weight. gain

[Brynmr]

I'm on 3000 mg of gabapentin daily and I'm gaining weight. In 2 years I'm up 20 lbs and this with me limiting what I eat not eating more than usual. I've read that gabapentin causes weight gain. Anyone else have this problem?

[Polar Bear]

I suffer from peripheral neuropathy as well as RLS and several other issues. I take 600mg Pregabalin daily which is a similar drug to Gabapentin. I've been on 400mg for about two years and 3 months ago at my first appointment with the Consultant at the Movement Disorder Clinic the dosage was raised from 400mg daily to the 600mg. It has the benefit of treating both my neuropathy and my RLS. By my reckoning my 600mg Pregab is the equivalent of 3600mg of your Gabapentin.

Two or three years ago when I first started Pregabalin I was aware that weight gain could be a side affect of Pregabalin and Gabapentin and reckoned if I don't over-eat then I can't put on weight. I did over eat, as though my brain didn't have an off switch, either that or my will power was non existent. Anyways I ended up gaining about 14 lbs which wasn't good as I could already have done with losing a few pounds. I don't know if the drug causes weight gain regardless of how little one would eat but my own on-line research on the Forums of those who are prescribed Pregabalin/Gabapentin would suggest it is an issue.

When my dosage was recently increased to the 600mg daily I determined my weight should not go up any further. I had to do something about it and have been counting calories, every single calorie, right down to including a teaspoon of butter and happy to say at present I'm down 14lbs and hope to keep going. So, Yes, I had this problem and had to actively take it in hand.

[Brynmr]

Hmmm...will power is called for. Bummer, I have so little being thin all my life.

[Polar Bear]

Brynmr - I am using a calorie counter app and it gives me a boundary of my own choosing. This was suggested by a dear friend and I was very sceptical that it would work for me, being someone with no willpower. Happy to say this method suits me. I can eat whatever I want just count the calories and most important..... Be honest.

[ViewsAskew]

I have found the only way I can manage to keep weight off (or lose) is to use delayed eating/intermittent fasting. It was very hard initially, but once my body adjusted (I would be sick if I waited more than 14 hours in the beginning), I can routinely go 18-20 hours without eating. The benefits are relatively well catalogued, too, so seems a win-win for me. Like Betty said, a boundary of your own choosing - we all find different things work.

[Polar Bear]

My problem is that I really like and enjoy food, nice simple food like a slice of bread with real butter and a smear of marmite or peanut butter. Unfortunately there's probably anything from 200 - 400 calories there. Yes, I use real butter as well as the peanut butter. That's quite a hole in a daily allowance of 1200 calories and leaves us with clear soup, salad, fish etc (for example) for the rest of the day. Thus we have our boundaries to suit, whichever method of control we use.

If we were to find that Pregabalin/Gabapentin, or indeed any other medication, boosts our appetite..... we definitely have to stay on our toes.

[Brynmr]

Eventually I'm going to see a specialist and a change of meds. I'm not eating freakin lettuce for the rest of my life.

[Polar Bear]

Brymr - I can honestly say that a lettuce leaf rarely crosses my lips. Good luck.

[Frunobulax]

When my dosage was recently increased to the 600mg daily I determined my weight should not go up any further. I had to do something about it and have been counting calories, every single calorie, right down to including a teaspoon of butter and happy to say at present I'm down 14lbs and hope to keep going. So, Yes, I had this problem and had to actively take it in hand.

Been there, done that -- and after a few months I got ravenously hungry and regained all the weight. I suppose it's because our body depends not only on calories but also on micronutrients, and on a calorie-reduced diet we usually don't get enough fat-soluble vitamins.

I suggest to check out Gary Taubes talks on the calorie counting model, for example https://www.youtube.com/watch?v=DFY0iPmzNqU. He expresses it better than I ever could... Calorie counting rarely works in the long run, because the body will lower base metabolic rate if the calorie supply is too low. Thats why most people start regaining the weight after half a year or so, even if they keep at the same restricted calories. A better approach, IMO, is a low carb diet which lowers insulin, which is the master "fattening up" hormone. Most people can eat as much as they want (still overeat at times) and lose weight on a low-carb high-fat diet.

I haven't counted calories in 3 years and I'm down 40 pounds on a low-carb diet. Bloodwork looks a lot better now (good cholesterol, triglycerides, GGT/GPT and more). And I always eat to satiety (and eat if I'm hungry), I even overeat at times.

[Yankiwi]

Interesting article from Dr. Gabe Mirkin who I respect and admire.

https://www.drmirkin.com/nutrition/why- ... -work.html

I read recently that when someone loses a lot of weight (such as yo yo dieting) they lose fat and muscle. When weight is regained, it is just fat.

[Frunobulax]

The crucial problem is that calorie counting assumes the energy expenditure as constant. This is far from the truth. There are immediate and long-term changes:

• If calories are plenty, we become much more active, generate more body heat and burn off excess calories. (Watch a healthy kid bounce off the walls if you give it sugar.)
• If calories are scarce, we downregulate activity and body heat.
• If calories are scarce for a long time (weeks/months) we downregulate our base metabolic rate, which is responsible for 80% of our energy expenditure.
• The presence of insulin (which is high whenever we eat carbs) sets the body in "fattening" mode. That is, high insulin means more fat stored or more energy conserved in the above scenarios. Evolutionary, this makes a lot of sense: Insulin is only high in the summer, where carbs are available. We build fat depots to survive the winter.
• If insulin is low, the body will downregulate energy expenditure at a much slower rate, and burn off fat depots. This is a bit counterintiutive, but makes sense again from an evolutionary standpoint: In winter we absolutely need to produce body heat, and if our fat depots are exhausted we need to get off our behinds and go hunting.

This all leads to some surprising observations, like people can eat more calories but still lose weight if they reduce carbs (drastically) and consume mostly fat. Conversely, on high carb diets people will gain weight long-term if they reduce their calorie intake because the base metabolic rate goes extremely low. That's why most people on a calorie-restricted, low-fat study see their weight drop for 3-6 months but then start regaining weight.

So it's fairly obvious (and backed by all long-term studies that compare low-carb and low-fat) that people lose more weight on low-carb diets and have an easier time to maintain that weight. Which is interesting because many of these studies were set up to prove the superiority of low-fat diets, and restrict calories for low-fat diets while low-carb diets allowed people to eat as much as they wanted.

The only debate is whether a high-fat, low-carb lifestyle is safe. And I won't get into that because it's a very, very complicated topic. Let's just say that I believe it's safe, safer than a high-carb lifestyle. But this view is controversial.

[Polar Bear]

Frunobulax- I'm taking note of your comments on carbs. Carbs are my weak spot and I could eat bread for every meal if I wasn't careful. Which of course is a no-no regardless of staying within any calorie limitation. I need to tighten my attitude.

[Brynmr]

Brymr - I can honestly say that a lettuce leaf rarely crosses my lips. Good luck.

I wasn't being literal. Lettuce as metaphor.

[Frunobulax]

Frunobulax- I'm taking note of your comments on carbs. Carbs are my weak spot and I could eat bread for every meal if I wasn't careful. Which of course is a no-no regardless of staying within any calorie limitation. I need to tighten my attitude.

Unfortunately this has been drilled into our brains for decades and it's completely wrong (according to all long-term studies on restricted calorie diets). We can't control our weight with discipline and attitude (at least the 99.99% of us that aren't supermodels). We are wired to eat till our body tells us that it has enough, it's pretty much impossible to beat this for more than a few months. Yes, we absolutely lose weight if we don't eat, but adherence to any calorie restricted diet (if we restrict them by a significant amount, say 1/3rd of our base metabolic rate) is abysmal. We just can't keep it up. And to add insult to injury, our body will downregulate energy expenditure if we go on a calorie restricted diet. I strongly suggest to forget about this "I need to control myself better".

A very good illustration of this is a recent study where people were required to restrict their calories dramatically: They lost weight for a few months (much less than predicted by the energy balance model though), but after half a year they started regaining weight -- while still restricting their calories! Peter from hyperlipid has done a wonderful blog post on this http://high-fat-nutrition.blogspot.com/ ... diets.html which explains it much better than I could. Self-imposed starvation doesn't work, and it doesn't matter if you starve yourself just a little or a lot.

The reason why we all gain weight is because the food composition affects our hormones that regulate fat storage, energy expenditure and satiety. This is a complex process, but in a nutshell: Carbs increase our hunger and appetite. We are evolutionary conditioned to eat as much as possible in times of plenty, while we use our fat reserves otherwise. "Times of plenty" is defined by presence of carbs (summer). Thus, we tend to overeat on carbs, in order to build up a nice big fat depot for the winter. (Nature never intended a year-round time of plenty, therefore we have some vicious cycles that kick in after a few years or even decades of high-carb diet, increasing this effect by affecting the hunger and satiety hormones leptin and ghrelin. That's one reason why some people are normal weight until they hit their 40s and then suddenly gain weight.)

On the other side, if we switch to a low-carb diet then we can eat to satiety (always!) and will still lose excess pounds. Nature has made sure that we use our body fat freely in winter (=absence of carbs). There is no calorie limitation, just eat as much as your body tells you to -- however, eat only when you're hungry and not when the clock dictates it. All the tricks that we were taught are unnecessary: Eat slowly, eat lots of fiber to fill up your stomach, and so on. These tricks are necessary only because a long-term effect of carbs is that our satiety signal doesn't work as intended. On a keto diet, the satiety signal will revert to normal, although this takes a few months for most people. And if you eat a bit more than you should have, then you'll be satiated for a longer time and start your next meal later.

In fact, most people won't gain weight if on a ketogenic diet even if they overeat intentionally... Overeating just prevents you from losing weight in this case.

I hope I'm not overstepping my bounds here... It just pains me to see how many people suffer as I have suffered for most of my life (controlling my weight). Research tells us again and again that it doesn't work, unfortunately we became very efficient in fooling ourselves (even scientists). The link above gives a very good example of scientists completely missing the forest because they look only at single trees.

[Polar Bear]

No, you did not overstep any boundary. All information is welcome.