Feedback on Topiramate

I just wanted to take a short moment to let all of you know how the addition of Topiramate to the medication regimen of my patients is working.  So far we have had many great reports.  The common comment is that "I just don't feel like eating."  The other thing that I routinely hear is that "I don't crave carbs, they just taste bad when I eat them."  I have had numerous patients that were stuck on plateaus, or were in a rut, that have gone on Topiramate in addition to their phentermine, and are now losing weight again. 

Most of the patients who have been taking Topiramate report NO side effects.  I have had three reports of headache, one report of tiredness, and a report of itchy rash.  Two other minor items were reported but we are not sure they are related to the topirimate.  Considering that hundreds of my patients are now taking it, I would say that the rate of any side effects is very low, and that they are non-serious in nature.  Any reported side effects stopped when the drug was stopped.

All in all, I think it is working great.  I would encourage you to add Topiramate to your regimen if you need additional appetite control, carb-craving control, or just need a "jumpstart."  I hope this update is helpful to you all

Wickham

New Diet Drug Update

NEW DIET DRUG UPDATE

For those who watch the news, you may have noticed that the FDA has approved a new diet drug  in 2012. The name of the drug is Qsymia and it is manufactured by Vivus. Dr. Simonds wants to give you the “scoop” in advance. Qsymia is a combination of 2 older drugs – phentermine and topiramate. The phentermine is a drug we all know about. Read on for more.

Topiramate is the generic form of the drug Topamax. It was initially approved 15 years ago by the FDA for treatment of seizure disorder. It now is used by physicians to treat multiple disorders such as migraine headaches, depression, neuropathy, obesity, etc. There are three benefits of this drug that make it useful in the treatment of obesity.

Curbs Carb Cravings - In a majority of patients who take it, they will report a change in the taste of and desire for processed carbohydrates – sugary drinks, snacks, breads, etc. This change leads to reduced consumption of these items in the diet.  

Curtails Bing Eating - Topiramate is known to curb binge eating in many of the patients who take it. The reduction in binge eating promotes weight loss.

Decreased Calorie Consumption - Patients eat fewer calories while taking topiramate. 

Doctor Simonds has been prescribing this drug with phentermine since 2005. However, it was not available in a generic form, and the cost was prohibitive to patients, which limited its use. Now it is available in an inexpensive generic form. The Good News – At PAWL, we now carry this drug, and it can be added to your medicine regimen to help you lose weight! In other words, you can take the components of Qsymia now – even before it comes to market. It is inexpensive, and it can be used along with almost all prescription medicines with no interaction. It is a nice drug to add to your regimen if your weight loss has slowed, or if you just need a “jumpstart.” A final advantage to using this drug combination at PAWL, is that we use phentermine at its normal, effective dosages. Qsymia only has 15mg of phentermine. As most of you know, this dose is entirely too low to adequately suppress your appetite. At PAWL, we tailor the dosages of phentermine and topiramate to your specific needs to get the best result.  If you are interested in adding this drug to your regimen, let us know.

DOSING INSTRUCTIONS FOR TOPIRIMATE

Patients who take topiramate for other disorders usually take doses in the range of 400mg per day.  The dose needed to treat obesity is a much lower dose - only 100mg per day.  When this drug is first started it requires a “taper up” over the period of a few weeks.  Should you decide to add this drug to your regimen, you will receive two pill bottles. 

The First Bottle - The first bottle will have 25mg tablets.  During week number one, the patient takes one 25mg tablet before bed.  Some patients find that topiramate makes them sleepy, hence the evening dosing.  During week two, the patient takes one 25mg tablet in the morning and one in the evening.  If this produces daytime sleepiness, then the entire dose can be taken in the evening. 

The Second Bottle - At the start of week number three, the patient will switch to the second pill bottle which has 50mg tablets.  They will take one tablet twice daily.  If there is daytime sleepiness, the entire dose can be taken in the evening. This dose, is the dose the patient takes until they have reached their goal and decide to stop taking it. If the patient remains on topiramate for several months or more, they should undergo a similar taper down.  The staff can guide you at that time.

SIDE EFFECTS

Side effects of topiramate at these low doses are generally mild and in most cases non-existent.  Some people experience a sensation of tingling during the first two weeks.  It does not affect your function at all, and it goes away in 1-2 weeks.  The other side effect that is sometimes seen is mild weakness and sleepiness.  This requires taking the drug in the evening before bed time. Patients will often ask, if I have any of these side effects, is there anything I can do about it?  Yes, there is.  The side effects will resolve if you take a Tums tablet in the morning and evening and if you take 500mg of vitamin C once daily.

A very small percentage of patients will report forgetfulness (usually at much higher doses).  If this happens and it affects the patient’s normal, daily functions, the drug will have to be discontinued.  The forgetfulness immediately resolves.  There is a rare anatomic disorder of the eye that is present in the general population.  It makes these people prone to a condition called acute angle closure glaucoma.  If you had this anatomic disorder and did not know it, you could develop this version of acute glaucoma when you take topiramate.  The symptoms are sudden one sided eye pain with headache.  If this were to happen to you, you would need to go an ophthalmologist or ER promptly to have the pressure in your eye checked.  If the pressure is elevated, it can easily be treated and topiramate will have to be discontinued.  If you form kidney stones several times a year or more, this drug may make this worse, and in that scenario you should not take it.  Topiramate may make you more susceptible to heat exhaustion and heat stroke.  If you are doing strenuous activity in the heat, make sure you take frequent breaks and drink plenty of water.  Finally, if you are pregnant, or actively trying to get pregnant, you should not take this drug. 

AGAIN, IF YOU ARE INTERESTED IN ADDING THIS DRUG TO YOUR CURRENT REGIMEN, JUST LET THE STAFF KNOW.

As I Was Saying...

As I predicted, hhe FDA has approved Qnexa - under the new name Qsymia.  See the announcement below that I recieved via Email yesterday.ASBP stands for American Society of Bariatric Physicians, of which I am a member.  Remember - you can get the generic components of this medicine right now at Physician Assisted Weight Loss.  If you need a jumpstart this is a good way to get "back on top of your diet game".

Obesity Medicine e-Weekly

News ASBP and American Society for Metabolic & Bariatric Surgery (ASMBS) release joint statement today applauding the FDA's approval of Qsymia (aka Qnexa) ASBP is pleased to announce to you that earlier today the U.S. Food & Drug Administration (FDA) approved Qsymia (also known as Qnexa prior to its approval). This marks the second time this year that the agency has approved a new obesity treatment drug--not one that just helps weight loss. Read the joint ASBP-ASMBS news release as well as the FDA's official press announcement. Look forward to seeing you at the office.  What are you waiting for? All you have to lose is more weight. Doctor Simonds

New Obesity Medicine Treatment

NEW OBESITY MEDICINE UPDATE

For those who watch the news, you may have noticed that the FDA is considering a new diet drug for approval in 2012.  As of right now, it seems to be on the fast track for approval.  The name of the drug is Qnexa and it is manufactured by Vivus.  Dr. Simonds wants to give you the “scoop” in advance.  Qnexa is a combination of 2 older drugs – phentermine and topirimate.  The phentermine is a drug we all know about.  Read on for more.

Topiramate is the generic form of the drug Topamax.  It was initially approved 15 years ago by the FDA for treatment of seizure disorder.  It now is used by physicians to treat multiple disorders such as migrane headaches, depression, neuropathy, obesity, etc. 

There are two helpful side effects of this drug that make it useful in the treatment of obesity.  First, in a majority of patients who take it, they will report a change in the taste of and desire for processed carbohydrates – sugary drinks, snacks, breads, etc.  This change leads to reduced consumption of these items in the diet.  Naturally, this promotes weight loss.  Second, topiramate is known to curb binge eating in many of the patients who take it.  The reduction in binge eating also promotes weight loss.  Doctor Simonds has been prescribing this drug with phentermine since 2005.  However, it was not available in a generic form, and the cost was prohibitive to patients, which limited its use.  Now it is available in an inexpensive generic form.

The Good News – At PAWL, we now carry this drug, and it can be added to your medicine regimen to help you lose weight!  In other words, you can take the components of Qnexa  now – even before it comes to market.  It is inexpensive, and it can be used along with almost all prescription medicines with no interaction.  It is a nice drug to add to your regimen if your weight loss has slowed, or if you just need a “jumpstart.”  A final advantage to using this drug combination at PAWL, is that we use phentermine at its normal, effective dosages.  Qnexa only has 15mg of phentermine.  As most of you know, this dose is entirely too low to adequately suppress your appetite.  At PAWL, we tailor the dosages of phentermine and topiramate to your specific needs to get the best result. 

If you are interested in adding this drug to your regimen, let us know at your next follow up, or call and make an appointment today. 

Attitude

How To Improve Your Attitude

Do you have what it takes to reach your weight-loss goals? If you think it's all about diet and exercise, you're wrong.
It sounds crazy, I know. Exercise and a proper diet are crucial to all weight-loss and fitness programs. But to reach any long-term goal — especially one that requires a major lifestyle change — you need to improve your attitude too. You can have all the external support in the world, but if your self-esteem is in the toilet, you'll never have long-term success.
Having the right attitude is so important because thought is behavior. The power of the mind is total — the way you think about yourself manifests as your reality. We all know how easily negative thoughts can lead to lack of confidence, hopelessness, and depression. You've heard about self-fulfilling prophecy, right? Well, if you tell yourself that you'll always be fat or you'll never find happiness, chances are you'll end up fat and unhappy. Hey, it makes sense.
Okay then, let's turn that scenario around. Tell yourself that you can get fit and you will be happy. It's that simple. You can master your own fate with positive thinking!

Test Yourself

To see whether your thoughts are predominantly positive or negative, test yourself. It sounds extreme, but you only need to do it once: Carry a small notebook around for an entire day. Each time a thought about yourself pops into your head, write it down and assess whether it's positive or negative. At the end of the day, tally your positive and negative thoughts. Even if you already suspect you lean toward the negative, seeing those thoughts on paper might give you the kick you need! When you change your attitude, you'll change your life.

Colors

What Colors Are on Your Plate?
Pick a color, any color. If you want to improve your health one serving at a time, choose vegetables and fruits of varying colors. Vibrant-colored fruits and veggies give you a range of phytonutrients, each with its own health-promoting strengths. Colorful plant foods happen to be incredible sources of soluble and insoluble fiber — both of which are essential for hormone balance and impossible to get from animal products.
Everyone knows that green veggies are great for you, but you don't always have to think green — explore your options. The UCLA Center for Human Nutrition has developed a system for grouping fruits and vegetables by color for easier selection. I've adapted this system into four categories, and I recommend aiming for one fruit or vegetable from each color group (including the greens!) every day.
Orange:  Carrots, sweet potatoes, cantaloupe, and mangoes are high in beta-carotene, which may help cells communicate with one another a bit more frequently, therefore increasing the body's ability to avoid cancer. Beta-carotene also plays an important role in the production of progesterone, which contributes to a smooth pregnancy.
Yellow: Research suggests that the vitamin C in citrus foods can be a stress-buster. A German study tested this theory by subjecting people to a high-stress situation (they had to do math problem in front of a bunch of other people — I'd say that's stressful!). Half of those studied were given 1,000 mg of vitamin C and half were not. The people who did not get the vitamin C had elevated levels of cortisol and high blood pressure — surefire signs of stress. Those who'd taken vitamin C felt less stressed. (However, why supplement? Get the real thing and eat your vitamin C!) Foods in the Yellow group include oranges, tangerines (I know that sounds odd, but nutritionally oranges and tangerines are "yellow"), yellow grapefruit, lemons, peaches, and nectarines.
Purple: Berries are powerhouse foods that can help you lose weight and keep your blood sugar low, so definitely include them in your diet. Look out for other purple fruits and vegetables too, including plums, prunes, grapes, and eggplant, which all boast numerous vitamins and minerals.
Red: Red fruits and veggies contain the phytochemical lycopene, a powerful cancer-fighting antioxidant.  Studies showed that men with high blood levels of lycopene had the lowest risk of developing prostate cancer. Tomatoes are one of the richest sources of lycopene. Plus, one cup of tomatoes gives you almost 60 percent of your daily value of vitamin C and almost 8 percent of your daily fiber needs. You can get the health benefits from organic pasta sauce, tomato paste, and ketchup — just make sure there's no high-fructose corn syrup in the products you buy!

Fat Burning Foods?

Are There Foods That Burn Fat?
Q: Are there really foods that burn fat? If so, what are they?
A: Not really, but there are foods that contain fewer calories than the body uses to digest them. Therefore, when you eat these foods (cruciferous veggies, leafy greens, and so forth), you're helping create a calorie deficit.
That said, there are also certain foods that will crank up your metabolism by releasing the right hormones. Protein will release more human growth hormone. Foods with selenium and zinc will support a healthy thyroid. You can boost your metabolic rate by eating clean, whole, fresh foods and avoiding processed foods and chemicals. But there is no food that will magically burn off fat. For that, you have to get off your butt and get moving!

Free Food!

Well, some food is virtually calorie free. Even if you're just eating healthy soup or making a salad, definitely include some chopped cruciferous veggies with your meal! Cabbage, kale, and rutabaga all offer more volume to keep you full longer and have practically zero calories — and you get all the good phytochemicals that come with them.