Friday, April 4, 2014

Will Vitamin D Help You Lose Weight?

Vitamin D

Vitamin D

As a regular reader, you may well be aware of the discussions regarding a potential role of calcium and vitamin D in promoting weight loss.

Now, this issue was examined by Mason and colleagues in a 12 month randomised controlled trial, published in the American Journal of Clinical Nutrition.

The study involved 218 overweight/obese women (50-75 y of age) with moderate vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] ≥10 ng/mL but

The weight-loss intervention included a reduced-calorie diet (10% weight loss goal) and 225 min/wk of moderate-to-vigorous aerobic activity.

A total of 86% of participants completed the 12-mo measurements losing on average about 7 Kg, with no significant differences between the two groups.

There were also no significant differences in the reduction in BMI, waist circumference, percentage body fat, trunk fat, insulin or CRP levels.

At best, there was a slight trend towards greater benefits in women, who became replete with vitamin D supplementation compared to those who did not.

Thus, in summary, simply adding vitamin D to a weight loss regimen does little (if anything) to aid weight loss.

This is not to say that vitamin D supplementation in people with vitamin D deficiency may not be a good thing – it just does not appear to have much effect on body weight.

@DrSharma
Halifax, NS

ResearchBlogging.orgMason C, Xiao L, Imayama I, Duggan C, Wang CY, Korde L, & McTiernan A (2014). Vitamin D3 supplementation during weight loss: a double-blind randomized controlled trial. The American journal of clinical nutrition PMID: 24622804

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Thursday, April 3, 2014

Why Coverage Of Anti-Obesity Medications For Federal Employees Is Only Fair

OPM-logo

One of the rather explicit biases that has hindered greater investment into finding more effective obesity medications, has been the unwillingness of many health care plans to cover the cost of such medications for their members.

Indeed, many private and public health plans around the world explicitly exclude obesity medications (and other obesity treatments) from coverage.

This is clearly a double standard, given that the very same plans have no problem covering medications for other “lifestyle” diseases such as type 2 diabetes, hypertension, or high-cholesterol.

Now, in a rather dramatic move last month, the US Office of Personnel Management (OPM), responsible for health insurance coverage for  over 2.7 million Federal Employees, ruled in support of health coverage for FDA-approved weight-loss treatments stating that obesity exclusions are no longer permissible in health plans for federal employees.

This move should set an important precedent for other health plans to follow.

In the March 20th letter to all FEHB carriers, John O’Brien, the Director of Healthcare and Insurance at OPM, agrees that while

“diet and exercise are the preferred methods for losing weight, …drug therapy can assist [those] who do not achieve weight loss through diet and exercise alone.”

In the letter, O’Brien provides further clarification:

“It has come to our attention that many FEHB carriers exclude coverage of weight-loss medications. Accordingly, we want to clarify that excluding weight loss drugs from FEHB coverage on the basis that obesity is a “lifestyle” condition and not a medical one or that obesity treatment is “cosmetic”- is not permissible. In addition, there is no prohibition for carriers to extend coverage to this class of prescription drugs, provided that appropriate safeguards are implemented concurrently to ensure safe and effective use.”

This ruling should end the long-standing practice of discrimination against people with obesity who require and are willing to take medications for their condition.

Obviously, medications for obesity need to always be used as an “adjunct” to diet and exercise, in the same manner that medications for diabetes, hypertension or high-cholesterol should always be used as an adjunct to diet and exercise.

It goes without stating that prescription medications for obesity, diabetes, hypertension or high-cholesterol should only be made available to those who fail to control their weight, blood sugar, blood pressure, or cholesterol levels with diet and exercise alone. (there is no “special case” for the role of diet and exercise in obesity management that does not also apply to these other conditions).

And of course, as for any prescription drug, means and measures must be in place to avoid misuse and monitor safety of such treatments.

That said, recognizing that prescription obesity drugs, deemed both effective and safe by the FDA should be made available to patients in the same manner as drugs for other chronic conditions, is only fair to patients and represents a major step towards decreasing bias and discrimination against those suffering the health consequences of excess weight.

@DrSharma
Edmonton, AB

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Tuesday, April 1, 2014

Dr. Oz’s Next Miracle Obesity Cure: Ginger?

ginger-health-benefits-usesA recent article in Forbes Magazine noted at least 16 nonsensical “weight-loss miracles” discovered by Dr. Oz.

Well, allow me to be the first to predict another weight-loss miacle that may soon make the airwaves (or rather your cable): ginger.

And this would by no means be a surprise given that Saravanan and colleagues from Tamil Nadu, India, in a paper published in the Journal of the Science of Food and Agriculture, note the anti-obesity effects of ginger, especially in the face of a high-fat diet.

Unfortunately (not that Dr. Oz would care), this finding was in rats, who were given varying amounts of gingerol for 30 days.

And indeed, at the highest dose (75 mg/Kg), animals did have lower glucose level, body weight, leptin, insulin, amylase, lipase plasma and tissue lipids when compared to controls.

As the authors show, this was about as much of an effect as seen in animals treated with lorcaserin, an anti-obesity drug recently approved by the FDA.

While, to their credit, the authors make only generically optimistic claims as to the use of these findings rather than proclaim  another “weight-loss miracle”, they also fail to tell us exactly how many kilograms of fresh ginger (or even ginger extract) one would have to eat every day to come anywhere close to reaching an effective dose of gingerol.

Never mind that we also have no idea how such a dose would be tolerated in humans (yes, natural products have side effects!), or even whether or not ginger would in fact have any similar effects on body weight or metabolism in humans.

Surely, there is nothing wrong with this line of research. Many medical discoveries (e.g. aspirin) were made through the isolation of pharmacologically active moieties from plants.

What is wrong, however, is when such basic findings are overhyped and presented as “miracles” with claims of curing everything from obesity and heart disease to cancer and Alzheimer’s (surprisingly such claims often fail to include world peace).

Will Dr. Oz pick up on ginger? I don’t know. But if he does, remember you heard it here first.

@DrSharma
Edmonton, AB

ResearchBlogging.orgSaravanan G, Ponmurugan P, Deepa MA, & Senthilkumar B (2014). Antiobesity action of gingerol: Effect on lipid profile, insulin, leptin, amylase and lipase on male obese rats induced by a high-fat diet. Journal of the science of food and agriculture PMID: 24615565

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Thursday, March 27, 2014

Three Essential Ways in Which Melatonin Links to Energy Balance

sharma-obesity-pineal-glandAs a regular reader, you will be quite familiar with the emerging recognition of sleep (or rather lack thereof) as an important determinant of weight gain.

Melatonin, an evolutionary ancient molecule that, in mammals, is secreted from the pineal gland, is a hormone that plays a major role as a key regulator of the circadian cycle, along which  virtually all metabolic activities are coordinated.

A paper by José Cipolla-Neto and colleagues, published in the Journal of Pineal Research, provides a fascinating overview of how melatonin plays a significant role in energy metabolism.

Its first role relates to insulin secretion and action. Thus, melatonin is not only necessary for the proper synthesis and secretion of insulin, it also plays a role in the insulin-signalling pathway through its effects on GLUT4 receptors.

Secondly, as a powerful chronobiotic, it helps coordinate various metabolic processes so that the activity/feeding phase of the day is associated with higher insulin sensitivity whereas the rest/fasting phase is synchronized to lower insulin sensitivity.

Thirdly, melatonin plays an important role in regulating energy flow to and from fat stores and directly regulating the energy expenditure through the activation of brown adipose tissue and participating in the browning process of white adipose tissue.

The paper discusses how the reduction in melatonin production, as seen during aging, shift-work or night-time light exposure can induce insulin resistance, glucose intolerance, sleep disturbance and metabolic circadian disorganization, which together can lead to weigh gain.

Thus, the available data supports the notion that melatonin replacement therapy may provide a novel strategy to influence metabolism, at least in people with disruptions in their melatonin system.

Clearly, these notions need to be tested in well-controlled randomised trials but there certainly appears to be ample data to suggest that such a trial may well be worthwhile.

If you have taken melatonin or prescribed it to your patients, I’d certainly like to hear about your experience.

@DrSharma
Edmonton, AB

Hat tip to Sukie for pointing me to this article.

ResearchBlogging.orgCipolla-Neto J, Amaral FG, Afeche SC, Tan DX, & Reiter RJ (2014). Melatonin, Energy Metabolism and Obesity: a Review. Journal of pineal research PMID: 24654916

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Friday, March 21, 2014

Does Surviving Breast Cancer Lead to Obesity?

sharma-obesity-mammographyWe have long recognised obesity as significant risk factor for post-menopausal breast cancer  but emerging data suggests that surviving cancer may in itself promote weight gain.

Thus, a study by Rebecca Sedjo and colleagues, in a paper published in the Journal of Cancer Survivorship, notes significant weight gain in 665 overweight and obese women within five years of surviving breast cancer.

The average weight gain over five years was 4.5% with almost half the participants gaining significantly more weight.

Younger women and those with lower BMIs were more likely to gain significant amounts of weight over time.

Pharmacological treatment was also an important predictor of weight gain, with women treated with selective estrogen-receptor modulators twice as likely to gain weight compared to women prescribed aromatase inhibitors.

Clearly, post-diagnosis weight gain is common in breast cancer survivors and is influenced by a complex set of factors including age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy.

It appears that exploration of effective strategies to prevent this weight gain or provide obesity management strategies to breast cancer survivors are long overdue.

@DrSharma
Edmonton, AB

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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