Dr. Terlinsky Attends the Precision Medicine Workshops Recently

Reproduced with permission from Jeanette McCarthy Ph.D of Precision Medicine Advisers

Reproduced with permission from Jeanette McCarthy Ph.D of Precision Medicine Advisers

The Precision Medicine Initiative was begun formally in 2009 and it involves using a person’s genetic information (genomics) to customize a health plan over the course of that person’s lifetime to optimize health and avoid chronic disease.

Reproduced with permission from Jeanette McCarthy Ph.D of Precision Medicine Advisers

Reproduced with permission from Jeanette McCarthy Ph.D of Precision Medicine Advisers

Specifically, Precision Medicine, through genomics seeks early detection of various cancers, cardiovascular disease and degenerative neurological diseases including parkinsonism and Alzheimer’s. Moreover, matching a patient with specific medications for conditions based on genomic information may lead to better control of neuropsychiatric conditions, epilepsy, hypertension, cardiovascular disease and many other medical conditions. This is known as pharmacogenomics.

The key to Precision Medicine is a person’s individual variability in their genes and how epigenetic factors such as environment and lifestyle interact to influence the expression of their genes.

This approach will allow physicians to predict the best treatments and prevention strategies for individuals based on their genes. The “ one size fits all “ approach will no longer apply.

Reproduced with permission from Jeanette McCarthy Ph.D of Precision Medicine Advisers

The entirety of a person’s genetic material is referred to as their genome. When the human genome was completely decoded around the year 2000, one could have their genetic code deciphered but it was very expensive approaching $30,000. Over the ensuing years, advances in technology have brought down the cost to the point that for a few hundred dollars a person can have their genetic information including important health information.

I am recommending all my patients to make an appointment with me to discuss genomic testing and the benefits of this testing.


Dr. Terlinsky Attends the Obesity Medicine Association Fall Conference

Dr. Terlinsky has been a member and a certified diplomat of the Obesity Medicine Association, OMA, for almost 2 decades.  The OMA, formerly The American Association of Bariatric Physicians, provides cutting edge education for physicians in the field of obesity medicine and is a nationally recognized medical organization dedicated to advancement in the treatment of obesity.  

I always look forward to the fall. That’s when I attend many medical conferences and I love medical conferences! I go to 5-7 medical conferences per year. Starting last December, I have been to the annual meeting of the A4m (American Academy of Antiaging and Restorative Medicine), Endocrine Society, European Society of Hypertension, Obesity Medicine Association and the North American Menopause Society. Before the end of 2018, I will attend a Concierge Medicine conference in Atlanta, a Precision Medicine conference in Hershey, PA, Laser Therapy Conference in Baltimore and the back to Las Vegas for the 2018 A4M.

In Washington DC, between Sept 26-30 I was at the OMA meeting and here is what I heard:

Mental Health Considerations in the Treatment of Obesity

Many psychiatric conditions and eating disorders are present in patients with obesity, and these conditions may interfere with obesity treatment. Many clinical are useful to help address psychiatric problems and eating disorders during obesity treatment.

Update on Bariatric Surgical Procedures

There are new developments in bariatric surgery, such as a more aggressive Roux-en-Y and SIPS (stomach intestinal pylorus-sparing surgery). There has been FDA recent warning on gastric balloons.

Bottom line: 50% classic Roux-en-Y, 50 % Gastric Sleeve.

Lap Band is out.

Exercise Physiology

There are many reasons to exercise beyond weight loss. Even if you do not lose weight, if you exercise, you will decrease your chances of heart attacks, strokes, heart failure, and sudden death. You will live longer if you exercise. The worst thing for health is the sedentary lifestyle. Sitting for 4-6 hours a day is like the new smoking. Exercise needs to create some perspiration for it to be valuable.

The Role of the Mediterranean Diet for Weight Control, Optimal Health, and Longevity

It is interesting to compare scientific results for health and weight loss when comparing various diet strategies. There is the Mediterranean diet, the ketogenic diet, and the low-fat diet. Guess which one has no scientific basis for any success at all? If you say the low-fat diet you’re correct.

As it turns out in the long-term the ketogenic diet and the Mediterranean diet are about equal. However, weight loss occurs faster with the ketogenic diet. Motivation is a significant factor in patient compliance with a diet. Short-term and tactically ketogenic diets keep people interested.

The Ketogenic Diet

Did you know that there were several levels of a ketogenic diet? It all depends on how low you go with carb restriction. The most intense ketogenic diet starts around 20 g and that is basically the Atkins diet which is very high in fat. If you do this diet successfully you burn through all the fat. If you do not become ketotic because of excessive carb intake wind up eating too much fat and their goal is your cholesterol. On the other hand, if you follow a 60-80 g ketogenic diet there is far less fat. That may be safer for people who have underlying vascular disease, diabetes and coronary artery disease.

Understanding and Managing Food Cravings

Do you know the difference between hunger, thirst and a craving? Hunger was caused by low blood sugar and it is very difficult to resist just as holding her breath. Drinking water eliminates hunger if the hunger was based on thirst. Cravings have nothing to do with blood sugar or body water status. Cravings go away in 7-10 minutes particularly if you can distract yourself. What is an anti-craving? That is when you have an aversion to a food for example spinach. Can you overcome this? Absolutely!

Medications for Obesity-related Diseases

5 years ago, there were virtually no safe FDA approved medications for obesity. We now have many. The problem is many providers are not able to prescribe the right medication for the right patient profile.

What’s in the Pipeline for Anti-obesity Medications?

Less take the following conditions: High cholesterol, diabetes, hypertension and obesity.

In the case of cholesterol, diabetes and hypertension, all these conditions initially had very few drugs that were effective and most of them had unfavorable side effects. That has changed over the last 20 years and now we have excellent medications for high cholesterol, diabetes and hypertension. Moreover, many of these medications have been proven safe and effective and prevent cardiovascular disease. We are using these medications in combinations.

What about obesity? We will remember fiasco of Fen/Phen. Many obesity medications have been taken off the market for adverse side effects and dangerous cardiovascular effects. But we have a new age now. Obesity medications both given singularly and in combination are catching up with high cholesterol, diabetes and hypertension. There are many new drugs in the pipeline which will be game changers.

Precision Medicine in Obesity Treatment

Around 2000, the human genetic code was broken. We are now reaping the benefits and people can now obtain the genetic profile relating to their health.  It is like getting your owners manual for your body.

Precision Medicine uses genetic information, refer to as genomics, to predict all sorts of useful information including the best medicines for a patient, the best nutritional strategies for patient and now the best nutritional plans for the overweight and obese. We are just at the beginning.

I learned about the relationship between genetics and obesity, including current research on genetic factors that influence individual variability for weight gain. I was excited to hear that there was a role of genetics in the prevention and treatment of obesity.

Dr. Terlinsky Attends the European Society on Hypertension and Cardiovascular Protection Meeting

One of my areas of medical expertise is hypertension having been certified as a specialist in clinical hypertension in 2002 by the American Society of Hypertension (ASH). As I do each year, I just attended the annual meeting of the European Society on  Hypertension and Cardiovascular Protection (ESH) which occurred in Barcelona Spain, June 8-11.

It was a very exciting event as ESH 2018 introduced its newest guidelines for the diagnosis and treatment of hypertension. Furthermore, Dr. Paul Whelton, the lead author of the American guidelines for the diagnosis and treatment of hypertension released in September 2017, was a guest speaker and he participated in a discussion comparing the American and the European Guidelines.

We tend to lose sight of the fact that poorly controlled blood pressure (hypertension) is the root cause of heart failure, atrial fibrillation, sudden death, kidney failure, heart attacks, stroke and atherosclerotic vascular disease. In fact, deaths from hypertension and related complications exceed all of the causes of death combined. Think about that, hypertension and hypertensive co-morbidities kill more people than all deaths caused by cancer, smoking, alcohol, influenza, AIDS, West Nile Virus, pneumonia, influenza, drug overdoses, car accidents and everything else imaginable!

We know from the landmark studies that started in the 1960s and 1970s and which have continued for the past 60 years that treating the “Silent Killer” dramatically reduces hypertension-related deaths.

Dr. Terlinsky Attends Medical Conferences Worldwide

Over the past year, I have attended several medical conferences all over the world. I go to these events for two very specific reasons:

First, I believe that I owe it to all my patients to be up to date and cutting edge.

Second, I love what I do. I love being able to learn what’s happening within my industry, connecting with other like-minded physicians and becoming a better care-provider as a result.

Here are my activities over past 15 months and what I have planned for the rest of the year:

1. June 2016, Paris European Society of Hypertension and Cardiovascular Disease Prevention

2. September 2016, Chicago Annual Meeting of Obesity Medicine Association

3. October 2016, Orlando Annual Meeting North American Menopause Society

4. December 2016, Las Vegas Advanced Workshop Men’s and Women’s Sexual Health 

5. December 2016, Las Vegas Annual Meeting American Society of Anti-aging and Restorative Medicine

6. April 2017, Orlando Endocrine Society Annual Meeting 

7. June 2017, Milan European Society of Hypertension

8. September 2017, San Antonio Obesity Medicine Association

9. October 2017, Philadelphia North American Menopause American Society

10. December 2017, American Association of Anti-aging and Restorative Medicine

Dr. Terlinsky’s Thoughts at the Annual Meeting of the Obesity Medical Association

Good morning, Dr. Terlinsky here in San Antonio, TX at the annual meeting of the Obesity Medicine Association. I will be attending lectures and other educational sessions on the latest developments in the fields of nutrition and weight management.

This morning I had breakfast with Dr. Eric Westman from Duke University who is an international expert on weight loss and ketogenic diets He told me about his program at Duke and how patients are treated with low carb diets. Dr. Westman is a firm believer in teaching patients how to follow low-carb diets to cure their sugar addiction, improve insulin sensitivity and lose excess body fat. He shared data with me relating to the likelihood of a patient getting into ketosis based on the total amount of carbs ingested. His initial favorite is to start at 20 grams per day.

I heard the results from an interesting, novel strategy to lose weight by following an alternate date fasting (ADF) vs. a calorie reduction diet (CR) of 25 % per day.

Basically, a person eats about 500 calories on one day and gets to eat whatever they want on the other.

After one year there was not much difference between the two. There may be an advantage to the alternate-day fasting for pre-diabetics as insulin sensitivity may improve with the alternate-day fasting.

Follow Me To Learn All You Need To Know About Beauty

I have been in the skincare business since the late 90’s and I can tell you that many advancements have been made.  Through my education and personal experience I have seen beauty treatments  work and transformations made.  There needs to be an understanding of how the skin works, how the body functions and a  desire to achieve.  My personal philosophy is to enhance what you already have and that beauty radiates from the inside out.  I will be discussing how to use color and placement with your cosmetics in my next entry.

I Return from the A4M Meeting with Lots of Important Clinical News

I have just returned from a great meeting of the American Academy of Anti-Aging and Restorative Medicine. It was full of important information which will enhance my programs for weight controlbioidentical hormones for men and womenanti-aging and functional medicine. I also plan to offer additional services for my Nu-Living Concierge Medical Practice.

On Wednesday, I took an advanced seminar on Bio-identical hormones for men and women. There were several new hormone monitoring procedures introduced which will not only enhance efficacy of hormone treatments but also safety. Techniques in the lab will allow fine tuning estrogen and progesterone dosing to avoid side effects, achieve the lowest effective dose and reduce negative side effects impacting the breasts. For men several important approaches to maintain prostate health and reduce BPH and prostate cancer risk were discussed. I attended many important, cutting edge sessions involving new treatments for chronic pain, obesity, depression and metabolic syndrome. The use of telomere testing to detect accelerated aging and interventions to reverse it was a hot topic. The measurement of Galactin-3 to warn against increase risk of cardiovascular disease, cancer and other chronic inflammatory diseases was very exciting. I plan to elaborate on many of these topics in the near future.

The Difficulties of Weight Loss Maintenance

It is Saturday afternoon in Boston, it a beautiful day, the city is eagerly awaiting the second game of the Stanley Cup Championship between the Bruins and the Canucks and I am at the Boston Convention and Exhibition Center attending Endo 2011. I was very impressed after an afternoon symposium on the subject of why patients have so much trouble with avoiding weight regain.

Obesity: An Epidemic

The obesity epidemic continues unabated in the United States along with all the medical problems it engenders such as diabetes, cardiovascular disease, kidney failure and reduced longevity. In the past year, several promising drugs for obesity were turned down for approval by the FDA which continues to demand long term safety data on every anti-obesity drug it reviews. This may be a result of the Phen-Phen experience back in the mid 1990s as the the FDA’s has heightened its scrutiny of ant-obesity drugs and has made the process more difficult for a pharmaceutical company to bring a drug to market with a weight loss indication. The “toxic food environment” made famous by Kelly Brownell Phd. still is entrenched in our society  with supersized caloric portions in restaurants, relentless food commercials for junk food, and fast food restaurants showing strong sales growth.

The Problem of Weight Regain After Successful Weight Loss

Today at Endo 2011, a symposium examined why over 70% of patients regain weight after successful weight loss efforts. The first presentation looked at the abnormal function in obese patients of the complicated communications system present in all humans which regulates the body fat store. The main players—the gut, the fat stores and the control centers in the brain—talk with each other to appropriately regulate appetite, total body energy expenditure and fat metabolism.

Ordinarily, a normal weight patient has a body weight/fat range which is kept relatively tightly controlled, particularly on the lower weight end of a “body weight zone.” So if a person weighs 150 and his weight drops to 145, the brain detects this and ramps up his appetite, reduces energy expenditure of the body and signals that energy should be stored as fat. Shortly, weight returns to 150 pounds. If the person gains an extra 5 pounds and is now 155 pounds, the opposite happens, as the command centers in the central nervous system decrease appetite, increase body energy expenditure and direct that fat be broken down and normal weight is restored back to 150 in a short time.

The problem, it seems, for patients who have become overweight or obese is that the body becomes “set” at a higher weight zone  than the one achieved after dieting and losing some weight in body fat. Several physiologic adjustments by the body to weight loss have been elucidated which demonstrate the reason for the difficulty a person has to hold on to the lower weight. After weight loss, the body goes into “economy” mode by decreasing basal and total energy consumption. Muscles become more efficient in doing the same work by switching from a high energy usage muscle fiber of strength, to a special muscle fiber designed for efficiency, endurance and preservation of energy.

There is also suppression of the satiety signal sent by the stomach to the brain which fails to reduce hunger while eating and more food is consumed. All of this puts a successful weight loss effort in jeopardy as the body can do more on less energy. The body also craves more food. It is as if overnight your car went from 19 miles per gallon to 45 miles per gallon. If the person does not reduce calories and intensify energy expenditure weight regain will be inevitable. Research is implicating the hormone Leptin as playing a significant role in all of this. Leptin ordinarily is produced by the fat cells and it increases as body fat increases. Leptin tells the brain “there is too much fat” in the body. The brain responds by speeding up metabolism, burning more calories, suppressing hunger and the net effect is weight loss and avoidance of excess storage of body fat.

Leptin Signal Disruption

However, in obese subjects, Leptin signaling is disrupted and the brain does not sense the message of increased body Leptin, which results in increased body fat. There is Leptin “resistance.” So when weight loss occurs and Leptin falls, the brain really has trouble as it sees even less Leptin than is present and interprets this as a “no fat storage” condition which is an emergency. The brain slows the metabolism, increases appetite and makes muscle energy expenditure very efficient.

The Importance of Exercise in Long-Term Weight Management

Intense research is under way now to understand the mechanism of Leptin résistance. Exercise is one way to overcome it. Research on the most successful weight loss patients, those in the National Weight Registry, who have lost at least 30 pounds and maintained it for over 1 year, reveals that they have discovered the necessity to become relentless exercisers in order to avoid weight regain. The American College of Sports Medicine recommends between 250-300 minutes per week of moderately intense exercise. Some combination of decreasing calories and increasing energy utilization is necessary to avoid weigh regain after a successful weight loss effort. Moreover, studies are ongoing on the mechanism of Leptin resistance and how to reverse it. One part of the solution is some critical amount of daily exercise after a weight loss effort.

HCG Diet Goes Viral

Over 50 years ago, Dr. A. T. W. Simeons, a British-born physician, began treating obese men and non-pregnant females with small daily subcutaneous injections of human chorionic gonadotropin (HCG), a hormone produced by the placenta during pregnancy. He combined this with a restrictive diet of 500 calories daily for six weeks. Simeons reported that patients lost an average of one pound per day, and selectively lost “bad” visceral fat, while at the same time preserved lean muscle mass, and had minimal symptoms of “starvation” diets, such as hunger and headaches.

HCG may have a role in transferring maternal fat-energy stores to the fetus and protecting maternal lean muscle from breakdown.  HCG is FDA approved for fertility treatments in women and hypogonadism in men improving testosterone and sperm counts. Using small doses, which produce blood levels far less than pregnancy, HCG has never been implicated in disease and has few side affects.

There are stories about thousands of obese patients treated with HCG and an ultra-low-calorie 500 calories per day diet achieving spectacular results.  A small 20 patient study done in the early 1970’s by Dr. W. L. Asher seemed to affirm Simeons’ findings. However, other studies failed to find any evidence that the Simeon HCG diet was any more effective than just 500 calories daily without HCG.  Some claim that the HCG only relieves feelings of starvation, which can help people endure such an ultra-low-calorie diet.

In1976, the Journal of the Amercan Medical Association (JAMA) harshly rebuked the Simeons HCG diet, for lack of placebo controlled studies and the potential to damage muscle due to ultra low protein intake. The FDA soon declared it was fraudulent and illegal to claim the HCG diet produced superior weight loss compared to a similar diet without HCG.  As recently as 2010 the American Society of Bariatric Physicians has affirmed its agreement with the FDA.

But, recently there has been a big push, mostly on the Internet, by companies distributing and recommending the classic HCG diet using the original and perhaps dangerously low protein, low calorie protocol.  They have also made HCG in forms that have never been studied available, such as oral high dose, poorly absorbable HCG, transdermal HCG and so-called “homeopathic” HCG.  Spectacular results with testimonials are widely reported, particularly on the Internet.

The modern very low calorie diet (VLCD), otherwise called the modified-protein sparing (MPS) diet is recommended, under physician supervision, in cases of obesity or morbid obesity when the excess weight is considered a substantial health risk.  The classic Simeon HCG diet is not a modern VLCD.

Recently, there are reports of combining sublingual HCG and a MPS, compared it to an MPS alone.  It has been reported that the result was rapid weight loss and muscle preservation in both groups with more weight loss in the HCG group. One of the conclusions was that there was less hunger with the MPS + HCG drops vs. the MPS alone.  It could also be concluded that HCG can be used safely by combining it with a MPS.

I’m off to New Orleans for The American Society of Bariatric Physicians (ASBP) 2010 Annual Meeting

Thursday I travel to New Orleans for the annual meeting of the American Society of Bariatric Physicians (ASBP), during which ASBP will celebrate its 60th anniversary. ASBP was established in 1951 and is the oldest medical association dedicated to the education of medical professionals treating obesity and its clinical consequences.

I am looking forward to this event as it provides me with an opportunity to hear about  the latest developments in the field of medical bariatrics. This year several new drugs are being reviewed by the FDA for consideration to be approved for use in clinical medicine. I will meet with my collegues to compare notes on our experiences and approaches in helping patients lose weight and keeping it off. There will be a large exhibition hall at the meeting where I will talk to various vendors who provide supplements and meal replacements which I employ in my treatment programs. I usually sample many new products and bring back samples for my patients. This year I will attend a session for all board certified bariatricians like myself who have sucessfully passed their recertification exam. The field is exploding with new reports and I keep up to date by taking the time away from my practice to attend such meetings.

Get Start