Here’s what SweetiePie has to say;

Hello:

55 Year old female here, 200 lbs, hypothyroid smoke free for 6 months. Feeling great about being smoke free and this time its permanent and for real.

I have quit smoking and relapsed so many times in my life. And dieting, on again and off again for 40 years. Pfffft…..This time what prompted me to go to the doctor and quit was that my heart feels heavy and hurts sometimes. Not angina yet, but scary and depressing. I’m fine, it turns out, but I definitely needed to quit smoking and still need to exercise more and lose weight . I am no expert in the weight loss department, having had limited success with that over the years. I can see from this interesting thread that I am not as weight conscious as most of you, but I still thought I’d share what my doctors told me because it may help and inspire you the way it did to me: When I tried to bring up the weight gain and the overweight with doctors heres what they said: CARDIOLOGIST told me I’d have to be about 100 lbs over my ideal weight of 145 for the weight to be as stressful and damaging on my heart and cardiovascular as SMOKING, GP #1 told me the key was, instead of focusing on an ideal weight and size, was to focus on preventing DIABETES through NONSMOKING, AND EXERCISE just as important as wholesome diet, and GP #2 (I moved and needed a new doctor for my thyroid perscription) told me, after my bloodwork tested all ok, “why don’t you just forget about losing weight for a little while and focus on quitting SMOKING? Well, I took all of that advice, and this time, it worked! I’ve really kicked the smoking habit and finally found freedom from that deadly addiction. The “permission” from doctors to stop beating myself up about my weight freed me up mentally to do what I needed to do (giving myself plenty of rewards, including food treats and being lazy treats!) in order to become smoke free and never going back! I am ready now to step up to exercise and weight loss this year with the same strategy: Increased exercise first, food modification instead of deprivation. The reason for my post is to say stick with it but your QUIT is SO IMPORTANT – don’t ever let your desire to be thinner or to get back down to an ideal outweigh your resolve to stay SMOKE FREE. SMOKING is the singlemost damaging behavior -don’t lose sight of that! Never take another puff! Oh, btw I gained about 5% while quitting and my first goal is to go back down 5%.

Greg writes:

I hope what I am about to write will be an inspiration for those who are truly serious about quitting AND losing weight. I have now been almost five months without a cigarette (the longest I have EVER lasted) and unlike every other time I tried quitting, this time I FEEL its for good. Truthfully, no temptations other than a quick subconscious glance (like noticing cleavage on a woman)!

Every time I quit in the past, I gained at least five pounds, then lost it as soon as I started smoking again. This time I tried a different strategy overall and it has made a world of difference. Instead of making my goal “quitting smoking and holding weight”, I made my goal far more ambitious: “quitting smoking and losing weight..gaining muscle, and looking 100% better overall.”

I am now 42. About ten years ago (while I was still smoking), before I met my wife, I lost about 20 lbs (and 12% bodyfat) in four months by simply using a bodybuilder’s type workout (3-5 set pyramid, every five days upper body and lower alternating), light-medium cardio two to three days per week, plus eating on the “Zone Diet” (40 Protein/40 Carb/20 Fat) and five time per day. The results were so dramatic and so fast that one of my teachers at college thought I was sick or on drugs.

When I quit smoking in October, I started the same routine. At first, my goal was to hold weight only…not to gain. But now, four and a half months later, I went from 200 lbs to 184 lbs and over 29% bodyfat to under 22% bodyfat. Now that’s not nearly as dramatic as the last transformation when I was 32 and smoking, but hell, at 42 and no longer smoking I am beating the monster and looking and feeling better every day.

Truth be told, if I was smoking and my metabolism was up, I’d probably be losing faster. But who cares, the fact is I’m clean of smokes and feeling and looking better than I did this time last year.

This isn’t a pitch for supplements, a workout program, or any other BS. I am just saying, if you truly want to quit AND lose weight, it is possible even at 42. Just be smart about it AND totally committed. I think this time what made the big diffrence was making my mind up that I will settle for nothing less. Now, four and a half months into my quit, my goal is 170 lbs and 12% bodyfat. F#@k smoking! F$#k gaining weight! I want to breathe a full breath of air and see a six pack of abs in the mirror!

Anyone who tells you that gaining weight is the price of quitting is lying or, more likely, just doesn’t know otherwise yet. Keep the faith!

A sensational action by the FDA to cripple development of new weight loss drugs came
about two weeks ago. The FDA denied approval to the weight loss drug candidate Contrave,
a combination of two medications. Both of the drugs in the combination pill are presently in
use and were FDA approved decades ago for indications other then weight loss. One of the
drugs Naltrexone, is used to treat opiate drug overdoses and the other bupropion HCL is used
to treat depression. Given the long history of safety of both drugs it would seem surprising
the FDA would reject the combination of these drugs on grounds of safety concerns, which
was what happened. Making the FDA rejection even more astounding is that just a month
before, a majority of members of the FDA’s own Endocrinologic and Metabolic Drugs Advisory
Committee, gave a thumbs-up to Contrave. In almost all previous instances where the Advisory
Committee gives their green light to a new drug candidate, the FDA has followed through with
an approval. I can hardly imagine a clearer way for the FDA to say “Drop Dead!!” to all those
seeking to get approval for a new weight loss medication.

Michael Narachi, CEO of Orexigen the maker of Contrave, is quoted as saying he “was
surprised and extremely disappointed with the agency’s (FDA’s) request”, a request which
essentially ended any chance of getting approval for his company’s weight loss drug. My advice
Michael, is to move on with your company and find another drug class to work on. Maybe
something to smooth away skin wrinkles or relieve constipation. I’m sure you will have a lot
more success. In the meanwhile, the epidemic of diabetes type 2, cardiovascular disease, and
disabilities due to degenerative joint disease, all related to obesity, marches on.

A final note of advice to investors in the medical field. I would spend my money on a psychiatrist
before investing money in companies conducting research on weight loss medication, since you
won’t see a penny from your investment for ten plus years.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

Most of my diabetic patients are on medication since they are unable to maintain good glucose
control with diet and exercise only. If they succeed however, in achieving weight loss then the
diabetes medication must be reduced to prevent undesirable hypoglycemia (low blood sugar).
Hypoglycemia is potentially dangerous because the brain cannot function properly resulting in
abnormal behavior, loss of muscle control and even unconsciousness. Imagine this occurring
while behind the wheel? Down here in Florida this is all too common.

Many commercial weight loss programs have started targeting Type 2 diabetics (adult onset)
with their TV ads. These programs are generally administered by people without any medical
background. They cannot advise medication changes (not that you would want them to) without
breaking the law by practicing medicine without a license. The result, as with my patient, is the
development of potentially serious complications of hypoglycemia.

In a previous blog http://www.metabolism.com/2010/10/17/injured-diabetic-diet , I worried that this type of problem could develop with commercial weight loss programs. I didn’t expect to see evidence of it so soon and in my own exam room. If my patient’s wife didn’t stop and mention his new symptoms at the last moment
that day, I imagine a far worse outcome for her husband was possible.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com

Yesterday, as I waited in the checkout line at Walmart, I saw a popular woman’s tabloid with a full page photo of Dr. Oz. The headline with the picture was “Dr. Oz’s Metabolic Makeover”. This intrigued me because I can use new information of this kind in my daily office encounters, so I bought the magazine. Imagine my surprise when, reading through the 2 page article, I didn’t find a single word from the great and powerful Oz. Instead a nameless author offered a summary of “Dr. Oz’s body-transforming secrets!”. What were Dr. Oz’s secrets? Take Vitamin D, fish oil, calcium, multivitamins, get enough sleep, and eat food with anti-oxidants low in carbs and sugar. In conclusion a dietitian put together a few simple recipes for meals based on a 1400 calorie per day diet. That’s it folks. That’s all she wrote!! Nothing even remotely new or body transforming. There was not a single original or inspirational thought to be found. Not even a single quote from the medical guru. I doubt whether he even read the article himself.

Dr. Oz was trained as a cardiac surgeon. It takes years of dedication and hard work to achieve that goal. In his mind must have been a desire to save people’s lives by literally taking them to the brink of death and bringing them back healthier than they were before. What this article says to me is that Dr. Oz has allowed himself to become the Kim Kardashian of medicine. A pretty but empty headed celebrity offering nothing of real value. His full page photo in this magazine is the portrait of an almost cynical drive to grab a few dollars from the pockets of adoring fans. What kind of deal do you have, Dr. Oz? Do you get a few pennies for each magazine sold? Do you really need the money, the fame, the glory that this kind of exploitation provides?

Nobody got hurt by this, you might say. That is true if you have time and money to waste. I know that many people would rather get up to date information they could use to get healthy and donate the money they wasted on this article to better causes.

We expect something more from you Dr. Oz. Shake off your advisers and entourage. Stand up for the person you originally sought to be.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

Cami writes:

What Dr. Simeons book does not tell you is that there is a good chance your hair will fall out aproximately three months after completing the 500 calorie phase of the diet. He also doesn’t mention that the shock to your system can cause adrenal fatigue, and hypothyroidism if you were already prone to these conditions.

My husband and I both went on the hCG diet and both lost the weight we had been hanging onto for years. I followed the diet perfectly, but as soon as the hCG stopped, the weight began coming back on, FAST! I had to do a steak day every other day, my blood sugar plummeted and I began to feel awful! I suffered fatigue, dry skin, dry mouth, no energy, no libido, and my muscles and joints began to hurt. The carb and sugar cravings were so intense I felt like a drug addict. I gained all the weight back plus 13 lbs. in three months, then the hair began to fall. My doctor was shocked and completely surprised. His only theory is that the usual dose wasn’t enough for me and I triggered a starvation response which affected my thyroid and adrenals. Together we are going to support adrenal health, then begin t3 therapy in an effort to repair my thyroid. My husband on the other hand, feel great! He has been able to keep off the weight, add some muscle and is happy and energetic every day. hCG does work, but if you have any health problems related in any way to the hypothalmus, I would consider taking the weight off very slowly to avoid starvation response.

The latest drug to be rejected by the FDA is Lorgess (lorcaserin), developed by Arena Pharmaceuticals. This drug, not as effective as Qnexa, produced 5% body mass loss in about half of participants in clinical trials. Lab animals showed a tendency to develop breast tumors when exposed to the medication, adding to the FDA’s decision to reject the drug application based on safety concerns.

I am a strong advocate of drug safety and regulation. On the other hand we know obesity, and with it Type 2 diabetes, is epidemic in the U.S. I regard weight loss as the “holy grail” when treating type 2 diabetes and yet it is the most difficult goal to achieve. Any drug which could assist in weight loss is highly desirable in the treatment of Type 2 diabetes. Not only does blood sugar improve with weight loss but also blood pressure and cholesterol readings show declines. All three of these parameters are known to be prime contributors to the main cause of death in diabetics, cardiovascular disease.

It has already been 10 years since the last drug was approved specifically for a weight loss indication. The failure of these two latest medications to achieve approval is certain to cause the pharmaceutical industry to severely curtail if not abandon further investment in this type of drug development.

Why is the FDA so reluctant to approve a weight loss pill? This is a complex issue but requires an answer. A new weight loss inducing medication is certain to be highly anticipated and widely prescribed. Therefore, from the very first day of approval the FDA must take responsibility for the well being of millions of people who are likely to take the medication. We are a society which demands our medications deliver miraculous cures with no side-effects. If someone perceives they have been injured by a medication our legal system is primed to unleash brutal retribution on everyone remotely involved in the approval process. Abuse and injury with a medication designed to cause weight loss is almost a certainty. This is a no-win situation for the administration of the FDA.
I predict it will be at least another 10 years before a medication for weight loss is approved by the FDA. Unless there is a change in the climate of litigation in this country it will take longer than that. In the meantime the only new developments in weight loss drugs will be the result of exploiting appetite suppressant effects which are the “side-effect” of medications approved for other purposes.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

The intestines produce hormones which regulate blood sugar and appetite. GLP-1 is among the best known of these intestinal hormones. GLP-1 is the basis of a whole new generation of medications used to treat diabetes such as Byetta, Victoza, Januvia and Onglyza. GLP-1 lowers blood sugar, stimulates the pancreas and reduces appetite. After gastric by-pass increased amounts of GLP-1 are produced by the remaining intestine. In a study published in the Journal of Clinical Endocrinology and Metabolism (95:4072-4076, 2010), researchers at St. Luke’s Hospital in New York discovered that levels of oxyntomodulin, another intestinal hormone that suppresses appetite and acts like GLP-1 on blood sugar levels, is doubled after gastric by-pass.

These exciting discoveries help explain why obese diabetics can often be sent home without any medication to control blood sugar immediately after undergoing gastric by-pass surgery. Although most insurance plans do not cover gastric by-pass surgery, dramatic improvements in patients after the procedure with greatly reduced medication costs may convince insurance companies that paying for the procedure will result in better outcomes and save them money in the long run.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com

Periodically, I update metabolism.com with interesting problems from my medical practice. Last week I was reminded of a particular thyroid disease which is little known and deserves more attention. In my patient’s case, she had an inactive thyroid (hypothyroid) due to Hashimoto’s thyroiditis for several years which, on its own switched to become an over-active thyroid (hyperthyroid). I call this event a “Zombie Thyroid”. Don’t bother trying to look this term up since ‘Zombie Thyroid’ is my own terminology. A Zombie Thyroid is, of course, one which returns from the dead. Most times when the thyroid is destroyed by either natural forces or by human intervention, the destruction is complete and irreversible. Rarely however, a thyroid which ceased function for years resumes producing thyroid hormone and may even becoming “hyper” or over-functioning. Such was the case of my patient last week. Confusion may result because the newly risen thyroid begins adding thyroid hormone to the blood of someone already taking thyroid hormone replacement for hypothyroidism (under-functioning thyroid). Recognizing the Zombie Thyroid can take months or years due to the rarity of the condition and the subtlety of the changes that occur on blood testing.

The Zombie Thyroid occurs in the setting of either autoimmune thyroid disease such as Hashimoto’s thyroiditis or a structural thyroid disease, multinodular goiter. Hashimoto’s is the most common cause of naturally occurring hypothyroidism in women under the age of 60 years. Hashimoto’s occurs when the body creates an antibody to the thyroid, resulting in destruction or impairment of the thyroid tissue. It is thought that the thyroid can ‘return from the dead’ if the body begins to produce more of another type of antibody that results in stimulation of the thyroid tissue. The switch from under active to over-active can take months or years. During this time the combination of taking thyroid hormone pills for Hashimoto’s plus the new supply of the body’s own thyroid hormone production can result in disturbing and seemingly unexplainable high thyroid levels. Once it is clear that the thyroid is producing thyroid hormone again it is possible to make appropriate adjustments in medication to return the situation back to normal.

Another situation involving the Zombie Thyroid is seen in elderly people who have had an enlarged and lumpy (nodular) thyroid for years. Some of these “multinodular goiters” produce adequate amounts of thyroid hormone but others can be associated with thyroid hormone deficiency (hypothyroid). When the multinodular goiter causes hypothyroidism, the patient will be treated with thyroid hormone replacement just like the Hashimoto’s patient. Over time the nodules may slowly begin to wake up and begin producing thyroid hormone. If the patient is already taking thyroid hormone due to the previous diagnosis of hypothyroidism, the combination of the two sources of thyroid hormone can result in excess or “hyper” thyroidism. In the elderly the doctor may suspect the elevated thyroid hormone levels are the result of a medication error perhaps due to the patient’s forgetfulness. If no action is taken serious complications of hyperthyroidism can develop such as irregular heart beat, congestive heart failure, excessive fatigue, and mental or mood impairment. Some elderly patients become withdrawn and lose weight mimicking depression, a situation known as “apathetic hyperthyroidism”. Recognition of the Zombie Thyroid is essential to restoring the thyroid levels and the patient’s clinical status back to normal.

Don’t let yourself or loved one become a victim of this ‘back from the dead’ thyroid. Alertness is the key to recognizing and treating the Zombie Thyroid. Ask your own physician for advice if you suspect this condition.

This article is for educational purposes only and is not meant as medical advice. The disclaimer of metabolism.com applies to this and all my blogs.

Gary Pepper, M.D., Editor-in-Chief, metabolism.com

Thank you for posting this but you havent posted all the information just parts of it.

Most people who have bariatric surgery really DO it as a last resort.

While you are right about that the one sole gastric bypass surgery is NOT a quick solution to the problem, however there are other bariatric procedures that are available to consider. One of them being the latest one called vertical sleeve which just cuts your stomach smaller and does not do all the plumbing that the drastic gastric bypass does. Another form is the popular lapband which is just a band thats inserted over your abdominal to restrict the food.

Any of the bariatric doctors do WARN the patient that with the gastric bypass that you run the risk of malabsorption and that can be detrimental in the long run.

As far as bariatric procedures are concerned I know TEN people who had various bariatric surgeries. I know 8 of them that are doing great! I know my cousin had the gastric bypass and she didnt do well. She has to go back in and get it removed because it was dangerous for her. But this was when gastric bypass first started out as a new procedure. The other person i dont know what procedure she had done but her situation is that she stopped taking the vitamins that she was supposed to take so she became ill. Shes doing better now that she is taking her supplements.

I”ve been to many bariatric seminars and i strongly recommend the vertical sleeve. Out of the ten i mentioned I know two of them had that done and are doing fantastic. They do not get malabsorption and just mainly control what they eat. If people are concerned then i suggest they opt for the lapband and if its not for them they can have it removed.

I personally cannot have ANY of these procedures even if i had the money for it. In 1996 I had acute pancreatitis(which left me diabetic) and they did abdominal surgery on me therefore the bariatric doctors will not touch anyone who had any kind of abdominal surgery due to that it might cause complications. How i dont know though. I’m hoping to find out.

Do know this that you can have any surgery and STILL gain the weight back. You can still eat tons of milk shakes with the lapband or constantly eat small portions with the vertical sleeve and re-stretch out your stomach. So they aren’t a cure all.