Welcome to presentation number 12. Getting your doctor involved in your goals. I'm a little bias in the session seems to my profession is just that. So hopefully I can give you some good, valid and not very biased information so you can make a wise decision about utilizing your physician. Now that being said, the majority of this presentation is about weight loss medication, medication that can cause weight gain, or just prevent you from losing weight. It's not so much everything else I discussed like in my book obtainable or what does your doctor look like naked?

This is purely a medication or drug talk, if you will. So I have to throw in the old disclaimer just because there's so many medications available online and in Canada and Mexico and everywhere else. And that's why must, you know gotta do the lawyer statement medications and all drugs for that matter can be dangerous. As I'm sure you're aware without proper consultation with your physician. This, this little presentation is not intended to replace medical advice. You have to talk to your doctor face to face.

If you're considering any of these drugs, if you're sick, or if you suspect you're sick, you need to see your doctor if you're taking other prescription drugs. Talk to your doctor about making any changes to medication, particularly when we talk about what drugs can be involved in weight gain and or inability to lose weight. Do not just stop drugs out of nowhere, talk to your doctor about any sort of medication change, any addition of supplements, any of those things. And I would encourage people not to purchase prescription drugs from the internet. Just because there's just so many issues and it's so amazing how many stories Hear almost weekly about fake drugs or drugs that are tainted with other drugs. So it's just the best.

Good idea. Best practices, talk to your doctor first. So can your doctor help you with your health and weight goals? Well, of course they can. I think doctors cannot only supply drugs, as we'll discuss shortly, but can help in treating conditions that can hinder your weight loss and health goals. For example, hormonal problems such as insulin resistance, polycystic ovarian syndrome, those things that makes it very, very hard for people to lose weight.

Just those two simple things all hormonal deficiencies or issues make it difficult to lose weight, thyroid gets blamed the most, but insulins probably the bigger culprit of the hormonal reasons for not losing weight. But we're not going to cover that here. I want to approach this presentation in three separate sections. First, I'm going to give you a little history of the medication and how it's been used for weight loss. second hour I'm going to talk about some more of the more popular weight loss drugs and their indications for both short term and long term weight loss. We have some drugs that have been around forever and some drugs that are relatively new.

So I'll cover both of those for you. And then finally, I'll cover drugs that inhibit weight loss or will even cause weight gain. So I have some other presentations and one really fun I think it's for selected audiences. It's it's the use of a number of drugs that be maybe construed as on the edge or underground, a lot of those out there using the physique world, bodybuilders, fitness gals, etc, etc. I'm not going to cover those in this presentation. So just be aware.

If you're interested in learning more about some of those, feel free to email me. So without question, there's been a long, long history of mad and frantic search for the perfect weight loss pill It was probably one of the first drug ideas that came about when pharmaceutical companies started to really rise. But I don't want to cover all the history behind that. But just know, the weight loss drugs are still probably one of the most sought after medications out there. It's unfortunate, but the majority of the public feels that weight problem is a disorder of will willpower. And for those who don't know that is Mr. willpower there.

Anyway, racecar driver NASCAR, I believe. And if it's a disorder of willpower than weight loss, drugs have nothing to do for you in the long run. And that is a lot of the issues that physicians have with writing, weight loss drugs. The majority of the medical opinion out there focuses on the fact that the drugs must not really work because people eventually plateau on the drug and once a person stops the drug, the weight comes back The logic behind that is a belief of true therapeutic failure and it reflects failure. The drug is what they think. You know, I've been guilty of that when I first started medicine years and years ago, I was like, well, phentermine doesn't work.

Because once you stop it, you put all your weight back on. But I think that's an unfortunate error in logic, as I would, I would, I'm convinced, excuse me, if every doctor out there there wrote drugs for something like let's say blood pressure, hypertension, blood pressure, that medication plateaus, so it only dropped blood pressure so far. So what do we do we increase the dose or we add other medications. And if our patients stop taking the medication, their weight loss or excuse me, their blood pressure goes back up. So does that mean there's a therapeutic drug failure of that particular blood pressure medication? No.

We apply the same logic though, to weight loss drugs. And I think that's unfortunate. Because not understanding some of the mechanisms of action of weight gain, weight loss, just the bigger picture that's missed by most physicians really puts those drugs in a bad light. The answer is obvious to me now and not to use drugs as the solution, but use them as part of the solution. Certainly don't rely on them solely. I think the majority of doctors who write prescriptions for dietary drugs do simply that they write prescriptions for the drugs with no mention of anything else.

Diet exercise, hormonal balance, HPA axis or stress balance. Are there toxins in the environment involved. How's the gut health? What's oxidative stress look like? Everything that we talked about. We'll talk we'll touch on at the end here that I call the five tenets of health if you just write a weight loss drug and forget all those.

Well, of course it doesn't work very well. The other Problem with some of these weight loss drugs is what I call guilt by association. In particular, the appetite suppressants. There are what we call simpatico my medic and means and they're all very closely if not hard to distinguish if you see the chemical structure from amphetamine, all amphetamines, methamphetamine speed crank whatever terminology is being used now for street speed. A lot of these weight loss drugs are very similar. So that may be part of the issue with doctors having a hard time with weight loss drugs.

Now let's dive into the mo a the mechanism of action. The drugs themselves have a variety of different mechanisms of action, but I'm going to cover the primary ones. They all work in one or two of the fine ways to either increase your feeling of fullness satiety. They decrease your hunger or appetite. They inhibit gastric emptying, so slows your bowels down. It causes you to decrease food intake.

Some of them are built to stimulate thermogenesis or energy usage so you burn more calories. Some inhibit the absorption of fats or lipids, and some decrease all food absorption. So, a lot of drugs have been studied in all these areas. They all rely on modifying or mimicking the gut and brain hormones that control all that list I just shared with you. Today, there's only I believe nine drugs are FDA approved for weight loss. And the majority of those are appetite suppressants.

Of interesting note, I think this is very important for the FDA to consider a drug a weight loss drug, it needs to cause a 5% reduction in weight when all other variables are controlled. So if you're a 300 pound individual and you take New FDA approved weight loss drug, it's anticipated you're going to lose at least 15 pounds with that drug. So 5% of 315. Obviously, that's not much but it may be some benefit long term weight loss maintenance. And we talked about, we're going to talk about a couple of the drugs that we doctors use sort of off labels, weight loss drugs. I'll give you one ahead of time, right now, Metformin, Metformin does cause weight loss in people, but if you look at the actual numbers, it's only 2.5% weight loss reduction.

And that is why the FDA does not consider it a weight loss drug per se. of drugs that were around for some time now since at least 1999. Back phentermine. phentermine goes all the way back to the 50s. There's over 1000, blinded control studies on that drug. So we'll talk about that in a minute.

Delta appropriation, very similar to bupropion, one of our drugs we'll cover here, the others other than Real Estate are and excuse me out hard time but my thoughts are, those are all appetite suppressants, their legal speed, if you will. Real estate is a lipid inhibitor. So the majority of the drugs we had out there before the year 2000 all inhibited appetite. By being that simpatico my medic and mean that I described earlier. We had some time there and I was practicing medicine between 1999 and 2012. And I remember all the hype about different drugs, some drugs that actually came out and then were FDA called the one of the drugs that stimulates the cannabinoid receptors, which was never really FDA approved but used a lot here in America because I had patients ordered it had a very, very bad side effect of suicide.

So people got extremely depressed on that cannabinoid receptor drug. And yes, legalized marijuana stimulates the same, I guess illegal marijuana does too, but stimulates the same receptors in a different way. These are blocking it though marijuana stimulates it. And that's why people associate marijuana with the munchies. If you block that receptor, you tend to eat less, but you also get extremely depressed the rates of depression were greater than 55%, if I remember, with a higher rate of suicide on that drug, so that one was never really approved. But long story short, is I get sidetracked there from 1999 to 2012.

There was just a ton of research. All of us in the weight loss field are watching all these drugs be claimed to be the next big thing and, of course, nothing came of it. We'll cover these drugs here right now. Because these are the new ones and these are the ones your doctors are going to be more likely to be familiar with. And understand on a different level, just because of their available ability and the big pharmaceutical companies pushing them to doctors. So let's dive right in with Lorcaserin or Bell wiig is another name of this drug.

It is a serotonin five to see receptor agonist. In other words it works on the serotonin receptor and therefore, one of the potential drug interactions are with other serotonergic drugs such as Paxil, Prozac, Lexapro all those you have to be careful with. It's a schedule for drug which means it is controlled by the DEA, the dosages, usually 10 milligrams twice a day. There are some supplements that interact with the two other supplements or over the counter medications. Similarly, serotonin like St. John's wort, you have to be careful with a lot of potential interactions with this drug. The biggest side effect I CR headache, nausea, dizziness.

I probably when I wrote it a few times, in my experience almost all the patients I let try it had dizziness to the point where the majority of them quit now some did fine on it. But dizziness was the big one dry mouth was another big one I heard about a lot. This is when you have to be careful with if you have a history of psychiatric disorders, including a history of previous drug use alcoholism because there is in some people they get a euphoric feeling with it. That's why it's a scheduled drug. It can cause hypoglycemia and in patients with diabetes on diabetes drug particularly insulin, it can cause some sexual issues and men you have to be careful with and if you have any heart history, you need to be aware of potential valvular disease with a phentermine to pyramid or excuse me. I like this one.

Long before you see me a came out those of us that utilize compounding pharmacies put these two drugs together. I was right in that compound in the late 90s, actually early 2000s. So it's we've been using it for a while. It too is an appetite suppressant. It is a scheduled drug because of the phentermine in there. It's a schedule for now, which is again what we call a short acting Sampath on my medic mean, and then Topiramate or topamax is a neuro stabilizer it's actually approved as a drug in and of itself to treat migraines or prevent migraines.

It's used in seizure or epilepsy. Pretty good drug with some side effects we'll talk about in a minute here, doses this there's a whole bunch of them. And you tend to good idea of doctors taper up with few semia starting at a 3.75 milligram phentermine and 23 milligram to pyramid is the starting dose that you do for two weeks, and then you escalate the dose the top dose of this one is 1500 milligrams of phentermine and 92 milligrams of the total pyramid that you take daily. So there's a lot of potential drug interactions. The big ones I've seen are with oral contraceptives causing irregular menstrual bleeding and women. There's no increased risk of pregnancy, just a lot of female issues with it.

Seen that quite a bit so it's something to be very aware of other adverse effects, pair seizures or numbness, pretty common with Topiramate dizziness again, bad taste in your mouth, some dry mouth but I've seen a lot of people say that their tastes they have this metallic taste in their mouth when using to pyramid and I see that when we use it for headache prevention and or a weight loss. So something to be aware of insomnia is another big one. If you take the phentermine too late in the day, you might be up for quite a while. There are a number of indications hyperthyroidism a drug called a mono amine oxidase inhibitors. We don't use those too much in order, but I do know psychiatrists that do prescribe those. So it's just again, don't order this on the internet, talk to your doctor about it, because there's a lot of potential interactions and issues, but overall, it's probably my favorite weight loss drug combo.

Just a little side note there, just because I've just used it so long and I'm just so familiar with how it works. The next one now, trek zone or bupropion is a combination drug, it's Contrave. Now, Trek's owns an opioid antagonist. And bupropion is what we call amino ketone antidepressant. It works on dopamine and norepinephrine. So this is not a scheduled drug.

The tablets are, I believe, now tractions eight milligrams and the appropriate 90 milligrams and you taper that up as well. Up to two tablets Am two tablets in the pm at the top dose. This too is one that those of us that use compounding pharmacists have been using for a number of years. Another good combination, I use a lot of low dose naltrexone in autoimmune disease, and a few other chronic diseases and it just works really well. I've always liked this drug combination, as well. It does have a ton of interactions, there's a lot of drugs because it's metabolized in the liver.

A lot of different drugs interact with it. So this is one to the you have to talk to your doctor about to make sure you're not any drugs or supplements that could adversely affect you. Big side effects that occur with this very similar list. All the other ones probably the one that's a little different than the other ones is constipation. I've seen constipation with the number of people taking this so a little bit of Metamucil or citrus oil every night while you're taking. This tends to help dizziness, another big one dry mouth insomnia again if you take it too late at night to be appropriate and potentially could keep you awake.

So that's just something again to be aware of just one more reason to get your doctor involved with your long term weight loss maintenance or weight goals. liraglutide Victoza is another one that's been around for a while it is a what we call glucagon like peptide one receptor agonist or a GLP one agonists. It is not scheduled. It's not a scheduled drug. It's a subcutaneous injection. It comes in a number of multi dose pins.

Doses range from 0.6 milligrams once to twice a day to 2.4 milligrams or three milligrams injected into a fatty area like your abdomen, thigh, upper arm. The recommended dose of this drug for obesity is three milligrams daily anytime of the day with or without me. But it's too, one of those that you taper up on over time, starting at 0.6 milligrams a day and increasing it by that amount every week for four weeks till you get to the three milligram per day. The big one with this is nausea. I think that's how it works. You're so nauseous, you don't eat, but it delays gastric emptying.

So it can change the way your other medications and supplements are absorbed. So that's important to be aware of and talk to your doctor about your other drugs, etc. It can cause hypoglycemia, if you're not eating enough. If you're an over exercise or under you're taking taking this drug, you may feel rather yucky, abdominal pains. Another one I see with people and this drug. So there is a risk of something called medullary thyroid carcinoma or thyroid c cell tumors.

That's actually not too uncommon. So it's something To talk to your doctor about if you have thyroid issues or a family history of thyroid cancer, probably one you need to avoid. So just be aware that the older agents used to decrease hunger. They're also closely related. They all have similar side effects, rapid heart rates and anxiety, nervousness. They're all contraindicated in people with a history of drug abuse, while using any depressants, history of eating disorder or seizure disorders, I wouldn't use them if you have coma.

Extremes of age. Also, the FDA says Be careful with never use them in pregnancy or if you're breastfeeding, obviously. The big one out of these four is phentermine. phentermine has a ton of names out of XP open Nick's Good grief pan shape em thin tried pro fast HS IV there's just a bunch of my remember out there. There's some over the counter supplements that some of those drugs once they were pulled or just discontinued for whatever reason, some over the counter supplements were put out there with ephedrine based, which is another Sampath Omen that it can mean. And people thought they were getting phentermine, but they weren't.

So I haven't seen those in a while. I think the FDA clamped down on that, but just something to be aware of. sent to me I wanted to spend a little more time on it just because it is the most popular one out there. It got a bad rap A few years ago, because of a drug combination called thin thin ph n dash FM fen fen and that was using phentermine and a drug called thin flourishing. Fleming had a metabolite called north and Flora mean that was actually the issue And probably not the fence for me. It It was found that the north and Flora mean caused heart valve disorders doctor at the Mayo Clinic actually was one that was at the forefront of that discovery.

And so that drug was rapidly pulled but phentermine kind of got a bad name with that just because, again, guilt by association center mean does not cause addiction because you had to stimulate dopamine, the real really feel good chemical in your brain. And the way that's done. phentermine does not have a methyl group on the side chain with a nitrogen. Like a lot of the other sub pathway medica means like amphetamine. So you're less likely to have a true addiction with it. Now Could you be addicted because you think you can't lose weight without it?

Well, yes, there's different levels of addiction. The other thing that people are worried about with phentermine is blood pressure. From a pharmacological standpoint, phentermine does not bind to alpha receptors and therefore really shouldn't affect blood pressure. So my thought is that the occasional short term rise in blood pressure that you see with phentermine may be due to increase norepinephrine release, that is norepinephrine and adrenaline in your brain. That is another simpatico movement. It can mean when people first start taking the drug, but in my experience, people that are on phentermine after they get over that first few weeks like bumping blood pressure, their blood pressure goes back to normal.

So it really is a good drug for appetite control. And, right now, the FDA as stated in the physicians Desk Reference, which I may add as a politically correct trolled periodical, but that phentermine should only be used at a maximum of three months or 90 days. That would make it a weight loss drug, but not a weight loss maintenance drug. But I think it can be used for both how it used in long term number of different ways to do it. If you have a big party to go to if you are on vacation and don't eat that much, in other words it can be used more as an as needed thing versus a daily thing. If you're on a lifestyle plan have a Christmas party coming up you're scared to death because you know your coworker is makes the most delicious, downright malevolent sugar cookies eventually might help you eat one not 20 of those.

So I think there's some benefits to long term phentermine use when you do it, right. It's certainly not for everyone. You need to talk to your doctor and decide especially it's a good idea for you to find a doctor that understands the drug real well. Because I think is one that can be used for long term weight loss maintenance. agents to decrease fat absorption. This one I don't like this guy at all real estate A cow.

It's over the counter now called Ali, it's been over the counter for a while. It's really called gastric and pancreatic lipase inhibitor. Those are the important enzymes that help you absorb fat. So when you take a real istat, you decrease absorption of roughly a third to a half of your fat. Weight Loss, actually, in the studies wasn't phenomenal. It's anywhere between six and nine pounds over a few months.

So to lose six pounds, you have runny, oily stools that spot your shorts every day because you can't control I don't think it's worth it. Not a good trade off. It's approved for children as young as 12, which is interesting, a lot of most of the drugs, if not all of them are suggested in kids but this one is that but that side effect is I'm not too happy with. I personally like my patients and so I'm not going to give them something that causes them to be incontinent stool And oily spotting in their underwear. Anyway, not my favorite drug, but I think you should be aware of it. There's some off label use of drugs for long term weight loss maintenance that I'll cover, there's a bunch of them.

Like I said, there's a whole bunch of underground ones. I'm not going to cover those, but I'm going to cover some of the main ones because a lot of doctors use them as weight loss drugs, even though they might not understand the true mechanism behind it. There's a couple things I like about it costs. These drugs tend to be cheaper than some of those more expensive, newer weight loss drugs, they told you about. Side effects you need to be again, talk to your doctor about them and stuff. But some of these are also convenient as well.

So let's cover some of those. First, bupropion is a norepinephrine and dopamine reuptake inhibitor we call them an MD ri. And it was found indirectly when people were being treated for depression, they lost weight on the drug. So the actually went through some trials to try. I think there was two trials back in 2000 to 2003. rains that showed bupropion, dosages of three to 400 milligrams of the SSR version showed a roughly up to if I remember a 10% total weight loss. So that's pretty good actually, but never really, really approved for that.

There's an Excel version we use in depression. That seems to have the same effect, but the SSR version is much cheaper. I found the ASR version, Merce much better for weight loss because you take it twice a day. But once again, it's just one of those that needs to be discussed with your doctors I banned that you see up there was for same drug but use for smoking cessation, because they also found that when people are treated for depression with this drug, they tend to quit smoking. So has some advantages there. Metformin, gluco five, this is another drug.

We use in Insulin resistance and diabetes. We use it in polycystic ovarian syndrome. We use it in infertility issues related to polycystic ovarian syndrome. It basically increases insulin sensitivity, and it reduces hepatic or liver glucose production. So it does work, it doesn't really lower your blood pressure too much. But it does help indirectly with weight loss like I shared with you earlier.

There was a study called the diabetes prevention study. Metformin group lasts roughly 2.5% of their body weight over 3.2 years of follow up. So and as I told you earlier, a weight loss drug needs to be FDA approved and call the weight loss drug, you need to lose 5%. So it didn't have that and it was never approved as a weight loss drug. But it is one of those that can be utilized in a long term weight loss plan, especially if you have underlying insulin disorder. Orders such as P, PCOS, insulin resistance, diabetes, etc.

Again, talk to your doctor about that and decide if that can be part of your long term plan. There's a number of supplements that I won't cover that kind of mimic the actions of Metformin. One I'll just throw out there. I just totally spaced the name as I'm talking here, because I just said I wasn't going to say it. But I can cover supplements if anyone's interested that have similar actions in the future here. To pyramid again, we've used this as a weight loss drug for some time.

Some people use it for sleep headache prevention, it's what we call a carbonic and dried on hydration inhibitor. And it has effects on GABA, which is gamma gamma amino butyric acid. It's a hormone in your brain. It's the one inhibitory hormone in your brain. And we think that's how it helps reduce food intake. Weight Loss at three months with the drug alone from anywhere from doses from 25 200 milligrams a day were between three and 7%.

The manufacturer the drug stopped all those studies because they didn't wasn't working as well. Again, it's used in combination with phentermine called q semia. Again, as I shared with you earlier, that is a good drug. This drug when use alone, I've had luck with it. When people get a lot of nighttime cravings and eating you take a short acting real low dose 1525 milligram compounded to a pyramid in the evening and it tends to make you eat less and then sleep pretty well. Following you have to be real careful if you have blood pressure issues with this drug because it can drop your blood pressure.

Pretty dang low. testosterone is another drug that people think is great for long term weight loss maintenance and I would agree when done appropriately. Testosterone I won't spend a lot of time on there's tons of information on it, my site and there's a full masterclass if you want to under testosterone replacement. But in and of itself, it does not cause fat loss. I think the bodybuilding and physique world tends to think it's a huge fat burner. It does help the big picture.

But I think just optimization of all your hormones is what helps long term weight loss maintenance, not just this one. I'm just mentioning this one because this is one I get asked all the time about. Yes, my patient profile might be a little biased, but it's, it's one that I think is important to understand. It's just a hormone that needs balance with all the other hormones. Let's talk to you about some drugs that are very commonly prescribed actually inhibit weight loss, or are guilty of causing weight gain. I'm going to cover a few the more common ones here and provide some potential alternatives.

But to reiterate, do not change your medication on your own. If you happen to be on one of these I mentioned taught your doctor About a workable alternative for you, I just think information so powerful. If you haven't, then you know what to go talk to your doctor about. When I look at a drug, I consider all the aspects of the drug. Whether that drug is weight positive, causing weight gain, weight neutral won't affect your weight or weight negative will actually cause weight loss. And I really do my best not to prescribe any weight positive drugs really focus on the weight neutral or weight native drugs.

And so that's what kind of this list is about. It's kind of long, but all of them are in your handouts there. So we won't go over them in great detail, but I'll just cover some of the main points. These drugs are for blood pressure, hypertension, so the ones that are actually known to cause weight gain, your beta blockers are the big ones. There are beta blockers that do not have a weight positive effect. Such as color red is one that's a great one.

It's not on here. Waiting Negative drugs, ACE inhibitors ARBs. These do not cause weight gain, they're more weight negative. Believe it or not, the ACE inhibitors in our little rat friends are shown to be weight negative drugs actually cause weight loss in rats. I don't know if that happens in humans, but it's definitely I would tend to lean toward that drug to treat blood pressure versus some of the other ones. Diabetes there's a lot of drugs that cause weight gain and diabetes and insulin should be on the list underweight positive.

But wait negative drugs meant for me we kind of talked about by ADA. We talked when we mentioned Victoza up above. We used to treat and it's actually one of our quote unquote weight loss drugs. Now I didn't put it on there just for that reason. But there's definitely choices that you need to sit and talk with your doctor about. If you're on one of the weight positive drugs as we know that weight gain and diabetes tend to go hand in hand Chicken in the egg question, but there still go hand in hand.

Depression and anxiety. A lot of them can be weight positive. There's some arguments as whether the SSRIs like Prozac, Paxil, Zoloft, cause it I would say Zoloft definitely is more of a weight positive drug. They're the early makers of fluoxetine. Prozac actually did some weight trials with high high doses, I think they have to 90 100 milligrams of Prozac a day. All those studies were discontinued because it didn't have the effect they'd hoped for.

We talked about bupropion as a weight, negative drug, some other ones that are classified as SSRIs Cymbalta. facture may be more weight neutral. for chronic headaches, beta blockers and Nao eyes are used. Again, those are way positive we talked about to pyramid so maybe an alternative if you're on any of those for chronic headache management. For sleep disorders, a lot of people have issues with sleep nowadays that is a big issue and a big problem. And it's a lot more than just the fact you can't sleep.

There's so many variables out there, but some of the common drugs that doctors prescribe to help people sleep may actually cause weight gain, so be careful with those. Some of the non benzodiazepine hypnotics such as Ambien Lunesta are more weight neutral. There's over the counter supplements definitely tend to be more weight neutral melatonin being one of them, phenol Gabba being another, there's a lot of options out there. So if your doctor prescribes you amitriptyline to sleep, you are going to gain weight. So just be aware that for chronic pain, that's a very similar list. We use a lot of the old tri cyclic antidepressants for chronic pain.

Fibromyalgia is a big one I see amitriptyline and some of these other ones in Some weight negative or weight, neutral alternatives effects are Cymbalta. I know a lot of Doc's now using those drugs for fibromyalgia and chronic pain rather than some of the old antidepressants and antipsychotics like you see here. And a histamines are one you can think of, but Benadryl can actually cause weight gain. We talked about sleep disorders earlier you taking Benadryl every night and could potentially increase your waking. So my alternative is is stay avoid allergens stay well hydrated and eat right now. That being said, I could also add it on this list.

Some of the non sedating antihistamines like Allegra Allegra is a good option. Claritin is another good option if you have allergens, but these real common anti histamines are very well known to cause weight gain. As you can see, one of them at the bottom is also used as an nausea pill. So just Be aware of them. Again, I'm providing these just as a general information so you can help. I didn't make a slightest but I do want to mention one of my arch nemesis drugs called proton pump inhibitors.

Therefore gastro esophageal reflux disease or GERD, those can cause weight gain, and a very, very hard time losing weight just due to the malabsorption of minerals most importantly being magnesium. So I would also if you can do your best to get off those reflux disease drugs because those two can cause problems with you losing weight and keeping your weight off. Just want to re emphasize that the big tenants of health, HPA axis hormonal health, toxins in your environment, oxidative stress, and gut health also should be talked about with your doctor. I just mentioned my book down there at the bottom obtainable. It's on amazon.com covers all those ingredients. detail and in relationship to weight gain weight loss.

So I apologize this was a slightly longer presentation than some of our other ones. But it just leads us right into a very important one. That's next called the behavioral aspects of eating. And I will see you then if you have any questions about this presentation, do not hesitate to send me an email. Thanks so much.