Each year, the pressure to set New Year’s resolutions drives patients to set weight management goals for themselves, which often involves following popular dieting plans. However, most of these efforts fail after about a year, as there’s no one-size-fits-all approach to weight loss. Due to the incredible complexity of this process, it often requires a combination of medications and long-term lifestyle changes.
Some patients may require assistance with this goal when they aren’t seeing the results they want with diet and exercise. Of the treatments available, bariatric surgery is the most effective, but it is expensive and patients often experience a variety of post-operative complications. Patients desiring less-invasive interventions typically turn to pharmacological treatments such as weight-loss drugs or supplements. Although many of these treatments provide rapid short-term results, patients are likely to regain any lost weight after stopping treatment regimens.
Long-term lifestyle changes are necessary to maintain any lost weight. Tailored combinations of vitamins, amino acids, and medications can kick-start metabolism, boost energy levels, and help patients lose weight and keep it off. In this month’s blog post, we’ll cover some of these options for helping patients manage their weight and how compounded preparations play a role in individualizing these combinations to meet a patient’s specific needs.
Injections to indirectly support weight loss and improve adverse events
Although there is no literature showing that vitamin B12 directly leads to weight loss, it still may have several other benefits. For example, patients who are prescribed commercially-available GLP-1s such as Wegovy® often experience gastrointestinal distress, and murine studies have suggested that vitamin B12 may reduce the incidence of nausea and vomiting.
Patients who have undergone bariatric surgery for weight loss tend to experience nutrient deficiencies due to malabsorption, including vitamin B12. According to one study, “intramuscular vitamin B12 continues to be the gold standard of therapy for vitamin B12 deficiency.” (1) Vitamin B12 injections can play a role in ensuring patients’ bodies have an adequate supply of this vitamin.
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Each of the three compounded injections includes a mixture of ingredients such as methionine, inositol, and choline (MIC) to potentially speed up metabolism and curb appetite. Consistent use of these formulations through injections can be an effective method to support patients in enhancing their lipid metabolism, aiding in the maintenance or achievement of high energy levels within the context of a balanced diet and regular exercise routine. Vitamin B12 can also be included in the MIC cocktail (known as lipotropic injections) to enhance benefits and provide an extra energy boost.
Fiber supplements to improve satiety
Few types of fiber have actually been shown to help reduce a patient’s food consumption, so it’s important to select the right one. Fibers that form gels in the stomach may help prolong feelings of satiety. A very recent meta-analysis showed that gel-like fiber such as psyllium is effective for weight loss in patients in obese and overweight patients. (2) Several randomized control trials have shown statistically significant weight loss when using glucomannan supplements versus a placebo group by prolonging feelings of satiety and reducing calorie intake. (3) Because glucomannan has the highest hydrated volume at the lowest concentration of any dietary fiber supplement, it may provide a greater feeling of satiety than other fiber supplements. (4)
Compounded semaglutide alternatives
The semaglutide-based drugs Ozempic®, Wegovy®, and Rybelsus® show no signs of waning in popularity. As we’ve stated numerous times, we do not compound semaglutide and dissuade prescribers and patients alike from prescribing or using it in a compounded (injectable) form. Mounting evidence is showing that many compounded semaglutide products are not being compounded according to state and federal regulations and are often full of impurities that the FDA has posted warnings about, such as BPC-157. Recently, they sent warning letters to two online vendors for selling unapproved and misbranded versions of both semaglutide and tirzepatide. (5)
Compounding risks aside, when taking any drug that causes rapid weight loss, patients are likely to lose fat and muscle mass. There are several semaglutide alternatives, including both pharmacological and non-pharmacological options that may help patients lose weight more gradually.
Low-dose naltrexone (LDN)
The combination of naltrexone/bupropion is thought to promote satiety, reduce food intake, and enhance energy expenditure. (6,7) Commercially available naltrexone is sold only as a 50mg tablet, but lower doses (0.5–4.5 mg) are typically sufficient for weight management and other conditions. Compounded preparations, then, can ensure that patients receive an accurate low dose of naltrexone.
A word of caution about supplements
Patients wishing to forego the use of prescription medications may turn to dietary supplements to aid in weight loss. Despite their benefits, adverse events can still occur from supplement use as well as drug-supplement interactions. One study estimated that one-fourth of all supplement-related emergency room visits due to adverse events were related to weight loss products, with symptoms most often manifesting as cardiovascular events. (8) As dietary supplements are highly unregulated and much is still unknown about drug-supplement interactions, it is critical they be sourced from a reputable pharmacy and administered under the supervision of an appropriately licensed prescriber.
How VLS Pharmacy and New Drug Loft support prescribers and patients with compounded weight loss preparations
Long-term treatment adherence is a critical part of any weight loss plan, and compounded preparations tailored to a patient’s exact needs can play a role in ensuring adherence. (9) For patients requiring an individualized weight loss plan that includes medications, 503A compounding pharmacies can provide compounded preparations to meet a patient’s specific needs, as determined by a prescriber.
Regardless of which path patients take on their weight loss journey, consultation with a licensed prescriber is critical to ensure that weight loss medications and supplements are being sourced from reputable suppliers. From dietary supplements to prescription weight loss aids, a licensed 503A compounding pharmacy like VLS Pharmacy and New Drug Loft can compound various medications so that they meet the needs of individual patients.
Please comment below with any thoughts or questions. Reach out to our team to learn about building trust and long-lasting patient relationships. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.
- Majumder S, Soriano J, Louie Cruz A, Dasanu CA. Vitamin B12 deficiency in patients undergoing bariatric surgery: Preventive strategies and key recommendations. Surgery for Obesity and Related Diseases. 2013;9(6):1013-1019. doi:10.1016/j.soard.2013.04.017
- Psyllium is a natural nonfermented gel-forming fiber that is effective for weight loss: A comprehensive review and meta-analysis – PMC. Accessed January 10, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389520/
- Au-Yeung F, Jovanovski E, Jenkins AL, Zurbau A, Ho HVT, Vuksan V. The effects of gelled konjac glucomannan fibre on appetite and energy intake in healthy individuals: a randomised cross-over trial. Br J Nutr. 2018;119(1):109-116. doi:10.1017/S0007114517003233
- Guo L, Yokoyama W, Chen M, Zhong F. Konjac glucomannan molecular and rheological properties that delay gastric emptying and improve the regulation of appetite. Food Hydrocolloids. 2021;120:106894. doi:10.1016/j.foodhyd.2021.106894
- Jain, P. (2024, February 13). FDA warns online vendors selling misbranded weight-loss, diabetes drugs. Reuters. Retrieved from https://www.reuters.com/business/healthcare-pharmaceuticals/fda-warns-online-vendors-selling-misbranded-weight-loss-diabetes-drugs-2024-02-13/.
- Billes SK, Sinnayah P, Cowley MA. Naltrexone/bupropion for obesity: An investigational combination pharmacotherapy for weight loss. Pharmacological Research. 2014;84:1-11. doi:10.1016/j.phrs.2014.04.004
- Sherman MM, Ungureanu S, Rey JA. Naltrexone/Bupropion ER (Contrave). P T. 2016;41(3):164-172.
- Geller AI, Shehab N, Weidle NJ, et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med. 2015;373(16):1531-1540. doi:10.1056/NEJMsa1504267
- 8. Carvalho M, Almeida IF. The Role of Pharmaceutical Compounding in Promoting Medication Adherence. Pharmaceuticals (Basel). 2022;15(9):1091. doi:10.3390/ph15091091
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