QUICKLINKS AND VIEW OPITONS
Lose weight with phentermine, Celexa and 5-HTP: An interview with Marty Hinz, M.D.
Wednesday, September 10, 2003 9:52 am Email this article
"We're getting seventy-eight percent greater weight loss than we got with Fen-Phen," says Martin Hinz, M.D., from Morgan Park Clinic of Duluth, Minn. "This is since we made some additional changes to our program in January of this year."
This interview was published in Obesity Research Update, August 1999, Volume 4 Number 8 Page 60.
Larry Hobbs spoke to Dr. Hinz by phone.
Hobbs: What combination of drugs are you using?
Hinz: We use a combination of phentermine, diethylpropion and the serotonin reuptake inhibitor Celexa (citalopram) plus a nutritional supplement of serotonin and norepinephrine precursors along with a computer program that gives exact calculations for each patient.
Hobbs: What dose of the medicines are you using?
Hinz: 15 to 60 mg of phentermine, 75 mg of Tenuate Dospan (sustained-release diethylpropion), 20 to 80 mg of Celexa plus the supplement of precursors. We start with 15 mg of phentermine in the morning plus 75 mg of Tenuate and 10 mg of Celexa at noon. After one week we add an additional 15 mg of phentermine at noon and double the dose of Celexa to 20 mg. From there we may increase the dose of phentermine to as much as 60 mg and the dose of Celexa to as high as 80 mg. With higher doses of Celexa we tend to split it giving half at lunch and half at dinner.
Hobbs: Do you ever adjust the timing of the medicines?
Hinz: I tell patients that they can take the Tenuate later in the day—as late as 3, 4 or even 5 o’clock—if they notice feeling hungry at night. Most patients who have done this have not reported any additional problems with sleep.
Hobbs: How did you come to use this combination?
Hinz: We were looking for a Fen-Phen replacement after fenfluramine was pulled from the market. Michael Anchors, M.D., Ph.D., had written the book Safer Than Phen-Fen about combining phentermine with Prozac, Zoloft and Luvox. So my partner and I started using these combinations. He started using Phen-Prozac and I started using Phen-Zoloft. We noticed a couple of things.
Hobbs: What was that?
Hinz: First we noticed that a lot of patients who had formerly taken Fen-Phen did not respond that well to Phen-Prozac or Phen-Zoloft. A lot of patients still seemed to be missing something. After doing some research and listening to patient’s other symptoms—things such as chronic insomnia—we decided that patients appeared to be depleted of serotonin. One reason is that fenfluramine depletes serotonin.
Hobbs: So what did you do?
Hinz: We added serotonin and norepinephrine precursor supplements—5-hydroxytryptophan (5-HTP) and L-tyrosine.
Hobbs: Did it help?
Hinz: Yes, it had a profound effect. Patients started losing more weight and other symptoms of serotonin deficiency—such as sleep problems—disappeared.
Hobbs: How quickly did patients notice an effect?
Hinz: Within a week or two. There seems to be a threshold effect with serotonin causing appetite suppression.
Hobbs: What do you mean?
Hinz: Patients would describe the exact day that the supplements kicked in and their appetite was suppressed. It was like a light switch turning on… or in this case turning off.
Hobbs: How much 5-HTP and L-tyrosine do you use?
Hinz: 100 mg of 5-HTP, 1000 mg of L-tyrosine, 1000 mg of vitamin C, 75 mg of vitamin B-6, 500 mg of L-Lysine and 1000 mg of calcium. We used to have patients buy them separately at the health food store but we have formulated a product called 1A that is cheaper for the patients and contains fewer pills than buying each item separately.
Hobbs: Do you ever vary the dose?
Hinz: Yes, sometimes. We give extra 5-HTP for one to three weeks in patients who don’t seem to respond. We also give extra 5-HTP to patients who show an increase in appetite after several months.
Hobbs: How much extra?
Hinz: An extra 200 mg per day. In a few patients we have given as much as an extra 500 mg per day.
Hobbs: Do you only use synthesized 5-HTP based on what one of your colleagues told me?
Hinz: No, not any more. Before we came up with the 1A product we found that only one brand of 5-HTP seemed to work. We thought that this was because it was a synthesized pharmaceutical grade rather than the Griffonia plant extract, but this doesn’t seem to be the case. Our manufacturer has switched to a highly-purified natural Griffonia-derived 5-HTP which seems to work just as well.
Hobbs: Are you worried about Peak X contaminant in the 5-HTP?
Hinz: No. Our product has been assayed at the University of Minnesota and is free from Peak X.
Hobbs: Have you had any side effects from the 5-HTP?
Hinz: Some gastrointestinal upset for the first one to four weeks in some patients, but it seems to be related to their serotonin status. Patients that have more symptoms of serotonin deficiency tend to have more problems with gastrointestinal upset when they first start taking the 5-HTP.
Hobbs: How do you deal with the side effects?
Hinz: Have them start with a lower dose, take it at bedtime, or take it with a soda cracker.
Hobbs: Does it resolve with time?
Hinz: Yes, usually within 4 weeks.
Hobbs: What is the lysine for?
Hinz: To help prevent hair loss. Some Fen-Phen patients experienced hair loss that was corrected with a lysine supplement. So we include it as a preventative.
Hobbs: What is the calcium for?
Hinz: To ensure adequate calcium intake. Low calorie diets are often calcium deficient.
Hobbs: When do patients take the supplement?
Hinz: Timing doesn’t seem to be critical.
Hobbs: What are the side effects of the combination?
Hinz: Celexa causes gastrointestinal upset—cramping and diarrhea—in about ten percent of patients. That’s why we start with only 10 mg for the first week. Other side effects have not been much of a problem.
Hobbs: How about tachycardia? A physician’s assistant who is putting patients on your program said that two of her patients went to the hospital because of tachycardia, one of them with a heart rate of 220 beats per minute.
Hinz: I am aware of those two cases, but none of the other clinics that we are working with have had any problems. We haven’t seen it in any of the 375 patients who have taken Phen-Tenuate-Celexa or Phen-Tenuate-Luvox, nor have any of the other seven clinics that we are working with. So out of about 700 patients who have been given one of the Phen-Tenuate combinations from nine different clinics, I’m only aware of those two cases from just the one clinic.
Hobbs: Is sexual dysfunction a problem with Celexa?
Hinz: Yes, in a few patients. About 3 or 4 percent of patients have delayed orgasm or inability to orgasm.
Hobbs: What do you do for those patients?
Hinz: We’ve found that 15 mg of Buspar (buspirone) twice a day is very effective at correcting this. We have about eight or nine patients out of 250 on the combination who are taking Buspar.
Hobbs: Does the Buspar affect appetite?
Hinz: Two patients taking Buspar reported an increase in appetite but they continued to lose weight. So it doesn’t seem to be a problem.
Hobbs: What other combinations have you tried?
Hinz: Phentermine-Prozac, phentermine-Zoloft, phentermine-Luvox, Tenuate-Prozac, Tenuate-Zoloft, Tenuate-Luvox and Meridia.
Hobbs: How well did the combinations work with Zoloft?
Hinz: Not as well as Fen-Phen, but we found that 150 mg of Zoloft worked a lot better than 100 mg. Patients lost more weight and there was an improvement in other complaints such as premenstrual syndrome (PMS) and migraines.
Hobbs: How well did the combinations work with Luvox?
Hinz: Tenuate-Luvox plus the precursors worked about 30 percent better than phentermine-Luvox plus the precursors. With Tenuate-Luvox patients were losing as much weight as they did with Fen-Phen. But the problem with Luvox is that about 25 percent of patients said that it put them in a mental fog. One guy said he couldn’t even sort his tackle box when he was on Luvox. But then I discovered something with one of my patients who was struggling to lose weight with Tenuate-Luvox.
Hobbs: What was that?
Hinz: I added phentermine and his weight loss took off. So I started adding phentermine to other patients who were also struggling. It seemed to make all of the difference. Then Celexa came along and we started substituting Celexa for Luvox.
Hobbs: How does Celexa compare with Prozac, Zoloft and Luvox?
Hinz: It’s in a league of its own. It’s more effective and has fewer side effects.
Hobbs: What percent of patients do you have on 20, 40, 60 and 80 mg of Celexa?
Hinz: About forty percent are on 20 mg, while another forty percent are on 60 mg. The other twenty percent are divided between 40 mg and 80 mg. The average dose is about 32 mg.
Hobbs: What is the average weight loss with phen-Tenuate-Celexa plus precursors?
Hinz: About 9 percent better than we got with Fen-Phen. But this increased dramatically with the addition of our computer-generated graph.
Hobbs: How much of an increase?
Hinz: An additional sixty percent.
Hobbs: That’s a huge increase.
Hinz: The average weight loss is now 78 percent better than we got with Fen-Phen. Before patients were losing about 65 to 70 percent as much weight as they wanted to. But since we added the graph that number has gone up to 89 percent. I was shocked how much of a difference it made.
Hobbs: What is the average weight loss?
Hinz: Forty-two pounds in the last five months. This is based on an average starting weight of 227 pounds. Our worst patient lost 23 pounds in the last five months.
Hobbs: Are all of your patients on Phen-Tenuate-Celexa?
Hinz: No, I still have some on just phentermine-Celexa and others on Tenuate-Luvox that are doing fine.
Hobbs: What does your computer program do?
Hinz: It’s a database program written for weight practices. It tracks a patient’s weight history, calculates individual calorie requirements, calculates how closely a patient has followed their calorie prescription, calculates their expected weight loss for the next week, two weeks and month. It also calculates how long it will take for a patient to reach their goal weight, and prints out a graph comparing their actual weight loss to their expected weight loss based on the calorie prescription. We have a total of 11,000 patient visits in our database. This way we are able to easily compare the efficacy of the various combinations that we are using in order to determine what works best. It works very well.
Hobbs: How do you calculate calorie requirements?
Hinz: We multiply goal weight in pounds by 10 calories per pound and subtract 500. For example, if someone’s goal weight is 150 pounds we calculate that they should eat 1000 calories per day—150 times 10 minus 500. For maintenance we increase it to 11 calories per pound.
Hobbs: Does the patient determine their goal weight?
Hinz: No. We use the high end of the Metropolitan Life Insurance Height-Weight Tables as the goal weight for everyone. The reason is that a lot of patients change their mind and reduce their goal weight after they start losing. But we know that if we have calculated their calorie requirements based on a higher goal weight that they will never get there.
Hobbs: Have you had any problems with serotonin syndrome?
Hinz: No. There have been no reports of serotonin syndrome in any of the 700 patients taking this combination.
Hobbs: How do you determine if someone is serotonin deficient?
Hinz: We have a list of 24 conditions that we believe are manifestations of serotonin deficiency.
Hobbs: How common are these conditions?
Hinz: Quite common as you can see from the table. For example, 41 percent of patients indicated that they had significant insomnia.
Hobbs: Does your formula reduce insomnia?
Hinz: Yes, the 1A formula helps. But in patients who need additional help we give them 50 or 100 mg of Serzone (nefazodone hydrochloride) in the evening.
Hobbs: How much does your combination suppress appetite?
Hinz: A lot. The average calorie intake is about 800 calories per day.
Hobbs: Have you seen any differences between men and women?
Hinz: No. Men and women respond the same.
Hobbs: How do your ex-Fen-Phen patients say they feel on your combination compared to how they felt on Fen-Phen?
Hinz: Patients report feeling less jittery than they did on Fen-Phen. Some have also reported better mental acuity and feeling less anxious when they are in stressful situations.
Hobbs: What is the “Narrow Range of Success”?
Hinz: It’s a term we came up with to emphasize to patients that if they want to achieve their goal weight they must adhere to the calorie prescription. The computer program calculates the effect of eating excess calories—the dramatic effect it has on increasing the time to reach goal weight or never reaching it at all. This seems to really hit home with patients when they can see in black and white that in order to achieve their goal that they have to watch their calorie intake or they will never get there.
Hobbs: Are you making your database program available to others?
Hinz: Yes. We are making the computer program available, the 1A supplements available, and over 100 articles on weight control available. The articles include patient orientation, physician orientation and administrative management of a weight program. The articles are available at no charge. Physicians are welcome to call me if they are interested.
Articles on the same subject can be found here:
On Mar 09, 2009 at 1:17 am herbalife wrote:
. . . . .
I too take celexa (60 mgs) for depression and phen (30 mgs) for weight loss. I've lost about 20 lbs in 4 months without exercising which I know I need to do.
It seems like such a slow loss but is really in the normal range.
Please feel free to share your comments about this article.
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