Weekly Wellness

Byetta: In a commercial for this drug which I believe is intended to treat diabetes, the announcer notes that the pill effects appetite and thus one may eat less and lose weight. Well, yes. Usually we do lose weight if we eat less, that is how weight loss works, through an energy imbalance. You can achieve weight loss and maybe even make an impact on your blood sugar (recommended for pre diabetics), by eating less and moving more without the side effects of nausea and vomiting that accompany Byetta.

$350, 000 Test: If you paid that kind of money for genetic testing and were then told that you should eat better and increase your physical activity to reduce the chance of contracting whichever disease your genetic profile pointed to, would you listen? In other words, if one needs to pay an exorbitant amount of money to accept the message that I happily provide for free, if that is what it takes, by all means, spend the money. It might save you some health care expenses down the road.

Living Longer: Research continues to confirm the health benefits of eating a Mediterranean diet. This study from NIH and AARP used people ages 50 -71 who live in America and had them eat a diet more lean than most of us choose. The diet was higher in fish, fruits, vegetables and monounsaturated fats like nuts and olive oil. This style of eating, hey I like that, “style of eating”, not dieting, is low in red meat and dairy foods. People in the study were less likely to die of any cause in the 5 year follow up period. I did not read the study itself so I am not sure how long the people ate that way before the five year follow up. The group was however, compared to one similar in all ways but the foods ingested.

No OTC for Mevacor: The FDA panel put together to explore whether or not Merck’s cholesterol lowering drug should be available OTC voted against it this week. Two strikes. The FDA can still approve the sale, but it is unlikely. The reasons the panel offered for its decision are not necessarily ones I’d mentioned and are interesting. The concerns which arise from focus group type research of 1500 people, is that too many people who do not need this medicine would take it. There was also concern that some who take higher dose prescription statin, or cholesterol lowering drugs, would switch to this OTC which is of a lower dose. (Hey remember my thoughts a few weeks ago, is this stuff even effective at a lower dose?). Anyway. It was noted too that the prescription statins would be cheaper for people with prescription drug benefits than this OTC med. While doing this research, the panel found that 30% of that pool of 1500 people actually had very high risk factors for disease risk and complication, i.e. they may have already had a heart attack or stroke, and were not being seen by a physician. Now Merck might argue that those people would take the drug and benefit, but those are the very ones that need the prescription strength drug. Further, there is no way to tell if you have high cholesterol beyond having a lab test. Most OTC meds are for ailments which are symptomatic. In other words, we don’t generally use wart remover if we don’t have warts!

Would you Like Mevacor with that? However, if one were to sell Mevacor without a prescription, perhaps Hardee’s would be a good place to start. I.e a “Philly Cheese Steak Thick Burger.” Are these people insane? The sandwich alone, without fries or a drink, has 930 calories and 63 grams of fat of which 24 are saturated. Far from being Mediterranean, eh. So I ask, “And would you like a cholesterol lowering drug with your order today? How about something to prevent that colon cancer you’re working on there buddy?”

Fructose: One of our country’s (USA) obesity experts was interviewed on Australian radio this past week, Dr. Robert Lustig. I was able to listen to the interview on my IPOD (whilst running :)) and though I cannot give you the same detailed explanation of this obesity explosion that Dr. Lustig offers, I can recap some very interesting, research based points. He refers to insulin, leptin and fructose in his lecture. It has been some years since we (in this newsletter) explored the appetite regulators grehlin and leptin, but you may recall that grehlin, from the stomach stimulates appetite and leptin, from fat cells turns it off. These hormones are often studied in the big quest for an obesity pill. That is NOT what Dr. Lustig is doing. He explains that our insulin resistance has led to leptin resistance and because we do not get the message that we are full we continue to eat and we pretty much feel listless and do not expend energy either. That was very simplistic and Dr. Lustig might fall off his chair if he read it. He said that the job of insulin is to get sugar out of the blood stream and to store it as energy. It is stored in fat cells. Because we have somehow overloaded our delicate metabolic and endocrine systems with the foods that we eat (processed) we release more and more insulin to get the energy into the cells. That is insulin resistance. When we need more to do the same job that less used to do. Diabetics can become completely immune to insulin. Okay, once the energy is stored in the fat cells, leptin is released. It goes in the blood stream and is taken to the brain which is told that we are full. More insulin, More Leptin and thus, leptin resistance occurs as well. Dr. Lustig said that we don’t “see the leptin.” Cycle goes on and on. He notes that the problem could in large part be do to fructose which has been added to our foods. Fructose is also in HFCS and sucrose. He talks about foods that are low fat that are anything but because they contain this fructose. Fructose is fruit sugar without the fruit, i.e. without the fiber. That is very important. Fructose is metabolized in the liver and has adverse effects on the liver, such as alcohol does and does increase fats in the blood as well. It also impairs an insulin receptor in the liver. In the end, fructose also causes insulin resistance and then leptin resistance and obesity. This is due to day after day of fructose intake. Fructose is in so many of our foods it could be called the nicotine of the food industry. It triggers eating behavior because our appetite suppressant mechanism is no longer working. Dr. Lustig was asked a question about the glycemic index which he did not discount but qualified with the glycemic load (so you may want to read about that on your own). In this part of his discussion, low carb diets were compared with low fat diets and he told the story about low fat diets not being low at all because the sugars were increasing blood fats, and increasing eating behavior. He also spoke about the way Japanese people ate white rice but did not get fat. He stated that the carb part is ameliorated by the high vegetable intake that Japanese people consume. I.e. they add fiber to their simple carb intake, further, until recently, there was NO fructose in the foods available in Japan. Now older persons in Japan eat the way they always have and young people eat more western meals and are themselves becoming obese. Take home message: Fiber yes, fructose no. I.e. eat the fruit don’t drink the juice, eat the whole grains and leave the Twinkies. Now you may be wondering if eating a Twinkie with an apple would be helpful and truthfully I do not know. http://www.ucsfhealth.org/adult/cgi-bin/prd.cgi?action=DISPLAYDOCTOR&doctorid=1721

Wishing you Wellness