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Wait for the Studies Before Trying Weight-Loss Supplement

Dear Dr. Roach: I am currently 100 pounds overweight, and I saw a doctor on television promoting the use of Garcinia cambogia for weight loss. I am 65 years old and, because of cancer, I underwent a radical nephrectomy and have only one kidney. I suffer from neuropathy and must use a cane for balance when I walk. I have Type 2 diabetes, but am monitoring my blood sugar and have it fairly well under control. However, I really need to try to shed some pounds, and because of my lousy physical condition, exercise isn’t much of an option. I purchased some Garcinia and thought I’d better ask you about it, as I don’t know whether the liver or the kidney would process the pills. I would be required to ingest four tablets three times a day. I currently am on several different medications for diabetes, gout, high blood pressure, etc. I would REALLY like to do this, but I need to know your opinion as to it being safe to do so. — D.W.

Answer: I am pretty conservative about new treatments and wait for well-done studies to prove effectiveness, and Garcinia doesn’t have that. The current enthusiasm for Garcinia may be warranted, but I can’t recommend it yet.

There are reports of liver but not kidney damage from Garcinia, as far as I can tell. If you choose to take it, you should use the lower end of the dose range.

Also, I see many people on medications for diabetes, and many of them, especially insulin and glyburide, make it harder to lose weight. Talk to your diabetes doctor about some newer options that may make it easier to lose weight. Exenatide (Byetta) and similar medications might be right for you, but only your doctor knows enough about you to help you make that decision. Often, we doctors don’t think as much as we should about the weight effects of medications.

At 100 pounds overweight, the most effective treatment for you is weight-loss surgery. It is highly effective at treating diabetes, but obviously it isn’t right for everybody.

Dear Dr. Roach: Please give some insight on the embarrassing problem of flatulence. I am a 72-year-old obese woman. My colon looks great. However, I am constantly passing gas. This is greatly interfering with my life.

What could be the cause? What is the cure? — O.W.

Answer: Passing gas is normal, and the average person does so 10 to 20 times daily (yes, there is a study on that — there are studies on everything). Many people who complain of this common problem are completely normal. When there really is excess gas, the most common reason is eating foods that are difficult for that person to digest. I have mentioned the low FODMAP diet before for irritable bowel syndrome, and the same diet should decrease gas production. Information about this diet can now be found at http://ibs.about.com/od/treatmentofibs/a/The-Fodmap-Theory-For-IBS.htm.

Dear Dr. Roach: What is a hammer toe? Is surgery always necessary?

Answer: A hammer toe is a deformity of the second, third or fourth toe, where it stays permanently bent. It may be caused from wearing shoes with too little toe room. Roomy shoes are always a good idea, and taping may be tried if the toe is still bendable.

Surgery is used in cases of pain that doesn’t respond to conservative treatments. Surgery should not be done just for cosmetic reasons.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.