Episode 28: AMA | CBD, Phentermine & Obesity Medicine

Dr. Simonds and Michelle Kennedy, NP-C were back to answer your weight loss and health questions while giving away another target gift card. Every other Monday, we stream live from the Raleigh office, answering viewer questions and spreading awareness about obesity and health.

Q: How long have you been practicing in weight loss and what got you into this field?

A: Dr. Simonds has a background as an emergency medicine doctor and started his venture in obesity medicine in 2004. He is now in his 17th year practicing obesity medicine. He, along with many others in the medical community have been aware of the rising obesity rates in this country. Back in 1972, 1 out of every 100 people were overweight or obese and today it’s 75% of the population. While many in the medical community have known that obesity is a problem, it takes time to get the medical community to act on the problem. Today, we’ve seen many positive changes in obesity medicine and it’s now a specialty that includes a board certification process. It’s a rapidly growing field and exciting to be a part of this growing specialty. Dr. Simonds initially entered this field because he knew that the rising obesity rates are a big problem and he couldn’t just sit there and do nothing about it.

Michelle has been with the practice for 9 years. Prior to joining the Raleigh office, Michelle was a registered nurse in a community hospital in Pennsylvania. She knew early on that working in acute care was not going to be a long-term career choice for her. She found that the majority of the patients had preventable illnesses and she wasn’t able to treat the actual problem. This resulted in many patients returning for the same issues, receiving a temporary fix for highly preventable conditions. Weight issues were a big part of this. Hundreds of medical conditions can be improved with weight loss and she is proud to be a part of a field where preventative medicine is at its best.

Q: I’m currently taking phentermine as an appetite suppressant and I love how it works. I do at times get a bit of brain fog midday. Is this normal or should I be doing something to combat it?

A: Phentermine is an extended-release product that is absorbed in the body at different rates due to the varying particle sizes of the pill. In theory, it’s a nice even absorption throughout the day for most people. Sometimes, people may metabolize particle sizes a little faster than others which results in a gap in time where you’re waiting for the next particle size to be absorbed. This may result in the brain fog that you are experiencing. If this is happening, we tell patients to break the pill in half, take one in the morning, and the other half 1-hour before lunch (always on an empty stomach). Brain fog can also be related to a drop in electrolytes, eating less, and experiencing the keto flu from being in a state of ketosis. Since the cause of your brain fog may be due to many different factors such as the ones we’ve just listed, it’s best to evaluate you individually to get to the possible root cause.

Q:  I’m a big fan of CBD, but I’m a bit overwhelmed with all the tincture varieties. Are there significant differences when one is marketed for better sleep vs. more muscle recovery?

A: Yes, actually there are some unique differences in the variety of tinctures available. We are big fans of the brand Naternal, a local CBD company that produces high-quality products from seed to oil. They rigorously test their products and are in accordance with all state and federal laws to produce the highest quality products available in the market. Full Spectrum CBD oil provides you with all 119 oils that are naturally derived from the hemp plant. From science, we know that of the 119 oils, some of those oils are responsible for different medicinal properties. For the more “boutique” style cannabinoids, we are taking the Full Spectrum Oil and adding in some additional oils for a heightened medicinal effect. For example, in the Naternal Rest oil, additional CBN is added, which is responsible for better rest and sleep. Naternal Move has additional CBG, which is one of the 119 cannabinoids responsible for anti-inflammatory properties. This is especially great for those that want to avoid the side effects that may happen from taking over-the-counter NSAIDs such as Ibuprofen. Basically, the CBD that is targeted towards certain conditions such as sleep or muscle recovery contains the same cannabinoids as the Full-Spectrum, but with additional oils that specifically target that area. It’s a natural, safe alternative that does not contain any psychedelic properties.

Contact our office if you have any questions or would like to purchase CBD products.

Q: I’ve heard your practice is more affordable and that you don’t have contracts. Is that true? And what else makes you different than those that require contracts?

A: Yes, it’s true that we never require contracts. While we are a business, we do not like to see our practice in competition with others. It’s more important to focus on helping patients and be in the business of medical treatment. We want patients to get the best care that fits their needs no matter where the service is provided. We never require contracts or require patients to purchase expensive products, supplements, or prepackaged foods. We treat each patient as an individual person, with individual needs. We are very upfront with our pricing and do require a $50.oo deposit for your first visit. This $50.00 deposit will be applied to the initial office visit of $200.00 and this is for new patients only. You will pay this initial fee only once because once a patient, always a patient, no matter the length of time in-between follow-up visits. Follow-up visits are $75.00 plus the cost of any medications that you may need. The average cost of medication from our in-house pharmacy is $30.00. We are certainly here to help and try to make it as easy as possible for patients and feel that this is also reflected in our prices. Weight loss is a journey that requires ongoing support, treatment plans, encouragement, and self-care.

Q: I’ve been doing keto for years and I can’t tell if it’s really effective anymore. I maintain my weight, but other than that is there a good way to test it and see if I’m still seeing the benefits?

A: This is a really great question and the keto diet is a great way to lose weight and maintain that weight loss. We like to focus on non-scale victories such as how you’re feeling, how well you’re sleeping, energy levels and how your moods are. If you’re still feeling good while maintaining your weight, then that’s also a great sign. At this point in your journey, we don’t really recommend urine test strips to test for ketones, and as long as your consuming under 30-50 grams of gross carbs per day you’ll be in ketosis. As far as testing goes, fasting blood sugar, lipid tests, and blood pressure levels are all good indicators of health.

Q: I just started taking Metformin, is it better to take the 2 tablets at once or is it better to take one with breakfast and one with dinner?

A: If you can remember, we prefer patients break up the dose and take 1 in the morning and 1 tablet in the evening. However, if you have difficulty remembering to take your medication, it’s better to take it all at once.