Posts on coping with weight and health while on medication for mental illness

Many psychoactive medications cause weight gain, and since starting them I've really struggled with my weight. With a lot of effort, I've managed to bring it back down to not much more than normal.

How to lose weight (continued) (March 2017)

I posted some time ago about my great success in applying science to losing weight. At one point I had lost about 30 pounds in 6 months. Most people who lose weight go on to regain it, sometimes even eventually weighing more than they had when they started, so after six months I thought it was time to revisit my diet – or more precisely, my lifestyle.

The news is mixed. I have regained a bit of weight, but I am now fitter than ever before, as measured by endurance capability, maximum weight I can lift, resting pulse, and blood pressure. Most of the weight I have put back on (about 12 pounds) is muscle, not fat. My visceral fat is down to 11%, and my body fat 17%. I still feel flabby around the middle though, and would like to lose more weight there. Some of the weight gain – a few pounds – is fat, so it is a work in progress with many gains and a few losses.

So I think overall the verdict is that a version of this “diet” works, at least for me.

As with most things, life gets in the way sometimes. It’s difficult to stick to a particular lifestyle  when there are events such as Christmas come along, or when you’re travelling. I try, but relax things a bit. After all one of my greatest pleasures is eating out, and one has to have some fun. I nearly always pass on the dessert though.

I have also had time to consider what were the essential aspects of my original diet. I still think for me then the big thing was obsessively weighing and measuring food, and calculating the nutritional content of what I ate. This monitoring enabled to stick to a diet of around 2000 Calories a day, with about 75 g protein, 25 g fibre, and 50 g or less of carbohydrate (and often less than 1 g of salt a day). (I didn’t and still don’t care about the fat/oil content because I am convinced by the data showing that fat does good rather than harm.) Note again that this intake is the inverse of the traditional food “pyramid” with a large carb intake at the base. I also aimed for as wide a variety of micronutrients as possible, by supplementation and by eating as many different vegetables, and some fruit, as possible.

I stick by these things although I have relaxed the carb limit a bit. In particular I enjoy baking, and make my own gluten-free bread, which is largely seed rather than grain-based, containing walnut pieces, linseed, flaxseed, sunflower seeds, chia seeds, and pumpkin seeds. It tastes good (others say that too), but doesn’t keep well. I still try and avoid sucrose (sugar) like the plague.

I think the increased carb intake, especially bread, makes it more difficult to lose more weight. My main struggle however has been finding a way of eating that enables me to continue gaining muscle while losing fat. I don’t yet have an answer. When you work out six times a week for 45-60 minutes a day you’re going to need more calories, but what is the ideal proportion of fat, carbohydrate, and protein? How many times should you eat a day, and when, relative to the workout? I have scoured websites and books on exercise physiology without finding any answers that convince me. It is also difficult to work out how many calories you need when you have a complex exercise regime with many different types of exercise. I’m pretty certain the answer is more than 2000 though!

I recently saw a television programme that monitored someone trying to lose weight rapidly by calorie restriction over a week. At the end he had lost weight – but it was all fluid and muscle, and muscle is the last thing I want to use. On the other hand this was a television programme not a scientific study (although the measurements appeared to be taken under laboratory conditions), his diet was extreme, and he was very fit and lean in the first place.

I am sure that the principles of my diet work if you want to lose weight and become healthier. Restrict your carbohydrate intake, watch the total calorie intake, drink plenty of water, and exercise – the more and the more different sorts the better. But to become super-fit and super-lean is a further challenge. If you know anything about the science of doing so, please let me know.

The other issue outstanding is why so many people who start to diet do well at first and then go downhill. There are of course several possible reasons.

     •     You don’t really like the food in your diet. I am lucky in that I don’t like the taste of sugar that much and love blueberries and fish. It would be much more difficult if it were the other way round. So you have to include as much good food that you like and also re-educate your palate.

     •     You’re not really too bothered about your current weight and appearance. That’s fine, it’s your life – just remember if you’re obese it might be quite a short life.

     •     Not giving yourself enough rewards. Rewards work! If you find the going tough, decide on a reward programme. You’re doing something important so the rewards should be reasonable: stay on the diet for a week and you deserve that new book you thought was a bit of a luxury. I’m not a great fan of “treats” in the diet as rewards: after all a diet with two days of cake treats is really just dieting for five days. Similarly all these points-based systems are over-complicated for many people (like me) and it’s easier just avoid the cake than working out if you can have it, and buy a trip to California instead.

     •     Lack of support. It’s difficult if everyone around you is gorging all the time. It’s difficult if you’re trying to diet alone. One of the reasons diet clubs work better than other things isn’t because of the system, but because they provide social support to encourage you.

     •     Yo-yo dieting. Going on a diet and then stopping and starting again, perhaps with a new system, and your weight oscillating as you diet – and don’t. You have to ask yourself why do you stop after a while. Perhaps you don’t like the food. Perhaps there is no support around. Perhaps you haven’t rewarded yourself sufficiently.

     •     Thinking of it as a diet rather than a lifestyle. I know I’ve used the word diet, but that’s just a shorthand. You should realise that you’re not just eating fewer cases, but embracing a new, better way of living. You’re not going just going to lose a few pounds, but you’re going to become a healthier, happier person, with a longer life expectancy and better quality of life. And a healthy body is important for a healthy mind.

Now pass the blueberries.

Mens sana in corpore sano (May 2016)

It’s under a hundred days to go now before my official “retirement” date and when my life as a full-time writer begins. I’ve made the big change – or at least the decision to make the big change – that I hope will lead to a more satisfying and mentally healthier life, and now it’s time to look at smaller changes I can make. I’ve already taken up exercise in a big way and been going to the gym regularly for some months now; I’m pleased – and surprised by myself – that I’ve stuck to it. I’ve reduced my medication gradually without too many ill effects. I have now sorted out my life, to some extent, and my depression is in abeyance, at least for now. I have identified a purpose – writing, in the first instance on consciousness. I now need to go further and tweak my mental and physical well-being. I also face many years (I hope) “post-work”, and I want them to be healthy, happy years. I can already feel a bit of arthritis in the fingers of my left hand, and I still feel more tired than I would like. I am at last doing enough exercise, so what else can I change for a better life?The obvious answer is diet.

Now I don’t think my diet is too bad – as I have coeliac (celiac) disease (I don’t like the phrase “I am celiac”, identifying myself with the disease), I already avoid gluten and wheat and too much dairy. I am fortunate in not particularly liking the taste of sugar, and avoid processed food. What else can be done for a better diet and hence better life? We are after all what we eat Note that I am using the word “diet” in a loose sense to refer to everything we eat, not specifically a means of calorie restriction.

Unfortunately the world of improving your health through diet is a nightmare. It used to be so straightforward: eat with the pyramid of a little fat, lots of complex starches, fruits, and vegetables, and avoid saturated fat, while doing moderate or more exercise three to five times a week.We can say with some certainty what is bad: smoking, too much alcohol, no exercise at all, processed food, sugar, modified sugars, trans and hydrogenated fats, and too many calories. But then things get very confusing. It’s pretty much agreed that leafy green vegetables are good for us (although opinion is divided on whether they are better lightly cooked or raw). But here is the list of some of the disputed foods:

– carbohydrates: much loved by “official” dieticians, treated with great suspicion by many food movements (e.g. Paleo, Primal, to a lesser extent South Beach). I’m assuming we’re talking about good carbs (no crisps, no cakes) that you get directly from vegetables. Sweet potato seems to be the healthiest.

– grains: many are a no-no already when you cut out gluten, but things like rice are disputed. I don’t like them much anyway.

– fruit: you thought you were on safe ground, but many are very high in sugars, particularly fructose, and Paleo and Primal limit their intake. Best fruit: berries.

– nuts: high in calories and oils and many have the wrong Omega 3:6 ratio.

– oily fish: generally agreed to be good, but some worry that they’re a source of contaminants, heavy metals, and colourings: wild or organic are best (if you can get them!).

– meat: disliked by many diets, but preferred in Paleo and Primal, particularly grass-fed and organic (again if you can get it).- saturated fat: despised in the traditional diet, but desired as a major source of calories in Paleo and Primal.

-mushrooms: full of fibre and vitamins – but argued by some to aggravate intestinal yeast infections. Is this anything more than superstitious thinking?

– garlic: how can garlic be evil? The Bulletproof diet says avoid because of its mind-altering properties.

– omega 3 oils (fish oil): as long as they’re heavy metal free, although the extent to which they are beneficial to adults remains disputed by some scientists.

– organic or not: surely it’s got to be better to eat stuff that’s free from pesticides and herbicides? Some scientists have argued it makes no difference.

– alcohol: preferably as red wine, a little is generally thought to be good by many.

What is most problematic is whether most of our calories should be coming from carbohydrates, or from fat, oils, and protein. Will fat kill us, or stave off the heart attack? It’s a high-stakes game.

But in the end, as my finger hurts and my back hurts and I decide to skip that glass of wine and measure out a nice, I sometimes just despair at the confusion. It’s difficult being an anti-ageing biohacker.

Making big changes the small way (April 2016)

If you want to change yourself for ever, make the change in tiny steps. We’re all familiar with people who make big resolutions at New Year (I’m just as guilty as anyone else), who then take out gym membership on 1 January but who have stopped going by the 10th. When I reflect I’m ashamed by the number of times I have resolved to eat less, drink less, exercise more, work more, travel more, go out more, and so on, and so on, and so on.

A few years ago the book Nudge by Cass Sunstein and Richard Thaler (2009) was very popular; apparently politicians were taking it on holiday as beach reading. I see that there is a forthcoming book (2015) by David Halpern called Inside the Nudge Unit; its Amazon description starts:

“Behavioural scientist Dr David Halpern heads up Number 10’s ‘Nudge Unit’, the world’s first government institution that uses behavioural economics to examine and influence human behaviour, to ‘nudge’ us into making better decisions. Seemingly small and subtle solutions have led to huge improvements across tax, healthcare, pensions, employment, crime reduction, energy conservation and economic growth.”

The much debated “sugar tax” is presumably a recent application of the nudge principle: a small increase in the price of sugar-containing goods will (or might) change behaviour by stopping some people eating quite as much sugar as they have, leading to a reduction in obesity levels. With millions of people you don’t need to make a big change to make a big difference.

Nudging means changing behaviour by making small changes. We know dramatic diets are often ineffective; indeed people often end up weighing more than they before dieting. When people fall off the diet wagon they think “what the heck”, and binge. Small changes to lifestyles are more likely to persist and have long-lasting effects than dramatic resolutions.

So I am reducing my medication, and doing it gradually. (A caveat: always discuss it with your healthcare professional before you change medication in any way. I did with mine, and they’re monitoring me in case I go downhill without appreciating it.) I’ve cut quetiapine from four to one a day, very gradually. I don’t feel so good after going down to just one but I’m hoping it’s just a blip.

And of course only change one thing at once, and give that change a chance to bed in and observe its effects. There are still many more things I want to change about my life so that I can find more time for writing, reading, and thinking, but this change is the big one for now. It will mean I need to sleep less and am more alert in the day.

This technique should work for everyone – including depressed non-writers and non-depressed writers and even non-depressed non-writers. Look at your life. Decide what is the most important thing you have to change. Decide upon a small step towards that change. Implement the change. Give it time until what you’ve changed is now habit, then repeat. The technique is good for diet, exercise, working more, working less, and so on.

One thing I am not so sure about is whether gradual change is better for making a permanent change in areas such as smoking and alcohol and drug addiction. In these areas many people appear to have success with going cold turkey. Whether nudging would be even more successful for these sorts of things I don’t know, and I don’t know of any figures either way.

So vow to make one small change today.