When One Medication Isn’t Enough: Exploring Your Options

In today’s episode, we’re expanding on last week’s biohacking mindset chat and taking a closer look at extra prescription medications for weight management. (If you missed it, give it a listen now for the full context!) We’ll discuss how these options might fit into your current plan, why you might consider adding them, and how tailoring your approach can really make a difference. 

Join me as I break down how medications like Contrave, Qsymia, and metformin can fit into a personalized approach to weight management. Remember, this episode aims to provide information to help you better understand your options and have more informed conversations with your healthcare provider—it is NOT personalized medical advice. Tune in now to explore more avenues on your weight management journey!

References

Last week’s episode (Ep. 105): Optimizing Your Toolbox: Biohacking with Anti-Obesity Meds

To learn more about specific weight loss percentages, check out this episode here: Anti-Obesity Medications: Part 2 

Audio Stamps

00:30 - A quick reminder to listen to Part 1, Optimizing Your Toolbox: Biohacking with Anti-Obesity Meds, before diving into this episode.

01:00 -  Dr. Rentea shares some updates, including an upcoming YouTube channel and a paid podcast launching in March with exclusive content and community access.

05:33 - Today's episode explores alternative medications that can help if GLP-1s aren’t an option or aren’t working as expected.

09:02 - Qsymia (Phentermine + Topamax) can help with hunger, but side effects make it hard for most to tolerate.

11:20 - Contrave can help with intense cravings and snacking when dietary changes aren’t enough. 

13:20 - Orlistat causes minimal weight loss with unpleasant side effects and is rarely prescribed or covered.

14:48 - Metformin aids insulin resistance and supports weight loss without causing low blood sugar.

16:35 - There are more weight loss options beyond GLP-1s, and your provider should be able to explain why certain medications may or may not be right for you.

Quotes

“Always know, if one thing doesn't work, there is always more that can be done if you're really seeing a skilled weight management expert.”

“Everyone’s physiology is different. We're talking about how to ma

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Premium Season 1 of The Obesity Guide: Behind the Curtain -Dive into real clinical scenarios, from my personal medication journey to tackling weight loss plateaus, understanding insulin resistance, and overcoming challenges with GLP-1s. Plus, get a 40+ page guide packed with protein charts, weight loss formulas, and more.

April 30/30 registration.

Transcript

0:29

Welcome back to another episode of the podcast. Today's episode is really a part two from last week's episode where I talked about a biohacking mindset when you're thinking about anti obesity medications if you need to add another one. And so, if you have not listened to that episode from last week, I would really encourage you to do that because this is going to be part two where I talk about what are some of those prescribed medications that can be added. And it really won't make sense if you don't hear the first part. All right. So with all of that, I want to give a few personal updates. First, I have a new home office that has been being built for what feels like months now, anyone else here? I find whenever you deal with construction people, I love who's doing our work, by the way, this is the second home project that this. Construction person has helped us with but it's just sort of irregular when they come to work. And so I had anticipated That as of January of this year, I'd be in the workspace. I am NOT. I don't even know at this point, now we're in February, the work began, was it November or December? So anyway, I'm really hoping by the end of February that I can be in that space. That is to say, once I'm in that space, we are also going to be having a YouTube channel where the video of the, when I'm talking, making the podcast, that will be an option as well. So if you're someone that likes to. Watch a YouTube video more than you do just listening to a podcast know that that will be an option. So that's really exciting We'll make sure to announce that it's a new land that I'm venturing into So I'm I've been much more a fan up to now with tick tock and Instagram short form content meeting just really little quick videos I'll just share little scenarios of what are helping my patients or different inspirational things stuff like that But I find that I think some people really are going to want to watch it long for more, but I really need to be in that new space because where I'm at right now, just the lighting and everything doesn't work out great. So hopefully that'll be coming. The other really exciting thing, I kind of announced this a few episodes back, but starting in March, we will have the option. As well for a paid podcast. So there's this same podcast stays the same, but there were so many of you where I get great fan mail questions. I want to share more behind the scenes deeper dives into things honestly, I have many more ideas compared to. Just every single week of the year that goes on here and there'll be some behind the scenes some workshops from my clinic that I'll release on there Some Q& A calls there's just gonna be a lot It is not the same as everything that's being released in those programs if you're in them But just one here there and then a lot more, it's going to be additional is the point. So, if you're someone that's interested in that, make sure that you're on our email list. You can always do that by going to rentilaclinic. com and either right at the top of the page or right at the bottom of the page, it's, Hey, you know, do you want to be updated with things that are going on? You can put in your name and email. And we usually just email you once a week when the podcast comes out. We kind of tell you what the podcast is about if you want to listen to it. And if we ever have any offerings, we usually do that. Rarely. When different programs are opening up, we'll send you stuff on that. But I have to tell you, if you're on my email list, I am not a fan of blasting a bunch of things. I know I've worked with so many different. Marketing people and this and that and they'll say, Oh, you know, you have to send like 12 to 15 emails when you launch something. I'm very annoyed by that from a consumer standpoint. So when we launch things, we'll send two, three emails. So just know if you ever actually want to join something of mine, the first email you see, you probably want to join. Because we're not going to do this like over a three week period. I don't have the energy for that. So when, if you want to join something, go ahead and jump on the first email. Otherwise we'll include it as a PS in the weekly thing. Let's say if we still have a spot in the April 30, 30 program, things like that. We'll make sure to make it a PS, but make sure you're on our email list. And then that way you can. get all this information. So, as soon as we have how you can sign up for that, the paid podcast aspect, there'll be that. Also, there's going to be a little bit of a community associated with it in the sense that we are running this through, so my website is hosted through an app called Kajabi. And in there, they have a function called community. where you can be together in a group so you can ask questions. And then that way I'll be able to know that it's directly from that community and be able to answer it in a different capacity. The other thing too, when I go, when I do the podcast in this way, you'll be able to take what's called an RSS feed. It's a code if you would, and you can put that into Apple or wherever else you listen to podcasts so you can still listen to it. Like you do this podcast, wherever you enjoy, you can still put in that code into most places it will work. And the only reason we're doing it through there and not something like Apple, it's because when you do Apple, I don't have a way for you to communicate with me when we do it through my website, the way in which I'm talking about, you still have that. Sort of minimal connection to me. If, if that makes sense. Like you can ask a question, I can make sure to answer it on a, one of the one of the paid podcasts. So we'll make sure to get that out to you. I'm hoping that that office is up soon so that we can get some video attached to this and you'll just be seeing me a whole lot more So I'm gonna jump to today's topic, which is a good one, which are, what are additional prescribed medications that can be added? If, let's say that you. Maybe you have a contraindication where you could never take a GLP 1, right? There are people that they have different family histories of different cancers or pancreatic disease. You know, there's different things that would make it a hard and fast contraindication not to use the medication. Or let's say that you're on it and you've been in that category where we would say a hyporesponder, meaning you didn't reach what we would have expected you to lose. And while, you still get help from it and you've had, clinically significant results, meaning more than 5 percent total body weight reduction. A lot of people are not happy with the 7%, the 10 percent if overall they wanted to get closer to 30%, which most of the medications on the market right now, remember they can't get you that on average. But again, if you're in that category where it's not working as much now, I want to be super clear here and just reiterate, we say this all over our intro, but you might be skipping it at this point. This podcast is for informational purposes only. So I'm not sitting here. telling you that you should add X, Y, Z. I'm simply saying some options that exist out there, but ultimately you really should be working with a weight care expert because it's not really a one size fits all. Like I had a patient here came into my clinic not too long ago. So if you're a resident of either Indiana or Illinois and you're 18 years or over, if you'd want to join my clinic, you could do that. And this person joined the clinic and. I think some people think that there's just this formula where every single person, we do the same thing. And they wanted to know, okay, tell me every single month what med changes we're going to make. Like as though I had a crystal ball, what would happen over the next 12 months? And I said, you know,, there's no formula here because I don't know. It might be where you're increasingly hungry and we need to adjust things. It might be where you have urges and cravings. It might be, there's just so many different. Factors that are involved in here. If you're losing too much muscle, we might add different supplements. There's so many variables, right? And so I'm gonna talk you through what I see in general with when I'm adding different stuff. But this is not gospel. This is not something that we a hundred percent follow. This is very much so nuanced. It's very much so the art of medicine. I just want you to know that. Always know if one thing doesn't work, there is always more that can be done if you're really seeing a skilled weight management expert. So remember, like I said in the last episode, I always want to first make sure that in addition to a medication that we've started, because I'm not someone that says, oh you have to Prove to me your food log and all those things. No, this is a medical condition and the medications help you in order to be able to do all the other things. But before we're adding on more medication, I always want to make sure, okay, what's your hydration status like? What is your protein and fiber intake? How much processed food are you having? What's. What's the balance to what you're doing? What's your exercise look like? Your sleep? Your stress? There are so many factors that can be worked on. But there comes a point, like we talked about in the last episode, when you have given it your all for a prolonged period of time. Months and months and months and months. Maybe six months and nothing's changing. Okay, maybe it's time to add something else. So I'm just going to lay out the list that I see used most commonly and then I want to talk through it. But know that there are also other supplements and things and that could be. A whole nother issue. I was actually talking to a coaching client here about different supplements and it's interesting because again, everyone has different needs for different things and so I don't want to throw a list out here and then everyone goes and buys that thing. We, we're, we're not really about that here. Okay, so Going to the medications, I find that if people are really still struggling with hunger, also urges and cravings, but really hunger, being a big factor, the medication Topamax with Phentermine, that's called Qsimia, again, there's different brand names for all of this, that medication, medication, medication. It's an oral, these are all oral medications that we're talking about today. That can be helpful as an add on. A lot of people will actually start with that to begin with. Many insurance companies will make you fail either Phentermine on its own or Qsemia, which is again, the Phentermine with Topamax. They might make you fail that before you're able to try other medications, but also it can be added on. And this might be, again,, the person that I really think of for this, it's someone their hunger is high. I will tell you why I personally really do not like this. So the Topamax part, unless you also have a history where there's some other reason to have Topamax involved. So for example, like you have migraine headaches, right? Topamax is very commonly used for something like that. Unless there's something else like that, Topamax can have a potential side effect of a sort of a fuzzy brain, right? Like you're thinking being a little fat. And most people that I'm working with are really professional go getters. They can't afford to be sort of a little bit off their game daily. So that's just something to think about. And again, remember with these medications, we always outweigh, do I get more help compared to the Literal headache that it creates, right? the, i, I don't mean that it cause a headache, but just the sort of the, the cognitive symptoms. I will tell you historically from this medication, I just find that the side effect profile is really hard for people to handle. So for example, the phentermine can have,, dry mouth and a lot of other type of symptoms Topamax can cause that fuzzy brain. It also can affect. For example, your perception of carbonated beverages. And so there are some things that people are honestly, they're distressed by it. They don't like how that feels for them. So I typically. I do not use a lot of this. Now, I'll also say another thing. Phentermine is not something that's a controlled medication. So that's not something if you use a telehealth service that they're going to be able to write for. But even when I was in brick and mortar, I just, it would be sort of a 1 out of 20 that could handle this. If they can handle it and it works, it's great. But otherwise, I don't see this being the main thing that we go for. Alright, the other really big option that, It works very well, again, also FDA approved, would be the combination of Welbutrin, which is Bupropion, with Naltrexone, and that would be the name brand Contrave, or you can prescribe each of them individually for what we call generic, and you can make that combination yourself. And with this, it's really good for the person that tells me, look, it's not that I'm hungry all the time. But I have very intense urges and cravings, and I'm talking about we have worked on their nutrition. We have really made sure that they're getting enough protein. We really make sure that they're balancing their plate, that it's not that they're having no carbohydrates, so their body is just screaming out for that, right? We really make sure that things are balanced, that they're hydrating enough, and All the things, and they say, I still, multiple times per day, just really want a cookie, really want some chocolate. We try other things to augment, to replace, there are so many strategies we try and it's not going down. This Contrave can be so incredibly helpful for that. And so I really think about it for a person with lots of urges and cravings or nighttime snacking, there's these areas that we just can't get under control. No matter how many different tips, tricks, techniques, there's, Always a million things you can do, but sometimes, and I'll tell you for me, you know, this is something that it's, you'll see people for years having worked on it and then they get on this and suddenly things click. So again, a lot of people might start with this to begin with. Or if you are on a GLP 1 and you've gone all the way up and you're, still struggling with that. And this is hard to believe because some of you have very pronounced effects when you start on a GLP 1. You can't fathom that someone wouldn't be appetite suppressed and they're never thinking about food. That's not everyone. So everyone's physiology is different. So again, we're talking about how to make your physiology work for you. And so this is going to be. I always say the 1 out of 20 patient, but there's this patient where they tell me, I'm just all the time thinking about suites. Contrave is really going to be the option that is potentially going to be really helpful for them. Okay, the other one that is also FDA approved will be Orlistat. Orlistat is, I just don't know anyone who's writing it. Orlistat or Ally, there's you know. There's different names for this. If you look at the studies, it's truly a few pounds over a six month to one year period. It's just abysmal. I'm sorry. I don't know if you having potential side effects of greasy stool or, you know, fecal incontinence episodes is worth you using this medication. So the only times I really see it, you also, sorry the other thing I want to mention is there can be things like. vitamins that you have to worry about their levels long term because there can be malabsorption with fat, with vitamins that are related to, with fat absorption. And so there's just so much that has to be thought of and I just don't see it being used often. This is something where I'll see it if someone has a really bad constipation and all the things that we're doing don't work, maybe then an Orlistat can get added in. Also, ironically, it's been around for a million years, and you would think, oh, it's covered great. It's actually poor coverage of this. So it's fascinating, right? You always think insurance companies are wanting you to try all this low hanging fruit and all the oral medications first, yet I don't see good coverage for this. So it's been a very fascinating thing. If I've ever had a patient on it, they are actually just buying the over the counter dose, and then I'm telling them what the prescribed amount is, and they're doing that. So definitely interesting on that. All right. So those have all been FDA approved that we just talked about. The one that's not FDA approved but I still put in this list would be metformin. And metformin is interesting because it really is helping with insulin resistance. So we don't think of it as a weight loss medication. If you look at small trials with women, they will show potentially like a 6 percent total body weight loss. So I do see That if someone is a hyporesponder and they continue to struggle despite dietary changes and exercise and all the things we're doing, I do find that for some people metformin can be that magic. Continuation that they need. So it's really interesting, making that puzzle fit into place. Is it Contrave? Is it Metformin? Is it another supplement? Which again, we won't get into here. Different macronutrient ratios, which doesn't even need to be someone necessarily counting calories and being rigid about it, but just changing the proportion of what we're eating and when we're eating and how we're eating. And so metformin is really one of those that if you have a significant insulin resistance, which is usually the case when it's a really hard time releasing weight, I find that it can be incredibly helpful as an add on. And so that is something that everyone has a different practice management style, whether they start someone on metformin and then add other things or do it in reverse. I think historically we've only thought of metformin as far as blood sugar management or delaying progression to things like type 2 diabetes if prediabetes is involved, but it's highly used actually in the weight management space. And again, it's about kind of how you're pairing things together. The nice thing about metformin, form and is that it cannot cause a low because what we're basically doing is we're stopping the liver from making more sugar, but that's not affecting insulin in any way. And so it's nice to have something that is not going to. have a risk of causing a low blood sugar or problems for people. So again, this list seems limited, but I just went over FDA approved options and then just one that was not. And so this is not extensive to everything that can get tried. Again, there are other supplements and other things. I would just really recommend that you talk to who you're working with. And if they're not able to tell you why things would or would not be a good option, sometimes, You're really locked in because of other mental health medications that someone's on. So, that's really a consideration whether you would be able to do something like a Contrave or not. Or even same thing with, a Qsimia or. Even metformin. But the point is that you need someone to tell you why or why not things are recommended. And if they can't, then you're likely not working with someone that's doing this all the time. Right? So that is just something to keep in mind is that they should be able to walk you through why things are or are not done. The other thing I want to stress too. You don't just add these things. I say willy nilly. You don't just like randomly start adding meds, shotgun approach. You do things at least the way I practice in my clinic. It, it is low and slow. You really see why you're starting it. You see if things work. If they don't, you get rid of it. You don't want to just end up down the road being on four or five medications. You really don't know what it's doing, but then you don't really want to upset the apple cart. So you don't. So, there really should be some oversight into this process. And so involve your team, but I just wanted to go over that I think we've just forgotten about all the other options. And all I ever hear are the GLP 1s. And the thing about it is it's a one trick pony, right? So a lot of physicians and other health care extenders have gotten into this space and basically all they know are, you know, they'll know semaglutide, which is ozempic wagovi, and then they'll know terzepatide, which is zep bound manjaro, but those are about the only two that they know. And when it doesn't work, they're like, Oh, that's it. I have nothing else to offer you. Or if someone, God forbid, is having a bunch of side effects and they say, gosh, I just need something else, but I don't want to lose this great, you know, 10, 15 percent total body weight loss. Remember the name of the game is weight stability so that you don't have this metabolic up and down. That's, that's ultimately more harmful than if you would have lost a certain amount and just And so when we're looking for that, when we want to protect, it's sort of, gosh, think about it, protecting it in times of war. It's like you're trying to not have your body go back to how it was before, and you need to kind of protect the line. And some of that might be these oral options. If not on their own in combination or used with other things. So I hope that this episode was helpful today. If you're wanting to know the specific weight loss percentages for all of this, I did this in a very early episode of this podcast. It was literally one of our first few. It was the part two where I talk about medication. I talk through a lot of these options. I go through the percentages of weight loss that you can expect with each of them if you use them in isolation. But I was not talking at that time about. Combining medications in this way. Alright, make sure that you talk to your medical team and they will always be the ones to guide you. At least now you've just heard that there are other avenues. I just worked with a patient today and they said, gosh, they were so grateful the fact that I had some other reasoning or logic or other things to change that it wasn't just, up, semaglutide isn't working for you and now everything's over. That's not ever how it is. Alright, I hope you all have an amazing rest of the week and we'll talk soon.