Monday, July 21, 2014

Diet Drugs That Work – Are They Right for You?



If you’ve ever tried to lose weight and keep it off, you know it’s tough. Many people get lured into over-the-counter gimmicks that are unproved, not approved by the FDA, and may even be dangerous.  But what many people don’t know is that two medicines have been approved by the FDA for long term weight loss. And if you’ve struggled with weight loss over the years, these may give you the boost you need. Interestingly, not many primary care doctors are using these helpful tools to help their obese patients.


Some of this reluctance may be a holdover from the fen-phen fiasco back in the 90’s. Fen-phen was a combination of two drugs – fenfluramine and phentermine that had been FDA-approved separately. When used together, they seemed to speed up weight loss. However, the combination of the two drugs had never been studied nor approved. While it is legal for doctors to prescribe combinations of separately approved medicines in what is called “off label use”, it can be dangerous. This was the case with fen-phen.  The dangerous combination of the two weight loss medicines caused heart valve disease and the fatal disease primary pulmonary hypertension in some patients.


But the good news is that newer and safer weight loss medications are now available. But they are not for everyone. If you just want to lose a few pounds before your high school reunion, your doctor should not prescribe these for you. However if you have:
  •   A BMI of 30 or higher
  •  A BMI of 27or higher and health problems that are related to body weight like diabetes, high blood pressure or heart disease

Your doctor may consider prescribing one of these medicines for you. To find out what your BMI is, use this BMI Calculator on the Academy of Nutrition and Dietetics website.


Two of the FDA-approved weight loss drugs that are the most effective are:

·       
 Belviq
o   Dose: 10 mg tablet twice a day
 o   How it works: Belviq activates hunger control mechanism in the brain
 o   The research: Researchers tested Belviq in three large clinical studies from 1 to 2 years with a total of 8,000 overweight and obese participants. Almost half (47%) of the people in the studies lost at least 5% of their total body weight after 12 weeks. The participants taking Belviq lost 3 to 3.7% more of their body weight than the participants on the placebo.
·        

  
        Qsymia

o   Dose: the once-a-day dose varies based on how you respond to the medication.

o   How it works: Qsymia is a combination of two medicines: phentermine and
topirmate. The combination reduces appetite (how much you eat) and your desire to eat.
  • The research: Researchers tested Qsymia in two large clinical studies that included almost 3,700 overweight and obese participants. On the lowest dose, the participants lost 6.7% more weight than the participants on the placebo . On the recommended dose (the middle dose), participants lost an average of 8.9% more than those on the placebo. Sixty-two percent of the participants on the lowest dose and 70 percent of the participants in the recommended dose groups lost at least 5% of their total body weight compared to 20% of the participants in the placebo group.     
  A very important point to remember here is that all of the participants were still dieting and exercising. None of these medications will magically melt the pounds away – you still need to change your health habits. But they can help you lose weight better than diet and exercise alone. These medications also have possible side effects that you should discuss with your doctor.

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Monday, July 7, 2014

Two Reports, One Conclusion: Chronic Disease Are Not Only Killers, They Stress Us Out



Two reports this week – one, the results of a National Public Radio (NPR), Robert Wood Johnson/Harvard School of Public Health poll; the second, a study in the British medical Journal Lancet – point a big finger at chronic diseases as a major source of stress and the biggest killer of people worldwide. NPR reported that “1 in every 4 Americans said they had a great deal of stress in the previous month”. The number 1 cause of stress was poor health. Disability was the biggest health stressor at 45 percent but chronic illness came in second at 36 percent. The Lancet researchers reported that non-communicable diseases now account for nearly two-thirds of deaths world-wide.

What does this mean for you? Some chronic diseases include conditions like disabilities and diseases that are not preventable like type 1 diabetes. But many chronic diseases can be prevented – or at least slowed down. Most of our preventable chronic diseases can be traced back to a fairly short list of risk factors:

  • Tobacco use
  • Poor diet
  • Physical Inactivity
  • Drinking Too Much Alcohol
  • Uncontrolled High Blood Pressure
  • High Blood Fats

All of these either are either behaviors we can change (smokin’ and drinkin’) or we can change them with behaviors (high blood pressure and high blood fats). Most of these factors are interconnected.  Let’s take a look at the healthy habits you can do every day that will have the biggest impact on these common killers:

·         Lose 10% of your body weight. If you are overweight, losing a small amount of weight can drop blood sugar, blood pressure, and blood fats. The good news is that you don’t have to get down to a textbook ideal body weight.  Even a 10% body weight loss, if you are overweight, can lower your numbers. So let’s say you weigh 275 pounds and need to drop 100 pounds to be at your “ideal body weight”.  A 27 pound weight loss could make a big difference in your numbers.

·         Walk, cycle, swim, move!   Even if exercising doesn’t give you big weight loss, your body often shows appreciation for your efforts. During and after exercise, blood sugar drops.  Long term, the body’s cells become more sensitive to insulin helping you to control your blood sugar. Exercise can also lower blood pressure and the blood fats that lead to heart disease. Most of the studies that show benefits have been done with aerobic exercise such as jogging ten to twelve miles a week (that’s just a couple of miles a day!). Some studies suggest that exercise can lower “visceral” fat (the type that many researchers consider highly related to disease) without lowering body weight.

·         Ditch the Empty Calories:  When I work with someone on weight loss, I always go for the “low hanging fruit”. One of the biggest is sweet drinks like sweet tea and regular sodas. If you drink these regularly, switching to unsweet or diet versions can have a huge impact on lowering your weight – as long as you don’t “compensate” by eating more of other foods.

·         Add On Potassium & Fiber:  High potassium foods like fresh fruits, vegetables, nuts and seeds, milk and yogurt can help lower your blood pressure. High fiber foods – particularly those with more soluble fiber like oats and starchy beans – can help lower blood fats.

Making these changes in your life is not easy. Busy schedules and difficulty getting motivated are typical barriers. But many people are finding success with using phone apps like my Fitness Pal and online support groups and weight loss programs. In the coming weeks, I’ll be highlighting some of the best!


Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Science
University of Alabama at Birmingham

Thursday, May 22, 2014

Almond Milk vs. Soy Milk



There are a lot of popular milk choices:  cow’s, soy, and almond. But are they nutritional equals?


Cow’s milk has a lot going for it. It’s naturally high in protein, calcium, phosphorus, potassium and selenium.  If you’re not a vegan vegetarian (no animal products!) and you’re not allergic to casein (milk protein), milk is a nutritious choice. If you’re lactose intolerant (you can’t digest the carbohydrate in milk), lactose reduced milk is a good and effective choice for most people.

A good alternative to milk if you’re allergic to milk protein or you are vegan vegetarian, is soy milk. Soy milk is also very high in protein (8 grams) and it’s a very high quality plant protein. It’s also naturally high in folate, magnesium, potassium, phosphorus and vitamin C. The

manufacturers add calcium, some B vitamins (B12 and riboflavin) and also vitamin D. I would say that soy and cow’s milk are the most nutritious milk choices. Both have a broad array of naturally occurring nutrients plus a few that are added for other benefits. Flavored soy milks have some sugar added so be sure to check out the sugars. Some have less, some have more than the natural sugar in milk (lactose).

A lot of people are drinking almond milk but it’s probably not as nutritious as you think. It only has one gram of protein compared to the eight grams in soy and cow’s milk. Nor does it have all the nutrition that almonds have – so don’t forgo your whole nuts for the milk. To make almond milk, the almonds are soaked in water and ground up and then more water is added. Then the mixture is strained – so much of the almond gets drained out.  When you look at the almond milk label, most of the nutrients in almond milk are added – not a natural part of the almond. The calcium, vitamin E, zinc, vitamin A, vitamin D, and the B-vitamins are all added synthetically. As with soy milk, the flavored versions can have quite a bit of sugar added. If you are vegan or allergic to cow’s milk, I definitely give a big nutritional edge to soy milk. One advantage to the plain almond milk (which is lightly sweetened) and the unsweetened is that they are low in calories – 30 and 60 respectively.  But light soy milk and skim milk are also pretty low in calories – 60 and 85 respectively. Now, if you love the way almond milk tastes, then it is fine to drink it – just make sure you’re getting your protein elsewhere. To me, taste always wins out! But if you’re just looking at which one packs the biggest nutritional punch, I’d have to give the edge to soy and cow’s milk over almond milk. 


Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Friday, May 16, 2014

Why I’m Not Surprised that Dietary Resveratrol may not be Associated with Living Longer



Headlines, supplements and nutrition fads often leap way ahead of the research. That’s why I’m not surprised at the results of the latest and best study done to date on dietary resveratrol. Resveratrol is a “phytochemical” – a naturally occurring chemical in plants – found in the skin of red grapes (and subsequently red wine), peanuts, and cocoa. This most recent study showed that resveratrol from foods and beverages did not correlate with a lower chance of dying, cancer risk, heart disease risk, or with markers of inflammation.
The study: Older adults in the Chianti region (a big red wine making area) were followed for 9 years. The participants reported on their dietary intake regularly during those years. The researchers and study geriatricians evaluated the participants’ dietary intake of resveratrol, their urinary resveratrol (which has been found to correlate with dietary intake), the diseases they had, and markers of inflammation over the course of the study. They found that the people who had the highest resveratrol intake were just as likely to suffer from heart disease and cancer and to die as the people with the lowest intake.  There were no differences in markers of inflammation between the groups.

Here’s why I am not surprised by the findings:
 

  • Many of the previous studies that have shown benefits from resveratrol have been done in rats. Rats are not humans – a fact often lost on those humans reporting on scientific studies and supplement makers.
  • Both the rat and the human studies have used large doses of resveratrol from supplements – far more than we can possibly get from foods and beverages.
     
  • Some human studies have shown benefits - and some have not. The ones that have shown benefits often look at “markers of inflammation” and show that resveratrol supplements lowered these markers. One study showed that resveratrol supplements lowered stiffness in the arteries of women. But, just lowering a marker of something bad does not necessarily translate into improved health or a lower chance of dying. I see this kind of data on markers of health all the time and they are useful but we shouldn’t base our recommendations off of them. These kinds of studies need to lead to studies that look at the outcomes that really matter – like disease, disability, and death.
     
  • Some human studies have shown no benefit and even harm from resveratrol supplements. One study showed that when older men were randomized to get either a 250 mg resveratrol supplement or a placebo for eight weeks during an intense exercise program, the men on the supplement did not experience the positive changes in cholesterol levels or in blood flow that the men on the placebo did. In other words, the supplements actually impaired some of the benefits of exercise rather than improving them as expected!

Keep in mind that this most recent study is also not the last word on resveratrol. While it was a strong, well-designed study, all studies have limitations. I also would not have been surprised if the study had shown that dietary resveratrol was beneficial because, again, the previous research had gone both ways. Neither outcome would have been surprising. 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham


Semba RD, Ferrucci L,  Bartali B, Urpi-Sarda M, Zamora-Ros R, Sun K, et al. Resveratrol levels and all-cause mortality in older community-dwelling adults. JAMA. 2014; published online May 12, 2014.