Medical Conditions Which Affect Weight: Separating Fact From Fiction

Sabine_Stroehm wrote: »

Liftng4Lis wrote: »

PeachyCarol wrote: »

Another type of fiction is that certain drugs cause weight gain. Well... yes and no. They don't directly just magically produce weight gain. They either lower metabolic rate or increase appetite, but that would only account for a certain margin of gain. Gains beyond that point come down to consumption.

Fiction is a loaded word, but it scans nicely with fact, so I went with it. I'd like this thread to explore the real causes of weight gain or loss with medical conditions as you did with explaining what happened to your friend there.

I find when we truly break these things down, it leads to understanding the component issues so that they can be addressed.

BOOM!

It's disturbing to so often see people say "blah blah" caused my weight gain. NO, eating too much causes weight gain. You may have different caloric needs now, for whatever reason, but it still comes down to CICO.

People attribute their weight gain to many things, don't they? I see threads here all the time where new jobs or break ups "caused" weight gain.
I do wonder if we truly know the effect of some medicines, however. So I'll reserve comment on that.
I do believe that with some conditions caloric needs may not remain constant, thus making it even harder to find the sweet spot for losing.

I am finding this true with my restrictions on sodium. I sometimes reach my upper limit of sodium before I reach my calorie goal. I have had to change many foods that I was eating before to get that sodium level down. Due to surgery on my right arm food prep has become hindered.

Due to the injury to my arm... the surgery...hypertension...the meds...I lost 10lbs in two weeks. Trying to balance all of that while at the same time becoming sedentary (because of the arm and a faulty EKG) it has been difficult. I am working on it but it has been havoc on my weight loss goals.

PeachyCarol wrote: »

EvgeniZyntx wrote: »

Perhaps what you are trying to do is reduce the short cuts people make?

I'll take an example - I have a friend that became wheelchair bound four years ago (lateral paralysis) - this had led to her being obese. Obviously the chair didn't CAUSE the obesity but the conditions of difficulty in limiting consumption, depression, reduced mobility and the associated difficulty of increasing energy expenditure for someone that has difficulty moving resulted in consuming more calories than those expended.

What 'fiction' do you think needs to be addressed?

I think the fiction is dependent on the condition, Ev. There was a recent thread where someone brought up his own DKA, and he grossly misstated the mechanism of it and implied a medically impossible outcome of it. That's one type of fiction.

As far as DKA that I brought up in a prior thread (2 prior threads, actually), you claim that my experience is impossible. That's not correct. Before I go any further, I'm going to stress that DKA should never be intentionally caused to occur. It is potentially fatal. Those who have diabulimia should consult appropriate professional help.

Here's how diabetic ketoacidosis (DKA) works:

Insulin breaks down glucose in blod and delivers it as fuel to cells... usually. When someone has very little or no insulin (type 1 diabetics fit this criteria), blood glucose (BG) rises and cells starve.

When BG rises: When BG rises above 225 mg/dl (average based on current research, but can be more or less), osmotic diuresis ocurs to remove BG through urine.

When cells starve: Gluconeogenesis occurs. Cells are calling for energy, but getting none. So you start breaking down fat for energy. The fat gets broken down and deposited into the blood as glucose. Then the cells should be able to get to that BG, but without insulin, the process of breaking down fat continues. Some of the BG is removed (see explanation abov of osmotic diuresis), but not all of it and certainly not as quickly as one is creating more glucose from fat. A by-product of this process are ketones.

Some on these forums will understand ketones because they are experiencing gluconeogenesis in a non-diabetic context. In DKA, ketone levels are significantly higher than in ketosis. High levels of ketones are toxic.

In addition to extreme thirst and frequent urination (because of osmotic diuresis), DKA also causes vomiting and very strong "ketone breath." Because cells are starving (most pathways for cells to get energy require insulin, which isn't present in this scenario), they start weakening and eventually organs will stop functioning altogether. Often this leads to a coma before death.

Here's what happened in my situation:

I was a teenager, and pretty much just gave up and decided I didn't want to deal with diabetes any more. I figured if I didn't eat anything, I would just run a little bit high and not have any immediate issues.

I was on multiple daily injections (MDI) of insulin, and last took insulin on Friday. On a Sat., I ate nothing and took no insulin, except late morning, I was super thirsty and drank 3 cans of regular soda (which propelled my BG even higher). I was feeling lethargic by Sat. evening and was urinating frequently.

On Sun., I ate nothing. Early in the day, I started vomiting and continued to urinate frequently. I was also still extremely thirsty and was drinking lots of water. I remember a particular point where I drank a glass of water, and ran to the bathroom (in this house, the kitchen and bathroom were connected - an unusual design today, but this was an old rural house and these rooms were added together when plumbing was installed). So the bathroom was about 10-12 feet away from where I was standing as I drank water, and I vomited all of that water within seconds of drinking it (except it was yellow when it came back up - obviously because it included other substances). There was another point where I thought I had vomited everything in my stomach, but was still heaving. What came out was a thick dark red - black substance. I was very sick at this point with DKA.

On Monday, I skipped school and was still sick after spending all night drinking lots of water and then vomiting and urinating (I was urinating about every 7-10 minutes at this point). My parents called the endocrinologist, who said to take some insulin and wanted me to be taken by ambulance to the nearest hospital (around 15 miles away) and then by helicopter to the nearest major city, where her hospital was located (around 80 miles by car). At this point, I had lost 47 lbs. from the last time I weighed (a week prior). I couldn't see clearly and had so little energy I could barely walk.

My parents decided (my dad decided, as my mom wanted to go with the endo's suggestion), for whatever reason (probably cost), to drive me himself for the whole 90-100 mile trip to the hospital. I took an ice cream bucket, which I continued to vomit and urinate in throughout the trip... I'm sure I lost at least another 3 lbs. on the way, but I usually say "about 50 lbs." because that is a rounded number and the specific amount beyond 47 is unknown. On the way down, I started going in and out of consciousness.

When we arrived at the emergency room, I was unable to even stand on my own power. My dad held me up as we walked in. The first stop was a water fountain, as I was still extremely thirsty. After I sat down, I noticed the tips of my fingers were starting to turn an indigo color.

When they were starting to take vital signs, I vomited on the nurse. They didn't finish, as it became clear how serious of shape I was in. Right away, they started taking me to the ICU (I was in a wheelchair at this point). I remember being pushed into an elevator on the wheelchair, and then losing consciousness again. The next time I awoke, for a brief moment, was in a bed in the ICU with lots of medical personnel surrounding me working very quickly. My dad was standing behind them at the foot of the bed with a very worried look on his face. The next time I awoke, there were just a couple of medical personnel on the other side of the room (it was a large room with several beds and just curtains), but nobody around me. I had an IV in the major blood vessel that runs through my groin.

On Tues., they transferred me out of the ICU to an intermediate area, and on Wed., sent me to the general section of the hospital. The endocrinologist visited, as did the CDE (because they thought I didn't have enough training, when it was just that I didn't care enough). So they sent a psychologist to talk to me, and I was released from the hospital on Fri. When I got home, the scale said I had only lost 24 lbs. compared to 2 weeks prior. They had been pumping plenty of fluids in me, but I'm leaving open the chance that I was still slightly dehydrated. The 50 lbs. is approximate because of what I described earlier. I'm guessing around 60% of that was water weight because of how much was re-gained in the hospital.

You can tell me that what happened to me didn't really happen to me, but I assure you it did. Just because you don't understand it doesn't mean it isn't possible.

I'm hypothyroid too due to requiring the removal of my cancer infested thyroid! Now I get to take meds for the rest of my life and my oncologist wants me forever hypothyroid in order to keep the chances of a cancer reoccurrence at its lowest percentage. One risk factor he told me about was possible weight gain due to my decreased metabolism.

I'm still losing weight. But others might not because we're all different!

I have PCOS and, YES, it does make it harder to lose weight. I am not sure about anyone else's journey; but I know that I have to approach things a little differently. I have hormonal spikes that make it nearly impossible for me to stop eating on certain days. Being insulin resistant makes converting carbs harder than the normal person. I am not blaming the PCOS for my weight; but it does mean I have to work harder and in a different way to achieve my goals. I try to limit my carbs to 30% and I supplement with GTF Chromium, Nettle Root Extract, Saw Palmetto, and Vitamin D3 to combat the PCOS and insulin issues. I had to have my gallbladder removed so I use a probiotic to help in digestion. No matter what anyone says, losing weight with PCOS is possible but incredibly hard. You have to reach that point where you are determined before it will happen.

midwesterner85 wrote: »

PeachyCarol wrote: »

EvgeniZyntx wrote: »

Perhaps what you are trying to do is reduce the short cuts people make?

I'll take an example - I have a friend that became wheelchair bound four years ago (lateral paralysis) - this had led to her being obese. Obviously the chair didn't CAUSE the obesity but the conditions of difficulty in limiting consumption, depression, reduced mobility and the associated difficulty of increasing energy expenditure for someone that has difficulty moving resulted in consuming more calories than those expended.

What 'fiction' do you think needs to be addressed?

I think the fiction is dependent on the condition, Ev. There was a recent thread where someone brought up his own DKA, and he grossly misstated the mechanism of it and implied a medically impossible outcome of it. That's one type of fiction.

DKA story....

In all likelihood the amount of weight lost has grown over time. The brain has a tendency to exaggerate crisis situations. Or, both your parents and your doctor were criminally negligent - because the weight loss indicator for hospitalisation is 5%. A known diabetic losing that in a week should be immediately hospitalised, along with the other signs you showed. The expected loss due to dehydration is somewhere in the order of 7-14lbs. Not 50lbs.
But it doesn't matter. Whether it was 10lbs or 30lbs or 50lbs, I don't see what this has to do with dieting?

Induced DKA is classified as an eating disorder.

Remember that as we look at our own medical stories - our mind does tricky things:

tincanonastring wrote: »

@midwesterner85 - This is now the 11th thread in which you're discussing DKA. Since it's so dangerous and has absolutely nothing to do with weight management, how about making this the last thread?

http://community.myfitnesspal.com/en/search?adv=1&search=dka&title=&author=midwesterner85&cat=all&tags=&discussion_d=1&comment_c=1&group_group=1&within=1+day&date=

Most of those other threads were either specifically about diabetes (where DKA is relevant), and I didn't really go into detail. In some of those threads, it was in response to others who had already mentioned DKA (as in this thread). DKA is related to weight loss, and is relevant to individual conditions experienced by users in the threads where I've either brought it up or responded to it.

This thread is specifically about medical conditions / anomalies that affect weight. It directly is linked to the topic of this thread. In addition, another user brought up the topic and provided bad information. What I'm providing is accurate information about the topic, and I'm not encouraging anyone to do it. In fact, I'm explicitly encouraging people NOT to inentionally go into DKA.

I'm not going to stop mentioning it any more than other users on this site will stop mentioning CICO (which is not as exact as most users purport).

midwesterner85 wrote: »

tincanonastring wrote: »

@midwesterner85 - This is now the 11th thread in which you're discussing DKA. Since it's so dangerous and has absolutely nothing to do with weight management, how about making this the last thread?

http://community.myfitnesspal.com/en/search?adv=1&search=dka&title=&author=midwesterner85&cat=all&tags=&discussion_d=1&comment_c=1&group_group=1&within=1+day&date=

Most of those other threads were either specifically about diabetes (where DKA is relevant), and I didn't really go into detail. In some of those threads, it was in response to others who had already mentioned DKA (as in this thread). DKA is related to weight loss, and is relevant to individual conditions experienced by users in the threads where I've either brought it up or responded to it.

This thread is specifically about medical conditions / anomalies that affect weight. It directly is linked to the topic of this thread. In addition, another user brought up the topic and provided bad information. What I'm providing is accurate information about the topic, and I'm not encouraging anyone to do it. In fact, I'm explicitly encouraging people NOT to inentionally go into DKA.

I'm not going to stop mentioning it any more than other users on this site will stop mentioning CICO (which is not as exact as most users purport).

CICO = useful to weight loss
DKA = not so much

(I know a guy that lost his legs and lost 40lbs that way! Neato, relevant to weight loss? I don't think so.)

Carol, thank you! Excellent conversation starter!

As for me, I'm blessed in that I don't have any medical conditions (that I know of), so I would like to give a different perspective here.

I was overweight all of my life, and obese for a short while in my mid-twenties, and I was convinced that I could not lose weight. I have a long history of disordered eating. I figured I was just destined to be a big person. While I did maintain at as overweight for quite a few years, I was convinced that my body at a set point and I could never get below a certain weight. This "proved" to be true when I reached that certain weight in my early 40's after working with a trainer who taught me about portion control, logging food (writing it down), eating at a calorie deficit, and how to properly weight lift and work out. I had him for about six or seven sessions before I knew I had it all down.

I did well. I maintained that weight for about a year, then the weight started creeping back on because I wasn't using the tools I had learned. I quit paying attention to what I was doing. All this time, I was convinced that my body was playing tricks on me and started restricting food choices more and more until I had cut out all the "fattening" foods, but I still was not losing weight. On and off, I wrote down what I ate and how much (eyeballing wise), but that habit became more off than on.

Even though I was caught in this craziness, the lessons my trainer taught me were still in the back of my mind, and I figured I might as well start logging food again, but I dreaded writing it down. Well, of course, with the internet, there had to be some kind of a logging "template" or something that I could use to log food on my computer.

Bingo--I found MFP, and I started logging food and participating in the forums.

The first thing I discovered is that I was eating way too many calories to maintain my weight.

The second thing I learned is that the only sane idea in my mind regarding weight management was that I was eating too much to lose weight, therefore I had to start eating less. Everything else was woo based on the insanity of believing I was somehow a special snowflake.

The third thing I learned was that weighing food, logging everything I eat, wearing a heart rate monitor for exercise, eating back those exercise calories, were great tools for success for me. The reason is because most of my personal success is based on structure.

Finally, I learned that the woo is just another way for me to not take responsibility for my weight management, therefore I learned to reject it without a second thought. Many people here helped me to learn how to throw away the woo and to understand that anything outside of CICO for weight loss for me is preference (since I don't have a medical condition that affects my weight in any way).

So, I think the bottom line is that separating fact from fiction is very important to be successful in weight loss. I know if my life when I've taken certain medications, especially birth control, that the labels contained warnings of weight gain, but they never said increased appetite. Now, because I've separated fact (science) from fiction (woo), I know what those labels mean when weight gain is listed as a side effect.

midwesterner85 wrote: »

tincanonastring wrote: »

@midwesterner85 - This is now the 11th thread in which you're discussing DKA. Since it's so dangerous and has absolutely nothing to do with weight management, how about making this the last thread?

http://community.myfitnesspal.com/en/search?adv=1&search=dka&title=&author=midwesterner85&cat=all&tags=&discussion_d=1&comment_c=1&group_group=1&within=1+day&date=

Most of those other threads were either specifically about diabetes (where DKA is relevant), and I didn't really go into detail. In some of those threads, it was in response to others who had already mentioned DKA (as in this thread). DKA is related to weight loss, and is relevant to individual conditions experienced by users in the threads where I've either brought it up or responded to it.

This thread is specifically about medical conditions / anomalies that affect weight. It directly is linked to the topic of this thread. In addition, another user brought up the topic and provided bad information. What I'm providing is accurate information about the topic, and I'm not encouraging anyone to do it. In fact, I'm explicitly encouraging people NOT to inentionally go into DKA.

I'm not going to stop mentioning it any more than other users on this site will stop mentioning CICO (which is not as exact as most users purport).

But this is a forum for an app dedicated to using CICO to meet weight goals. This isn't a DKA site.