Diets seem to be divided into two categories—the fad diet of the day and the traditional standbys. The fad diets may include regimens such as eating three protein-fortified cookies a day, cleansing of the colon, or eating like skinny Frenchwomen or robust Italians. What they may have in common is novelty, quick weight loss, the chance to talk about the diet at a dinner party, and ultimately abandonment after a few weeks.
In contrast, Conventional diets, such as the American Heart Association plan or Weight Watchers®, seem to offer a way of staying on a weight-loss program for many weeks with the chance to change permanently eating and exercise patterns. The point system of Weight Watchers, which allows the dieter to devise his or her individual food plan, stresses the consumption of vegetables and fruits, as they are “free food.” They allow the points to be used for protein, starchy carbohydrates, dairy products, and fats. The support given by Weight Watchers’ meetings takes away the loneliness of dieting to some extent and offers weekly encouragement.
But conventional diets such as Weight Watchers pose a problem for people whose weight gain is caused by their antidepressant or mood stabilizing medications. These drugs weaken will power and often leave the dieter feeling permanently hungry even though enough food has been eaten to meet the dieter’s calorie needs. No matter how many bowls of salad or plates of steamed vegetables are consumed and no matter how full or even bloated these foods make the stomach, the antidepressant–treated dieter still wants to eat. The meal is over, the points have been used up, but the dieter is still looking around for more food to eat.
Recently, a college student wrote to me asking advice about weight loss as he had gained about fifteen pounds after starting on the antidepressant Lexapro for his anxiety. He had successfully lost about ten pounds on Weight Watchers before starting the medication and returned to the program after gaining back the weight while on the antidepressant.
“The diet program isn’t working for me anymore,” he e-mailed me. “I crave carbohydrates constantly but if I allow myself to eat them, say a cup of rice, I use up too many points. So I fill up on vegetables and my stomach feels bloated but my brain keeps telling me that I am hungry. I don’t understand what is happening.”
In my return e-mail, I told him that his antidepressant and, unfortunately his diet, were preventing him from feeling satiated after eating. Even though his antidepressant was making him feel less anxious and depressed by activating serotonin, the drug was somehow weakening the appetite-controlling function of this brain chemical. Had he been allowed to eat enough starchy carbohydrates, his brain would have made new serotonin, and this would have resolved the problem. We had shown in our research that the brain, even on antidepressants and mood stabilizers, could shut off eating when enough serotonin was made. Serotonin is produced when an amino acid called tryptophan gets into the brain. This event occurs when a specific amount of starchy or sweet carbohydrate is eaten with no or very little protein.
My diet advice startled and dismayed him since I told him that if he was going to feel full after a meal, he had to consume a pre-meal snack of a carbohydrate like a roll or dry cereal about an hour before eating. “That way,” I told him, “your serotonin will be making you feel full even before you eat your meal. And for the first couple of weeks, you must eat only starchy carbohydrates and vegetables for dinner so you won’t be fighting the urge to snack all evening.”
“I can’t do this,” he replied. “It goes against all the guidelines I have been following. And I am sure I will gain weight from all those carbohydrates.” After I assured him that our diet had the same number of calories as the one using the point system, he was willing to try our approach for a couple of days. “It is so hard for me to go against what I have been told about carbs,” he e-mailed, “but I can’t stand feeling hungry all the time. All I think about is eating.”
