How a man lost 10lb in 3 weeks while taking a medication that packs pounds

Josh is a young man who has taken several antipsychotic meds over the past 4 years for bipolar disorder. Most recently, his doctors put him on Olanzapine. It has fewer side effects than other meds that block the neurotransmitter dopamine. But it packs on the pounds bad — 1 to 2 lb a week — for at least a year, likely more. Weeks after starting Olanzapine, Josh's belly protruded like a wine barrel.

By the time he approached me for help, Josh was doing well. His acupuncturist had helped to relieve his blurry vision, extreme fatigue and hemorrhoids. His moods were stable. He had also given up coffee. He could wake up by 10 am in the morning.

But his Olanzapine-induced weight gain would not budge no matter how much he worked out. It's depressing.

"I can't wear my APC jeans anymore. Even my new stretch jeans are tight," he said wistfully. "I saw a nutritionist. She asked me to eat what I ate before I put on weight!"

Josh rolled his eyes as he recounted how he ballooned from 120 lb to 230lb after he started taking the meds. He had many stretch marks on his trunk.

"My acupuncturist told me to exercise more." He was already working out an hour a day five days a week.

Jeans reveal all — they motivate a young man to seek help for Antipsychotic Induced Weight Gain

That's when he decided he needed another approach.

Second generation antipsychotics are well known for causing weight gain. It's called AIWG (Antipsychotic-Induced Weight Gain) in the scientific literature. It affects nearly all patients and leads to metabolic syndrome. Olanzapine is the second-worst culprit, after Clozapine, the drug of choice for treament-resistant schizophrenia. Children are more vulnerable than adults. How much weight each patient gains is a toss of the genetic dice. [click for reference]

Olanzapine targets the dopamine, serotonin, histamine 1, muscarinic and adrenergic receptors. Genetic variants of these receptors result in different responses to the drug. An individual's genetics also decides how well the liver can clear these drugs.

More ghrelin, the hunger hormone, circulates in the blood after you take Olanzapine. So does leptin, the hormone that tells you you're full. Josh felt both hungry and full after eating. It's very confusing.

Diet and exercise are necessary but only "moderately effective," and helps to shed 5-6 lb, according to clinical studies.

Is Josh doomed to early death from drowning in fat? Must he take diabetic meds soon to counteract the side effects of his anti psychotics?

I had a hunch. Gut bacteria produce the neurotransmitters that Olanzapine targets. The hormonal changes that lead to weight gain are collateral damage. Our first order of business is to heal the gut — the microbiome and the gut lining.

Josh needs probiotics and Akkermansia. Akkermansia grows in the mucin layer of the gut and improves gut barrier function. It supports the hormones that improve sugar metabolism, decreasing insulin resistance. [reference]

I did some research. A March 2024 review article [reference] concludes that probiotics are helpful in mitigating the side effects of antipsychotics. A 2021 study found that Akkermansia lowered systemic inflammation and insulin resistance in mice that were given Olanzapine. [reference] The mice that were lean to begin with lost some of the Olanzapine weight after 4 months. Not too promising:(

The first week he took the potent probiotics and Akkermansia, Josh did not gain any weight. He also felt less hungry. After two weeks, he lost 1 lb. He started to have 3 meals instead of 4.

It's a very modest result, but it was encouraging enough for him to return for more help.

Fibre feeds our gut bacteria that produce healthy neurotransmitters and hormones

I gave him homeopathic support to balance his hormones and neurotransmitters. I added a support for his gut and gave him a remedy to consolidate his sense of self. I also added supplements to support his detox processes. This is a complex dosing strategy, and it takes focus and motivation to follow through. Above all, he must help himself by kicking carbs to the curb. He's finally ready.

Josh has to firm up his identity from within. He knows the effects of the antipsychotics and the nuances of his medical diagnosis. He’s done the research. Yet, he cared most about his cool clothes. He wasn't in the fashion industry. He took the saying "Clothes make the man," as his compass. He needs Lithum Phos, a remedy for identity borrowed from external sources. He's a naive chameleon who loves to perform.

After three weeks on the homeopathic remedies, Josh reported that he had lost 10 lb, and he’s still losing weight. His belly looked a little smaller and he was not as puffy. His bowel movements improved. He was able to transition to a low-carb diet most of the time. His energy and motivation continued to improve. He’s sleeping better. He’s more aware that the meds have affected his memory and wants to change that.

And, he revealed,

“I’m not so excited about clothes now. Nothing’s going to look amazing on me at the moment. It doesn’t matter. I’m more interested in my work.”

His identity has started to shift from what he wears to what he does! And it will continue to shift, till he is rooted in himself.

This is work in progress. Josh may get to a point where he is able to wean off his meds and lose most of his extra weight. That will take at least a year, likely more. It's not the focus of our work. His psychiatrist will consider his progress when she decides how to adjust his meds.

Josh feels profound and gentle healing from acupuncture and homeopathy within himself. His body is producing its own chemicals to balance the suppression of the psychotic meds. And that gives him confidence that he has the keys to his health of mind and body.

He knows that he can heal. It motivates him to take the small cumulative steps of self-care. His genetics is a given. But he has control over his epigenetics. That is not the luck of the draw.