PT on the Net Research

Epilepsy Medication and Weight Loss


Question:

I have a regular client who has been training three times per week for the past 18 months. She has an extensive medical history including several operations on her spine and legs and severe epilepsy for the past 40 years. Her epilepsy is now very well controlled by a medication called Lamotrigine; however, a side effect of this drug is weight gain, which she is struggling to handle. Her fat is around 46 percent, which we are able to maintain but not reduce. Fitness/health wise, she has improved 100 percent as she now walks without any assistance after being confined to a wheelchair for five years and is able to carry out a "normal" way of life. Is there any advice you could give me with regards to her weight loss? I’ve explored every avenue I can think of! (P.S. She maintains a very balanced and healthy diet.) Thank you!

Answer:

My first concern on your behalf is the side effects of this drug. While there are pages of side effects listed, I clipped this summary for you from Mosby's Drug Consult.app: "Other Adverse Events Observed During All Clinical Trials for Pediatric and Adult Patients with Epilepsy or Bipolar Disorder and Other Mood Disorders."

Lamotrigine has been administered to 6,694 individuals for whom complete adverse event data was captured during all clinical trials, only some of which were placebo controlled. During these trials, all adverse events were recorded by the clinical investigators using terminology of their own choosing. To provide a meaningful estimate of the proportion of individuals having adverse events, similar types of events were grouped into a smaller number of standardized categories using modified COSTART dictionary terminology. The frequencies presented represent the proportion of the 6,694 individuals exposed to lamotrigine who experienced an event of the type cited on at least one occasion while receiving lamotrigine. All reported events are included except those already listed in the previous tables or elsewhere in the labeling, those too general to be informative, and those not reasonably associated with the use of the drug.

Events are further classified within body system categories and enumerated in order of decreasing frequency using the following definitions: Frequent adverse events are defined as those occurring in at least 1/100 patients; infrequent adverse events are those occurring in 1/100 to 1/1000 patients; rare adverse events are those occurring in fewer than 1/1000 patients.

Side Effects

  • Body as a Whole - Infrequent: Allergic reaction, chills, halitosis and malaise. Rare: Abdomen enlarged, abscess and suicide/suicide attempt.
  • Cardiovascular System - Infrequent: Flushing, hot flashes, hypertension, palpitations, postural hypotension, syncope, tachycardia and vasodilation. Rare: Angina pectoris, atrial fibrillation, deep thrombophlebitis, ECG abnormality and myocardial infarction.
  • Dermatological - Infrequent: Acne, alopecia, hirsutism, maculopapular rash, skin discoloration and urticaria. Rare: Angioedema, erythema, exfoliative dermatitis, fungal dermatitis, herpes zoster, leukoderma, multiforme erythema, petechial rash, pustular rash, seborrhea, Stevens-Johnson syndrome and vesiculobullous rash.
  • Digestive System - Infrequent: Dysphagia, eructation, gastritis, gingivitis, increased appetite, increased salivation, liver function tests abnormal and mouth ulceration. Rare: Gastrointestinal hemorrhage, glossitis, gum hemorrhage, gum hyperplasia, hematemesis, hemorrhagic colitis, hepatitis, melena, stomach ulcer, stomatitis, thirst and tongue edema.
  • Endocrine System - Rare: Goiter and hypothyroidism.
  • Hematologic and Lymphatic System - Infrequent: Ecchymosis and leukopenia. Rare: Anemia, eosinophilia, fibrin decrease, fibrinogen decrease, iron deficiency anemia, leukocytosis, lymphocytosis, macrocytic anemia, petechia and thrombocytopenia.
  • Metabolic and Nutritional Disorders - Infrequent: Aspartate transaminase increased. Rare: Alcohol intolerance, alkaline phosphatase increase, alanine transaminase increase, bilirubinemia, general edema, gamma glutamyl transpeptidase increase and hyperglycemia.
  • Musculoskeletal System - Infrequent: Arthritis, leg cramps, myasthenia and twitching. Rare: Bursitis, joint disorder, muscle atrophy, pathological fracture and tendinous contracture.
  • Respiratory System - Infrequent: Yawn. Rare: Hiccup and hyperventilation.
  • Special Senses - Frequent: Amblyopia. Infrequent: Abnormality of accommodation, conjunctivitis, dry eyes, ear pain, photophobia, taste perversion and tinnitus. Rare: Deafness, lacrimation disorder, oscillopsia, parosmia, ptosis, strabismus, taste loss, uveitis and visual field defect.
  • Urogenital System - Infrequent: Abnormal ejaculation, breast pain, hematuria, impotence, menorrhagia, polyuria, urinary incontinence and urine abnormality. Rare: Acute kidney failure, anorgasmia, breast abscess, breast neoplasm, creatinine increase, cystitis, dysuria, epididymitis, female lactation, kidney failure, kidney pain, nocturia, urinary retention, urinary urgency and vaginal moniliasis.

Post Marketing and Other Experience

In addition to the adverse experiences reported during clinical testing of lamotrigine, the following adverse experiences have been reported in patients receiving marketed lamotrigine and from worldwide noncontrolled investigational use. These adverse experiences have not been listed above, and data are insufficient to support an estimate of their incidence or to establish causation.

  • Blood and Lymphatic - Agranulocytosis, aplastic anemia, disseminated intravascular coagulation, hemolytic anemia, neutropenia, pancytopenia, red cell aplasia
  • Gastrointestinal - Esophagitis
  • Hepatobiliary Tract and Pancreas - Pancreatitis
  • Immunologic - Lupus like reaction, vasculitis
  • Lower Respiratory - Apnea
  • Musculoskeletal - Rhabdomyolysis has been observed in patients experiencing hypersensitivity reactions
  • Neurology - Exacerbation of parkinsonian symptoms in patients with pre-existing Parkinson's disease, tics
  • Non-Site Specific - Hypersensitivity reaction, multiorgan failure, progressive immunosuppression

Now, here are a few suggestions:

The drug could very well cause gastrointestinal inflammation (as you can see above), which is a symptom found with MANY medical drugs. This essentially means that it will produce a leaky gut syndrome. The result will be that undigested food particles make it past the gut wall, overloading the liver and are very likely to get into general circulation, where the immune system will attack them quite logically, producing capillary leakage. You will see this as a very puffy looking body, which also causes a lot of weight gain from water weight accumulation in the interstitial tissues. On top of that, one of the side effects of the drug is vasculitis, which also does that.

You will very probably see a BIG change in your client's body shape within two weeks of adopting a four day rotation diet plan. You can follow the four day plan in the book How To Eat, Move and Be Healthy. By rotating the foods based on genetic families, the immune system gets much needed rest, and there is much less exposure to the same antigens over and over, decreasing the overall inflammatory response to any given foodstuff. While you won't get the client's body to fully tighten up and regulate water because of the drug effects, you will surely notice a big difference. There is likely to be a period of frequent urination during the first week on the rotation plan, which will come with significant weight loss.

During this time and here after, I strongly recommend that this client drink a minimum of eight cups of quality water daily. Normally I recommend half a person's body weight in ounces for daily consumption, but with someone who is overweight, that formula may need to be altered slightly, and I can't do this without first-hand knowledge of the client. Just remember that drugs are essentially toxins, and the best solution for pollution is dilution! I would go with Evian or Vital. Usually, you can get a good deal if you buy it five cases at a time from a restaurant supplier.

One thing that may happen while on the rotation diet is that the client may have a mild detox reaction; her immune system will become rested and her diet will improve by variety alone if nothing else. This often results when the body starts to detoxify itself. You may see body aching and flu-like symptoms. I would just inform the client in advance and let her know it will pass. However, I should warn you that if the client sticks to this plan for two weeks or more and then goes on a binge, eating highly processed foods or what you and I would refer to as "junk food," chances are good she will have an adverse reaction. I frequently see clients get what I call "Hagen Daaz Syndrome." I created this name after a number of my patients ended up in the emergency room with severe kidney pain after eating (cheating on their diet plan!) Hagen Daaz ice cream. The problem is that once the immune system rests on the rotation diet plan, it becomes sensitized to invasive proteins. And since the kidneys filter antigens from the blood, when the immune system is back up to speed, it will attack whatever it can't get from the body tissues there, causing severe pain. It may or may not confuse the doctors if this happens, but you are best to warn the patient/client of the possible risk of such processed foods.

I would recommend that this client follow some basic dietary rules:

  1. Don't eat any of the four white devils: white flour, white sugar, white processed table salt (Sodium Chloride should be replaced with French unprocessed sea salt which you can get from the Grain & Salt Society) and no pasteurized milk (or juice) products.
  2. If it wasn't here 10,000 years ago, DON'T EAT IT!
  3. If you can't pronounce a word on the label, DON'T EAT IT!
  4. No microwave oven cooked food or drink of any kind!
  5. Avoid anything that lasts longer on the shelf than it would in its natural state (pasteurized milk, for example).

I would recommend you go to http://www.metabolictypingonline.com and have your client get metabolically typed. It is critical that she know how to proportion her meals to get optimal energy production. Eating what you describe as a "balanced diet" is impossible to do without testing for and knowing each person's individual metabolic type.

With regard to exercise, since I have no idea of your skill level, I would suggest being careful overall. The drug side effects, more than the history of surgical procedure, make this person (in my opinion) tricky with regard to exercise.

This is the kind of case to take slowly and gently. It is also the kind of case that would be very good to get help from a good Naturopathic Physician. Working together with an ND, you could do wonders for the client. There are many additional benefits that could come from:

This client, after eating correctly and drinking adequate water for three to six months, would benefit from a managed detoxification program. If she were my client, I would have her use an oral colon cleanse kit once a month to help detox her body. I would also have an ND evaluate her for parasites and dysbiosis due to the fact that she will have endured many rounds of antibiotics with all the surgery you describe, and having a leaky gut disrupts digestion, often opening the door for both fungal and parasitic infection, all of which diminish immunity, reduce energy and sleep quality and can result in your exercise attempts being relatively futile because the body is too catabolic to benefit from any form of catabolic stressor.

I hope this is helpful to you. Please understand that answering questions over the Internet like this is akin to trying to mobilize someone's glenohumeral joint over the telephone!