Very low-calorie diets (VLCDs) have been around since the early 1920s and if done correctly are pretty safe. As a matter of fact, I think they are underutilized tools in medicine. On occasion, they get a bad rap in news stories, but those stories often fail to explain that those particular cases were not done in accordance to clinical standards.

Most physicians who prescribe VLCDs used commercial formulas such as bars and shakes to replace your food completely. These formulas are standardized by the Codex standardization. At Enara Health, we use compendium of real food recipes, but make sure the sum of what patients are eating matches the same standardization.

VLCDs must always be accompanied with weekly provider/group support and therapy on behavior change. I’ve found them particularly useful for people who have dieted a lot in the past and have become resistant to weight loss, as well as for patients with busy, active lives. For unknown reasons, VLCD treatment have been shown to improve glycemic profile, restore hepatic insulin sensitivity, and beta cell function far more than traditional dieting or carbohydrate counting. Other health benefits that come with a VLCD:

  • 10-15% improvement in blood pressure.
  • 25-50% reduction in triglycerides.
  • 15-25% reduction in LDL (bad cholesterol).

There is large misconception that slow and steady wins the race when it comes to weight loss: steady and gradual changes are likely to last longer and produce sustainable results. Problematically, this is not true. Fast weight losers have repeatedly been shown to achieve greater weight loss and are not more susceptible to weight regain than gradual weight losers.

For Larry, he ultimately decided on VLCD because

  • Traditional strategies had not worked in the past.
  • He is super busy and wanted regimented program.
  • He had evidence of severe insulin resistance bordering diabetes and wanted to reverse this.

What About Phentermine?

After a thorough discussion, Larry and I agreed to start phentermine to help him with his weight loss. Now for many people, prescribing drugs to treat obesity is seen as sin. From my standpoint, I see obesity as a complex medical disease. I occasionally use prescription medications to help people fight biochemical and hormonal signals. Larry had tried a multitude of diets in the past with limited success, including sustaining a 1300 calorie diet with no weight improvement and constant hunger. His weight is not his fault! It was time to try to give him a new arsenal in fighting this disease and I hope that a VLCD/Phentermine combo works.

Phentermine first received approval from the FDA as an appetite-suppressing drug in the 1970s. Phentermine, itself has had relatively ok safety profile (other than raising HR and BP). It has gotten a bad rap due to its combination with other drugs. However used alone phentermine has been shown to be fairly safe and well tolerated drug.  Larry wanted a short-term medication and that is why we choose phentermine over other FDA approved weight loss medications.