Category Archives: Weight Loss

Can a Low-Carb Diet Be Sustained for Five Years?

Registered Dietitian Joy Kiddie has a blog post summarizing the results of her five-year low-carb journey.

It start thusly:

Tomorrow is March 5th and it is five years since I began my personal health and weight recovery journey that I’ve dubbed “A Dietitian’s Journey“.  While it began in 2017, in a way it still continues today and that is the point behind this post. 

Five years ago, I was obese, had type 2 diabetes for the previous 8 years, and had developed dangerously high blood pressure. 

Recommended. You’ll find out if low-carb eating put her diabetes into remission.

Steve Parker, M.D.

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Which is Healthier: Low-Cal Mediterranean Diet Or High-Protein Non-Mediterranean

Judicious wine consumption is one component of the traditional healthy Mediterranean diet

Researchers compared three low-calorie diets and concluded that the Mediterranean option was the healthiest. The study at hand today is way too small to be considered anything but a pilot study. So results may not be replicable on a larger scale. I’d like to know how compliant study subjects were with the protocol, because 700 calories a day for six weeks is quite a challenge.

Link to article article

Comparison of short-term hypocaloric high-protein diets with a hypocaloric Mediterranean diet: Effect on body composition and health-related blood markers in overweight and sedentary young participants

Highlights

A hypocaloric Mediterranean diet provides all the necessary nutrients.

The hypocaloric Mediterranean diet reduces body mass and fat mass and maintains fat-free mass.

The hypocaloric Mediterranean diet is beneficial on metabolic and inflammation/muscle- damage indices.

Hypocaloric high-protein diets with and without whey supplementation reduce body mass and fat-free mass but not fat mass.

Hypocaloric high-protein diets with and without whey supplementation are adverse on metabolic and inflammation/muscle-damage indices

Abstract

Objectives

The aim of the present study was to compare the short-term effects of a hypocaloric Mediterranean diet and two high protein diets, with and without whey protein supplementation, on body composition, lipidemic profile, and inflammation and muscle-damage blood indices in overweight, sedentary, young participants.

Methods

Thirty-three young, overweight, male and female participants (mean ± SD age: 22.8 ± 4.8 y; body mass: 85.5 ± 10.2 kg; body fat percentage: 34.3% ± 8.1%) were randomly allocated to three different hypocaloric (−700 kcal/d) diets: a Mediterranean diet (MD; n = 10), a high-protein diet (HP; n = 10) diet, and a high-protein diet with whey supplementation (n = 10). The intervention lasted 6 wk. Body composition and biochemical indices were evaluated 1 wk before and after the nutritional interventions.

Results

Body and fat mass were decreased in the MD and HP groups (−3.5% ± 1.1% and −5.9% ± 4.2% for body and fat mass respectively in MD, and −1.7% ± 1.2% and −2.0% ± 1.8% for body and fat mass respectively in HP;P < 0.05), with no significant decline of fat-free mass observed in the MD group. The MD group’s diet beneficially altered the lipid profile (P < 0.05), but the HP and HPW groups’ diets did not induce significant changes. Subclinical inflammation and muscle-damage indices significantly increased in the HP and HPW groups (7.4% ± 3.5% and 66.6% ± 40.1% for neutrophils and CRP respectively in HP, and 14.3% ± 6.4% and 266.6% ± 55.1% for neutrophils and CRP respectively in HPW; P < 0.05) but decreased in the MD group (1.8% ± 1.2% and −33.3% ± 10.1% for neutrophils and CRP respectivelyc; P < 0.05). Energy intake of carbohydrates and proteins were significantly related to the changes in body composition and biochemical blood markers (r = −0.389 and −0.889; P < 0.05).

Conclusions

Among the three hypocaloric diets, only the Mediterranean diet induced positive changes in body composition and metabolic profile in overweight, sedentary individuals.


Steve Parker, M.D.

PS: I haven’t read the full report and don’t plan to any time soon.

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Semaglutide Beats Liraglutide for Weight Loss

How much does it cost?

Semaglutide and liraglutide are drugs that were developed to treat diabetes and are FDA-approved for that. They are given by subcutaneous injection. Semaglutide is also FDA-approved for weight loss in non-diabetics if certain conditions are met.

Once-weekly semaglutide outperformed daily liraglutide in overweight and obese non-diabetics.

From JAMA Network:

Question Among adults with overweight or obesity without diabetes, what is the effect of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg, on weight loss when each is added to counseling for diet and physical activity?

Findings In this randomized clinical trial that included 338 participants, mean body weight change from baseline to 68 weeks was –15.8% with semaglutide vs –6.4% with liraglutide, a statistically significant difference.

Meaning Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide, compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity resulted in significantly greater weight loss at 68 weeks.

For prevention or improvement of overweight- and obesity-related illnesses, aim for loss of at least 5 to 10% of body weight. Assuming you’re overweight or obese in the first place. 16% body weight change is significant. 16% of 300 pounds (136 kg) would be 48 pounds (22 kg).

Steve Parker, M.D.

PS: My book’s less expensive than those drugs. And no needles!

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Mediterranean Diet Is Ranked Best for Diabetes

according to U.S. News & World Report. Click through if interested in the two runners-up. I think a low-carb version of Mediterranean is better for most folks.

Steve Parker MD, low-carb diet, diabetic diet
Olives, olive oil, and vinegar: classic Mediterranean foods

I’m surprised they ranked Atkins as the “Best Fast Weight-Loss Diet.” Looks like we’re getting over our collective phobia about saturated fat. “Keto Diet” ranked #4 in that category.

Steve Parker, M.D.

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Diabetes Drug Semaglutide Promotes Weight Loss

“Should I wait for FDA approval?”

I met a patient at the hospital recently who was taking semaglutide. I asked how long he had diabetes and he told me he didn’t have diabetes: his PCP (primary care physician) was prescribing it for weight loss.

A recent study enrolled 1,961 obese non-diabetics and found a very significant weight loss difference compared to the placebo group. I expect Novo Nordisc will be asking for FDA approval to market semaglutide, originally for diabetes, as a weight-loss drug. But what happens after you quit taking the drug? I bet you know.

In participants with overweight or obesity, 2.4 mg of semaglutide [injected] once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight.

Source: Once-Weekly Semaglutide in Adults with Overweight or Obesity | NEJM

Steve Parker, M.D.

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Lose Weight With the Mediterranean Diet Despite Pasta

spaghetti squash, spaghetti
Spaghetti squash is an alternative to pasta

The title above sums it up. If you’re eating pasta frequently and trying to lose weight, you do have to be careful not to over-eat. In other words, you generally have to restrict calories. In the study at hand, I don’t know how many daily calories were allowed since I haven’t read the full report. Here’s the abstract:

Background & aims

The effect of pasta consumption within a low-energy [read: calorie-restricted] Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity.

Methods & Results

Forty-nine volunteers finished a quasi-experimental 6-month two–parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was −10 ± 8% and −7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component.

Conclusions

Independent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention.

Source: Body weight of individuals with obesity decreases after a 6-month high pasta or low pasta Mediterranean diet weight-loss intervention – Nutrition, Metabolism and Cardiovascular Diseases

Steve Parker, M.D.

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The Best Exercises to Fight Obesity

From Obesity Reviews:

Current international guidelines recommend people living with obesity should be prescribed a minimum of 300 min of moderately intense activity per week for weight loss. However, the most efficacious exercise prescription to improve anthropometry, cardiorespiratory fitness (CRF) and metabolic health in this population remains unknown. Thus, this network meta‐analysis was conducted to assess and rank comparative efficacy of different exercise interventions on anthropometry, CRF and other metabolic risk factors.

* * *

Results reveal that while any type of exercise intervention is more effective than control, weight loss induced is modest. Interventions that combine high‐intensity aerobic and high‐load resistance training exert beneficial effects that are superior to any other exercise modality at decreasing abdominal adiposity, improving lean body mass and increasing cardiorespiratory fitness. Clinicians should consider this evidence when prescribing exercise for adults living with obesity, to ensure optimal effectiveness.

Source: What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis – O’Donoghue – – Obesity Reviews – Wiley Online Library

Steve Parker, M.D.

 

Front cover

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Stop the Weight-Loss Drug Lorcaserin: Linked to Cancer

From the U.S. Food and Drug Administration:

ISSUE: FDA has requested that the manufacturer of Belviq, Belviq XR (lorcaserin) voluntarily withdraw the weight-loss drug from the U.S. market because a safety clinical trial shows an increased occurrence of cancer. The drug manufacturer, Eisai Inc,. has submitted a request to voluntarily withdraw the drug. When FDA approved lorcaserin in 2012, we required the drug manufacturer to conduct a clinical trial to evaluate the risk of cardiovascular problems. A range of cancer types was reported, with several different types of cancers occurring more frequently in the lorcaserin group, including pancreatic, colorectal, and lung.

BACKGROUND: In January 2020, FDA announced we were reviewing clinical trial data and alerted the public about a possible risk of cancer associated with lorcaserin based on preliminary analysis of the data.

RECOMMENDATION: PatientsPatients should stop taking lorcaserin and talk to your health professionals about alternative weight-loss medicines and weight management programs.

Source: Belviq, Belviq XR (lorcaserin) by Eisai: Drug Safety Communication – FDA Requests Withdrawal of Weight-Loss Drug | FDA

I never ran across a patient taking it, nor did I ever prescribe it. There are better ways to lose weight.

Steve Parker, M.D.

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Mediterranean Diet Wins #1 Rank Once Again #MediterraneanDiet

Santorini, Greek seaside

Not surprising!

Every year, the U.S. News and World Report puts together a panel of experts to rank various diets.

From MedScape:

For the third year in a row, the Mediterranean diet has been named the best diet overall in the U.S. News & World Report annual rankings.

In 2018, the Mediterranean diet shared top honors with the DASH (Dietary Approaches to Stop Hypertension) diet. Both focus on fruits, vegetables, and whole grains. The ketogenic diet, one of the most popular, again fared well in the annual survey, but only in the fast weight loss category. Overall, it was not rated highly.

Angela Haupt, managing editor of health for the publication, says this year’s list has ”no surprises,” as it includes many diets that have been named outstanding before. Trendy diets typically won’t be found on its list, she says, explaining that its experts look for plans that have solid research and staying power.

Source: Mediterranean Diet Repeats as Best Overall of 2020

Steve Parker, M.D.

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Fasting: Not Ready for Prime Time?

This caveman probably went days without food, and often

Dr Axel Sigurdsson published an epic post on intermittent fasting early in 2020. I don’t doubt anything in it although I haven’t yet taken a deep dive into the subject like he has. I touched on it here, here, here, and here. I’ve done some 24-hour fasting myself (here and here).

From the good doctor:

Animal studies suggest that intermittent fasting may have several health benefits. Some of these benefits, in particular, the effects on obesity, type 2 diabetes, and cardiovascular risk factors, have been confirmed in studies on humans.

However, the popularity of intermittent fasting within the general public is in stark contrast with the gaps in evidence on the clinical benefits of this approach.

Source: Intermittent Fasting and Health – The Scientific Evidence

Steve Parker, M.D.

PS: PWDs taking drugs that can cause hypoglycemia would have to be extremely careful about fasting, working with their doctors or CDEs.

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