To think this is not just because I’m fat?

[exercisewoe]

I’m permanently exhausted . I weigh 21 stone, I’m aware I’m morbidly obese and I’m trying to fix it .

I take a beta blocker twice a day for anxiety . I take mirtazapine before bed .

I’m absolutely fucking exhausted . I’m wearing a sports watch and can see even if I’m out of breath and sweating (walking briskly) my HR rarely gets above 80, it’s hire often just 65 when walking quickly - it usually sits at 50 when relaxing . God knows what’s happening when I’m asleep .

I’ve started blacking out when standing for prolonged periods, so GP did an ECG, fine.

Severe postural hypotension though - BP drops by 45 on standing up . I know that’s happening as I can feel my heart pounding in my head when I stand up or move quickly . The nurse I saw on Friday said she thinks I need a GP review so asked me to organise .

GP did online review via email - said it’s definitely because I’m overweight and suggested I start running - said if my HR isn’t going above 90 I’m not exercising hard enough .

I cannot physically get my HR that high .

I’ve also been advised by cardiology specifically not to run - or do intensive exercise - as there’s a small chance of me having an inherited condition, get screened for it yearly .

I’m feeling very miserable with it all and so bewildered about being told it’s just because I’m fat, with no advice other than that !

Worth asking to come off the sodding beta blockers all together?

Hi Op,

I really feel for you as it must be such a horrible position to be in. I have anxiety and it can be hell.
I’m no doctor so can’t advise about heart rate, but even you know 21stone is just to heavy.

I wouldn’t start running, it’s to much.
I suggest walking every day for an hour.

And cutting back on what you eat.

Have you heard of James Smith Academy? It’s online and may be worth you joining.

It could save your life

I take propranolol when needed for anxiety. What dose are you on? I have been known to take 4 or 5 5mg tablets in quick succession for a particularly anxiety inducing activity. My heart rate remains stable, but I am fit for nothing afterwards. I also couldn't lose weight taking them, despite having a very low calorie diet at the time - and losing 0.5 - 1lb a week when I didn't take them (I didn't have much weight to lose). I am not surprised you are constantly knackered with the P & M combined. Your GP sounds fat phobic and seriously shit. We all know being overweight CAN lead to health issues. It doesn't mean weight is ALWAYS the cause.

Thanks all so, so much - was feeling quite desperate earlier and so relieved to realise there are things I can be doing . Going to go through thread and make a list 😂, but thanks so much, I’m honestly really grateful - small steps but hopefully this is the start of a big change . Starting with finding out what’s happening with sleep aponea as I was certainly told back in Oct 19 I probably had it, I needed specialist treatment in hospital because of it .

Will absolutely definitely ask to start weaning off the propranolol (40mg at 8am, 20 at bed) and mirtazipine too . It’s horrendous for making me hungry .

Have also been thinking quite critically about my diet this evening which has helped too .

Thanks so much though, it’s such an enormous relief to see others’ perspective on this and to realise it can be fixed, somehow .

Just looking at the BNF page for mirtazapine

As well as weight gain listed in side effects, which I obviously knew, under cautions, it lists hypotension.

@GreySkyClouds with all due respect, 1500 is far far too low. This will cause way more damage than help.

OP please please don't listen to advice like this. It'll destroy your metabolism and might even cause more issues. Low carb and no sugar will help the most and if you have the cash, please see a nutritionist.

X post

Be prepared, your GP might tell you not to come off either.

The GP advice is just advice though. Can you consult with a different GP at the practice?

Btw why were you given the mirtapazine rather than other meds?

@anamazingfind

Of course your health and energy levels are down to being overweight. You would not need to be on beta blockers if you weren't overweight.

Did you see the bit where OP says she takes propranolol for anxiety and panic disorder? She is not taking beta blockers for her weight.

The number of posters who didn't even read OP first post...🙄

@AlrightTreacle

Excuse me if I'm stating the obvious here, but your GP did tell you that beta blockers will lower your heart rate and can cause postural hypotension?!

Is it proponaol?

Spot on! The obvious culprit for the hypotension and low HR is the beta blocker. Please don't run if you are 21 stone, so bad for your joints

I take propranolol when needed, it does lower your heart rate making you feel tired, having a low heart rate also means your burning less calories. I have also been on mirtazapine which I stopped because it was making me so hungry I was waking up in the night and raiding the fridge.

@LunaHeather

X post

Be prepared, your GP might tell you not to come off either.

The GP advice is just advice though. Can you consult with a different GP at the practice?

Btw why were you given the mirtapazine rather than other meds?

I’d had a reaction to escitalopram in the past so was taken off it (stopped me peeing and admitted a few times), tried it again about a year ago and came out in a rash .

GP felt mirtazapine would work best; said most other SSRIs would also knock bladder off but apparently mirtazapine doesn’t do that so much .

Have tried sertraline a few years ago but was very unwell at the time anyway, I’d happily try that again .

Psych wanted me to take quetiapine too, but have since said to stick with the sedating one at night and beta blockers during the day . Although they haven’t seen me in well over a year .

i take mirtazapine and quetiapine which are both known for causing weight gain and making it harder to lose (along with a cocktail of other meds - 20 in all). my thyroid is so fucked it needs removing. i was too fat for the surgery and am waiting to see about funding for bariatric surgery.

i’m also pretty immobile due to arthritis.

BUT. i have lost 3 stone in the last 4 months just by logging everything i eat or drink on My Fitness Pal. it’s been a revelation.

just offering some anecdata that it is possible to lose weight on medication. i had it in my head for years that there was no way i could lose weight on my own. turns out, i can. it’s hard, but it’s working.

i’m still fat. i’m probably still going to get the bariatric surgery, as i know it will get harder and harder to lose weight as i go along. my thyroid is growing down into my chest cavity and slowly crushing my trachea so it’s vital that i get it removed. in order for this to happen, i need to be less fat.

i’m not posting this to be snarky. i hope it gives you some hope for being able to lose some weight even on your meds.

oh! forgot to mention that i now take a daily Vit D supplement which might also have made it easier to start losing weight.

Oh I didn't know there were potential bladder issues with SSRIs.

quetiapine is an anti psychotic and will also cause weight gain.

Wondering why you are being pushed to the strongest ones.

"I’ve also been advised by cardiology specifically not to run - or do intensive exercise - as there’s a small chance of me having an inherited condition, get screened for it yearly ."

Is it not possible to get a genetic screen for this inherited condition, so you know one way or the other? (Or is it something where there are many mutations that can cause the condition, not all known, and the mutation you may nor may not have is not known?)

@uytp

"I’ve also been advised by cardiology specifically not to run - or do intensive exercise - as there’s a small chance of me having an inherited condition, get screened for it yearly ."

Is it not possible to get a genetic screen for this inherited condition, so you know one way or the other? (Or is it something where there are many mutations that can cause the condition, not all known, and the mutation you may nor may not have is not known?)

I think it’s a case of them not knowing really - they said at last consult they believe the relative that is ill has a sporadic mutation but can’t rule it out . So my mum, me, I think a few cousins and others get regular echos/ECGs to check . Trouble is my anxiety thrives on that one . It’s all a bit of a vicious cycle really .

Mirtazapine can cause orthostatic hypotension too. I think you need a meds review.

I can't advice on the beta blocker issue (are you also on Metformin for your PCOS?), but I understand the frustrations of doctors blaming your weight for any health problem - I had the same in the past. I used to be 23 stone and am now under 13 stone (I have PCOS too) - it took me a long period of time (10 years) and I still have a stone to go to get a healthy BMI, but at least I've maintained the loss.

I also can't believe a GP told you to take up running! Even with my weight loss, I still struggle to jog/run far and at a heavier weight it would have been almost impossible - too much chafing and knee/joint pain. I walked more instead - easy to build up gradually, cheap to do and better for the joints/knees.

What really worked for me was going on a modified PCOS diet for health reasons- basically gradually going lower carb and lower sugar. So I try to only have carbs at one meal a day, and I generally chose lower sugar treats like very dark chocolate. I upped my fruit and veg consumption as well as healthy fats (like nuts or full fat unsweetened yogurt) so I didn't get too hungry. I'm not always successful at sticking to it (time of the month and all...) but if I manage it 80 -90% of the time then I'm happy and it seems to work.

was going to suggest sleep apnea. It's fairly common. You'll need a sleep study.

The exhaustion from not having a proper rest is awful.

I managed to get a sleep study for sleep apnea. I wear a breathing mask at night now,the difference to my sleep and energy levels is amazing.

TBH, whatever it is, the effects can probably be lessened by weight loss. And that is within your power, so whilst you're waiting to get some proper medical advice (keep fighting for it!) you can try to address your weight.

Weight loss mostly comes down to diet rather than exercise and TBH, at your size, and with your current level of exhaustion, a lot of exercise is going to feel outside your reach right now. Running is a high impact activity that can cause problems for the lightest of people at the best of times - I wouldn't recommend it for you until you get your weight down. The last thing you want is adding another problem to your list of woes - it's so easy to pick up a running injury.

If you're up to walking, do that instead. When swimming pools reopen, if you're a swimmer, that's really good for you as it's gentle on your joints, and it allows you to work on your breathing.

Can you start keeping an accurate food diary? Record what you're eating every day and weigh yourself too. Basically, start collating data so you understand what's going in, what the impact on the scales is, and if there any foods which are making you feel worse.

My advice is to try eating a bit better than the day before. Dramatically changing your diet overnight is not going to stick, whereas if you make a small change, you will find it easier to keep to it. When you feel ready, you make another small change. Eventually, you'll find you are eating more healthily overall, plus you'll have built up an accurate food diary that you can share with your doctor if you need to. Until you actually log everything, it's very hard to argue that the medication is causing you to gain weight or your body is being funny at a particular time of day and it's not linked to what you're eating.

Do you wear the sports watch overnight? Does it track your sleeping and how disturbed it is? I would also record somewhere (if your watch doesn't already) how much sleep you're getting and how you feel afterwards. If you're getting a solid 8 hours sleep a day every day and you still feel like shit when you wake up, something isn't right whilst you're sleeping (as already mentioned a few times, it could be sleep apnea).

Some sports watches do record an artificially low/high heart rate. I would use them for the trend, i.e. to show any changes from day to day, and the difference between your resting rate and your active rate, but take the underlying base number with a pinch of salt.

It does sound like you feel pretty miserable and you're not getting much support from your GP, so you have my sympathy. Keep persevering though - you deserve more support than 'lose weight'. If it was so bloody easy, you'd have done it by now. Hell, we'd all have done it.

OP you may find that you anxiety reduces or disappears with treatment for sleep apnea. Mine did. I was seeing a psychologist at the time after a life time of not coping and worrying about everything. But I didn't need to see him once I started CPAP therapy. Sleeping properly allowed my brain to sort out its shit for itself and to genuinely not care about issues that were crippling me before.

@BonesJones

And don't allow them to tell you it doesn't cause weight gain. I've been more or less the same weight since I was about 17 (just nature I think I because I eat plenty). I gained over a stone in 2 weeks with mirzapine and lost it within a month of stopping. When on it I was going to bed planning my breakfast and planning the next meal as I was eating the current one. Never felt that level of ravenous hunger before or since!

Same here! I'm in my 50s and it took a lot to lose that. GP told me it didn't cause weight gain. Bullshit! The fucking leaflet listed it as a side effect.

Why are you on a drug for anxiety that can cause weight gain and why can’t you take an SSRI like sertraline for anxiety instead? I’ve read many articles and studies where they say sertraline is the most popularly prescribed one now because it doesn’t cause weight gain and makes people relax without causing sleepiness?

Check out get fit with Rick plus just go outside and walk, slowly get up to 10K steps per day.... it's didn't take a day, r month to put your weight on, be kind to yourself

oh! also forgot to mention that my sleep apnoea has lessened significantly with my weight loss. my thyroid still tries to strangle me if i lie on the wrong side but overall things are better.