Category Archives: Weight Loss

Six Weeks to OMG: A Book Review

I heard about this book before it was available in the U.S. and I thought it had the potential to be huge here.  So I read Six Weeks to OMG: Get Skinnier Than All Your Friends by Venice Fulton, published in 2012.  Per Amazon.com’s rating system, I give it two stars (“I don’t like it”).

♦   ♦   ♦

Judging from the wording and writing style, this book was written for not-too-bright girls and women from 12 to 22 years old.  Others need not bother with it.

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Will it work for weight loss?  Yes, even without the author’s three cornerstone gimmicks: 1) Skip breakfast, but eat three meals daily, 2) Black coffee one or two cups every morning, and 3) Cold-water baths at 59 to 68°F for up to 15 minutes.  There’s no good scientific data to support those prescriptions.

The diet will work because it restricts your consumption of items that make us fat: concentrated sugars and refined starches.  It’s a low-carbohydrate diet—up to 60, 90, or 120 grams a day, depending on how fast you want to lose.

The diet consists mostly of high-protein animal-derived foods, low-carb vegetables, and up to three pieces of fruit daily.  Do not exceed 40 grams of carbohydrate per meal, even less is better, the author says.  Grains and dairy products aren’t mentioned much; it’s easy to blow your carb limit with them.  High-carb vegetables are listed, so you can avoid them.

Mr. Fulton emphasizes some important, valid points.  High protein consumption helps control appetite.  Trans fats are bad.  Eat cold-water fatty fish twice weekly.  Eat off a small plate (maximum of 9-inch diameter).  No snacking.  He says good things about weight training, while failing to mention it’s more much important long-term maintenance than for active weight loss.

He says some things that are just plain wrong, such as 1) everyone can be skinny, 2) there are only eight essential amino acids, 3) exercise is fairly helpful with weight loss, and 4) weight training just once every 10 days is adequate.

I’ll confess I didn’t read every word of the book.  The writing style is just too irritating unless you’re a not-too-bright 12 to 22-year-old.  For instance, every page had at least four exclamation marks!

Here are some of the dumbed-down sentences that unintentionally made me laugh out loud:

  • “The key to success is understanding stuff.”
  • “If you have problems controlling your appetite, the main reason is that you eat too often.”
  • “The person in the mirror, that’s you.”
  • “Human beings are part of the universe.  And that’s full of laws.  The laws of physics, chemistry and biology are three well-known laws.”

If you want a low-carb weight loss diet, you’re better off with Protein PowerThe New Atkins For a New You, or the Low-Carb Mediterranean Diet.  A low-carb diet specifically for diabetics is my Conquer Diabetes and Prediabetes.

Steve Parker, M.D.

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New Analysis Finds Low-Carb Diets Reduce Heart Disease Risk Factors

Obesity Reviews just published details of a recent meta-analyis of low-carbohydrate diet effects on cardiovascular risk factors.

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria.

Over a thousand obese patients were involved.  By eating low-carb, average body weight decreased by 7 kg (15 lb), body mass index dropped by 2, blood pressure dropped by 3-4 mmHg, triglycerides decreased by 30 mg/dl, hemoglobin A1c dropped by 0.21% (absolute decrease), insulin levels fell by 2.23 micro IU/ml, while HDL cholesterol rose by 1.73 mg/dl.  LDL cholesterol didn’t change.

The authors conclusion:

Low-carboydrate diet was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown.

I haven’t see the full text of the article yet, so I don’t know the carbohydrate level under review.  I bet it’s under 50 g of digestible carb daily.  My Low-Carb Mediterranean Diet starts at 20-30 grams a day.

Steve Parker, M.D.

Reference:  Santos, F.L., et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews. Article first published online: 20 AUG 2012. DOI: 10.1111/j.1467-789X.2012.01021.x

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New Weight Loss Pill – Qsymia – Now Available in U.S.

“These are flying off the shelves!”

On July 17, 2012, the U.S. Food and Drug Administration approved the combination of topiramate and phentermine for weight loss and management.  They’ll be marketed in the U.S. as Qsymia.

The drugs individually had been approved by the FDA years ago for other purposes, so we already know a lot about them.  If memory serves me, phentermine alone is FDA-approved for weight loss, but only for “several weeks,” which many physicians interpret as up to 12.

The press releases from the FDA and Vivus, Inc., don’t say how long the combo drug can be used.  I’m guessing up to one year since that’s how long the clinical trials lasted.  Any longer than that, you’re on your own.

Who Can Take Qsymia?

Obese adults with a body mass index 30 or higher, or overweight adults with BMI 27 or higher if they have one or more weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol.

You Should NOT Take Qsymia If You Have or Are:

  • Pregnant
  • Glaucoma
  • Overactive thyroid
  • Recent stroke
  • Recent unstable heart disease

If I Take the Pill, Do I Still Have to Exercise and Watch My Calories?

Yes.

What’s the Dose?

Phentermine 7.5 mg and topiramate 46 mg daily.  A double strength pill (15 + 92 mg) is available for select patients.

Final Thoughts

Lorcaserin (Belviq) is a weight loss drug approved by the FDA within the last month.  These are the first new weight loss drugs on the U.S. market since 1999.

Abbott voluntarily withdrew Meridia (sibutramine) from the U.S. market in 2010 due to concern about it causing heart attacks and strokes.

In 2008, the European Medicines Agency withdrew prescription-writing for the weight-loss drug rimonabant, citing concern about psychiatric side effects.

Between 1997 and 2007, five weight-loss drugs were removed from various markets around the world due to safety or effectiveness considerations: phenylpropanolamine HCl, dexfenfluramine HCl (e.g., Redux), fenfluramine HCl (Pondimin), diethylpropion HCl (Tenuate), and phentermine HCl (e.g., Ionamin).

It’s unknown whether weight-loss drug therapy reduces the morbidity and mortality of obesity over the long run.

I’ll wait at least two or three years before giving these new drugs to my patients—I’ve seen too many drugs withdrawn from the market because of adverse effects showing up years after drug approval.

Without permanent changes in lifestyle, lost weight is likely to return after you stop taking any weight-loss pill.

Clearly, drugs are no panacea.

Steve Parker, M.D.

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Is Heavy Exercise a Reasonable Approach to Obese Diabetes?

Women DO NOT get gross bulky muscles from resistance training

With regards to TV’s “The Biggest Loser” show:

The show’s 24-week regimen consists of approximately 4 hours of daily exercise, including 1 hour of intense resistance, 1 hour of intense aerobic activity, and 2 hours of moderate aerobic activity (for example, walking), along with a caloric  intake of at least 70% of estimated resting daily energy expenditure, explained Dr. [Robert] Huizenga, who is a a former team physician to the L.A. Raiders football team.

This is an excerpt from “The Biggest Loser Pushes Envelope on Diabetes,” in Internal Medicine News, vol. 45, No.11, page 17.

In a previous post about The Biggest Loser, I’d written that I didn’t know how much they exercised.

For purposes of discussion, let’s assume the documented major weight losses of Biggest Loser contestants are not simply due to caloric restriction.

Dr. Huizenga shared some of his experience at the recent annual meeting of the American Association of Clinical Endocrinologists.  In a study of 35 Biggest Loser participants, about half had prediabetes or type 2 diabetes.  Hemoglobin A1c, a measure of blood sugar control, fell significantly in this subset.  Three of the six with diabetes were able to stop metformin early on.  By week 29 of the study, average body mass index for the entire group had fallen from 46 to 29.

Sure, this is a small study, but my clinical intuition is that results are reproducible on a larger scale.  Television exposure and the $250,000 (USD) prize to the winning contestant are major motivators.  Furthermore, I bet there’s also a process for weeding out those who are likely to fail, before they ever get started.

Yes, exercise helps with weight loss.  But most folks aren’t willing or able to exercise vigorously for almost four hour daily.  If I were an obese sedentary diabetic, I’d sure try.

Steve Parker, M.D.

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TV’s Biggest Loser Plan Improves Diabetes and Prediabetes

TV’s “The Biggest Loser” weight-loss program works great for overweight diabetics and pre diabetics, according to an article May 30, 2012, in MedPage Today.  Some quotes:

For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.

In addition, the mean percentage of weight loss of the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24…

The exercise regimen for those appearing on “The Biggest Loser” comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.

Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.

At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.

“I have a job and I work out from 90 to 100 minutes per day,” he said. “It’s about setting priorities. Time is not the issue; priorities are the issue.”

Of the 35 participants in this study, 12 had prediabetes and six had diabetes.  This is a small pilot study, then.  I bet the results would be reproducible on a larger scale IF all conditions of the TV program are in place.  Of course, that’s not very realistic.  A chance to win $250,000 (USD) is strong motivation for lifestyle change.

Steve Parker, M.D.

PS: Although not mentioned in the article, these must have been type 2 diabetics, not type 1.

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Diabetes Plus Bulimia Equals Diabulimia

MedPage Today has a brief article on “diabulimia,” a disorder in type 1 diabetics who withhold insulin in order to lose weight.

After following the women for 11 years, the researchers found that those who restricted insulin had increased rates of diabetes complications, shortened lifespan, and increased mortality risk.

Factors that were associated with insulin restriction included greater eating disorder symptoms, diabetes-specific distress, overall psychological symptoms, and fear of hypoglycemia at baseline.

Diabulimics believe the theory that insulin is a major fat-storage hormone.  Furthermore, the high blood sugar levels resulting from inadequate insulin dosing lead to loss of calories (sugar) via urine.

Steve Parker, M.D.

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Science in Support of the Paleo Diet

Stockholm Palace

Investigators at Karolinska Institutet in Sweden found diminished weight, body mass index, blood pressure, and waist circumference in 14 healthy medical students eating a paleo diet for three weeks.  

I reviewed this research report in my effort to determine if the paleo diet—aka Old Stone Age, caveman, ancestral, or Paleolithic diet—has anything to offer diabetics.

Published in 2008, this seems to be one of the seminal scientific studies of the paleo diet in modern Europeans.

Their version of the paleo diet:

  • Allowed ad lib: All fresh or frozen fruits, berries and vegetables except legumes, canned tomatoes w/o additives, fresh or frozen unsalted fish and seafood, fresh or frozen unsalted lean meats and minced meat, unsalted nuts (except peanuts – a legume), fresh squeezed lemon or lime juice (as dressing), flaxseed or rapeseed oil (as dressing), coffee and tea (w/o sugar, milk, honey, or cream), all salt-free spices.
  • Allowed but with major restrictions: dried fruit, salted seafood, fat meat, potatoes (two medium-sized per day), honey, cured meats
  • Prohibited: all milk and dairy products, all grain products (including corn and rice), all legumes, canned food except tomatoes, candy, ice cream, soft drinks, juices, syrups, alcohol, sugar, and salt

What Did They Find After Three Weeks?

  • Average weight dropped from 65.2 kg (144 lb) to 62.9 (139 lb)
  • Average body mass index fell from 22.2 to 21.4
  • Average waist circumference decreased from 74.3 cm (29.25″) to 72.6 cm (28.58″)
  • Average systolic blood pressure fell from 110 to 104 mmHg
  • plasminogen activator inhibitor-1 decreased from 5.0 kIE/l to 2.8 kIE/l
  • All of these changes were statistically significant

The researchers looked at a number of other blood tests and didn’t find any significant differences.

Five men and three women completed the study. Of the 20 who originally signed up, one could not fulfill the diet, three became ill (no details), two failed to show up.

So What?

That’s a remarkable weight loss over just three weeks for slender people eating ad lib.

The study authors concluded that these paleo diet-induced changes could reduce risk for cardiovascular disease. They called for a larger study with a control group. (If it’s been done, I haven’t found it yet.)

Sounds reasonable.

Steve Parker, M.D.

PS: You’d think they would have said more about the three participants who got sick, rather than leave us wondering if the diet made them ill.

Reference: Österdahl, M; Kocturk, T; Koochek, A;Wändell, PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. European Journal of Clinical Nutrition, 62 (2008): 682-685.

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Does Cutting Out Sugary Drinks Help With Weight Loss?

Are you obese, love sugary drinks, and want to easily lose four pounds (1.8 kg) over the next six months? Simply cut a couple of sugary drinks out of your daily diet, replace them with water or diet soa, and you may lose the pounds.  Or so say University of North Carolina researchers.
Down 4 pounds in 6 months. I’ll take it!

In the U.S., our consumption of calories from sugar-sweetened beverages (SSBs) almost doubled between 1965 and 2002, now comprising 21% of our total calories.  (I’ve seen lower estimates, too, such as all added sugars accounting for 17% of total calories.)  Remember that our overweight and obesity rates started rising around 1970.  Any connection there?

Some have speculated that cutting back on SSB consumption would lead to loss of some excess weight.  But it’s never really been tested until now.

By the way, your typical sugary carbonated beverage has 145 calories of pure carbohydrate, most often high fructose corn syrup.  That’s equivalent to 10 tsp (50 ml) of table sugar.  Soft drinks are liquid candy.

Methodology

UNC investigators recruited  about 300 overweight and obese folks (average BMI 36, average weight 100 kg (220 lb), 84% female, 54% black) who drank at least 280 calories daily of caloric beverages (sugar-sweetened beverages, juice, juice drinks, sweetened coffee and tea, sweetened milk, sports drinks, and alcohol).  In other words, they all drank at least two soft drinks or the equivalent daily.  Participants agreed to make a dietary substitution for six months.

The participants were randomly assigned to one of three study groups with a hundred participants per group. For the next six months…

  • Group WA substituted at least two of their SSBs daily with water (WA), any type as long as it was calorie-free.  Bottled water was provided.  This reduced sugary drink calories by 230/day.
  • Group DB substituted at least two of their SSBs daily with calorie-free diet beverages (DB).  Beverages were provided.  This reduced sugary drink calories by 230/day.
  • Group AC (attention controls) made no changes in baseline beverage consumption.  Investigators made a point not to talk to them about beverages.

All three groups had monthly group meetings.  WA and DB group meetings were focused on adherence to the beverage substitution guidelines.
The AC group meetings will involved a weigh-in and general weight loss information (e.g., read food labels, increase vegetable consumption, portion control, and increase physical exercise).

“All … groups had access to a group-specific …website, where they recorded the beverages (water and DB only) they consumed, reported their weekly weight, received feedback on progress, viewed tips, and linked to group-specific resources.”

Results

All three groups lost statistically significant amounts of weight, but there was no difference in amount of weight lost among the groups.  In other words, the folks who substituted water or diet beverages for  sweet drinks didn’t do any better than the AC (attentive control) group.

Average amounts of weight lost were in the range of 1.8 to 2.5% of total body weight.  For example, if you weigh 200 lb (91 kg) and lose 2% of your weight, that’s a 4-lb loss (1.8 kg).

Compared to the AC group, the WA group showed a statistically significant decrease in fasting blood sugar (down 3 mg/dl).  BTW, none of the participants were diabetic.

Sugar cane

Take-Home Points

Would the substituters have lost weight if they had simply cut out two sugary drinks a day, skipping the monthy meetings and website?  Don’t know.  But I bet that’s how the mainstream press will spin this.

If I were obese and had a sugary drink habit, I’d start substituting water.  Yesterday.

Substituting water for a couple sugary drinks a day could reduce risk of developing diabetes.

I was hoping to see a significantly greater weight loss in the water and diet drink substituters compared to the AC (Attention Control) group.  Presumably all of these AC folks would have stayed at their baseline weights if they hadn’t done any of this.  The substitution groups apparently didn’t receive the general weight-loss information given to the AC group.

One caveat: All groups had monthly meetings for six months.  What were the substitution groups  talking about other than adherence to the protocol?  Your guess is as good as mine since the researchers don’t say.  Perhaps something about those meetings led to the weight loss, not the act of substituting water or diet drinks for sugar.

So they lost an average of 4–5 lb (2 kg).  Big deal, right?  But remember this was just a six-month study.  Could that 4 lb turn into 12 lb (5.5 kg) over 18 months?  Maybe, but we don’t know.

Here’s the thing about averages.  Some of these people I’m sure lost closer to 5% of body weight, and some didn’t lose any, or gained.  Which group would you be in?  Only one way to find out.

Remember that many medical conditions linked to overweight and obesity improve with loss of just 5% of body weight.

The substituters cut out 230 calories a day of sugary drinks.  All other things being equal, they should have lost 12 lb (5.5 kg).  Problem is, all other things aren’t equal.  Numerous other factors are at play, such as activity levels, replacement of sugary drink calories with other calories, measurement errors, reporting errors, etc.

This was a female-heavy study.  Would this strategy work for men?  Even better in men?  We don’t know.  Why not try it yourself?

Steve Parker, M.D.

PS: I did a sugar-free and wheat-free experiment on myself earlier this year.  Lost some weight, too.

Reference: Tate, Deborah, et al.  Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Conscioulsly Everday (CHOICE) randomized clinical trialAmerican Journal of Clinical Nutrition, February 1, 2012, Epub ahead of print.  doi: 10.3945/ajcn.111.026278

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Alec Baldwin Cut Out Sugar, Lost 30 Pounds

Mother Nature Network last January reported Alec Baldwin’s successful weight loss effort.  An excerpt:

“I gave up sugar,” he told Access Hollywood. “I lost 30 pounds in four months. It’s amazing.”
“(I do) Pilates, spin, not as much yoga as I’d like,” he added. “When we’re shooting (’30 Rock’) it’s tough…When we’re shooting and I can’t work out, I just have to eat less. So, I’m very conscious of that. But sugar was the real killer for me — that was the problem.”
 
 
 

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Book Review: Choose to Lose: The 7-Day Carb Cycle Solution

I saw the author of Choose to Lose on a rerun of Dr. Oz in early January.  Then I checked the book’s sales rank at Amazon.com (22nd overall—a blockbuster in my view).  (Don’t get me wrong; I’m not in the habit of watching Dr. Oz.)  Here’s my review of 2012’s Choose to Lose: The 7-Day Carb Cycle Solution, by Chris Powell.  The book is for the general public, not people with diabetes.  I give it three stars per Amazon.com’s five-star system.

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Will it work?  Certainly for some, quite possibly a majority.  Like most published programs, it’ll work for for you if you work the program.  Question is, can you do it?

The underlying idea is to alternate high-carb and low-carb eating days, which supposedly revs up your metabolism and tricks your body into thinking it’s not on a diet so it won’t go into self-preservation starvation mode.  Mr. Powell calls this carb cycling.

The high-carb days are also low-fat, and the low-carb days are low-calorie.  Actually, both days are reduced-calorie if your goal is the most dramatic results.  A moderate calorie deficit is built into the program.  Women get about 1350 calories; men around 1700.  Those levels are lower than necessary. Other than that, it appears you’ll get all the other nutrients you need, which is good.

I can see how the diet would work for some because it drastically reduces consumption of our most fattening carboydrates.  Loser Choosers aren’t supposed to eat baked goods, white flour, refined sugar, beer, candy, chips (crisps, for those in the UK), conventional breads, cookies, crackers, ice cream, sugar-sweetened beverages, corn syrup, and milk.  I suspect if we all stopped eating those right now, the overweight rate in the U.S. would drop by at least 10% in the next 12 months.

The author allows no wheat or white rice except for whole wheat bread and pasta.  Potatoes, peas, and corn made it to the “approved” list.  You eat mostly natural, minimally processed foods (yay!).

I don’t know Mr. Powell, but he comes off as earnest, honest, compassionate, experienced, and intelligent.  He’s not a scammer.  Mr. Powell has more faith than I do in the benefits of exercise for weight loss.  He notes that nutrition is more important.  We agree that exercise is often critical for prevention of weight regain.  He barely, if at all, mentions the benefits of exercise in prevention of disease and prolongation of longevity.  His well-illustrated exercise recommendations are  a good start for fitness beginners.  He wants you to exercise for 10-30 minutes on six days a week, doing a combo of cardio intervals and body weight resistance training.  No expensive equipment to buy.

Carb cycling like this is supposed to “boost your metabolism to burn fat quickly.”  It does not, to any clinically meaningful extent.  Nor is carb cycling mentioned in this year’s massively referenced The Smart Science of Slim.  Contrary to the author’s opinion, neither eating five meals a day nor eating carboydrates revs up your metabolism.

Mr. Powell provides some helpful mind tricks to prepare you for a lifestyle change.

My favorite sentence: “Success doesn’t just happen.  It’s a result of the 4 Ps of action: Planning, Preparation, Performance, Persevance.”

My least favorite sentence: “Water is imperative for loosing [sic] weight.”  A close second was: “Alcohol is a powerful diuretic (it flushes water out of your system), so it dehydrates you, causing water retention and bloating for one to three days after you drink.”  Huh?

I like his incorporation of cheat meals, although he allows more than I would.  To his credit, the all-important maintenance phase is covered well.

Mr. Powell recommends supplementing with probiotics and digestive enzymes, being unaware of their uselessness for most dieters.

I note that Amazon sells Choose to Lose by Dr. Ron and Nancy Goor, and The Carb Cycling Diet by Dr. Roman Malkov.  Coincidence ? 

In terms of complexity, the program is about average. 

I wonder if you’d do just as well by swearing off the fattening carbohydrates I listed above.  If you’re looking to lose weight, you could do a lot worse than Choose to Lose.  And you could do better.

Steve Parker, M.D.

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