UPDATE: After multiple years utilizing multiple GLP-1s we can clearly state thier effectiveness, and a high safety profile. Candicay is not guaranteed, consult with us if you are considering obesity treatment.
A physicians guide to weight loss
Losing weight is hard. We all know this, but how can we make losing weight just a little more attainable for the average person? Well, it's like the old saying goes; "The problem as a whole is unsurmountable, but the pieces are easily digested"
This means when we look at weight loss as one giant mountain of a problem to overcome it almost seems impossible. The goal is to break down the mountain into small easily digestible "bites" and just get to work on one piece at a time.
Weight loss can be broken down into a few separate sections that can be interwoven later on to create a better overall quality of life, but the person who is doing this will eventually go through a larger life change including change of daily habits, thinking, and even their perception of the word "full" and what food really means to them.
To bring about this change in the perception we have to first ask ourselves how we feel about food, and whether or not food is the cause or the symptom of a larger problem. Eating due to stress, emotional concern, anxiety, or depression is a very common unhealthy coping skill adopted by many. Late night snacking, sleep eating, and eating excessively in the evenings after daily starvation are all common causes of an unhealthy relationship to food.
Sometimes the problem is simpler, sometimes the problem is ignorance of diet, or just plain old laziness. This is easier to fix, because the patient typically only needs to be educated on how to plan each day, and which foods/habits they need to stay away from. There are so many crazy diets on the internet bordering on so many extremes it can be daunting to know which is right for you. The answer is pretty simple, if you can't see yourself keeping it up forever, it's not right for you. Why do we say this? Well it's because the change we need a patient to make must be a permanent one, and a diet implies temporary. We try and guide our patients to a healthier lifestyle, healthier choices without needing to consult us at every turn. We want them to become the best versions of themselves and to achieve that, their relationship with how they think of food, and their own body has to change at the source. This way our patients start to slowly think and react differently. "Is this decision in line with my goal" pops into their head more and more often at each of life's delicious crossroads. We have to BELIEVE we are worth it, and that we CAN achieve it.
What about my Thyroid?
Data pulled from the National Health & Nutrition Examination Survey suggest that about one in 300 people in the US have hypothyroidism. We hear this question very often, which means way more people want to blame a thyroid that's not malfunctioning to begin with. Not convinced? Simply ask your primary care physician to run thyroid-stimulating hormone (TSH) and thyroxine (T4) blood analysis panels. If your thyroid really is malfuntioning, an endocrinologist may be able to help. But most often, the thyroid is functioning properly. If your thyroid is a little out of normal range Thyroid Synergy can help.
Insulin Resistance
For decades, Americans have fought a losing battle with obesity. Between 1960 and 2010, the prevalence of adult obesity in the United States nearly tripled, to 36 percent from 13 percent, according to the Centers for Disease Control and Prevention. Semaglutide, an injectable drug already approved by the Food and Drug Administration as a treatment for Type 2 diabetes, produced moderate weight loss at a titrated dose of 1mg & increasing to 2.4mg weekly. The new trials at UAB and other medical centers around the country, known as STEP, were studying the potential of a higher dose, 2.4 mg. The results, released in February, were important enough to warrant prominent placement in the New England Journal of Medicine for the STEP 1 trial results and Journal of the American Medical Association for STEP 3 trial results, and a major feature in the New York Times.
What can a Doctor do to help?
Well, weight loss is a 3 part problem:
Mental
Physiological
Social
This means the solutions physicians can offer will really depend on the training, and the time the doc is willing to spend with you. Here at our clinic we try to take a functional approach to losing weight. We combine medications, lifestyle adjustments, motivation, and exercise coaching to create a "new you" essentially. Our programs change with the person, but typically follow a similar pattern: Medication + Small Changes + Exercise = Healthier lifestyle = Healthier Body = Healthier Mind = Happy Patient!
What medications and supplements can help?
1. The gold standard for oral weight loss was Phentermin, the patients must not have previous cardiac concerns before starting this medication due to it's potency. It is very effective at appetite suppression, while providing lasting energy to help motivate a healthier lifestyle during the initial weight dropping period. Our patients are typically only on this medicine until their goal is reached. But the work doesn't stop, now we have to maintain that goal without the help of medication.
2. Lipo-Burn is a custom compound we use here at the clinic which is also very effective. It consists of primarily Phentermine/Caffein/Naltrexone/MIC which all work together to help patients continue exercising while suppressing appetite, and activating the digestive system. We typically pair this with high intensity cardio such as a spin class, and a keto like diet.
3. Semaglutide A GLP-1 peptide taken via subcutaneous injection once weekly with a titrating dose. The typical regiment is 16 weeks long, but can safely be taken for longer periods of time. “This is a game-changer,” said UAB’s Timothy Garvey, M.D., co-author of the JAMA article and Butterworth Professor of Medicine in the Department of Nutrition Sciences. “We have not seen this degree of weight loss with any previous medication. More than 50 percent of trial participants are losing 15 percent of their body weight, and anywhere between a third and 40 percent of participants are losing 20 percent of their body weight. That is beginning to close the gap with bariatric surgery. I think this truly gives us a very powerful tool to treat obesity as a disease.”
4. Desiccated Porcine are custom compounds made by specialty pharmacists that help to restore the thyroid to normal working condition, or inhibit receptor agonists.
5. 5HTP helps to increase serotonin production which can help symptoms of depression causing obesity. This is especially helpful in patients who use food as a coping mechanism for stress or emotional pain.
6. Human Chorionic Gonadatropin (HCG) Is a medication used primarily by fertility doctors, and hormone replacement clinics. In fact we use it in micro doses with many of our testosterone replacement patients to promote leutenizing hormone. This medication is a biologic and has been used for weight loss as a subcutaneous daily injection by both men and women. A small injection with an insulin syringe is performed daily by the patient into the belly area. HCG is produced by the body to reset the metabolism, studies are widely varied on this but the "HCG Diet" consists of a 500-700 daily calorie restriction which should make the average person see weight loss without the use of HCG.
7. Methionine, Inositol, Choline (MIC) + Carnitine/B12 or otherwise referred to as Lipo-C when made by compounding pharmacists. This medication can help assist the last leg of the weight loss process, or a slightly overweight person lose 10-15 lbs. It is not going to be very effective for someone with a BMI over 24, or someone who is obese. It is more like a prescription weight loss supplement than a weight loss medication. It does help the metabolism and gives a slight natural energy boost, but the patient must be already committed to a diet and exercise plan. LipoStat-Plus is typically one of the stronger compounds available that we have found, available in sulfa free versions too.
Dieting?
We typically will prescribe modified diets for our weight loss patients, we can also refer you to a dietician we work closely with for a more tailored and accountable approach. Finding a diet you can adjust to slowly, and continue long term is the key for success. Tracking is key, if you don't know exactly what is going in, how can you recalibrate and adjust for your goals? We don't expect our patients to become 100% keto, or paleo, or any of the extremes. We have some that do, but ultimately you need to do this for life, so an extreme just isn't sustainable. Our goal is to facilitate a slow lifestyle change, while replacing bad habits with good ones, medication is simply a springboard to get you started.
Some basic rules to follow can simplify this:
No food in bed
Chances are you are not hungry, you are bored or thirsty at night. Did you know most of the hunger we feel is actually thirst, for water. Drink a half gallon of water in the hour leading to bedtime. This will help curb your appetite and make you feel surprisingly good the next morning.
Hydrate all Day
Increase water intake throughout the day. Drink 1oz of water for every pound you weigh. (yea, we know... it's allot.)
Don't buy junk
If its not around, you can't eat it. Sounds simple, but don't go shopping when your hungry, you are more likely to buy junk food that way. Buy snacks that satisfy the salty and sweet cravings but are low in calories and carbs. Popcorn, rice based snacks, vegetables, nuts, certain fruits, some cheeses and meats. If the first ingredient is corn, flour, wheat, or corn syrup look away.
What the heck are carbs anyway?
Sugars, sugar alcohols, starches and fiber are carbohydrates. While carbs are generally seen as bad, some carbs are nutritionally acceptable even on a diet. Here are some examples of good and bad carbohydrates.
Good Carbs (in moderation)
Quinoa
Barley
Legumes
Potatoes
Whole grains
Vegetables
Bad carbs (stay clear especially during weight loss)
sugar-sweetened beverages
white bread
pastries
other items containing white flour
Portion size is one thing Americans especially have a hard time with. We are programmed to be upset when a restaurant serves a small portion. When eating out you can immediately ask for a to-go container when your food arrives, this way you can portion out your own food before digging in. A typical portion is about a fist size worth of meat, fish, tofu, rice, quinoa, legumes (other proteins) and about double for vegetables.
3 Squares a day
Most people grew up eating breakfast, lunch, and dinner. These typical meals are usually the same size, and served around the same time each day. This is fine for most people who are physically active and eat a healthy diet. But if you are like many of us, you don't always make the best choices when it comes to food, and you eat a portion that could feed 3 people. So what's the solve for this? Studies have shown that micro meals consumed more often throughout the day keep the metabolism running longer, and more efficiently than eating larger meals less often. The other way to help control the metabolism is to eat a small healthy snack as soon as you wake up. A healthy shake can be substituted here. Many people do not eat breakfast, this is very common. It actually hurts the weight loss process because the metabolism doesn't start until solid food is detected by the chemicals in the stomach. We usually tell our clients to eat about 6 mini meals throughout the day, basically eating a small snack every 3 hours coupled with approximately 1 gallon of water per day. If you starve yourself, your body will hold on to every calorie it gets because it doesn't know when the next calorie will come, just like hibernation.
Source Credit: PubMed/NIH/CDC/UAB News
We really hope you found this helpful!
If you are in the Palm Beach, FL area and would like to consult with us about your weight loss goals please call our office at 561-214-3323 or submit our contact form on our home page.
Thank You
MedClub by Dr. Jenn
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