Category Archives: Weight Loss

FDA Warns About Lipodissolve

I wrote elsewhere about mesotherapy (also known as lipodissolve) in April, 2008.  It’s a technique designed to “dissolve” localized fat deposits under the skin.

The U.S. Food and Drug Administration this month is alerting consumers that

  • it has not evaluated or approved products for use in lipodissolve
  • it is not aware of evidence supporting the effectiveness of the substances used in lipodissolve for fat elimination
  • the safety of these substances, when used alone or in combination, is unknown
  • it is not aware of clinical studies to support medical uses of lipodissolve

In addition, FDA has reports of unexpected side effects in people who’ve undergone the lipodissolve procedure. These side effects include

  • permanent scarring
  • skin deformation
  • deep, painful knots under the skin in areas where the lipodissolve treatments were injected

This is good to know before you invest time and money in the procedure.   

Steve Parker, M.D.

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Cinnabon Schninnamon

I woke up today and found my wife had brought home six Cinnabon cinnamon rolls.  I had mentioned off-hand a few days ago how much I missed them.  She interpreted that as a request [it wasn’t].

I couldn’t say “no” now, could I?

No, I couldn’t.

According to Calorie Count, the classic Cinnabon roll provides:

  • 730 calories
  • 216 calories from fat (24 g)
  • 114 g of carbohydrate
  • 1.5 g fiber

Looking at the carb count, you can understand how the typical American gets 250-300 g of carb daily.  For the last nine months, I’ve been eating 50 g or less, and about 2000 calories/day.

I ate the Cinnabon as a meal, rather than as dessert after—and in addition to—a meal.  If you’re gonna cheat during a weight-control program—and who doesn’t?—that may be a good way to do it.

Compare the Cinnabon with a 700-cal large green salad with tomato, onion, olive oil vinaigrette, topped with tuna or chicken.  Which has “more nutrition”? 

Did I enjoy the Cinnabon?  You bet!  Will I be able to resist the temptation of the ones remaining?  I hope so.

Steve Parker, M.D.

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London’s Low-Carb Diet Fad of 1865

Dr. Robert Atkins didn’t invent low-carb dieting.  William Banting (1797-1878) sparked a low-carb diet craze in London with his low-carb weight-loss diet, first published in 1863.  Even that probaby wasn’t the first low-carb diet.

According to Wikipedia, Banting was a distant relative of Frederick Banting, the co-discoverer of insulin in 1921.

Mr. Banting attributes his successful program design to a “medical gentleman,” Mr. Harvey, of Soho Square, London. 

Click to read Mr. Banting’s 1865 “Letter on Corpulence” at Internet Archive.

Steve Parker, M.D.

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Individual Response to Weight-Loss Diet May Depend on Genes

Dieters with particular genetic make-up respond better or worse to specific types of weight-loss diets, suggest researchers who presented data at the 2010 Cardiovascular Disease Epidemiology and Prevention /Nutrition, Physical Activity, and Metabolism conference.  Findings are preliminary, but may explain the common phenomenon of two people going on the same diet, but only one achieving good results. 

I’ll bet you can imagine several other explanations.

Several years ago, the “A to Z” study compared the weight loss of 311 overweight women on one of four diets:  Atkins (low-carb), Ornish (very low fat, vegetarian), Learn (low-fat), and Zone (moderate carb restriction, high protein, moderate fat).  Atkins was a bit better than the other diets, in terms of long-term (one year) weight loss.  But within each diet group, some women lost 40–50 pounds (18–23 kg), whereas others gained over 10 pounds (4.5 kg).

Stanford University researchers obtained DNA from 138 of the 311 women and noted the occurence of three genes—ABP2, ADRB2, and PPAR-gamma—that had previously been shown to predict weight loss via diet-gene interactions.  For example, a particular mix of these genes predict better weight loss with a low-fat diet; a different mix predicts more loss with a low-carb diet.

Women who had been randomly assigned to one of the A to Z diets tended to lose much more weight if they happened to have the gene mix appropriate for that diet (compared to those on the same diet with the wrong gene mix).  The difference, for example, might be loss of 12 pounds versus two pounds.

The lead researcher, Dr. Mindy P. Nelson, told TheHeart.Org that the proportion in the general population genetically predisposed to the low-fat versus low-carb approach is about 50:50.

Take-Home Points

These results, again, are preliminary; additional testing is necessary for confirmation.  If they had been able to test the DNA of the other 178 women in the A to Z study, the results could have been either stronger or shown no diet-gene interaction.  The study hasn’t even been published in a peer-reviewed journal yet.

Men may or may not be subject to similar diet-gene interaction.

If a genetic test is ever clinically available to tell a dieter which type of weight-loss diet would be more successful, it will likely be cheaper to just try a particular diet first and see if it works over 4–6 weeks.  Successful long-term weight loss is like smoking cessation—most smokers try 5–7 different times or methods before hitting on one that works for them.

This potential diet-gene interaction could be a major finding that will stop the arguing about which is the single best way to lose excess fat.  Many paths may lead to the mountaintop. 

Steve Parker, M.D.

Reference:  O’Riordan, Michael.  Dieting by DNA?  Popular diets work best by genotype, reseach shows.  HeartWire by TheHeart.Org, March 8, 2010.

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Filed under Carbohydrate, Fat in Diet, ketogenic diet, Vegetarian Diet, Weight Loss

Prediabetes Ignored Way Too Often

Only half of Americans with prediabetes take steps to avoid progression to diabetes, according to a recent report in the American Journal of Preventive Medicine.

Prediabetes is defined as:

  1. fasting blood sugar between 100 and 125 mg/dl (5.56–6.94 mmol/l) or
  2. blood sugar level 140–199 mg/dl (7.78–11.06 mmol/l) two hours after drinking 75 grams of glucose

Prediabetes is a strong risk factor for development of full-blown diabetes.  It’s also associated with increased risk for cardiovascular disease such as heart attack and stroke.  One of every four adults with prediabetes develops diabetes over the next 3 to 5 years.  The progression can often be prevented by lifestyle modifications such as dietary changes, moderate-intensity exercise, and modest weight loss.  

Investigators looked at 1,402 adult participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) who had fasting blood sugar tests and oral glucose tolerance tests diagnostic of  prediabetes.  

The researchers estimate that 30% (almost one out of every three) of the adult U.S. population had prediabetes in 2005-2006, but only 7% of them (less than one in 10) were aware they had it.

Only half of the prediabetics in this survey reported attempts at preventative lifestyle changes in the prior year.  Only one of every three prediabetics reported hearing about risk reduction advice from their healthcare provider.

People, we’ve got to do better! 

My fellow physicians, we’ve got to do better!

The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in 2000 will develop diabetes.  The great majority of this will be type 2 diabetes.  You understand now why James Hirsch, author of Cheating Destiny, calls diabetes America’s leading public health crisis.  I agree.

Steve Parker, M.D.

Reference:  Geiss, Linda S., et al.  Diabetes risk reduction behaviors among U.S. adults with prediabetesAmerican Journal of Preventive Medicine, 38 (2010): 403-409.

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Filed under Causes of Diabetes, coronary heart disease, Overweight and Obesity, Prevention of T2 Diabetes, Stroke, Weight Loss

Do You Hari Hachi Bu?

I loved the sound of this phrase—hari hachi bu—even before I knew what it meant.

“Hari hachi bu” comes from the Japanese islands of Okinawa.  It refers to eating a meal until you’re only 80% full, then stop eating.  It’s a method to control weight. 

Okinawa, remember, is one of the longevity hot spots in Dan Buettner’s Blue Zones

But would it really work for many in Western culture?  Probably not.  We don’t have the discipline to stick with it long-term.  Maybe for a day.

One of the currently popular dieting gimmicks is to eat every 3-4 hours while awake.  The rationale is, “you need the energy.”  If you eat 5–6 meals a day, you’re not cutting back on total calories even if you eat only until 80% full.

As long as you’re eating a fair amount of carbohydrates, you can store plenty of energy as glucose in glycogen—in your liver and muscles—to easily live without eating for at least 8–12 hours.  So, there’s no “need” to eat every 3–4 hours.  If there were, we would have gone extinct years ago.  At rest, you’re getting about 60% of your energy supplied by metabolism of fats, not carbohydrates.  Most people can live without all food, but not water, for about two months.

Plenty of people have said, “I’m going to lose weight by just cutting back on food consumption.”  I don’t have scientific data to back it up, but I’d bet that a food diary works better.

A simple weight-loss or management plan that would work better than “just cutting back” would be:

Don’t eat anything man-made

So off limits are bread, rolls, soft drinks, table sugar, high fructose corn syrup, pancakes, pizza, potato chips, Pringles, pies, cookies, cake, casseroles, cannolis, Doritos, Ding-Dongs, Snickers, etc.  I’d complicate it just a bit by avoiding naturally starchy foods like potatoes and corn.

For those who don’t like the negativity of “don’t eat that,” here’s the positive spin:

Eat only natural, minimally processed food

In other words, eat fresh fruit, vegetables, eggs, meat, chicken, fish, olive oil, nuts, etc.  These are God-made foods, not man-made.

Steve Parker, M.D.

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Book Review: The New Atkins for a New You

Here’s my review of The New Atkins for  a New You, a weight-loss book by Dr. Eric Westman, Dr. Stephen Phinney, and Dr. Jeff Volek released a week ago.  The copyright holder is Atkins Nutritionals, Inc.  Under Amazon.com’s five-star rating system, I give it four stars (“I like it”).  

♦   ♦   ♦ 

The most exciting nutritional medicine development in recent memory is the fact that saturated fat consumption is not a significant cause of heart disease and premature death. The same goes for for total fat and cholesterol.  When enough physicians, nutritionists, and dietitians learn this, low-carb eating will take off like a rocket.

For those unfamiliar with the Atkins diet, it is designed for weight loss via high fat consumption and major carbohydrate restriction.  Protein intake is a bit higher than average.  As long as carbohydrates (carbs) are kept low, other foods are mostly unlimited.  Atkins has four phases.  As you graduate from one phase tothe next, more carbs are allowed, adding some carb sources before others (the Carb Ladder). 

Atkins has been around for years.  It’s not just a weight-loss diet; it’s a lifetime way of eating.

Doctors Westman, Phinney, and Volek are leaders in low-carb nutritional science.  The last time Atkins peaked (2003), we didn’t have the scientific studies backing up safety of the diet.  Now we do, in large part thanks to these guys. 

Physicians see beaucoup patients with overweight-related medical conditions.  We’re not going to recommend a diet that causes heart attacks, strokes, and other major medical complications.  Published research over the last eight years has established the relative safety of very low-carb diets, particularly Atkins.  Low-carb diets may even be healthier than the low-fat, high-carb diet that has been recommended by U.S. public health authorities for the last forty years.  Come to think of it, our current obesity and diabetes epidemics started around that same time.

The book covers nutrition basics, day-to-day practical application of Atkins eating, recipes and detailed meal plans, and the science behind the program.    

What’s New Since Dr. Atkins’ 2002 Book?

  • adaptations for vegetarians and vegans
  • adaptations for Latinos
  • coffee is now OK
  • introduction of the term “foundation vegetables” and almost doubling the amount of vegetables allowed in Phase 1: “approximately six cups of salad and up to two cups of cooked vegetables, depending upon the ones you select”
  • more flexility, such as the option to skip Phase 1 (induction)
  • focus on adequate protein intake, based on your height
  • emphasis on getting enough omega-3 fatty acids
  • no emphasis on supplements and low-carb products sold by Atkins Nutritionals,Inc.
  • diet journals—a personal record of your weight-loss journey—are recommended
  • eliminate or minimize “induction flu” and constipation (in Phase 1) by eating at least 1/2 teaspoon of salt daily [I’m skeptical.]
  • discussion of the trendy omega-6/omega-3 fatty acid ratio
  • favor monounsaturated fatty acids (e.g., olive oil, canola oil) over certain polyunsaturated fats, as in oils from corn, soybeans, sunflower, cottonseed, and peanuts
  • no mention of testing urine for ketosis
  • more discussion of psychological aspects of weight

The lack of ads for Atkins Nutritionals products is welcome and refreshing.  Too many of the official Atkins books read like infomercials, which diminishes credibility.

A vegetarian or vegan “Atkins diet” is just not something I can visualize.

What Could Have Been Done Better?

  • no specific amounts given for these recommended supplements: calcium, vitamin D, omega-3 fats, multivitamin, magnesium and other minerals (except “no iron”).  [Is the idea to encourage a visit the official Atkins website?]
  • little guidance for physicians who are to advise diabetics doing Atkins.  Few physicians are familiar enough with the program to make the necessary changes in particular diabetic medications.
  • little discussion of the constipation and leg cramps that often accompany very low-carb diets
  • the hype on the cover: “How would you like to LOSE UP TO 15 POUNDS IN TWO WEEKS!”  [To their credit, the authors note that such results are not typical.]
  • nearly all the measurements are U.S. Customary.  Metric users are out of luck.
  • four phases seem a bit much.  The beauty of Atkins Phase 1 is its simplicity. 

My favorite sentence: “White flour is better suited to glue for kindergarten art projects than to nutrition.”

My least favorite sentence: “We can’t stress strongly enough that the best diet for you is one composed of foods you love.”  I love apple pie and Cinnabon cinnamon rolls, but they won’t help me manage my weight.

The only error I found worth mentioning is minor.  The authors state that the American Heart Association recommends consumption of fish three times a week. The official policy is still “at least twice weekly.”

The book is very practical and easily understood by average people.  Most will skip the science chapters at the end.  I know the basic Atkins program works at least short-term; many of my patients have done it.

In summary, the book has nearly everything you need to be successful with the Atkins diet. 

As far as I know, there are no comprehensive long-term studies (e.g., 10+ years) regarding health outcomes of Atkins-style eating.  In other words, does Atkins have any effect on longevity, cancer, heart attacks, strokes, etc.?  But very few of the popular diets have these data either.  The best researched ways of eating in this respect are the Mediterranean diet and vegetarian diets.

Steve Parker, M.D.

Disclosure:  I was given nothing of value for this review by the authors, publisher, or Atkins Nutritionals, Inc.  I wrote it for the benefit of my patients and readers.

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Filed under Book Reviews, Carbohydrate, Fat in Diet, ketogenic diet, Weight Loss

Legumes and Cereal Grains: Any Role in Weight Management?

Researchers at the University of Wollongong (Australia) reviewed the scientific literature on the role for cereal grains and legumes in weight management.

In this context, “cereal” refers to “a grass such as wheat, oats, or corn, the starchy grains of which are used as food” (American Heritage Dictionary). 

Here’s their summary:

There is strong evidence that a diet high in whole grains is associated with lower body mass index, smaller waist circumference, and reduced risk of being overweight; that a diet high in whole grains and legumes can help reduce weight gain; and that significant weight loss is achievable with energy-controlled diets that are high in cereals and legumes. There is weak evidence that high intakes of refined grains may cause small increases in waist circumference in women. There is no evidence that low-carbohydrate diets that restrict cereal intakes offer long-term advantages for sustained weight loss. There is insufficient evidence to make clear conclusions about the protective effect of legumes on weight.  

I haven’t read the entire article, but invite you to do so.  I’m searching for clues as to which type of carbs to add after one finishes the Ketogenic Mediterranean Diet.

Steve Parker, M.D.

Reference:  Williams, P.G., et al.  Cereal grains, legumes, and weight management: a comprehensive review of the scientific evidence.  Nutrition Reviews, 66(2008): 171-82.

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Filed under Carbohydrate, Grains, legumes, Overweight and Obesity, Weight Loss

Low-Carb Killing Spree Continues

The choice is clear . . . NOT

Low-fat and low-carb diets produce equal weight loss and improvements in insulin resistance but the low-carb diet may be detrimental to vascular health, according to a new study in Diabetes.

Methodology

Researchers in the the UK studied 24 obese subjects—15 female and 9 male—randomized to eat either a low-fat (20% fat, 60% carbohydrate) or low-carb (20% carb, 60% fat) diet over 8 weeks.  Average age was 39; average body mass index was 33.6.  Most of them had prediabetes.  Food intake was calculated to result in a 500 calorie per day energy deficit (a reasonable reduced-calorie diet, in other words).  Study participants visited a nutritionist every other day, and all food was provided in exact weighed portions. 

Results

Both groups lost the same amount of weight, about 7.3% of initial body weight. 

Triglycerides dropped by a third in the low-carb group; unchanged in the low-fat cohort.  Changes in total cholesterol, LDL cholesterol, and HDL changes were about the same for both groups.

Systolic blood pressure dropped about 10 points in both groups; diastolic fell by 5 in both.

Aortic augmentation index” fell significantly in the low-fat group and tended to rise in the low-carb group.  According to the researchers, the index is used to estimate systemic arterial stiffness.  [In general, flexible arteries are better for you than stiff ones.  “Hardening-of-the-arteries,” etc.]  The low-fat group started with a AAI of 17, the low-carb group started at 12.  They both ended up in the 13-14 range. 

Peripheral insulin sensitivity improved significantly only in the low-carb group but “there was no significant difference between groups.”  No difference between the groups in hepatic (liver) insulin resistance. 

Fasting insulin levels fell about 20% in the low-fat group and about 40% in the low-carb group, a difference not reaching statistical significance (p=0.17).

The Authors’ Conclusions

This study demonstrates comparable effects on insulin resistance of low-fat and low-carbohydrate diets independent of macronutrient content.  The difference in augmentation index may imply a negative effect of low-carbohydrate diets on vascular risk.

My Comments

Yes, you can indeed lose weight over eight weeks on both low-fat and low-carb diets, if you follow them.  So diets DO work.  No surprise.

Loss of excess body fat by either method lowers your blood pressure.  No surprise.

Once again, concerns about low-carb/high-fat diets adversely affecting common blood lipids—increasing heart disease risk—are not supported.  No surprise

Hyperinsulinemia and insulin resistance are risk factors for development of diabetes and cardiovascular disease.  Results here tend to favor the low-carb diet.  I have to wonder if a study with just twice the number of test subjects would have shown a clear superiority for the low-carb diet.

The authors imply that aortic augmentation index is an important measure in terms of future cardiovascular health.  A major conclusion of this study is that a change in this index with the low-carb diet might adveresly affect heart health.  Yet they don’t bother to discuss this test much at all.  I’m no genius, but neither are the typical readers of Diabetes.  I doubt that they are any more familiar with that index than am I, and I’d never heard of it before. 

[Feel free to educate me regarding aortic augmentation index in the comment section.]

Unfortunately, many readers of this journal article and the associated news releases will come away with the impression, once again, that low-carb diets are bad for your heart. 

I’m not convinced.

Steve Parker, M.D.   

References:

Bradley, Una, et al.  Low-fat versus low-carbohydrate weight reduction diets.  Effects on weight loss, insulin resistance, and cardiovascular risk: A randomized control trialDiabetes, 58 (2009): 2,741-2,748.

Nainggolan, Lisa.  Low-carb diets hit the headlines again.  HeartWire, December 11, 2009.

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Filed under Carbohydrate, coronary heart disease, Fat in Diet, Prevention of T2 Diabetes, Weight Loss

Low-Carb Ketogenic Diet for Overweight Diabetic Men: A Pilot Study

A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients, according to U.S. researchers.  The 2005 report recommends that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar  dramatically. 

Methodology

Twenty-eight overweight people with type 2 diabetes were placed on the study diet and followed for 16 weeks.  Seven people dropped out, so the analysis involved 21, of which 20 were men—the study was done at a Veterans Administration clinic.  Thirteen were caucasian, eight were black.  Average age was 56; average body mass index was 42.  The seven dropouts were unable to come to the scheduled meetings or couldn’t follow the diet.  No dropout complained of adverse effects of the diet.

Results

Participants were instructed on the Atkins Induction Phase diet, which daily includes:

  • under 20 g carbohydrate
  • one cup of low-carb vegetables
  • two cups of salad greens
  • four ounces of hard cheese
  • unlimited meat, poultry, fish, eggs, shellfish
  • a multivitamin

At the outset, diabetes medication dosages were reduced in this general fashion: insulin was halved, sulfonyureas were halved or discontinued.  If the participant were taking a diuretic (fluid pill), low doses were discontinued; high doses were halved.

Study subjects returned every two weeks for diet counseling and medication adjustment (based on twice daily glucose readings and episodes of hypoglycemia).  Food cravings and/or good progress on weight goals triggered a 5-gram (per day) weekly increase in carbohydrate allowance.  In other words, if a participant’s weight loss goal was 20 pounds and he’d already lost 10, he could increase his daily carbs during the next week from 20 to 25 g.  Carbs could be increased weekly by five gram increments as long as weight loss progressed.  [This is typical Atkins.]   Food records were analyzed periodically.   

Results

  • hemoglobin A1c decreased from an average baseline of 7.5% down to 6.3% (a 1.2% absolute decrease and 16% relative drop)
  • the absolute hemoglobin A1c decrease was at least 1.0% in half of the participants
  • diabetic drugs were reduced in 10 patients, discontinued in seven, and unchanged in four
  • average body weight decreased by 6.6%, from 131 kg (288 lb) to 122 kg (268 lb)
  • triglycerides decreased 42%, while cholesterols (total, HDL, and LDL) didn’t change significantly
  • no change in blood pressures
  • average fasting glucose decreased by 17% (by week 16)
  • uric acid decreased by 10%
  • no serious adverse effects occurred
  • one hypoglycemic event involved EMS but was treated without transport
  • only 27 of 151 urine ketone measurements  were greater than trace

My Comments

The degree of improvement in hemoglobin A1c—our primary gauge of diabetes control—is equivalent to that seen with many diabetic medications.  I see many overweight diabetics on two or three drugs and a standard “diabetic diet,” and they’re still poorly controlled.  This diet could replace the expense and potential adverse effects of an additional drug.   

In August this year I blogged about a study comparing the Atkins diet with a traditional low-fat diet in overweight diabetic black women in the U.S.  As measured at three months, the Atkins diet proved superior for weight loss and glucose control.

This study at hand is small, but certainly points to the effectiveness of an Atkins-style very low-carb ketogenic diet in overweight men with type 2 diabetes.

Steve Parker, M.D.

Yancy, William, et al.  A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men].  Nutrition and Metabolism, 2:34 (2005).   doi: 10.1186/1743-7075-2-34

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Filed under Carbohydrate, ketogenic diet, Overweight and Obesity, Weight Loss