Lamotrigine Competes With Ketosis - Why?
I have had a fun journey with my weight, and by fun, I mean maddening. Undiagnosed hypothyroidism made me gain 50 pounds in three months and all traditional diets do diddly squat. For example, I strictly adhered to Jenny Craig for three months and lost three pounds. When my thyroid got treated, I thought I could lose weight, but nothing worked until I tried keto a few years later. I successfully lost 50 pounds. Even though I took breaks from being strictly low carb, I always maintained easily. Then after a nervous breakdown I had to take lamotrigine and zyprexa, the latter of which not only made me so ravenously hungry I couldn't be selective and ate anything at hand, but was completely unnecessary. I gained 20 pounds before I was taken off of it and left with the lamotrigine. I did keto (25-50g carbs) for a month...and lost three pounds. Before lamotrigine I could eat up to 125g carbs and still stay in ketosis. Now, even on a mostly liquid, calorie restricted, low carb diet it is extremely hard to lose any weight. I got the stomach flu in 2020 and couldn't eat and lost 13 pounds by trying IF. But my lamotrigine had to be increased and I had sleep issues and IF stressed my body too much at that time and I kept getting sick. So I maintained. My question is: WHY? My former psychiatrist didn't believe me, and my doctor took some convincing and we are looking into insulin resistance. But if I was insulin resistant before lamotrigine, why was it so easy for me to lose weight eating more carbs? In addition to hypothyroidism, I have a neurodiverse ADD brain, so maybe I have different receptors, which would be in line with the study I found involving Scandanavian children with epilepsy where 30% of the subjects treated with lamotrigine could not achieve ketosis- it's just a biological difference. Very few studies examine just ketones and lamotrigine, and the ones that look at lamotrigine and metabolism find that it's pretty neutral. However, looking at the rare side effects, elevated liver enzymes indicating liver damage as well as other metabolic side effects do happen. I believe that, for some unknown reason, lamotrigine is triggering metabolic syndrome like processes and I have become insulin resistant when I was not previously (I am working with my doctor to confirm this with lab tests, but based on my knowledge of metabolism it seems to make sense that if I need to push my body to extreme caloric and carb restriction to get inferior results to my pre-lamotrigine weight loss capacity, that's a reasonable assumption). Why does lamotrigine inhibit ketosis in my body? Are there any studies (other than individual case studies that involve patients taking many different drugs) examining the effects of lamotrigine on the liver and other organs involved in metabolic syndrome? I have spent countless hours reading hundreds of studies and filling notebooks with beautiful mind like notes trying to find connections, but the only answer I have about why it would inhibit ketosis is that it reduces glutamate. I can't find any evidence for hepatic or renal damage or metabolic disturbance. I hate the weight I've gained and want control back over my body, I self hack and experiment all of the time which is why I LOVE what you do and am such a huge fan. I don't expect a complete answer, but your thoughts on this or leads to more information would mean so much. Oh, and one additional point of data is that after my thyroid was treated but before I tried keto I took metformin for a few months while eating a "healthy" low fat diet. It did absolutely nothing, and my doctor is not sure about whether it would help me lose weight now. My blood sugar is stable on low carb, blood pressure is normal, and even if I don't lose weight low carb keeps away migraines, bloat, indigestion etc, so it is doing what it is supposed to...except it's not. Thank you! 💋
Hospital protocols for patients with COVID
I recently learned that hospitals treat patients with covid as being at a higher level of infectious risk than patients with other respiratory viruses like the flu. What is the science behind this difference in protocols? Is COVID at more risk of aerosol transmission than the flu, RSV etc? It seems that these additional precautions place more stress on hospital staff and capacity, especially when such a high portion of the current hospital population tests positve.
Stephan Guyenet/Kevin Hall vs Stephen Phinney/David Ludwig (+/- Peter Attia as host)
Personally I am convinced that therapeutic carbohydrate restriction is the most sustainable and effective way to improve dysglycemia and decrease body weight. The only debate b/t the CIM and EBM I've seen was on Rogan with Gary Taubes and Stephan Guyenet which was cringe-worthy, mainly because Gary just didn't seem to be prepared and doesn't have the full scientific understanding to defend his case, and Stephan is a walking encyclopedia. I don't think journalist vs PhD was fair but I would like to hear a debate of the CIM vs EBM from Stephan Guyenet/Kevin Hall vs Stephen Phinney/David Ludwig - perhaps it would be best to stop debates on twitter and just get these folks together. Can you make this happen Peter? Pretty please???