58) Lifestyle factors: what (meds and foods) does Sasha consume, anyway?

A typical Sasha snack: small bowl of peanuts and sesame seed crackers
Sasha eats a snack twice a day (at 10:30 AM and at 4:30 PM)

Sasha has been losing weight steadily and gradually since we started daily oxytocin (since September 1, he has lost 5.5 kg or 12 pounds). On September 1, his BMI was 27.0 (97%).   His BMI today is 23.7 (89%). Some readers have wondered what other lifestyle factors (besides oxytocin) may be contributing to his weight loss.

To describe his normal lifestyle routine:
Being a person with panhypopituitarism, he has relied upon full hormone replacement and takes many hormones including T4, T3, hydrocortisone, growth hormone, desmopressin, melatonin, and (more recently) oxytocin. Additionally, he takes dextroamphetamine (generic Adderall) to help him stay alert and awake and takes fish oils to keep his lipids under control. We added Naltrexone right after Halloween to see if it could reduce his cravings for sweets. In a week, he will be starting testosterone.

As for exercise, Sasha participates in PE in school and does his best to keep up with the typical non-panhypopit kids in his class.  Outside of school, we take regular walks in the neighborhood (average 3 km a day, a few days per week) and he works out at the gym with his dad on the weekend.

Regarding his food regime, at school he has an IEP for his vision impairment and food seeking problems and is supervised by a full time aide. At home, he is carefully supervised by us in the kitchen and our food is locked up (most of the time with the exception of during exposure sessions a few hours a day). Sasha has been eating about 1900-2000 calories/day of a lower carb/higher fat diet, give (whatever he ends up sneaking on the side) OR take (whatever foods he doesn't finish from his meal) a couple hundred calories here or there.

Everything I described above has stayed consistent over the last four years EXCEPT:
1.  He started oxytocin on May 15, 2016 and began a daily dose of 6 iu at the end of August, 2016.
2.  He has had lighter supervision by us and more exposure and freedom to an unlocked fridge in the last few months.
3.  He has added Naltrexone to his cocktail of medicines at the end of October.

As the "food police", we supervise him to prevent unsavory behavior (shoplifting, middle-of-the-night chocolate candy buying, taking other kids' lunches at school) and to help him control any overeating (by locking snack cabinets) but we are not (and have never) intentionally restricted calories for weight LOSS purposes. Behaviorally, as I've been noting in this blog over the last few months, Sasha has had ups and downs with his appetite and food intensity- on average, his appetite/food intensity has decreased (as evidenced by his ability to leave food on his plate, delay snacks, reduce the frequency of meltdowns related to food) but it has not ceased his food sneaking.  For this reason, it has been difficult for us to really know if his calorie intake has changed over the time he has begun oxytocin/Naltrexone.

To give another "picture is worth 1000 words" description of what he eats, I have photographed a sampling of the types of foods Sasha eats:

Breakfast: Scrambled eggs with kale and cheese,
wheat toast with butter (often we add 1.5 slices of bacon)

Another breakfast: Oatmeal with peanut butter, plain Greek yogurt
with slivered almonds and coconut chips

Dinner: Beef meatballs with cheesy polenta cakes, spinach salad

What he takes for school lunch- packed by Sasha himself:
Cauliflower fried "rice" with mixed vegetables,
salami/cheese, carrots, jicama, peanuts

Weekend lunch: grilled cheese sandwich on wheat toast, baby carrots and hummus
(this lunch is smaller than normal but satisfied him)

We also eat out in restaurants (probably too) frequently, once or twice a week. We try to stick with restaurants that serve Sasha-friendly foods (salads, grilled meats/vegetables, Asian foods minus rice and noodles).  For dessert, Sasha eats his signature Greek yogurt with almonds/coconut chips (pictured above in one of the breakfasts), nuts, or seasonal whole fruit.  Once a week, he gets a sugar free/fat free frozen yogurt with nuts (which he now leaves half-finished, aka the HEFY). On rare and special occasions (holiday, birthday), he gets a special treat and will eat a slice of cake or other type of sugary dessert.

Overall, as his parents, we do the best we can to support a healthy lifestyle for Sasha.  I think he's doing very well considering all of his complex conditions and I think the addition of oxytocin (and perhaps Naltrexone) has definitely improved his metabolic health and aided him in many ways, including this (unintended) weight loss.

P.S.  Other good news: he had a "no-disasters" last week AND Sasha had a classmate from school over at our house yesterday to hang out/play and it went really well! Dare I say that he is making a new friend...?