Modern Metabolic Health with Dr. Lindsay Ogle, MD

Learn How Older, Low-Cost Medications Help Curb Hunger, Reduce Emotional Eating, And Support Metabolic Health

• Lindsay Ogle, MD • Episode 11

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We walk through proven, affordable weight loss medications that target hunger, emotional eating, and insulin resistance. We explain phentermine, Qsymia, Contrave, and metformin with real benefits, risks, and who they fit best.

• Why older oral options remain effective and affordable
• How phentermine suppresses hunger and typical side effects
• Qsymia’s combo benefits and the lower-cost split strategy
• Topiramate cautions including pregnancy, kidney stones, and brain fog
• Contrave for emotional eating and when not to use it
• Metformin for insulin resistance, prediabetes, PCOS, and type 2 diabetes
• Practical expectations for weight loss percentages
• Safety, follow-up cadence, and telehealth flexibility
• How to match a medication to your primary barrier

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Dr. Lindsay Ogle:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board-Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatment. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Now we are going to finally dive into the different treatment options. Specifically, we are going to talk about medications. And so today we're going to talk about three medications as well as a bonus medication. And these are the older medications that have been available for many, many years and decades, and have proven to be safe, effective, and a big benefit right now is that they are not very expensive, and that is something that is definitely different than the newer medications, which can be very expensive. So without further ado, let's get started. So the first medication that I want to talk about is called Phentermine. And Phentermine is the oldest medication that we have for weight management. And this was FDA approved in the US in 1959. So it's been around for a very long time. Now this medication sometimes gets a bad rep because at one point it was combined with a yet another medication called fin furamine. And this combination was proved to be unsafe, and it led to complications as far as heart conditions, and ultimately there were some deaths associated with it. So because of that, that combination medication was discontinued and the fin fluamine was removed from fentramine, and fentermine has since been prescribed for many decades and has been proven to be safe by itself. So fenturamine is a stimulant medication, and because of that, it is a controlled substance, but it is one that does not tend to be misused. So I tell my patients you don't really see fentramine being sold on the streets. It's not a drug of abuse, but it is a medication that is considered a stimulant, and so it is controlled, which means that you need to see your doctor at least every three months to get this prescription. And these appointments need to be in person, and so that is something to be aware of when you are prescribed this medication. And the way that it helps with weight management is that it helps suppress the appetite, and this can have a varying effect on patients. So I have some patients who take it and they say automatically it is a dramatic decrease in their appetite, which is very beneficial, so it allows them to stick to the nutrition plan that they created for their health and weight loss and weight maintenance. Some other patients they feel like it is not as effective for them, and so they may need to switch to a different medication. It does not have an impact on fullness, and it does not have an impact on hormones. So it really helps with weight management by decreasing the hunger signals to the brain. With any stimulant, some of the common side effects can be increased heart rate, change in blood pressure, it can affect sleep, so it's always recommended to be taken first thing in the morning. Some people may feel a little bit more irritable or anxious on the medication. By far the most common side effect that I hear is dry mouth, and so I just recommend my patients keep their water bottle on them at all times, and most of the time it is manageable with that. Sometimes I hear people complain about headaches or constipation on the medication, and if that is the case and a patient is unable to tolerate Phentermine because of the side effects, there are some other medications in this category that are just slightly different and sometimes better tolerated. On average, patients can expect to lose about 7 to 10% of their body weight on Phentermine. The next medication is called Qsymia, and this is kind of the next version of Phentermine. So it combines two medications. It combines Phentermine with topiramate, or the brand name is Topamax, and the combination of these two medications are just a little bit more effective for some people. So on average, people can expect to lose between 9 and 15% body weight on Qysmia This is also a pill that you take once a day, so it is very easy to take. And the brand name can be a little bit more pricey, but what I often do for patients is prescribe the Phentermine by itself, which can be about $20 to $30, and then the topiramate by itself, which is also usually less than $20, and they can take those medications individually and can kind of use an off-label version of Qsymia. And it works in a similar way to decrease those hunger hormones and signals to the brain, and again help patients to stick to that nutrition plan and diet that they created for themselves for health, weight maintenance, and weight loss. It is really important to know that topiramate cannot be used in any woman with childbearing potential. So it has been known to be associated with the development of clef lip and cleft palate, and when women take this if they are pregnant. And so it is really important that women are on effective birth control if they choose this medication. It's also great a great choice for patients who have chronic migraine, they have tremors, they are wanting to decrease their alcohol intake because topiramates can be a medication for all of these things as well. So you get dual benefit with the Qsymia or the topiramates in combination with the Phentermine if you have these other conditions. Some of the side effects that uh we see are everything that we talked about with the Phentermine, but with topiramate we sometimes see change in taste, and we see this most pronounced in drinks that have carbonation, so soda, beer, uh those things are gonna taste much different when you are on topiramate. Some people get an abnormal sensation in their fingers or toes. It's important to know that this is not permanent, so once you stop the medication, then things will go away. Some people feel like brain fog or tired on topiramate. Because of this, I often recommend taking it in the evening time, and it's less likely to happen at the lower doses that are used in Qsymia, but it is possible, so something to watch out for. Topiramate may also increase the risk of kidney stones. So if you have a history of kidney stones, this may not be the best medication for you. It should also be used in caution with patients who have a history of glaucoma. The next medication that we have had around for many years and is available in a pill form is called Contrave. And Contrave is another combination medication where there are two different active ingredients in it. So it is a combination of a medication called buproprion, and that brand name is Well butrin, and the second medication is naltrexone. Both of these medications are used by themselves for various reasons. The buproprion or wellbutrin is used for many different reasons. It can be used for depression or a non-stimulant ADHD medication. It is used for patients who are wanting help to cut back on their cigarette smoking. It has a lot of other benefits. So if you are needing help in those areas, this may be a good option for you. And the contraindications to using this medication or reasons why you cannot use this medication. The biggest one is a history of seizures. And so if you've ever had a seizure before, this is not the medication for you. It is also not appropriate for patients who drink high amounts of alcohol. The naltrexone portion of Contrave is used more in the addiction medicine world. So it is an anti-opioid, and what that means is that you cannot take opioids while on this medication. It is not addictive, it's actually used to treat opioid use disorder, so you don't have to worry about that. Um, it is often used for alcohol use disorder, so it can help people decrease the amount of alcohol that they're drinking, but it will not make you sick if you do drink. The most common side effects of Contrave include headaches, uh, dizziness, stomach upset, uh, nausea, stomach discomfort. Um, that's typically what I hear from patients. And the weight loss that we see with Contrave on average is more modest compared to fentramine or qsimia. It's more around 5% weight loss. Although I do have some patients who respond very well to Contrave, so it can be very individualized. This is not a controlled substance, and so there's a little bit more flexibility with prescribing this medication. You could space out your appointments more, you can be prescribed via telehealth. So those are all things to be aware of. It helps for patients who have a lot of emotional eating, and so people who tend to eat when they're stressed, when they're overwhelmed, when they're feeling down, or even when they're feeling excited or they want to celebrate. The Contrave can really help kind of even that out and take away that desire for eating during those times, and so it's not as um strong as an appetite suppressant as fentramine or gusemia, and it does not impact fullness, but it takes away that desire to eat for emotional reasons, kind of blocks that food reward pathway in the brain. And then our bonus medication is metformin. And the reason this is a bonus is because metformin is not specifically a weight loss medication, but some patients do lose weight when they take metformin. Metformin is a type 2 diabetes medication, and what it does is it helps the body utilize the insulin that it is already making more efficiently. And how that and why that's helpful for weight loss is that when your body is more effective at using the insulin that it produces, it helps to actually lower those insulin levels. And I will talk in a further video about how insulin is related to weight maintenance and weight gain and why it is so beneficial to have lower levels of insulin. So if somebody has insulin resistance, they have prediabetes, PCOS, type 2 diabetes, then adding on metformin may show not only benefits in their blood sugar levels, but it will help those patients to lose weight. It does not impact hunger, it does not impact fullness, it will affect those insulin levels and make it easier to lose weight. So it kind of helps your body to work with you instead of against you in your weight loss journey. Alright, so there you have it. The three medications for weight loss and weight management that have been around for many years they tend to be um less expensive. They're all oral pills that you take, which make them great options and tend to be very effective for many of my patients. So stay tuned, subscribe, and you will see my next video next week where I will talk about the newer medications that are available, the injectable uh weekly medications, and I look forward to sharing more with you then. Take care, have a great week. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.