November 13, 2009
There’s . . . this girl. She coerced me into visiting her in her college town on the sound. I guess it was a good time. Here’s a little rehash of the food that slid past my tongue.
“Slid” is actually an appropriate word as the first full meal I had in Washington State was at McCormick and Schmick’s and we ate four pan fried oysters as well as four raw oysters. Without saying that these tasted great, they tasted better than the rest of the meal which my girlfriend and I walked out of the restaurant unimpressed with. I ordered the Dover Sole while the girl tried the rockfish with hazelnuts and apples. The plates came with golden crusted fish and some leafy greens. They both looked the same and the food tasted the same, greasy. We were disappointed, we looked forward to this meal. My sister used to work at this location and I remember going there at 15 years old and my parents, sister, and brother-in-law loving the food. I think it has gone downhill.
The meal we ate at a mexican restaurant was unexpectedly tremendous. The locals call it “QB,” which made me think this was going to be an adventure at another Q’doba or Chipotle, but I was soon corrected. I left the “Quality Burrito” very satisfied, and the below pictures show why. We ate Sweet Potato Chili and Lime soup, Sweet Potato fries with Mango Ketchup, and then I had a Carnitas Burrito with roasted apple. My food and the appetizers absorbed me so I do not remembebr exactly what the girl ate. But I tasted it, and I remember liking it.
I decided I would finnd a recipe for that soup after I ate it at QB and I think I discovered the exact recipe here. James Peterson published it in his book Splendid Soups. I love his books. I am currently waiting to receive Splendid Soups in the mail after ordering it from Amazon.
We made a couple meals too. One we made for her roommates as well. I had a hankering for my mother’s asparagus cream casserole (I know, a hot dish!?), my partner made a roasted cauliflower dish with kalamata olives, garlic, and oil as a sauce, and I fried up some make-shift chicken nuggets with breaded chicken thigh chunks. The vegetarian were clearly better tasting.
Then when our last night together was on its way we went down to the farmers market and decided we would make a dinner nearly exclusively from ingredients purchased there. We decided on mussels in a chanterelle, shallot, and garlic sauce, Steelhead with tomato, garlic, and capers, and a dish that has become a staple in my repertoire apparently: celeriac salad. I think the only things we did not purchase from the market were the mayo and dijon for the salad. There were also some hot toddies involved. While the brandy and tea were not local, the honey was. This meal was fun because I got to bring it up to her bed while she was doing homework and we ate on her bed while she was in awe of how awesome I was. Maybe I should pop that ego-bubble my head is growing.
You know what, for simply the reason of food (not to mention everything else we did, you know, the long walks on the beach, the intellectual conversations, etc. etc.) I have to upgrade this trip to fantastic.
November 6, 2009
Something a little more educational this time: having schizophrenia can make you a lard ass at no fault of your own. The two drugs that you will hear most often making this a problem are clozapine (Clozaril – and not clonazepam (Klonopin), which is an anxiolytic), and olanzapine (Zyprexa). The odd part is recognizing that the greater the increase in BMI while taking the antipsychotic, the better the antipsychotic is controlling the psychosis (generally). There are a lot of mechanisms that are suggested for this weight gain and they are still finding more.
The simplest explanation is caloric intake v. caloric output. Easy. We all know that eating more calories than we use will eventually put on the pounds. Sad but true. People with schizophrenia are much more often sedentary than people sans schizophrenia for numerous reasons (quickly: paranoia, avolition, anhedonia, drowsiness from meds, etc.). But there is the opposite side of the above equation: what kind of caloric intake are we talking about, here?
Clozapine and Zyprexa are both serotonin and histamine antagonists, meaning they slow the use of these neurotransmitters down (throwing the Dopamine Hypothesis to the wind). This is a very effective way to control psychosis, on the other hand, I know of people who have come in Andrew at a standard BMI and live there now at a weight of 350 lbs. The decrease in serotonin activity increases food intake because it decreases the sense of satiety. The histamine antagonism increases appetite and actually reverses the effects of another neurotransmitter/hormone called leptin that is released by your fat cells that tells your brain to stop consuming.
There were other mechanisms for why people with schizophrenia continue to gain weight on their antipsychotics, but most of them were poorly researched because they were only recently discovered. So instead of looking at those, I am going to try to discuss some interventions to the weight gain that I found in the literature, both behavioral and medicinal.
Most of the behavioral mechanisms are pretty straightforward: more exercise. This is done with strict regimens that include nutrition education, frequent weight measurements and group discussions about weight. The program has shown some success, but I know many patients at Andrew who just don’t care to exercise more or pay attention to their diets. As much as we want to control some of these things for them, it is their choice.
Metformin (Glucophage) is a commonly used medication with people who are on anti-psychotics (well, at least with the people I work with). This is because many of them have non-insulin dependent diabetes mellitus (NIDDM). But it has turned out in one very controlled study (admittedly small number of subjects though) that metformin has helped to control the weight gain better than a placebo. In some cases, the subjects even lost a little weight to bring their BMI closer to a normal range. The authors suggested that they might not gain the weight because the metformin makes the glucose available for use rather than storing it as fat right away as well as reducing the production of glucose by the liver. This sounds very hopeful, but really, there is only one gold standard study showing this and two others showing no conclusive results.
Amantadine has been used for controlling weight gain as well, but this drug increases the use of dopamine in the brain. All well and good if the dopamine hypothesis is indeed false, but having two drugs that work to decrease psychosis through serotonin release rather than dopamine is not enough to cast away all the evidence for the dopamine hypothesis.
All together it is a tricky issue. There are other drugs that can be used, but they might increase the side effects of the antipsychotics or have serious side effects of their own. I think more research should go into this work on metformin personally. It’s a cheap drug that might be able to prevent a lot of heart ache in the future for these people, as well as allow them to be more active which could increase mood and decrease psychosis. More money for metformin, please?
Klein, D.K., Cottingham, E.M., Sorter, M., Barton, B.A., Morrison, J.A. (2006). A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents. American Journal of Psychiatry, 163, 2072-2079.
Rege, S. (2008). Antipsychotic induced weight gain in schizophrenia: mechanisms and management. Australian and New Zealand Journal of Psychiatry, 42, 369-381.