Phentermine for long-term weight loss?
June 21, 2011 11:27 AM   Subscribe

Tell me about your experiences with phentermine.

After months of diet/exercise, I returned to my doctor with 7 more pounds than I'd had on me the last time I saw him. They put me on an electronic scale that spit out the result that I have a deficiency of lean muscle and a Basal Metabolic Rate of 1200 kcal/day. My doctor said I needed to lose at least 30 lbs and that he wanted to prescribe this diet plan that includes serotonin supplements and phentermine combined with a low-carb diet. This is part of a program marketed as "Serotonin Plus Weight Loss."

The low-carb diet part won't be too tough for me, but I've never been on stimulants like phentermine before. Have any Mefites successfully lost weight with phentermine? I'm concerned that with an appetite suppressant, any weight I might lose will be voided as soon as I go off the stuff. The doctor said my BMR was so low because I've spent the last year reducing my calorie consumption. Won't artificially suppressing my food intake further reduce my BMR? I want any physical changes I make to be sustainable. I also assume that it's the phentermine that will be doing the heavy lifting and that "serotonin" supplements are just the marketing gimmick. Nonetheless, I am very interested in doing a medically guided plan rather than continuing my futile homebrew efforts.

Before you tell me about weight training, yes, I've been doing that for years and even if I lift 4 days a week, I can't seem to build muscle.
posted by Kitty Stardust to Health & Fitness (24 answers total) 1 user marked this as a favorite
There are a bunch of things in this that pop out at me as red flags:

- Your doctor is basing this on a reading from an electronic scale, which are notoriously unreliable for body mass

- The doc immediately went to a trademarked "diet plan" rather than just trying a low-carb approach first

- The doc wants you to lose 30 pounds AND increase your lean muscle, which is really, really not easy, particularly if you're not a complete novice to exercise.

I would strongly suggest getting a second (medical) opinion if you really want to go that route. The packaged diet plan gives me the screaming meemies. I'm also more than happy to point you at what's worked for me without any sort of pills if you want to memail me.
posted by restless_nomad at 11:34 AM on June 21, 2011 [10 favorites]

Phentermine made me light-headed and anxious.* I fainted while standing at the top of a flight of stairs and nearly broke my neck. The weight loss I experienced while on the drug differed not in the slightest from that after I stopped taking it.

I did get good results from a grain-free food plan, though. Additionally, I continue to get good results from working actively with a fitness coach instead of lifting, rowing, and using the elliptical on my own.

*I struggle with anxiety anyway, and phentermine made it worse in my case.
posted by S'Tella Fabula at 11:35 AM on June 21, 2011

I lost staggering amounts of weight when I tried phentermine. While on it, I had zero appetite & the energy to work out a lot. I also slept about 3-4 hours per night...which was great for getting all that painting done around the house in the wee hours of the morning.

Most importantly, I gained staggering amounts of weight back (more than I had lost) when I went off the stuff.

And I agree completely with restless_nomad. (The only way I've lost weight successfully is slowly through low-carb diets & exercise over a long haul.)
posted by Kronur at 11:37 AM on June 21, 2011 [1 favorite]

Anxiety attacks here too, where I had no history of them. Phen was very hit or miss when it came to the appetite suppression. Some days I couldn't eat, some days I could eat as 'normal'. (That is to say: badly)

There's a lot going on here - SSRIs (which I assume are the seritonin portion) are linked to weight gain. Starting SSRIs in addition to Phen is a pretty hefty combo. That's also an amazingly low BMR measurement - I'm a bit dubious. How does the 1200 compare to something rule-of-thumb like weight * 14?

I wish you luck, any path you choose.
posted by unixrat at 11:52 AM on June 21, 2011 [1 favorite]

Er, that is, electronic scales are notoriously unreliable for lean mass readings.

And yeah, grain-free dairy-free all the way.
posted by restless_nomad at 11:56 AM on June 21, 2011

The doc wants you to lose 30 pounds AND increase your lean muscle, which is really, really not easy, particularly if you're not a complete novice to exercise.

She's not going to put on as much muscle mass as she would without cutting, but she's definitely going to put on muscle mass. OP, it is possible but you need to commit yourself to a solid strength-training program--not BodyPump or crap like that. If I were your doctor I'd be far more concerned about your lack of muscle mass than dropping the 30lbs as quickly as possible.
posted by Anonymous at 12:13 PM on June 21, 2011

Oops, just saw you already do weight training. Could you outline both how much you've been eating and the type of strength-training you've been doing?
posted by Anonymous at 12:14 PM on June 21, 2011

Why specifically did your doctor say you "needed" to lose 30 pounds? Are you 30 pounds above your optimal weight? In that case, saying you "need" to lose that much weight is inaccurate overkill, and taking phentermine seems like overkill. This article says it "may be recommended if you're significantly overweight — not if you want to lose just a few pounds." If you are grossly obese, then it might be warrented. In either case, restless_nomad's suggestion to get a second opinion seems completely appropriate.
posted by Mr.Know-it-some at 12:32 PM on June 21, 2011 [1 favorite]

Response by poster: Mr. Know-it-some: I'm obese by BMI standards and about 58lbs above my "ideal" weight. 30lbs would put me into just being a regular overweight person.

I eat a mostly low-carb diet that includes fruit as my main source of carbs. No bread, pasta, rice, potatoes, refined sugar etc 90% of the time. White meat chicken, fish & the occasional foray into lean beef or lamb. I find the taste of most animal fats repugnant. No dairy. Snacks if I have them are a few plain almonds perhaps with some fresh cherries or berries. I literally eat at least one meal of spinach salad a day. Dinner is usually salad plus either broiled chicken breast, broiled salmon or other fish.

I usually lift about 2-3 times a week. Freeweights, mostly. I also do yoga twice a week.
posted by Kitty Stardust at 1:12 PM on June 21, 2011

I lost a buncha weight with phentermine. The only side-effect I experienced while on the drug was insomnia. After stopping the drug it took a very long time for my appetite to return to normal (like, a year).

I do not regret taking it and I would do it again in a heartbeat.
posted by geekchic at 1:16 PM on June 21, 2011

There is a difference between working your muscles and building muscle mass. Yoga certainly works your muscles but will do nothing to build muscle mass. 3 sets of 10 of anything that does not really push you to the limit will not result in building mass either. I know there are exceptions and oddball circumstances but outside of them, building muscle mass means lifting HEAVY; the kind of weight you can only lift three to five times before failure (again, generalizing).
posted by dzot at 1:39 PM on June 21, 2011

I mean like how many grams of protein do you get a day, how many calories do you intake?

What are the specifics of your lifting program? Exercises, sets, reps?

Like dzot said, the specifics of your program are really important on whether or not it's actually effective.
posted by Anonymous at 1:46 PM on June 21, 2011

I think you'd be shocked at how much muscle you would gain if you started on a structured, novice strength training program. Granted, there is a certain contingent on Metafilter (including me) that will tend to recommend heavy strength training for most any fitness issue, and I can see how that could get old, but if you want to gain lean body mass, weight loss or no, that is the best way.

Certainly I'd try it before using powerful stimulants, despite the doctor's orders. Doctors can be really, uh, weird, about physical fitness, I've found.
posted by Theodore Sign at 1:55 PM on June 21, 2011

even if I lift 4 days a week, I can't seem to build muscle.

This could be because you're not lifting heavy (as others have mentioned). Your diet is also a likely culprit. A low-carb, no-dairy, salad-heavy diet of "white meat chicken, fish & the occasional foray into lean beef or lamb" implies low protein and hardly any fats, and you need both to gain muscle (protein is a given; fat is the body's primary source of energy in the absence of carbs).

I'd suggest tracking your diet with something like FitDay, aiming for 1g of protein per pound of bodyweight per day, plus between 20% and 30% of your calories from fat.

I realize you don't like the taste of animal fat and don't do dairy, which makes this tough... but there are ways. Protein powder will help, as will doubling your servings of meat/fish at dinner. Your fats can come from avocado, flax oil, fish oil, nuts & seeds, and fatty fish (you might find eating lots of salmon, mackerel, sardines, trout, albacore etc to be less offensive than fatty meat).

Combine this with three heavy sets of compound lifts three times a week, and I'm sure you'll get results.
posted by vorfeed at 2:11 PM on June 21, 2011

OK, I know your question is about phentermine, but did your doctor do anything else besides stick you on a scale & prescribe drugs? The things you said about working out. reducing calories and then gaining weight sound like my friend who has thyroid issues and PCOS. Perhaps some more tests are in order?
posted by anotherkate at 2:22 PM on June 21, 2011

Is this doctor a GP or a specialist? Have you consulted with a dietitian or an endocrinologist? IANAMD, but I agree with the consensus that the use of an electric scale to measure body fat percentage is suspicious.

I'd also like to take the chance to preemptively defend the people who are telling you that you're not lifting heavy enough without actually knowing how much you lift (obnoxious though that may seem). When a lot of people lift weights, they'll do something like 3 sets of 10 repetitions, where they stop at 10 repetitions only because they've hit that number. With any exercise program, you only make progress if you push yourself, and if you're habitually stopping before failure, then you should probably be lifting heavier weights. (I personally find it psychologically easier to push myself until failure---where "failure" actually means success---when I pick a weight high enough that I can only do 3-5 repetitions, but YMMV.)

If you're lifting as often as you say you are, are working on large muscle groups (i.e. you're emphasizing things like squats, deadlifts, bench press and pull-ups or lat pull-downs more than things like bicep curls and crunches), and are pushing yourself hard on each set, then you really should be making progress, at least in terms of strength and muscle mass. If this isn't happening, you really should insist that your doctor start looking at things that might be wrong with you other than just your weight, because this situation is both abnormal and worrying.
posted by Dr. Eigenvariable at 2:39 PM on June 21, 2011

I'd also like to take the chance to preemptively defend the people who are telling you that you're not lifting heavy enough without actually knowing how much you lift (obnoxious though that may seem).

Yeah, to clarify, when I said "this could be because you're not lifting heavy", I meant "this could be because you're not lifting heavy [or it could be that you are lifting heavy]". It's quite possible that something else is the missing link, here, not what you're doing in the gym.
posted by vorfeed at 3:16 PM on June 21, 2011

I took phentermine over-the-counter back when it was legal. I took it to do all-nighters and because I was anorexic. I ended up with increased anxiety, heart palpitations, and ultimately a kidney infection.
Now I can't even handle non-drowsy antihistamines.
posted by L'Estrange Fruit at 5:02 PM on June 21, 2011

Let me put something forward other than the term "HEAVY", because I think people kind of miss the point of why some people workout in lieu of infatuation with that. Also because every single workout regimen really doesn't need to revolve around reps of 3 - 5.
Here's what I would ask: What is your exertion level when you workout? Are you honestly pushing yourself when you workout? Each and every time? If not then you should pick up heavier weights, or shorten your rest between sets, exercises, and workouts; or increase the speed of the exercises. If you enjoy the workouts you do then that's good and you don't necessarily need to change everything, just change some of the variables to increase your exertion level.

The bigger question around this is your diet, because it sounds like you have a good plan but how closely do you monitor your intake?
Stimulants can be an easy shortcut but can also screw with your body and have side effects that are not make it worth it. For most fitness enthusiasts they take them as last resort usage to get rid of the last bit of nagging bodyfat.
posted by P.o.B. at 6:22 PM on June 21, 2011

I'd be very, very wary of using phentermine in this way.

Also: Was this a doctor or a chiropractor? I've had friends tell me similar stories about chiropractors recommending phentermine as part of a weight loss clinic. Usually, there's an MD on retainer who prescribes the actual drugs without being the person monitoring the weight loss plan.
posted by yellowcandy at 9:01 PM on June 21, 2011

Watch Requiem for a Dream before taking weightloss stimulants, if you can stomach it.
posted by polyglot at 7:00 AM on June 22, 2011

Response by poster: I appreciate everyone's input on diet, exercise and etcetera, but right now I just want to hear from people who've taken phentermine.
posted by Kitty Stardust at 12:28 PM on June 22, 2011

I took phentermine a long time ago and my experience was: not just appetite suppresion, but actual REVULSION around food, and then after I'd developed a mild tolerance, extreme irritability, insomnia (I already had wicked insomnia - this dragged me down to 2-4 hours of sleep per night), and ravenous hunger anytime I took a break.

Paxil made me gain 30 lbs. in 8 months, so this was what I tried to kick-start my weight loss after tapering off antidepressants. It worked, but I wouldn't do it again.

It made my hands shaky, my stomach cramp and my throat/mouth dry and sticky. I lost weight, but regained as soon as I stopped. I did what you did - went to a doctor, had it prescribed after an official diagnosis, pretty much what you described - and stopped after about 6 weeks because of anxiety problems.

For me, it felt like what happens when you don't sleep good the night before, then drink a crapload of coffee to get through your workday. Then, to go out at night, you drink vodka and red bull to stay awake. You just feel like shit about half the time, the rest of the time you're wired and productive and unaware of food. I found myself getting dehydrated and having muscle cramps, too, so I was physically sore from it without even realizing why until I stopped.

Everybody's different, though, so YMMV.
posted by Unicorn on the cob at 9:43 PM on June 22, 2011

Response by poster: Follow up:

I've been on phentermine for seven days now and I'm very pleased with the results. The diet I'm following is low-carb and low-fat. Phentermine allows me to eat chicken breast and spinach every day without feeling like I'm starving to death. I have no carb cravings. I've had no low-carb headaches and no major negative side effects from phentermine.

My first two days on phentermine I was blissfully apathetic toward all food. After that, my appetite began to reassert itself but at much lower levels than would be normal. I had some trouble sleeping the first night, but I've been able to mitigate that by taking my second dose earlier in the afternoon. I've even gone down to one dose of phentermine a day in the last 2 days with no massive increase in appetite. Yesterday Mr. Stardust & I went out for dinner & he got pitas & rice with his meal. I had no urge at all to eat any of his carbs and was well-satisfied with my sirloin kebab and greek salad.

I'm tolerating phentermine even better than caffeine (which gives me nausea) and it actually suppresses my appetite. Oh, and I have had more energy to complete my morning cardio/lifting routine as well.
posted by Kitty Stardust at 9:26 AM on July 3, 2011 [2 favorites]

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