TIP: This article is a transcription of SANE multimedia you can enjoy by clicking here.
Jonathan: Hey, everyone, Jonathan Bailor back with another bonus Smarter Science of Slim podcast. I wanted to make sure I smiled extra broadly when doing the intro to today’s show because we’re going to talk about a subject which may not be – not may not, let’s call a spade a spade, is not – as smiley as many of the topics we talk about. It’s a topic that I know I and my family have had some deep connection with, and I know many of you have had connection with.
When we have some struggles in our lives and if our mood has taken a turn for the worse and maybe we even get a little depressed, we need some help. There have obviously been some amazing pharmacological advancements in that arena, but I get so many questions and I hear so many stories about individuals who, to help with some of the struggles they’re going through mentally, leverage these tools, and it causes some unappreciated physical consequences in terms of weight gain and related things. So I wanted to bring in one of the top experts in the world in this field to help us talk about the science and the situation and what, if anything, we can do about it. She’s the author of Break the Bipolar Cycle: A Day-by-Day Guide to Living with Bipolar Disorder. You can learn more about that book at BreakTheBipolarCycle.com. She is a professor with the Department of Psychology over at St. John’s University in the lovely state of New York. Dr. Elizabeth Brondolo, welcome to the show.
Elizabeth: Thank you very much.
Jonathan: Dr. Brondolo, before we get into the meat of our podcast, can you give us a quick introduction to you personally and your research?
Elizabeth: Sure. I am a researcher specializing in the study of stress and health. I in particular look at stigmatization and work stress and how it affects depression and cardiovascular function. In my clinical work, where I don’t do research but I see patients and work with their families and their employers, I specialize in the treatment of bipolar and schizoaffective disorder. That’s what I do. I am a mother of two, just on the side.
Jonathan: In your copious amounts of free time.
Elizabeth: No, it’s a very important part of who I am, so I thought I would mention it.
Jonathan: Absolutely, absolutely. Well, Dr. Brondolo, in your extensive clinical practice, can you describe a typical scenario you see where an individual is coming in having some tough times, looks to pharmacology to help with that situation, gets some relief, but then experiences maybe some unappreciated side effects?
Elizabeth: It’s a really common problem. In particular for people with bipolar disorder and people with depression, it’s very important to be able to use pharmacological interventions. The medications, particularly for bipolar disorder, are really, really helpful and they are an integral and a necessary part of getting better.
But they have some consequences. One of the consequences, although it’s not true for everybody and it’s not true for all the medications, can be substantial weight gain. In some cases, it’s not one or two pounds over a-couple-year period; sometimes people gain up to 50 pounds. And that’s scary. There are things that you can do to manage and prevent it, but it isn’t unheard of, and it’s a fact of life that people do have to address and think about as they’re coping with their mental illness.
Jonathan: Dr. Brondolo, we’ll get into how this can become such a destructive cycle here in a second which is, of course, an individual is struggling with their mood and then they take something to help with it which causes them to gain 50 pounds, which probably doesn’t do their mood any favors. Before we get into that and what we can do about that, why does this happen; what is it about these medications that can cause this rapid weight gain?
Elizabeth: It’s not necessarily a rapid weight gain, although you can see it. Certainly it’s important to emphasize that most people don’t gain that much weight; but it isn’t unheard of for that to happen. I’m not a researcher in this area, but I’ll try to help you understand what’s happening, and it’s really important to understand what’s happening because people do a lot of blaming of themselves and get blamed by other people for the kinds of weight gain that they show.
So it ends up that some of these medications, in particular the anti-psychotic medications that are really important for mood stabilization and decreasing anxiety in many mood disorders, these are phenomenally helpful drugs, really helpful drugs, and they can make the difference between having a life that is productive and safe versus not. But they have some effects where they change some of the hormones that are involved in regulating satiety, meaning fullness.
So in addition to other effects that they have, you don’t necessarily get the same kind of internal responses that you would feel when you’re full. Most of us, when we’re eating, we’re not spending a lot of time counting calories or measuring; we use the internal cues from our body that tell us it’s time to stop eating, we’ve had enough. Those cues aren’t based on what we see or ideas that we have about how many calories we’ve eaten; they’re created by responses inside our body, hormonal responses inside our body, that sort of signal our brain and say, Okay, that’s enough. We’re not conscious of those signals, but they occur and it’s a long chain of communication, chemical communication, throughout our body and our brain. These medications actually interfere with that so that it becomes harder. They interfere with the communication of the satiety hormones so that we’re not getting the signal at the same time that we usually would have gotten it that would have allowed us to stop eating a little bit earlier.
Jonathan: Dr. Brondolo, this is really transformative information. I think it, in and of itself, can help individuals in this situation not beat themselves up. Because I think the typical story we hear is like this, it’s as simple as one-two-three: You’re lazy or weak as a person; because of that, you overeat; because of that, you’re overweight. That’s not at all what you just described.
What you just described was hormones play a critical role in the automatic regulation of appetite. When you take certain substances into your body – correct me if I’m wrong – that can dis-regulate those hormones, change the way your brain, particularly your hypothalamus, perceives satiety, as a result, you do what everyone else does, you eat until you’re full. However, when you’re full is different than other people because of this hormonal dis-regulation and therefore, you gain weight; is that accurate?
Elizabeth: It is, yes, a real simplified version. There are probably other factors that are also influencing and other factors in lipid metabolism and fat metabolism; but yes, that’s the right idea. It’s not so much that it’s even different from other people; it’s different from how you were.
Most of us don’t think much about how we eat, and we develop habits about food regulation, and we may know that we’re kind of a little sloppy when it comes to dessert, or I love to eat candy. So we’re sort of naturally accustomed to understanding that we’re a little bit less self-controlled in certain specific areas, but we know something about what the outside limits of that lack of self-control are. We kind of know that we’ve really got to stop after a certain point. After you take those medications, your understanding of that limit is a little bit different and has to change.
Jonathan: Empowering might be the wrong word, but for individuals who, again, are struggling with their mood, the last thing they need is people stigmatizing them and saying they’re weak people; whereas in reality, if I’m understanding correctly, these individuals – or anyone who has a hormonal dis-regulation, be it caused by these medications, be it caused by something else – are trying to avoid hunger. They are eating until they are no longer hungry; and that’s not weakness, that’s what everybody does.
Elizabeth: Exactly. It’s actually even more than just hunger. The way that I’ve heard it expressed by my patients is that there’s kind of like a neon light in your head that makes you feel like the hunger is louder, sort of louder in your head. I agree with you that it’s absolutely critical that people understand that this is kind of part of illness management.
You’re going to have this side effect, and you’re going to have to sit down with your mental-health team and figure out how you’re going to manage it. Not you’re a bad person and you’re weak or lazy; those things have nothing to do with it. It’s that you have to sit down with your mental-health team and say, Okay, this is going to happen, or this may have happened, and I’m having this problem; what are we all together going to do about it so that it’s not as much of a problem.
Jonathan: Dr. Brondolo, let’s talk about what we do about it now. What are some of those strategies that you can go to your mental-health team and say, All right, I’ve got this neon hunger signal in my brain now; what do we do about it.
Elizabeth: I will talk about that in one second. I just want to make one point because this is very confusing because almost everybody can find somebody who didn’t get overweight on these drugs or say, But I know so-and-so and he didn’t have this problem, he didn’t put on pounds, why are you?
There is some new research out – so this is really a growing and changing field – some evidence that suggests that there are actually genetic differences that make you more susceptible to the effects of these drugs, particularly the effects on the satiety system. So it’s not like there are some super-controlled people and some super-uncontrolled people. There are some people with predispositions to have this kind of response to these kinds of medications, and there are some people who don’t happen to have that.
Jonathan: Dr. Brondolo, I’m so happy you plugged that in there because it is extremely helpful information. One other plug I want to make — this might be a little bit redundant for you because I know you’re an expert in this arena, but I want to really drive this home with the listeners for a moment, because you talked about the satiety signals and the satiety system.
So a really quick case study. Someone I know well, a young child, when she was 12, really having some struggles with psychological issues; had to go leverage pharmacology to correct this problem. This is a child who weighed maybe like 80 pounds. So she then spontaneously – it’s not like she got lazy – gained 14 pounds within a matter of like two weeks. For an 80-pound person, gaining 14 pounds is not trivial. Then things got better. She went off the medication and literally, the exact 14 pounds came off. She wasn’t trying to eat less or exercise more. Those things may have happened spontaneously, but again, it sounds like those were a consequence of a deeper hormonal change, not a moral failing.
Elizabeth: That’s absolutely the case. None of this has to do with moral failings. This just has to do with the fact that you have medical conditions that require medications that happen to have these particular side effects that have to be dealt with.
Jonathan: Dr. Brondolo, I don’t want to go too far off on a tangent, but as a clinician, do you just get – because I see, like people do, they make this a moral issue. So, again, people who are just doing what everyone else is doing, they are eating until they are full, are made to feel like they are lazy gluttons and they just need to eat less and exercise more. Does that piss you off?
Elizabeth: Sometimes. That’s actually an important part about why I wrote the book and why I’ve continued to try to talk to people about some of these issues. The more you understand actually how this works, the less you’re likely to make judgments about the moral quality of somebody and really realize that they’re people. We are all people, and everybody has something to face; and sometimes the treatments are much more complicated than you wish they would be.
Jonathan: At least in my family, we use the analogy – like, I wear glasses because my eyes work differently than, say, my sister’s, who doesn’t wear glasses. And no one says, Jonathan, try harder to see. It’s just like my eyes don’t work the same as yours; I need glasses. It’s not a criticism of me personally. So some people just need mental glasses, right?
Elizabeth: Yes, yes.
Jonathan: Dr. Brondolo, what can we then do about this? If we personally or someone we know and love is at risk of coming in this cycle of needing to get help, weight gain, stigmatism, what can we do about that?
Elizabeth: Well, one of the first things you can do is to tell your doctor that you’re pretty worried about this and that you want to make sure — because it’s not just weight gain but there can also be changes in lipid metabolism and, in some cases, increasing the risk for diabetes. So you can say, Can we please set up a regular schedule for monitoring my health, including my weight and my blood labs, so that I’m staying on top of this and that we’re working together to monitor this?
That’s probably one of the most important steps, because getting that kind of regular feedback and making sure that everybody’s on the same page, that this is a risk that you’re running, and that you understand that that is a risk that you’re running, it makes everybody more responsible and conscious that this might happen. So regular monitoring with your physician is probably one of the most important things that can happen.
The second thing is that it’s not very easy for anybody to lose weight or to keep it off, and dieting is a very hard thing for everybody. So setting short-term frantic weight-reduction goals is probably going to be no more successful for somebody whose weight gain is a function of medication than it is for somebody who’s just trying to lose weight for other reasons.
Instead, I can’t say honestly that — I don’t do research in this area and I’m not sure what the best recommended strategies are, because it’s something that people are just beginning to understand. But one thing that is helpful is that you start to understand that it’s a lifestyle problem, that you’re going to have to pay attention to this as a part of your treatment, and that you may want to make changes that allow you to have, overall, a healthier lifestyle.
Some mental disorders confer risk for cardiovascular disease independent of the treatment, and so anything that you’re doing to help your health is actually helping you on many fronts. So working to improve the overall quality of your nutrition and the overall quality of your fitness is something that, over the long run, is going to be good for you no matter what you’re doing.
What I have found is that there are many apps that are very helpful in terms of recognizing the nutritional quality and the calories or points that are associated with your food. So since you can’t trust yourself necessarily – I don’t mean trust yourself because you’re a bad person, but your internal feedback is not the same – based on the regular cues that you would get from your body, you can use apps to quickly and efficiently give you more feedback about what’s it costing you in terms of fat and calories when you’re eating something in particular.
Lots of people really don’t have that information at their fingertips. So using some of the apps — I’m not paid by Weight Watchers, but what I would say is that their app is actually helpful, very helpful. I’m sure there are lots of others; I’m just most familiar with that.
Jonathan: So if I understand correctly, Dr. Brondolo, focusing on the quality of how we’re moving our body, the quality of the food we’re eating, and the quality of our life in general, and making that a very conscious, deliberate effort can help with this issue. Because then it’s not just this mystery of, Oh, why is this happening; I’m going to go take this pill I buy off an infomercial. Because you understand this is a calculated thing, you’re monitoring it, you understand why it’s happening, and then you can consciously, with your physician, come up with a plan to address it.
Elizabeth: Yes. Often, it’s useful to include a mental-health provider in this planning because they can help you understand, work through very systematically what are the high-risk situations where you’re likely to eat snack food that is maybe not so beneficial for you, where could you build in better nutritional opportunities, how can you substitute fruits and vegetables for high-fat snacks, and when are you most likely to have cravings that are pretty hard to deal with.
They can work it through and help you plan all the way through your day and through your week of meal planning. They can give you a hand recognizing the cues that trigger eating, the environmental cues, the internal cues, interpersonal cues, and help you develop strategies to better manage those.
Jonathan: Brilliant, brilliant. Well, Dr. Brondolo, obviously you are saving lives day in and day out, and I mean that, and I appreciate that. Because I know – I’ve never obviously worked with you professionally, but like I said, this issue hits home for me, and I know a lot of individuals like you, and I so appreciate the work you do.
Elizabeth: Thank you.
Jonathan: What’s next for you?
Elizabeth: We’re continuing on our stigmatization research, because one thing that’s really important to understand is that all by itself, stigmatization affects health. So one of the reasons why I think it’s really helpful to do shows like this is to help people get less stigmatized and to begin to open up the conversation so you can have a direct effect on health by decreasing the stigmatization. I’m going to continue to work with the wonderful people I work with in my practice.
Jonathan: Certainly a noble effort and certainly you are being the change that you want to see in the world, so just an excellent job all around. Dr. Brondolo, thank you so much for joining us today.
Elizabeth: Thank you.
Jonathan: Listeners, I hope you enjoyed this conversation as much as I did. It really, really hits home, and it’s just really, really empowering, consciousness-raising information. Our guest today was Dr. Elizabeth Brondolo. She is a professor at the Department of Psychology over at St. John’s University. You can learn more about her, again, in her book Break the Bipolar Cycle: A Day-by-Day Guide to Living with Bipolar Disorder, and the URL is BreakTheBipolarCycle.com. Remember, this week and every week after, eat smarter, exercise smarter, and live better. Chat with you soon.