Dr. Sarah Molasky

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127 appearances 1 recordings 1 series first heard Mar 2024 last heard Mar 2024

Dr. Sarah Molasky’s voice in public audio — every appearance, attributed to the second.

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Health Chatter · Weight Loss Meds · 28 Mar 2024 podcast

Or they're worried that they may lose muscle mass, which is a concern with some of these meds if someone isn't getting both enough calories and enough weight resistant exercise. So it really is about what is the patient who comes up to me like concerned about and addressing that directly. But the main thing is get more information that's customized to you. Right.

I, as your pharmacist only have your medication, assuming you're even my, my patient, right. I only have your medication list. I don't have your lab results. I don't have your health history, but your clinic does. And your healthcare, your larger healthcare team does have access to that. So work with a dietician for that.

And I personally have worked with a dietician myself because I was trying to, um, I had the opposite problem where I stress starve, where I forget to eat when I'm stressed out. And so I went to a dietician to say, Hey, I feel like I'm eating enough, but I don't know if I'm eating effectively.

And she was able to educate me on what sorts of foods to look for, for my personal health and my eating habits. So registered dieticians are horribly underutilized, especially when it comes to, you know, weight in blood sugar, just general health. So that would be my number one thing is.

registered dietitian, and also talk to your healthcare team about whether any of these are even remotely appropriate for your overall health.

I mean, if someone's weight is going up and down, that's again, something that should be, you know, discussed with their healthcare team. And that can happen for a lot of reasons. If we're talking a weight loss or gain of like five to 10 pounds at a time, a lot of people with uteruses naturally go through that throughout the month.

So it's a matter of is this weight gain and loss like necessarily metabolic or is it just hormonal or fluid retention or is it in a cycle? But when it comes to people who are doing these crash diets or things like keto is really popular and I can't roll my eyes enough at that because I have to counsel patients on that all the time on why it's not the best idea overall for most people.

I really do think that talking to their healthcare team, getting a meal plan from registered dietitian, and then also potentially, you know, seeing occupational therapy or physical therapy about how should I be exercising correctly so I don't injure myself. All of those are things that people should be doing first before they turn to medication.

But if we're talking somebody who, yeah, my weight fluctuates by 10, 20 pounds, but I'm morbidly obese, well, I don't care about the 10, 20 pound fluctuation. I care about how, if this morbid obesity is negatively impacting your life and your health, how are we going to address that? And for some of those patients- then these medications may be clinically appropriate.

But again, I, as their pharmacist, can't give them that advice. They would need to talk to their whole team and try to set up a plan. And healthy, maintainable weight loss is not fast. That's one thing I wanted to say is outside of bariatric surgery, if we're talking the behavior I'm doing is going to change my weight,

when you're losing weight in a way that's maintainable long-term, it's not going to be like that. It's going to be a slog. And that's what's really hard for people. And I think that's maybe what isn't communicated super accurately a lot of the time in a lot of social media about weight loss, where we get to see the before and after. And it's like, yeah, a year went by. No big deal.

That was a year. That was a year of discouraging stuff in the middle that isn't being shown.

Yeah. So I fortunately or unfortunately went viral while I was on clinical rotations because I went on a gigantic rant about some of those like weight loss supplements and It wasn't tummy tea, although that's basically just a laxative. So you're, you're basically trying to poop really, really quickly so that you can eat stuff, but you're not absorbing it very well.

And that definitely does damage to your GI tract and should not be done. And many of those weight loss teas and supplements, again, also contain stimulants. But there are the biggest, Story I have about those sorts of weight loss shakes and supplements and teas and how they can impact your health is the woman I saw in the hospital was on rotation.

She was in there for like heart failure and other things. And one of the biggest issues they could not resolve was that her legs were super swollen with fluid. Right. So she had major water retention and they were pumping her with diuretics and just nothing was working.

And I went in and, you know, did my medication rec, which is, you know, as a pharmacist or a nurse, you go through their med list. And I asked about supplements, health shakes. And her daughter was like, oh, mom, you're using that shake.

I looked up that shake, which was very difficult because they make it hard to find the ingredients list and cross referenced every ingredient and found out that one of the ingredients, which was ginseng, can cause diuretic resistance.

So when I said that, they switched to a different diuretic that was harder hitting, got the water retention under control, and I don't know what happened with the patient after that because I moved rotations at that point.

But, you know, for someone with heart issues, taking a stimulant containing weight loss supplement, which is what almost all these over-the-counter weight loss supplements contain, is a laxative probably, right? a stimulant almost definitely. And then a bunch of other things that might cause many problems.

And another one is a lot of focus supplements, like certain types of like coffee for focus or whatever. A lot of those contain additional things that can raise blood pressure and suppress appetites through the stimulant activity, but can cause, you know, really big issues for the heart. In some cases for the liver, it's, I do not ever recommend them is the short answer.

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