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Fiber and the Facts

Posted on January 27, 2020 by

Fiber is good. There’s no doubt in my mind. Is it as good as some people claim? The best thing about fiber is all the nutrition that it carries with it. The best fiber comes from food. The best fiber foods have no labels on them. Basically it’s the vegetable/salad stuff we prepare ourselves.

Most people don’t get enough fiber. It can help with bowel function. The best fiber foods are from salad and colorful vegetables. A lot of nutrients in there like vitamins and minerals. Eating clean is basically purchasing the food and preparing it.

Fiber foods are usually a mixture between soluble and insoluble.  Soluble fiber means it dissolves in water. Insoluble doesn’t dissolve in water. It pulls water in. All plants have fiber. It’s the non-digestible part of the plant. We can only digest certain parts of plants. Fiber is everything else. I’ll give an example of carb blockers. Basically a carb blocker takes the digestible part of some of the plants, (carbohydrate), and makes the absorbable part non-absorbable.  It acts more like fiber because fiber is a non-absorbable carbohydrate. Soluble fiber can be found in foods such as barley, nuts, seeds, beans, lentils, and fruits. Some of them are still very high in carbohydrate. Just because it may be “healthy” and contains fiber, doesn’t necessarily mean it’s going to help you lose weight. Eating healthy and losing weight are two different things.  Fruit has a lot of fiber in it. Most of that is soluble fiber (mostly citrus fruits). Many vegetable have a lot of soluble fiber. They also have insoluble fiber.  Insoluble fiber is a whole wheat/whole grain type of thing.

Fiber can potentially help with weight loss. It does tend to make us feel full, especially insoluble fiber because it pulls water in and swells. There are things out there sold as weight loss products. They’re fiber tablets that swell. There is something new coming out on the market. They’re little tablets that have microfibers that absorb water. They swell up and make you feel full. They break down again, and you just pass them through. In theory that can be very helpful. It’s working on that same principle that fiber itself makes you feel fuller, therefore fewer calories.

Fiber is a misunderstood nutrient

People often “know” fiber is important, but not much more than that. Fiber is found naturally in plants. It’s the non-digestible part of the plants. It’s the part of the plants that don’t break down in your intestines. They pass through your system undigested and end up as stool. The average person gets about 15 grams a day (25-30 recommended).  Dietary fiber can be soluble or insoluble. Plants often contain both types. Both types are important and potentially have health benefits. The health benefit is probably the whole food that contains the fiber.  Whether you’re getting the health benefit from fiber itself has never actually been proven.

Soluble fiber dissolves in water. Because it absorbs water, soluble fiber becomes a viscous gel and may slow absorption of other carbs and cholesterol products. It can also be fermented by the bacteria along the intestinal tract. We can’t digest the fiber. The fiber itself can be a good source of nutrition to the bacteria that live along our intestinal tract. That means that certain plants can potentially cause certain individuals more “gas”, bloating, cramping, and diarrhea. Some of this is because everybody’s microflora is a little different. Subsequently, if you have more of the bacteria that cause this bloating and cramping, you’re going to be more susceptible.  Good sources of soluble fiber are: oats, dried beans, barley, flax seed, carrots, oranges, and apples. Again, a lot of these healthy foods don’t necessarily help you lose weight.

Insoluble fiber doesn’t dissolve in water. It absorbs water which increases bulk and softens stools and shortens intestinal transit time. It swells up like a sponge. It aids in constipation and diarrhea. Food sources for insoluble fiber: leafy vegetables, fruit skins, whole grain products, bran products, seeds and nuts. There’s a question of whether it can prevent cancer. Early studies say potentially it can. Later studies show there may not be anything to that. That doesn’t mean it’s not healthy.

Fiber supplements are different from fiber in food. The best fiber comes from real food. Almost all the studies done on high fiber diets were done on fiber-based foods. The question is whether the benefit came from the fiber or the healthy foods containing the fiber? Studies done on people taking fiber supplements don’t really show any benefits. Although, it does help with regular bowel movements. But does it actually improve other health benefits? Doubtful. Fiber supplements are made from “functional” fibers from plants. The two that are often used are inulin and oligofructose. These can act as prebiotics (what the bacteria live on).  The prebiotics can stimulate the growth of the beneficial bacteria. Prebiotics means supplying the healthy bacteria with a good food source. The hope is that they will grow more and help you. It actually makes a lot of sense. Some of these supplements are: psyllium, guar gum, pectin, and cellulose. Many products just have different amounts of the soluble and insoluble fibers. You have to watch for abdominal gas/bloating, cramping and diarrhea. Then the question is can it bind with other nutrients preventing their absorption? You should take your medications separate from your fiber supplements. Fiber supplements have never been shown to have the same benefits as fiber-rich food.

What’s the real “poop”?  Why did we think fiber was good to begin with? The original theory of fiber being good for us began in the 1960’s. Many disease processes were due not to the increase in processed sugar/carbs, but rather to the lack of fiber. Small studies supported this. In the 1970’s the “fiber hypothesis” became dogma, theorizing that fiber would prevent many of the world’s diseases: intestinal problems, weight, breast cancer, colon cancer, CHO, etc.… Between 1994-2006, long term studies involving over 180,000 people revealed NO beneficial effect on colon/breast cancer, heart disease or weight loss. The benefit is probably all the extra nutritional benefits come from high fiber foods, not the fiber itself. The belief that fiber is an intrinsic part of a “healthy diet” has been kept alive by factors that have little to do with science. The high fiber foods are nutritionally dense.

The best fiber comes from food: leafy greens and colorful veggies. Don’t worry about the “kind” unless you are seeking a specific health benefit.  Remember a few things if you’re taking fiber supplements. Start out slowly. Gradually increase the amount each day. Drink plenty of water. Some of the fiber pulls in the water. Spread the fiber out throughout the day. And, separate your fiber supplements from your medications. Realize that not all the implied “health benefits” are real.  Nutrition benefits can be very real; the whole foods.

 

We carry fiber supplements in our CFWLS Nutritional Store as well – you can pick them up onsite or order online!

Weight Loss…Simplified

Posted on January 20, 2020 by

The goal is to identify essential weight loss principles that you can use starting today for both medical and surgical patients. I’ll throw in a few “random thoughts” by Dr. Clark telling you my though process. One of my favorite quotes and favorite people, Albert Einstein, said “If you can’t explain it simply, then you don’t understand it well enough.” So, hopefully I can explain it simply.

It often seems like weight loss concepts and principles are significantly different between medical patients and surgical patients. Nothing could be further from the truth. The principles and concepts are exactly the same thing. The weight loss principles for a patient will be the same post weight loss surgery. They just have a slightly different anatomy. The essence of any weight loss plan will always be behavior modification. Change what you do, whether it’s nutritional or activity level. Change (weight loss) will not occur unless you change your behavior. Sometimes we’re waiting for the life around us to change or people around us the change. The reality is that’s never going to happen. If you don’t change, change will never occur. Don’t wait for someone else to change for you.

Energy storage is extremely important for survival. If we couldn’t store energy, we would have to eat continuously. We can store energy in 2 ways. We can store it as fat or we can store it as glycogen. Storing energy as fat is unlimited. We can store hundreds of pounds of fat. Even a thin persona has a lot of fat storage. Even a 200 pound male with 10% body fat has 70,000 available calories. That’s a lot of stored calories! We can’t store very much glycogen (sugar). We can only store about 2000 calories. Most of the glycogen is in the muscle. The muscle doesn’t like to give up any of this energy (it’s kinda selfish). The liver is unselfish. It will share sugar. What’s the problem with this?  The problem is just because you may have a tremendous amount of stored energy as fat does not mean that you have unrestricted access to it. Unfortunately it’s not very accessible.

What do we do here at The Center for Weight Loss Success? We have 2 comprehensive programs. We also have a full fitness center, nutritional store, clinical area, educational classroom, behavior modification classes, weekly live webinars, weight loss meds, Hormone Replacement Therapy, and more. We have a 6 month medical program referred to as “Weight Management University™.” We have a 12 month post-surgical program called, “Weight Management for Weight Loss Surgery™.” Both of these programs are very similar. A lot of the topics in the programs are interchangeable. The medical program has 14 different topics. The surgical program has 12 topics. The difference is how we present them. We put them in different order because they become pertinent at different times depending if you’ve had surgery or not.

The real question is:  how do you do it?? The dietary plan, activity plan, and behavior modification changes don’t take place immediately just because someone has undergone weight loss surgery. There should not be a “cloud of mystique” that surrounds someone who has had weight loss surgery. We didn’t change things by operating on you.

My job is to figure out why someone is overweight. Then, I have to figure out what are the right “things” to do for that individual. Finally, (the hard part), is how that individual implements those things and make them a lifestyle. Part of that is being willing and able to do those things in order to lose the weight. That’s a very important concept and mindset for anyone, especially with weight loss. Some people are just natural athletes. They may have never picked up a golf club. But when they do, they’re able to play pretty darn well. Other people might have to practice really hard but are mediocre at the sport. Is there a difference?  Maybe some of us will never be pro golfers. But if we practice and work at it we will get better. All weight loss surgery does is just exaggerate the “normal” weight loss curve. The normal weight loss curve is this: you go on a specific diet and lose weight. Then you’re weight is going to stabilize. You might regain a little bit. With weight loss surgery you lose weight much quicker, greater weight loss, and it lasts longer. Long term it’s still doing all the same things. One of the “downfalls” of WLS is….it works! Because WLS works so well, people often think they’re doing the right things. You’re going to lose weight the first few months no matter what you do, but if you don’t do all the right things long term you will find that you’re going to start struggling. You need to do all the right things. Weight loss is something we work on forever. It’s a process. You’ve got to do the right things. Are you willing and able to do the right things?

I’ll sometimes see people back in the office several years after having WLS. They’ve gained weight. Or, I see people who were successful in the Medical program but they return because they’ve gained weight back. No one gains weight due to a deficiency of surgery. Some people say they need surgery because they’re gaining weight. Likewise, no one gains weight due to a deficiency of phentermine or any other weight loss medication.  They gain weight because they are eating and/or doing the wrong things. As physicians sometimes we contribute to that. There are certain medications that physicians prescribe that cause weight gain.

The concept of eating is, “How little can I eat and be satisfied.” It’s not, “How much can I cram in there.” The difference between those two thought processes is about 20-25%.  It’s often the difference between losing weight and keeping it off, and gaining weight. Long-term the pattern of eating needs to be 3 meals a day +/- a planned snack. No one has ever starved in 3 hours. If your mind is telling you it’s time to eat something, but it’s not time to eat, drink some water or do something else. Meals should be small plate size. The best food has absolutely no labels. It’s eating green and clean.

The Basics

The “Basics” of the eating plan are calories, protein, and carbohydrates. Everyone has a calorie “ceiling.” If you go above it, you gain weight. It does not mean that if you stay below the calorie ceiling you will lose weight. You can’t survive without protein. Preserving lean body mass is key. We talk about this all the time. The best protein source is from food. Everyone has a carbohydrate “tipping point.” A certain level of carb intake makes insulin levels rise. Insulin turns on fat storage. Some people have a very high tipping point. They can eat just about whatever they want to and never gain a pound. They don’t have a better physiology. They have a more efficient physiology. If what you eat increases your insulin levels. It turns on fat storage. If you eat a mountain of lettuce and it makes your blood sugar go up, it will also make your insulin level go up. One thing you can do is get a blood sugar monitor and check your blood sugar after you eat.

I have a few things for you to “chew” on.  “Kinda” working on weight loss will never help.  You can’t, for example, do a good job during the week and then go crazy on the weekends. If you’re only going to do one thing, count your carbohydrate intake. Carbohydrate is not an essential nutrient and there is no such thing as carbohydrate deficiency. Carbohydrate influences insulin which is the “fat storage” hormone. If you don’t make insulin, you cannot store fat. One of the first symptoms of a Type I diabetic who does not make insulin is that they are losing weight like crazy. They can’t store fat. Two thirds of the population is “carb sensitive.” If they eat carbs they get large blood sugar swings. Large blood sugar swings cause 2 major problems:  symptoms (headaches, irritability, shaky, not thinking clearly) and weight gain.

What do blood sugar swings actually mean?

If your blood sugar level is 100, what does that actually mean? That’s at the higher end actually. We would rather that it be 80. Each of us has about 5 liters of blood in our body. When we say that your blood sugar is 100 mg/dl, that means there is 5 grams of sugar in your entire blood volume. There’s 1 gram in each of those liters. How much sugar is 1 gram? If you have just 5 grams of carbohydrate, in theory you will double your blood sugar. If it was 100, it will jump to 200 after eating 5 grams of carbohydrate.  Examples of 5 grams of sugar (1 tsp): ½ Oreo, 1 triscuit, 1/5 banana, ¼ apple, ¼ slice of bread. I often have patients come into the office and say, “Well I only had…” It only takes a little bit and you’ve doubled your blood sugar. The point of all this is that it doesn’t take much carbohydrate to give you tremendous blood sugar swings.

In review, the Basics of the eating plan include: a calorie ceiling, sufficient protein, and a carbohydrate tipping point. The trick is to figure out the numbers. If you’re a woman who’s had WLS, if you get about 1200 calories you’ll struggle. If you’re a man and get about 1500-1600 calories you’ll probably struggle. Protein is based on lean body mass. It almost always comes around 90-100grams/day. It depends on how big you are. A male with a much bigger frame is going to need more protein. We typically say less than 50 grams a day. Some patients are so sensitive they need to be in the 20-30 gram range to really see good weight loss. What about fat? I’m not concerned too much unless it drives your calories too high. You want to try and stick to the monounsaturated fats. There are good and bad fats. They do tend to influence calories. Fat does not affect the hormones the affect weight. Carbohydrate and protein do affect hormones that affect weight.

The best foods have no labels

The best foods have no labels. Eat just 3 things. We would die without water. Water is the best thing to drink. Get rid of everything else. Good protein sources are meat, seafood, cheese and eggs. They have basically no carbohydrates. Eat colorful vegetables/salad stuff which is typically low calorie, nutrient dense, and fairly low carbohydrate. If it falls outside the “core,” then don’t eat it!

Dr. Clark’s low carb diet simplified (LCDS) is avoiding these three things: starches, “crumbly” carbs, and watching the fruit. Fruit can be the downfall of any weight loss plan. I’ve heard so many people say they eat healthy (including a lot of fruit). Fruit is healthy. There’s no doubt about that. However, it won’t help you lose weight. Healthy and losing weight are two different things. The main starches to avoid are potato, rice, pasta and bread. The “crumbly” carbs (6 “C”s) are chips, cookies, cereal, cake and candy. That includes hot cereal too. It’s simple to understand but NOT easy to do! Simple does not equate with easy.

A good weight loss plan includes a good diet/nutrition plan, activity/exercise plan, and behavior modification. There is no difference between surgical and medical weight loss patients trying to lose weight. The hard part is behavior modification.

We can help you get started! Call us at 757-873-1880 to schedule a free consultation if you are interested in a non-surgical program or watch our free weight loss surgery webinar.

Food Triggers & Dietary Disasters

Posted on January 13, 2020 by

A lot of times emotions can turn on that “feeding frenzy.” Or, sometimes situations will turn it on. Certain foods will call your name. We all seem to have our own triggers. We also have our own cravings. A trigger is something that sets in motion a course of events. Here we’re talking about eating when we don’t necessarily want to eat or should be eating. Eating triggers fall into 3 categories: trigger foods, trigger feelings, and trigger environments.

A trigger food is a specific food that sets off a course of overeating. Is there some food that you can only have a tiny bit and then you need to eat everything in sight? Control is often lost and excessive amounts of food may be consumed. Common trigger foods are usually highly refined foods such as sugar/fat combinations like ice cream. Another common trigger food is salty/starchy combination such as bread, chips, or crackers. I’m not a big fan of diet deprivation. I don’t believe in saying, “You can never eat this…” You’ll typically want it even more if you think you can never have it. If you want it even more it makes it harder to leave it alone. Can we be satisfied with a little bit? That’s what you want to strive for. If there truly is a food that causes you to eat the whole thing (whole bag of chips) then you probably should avoid that food. It’s the food, not the emotion that triggers the out of control eating. It’s not the situation.

Physiologic cravings are real. They tend to be most pronounced with high carb foods such as cookies, breads, pastries, and chips. They usually peak during the first few weeks of dieting. Then they fade. But you can experience true withdrawal symptoms. Carbohydrates are like a drug. If you have a little bit you’re going to want more. The symptoms are worsening cravings, headaches, fatigue, shakiness, and irritability. Once you get through the withdrawal symptoms it gets easier but that doesn’t make it easy. Many cravings are related to blood sugar swings. Every time the blood sugar comes down you’re going to want more because your body wants something to keep that blood sugar from dropping. Consequently you’re going to get a big swing up if you have more of that food. The big blood sugar swings make the cravings even worse. Appetite suppressants can help. Chromium can also help. It’s a mineral and can help smooth over blood sugar swings. You can get it just about anywhere. We sell it here in our nutrition store. On the bottle it will say take one a day as a supplement. Unfortunately that doesn’t work for cravings. Generally you need to take it 3 times a day. It’s very safe but you shouldn’t take a bottle every day!

A trigger feeling is an emotion (good or bad) which sets off a period of overeating. Examples are stress, anxiety, anger, sadness, or loneliness. It often sets off overeating of just about any food (salty, crunchy, sweet, doughy, etc.….). Identifying the emotion is key to controlling these triggers. Journaling is one of the best ways to sort this out. It’s not just writing down what you’re eating. It’s writing down why you’re eating. If you’re hungry and it’s time to eat then that’s a good reason. What if it’s not time to eat? If you’re not hungry, what are the reasons? Am I stressed? Am I excited? Am I depressed? You’ll see a pattern developing.

Trigger environments are specific situations or places that set off an episode of overeating (Movie Theater, buffet, sporting event, socializing with a specific group of friends).  The overeating is set off by the specific environment or situation. Usually you regret it the next day. To manage this you have to identify the specific location, people, or events. Avoidance works, but often that’s not possible. Are you really never going to the movies again? Are you really going to avoid your friends? It’s important to develop strategies to minimize the overeating in those environments. Plan ahead of time what you’re going to do. It’s hard to unlearn things but we have to.

We all have willpower even though we don’t think we do. Some of us need to take it up a notch. Cravings tend to fade with time. They can come back. The internal struggle with cravings leads to emotional pain. It’s often due to indecision. We really haven’t made up our mind. We literally make thousands of eating decisions every day. With fasting you get rid of a lot of decisions. Make the hard and fast decision that you won’t give in to the craving. To weaken the intensity and reduce the craving you must stop giving in to them. It’s easier said than done but it does work. Avoiding the indecision can be very helpful. Willpower is like a muscle. It can be strengthened with practice.

Your Strategies for Improving Willpower

There are strategies for improving willpower. The first strategy is Mindset Changing Techniques. You need to be truthful with yourself. Tell yourself it’s a craving, not true hunger. Is there another reason you’re eating (angry, lonely, tired, and stressed)? Don’t waiver in your commitment. It will get easier with time. We want to imagine the aftermath of giving in. Sometimes when we give in it feels good to eat that sugary food for a few minutes. You might even get a sugar high. But typically, a little later, you’re not going to feel so good. Replace the word can’t with won’t. You always have a choice.  Review your goals and remind yourself why you’re doing this. Why do you want to continue with this weight loss process? If you give in all the time, you’re always going to be at risk for gaining weight.

The second strategy for improving willpower is Habit Changing Techniques. You want to distance yourself from the food you crave. Remove the food or yourself from the scene. Remove the food or distance yourself from the scene. For example, don’t go to the movies for a while. When you go back, don’t revert back to the big tub of buttered popcorn, bring some protein snack along with you instead.  Drink something. Thirst is often confused with hunger. If you drink something you often realize you weren’t hungry. Your body will tell you that you need something. It could be just the water that it needs.  Try to change your mindset. Relax. Set a timer for 5 minutes and concentrate on breathing. Distract yourself: brush your teeth (how many people want to eat after they’ve brushed their teeth?), paint your nails, brisk walk, exercise, call a friend, shower, practice a musical instrument, or work in the yard. Do something that will distract you for a period of time and the cravings will fade away.

In summation, food trigger are all around you. Learn to recognize them for what they are. Develop the strategies to combat them. It will get you that much closer to your weight loss goals! If you need help, we offer counseling for anyone that’s struggling with that. The counselors will figure out a solution for you. Contact us at 757-873-1880 and set up a free consultation to figure out which program or plan fits your needs!

What You Need to Know About the Gastric Sleeve

Posted on November 20, 2019 by

The gastric sleeve, or sleeve gastrectomy, is the new kid on the block so to speak. It’s not a new operation. We used to do the surgeries for other reasons not including weight loss. About 15 years ago a hormone was discovered called ghrelin. It’s a hormone made by part of the stomach that makes you feel hungry. We thought if we took that part of the stomach out, we’ve actually done two things. First we’ve made you a smaller stomach so you can’t eat very much. Secondly, when you take that part of the stomach out, ghrelin levels go way down. Since ghrelin makes you feel hungry, hunger levels go way down in its absence. If you think about it, one of the potential downfalls of every single weight loss plan in the world is hunger. If we can control hunger it’s a lot easier to lose weight and keep the weight off. Sleeve gastrectomy is the fastest growing option out there. It is the most common operation for weight loss right now. Last year about 2/3 of all operations done for weight loss were sleeve gastrectomy in the US. It’s close to 95% of what I do these days because it works so well and we see a quick recovery with very low risk. It keeps your anatomy normal.

In the sleeve gastrectomy, we remove the greater curve of the stomach (stretchy part). If you eat a large meal the stomach fills and stretches way out as you eat. That’s how it can hold so much. When we remove the stretchy part it leaves you with a tubular part (or sleeve). Sometimes when people hear the term sleeve gastrectomy they mistakenly think we’re placing something around the stomach. We’re not placing anything around the stomach. It’s referred to as a sleeve gastrectomy because we’re changing the shape. Like the sleeve on a shirt, it’s tubular shaped. We’re making it into a tubular shape. Nothing is bypassed so there is no malabsorption.  Your anatomy remains normal. Food is going to enter the stomach and empty into the small intestine the same way it did before. The size of the stomach is about the size and shape of a medium banana. The part of the stomach that’s removed is the part that makes the hormone ghrelin. Ghrelin is decreased so hunger decreases. This doesn’t mean that you won’t get hungry. There are still good reasons to get hungry. Your hunger is just much easier to control. This surgery is increasingly popular and the fastest growing option out there. It’s literally close to 95% of what I do nowadays.

The surgery doesn’t take that long. It generally lasts about 45 minutes. 95% of the surgeries we do are outpatient. It’s pretty rare that someone needs to spend the night. Full recovery isn’t as fast as the adjustable bands but it’s a lot faster than gastric bypass. Most people are comfortable driving about 3-4 days after surgery. Generally in 2 weeks people can do most things. In a month you can do anything you want. Recovery tends to be really quick.

What are the risks?  The first 30 days is the same as the other surgeries. It’s just slightly different numbers. In theory the death rate and leak rate should be the same as gastric bypass. But we’re not seeing that. What we’re seeing is about 1:1000 for deaths and less than half a percent for leaks. Wound infections, DVT’s, PE’s and dehydration have fewer risks than gastric bypass because the surgery doesn’t last as long. But it’s not impossible for any of those things. One of the things I really like about this operation is that we’ve gotten rid a lot of the long term risks. You’ve got normal anatomy so once you’re healed, you’re healed. The thing we have to keep in mind is stenosis.   Stenosis means narrowing. Anywhere along the tubular stomach could get scarring and become too narrow. If that happened you would go see a gastroenterologist. They can look in there and take care of it. It would be very rare to need another surgery after the sleeve. In theory stenosis should be about 1%. I’ve done over 1600 of these surgeries. I’ve only seen 1 case of stenosis.

We basically see the same weight loss as we did with the gastric bypass. Average weight loss is 70% of what you were overweight. If you are 100 pounds overweight, your average weight loss will be 70 pounds. If you are 200 pounds overweight, your average weight loss will be 140 pounds. That’s average. Some will lose more and some will lose less. That is very good weight loss. Long-term we see about 10-20% regain most of their weight. With any of these operations you can gain your weight back. Your stomach is a little bigger than with the gastric bypass. So why do we see a similar result?  It’s because ghrelin levels go down. In the other operations, that part of the stomach is still there. We can control the hunger somewhat with appetite suppressants. But they’re not necessarily ideal. With the sleeve gastrectomy ghrelin levels go down and hunger is easier to control.

Overall, for most people considering weight loss surgery, the sleeve gastrectomy is the better option. One of the reasons is we keep the anatomy normal. There’s a lower risk with the procedure, a fairly quick recovery and very good weight loss. We also get rid of any concerns about having anatomic abnormalities or nutritional abnormalities (malabsorption). There’s no mechanical device. Finally, you haven’t burned a bridge. That means if you don’t get out of it what you wanted out of it your anatomy is at least still normal. If your anatomy is still normal you could still have any of the other surgeries done. You could have a band placed on it or converted to a bypass. This is much more difficult after any other the other weight loss surgeries. We haven’t revised these things. We’ve seen really good results with them.

How does CFWLS compare to the national average? Obviously we’re doing this for weight loss to improve medical problems and improve your life.  We’re doing the same thing as everyone else in the world but we’re seeing better weight loss. We have a 15.8% better average weight loss at 2 years. We have good education and weight loss.  We give you a full year afterward. And with that better weight loss we also see better reduction in medical problems:  Diabetes 78.6% vs 62.3%, HTN 62.5% vs 46.9%, lipids 70.7% vs 45.3%, sleep apnea 69.4% vs 56.6%, and GERD 74.3% vs 16.6%.  Some people think weight loss surgery shouldn’t be done on patients with GERD. But we’ve seen it get much better, not worse. Again, it’s not the operation. It’s what you do with the operation. If you do the right things it can fix these medical problems.

Why is the education and support so important? We have Weight Management University for Weight Loss Surgery™.  It’s a 12-month post-op program. It includes all kinds of thing including the following:  pre-op and post-op text books, monthly support group, 12 Weight Management University courses, access to Members Only portal, fitness classes, personal training and more.

View the online surgical webinar and then schedule a call with Cat Williamson to go over any further questions you may have.  You’ll get a copy of my best-selling book, Less Weight…More Life!

Overeating…How Common Is It?

Posted on October 28, 2019 by

We’re all guilty of overeating. Overeating is eating more than what’s on your diet plan. Or, it can be just eating more than what you had planned. It’s also when you continue to finish your meal even though you feel full partway through it. Binge eating is different. It’s an extreme form of overeating. It’s eating an abnormally large amount. For someone who has a normal size stomach and hasn’t had weight loss surgery, that would be consuming around 5000 calories.  It means you are feeling out of control and you should see a mental health professional. If you have a small stomach from weight loss surgery then you can’t really ever binge eat, right?! The issue isn’t the amount. It’s the feeling out of control with your eating. If that is the case you need to seek professional help. It’s out of the scope of this discussion.

Sometimes we “justify” overeating. When you go out to eat, you want to get what you’ve paid for. Maybe you’re celebrating a birthday or anniversary.  When you go on vacation and let loose. Someone might be urging you to eat. Another justification is that the food is free.  When this happens we often get into the mentality of, “Since I’ve strayed, I might as well just keep eating.” “I fell off the wagon and ate the candy bar. I might as well eat the whole bag of candy bars.” We discourage that type of “all or nothing” thinking.

There are lots of different causes of overeating. Some of the common causes are: stress, irritation, frustration, habit, boredom, overwork, and worry. Often it has to do with some type of emotion. We’re going to go over 10 common “triggers” for overeating and also what you can do about them.

The first common “trigger” for overeating is boredom. It leads you to TV watching (TV commercials) which leads you to the refrigerator/pantry. What can you do? You can watch commercial free TV and prepare healthy snacks to keep on hand (cut up veggies are a good choice).

The second “trigger” is feeling deprived. This tends to come about by completely avoiding certain foods. We talk a lot here about avoiding simple carbohydrates and processed foods. We’re trying to avoid a whole category of foods. It’s easier said than done. It’s difficult for an extended period of time. I’m not a big fan of true “deprivation diets.” It’s the thinking that, “I can never have this again because I’m on a low-carb diet.” “I can never have ice cream.” You want to focus on a balanced diet and healthy eating and exercise habits.  We also need to have that portion control. “I’m just going to have this little bit…” Deprivation doesn’t work very well. There is an exception to that. The exception is if you have a true trigger food. That means if you have one piece of that trigger food I’m going to eat the whole bag. You need to avoid those foods.

The next trigger for overeating is feeling self-disgust or hating your body. What you’re really doing is focusing on what’s wrong with your body and some societal ideals. We often see the societal ideals on TV. Realize your body is only a portion of who you are. Your body is just a part of you. It’s not all of you. If this is a significant problem you should seek professional help.  I see this in many patients who have lost a lot of weight. They still see themselves as who they were, not who they are.  It usually fixes itself over time.

Carbohydrate sensitivity or glucose intolerance are the next common trigger. This means you’re prone to big blood sugar swings. This is a true physiologic trigger. Blood sugar swings lead to insulin swings resulting in hunger/cravings. It’s really hard to ignore this. If it comes from blood sugar swings, the answer is to avoid blood sugar swings. Avoid simple carbs and increase your protein intake. If you’re having carbs they should come from vegetables. Chromium is a mineral that helps with blood sugar swings. Usually you need to take it three times a day for the blood sugar swings.

Another trigger is Habits. It’s what “you’ve always done.” It’s like when you go to the movies and always have a tub of popcorn. Try to engage your mind and hands in some type of new activity. It could be as simple as reading a book or playing an instrument. You need to break the habits or break the routine.

Next is depression and/or lack of energy. You often turn to food as that “pick me up.” Yes sugar is an energy source. Your body has plenty of energy. You just need to access that energy that’s there, meaning the fatty tissue. In order to accomplish this, the carbohydrates need to be low. The food gives you a pick me up but it’s not a long-term answer. Try to identify those low energy times of your day and take a brisk walk. Don’t ignore depression. It can happen frequently in a weight loss plan. Don’t ignore it. It tends to be relatively fleeting. It’s very real for someone who’s losing weight fairly quickly that they get a chemical imbalance. Seek professional help.

Needing comfort is the next trigger for overeating. There are pressures at work and home. There’s lack of appreciation. Everyone tends to have their favorite comfort foods. Baked potato to pizza to ice cream. How do you beat it? Take some time out for yourself. Go get a massage for pedicure/manicure. Make sure you schedule “me” time.

Feeling overwhelmed can be a trigger. It happens sometimes a couples times a day for me. You have too much to do and not enough time to do it in. Realize you can only do so much. To get a project done we have to make the first step. The 2nd and 3rd steps will be easier. We all have a lot to do and can’t get it all done. It’s often prioritizing.

More common trigger: being emotional. Emotions tend to bring on eating; being upset, hurt, anxious, stressed, sadness, or happiness. Go outside for that quick walk. Remove yourself from the situation if it’s a negative emotion.  Deep breathe/stretch.  Exercise is a great stress reliever.

Lack of willpower is a common trigger for overeating.  Willpower is like a muscle. We can train ourselves to use and slowly improve on it. Exercise your will power. It will get stronger.  How many times have I heard, “Gee I don’t have any willpower?” Everybody has willpower, it’s just how much.  Every Wednesday I was fasting. I did some videos on fasting. It works. After a while you get used to it. Anything we practice we get better at. Fasting got easier for me as time went on. If you think about it, we make thousands of food decisions just about every day. When to eat? How much to eat? What to eat? Is it time to eat yet? Fasting frees up a lot of time and energy. There’s no thinking about food because it’s not happening. You just have to figure out what the best times are for you to do those things. I did videos on Losing Weight USA as well as our YouTube site. It can be very helpful with weight loss. Time yourself. I assure you no one has ever starved in a few hours.

Here are some tips to avoid overeating. These are things we should ask ourselves all the time.

Get in the habit of asking yourself 2 questions: why am I eating and am I still hungry? Part of it may be that it’s time for lunch. Maybe you haven’t eaten all day. Literally bite-to-bite you can ask yourself, “Am I still hungry?” You want to stop when you feel satisfied. Make sure you’re avoiding the “overeating” foods; simple carbs. If you’re going to overeat, have more protein.  The simple carbs are like a drug. If you have a little bit, you’re going to want more. You’ll crave more. One of my favorite eating rules is eat only when seated at a table. The other eating rule is always use utensils and a plate. That’s gets away from wandering through the pantry and grabbing something or eating something over the kitchen sink. It doesn’t necessarily mean it will change what you’re eating. It will change what you’re eating if you have to be seated at a table and use utensils and a plate, it gets rid of a lot of the eating on the fly. There are a lot of decisions that have to be made when you eat that way.  For example, if you grab a handful of M & M’s. You put them on a plate, get a spoon and you sit down at a table to eat them. By the time you actually do that, you may not even eat them. If you just walk by and grab a handful, you’re likely to eat more because you’re eating them “on the fly.” It’s an eating rule that is very simple but effective.

Avoid “family style” eating. This means bringing all the food to the table and passes it around until it’s all gone. You need to leave the food in the other room, make your plate, and go sit down and eat it. You can still get more but you have to physically get up, go into the other room, stand there and figure out what you’re going to put on your plate, and walk back to the table and eat. This is better than having a person pass you the food dishes at the table. Little things might be what the difference is between being successful and unsuccessful. Use small plates and small utensils. Remember propinquity. It’s about shaping our environment for success. Measure your portions. You will likely be at least 30% off when “eyeballing.” We all tend to drift with portion sizes. Eat slowly. Chew slowly and set your utensils down between bites. Give your body time to tell your mind that you’re done.  Wait 10-15 minutes before you get more. Ask yourself, “Why do I need more?”

For cravings use distractions. You need to use that willpower muscle. Change your activity. Distract yourself until the cravings go away. Chromium can help. You usually have to take it 3 times a day. Practice! Always leave a little food on your plate. If you’re out at a restaurant and you leave some food on our plate, typically people aren’t going to be bugging you about bringing you more food. Finally, a carb blocker can be helpful. Also an appetite suppressant, especially for cravings.  The FDA regulates appetite suppressants very carefully.  So there are a number of hoops to jump through, but they’re all very doable.

Remember, you do NOT have to be a member of the “Clean Plate Club.” It’s really not going to help any starving children anywhere!

Questions? “What’s a good snack food to avoid blood sugar swings?” Well anything that has carbohydrates will typically cause blood sugar swings. Simple carbs are much worse than complex carbs. It depends on what you tend to drift toward. The snack should be low-carb. That can be meat, cheese, or eggs. A lot of that is snack-worthy. Nuts are OK as long as you limit them. Be careful there. Cut up veggies are good. The flip side is that any food potentially can cause a blood sugar swing, even something with 0 sugars in it. I see this all the time with diabetics drinking why protein shakes. Typically 95% of my surgical patients are really sensitive to carbohydrates. Whey is efficiently absorbed. If you drink a whey protein shake that’s filled with amino acids and your body doesn’t need all those amino acids at that one time, your body will just convert it to sugar. Your body is good at doing that. Protein with any carbohydrate will smooth out the blood sugar somewhat too.

If you think of other things, just give us a yell 757-873-1880. Stop by and get your body comp done. Remember!  It’s your life. Make it a healthy one! Have a good evening everyone. Take care!

What About Fasting?

Posted on October 28, 2019 by

Is fasting something that could be helpful to you? Could it help with your health? Could it help with your weight? The short answer is yes!

Fasting is a pattern of eating. It’s been around forever. Food was scarce. Now….not so much. People fasted all the time thousands of years ago because food wasn’t available. We have plenty of food available now. Is this something that can actually be helpful? Is it a form of “fad” diet or are there any health benefits and could it help with weight loss? Fasting versus starvation are two different things. Starvation is never really a good weight loss plan. Fasting is something we choose to do. Starvation is something forced on us. We don’t know where our next meal is coming from. With fasting we know where our next meal is coming from. It’s readily available. We’re just choosing not to have that meal. Your body’s response to those two things is completely different. There can be some health benefits or hormonal changes that occur with fasting. Not with starvation. In the early 1900’s fasting was one of the only ways to treat diabetes. They realized they could at least keep blood sugars decent and controlled.  I’m talking about type I diabetics.  They also found they could treat some medical problems with avoiding food completely. It fell by the wayside when some of the new medications came along, as well as all the marketing with the food companies. Fasting doesn’t make those huge corporations any money. The last thing they’re going to tell you is to fast and skip a few meals. No one was talking about fasting after that because it didn’t make the big corporations any money at all because it’s free.

Fasting came back into vogue in the 1960’s. In 1965 a 27-year-old Scotsman, at 456 pounds, saw his doctor who suggested he shouldn’t eat for a few days. So he didn’t eat for 382 days!! He lost 276 pounds. He was monitored very carefully by the physician, took vitamins, drank broth, and took extra sodium/potassium. He only regained 16 pounds in 5 years! The point of this is it can actually be done very safely and can show good results. We all fast. Every single night we go to bed we are fasting. That’s where the word breakfast came from. You are breaking the fast. In the 60’s and 70’s most people fasted for about 12 hours a day because you ate breakfast at 700am, lunch at noon, and dinner around 600pm. So most people fasted for a good 12 hours a day. That was pretty normal. Nowadays that’s not so true. The real question to figure out for any individual is how long to do it? It can be done for an extended period of time, and very safely. It should be monitored if you’re going to do it for an extended period.

Isn’t this just calorie restriction? Your body’s response between 0 calories to calorie restriction is different. Everybody knows that when you cut way back on calories you’re going to lose decent weight in a short period of time. And then it quits working. Your body’s response to just decreasing your calories is to slow your metabolism down. Many studies have shown that if you cut your calories back enough you can actually slow your metabolism down to 40%. That’s a big number. If you normally consume 2000 calories and you cut back to 1200 calories, that means you slow your metabolism down to 1200 calories as well. You’re not losing weight anymore. Calorie restriction is a little different because you will slow your metabolism down. With short term fasting, you actually increase your metabolism. Inherently it doesn’t make sense. Think about it this way. Fasting is just a short term acute stress. An acute stress is much different than chronic stress. Chronic stress is when you slow your metabolism down because of severe calorie restriction. Acute stress hormones will go way up. It’s like a Fight or Flight kind of response. Those same hormones come in to play. Growth hormone goes way up. Growth hormone secretes during the fasting. Growth hormone is one of the best hormones to help you lose weight. It’s a fat burning hormone. Studies have shown that with a 24 hour fast, GH will increase 130% in females and 200% in males. If we can boost up our growth hormone it will help us significantly. Fasting decreases fasting insulin levels. Insulin inhibits fat burning. It also improves insulin sensitivity. Fasting increases catecholamines, acute stress hormone (epinephrine and norepinephrine). They are sometimes called adrenaline/noradrenaline.  They both help mobilize fat. They both activate the hormone-sensitive Lipase. Lipase is an enzyme that helps break down fat.

Is it just calorie restriction? The answer is NO! It increases your metabolism short term.  The real question is when does acute stress turn into chronic stress? It’s hard for me to tell you that in any individual. At some point after so many days acute stress starts turning into chronic. For any individual you need to figure out how long to do it and how often to do it. I can’t actually tell you what the answer is. I can tell you different ways to do it, but you have to figure it out.

Fasting and calorie restriction are equally effective in decreasing body weight and fat mass, but fasting is more effective in retention of lean body mass.  You can do it for an extended period of time (382 days). Fasting can be very helpful for weight loss and breaking through plateaus. We’re going to talk about how you do it and how to get started in a few minutes.

There are some other health benefits to fasting. A natural response to illness is often fasting. We’re not hungry when we feel bad. Hippocrates said, “To eat when you are sick is to feed your illness.”  Plutarch said, “Instead of using medicine, fast a day.” This has been around for a long period of time. Physicians realized that it actually could be helpful.

Fasting could help with cancer. Rats who had breast cancer lived longer when they fasted. Fasting seems to protect normal cells and “starves” cancer cells. It starves cancer cells.  Many cancers survive on sugar.  If we take the sugar away and your body is utilizing your fat to give yourself energy, the cancer cells can’t utilize the fat as an energy source. The cancer cells can die. There are some studies that are looking at brain cancers where very low carbohydrate can kill the cancer.

A study was done on mice and longevity. The mice fasted every other day. They kept the calories the same but they kept the food away from them every other day. The mice that fasted lived almost twice as long! The short (acute) stress may be better than chronic stress.

I want to go back to weight again. I’m going to give you an example. Let’s say you’re trying to be on a 1000 calorie a day diet. That’s a really low calorie diet. That’s 7000 calories a week. What if you did a 1200 calorie a day diet? That could be much easier to tolerate. It probably won’t slow your metabolism down because it’s not so calorie restrictive.  You could fast one day a week. The numbers come out about the same. It’s still 7000 calories a week. The 1200 calories a day is much more tolerable and you get the hormonal benefits of fasting.

Fasting increases Neuronal Autophagy. That means the breakdown products around the neurons which have to be removed. Subsequently fasting helps do this. It also increases Brain Derived Neurotrophic Factor (BDNF). This helps regulate memory, learning, and cognitive function. Your brain uses ketones wonderfully. Fasting increases ketones. You don’t need sugar for your brain! Keystones actually work better. They’re made from B-hydroxybutyrate which is neuro-protective. There’s some good evidence that is can protect your brain long term and make it less likely to get Alzheimer’s.

What about exercise? We tell you all the time to eat your protein to improve exercise benefits. How could fasting possibly help? First of all, don’t even consider fasting and training if you’re not going to hydrate well, sleep well, and become fat adapted (low carb diet).  There is good evidence that well-trained athletes who live in ketosis actually perform better once they adapt to it. Most people don’t take the time to get adapted to ketosis.  Fasting likely improves your adaption to exercise by forcing you to train in a less optimal state, which can boost performance down the line. It likely won’t improve your performance right then, but you’re working in a stress condition.  It can actually could benefit exercise.

So how do you do this? Implementation is the only way that any of the theoretical benefits will help you! Extended fasting can be done for long periods. If weight loss is your main goal, I don’t recommend doing multiple extended fasts. You don’t want to transition from acute stress to chronic stress. Typically it’s going to be in that 2-3 day range. Again, you’d have to play with that. See how you feel and how you do. You don’t want to lose those acute stress benefits. Again, it can be done indefinitely.

Sleep Deeply~

A couple of rules apply. You want to make sure you get quality sleep. Sleep counts as fasting hours. Fasting doesn’t make up for a poor eating plan. You have to have a good eating plan. If you don’t eat well, no method of fasting is helpful besides possibly a few less calories. Fasting is always easier to do on a low carb diet (controls blood sugar swings and cravings). When you first start fasting, I assure you that you will have hunger and cravings. Hunger tends to go away. It doesn’t just keep increasing. It comes in waves. Most people notice after the 2nd day that hunger goes away. It’s much easier to get there with a low carb diet.

There are a lot of different ways to do fasting. There’s one that’s fairly popular. A lot of people talk about it. It’s referred to as Leangains. (16/8). In a 24 hour period you fast for 16 hours and there’s an 8 hour window when you eat. For 16 hours you push non caloric fluids. It can include tea and black coffee. If you’re going to fast, I encourage you to avoid anything that’s artificial (flavors, sweeteners and colors).  The best way to break the fast and get results is after a workout. People often do this every day. Some people narrow the window down. That means a 20 hour fast and a 4 hour window. There are a few people out there that do 1 meal a day.

Another way to fast is Eat-Stop-Eat. Once to twice a week you don’t eat for 24 hours (you pick the time). There is good evidence that the later you have your dinner, the bigger the insulin response. The same meal you eat at lunch is going to have a different insulin response than the one eaten at dinner.  Having your main meal earlier is a good thing.

The 5:2 Diet is not a true fast. It’s eating healthy for 5 days a week. For 2 non-consecutive  days you cut the calories down to 400-500 calories. That adds up to about 1 day of a fast. Some people find this a lot easier to do. You can drink protein shakes for your meal.

Feast, then fast is eating one big meal a day then fast the remainder of the 24 hours.

Alternate day (often used in research) can work really nicely. You eat normally one day, then don’t eat the next day. Some people will do that with a true 36 hour fast. You can do this 1-2X a week. It’s hard to start. Once you get used to it, it’s very doable.

You can do extended fasting.

There are a few questions that always come up. Won’t you lose lean body mass? It works best when you’re keto-adapted; burning fat as energy. You actually don’t lose lean body mass. There’s been a good study that looked at alternate day fasting for two months. The people lost no lean body mass. It was all fat. Can you exercise during a fast? It really depends on your response to the exercise. You might want to cut your exercise back a little bit. You want to stay active because “slugs” tend to dwell on food. Stay busy so you’re not thinking about food. How often should you fast? You can do it daily and have that window (leangains). You can do it 1-2 times a week. Or you can do it for an extended period of time. You have to figure it out. I’d love to be able to tell you what the right answer is but I can’t. You need to figure out how long to do it and how often. Should you take your vitamins on fasting days? It depends on how well you tolerate them on an empty stomach. You can skip those days if you’re not able to tolerate them. No one ever got vitamin deficient by missing one day of vitamins. Vitamin deficiency is a long term issue, not a 1 day issue. Who shouldn’t fast? The following people should not fast: if you’re under high stress, over-training, chronic poor sleep habits, eating the standard American diet, underweight, pregnant, breastfeeding , or if you’re a child (if you’re still growing).

What are the advantages of Intermittent Fasting? It’s available immediately to anyone! It’s simple, effective, no skill needed, and it will work. It’s free and will save you money! Fasting is convenient and saves time! We make thousands of food decisions every single day (What am I going to eat? Where am I going to eat? How much am I going to eat?). If you’re not eating, you’ve gotten rid of all the anxiety about what where and when? It’s flexible and you can add it to any diet. You can do it wherever and whenever you want. It gives you unlimited power. You decide how long and how often. You’re in control.

Do not use intermittent fasting as self-punishment for “bad” eating or to “make up” for a generally poor diet. For any individual you need to determine how long to fast and how often to fast. No one can figure that out for you! What do I do?? I’ve been fasting for years.  I typically fast one day a week. I have my last meal on Tuesday. I will fast until Thursday morning. I push the water like crazy. I typically exercise the way I always do. If I get a little worn out, I cut it short. I try to keep the rest of my routine fairly normal. I stay busy. It works with my schedule. When I first started fasting, it was incredibly difficult. It was hard, but it’s very doable. I originally was going to fast for 24 hours (Tuesday evening to Wednesday evening). Here’s my problem: typically you’re hungry in evening. So if you’re going to break your fast in the evening, it’s a lot harder to break it gently than to just have a normal amount of food. I found that if I could just get through those few hours in the evening and go to bed, I could wake up the next morning not hungry. Most of us don’t wake up hungry. I found it easier to do a 36 hour fast than 24 hour. I routinely do it once a week. If I have some kind of event like a birthday celebration, I don’t fast. I change the day. Nothing is written in stone. You get to make the rules. That works well for me. That doesn’t necessarily mean it’s right for you. But, it can be.

Here are a few tips if you’re thinking about it. You want to drink lots of water. Stay busy. I certainly wouldn’t sit around in the kitchen.  Ride out “hunger waves.” Hunger is not something that keeps escalating. It goes away. I would encourage you to not tell everybody that you’re doing this, especially those who aren’t supportive. They’re just going to look at you like you’re crazy. You want to avoid high stress time. If you’re in the middle of a move or you have a big project going at work it will be a lot harder.  Try practicing. Give yourself some time. Try it for a month. Just try it intermittently. Just like everything we practice, it gets easier.  Follow a low carb diet between fasting periods. This reduces hunger and makes fasting easier. Don’t binge after fasting. Break the fast gently. Fit fasting into your own life. Don’t change your life to fit your fasting schedule. Change your fasting schedule to fit your life!

Mark Twain said, “A little starvation can really do more for the average sick man than the best medicines and the best doctors.” There’s probably a lot of truth to that statement.

If you have questions, don’t hesitate to give us a call or text us at The Center for Weight Loss Success 757-873-1880.  You should be stopping by to get your body composition done. Fasting can help you preserve that lean body mass!

Remember!  It’s your life. Make it a healthy one! Have a good evening everyone! Take care!

Low Carb Diets and the Truth About Water Weight

Posted on April 08, 2019 by

It’s often thought that low carbohydrate diets are only good for short term weight loss because they cause you to lose water.  Isn’t that bad??  Yes it is good for short term weight loss is because you lose water. The reason you lose water is because insulin levels will go down on low carbohydrate diets. Insulin is a hormone that tends to make you retain sodium. When you retain sodium, you’re going to retain water. So, when insulin levels go down on a low carb diet, you no longer will retain sodium. Subsequently you’re going to get rid a lot of that extra water that goes along with the sodium. One of the nice things about that is you can actually have a little bit of extra sodium because you won’t retain it. So, yet, you will lose weight fairly quickly on a low carb diet because you lose some water weight. But you’re also losing fat.

Remember-it’s your life. Make it a healthy one!

Phentermine – Could it Help You Lose Weight?

Posted on February 21, 2019 by

I’d like to talk to you about Phentermine. Phentermine is an appetite suppressant. It’s been around for a long time. Appetite suppressants are really carefully regulated by the FDA, so there are some hoops to jump through for those people utilizing them, but it’s very doable.  Potentially it can be helpful from a weight perspective, but also from a hunger/craving perspective.  It works very well for cravings.

A lot of appetite suppressants have come and gone.  There have been a number of them over the last 20 years or so. They got approved by the FDA, were around for a few years, and then gone.  One of the reasons is because the drugs were causing other problems.  There are a couple of newer ones in the last few years.  None of them really work any better than phentermine.  The new ones can be really expensive.  Phentermine has been around for about 60 years now. It can be very helpful.  And it’s very safe. We’ll talk about the risks, which are something we do have to keep an eye on. It can help with any medical weight loss plan. You have to be doing the right things. Phentermine will not make up for a bad eating and exercise plan.  It’s very closely monitored by the FDA. Part of that is because back in the 90’s they had phen-phen. It was a combination medication of phentermine and also phenfluramine. They put two medications together and it worked wonderfully. Unfortunately, the phenfluramine ended up causing heart problems. It was taken off the market.  Because phentermine was associated with it, it’s very closely regulated. Overall, it’s a very safe medication.  It has stood the test of time.  It can actually be used long-term but it needs to be monitored.  There can be some potential side effects. You do have to watch blood pressure. It’s rare but not impossible.

The clinical indications for using phentermine are a BMI over 30 or BMI over 28 with medicals problems.  It’s similar to having weight loss surgery.  Generally what they’re talking about mostly are sleep apnea and diabetes.  Chemically, phentermine looks like amphetamine. Because amphetamine can cause all kinds of problems, and can be addicting, it was thought that phentermine was in the same class as amphetamine, and therefore just as dangerous. It was more regulated by the FDA. A lot of those theoretical problems really never panned out.

I’ve been utilizing phentermine in the patient population for about 15 years now. Just like surgery, it’s a good tool. It’s just another tool in the toolbox. There’s nothing magic about it. It can be a good additive tool along with the surgery. All it really does is takes the edge off hunger.  It really takes the edge off cravings. It won’t prevent you from eating. It can also help with carbohydrate withdrawal. Most of our patients are very sensitive to carbohydrates. If they fall off the wagon and start eating too many carbs and then try to cut them back again they’ll go through withdrawal. Carbohydrates are like a drug. The phentermine can help with the carbohydrate withdrawal symptoms.  We have found that phentermine can give you 8-12 pounds of extra weight loss. It’s the same with our surgical patients. If they feel like they’ve stalled out, the phentermine can give them some more weight loss.

If you are keeping your carbohydrates down while utilizing phentermine, you can lose a tremendous amount of weight. The weight loss from phentermine will vary from person-to-person depending on age, genetics, sex, and other health problems.

There are potential side effects. You absolutely need to have an EKG done prior to starting phentermine. You want to document that your heart is fine. It’s not going to cause a heart problem. But if you’ve already got a heart problem, it can worsen the problem.  Almost everyone starting phentermine gets a dry mouth. Make sure you’re drinking a lot of water. It can make you feel slightly jittery. It’s kind of like having a few cups of coffee. They typically fade away in about 7-14 days. It’s a side effect. It’s not how the medication works.  I tell people that if it makes you jittery and it bothers you, then quit taking it. The medication will be out of your system within 12 hours. One of the uncommon side effects of phentermine is insomnia. If you take it too late in the day you might have a hard time going to sleep. But that typically over time goes away. Other uncommon side effects are tremors, dizziness, and high blood pressure. It’s really rare for blood pressure to go up, but that’s one of the reasons why we have to monitor it. Theoretical potential problems (which are related back to the phen-phen) are heart problems and addiction/withdrawal. You can get used to the medication, but that’s not necessarily addiction. You can build up a tolerance to the medication where it stops working as well. But you can’t go through withdrawals.  You don’t have to wean off the medication. You can just stop taking it.

There are some real reasons to avoid phentermine. If you have an allergic reaction to it, obviously you shouldn’t take it. If you have a history of heart problems (no matter what it is), I would discourage you from taking it. You shouldn’t take it if you have high blood pressure that’s poorly controlled.  You can take it if your blood pressure is well controlled. Theoretically you should avoid phentermine if you’re taking antidepressants. Because of the chemical make up of phentermine, there was a thought that there would be a cross over, and some antidepressants would make this exacerbate heart problems. It would make antidepressants not work as well or the antidepressant would make it exacerbate heart problems. But it’s absolutely fine to take it with antidepressants. There is actually some antidepressant affect with phentermine.

Legally I have to have a discussion about the” art” of taking phentermine to a patient if they’re going to be taking it. I have to talk about the potential side effects as well as the” art” of using the medication. It tends to last for 10-12 hours. So, since most people don’t wake up starving, don’t take it first thing in the morning.  There’s no sense in taking it then.  Take it mid to late morning.  Play with the timing. If you find you’re having a hard time getting to sleep, then take it earlier. If you have a lot of hunger and cravings right before bed then you need to take it later.  It’s one of those medications that work if you take it.  It doesn’t work if you don’t take it. You don’t have to build up to it or wean off of it.  Therefore you can use it intermittently. It’s fine to use it certain days of the week. We typically write it as a daily dose but there’s no reason you need to take it every day.  Take it as you need it. It can be used long term. It originally was written in the PDR to be used for only 8-10 weeks. They originally said that because the original studies were only done for 8-10 weeks.  It was then approved by the FDA but never approved for long term use.  It has been used for long term use for many years the PDR has never been changed. So most physicians only prescribe it for a few months. It’s kind of silly to think we can fix something in a couple months. I’ve had people on phentermine for 10-12 years. It just has to be monitored. We’re making sure there aren’t any blood pressure problems, ensuring it’s still helping, and make sure there are not side effects bothering you. If it’s not helping, you shouldn’t be taking it anymore. There is evidence that if a person is taking it long term that if they stop it every few months for 7-10 days, and then it tends to work better.

There are some cautions about phentermine. Sometimes it may work so well that you don’t eat. We’ve talked about intermittent fasting and how that works.  The problem with skipping meals and intermittent fasting are two different things. If you’re just skipping means, then it was unintentional. Fasting is intentional. You don’t want to be skipping meals all the time. If you’re doing intermittent fasting for a day or two, you can take phentermine. It’s another tool in the tool box. Starvation has never been a good weight loss plan. Phentermine won’t stop you from eating. If you’re eating for many reasons (not hunger), then it’s not going to help you. You need to take a good look at the behavior side of things.  Why are you actually eating? Work on solving those problems. Without a good nutritional and exercise plan, any weight loss with the phentermine will likely be temporary.

In summary, phentermine has been around for a long time. It has stood the test of time. It can be very safe. It can be very helpful, especially for cravings. But it still needs to be used with a good diet and exercise plan. It doesn’t work to fix a poor life plan. You need to have a normal EKG. We have to monitor your blood pressure as well as side effects.

Come in and get your body composition done.  Make sure your losing body fat and not lean body mass.  Remember it’s your life! Make it a healthy one!  Take care everyone.