Tips on getting more calories? (Medication issue)

lexbubbles

So this is kind of a weird setup, and also very delicate. It's taken a lot of trial and error to get this far, but I'm SO BORED.

I have (what has been described as "an absolute whopper of a case") ADHD that doesn't respond very well to medication. After 3 years, we finally landed on a cocktail that probably about 25% works but we've run out of drugs now so this is as good as it gets. I take a combination of 3 medications for the ADHD and then an anti-emetic on top of that because the nausea is unreal.

The real problem is that those 3 drugs are all appetite suppressants. Some people find the appetite destruction goes away eventually, but mine doesn't. If I don't set reminders to consume food of some kind I can easily go for 3 days with nothing but a yogurt to take the pills with without feeling hungry.

Which in and of itself wouldn't be a problem... if I could actually eat. It's 50/50 whether the anti-emetic works in the morning so some days I can't put anything into my body until mid-afternoon but even if it works eating anything solid larger than a snack will make me throw up an hour or so later.

I fare better with drinking my calories. Shakes don't disturb my stomach as much as solid food, but there's a limit to that as well. Soup is okay, being mostly liquid, but not exactly calorie central. Iced coffee and tea mix beefs the calorie intake a bit but is also mostly sugar and not a lot else.

I can eat by going off my meds - which I sometimes do when I get sick of not eating and just miss actual food too much - but unmedicated me is entirely unfunctional and absent stimulant medication I have constant all-consuming cravings for sugar and caffeine. So I go entirely the other way and eat 6-pack of donuts in one sitting.

I also don't take them when I'm sick, because a cold + side effects is just too much so I gain a LOT of weight if I catch anything. I came out of my last cold 12lb heavier than I went in.

In the first 8 weeks or so I dropped 35lb and went from 188 to about 155. Since then I've been bouncing around the same 10lbs from 145-155 (i both drop and gain that amount in 2 weeks) by alternately taking and not taking my meds. I'd like to get down to 130 to ease the joint pain from EDS, but not by just... not eating. I'm stuck in limbo.

tldr trying to work out something of a plan to get at least 1300 calories in my body a day without having to cycle my medication and go back and forth between starvation and binge eating like a goddamn metronome.

This is where I've landed so far, but I'd like suggestions of calorie-dense (that aren't entirely sugar) nutritional... things I can put in my body without it coming back again an hour later.

0900 (ish)
The Protein Works protein porridge 360. 75g serving. 275 cal. 41g carb. 20g protein.

At which point I have to wait an hour before I can take my medication otherwise... you guessed it.

1000 (ish)
Single serving flavoured greek yogurt. 76 cal (average). 8g carb. 6g protein.

Yogurt to coat the meds on the way down otherwise... yeah. Once the meds are in it's at least 4 hours before I can even have a meal shake. Any food at all, or thick liquid, is off limits at the moment. If the nausea meds don't work and I get an attack of the "oh god why"s then 4 hours becomes about 6.

Sometime between 1000 and 1400 or 1600
Instant iced latte. 2 sachets in a 750ml bottle. 166 cal. 32g carb. 3g protein.

1400ish / 1600ish
Shake of 1 scoop of whey protein 80 + 16g full cream dried milk. 179 cal. 8g carb. 24g protein.

Tried adding peanut butter to this one, but it didn't go down well. (Also attempted the addition of chia seed but it was just really gross). Take the second dose of medication - thankfully only 1 pill not 3 so the effects are less severe.

Sometime in the evening, if I remember, at least 3 hours after the shake/meds.
25g pistachio nuts. 140cal. 7g carb. 4g protein.


Pretty late, like 2100 or 2200
Shake of Slimfast powder/16g full cream dried milk/15g peanut butter. 304cal. 31g carb. 13g protein.


Total: 1140cal. 127g carb. 71g protein.



Of course that's an "ideal" day and quite often I can't even "eat" that much (or forget, despite my reminders) and get to 9pm on about 500 calories and down 750ml iced tea mix to try and reduce the damage.

Sometimes I have a tin of tuna mixed with mayonnaise instead of the initial shake, which is about the same calorie content. I can't get both into my system.

Equally sometimes I sub the handful of nuts for a hard boiled egg but again, not both. At enforced "snack time" I am actively not hungry because it's only been 3h since I had a small shake. You know "I had a huge meal 10 min ago and I don't want to even think about food until next week" type of not hungry.

Sure, 1140 isn't so bad but ending up in the 600-800 range is more common and even 1140 isn't really enough for someone who runs 30 min 6 days a week.

So! Sorry, that was really long! I'm trying to cover all bases to preempt unworkable suggestions.

How to get more calories in my body consistently without increasing the volume of food, or at the very least things I could have instead (light, but also packing an equivalent punch) because if I drink ONE MORE milkshake...

GO!

ladyreva78

Several options I see from what you've described:

First option ist adding Maltodextrine and/or full fat cream to all liquids and semi-liquids (shakes/porridges/yogurts)
Malto is a powder that's mostly tasteless but adds the same amount of calories as sugar would - simply without the sweetness of sugar. (just don't put it into mashed potatoes. The consistency is a killer... think glue). Calorie wise that would be about 40kcal/10g (and you can easily add more before you start noticing it at all. You'd need to test out what's feasible).

Full fat cream (or any source of fat such as butter/oil) is another (almost) taste neutral option that adds calories (also around 40kcal/10g) but through fat instead of carbs. 1 table spoon is usually about the limits of what you can add before seriously changing the consistency and/or taste of a usual serving. Any source of fat will add calories without adding much bulk, some sources are just harder to mix into a product without some rather nasty side effects (unlike heavy creams that just tend to disappear into the product).

So add some maltodextrin and some full fat cream to those shakes (an easy 80kcal/shake if you go 1 tablespoon each) and to the protein porridge (another easy 80kcal). So that would be + 240kcal/day without much additional volume.

A second option (more along the line of solids) would be cheese and fatty cuts of meats (think sandwich meats/salami) as a snack or a larger serving of nuts (you have 25g pistachios listed right now. Would an additional 10g be feasible for you as a serving?). Although not sure what solids might work. Or add mayonnaise when you eat your boiled egg (or another fatty spread)?

A third option is to double the size of the snack but eat it over a longer time period (think grazing kind of habits). So it doesn't feel like forcing yourself to eat a large "meal" right after having eaten (going by your description of what it feels like to have to eat). Although not sure how that would influence the meal following that.

A fourth option is to ask for a referral to a registered dietitian. He/she would be able to provide ideas for products available locally and (sometimes) provide access to other types of products (oral nutrition such as ensure and co which can pack quite the punch for very little volume) that might be worth a try and (depending on where you live) for which you might qualify for health insurance to cover them.

lexbubbles

ladyreva78 wrote: »

Several options I see from what you've described:

First option ist adding Maltodextrine and/or full fat cream to all liquids and semi-liquids (shakes/porridges/yogurts)
Malto is a powder that's mostly tasteless but adds the same amount of calories as sugar would - simply without the sweetness of sugar. (just don't put it into mashed potatoes. The consistency is a killer... think glue). Calorie wise that would be about 40kcal/10g (and you can easily add more before you start noticing it at all. You'd need to test out what's feasible).
[...]

A fourth option is to ask for a referral to a registered dietitian. He/she would be able to provide ideas for products available locally and (sometimes) provide access to other types of products (oral nutrition such as ensure and co which can pack quite the punch for very little volume) that might be worth a try and (depending on where you live) for which you might qualify for health insurance to cover them.

I'm in Scotland so health insurance isn't a concern and any prescribed products are free, so I'll ask for a referral from my GP when everything returns to normal(ish) and non-urgent appointments are a thing again. My psychiatrist isn't at all concerned about the weight loss since I'm not underweight (I was over and now I'm juuust scooching in under the line of healthy) but my GP is a little more sane. I do know that oral nutrition supplement can be prescribed although I'm unlikely to get it since I'm borderline overweight

Will definitely look into getting some maltodextrin, thank you! I hadn't heard of it before. I think that will be a good solution if it doesn't really make things much heavier.

ladyreva78

lexbubbles wrote: »

ladyreva78 wrote: »

Several options I see from what you've described:

First option ist adding Maltodextrine and/or full fat cream to all liquids and semi-liquids (shakes/porridges/yogurts)
Malto is a powder that's mostly tasteless but adds the same amount of calories as sugar would - simply without the sweetness of sugar. (just don't put it into mashed potatoes. The consistency is a killer... think glue). Calorie wise that would be about 40kcal/10g (and you can easily add more before you start noticing it at all. You'd need to test out what's feasible).
[...]

A fourth option is to ask for a referral to a registered dietitian. He/she would be able to provide ideas for products available locally and (sometimes) provide access to other types of products (oral nutrition such as ensure and co which can pack quite the punch for very little volume) that might be worth a try and (depending on where you live) for which you might qualify for health insurance to cover them.

I'm in Scotland so health insurance isn't a concern and any prescribed products are free, so I'll ask for a referral from my GP when everything returns to normal(ish) and non-urgent appointments are a thing again. My psychiatrist isn't at all concerned about the weight loss since I'm not underweight (I was over and now I'm juuust scooching in under the line of healthy) but my GP is a little more sane. I do know that oral nutrition supplement can be prescribed although I'm unlikely to get it since I'm borderline overweight

Will definitely look into getting some maltodextrin, thank you! I hadn't heard of it before. I think that will be a good solution if it doesn't really make things much heavier.

I'm in Switzerland, so take what I say with a grain of salt.

Effective weight has little to do with whether or not someone is prescribed oral nutrition supplements or not. More importent ist how much (unvoluntary) weight loss occurred in the past month(s) (based on the NRS 2002 from Kondrup et al). So someone who's lost more than 5% of their body weight due to illness is will have the products paid for, especially if there's a medical reason (in your case the medication induced nausea and anorexia*). A doctor who does not consider that also someone obese can be at risk for a malnutrition (rapid, unvoluntary, and usually uncontrolled weight loss) should reconsider his stance. Sarcopenia isn't pretty in the obese and makes such patients a huge burden on nursing staff (not saying you fit into that category, but doctors who don't take weight loss in such situations seriously make me angry.)

Maltodextrin is a modified starch which is often used to increase the calorie of a drink or food without adding too much bulk. Most people I know who use it don't notice it's presence (preferred vehicle is coffee or tea, but can be added to quite a lot of things )





*used in the sense of lack of appetite and not the eating disorder.

lexbubbles

ladyreva78 wrote: »

I'm in Switzerland, so take what I say with a grain of salt.

Effective weight has little to do with whether or not someone is prescribed oral nutrition supplements or not. More importent ist how much (unvoluntary) weight loss occurred in the past month(s) (based on the NRS 2002 from Kondrup et al). So someone who's lost more than 5% of their body weight due to illness is will have the products paid for, especially if there's a medical reason (in your case the medication induced nausea and anorexia*). A doctor who does not consider that also someone obese can be at risk for a malnutrition (rapid, unvoluntary, and usually uncontrolled weight loss) should reconsider his stance. Sarcopenia isn't pretty in the obese and makes such patients a huge burden on nursing staff (not saying you fit into that category, but doctors who don't take weight loss in such situations seriously make me angry.)

Oh our regulations for prescribing are 10% in the last 3 months and my medication cycling kept me outside of that. I'm the same weight now I was in October, I've just gained and lost the same 10lb 3? 4? times in 7 months. It also gets muddled by the fact I am wanting to lose weight I just have no intention of doing it like... this. I've been bouncing up and down for a year on/off meds trying to find a sustainable middle ground instead of just letting it drop.

Although if I stop trying to do anything about it and just let it be I'll definitely drop 10% (which is 14.5lb) before I can get an appointment. If I truly only ate what I can without doing magic tricks and forcing it in, I'd be on a 500cal diet and lose it in about 5 weeks.

I think I'll give heavy cream a shot first since my shakes are dairy anyway but if my body rejects it I'll definitely try maltodextrin... or just accept my fate and replace my water intake with 45g sugar/750ml iced tea. Thankfully I'm not diabetic or pre-diabetic or anything.

God I miss chicken so much. I don't even miss donuts or chocolate since I have no cravings for that stuff when I take my meds, but I'd sell my own grandma to keep thai green curry in my system. Hopefully, if I get it stable now so I can stop med (and weight) cycling I can super gradually train my body into accepting real food because I'm not wild about the idea of choosing between "working brain" and "solid food" for the rest of my natural life.

Inititally I tried just not taking the meds one day a week (Lex can have a little real food, as a treat) but it always ends up being 2+ weeks before I can get myself back on them, by which point my weight has skyrocketed and I have stocks in krispy kreme and red bull. So. That didn't really work.