€¦ · 08-08-2016 · if you are trying to lose weight, then please remember this statement: the...

© Dr. Simonds Weight Loss 08/16 www.dsweightloss.com 1

"Keys to weight-loss success"

Durham Raleigh

6905 Fayetteville Rd. Suite 201 8300 Falls of Neuse Rd. Suite 112

Durham, NC 27713 Raleigh, NC 27615

919-490-8899 919-861-8999

www.dsweightloss.com

www.missionorientedweightloss.blogspot.com

http://www.pa-weightloss.com/

http://www.missionorientedweightloss.blogspot.com/


ALL patients are required to read this manual prior to their first visit at Dr. Simonds Weight Loss.

Your appointment may be rescheduled if you FAIL TO READ ALL of the information in this document prior to your first visit. This information is fundamental for beginning the program and will

assist us in providing better patient care. We welcome your questions about any or all of this information.

Hello, I am Wickham Simonds, M.D. Years ago, I started Dr. Simonds Weight Loss, a practice that

assists patients in achieving and maintaining a healthy weight. The principles of our practice are three-

fold:

1. Teaching patients a portion-controlled, nutritious diet,

2. Motivating patients to live a physically active lifestyle through the development of a consistent

exercise routine and

3. Offering patients access to prescription diet medication, if needed, to assist them in doing this.

This paper will address each of these three principles with a primary focus on medications and dieting.

It is important to know that here at Dr. Simonds Weight Loss, we focus on helping you get into life-long

healthy eating and exercise habits that will help you lose weight and maintain your weight-loss long-term.

There is no “quick-fix” for weight loss, but as long as you are committed to the lifestyle changes required

to achieve success, we are committed to helping you. If you are starting as a new patient, if you are

seeking a “diet refresher”, or if you just want to know more about Dr. Simonds Weight Loss, then please

read on.

Before beginning, to clear up any confusion, you should know that traditional medical insurance does not

cover these services. At Dr. Simonds Weight Loss, we do not file or accept medical insurance. If you have

an HSA or Flex spending account, it will cover these services.

SUMMARY:

At Dr. Simonds Weight Loss we focus on helping you achieve and maintain a healthy weight by (1.)

Helping you to adopt a portion-controlled, nutritious diet, (2.) Motivating you to live a physically

active lifestyle through regular, consistent exercise and (3.) Offering you access to prescription diet

medication if needed to assist you in doing this.


DSWL HEALTHY DIET

FOREWORD - TIME FOR A CHANGE

As an Obesity Medicine Specialist, I teach many kinds of diets. My goal with this section is to present a

diet for those who need a program to follow. However, if you already have a program you like following

that is also fine, we can work with that. If you like counting calories, Weight Watchers®, Jenny Craig®,

Nutrisystem®, South Beach®, Paleo, etc., feel free to do the diet you are comfortable doing and we will

help with medication and advice.

For those of you who have been my patients, for those of you who know what I have been teaching over

the years, and for those of you who have read my website in the past and viewed the information that I

have been teaching on diet – the information that I will now present represents a change. Over the last ten

years, clinical experience, new science, and a changing landscape in nutrition have changed some of the

things that I have been teaching patients. For those of you who are new to the practice, I am excited for

you – this represents the cutting edge of nutrition. I, along with my fellow providers, decided to make this

new nutritional guide to reflect what we are teaching day-to-day in our Obesity Medicine practice. This

document represents a “lower carbohydrate diet” but not a true low carbohydrate ketogenic diet. If you

are pre-diabetic, diabetic, peri-menopausal, menopausal, insulin resistant, have PCOS, or have metabolic

syndrome, and are having trouble losing weight you may need a true low carbohydrate ketogenic diet.

The providers at DSWL can help you determine this and help get you started on this type of diet if needed.

The information contained in this document will be taught as “mainstream nutrition” years from now –

you are getting it way ahead of time. This is the “cutting edge of nutrition.” Please give your devoted

attention to this document.

Wickham B. Simonds, MD

CALORIES , CONTENT, AND IMPORTANT CONCEPTS

If you are trying to lose weight, then please remember this statement: the amount of food you consume

(quantity/calories) and the nutritional quality of the food you consume (quality/content) will be key to

your success. In this document, I will teach you how to do this. The whole point of prescribing diet

medication is to help you master these two concepts: quantity and quality or put another way, calories and

content. If you can master these two concepts, then successful weight loss and weight maintenance will

always be yours.

Rather than bore you with excessive scientific detail, I will just try to boil it down to five key concepts

that I want you all to remember. I recommend that you review this document on a routine basis so that

you can be reminded of these key concepts along with the supporting diet recommendations.


5 KEY CONCEPTS:

1. Protein Is Primary. It is the foundation to your diet success. The key is to eat the correct type and

amount of protein at the right time intervals. The providers at Dr. Simonds Weight Loss will make a

specific recommendation to you about your total daily protein needs. Most patients will need between

90 and 150 grams of protein daily while dieting. Getting this correct amount of protein will spare

your lean muscle mass while losing weight, and force your body to burn its own fat for energy.

More importantly, consuming 30-40 grams of protein in one meal raises your metabolic rate by

40% for 3-4 hours after you do this. This is the same as running 30 minutes on a treadmill. Less

than 30 grams will not evoke this response. The best protein source to produce this change is

protein from a milk source like whey or calcium caseinate. Protein from eggs, meats (poultry, red

meat, and pork) and fish are acceptable also. Vegetable protein lacks the amino acid composition to

produce this effect. If you don’t eat a large portion of carbohydrates (carbs) with it, your body will get

the extra 40% of energy it requires by burning abdominal fat stores – in other words, it slims your

waistline and who doesn’t want that?

2. Fat is Filling and It Doesn’t Make You Fat. The fullness, or satiety, that fat produces helps you feel

satisfied with much smaller amounts of food. In addition, in the absence of carbs, fat serves as a great

energy source, raises good cholesterol (HDL) and lowers your triglycerides (free floating fat in your

blood). In the absence of high insulin levels (which come from eating carbs), your body’s physiologic

response to fat is to burn it – not store it.

3. Carbs Make You Crave, and They Make You Fat. Flour, sugar, rice, and potatoes, in most of their

forms, are absorbed quickly by your GI tract. This causes a surge in insulin levels. Elevated insulin

levels promote fat storage – particularly in your abdomen. Elevated insulin levels will produce other

evils: increased hunger, increased cravings, lower metabolic rate, high blood pressure, cholesterol

abnormalities, and blood sugar abnormalities.

4. Portions Are Powerful. I have already hinted that to lose weight you have to reduce

quantity/calories. The goal is to get the content of the food you are eating correct, so that you can eat

smaller portions and be satisfied with that. If prescription medications are needed to reduce appetite

and help with this, we can provide them. Many people do well keeping track of their food intake using

an app such as My Fitness Pal, which can help ensure you are consuming the proper amount of

protein each day and can also keep you accountable on your calorie and carbohydrate intake.

5. Timing Is Tantamount. One of the common problems I see is patients skipping meals, eating one

meal per day, etc. This creates a host of problems. My recommendation is to get at least 3 “servings of

protein” (30 - 40 grams each) spaced out 3-4 hours apart. By doing this, and limiting carb intake, you

will find that your weight loss will be greater, your satiety (feeling of fullness) will be improved, your

metabolism will work better, you will lose more body fat, and you will be happier with the entire “diet

experience.”

CATEGORY SERVINGS PER DAY

Protein 3-5 servings per day

Vegetables Minimum 3 servings per day

Dairy Up to 3 servings per day

Fats Up to 4 servings per day

Fruit Up to 2 servings per day

Grains and Starches Up to 2 servings per day

Beans and Legumes Up to 1 serving per day

Approved Drinks Minimum 60 ounces per day

Condiments May add as needed


PROTEIN

o Your entire diet should be organized around 3-5 servings of protein that are spaced out 3-4

hours apart. A SERVING HAS 30 GRAMS OF PROTEIN. Never do less than 3 servings –

morning, midday, and suppertime. If you are eating protein-based snacks, the sum of the

grams of protein in those snacks can count as your 4th

or 5th

serving. THE BREAKFAST

SERVING IS THE MOST CRITICAL OF ALL.

Meal Protein Sources:

1. Meats & Seafood (including Poultry, Pork, Red Meat, Fish, and Wild Game) – 4 to 5 ounces will

give the necessary 30 grams of protein.

2. Greek Yogurt – on average, Greek yogurt has 3 grams of protein per ounce. To get 30 grams you

would need to eat 10 ounces! This is more than most people will eat at a meal so try 6 ounces of

Greek yogurt mixed with a whey protein powder in the correct amount to get 15-20 grams of

protein (typically about ½-¾ of a scoop depending on the brand).

3. Eggs – 1 large egg has 7 grams of protein. 5 eggs would be 35 grams, but most people don’t want 5

eggs at a time. I would suggest 2 whole eggs with ¾ cup of egg whites. The 2 whole eggs are 14

grams of protein and the ¾ cup of egg whites are 20 grams.

4. Protein Supplements – meal replacement shakes are a great idea, particularly for breakfast. In the

office, we carry pre-prepared shakes made by “Oh Yeah!” which have 32 grams of protein, taste

excellent, and are very satisfying. We also carry powdered “make your own” shakes by HealthWise

which have 35 grams of protein. You may already have a brand you prefer to use. Recommended

whey protein powder brands include, but are not limited to: NutraBio, Body Fortress, Optimum

Gold Standard, Jay Robb, Pure Protein, and EAS. Protein bars can be used as snacks or meals. The

bars usually have somewhere between 15 and 30 grams of protein each. If you are consuming a bar

that is intended to replace a meal then make sure you are getting 30 grams of protein. If the bar has

less than this, then add some extra protein like Greek yogurt or a boiled egg. We carry several

kinds of bars – Quest, Oh Yeah!, and HealthWise. All three are tasty and can be easily incorporated

into this diet.

5. Other Sources – nuts, cheeses, and nut butters are a good source of fat but do not have enough

protein to be considered a primary protein source in the diet. Each ounce of these three food items

contains only 6-7 grams of protein. They can be used as a snack or component in a meal, but not as

your main protein source for that meal. Main protein sources from which you get your 30-40 gram

serving of protein should be from the sources listed above.

VEGETABLES

o Vegetables are free with no limit. AIM TO EAT A MINIMUM OF 3 CUPS DAILY.

Alfalfa sprouts Artichoke Asparagus Avocado

Bok choy Broccoli/Broccolini Brussels sprouts Cabbage

Cauliflower Celery Collard greens Cucumber

Eggplant Green beans Garlic Fennel

Jicama Kale Kohlrabi Leeks

Lettuces/Greens (all) Mushrooms Okra Olives (all)

Onions (all) Peas Peppers (all) Radishes

Sauerkraut Scallions Shallots Spinach

Spaghetti squash Summer squash (all) Swiss chard Tomatoes

Turnips Water chestnuts Watercress Zucchini


DAIRY

o Three servings per day are allowed – but not required

Serving sizes listed (organic products are best)

Cottage cheese, regular or 2%- ½ cup Greek yogurt, plain- up to 8 ounces

Sour cream- 2 Tablespoons Ricotta cheese, regular or part skim- ¼ cup

Cheese, full-fat, hard (e.g. cheddar) or soft (e.g. cream cheese)- 1 ounce/2 Tablespoons

FATS

o Four servings per day are allowed – but not required

Cooking Fats Serving size: 1 Tablespoon

Animal fats Avocado oil Butter (grass-fed is best)

Coconut oil Ghee (clarified butter) Olive oil (extra virgin is best)

Nuts/Seeds Serving size: 1 ounce (2 Tablespoons for nut butters- natural is best)

Almonds/almond butter Brazil nuts Cashews/cashew butter

Coconut meat/flakes Coconut butter Peanuts/peanut butter

Hazelnuts/filberts Macadamia nuts/nut butter Pecans

Walnuts Chia & Flax seeds Pine nuts

Pumpkin seeds Sesame seeds Sunflower seeds

CONDIMENTS

Add as necessary SAVORY:

Capers Guacamole- 1-2 Tablespoons

Herbs/spices- fresh or dried Heavy cream (organic best) 1-2 Tablespoons

Hot sauce (Texas Pete, etc.) Ketchup-sugar-free/reduced sugar- 1 Tablespoon

Horseradish Lemon/lime juice

Full-fat salad dressing low in sugar

(ranch, blue cheese)- 1-2 Tablespoons

Mayonnaise (homemade is best, or Dukes or

Hellmans) 1-2 Tablespoons

Pepper-black/white/cayenne pepper Mustard (any except honey)

Pickles/relish low in sugar Salsa/pico de gallo

Sauerkraut Sea salt

Seasonings without MSG or sugar Soy sauce

Tahini- 1 Tablespoon Wasabi

Vinegar (white, cider, wine, balsamic) Walden Farms calorie & carb free products

SWEET:

Erythritol or Xylitol Monkfruit

Splenda (sucralose) Stevia/stevia products

Sugar-free flavoring syrups (DaVinci, Torani, Walden Farms)

DRINKS

DRINK AT LEAST 60 OUNCES PER DAY, 100 OUNCES IS EVEN BETTER!

Plain water (preferred beverage) Sparkling water/club soda

Unsweetened tea Diet sodas/diet teas

Unsweetened almond or coconut milk Calorie-free flavor enhancers (Crystal Light, etc.)

Decaffeinated or regular coffee/tea Flavored seltzer water with “0” calories

Powerade Zero/Propel Zero 100% Tomato juice- no sugar added

Broth/Bouillon 100% Coconut water- no sugar added


PROCEED WITH CAUTION!

Many people who struggle with their weight are “carbohydrate intolerant” and will have difficulty

getting and/or keeping their weight off if the following products are included in the diet!*

FRUITS

o Two servings per day are allowed, but not required

If you choose to consume fruit, those with a star* are preferred over others

AVOID candied/dried fruit, fruits canned in syrup or with added sugar, and fruit juices

Serving size: ½ cup (size of a tennis ball)

Apples (all)* Apricots Banana Berries (all)* Cherries

Citrus fruits (all)* Dates Figs Grapes Kiwi

Mango Melons (all) Papaya Peaches/Plums Pineapple

STOP HERE!

***IT IS RECOMMENDED TO AVOID GRAINS***

THE FOLLOWING FOODS SHOULD ONLY BE OPTIONS FOR THOSE WHO CAN

TOLERATE THEM

GRAINS AND STARCHES

o Two servings per day are allowed – but not required

Grains

Serving size: ½ cup cooked or 1 slice of bread (the size of a cassette tape)

ALWAYS AVOID ALL “WHITE” FLOUR, SUGAR, BREAD, PASTA, RICE, AND

POTATOES.

Products with labels stating “made with ‘whole grains’ or ‘whole wheat’” are often still

overly processed and therefore lack the nutritional benefits of true whole grains.

If you choose to eat grains (i.e. bread, pasta, rice, crackers, chips, etc.), read the labels and

opt for products with a Total Carbohydrate : Fiber ratio of < 10 : 1; (BEST is < 5 : 1)

Brown rice Sprouted-grain bread Quinoa Whole or old fashioned oats

Starchy Vegetables

Serving size: ½ cup cooked

Beets Corn Carrots Parsnips Pumpkin

Rutabaga Sweet potato Taro Yam Yucca

Potatoes (yellow, red, purple) Winter squash (acorn, butternut, hubbard, turban)

BEANS AND LEGUMES

o One serving per day allowed - but not required

Serving size: ½ cup cooked

Bean sprouts Black beans Black-eyed peas

Butter beans Cannellini beans Chickpeas/Garbanzo beans

Fava beans Great northern beans Kidney beans

Lentils Lima beans Navy beans

Pinto beans Soybeans Split peas


AN EXAMPLE DAY

Breakfast – “Oh Yeah!” protein shake or your preferred brand protein shake (must have at least 30 grams

of protein). Another acceptable breakfast would be 2 eggs scrambled with 2 ounces of cubed ham, and 1

ounce of cheese cooked in 1 Tablespoon of grass-fed butter (like KerryGold).

Snack – A cheese stick or 1 ounce of nuts. If you are not hungry, skip this snack.

Lunch – Salad with 2 cups of greens, 1 cup of vegetables, and 4-5 ounces of animal protein such as

chicken, fish, or steak. You could also use less meat and supplement the protein with hardboiled egg

and/or cheese. Dressings would include up to 2 Tablespoons of blue cheese, ranch, thousand island, or oil

and vinegar. Italian and vinaigrette dressings are also acceptable if they have less than 2 grams of

carbohydrates per 2 Tablespoons.

Snack – HealthWise protein bar or 6 ounces of plain Greek yogurt with ½ cup of berries, zero-calorie

sweetener as desired to taste. If you are not hungry, skip this snack.

Dinner – 5 ounces of animal protein with 1 cup of cooked veggie (such as green beans, broccoli, or

asparagus). Those who are not carbohydrate intolerant may choose to add half of a sweet potato with a pat

of grass-fed butter.

Snack – ½ to 1 HealthWise, Oh Yeah!, or Quest* protein bar. (*TIP: Quest bars can be enjoyed several

ways: as an easy and delicious treat right out of the wrapper; as a warm and gooey treat by microwaving

for 15-20 seconds; or as a baked treat by placing on foil with non-stick spray and into a 400o

oven for 2-3

minutes.)

A FEW QUICK SNACK IDEAS

Quick, Easy, & Tasty – ½ to 1 HealthWise protein bar or Quest protein bar or 1 HealthWise 15 gram

protein drink.

Nuts – 1 ounce of your favorite nuts.

Eggs – 1-2 hard-boiled or deviled eggs or 1 egg “muffin” (bake eggs, cheese, meat, veggies in muffin

tin and keep in baggies for grabbing quickly).

Berries & Cream – ½ cup of berries with 2 Tablespoons of heavy cream, zero-calorie sweetener as

desired to taste.

Doc’s Favorite – 1 ounce of KerryGold cheese cut into small pieces and topped with a thin layer of

KerryGold butter.

Avocado – ½ an avocado with 2 Tablespoons of salsa on top.

Meat Lovers – 3 slices of deli meat of your choice rolled up with 1 thin piece of cheese- can also wrap

around a dill pickle spear or roll up in lettuce leaves.

Veggie Lovers – 1 cup of vegetables of your choice paired with 2 Tablespoons of guacamole, cream

cheese, ranch, blue cheese, or other low-sugar dressing or dip.

Greek Yogurt – 4-6 ounces of plain Greek yogurt, zero-calorie sweetener as desired to taste.

Bulletproof® Coffee – 1 cup of hot coffee blended with 1 Tablespoon of grass-fed butter and 1

Tablespoon of medium-chain triglyceride oil (MCT oil- can be purchased online).


A FEW QUICK BREAKFAST IDEAS

Omelet – 1 whole egg plus ¾ cup of egg whites with 1 ounce of cheese and any mix of veggies such as

peppers, spinach, onions, tomatoes, etc.

Cottage Cheese – 1¼ cup of cottage cheese with 1 ounce of almonds and ½ cup of berries, zero-calorie

sweetener as desired to taste.

Iced Coffee Shake – 1 cup of coffee mixed with 1 Tablespoon of heavy cream and whey protein

powder in amount to get 30 grams of protein. Add a dash of cinnamon. Shake well or use a blender and

serve on ice.

Blueberry Yogurt Bowl – ½ cup of frozen blueberries, 1 cup of unsweetened almond milk, whey

protein powder in correct amount to get 30 grams of protein, zero-calorie sweetener as desired to taste.

Top with ¼ cup of plain Greek yogurt if desired.

Quick and Easy – 2 hardboiled eggs with a HealthWise 15 gram protein drink (available at DSWL- you

could even blend the chocolate or coffee flavor drink powder with your morning coffee).

Yogurt Protein Blast – 6 ounces of plain Greek yogurt, whey protein in correct amount to get 15-20

grams of protein, 1 Tablespoon ground flax or chia seeds, zero calorie sweetener as desired to taste.

Simple, Quick, On the Run – Oh Yeah! protein shake (available at DSWL and commercially).

A FEW QUICK LUNCH IDEAS

Tuna Salad – 5 ounce can of chunk light tuna mixed with 1 Tablespoon of mayonnaise, chopped

pickle, onion, and 1 hardboiled egg. Serve inside a hollow tomato, on lettuce leaves, or as a dip for

veggies.

Dressed Up Ground Beef – 4 ounces of ground beef sautéed with ¼ cup of scallions, ½ cup chopped

red bell peppers, and topped with ¼ cup shredded mozzarella cheese.

Omega Salad – 5 ounces of canned salmon on top of 2 cups of mixed greens, 1 ounce of avocado and

½ cup chopped bell pepper with 2 Tablespoons of low or no-sugar salad dressing.

Ground Turkey Plus – 4 ounces of seasoned ground turkey with 1 cup of sautéed veggies and 2

Tablespoons of parmesan cheese. Optional: add ½ cup of quinoa.

Shake Plus – Oh Yeah! shake with ¼ cup of shredded cheese on ½ of a medium tomato.

I Have No Time! – Oh Yeah! meal replacement protein shake or Oh Yeah! meal replacement protein

bar. Or a Quest protein bar paired with 2 hardboiled eggs or 4 ounces of plain Greek yogurt.

A FEW QUICK DINNER IDEAS

Hamburger Steak – 4-6 ounce hamburger patty topped with 1 slice of cheese and ½ cup of sautéed

mushrooms. Pair with 2 cups of salad greens with 2 Tablespoons of dressing.

Lamb Kabobs – 4-6 ounces of lamb kabobs, 1 cup of roasted broccoli, and a few black olives.

Optional: add ½ of a small baked sweet potato topped with a pat of grass-fed butter.

Pesto Chicken – 4-6 ounces of grilled chicken breast topped with 1-2 Tablespoons of pesto and paired

with 1 cup of roasted green beans and cherry tomatoes.

Salmon Steak – 4-6 ounces of salmon steak over 1 cup of sautéed spinach. Optional: add ½ ear of corn.

Baked Chicken – 4-6 ounces of baked chicken thigh and 2 cups of salad greens with 2 Tablespoons of

dressing. Optional: add ½ of a small baked sweet potato with a pat of grass-fed butter.

Garlic Shrimp – 4-6 ounces of grilled garlic shrimp with 1 cup of sautéed zucchini and onions. Season

to taste.

I’ve Got the Idea! – 4-6 ounces of animal protein (pick your favorite). Pair with veggies of your

choosing, plus or minus a small amount of nutrient-rich starch like sweet potato or quinoa. Accompany

any of these with grass-fed butter, extra virgin olive oil, and dry seasonings.


DSWL DAILY ACCOUNTABILITY AND GOALS CHECKLIST

DATE -____________________

☐Protein 1 ☐Protein 2 ☐ Protein 3 ☐Protein 4 and/or 5

☐Veg 1 ☐Veg 2 ☐Veg 3

☐Fruit 1 ☐Fruit 2 ☐Grain/starch 1 ☐Grain/starch 2

☐Fats 1 ☐Fats 2 ☐Fats 3 ☐Fats 4

☐Dairy 1 ☐Dairy 2 ☐Dairy 3 ☐Beans/legumes 1

☐Water 60 ounces ☐Water 60-100 ounces

☐Attempted to be more physically active

☐Took my meds correctly

☐I’m doing this right ☐I need help!

Notes:

DATE -____________________










Notes:

DATE -____________________










Notes:


BEHAVIORAL CHANGE

1. KEEP A JOURNAL – The previous page includes a great checklist that is designed to keep you

accountable. Use it. I also encourage you to keep a journal of your emotions and feelings and how

they relate to cravings and inappropriate eating habits. Allowing emotions to lead you down the path

to poor eating habits is something that needs to be dealt with if you are to be successful. This sort of

journaling allows you to identify triggers, emotional feelings in response to the trigger, and eating

habits that subsequently happen after the onset of the emotion or feeling. If you are keeping this sort

of journal, you will start to recognize and avoid triggers, and plan productive responses to them.

2. HEAD HUNGER AND REAL HUNGER – As you are keeping a journal, be attentive to your sense

of hunger. It has been my experience that there are two types of hunger – that which arises from your

thoughts (head hunger) and that which originates from your body (real hunger). Real hunger is

accompanied by generalized weakness and malaise that results from the need for more food. Head

hunger is your mind telling you it is time to eat because you have just experienced some cue like

seeing an ad about food, smelling some food, someone talking about food, seeing a display of food,

etc. I experience head hunger every night between 6pm and 8pm. Why? I have always eaten supper

during this time frame and my mind signals me every day at this time to eat. The truth is that I

experience little real hunger at this time. Your brain can even trigger your stomach to rumble in

response to these cues. None of this is an indication that you have real hunger. Learning to recognize

the difference between these two types of hunger is critical. Eat in response to real hunger. Don’t eat

just because you have head hunger – stick to your plan and your goals instead.

3. ACCOUNTABILITY – There are two levels of accountability: accountability to self and

accountability to another person or entity (like the providers at DSWL). The former is much harder.

This is because you are usually your biggest critic and you fear failure. I suggest that you fill out your

checklist every day. In addition, you need to be weighing in at least once weekly if not more. These

two actions keep you accountable to self and help you stay on track and consistent. If you think it

would help, we can weigh you every week in the office- no appointment necessary. Just let us know if

you would like to do this and together we can make it happen.

4. SIMPLIFY – Sometimes figuring out what you are going to eat, obtaining it, preparing it, transporting

it, etc. can actually derail your efforts to lose weight. Only you can know whether this is true for you.

This is definitely true for me. Studies of this subject are very clear: People who use meal

replacements like protein shakes or bars lose more weight and do a better job of keeping it off than

people trying other methods. I think this is because of the simplicity of this plan. For those of you who

are trying to lose weight quickly, and would like a simple way to do it, I suggest 2 meal replacement

shakes or bars per day and 1 regular meal (usually the evening meal) while keeping to the 30 grams of

protein per meal guideline. If you think this would help you, I think you should definitely attempt to

do it.

5. RELAPSE PREVENTION – Let’s face it: diet relapses are a part of life. I promise you that you will

have them. We all have them. If you are experiencing relapse right now, then welcome to the club. We

at DSWL exist to help you get back on track. Your goal is to work at recovering from relapses faster.

Neither I, nor my staff, will make you feel guilty or condemned about relapsing. We will encourage

you to try again, we will build you up, and we will be positive. I want you to become an expert at

recognizing your diet relapses and getting committed to starting again. Quickly forgive yourself and

let’s move forward. Remember that keeping the daily checklist, keeping a journal of emotions,

feelings, eating habits, etc., regularly weighing yourself, and making your routine follow-up visits at

DSWL are a great way to keep relapses from happening.


6. LET GO OF YOUR TRADITIONS – Remember that this whole experience is about making some

positive changes in your dietary habits. By necessity that means letting go of some old family

traditions about eating. For example, it is not necessary to eat large amounts of unhealthy food for

several days in a row at Thanksgiving, Valentine’s Day, Easter, and Halloween. These holidays have

the tradition of consuming sweets – lots of them. You don’t have to do it! This sort of thing is

counterproductive to your goals and it hurts your health. I am happy for your birthday, but why should

that mean consuming cake, ice cream, and other unhealthy sweets is a good thing? I think you are

probably getting the point. Be willing to talk with friends, family members, and co-workers about

what you are trying to accomplish. This creates a network and atmosphere of support. It also clearly

identifies who is sabotaging you.

EXERCISE

1. YOU LOSE WEIGHT BY DIETING, NOT EXERCISING – Exercise has many benefits, but losing

weight is not one of them. The cornerstone of your weight loss efforts should be compliance with a

diet.

2. EXERCISE HAS MANY OTHER HEALTH BENEFITS – Although exercise plays no major role in

weight loss, it does have many other positive benefits. It improves body composition (more lean

tissue, less fat). It makes you more functional. It improves mood and sleep. It improves blood

pressure, blood sugar, and blood lipids. Regular exercise can act like medicine – it has a positive

effect on most diseases and it likely plays a role in disease prevention.

3. EXERCISE PLAYS A HUGE ROLE IN WEIGHT MAINTENANCE – As I said, exercise does not

cause you to lose weight. However, regular exercise plays a significant role in maintaining your

weight. It is important that while dieting you develop this regular habit of exercise. Continuing in this

habit will help you prevent weight regain.

4. HOW MUCH EXERCISE SHOULD I DO? My goal is for you to work your way up to 5 hours of

moderate intensity exercise weekly (like walking at a brisk pace). If you are just starting out, just do

what you can without injuring yourself. The key is to form the habit of regular exercise – not meeting

an arbitrary time goal. Over time you can work your way up to the 5 hours of weekly exercise.

5. WHAT KIND OF EXERCISE SHOULD I DO? Initially, it doesn’t matter. The fact that you are

actually doing some exercise is the key thing- to start, it could be something as simple as taking the

stairs instead of the elevator or walking for 5 minutes during your lunch break. Once the exercise has

become habitual, you should work at getting 3 hours of your preferred form of cardiovascular exercise

weekly and 2 hours of resistance training weekly. There is no rule against doing extra if you so desire.

Just make sure the time you spend is worth it- if you only have 5 minutes, give it all you got for those

5 minutes!

We will provide you with guidance related to exercise at your appointments as appropriate. We also

have several staff members certified as personal trainers who can offer additional recommendations

regarding your exercise plan.


FOOD & BEVERAGE TIPS

What Does a Serving Size Look Like?

1 cup = size of a baseball

1 teaspoon = size of 1 small die

or 1 fingertip

½ cup = size of a tennis ball or

light bulb

1 ounce of cheese = size of 4

small dice

¼ cup = size of 1 large egg

4-6 ounces of meat = size of

1.5-2 decks of cards

2 Tablespoons = size of a golf

ball or ping pong ball

4-6 ounces of fish = size of 1.5-

2 checkbooks

Portion Control & Mindful Eating

Use a salad plate, NOT a dinner plate for your meals.

Always fill at least half of your plate with non-starchy vegetables, the other half should contain your

30-40 grams of protein.

If you choose to consume starchy vegetables or grains they should be < ¼ of your plate.

Use smaller utensils or try chopsticks to help you slow down and take smaller bites.

Put your fork down onto the plate between bites or hold it in your non-dominant hand to slow down.

Do not eat in front of a screen (i.e. television, computer, etc.).

Sit and eat at a table to experience the meal vs. standing/walking around/on the couch.

Take one bite at a time and chew your food thoroughly to savor the flavor and help digestion.

If appropriate, have a sit-down family meal- make it a routine and something to look forward to each

day.

If you have a habit of over-eating or getting second or third helpings, serve yourself a reasonable

portion and put away any extra food before sitting down to eat. This decreases the temptation of

getting those extra helpings or nibbling while cleaning up after the meal.

Avoid leaving snacks out in plain sight (candy bowls, etc.) as this can promote the “see-food” diet-

eating because you see it and want it and not because you are hungry.

Pre-portion snacks in small bags/containers or buy the pre-packaged single serving sizes of them- this

helps your mind and stomach know you had enough and are finished eating.

Stick a piece of sugar-free gum in your mouth after a meal for a sweet treat instead of dessert.


Tips to Consume More Water

Drink an 8 ounce glass of water when you first wake up in the morning- this can be used to take your

medications or just as a good way to start the day.

Make it a habit to always have a bottle of water with you when you leave the house.

Drink water in the car, and set a goal to finish the bottle by the time you reach your destination.

Add flavor enhancers like lemon/lime juice or sugar-free Crystal Light, Mio, etc. if it helps increase

your desire for water.

Invest in an insulated reusable water bottle such as a Camelbak or Polar Bottle to keep the water the

temperature you prefer.

Set goals such as consuming one bottle of water before breakfast, one on the commute into work, one

between breakfast and lunch, one between lunch and dinner, and one on the commute home - this will

allow you to reach the recommended goal of at least four to five 16-ounce water bottles per day.

Download a free water-drinking app on your phone that reminds you to drink water.

Swap It Out!

Low Carb Alternatives Worth Trying

In place of traditional bread…

Wrap your burger or sandwich contents in lettuce or cabbage leaves.

Use portabella mushrooms, bell pepper, tomato, or cucumber slices as the “bun”.

Put the burger or sandwich contents on shredded lettuce and make it into a salad.

Simply roll deli meat and cheese slices into a tube and enjoy as a “roll-up” or wrap around a

cheese stick or pickle.

Put chicken, egg, or tuna salad inside of a hallow tomato, cucumber, pepper, or mushroom- “boat

style”.

Replace bread with vegetables and dip, meat, or cheese as an appetizer and/or side dish.

Instead of flour-based pizza crust, try…

Cauliflower, zucchini, or spaghetti squash pizza crust.

Topping a portabella mushroom or eggplant round with sauce, cheese, etc.

Egg pizza crust (cook in a non-stick pan, top, and bake- great breakfast option).

“Meatza” pizza crust (bacon, pork, or your choice of ground meat baked crispy and adorned with

your favorite pizza toppings).

In place of traditional pasta or rice, try…

Spaghetti squash “noodles”.

Julienned squash, zucchini, or cucumber (a kitchen tool called the “Veggetti” can help make these

“noodles”).

Shirataki noodles (low carb, fiber-based noodles found in the produce section).

‘Quest Nutrition’ brand pasta.

Thin, length-wise slices of zucchini, squash, or eggplant in place of lasagna noodles.

Cauliflower “rice” (process florets in food processor to get rice-like texture).

Broccoli slaw or cabbage- when cooked slightly and mixed with meat sauce and cheese, this can

replace the pasta in baked ziti or be the bed of “noodles” for sauce.

Bean sprouts or cabbage as a base for cold or warm Asian noodle dishes in place of flour or rice-

based noodles.


PRESCRIPTION DIET MEDICATION

At Dr. Simonds Weight Loss, we offer access to prescription diet medications that are commonly used in

weight loss practices throughout the country. These medications are used as a tool to help make it easier

to adopt the healthy eating and exercise habits that will assist you in maintaining your weight loss long-

term. Simply relying on medication to lose weight without the commitment of diet and exercise will not

work. Nor will simply “going through the motions” of diet and exercise while losing weight and then

going right back to unhealthy eating habits with little or no exercise once you reach your goal weight- this

is a guaranteed way to re-gain previously lost weight.

The following sections will provide information on many of the prescription diet pills and injections we

offer at Dr. Simonds Weight Loss. Armed with this information, you can help us decide what medication

or combination of medications is right for you. In addition to the medications outlined below, we

prescribe several other medications that may be appropriate for certain patients such as Metformin, 5-

HTP/Carbidopa, Belviq, and Contrave. The providers can discuss these medications with you at your

appointment and help determine which medication regimen is most appropriate for you. Remember, diet

and exercise are a matter of necessity, but prescription medication is a matter of personal choice, and we

want you to help us decide what medications you are comfortable taking. All of the medications presented

here can be taken alone or in combination. Keep in mind that medications used in weight loss practices

such as ours are rarely covered by insurance.

SUMMARY:

While diet and exercise are a matter of necessity, prescription medication is a matter of personal

choice, and we want you to help us decide what medications you are comfortable taking. All of the

medications we offer can be taken alone or in combination.

PHENTERMINE

Phentermine is an FDA approved appetite suppressant pill that has been on the market since 1958. For

over 50 years it has been the most commonly prescribed diet pill in the world. Phentermine is a stimulant

and is similar in character to the drugs that are used today to treat ADD or ADHD. Because it is a

stimulant, some patients may experience a “speedy” or “energized” feeling when they first start taking

phentermine. This resolves once your body becomes used to the medication, which is typically within the

first few weeks of use. When used correctly phentermine is generally safe, and is also inexpensive. If you

have taken it before you can start with a whole pill if you would like, but if you have never taken it, you

should always start with a half pill. It is scored and easily “split-able” by hand or you can use a pill

splitter. Pill splitters are cheap and available at any pharmacy. If you start with a half pill daily, you may

increase the dose to one whole pill daily if you begin to feel like the medication is not suppressing your

appetite all day.

Phentermine should be taken on an empty stomach in order to be absorbed properly and work most

effectively. This means you should take it either first thing in the morning or wait at least 2.5 hours after

eating. You should also wait at least one hour after taking the medication to eat. Drinking water or black

coffee during this one hour after taking the medication is fine; just avoid food and other beverages,

including creamed coffee during this time. If you sometimes have trouble falling to sleep, you should take

your pill first thing in the morning upon rising. By taking it first thing in the morning, you are more likely

to fall to sleep normally in the evening. If you fall to sleep easily and are a sound sleeper, and if you need

greater appetite suppression in the evening than the morning, you may choose take it your pill at 10 or 11

o’clock in the morning. Remember to wait at least 2.5 hours after and 1 hour before eating anything. By

taking it later in the morning it will last later in the evening. This tends to prevent evening hunger and

cravings.


A common question presented by patients is how long they can take a drug like phentermine. Provided

there are no contra-indications or significant side effects, phentermine can be taken as long as necessary

to achieve a patient’s treatment goal. There is no duration limit. However, it should be clearly understood

that it is used to accomplish a treatment goal – it should not be used just to give you extra energy. It is

designed to assist you in losing weight and maintaining this lost weight. Some patients will notice that

after some period of time the drug does not feel it works as well. In almost all instances of this the

medication continues to work, but our hunger levels are increased due to weight loss. Our bodies actually

have built-in mechanisms to oppose weight loss and increase hunger as we lose weight. The main sign of

this is that the pill does not suppress your appetite and you have difficulty losing weight. If you are still

losing weight at a reasonable pace, the medication is still helping and no adjustments are needed. A

provider will assess this at follow-up visits. If appropriate, short drug holidays or pill breaks may be

recommended.

Most patients who take phentermine will experience a dry mouth. To minimize this sensation, make sure

that you drink plenty of water, which for most people should be between 60 ounces and 100 ounces per

day. If you do not like drinking plain water it is okay to add zero calorie flavorings such as Crystal Light

or buy sparkling flavored water. Some patients will experience mild constipation. To alleviate this, make

sure that you are drinking plenty of water, and that you have plenty of vegetables in your diet daily. If you

need more than this, you can take 2 tablespoons of milk of magnesia morning and night until the

constipation subsides. Another option is to use polyethylene glycol powder (Miralax) 17g dissolved in 8

ounces of water or another beverage daily or several times per week as a preventative measure. All

stimulants can potentially raise your blood pressure. If this happens, it is generally mild. If you take

medication for high blood pressure, keep a blood pressure journal that has three weekly readings taken

first thing in the morning. This will help the providers to know how your blood pressure is doing at home.

If you don’t own a blood pressure cuff, you can check it at just about any pharmacy. When your weight

significantly drops, expect your blood pressure to come down also. This may require taking you off of

your blood pressure medication. Remember, if you take your phentermine too late in the day, it is likely

that you will have difficulty falling to sleep. For patients who find that phentermine is too strong, weaker

alternatives like Phendimetrazine (generic for “Bontril”) or Diethylpropion (generic for “Tenuate”) are

available. The providers can assist you if this is your case.

There are some patients who should not take stimulants such as phentermine. The providers will carefully

screen your medical history and list of medications to make sure that you are able to take stimulants. If

you have heart disease, history of abnormal heart rhythm, or structural abnormalities of the heart you

should not take stimulants. You should not take stimulants if you have had a stroke or have peripheral

vascular disease. You should not take stimulants if you have had acute angle closure glaucoma, seizure

disorder, or bipolar disorder. Do not mix phentermine with Sudafed or phenylephrine which are common

in many cold preparations. Usually these cold medications have the word “decongestant” on the label.

They may also have a “-D” like Claritin-D or “-PE” like Sudafed-PE. Do not mix with other stimulants

that are taken for ADHD or narcolepsy. Should you in the future have any questions about this, please

contact the office for advice before taking any new medication.

SUMMARY:

Phentermine is an FDA approved appetite suppressant that most patients use to achieve their goal

weight. The medication must be taken on an empty stomach and you should drink plenty of water

daily while taking it.


TOPIRAMATE

Topiramate is the generic name for Topamax. It was initially approved by the FDA to treat seizure

disorder, and is now used to treat many other problems such as migraines, depression, chronic pain, and

obesity. In the majority of patients who take it, topiramate cuts carbohydrate cravings, curbs binge-eating

behavior, and reduces overall calorie intake. It works by a different mechanism than phentermine, so the

two drugs can be used in combination. In July 2012, the FDA approved a brand name drug that is a

combination of phentermine and topiramate called Qsymia. The disadvantage of Qsymia is that it only has

15mg of phentermine. This dose is much lower than the 37.5mg dose that is traditionally used for weight

loss. By taking the phentermine and topiramate separately, a patient can customize the dose of

phentermine to their needs, and save lots of money by paying generic versus brand name prices.

Topiramate is prescribed at a dose of 100mg daily when used for weight loss. Side effects of topiramate at

this low dose are generally mild and can often be alleviated by taking 500mg of vitamin C daily and 2

Tums chewable tablets daily- 1 in the morning and 1 at night. Some patients experience a sensation of

numbness or tingling in their hands and feet when they begin taking this medication. This sensation does

not affect your function at all, and it typically goes away in 1-2 weeks. Another side effect that is

sometimes seen is drowsiness. For those patients who experience drowsiness to the point that they cannot

take a morning dose, the entire dose can be taken at bedtime. Many patients who take this medication

experience an alteration in taste for certain foods, particularly carbonated beverages. This is sometimes

described as a metallic taste or loss of the carbonation (i.e. soda tastes flat). A very small percentage of

patients will report forgetfulness (this is more common at much higher doses). If this happens and it

affects the patient’s normal, daily functions, the medication will have to be discontinued. The

forgetfulness immediately resolves upon discontinuation of the medication. A very small percentage of

people in the general population have a rare anatomic disorder of the eye that makes them prone to a

condition called acute angle closure glaucoma. If you had this anatomic disorder and did not know it, you

could develop this version of acute glaucoma when you take topiramate. The symptoms are sudden,

severe one sided eye pain with blurred vision and a headache. If this were to happen to you, you would

need to go an ophthalmologist or ER promptly to have the pressure in your eye checked. If the pressure is

elevated, it can easily be treated but topiramate will have to be discontinued. Women of child-bearing age

must use contraception while taking topiramate as there is a risk for birth defects if pregnancy occurs

while taking this medication.

Patients who take topiramate for other disorders usually take doses in the range of 200-400mg per day.

The dose used to treat obesity is only 100mg per day. When this drug is first started it requires a “taper

up” over a period of three weeks. Should this drug be added to your regimen, you will receive two pill

bottles the first month. One bottle will have 25mg tablets. During week number one, the patient takes one

25mg tablet before bed. Some patients find that topiramate makes them sleepy, hence the evening dosing.

During week two, the patient takes one 25mg tablet in the morning and one in the evening. If this

produces daytime sleepiness, then the entire dose can be taken in the evening. At the start of week number

three, the patient will switch to the second pill bottle that has 50mg tablets. They will take one 50mg

tablet twice daily. If there is daytime sleepiness, the entire dose can be taken in the evening. If the patient

remains on topiramate for several months, they should undergo a similar taper down. Do not stop this

medication without a healthcare provider’s supervision.

SUMMARY:

Topiramate is a prescription medication that has been shown to cut carbohydrate cravings, curb

binge-eating behavior, and reduce overall calorie intake. It is FDA approved in combination with

phentermine to assist with weight loss. It requires a “taper up” period over three weeks where you

start at a lower oral dose and gradually increase to your final dose.


HCTZ

HCTZ stands for hydrochlorothiazide and is a prescription diuretic pill that helps patients with fluid

retention. It is also used to lower blood pressure. It is particularly effective in low doses for women who

retain fluid around the time of their menses. It is usually taken on an “as needed” basis, but can be taken

every day if recommended by the provider. Be sure to take it during the morning hours. If you take it in

the evening you will have a hard time sleeping because of frequent urination. On the days you take HCTZ

you need to take in extra potassium. You can get potassium from green leafy veggies, coconut water,

bananas, and citrus fruits. You should not take HCTZ if you are already taking a diuretic pill. Since

diuretic pills can lower your blood pressure, you should not take HCTZ if you normally have a low blood

pressure. The providers will assess whether this medication is appropriate for you.

SUMMARY:

HCTZ is a prescription diuretic pill that helps patients with fluid retention and can help lower

blood pressure. It is particularly effective for women who retain fluid around the time of their

menses. It can be taken on an “as needed” basis or daily and requires extra potassium intake on the

days it is taken.

VITAMIN B-12

For many years vitamin B-12 has enjoyed popularity amongst dieters and non-dieters alike. Patients

report that injections of vitamin B-12 increase their energy levels and sense of well-being. They also

report enhanced mental clarity. Many patients feel that vitamin B-12 injections help them deal with stress

better, and that it improves their sleep. Oral vitamin B-12 is often poorly absorbed from the stomach, and

as a result B-12 injections are a superior way to raise B-12 levels in your body quickly. Although vitamin

B-12 will not make you lose weight any faster, it most likely will make you feel better while you diet.

Vitamin B-12 is given in the muscle of the upper arm rather than in the abdominal fat. For most patients a

once a month injection is sufficient. However, some patients feel that weekly or bimonthly doses of

vitamin B-12 are more helpful. If you feel this is the case with you, you are welcome to come by our

office during business hours and get a B-12 injection. You do not need to pay an office visit fee or

schedule an appointment. Vitamin B-12 injections can be combined with any other medication. You

cannot take too much, and there is no risk of toxicity.

SUMMARY:

Vitamin B-12 is reported by patients to increase energy levels, improve sleep, and promote a

greater sense of well being. It is given as a once monthly injection in the upper arm and can be

given more often if needed. There are no side effects or contraindications.


MIC/B-12

MIC/B-12 is an injection and pill combination that is gaining popularity around the country in diet

programs. It goes by several names including lipotropic, lipo, lipodissolve, and lipolytic. It is a twice-

weekly injection of vitamin B-12 given with a very small needle in superficial fat on your abdomen. It

causes little, if any, pain. The providers can teach you how to administer this to yourself at home. This

method of B12 administration provides a consistent high level of B12 throughout the entire month

between office visits. It is superior to the once monthly injection of B12 mentioned above. The MIC

component is taken orally on the days that you administer your injection. MIC/B-12 is natural and does

not interfere with other medications. It can be taken by almost all patients. The oral component does have

a small amount of a sulfa preservative and therefore patients who are allergic to sulfa drugs should not

take the oral component. The injection component is vitamin B-12 and has all of the benefits mentioned

in the previous section, including improved energy levels and sense of well-being. The oral component

has 2 additional B vitamins, and the amino acid methionine. This combination is believed to assist in

weight loss. The MIC stands for Methionine, Inositol, and Choline. Methionine is a sulfur containing

amino acid that neutralizes free radicals, aids in breaking down fat and removing heavy metals from the

body, assists in lowering cholesterol, and aids with digestion. It is also helpful in relieving fatigue.

Inositol is a nutrient belonging to the vitamin B complex family and is vital for the metabolism of fat and

cholesterol. It also participates in the action of serotonin, a neurotransmitter known to control mood and

appetite. Choline is also part of the vitamin B complex family and plays a major role in cardiovascular

health by lowering cholesterol and homocysteine levels. It also may help protect against some cancers.

MIC/B-12 enjoys wide popularity because the multiple actions of the B-12, methionine, inositol, and

choline get many good patient reviews. MIC/B-12 is used in conjunction with an appetite suppressant like

phentermine. If you use MIC/B-12, you will be provided the B-12 shots and MIC pills in a brown plastic

bag to take home. The B-12 must be kept in this dark colored bag to prevent breakdown of the vitamin by

sunlight.

SUMMARY:

MIC/B-12 is an injection and pill combination that has many benefits. The B-12 shot is

administered at home by the patient in the superficial fat of the abdomen with a tiny needle twice

per week following in-office instruction on how to give the injection. Using B12 in this manner

results in consistently higher B12 levels between office visits and this is superior to the once monthly

B12 injection. The MIC oral component is taken on the days the shot is administered. There are no

side effects but patients allergic to sulfa drugs should not take the oral component.


WHICH MEDICATIONS SHOULD I USE?

You may now be asking, “So, which medications should I use?” As a general rule, most patients require

an appetite suppressant. So, most patients will use the phentermine to restrict their appetite. If you

struggle with carbs and binge eating, consider adding topiramate. The diuretic pill HCTZ should be added

to the phentermine if you know that you frequently retain fluid. If you are uncertain about this, you

probably don’t need a diuretic. Injections are a matter of personal preference. Remember, they are not

required for you to eat right and exercise. They are simply a tool to assist you in developing a healthy

lifestyle of diet and exercise. If you like the idea of their added benefits, you may add them to your

medication regimen. Patients who need a “boost of energy” along with many other benefits should

consider adding the MIC/B-12. Phentermine with MIC/B12 is our most popular medicine combination.

Some patients only prefer the phentermine and a once monthly injection of plain vitamin B-12. Most of

these patients do not like the idea of injecting themselves at home. This is perfectly appropriate.

Remember, whatever medication regimen you choose, the central core issue will always be eating

right and developing an exercise routine to maintain your weight loss – your medication is just a

“tool” to help you do this.

All patients should know that there are multiple medications that Doctor Simonds and his staff use to treat

obesity that are not discussed or written about in the new patient manual. In many cases these

medications can be used in combination(s) and as you are going through the process of losing weight or

preventing weight re-gain, some of these may be necessary. At that time, one of the medical providers

can discuss them with you. Examples of these medications include: Metformin, Belviq, Contrave, and

Saxenda. These medications are never required, and are always offered as treatment options for patients

who need options.

We look forward to meeting you!

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