Tuesday, September 2, 2008

Why are cats and bipolar disorder showing up in the same blog post?

I volunteer for two different animal rescue groups here in Phoenix. I like to say that when things get tough with humans, I de-stress with the animals. As my friends in these organizations have realized what I do for a living, I've been presented with some interesting opportunities to combine both interests. You may have seen the post about Norm, the abandoned cat who we eventually lost due to consequences of prolonged and severe malnutrition. Thanks to my nutrition colleagues, I was steered toward a refeeding protocol developed by the World Health Organization used with children in third world countries. It's had limited and successful use in animals. I have submitted it to our vet staff for review, with the hopes that the next time an animal in need comes our way, we won't have to go through the emotional stress of losing it.

Last week, my friend Gerda paid me to consult with her about her cat Yani. I know Yani from the Arizona Animal Welfare League, and Gerda is a PhD candidate at Arizona State University. She is so diligent, she has plotted Yani's weight on a white board and kept his intake records over several months so we can problem solve. (Being the animal lover that she is, she put "anonymous" rather than "Yani" next to his assigned color so he wouldn't develop body image issues over being identified as obese!) So all of the medical and nutritional history I have for him makes this like a dream project in a fancy nutritional lab.

Despite Gerda's best efforts and documentation that Yani's food intake is limited, he continues to gain weight. He is, in turn, exhibiting signs and symptoms of depression. No interest in exercise. Extreme interest in food. Interest in food with any kind of environmental stimulation. I find this fascinating, because I used to work in eating disorders. Humans with eating disorders tend to connect all of their eating issues to some kind of psychological issue--an abuse, a trauma, an emotional issue. But here we have a cat, exhibiting the same behaviors and as far as we know he's not been verbally belittled, he's not had his body image assaulted by reading a few too many issues of Elle or Vogue, and he's certainly not being coerced by food ads on television. (Fortunately for Yani, and my Ivy League-ingrained insistence on maintaining proper scientific method, Gerda is more of a PBS than a Desperate Housewives person.)

So we've started a Facebook group and we're trying to figure out why Yani is getting fat when, thanks to a conscientious kitty mom and dad, he is following all the rules.

It seems, we've learned, that cats don't do well with carbohydrates. Many cat foods have carbohydrate fillers. And in reading cat food labels, I've seen supposedly high-protein foods that are high protein because they contain fillers such as corn gluten and soy protein that any self-respecting cat would never choose on his own. Cats are meat eaters. We've switched Yani primarily to meat, tossed the fillers, and we're experimenting with carnitine, a supplement that has been found to help metabolize fat and has actually been studied in cats.

I am particularly interested in what happens with Yani, because it's been my experience that people with mood disorders also seem to have problems with their weight. Some of it is binge eating, I know, but there just seems to be something metabolic that goes with a mood disorder that causes a proneness to gaining weight. It can even often be seen in the body type--solid center of gravity, proneness to gaining weight around the abdomen, skinny legs, in women, a tendency toward bustiness--it's the most common body type I treat in working with mental illness. I just described the apple shaped body type that is defined as a risk factor for metabolic syndrome, if you're not familiar with it. More and more, my observation is being supported in the literature, that people who have metabolic syndrome tend to have this body type...and to be more prone to mood disorders. This long drawn out dissertation is my attempt to be politically correct at saying that sometimes there is a genetic tendency toward a mood disorder, and that can be strongly linked with problems with weight.

When you see the issue manifest in a cat, who isn't subject to the same kind of emotional conditioning as a human, it really points to the fact that some people are, weight and calorie wise, completely different from others.

Researchers recently looked at the medical records of 161 individuals with bipolar disorder. Over three fourths of them were were overweight, and almost half were obese. High triglycerides, high blood pressure, and diabetes were noted at a rate greater than is observed in the general population. Over half met the criteria for metabolic syndrome.

There was a trend toward even greater incidence among individuals whose bipolar disorder was being managed with second generation antipsychotics (for example, Zyprexa). However, the trend existed whether or not those medications were part of the scenario.

My point? There are many psych meds that get blamed for weight gain. The reality is that they may exacerbate a pre-existing tendency toward weight gain, but they do not cause it. That genetic profile may benefit from a certain kind of diet. Just as Yani cannot blame his weight gain on poor social conditioning and must be encouraged to follow a lifestyle that minimizes his identified genetically-based medical risks, so must people with bipolar and other mood disorders. Weight gain is not necessarily an excuse to not take medications. A well-planned diet may help to minimize weight gain, and that is why it can be helpful to work with a nutritionist specializing in mental health, in conjunction with a psychiatrist who understands the complex interactions of mood, weight, and hormone function.

Fiedorowicz JG, Palagummi NM, Forman-Hoffman VL, Miller del D, Haynes WG. Elevated prevalence of obesity, metabolic syndrome, and cardiovascular risk factors in bipolar disorder. Ann Clin Psychiatry. 2008 Jul-Sep;20(3):131-7.

Special note: In order to continue to protect Yani's identity and self-image, the photo above is merely a stock photo of a random cat. The photo is included solely for illustrative purposes and is not intended to belittle or poke fun at any animal whose weight exceeds kitty culturally-accepted norms.

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