Episode 4: Ask Me Anything Live | Dr. Simonds & Michelle Kennedy, NP-C

Dr. Simonds and Nurse Practitioner, Michelle Kennedy were back in Raleigh to answer viewer questions about weight loss, medications, health and more. Today was an extra special AMA episode, May the 4th be with you! You’ve got to tune in for some additional fun in the beginning. Hint: Michelle and Dr. Simonds just might be wearing some special Star Wars attire. Now, let’s get to your questions:

Q: I have been doing really well losing weight on phentermine, topiramate and HCTZ, however, I’m struggling with constipation. I’ve taken one tsp. of Milk of Magnesia a night for the last week with no results. I’m sure I’m eating adequate green vegetables. I walk each day. I drink lots of water. Also, while my weight loss has been pretty steady every week since the end of January, I’ve stayed the same for the last 10 days (about the same time as I’ve suffered from constipation). Any suggestions?

A: This is a very common question that we receive, so you’re not alone. Milk of Magnesia is a great option and typically works well. However, 1 teaspoon is a pretty small dose. It’s recommended to increase your dose to up to 4 tablespoons twice a day, along with plenty of water. 1 tablespoon of mineral oil twice daily along with the Milk of Magnesia will also help the hard stool move through as well.

Sometimes a stool softener can help. We find that taking Magnesium citrate, which can be found in both liquid and pill form can also be helpful and also aids with sleep and stress. Magnesium, in general, is a mineral that most of us need more of daily.

We also recommend a product called Natural Calm, which is a powder form that mixes into a tasty drink. We do offer some of these supplements in the office too. And experiencing a weight loss plateau while being constipated can certainly be related and once things get moving again, you may find yourself back on track.

Q: I am trying to do low carb for weight loss and to keep my diabetes stable. I saw where you had stated that berberine might help. Some days I overdo the carbs and wonder if berberine will help without having a negative interaction with sertraline. Also, can it be taken as needed?

A: Berberine and Metformin are medications that are commonly discussed at the office. We commonly use Metformin in the office, and while it’s an effective medication it can have some G.I. side effects such as stomach upset and nausea. Berberine is basically the over-the-counter version of Metformin and works the same way for insulin sensitivity. However,  Berberine does not seem to cause the same G.I.  upsets that Metformin users sometimes report.

If you decide to take Berberine, it is recommended to be taken 3 times a day consistently, and not as an as-needed medication. Berberine can be found via Amazon or many other health stores. If you can’t tolerate Metformin, then Berberine may be a good option for you. Berberine doesn’t have any drug interactions with any other medications. Just make sure you use it regularly, not intermittently.

Q: How does curbside pickup work?

A: We have a convenient onsite pharmacy for weight loss medications at both our Durham and Raleigh offices and we have several convenient options for patients to receive their medications. For curbside pickup, just give us a call ahead of time and we will bring the medication out to you upon your arrival. We are also able to ship your prescriptions at regular cost plus $15 for shipping via UPS right to your home. Contact the office if you have any other questions.

Q: I would like to lose weight. I am finding it harder as I get closer to 50 years of age. I was a patient many years ago at the Durham office, but the Falls of the Neuse office would work best with my current job. How soon can I get started? Am I considered a new patient?

A: Once a patient, always a patient! You are considered an existing patient, no matter how long it’s been since returning to see us. This is something that sets us apart from other weight loss offices, as we do NOT make returning patients restart and charge extra fees. We want to make it as easy as possible for patients to return because we know that obesity is a very serious disease and does not just go away.

It’s also very common for women to find it harder to lose weight with age and it’s usually due to the hormonal changes that come along with getting older. We can help you with the physiology of insulin resistance by recommending an appropriate diet and getting you on the right medications to make you successful. It is absolutely not a problem to switch between our two office locations!

Q: I keep gaining weight. I’ve been exercising every day but I keep snacking all day.

A: Exercise makes us hungry! And you can’t out-exercise what you eat, especially as you get older, or even past your 20’s. Losing weight is mostly about following a diet regime for weight loss. While exercise makes you healthy, it’s not the cornerstone of weight loss. Sometimes, modifying the type of exercise can help you control your appetite better. Certain exercises such as cross-fit or boxing or other forms of intense exercise can actually increase appetite. If this is the case, we recommend lighter exercises such as yoga, swimming or even walking. Weight loss medications can also be beneficial in this instance.

Q: This virus/lockdown is taking its toll. I was 188, now I’m 212 in like a month-more so stress. I took a break from phentermine-it stopped working and a friend said to take a 3-4 month break and then return.

A: Obesity is physiology and there’s a reason we crave and gain weight. In your case, stress is a provoking incident that’s setting you back and this is very common. Medications can help in this instance. While many people think they are tolerant of Phentermine, they are actually tolerant of the stimulant effect. Don’t worry if you grow tolerant to the stimulant effect because the appetite suppression is still working. Take 1-2 weeks off from taking it and see how it affects your appetite. If you find yourself eating more, then you may want to resume taking it. Especially in your case where you have been off it for 3-4 months, you may want to resume taking it. We can also increase the dose or look at some combination of drug therapy to further help with weight loss.

Q: I was a patient and was able to maintain weight loss for quite some time but with the quarantine, my weight and BMI are creeping back up. How would I go about becoming a patient again?

A: It’s as easy as a call to our office or simply send us an email and we’ll contact you. We will treat you as a returning patient, not as a new patient. We will not make you jump through hoops and we will not charge you as a new patient as we try to make the process as easy as possible. We are open at both locations and we can also provide you with a telephone follow-up if you prefer. Our offices are very safe and we are practicing social distancing. We’d love to see you back! We know that quarantine is causing many weight issues and we are trying to be as accommodating as possible.

Q: Hi! I’m a new mom and my daughter was born 15 weeks ago. How soon after having a baby can new moms startup as a new patient? Will I be able to take weight loss medications?

A: Congratulations on your baby girl! We know it’s an exciting time and a lot of new moms are looking forward to getting back on track after the baby comes. As long as you’re not breastfeeding, you can take weight loss medications immediately. We would hold off on prescribing medications until you’re done nursing. If you are currently nursing your newborn, we can help in other ways until such as guidance with food, fitness and accountability.  Either way, we can still help get you started and provide you with a plan to begin your weight loss journey.

Q: I’ve been diagnosed as having PCOS and it’s been difficult for me to lose weight and keep it off. It’s really affected my health and I just feel bad a lot of the time. Do you have experience treating patients with this condition? Will weight loss medications help me?

A: Yes and Yes! We treat many patients diagnosed with PCOS (Polycystic ovary syndrome) and it’s something that many women struggle with. If you’re not familiar with PCOS, it is a hormonal disorder that traditionally is known to cause weight gain, acne, fertility issues, irregular menstrual cycles and hair growth. We have helped many women with PCOS that have actually had unsuccessful treatments in the past with other weight loss clinics. The physiology of PCOS is basically insulin resistance.

The answer is to restrict carbohydrates to control insulin levels, which can be hard to follow when dealing with PCOS. Medications will help suppress the appetite and make it easier to follow a low carb diet. We have helped many women with PCOS with this combination of treatments. As a result, we have actually had many women able to conceive after weight loss that had difficulty before seeing us. We often joke that we are also part-time infertility specialists.

Q: I’m interested in becoming a new patient and was wondering how often you recommend patients return for office checkups? What should I expect at each visit?

A: A standard patient usually follows up with us once a month. However, everyone is different and if you feel that you need more guidance, you’re welcome to be seen more often. Just let us know!

We do not charge extra for that. At your first visit, we will provide you with a complete metabolic assessment which usually takes about 45 minutes. The targeted metabolic assessment is a history and physical exam that lets us tailor a program specifically for you. We will also provide you with any medications, directly from our onsite pharmacy. We, also, offer early morning and evening hours as well as telephone follow-ups. We try to make it as easy and convenient as possible for everyone.

During your follow up visit, we will record your weight, body fat, blood pressure and see how you’re doing overall. We basically want to get an assessment of where you’re currently at and access your progress or discuss any setbacks you may be having. Most follow-up visits usually take about 15-20 minutes. Patients also frequent our office for Lipotropic injections and to shop at our pantry for supplements and protein snacks.

Q: I really struggle with cravings and overeating. It’s been a struggle to maintain any weight loss and I’ve actually used a weight loss doctor before. I feel like I need help again but didn’t get the results I was looking for before at another place. What makes your clinic different? Can you help me?

A: Absolutely, we can help! We hear this quite often when patients have tried other clinics before us. We don’t like to see us as in competition, however, we frequently hear that other practices have MADE patients follow certain diets, asked them to pay large sums of money upfront or have demanded them to make frequent visits. We’ve also heard that they only used certain medications and will not try anything else.

We hear this a lot and this is not how we treat patients at Dr. Simonds Metabolics & Weight Loss. We do not use a standard, one-size-fits-all approach. We use all of the tools in any safe combination that we can to help patients succeed. We will not make you purchase foods or a bunch of supplements and we are very affordable and convenient. We NEVER give up and will always be here to encourage patients along the way. And, we make ourselves easily accessible, whether through our personal emails or through our phone system. You’re never alone when you’re on a journey with us!

Thanks again everyone for submitting your questions and for tuning into the show today. It’s important to recognize that for the past 20 years, Obesity has killed 325,000 people per YEAR. That’s almost 1000 people per day. Heart disease, diabetes and cancer are all related to obesity and it’s important to address obesity as a serious disease. Treating and overcoming obesity is a lifelong journey and we’re here to help.

Dr. Simonds Metabolics & Weight Loss is an essential business serving patients’ medical needs related to obesity,  and we are operating all of our services and operations. Contact us to get started or restarted today!