Methadone and Weight Gain

Chronic opiate/opioid use has been associated with weight gain. Medical literature links opiate use and the development of a preference for sweet-tasting foods. The preference for sugary foods can lead to increased consumption of such foods, potentially resulting in weight gain.

In fact, several studies have shown that chronic opiate use increases sugar intake. There are many reasons why this can happen. Let’s review some of them.

When patients start an opiate addiction/dependence treatment program, the cravings for sugary foods can be worse. One possible reason is that, during the induction phase, patients might be using the effects of sugar on the brain to stimulate the production of dopamine to help them feel better and deal with the cravings. Consuming simple carbohydrates and sugar, for most people, is also considered a pleasurable activity. As with any other pleasurable activity, it will stimulate your brain to produce and release dopamine. The more dopamine you produce, the more pleasure you experience.

Consuming simple carbohydrates or sugar will also stimulate the production of insulin in the pancreas, which will then go to the brain and release a chemical called Serotonin, which participates in feelings of well-being, energy, stress management, sleep, and overall helps people feel better.

Consumption of sugar has also been linked to increased pain tolerance by increasing the production of an endogenous opiate called beta-endorphin, which helps attenuate pain sensation.

Weight gain is less of a problem when addiction therapy incorporates an opiate antagonist like Naloxone, which is often combined with Buprenorphine, found in a generic form and also in the following combination brand name medicines: Suboxone, Zubsolv, and Bunavail. Naloxone acts in your hunger center (known as the “hypothalamus”) and can have appetite-suppressing effects. It also acts in your brain’s pleasure and reward system (known as the “mesolimbic system”) by increasing the sensitivity and number of dopamine receptors. The dopamine effect on the mesolimbic system gives people pleasure. The higher the Dopamine effect, the higher the pleasure people experience. This effect helps people that suffer from addiction by making them feel they do not need to consume more and more of the addictive substance to achieve pleasure. This effect will then also help with cravings.

We at Addiction Medical Solutions want to make sure we offer our patients additional tools to help their journey and prevent some of the obstacles they may encounter, such as undesirable weight gain caused by the medications we might use to treat addiction.

Attached is some information that might be helpful in controlling the consumption of carbohydrates and hopefully preventing any undesirable weight gain.

Simple Ways to Control Carbohydrate Intake and Help Prevent Weight Gain

Consume no more than 130 grams of Carbohydrates each day. Keep track of food labels.

Eat 5 times a day    (Breakfast, Snack, Lunch, Snack, and Dinner)

Eat in two to three-hour intervals

Do not use Sugar

If you absolutely need to add sweetness, use a sugar substitute such as Stevia.

Avoid high carbohydrate, high glycemic index/load foods:

Especially avoid bread, pasta, rice, potatoes, sweets, sodas, fruit juices, and energy drinks.  Do not eat more than 20 grams of sugar (5 teaspoons) per day. Do not eat more than 10 grams of sugar (2 teaspoons) in one serving.

Do not eat foods where the sugar content is more than half the total amount of carbohydrates per serving.

No fruits for the first few weeks of your low-carbohydrate diet plan.

Favor foods that are good sources of protein

Eggs, lean meats, fish, legumes, soy, nuts

Favor Non-starchy Vegetables (see list below)

Drink at least 8- 8 ounce glasses of water each day

Read all nutritional labels for Total Carbohydrates

A friendly Website for Checking Nutritional Facts is:

Calorieking.com (This website offers free insight into nutritional labels for various types of foods).

Plan Ahead

It’s very important when starting out on a new way of eating to plan your food ahead of time. This really cannot be emphasized enough. Try to plan at least a week’s worth of menus, and have food on hand a few days ahead of time. Then you won’t be caught wondering what to eat and fall for the easy, quick, high-carbohydrate food.

Some useful information about food groups:

Vegetables — Try to eat lots of non-starchy vegetables — at least three to five cups per day.

Protein Foods — The next runner-up is typically protein foods.  Large amounts of protein are found in eggs, meats, and fish.  Many people find that protein helps keep them satisfied longer. Eating protein also helps stimulate your metabolism.

The next groups are in random order and can be “ranked” depending on the individual:

Low-Sugar Fruit — Most people who cut carbs eat one serving of low-sugar fruit per day. Avoid fruit juice, which can lack the fiber and some of the nutrients of the whole fruit and raises blood sugar much more.

Nuts and Seeds — Nuts and seeds have lots of nutrients and, in some ways, can substitute for starchier foods. Nut flour can be used to make some baked goods. Among the seeds, flax seeds are especially healthful and low in carbohydrates; they can also be used in baking. The combination of fiber, protein, and healthy fat in nuts and seeds makes them satisfying, and they have many of the nutrients of the more starchy grains, such as wheat.

Fats — Although reducing carbohydrates usually means increasing fats, it is a common misconception that low-carbohydrate diets are loaded with saturated fats. Monounsaturated fats, especially olive oil, should be emphasized as a source of fat. The essential fats in foods, such as omega-3s found in fatty fish, are even more important.

Dairy Products — The amount of dairy you eat or drink will partly be determined by your sensitivity to carbohydrates. Milk has quite a bit of sugar, so we suggest using a product called “Unsweetened Almond Milk”.

Diary products in which the whey is removed (such as strained yogurt, cottage cheese, or other cheeses) have less sugar. If you don’t eat a lot of dairies, make sure you are getting calcium in other ways.

Legumes — Beans and other legumes, such as lentils and peas, have quite a lot of carbohydrates. But this is a type of carb that is either digested slowly or not digested in the small intestine at all (resistant starch). Therefore, in moderation, they are excellent choices for people who don’t process sugar well. They are also a good source of protein.

Whole grains — Whole grains, such as brown rice and barley, are tolerated by some people as a part of a moderately low-carbohydrate diet. Their starch is broken down into glucose more slowly than refined grains and flour. A serving of grains is about half a cup. Whole grain pasta should be cooked “al dente” (slightly firm), as the more you cook it, the faster it is broken down. If pasta is a “must-have” in your diet, then inquire about low-carb, high-protein alternatives, and we can discuss some options with you.

Sugary and starchy foods – These are foods that are rapidly converted into glucose, raise insulin levels and promote fat accumulation. Therefore, AVOID them.

These include:

• Foods made with a lot of sugar (candy, soft drinks, etc.)
• Foods made with a lot of flour (cakes, cookies, crackers, etc.)
• Fruit juices
• High-sugar fruits (dried and tropical fruits have the highest amount of sugar)
• Some condiments, such as barbecue sauce, some ketchup brands, and salad dressings (check labels)Starchy and non-starchy vegetables: look for low-starch/non-starchy vegetables green VegetablesLow-starch green vegetables include spinach, turnip greens, beet greens, kale, mustard greens, amaranth greens, lettuce, broccoli, green beans, cabbage, cucumbers, peas, green peppers, Brussels sprouts, artichokes, leeks, scallions, and zucchini. Yellow and Orange VegetablesAlthough many of the high-starch vegetables, such as pumpkin and sweet potatoes, reside in the yellow-orange family, some low-starchy members also exist. They include yellow and orange peppers, yellow squash, carrots, yellow tomatoes, and rutabagas. Red and Purple VegetablesMost vegetables in this category are considered low-starch: tomatoes, red peppers, red cabbage, radishes, and rhubarb head the list of red vegetables with few carbohydrates. More blue or purple fruits exist than vegetables, but eggplant fits into this healthy group. Even though you might find beets listed in non-starchy vegetable lists, we do not recommend them as part of a low-carbohydrate diet due to their high glycemic index. White VegetablesLow-starch white vegetables include jicama, onions, cauliflower, turnips, and mushrooms. High-Starch Veggies: try to avoid them if you keep a strict eye on your carbs and starches. Certain vegetables should be on your “watch” list. High-starch vegetables include potatoes, sweet potatoes, yams, parsnips, corn, and mixed vegetable dishes like succotash, pumpkins, and other winter squash varieties.

Author:  Dr. Fabricio Alarcon, MD, FACP
AMS of Delaware, LLC Medical Director