Hunger + insomnia, my two worst pals
May 27, 2014 6:43 AM   Subscribe

I asked this question about two months ago. This is me again now. What are my next steps?

For about three weeks, I had a very good run where I was managing my blood sugar very well, and I was actually sleeping through the night.

Recently, I tried to do the Buzzfeed Clean Eating Challenge, and it completely screwed up my metabolism. (Don't do it.) I gave up after just two days, but the hunger and insomnia have stuck. It's been about a week now, and I am desperate to sleep again.

I learned a few things in between my previous question and this one:
1) I started adding a lot more protein to my meals: my fridge is now stocked with chicken breasts and fish.
2) I started eating back my exercise calories.
3) I started tracking my calories and realized that I was often eating 400-500 calories less than I needed.
4) I used to take 10mg of citalopram for anxiety, but after my previous post, I decided to quit in case it was making me hungry and put on weight. Nothing has changed, except that my stress levels and anxiety levels are way higher.
5) I can't cut carbs, they are what make help me sleep.

So here's the thing: I am eating back my exercise calories. My Basal Metabolic Rate is 1686 calories, and exercise usually adds another 300 or so. (I track all of this on My Fitness Pal.)

What I do for exercise:
1) Bootcamp 2-3x a week, includes strength training and a lot of HIIT.
2) Jog for about 30-40 minutes 2x a week.
3) Every day I manage at least 10K steps.
4) I hula hoop for 15 minutes a day.
5) Sometimes I'll bike to and from work, each way is 8 miles and I do them on separate days so I am not biking 16 miles a day.

And I still haven't lost any weight, I'm at 5'1", 133lbs, 23% body fat. I'm not gaining muscle, though I definitely look more toned in certain parts of my body, like my arms. I'm just stuck.

What should I do next? I'm planning on making appointments with a dietitian and a sleep specialist today when the offices open, but I expect to wait weeks before I see them.
posted by so much modern time to Health & Fitness (16 answers total) 3 users marked this as a favorite
Did you see a GP for a regular physical? I know it got suggested by multiple folks in the last question, but you don't say either way if you went. If you haven't had a regular physical, that is a really really good place to start -- and as said previously, make sure they check blood sugar plus thyroid.

A dietician and sleep specialist might be the way to go, but I'd definitely check in with your GP before going there. It might be something totally different. (Crazy hunger plus insomnia can mean hyperthyroid, for example.)

Also, could cutting out the citalopram be part of the reason for your sleep issues?
posted by pie ninja at 7:01 AM on May 27, 2014 [3 favorites]

There are so many variables here that it's hard to say what will work for you. I dropped 20 pounds by taking up heavy weightlifting (initially Starting Strength) and skipping breakfast on days I don't work out (intermittent fasting). I tend to do most of my eating in the evening because that's when I'm hungriest; maybe experiment with your meal timing to see if that helps with the midnight hunger pangs. (All of the "eat six small meals a day" "stoke the metabolism fires" "breakfast is the most important meal" stuff is essentially nonsense.)

Also, it sounds like you should really start taking the citalopram again, if you haven't already. And do go see your GP!
posted by baby beluga at 7:14 AM on May 27, 2014

There are a number of things about your approach that are seem a little offbeat.

-- There is nothing you can do for just two days that will "completely screw up [your] metabolism". Otherwise people would be dropping like flies every time they skipped a meal or ate too any cookies. What was wrong with the Buzzfeed plan, and different about it from what you were doing when things were going well? By the looks of it, it's a simple, whole-foods based plan with some complex carbs and plenty of protein.

-- You cannot lose weight without eating at a deficit. Sorry, but it's true. At 5'1" and 133 lbs, your estimated base rate is really high, and eating back exercise calories at 300 a day introduces another place for error. Especially for small people, it's wildly easy to overestimate exercise calories burned. To give you some perspective, I'm 5'2", weigh 115-120, and even when I'm running 40 miles a week and biking 10 miles every work day I eat about 1400-1500 calories tops to lose weight at a pound per week.

Sounds like 2000 calories per day is about maintenance for you with all that exercise if you're not gaining or losing. Eat less if you want to lose.

-- You say carbs help you sleep - do you mean get to sleep? Anecdotally, I know the crash that comes after eating carbs definitely helps me to feel tired, but it leads to waking up hungry. Is something like that going on for you? If you have ongoing blood sugar issues, I strongly suggest trying a lower-carb diet (or even just a lower-carb dinner) for a while and seeing how it helps. I would check out the keto diet if I were you and my main concern was managing weight loss without hunger. It's extremely low carb and may be tough for you to get used to, but it's rock-solid at quelling hunger pangs. I think there are a lot of other benefits, too, but you can decide for yourself what works for you.

--I'd also consider adding some real weightlifting to your routine, maybe replacing some of the steady-state cardio. It will help you sleep at night as well as give you more calories to play with.

In general, you have to be patient when trying to change your body - willing to self-experiment and see what works. If you want to lose weight, the first thing to try is eating less. You have to stick with things longer than a couple of days to see what they're really doing. You might have to be kind of uncomfortable sometimes; i.e., hungry. There are way too many variables to pinpoint what this person is doing right or wrong.

And I agree about getting a regular physical. Get your thyroid checked, look for hormone problems (PCOS can make it very difficult to lose weight), etc.
posted by peachfuzz at 7:21 AM on May 27, 2014 [8 favorites]

Yeah, this is alarming enough that you need to see a GP (or OBGYN, they can do all this and are sometimes better at it) sooner rather than later for basic bloodwork and GTT, probably get an endocrinologist referral, and then later on if you don't get answers there a sleep study and a nutritionist.

You are describing a situation serious enough to indicate a serious medical problem that you cannot fix yourself, like diabetes. Or a pituitary or other brain tumor, since your hunger seems to be unregulatable, or serious thyroid problem. Stuff you cannot fix with diet and exercise - can't even mask with diet and exercise anymore. Two days of a dietary change should not have that dramatic an impact on you. That's another diabetes flag, and serious enough that if you do not make a doctor's appointment under your own steam now you could very well end up having to make one before you're allowed to leave the emergency room before the summer is out.

Like, these are not fucking-around symptoms anymore.
posted by Lyn Never at 7:41 AM on May 27, 2014 [1 favorite]

Nothing has changed, except that my stress levels and anxiety levels are way higher.

This is why you can't sleep. I know it's a crappy feeling generally, but there is a decent chance (talk to your doc) that what feels like "I am starving" is partly "I am anxious and I am fixating on hunger as a way to pinpoint what is wrong" That said, talk to your doctor. I am not saying this is what is going on, I am saying this is often what is happening with me. If you wake up "starving" consider having something low cal that will appease hunger pangs without becoming high calorie snacks. I often have half an apple or some carrots or even a small number of almonds. Then if you're still feeling starving either you have an abnormal metabolism (repeat: see your doc) or your anxiety is lying to you (as it does) about what is wrong.

Agreeing with peachfuzz, you pretty much can't screw up your metabolism in two days. You also may need to get more rigorous with your calorie counting. For me (and ymmv and it probably does) short bursts of exercise did basically nothing and I needed extended 45-75 minute exercise to really show a difference. Not saying that if hula hooping feels good don't do it but maybe getting your cardiovascular workout up (jog for an hour) might help with this.

Carbs are not helping you sleep. Not being hungry will help you sleep. I am not really a "you need to cut carbs" person generally so feel free to take in your calories however you want, but you seem to be attached to some slightly magical-thinking ideas about sleep (I have anxiety, I have had insomnia, I have been there) that are maybe not helping with the overall issue. I am sorry, I know it sucks
posted by jessamyn at 7:44 AM on May 27, 2014 [3 favorites]

Carbs may be helping you *fall* asleep but I'd bet that they are not helping you stay asleep. (Caveat: Everybody's body is different.) Try having a serving of full-fat yogurt at dinnertime/for dessert.

The ramped-up anxiety also cannot be helping.
posted by rtha at 8:22 AM on May 27, 2014

You cannot lose weight without eating at a deficit. Sorry, but it's true. At 5'1" and 133 lbs, your estimated [Basal Metabolic Rate of 1686 calories] is really high, and eating back exercise calories at 300 a day introduces another place for error. Especially for small people, it's wildly easy to overestimate exercise calories burned. To give you some perspective, I'm 5'2", weigh 115–120, and even when I'm running 40 miles a week and biking 10 miles every work day I eat about 1400–1500 calories tops to lose weight at a pound per week.

Sounds like 2000 calories per day is about maintenance for you with all that exercise if you're not gaining or losing. Eat less if you want to lose.
This. Your TDEE (total daily energy expenditure) is by definition the number of calories at which your weight will stabilize. The calorie counts & burns on MyFitnessPal are only estimates, so it takes a whole lot of trial & error to find what works for you. As peachfuzz says, you must must eat at a deficit to lose weight.

Nth-ing the recommendation to see your primary care physician—and please resume treatment for your anxiety disorder. (Anectdata: my anxiety was caused by Hashimoto’s, a long undiagnosed autoimmune thyroid disease.)
posted by editorgrrl at 8:27 AM on May 27, 2014

I'd keep a really good food log. Note also how you sleep and your degree of hunger. After a week or two, take notice of days where you slept well and hunger was controlled. And whatever and whenever you ate that day, try to recreate that as faithfully as you can for next few days, and see if that does it. Timing is particularly important (the body works best with a steady schedule of eating time, bed time, and wake time).

Let that set the theme, and start introducing variations, just for diversity. But introduce changes gradually. And don't change the timings or the per-meal fat/carb/protein proportions or caloric load.

Time-specific recurring hunger is a learned response. If you eat a snack at a certain time for 3 days in a row, you will get quite hungry at that time. The habit breaks easily, however. Just reduce and then eliminate eating at any given hour where you dont' want to create a hunger pattern (for, again, 3 days or so...that's all it takes).

It works in the negative, as well. People who skip breakfast invariably insist they're simply not hungry in the mornings. They've confused cause/effect. If they work up to eating breakfast for just a few days in a row, they'll find themselves positively raging for breakfast.

So the trick is to work up positive rages at all the right times via gentle reinforcement (i.e. keeping a steady schedule). It takes just days, not weeks or months.
posted by Quisp Lover at 8:48 AM on May 27, 2014 [1 favorite]

Response by poster: I did go see my GP after my last post. I was checked for my thyroid, and it came back normal. I specifically asked if she thought I should be tested for diabetes, but she felt that I was low risk. I did schedule another appointment for tomorrow morning.

With the Buzzfeed diet, it didn't work for me because I was hungry all the time. The first night I also had bootcamp, so I didn't eat back my exercise calories, and of course I was really hungry. The second night I didn't exercise, and I woke up in the middle of the night, hungry. So I gave up after that. The recipes only let you eat 1200-1500 calories anyway.

I need to eat carbs because whenever I haven't, I am starving. I have tried eating Greek yogurt for dessert, and while it is delicious, I still woke up hungry.

I will consider taking medication again for anxiety, but I also had insomnia while I was on it. And I am very wary about taking any more medication that might make me put on weight. Under citalopram, I put on about 12lbs, though I can't be certain that that's what caused it.

Also, I am only trying to lose 0.5lbs a week, not 1lb a week. But I agree that the real problem is the hunger.
posted by so much modern time at 9:16 AM on May 27, 2014

Have you tried a high fat, low carb diet (also known as a keto diet)? When I first tried low carb (paleo) I kept my fat intake pretty low and, like you, I was starving all the time and ended up binging on carbs to feel better. A few months ago I gave the keto diet a try and was amazed to find how full I felt AND how much weight I lost. By eating about 70% of my calories from fat and keeping my carbs under 20 grams, I only needed to eat about 1200 calories a day in order to stay feeling full.
posted by joan_holloway at 9:28 AM on May 27, 2014 [1 favorite]

Did you titrate off of the citalopram? The symptoms you describe sounds med withdrawal - VERY common with anti-anxiety, anti-depressant and other mood-related pharma that interact with the serotonin or dopamine receptors. I'm battling withdrawal symptoms nearly 2 weeks after quitting seroquel (and I even tirated off). Your comments didn't indicate, but if you cold-turkeyed your citalopram, that could definitely be impacting your sleep.

It's also understandable your hunger and insomnia are going hand-in-hand. When you can't sleep to re-energize, your body must get the fuel from food, so if you're not sleeping you're going to get more hunger cravings.

I would discuss this with your doctor, especially since you'll need to titrate back onto the citalopram if you've been off of it for weeks already.
posted by stubbehtail at 9:52 AM on May 27, 2014

Response by poster: I had these hunger and insomnia problems while I was on citalopram, and they were a big factor for me getting off. I was at such a low dose that my doctor felt I could quit cold turkey after two weeks.
posted by so much modern time at 9:55 AM on May 27, 2014

Losing weight is really hard. It's harder when you're small (you need fewer calories to maintain) and even harder when you don't have much to lose (you have a much smaller window of things that work and have to work harder to find them).

Compounding all of this is the fact that nutrition isn't an exact science, bodies aren't all the same, food and eating are tied to habit and emotion, hormones and stress can change all the rules, etc.

All the anecdata in the world doesn't really matter - if you're doing everything "right" but it's not working the way you want it to work, it's not right for your particular situation. Or think of it like an equation - the inputs are the food you eat, the exercise you do, your daily lifestyle, your general state of health; the outcome is your desired result. If you're not getting the desired result, you have to change something about the inputs. Change one thing at a time for a couple of weeks, see if it makes a difference. Rinse, repeat.

Some more things to consider -

- Sleep and weight are linked; sleep debt zaps your willpower and messes with the hormones that signal appetite. You say you are waking up from hunger but also look at your sleep hygiene overall and see if there are other things you can correct - do you drink caffeine late in the day? Is your room too bright or loud, or do you look at screens too late? Are you overtraining without adequate rest (is your pulse elevated?) Focus on non-diet changes and see if they help.

- You're so focused on the hunger piece of it. It's not especially politic, but most people have to be hungry sometimes to lose weight. For most of us, actual real hunger isn't something we're very used to, and it can be disturbing at first.

- Consider examining your feelings of hunger and satiety. For most people, wanting to eat is not really the same as actually being hungry. Are you confusing a full belly with being not hungry? Are you dehydrated? If you drink a big glass of water, does your hunger go away? How about if you eat half an apple?

- About carbs - It sounds like you're very reliant on them. I'm not a carbs are poison person and think they fit into healthy eating for lots of people, but you should remember that their nutritional function is to deliver quick, cheap sugar to your system at a high calorie price. I promise, you can learn to be as satisfied with an equivalent bulk of leafy greens and protein or whatever with fewer calories, which is ultimately the most important metric if you're trying to lose weight.

- Fat. Are you eating enough? It's critical for managing hunger. This is why low carb, high fat works for people when the same number of calories of bread leaves them ravenous. Fats are very calorie-dense, of course, but once you unchain the idea that a full belly = satisfied, adequate fat is very powerful for controlling appetite.

Find what works for you. It takes a long time and is hard work and will hopefully lead to lots of small tweaks to your lifestyle that will leave you happier and healther. I wish you luck.
posted by peachfuzz at 10:05 AM on May 27, 2014 [4 favorites]

I think a dietitian is a great next step, because while you sound generally well-educated about diet and exercise, I agree there is some magical thinking going on here.

There is a weird mental place I get to with weight loss sometimes that sets off alarm bells for me, and I see some of it in your question: treating very specific numbers and data from sites like MyFitnessPal as bible truths and making hard-and-fast rules about the kinds of foods you have to eat, even if those foods are not showing you good results right now.

1. My Basal Metabolic Rate is 1686 calories, and exercise usually adds another 300 or so.
2. I can't cut carbs, they are what make help me sleep.

Those are both assumptions that are not proving to be correct. Since both are central to your success, a professional dietitian should be able to help you adjust your intake (both calories and fat/carb/protein ratios) in a way that will be successful for you.

I also think you need to quit monkeying around with the Citalopram. You should work with a second professional, your prescribing doc, to get that back on track. Please treat your anxiety separately from your weight loss; that way lies madness, and failing to treat your anxiety will impact you negatively in ways that can't necessarily be measured on a scale. Your goal is health, not a specific set of digits on your bathroom floor.
posted by juliplease at 10:08 AM on May 27, 2014 [2 favorites]

I'm pretty skeptical of the MyFitnessPal calculator. Maybe cross-check your numbers with the If It Fits Your Macros calculator? It's kinda bro-science, but following the macros (including carbs!) and staying within my calorie limit, I did lose weight. (Their ratios favor protein but don't go fat-crazy.)

Also. I know this is anecdote, but I just spent a few months badly neglecting my previously beloved boot camp class and working out (max!) 3 times a week (more often 2) while focusing on diet and I lost 15 pounds. So, maybe ... work out less while you are keeping to a strict calorie budget? I dunno. My fat percentage has gone down as my weight has too. I think (this is kinda magical thinking-land) that all my early-morning vigorous exercise was making my body think it had to hold on to a lot of fat. Anyway, play around with what you're doing. That's my point.
posted by purpleclover at 12:36 PM on May 27, 2014

Response by poster: Results of my blood test showed that I am prediabetic. Wow. But at least I caught it early before it became full blown diabetes. Thanks for putting it all in perspective, MeFi, I never thought I would be at risk.
posted by so much modern time at 6:16 PM on June 4, 2014

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