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Body
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Body
Mass Index
Calculation
Glycemic
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Carbithane
Protocol
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Test
America
Medical Center
Phone: 805.563-3301
Fax: 805.563-3303
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Welcome to
the Santa Barbara
Weight Loss Program
John D. Dorman, M.D.
3603 State Street
Santa Barbara, California 93105
We can help you lose weight quickly and safely in a
way you might never have thought possible. Whether you've had a weight problem your whole
life or just put on the pounds little by little over the years, our physician-supervised
program can help you lose weight. Along with weight loss comes a healthier and more
attractive body, increased energy, and a more outgoing lifestyle.
Entering the new millennium Americans face a major health problem.
Sixty-eight (68%) percent of all Americans are overweight,
and the percentage of adults who are obese has been rising for a decade. Obesity is
the second most common preventable cause of death in the United States. The risk of
disease is not just confined to adults, children and young adults also face increased
health risks if they are overweight or obese.
Initial Visit
Your first visit will include the following:
Blood work
to determine proper organ function
Bioanalysis to determine ideal weight and
current percentage of body fat
Light physical exam by the medical doctor to
confirm that the program will be safe and effective for you
Health appraisal questionnaire to determine
the status of all body systems
After your initial visit, your progress will be
monitored frequently.
If you have any questions, please contact the Test America Medical Clinic by phone (805)
563-3301, fax (805) 563-3303 or e-mail:
CustService@testamerica.com
. Our address is 3603 State Street, Santa Barbara, California 93105.
It is increasingly recognized that obesity is not a failure of will or behavior,
nor is it a disorder of body weight regulation. It is a chronic medical condition,
like hypertension or diabetes.
Natural Protocol
for Weight Loss
Determine your body mass index (BMI).
Your BMI is a more accurate indicator of obesity than the bathroom scale, as it provides a
standard measure of body fat and takes into account gains in muscle mass.
Follow a low carbohydrate (low glycemic) low-fat diet (40-30-30) emphasizing fresh, whole fruits and
vegetables, beans and whole grains, nonfat yogurt, skinless chicken, and poached fish.
Avoid high-fat dairy, red meat, pork and fatty poultry, processed meats, oils, and
margarine. Also avoid carbohydrates that trigger a quick release of insulin, such as
breads, processed grains, starchy vegetables (potatoes, winter squash, corn), and sugary
snack foods. The carbohydrates recommended above result in a more sustained release of
insulin, allowing your body to use glucose for energy rather than storing it as fat and
satisfying your hunger as well.
Flush out fat by drinking eight to twelve 8-oz. glasses of pure, filtered water daily.
Water is essential for good health, and it's invaluable for achieving permanent weight
loss. Drinking a glass of water before meals will aid digestion and help satisfy hunger.
Besides diet, exercise is the most significant factor in improving your metabolism,
increasing your insulin sensitivity and maintaining weight loss. Walking is an ideal form
of exercise for most people.
We recommend the following nutrients (in addition to a multivitamin and antioxidants):
Chitosan, Conjugated Linoleic Acid (CLA), Chromium and Magnesium, Soy Protein and if you
are over 35, DHEA. For the specific doses and frequency protocols email us at
CustService@testamerica.com
.
CARBITHANE
WEIGHT LOSS PROTOCOL
The Carbithane Weight Loss
Protocol was developed by John D. Dorman, M.D. This unique protocol utilizes
the balancing of neurotransmitters in the brain that control satiety
and hunger with nutrients and supplements and a low (40%) carbohydrate
diet. We have had phenomenal success with
the protocol.
This protocol is generally only available
for our office patients in Santa Barbara. However, special
arrangements can be made for persons living outside of Santa
Barbara. We require an office visit and appropriate laboratory test
to start the protocol. On going care can be provided over the
telephone for out of resident patients.
For further information about
the Carbithane Weight Loss Protocol, click here: Send
Me Information About the Carbithane Weight Loss Protocol.
What is the body
mass index (BMI)?
The body mass index (BMI) is a new term to most
people. However, it is now the measurement of choice for many physicians and researchers
studying obesity. The BMI uses a mathematical formula that takes into account both
a person's weight and height. The BMI equals a person's weight in kilograms divided by
height in meters squared.
A BMI of 25 or more indicates overweight.
A BMI over 30 is usually taken as a sign of moderate to severe obesity.
The BMI measurement poses some of the same
problems as the weight-for-height tables. Not everyone agrees on the cutoff points for
"healthy" versus "unhealthy" BMI ranges. BMI also does not provide
information on a person's percentage of body fat. However, like the
weight-for-height table, BMI is a useful general guideline and is a good estimator of body
fat for most adults between the ages of 19 and 70 years. It may not be accurate
measurement of body fat for body builders, certain athletes, and pregnant women.
Click
Here for a BMI chart.
Causes
of Obesity
Many factors other than overeating can play a part in being
overweight: Cultural influences, your genetic make up and natural hormonal and
neurological regulators can make it hard to control body fat by diet alone.
Currently, the causes of chronic obesity are under intense investigation, there is still
much that is unknown.
Cultural Influences on Eating and Activity Patterns. .
Both leisure and working time are increasing sedentary as
people move from one seated position to another in their use of the automobile, the
television, video games, and the computer. The effect of Western culture can be
demonstrated by the fact that adolescent obesity increases dramatically among second and
third generation immigrants to the U.S. as they adapt to the American diet and lifestyle.
Metabolic and Behavioral Regulation by the Brain..
Eating patterns are regulated by feeding and satiety centers
located in the hypothalamus and pituitary gland of the brain that respond to signals
indicating high fat stores and hunger. The level of the body’s stores of fat may also
be dictated by a mechanism in the brain that establishes a set point for a fixed amount of
body fat just as a thermostat regulates heat according to a preset temperature. In the
case of obesity, the set point may be set at an unhealthy level. Losing weight in such
cases becomes extremely difficult because, unknown to the person who has been painfully
dieting, the brain is busily undermining these efforts by working to restore the original
weight. This set point -- strongly influenced by genetics and is extraordinarily
difficult to alter -- is probably controlled by neurotransmitters that signal hunger or
signal satiety. Only those individuals with exceptional willpower and the ability to
tolerate discomfort are able to defeat this mechanism through dietary energy restriction.
Insulin and Its Role in the Body.
Insulin is a hormone that regulates blood sugar and triggers
the body to store fat. Carbohydrates, the cornerstone of most diets, raise blood sugar
levels, and increase insulin levels. Some people develop insulin resistance due to
excessive carbohydrate intake, which causes you body to release even more insulin which
may contribute to more fat storage.
Genetic Factors. .
Genetic factors influence fat metabolism and regulate certain
hormones and proteins that affect appetite and may play some part in 70% of obesity cases.
Inherited attributes can include the way fat is distributed, metabolic rates, changes in
energy responses to over eating food preferences, and other factors.
Other Causes of Obesity..
A number of medical conditions may contribute to being
overweight, although rarely are they a primary cause of obesity. Hypothyroidism (under
active thyroid) may cause some weight gain but it is only moderate weight increase of five
to ten pounds. Cushing’s disease is a rare condition caused by high levels of steroid
hormones, which results in obesity, a moon-shaped face, and muscle wasting. Diabetes is
often associated with obesity. Almost 90% of type 2 diabetics are obese, and they
generally have high levels of insulin, a condition called insulin resistance.
Diets.
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Bioanalogics
Health
Management
System |
There are many diets out there. The different types
of diets do not have any particular "magic" to them. They all work only if
and only if the intake of calories is less than the energy a person uses. One of the
more reproducible findings in medicine is the tendency towards regaining weight after an
intervention aimed at weight loss. That is, most people land up right where they
were one year after the weigh loss intervention whether it be diet only, medications, etc.
At Test America Medical Center we recommend a
low-carbohydrate, low saturated fat and low trans fat diet. The carbohydrates must be
complex carbohydrates or low glycemic carbohydrates. The ratio is 40 - 30 - 30 caloric
ratio of carbohydrates to protein to fat. Basically, a low-carbohydrate diet is one of the
easiest diets to follow, because you don’t count calories! The only thing you really
need to count are grams of carbohydrates. You may add carbohydrate as you lose weight. If
you stop losing weight, you’ve added to many carbs, so back off. Obesity is a chronic
condition. You will need to pay attention to your food intake for the rest of your life.
1. The carbohydrates that we eat, ranging from bread to
fruit, are broken down by enzymes into simple sugars. The sugars stimulate the pancreas to
produce insulin, the body’s main energy regulator.
2. The insulin allows sugars to enter muscle and other
tissue through receptors. The cells then use the sugars for energy. Any excess sugars are
stored as fat for later use.
3. If a lot of sugars are present, the body produces too
much insulin. This overwhelms the receptors, and the system breaks down. The receptors
lose almost all their ability to take sugars into the cell. The body then stores most of
this excess sugar as fat.
4. By eating fewer carbohydrates, you can reduce sugar
levels, allowing the insulin system to begin functioning correctly again. When blood sugar
levels drop low enough, stored fat is used for the body’s energy needs, causing
weight loss
Low-Carb Diet Guidelines
It is important to point out that, for most people, the only foods that are NEVER
allowed on a low-carbohydrate diet are those containing white flour and/or sugar
(including honey). Although grains and breads are on the "Not Allowed" list,
people who are on a weight-maintenance diet, or those who can tolerate a few additional
carbs and still lose weight, may eat a limited amount of grain products. The same applies
to fruits. Most fruits are restricted, but some fruit (other than grapes and watermelons)
are allowed as long as they do not produce weight gains.
Make sure every gram of carbohydrate you eat is the healthier complex carbohydrates
found in vegetables or whole grains.
Insulin Reducing Diet, Lower Carbohydrate Foods
Meats: Beef, buffalo, lamb, veal, rabbit, venison, elk, pork, turkey, chicken,
duck, ostrich, emu, or goose. (Trim visible excess fat from meats and skin off poultry.)
Bake, broil, boil or saute in vegetable oil or butter. Minimally processed deli turkey,
ham, beef and organ meats are allowed. Avoid all highly processed meats (i.e. sausage,
bacon, and corned beef.) Read labels!
Fish, Seafood: All fresh fish (i.e. cod, flounder, haddock, halibut, herring,
mackerel, perch, pike, salmon, sardines, trout, tuna, catfish, etc.) Mollusks and
crustaceans (clams, oysters, scallops, shrimp, crab-and lobster) may be broiled, baked,
boiled or sautéed. Avoid skin. If you must fry use butter or vegetable oils (corn,
safflower, soy, olive or sesame) No lard, trans or hydrogenated fats. (i.e. Crisco etc.).
Do not use bread crumbs or flour.
Vegetables: Artichokes, asparagus, brussels sprouts, string beans, green beans,
lentils, kidney beans (not canned), soy beans, navy beans, pinto beans, black beans,
alfalfa and bean sprouts, bamboo shoots, beet greens, broccoli, cabbage, cauliflower, bok
choy, celery, Swiss chard, chicory, chives, collard greens, cucumbers, dandelion leaves,
eggplant, endive, escarole, fennel, garden cress, romaine, garlic, herbs, jicama, kale,
kohlrabi, leeks, lettuce, celery, mushrooms, mustard greens, onions, parsley, pea pods,
red peppers, green peppers, pumpkin, radishes, rhubarb, sauerkraut, scallions, spinach,
spaghetti and summer squash, tomatoes, turnips, water chestnuts, watercress, water
chestnuts, zucchini. Fresh are preferred, but frozen or canned may be used.
LIMIT: POTATO,
CARROTS, CORN, PEAS.
Fruits: Avocado, small amounts of fresh cranberries, cantaloupe, cherries,
grapefruit, plum, raspberries, strawberries, lemon and lime. No canned or dried fruits.
Fresh are preferred, but frozen may be used if unsweetened.
Salad Dressings: Mayonnaise, Cardini's or Paul Newman's Oil and Vinegar
Dressing. Salad dressings made with cider or wine vinegar, lemon or lime juice (fresh or
concentrate,) corn oil, canola oil, flax seed oil, hemp oil, sunflower oil, olive oil,
sesame oil, soybean oil or safflower oil, cold pressed oils preferred.
Soups and Broth: Homemade soups with meat or beans and vegetables only. (No
rice, barley, milk, pasta, flour, corn starch or potato.) Unsweetened bouillon cubes or
granules.
Breads Cereals and Pasta: None of any kind. Positively limit
your intake of rice, wheat, corn,
oat, rye, buckwheat, barley, millet, amaranth, kamut, quinoa, spelt, etc.
Dairy Products: Sour cream, ice cream or yogurt. Limited amounts of cheese and
cottage cheese.
Eggs: Preferably poached, boiled, over easy, or basted in butter, suggested
maximum of seven per week.
Beverages: Filtered, purified or spring water is preferred. Club soda, Herb
teas, unsweetened and caffeine free. Half of a lemon or lime in a glass of water. Tomato
juice or V-8 Juice. No regular soft drinks of any kind.
Miscellaneous: Limited sugar free gelatin, ripe or green olives,
dill or sour pickles only. Fresh or dry mustard. Hard-boiled or deviled eggs. Limited
fresh or dry roasted nuts: walnuts, pistachios, pecans, filberts (hazelnuts), almonds,
pine nuts and macadamia nuts. No cashews, no peanuts. Seeds: sunflower, pumpkin and
sesame.
Medications
Prescription medication may be part of a weight
management program for obese patients that also includes nutrition counseling and regular
physical activity. Prescription medications for weight loss generally reduce appetite,
making it easier to control food intake. If eating behavior, like mood and
personality, is simply the result of a mixture of neurotransmitters in the brain, then a
pharmaceutical intervention may be more effective than attempts at behavior modifications,
just a antidepressants are generally more effective for clinical depression than a
psychiatrist.
Prescriptions for for weight control are not popular because one complaint is that
as soon as the drug was discontinued, the patient gained back all the lost weight.
However, if obesity is a chronic medical condition in the same way that hypertension is a
chronic medical condition, then weight gain following drug discontinuation is no different
from rising blood pressure after the discontinuation of antihypertensive medications.
Some people are able to lose weight and discontinue taking anorectic medications,
but those people are few and far between. Obesity is a genetic and
metabolic condition. The "weight reduced" body tries hard to
maintain the old "set point" by reducing energy expenditure and increasing
appetite.
There are two main types of medications in treating obesity; medications that
decrease appetite and medications that inhibit absorption of nutrients from the
intestines. Examples of medications that decrease appetite include phentermine (FASTIN,
ADIPEX-P), Meridia. Orlistat (XENICAL) is an example of medications that inhibit intestinal fat
absorption.
Feeling of hunger and fullness (satiety) are regulated by brain chemicals called
neurotransmitters. Examples of neurotransmitters include serotonin, norepinephrine, and
dopamine. Anti-obesity medications that suppress appetite do so by increasing the level of
these neurotransmitters at the junction (called synapse) between nerve endings in the
brain. Phentermine suppresses appetite by causing release of norepinephrine by the
cells and indirectly, raising the level of serotonin.. The common side effects of
phentermine include headache, insomnia, irritability and nervousness.
Sibutramine (MERIDIA) suppresses appetite by increasing the amount of neurotransmitters
serotonin and norepinephrine in the brain synapses. Sibutramine inhibits the re-uptake of
these neurotransmitters by the nerve cells. Therefore, the action of sibutramine is
similar to that of anti-depressants that inhibit re-uptake of serotonin such as fluoxetine
(PROZAC) - a medication that has been used for years without known association with
pulmonary hypertension or heart valve damage.
In December, 1997, the United States Food and Drug Administration (FDA) approved
sibutramine (MERIDIA) to treat obesity (both in attaining and in maintaining weight loss).
MERIDIA should always be prescribed by doctors familiar with the patients' medical
condition and familiar with the use and side effects of the medicine.
In clinical trials involving 6,000 individuals, MERIDIA produced statistically
significantly more weight loss when compared to placebo. Generally, weight loss achieved
with MERIDIA is modest. On average, MERIDIA treated patients lost 5%-10% of initial weight
at various dosage levels. In two 12-month studies, maximal weight loss was achieved by six
months, and statistically significant weight loss was maintained over 12 months.
The known side effects of MERIDIA are mild and transient. They include dry mouth,
headache, constipation and insomnia. MERIDIA also causes small increase in average blood
pressure and heart rate. But in some individuals, the increase in blood pressure can be
more pronounced. Therefore, patients on MERIDIA should have regular monitoring of their
blood pressure. MERIDIA should not be used in patients with uncontrolled high blood
pressure, history of stroke, coronary heart disease, and congestive heart failure.
Orlistat (XENICAL) is a new class of anti-obesity drugs called lipase inhibitors, or fat
blockers. Fat from food can only be absorbed into the body after being broken up (a
process called digestion) by digestive enzymes called lipase in the intestines. By
inhibiting the action of lipase enzymes, XENICAL prevents the intestinal absorption of fat
by 30%. Drugs in this class do not affect brain chemistry. Theoretically, XENICAL also
should have minimal or no systemic side effects ( side effects in other parts of the body)
because the major locale of action is inside the gut lumen and very little of the drug is
absorbed.
In clinical trials, XENICAL with a moderately reduced calorie diet was found to be
superior to placebo in achieving weight loss. The average patient in the one-year trial
using XENICAL lost about 10% of body weight. Many patients who continued treatment were
able to keep off the lost weight. In addition, XENICAL treated patients had statistically
significant reductions in total and LDL cholesterol, blood pressure, and improvements in
blood glucose levels after one year when compared to patients on only placebo and diet.
The clinical trials showed that XENICAL was well tolerated. The most common side effects
were gas, cramps and diarrhea. These side effects were believed to be due to the action of
the drug (the unabsorbed fat in the gut can cause cramps and diarrhea). According to
Hoffmann La- Roche, the maker of XENICAL, these side effects generally occurred early in
treatment and were of short duration.
Long-term decrease in fat absorption can cause deficiency of fat soluble vitamins (such as
vitamins A,D,E,K). Therefore, patients on XENICAL should receive adequate vitamin
supplementation.
Nutrients for Weight Loss
Most dieters need help in taking off pounds. They need
dietary aids to jump-start the weight loss process to give them the encouragement they
need to stay on the program long enough to succeed. At Test America we have specific
nutrients we recommend for weight loss (in addition to a multivitamin and anti-oxidants).
See Natural Weight Loss Protocol above).
Copyright © 1998 - 2006,
Test America
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Information on this web
site is provided for informational purposes only and is not a
substitute for professional medical advice. You should not use the
information on this web site for diagnosing or treating a medical or
health condition. You should carefully read all product packaging.
If you have or suspect you have a medical problem, promptly contact
your professional healthcare provider.
Statements and information regarding
dietary supplements have not been evaluated or approved by the Food
and Drug Administration. Please consult your healthcare provider
before beginning any course of supplementation or treatment.
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