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Dx Weight Gain Treatment:

N.H.S. Choices
"Weight loss guide features:
*promotes safe and sustainable weight loss
*learn to make healthier food choices
*get support from our online community

*a weekly progress chart (view sample PDF, 545kb)
*exercise plans to help you lose weight
*learn skills to prevent weight regain

We want to help you adopt a healthier lifestyle so you can lose weight safely and learn the skills you need to keep it off in the long term.

Your calorie allowance on the plan:
*Men should eat and drink no more than 1,900kcal a day.
*Women should eat and drink no more than 1,400kcal a day.

If you normally eat a lot more than the recommended 2,500kcal for a man and 2,000kcal for a woman you may find it hard to cut back to our suggested calorie limit. If so, aim to reduce your calorie intake gradually over the next few weeks.

If people are overweight, it’s usually because they
*eat and drink more calories than they need.

Losing weight - Getting started is designed to help you lose weight at a safe rate of 0.5kg to 1kg (1lb to 2lb) each week by sticking to a daily calorie allowance.

If you go over your limit one day, don’t worry, we've got that covered. It simply means you’ll have to reduce your calorie intake the following days.

For example, if you're a woman and you have 1,700kcal on Tuesday – that’s 300kcal more than your daily calorie allowance of 1,400kcal.To stay on track, you’ll need to remove 300kcal from your remaining calorie allowance over the rest of the week.

Information guides:
The guide is delivered through 12 weekly information packs full of diet, healthy eating and physical activity advice, including weekly challenges.

Is this for me?
This guide is intended for use by healthy adults with a body mass index (BMI) of 25 and over. Find out if you need to lose weight using the BMI healthy weight calculator. It is not suitable for children and young people or pregnant women.

If you suffer from any medical condition you should consult your GP before starting.

You are urged to seek the advice of a health professional before starting on any weight loss program.

Each information guide contains a food and activity chart (view sample PDF, 545kb) to help you record your calories, exercise and weight loss so you can see how well you're doing at a glance.

*Print and stick the chart somewhere you can see it, such as the fridge or a kitchen cupboard, and update it at the end of each day.
*In addition to a healthier diet, regular physical activity is a vital component of your weight loss journey.

Not only will it help you lose more weight but it will also keep you motivated and improve your general health and well-being.

As you work through the weeks, you'll get lots of ideas and structured program to help you get active, from easy ways to gradually build activity into your day, to the popular Couch to 5K, 5K+ and Strength and Flex podcasts.

Getting started The links below provide the tools and knowledge you'll need from day one on the plan. Before you download Week 1, it's worth taking a look so you can:
*work out how much weight you need to lose *learn how to count calories on the plan *line up some non-food rewards to celebrate your progress along the way *make the best start on the plan with our 12 weight loss tips *The NHS Choices weight loss guide has been developed under the supervision and advice of specialist dietitians from the British Dietetic Association, which represents registered dietitians in the UK. Thanks to dietitians within DOM UK (Dietitians in Obesity Management) – a specialist group of the British Dietetic Association."

[Editor] Although every weight loss program includes a stimulant or drug that temporarily decreases your brain's desire to eat, the medications will be stopped sometime and the weight will return. The N.H.S. Choices is a long-term easy to adjust to plan for improved exercise and portion control."

*[Editor]: Supplements. An excellent study of post-menopausal women showed that the addition of inositol and alpha lipoic acid in combination reduced insulin resistance by 20% in 66.7% and a reduction in fating insulin in 89.3%. The HDL (good cholesterol) was found to be increased in 48.6%.

*[Editor- reproduced by permission]
Contribution by the Holtorf Medical Group, Inc. - Center for Hormone Imbalance, Hypothyroidism and Fatigue:
CURRENT PATIENTS CALL: You have tried everything to lose weight. You’ve tried the latest and greatest diet or fat-melting workout. You may have tried weight loss supplements or prescription medications but you are now heavier than ever. Sound familiar?

Humans are very successful as a species because we can store energy (fat) very efficiently and have multiple ways to store this energy. Thus, for long-term success physicians must look at the metabolic and endocrinological factors leading to weight gain and not assume it is a matter of will-power to eat less and exercise more. We identify the underlying causes of the inability to lose weight, including hormonal deficiencies, thyroid imbalance, leptin resistance, insulin resistance, mitochondrial dysfunction, metabolic insufficiency, set-point abnormalities and vitamin deficiencies. We have a wide-range of methods to treat these conditions, ultimately leading to weight loss. Diet and exercise is rarely successful for long-term weight loss if such metabolic disturbances are left untreated.

The hormone leptin has been found to be a major regulator of body weight and me­tabolism and dysfunctional leptin signaling results in one of many viscous-cycles that prevents individuals from losing weight. With increased weight, leptin is secreted as a signal to the body to stop storing fat. Leptin stimulates metabolism, reduces appetite and signals the body to burn fat. Studies are finding, however, that the ma­jority of overweight individuals that are having difficulty losing weight have varying degrees of leptin resistance. The leptin is un­able to produce its normal effects of weight loss, with the severity correlating with the degree of obesity and difficulty losing weight. This leptin resis­tance results in a leptin deficiency in the hypothalamus, which is sensed as starva­tion, so multiple mechanisms are activated to increase fat stores, as the body perceives a state of starvation. Baseline leptin levels and the degree of leptin resistance is shown to be a good predictor of a person’s likelihood of achieving successful weight loss with dieting. Leptin levels above 12 ng/dl indicates there is leptin resistance and, as with insulin, the higher the leptin the more resistance is present. Leptin resistance also results in cellular hypothyroidism that is not detected by standard thyroid function tests, including the TSH, free T4 and free T3 levels. The metabolic effects of leptin resistance include a diminished TSH secretion, a sup­pressed T4 to T3 conversion, an increase in reverse T3, an increase in appetite, an in­crease in insulin resistance and an inhibi­tion of lipolysis (fat breakdown). Thus, with leptin resistance, significant hypothyroidism may exist despite the fact that standard thyroid tests look “normal”. If a person is not able to lose weight despite dieting, there is usually a problem with leptin resistance that needs to be diagnosed and treated. With treatment, dramatic weight loss can be obtained. A newly published study presented at the annual Obesity Society meeting demonstrated that new therapies treating leptin resistance are very effective for weight loss in overweight individuals with or without diabetes. In a randomized, double-blind placebo controlled, cross-over trial, it was found that short-term use (less than 4 months) of the leptin sensitizing medication/ Byetta, resulted in significant weight loss in 65% of individuals. In the responders, 48% lost significant weight in two to four weeks with no change in diet. Individuals also experienced increased satiety vs. placebo. There were no reported side-effects with treatment. Studies also show significant improvements in cardiovascular risk factors.

Many doctors are not aware of this class of medications or believe they are only useful to control blood sugar in diabetic patients. As the studies have shown, we have found this class of medications to be very safe and effective for weight loss in both diabetic and non-diabetic patients, especially for patients who have leptin resistance.

Have you wrecked your metabolism with too much dieting or exercise?
You never eat fast food, let alone supersize anything. To the contrary, you are constantly depriving yourself and doing regular rigorous exercise. But you can’t seem to lose weight or keep it off. You starve yourself and run extra miles per week–wow a quarter pound lighter. As soon as you go back to your normal diet routine, the weight comes back. You swear you have no metabolism but your doctor says everything is normal. Your friends recommend yet another fat burning diet but nothing seems to work. Sound familiar?

Could you be doing too much exercise or eating too little? Such a thought is often met with skepticism and eye rolling, as it is assumed you are eating Ding Dongs in the closet at midnight. But it may be that too much exercise or dieting may be to blame. Really, say it isn’t so. All that work for nothing?

Studies show that if you chronically diet or “over exercise” your body may turn on you and reduce your metabolism by suppressing thyroid levels. The body normally produces an inactive thyroid hormone called T4, which is then converted to T3. The T3 is the active substance that is responsible for your body’s metabolism. When it is low or suboptimal, your metabolism is low. When it is high, your metabolism is high.

When the body senses excessive dieting or exercise this normal sequence of events is altered. Instead of converting T4 to the active T3, the body then converts the T4 into a substance called reverse T3 instead of into T3. This causes the metabolism to drop and it is shown to often not return to normal even after regular eating or exercise is resumed. You have now wrecked your metabolism.

A study published in American Journal of Physiology, Endocrinology and Metabolism found that 25 days of dieting reduced T4 to T3 conversion by 50% while a study in the journal Metabolism found that chronic dieting dramatically lowers metabolism that stays depressed even after resuming normal food intake. This dramatic reduction in tissue T3 levels (and increased reverse T3) that results in hypometabolism is not detected by the standard blood tests used by 99% of physicians and endocrinologists.

Mirroring the results of the above study, our center has found that a reduced basal metabolic rate is a consistent finding in those who chronically diet, with many such individuals having a 20-40% lower metabolism than expected for their body mass index (BMI). With such a reduced metabolism, you must eat 500-1000 less calories per day or burn that many calories to just stay even and not gain weight. While diet and exercise are important components of successful weight loss, they will certainly fail to achieve long-term success if metabolic abnormalities are not addressed.

The question is how much exercise or dieting is too much. The answer is, “it depends” because everyone is different. Women are much more prone to this syndrome of exercise or diet induced hypothyroidism than men. And those that do intense yo-yo dieting and have lost and gained significant weight in the past or only eat one meal a day are at particular risk. It is important to determine the extent that a suppressed metabolism is contributing to the inability to lose weight. This is done in our center with in-house metabolic testing and the measurement of tissue thyroid levels, as well as extensive metabolic and hormonal laboratory testing to determine the physiologic basis of the inability to lose weight.

HCG Injection for Weight Loss:
HCG, which stands for human chorionic gonadotropin, is a hormone produced during pregnancy. Research has shown that a small amount injected everyday can aid in weight loss. While most studies were done in combination with a very low calorie diet, it can aid in the selective reduction of fat and reduce appetite, increasing the effectiveness of any sensible diet. Thus, it is not necessary to do a very restrictive diet to see results. There is also evidence that it may reduced the risk of breast cancer and improve prostate health.

Has your set-point malfunctioned?

The basic premise of the set-point theory is that the body has a built in weight regulating mechanism that will tend to keep your weight in a physiologically established comfortable range. Have you felt that despite initial weight loss success, your body will tend to go back to your “normal” increased weight despite significantly reducing calories and/or increasing exercise? There are numerous medications that can result in an increase in the body’s weight set point and stimulate weight gain. These medications include antidepressants such as Zoloft, Paxil, Celexa and Lexapro; SNRI’s, such as Effexor, Cymbalta and Sevella; mood modulators such as Serequel and Abilify; anti-seizure/pain medication such as Lyrica and Neurontin; birth control pills; synthetic hormone replacement; diabetic medications that stimulate insulin such as glyburide and Amaryl; many blood pressure medications; and many more. There are, however, medications that have the opposite effect and lower the body’s weight set. Thus, they can be used to aid in weight loss.

The most recent medication that has been shown to decrease the body’s set-point is naltrexone. This medication blocks a particular type of opioid receptor and has been used for many years to as treatment for a narcotic overdose and to reduce the incidence of relapse in alcoholism and opiate addiction.

At lower dose, however, naltrexone has very different effects. At very low dose it is an immune modulator and has shown to be effective for autoimmune diseases such as Lupus, rheumatoid arthritis, Hashimoto’s and Crohn’s disease as well as conditions associated with immune dysfunction such as chronic fatigue syndrome, Lyme disease and fibromyalgia. At low doses, but higher than the immune modulation doses, it is shown to reduce the body’s set point and cause significant weight loss. The effect is enhanced when used with bupropion (Wellbutrin). In a recent trial, this combination was shown to result in significant weight loss over twice the rate of placebo with an average weight loss of over 17 pounds. Studies also show an increased reported sense-of-well-being and quality-of-life with this combination. There are other medications that can be used to lower the body’s set point, as well.

We have found the combination of naltrexone and buproprion to be effective in a significant number of patients with few side-effects. This combination will soon be available in one pill for weight loss, but can now be given as separate prescriptions.

Related Posts:
Tests Can Reveal Hidden Causes of Weight Loss Failure
Jan 15.Losing Weight Tips for Losing Weight With Thyroid Problems Scale-with-tiptoes-small steps
There’s more to losing weight than diet and exercise.

*[Editor]: The following is an example of not using weight loss medication: diet, exercise, HRT and Thyroid replacement. For some it works very well.
"It’s been 8 months
since that first visit. I’ve lost over 100 pounds..."Karen...I am feeling fantastic and have lost all the pounds with..." "I started hormones, including T3, and things really got going. I lost almost 10 pounds a month until I got to 130. My dress size went from a 12 to a 2. Hormones kept my skin from being flabby.

Medications Used in Treatment:
1. Sympathomimietics: Adipex®-P/phentermine, Bontril® Pdm®phendimetrazine,diethylpropion, phendimetrazine ER
2. Sympathomimietics/ anti-epileptic combinations: Qsymia® /phentermine-topiramate, Suprenza® /phentermine
3. Lipase Inhibitors: Xenical® /orlistat, Alli® /orlistat
4. Central Nervous System Stimulants: Belviq® /phentermine-topiramate, Desoxyn® /methamphetamine
5. Leptin Sensitizing Medication: Byetta®/ GLP-1 Agonists
6. High Protein Diet: Adkin's, Mediterranean Diet.
6. Green Supplements: These work by killing the yeast and bacteria in the gut to reestablish a normal flora. Take twice daily with the protein powder shakes.

Suggested Links:
*Medscape (obesity)
*Merck Manual Home Edition (Metabolic Syndrome)

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