Physician’s Guide: Using Blood Test Findings To Safely Induce Weight LossJune 2009
By William Faloon
Optimal Blood Ranges to Facilitate Weight Loss
There are a variety of blood tests that can direct what drugs, hormones, and nutrients you prescribe to correct underlying hormonal and metabolic disorders and facilitate weight loss.
An obese individual will often exhibit dangerously high levels of C-reactive protein. Not only is this inflammatory marker associated with increased vascular disease, dementia, and cancer risk, but it can preclude weight loss by binding to leptin and creating a state of leptin resistance.123,148-150 Leptin is a satiety hormone that also helps promote the breakdown of triglycerides in adipocytes.151-153 Most of the drugs suggested in this protocol will induce a significant reduction in C-reactive protein blood levels. For men, ideal C-reactive protein is below 0.55 mg/L. Women should be below 1.55 mg/L of blood.
We have learned to accept any reading of fasting glucose under 100 mg/dL of blood as acceptable. The reality is that any increase of fasting glucose over 85 mg/dL incrementally increases heart attack risk and probably contributes to unwanted fat accumulation. Ideal fasting glucose is probably in the range of 72-74 mg/dL, but it will be challenging to achieve these levels in overweight and obese individuals even when all the medications suggested in this protocol are concomitantly prescribed.
The standard reference range for fasting triglycerides extends up to 149 mg/dL of blood, but any number above 80 mg/dL is probably too high. To protect against vascular disease, triglyceride levels should be suppressed far below 100 mg/dL. To treat the postprandial lipemia that has been identified as a probable cause of obesity, suppressing triglyceride levels below 60 mg/dL of blood would be ideal, though you will be challenged to achieve these levels in most aging overweight patients. Scientists have identified a phenomenon known as postprandial hypertriglyceridemia, in which triglyceride levels remain high after a meal; this represents a significant independent risk factor for vascular disease. Don’t hesitate to test your patient’s blood two to three hours after they have ingested a typical meal. A patient with acceptable fasting triglycerides might demonstrate higher than desirable (greater than 133 mg/dL) postprandial triglycerides. The medications and nutrients suggested in this protocol should sharply reduce triglyceride levels and thus help purge the bloodstream of chronic postprandial lipemia that contributes to their surplus body fat stores.
The reference range for thyroid hormone tests can cause those with less than optimal thyroid hormone levels to be diagnosed as “normal.” Make sure your patient’s TSH is below 2.00 mIU/mL of blood and free T3 is in the upper one-third of the standard reference range.
For most aging men, a free testosterone blood reading of 20-25 pg/mL is optimal, while estradiol levels should be kept at 20-30 pg/mL of blood.
The optimal blood level of estradiol in aging women varies considerably amongst individuals. An estradiol target to attain using bioidentical estrogens is 90-250 pg/mL. If this range helps facilitate abdominal fat loss, then it may be ideal for that particular patient. Make sure any female patient prescribed estrogen reviews the cancer risk-reduction program that can be accessed by logging on to www.lifeextension.com/estrogen. Remember that in female patients, excess free testosterone can cause abdominal obesity.
Managing “Unrealistic” Weight-Loss Expectations
Clinical studies document that overweight and obese subjects have unrealistic expectations about the rapidity and amount of body fat loss that will occur in response to weight-loss drugs.154
For many patients, if immediate fat-loss results do not occur, they will abandon the program, even when being repeatedly told that weight loss will be a gradual process. Regrettably, the desire for major cosmetic weight loss and the lack of understanding of the medical benefits derived from modest body fat reduction can conspire to derail the best-laid scientific protocols.
A key element to short- and long-term success is to educate the patient while encouraging continuous compliance. The article titled Weight Loss should be printed out and given to patients to help them understand what they need to do to allow a comprehensive program like this to work for them.
Addressing psychological issues such as emotional eating are important patient considerations. Drugs like Wellbutrin® and Adderall® have been shown to induce weight loss, but can cause psychological disturbances.155-157 Likewise, the drug sibutramine (Meridia®) has demonstrated potent weight-loss properties,158,159 but we are concerned about the long-term effects of artificially interfering with normal neurotransmitter reuptake. Sibutramine reduces the reuptake of serotonin (by 54%), norepinephrine (by 73%), and dopamine (by 16%), thereby increasing the levels of these transmitters in the brain and helping to enhance early satiety.160
As is explained in Weight Loss, patients with emotional eating issues may benefit from a specially formulated tryptophan supplement designed to deliver greater amounts of tryptophan into the brain for conversion to serotonin.
Summary: Is All of This Too Complicated?
After reading this multi-pronged approach to optimally induce immediate and sustainable weight loss in your patients, you may wonder if it is too complicated and expensive.
Fortunately, Life Extension® now offers comprehensive blood tests at the lowest prices ever. Many of the drugs can be obtained in very low-cost generic or compounded form. There are also nutritional supplements that can be substituted for some of the medications. So the cost of implementing this program is affordable to most patients.
As far as the complexities of this protocol, please remember that approximately 2.2 million Americans die each year.161,162 When tallying up the data, including higher rates of suicides and accidents in obese individuals, it becomes rapidly apparent that the metabolic dysfunction displayed outwardly in the form of excess body fat is by far the leading killer. Be it stroke, heart attack, dementia, or cancer, the more overweight a patient is, the greater the likelihood they will be stricken by these lethal diseases.
If this multi-pronged protocol induces the kind of sustainable weight loss and reduction in metabolic disorders that the published studies indicate it will, you may want to recommend it for all of your overweight or obese patients. It seems more logical to prioritize even modest reductions in body weight as opposed to dealing with the plethora of obesity-related diseases that inevitably develop.
Up until now, there was little that physicians could do to induce significant fat loss in their aging patients. For the past 50 years, a wide variety of methods have been attempted to overcome the worsening obesity epidemic, yet there are more overweight Americans now than ever before. Until a magic bullet is discovered, the only way to achieve optimal weight control in your patients may be to follow most, if not all, of the suggestions you have just read.
In addition, please refer your patients to the Nine Pillars of Successful Weight Loss to provide them with guidance on dietary and lifestyle changes they should implement to enhance the fat-reducing benefits of the various medications discussed in this article.
If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-800-226-2370.