Unexplained Weight Gain - Prozac? Birth Control?

I'm 32, 5'2" and 160lb. I used to be 130lb this time last year. That's quite a weight gain in 12 months! During that period of weight gain, my diet didn't change (except when I joined a slimming group, in desperation - and gained 7lb before I realised I was wasting my money) and my exercise routine, if anything, increased. I'm a runner and am currently working towards my first marathon in May. I work out at least 5 days a week, on average for about an hour each time and often for much longer. And still my weight is going up.

I just got the results of my bloodwork back from my doctor today and it's all normal. No thyroid issues, no PCOS, no hormone levels out of flux. The ONLY things I can think of are:

1. I was on Prozac from December 09 through to the beginning of February this year. I hear that weight gain can be a side effect of this. The weight is still not shifting, though - has anyone else had this problem with Prozac? Please tell me it just needs to clear my system and then the scales will start to move downwards again! I don't think I could bear it if I had to carry this weight around for life - it's much too heavy for my little frame....

2. Possibility number two is that I had a Mirena IUD fitted in April of last year. I've never heard of any weight gain associated with the Mirena, but then again I hadn't heard of weight gain with Prozac until early this year.

If anyone has any insight, please let me know! I'm booked in to talk things through with my doctor again next week, but I'm reasonably sure she's decided that it's all in my head and I'm lying about my calorie intake / exercise regime. This is what most people assume, and I could just cry. I KNOW I'm not doing anything to make this weight go on!

Are you eating enough? Are you sure your intake/burn has not increased/decreased?

I think prozac and birth control can both cause water retention as well as increased appetite in some people, but I'm not sure if it can actually add on pounds.

First antibinge is right. If you are in training it is counterproductive to restrict calories. 

If you create any kind of energy deficit, then that bumps up the glucocorticoids in your system. Glucocorticoids do a whole mess of stuff not the least of which can be metabolic suppression and most specifically the increase of subcutaneous fat stores around the mid-section, shoulders and arms.

So while the occasional energy deficit is not detrimental, longer term energy deficits start to rack up the glucocorticoid-related damage in the body.

It is an often overlooked element of weight gain: stress. There you are watching every calorie and in training and it seems impossible weight could be packed on with that equation.

As you have seen your physician and any other health issue that might cause unexplained weight gain has been ruled out, that really does leave stress (which triggers the flood of glucocorticoids in your system).

So, you have to go back to basics. Get sleep. More than enough sleep. Do not restrict calories. Eat before you are hungry in training. Eat to cover off every calorie burned. Consider whether other stressors are at play in your life: miserable work environment? difficult family life?

The type of stress that really generates a surge of glucocorticoids is the one where it is unpredictable, constant and you feel powerless to resolve it.

As you were prescribed Prozac (and did not continue with it), I can assume that you sought support for depression and/or anxiety and the accompanying symptoms on Prozac were unacceptable to you.

Depression occurs in animals that have been injured or are ill. It causes a withdrawal, marked reduction in interaction with others, and it reserves energy for healing. Depression in humans has been medicalized so we fail to address the possibility that it occurs because our bodies have determined something in our environment is harming us and we must withdraw to heal.

(I am not referring to major depressive disorder that requires hospitalization when I speak of the possibility that clinical depression may not require pharmacotherapy to be successfully resolved).

I have no real sense of your circumstances so I am not passing judgment but offering up ideas that may or may not be of use to you.

Generally, you may want to just be kind to yourself for a while. I think you deserve it. The weight will probably resolve if you do just that.

Best wishes

Thanks for the advice. I elected to discontinue Prozac (with my doctor's agreement and supervision) as we had determined that the depression for which it was prescribed had resolved. I also absolutely hated the drug and was glad to taper it off (and delighted to stop it altogether), but that's beside the point - I'm all about following doctor's orders, since they are the experts, and if she tells me I need to be on medication, I'm going to listen to her.

As for stress, I haven't been particularly stressed - at least, not out of the ordinary. There are ongoing problems in the family, but they are longstanding and the weight gain is not. There hasn't been any appreciable increase or decrease in family craziness. I'm not injured and I've been in a job that I love during the period of the major weight gain - if anything, the extra stresses have come in these past few months after the weight was mostly already on.

I'm interested in this idea of glucocorticoids, though. It's not something I've come across before. I'm wondering (and I hope this doesn't come across as aggressive or rude; it's not meant to: I'm really just curious) - if a calorie deficit causes glucocorticoids to be produced that cause fat production in those areas - which are, incidentally, the areas where the weight gain has been most pronounced - why is calorie control prescribed as a method of weight loss? Surely then any calorie deficit in someone trying to control their weight is going to be counter-productive? On a more personal note, my concerns about this as a possible cause of my own weight gain is that:

(a) The serious training is over the past 6 months. Before that, I had a nice, rigorous exercise programme that I'd been following for a number of years without weight gain. The serious training, in other words, post-dates the weight gain: I'm not prepared to let weight gain get in the way of my dream of running a marathon (although it's making life more difficult: my speed is down since my weight is up).

(b) Also, the major weight gain began while I was following the same diet I'd been following for years - healthy, everything in moderation, low fat, high fruit and veggies, etc.

So in other words, nothing changed in diet or exercise UNTIL the weight had gone on. That's why I'm looking to the stuff that did change - like the Mirena and the Prozac (and, incidentally, since posting, I've found several forums where people claim to be in the same situation as me on both counts: people who've been on a course of Prozac or had a Mirena fitted and suddenly had a serious weight gain despite maintaining diet and fitness). So I suppose I'm wondering if anyone on this site has noticed a similar pattern, and what they did about it. I'm happy to lose the Mirena if that's going to make the weight come off - I like it as a birth control method, but I like my old body better.

It's taken me a while to get back here...

In fact, yes calorie restriction is counterproductive for almost everyone. It is formulaic starvation. Restricting calories is a much quicker way to lose weight than increasing activity for our relatively non-active modern lives and so we take the consequences with the expediency.

You know the old-fashioned concept that you should see your doctor before you go on a diet? Well, we view dieting as equivalent to a hair cut, but biologically it's not.

Medically, dieting (calorie restriction) is considered a reasonable and viable choice only for the morbidly obese. And while our bodies are resilient to periodic famine, that does not mean that it is ideal or has no physiological impact and damage associated with it.

It is human nature to presume that the onset of a change is due to something new in the environment. This is often a limitation when trying to identify allergens in the environment for those who have suddenly developed allergies -- sometimes it's that cream you've been using for 17 years and other times it really is something new. Or both.

Have you had a long-term sub-clinical level of calorie deficits in your life? That will build up the glucocorticoid damage over years.

Do you eat what this CC site suggests for your current weight/height/age and have been doing so for years? If you have then you have been sub-clinically under-eating for years as well, causing glucocorticoids to rise over time.

CC and other sites all use the equation BMR x activity level (basal metabolic rate). That equation underestimates adult female requirements by about 1/3. TEE (total energy expenditure) is a far more accurate equation and is particularly useful for female athletes.

That your weight increase predates the training increase would suggest that you may have gained weight due to stress-induced glucocorticoid levels as a result of the cumulative impact of under-nourishing over the years.

At 5'4, age 35, 127 and for my current activity levels, I should eat 1750 odd calories a day according to this site. I eat 2300-2600 to maintain my weight and  my health. If I had eaten 1750 calories a day for the past 10 years I may still be 127 lbs but I would have a very suppressed metabolic rate and as I move into my late 30s and early 40s I would start to pack on the pounds despite changing nothing.

Here's what is happening to your body over time if you stay between 1200-1800 calories as an adult woman over 4'11":

1. It lays down what little fat it can around the vital organs as protection (which actually increases risks for heart disease in later life); 
2. it pilfers calcium from bones leading to osteoporosis in later life -- your bones will break when you step off a curb;
3. it slows the metabolism to try to eek as much as it can from the calories it can get (which leads to pre-metabolic syndrome/diabetes -- which surprises a lot of habitual under-eaters because they assume those are only diseases of the obese, not so);
4. it ignores the huge piggy glucose demands from the prefrontal cortex (which leads to slowed thought and poor judgment);
5. it ups the glucocorticoids* in the body (stress response) which in turn shrinks the hippocampus in the brain and that causes more glucocorticoids in the body (vicious circle) and wrecks your memory capability possibly leading to dementia in later life;
6. it starts scrimping on the red blood cell count (anemia and profound fatigue).
7. Depression and anxiety disorders become far more likely as insufficient energy harms all neurological functions including neurotransmitters.
8. Most women develop amenorrhea (irregular or stopped menstrual cycle) at these levels and they are the lucky ones because that's the only warning sign they get that they are in trouble.

*glucocorticoids are legendary in their ability to cause serious auto-immune diseases (such as rheumatoid arthritis, inflammation of the circulatory system), hardening of the arteries, severe immuno-suppression (constant colds, flus, secondary infections)... and they also worsen all the conditions you develop with chronic under-eating.

At age 50 this lifetime of sub-clinical starvation will become critical. Your metabolism will drop (as it naturally does at menopause) -- but this will be a more severe drop for you than for those women who have not restricted for life.

If you eat these sub-clinical starvation levels then the metabolism seems to slow with each passing decade. However, with adequate intake the metabolic rate does not slow until age 50 (and even then, very marginally).

Low fat is a bad idea for female athletes. For years female athletes were just assumed to be small male athletes. No so. Women preferentially metabolize fats during endurance runs and men metabolize carbohydrates. Carb loading is great for the guys and useless for the women.

Now, I'm just providing the data and it may or may not pertain to your circumstance -- just like with the allergies -- is it the cream you've been using for 17 years or the new shampoo? Is the calorie intake you've had for years or the Prozac/Mirena (or a bit of both)?

Stay open to what the possible causes might be and that's the best way to get a solution that suits you. Best of luck!

Thank you for such a long and detailed reply! This is fascinating stuff. I've been on a diet for as long as I can remember, and for most of my adult life I've been a yo-yo dieter, which finally came to an end when I discovered distance running. I truly believed that I was eating healthily, especially for my lifestyle, as I do read up on nutrition for runners and try to follow it. I'm seeing my doctor today to discuss my bloodwork results, and I'll definitely be discussing your advice with her. Though I'll also be losing the Mirena, just to be on the safe side!

Also, I forgot to ask - how should I calculate my required calorie intake per day? I've always relied on sites like this to do so. As I'm training, there are days (long runs) in which my calorie requirement is much higher than others; I'd seen that as an opportunity to increase my deficit and burn off the excess fat (although I do, of course, increase my calorie intake on a day with an 10 or 11 mile run...). And is it possible to reverse metabolic changes caused by calorie restriction, even if it's been a long-standing problem? As I'm sure you can appreciate, with the current weight problem, I'm really worried about eating too much, and it seems like I've got a delicate balancing act to do! I'm wondering if perhaps a nutritionist might be a good idea. Finally, are glucocorticoid levels something that can be tested for? I feel very much as though I'll need my doctor's continuing support and she's much more likely to come on board if there's something she can test for! At the moment, I'm reasonably certain that she's decided I'm the fat chick who lies about eating all the pies, since all the bloodwork was normal, and I'm not sure she's sympathetic anymore... This is driving me mad! I want my old body back! :o)

As I mentioned total energy expenditure (TEE) is a more accurate way to calculate required energy intake. This calculator (link below) I have located seems reasonable (I used my stats as a guinea pig and it generated what I really eat whereas the CC site is too low).

http://www.health-calc.com/diet/energy-expend iture-advanced

What you should find is that your calorie intake requirements using TEE should look to be about 30% more than what BMR x activity will generate.

Given that you are generating significant deficits (eating the same and trying to burn off excess fat through some of your more intense workouts), it may explain why the weight won't move -- the deficits have suppressed your metabolism.

Yes, the metabolic rate will bounce back no problem if you remove the deficits. I understand the anxiety of eating more as this seems counter-intuitive. And, initially, if you up your calorie intake to exactly match your energy requirements for your current weight/age/height/activity level (using TEE) you may find a few extra pounds show up initially.

But -- and this is important to note -- that only happens while the metabolism catches up and goes back to its normal rate. At that point, those few extra pounds will go. It'll likely take somewhere between 4-6 weeks.

Then, as you want to drop some additional weight, what you do is never create a deficit of more than 200-400 calories on any single day. You keep it very minimal so that the metabolism stays normal and the glucocorticoids remain at normal levels as well.

Also, if you skip the in between phase of eating to stay at your current weight for about six weeks and try to just go to the 200-400 calorie a day deficit, your metabolism will stay suppressed. Not only that, but as you age it will continue to drop making weight loss harder and more stressful with each decade.

Yes, glucocorticoids can be tested. You can ask your doctor for a cortisol level blood or salivary test (cortisol being one of the glucocorticoids). But this may be a Pandora's box for you. When doctors have a hammer, everything looks like a nail.

There adrenal gland disorders that can cause elevated cortisol levels, but certain drugs and stress can also elevate cortisol levels. You probably want to discuss ahead of doing the test what your physician may want to do *if* your test comes back with elevated cortisol levels. Both hyperthyroidism (elevated cortisol) and hypthyroidism (decreased cortisol) are over-diagnosed and over-treated and the last thing you'll want to do is take more prescriptions when elevated cortisol may purely be the result of the stress of calorie deficits over the years.

Also, it might be an idea to confirm with your physician whether she believes your weight gain is entirely of your own doing. Sometimes we get the wrong impressions, but sometimes we are just plain right. It's best if it's on the table because you need to decide whether you want to continue to work with a physician who may have lost all interest and curiosity regarding your current issues and symptoms.

You deserve a physician who is interested in your case.

Use nutritionists and dieticians with caution. Studies show that those who enter the nutritional sciences in university are far more likely to suffer eating disorders than the general student population.

They are a great resource for real beginners: those with no concept of whole foods or vegetable and fruit portions and those who have lived a life of fast-foods and TV watching. That's not you.

Perhaps consider a sports nutritionist where the focus will hopefully be about performance and adequate intake. Even then, you'll want a sports nutritionist with some depth in female athlete requirements (as I mentioned you need fats more than carbs and you'll want a professional familiar with some of that important recent research on female athletic energy requirements).

Hope this helps give you more ideas to investigate.

Hedgren, your replies have been amazing and really helpful - thank you so much! However, having done some serious research and spoken to a lot of women in a similar position, I'm now absolutely convinced that the birth control is the culprit - to whit, 4 days after removal I had dropped 7lb without changing anything in my diet or exercise regime! I've discovered that thousands of women using the hormonal IUD have experienced the same constellation of symptoms as I've had, including unexplained weight gain that doesn't respond to dieting. But I will continue to bear in mind everything you've said; it's very interesting reading and much food for thought. I think I need to be kinder to my metabolism in future, regardless. Thanks again!

Original Post by eimeo:

Hedgren, your replies have been amazing and really helpful - thank you so much! However, having done some serious research and spoken to a lot of women in a similar position, I'm now absolutely convinced that the birth control is the culprit - to whit, 4 days after removal I had dropped 7lb without changing anything in my diet or exercise regime! I've discovered that thousands of women using the hormonal IUD have experienced the same constellation of symptoms as I've had, including unexplained weight gain that doesn't respond to dieting. But I will continue to bear in mind everything you've said; it's very interesting reading and much food for thought. I think I need to be kinder to my metabolism in future, regardless. Thanks again!

I am really glad that the source of some of your weight gain has been quickly resolved and I will keep in mind your research regarding IUD issues for many, many women (that's very helpful for me to bear in mind in future as well).

I'm also really happy to hear you intend to be kinder to your metabolism in future. That can only mean great things for your upcoming distance running event.

Here's to your health and longevity!

Sounds exactly like my daughter. After working out for 7-8 months 4-5 times a week and running she stopped having her period. Even though she started to gain weight. As far as her diet it is low fat no white flour or sugar no candy or soda. She eats same as I do and we started this exercise program together. ( She's 18 I'm 60) I lost 10 lbs. She went on the pill in November to try and get her period back ...nothing so far..so she had blood tests done and everything came back normal. It's now been over a year without her period and 5 months on the pill. She's 15 pounds over her normal weight and maybe gaining!! HELP!