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Doctors' Answers to "Frequently Asked Questions" - Weight Loss


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An indi vidual patient is always advised to consult their own physician.

[posted 08/17/2000]
Question: what do you think is the best pill to loose weight.or the best to even loose weight. i've tried a lot of things and nothing has worked for me in the past.

Answer: The only ones that work currently from my prospective are Xenical and Meridia. Xenical seems to work the best, but can cause severe diarrhea. Meridia is slower and seems to have fewer side effects.

[posted 03/25/2000]
Question: Hello, I am 15 and I have an overweight problem. One day I was watching TV and i saw an infomercial for a product called Chitosol. And it made me think that it could maybe work for me. But I wanted to get some advise from a doctor first. What do you think? Would my age prevent me from taking it? If you think that this drug is safe for me, would you please also include a website where I could maybe get some? Thank you for you help.

Answer: I've not heard of this product. What are the ingredients? Also, most of the OTC remedies are of little use. Like most things when there are many solutions it is because none work very well if at all.

[posted 02/29/2000]
Question: My friend is 6'3 weighs about 290 lbs and has aprox 30% body fat he lifts weights and wants a leaner meaner body. I object to any kind of steriod use but he disagrees with me and says that used correctly steriods are beneficial. What kind of diet would you recomnend and should he take growth hormones/steriods stack to become leaner? His goal is between 10%-15% body fat. Also what information do you have about Parabolin?
Thank you for your time.

Answer: Don't take steroids they can be deadly and will sometimes increase body fat, not decrease it. Growth hormone won't help either, but will increase the density of his bones(not necessarily stronger). I have no information about parabolin.

[posted 02/14/2000]
Question: Since my hysterectomy 3 years ago I have gained over 50 lbs. This weight gain began shortly after I started with my estrogen therapy, however we I tell my OB/Gyn he says it is not the estrogen. I need to lose weight. I weigh 195 lb (5 10 1/2"), I weighed a solid 135 lbs prior to my hysterectomy. I need something to help me lose weight. Please help!

Answer: There are two medications that you can take to lose weight. Meridia and Xenical. Both cost about 70-90$ a month. Meridia will lose 1-2 pounds a month and generally is well tolerated. Xenical has the propensity to lose more weight faster, but at the cost of diarrhea and loose stools.

[posted 02/4/2000]
Question: What is a good drug for someone who needs to loose
20 - 30 pounds? Excercise and watching what we eat
is very important in this regard, but I am 45 and it
appears my metabolism is stuck. My self esteem is
plunging. I need a boost to help with these last 20 -
30 lbs. Doc prescribed Adipex, but I stay awake and
grind my teeth - so that is out. And when I say stay
awake I mean a couple of days with only 2 -4 hours sleep.
Talk about 45 and loony! Couple 2 -3 weeks of that and
I gave it up.

I really don't like this aging process. Due to smoking related
lung cancer my Father died @47, my Mother @ 64 and 1 1/2 years
ago, my Brother @ 41. None of them had a weight problem, they
just smoked.. I have never smoked and i am getting chubbier.

Any suggestions. If you tell me to increase/vary the exercise and
watch my food, etc. - I can tell you I am doing that. All my Doc can
say is your metabolism is slowing down as you age.

Any comments will be appreciated.

Answer: First set your mind on increasing your exercise. Second as an adjunct you may want to consider either Meridia or Xenical. These are weight loss drugs that do not appear to have the cardiac side effects of the previous phen-fen regimen. Xenical works better but at a price of diarrhea. Meridia will result in a couple of pounds a month if you stay with it. Both cost about 60-80$ depending on your pharmacy a month.

[posted 01/31/2000]
Question: Is it safe to take both Meridia (to help me control food cravings and learn better eating habits) and Xenical (to help me lose weight more quickly, which is highly motivating)? I currently take thyroid medication, asthma medication (Azmacort, Ventolin, & Singulaire), a multivitamin, gingko biloba, and L-lysine. I am in good health except for exercise-induced asthma, which has gotten worse with my weight gain.

Answer: I wouldn't. Try one at a time and ensure you take your other medications separate from the xenical if that is your option.

[posted 11/24/1999]
Question: I'm taking 120mg Xenical with each meal that contains fat. I'm also on 50mg Atenolol once a day for hypertension. I recently started taking 100mg Niacin because I read that the "Niacin Flush" was good for your circulation and clears 'toxins' in your fatty tissue. Is this true? Is it safe to take 100mg Niacin per day to keep my cholesterol from becoming high?

Answer: No truth to this that I'm aware. The flush is dilation of peripheral arteries and does nothing except cause a hot flash and lower your blood pressure. Niacin has potential liver toxicity and needs ongoing liver function tests, however, this is a pretty low dosage.

[posted 11/25/1999]
Question: After reading several FAQ on people taking synthroid and having weight gain, like myself, and not being able to take the weight off, why would the answer always be it's not the Synthroid. With so many people having the same complaint there has to be something to it. I take .88mg and have fluctuated at times and sometimes not even enough for my doctor to want to change the dose. I am 46 and for the last 2 yrs have fought this weight gain with working out and watching what I eat. There has to be some correlation with that and taking Synthroid and plus so many others with the same problem. It's like you hit this wall and no matter what you do to lose it won't come off. I remember when I first started taking Synthroid I lost weight. I was hypo so I know that was one reason. I just don't understand why now I can't seem to get the weight off or when I do it comes right back. I have talked to my doctor he says the same it's not your thyroid. But if so many people are having the same weight gain problem there MUST be something to this Synthroid medication causing it. I know this sounds like a broken record and everyone is always trying to blame weight gain on something else besides themselves. But for a person like myself who is very in-tune with their body and likes to stay fit there has to be some reason I can't lose or keep it off. I know age has something to do with it but not always if you watch what you eat. I do at times experience fatigue and know there is a different feeling of fatigue when it's a thyroid problem. I usually can always tell when it's just tired from stress or work but when it's from my thyroid it is a tiredness you can't describe. I have that at times so I wonder why even if my TSH is ok or slightly off could it still effect me as far as energy and weight gain? I hope I have given you enough information. I go back for a check-up on my thyroid end of December. If it checks out OK or slightly off would it make a difference in changing the dosage? My doctor doesn't seem to think so but I sometimes think that any change in your thyroid can make a difference whether it's the medication dosage or your TSH levels, what do you say? Thanks!

Answer: Try it and see, but I don't think you will see any difference. Do a controlled trial for a month and see-but, expect to be disappointed.

[posted 11/25/1999]
Question: I have a good friend who has been taking this Metabolife for awhile, maybe 6mths or longer. She has lost alot of weight and it worries me that she keeps taking it. What can I tell her to watch for as far as dangerous side effects? Why do some people who take this Metabolife or similar products seem to have weight loss and others don't? This stuff sounds scary, especially the Ma Huang that's the main ingredient.

Answer: I haven't seen any particularly bad side effects in my patients, we really have little training in herbal supplements. Consequently, I can't help much here.

[posted 11/4/1999]
Question: Recently, I have seen several commercials for a new perscription drug that supposedly blocks fat. I can't remember the name of it -- do you know what it is, or have any information about it?

Answer: The prescription one is called Xenical. After your food leaves the stomach, it enters the small intestine. At this point, the pancreas produces different enzymes to cut up the big molecules and allow them to be absorbed. One of these is an enzyme that cuts/reduces fat molecules. Xenical blocks the ability of this enzyme to work. Consequently, you cannot absorb most of the fat and it passes through the stool and out the other end. It needs to be taken 30 minutes before or 45 minutes after eating. It can produce Vitamin A,D,E,K malabsorption since these are fat soluble vitamins, consequently you'll need to take a multivitamin some time away from the Xenical. It only works if you eat, so if you have a small meal, a very low fat meal or don't eat it does not help to take it. Taking it with a very high fat meal(prime rib with sour cream for example) can result in uncontrolled diarrhea-even to loss of bowel control. So, most patients learn to reduce the fat in their meals to avoid this and not take it with the really fat excessive meals. It's not cheap but works without many systemic side effects since it only works in the small intestine. There is concern about blood vitamin levels with this drug and this needs to be watched closely. It is relatively new and we may find problems that we don't suspect due to it's relative newness.

[posted 11/11/1999]
Question: I had gone to see the doctor last month and explained my thoughts on my weight loss and loss of apetite which I thought was due to a recent situation (divorce)and she gave me samples of paxil (10 mg) and megase (40 mf) for my appetite i finished the megase and my apetite has returned as well as gaining a few pounds but the question I had was on side effects for paxil. I have been experiencing excessive sweating at night when I am asleep to the point I have to change clothes and I've never experienced that before and it's happened now for the about the past two weeks and its only at the time when I'm asleep. I've turned up the ac and have the ceiling fan on. Thank you.

Answer: Probably not the Paxil, but a 2 week drug holiday would answer the problem. With the weight loss and the sweats check your thyroid funcion and a sedimentation rate. Both should be normal if nothing else is going on.

[posted 11/12/1999]
Question: A friend picked me up a product called cal rid that is suppose to burn calories while you sleep other than what is on the label which isn't much I can't find any info on this product. I even called the pharmacy and the druggist could find nothing the company that Manufractures it is Healthy associates. Can you tell me anything at all about this product.

Answer: Not familiar with this, does it list the ingredients? In general, these don't work too well. Many of them have caffeine or pseudoephredinre which is of limited use.

[posted 08/24/1999]
Question: I have been on Prozac for 3 years and have been undergoing therapy for depression with excellent results. The one remaining problem is that I have been unable to stay on a diet and be motivated enough to lose the substantial amount of weight I've gained during the last few years. This is the only area of my life which causes me to feel very depressed and sometimes suicidal anymore. I spoke with my MD about either going off Prozac and trying Meridia or staying on and trying Xenical to help me lose weight and then begin to tackle any additional issues in therapy. He advised against Meridia and going off Prozac and instead prescribed wellbutrin 150-300 mg daily in addition to my 80 mg of Prozac to help my motivation and sense of focus and reward. He feels that these changes may make me feel better and consequently help me lose weight. He also feels that Xenical is not particularly effective and not worth trying. So, what do you do when you are desperate to lose weight? How do you feel about Meridia/Xenical? What is your opinion of using Prozac and Wellbutrin together to achieve the effect my MD hopes for? I will be very interested to hear you thoughts on these matters. Thank you. By the way, your FAQ on Prozac gave me more info than anything else I've seen --THANKS

Answer: I haven't been impressed with Meridia, but some patients do get results. Xenical works but at the price of diarrhea in some(occasionally uncontrollable). I would not be opposed to the combo of Prozac and Wellbutrin.

[posted 10/13/1999]
Question: i am currently a healthy male who is gradually losing weight. my only concern is that my bodily waste has been in the green form instead of the brown form. Can you tell me if this is healthy and what causes this?

Answer: Changes in stool color usually signal changes in liver metabolism or bowel flora. See your md.

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