Weight Loss Tips: All About Medications, Including Phentermine

Hi everyone. It's Dr. Angela. 

Today’s topic is weight loss medications. This is one of those topics that's pretty controversial and a lot of people are afraid of them. And so I want to reassure you a little bit. I want to let you know what they do and whether it's something that you might want to consider as an aid in your weight loss journey.

So what do you need to know about weight loss medications? Well, a lot of people are afraid of them and a lot of healthcare providers are afraid of them because there was a medication back in the mid nineties, called Fen-Phen. Now, many people come to me having been on Fen-Phen in the past, and they did great. And they're like, it helped me so much, but then it got taken off the market. And the reason it got taken off the market is because it was a combination of Phentermine and Fenfluramine. Phentermine has been around since 1959 and is a safe medication, but the Fenfluramine piece they discovered was causing some heart valve issues in some people.

And so there was this big debacle. Everybody who'd been on it had to get an echocardiogram to make sure their heart valve was okay. And it was just a big mess. After that, weight loss medications became really hard to get approved by the Food and Drug Administration (FDA). Safety was a huge issue and many healthcare professionals just decided not to prescribe these medications because first of all, they still have in their mind that there's this bias… that there's a character flaw going on in people, and they also just didn't feel comfortable because they just were worried about potential side effects.

So here's what I want you to know about weight loss medications. There are many other weight loss medications out there now besides phentermine, but that's the oldest one. And there are some medications out there that are similar to phentermine, I call them phentermine's kinder, gentler cousins, because they're not quite as strong and they're not quite as long lasting. So for some people, that is a better option.Sometimes, I use phentermine in combination with some of these other ones. So this is a big issue for people, whether or not to take weight loss medications. And how do they help? What do they do?

So the medications that are available right now are phentermine, and the combination of phentermine and Topiramate, which is called Qsymia.  There's one called Belviq that got taken off the market. There's one called Contrave, which is actually a combination of two medications that have been around for a long time.  There's one called Saxenda, that's a shot … and there's one called Vyvanse, which is approved for binge eating disorder. So, so those are all of the options. We also use some diabetes medications off-label for weight loss, but they’re very expensive and insurance won’t cover them.  What I have discovered over 13 years of practicing obesity medicine is that tried and true Phentermine works the best for the most people, and it’s safe, and generic, so it’s not expensive. 

But there are some things that I want you to know about it. First of all, what are these medications? I'm going to share screen because I want you to understand what these medications do.

This is your brain, and this is how your brain regulates your eating behavior. So this is all about survival. And there are different parts of your brain that are involved. There's what we call the homeostatic part of it, which is deciding what your weight set point should be. And there are certain hormones that are regulating that. Ghrelin is the most well known hunger hormone and Leptin is the most well known satiety or satisfaction hormone. 

And then there's also the pleasure center that gets involved. Eating is pleasurable if your body needs food. Once your body is done with food, eating is supposed to not be pleasurable anymore. That's normal. What happens for people is when they have the disease of obesity, this whole thing gets out of whack. And I talk about it in my online course called Journey Beyond Weight Loss. Basically what happens is the Standard American Diet, or what I call SAD food, causes huge derangements in all of this chemistry. And so the brain is no longer sensing satiety correctly, and it is over-experiencing pleasure from food. So people think they have a character problem because it's like, I can't stop eating or I'm thinking about food all the time. Well, there's no character problem going on here. This is the way the brain responds when it doesn't have enough leptin.

I just want you to understand - this is a lot of science and I don't want to overwhelm you and bore you with crazy diagrams, but I do want you to understand there's a lot of science behind this, and there's actually a whole field of research and a whole journal called Appetite.

So what we now understand is that these are not character flaws when people are experiencing this. This is the response of the brain to the errant chemistry. So that's what these weight loss medications do. They really help correct that chemistry in the brain, so that your brain is not thinking about food all the time. I've actually had people come in in tears after they have started these medications saying, I had no idea what normal people feel like around food. This is amazing! Like I'm not even sure what I'm supposed to do with my life now that I'm not thinking about food all the time anymore. So it's really interesting. These medications can be very, very helpful, but I have some precautions that you need to know about.

The first thing is you want to make sure that who's ever prescribing it to you knows what they're doing. You want to find somebody who is board certified in obesity medicine. Go to  www.abom.org so that you can find somebody near you who is board certified and who knows how to use these medications. There are a lot of people out there who don't understand the disease of obesity. They don't understand that there are appetite issues going on. They might be willing to prescribe the medications, but they just don't know that much about it. And so they'll be willing to prescribe the medications for three months, like Phentermine initially got labeled in 1959 to be used for three months. Well, this is a chronic disease, like high blood pressure.  You don't want to put somebody on high blood pressure medications for three months and then take them off and say, good luck. That's not the way you use these medications.

If you start these medications, you want to be willing to use them long term, if need be. What we have discovered is that in some people with obesity, there can be permanent damage to the brain's appetite regulation system. And if there's ever a reason to get PO'd at the food industry, this is one of them. They understand exactly what they're doing. And they're very happy if your brain's appetite regulation system is permanently damaged and they start the kids young. I've done other videos about that. So I just want you to be aware of that. You need to be willing to stay on the appetite medications long-term if needed. I do experimenting with my patients once they get down to their plateau to find out whether they still need them or not. And you don't want to be using them as a quick jump-start to weight loss.   

Make sure that the person who's prescribing them for you knows what the heck they're doing!  If you have ever thought about just Googling it and getting something online, bad idea, very bad idea. You don't know where the medication Is coming from. It could be coming from some other country. You don't know if it's regulated and anybody who is willing to prescribe these medications without seeing you in person and doing the appropriate surveillance and watching for side effects and all of that, I wouldn't have good faith in that.

The next thing you want to know is if you are in the childbearing years, do not get pregnant on these medications. As you lose weight, you get more fertile. And so I have a lot of patients coming in and they're saying, I haven't had a period in a long time, even though I'm in the childbearing range, like I've been trying to get pregnant. I just don't think it's possible. Trust me, it's possible. I see it all the time. We need to make sure that you have good birth control. We don't want you getting pregnant on these medications. So condoms are not enough. You need to have at least condoms and some other over-the-counter spermicide or some other hormonal form of birth control. If your partner has had a vasectomy, that's good. Or if you've had a hysterectomy, or a tubal, that’s good. 

The next thing is your heart has to be healthy. And depending on the person and their age and their medical history, I will do an EKG ahead of time just to make sure that the heart rhythm is good and that we don't have any concerns about heart issues. If you are at an advanced age where you're really at risk for heart disease and the EKG shows up with some abnormalities, I will sometimes have the patient go see a cardiologist and just get checked out, make sure everything is okay. You have to be cognizant that you don't have any heart issues or any cardiovascular issues at all.

You want to monitor for side effects. What we're doing here with these medications is we're stimulating what's called the fight or flight response at a very low level. Think about the fight or flight response:  the classic example is primordial man gets confronted with a saber tooth tiger. And all of a sudden, the hormones respond - stress hormones. He's got to get ready to either run like hell or fight. Now what happens during that? What is that response all about? The heart rate's going to go up, the blood pressure is going to go up. The system is getting ready to move. So there's not going to be any thoughts about food, not going to be any thoughts about drinking water or anything like that. There's not going to be any thoughts about sex.

What we're doing with these medications is we are stimulating this response at a very low level so that we get the appetite control effect, like not thinking about food, but we don't want all those other side effects. So when people first start, they might have some side effects, like insomnia, or like a feeling of jitteriness, like too much caffeine. Those side effects usually go away. You want to make sure that you're not having any issues with blood pressure. So we check pulse and blood pressure every time somebody comes into our office. 

If you already have high blood pressure, we're super careful about making sure that your blood pressure is in really good control.  We have you watch your blood pressure at home. The interesting research shows that getting obesity under control helps bring the blood pressure down. Longterm use of phentermine and the other medications actually really stabilizes the blood pressure, but we have to be careful in beginning.

The other thing you want to make sure of is that you're sleeping. So sometimes people will say, you know, I can get to sleep okay. But I wake up. So that means we've got you on too high of a dose. So again, you need to be with somebody who knows what they're doing. Sleep is important. If you want to lose weight, you gotta be sleeping. Constipation is another one of those side effects that can be really bothersome for people. And so we have to watch for that. If you're somebody who's prone to anxiety my rule of thumb is to start with one of the other kinder, gentler ones, just so that we don't trigger anxiety.

Every person is different and every patient who comes to see me is different. And again, if you don't live in the Pacific Northwest where I live and you want to see an obesity medicine specialist near you, I would highly recommend that. These medications can be super, super helpful. Obesity medicine specialists are also diagnosing and treating all the other diseases that go along with obesity. It's not just about the weight loss medications.

The other thing you need to know is that Phentermine and the medications that are similar to it are controlled substances. So depending on the state that you live in, they need to be following guidelines for controlled substances. There's no reason for these medications to be controlled substances. They are not addictive.! And so again, you need to be working with somebody who's board certified, who has a DEA registration, and who is able to prescribe controlled substances and is doing the proper reporting and all of that.

Some people always ask, are they going to show up on drug screening tests? It depends on the drug screening test. Sometimes they do. So if you work in a company that does drug screening, you will want to have documentation that you're taking this as part of a comprehensive weight loss program.

These medications are really, really helpful for people. They correct that obsessive thinking about food. They allow you to stop eating at the right times. They allow you to really stick with your meal plan. But I will say - if you continue to eat a bunch of sugar and flour products, they don't affect the dopamine center in the brain that much, so you might still have cravings from that. You do also have to get off the sugar and flour drug as well.  

If you think weight loss medications might be helpful for you, find an obesity medicine specialist near you at this link.  www.abom.org

To your health,

Dr. Angela