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Diet pills and supplements, part one

Saturday, April 9th, 2011

Take two and call me in the morning

I've never used diet pills and have avoided supplements that are supposed to help you lose weight, but there's a great new article on them. It's in a distinctly non-medical source, but was as useful as the medical sites I found and the medical newsletters I received, so let's start there.

The article is in Redbook which I can state categorically I normally don't read. But I got in the mail yesterday, unsolicited, a health-related newsletter from a major university and saw an article in it on diet supplements and weight loss. That started my online search that circuitously led me to the Redbook article, also available online  at http://www.redbookmag.com/print-this/diet-pills-yl?page=all

The piece says it will update you on five of the newest diet pills (I counted four, but who's counting?). They walk through the pros and cons of orlistat, available OTC as Alli, which prevents digestion of a share of any fat you consume. The manufacturer of this drug did a study (I prefer totally independent sources) and found increased weight loss in subjects who took the med. What's the con? Well if you consume more fat than ~15 grams per meal, you can develop diarrhea and you may not absorb your daily vitamin intake as well (A, D, E, and K are fat-soluble).

The next drug is Merida (Silbutramine) which acts centrally, i.e., in the brain, altering two chemicals that tell you when you're full. It also can raise your blood pressure and has been assocaiated with strokes and heart attacks. This one is only for the obese or those seriously overweight with other rick factors (e.g., diabetes), is expensive and your healthcare insurance may not cover its cost.

Then there's a duo, Glucophage (metformin) and Byetta (exenatide) that are mostly used for diabetics with weight control problems. Therefore they are usually covered by insurance plans. They also can cause nausea and diarrhea, but have been effective in some fairly long-term studies.

I won't even start on the supplements in this post. What I do want to mention is that most of the medical specialists that Redbook consulted emphasize these drugs are not for the person who wants to lose five or ten pounds so they look good in party clothes or a swim suit. They're for the seriously overweight who preferably are under a doctor's care. And one medical expert said they only work if you are willing to make lifestyle changes.

Guess what? That means dieting and exercising.

 

 

Posted in Dieting, medically-oriented background info, Obesity, supplements, Weight Loss | No Comments »

Eating Disorders, Part one

Wednesday, April 6th, 2011

Drugs as food

I was reading the Wall Street Journal yesterday and saw an article titled "Food may be addicting for some." Thus far I've been able to find the Archives of General Psychiatry online and ran across a synopsis of the article that was perhaps more erudite, but less helpful than the newspaper article. I then read a "psychcentral.com" review of the study.

Let's start with the newspaper. It describes a study on a small number of subjects, 39 women, who had MRI brain scans after completing a short food addiction test that was originally designed to detect people with eating disorders. Fifteen of the women had high scores indicative of potential addictive eating problems; those same women had markedly different brain scan results than the lean subjects.

Okay, let's go back a ways. Last year in the journal Nature Neuroscience, Scripps researchers found that obese rats had brain alterations as compared with lean rats. The changes in the rats' brains were similar to those reported in people who are drug addicts. In short we normally get neural (brain-mediated) rewards for "pleasurable" activities. Similar rewards occur in response to addicting drugs.

The current study started with 48 healthy young women, some of whom were thin and some fat (or as, in our world of political correctness, we now term "obese."). They were enrolled in a "healthy weight maintenance' study.  Thirty-nine MRI results are reported, after the women were show pictures of chocolate milkshakes or a less enticing solution and some actually got either the milk shake or a tasteless control surrogate.

Then they had brain scans and the pattern of neural activation was much like those seen in drug addicts. Either food intake (or even viewing a photo of food) or drug use can stimulate the brains release of chemicals we find pleasurable.

"It ain't easy" for some to lose the extra weight

So what does this mean for society? Number one: not everyone can lose weight by following a deciding to diet. Number two: the omnipresent visual food ads can be detrimental to a segment of our population. Number three: I think organizations similar to Alcoholics Anonymous may be one aid to that group of the obese.

The lead author, Ashley N. Gearhardt, a doctoral student at Yale, who help devise the 26-question Food Addiction Scale, was quoted as sayying, "Some of them actually stop socializing because it gets in the way of their eating."

We've got a major problem here folks. I gained a few pounds on a 11-day trip to see old friends all of whom wanted to feed me wonderful meals. When I got home I went back to my usual eating pattern and the extra weight dropped off rapidly.

That's not going to be as easy for some and darn near impossible for others.

 

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Posted in eating disorders, medically-oriented background info, Obesity, our kids and their weight issues, Unhealthy eating | No Comments »

Gluten appears to cause more problems than we thought

Thursday, March 31st, 2011

Ah, that wheat beckons or does it?

My wife handed me an article the other day that she had clipped from the March 15, 2011 edition of The Wall Street Journal. The title was "Clues to Gluten Sensitivity." We've got several friends who have adopted gluten-free diets. When I went through medical school, in the Dark Ages, I only learned about celiac disease (CD), an autoimmune response to gluten. I hadn't thought about CD in years, but after finding a number of articles in the web-based medical literature, I realized there was an analogy between CD and severe lactose intolerance.

Some people lack the enzyme necessary to successfully drink cow's milk. They have bloating, pass gas and may have diarhea after drinking milk. Others, like me, can drink some milk, but have symptoms if they drink it in quantity. Still others may have a normal level of lactase, the enyzyme that allows digestion of lactose (the main sugar in cow's milk), but have an allergy to a protein in milk.

Similarly, about 1% of our population has CD as a genetic disease which causes severe symptoms after ingestion of gluten, a protein found in wheat, rye and barley. They can be diagnosed (while on a normal diet) with blood tests and a biopsy of the small bowel. The blood tests show the presence of certain antibodies and the biopsy shows the flattening of the usual villi, tiny finger-like projections that are crucial for the absorption of foods. CD doesn't go away, but a gluten-free diet can allow them to lead a normal, healthy life. The incidence of CD appears to have risen markedly over the last half century, perhaps because of alterations in modern wheat that increase the amount of gluten.

Now physicians at the University of Maryland Center for Celiac Research, Johns Hopkins and several Italian medical schools have found a much more common gluten sensitivity (GS) disorder. Those people don't have damaged villi or positive blood tests and may have a host of symptoms that relent when gluten is removed from their diet.

Whole wheat bread, my favorite, but not for everyone

The estimates I've read range from 6 to 10% of our population as having GS. They don't appear to be reacting in the same way as those with CD. At present there's no definitive test for GS, but a gluten-free diet relieves the multitude of symptms that may be associated with this disorder.

Then, just to complicate things a bit further, there is also wheat allergy, a condition that is relatively rare (less than 1% of kids and some adults after exercise). That can cause severe problems with hives, nasal congestion or even anaphylactic shock.

The new disorder, GS, raise lots of questions with few answers, so stay tuned in and think about your own tolerance for gluten.

 

Posted in Food-related disease, medically-oriented background info | 1 Comment »

Good fish, bad fish: a cautionary tale

Monday, March 21st, 2011

This fish is in trouble

I've learned something about fish food poisoning these past few weeks. Perhaps I knew about it  in medical school, but that was a long time ago. We love fish, consider it a treat, eat it several times a week and, once in a while, partake of other marine creatures. I like mussels as long as they're cooked,  and will eat sushi, but never raw oysters.

So four people we know have had apparent fish-related food poisoning recently. They didn't eat at the same place or the same fish. That got me curious and I started to hunt down types of food poisoning related to eating fish and other marine critters. I found two that aren't the usual bacterial- or viral-caused forms (I'll write about those another time).

So what happened in the first instance was at a play when a close friend got suddenly and violently ill. He collapsed, was "out of it" for perhaps thirty seconds (I thought cardiac arrest or major stroke), then sat up and vomited copiously over himself and his spouse. Then he seemed weak, but otherwise normal. I went with hin to the ER where he was monitored for cardiac rhythm changes for four hours, got blood work and had a brain scan. All those were essentially normal, but he vomited four more times in the ER and once more as I was driving him home.

Over the next two weeks he had a cardiac workup with an echocardiogram, a stress test and a 24-hour Holter monitor for rhythm disturbances. All those were negative. He was previously reasonably healthy for his age of 72 and had no history of any seizure disorder.

A few other tests are pending, but then I spoke to a friend who had suffered a similar illness and heard of two others in the community. I went hunting for odd forms of food poisoning as none of these folk had diarrhea and none had sequelae of their short-term illness.

I finally heard the term scromboid fish food poisoning. All four had eaten fish and several had eaten shellfish.

Scromboid turns out to fit better than other diagnoses. It's typically associated with the consumption of fish, especially Scombridae fish like tuna or mackerel. It has a rapid onset, is marked by abdominal symptoms and or prostration, headache, palpitations, or flushing., sometimes tachycardia (rapid heart beat) and low or high BP and usually is self limited. It is caused by a toxin which is not inactivated by cooking and may be associated with spoiled meat.

The CDC says it's the most common chemically-related food poisoning in the United States., but at that only causes 5% of the food-related illness reported. It's much less nasty than ciguatera, the other fish related illlness I found. That one is also toxin-related, heat-resistent, can cause somewhat similar symptoms, but can lead to months ort even years of problems.

After reading of these I'll still go back to our favorite fish restaurant; they had no other patrons with similar symptoms. Scromboid seems to be relatively uncommon & mild in retrospect. On the other hand some speculate that ciguatera caused the migration of the Polynesians between 1,000 and 1,400 CE.

Posted in food and food-producing animals, Food Choices, Food producers and less-healthy foods, Food-related disease, medically-oriented background info, Unhealthy eating | 1 Comment »

Eggs, eggs and more eggs

Friday, March 4th, 2011

Eggs from Morning Fresh Dairy

I recently started eating egg whites on a regular basis.  We get our eggs from the Morning Fresh Dairy, the same organic dairy that delivers milk to our front door once a week. Lynnette gets a half gallon of fat-free, locally produced milk every week and I  buy a half gallon of their whole milk every other week. The herd resides about eight miles from us and we enjoy purchasing local products whenever we can. Since I'm moderately lactose intolerant, I also buy vanilla soy milk.

We get eggs from the same dairy, and usually go through a dozen a week. I worried about the cholesterol in the eggs yolks although I love to make omelets. So more recently I've started hard-boiling six eggs at a time, keeping the resultant cooked eggs in the refrigerator and eating just the whites. I felt good about getting egg protein, but hadn't done my due diligence so today I started looking at various comments on eggs.

The eggs come from Platteville, Colorado, a small community about 35 miles southeast of Fort Collins where we live. They're produced under the United Egg Producer Animal Husbandry (UEP) standards and, having Googled those, I'm reasonably content. For instance those chickens get no hormones in their food. The UEP standards started with an independent scientific advisory committee in 1999 and came out as a voluntary program in 2002. The USDA and an independent firm called Validus audit farms seeking UEP certification annually and look at cage space, clean water and nutritious food issues.

a better chicken coop

On the other hand, The Humane Society issued a statement against the UEP in 2009, saying their standards were misleading and the so-called battery cages were abusive. In response the UEP issued their own statement in January 2010 discussing revisions in the guidelines. I haven't been to the Plateville facility, so I can't comment on their "hen-friendly" environment.

The other issue is eating eggs. There has been a recent downplay of the role of dietary cholesterol as a risk factor as compared to saturated and especially trans fats. The Harvard nurses' longitudinal study found that consuming an egg a day wasn't associated with a higher risk of heart disease.

Chicken eggs have been termed the "perfect protein" and supply all essential amino acids needed for humans. The yolk is the question I haven't totally resolved: it contains all the egg's vitamin A, D, and E, but rougly four times the calories of the egg white and a large yolk has greater than two-thirds of the recommended daily intake of 300 mg. of cholesterol. There is debate as to whether the egg yolk presents a significant health risk with a variety of research studies showing differing results. On the other hand, one amino acid, choline, is found only in the yolk. Pregnant and nursing women need choline (from some source), as it's needed for fetal brain development.

So for now I'm going to continue eating my hard-boiled egg whites and I'll try to go to Plateville and do my own inspection of the chicken farm one of these days.

 

 

Posted in food and food-producing animals, Governmental Efforts, Healthy eating, medically-oriented background info | No Comments »

Fish or fish oil or neither?

Tuesday, March 1st, 2011

I read the Harvard Health Letter for March 2011 and then found a series of related medical articles and an interesting editorial. Let's start with the Harvard publication.It mentions four trials of fish oil supplements in people with pre-existing heart disease. None of those showed a positive effect in patients who are also on modern drug therapies.

Above the brief summary box was an longer commentary quoting Dr. Robert Eckel, the former president of the American Heart Association. He said "If you have heart disease, taking fish oil doesn't seem to replace eating fish." He also wrote the editorial I read in the journal Circulation. Dr. Eckel, who is on the staff of the Department of Medicine in the University of Colorado's medical school (down the road about 65 miles from me), carefully analyzed the four studies and concludes that prior evidence showing diets that include fish make sense, but taking fish oil supplements after you've had a heart attack doesn't.

A Mayo Clinic position paper I found online recommends eating one to two servings of fish a week and notes that fatty fishes, like salmon, herring and even tuna, are higher in the omega-3 fatty acids that may help. Talapia (which I've eaten twice this week) and catfish, are less likely to be heart healthy and any fish that's deep-fat fried may be bad for you.

What about those of us who haven't had clinical heart disease (yet)? Even the Harvard letter says fish oil may be okay for preventive therapy. But I'm not able to find good solid data to support this.

It seems true that populations that eat more fish, like the Inuit and some of the long-term participants in the Nurses' Health Study, were less likely to have a variety of severe heart disease issues (heart attacks, sudden death, heart rhythm problems). The unresolved question is whether they also had better health habits or genetics or other reasons for their diminished risk.

So from my point of view I'll continue taking my twice-a-day fish oil capsule. It's one that is third-party tested for heavy metals, PCBs and dioxins and the relative low dose of omega-3s (270 mg of EPA, 180 mg of DHA, 115 mg of other omega-3s) plus the addition of small doses of omega-9s and 6s seems more likely to help than harm

But I'm going to keep on eating fish, try some fatty fishes and watch the literature.

Posted in Healthy eating, medically-oriented background info, supplements | No Comments »

Which came first: the diabetic chicken, the obese egg or the depressed farmer?

Saturday, February 26th, 2011

The chicken and the egg

My wife is a Mental Health therapist, attended a conference recently & then got an email from the presenter which referred to a study linking diabetes and depression. I got the synopsis from the Web and then went to our local hospital library where I could get a copy of the article. I'll come back to it later, since it was a new twist on the familiar entity .

the depressed farmer

Firstly, in spite of my post's title, this is no joking matter. I found a World Health Organization (WHO) fact sheet dated January 2011 on diabetes: It's a worldwide epidemic with more than 220 million suffering from the disorder and its consequences including an estimated 3.4 million deaths a year. If you're diabetic your chance of dying at a given age is twice that of your peers. If you are diabetic for fifteen years, you have a 2% chance of being blind and a 10% possibility of having severe visual impairment. Ten to twenty percent of diabetics die of kidney failure and then, of course, there's heart disease and stroke and amputations from diabetic vascular disease.

Next I found a medical article with stark  statistics: in 2007 about 2.6% of the US population aged 20-39 had diabetes, 10.8% of those aged 40 to 59 and 23.1% of those over 60. Diabetes and its complications consume 14% of the US health dollar and we're fairly high up there in the list of countries having a significant prevalence of the disease. Lowest on the WHO list was Iceland at 2% and highest was Saudi Arabia with 13+% of those who are 20 to 79 years old being diabetic.

There is a strong correlation between diabetes type 2 & excess weight, especially among women. That association is 80% or higher in Europe, Latin America and North America according to still another article.

And, as you might expect, eating a healthy diet, getting regular physical activity, maintaining a normal body weight and not smoking are the basic of diabetes prevention. By the way, 90% of diabetics around the world have type 2 disease, resulting from the body's ineffective use of insulin.

So what's the new angle? I already knew that half of all diabetics die from cardiovascular diseases, incluing heart attacks and stroke. I didn't know the odds were considerably worse for women with both diabetes and depression. The article I had printed off followed over 55,000 women for ten years (1996-2006) as part of the Nurses' Health Study. There were strong correlations between diabetes and depression in this study performed by researchers from Harvard, the University of Singapore and two English medical schools. Another professor, this one from Indiana, stated that over the past twenty years they'd learned that people with diabetes are twice as likely to suffer from depression as those who don't have the disease.

The Harvard group, in another article, state that death risk is three times as great if a person has both diabetes and depression. The two diseases appear to be linked; the question of antidepressant drugs being associated with an increased risk of diabetes was raised, but causation is unclear at present.

So once more, eat well, stay slim, exercise and be happy; it's good for your health.

Posted in Complications of Obesity, Exercise possibilities, Life Expectancy, medically-oriented background info, Obesity | 5 Comments »

Dietary supplements and scams

Friday, February 11th, 2011

and it isn't cheap

When I was at Langley AFB in th early 1970s, we had an opportunity to take a field trip to the Cayce Institute. Edgar Cayce was a supposed psychic who lived from 1877 to 1945. I came away from that trip with a healthy dose of scepticism, not so much about Mr. Cayce himself, whose work I never saw, but of those who inherited his mantle,

That scepticism has served me well over the years and today led to a prolonged web search on the supposed benefits of acia berries as a dietary modality and supplement. It started with a news article I found that claimed a Channel 10 employee had lost 25 pounds in 4 weeks on the "Optimal Acai" program.

I began tracing the story and found a number of websites that were pertinent: WebMD said acai berries are claimed by marketeers to be an "elite superfood with anti-aging and weight loss properties." They did note that the berry, which comes from a palm tree found in Central and South America, has lots of antioxidant capacity, even more than other berries (cranberry, raspberry, blueberry). It contains chemicals that are in the flavinoid and anthocyanin family, the latter being found in red wine for example.

But as to the claimed health benefits of this particular berry, who knows. Thus far there are no studies that show it's better than other similar fruits.

MedlinePlus, the National Library of Medicine's consumer information source, notes the acai berry has antioxidants, but says there is insufficient evidence thus far to show its effectiveness.

So how did the acai berry craze start? In November of 2004 a dermatologist, Dr. Nichoas Perricone, appeared on the Oprah show. Subsequently a post on oprah.com touted his so-called superfoods, especially acai. The comment that struck me was "harvested in the rain forests of Brazil, acai tastes like a vibrant blend of berries and chocolate."

Well that sounds yummy, but who is Dr. Perricone and what's the data? And why do I connect this back to Edgar Cayce?

Dr. Perricone is a dermatologist who writes on weight loss and anti-aging. He's also an Adjunct Professor of Medicine at Michigan State's medical school. One of his books, The Perricone Promise, tells of neuropeptides and their role in aging and focuses on a particular diet. A three-month supply of a neuropeptide-based serum that his own company sells costs $570.

Subsequently there have been scams with emails sent off linking to supposed news reports on the acai berry diet; one was to a website New7health.com which had an identical claim as the supposed website I saw today (reporter lost 25 pounds in 4 weeks). This was exposed as bogus in March 2010 and led me to reread the supposed Channel 10 health news article.

Part of the promise beside rapid weight loss is to eliminate bad toxins built up over many years and remove sludge from the walls of the colon. Now I was back at the Cayce Institute with a basic part of their program being so-called "High Colonics," enemas to lose weight.

I won't believe any of this kind of spiel until The NLM and other reputable medical organizations report controlled, double-blind, peer-reviewed, evidence-based studies.

Posted in Dieting, Governmental Efforts, medically-oriented background info, supplements, tricks and gimmicks | 4 Comments »

They're finally here!

Tuesday, February 1st, 2011

I woke up at 6:30 AM this morning and weighed myself: 149.6 pounds, right in the middle of my goal weight.  I've been working on my life style changes, more exercise and less food, since May 2009 and, although I bounce up and down 2-3 pounds, I'm basically lean.

Breakfast was a quart of "lime water" (I squeeze fresh limes three times a day), a cup of regular coffee for Lynnette and of Cafix for me (a blend of barley, rye, chicory and sugar beets; I avoid caffeine), a banana and a home-made oatmeal dish with millet, brown sugar, sunflower seeds, walnuts, and ground flaxseed to complement the commercial oatmeal. There's no salt in any of the above and we added fat-free milk (Lynnette) or soy milk (Peter) to our oatmeal. We'll eat our big meal of the day at noon and at home.

The Wall Street Journal's Personal Journal section had an article titled "New Dietary Guidelines: Less Food, Less TV." The June 2010 DGAC version from the advisory committee of sceintists and nutrition experts had gone through the expected round of commentary, largely from food indusrty sources and the final products, as always is considerably watered down. You can find it online at www.dietaryguidelines.gov if you want to read the entire document, or skim through portions.

So here's a section of what it says:

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Limit the consumption of foods that contain refined grains, especiallyrefined grain foods that contain solid fats, added sugars, and sodium.

How do we translate that into simple English? More than 1/2 your plateful should be vegetables and fruits, buy lower salt products and don't add any when you cook or at the table; eat less red meat. Eat real food, not food products; read labels carefully when you shop. I'd add: eat out less and exercise more.

I read Dr, David Katz's column, "New Dietary Guidelines: A Physician's Perspective" on the Huffingtonpst.com website (Katz is the Director of Yale's Prevention Research Center). He agrees that the feedback gave a politicized spin to the final document, but liked the new emphasis on obesity and chronic disease prevention (roughly 1/6 of our kids and 1/3 of our adults are obese). He didn't care as much for the continued emphasis on dairy and meat consumption with less attention paid to plant-based diets.

So this version of the Dietary Guidelines isn't all that much different from prior versions, unless you read carefully and, in some cases, between the lines. I found a section (Chapter one, page 3) on "The Heavy Toll of Diet-related Chronic Diseases that I'll comment on at another time.

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Posted in Food-related disease, Governmental Efforts, Healthly lifestyle, Healthy eating, medically-oriented background info, Obesity, our kids and their weight issues | No Comments »

I've got (Circadian) rhythm

Friday, January 28th, 2011

"to sleep, perchance to dream..."

I was thinking about sleep patterns the other day. We're both trying for eight hours of sleep a night and I achieve that goal most nights; about twice a month I'll wake up at 3 or 4 AM and find myself unable to fall back asleep. Lynnette has that happen more frequently than I do.

So are short sleep nights important? I think it depends on how many you have.

The Center for Science in the Public Interest publishes a "Nutrition Action Health letter" that I just started a subscription to. CSPI has been in operation for those forty years and this was an anniversary/retrospective newsletter. In their January/February 2011 edition was an article titled "Unexpected: Surprising Findings From the Last 40 years."

One of those (actually many of those were of interest, but one I followed up on today) was "Too Little Sleep can lead to Too Much Fat." This discussed studies done by Kristen Knutson at the University of Chicago.

When I Googled Knutson and her work I found she's an assistant professor of medicine at the University of Chicago's medical school. She's actually a biomedical anthropologist with a PhD from the State University of New York (SUNY). and did her Master's work at SUNY also.

"Her research focuses on the association between sleep and cardiometabolic health in various populations."

That was cut and pasted from her U of C Department of Medicine (Section of Pulmonary Disease/Critical Care) bio. I also found an article she published in the Achives of Internal Medicine in 2009 where her group found a correlation between reduced sleep and hypertension.

In this current piece, Knutson noted that a a long-term study (16 years) of >68,000 women showed that those who slept less (under five hours a night) were a third more likely to gain significantly (more than 30 pounds) than those who slept seven hours or more a night.

So she recently conducted a much shorter study, getting volunteers and using a sleep laboratory for a month-long period. The research subjects were allowed to sleep four hours a night in one arm of the study and Knutson found they then had higher levels of a hormone that increases appetite and lower levels of another that decreases appetite than when they slept nine hours.

Another part of her study had the subjects, confined to the sleep lab, allowed to snack. When they were allowed to sleep less than six hours they ate more than when they slept over 8 hours.

Hmm, that's intriguing as is her quote from a meta-analysis (a brief definition of that is a statistical combination of a number of studies), that short sleepers are more likely to develop diabetes. That meta-analysis was published in 2009 in the Achives and in 2010 in another medical journal.

When I put those issues together (high BP, obesity, diabetes), I see the Metabolic Syndrome a fairly recently defined entity that goes along with increased cardiovascular risk.

So try to develop better sleeping habits if you're consistently on the short end of the scale (pun unintentional).

They may save your life.

Posted in Healthly lifestyle, medically-oriented background info, Obesity | No Comments »

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