes that kill me or the delicious 5-scoop caramel strawberry brownie sundae from Friendly’s or a few helpings of those 200-calorie Krispy Kreme donuts. It also doesn’t help that I live across the street from a bakery that’s been named one of the best in the Philly area.

I grew up skinny and petite for the majority of my life and gained the usual “Freshman 15″ (or in my case 25) when I attended college at New York University. I did an incredible amount of walking each day — an average total of at least 75 minutes — and still somehow managed to gain weight. I didn’t occur to me at the time that 2 full plates of food from the cafeteria with several scoops of ice cream needed to be phased out of my diet.

By the time I attended a small Christian college in Florida, I was sitting at 150 lbs. (For a 5’4” female, this is considered slightly overweight.) During the nearly 2 years that I attended that college, I rarely ever rode in a car, which resulted in a drop of 20 lbs. Mind you, I still hadn’t changed my eating ways.

Fast-forward to August 2005, the month of my wedding. After a year of Paxil (3 months) and Lexapro (9 months), I hovered around 169-170 lbs. This was the largest I had ever been in my life. I never really realized that I’d gained all that weight. I was always pretty comfortable in my own skin. Sure, my jeans didn’t fit me as well as they used to but that was OK; it just gave me an excuse to buy new clothes!

Then, my family — pretty harsh critics, according to my husband — labeled me F-A-T. I never saw fat until they said it. The next time I looked in the mirror, I saw they were right. When I grinned, a double chin suddenly appeared. Saggy breasts hung in place of my once perky chest. Triple-fat rolls had now replaced the tummy that if I’d sucked it in just right, they’d look washboard. My lowest love handle drooped over my string bikini underwear like a fading flower.

Stretch marks also began to appear. They showed up looking like extremely red rashes. It was like watching my capillaries slowly attempting to burst out of the seams of my skin. The marks finally made permanent rest stops on my inner biceps and inner thighs.

A few months later, my max hit 180 lbs. To a lot of women, especially those who have been obese or overweight for a long time might pooh-pooh my weight problems. For a girl who — when her growth spurt had ended — fluctuated between 110 and 125 lbs, this was devastating. Unfortunately, it probably wouldn’t have been as bad if her family members hadn’t taken the liberty of pointing that out. Especially since she needed to be “skinny” for her wedding.

Nutrition, Part 1

Two posts from Jazz In Pieces have me wondering about my sugar consumption. Here’s the problem:

I don’t consume sugar.

SplendaWell, I do but not in drinks really. I’m addicted to Splenda.

I’m attracted to Splenda because of all the purported benefits:

  • accepted by several national and international food safety regulatory bodies
  • the only artificial sweetener ranked as “safe” by the consumer advocacy group Center for Science in the Public Interest.
  • one can consume 15 mg/kg/day … “on a daily basis over a … lifetime without any adverse effects”.
  • usually contains 95% dextrose, which the body readily metabolizes.
  • safe to ingest as a diabetic sugar substitute

But it’s still considered an artificial sweetener, which means that it’s not “natural” or “unrefined.”

Is unrefined sugar really better? I’m not sure. My mother uses brown sugar because “it’s healthier for you” but after doing a bit of reading, brown sugar can be refined as well. But “natural brown sugar” exists and I wonder if my mother is on to something.

The reason I’m so concerned about refined sugar and artificial sweeteners doesn’t really have so much to do with my mental health as it does to do with my weight. But depending on my weight (namely gain), it affects my mental health so I suppose the two go hand-in-hand.

Read the rest of this entry »

Women & Antidepressants

Pink, a magazine for business women, has an article in its April/May 2007 issue titled, “The Magic Pill.” (The only way to read this article is to get a hard-copy of the mag.) No, this isn’t about birth control. The subhead: “Antidepressants are now used for everything from migraines to menopause. But are women getting an overdose?”

Good question. The article, well-written by Mary Anne Dunkin, does a nice job of trying to present both sides of the coin. One subject, Pam Gilchrist, takes tricyclic antidepressants to relieve her fibromyalgia symptoms. “One of the [antidepressants] that allows her to keep going” is Effexor (venlafaxine). God forbid the woman should ever have to come off of that one. (It works well when you’re on it, but withdrawal is sheer hell.)

The other subject mentioned in the article, Billie Wickstrom, suffers from bipolar disorder, but had a therapist who diagnosed her with obsessive-compulsive disorder. The psychiatrist she was referred to promptly put her on Anafranil (clomipramine). We all know what antidepressants tend to do for those with bipolar disorder. Wickstrom blanked out at an interview that she says she normally would have aced. In another incident, she veered off-course after leaving town and spent the night on the side of the road with her daughter. “Search parties in three states” were out looking for them.

“Three years and three hospitalizations later, Wickstrom is finally free of clomipramine and has a job she loves as PR director for a $300 million family of companies. She says she’s happy, she’s focused and she feels great – consistently.”

Dunkin’s article uncovers a large, problematic use – by my standards, anyway – of off-label usage by doctors.

“Gilchrist… is one of the estimated one in 10 American women taking some type of antidepressant medication. And a considerable percentage of these prescriptions, particularly those for tricyclic antidepressants, are not used to treat depression at all.

A growing number of doctors today prescribe antidepressants for a wide range of problems, including anxiety, chronic pain, insomnia, migraines, high blood pressure, irritable bowel syndrome, premenstrual syndrome, menopausal hot flashes and smoking cessation.”

I’m sure the list goes on, but magazines have but oh so much space.

Melissa McNeilDr. Melissa McNeil at the University of Pittsburgh points out three things:

  1. Since depression is a prevalent (see common) condition, doctors are better detecting it.
  2. Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
  3. Clinical studies are finding that antidepressants can aid a number of medical issues apart from depression.

My take on McNeil’s points (I’ll try to keep them brief):

  • Depression is way too common to be abnormal. If a woman has a rough patch in life for 2 weeks or more, she’s got depression. As for doctors being better at detecting depression? Studies consistently show that doctors are great at overlooking depression in men.
  • Antidepressants haven’t proven jack squat. Placebos have proven more safety and efficacy than antidepressants. PCPs have no reservations prescribing them because they only know about the positive facts that pharma reps tell them instead of researching the potential side effects.
  • Clinical studies aren’t finding all those things out. Seroquel has FDA-approval to treat psychiatric symptoms (psychosis, for one). As far as I know, Seroquel is not FDA-approved to treat insomnia or crappy sleeping patterns. There are no specific clinical studies to see if Seroquel can treat insomnia. Seroquel is prescribed to treat insomnia/restless sleep because doctors have found that a major side effect of the drug is somnolence. If this is the case, Effexor should be prescribed for weight loss. It’d be the new Fen-Phen.

Dunkin cites two widely used antidepressants for nonpsychiatric uses: Wellbutrin (bupropion) and Prozac (fluoxetine). Zyban, used for smoking cessation is, well, bupropion. Sarafem, used to treat PMS symptoms is – you guessed it – fluoxetine.

Viktor BouquetteDr. Viktor Bouquette of Progressive Medical Group thankfully takes a more cautious approach:

“The widespread use – mostly misuse – by physicians of antidepressants to treat women for far-ranging symptoms from insomnia, chronic fatigue and irritability to PMS and menopause is merely another unfortunate example of the pharmaceutical industry’s tremendous influence on the practice of modern medicine. Take enough antidepressants and you may likely still have the symptoms, but you won’t care.”

Kudos to Dunkin for landing that quote. Since Bouquette is part of an alternative medicine group, he’s got a good motive for slamming pharma companies.

McNeil goes on to sound anti-d happy in the article. Not that it matters, but she is also a section editor for the Journal of Women’s Health, which has several corporate associates representing pharmaceutical companies. (She is also the only source in the article who sings anti-d’s praises.) Dunkin tracked down Dr. Scott Haltzman, a clinical professor at the Brown University Department of Psychiatry, who advocated patient responsibility.

“Just because antidepressants work for depression does not mean they should always be used. People need to learn skills to manage their depressive symptoms instead of depending on medication. When you take medicine for every complaint, you lose the opportunity to learn how to regulate your mood on your own.”

Oh, for more doctors like Haltzman and Bouquette.

UPDATE: Uh, alleged fraud suit pending against Progressive Medical Group. Bouquette is now part of Progressive Medical Centers of America.

"Quetiapine comes from the root word 'quiet'"

[UPDATE: I had some funky issues with my table. It should be fixed now. Sorry about that.]

The first time I visited my psychiatrist for my initial evaluation, he gave me the option of choosing one of three medications: Seroquel, Lithium, or Lamictal. He handed me information about Seroquel and Lamictal. I did some research on both meds (lithium was out of the question because I don’t have time to get my blood checked constantly) and Lamictal sounded like a way better deal than Seroquel. I found mental health blog Furious Seasons (probably via The Trouble With Spikol) and read numerous posts on Seroquel’s adverse effects and all the good stuff AstraZeneca doesn’t tell anyone. From Philip Dawdy’s “Seroquel, The Bipolar Pill?” post, here’s what stood out to me:

“He told her that he didn’t think Seroquel worked benignly for patients and that the increased blood-sugar levels and cholesterol levels associated with its use were unacceptable to him. She broke out a recent paper which claimed that there were no metabolic syndrome problems with Seroquel.”

The post got me thinking. One of the materials I received from my psychiatrist was an article on how Seroquel seems to help the depressive part of bipolar disorder. He had a stack of these articles. My guess is not that he’s an overzealous reader of various newspapers but received the glowing article from – you got it! – a pharma rep. The article was taken from the August 2005 issue of Clinical Psychiatry News. (NOTE: I received the article in November 2006.)

Clinical Psychiatry News’ publication goals:

“Clinical Psychiatry News is an independent newspaper that provides the practicing psychiatrist with timely and relevant news and commentary about clinical developments in the field and about the impact of health care policy on the specialty and the physician’s practice.”

Good thing they didn’t say objectively.

I don’t know much about ClinPsych’s reputation and whether they are generally a good paper that reports things objectively. However, the article, “Atypical Quetiapine Appears Effective for Bipolar Depression,” reads like a press release. I’m not happy about receiving (practically) PR material from my doctor when trying to make an unbiased decision.

The article’s lede:

“The atypical antipsychotic quetiapine led to significantly greater reductions in bipolar depression than did placebo within the first week of treatment and throughout an 8-week randomized, controlled study of 511 patients, Andrew J. Cutler, M.D., said.”

Dr. Andrew CutlerDr. Cutler? Who IS Dr. Cutler? No research necessary; look no further than the article itself:

“The differences between the placebo group and each quetiapine group were significant at each weekly assessment, said Dr. Cutler of the University of South Florida, Tampa. He is a speaker and consultant for, and has received research grants from, the company that makes quetiapine: AstraZeneca.”

At least they disclosed his financial affiliations.

It is also worth noting that Dr. Cutler also founded a clinical research company, CORE Research, which runs many of the clinical trials that he’s involved in. CORE Research’s background details:

“CORE Research, Inc. is a private research company with three offices in the Central Florida area. CORE specializes in pharmaceutical research and psychopharmacology for mental illnesses such as Bipolar Disorder, Depression, Anxiety, Schizophrenia, Attention Deficit Disorder, and Insomnia.”

Private + Pharmaceutical research + Psychopharmacology = Funding from Big Pharma Companies

I sound like I’m touting some grand conspiracy theory. (OK, maybe I am.) CORE’s background bio makes the company sound objective and unaffiliated, which isn’t the case. If Dr. Cutler has “received research grants from” not only AstraZeneca, but other companies, it’s in his best interest to make sure that their pharmaceutical products turn out OK. Namely in the interest of AZ – remember: he’s a consultant for them.

How can I expect to make a decision about which medication to take (remember it’s between Lamictal and Seroquel now) based on promotional materials from pharm companies and – oh – an article touting the benefits of Seroquel with quotes only from the study’s lead author who is paid to say good things about the company’s products?

I didn’t.

Then how did I decide on Lamictal over Seroquel? Wikipedia‘s outline of each medication’s side effects, of course, in addition to other materials. (Don’t EVER overlook the Patient Safety Information of any medication. Unless you’re reading about the molecular structure – ignore that.)

Lamictal (lamotrigine) side effects Seroquel (quetiapine) side effects
Headaches Sedation
Insomnia Agitation
Insomnia Constipation
Major weight loss Memory problems (i.e. anterograde amnesia)
Blurred/double vision Headaches
Muscle aches Abnormal liver tests
Lack of coordination Dizziness
Sleepiness Upset stomach
Nausea Substantial weight gain
Vomiting Stuffy nose feeling
Rash (Stevens-Johnson syndrome) [uncommon in adults] Neuroleptic malignant syndrome [rare]
Binds to melanin-containing tissues (i.e. iris of the eye) Tardive dyskinesia [rare]
Diabetes [unclear]
Cataracts [possible]

Not that Lamictal’s side effects looked like a walk in the park, but considering that I’d already had awful trouble with weight gain on Paxil and Lexapro – nearly 50 lbs. – Seroquel was a serious no-go on my part. That and I don’t mind major weight loss from Lamictal. (Although I have been told Lamictal has no effect on weight.) Below is a copy of the article I received from my psychiatrist or you can just go and read the archived full text at Clinical Psychiatry News.

Quetiapine article