Weight Loss Programs; Medical Credentials?; Beano; Weight Gain & Anti-Depressants; Depression; Over-used Tests.

Welcome back to the Let's Talk Medical with Doctor Gigi follow-up.  This blog refers to the show which was broadcast on Friday April 27, 2012. 


Weight Loss Programs:

I am certainly no expert on weight loss programs, though I did attend a weight loss program myself when I was a teen, & I even underwent a suction lipectomy when I was 24.  I also used to work in a Phen-Fen clinic years ago, so I do understand the desire to discover a magic bullet for obesity!  Unfortunately there still is no such thing.  Though many programs exist, no one program works for everybody, so I really can't suggest one over the other.  I would however like to make you aware that if the program involves an herbal supplement, that supplement is on the market as a food product only.  In other words, unless it is a prescription medication, it has not been evaluated as a medication by the FDA; thus, it is treated as food.  No one evaluates food for safety or efficacy, so again the claims of weight loss have not been verified... unless it is listed on the product label (which cannot make false claims).  So be cautious of supplements, & realize that the gold standard weight loss programs involve a decrease of calories eaten, AND an increase in calories spent.  I like healthy meal replacements like Jenny Craig as they give you complete nutrition but help limit your caloric intake.  Be sure to increase your activity, even if you just take a brisk 30 minute walk every day or two, as this helps to increase your metabolism thus burning off the calories more effectively.

Also, just because a physician has a weight loss program in his office does not mean that it is a great program or more medically sound than others.  It also does not mean the doctor is going to oversee the program, as sadly most doctors have had very little training in obesity & nutrition.  There is a specialty in Bariatrics which we can obtain if we wish to learn more about this, but few docs truly pursue that training.  The draw for physicians to have weight loss programs in their offices is usually a financial incentive, as usually it is a cash pay program.  Unfortunately, doctors no longer make ancillary income through ownership in labs, home healthcare agencies, radiology suites, or medical supply companies.  This, along with the increased costs of running a medical clinic, as well as fairly stagnant fees (which are controlled by insurance companies &/or the government) has resulted in many physicians looking to do things which bring in cash money... as these cash pay services are not controlled by insurance or government. 


Medical Credentials?:

All physicians have an MD or DO degree, indicating that he has a doctorate degree in medicine.  After that however, that are many different residencies which train us to be specialists.  Many of the procedures done by one specialty are also done by other specialists.  Thus an ENT doctor might do a face lift, as Plastic Surgeons are not the only group trained to do this.  After the doctor becomes a specialist, he can also choose to study in other programs to achieve the knowledge needed to do certain procedures, such as liposuction or face peels.

The point is that many doctors are qualified to do procedures, & they get that training in a variety of ways.  You as the consumer have a right however to know what the doctor's training is, so don't hesitate to ask... especially if you are paying cash for a procedure as you are a person who has a choice...


Beano:

Beano is one of my favorite products!  It is basically a digestive enzyme which humans do not have.  It digests certain carbohydrates which are found in gassy foods such as beans & cabbage.  Unfortunately the bacteria which live in your bowel do have this enzyme.  So when you eat these foods which you cannot digest, the food gets to your bowel where your bacteria do digest the carbohydrate... and the byproduct of that digestion is methane gas.  So, if you take Beano with these foods which you cannot digest, the Beano will digest the carb so by the time the food gets to your bowel the bacteria have nothing to do, thus you get no gas production!  Yeah Beano... natural & effective!


Weight Gain & Anti-Depressants:

Many anti-depressants do cause weight gain.  The most notorious for this is Paxil, & I can remember this as we used to say:  "Paxil packs on pounds."  In all fairness, this is probably an issue with all SSRI's, including Paxil, Prozac, Zoloft, Celexa, & Lexapro.  Though Paxil is thought to be the worst offender, it has been modified to decrease it's side-effects including this one.  Paxil was changed slightly to create Celexa, which was in turn modified to create Lexapro.  So perhaps Lexapro (which just went generic) has less weight-gain issue than other SSRI anti-depressants.  There is a new anti-depressant named Viibryd (Vilazodone), which is a special sort of an SSRI.  It has studies which actually show it does not cause weight gain.  If reality proves to be true, it would perhaps be the preferred SSRI anti-depressant as it is also reportedly well tolerated, has little to no sexual dysfunction side-effects, & has less likelihood of a "poop-out syndrome"... call or e-mail if you want to know more about what that is!

We don't really know why weight gain occurs with anti-depressant use, but some propose that they cause the patient to crave carbs, which might result in increased calorie intake.  So I try to remind my patients to be cognizant of this carb craving & to try to make an effort to limit carb intake... & instead to increase protein intake as this tends to be more filling.

So what can you do if you have depression, but are concerned about your weight?  First, watch your carbohydrate intake.  Secondly, ask your doctor if Wellbutrin (= Buproprion) is an option.  Remember however that although Wellbutrin is a good anti-depressant which is associated with very little in the way of weight gain & sexual dysfunction, it is not good if that depressed person also has anxiety.  By the way, the SSRI's (see above) are the best for treating depression AND anxiety.  Another option is to try an SNRI such as Effexor (= Venlafaxine), Cymbalta (= Duloxetine), Pristiq (= Desvenlafaxine), or Savella (= Milnacipran), but they often cause weight gain also.  Lastly, perhaps you should simply take the best anti-depressant for you, & when you feel better physically & emotionally, make better choices regarding your diet & exercise, as often depressed people don't exercise or eat properly.

As a final thought, hypothyroidism is a condition in which a person's thyroid functions too slowly.  The thyroid is essentially your metabolic gland, so when it is slow, your metabolism is slow & you tend to gain weight.  Also, when you have a slow thyroid, you tend to be depressed.  So every depressed patient needs a TSH blood test to rule-out hypothyroidism as part of the problem.


Depression:

How do you know when to take medication for depression?  First we need to understand that depression can be due to outside influences, such as unemployment or relationship issues.  But depression can also be due to a chemical imbalance in the brain.  It is this chemical imbalance which is corrected by the medications we call anti-depressants.  Though some anti-depressants replace the serotonin in one's brain, others replace norepinephrine, & still others replace dopamine. 

Depression is like any other disease... it has a stepwise method of treatment depending upon a patient's disease severity & personal choices.  I suggest that it is similar to diabetes.  If you are diabetic, it is first your responsibility to eat right & exercise.  If that does not control your diabetes, then you might need pills, & ultimately you might need insulin.  So a depressed person should first try to deal with life issues within his control, & perhaps try counseling, but if that is not successful, perhaps medications are necessary... to correct that chemical imbalance.

Realize that anti-depressants often do not work well until you have been on them for 6 weeks, so it is important not to wait too long to try them.  There is no shame in trying an anti-depressant, & you can certainly stop at any time, but they work best if you take them for about one year.  They also can cause a withdrawal if you stop them too quickly, so always speak with your doctor before you abruptly stop or skip doses.  The withdrawal is not an indication that the anti-depressant is addicting however.  The anti-depressant replaces certain chemicals in the brain (as noted above), so when you abruptly stop your pills it takes a while for your brain to try to produce those chemicals, resulting in odd feelings such as shock-type feelings in your body & brain.  After a few days this will resolve, but slowly weaning your dose should prevent withdrawal from occurring.


Over-used Tests:

Recently each of 9 specialty organizations in medicine, including mine... the American Association of Family Physicians... chose 5 tests which they feel are over-used in practices today.  This establishes 45 procedures for which our specialty organizations have given us guidance to help decrease over-use... likely in an effort to rein in healthcare spending.  Most make sense & should not result in withholding of care.  Instead, this sets guidelines which allows doctors to decrease inappropriate use of tests by applying scientific principles to when & why tests should be conducted.  Also, by having these guidelines, doctors have created a means of protecting ourselves from lawsuits which might claim that we did wrong to a patient by delaying such tests.

Remember however that these are only guidelines.  A patient & his physician can always opt to do more agressive testing if the situation calls for it, so be sure to speak with your doctor if you have concerns, as exeptions can always be made.  I think the point of all this is that because we live in an educated society, we have gotten to the point where much of medical care is done at the demand of society or to protect the doctor from lawsuits.  These guidelines will help get doctors back in control of the practice of medicine which should help with the tremendous costs of healthcare. 


And so this concludes another segment of the blog.  Hopefully you found something useful in it, & don't forget to share with your friends & family as perhaps they can learn something useful as well.  And don't forget to tune in on Fridays at 1:00 PM Eastern time when we broadcast Let's Talk Medical with Doctor Gigi live on WTAN 1340-AM in the Tampa/St. Pete area.  If you are not local, you can catch us on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts.  As always, I happily accept questions & comments, & you can reach me during the broadcast via:  (727)-441-3000 or toll-free (866)-TAN-1340, or you can e-mail me any time via:  DoctorGigi@SkipShow.com.

So until the next time, here's to our health!

Doctor Gigi