Its been a few months after your injury, and youre recovering pretty well. So, you take off your favorite comfy pants and pull out your old jeans, but ouch! They wont zip up anymore. You vow to go on a diet and all but starve yourself for the next few weeks. You discover that its now impossible to make the scale budge, no matter what you do. Talk about adding insult to injury.
Research shows that in the months and years after a brain injury, its not only more common to gain weight than it is to lose weight, but it also becomes more difficult to shed the pounds. The problem might be directly related to the brain injury. Heres how:
The hypothalamic-pituitary axis is a part of the brain responsible for producing and distributing hormones. Damage to it can result in hypopituitarism, which is a decrease in hormone levels. Depending on where the damage is, this could lead to hypothyroidism or a growth hormone deficiencyboth of which can cause weight gain.
Hypopituitarism is relatively common after a brain injury. If theres unexplained weight gain after a brain injury, theres a good chance its hormonal. Hormone-related weight gain will seem to come from nowhere. It will feel frustratingyouve made no changes to your eating habits, and yet the scale keeps going up. And trying to lose weight will be like trying to scratch your way through a brick wall.
Fortunately, hormone deficiencies can be treated and sometimes this treatment is enough to break though that brick wall. But youll have to talk to your doctor about getting a comprehensive hormone test or a referral to an endocrinologist. Many doctors will know that a brain injury can cause hormone problems, but you might encounter some reluctance if you have a milder brain injury or concussion. Although chronic hormone deficiencies are more common after severe brain injuries, milder brain injuries can cause hormone changes too.
Brain derived neurotropic factor (BDNF)
Brain derived neurotropic factor (BDNF) is a protein found in the brain that is important for, among other things, weight control. High levels of BDNF are essential for keeping energy high, appetite low, and weight down. High levels of BDNF also increase brown fatthe good fat that burns off unwanted white fat.
Unfortunately, a brain injury can decrease levels of BDNF. Having low levels of BDNF can increase your appetite and slow down your metabolism. It can also impair your memory and make you feel depressed. Its a sluggish, foggy feeling.
Getting tested for BDNF isnt so easy because its a research tool right now. You cant just walk into your doctors office and ask for a test or an injection. Fortunately, there are ways you can naturally increase BDNF. Drastically decreasing calories and increasing exercise is one good way (go figure). But there may be easier ways. Research shows that some antidepressants can increase levels of BDNF, and so can curcumin, a type of curry, or omega 3 fish oil.
Read more about BDNF.
Medication side effects
Certain prescription drugs are associated with weight gain. Medication-related weight gain can happen in a few different ways. Some drugs cause water retention, and others make you feel too tired to exercise. Some drugs increase appetite, and others reduce metabolism. Some drugs do all of the abovequadruple whammy!
Its common for a person with a brain injury to take at least one kind of medication that is associated with weight gain. Sometimes it helps just to be aware that the medication might be part of the problem. You can then balance the pros and consis it just a few pounds that you cant lose? Its not worth coming off an important medication. Is it a significant amount of weight? Your doctor might suggest an alternative.
But remember that just because a drug lists weight gain as a side effect doesnt mean that you will gain weight. Or you might gain weight, but not because of the drug. Its most likely that medication-related weight gain is only one part of a bigger picture.
Read more about medication-related weight gain.
Depression is common after a brain injury. One of the symptoms of depression is a change in eating habits. Some people eat too little, and others eat too much (and some cycle between both). Some people who are depressed crave sweets or fast food. Changes in eating habits, whether its eating too much, too much of the wrong thing, or eating irregularly, can lead to weight gain.
Depression-related overeating often means bingingthe mindless eating of an inappropriate amount of food, such as an entire large pizza or huge bag of chips. Binge eating not only leads to weight gain, it can also increase the self-loathing and guilt that are the hallmarks of depression. This can lead to more mindless bingingnot a good cycle.
Depression-related overeating might also come in the form of carbohydrate cravingsan impulse to eat carb-heavy goodies such as bread, cookies, or ice cream when youre feeling sad or irritable. Carbohydrate cravings might be related to a need for serotoninthe same chemical that is increased by antidepressants.
Fortunately, treating depression with either antidepressants or cognitive behavioral therapy (preferably both) can sometimes help boost weight loss. This might be because an antidepressant that increases serotonin will help reduce carbohydrate cravings. Or it could be that an antidepressant helps you feel well enough to get outside and become more active. Or therapy might help you become mindful of your feelings so that you dont get lost in mindless eating.
Read more about depression and weight.
Sleep disruptions such as insomnia, sleep apnea, or restless leg syndrome are common after a brain injury. You may have heard that not sleeping well can cause weight gainbut how?
There are few possible ways. One is obviousif you arent sleeping, you might be up and eating. Some suggest that night eating creates weight gain because you arent moving around and burning up calories like you would be during the day. But night eating is also about the type of food youre eating (usually junk). How many more calories are being added to your day (200? 1000?)? How mindless is your eating (are you distracted by the TV or computer)?
Heres another obvious reasonwhen youre tired during the day, youre more likely to try to boost your energy with simple carbohydrates or sugars. Hypersomnia, which is excessive daytime sleepiness, is another common problem after a brain injury. Hypersomnia could result from insomnia or other sleep disruptions, but it could also be a direct result of chemical changes after a brain injury. When youre so tired that you cant hold your head up, youre more likely to grab the quick fixan energy drink, a candy bar, or fast food. This high calorie, high carbohydrate food can quickly defeat a diet.
A bad nights sleep can also cause changes to the hormones important for weight loss. Leptin is the eat less hormonewhen you dont sleep well, leptin levels go down. Ghrelin is the eat now hormonewhen you dont sleep well, ghrelin levels go up. The result? Overeating, higher body fat, and weight gain.
Sleep apnea is another problem related to high levels of leptin. Sleep apnea is not only associated with being overweight, its also fairly common after a brain injury. Research has found that treating sleep apnea decreases leptin and increases daytime energyboth of which are related to weight loss.
Some antidepressants can make you drowsy and could be effective for both depression and sleep problems, if taken at night. In addition, cognitive behavioral therapy can help reduce the anxiety and depression that often cause insomnia. Meditation can quiet the inner chatter that keeps you awake, as well as make you mindful of your feelings and cravings. Massage is great for relaxation, and its also an excellent substitute for stress-related food cravings. Melatonin is a widely available supplement that can treat disruption to the sleep-wake (circadian) cycle, a common problem after a brain injury, and possibly depression as well.
If these solutions arent enough, ask your doctor about the short-term use of a sleep medication.
Read more about sleep and weight loss.
Not enough activity
Whether its because of chronic pain, depression, anxiety, or physical disabilities, people with a brain injury are less active, both physically and socially. This can lead to weight gain and become a barrier to weight loss.
Physical activity helps keep weight down, thats obvious. But its not a simple calories-in calories-out equation. Physical activity releases endorphins, boosts your vitamin D levels (if theres sun exposure), increases oxygen to your brain, balances mood, strengthens musclesall of which can indirectly contribute to weight loss.
Combining physical activity with social activity, such as walking with a friend or group sports, promotes weight loss even more. Research shows that there is around twice as much weight loss when physical and social activities are combined than with physical activity alone. This is especially important for a person with a brain injury because both physical and social activities can also promote overall recovery.
Treating the problem that is keeping you inactive can often be the first breakthrough for weight loss. For instance, reducing chronic pain can make a person feel comfortable enough to exercise. Decreasing anxiety or depression can help a person feel motivated to get out of the house. Solving a sleep problem can give a person enough energy to get moving.
Read about the importance of physical activity after brain injury. Join this social group for people with a brain injury.
Now you know
Weight gain and stubborn weight loss may be common problems after a brain injury, but now you can start to investigate why exactly it might be happening to you. Keep a daily journal of what you eat, how youre feeling, how well you sleep, and what happens to your weight. Then you can talk to your doctor about different therapies, hormone tests, or medications. And don’t forget to practice good sleep hygiene. Small changes can make all the difference.
Not sure how to talk to your doctor? Want more information about different medications? Read more here.