As Sasha experienced his first weekend of the exposure hierarchy, we experienced a little anxiety- we had already started loosening things up a little over the last couple of months but it has always been with extreme caution and trepidation. With our official exposure hierarchy starting up, I felt some anticipation...would it backfire? Would he fail to advance? Would we have to deal with too much rule breaking and have to resort back to our awful policing again? Would he just take advantage of his newfound freedom and end up overeating and gaining weight? Would I unravel and be unable to contain Kitchen Bitch?
Although it is extremely early to judge, I am relieved to report that none of these things happened over the weekend! We started by practicing some easier exposure tasks. We started with our lowest anxiety task of having Sasha make a meal with the fridge unlocked and with "light" supervision from us. We did two sessions of this task and he did well with no detectable problems of rule breaking (by either party) or meltdowns. He reported his anxiety/temptation level as low both before and after the tasks. To my surprise, he actually volunteered to me that his anxiety/temptation levels would be rated higher depending on what is in the fridge and he even listed salami and cheese as food items that will raise his temptation levels. I was glad that he was thinking in this manner and that he was forthright enough to mention it to me so that we can be mindful of it as we go through our exposures. Although there was one incident of food stashing (where I caught Sasha in the middle of the night with a pack of nuts/dried fruit), it was due to his dad's carelessness when he left the snack cabinet open without supervising Sasha. I pointed out to his dad that leaving the snack cabinet unlocked was clearly an advanced exposure task and one that Sasha was not ready to attempt. I even apologized to Sasha about the mistake and made sure he knew that his stashed snack was due to our unintended neglect to lock the cabinet and not his fault for having given in to temptation.
Besides venturing into starting the exposure hierarchy, it has been a very social weekend with lots of food/entertainment which we handled quite well. On Friday, we had friends over for dinner at our house. Sasha ate a good-sized portion of food but was able to stop short of pigging out (nuts, cheeses, veggies, olives, and crackers for appetizers & shish kabobs, green salad for dinner & watermelon for dessert). On Saturday night, we attended a city-wide outdoor dinner (potluck burrito bar and his own low-carb chocolate macaroons and strawberries for dessert). Today we attended a charity event for the Pediatric Brain Tumor Foundation where he and his sister participated as models in a fashion show. They offered a buffet spread of brunch finger foods including muffins, bagels with cream cheese, skewered fruits, egg frittata. Despite the fact that some of these events (especially the buffet food spread today) are considered "advanced" on his exposure hierarchy, all in all, things went pretty well at these social events. We supervised him adequately and he behaved himself with a reasonable degree of self-control, given the difficulty level of the event.
As usual, we went to the lab this morning to check his electrolytes as we do every week. As I have previously mentioned, he has diabetes insipidus with absent thirst and it requires that we weigh him several times a day to estimate his hydration levels and then take him to the lab for a serum sodium level. For this reason, we are able to calculate his weight corrected to a normal sodium level. Sasha ate pretty heartily over the weekend and I was hoping that it would not cause a jump in his weight. To my surprise, his weight slightly decreased (by 1/3 kilo or 2/3 of a pound) over the past week!
I had previously thought that any weight lost on oxytocin would be attributed to the decrease in food intake. After all, oxytocin is known as a anorexigenic hormone, causing reduced appetite and eating. Now I wonder if it does more than that... does it increase energy metabolism too? How can he be losing weight when he does not appear to be eating that daintily and when his physical activity levels are not grossly increased?
In looking for some answers on the subject, I came across a few interesting papers on the subject of oxytocin's role in weight control. Given the density of these scientific papers, I was only able to glean a superficial understanding of the main points but I believe they are compelling enough to begin to explain Sasha's ability to lose weight on oxytocin while still attending parties!
This one describes how oxytocin may have an impact on energy metabolism and homeostasis:
https://www.researchgate.net/profile/Valeria_Chaves2/publication/236580181_Role_of_oxytocin_in_energy_metabolism/links/02e7e519537d0e06ed000000.pdf
This article describes the relationship between lower oxytocin levels and those at risk for metabolic syndrome (a cluster of symptoms including abdominal obesity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance):
https://www.jstage.jst.go.jp/article/endocrj/63/7/63_EJ16-0078/_pdf
And finally, if you can wade through the medical-ese of this paper, you will see that it describes the role of hypothalamic neuropeptides (including oxytocin) as being responsible for lipid and glucose metabolism in the body:
http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2010.05800.x/full
Happy reading!
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