Q. Is the HCG diet a successful means to permanent weight loss?

A. Dr. Smith, one of our surgeons, responded:

“Human chorionic gonadotropin (HCG) is produced by the placenta signaling the hypothalamus to mobilize fat stores in the pregnant woman.  This helps bring appropriate energy to the developing fetus for growth and development.  There are some cancers from the reproductive cells in men and woman which also can secrete this hormone.

The recent resurgence of interest in this hormone has raised questions about the validity of relying on HCG to help people tolerate an extremely low caloric intake of 500 Kcal/day.  While the first attempts at using this approach date back to the 1950’s, strong surges of interest have resurfaced about every ten years.

In 1975 during a similar flurry of curiosity in this weight loss method, the FDA stated: “HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or ‘normal’ distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.”

Many individuals claim to have had success with this regimen; however, several scientific studies using a placebo control group in a prospective fashion have proven that there is no discernible difference in weight loss outcomes. Nor is there an improvement in the tolerance of such a restrictive diet with the help of HCG.

While we all hope for that magic pill or injection which will make weight loss successful and durable, there remains a paucity of proof that the HCG diet fulfills that hope.  Any diet which includes only 500 Kcal/day will lead to dramatic weight loss in the normal adult.  Eventually, returning to normal caloric intake is inevitable to survive, and weight regain is likely to occur. 

The good news in the world of treating severe clinical obesity is that certain surgical procedures do have proven value.  They have stood the test of time and the scrutiny of science. They include Roux-en-Y Gastric Bypass, Adjustable Gastric Band, Biliopancreatic Diversion (Duodenal Switch), and Vertical Sleeve Gastrectomy.  These procedures all help people to adapt to a lower caloric intake. These procedures are successful and durable.

Many comorbid conditions of obesity including sleep apnea, hypertension, high cholesterol, diabetes and heart failure, have all been shown to improve or even disappear following weight loss surgery.  We recommend these procedures for patients with a Body Mass Index (BMI) equal to or greater than 35.”

Q. How do I make a profile on the RMAP website and create a weight loss ticker?

A. The following is a response from a patient, Susan, on our forums: 

“In the blue bar at the top of [the online forums], click on ‘User Control Panel’. Then choose ‘Profile’ from the list on the left side. There are several options to play with there. The ‘Avatar’ is where you upload a photo. The ‘Signature’ is where you put the cute little weight trackers and your name, or whatever else you want to announce.

To get the ticker, go to www.tickerfactory.com and click on ‘weight loss’ to get one of the weightloss themed tickers. Make your selections to create your ticker. After you are done, there’s a box at the bottom with code lines in it. Select and copy the code for ‘bulletin boards’ and then come back here to your profile and paste the code into the signature box. It won’t look like anything until you ‘preview’ your profile. Any changes you make to your profile will instantly change on every post you’ve previously made. Be sure to bookmark the tickerfactory site. You will need to go back there to make updates to your ticker.”

Q. Should I use protein bars/shakes in my routine diet? 

A. Our philosophy at RMAP is to eat for the lifetime; point being to utilize natural/real food for energy sources. We recommend eating 40-60 grams of protein/day, which equates to 160-240 calories/day. This is very achievable by eating more natural sources of protein- yogurt, cheese, beans, tofu, deli meats, chicken, ground beef, steak, and even vegetables. 

Protein shakes are very calorie dense for a small volume, and they will empty your pouch faster than regular food, leaving you hungry sooner. Protein shakes are also not always available wherever you may go in the world, and learning how to eat appropriately on food is the best route to making lifestyle changes. 

There are several patients who have been very successful at weight loss and maintenance by choosing to use protein supplements on a more regular basis. Who are we to argue success in that circumstance? Our philosophy simply stems from the success we have seen in the majority of our patients, and not the exception.

Q. Can I use artificial sweeteners to flavor my water? 

A. Artificial sweeteners like splenda, aspartame, and sucralose that are found in Crystal Light and Propel can be diluted and used sparingly to spice up your water. Do be aware that artificial sweeteners are known to be potent appetite stimulants. Another option is to use lemon or lime squeezes, as well as sliced cucumbers.

Q. If a particular food I consume doesn’t settle well and I vomit it back up, what should I do?

A. If vomiting is a consistent pattern, please call our office at (801)-268-3800. If the vomiting is a one time episode, do as follows: Put your fork down, do not take another bite, and do not drink water for 30 minutes. 

At that point, it is recommended to do a liquid diet for about 1-3 days, varying on the severity of the episode. Write the culprit food down in a journal and it is best to avoid that food for a couple of weeks. As you reintroduce yourself to a regular diet, remember to chew very thoroughly and make sure the prepared food is moist. 

Most common food culprits? Eggs and chicken breast. When eating these particular choices, take extra care: check moisture and chew each pea-sized bite 10-15 times.

In the spirit of the upcoming holiday- let us give thanks! Bring your own success story to share and learn from others’ life changing experiences. Meredith Mangum, RN will be leading the discussion.

Salt Lake City: 11/11/09 St. Mark’s Hospital, Room G04C @ 6pm

Ogden: 11/10/09 Ogden Regional Medical Center, Oak Room @ 7pm

Orem: 11/4/09 Timpanogos Regional Hospital, Women’s Center Classroom @ 7pm

October’s support group has come and gone, but we hope the inspiration gained and information learned has stayed with you. The topic for the month was Vitamins and Minerals, with the discussion led by our three surgeons. Dr. Smith attended Orem, Dr. McKinlay visited Ogden, and Dr. Simper remained in Salt Lake. 

Topic: Vitamins and Minerals. The hope was to remind you what supplementation is needed, and WHY it is needed. We have 30 years of good data on gastric bypass patients specifically, and those who supplement do not have deficiencies. So, as a reminder, our recommended supplementation regimen is as follows:

1) Multivitamin: One/day, we don’t recommend a certain brand, but do know that Centrum is a popular one amongst our patients. For about two weeks after surgery, this pill should be chewable or liquid. Taking children’s vitamins is okay, as long as you take two pills (or the recommended adult dose as indicated on the bottle). Using a gummy bear multivitamin is okay, but do be aware of extra added sugar. Take it at a time that can become habit for you.

2) Vitamin B-12: 500-1,000 mcg/day. Take sublingually (a small pill that is placed under the tongue and absorbed directly into the bloodstream) daily or by intra-muscular injections, monthly. Take at a time that can become habit for you.

 3) Calcium: 1,200mg (pre-menopausal) — 1,500mg (post-menopausal) daily, but it is best to take in smaller doses 3x/day. Hence, 400-500mg 3x/day (at each meal). Do not take your calcium supplement until you are drinking at least 64 ounces of water. For the first two weeks after surgery, this pill will need to be chewable. Calcium Chews are okay to use, but be aware of any extra added sugar.

4) Iron: This may be prescribed by your surgeon at a later date, if needed. Usually only needed by menstruating women. Take at a time that can become habit for you, but with one stipulation: Iron must be taken at least 2 hours apart from the calcium supplement. They compete for absorption sites.

Not only was it a successful discussion on the assigned topic, but it was a good chance for our patients to connect with one another and get answers to questions that have arised since last month’s support group. I was able to attend to Salt Lake City’s group and so enjoyed meeting with our patients on a more personal level.

Look forward to seeing you next month! I need everybody’s participation, as the topic for November is:

            Success Stories. Bring your own success story to share and learn from others’  life changing experiences.

As we approach the colder months of fall and winter, flu season will be kicking into full swing. October 2009 has already seen record numbers of flu cases in doctor’s offices. We would like to remind you that the H1N1 flu is still something of which to be aware.

With simple precautions, we can reduce the spread of the influenza to others.

If you are experiencing signs such as a sore throat, cough, fever (but not always present in H1N1), and muscle soreness you should limit your exposure to others.  With the exception of visits to your primary care physician, or the hospital, you should reschedule non urgent visits outside your home.

Visits to our office should be rescheduled if you are experiencing the above symptoms.

A new website has been established to better guide you if a visit to see your primary care doctor is necessary and if you should stay home from work/school:

        Flu.gov 

If you are still unsure if you should reschedule your Rocky Mountain Associated Physicians appointment or not, please don’t hesitate to contact our office at (801) 268-3800.

Make sure to wash your hands frequently throughout the day, and/or carry hand sanitizer with you. Remember, that after 10 consecutive uses of hand sanitizer, it is no longer effective and a hand wash is necessary. Drink plenty of water throughout the day, get adequate rest (8 hours/day), and eat properly.

Time to take care of you and yours!

Q: Can hair loss occur after weight loss surgery?

A: Yes. Most commonly hair loss happens around months 3 or 4 postoperatively, but that can vary. It does stop and it does grow back. Rest assured, you will not go bald. The patient is the one who notices their own hair loss the most; we are our own worst critic.

No remedy is thoroughly scientifically proven, but some patients swear by biotin, niacin, or gelatin capsules to abate hair loss. As long as you are eating adequate amounts of protein (40-60g/day), the hair loss is stemming from the body’s way of shedding itself while maintaining the most vital organs (the ones inside you!).