Weight Loss Program
Let’s face it, losing fat is difficult. It is relatively easy to know what we should eat, more vegetables and lean meats. And we know what we are not supposed to eat, processed starches, junk food, alcohol. It can also be easy to maintain your weight. But when we try to lose, we are in a constant state of hunger which can actually develop into food obsession and increased cravings!
But don't despair! Dr. Michelle Parsons can assist you with your endeavor to lose body fat and develop increased lean muscle mass and to give you the tools to know which diet approach is best for you as an individual. The latest fad diet, whether it be the Paleo diet, the Bulletproof diet or the Grapefruit diet, though one of these plans might work well for some of us, especially the authors of the plans, they might not work as well for you.
Genetically speaking, we are all different, and we respond better to different dietary approaches. This is where APO E genotyping can help. Knowing your APO E genotype will help guide you whether you could benefit from a higher fat diet, such as the Bulletproof diet, or whether such a high or moderate-fat diet would be disastrous for you, and you would benefit from a higher carbohydrate, low-fat diet. Changing the types of foods you eat, could be all that it takes to help your body burn the food you consume for pleasure and burn it for fuel, and not for fat storage.
Though changing the food we eat will help us feel better, often when we are attempting to lose long-standing stored fat, we need to go into a caloric deficit, where we consume fewer calories than we need to maintain our weight. Often this is an uncomfortable scenario, leaving us feeling hungry for most of the day. In the short term, to get you started on your weight loss journey, if you qualify, Dr. Parsons can prescribe the safe and very effective prescription appetite suppressant, known as phentermine, or Adipex. Prescription phentermine helps to markedly decrease appetite so that while you are cutting down on calories, you do not have to combat the constant annoying symptoms of hunger. You can effortlessly cut back on what you eat and not give food a second thought. Weight loss for most clients begins within one week and continues for as long as you take the phentermine for up to 3 months.
If you are interested in learning more about this program, please make an appointment with Dr. Parsons, at Renove Medical Spa, Rehoboth Beach, Delaware, to discuss your specific weight loss goals. Dr. Parsons will perform a physical exam, go over your medical history, to determine that you are a good candidate for phentermine. People who are typically not good candidates have uncontrolled high blood pressure, a history of heart disease including structural abnormalities of the heart or palpitations, and uncontrolled thyroid disease. If you are over the age of forty, Dr. Parsons will order basic lab work and a 12 lead EKG.
What is Phentermine?
Phentermine is a prescription appetite suppressant of the amphetamine and phenethylamine class. Phentermine, in doses clinically used, works on the hypothalamus portion of the brain to release norepinephrine, a neurotransmitter or chemical messenger that signals a fight or flight response, reducing hunger. Phentermine works outside the brain as well to release epinephrine or adrenaline causing fat cells to break down stored fat, but the principal basis of efficacy is hunger-reduction. It is recommended by the Food And Drug Administration (FDA) that phentermine should be used short-term (usually interpreted as ‘up to 12 weeks’) while following nonpharmacological approaches to weight loss such as healthy dieting and exercise.
People Who Should Not Take Phentermine
Are also taking dexfenfluramine, fenfluramine, furazolidone, guanadrel, guanethidine, or have taken a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) in the last 14 days.
Have severe high blood pressure, an overactive thyroid, glaucoma, heart or blood vessel disease, or severe narrowing of the blood vessels.
Are agitated, or have a history of substance abuse.
Some medical conditions may interact with Phentermine, patients with the following should consult with their doctor before using phentermine: Are pregnant, planning to become pregnant, or are breastfeeding.
Saxenda Daily Injection for Weight Loss
SAXENDA® is a glucagon like peptide 1 (GLP-1) receptor agonist indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in: Adult patients with an initial body mass index (BMI) of • 30 kg/m2 or greater (obese), or • 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g. hypertension, type 2 diabetes mellitus, or dyslipidemia).
DOSAGE FORMS AND STRENGTHS • Injection: 6 mg/mL solution in a 3 mL pre-filled, single-patientuse pen that delivers doses of 0.6 mg, 1.2 mg, 1.8 mg, 2.4 mg or 3 mg.
Week 1 administer 0.6 mg daily Week 2 administer 1.2 mg daily Week 3 administer 1.8 mg daily Week 4 administer 2.4 mg daily Week 5 administer 3 mg daily - Maintenance dose
CONTRAINDICATIONS • Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome t • Hypersensitivity to liraglutide or any excipients in SAXENDA® • Pregnancy
WARNINGS AND PRECAUTIONS • Thyroid C-cell Tumors • Acute Pancreatitis: Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed. • Acute Gallbladder Disease: If cholelithiasis or cholecystitis are suspected, gallbladder studies are indicated. .
Cobalamin, or as it is better known, vitamin B12, is one of the vital nutrients our bodies need to work properly. It is necessary to perform many of the body’s more important tasks, including the making of DNA during cell division and the healthy formation of red blood cells.
Vitamin b12 is known as the “energy vitamin” because it gives a real energy boost. It is used to remedy fatigue and it speeds up the metabolism. B12 shots give a tremendous boost of energy. This generally helps people to maintain their diets and motivates them to exercise and increase physical activity. Vitamin b12 also helps to fight stress and depression, symptoms which are sometimes associated with weight gain.
Lipotropic compounds are those that help catalyze the breakdown of fat during metabolism in the body. A lipotropic injection is a combination of methionine, inositol, choline, (amino acids) and methylcobalamin (B12). It is given once weekly to once every 2 weeks. It helps “release” fat from the liver and the fat stores in the body, speed up metabolism, and reduce appetite.
We are individuals, and what exercise type may benefit some of us, may not be the best choice for a healthy body and brain for you. With APO Genotyping, we can again identify what exercise type you may benefit most from, whether it be a short burst of high intensity, anaerobic exercise, or longer sustained aerobic type of exercise. Strength training to build muscle tissue will be beneficial for most of us as muscle burns calories at rest more than fat. Exercise before breakfast to gain control of your weight. A morning workout before the first meal of the day shows positive metabolic adaptions. A recent study published in The Journal of Physiology involved young, healthy volunteers who were fed a fat-rich diet for six weeks. Some of them performed endurance exercise training (four days per week) in the fasted state, while the others exercised after eating. A third control group did not train.
The group that worked out before eating gained virtually no weight. Those who exercised after breakfast gained an average of 3 pounds each, while the non-exercising bunch put on average of 6 pounds.
Dr. Parsons’ Dietary Recommendations
"I recommend to my clients that while you are using phentermine prescription appetite suppressant that you use this time to initiate a healthy and appropriate calorie diet. Our goal is that you continue this diet after discontinuing phentermine so that you may continue to maintain the fat loss that you achieved while taking phentermine.
Diets I have studied and personally followed include Weight Watchers and the Zone Diet. These two diets, in particular, have been proven in clinical trials to be the two most effective for weight loss. Any diet plan that includes a wide variety of food, including a healthy intake of fruits and vegetable, avoiding heavily processed foods and limiting excess calories, is appropriate for long term health and weight maintenance. If you are interested in following higher fat diets such as the Atkins diet or the Bulletproof diet, I highly recommend that you obtain your Apolipoprotein genotype testing, a simple blood test, to be sure you won’t be causing more harm than good to your body following such an approach.
Include protein in every meal. Protein will make you feel fuller and more satisfied longer than fats or carbohydrates. It also makes your body more energy to digest protein." Dr. Michelle Parsons.
Consume 30 grams of fiber daily. Fiber will also give you a feeling of satiation longer and also takes more energy for your body to process.
Thirst pangs are often misinterpreted as hunger pangs. Drink a glass of water before you eat.
Weigh yourself every morning after urinating. If you have gained any weight, do not eat breakfast or lunch that day. Do not wait until the next day to comply with this. This may seem harsh, but short periods of fasting are not harmful and are beneficial to maintaining a normal weight.
Consume spicy foods. A study by UCLA has shown that eating foods containing capsaicin, a chemical naturally present in hot peppers, can help burn calories by speeding up your metabolism. Scientists tested the amount of energy expended after a meal by people who had taken capsaicin supplements and those who received a placebo. The capsaicin group far surpassed the placebo group, and the effect continued for at least several hours.
Clean eating has no official definition, but it’s usually described as avoiding processed foods, chemicals, preservatives, and artificial ingredients. Instead, clean eaters choose natural foods, the way they came out of the ground or as close to their natural form as possible. Vegetables, rice, sweet potatoes, yams, egg, wild-caught fish, and pastured chickens are clean eating staples.
Anything you want to improve should be measured, and everything related to your nutrition, training and even lifestyle (hours and quality of sleep, etc) should be tracked in writing (or electronically). A great app is My Fitness Pal to enter the foods you consume and Sleep Cycle to monitor your sleep quality.
Accountability is a massive leverage factor in achieving any kind of success, whether in business or a fitness program and here’s where it starts:
Self-accountability, also known as internal accountability, means you set a goal, map out a plan, make a commitment to it and then “keep score.”
You can become accountable to yourself by:
Setting written goals
Measuring body composition
Taking body (circumference) measurements
Tracking results on a weekly progress chart
Creating menu plans or tracking nutritional intake in a journal
Creating workout schedules and tracking training performance in a journal
Remember, “Performance is improved when performance is measured.” Train hard and expect success!
The HCG Diet – Medical HCG also available by consultation.
In a nutshell: The below diet is to be used in conjunction with medically supervised HCG administration only. Without using HCG this is dangerously low in calorie diet and can lead to lean muscle mass wasting.
The HCG program is not for the faint of heart and will take enormous commitment. We recommend starting this plan with a partner as you will need support and accountability. We will plan to meet with you weekly. You will be started on a multivitamin, daily B-complex, and weekly B12 injections. Most people will do 1 cycle. Two cycles may be done back to back or a break may be taken for 1 month on the maintenance plan in between.
Competition Shape (“ripped”):
8-12%Very Lean (excellent): <15%
Lean (good): 16-20%
Satisfactory (fair): 21-25%
Improvement needed (poor): 26-30%
Major improvement needed
(Very poor): 31-40%+
Competition Shape (“ripped”): 3-6%
Very Lean (excellent): < 9%
Lean (good): 10-14%
Satisfactory (fair): 15-19%
Improvement needed (poor): 20-25%
Major improvement needed
(Very poor): 26-30%+
BODY FAT COMPOSITION
Body Fat Levels and Aging
Just a quick note: You’re not destined to get fatter as you get older, but in the general population (not fitness and bodybuilding folks), the average older person has more body fat. What I did to accommodate this was to include a body fat range instead of one number, so younger people can use the low end of the range and older people can use the higher number. Also, single-digit body fat for women and low single digits for men is far beyond lean – it’s RIPPED – and that’s usually solely the domain of competitive physique athletes. Competition body fat levels were not meant to be maintained all year round. It’s not realistic and it may not be healthy, particularly for women (when a female’s body fat gets too low and she tries to maintain it too low, it can affect her monthly cycle or have other health implications).
The average guy or gal should probably aim for the “lean” category as a realistic year-round goal, or if you’re ambitious and dedicated, the “very lean category.” You’ll probably have to hit the “very lean” category for six-pack abs. However, the bottom line is that there’s no “perfect” body fat percentage where you’re assured of seeing your abs.
Vitamins and Weight Loss Benefits
Vitamin K - Poor vitamin K status linked to excess fat tissue; Vitamin K helps metabolize sugars.
Biotin Boosts metabolism by improving glycemic control (stabilizes blood sugar) and lowering insulin, a hormone that promotes fat formation.
Vitamin A Enhances expression of genes that reduce a person’s tendency to store food as fat; Reduces the size of fat cells.
Vitamin E Inhibits pre-fat cells from changing into mature fat cells, thus reducing body fat.
Asparagine – This amino acid increases insulin sensitivity which helps the body store energy in muscle instead of storing it as body fat. Glutamine reduces fat mass by improving glucose uptake into muscle.
Vitamin B5 – Taking B5 lowers body weight by activating lipoprotein lipase, an enzyme that burns fat cells. One study linked B5 supplementation to less hunger when dieting.
Vitamin B3 (niacin) – Treatment with B3 increases adiponectin, a weight-loss hormone secreted by fat cells; niacin-bound chromium supplements helped reduced body weight in clinical trials. Chromium makes the body more sensitive to insulin, helping to reduce body fat and increase lean muscle.
Carnitine Carries fatty acids into cell so they can be burned for fuel; Helps reduce visceral adiposity (belly fat).
Vitamin D Deficiency strongly linked to poor metabolism of carbohydrates; Genes that are regulated by vitamin D may alter the way fat cells form in some people.
Magnesium – Low magnesium in cells impairs a person’s ability to use glucose for fuel, instead of storing it as fat; Correcting a magnesium deficiency stimulates metabolism by increasing insulin sensitivity. Magnesium may also inhibit fat absorption. Calcium Inhibits the formation of fat cells; Also helps oxidize (burn) fat cells.
Inositol Supplementation may increase adiponectin levels.
Lipoic Acid improves glucose uptake into cells, which helps a person burn carbohydrates more efficiently.
Cysteine – Supplementation with this antioxidant reduced body fat in obese patients.
Zinc – Deficiency of zinc reduces leptin, a beneficial hormone that regulates appetite, which is reversed by zinc repletion.
Change Bad Habits
“I eat because I am lonely or bored” – Take a class (like art or theatre), go to the gym, take up a hobby or learn a new language. Do volunteer work. Place yourself in positive situations to meet new friends and expand your horizons.
“I eat when I am stressed. Food comforts me” – Write in your journal what stresses you and where you eat when you’re stressed. Talk with someone who cares about you, about what made you stressed and ways to deal with it next time. You will be amazed at how your hunger disappears when you deal with the real issue.
But do you feel better, less stressed out or lonely after you’ve binged or consumed junk food? Or do you feel worse? Food will not comfort you. You can replace stressful eating with new healthy habits that will make a positive difference in your life.
Weight Loss Myth Busters
QUESTION: Is it possible to not lose body fat because you’re eating too little?
ANSWER: Yes and no. This gets a little complicated so let me explain both sides.
Part one of my answer: I say NO because if you are in a calorie deficit you WILL lose weight.
Most people have heard anecdotes of the dieter who claims to be eating 800 calories a day or some starvation diet level of intake that is clearly in a deficit and yet is not losing fat. Like the mythical unicorn, such an animal does not exist.
Every time you take a person like that and put them in a hospital research center or metabolic ward where their food can be counted, weighed, measured and almost literally “spoon-fed” to them, a calorie deficit always produces weight loss. There are no exceptions, except possibly in rare diseases or mutations. Even then metabolic or hormonal defects or diseases merely lead to energy imbalance via increases in appetite, decreases in energy expenditure or changes in energy partitioning. So at the end of the day, it’s STILL calories in versus calories out.
In other words, NO – it’s NOT your thyroid (unless you’ve got a confirmed diagnosis as such…and then guess what… it’s STILL calories in vs calories out, you’re just not burning as many as someone should at your height and weight).
One famous study that was published in the New England Journal of Medicine years ago proved this point rather dramatically. After studying obese people – selected specifically because they swore they were eating less than 1200 calories but could not lose weight – Steven Lichtman and his colleagues at St. Luke’s Roosevelt Hospital in New York came to the following conclusion:
“The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis.”
That’s right – the so-called “diet-resistant” subjects were eating more than they thought and moving less than they thought. This was probably the single best study ever published that debunks the “I’m in a calorie deficit but I can’t lose weight” myth:
Part two of my answer, YES, because:
Energy intake increases. Eating too little causes major increases in appetite. With hunger raging out of control, you lose your deficit by overeating. This happens in many ways, such as giving in to cravings, binge eating, eating more on weekends or simply being inconsistent, so some days you’re on your prescribed 1600 calories a day or whatever is your target amount, but on others you’re taking in 2200, 2500, 3000, etc and you don’t realize it or remember it. The overeating days wipe out the deficit days.
Metabolism decreases due to smaller body mass. Any time at all when you’re losing weight, your metabolism is slowly decreasing due to your reduced body mass. The smaller and lighter you get, especially if there’s a large drop in skeletal muscle mass, the fewer calories you need. So your calorie deficit slowly shrinks over time as your diet progresses. As a result, your progress slows down even though you haven’t changed how much you eat.
With starvation, you always lose weight, but eventually, you lose so much weight/body mass that you can reach energy balance at the same caloric intake you used to lose weight on. You might translate that as “I went into starvation mode” which wouldn’t be incorrect, but it would be more accurate to say that your calorie needs to be decreased.
Metabolism decreases due to adaptive thermogenesis. Eating too little also causes a starvation response (adaptive thermogenesis) where the metabolic rate can decrease above and beyond what can be accounted for from the change in body mass (#2 above). This is “starvation response” in the truest sense. It does exist and it is well documented. However, the latest research says that the vast majority of the decrease in metabolism comes from reduced body mass. The adaptive component of the reduced metabolic rate is fairly small, perhaps 10% (ie, 220 calories for an average female with a 2200 TDEE). The result is when you don’t eat enough, your actual weight loss is less than predicted on paper, but weight loss doesn’t stop completely.
There is a BIG myth about starvation mode (adaptive thermogenesis) that implies that if you don’t eat enough, your metabolism will slow down so much that you stop losing weight. That can’t happen, it only appears that way because weight loss stops for other reasons. What happens is the math equation changes!
Energy balance is dynamic, so your weight loss slows down and eventually stops over time if you fail to adjust your calories and activity levels in real-time each week.
So what can be done to stop this metabolic slowdown caused by low-calorie dieting and the dreaded fat loss plateau that follows? I recommend the following 5 tips:
Lose the pounds slowly. Slow and steady wins in long term fat loss and maintenance every time. Rapid weight loss correlates strongly with weight relapse and loss of lean body mass. Aim for one to two pounds per week, or no more than 1% of total body weight (ie, 3 lbs per week if you weigh 300 lbs).
Use a higher energy flux program. If you are physically capable of exercise, then use weight training AND cardio to increase your calorie expenditure, so you can still have a calorie deficit, but at a higher food intake (also known as a “high energy flux” program, or “eat more, burn more.”)
Use a conservative calorie deficit. You must have a calorie deficit to lose fat, but your best bet is to keep the deficit small. This helps you avoid triggering the starvation response, which includes the increased appetite and potential to binge that comes along with starvation diets. I recommend a 20% deficit below your maintenance calories (TDEE), a 30% deficit at most for those with high body fat.
Refeed. Increase your calories (refeed) for a full day periodically (once a week or so if you are heavy, twice a week if you are already lean), to stimulate metabolism. On the higher calorie day, take your calories to maintenance or even 10, 15, 20% above maintenance and add the extra calories in the form of carbs (carb cycling). The leaner you get, and the longer you’ve been on reduced calories, the more important the re-feeds will be.
Take periodic diet breaks. Take 1 week off your calorie-restricted diet approximately every 12 weeks or so. During this period, take your calories back up to maintenance, but continue to eat healthy, “clean” foods. Alternately, go into a muscle-building phase if increasing your lean mass is one of your goals. This will bring metabolism and regulatory hormones back up to normal and keep lean body mass stable.
There is much confusion about how your metabolism, hormones and appetite mechanisms are affected when you’re dieting, so this was one of the most important questions anyone could have asked.
If this didn’t click – then you may want to save this and read this again because misunderstanding this stuff leads more people to remain frustrated and stuck at plateaus than anything else I can think of.
Other Weight Loss Medications
A gastrointestinal and pancreatic lipase inhibitor, orlistat was approved in 1999 as the first in a new class of anti-obesity agents. In the gastrointestinal tract, orlistat binds to gastric and pancreatic lipases, preventing these enzymes from hydrolyzing dietary fat into absorbable free fatty acids. When not absorbed, triglycerides are excreted in the feces, along with cholesterol and fat-soluble vitamins. Taken with meals, orlistat can block the absorption of 30% of ingested fat. In this manner, orlistat reduces caloric intake and may have additional benefits. Before using Orlistat, I again recommend APO genotype testing, as some genotypes may respond better to a higher or moderate-fat diet. For those with Genotype E4, treating with Orlistat may be very beneficial.
Adverse effects of orlistat are fairly common, affecting 15%-30% of patients and considered unpleasant and unacceptable by some patients. These include steatorrhea, bloating, fecal urgency, fecal incontinence, and oily stools. Orlistat might also interfere with the absorption of fat-soluble vitamins, including vitamins A, D, E, and K, so it has been suggested that patients taking orlistat should also take a multivitamin supplement containing these micronutrients, at least 2 hours before or after the administration of orlistat.
Orlistat is currently available as a prescription drug (Xenical® 120 mg) or an over-the-counter weight loss supplement (Alli® 60 mg). Although it is approved for long-term weight loss, the somewhat low tolerability and high cost of orlistat may limit its long-term use.
According to Dr. Parsons, while our bodies are amazingly designed to get rid of toxins, they cannot always handle the overload present in today’s environment. Thus, a proper detoxication program is needed, one that includes assessment, minimizing exposure, foods to avoid, foods that protect and nutrients to support detoxification.
A carefully planned detoxification program can offer: anti-aging effects, increased productivity, weight loss, clearer skin and eyes, greater motivation and creativity, reduction of allergic symptoms.
Here is a basic outline of the detoxification program:
NO WHEAT, NO SWEET, NO RED MEAT, NO DAIRY
Use organic and free-range products to reduce exogenous toxins and hormones.
Drink 1 cup of hot water with 1/4 lemon and 2 pinches of cayenne pepper first thing upon waking (on an empty stomach).
Drink 1/2 your weight in filtered water (i.e. you weigh 130 lbs drink 65 oz. per day; more if increased exercise or sauna use).
Water should be consumed up to 20 minutes and resumed 1-2 hours after meals so that your stomach acid can digest your food. (Too much fluid dilutes the acid).
Walk 20 minutes each day.
Do not eat after 8 pm
Buy organic fruits, vegetables, and meats.
Eliminate coffee, alcohol, wine, and refined sugars.
Stopping antacids: drink 1 tablespoon of apple cider vinegar each day. Can us in a.m. or with meals.
If constipation or diarrhea, add a probiotic and extra fiber. You should have at least 2 bowel movements per day.
Remember: “Enjoy breakfast like a king, lunch like a nobleman, and dinner like a pauper.”
Healthy Food Choice Tips
Pistachios – The pistachio nut is a member of the cashew family. Pistachios are cholesterol-free and high in monounsaturated fat, which is good fat and means that they, along with other nuts, will help protect you from heart attacks. The copper, magnesium, and B vitamins in pistachios all strengthen your immune system, making your body fit. These nuts also have a relatively low-calorie value when compared to other nuts. They are also time-consuming to open, limiting total intake. Recommended serving, 30 nuts.
Apple Cider – That lovely, thick, cloudy apple “cider” that you see in your farmers market or supermarket in the fall is way better for you than the clear, filtered apple juice. Researchers have found that apple cider has much more anti-oxidants than clear apple juice. Just as you would think, when the cloudy apple juice is filtered all the good stuff gets stripped right out, along with much of the tart and tangy flavor. Sure the clear juice looks nicer and has a much longer shelf life, but the health benefits are much less.
Let’s get personal
Every person is different—it all depends on your natural body shape and the specific areas of fat you are targeting. We will help you make the decision between a fat reduction plan and a weight loss plan, or a combination of both.
Wow! What a reset. I’ve lost 9 lbs in the first month on Dr. Parsons weight loss program and have increased my energy levels and my appetite has also decreased. This initial weight loss has motivated me to continue to exercise and monitor my daily caloric intake. I would recommend Dr. Parsons weight loss plan to anyone who is in need of a jump start to get rid of stubborn excess weight.