Why isn't your doctor helping you lose weight?

Your doctor is busy with sick people. Most physicians spend the day caring for patients who are already ill, not on keeping people well. Most insurance companies do not pay for preventive care, because they call it elective or not cost-effective. So the patient who is heavy but not yet diabetic falls through the floor: too heavy to be healthy, not sick enough to be paid for.

Live Health Protocol was built for that floor.

Not sure this is your service? Tap the directory assistant (the light in the corner of the page) and it will point you to the right place. This page sits in our pain and metabolic medicine directory.

Where did Live Health Protocol come from?

A pain clinic.

After years of seeing patient after patient in pain, one theme kept surfacing. The practice was never going to rid patients of their symptoms without treating what caused them, and for most of them that was excess weight and chronic inflammation. The weight led to pain. It also led to exhaustion, irritability and depression. There are exceptions. For the majority, there are not.

The program was created in St. Louis by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and Ami M. Grimes, CEO of his practices. They have been business partners for close to ten years. Between them they run an interventional pain clinic, an anti-aging clinic and restaurants, and they rehabilitate old homes and buildings. They love great food, a good drink and a table full of people they love.

Why does a pain physician run a weight program?

Because he treats the end stage of metabolic disease every day: the neuropathy, the joint degeneration, the chronic pain that follow years of unmanaged insulin resistance.

Dr. Padda holds five board certifications. Two of them sit on either side of the weight problem. Obesity medicine covers the body that stores the fat. Addiction medicine covers the brain that keeps reaching for the food. The Live Health Protocol is built where they overlap.

His years as Director of Pain Management and Neurobehavioral Research at PsychCare, 2010 to 2017, bear on it directly. That research covered what pain does to mood and what long-term medication does to the endocrine system: the hormonal middle ground where sleep, appetite, insulin and pain act on each other. A protocol that fixes diet alone is working one corner of that square.

He is a Diplomate of the Society of Metabolic Health Practitioners, an advisor to the Nutrition Network, and practices at a Low Carb USA certified clinic.

Most protocols come from someone with credentials and no patients, or an audience and no training. This one is built around what changes outcomes, not what is easiest to sell.

How does the program work?

Two phases.

Phase one: the mdHCG kickstart

The first goal was a healthy, relatively easy way to lose weight in a short time, one that actually worked and could kickstart an entirely new way of living. The practice researched the question hard and kept coming back to HCG. When it introduced the protocol in its own clinic, patients had amazing results, enough that the practice opened it to everyone looking to change. That became the mdHCG protocol. For abdominal fat, the practice calls it a guaranteed solution.

Phase two: the Live Health Protocol

Losing weight is the easy half. Keeping it off is where every diet dies. Once patients were losing, the practice wanted them to keep it off and keep improving, physically and mentally. That is the Live Health Protocol: the food, the training, the sleep and the understanding of your own biology that hold the new weight in place.

None of it rests on willpower. It rests on the mechanisms below.

Are carbohydrates really addictive?

Yes. The program treats them as a drug.

Eat carbohydrate and insulin rises. Insulin carries tryptophan into the brain. Tryptophan becomes serotonin, and serotonin release climbs sharply. Mood lifts. Contentment follows. So people learn to self-medicate with soda, chips and pastries. It shows up most in:

• People who gain weight under stress
• Women with premenstrual syndrome
• People with seasonal winter depression
• People in chronic pain, who eat for analgesia
• People quitting smoking, because nicotine raises serotonin and withdrawal drops it

Repeat the pattern and the neurons hardwire it. Withhold the carbohydrate and cravings and withdrawal follow. A food's glycemic index tracks its addictive strength. Carbohydrate bingeing behaves like heroin addiction: opiates blunt carbohydrate cravings, and cravings surge during opiate withdrawal.

That is the case for an addiction physician running a weight program. The craving is physiology. It gets managed like physiology.

What do glycemic index and insulin have to do with fat?

Everything. All carbohydrate becomes blood sugar, and the more refined it is, the faster. A glazed doughnut or a plate of mashed potatoes hits the blood almost at once. The pancreas answers with insulin, which pushes the glucose into cells to burn or store.

As cells grow resistant, the pancreas makes more insulin for the same meal. More insulin means more storage. When the pancreas cannot keep up, diabetes arrives. Americans eat 250 to 300 grams of carbohydrate a day, about 55% of their calories, after decades of official advice, pressed by grain producers, to cut fat and eat "complex carbohydrate."

The glycemic index ranks foods by how fast they raise blood sugar against pure glucose at 100. At the top sit corn syrup, beer, potato products, rice flour, maltodextrin, gluten-free white bread and hamburger buns. Low-glycemic eating keeps insulin low enough for the body to burn its own fat.

The first sign of insulin resistance is metabolic syndrome: three or more of high triglycerides, blood pressure over 135/85, a waist over 40 inches in men or 35 in women, low HDL, and elevated fasting glucose. Nearly a quarter of adults have it. If diabetes is already on the table, see type 2 diabetes reversal.

Why is belly fat the dangerous fat?

The abdomen holds three kinds of fat: under the skin, structural fat around the organs, and visceral fat inside the cavity, much of it hung on the greater omentum, the apron that drapes over the organs. Visceral fat behaves less like a storage tank and more like a gland. It dumps adipokines and toxic metabolites straight into the venous drainage, driving insulin resistance, type 2 diabetes, high blood pressure and cancer risk. Middle-age belly fat nearly triples the chance of Alzheimer's or another dementia later.

You cannot spot-reduce it. Visceral fat is the last reservoir the body surrenders and the first it refills. You reach it by driving total body fat down, to about 16% for men and under 22% for women, with low-glycemic eating, targeted supplementation, high-intensity intervals and resistance training.

Is BMI a useful number?

A reasonable one. In a Lancet analysis of 57 studies, death rates were lowest at a BMI of 22.5 to 25, and every five points above that raised all-cause mortality about 30%.

Its flaw: it cannot tell fat from muscle. A pound of muscle weighs exactly what a pound of fat weighs. Fat just takes up nearly 18% more room. So pair BMI with:

• Waist girth. Over 40 inches for men or 35 for women: time to get serious.
• Waist-to-hip ratio, which shows where the fat sits.
• Body-fat percentage by bioimpedance scale, calipers or DEXA.
• Exercise capacity in METs, the functional test that may beat all the others.

Measured body composition and resting metabolic rate are available through autonomic and vascular testing.

Do a few extra pounds matter?

Seven pounds is enough. In the Physicians' Health Study, every seven pounds of excess weight meant about 11% more heart failure risk over 20 years. Overweight men had 49% more heart failure. Obese men had 180% more. Activity cut the risk: 18% lower with exercise one to three times a month, 36% lower at five to seven times a week.

What does obesity do to the brain?

It shrinks it. In published MRI research, obese people had about 8% less brain tissue than people of normal weight, and brains that looked 16 years older. Overweight people had 4% less tissue and brains that looked eight years older. Age, gender and race did not change it. The frontal and temporal lobes, which run planning and memory, take the hit.

The mechanism is plumbing. Vessels shrink and stiffen. Blood pressure rises. Insulin resistance glycates and inflames. Fat tissue releases hormone-like toxins. Less blood reaches brain tissue, and the tissue dies. Vigorous exercise runs the process in reverse and conserves brain tissue.

How hard should you exercise?

Hard, briefly. The benefit concentrates in the worst part of the effort: the last 15 seconds of a sprint, the hardest 10 seconds on the bike, the final reps to failure.

In a Circulation study of more than 14,000 men averaging 60 years old, the highly fit had 50% to 70% lower mortality than the least fit. Peak treadmill capacity predicted survival better than cholesterol, diabetes, smoking, blood pressure or even heart disease. Each one-MET gain raised survival 12% to 13%. Thirty minutes, five to six days a week, cut the risk of death in half. Two sessions of 10 to 15 minutes work as well as one.

Weight training burns more fat than aerobic work alone, because it burns during the session and again at rest while muscle repairs. It also raises growth hormone, thyroid hormone and testosterone.

Why does sleep decide your weight?

Growth hormone release, tissue repair and muscle growth happen mostly, sometimes only, during sleep. Restorative sleep drives hormone production, stress control and cardiometabolic health. It is part of the treatment of obesity.

Pills do not deliver it. Most sleep medication makes you forget a bad night, not recover from it, and ongoing use breeds dependence. The protocol fixes sleep with habits: the same bedtime and wake time every day, weekends included; no caffeine, nicotine or alcohol for four to six hours before bed; no hard exercise in the last three hours; a cool, dark, quiet room used only for sleep and sex; bright light by day, blackout at night; naps under an hour and before 3 p.m., or none.

Can gut bacteria make you fat?

Yes. The gut decides how many calories you harvest from the same plate. People with obesity carry more Firmicutes relative to Bacteroidetes, and Firmicutes extract energy from fiber far more efficiently. Identical twins differ by it: the obese twin carries more Firmicutes. The ratio falls as weight comes off.

Antibiotics wipe out good bacteria with the bad, and 50% to 70% of US antibiotics go to healthy livestock to fatten them. The protocol favors grass-fed, organically raised meat. Cut refined carbohydrate and add fiber, and the ratio shifts within 72 hours.

How do you start?

If you take prescription medication, especially for blood sugar, blood pressure or mood, do not change how you eat on your own. Start with a physician.

Live Health Protocol, 12174 Natural Bridge Rd, St. Louis, MO. Call (866) 881-7246, 1-866-881-PAIN.

Frequently asked questions

Will insurance pay for this?

Usually not. Insurers treat weight loss before you are sick as elective or not cost-effective. That gap is the reason the program exists.

Can you go through carbohydrate withdrawal?

Yes. Repeated carbohydrate eating hardwires the neurons, so cravings and withdrawal appear when it is withheld, the same way nicotine withdrawal drives smokers toward snacks.

What burns visceral fat fastest?

Weight training, backed by high-intensity intervals and low-glycemic eating. Resistance work burns during the session and again at rest.

Is my BMI of 26 a problem?

It sits in the overweight range of 25 to 29.9, above the 22.5 to 25 band where death rates are lowest. Check your waist too: over 40 inches for men or 35 for women raises the risk.

Can exercise protect my brain?

Yes. The same research that showed obesity shrinking the brain found that regular, vigorous exercise conserves brain tissue.