Follow-up on Medication

After taking phentermine for a month, I stopped because I ran out before I had a doctor visit. I had difficulty falling asleep on this stimulant.

At my doctor visit, I asked about other ideas. We thought of the generics of Contrave, which are buproprion (Wellbutrin) and naltrexone. Wellbutrin costs less, but not the naltrexone. It cost more than $100 for a month's worth. He prescribed Metformin to control blood sugar, and Wellbutrin as an experiment.

Ultimately, I tried Wellbutrin and Metformin. I stopped taking the Metformin because of the bowel symptoms. I stayed on Wellbutrin for 2 months with few results. I fluctuate within the same weight range since giving birth last year. I never returned to my PCP because the only medications left cost the weight of an arm and a leg.

I lost 2-4 lbs. when I went to sleep before 10:30 for a week. Going to bed on time, had a greater effect than anything else I have tried.

So what should be my goal? Go to sleep by midnight every night!

I bought a Fitbit the end of June. Now I have more information. I realize that I eat the same amount of calories as I burn most days. I usually hit 8000-10,000 steps a day and have active minutes from doing housework.

Since coming off the Wellbutrin, my appetite may have increased--due to stress. I have binged on several times when I felt bored or stressed. I gained 6 lbs back during my trip to see the eclipse and family.

My new fresh-out-of-residency psychiatrist said that Wellbutrin alone won't have much effect on weight loss. We discussed changing my mood stabilizer to topiramate and my antidepressant to buproprion, which are both ingredients in weight loss medications. My previous psychiatrist discouraged topiramate since brain fog is a symptom. My current psychiatrist said that symptom only occurred in some people. The "brain fog" at a lesser degree clears racing thoughts.

I am thinking of changing my psychiatric medications now. My mood stabilizer has worked for 11 years, and my current antidepressant has worked for 5 years. Neither of them cause weight gain. Changing medications takes several months. Those medications aren't guaranteed to work for my bipolar 2.

For now, I need to focus on going to bed earlier (barring my baby waking at all hours in the night), eating less and reducing stress.

Weight loss is such a puzzle.

Update:

I started the topiramate.

Trying Medication

Via Public Domain Photos

I talked with my dietitian three weeks ago about taking medication to lose weight. We discussed the different options--fat inhibitors or appetite suppressants. One medication I can't take because it conflicts with my current medications.

I thought my dietitian might be able to write the prescription, but she said she couldn't.

I asked about Lipozene and she couldn't find it in the normal drug database. She googled it. Lipozene is just fiber from the konjac root. It helps you feel fuller. It is fiber.

At the visit, I weighed the same as I did in February. The five pounds I gained came off. The big difference was when I stopped tracking my food and exercise. Tracking caused me stress.

I said my goal would be intuitive "living" by listening to my body's hunger and sleep cues. I still need to go to bed on time, eat veggies and fruits, and add some exercise. Just not stress about it.

I made an appointment to see my primary care physician. I used my preventive visit to make it "free". On my cell phone, I checked which prescriptions my insurance would cover--none of them. I took medications that put on the weight that insurance paid for. Why won't insurance pay for medications that take it off? 

Really, my insurance pays for several dietitian visits as preventive visits, and a specialist copay after that. Dietitians help more than medication since they impart wisdom.

My doctor said fat inhibitors like Orlistat can cause diarrhea and incontinent bowel movements. Joy. He said eating enough vegetables would inhibit fat too without diarrhea. Instead, I vowed to eat more veggies.

We decided on an appetite suppressant to try for one month. I have taken it for a couple weeks without weight loss (as far as I can tell). I feel hungry less often and eat less. The medication is a stimulant, which has interfered with sleep to some degree. I take a sleeping pill anyway.

I weighed myself more than once a week, which caused me stress. My new focus is on what I can control instead of what I can't control. I can't control the number on the scale, but I can control what I eat. I can exercise. I can.

A Depressing 100 Extra Pounds and Bleeding

238 lbs

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I have been bleeding since giving birth to my fourth son. It has driven me nuts. I have tried multiple things and it doesn't seem to fully work. I am more frustrated because the IUD and birth control pill have made me gain around 5+ lbs over the last month. Yet, they have lessened the bleeding to an extent. The "pill" has sent my emotions on a roller coaster that was well-controlled.

I have had an ultrasound and antibiotics. My doctor ruled out any left over placenta, glucose levels, thyroid problems, and other common issues. I have a slightly thickened endometrial lining.

I mentioned my problems on Facebook and friends and family suggested things. Mostly love and support. Many female friends empathized that they had similar bleeding that had no apparent reason for happening.

Sometimes, I wish I were male.

Well, not really.

I tried raspberry leaf tea and shepherd's purse. I stopped trying those a few days ago. Now I should be "on" bleeding with the pill. So maybe next week I should find out if the bleeding stops. I am embracing it this week. Haha.

I can't believe how much birth control can make me gain weight. So many things have been working against me for the last 13 years.

When I was 19, I had a breakdown at college. I was misdiagnosed with depression only and given an antidepressant. I gained 40 lbs over two years of taking it. I was active for most of that time. It was a stressful time I suppose at school, teaching English in China, and a brief mission. In China and the MTC, I didn't have the option to eat anytime, so I scarfed down more food at meals. I felt no control.

At 21, I switched medication and started more medications. I had a new diagnosis of bipolar 2. I started the patch a few months later when I married, which made me gain 5 lbs. I don't believe the bipolar medications had made me gain weight.

I lost 16 lbs puking through my first pregnancy. I tried going off my mood stabilizer and started a new antidepressant while breastfeeding. Eight weeks later, I went back on the mood stabilizer plus the antidepressant.

That antidepressant was notorious for gaining weight. Over the course of taking that medication, I gained 45 lbs. I had one more child, 2 IUDs in and out, 9 moves, a broken foot, and joblessness. That stress might have contributed.

So much has happened to my body. I had two more children with my body gaining, losing, and finally gaining. Changed medications several times. I had periods of losing 5-10 lbs., but it returned when stress hit.

Currently, I am 238 lbs. I figure I am gaining weight because of stress, lack of sleep, overeating, and too little activity. I don't know what perfect storm caused me to gain 100 lbs in the last 13 years. Medication and birth control don't help.

The extra weight holds me back from my dreams. I feel the weight hang off my belly and I just want to cry sometimes. It is just the last 15 lbs that has really depressed me.

Anyway, there's my pity party.

So here's a new year. Go to bed by 10 pm. Tell my infant to sleep through the night every night. Tell my toddler to sleep through the entire night too. Eat vegetables and fruit. Reduce stress. Blah...

I bought a stationary bike, which I ride for about 15 minutes a day. It helps in the winter.

My Thoughts on Weight Loss Supplements

"Aluminum Pill Busters" by Lynn Greyling

In my weight loss class, we looked over a handout about what supplements work and don't work. Many products claim that they help you lose weight, but most have inconclusive evidence or can be dangerous. I've thought of listing all the supplements, but that's an exhaustive list. You can check out weight loss supplement facts here. I'll mention a few supplements.

Research Supplement from Credible Sources

If you have questions about a supplement, look at the scientific evidence and not the advertisements and anecdotal evidence. Find credible studies not funded by the seller. Second, make sure the supplement is safe. Find out more information about products on websites like the National Institute of Health, NSF International, or US Pharmocopeia. I tend to use WebMD. Use your best judgment.

One man I knew lost weight on fen-phen, but had a heart attack soon after. Fen-phen causes regurgitation in the heart valves for a small amount of people. Is that what happened to this man? Maybe. So, I'm wary about even FDA approved drugs because they may be pulled like Fen-phen.

Some Evidence Category

The some evidence category has capsaicin, green tea, and psyllium. I looked up capsaicin and it's naturally in hot peppers. Just eat chili peppers if you can stand the heartburn.

"White Cup of  a Green Tea" by Petr Kratochvil

When I taught English in China, I was occasionally served green tea and I tried a green tea popsicle (weird). But I was hesitant about green tea because of my religious health guide. Drinking tea is a sometimes fuzzy area among my congregation because we accept many herbal teas as beneficial, but most consider tea from the tea plant--white, black, oolong, and green--as against the health guide (see this article). The official religious website only mentions "tea" and "herbal tea" but not specific teas from the tea plant. Using my own judgment, I choose to avoid green tea.

After seeing psyllium on the list, I started taking psyllium fiber, just your regular fiber. I believe it may have helped me lose a pound or two, but I also reduced my stress those two weeks. It's supposed to help you feel fuller, but I still benefit from the regulating effects of fiber. (I refuse to take laxatives because I've seen a friend suffer from the aftereffects of anorexia/bulimia.)

Inconsistent Evidence

Under inconsistent evidence, I only recognize caffeine, ginseng, and St. John's Wort. The others are chromium, hydorxycitric acid, pyruvate, and linoleic acid.

I avoid large amounts of caffeine and only ingest some from chocolate and an occasional cola. It messes with my sleep rhythm and bipolar. The Mayo Clinic recommends under 500 mg a day for adults. Besides, energy drinks with high caffeine and other stimulants cause some teenagers heart palpitations, strokes, seizures, and sudden death (Source).

I took St. John's Wort in my late teens to relieve depression, but I didn't know it actually made my undiagnosed bipolar worse. It increased my hypomania and suicidal thoughts. St. John's Wort isn't for me.

UNSAFE But Effective

Bitter orange, ephedrine, Ma Huang (Ephedra) have strong evidence for weight loss, but are NOT recommended. Some people have had heart attacks, strokes, or died using weight loss supplements containing these ingredients. It's unclear if it may have been a combination of ingredients as the cause. Ma Huang causes mood problems. Why take the risk?

FDA Approved Supplements

There are a few FDA approved weight loss supplements, but most require a prescription. Essentially, they are a last resort if diet and exercise alone don't work. Orlistat blocks fat absorption and the others are appetite suppressants. Follow the links for more information. These drugs include:

• Alli (OTC)
• Orlistat (stronger version of Alli)
• Phentermine
• Phentermine + Topiramate = Qsymia
• Belviq
• Tenuate

Save Money--Don't Take Any

Weight loss supplements cost money and only some actually work or are safe. Might as well save money and work on other areas to improve weight loss first:

• Sleep
• Stress
• Social support
• Mental health
• Food tracking
• Portion control
• Physical activity

If you've addressed all these areas, then your doctor or dietitian may recommend weight loss supplements. If you take a supplement like fiber or drink green tea anyway, then it doesn't cost you more money.

I sometimes feel desperate about losing weight, but I'm not addressing some of my other issues such as stress, sleep, and physical activity. Right now I'm concentrating on sleep, reducing stress, eating fruits and vegetables, and being more active. I'll see where my journey takes me.

Have you taken any supplements and what happened for you? Any other thoughts?