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  • Phen-Celexa-5-HTP: Focusing on Fat, not BMI: An interview with Dr. William Wilson


    Posted by .(JavaScript must be enabled to view this email address)
    Friday, May 21, 2004 8:01 am Email this article
    "Presenting symptoms and excess body fat should be the determining factor for treating obesity, not body mass index," says William L. Wilson, M.D. of Chisholm, Minn. "We have found that Body Mass Index (BMI) does not consistently correlate with percent body fat until BMI exceeds 35.2.

    William Wilson, M.D., a Board-Certified Family physician, discusses his use of phentermine, Celexa and other SSRIs along with supplements in addition to basing treatment on body composition, not BMI.

    Larry Hobbs interviewed Dr. Wilson by phone.

    Hobbs: How do you define and determine when to treat obesity in your practice?

    Wilson: By directly measuring percent body fat. We don’t base diagnosis or treatment decisions on body mass index (BMI).

    Hobbs: Why not?

    Wilson: We have found that BMI does not consistently correlate with percent body fat until BMI exceeds 35.

    We based this on a study of 522 of our patients and found that many had excessive body fat relative to their lean body mass despite having a BMI of less than 30.

    In other words, these “normal-sized” or even thin individuals had percent body fat measurements in the obese range.

    We also found that it is also extremely important to measure percent body fat before and after weight loss or treatment.

    Hobbs: Why is that?

    Wilson: Some patients lose weight but their percent body fat actually increases.

    Hobbs: Can you give me an example?

    Wilson: Sure. One female patient lost 20 pounds on a calorie-restricted diet but her percent body fat increased from 35 percent to 40 percent, indicating that she lost only lean body mass and virtually no fat. This is not healthy weight loss.

    Hobbs: What causes this to happen?

    Wilson: It is the result of the calorie-restricted diet which I do not recommend. It is essential to change diet composition and to avoid a negative caloric balance. A person’s daily caloric intake must come close to the body’s actual metabolic needs.

    Hobbs: What about exercise?

    Wilson: Exercise alone has little or no effect on body composition in people with excess body fat. The same is true of excessive calorie restriction—it causes weight loss but has little or no effect on body composition.

    The best that can be expected from diet and exercise is for a person to maintain their current percent body fat.

    I have NEVER had a patient reduce their percent body fat with diet and exercise alone.

    Reducing percent body fat to normal requires some type of medical management.

    The ideal exercise plan consists of half aerobic exercise such as walking, jogging, biking, swimming or cross-country skiing and half strength training which involves lifting weights.

    Hobbs: What are your dietary recommendations?

    Wilson: It is most important to restrict or eliminate highly-refined carbohydrates, alcohol and soft drinks, as well as increase the intake of high-quality protein.

    Most people need to roughly double their intake of protein so it is 25-30 percent of calories. It is also important to decrease the intake of saturated fat and partially hydrogenated fats and to increase the intake of monounsaturated fats and omega-3 fats from cold-water fish. And, as I said before, I do not recommend calorie-restricted diets because they never significantly improve body composition.

    In my experience the only effective treatment for people with excessive body fat is a combination of healthy eating, exercise, medications and supplements.

    Hobbs: What medicines do you use?

    Wilson: When medical treatment appears to be indicated, I use various combinations of medications including dopamine/norepinephrine-enhancing medications such as phentermine, Wellbutrin SR (bupropion sustained-release) or Tenuate Dospan (diethylpropion sustained-release) combined with serotonin enhancing medications such as Celexa (citalopram), Effexor XR (venlafaxine extended-release), Luvox (fluvoxamine) or Serzone (nefazodone).

    Hobbs: What dosages do you use?

    Wilson: It varies by patient and must be individually titrated against each patient’s symptoms, but in general I use phentermine 15-30 mg in the AM and sometimes add a second dose of 15-30 mg in the mid-afternoon, often combined with Celexa 10-40 mg in the AM, Effexor XR 37.5-75 mg once or twice daily or Luvox 12.5 to 100 mg once or twice daily.

    Occasionally I’ll give Serzone at a dose of 50-150 mg twice a day.

    I often augment with low doses of Wellbutrin SR 100-150 mg once or twice daily or Tenuate Dospan 75 mg in the AM and Tenuate 25 mg in the mid-afternoon.

    Sometimes I combine three or four of these medications in lower doses.

    The decision of which drugs to use and the appropriate doses are entirely based on the patients symptoms and response to treatment. Because these drugs are being used to treat symptoms rather than weight, their use falls well within current practice standards.

    Hobbs: Do you use any Prozac, Zoloft or Paxil?

    Wilson: No, not in people with elevated percent body fat. While they may in some cases cause short-term weight loss, eventually these medication seem to cause a rise in percent body fat in genetically susceptible individuals.

    Hobbs: Have you tried Meridia (sibutramine) or Xenical (orlistat)?

    Wilson: Yes, but they are not very effective in most patients. I’ve found that they improve body composition in only 20-25 percent of patients who try them. Xenical might be useful in some patients but it probably is most effective as an add-on medication, possibly in people who have lipid abnormalities.

    Hobbs: Do you use any supplements with the medications?

    Wilson: Yes. I often add 5-hydroxytryptophan (5-HTP) in patients taking SSRI’s who have symptoms of serotonin deficiency. And I add tyrosine to patients taking phentermine, Tenuate Dospan or Tenuate, or Wellbutrin SR in patients with symptoms of a dopamine/norepinephrine deficiency.

    Hobbs: What are the symptoms of serotonin deficiency?

    Wilson: Carbohydrate craving, lack of satiety, mood swings, depression, dysthymia, anxiety, premenstrual syndrome and obsessive-compulsive thoughts.

    Hobbs: What are the symptoms of dopamine/norepinephrine deficiency?

    Wilson: Fatigue, excessive hunger, mental preoccupation with food or eating and chocolate craving.

    Hobbs: Are 5-HTP and tyrosine helpful?

    Wilson: Yes, when indicated. They augment the medications and enhance their effects, especially in patients where improvements in body composition have plateaued but a patient’s percent body fat is still in the high-risk range.

    Hobbs: How much do you use?

    Wilson: 100 mg of 5-HTP usually given at bedtime and 500 to 1000 mg of tyrosine given once or twice a day with breakfast and supper.

    Hobbs: How do you measure body fat?

    Wilson: We use the Futrex 5000 Body Fat Analyzer. It uses near-infrared light technology. It is ideally suited for a practice setting because of its ease of use and reliability.

    Hobbs: How much body fat do you consider excessive?

    Wilson: I use a table which shows age-related ranges of percent body fat, by far the most useful measure of body composition. (See table.)

    Hobbs: How quickly does body fat decrease?

    Wilson: One or two percent per month.

    Hobbs: What is the average decrease in body fat?

    Wilson: Ninety percent of patients experience a decrease in percent body fat. Roughly one-third of patients reduce body fat by 8 to 12 percent, another one-third by 4 to 7 percent, and the other one-third by 1 to 3 percent.

    Hobbs: What is the average weight loss?

    Wilson: Approximately seventy percent of patients lose anywhere from 20 to 100 pounds, another fifteen percent experience no weight loss, and maybe fifteen percent gain weight even though they reduce their body fat.

    Hobbs: What is the average weight loss that accompanies improved body composition?

    Wilson: I only weigh patients to calculate their BMI but otherwise all diagnostic and treatment decisions are based on body composition. Weight is not used as a medical diagnosis. Obesity is defined as excessive body fat which often does not correlate with weight or size. If a patient has an elevated percent body fat, weight and size are irrelevant.

    Hobbs: Did I hear you correctly?

    Wilson: Yes, weight and size are irrelevant.

    I don’t care for the term obesity because it implies largeness or excessive weight and does not reflect the underlying pathophysiology of the illness.

    I prefer to call it hypothalamic dysfunction syndrome or HDS for short.

    All of my patients with excessive body fat seem to share a very well defined set of symptoms indicating deficiencies in either dopamine/norepinephrine and/or serotonin in the hypothalamus. Whereas people with normal body composition almost never experience these symptoms.

    Hobbs: What do you think causes HDS?

    Wilson: I believe that HDS is triggered in genetically susceptible individuals by eating a modern western diet which contains an excessive amount of highly-refined carbohydrates, partially hydrogenated oils and saturated fats.

    It appears that the hypothalamus is able to auto-regulated percent body fat almost independent of caloric intake in healthy individuals when food is abundant. However, in times of food shortage the hypothalamus shifts to excessive fat storage in preparation for a possible famine.

    I believe that the modern western diet damages the hypothalamus to the point where it is no longer able to auto-regulate fat stores and genetically-susceptible individuals gets stuck in a fat storage mode where body fat rises regardless of caloric intake.

    Hobbs: Does viewing the condition as HDS rather than obesity affect treatment?

    Wilson: Yes. Treatment should be based on the presence of these symptoms of hypothalamic dysfunction and on directly measured high percent body fat. Using this definition, the disease includes a wide range of disorders now thought to be psychiatric in nature including anorexia, bulimia, binge eating disorder, night eating disorder, atypical depression and traditional obesity. Patients with all of these disorders share the same symptoms—they all have excessive high percent body fat and they all respond to the same treatments.

    Hobbs: Are there other triggers for the disorder?

    Wilson: Yes. In addition to eating a modern western diet secondary triggers include childbirth, menopause, quitting cigarette smoking, surgery and stress. It can also be triggered by many different medications such as corticosteroids, antihistamines, many antidepressants and most anti-psychotic medications.

    HDS is twice as common in females as males.

    Triggers are most obvious when patients can remember the exact day that their symptoms started and these symptoms are always associated with a feeling of increased fatness and body expansion which occur long before body size or weight noticeably changes.

    And the problem is that once the disorder surfaces, the symptoms are always progressive—the hypothalamic damage is probably permanent and the only decision left to be made is whether to treat the illness or not. In my experience, a person with HDS has no chance of normalizing their body composition without medical intervention.

    Hobbs: What symptoms do you look for?

    Wilson: Symptoms of a dopamine/norepinephrine deficiency include:

    1. Extreme fatigue or sluggishness is the most prominent symptom. Patients say that they feel lousy and don’t have enough energy to function normally.
    2. Excessive hunger drives, that is a strong desire to eat regardless of food already eaten.
    3. Abnormal eating drives which include eating when a person is not hungry, constantly thinking about food or thinking about eating, night eating syndrome, and/or binge eating.
    4. Abnormal cravings for chocolate.

    Symptoms of a serotonin deficiency include:

    1. Lack of satiety, that is not feeling full after eating a normal amount of food.
    2. Menstrual irregularities which include heavy or irregular menstrual cycles or severe cramps.
    3. Mood instability which includes depression, anxiety, panic disorder, premenstrual syndrome (PMS), obsessive compulsive thinking, or unusual and excessive mood swings (dysthymia).
    4. Carbohydrate cravings, that is cravings for sweets and/or starchy foods such as bread, potatoes and junk food all of which are one of the hallmark symptoms of the illness.


    Hobbs: How important are treating symptoms?

    Wilson: Extremely important. In my experience symptoms MUST be significantly suppressed or disappear before body composition begins to change.

    Diet, exercise and treatment with drugs and/or supplements must be titrated against the symptoms.

    When the dose and combination of medicines and supplements is correct, patients respond as though a light switch has been turned on. I call it the “Fen-Phen Effect”.

    Patients can tell you the exact day that they started feeling “normal”. In fact, I can usually tell if a patient has improved their body composition just by asking them about their symptoms. If their symptoms have disappeared I know that their body composition has improved. I am completely symptom-based when it comes to treatment. I have learned that body composition never improves unless the symptoms of HDS improve or disappear.

    Hobbs: How important are medicines in your practice?

    Wilson: They are essential for many patients but must be combined with proper diet and exercise. Hypothalamic Dysfunction Syndrome is a treatable illness, but no more curable than is diabetes or hypertension. The goals of treatment are to improve quality of life by eliminating the debilitating symptoms of the illness and decreasing morbidity and mortality by improving body composition.

    Diet and exercise are not enough to correct the chemical imbalance or dysfunction in people with HDS. That is what is most frustrating for patients—that traditional treatments such as calorie restricted diets are not only ineffective but can make the condition worse.

    I think it’s encouraging for patients to know that HDS is an illness rather than a choice and I try to train patients to recognize their symptoms so that they know when their illness is stable or out of control and when to seek further medical advice about adjusting food composition, exercise, the medications and supplements.

    —END

    Futrex 5000 Body Fat Analyzer. Information on the Futrex 5000 Near-Infrared Body Fat Analyzer can be found on the web at http://www.futrex.com or by contacting them at Futrex, Inc, 6 Montgomery Village Ave, Gaithersburg, MD 20879; Tel: (800) 255-4206 or (301) 670-1106; Fax: (301) 670-1103; .(JavaScript must be enabled to view this email address).
    REFERENCE

    Articles on the same subject can be found here:


    COMMENTS

    On May 22, 2004 at 9:23 am robert skversky m.d. wrote:

    . . . . .

    In reference to the woman with 20 lb weight loss and an increase in body fat %; my suspicion is that much of the weight loss was water (part of lean body mass)and thus an increase in body fat % rather than body fat pounds. would be interesting to see the actual readout from the analyzer. dr s

    On May 22, 2004 at 5:35 pm William Wilson, M.D. wrote:

    . . . . .

    The patient in question was followed over a period of months and the changes persisted so I don't think that water loss was a major factor.?

    Most water loss occurs quickley and the Futrex machine will measure water weight as well as lean body mass weight and fat weight.?

    We have seen many patients who have lost substantial lean body mass through calorie restricted diets and this seems to be fairly consistent.

    On May 24, 2004 at 3:58 am mark h eig, m.d. wrote:

    . . . . .

    dr wilson-

    i compliment you on your work...

    like you, i have used combinations of similar meds with similar results; do you correct any of your anthropological measurements for body morphology (basketball and football players have different 's for example)?... i have created a categorization for morphology that has corrections for endomorphs, mesendomorphs, mesomorphs, mesectomorphs, and ectomorphs... i further correct by separately considering 'soft' and 'hard' tissue compartments... it has been very helpful to'correct' for the patient what to expect in terms their likely zone of improvement since standards are so inaccurate and unreasonable... mhe

    On May 27, 2004 at 3:23 am zen bintang wrote:

    . . . . .

    Dear Doctor,

    Why.
    Diethilpropion comein to the amphetamine if I take DEP how much must be take?

    Doctor, I have tried sibutramine and it did not work for me. Will you give me sugest there is good or not and how is the side effect?

    Regards,

    zen bintang

    (Note added by Larry Hobbs: Zen is from Jakarta, Indonesia. I edited his comment to correct the English to make it more understandable to others. I do not understand his first comment of "Diethilpropion comein to the amphetamine...". He emailed me and asked if diethylpropion is an amphetamine, and if not, for evidence of it. Perhaps this is what this first comment is. I appologize to Zen if I misinterpreted something that he wrote.)

    On May 27, 2004 at 10:04 am Larry Hobbs wrote:

    . . . . .

    For others reading these comments, Zen is from Jakarta, Indonesia.

    Zen,

    The normal dose of diethylpropion is 75 mg per day.

    Possible side effects of diethylpropion include:

    -- central nervous system stimulation (including insomnia, irritability, tension) (in 15% of patients)
    -- dry mouth (in 6% of patients)
    -- depression (in 4% of patients)
    -- headache (in 4% of patients)
    -- gastrointestinal upset (in 3% of patients)
    -- cardiovascular symptoms (in 1% of patients)
    -- dizziness/giddiness
    -- drowsiness/tiredness
    -- constipation
    -- upset stomach
    -- bad taste
    -- diarrhea.
    -- dizziness
    -- edginess
    -- flush
    -- hallucinations
    -- heart palpitations.
    -- increased angina (chest pain)
    -- insomnia
    -- lassitude (weakness characterized by a lack of vitality or energy)
    -- lethargy (weakness characterized by a lack of vitality or energy)
    -- nausea (1)
    -- nervousness
    -- palpitations
    -- rash
    -- restlessness
    -- sleepiness
    -- tiredness
    -- vomiting
    -- wakefulness

    On May 27, 2004 at 10:11 am Larry Hobbs wrote:

    . . . . .

    Zen,

    It is my impression that most doctors prefer phentermine as their diet drug of choice.

    You noted that you tried Meridia (sibutramine) but it did not work for you. Some doctors have said that they have not found Meridia (sibutramine) to be that effective compared to phentermine.

    On May 27, 2004 at 10:27 am Larry Hobbs wrote:

    . . . . .

    Zen email me and asked for literature showing that diethylpropion is not an amphetamine.

    This is common knowledge among doctors, however, I am posting this information here for others who may have the same question as Zen.

    The chemical structure of diethylpropion is similar to amphetamines, but it is not an amphetamine.

    Below is section from the book titled "Eating Disorders and Obesity" (1995) by Dr. Kelly Brownell, Ph.D. from Yale University, and Dr. Christopher Fairburn, M.D. from the University of Oxford which describes that diethylpropion is not an amphetamine.

    Here is what they say on page 505 ...

    "One major category of anorexiants [appetite suppressants] is the amphetamines (for example, dextroamphetamine sulfate). Amphetamines are now rarely used for weight reduction because of their high potential for abuse and the possibility of drug dependence."

    ...

    "The second major grouping [of appetite suppressants] consists of pharmacological agents closely related to amphetamine but whose CNS stimulatory action and abuse potential are greatly reduced. In this grouping are:"

    ...

    "Diethylpropion (hydrochloride): A sympathomimetic amine that stimulate the CNS [central nervous system] produces anorexia [a reduction in appetite]. As with other agents in this class, some tolerance to the medications appetite-suppressing effects develops over time."

    On Jun 23, 2004 at 9:54 am T Tabor wrote:

    . . . . .

    Dr. Wilson,

    What do you think of Parlodel as a drug for dopamine enhancement in conjunction with the other medications indicated in your interview? What dosage range might be appropriate?

    T. Tabor

    On Dec 23, 2005 at 10:13 am Princess wrote:

    . . . . .

    Hobbs: What medicines do you use?


    Wilson: When medical treatment appears to be indicated, I use various combinations of medications including dopamine/norepinephrine-enhancing medications such as phentermine, Wellbutrin SR (bupropion sustained-release) or Tenuate Dospan (diethylpropion sustained-release) combined with serotonin enhancing medications such as Celexa (citalopram), Effexor XR (venlafaxine extended-release), Luvox (fluvoxamine) or Serzone (nefazodone).

    Hobbs: What dosages do you use?


    Wilson: It varies by patient and must be individually titrated against each patient?s symptoms, but in general I use phentermine 15-30 mg in the AM and sometimes add a second dose of 15-30 mg in the mid-afternoon, often combined with Celexa 10-40 mg in the AM, Effexor XR 37.5-75 mg once or twice daily or Luvox 12.5 to 100 mg once or twice daily.

    Occasionally I?ll give Serzone at a dose of 50-150 mg twice a day.

    I often augment with low doses of Wellbutrin SR 100-150 mg once or twice daily or Tenuate Dospan 75 mg in the AM and Tenuate 25 mg in the mid-afternoon.

    Sometimes I combine three or four of these medications in lower doses.

    The decision of which drugs to use and the appropriate doses are entirely based on the patients symptoms and response to treatment. Because these drugs are being used to treat symptoms rather than weight, their use falls well within current practice standards.



    My doc put me on Celexa when my mom was dying when I was 5-6 months pregnant, I stopped it when I went on Phen and now I am on both again. I start 5HTP tommorow, so we'll see if it kicks it up a notch or 2. Christmas will be the true test.
    Any tips would be helpful.

    On Dec 27, 2005 at 10:09 am Larry Hobbs wrote:

    . . . . .

    Princess,

    Sorry to hear about your mother.

    I would suggest that you ask the question of Dr. Michael Anchors, MD, PhD.

    You can do so in the discussion forum on his website:

    http://www.phenpro.com/

    Dr. Anchors has treated well over 1,000 people with Phen-Pro, that is phentermine combined with an SSRI such as Celexa.

    He also sometimes recommends 5-HTP in place of or in addition to the SSRI.

    He will have some tips for you.

    -----

    If I remember correctly, Dr. Anchors does not believe that the timing of 5-HTP matters.

    However, I believe that if you tend to overeat at night, then it makes sense to take the 5-HTP in late afternoon or early evening.

    The research suggests that it can have a energizing effect in some people. So if it keeps you awake, then you should take the 5-HTP earlier -- maybe an hour earlier each day -- until it does not affect your sleep.

    Research suggest that lack of sleep increases appetite, therefore, you want to make sure it does not interfere with sleep.

    On Jun 03, 2006 at 8:26 am Jolie wrote:

    . . . . .

    Is it okay to take 5-htp and tyrosine together, one in the evening and the tyrosine in the morning?

    On Jun 03, 2006 at 11:24 am Larry Hobbs wrote:

    . . . . .

    Jolie,

    Regarding tyrosine...

    It makes the most sense to me to take tyrosine with phentermine and take 5-HTP at maybe 5 PM to reduce eating in the evening.

    Research on ephedrine has found that tyrosine works best when taken as the same time as ephedrine.

    Phentermine works in a manner similar to ephedrine, therefore, I assume that the it is best to take them at the same time.

    --------

    Regarding 5-HTP...

    Some doctors, such as Dr. Michael Anchors, who uses Phen-Pro -- phentermine with certain SSRI's -- says he does not think it matters when 5-HTP is taken.

    Timing may be less critical if taken with an SSRI because the combination of these two causes "a profound serotonin effect" according to a classic book on pharmacology (Goodman and Gilman's Pharmacological Basis of Therapeutics).

    However, other doctors, such as Dr. Jay Piatek, has his patients take the 5-HTP in the early evening in order to reduce night time hunger.

    This approach makes the most sense to me.

    Some nutrional companies recommend taking it before bed to help a person sleep, however, this approach makes no sense if you are trying to reduce your appetite.

    Nor do I agree that it should be taken at bedtime because the research says that people may feel some stimulation several hours after taking 5-HTP.

    So therefore, I would not take it close to bed time.

    ----------

    By the way, my favorite interview is the one with Dr. Jay Piatek.

    It is posted here:

    http://fatnews.com/index.php?/weblog/comments/382/

    ----------

    You might also be interested in Dr. Piatek's use of Zonegran along with phentermine for weight loss.

    The article is posted here:

    http://fatnews.com/index.php?/weblog/comments/896/

    On Jun 05, 2006 at 6:16 am jennifer HOrnsby wrote:

    . . . . .

    How many mg do you take of the tyrosine with the Phentermine? I currently take 30 mg of Phen every morning around 6:30. I have not noticed any inches or weight loss. I was considering taking two 30 mg a day to see if that would make the Phen kick back in. I need suggestions on haw to boost my weight loss.

    I am trying to enhance the Phen but did not want to over do it.

    On Jun 05, 2006 at 6:58 am Larry Hobbs wrote:

    . . . . .

    Jennifer,

    Taking L-tyrosine with phentermine is purely theoretical. I am not aware of any studies which have tried this or have not talked to anyone who has tried this. I've suggested it to a couple of doctors, but I am not aware of any who have tried it.

    You might try 250 mg of L-tyrosine.

    If you buy powder, you might try one-eight to one-fourth of a teaspoon.

    Taking it at the same time as phentmerine would be best based on the studies with ephedrine.

    --------

    If it were me, I would try taking the phentermine later in the day, but not so late that it disturbed my sleep.

    Most people who are overweight eat a majority of their calories in the evening, so if it were me, I would trying taking the phentermine at maybe 1 PM or 2 PM or 3 PM to help reduce night time hunger.

    However, if it interfered with sleep, then I would take it an hour earlier or two hours earlier or three hours earlier until it did not affect my sleep.

    For example, if I tried taking it at 3 PM and it disturbed my sleep, I would try taking it at 2 PM. If it still disturbed my sleep, I would trying taking it at 1 PM.

    ---------

    Some doctors give 30 mg of phentermine in the morning and then an additional 15 mg in the afternoon.

    On Jun 06, 2006 at 12:50 am Jennifer Hornbsy wrote:

    . . . . .

    I though it stated in the article that you add tyrosine to patients taking phentermine.


    "And I add tyrosine to patients taking phentermine, Tenuate Dospan or Tenuate, or Wellbutrin SR in patients with symptoms of a dopamine/norepinephrine deficiency."


    I am little confused about your reply to me earlier. Can you clarify which medicines and supplements you normally precribe to people for weight loss?

    On Jun 06, 2006 at 5:18 am Larry Hobbs wrote:

    . . . . .

    Jennifer,

    I'm sorry. I answered your question based on the research.

    I will forward your comment to Dr. Wilson and post his reply as to how he does it in his practice.

    On Jun 09, 2006 at 6:17 pm Jolie wrote:

    . . . . .

    I have begun taking Tyrosine in the morning with my Phentermine and so far it is working great. The hunger feelings where starting to come back on my 3 week of Phentermine( but I was still able to keep from eating too much and craving foods), but the Tyrosine has seemed to stop the hunger in its tracks almost better then the Phentermine alone. Now this is how I reacted to it, everyone else may not.
    I am also taking the lowest dose of 5HTP in the evening and that has helped with night time hunger returning, even though the Tyrosine helps with that as well.It hasn't helped with sleep but I am on the lowest dose and will consider increasing the dose. I do sleep better but it still takes a bit to fall a asleep.
    Jolie

    On Jun 10, 2006 at 3:07 am Larry Hobbs wrote:

    . . . . .

    Jolie,

    Thank you for your feedback.

    Congratulations. That's great that you figured out what is working best for you.

    On Jun 14, 2006 at 12:07 am Jennifer Hornsby wrote:

    . . . . .

    Jolie,

    What dosage do you take on the tyrosine?

    Thanks for the feedback!!

    On Feb 15, 2008 at 6:36 pm suzan Rhodes wrote:

    . . . . .

    Where are you and how can I contact you. I am a 50 yo post menopausal woman I had a hystorecotmy At 19 due to uterin cancer have 1 ovary. I started menopause at 47 full blown. Checked thyroid seems ok, bp 98/60 Sleep apnea. my doc put me p\on premerin and I begain to gain weight. I gained 40 lbs in 3 months. She then put me on wellbutrin to slow down the weight gain well it did but now Im 80lbs overweight. I am 5.9 and I weighed 160 for 20 years. I am not at 250 help help help. I do have ocd with house cleaning, thats okay now with celexa but geesh I dont want to look like shamu

    On Feb 15, 2008 at 7:15 pm Larry Hobbs wrote:

    . . . . .

    Suzan,

    Dr. Piatek is the best weight loss doctor I know.

    He is in Indianapolis, Indiana not too far from the airport.

    If you can afford it, I would go see him.

    I believe he requires that everyone go see him at least once at the start of treatment in order to understand exactly what he does.

    Then, I think, he is willing to treat you from a distance after that.

    Here is his contact information.

    Roger Andrew "Jay" Piatek, MD
    745 Beachway Dr
    Indianapolis, IN 46224
    (317) 243-3000 phone

    On Feb 15, 2008 at 7:18 pm Larry Hobbs wrote:

    . . . . .

    Suzan,

    My mistake.

    I thought your comment was under Dr. Piatek's article.

    Here is Dr. Wilson's contact information.

    I have had less contact with him, but he sees to be very good as well.

    William L Wilson, MD
    Chisholm Medical Clinic PA
    401 NW 1st Street
    Chisholm, MN 55719
    (218) 254-7476 phone

    On Feb 16, 2008 at 6:58 am suzan Rhodes wrote:

    . . . . .

    Thank you Ill consider both. I hav to do something thi is just not healthy for me.

    thanks
    suz

    On Apr 17, 2008 at 9:38 am Linda Mitchell wrote:

    . . . . .

    This sounds like me! I am very small boned and have low muscle mass. My body fat is about 40%, although I weigh only 160 lb and am 5'8".

    All docs think I am "normal" and don't need to lose weight. Or don't think I need to lose much and certainly won't give any Rx for weight loss.

    Are there any docs with Dr. Wilson's type of thinking in the Sacramento, California area? Or will any treat solely via long distance?

    Thanks.

    On Nov 27, 2008 at 4:21 pm ciya wrote:

    . . . . .

    In april 2008 I was diagnosed with type 2 diabetes and high blood pressure all symptomatic of my weight. I am 5'6 and 246lbs. I WANT and NEED to loose weight to be healthy and happy. My doctor told me to stop eating meat, cheese and drink diet soda to curb my appetite. I really need help. I want to do something but I don't know what or where to begin. Can you recomend a doctor in the NYC area or a hospital? I have really great health insurance. Currently my meds are diovan hct 160/12.5 and glucovan 5/500

    On Nov 27, 2008 at 8:54 pm Larry Hobbs wrote:

    . . . . .

    Ciya,

    If it were me, I would fly to Indianapolis and see Dr. Jay Piatek.

    He's near the airport.

    He requires you come and see him once, then he will treat you from a distance.

    To me, it is well worth it.

    Here is his contact information.

    Roger Andrew "Jay" Piatek, MD
    745 Beachway Dr
    Indianapolis, IN 46224
    (317) 243-3000 phone

    Another doctor I'd recommend is:

    Michael Anchors, MD PhD
    16220 Frederick Rd Ste 210
    Gaithersburg, MD 20877
    (301) 990-6061 phone
    .(JavaScript must be enabled to view this email address)

    You can also ask him questions on the Discussion Forum on his website:

    http://www.phenpro.com/

    In NYC, I would recommend Dr. Louis Aronne at Columbia University.

    Louis J. Aronne, M.D.
    Adjunct Associate Professor of Clinical Medicine
    Columbia University
    1165 York Ave
    New York, NY 10021

    212-583-1000
    .(JavaScript must be enabled to view this email address)

    On Jan 15, 2009 at 10:51 am Lisa wrote:

    . . . . .

    I accidently stumbled on your website and am so grateful I did! I seem to have most of the symptoms for both syndroms. Is that possible? I have gained 50 lbs in 6 years (5'2" 153# and counting!!) Dx was depression, Post partum depression, PTSD,...was on Prozac for 6 years now on Celexa. Is there a doctor in the south (Texas) area that I could see? Thanks in advance!

    Lisa

    On Jan 15, 2009 at 1:47 pm Larry Hobbs wrote:

    . . . . .

    Lisa,

    You can email Dr. Wilson directly and ask him.

    William Wilson, MD
    .(JavaScript must be enabled to view this email address)

    I don't know a doctor in Texas who is doing this type of thing.

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