Night-Eating Syndrome

Who is this person who lives in my body? She confuses and scares me sometimes. Here’s why. I’ve got night-eating syndrome, and it baffles me.

The Pattern

I wake up at 6 am most mornings, not hungry. In fact, I’m not ready to eat until late morning. I work at my desk until almost noon, when I concede to my growling stomach and have a light breakfast. Then I go back to work for the afternoon, seldom thinking about food.

At this point, despite my dismal record of weight loss, I tell myself that I’ve got my diet problem under control. I’ll make a nutritious supper after work, clean the kitchen, play games on my iPad and read for a couple of hours, and then sleep soundly through the night.

All goes according to plan until around 9 pm, when the iPad games start to bore me and I find myself hungry despite the hearty dinner I enjoyed a couple of hours earlier. I’m hungry, but my stomach tells me I do not want rabbit food. I want donuts or ice cream. I have completely forgotten any healthy diet plans made twelve hours earlier.

The Cuckoo Clock

At these times, I am reminded of the little figures in old Black Forest cuckoo clocks. Several carved miniature Bavarian figures stand on a disc that rotates with the cycles of the day. Once every twelve hours, a group rotates to the front to the tinkle of music. Twelve hours and one rotation later a new set of figures appears. The two never meet.

bavarian-clockThe morning figures are bright-eyed and full of good intentions. They have plans for my day and rules to live by. We all agree that night-time bingeing is unhealthy.

When the sun goes down, and my virtuous friends rotate to the back of the clock, they are replaced by a night crew— a group of self-indulgent rascals with entirely different standards of behavior.

The night figures tell me that something sweet and fattening is just what I need for a good night’s sleep. I could make brownies or run out for ice cream. What the heck. What’s one little binge? They whisper, “Don’t go to bed hungry tonight. You’ll never fall asleep. You know what insomnia and hunger do to you. You’ll be in hell all night.”

In the morning—after a bout of guilt and remorse—I’m again under the influence of the daytime figures. They help me rationalize the previous night’s binge. They give me their daily pep talk. We agree that I won’t repeat the mistake.

What’s the Cure?

Here are some ideas that have helped me:

Eat something for breakfast and lunch. Don’t postpone eating with the hope of delaying hunger. Fasting throughout the day sets a physiological cycle in motion that almost always ends with hunger piling up, only to become overwhelming by night. Regularly spaced food intake also keeps blood glucose levels from spiking and dropping, throwing off your metabolism.

Be sure your last meal of the day contains protein and fat. They keep you feeling full and satisfied longer than foods high in carbohydrate.

Get some exercise or participate in an interesting activity in the evening to divert your metabolism and mind away from the digestive process. You’re less likely to be hungry at bedtime and will sleep more soundly.

Before going to bed, prepare a cheese, meat and/or fruit snack in case hunger strikes during the night. With something waiting for you in the kitchen, you won’t be as tempted by sweet, fatty foods that you run across.

Drink plenty of water throughout the day and evening. Often dieters confuse hunger with thirst. Keep a bottle of water at your bedside so that, if you wake up hungry, you can see whether it will do the trick.

Chew some nicotine gum in the evening. It reduces appetite.

Ask your doctor for a sleep aid to get you through the first week or two of reduced food intake. It may help get you accustomed to sleeping without being awakened by food cravings.

My search for a cure hasn’t been entirely successful, but it’s helped. The book “Overcoming Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle” by Kelly C. Allison, and co-authors has given me many good tips. Advice from friends and professionals along the way has been useful.

Famous Entertainers Who Were Alcoholics or Addicts

Alcoholism and drug addiction seem to strike more people in the entertainment industry than in any other occupation. Many performers with troubled childhoods turned to substance abuse before they were out of their teen years. Others responded to the stress of public life and grueling schedules by using alcohol and drugs to find relief.

Eight of the most popular entertainers in the world, now deceased, paid the price of life in the spotlight with their early deaths—Richard Burton, Billie Holiday, Hank Williams, Whitney Houston, Michael Jackson, Elvis Presley, Jimi Hendrix, and Marilyn Monroe.

Richard Burton

richard-burtonRichard Burton was a famous Hollywood star who was twice married to actress Elizabeth Taylor. One of 13 children, he was born in Wales in 1925. His father was a coal miner and his mother a bartender. He began his career as a Shakespearean actor on the stage in England before becoming a movie celebrity in America. Drinking heavily from the time he was a young man, Burton never accepted help for his drinking problem. At one point, he drank three bottles of vodka daily. He suffered many health consequences, including cirrhosis of the liver. He died in 1984 at age 58.

Billie Holiday

billi-holidayBillie Holiday, famous black singer and songwriter, was born Eleanora Fagan in 1915 in Harlem. After a troubled childhood, she began performing in nightclubs as a teenager. In her 30-year entertainment career, she influenced jazz musicians and singers throughout the world with her passion and style. She even gave a sold-out performance at Carnegie Hall. Frank Sinatra called her his greatest influence. Beset by severe drug and alcohol problems, she died in 1955 at age 44.

Hank Williams

hank-williamsHank Williams, country and western singer and songwriter, was born in Alabama in 1923. From birth, he suffered from spina bifida, a painful condition that later led to drug abuse and alcoholism. As a child, he learned guitar from a black street performer. His career peaked in the 1950s at the time he toured the U.S. with Bob Hope. When he was a star, the Grand Ole Opry fired him for habitual drunkenness. Hank Williams died of heart failure in 1953, months before his 30th birthday.

Whitney Houston

whitney-houstonWhitney Houston, one of the top-selling entertainers of all time, was born in 1963 to a middle class family in New Jersey. She began by performing as a gospel soloist in churches but soon started touring nightclubs singing popular songs. After a 3-year courtship, she married the performer Bobby Brown, who introduced her to cocaine and other drugs. As her addiction worsened, she failed to show up for many concerts or appeared onstage confused and intoxicated. She was found dead in a hotel bathroom in 2012, drowned in bathwater as the result of a cocaine overdose at age 44.

Michael Jackson

michael-jacksonIn 1958, Michael Jackson was born in Gary, Indiana. He began his musical career when he was 8 years old, singing with his brothers in the Jackson Five. In a few years, he became a solo performer, travelling on world tours. Not only were his songs immensely popular, but he introduced new dance moves to his fans—such as the Moon Walk. The “King of Pop” was accused of child molestation in his later years, and he died just before a comeback tour in 2009. His death was due to an overdose of drugs administered by his physician. He was 50 years old.

Elvis Presley

elvisBorn in Tupelo, Mississippi, in 1935, Elvis Presley was an American rock star—considered a major culture icon of the 20th century. Raised by loving, working-class parents, Presley’s family had little money and moved often. When they lived in Memphis, Elvis made his first recording at the age of 13. Not long after, he rose to fame. John Lennon once observed, “Before Elvis, there was nothing.” Presley suffered from drug addiction during most of his adult life and died at age 42 of heart failure, a complication of drug use.

Jimi Hendrix

jimi-hendrixBorn in Seattle in 1942, Jimi Hendrix was a musician, singer and songwriter who entertained audiences in the 1960s with his phenomenal guitar-playing skills. Videos of his memorable performances at Woodstock in 1969 are now collectors’ items. Hendrix was described by the Rock and Roll Hall of Fame as “the greatest instrumentalist in the history of rock music.” Like many musicians of his era, he frequently used drugs. He died at age 27 from complications of barbiturate use.

Marilyn Monroe

marilyn-monroeBorn as Norma Jean Mortenson in 1926, Marilyn Monroe was raised in Los Angeles, where she spent most of her childhood in foster homes and an orphanage. She married for the first time at age 16. Playing dumb blonde characters in 1950s Hollywood films, she became a popular sex symbol. Her movie career was briefly troubled when the media discovered she’d posed for nude photos before becoming a star, but criticism soon passed. She was married to the baseball icon Joe DiMaggio for a short time and then to the playwright Arthur Miller. By the 1960s, her health was failing, partly due to drug addiction. She died of a barbiturate overdose at age 36.

These are cautionary tales for drinkers and drug users.

 

 

 

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Abilify®—Is It Worth It?

My doctor recently gave me a prescription for Abilify, a fast-acting antidepressant for patients with major depressive disorder. I couldn’t shake a depression that had kept me in bed for most of a month. Although I’d been taking a maintenance dose of Zoloft for years, it wasn’t potent enough to prevent this episode. I needed a drug that would supplement the Zoloft.

Abilify was developed by Bristol-Myers Squibb for patients with major clinical depression resistant to treatment with standard antidepressants. (It’s used for other psychiatric indications, too.) Abilify is intended to serve as an add-on treatment.

After 5 days of 10 mg of Abilify nightly, I felt my depression start to lift. I was regaining my motivation to move around and get things done. By day 7, I was pretty much back to normal, working on writing projects, talking with friends, and running errands. My enthusiasm for life was returning

By day 8, I was a bit too enthusiastic. My mood was slightly manic. My speech was pressured. At the same time, my body felt clumsy and my balance shaky. I took two falls in a week. Also, I was becoming surprisingly forgetful. In the middle of a conversation, I’d lose track of the topic. When going to another room to get something, I’d forget what it was by the time I got there. According to clinical studies, impaired memory is sometimes reported by Abilify users. My other symptoms weren’t listed among adverse events associated with taking the medication, but they felt like side effects.

abilifytabs

Since my mood was lightening, the doctor suggested lowering the dose to 5 mg by splitting the pills in half. Then, if the improvement continued after several days, I could take one quarter of a pill. After that, I could stop altogether.

While the effects of Abilify were gratifying, the cost of the drug was daunting. My pharmacist told me a 30-day supply would cost $834.00. When he saw my shock, he asked whether I had insurance. I said no. He suggested that I apply to Bristol-Myers Squibb online for a discount coupon. I did that and found that the application could take up to two weeks to process—too long for me. I bought a 7-day supply of Abilify for $199 from my pharmacist and ordered the rest from a Canadian pharmacy, where the cost was only $165 for a 30-day supply. It would arrive by the time my initial supply was used up.

Abilify comes in six dosage strengths, ranging from 2 mg to 30 mg. In the U.S., a one-month supply of any of the four lower doses is the same—about $800. The two higher doses sell for about $1200. In Canada, the same branded product costs 80% less.

Why Canadian Prices Are Lower

The reason Canadian prices for Abilify are so much lower is that Canada, like many other countries, imposes price controls on retail medications. In the U.S., the sky’s the limit. Pharmaceutical lobbies in Washington have persuaded Congress that the high prices are justified by the cost of research and development. While this is true, the profits are often many times the amount needed to reach this goal. It’s true, too, that drug companies need to be compensated for their risk in developing new drugs that never come to market because FDA approval can’t be obtained. When this happens, they rely on the profits from other branded drugs to make up for their losses.

After Abilify sales had been tallied for the last 10 months in 2013, Bristol-Myers Squibb was found to net $16.4 billion. Only $3.7 billion of this was needed to recoup research costs. The company is undoubtedly currently maximizing profits before generic products are introduced in the U.S. in mid-2015.

Why Are Abilify Tablets So Tiny?

photoThe tiny size of Abilify tablets may have been a measure of Bristol-Myers Squibb to deter users from sectioning high-dose tablets into pieces; pill-splitting is a money-saving exercise. A doctor may prescribe 5 mg of an expensive drug per day, but write a 15-mg prescription so the patient can score the tablets in thirds and cut costs. Sectioning is difficult with the tiny Abilify tablets. Using a pill crusher is an option, but even this is tricky for a patient trying to divide a 30-mg pill into sixths to achieve separate 5-mg doses.

Bristol-Myers Squibb warns consumers to “take tablets whole.” There’s no pharmacological need for this, as the density and composition of each tablet are uniform throughout. The Discmelt formulation of Abilify is the exception.

Is Abilify Worth It?

Who wouldn’t pay a lot of money to recover from a severe clinical depression? It’s like death to many of us. We’re convinced that it’s permanent. Knowing that a rescue drug is available is priceless.

If I need the Abilify again in the future, I’ll buy ten 10-mg tablets from Canada ($55.00) and take one pill a day for six days. I’ll cut two pills in half and take the half-pills for four nights. I’ll quarter one and take the quarters for four nights. (This will leave one pill just in case.) Abilify will then most certainly be worth it.

Drug Company Games–The Case of Prilosec vs Nexium

Prilosec is a drug I started taking in 2001 for heartburn. It’s the best-selling drug in pharmaceutical history, netting billions of dollars in profits for AstraZeneca, the manufacturer. In early 2001, this branded version of generic omeprazole was available only by prescription–$4.00 per pill.  Now the brand name is available for 63¢ each. The generic form is only 40¢.

What happened to Prilosec price?

The Prilosec patent ran out in 2001. Until then, AstraZeneca had a monopoly on omeprazole. Demand let them set the price sky-high. But in 2001 they had to scramble to save their cash cow. Generic companies would soon be able to sell the generic form of Prilosec and charge amounts more in line with production costs.

One corporate strategy was to develop a replacement drug for Prilosec, rename the drug, and get a new patent. Their R&D team came up with Nexium, an isomer of Prilosec. An isomer is a compound almost identical to the parent compound, with a molecule or two tweaked. Unfortunately, the new drug performed no better than Prilosec. It was basically the same compound with a new name and a higher price.

This was a problem. The company had to find some reason to claim that Nexium worked better than Prilosec.  So they surveyed patients taking Prilosec for signs of discontent. To their delight, only half of the patients were entirely satisfied and pain-free.

Drug company tricks

Using a tried-and-true industry move, AstroZeneca designed clinical trials to show improved performance of the new drug, no matter how slight. Data from two of four studies showed enough difference to build a weak case for Nexium. The other two showed no difference. The two favorable studies became the company’s marketing platform. Data from the other two studies were ushered out a back door.

Racing against the clock, the company got FDA approval for Nexium two months before expiration of the Prilosec patent in 2001.  But they needed more time to build a customer base for Nexium before patients could buy low-cost generics.

Company lawyers found legal loopholes that gave them six extra months of exclusive Prilosec sales.  They dug up a clause in their FDA contract that allowed only one generic competitor on the field at first. According to a former company executive, the idea is, “If you’re going to lose, you lose to one generic. Because if four or five come in, it gets really ugly.”

Corporate greed works

The company’s legal experts stalled the introduction of cheap knockoffs for several years. Delaying tactics, including a series of lawsuits against generic companies, bought AstraZeneca enough time to court U.S. doctors with promotional claims about Nexium, Prilosec’s child.

Although the last U.S. Prilosec patent expired in 2001, not until December 2007 did the first generic manufacturer get FDA approval to sell the drug. By that time, Nexium had a solid foothold. In both 2009 and 2010, AstraZeneca reported Nexium sales at $5 billion.

Today consumers pay ten times more for a heartburn medication (Nexium) no better than its parent drug Prilosec or generic omeprazole. As David Campen MD, a Kaiser physician and pharmacy executive, says, “Nexium clearly is a no-value-added drug.”

Winners Never Lose

This scenario is played out in the marketing and legal departments of most pharmaceutical companies facing the disaster of expiring patents for high-dollar drugs.  Their ploys work almost every time.

Droid Addiction

At an upscale restaurant with two women friends the other night, I watched one play with her android nonstop during dinner.  She showed us over 100 photos taken with several cameras on the device.  She pulled up Google Earth and other apps and played with them.  The conversation was never allowed to stray far from her ‘droid.

This woman is in her mid-forties; the other friend and I are 87 and 79, respectively.  The 87-year-old is sharp as a tack but knows nothing about electronic devices.  While I know my way around computers, I’m a tyro compared to the ‘droid addict.  Since all social interaction was dominated by her, my older friend and I could only listen and look at the photos.  I could excuse this rudeness if my younger friend were showing off a new toy that she was enchanted with. But she’s had it over a year.

Doesn’t it ever occur to ‘droid junkies that they’re being rude?  With their fingers dancing over their devices and their eyes focused on the images, they’re only half present at best.  They don’t make eye contact. Where in God’s name are they?  Would taking their ‘droids away leave them feeling helpless and naked?

In the 1990s, I was addicted to internet chat rooms.  Sometimes I sat at my computer 16 hours at a stretch, getting up only for bathroom breaks or food.  When my computer crashed one weekend, I was desolated.  Only then did it occur to me that I’d become a chat room junkie. Fortunately, around that time the rooms began to degenerate and I lost my taste for them.

Droid addicts seem to be under a spell, cut off from their physical environment and human intimacy.  After a few hours in their company, I feel unworthy and boring.  Soon I’ll have the nerve to say, “It’s me or the ‘droid.  Take your pick.”