GERD, Vyvanse, and EGDs, oh my (an update)

My life sounds like some sort of medical musical, but I swear it isn't! 

EGD update: despite having suuuuper high serology anti-immune responses, my villi are just dandy.  I am cleared to have any intestinal bypass rejiggering surgery due to no damage or h. pylori.  Much to my relief I made no incriminating statements while under the throes of anesthesia (this time).

I have completely ended gluten in my diet aside from some in my medications which I am working on phasing out.  I have also basically eliminated lactose.  If you have Hashimoto's thyroiditis, lactose and gluten are bad, anyhow.  And hoo-boy, you were right, Hala.  I had an almost immediate GERD relief.  I'm actually dumbfounded at how profound it was after the lactose.  I still eat yogurt, but that's it.  I switched away from premier protein to isolate/hydrolyzed whey again, and the difference is dramatic - and expensive, lol.  However, so is GERD if it becomes cancerous, so...

I also started Vyvanse.  While I have not binged for a time, I have also avoided it because, well, stimulants make me nervous as a counselor.  It's also got an expensive copay.  However, they work very well for binge eating disorder.  Stimulants work well because they alter dopamine regulation.  They help us stop seeking out external stimulus.  Anyone with true ADHD knows this - this is why even kids with ADHD see such huge benefits from them.  

I love my bariatrician because he is blunt, direct, and doesn't hesitate to respect me.  He helped me begin to document the skin changes for the eventual panneculoutomy and breast lift in 1-2 years.  I see my surgeon tomorrow, and we will talk about the duodenal switch.  I am expected to lose ~40 more with the sleeve or so before I reach the (theoretical) limit. 

It's been quite a journey.  I never expected to be able to walk across a room - never mind finish graduate school!  It's a humbling experience.  I hope I am able to help others as I was helped for so many years.  The difference good medical care has made astounds me.  I am so very grateful and fortunate to be alive and able to be the healthiest I've been in ten years.  

Er, serology for celiac!  Alas, Safari dislikes the forums and won't let me edit my post. >.>

Congrats Donna & so happy you have good doctors. Best to you!

I am glad to see things are improving for you. 

BTW: some meds have lactose as a "filler" that of SLS.  so check that in case you need to go a step farther with eliminating the lactose. 

I recently discovered that I can no longer drink wine... any wine - and i get a horrible GERD- burning in my esophagus, that does not responds to any meds and last 5-6 days with meds... longer if I don't treat it. 

...ughh, I never even thought of lactose in meds!  Gah.  I have to do this for wheat anyway, so.

Interesting about the wine.  I actually haven't drunk since before surgery.  I'm weird enough sober, lol.  I appreciate the warning though, as if anyone can have a bad food reaction, surely it will be me...

Thank you so much for your help, Hala.  I appreciate it very much.

Hi Donna!

I am thinking about trying Vyvanse for Bingeing. Can you tell me more about it? Do you like it? Did you lose any weight from not bingeing? I read it could be addicting.

I'm 3 years post op VSG. 

Thx!

Vyvanse is regarded as safer and less addictive than other stimulants (however this does not mean it is safe or non-addictive at all). This is because Vyvanse breaks down more slowly in the body than other stimulants so it has a more gradual titration rate.  What this means is that it is not as addictive, in theory.

If you have food addiction, I'd argue it's a bit trickier.  Standard addiction treatment regards stimulants as being contraindicated, which means they should actually not be taken.  This is because they can increase addictive behavior, as they stimulate dopamine.  Dopamine is one of the neurotransmitters responsible for reward behavior.  So, when you eat some really good chocolate cake, or have sex, or use drugs, dopamine surges and the reward mechanism of the brain kicks in.  

For those of us with binge eating disorder, it works for us for the same reason it works for kids with ADHD - it stops our need for self-stimulating behavior.  I used to treat ADHD kids, and part of why kids with true neurological ADHD fidget and move around and are restless is they have a constant neurological need for stimulation.  With binge eating disorder we do too - except our stimulation becomes eating repetitively.  Drugs like Vyvanse pretty much stops us from self-stimulating...not necessarily just cessation of eating.  Very little of the therapeutic effect is from appetite restriction, I'd argue.  If you are just overeating it will not necessarily help. 

I do notice a minor reduction in self-soothing impulses.  It doesn't stop me from making crappy food choices.  It does help with the desire to constantly eat 24/7, though.  I have true binge eating disorder, where I just need to eat.  Even if I am 100% full and stuffed to the point where I need to vomit I will want to eat (and will eat) if my binge eating is uncontrolled.  Years of therapy made it vastly better.  Surprisingly, the VSG curbed it even more, and the Vyvanse even further improved on it. 

Sadly, it appears impossible to surgically remove my desire for crappy pizza and raspberry zingers, which are total crap foods I don't even eat anymore but sometimes crave for no logical reason.

Vyvanse is especially successful when used in conjunction with therapy.  When we do things we physically also change the pathways of our neurons, as the brain constantly rewrites itself to adapt.  Just taking Vyvanse alone doesn't do that.  It is a powerful tool alongside therapy, though.

Thank you so much Donna! 

I am glad to read that you found some relief with the Gerd! Avoiding lactose is a bummer, but at least it is something within your sphere of influence and seems to be dramatically helping. My daughter takes Vyvanse (when she remembers anyway). Initially she lost weight, but eventually started to gain a little due to changing her eating habits to her boyfriend's junk food driven diet. Not that she is heavy at all, but heavier than she used to be. She asked at the beginning of the school year if it might be needed to increase her dose, due to it losing effectiveness. Not sure if this might be an issue for you, nor do I know if there is a point she just becomes more and more habituated to it. In her case she doesn't take it at all over the summer or on the weekends. Not sure if that is long enough to detox, but it can't hurt. Anyway, after that rambling my question is if you are aware of any research indicating the propensity to habituate to the drug and needing it to spiral up in the dosage to maintain effectiveness?

I'm still on 20mg of Vyvanse, so we'll see.  Usually tolerance takes months, or years, to develop at high doses.  I'm good for a while.  My driving has also gotten more aggressive so I need to keep an eye on that, lol.  I think it's more of an issue for kids with ADHD who become adults with ADHD, because they need stimulants for their entire lives, and they run into this issue far more simply because they have been treating ADHD with stimulants longer than BED - they've been on it a long time and so they have had to switch meds.  I imagine we will see that as people with BED take Vyvanse longer than 5-10 years, too.

It's probably quite beneficial she does not take it on weekends or over the summer, though it might be useful if she needs it to focus or concentrate.  Regarding how long it stays in your body, Vyvanse is actually out of your system in 2-3 days, and you will test negative for amphetamine on a urine test after 5-7 days.  And yep, it still metabolizes into d-amphetamine even though it's called "vyvanse."  This is something doctors neglect to tell people, but if you are on stimulants and you are taking a drug test, you absolutely must disclose this or you will come back positive for amphetamine.  Anyways, all stimulants though have a very short half life, which is also part of why they are easily abused. 

The problem with anything that is a stimulant is that the brain down regulates in response to the CNS (central nervous system) stimulant to balance itself.  Over time it adapts.  Brains are pretty cheeky like that!  You typically can go off stimulants without titrating down, though its not recommended for higher doses or people who may be dependent.  The balancing act of the brain makes all medication less effective.  

Stimulant tolerance is tricky, and poorly understood.  You must understand that while we have a lot of research about drugs, we also don't have a lot of precise answers about how they specifically work.  Vyvanse and BED is so new it is basically what I'd consider to be highly experimental (my own opinion), in that we have no 10-20 year data in large amounts for BED treatment if any sort.  It is new territory :)

At any rate, I do know that the problem with raising a stimulant dose in response to perceived tolerance can sometimes hide stimulant dependence.  Sadly, it is very easy to become dependent, and most of us are dependent after long term use.  It isn't necessarily as bad as it sounds if it is therapeutic.  I mean, technically if you get caffeine headaches you are dependent on that, too (caffeine is also a CNS stimulant).  I actually only know about how they handle it with ADHD and not BED.   Here's an article I often show parents of ADHD kids who want more science to explain what is happening, so some may be applicable.  We don't really know long-term if people will need to adjust doses upward with BED 100% of the time, though it is very likely that's the case because that is the nature of stimulants.  Maybe adjusting the dose would also be useful.

As for ADHD: absolutely it is possible and even likely, depending on individual metabolism, severity of the ADHD, environment, and therapy, that the type of drug as well as the dose needs to be changed.  It is dependent on many factors.  I always encourage people who take psychotropic drugs, like stimulants and antidepressants, to keep mood and symptom logs for this reason.  It's really easy to forget by the time you see the doc.

I'll try and find some more specific research when I am awake.