Qsymia approved for Weight Loss. Here are some helpful tips!

The FDA has recently approved Qsymia for weight loss. It is a combination medication previously called Qnexa. The combination of medication is that of Phentermine and Topiramate. It is designed to decrease hunger in patients while simultaneously help with binge eating urges.


We will be using this on a case by case basis, but with some serious caveats.


The medication has been shown to be helpful in losing weight and burning fat first! But there are some precautions that need to be taken with this medication most notably the risk of birth defects. VIVUS has a healthcare provider information letter that all doctors looking to use this medication should read here!


If a patient has not lost at least 3% of baseline body weight on Qsymia 7.5 mg/46 mg, discontinue Qsymia or escalate the dose as directed, as it is unlikely that the patient will achieve and sustain clinically meaningful weight loss at the Qysmia 7.5 mg/46 mg dose.


ALL women, except those who have gone through menopause or undergone surgical sterilization, should be advised to consistently use effective contraception, even women who have had difficulty getting pregnant in the past.

It is important to have this conversation with all patients. It is important to know whether a patient is:

• Trying to get pregnant and not using contraception, in which case do not prescribe Qsymia

• Sexually active and what contraception she is using, in which case reinforce the importance of consistent use of effective contraception

• Surgically sterilized or has gone through menopause that has been clinically confirmed, in which case no contraception is required

It is important to have this conversation with all patients, so that if there is a female of reproductive potential in the house, the patient knows to keep Qsymia in a secure location and not share it with anyone else.

If a woman believes she might be pregnant, she should stop taking Qsymia immediately and contact her healthcare provider.

Dispensing by certified mail order pharmacies

Qsymia is available only through certified mail order pharmacies that provide a Qsymia Medication Guide and Risk of Birth Defects with Qsymia patient brochure with every prescription and refill as required by the REMS. The list of certified mail order pharmacies can be found at www.QsymiaREMS.com.

Reporting adverse events
Healthcare providers should report all suspected adverse events associated with the use of Qsymia. If you become aware of a patient experiencing an adverse event while taking Qsymia, please contact VIVUS Medical Information at 1-888-998-4887 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.


If you have any questions you can always come in the office or call. 

Pregnant Mommy Diet builds a Better Baby

Today I want to write about some exciting studies coming out. The most notable is the idea that caloric control in a pregnant mother will "Build a Better Baby".

Is this true? Is that bundle of joy really made up of what mommy eats whilst bambina or bambino is in the womb? Through simple animal studies and even human studies, we know this to be true. Food and the chemicals that are in what we eat tend to make subtle changes to mommy AND baby's DNA. The building blocks of life.

Think of DNA like a blueprint of a house. The architect drew this wonderful house, which the builders will use to construct the house. Well, how many of you have built a house? It never goes as smoothly as the drawing would depict. Why? The builders are subjected to the elements of the environment. Rain, Hail, Winds, Snow.

Think of your body the same way. By introducing environmental changes, you can alter or slow down who you are really meant to be. This also holds true when you are building another human being inside of you.

So, it comes as now surprise to me, when we find out, prenatal diet matters. In this Meta Analysis (a compilation of studies) they discover dietary modification reduces risk of Pre Eclampsia and gestational diabetes. Surprisingly, exercise does not have the same effect.

You heard that right. Only diet in this study was shown to reduce risk of complications. The good news is, we can help with this. Weight gain control and dietary modification is the key and we excel at this!

The next study shows that maternal diet can cause obesity and metabolic syndrome in children. How? Through a set of chemical changes called epigenetics. Think of epigenetics as the sleet, rain, hail and wind of your home building. As you know, these environmental forces can have a devastating effect on your home. So too can epigenetic changes affect the way your are born and the diseases you may get.

The goal of diet is to have the right amount of protein, carbohydrates and fats. Ultimately that is the plan.

At Murphy Medical Weight Loss Programs, we can help plan a diet that will help you minimize weight gain during pregnancy and also feed you all the right nutrients to keep your "Forces of Nature" at bay!

Surgery beats Diabetes Medications in Diabesity and Diabetes

I would like to take the next few minutes to review what I see as a grave misrepresentation. You see, I treat patients who want to lose weight. I see patients for weight loss daily. Unfortunately, some of these patients are obese and a growing number are what we call morbidly obese.

It is in this morbidly obese group that I am making more and more diagnoses of diabetes. Other doctors have not told them about this diagnosis, because we have been using imprecise measures in general medicine to diagnose diabetes. By using imprecise tools, we have been missing the diagnosis.

Why does this matter? Because this epidemic of diabetes in the obese is UNDER-DIAGNOSED and what I am about to tell you will apply to many more patients in the next 5 years.

But first the misrepresentation.

The popular media has been covering a study in Italy which looked at a grand total of just 60 patients. Correct, JUST 60 patients. But the "news" is hailing it as a great study. Scientifically, this is a very, very small number of individuals. But results of surgery were fantastic and reflect what has always been known in the weight loss community.

If the patient gets diabetes from being overweight, treating the diabetes without getting the patient to lose weight is a fool's errand. You have to lose weight. This study is not revolutionary. It is not HUGE news!

That is the misrepresentation. Here is the straight scoop. By shrinking the fat mass on a patient, you improve insulin sensitivity and can remove medications and CURE Diabetes. As the study indicated. If you drop your BMI from 41.3 to 28 you can cure Diabetes 80% of the time, in this group of 30 patients.

How much diabetes do you cure with medications? ZERO. No patients with diabetes were cured with medications that are used to treat diabetes. This is no surprise as almost all diabetes medications cause weight gain or no weight loss. You need to lose weight to cure diabetes.

Does this means I as a non-Surgical weight loss doctor cannot cure diabetes? No.

I Cure Diabetes Daily with weight loss medications and diet! Put simply, I can cure diabetes without surgery.
That is HUGE news and I am blown away the media isn't covering this. The grave misrepresentation is that SURGERY ALONE AND NOT MEDICATION can cure diabetes. Doctors who cure obesity also cure diabetes. The treatments are the EXACT same.

K-E Diet. Here comes the bride, with a feeding tube

I have thought that I have heard everything regarding weight loss. But, simply, I am blown away by the level of desperation in these poor brides.

What are wives-to-be doing to lose weight before the big day? They are getting feeding tubes inserted in their noses and sent to their stomachs. These tubes are used to deliver food via a pump which is kept in their handbag.

The pressure to lose weight prior to a wedding has driven many people to a diet plan which has been around in Europe for some time. This diet is called the K E diet. It is offered by a physician in Florida and I wonder if many more will follow.

What are the risks of a very low calorie diet. Simple.

1. Dehydration-starting a low calorie diet requires enough water to offset the increased urination
2. Electrolyte abnormalities-If the tube feed does not meet those requirements, you can get a problem with the chemicals in your blood stream which can cause a host of other problems
3. Feeding tubes over longer than 4 days can increase your risk of infection in your sinus cavities
4. Nausea, stomach upset, acid reflux of stomach.

Why try this diet? Supposedly according to the physician doing this in Florida, it is more successful at suppressing hunger than regular eating due to continuous feeding.

I would like to see a head to head trial on this because, I don't see how very low calorie diets would differ that much in orexigenic properties.

In a nutshell, I would avoid this diet and instead save the 1500 USD for a proven medical weight loss program. Our program costs WAY Less than 1500 USD and can help you lose this much weight loss and even more.

Photo Courtesy: ABC News

60 Minutes about to Blast the Sugar Industry! I am excited.

It appears that what the American Society of Bariatric Physicians has been saying is finally getting some press.

Tomorrow night 60 Minutes will be covering the risks of sugar in the diet. This year in Circulation, a key journal for heart doctors and weight loss doctors like myself, it was proven that sugar sweetened beverages increase risk of heart disease and risk markers.

In fact, your cholesterol, your levels of inflammation, your weight all go up with sugar sweetened beverages.

It was just 7 months ago when I lost nearly 30 pounds by burning fat first and knowing what's in my tank. But the most important thing I did was to research and train in bariatric medicine. What is crystal clear according to food researchers and my education is this.

Fat is not the enemy, Sugar is the enemy.

Now the media is covering it. You see, the real enemy is Insulin a hormone produced normally in little amounts at baseline. The real problem is when we cause our bodies to secrete large amounts of insulin. Insulin elevation has also been linked to inflammation, elevated fat in our blood stream and fat in our livers.

Worse than that is the fact that Insulin prevents your body from ever burning fat as an energy source. Insulin suppreses a chemical reaction called lipolysis. Lipolysis is responsible for burning fat as an energy source. This prevention leads to a significant craving of carbohydrates to fuel the human machine.

Sugar in small amounts is ok. Sugar added to Skim Milk? That's not ok and the industry needs to stop doing it. Immediately. For the love of the kids and the adults with obesity, heart disease and cancer everywhere!

Is a calorie just a calorie? 3 philosophies for smart diet choices

I was reading an op-ed in the NYT where the reporter interviews 2 food researchers who answer the age old question. "Is a calorie just a calorie?"

Well, at our weight loss program we have 2 views on this. They stem from 3 fundamental philosophies.

The First Philosophy: You can never keep weight off if you don't now how many gallons your fuel tank holds.

Meaning: If you don't know how many calories your body needs in a day, you are likely to overfill yourself calorically.

Why? We live in a non-filling food paradise where everything has too many calories and too many sugars.

The Second Philosophy: Once you are overfilled with calories, the fat on your body is the problem, not the weight.

Meaning: When you want to lose weight, the chemical secreted by fat make you hungry and make it tougher to lose weight.

Why? There are over 100 chemical secreted by fat cells and only 2 of them are salubrious.

The Third Philosophy: A little hunger is a good thing, a lot of hunger is a dangerous thing.

Meaning: Being overly hungry could mean you are dehydrated or not eating enough to feed your machine, resulting in lean muscle mass breakdown. Or worse, you are spiking insulin levels and your blood sugar is all over the place.

Why? Too much hunger makes us reach for quick fixes like carbs, resulting in the same cycle of hunger all over again. We chose lean protein over carbs because they fill us up. Similarly, high fiber veggies work nicely too.

So here's the deal. A calorie is just a calorie if you don't feed yourself too many of them. When you feed yourself too many calories carbohydrates are far more dangerous for you than just about anything.

Dangerous how? By causing diabetes, inflammation, heart disease and god knows what else.

So when looking at calories:

1. Know how many you need. You can do that by checking a resting metabolic rate Don't use a calculator they are almost always off. Do the testing!

2. Chose calories that will fill you up and reduce your hunger. In those cases, chose lean protein and high fiber calories.

3. If you have to overfill your tank, chose calories that won't cause the yo-yo of insulin and blood sugar.

So is a calorie a calorie? It depends.......But often the answer is No!

Botox and Juvederm in Greenwich Office. Dr Gamble.

I am very excited to let everyone know that Doctor Sarah Gamble will be joining practices with us. She will bring her aesthetic medicine specialty as well as her skills with plant based nutrition. Now you will be able to receive Juvederm, Botox, Radiesse and other treatments in our practices in Greenwich CT!

Yes, now not only weight loss, but also aesthetic medicine in our Greenwich Offices! 115 East Putnam Greenwich CT.