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This potential new pill could be worth the weight.

Researchers at Stanford University found an anti-hunger molecule, called Lac-Phe, which is normally only produced after an intense workout.

After giving obese mice this molecule, they were discovered to have not only eaten 30% less but also weighed less in the long term. They also had a lower percentage of body fat and improved blood sugar regulation, according to a study published in the journal Nature.

Dr. Yong Xu, from the Baylor College of Medicine, claims that the research could lead to the creation of a fat-fighting pill.

This could lead to the development of a pill that can directly be used to suppress appetite for certain individuals who cannot easily exercise because of other conditions, aging or bone issues, he told New Scientist.

We just filed a patent for hopefully using this knowledge to treat human diseases such as obesity.

This is the latest attempt to get a weight loss pill to consumers. What has mostly been on the market are pills and injections meant to trim body fat or drugs, such as a diabetes medication that is being prescribed off-label, to curb hunger.

Scientists are still conducting research to determine what Lac-Phe can do to the brain besides suppressing hunger. Lac-Phe was said to be responsible for almost 25% of the anti-obesity effects of exercise. It was seen to have no effect when given to lean mice.

Despite only being tested on animals, the researchers are suggesting their results would be the same for humans.

As of 2020, the obesity prevalence for adults was 41.9% in the United States, according to the Centers for Disease Control and Prevention.

Excerpt from:
Pill to help you lose weight in the works - New York Post

In Part 3 of the esteemed Professor Tim Noakes series on insulin resistance, Noakes tells a genuinely compelling story about the heavyweights that assisted in establishing the foundation and credibility of the low carbohydrate, high fat (LCHF) diet. One of these is Dr Robert Atkins, whose deep depression after President John F Kennedy was assassinated in 1963 was the catalyst for an overweight Atkins to decide that it was time to save his own life and immediately find a way to begin his recovery. Noakes also relays the journey undergone by Dr Eric Westman, a physician practising at Duke University Medical Centre. Westman, initially sceptical of the Atkins diet, was transformed by his observation of its success in his patients and, after a visit from Atkins, he was convinced of the safety of the Atkins diet and its ability to successfully treat obesity and Type 2 diabetes. BizNews had a hugely informative interview with Dr Westman earlier this month. Nadya Swart

ATKINS DISCOVERS THE WORK OF DRS. BLAKE DONALDSON AND ALFRED PENNINGTON

Atkins subsequent academic search introduces him to the work of two other New York physicians, Drs. Blake F. Donaldson and Alfred Pennington, both of whom had been promoting low-carbohydrate diets, Donaldson from as early as the 1920s.As Gary Taubes, who carefully researched the topic, explains, Donaldson had been working with a group of fat cardiacs in New York (7). Frustrated at their inability to lose weight when trying to eat less and exercise more, Donaldson seeks another explanation (1). By chance, he befriends a Canadian engineer who is himself a friend of the Arctic explorer Vilhjalmur Stefansson, author of a series of books describing his life among the Arctic Inuit (8-12). After they meet in New York City and Stefansson describes how the Inuit live on a purely carnivorous diet, Donaldson recalls wondering, What was I worrying about? If Stefansson could get his people (North American Europeans) to live that way, I certainly should have enough executive ability to get my patients to stick to a beautifully broiled sirloin and a demitasse of black coffee (1, p. 41).Based on the meat-only diet Stefansson had eaten for a full year during the iconic laboratory study that included himself and fellow explorer Karsten Anderson (13), Donaldson designs an identical diet of three meals a day, each of a half-pound of fatty meat, three parts fat to one part lean protein by calories. After cooking, this would provide 18 ounces of lean meat with six ounces of attached fat per day (1). The Stefansson/Donaldson diet prohibits all sugar, flour, alcohol, and starches, with the exception of a small portion of raw fruit or potato once a day.According to Taubes (7), Donaldson claims to have treated about 17,000 patients over four decades, most of whom lost two to three pounds per week on the diet without experiencing hunger. The only patients who failed to lose weight were those with a bread addiction, for which his advice was, No breadstuff means any kind of bread . They must go out of your life, now and forever. To diabetics, he admonished: You are out of your mind when you take insulin in order to eat Danish pastry.Donaldson does not publish any personal scientific research, preferring to speak only to audiences at the New York Hospital, where Pennington, a local internist, hears him speak. Impressed, Pennington tests the diet on himself and soon begins prescribing it to his patients.At the time, Pennington is employed as a company physician in the medical care division of E.I. du Pont de Nemours and Company. By 1948, the company is becoming concerned about the rising incidence of heart attack among its employees; the target of the diet prescription is the prevention and reversal of obesity in the hope that this will reduce heart-disease risk.The original dietary intervention followed the standard for the day, which called for a reduction in portion size, calorie counting, limiting the amount of fat and carbohydrate consumed in meals, and exercising more (7). The results of the original diet were predictable: None of those things worked, so instead Pennington and his team decided to test Donaldsons diet on their overweight executives.In his first publications (14, 15), Pennington reports the outcomes in 20 Du Pont executives who have lost between nine and 54 pounds at an average rate of nearly two pounds per week. Subjects ate a minimum of 2,400 calories.Notable was a lack of hunger between meals, increased physical activity and sense of well-being, Pennington writes. Although carbohydrate intake was restricted to no more than 80 calories (20 grams) at each meal, he notes that in a few cases even this much carbohydrate prevented weight loss, though an ad-libitum (unrestricted) intake of protein and fat, more exclusively, was successful (14, p. 260).Pennington subsequently writes extensively on what he learns from his clinical experience working with these patients (16-23). The model of obesity he develops includes the following:Appetite is homeostatically regulated to ensure energy intake exactly matches energy expenditure. The mechanism can be affected by (i) altered hormonal influences, as in hyperinsulinemia or through the action of the stress hormones; (ii) structural damage to the center (in the hypothalamus); (iii) conscious overeating (careless or perverted eating habits).Alterations in lipophilia, which is the theory that obesity is the result of increased fat storage in the body (and which is) presumed an active regulation of the size of the adipose deposits, rather than the mere passive response to the balance between calorie intake and output (18, p. 102, my emphasis). (This concept is first described in the English scientific literature by Julius Bauer (24): The adipose tissue is not merely a passive storing place for reserve fat, but a living and active part of the body, with its own physiologic and pathologic processes (p. 993). Lipophilia explains, for example, why hunger is stimulated by weight loss and is only restrained when the adipose fat stores are again refilled.)Fat is stored in adipose tissue, not just from ingested fat but also from carbohydrate (22), and this later process is stimulated in the presence of insulin.The oxidation of fat is impaired in the obese, a consequence of a reduced capacity to fully oxidize carbohydrates. Instead, partial (glycolytic; fermentation) carbohydrate metabolism causes blood pyruvic (and lactic) acid levels to rise. Higher pyruvic acid levels then inhibit fat oxidation in all tissues, particularly in the muscles. Thus, pyruvic acid is a metabolic regulator, stimulating fat formation and inhibiting fat oxidation (18, p. 104).Since the obese have an impaired capacity to generate energy from both carbohydrate and fat, they will be continually hungry. As a result, excessive fat storage, or obesity, would be the cause of an increased appetite, rather than the result of it (22, p. 71).Pennington states his hypothesis in the following terms: Obesity, in most cases, is a compensatory hypertrophy of the adipose tissues, providing for a greater utilization of fat by an organism that suffers a defect in its ability to oxidize carbohydrate (21, p. 68).He concludes that if obesity is due to excessive fat storage (lipophilia) directed by the fat cells themselves, then caloric restriction is a non-specific therapy that acts solely at the level of the appetite, reducing calorie consumption without addressing the disordered drive of the fat cells to store excessive amounts of fat. His solution is to promote treatment directed primarily toward mobilization of the adipose deposits, which would allow the appetite to regulate the intake of food needed to supplement the mobilized fat in fulfilling the energy needs of the body.Since incomplete metabolism of carbohydrate is the key factor preventing fat utilization, Limitation of dietary carbohydrate, specifically, as the chief source of pyruvic acid makes possible a treatment of obesity without restriction of the total caloric intake (22, p. 73). His experience with the Du Pont executives teaches him, The use of a diet allowing an ad libitum intake of protein and fat and restricting only carbohydrate appears to meet the qualifications of such a treatment (18, p. 104).The advantages of this approach include the following:Restriction of carbohydrate, alone, appears to make possible the treatment of obesity on a calorically unrestricted diet composed chiefly of protein and fat. The limiting factor on appetite, necessary to any treatment of obesity, appears to be provided by increased mobilization and utilization of fat, in conjunction with the homeostatic forces which normally regulate the appetite. Ketogenesis appears to be a key factor in the increased utilization of fat. Treatment of obesity by this method appears to avoid the decline in the metabolism encountered in treatment of caloric restriction. (19, p. 347).Pennington also notes that some patients become hungry on the low-carbohydrate diet and need to increase their fat intake (23, p. 36). He writes: Provided carbohydrate is restricted sufficiently, there does not seem to be any need to restrict fat at all . Although the emphasis has often been put on protein in constructing diets for the obese, it seems that the emphasis should be put on fat as the major source of energy, with carbohydrate restricted to the degree necessitated by the obesity defect, and ample protein allowed for its well-recognized benefits to health (23, p.36).Penningtons ideas strengthen Atkins understanding that a low-carbohydrate diet that induces ketosis and reduces hunger without requiring significant caloric restriction is the solution for his own weight problem and perhaps for many others who have a similar problem.Atkins is further encouraged by a recent publication showing that the Pennington diet reduces hunger and produces weight loss in the majority: Our results do show that satisfactory weight loss may be accomplished by a full caloric, low carbohydrate diet. The patients ingested protein and fat as desired. Careful attention was paid to keeping carbohydrate intake to a minimum (25, p. 1413).The authors continue: All the other methods of weight reduction mentioned earlier have been utilized by the author in the past. The diet discussed was found to be the most satisfactory of all these methods in our hands. Weight reduction occurred dramatically with a rapid fall early and proceeding slowly but surely (25, p.1414).Perhaps Atkins also reads the chairmans address, presented by George L.Thorpe, MD, of Wichita, Kansas, at the 106th Annual Meeting of the American Medical Association in New York on June 4, 1957 (26). There, Thorpe repeats the Pennington interpretation of how a low-carbohydrate diet induces weight loss in the obese: That the usual low-calorie diet is rarely successful is readily understood in the light of our present knowledge of carbohydrate and fat metabolism (as) the presence of carbohydrate suppresses the fat-mobilizing ability of the pituitary gland and increases the fat-depositing activity of insulin (p.1364).Thorpe says, It is possible to lose weight without counting the calorie intake, without being weak, hungry, lethargic, irritable, and constipated. There is no magic or mystery, no fancy rules to follow, and the entire program may be successfully conducted without radical change to ones normal routine but the key to long-term success is the simple return to normal eating habits. Normal eating habits might be described in technical language as adhering to a high-protein, high-fat, low-carbohydrate diet (p. 1364).Thorpe then describes how his own consumption of high-carbohydrate foods had caused him to develop a personal problem of excess weight and how, in trying to solve this personal issue, he had discovered the low-carbohydrate diet promoted by Stefansson, Donaldson, and Pennington.This information likely confirms to Atkins that the solution to his personal weight problem is the same as it was for Thorpe: a low-carbohydrate diet.THE STUDIES OF KERWICK AND PAWANAtkins finds one final piece of evidence to further support his growing conviction that he has discovered a cure for obesity. Dr. A. Kerwick and Mr. G. L. S. Pawan from Middlesex Hospital Medical School had also become disillusioned with the calories-in, calories-out model of human weight control (27-29). As they wrote, If deficiency of calories accounts for loss of weight, low calorie diets should induce the same rate of weight loss in the same patient, no matter what the composition of the diet. Manifestly they do not do so (29, p. 449).A series of their studies shows that whereas subjects eating a low-calorie (1,000 cal), high-protein or high-fat diet for seven days lost substantial amounts of weight, eating a high-carbohydrate diet resulted in little if any weight loss (28). They conclude, An alteration in metabolism takes place (in those eating low-carbohydrate diets) (28, p. 161). This alteration in metabolism apparently explains the greater rates of weight loss in those eating low-carbohydrate diets.We now know that Kerwick and Pawans conclusions are in error. Marjorie Yang and Theodore Van Itallie subsequently show that, in the short term, any differences in absolute weight losses on isocaloric diets differing in their fat, protein, and carbohydrate contents can be explained entirely by much greater water losses on the higher fat and protein diets (30). However, this applies only to short-duration studies of less than perhaps 14 days or so. The one fact established by these studies is that high-carbohydrate diets promote fluid retention, most likely as a result of an insulin effect increasing water retention by the kidneys (31).Fortunately, at the time, Atkins is unaware of this error.THE ERIC WESTMAN, MD, CONNECTIONBy the late 1960s, Atkins has converted his private medical practice to focus purely on weight loss using the low-carbohydrate diet. Although he treats tens of thousands of patients during this period, he has little interest in documenting the results of his diet prescription on their health. He is happy to be surrounded by so much clear evidence of success.In 1997, Dr. Eric Westman, a physician practising at the Duke University Medical Center in Durham, North Carolina, is becoming concerned that some of his patients have chosen to follow what had by then become known as the Atkins Diet. In particular, he is worried that the high fat content of the diet will increase his patients blood cholesterol concentrations, placing them at risk of artery clogging and heart attacks. He is initially so sceptical of Atkins dietary advice that he didnt believe Atkins actually had gone to medical school and earned his M.D. (2, p. 167).Yet Westmans patients continue to show impressive weight loss. At their suggestion, he agrees to read Atkins first book (32). He remains puzzled about how Atkins can claim success from a diet that conflicts with everything Westman has been taught in his medical training. He cant understand how, first, his patients are losing weight eating so much fat, and second, why their blood cholesterol concentrations dont seem to be reaching dangerous levels.When faced with such a paradox, the majority of physicians simply ignore it as if what they are seeing hasnt really happened. But Westman is different. He writes to Atkins, who invites him to come to New York to sit in on some patient consultations. Later, Westman recalls, I was both surprised and impressed that he actually had an office and was seeing patients. I had to see through the veneer of the book before I could actually start to believe the concept behind the diet (2, p. 169).By the end of his visit, Westman has convinced Atkins that he needs to fund rigorous scientific studies to prove to a growing body of medical sceptics that his diet is safe and can successfully treat obesity and Type 2 diabetes mellitus (T2DM).WESTMAN FINDS A LOW-CARBOHYDRATE DIET CAN PUT T2DM INTO REMISSIONWestman uses Atkins funding to undertake a six-month pilot study of the effects of a low-carbohydrate (<25 g/day) diet with no limit on caloric intake on body weight and blood lipid parameters in 51 overweight/obese healthy volunteers (33). The 41 subjects who adhere to the program lose an average of 9.0 kg (19.8 lb.) and improve all their blood parameters, including lowering their total cholesterol and LDL-cholesterol concentrations. The authors conclude rather modestly, A very low carbohydrate diet program led to sustained weight loss during a 6-month period (without any adverse effects in the 41 subjects who completed the programme).The study leads to a larger study, this time with 120 subjects, 60 of whom follow a hypocaloric low-fat diet and the other 60 a low-carbohydrate diet for 24 weeks (34). The study finds that compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. The authors observe, During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol levels increased more with the low-carbohydrate than with the low-fat diet (p. 769).Predictably, when the same study is presented at the American Heart Association (AHA) meeting in November 2002, the Association feels compelled to issue a media advisory that conveys its concerns with the study in the following terms:The study is very small, with only 120 total participants and just 60 on the high-fat, low-carbohydrate diet.This is a short-term study, following participants for just 6 months. There is no evidence provided by this study that the weight loss produced could be maintained long term.There is no evidence provided by the study that the diet is effective long term in improving health.A high intake of saturated fats over time raises great concern about increased cardiovascular risk the study did not follow participants long enough to evaluate this.This study did not actually compare the Atkins diet with the current AHA dietary recommendations. (35)The advisory concludes with a statement from Robert O. Bonow, MD, President of the AHA: Bottom line, the American Heart Association says that people who want to lose weight and keep it off need to make lifestyle changes for the long term this means regular exercise and a balanced diet.Bonow adds, People should not change their eating patterns based on one very small, short-term study. Instead, we hope that the public will continue to rely on the guidance of organisations such as the American Heart Association which look at all the very best evidence before formulating recommendations.This advisory echoes some of the sentiments published in the Journal of the American Medical Association 29 years earlier in a highly critical review of Atkins first book (36). The article is attributed to Philip L. White, D.Sc., Secretary of the American Medical Association Council on Food and Nutrition. White is not a trained medical practitioner.Whites relevant points include the following:The low-carbohydrate diet approach to weight reduction is neither new nor innovative (p. 1415).If such diets are truly successful, why then, do they fade into obscurity within a relatively short period only to be resurrected some years later in slightly different guise and under new sponsorship? (p. 1415).Moreover, despite the claims of universal and painless success for such diets, no nationwide decrease in obesity has been reported (p. 1415).Dietary carbohydrate, particularly sugar, is considered by some advocates to be a nutritional poison that promotes hypoglycemia, diabetes, atherosclerosis and, of course, obesity (p. 1415). the weight reduction that occurs in obese subjects who are shifted to a low-carbohydrate diet seems to reflect their inability to adapt rapidly to the marked change in dietary composition (p. 1416).There appears to be no inherent reason why body weight cannot be maintained on a diet devoid of carbohydrate if the other essential nutrients are provided (p. 1416). (Dr. White appears to have forgotten this is a discussion on diets for weight loss, not weight maintenance.)Many human populations remain lean on diets extremely high in carbohydrate (by American standards) and correspondingly low in fat. Thus, there is equally no inherent reason to associate a diet rich in carbohydrate with obesity (p. 1416).Potential hazards of low-carbohydrate diets include hypercholesterolemia and hypertriglyceridemia (p.1416-1417). (White does not realize hypertriglyceridemia is caused by high-carbohydrate diets in those with carbohydrate-sensitive hypertriglyceridemia, but he is right to note hypertriglyceridemia is a risk factor for coronary heart disease).Other potential hazards include hyperuricemia, fatigue, and postural hypotension. (Note: Postural hypotension is a benign condition and indicates that the diet is producing an overall reduction in blood pressure. This surely is good since high blood pressure is common and in most is described as essential hypertension. In other words, medicine has no understanding of what is causing the hypertension, but if a low-carbohydrate diet causes hypotension, could this not possibly be an indication of a possible mechanism for hypertension high-carbohydrate diets in persons with insulin resistance?)The assertion that carbohydrates are the principal elements in foods that fatten is, at best, a half-truth (p. 1417). White argues instead that higher rates of dietary fat intake explain the high rates of obesity in North Americans: Obesity is relatively rare in large areas of the world where the hidden sugar of rice starch comprises a very high proportion of the total daily food intake (p. 1417).White concludes: The diet revolution is neither new nor revolutionary (p. 1418). He argues the low-carb diet is simply a variant of a diet that has been promoted for many years. The rationale used to promote the diet is for the most part without scientific merit (p. 1418). The unlimited intake of saturated fat and cholesterol-rich foods may well increase coronary artery disease and other clinical manifestations of atherosclerosis particularly if the diet is maintained over a prolonged period (p. 1418). Any grossly unbalanced diet, particularly one which interdicts the 45% of calories that is usually consumed as carbohydrate, is likely to induce some anorexia if the subject is willing to persevere in following such a bizarre regimen (p. 1419). Bizarre concepts of nutrition and dieting should not be promoted to the public as if they were established scientific principles (p. 1419). Patients should counsel their patients as to the potentially harmful results that might occur because of the adherence to the ketogenic diet (p. 1419). And finally: Observations on patients who suffer adverse effects from this regimen should be reported in the medical literature or elsewhere, just as in the case of an adverse drug reaction (p. 1419).Important points missing from Whites critique include the following:He ignores evidence from North America that establishes a high-fat diet can manage T2DM (see subsequent discussion). He also ignores Penningtons work, which shows obesity can be effectively treated with this dietary intervention.He ignores opinions from Britain, especially the published work of John Yudkin, a former Professor of Nutrition and Dietetics at the University of London. Unlike White, but like Pennington (and Atkins), Yudkin had actually studied the low-carbohydrate diet in real patients and become convinced of the value of this diet for the management of obesity (37-41). Thus, Yudkin wrote in 1972: I have no doubt that in practice the low-carbohydrate diet will be found to be the most effective and, nutritionally, the most desirable for the management of obese patients (41, p. 154). In the same article, he warned of the danger of drawing conclusions from theoretical considerations rather than practical experience.White ignores the editorial by Thorpe, advocating the value of this diet in the same journal two decades earlier (26).He ignores Atkins extensive discussions of the role of carbohydrate intolerance (insulin resistance) in obesity and T2DM, as well as Atkins explanation of why the high-fat diet works in persons with this condition. White, who is not a medical practitioner and has no personal experience in the treatment of persons with obesity/T2DM, fails to appreciate that Atkins advocacy was for a diet that worked best for persons with carbohydrate intolerance/insulin resistance.Whites errors are further underscored by the absence of reports in the medical literature of adverse effects from the regimen in the 46 years since he made the plea that all such negative outcomes should be reported.None of Whites misgivings deter Westman, who negotiates with Atkins to fund another trial, this time in persons with T2DM. The resulting study finds that 21 patients with T2DM who followed the diet for 16 weeks lost an average of 9 kg (19.8lbs), reduced their blood HbA1c values by 1.2% (Figure 1), and improved all their blood markers, including reducing blood triglyceride concentrations by an average of 1.1 mmol/L (42). Seventeen of the 21 patients reduced or stopped using anti-diabetic medications, indicating disease remission or perhaps even reversal in some.

Figure 1: Changes in glycated hemoglobin (HbA1c) concentrations in 21 patients with T2DM who ate a low-carbohydrate diet for 16 weeks. HbA1c concentrations are a measure of the average 24-hour blood glucose concentrations over the previous three months. Values greater than 6.5% are considered diagnostic of T2DM. According to this measurement, 14 of 21 (67%) patients put their T2DM into remission on this eating plan. Reproduced from reference 42.

Since an HbA1c below 6.5% is considered to be the upper end of the normal range, perhaps this is the first study in the modern literature showing remission or reversal of T2DM while using nothing more than a dietary intervention. Importantly, there is no single report in the medical literature documenting T2DM remission or reversal while following usual medical care including the prescription of insulin or other medications.

For historical completeness, its appropriate to mention that Leslie Newburg and colleagues at the University of Michigan began to use a high-fat, low-carbohydrate diet to treat T2DM in the 1920s (43-49). It seems probable that among the 73 patients they reported in their first paper (43), some may have gone into remission on the high-fat diet. Indeed, their second paper (44) shows a number of patients whose random blood glucose concentrations fall below 5.5 mmol/L (0.10%), as does their third paper (45). The authors also argued that mortality in the group treated with this diet was no worse and might even have been slightly better than that for similar patients treated with the low-fat, low-calorie diet then promoted at the Joslin clinic.

In 1973, J.R. Wall and colleagues also reported the use of a carbohydrate-restricted diet produced good diabetic control on diet alone, in two-thirds of cases by the time of the second visit that is, within 2 to 3 weeks (51, p. 578). The authors main focus was not on reversal of T2DM. Rather, they wished to determine whether weight loss or carbohydrate restriction was the key to successful management of T2DM. They concluded that control of diabetes in obese patients who respond to diet alone is due to carbohydrate restriction rather than to weight loss (p. 578).

These studies show that already in the 1920s, there were those who argued that a carbohydrate-restricted diet is beneficial for the management of T2DM.

Westman and his colleagues establish this as fact, and their study shows that on a carbohydrate-restricted diet, some T2DM patients do not require medications to maintain good glucose control (42).

It takes another 13 years for a larger study to confirm these findings and bring the value of the low-carbohydrate diet for the management of T2DM to a much wider audience.

Drs. Jeff Volek, Ph.D., and Stephen Phinney, MD, are two other scientists whose research was funded by the Atkins Foundation. They undertake a number of studies of low-carbohydrate diets in different populations, ultimately focusing on changes in blood lipid profiles in those with metabolic syndrome (52-58).

The key difference between their work and Dr. Gerald Reavens is, for the reasons I will suggest in due course, that Reaven balks at studying truly low-carbohydrate diets. Instead, Volek and Phinney choose to study properly low-carbohydrate diets (<50 g/day), and in the end, that makes all the difference.

Some of the most important findings from these studies are shown in Figure 2.

Figure 2: Changes in metabolic and other health markers in person with metabolic syndrome, randomized to either a high-carbohydrate (56%), low-fat (24%) diet or a high-fat (59%), low-carbohydrate (12%) diet. Both diets were hypocaloric (~1,500 cal/day). Note that all variables show greater improvement on the low-carbohydrate diet than the low-fat diet. Data from reference 54.

The evidence clearly shows that all variables improve to a greater extent on the low-carbohydrate diet. The greatest reductions are in blood triglyceride, insulin, and saturated fatty acid concentrations, with a marked increase in blood HDL-cholesterol concentrations as well.

The authors conclude:

Restriction in dietary carbohydrate, even in the presence of high saturated fatty acids, decreases the availability of ligands (glucose, fructose, and insulin) that activate lipogenic and inhibit fatty oxidation pathways. The relative importance of each transcriptional pathway is unclear, but the end result increased fat oxidation, decreased lipogenesis, and decreased secretion of very low-density lipoprotein is a highly reliable outcome of a low-carbohydrate diet. (55, p. 309)

In their most recent study, Phinney and Volek find that these benefits can occur rapidly and are not dependent on weight loss (58). There, they conclude: Overall, this work highlights the importance of the dietary carbohydrate-to-fat ratio as a control element in Metabolic Syndrome expression and points to low carbohydrate diets as being uniquely therapeutic independent of traditional concerns about dietary total and saturated fat intakes . Based on these results, any long-term trials in participants with Metabolic Syndrome should include low carbohydrate diets (p. 11).

Phinney and Voleks studies confirm and extend Reavens findings from between 1987 and 1994 (59), and address the impact of low-carbohydrate diets on the metabolic profile and other health markers of persons with the metabolic syndrome.

Logically, Reavens group should have completed and published studies identical to these already by the turn of the last century. Why they did not is a mystery I will explain subsequently.

Certain that the low-carbohydrate diet could correct the metabolic syndrome (55) and might even reverse T2DM in some individuals (41), some time around 2014, Phinney has the opportunity to speak to recently retired Sami Inkinen, who was planning to row across the Pacific from San Francisco to Honolulu on a carbohydrate-free diet (60, 61). Phinney, together with Jeff Volek, wishes to repeat the Westman study (41) in a larger group. But Phinney and Volek need help, so they ask Inkinen if he would be interested.

Inkinen agrees on one condition: that the study becomes part of a startup tech company, the ultimate goal of which is to reverse diabetes in 100 million persons by the year 2025. And thus, the Virta Health company is founded.

By 2016, the new company has recruited 262 persons with T2DM for a five-year study using a novel model of remote care that focuses on the prescription of a ketogenic, low-carbohydrate diet with regular feedback using relevant biometric measurements of food intake, and blood glucose and insulin concentrations.

In early 2017, the results of the first 10 weeks of the intervention are published (62). They show that the ketogenic diet reduces blood HbA1c by 1% (compare with Figure 1), even though 57% of subjects have either reduced or terminated their use of diabetic medications; 56% of subjects have reduced HbA1c values to below 6.5%, the value traditionally used for a diagnosis of T2DM.

In February 2018, the results for the first year of the study are published (63)*. Average HbA1c levels were now 6.3%, down from 7.6%; average weight loss was 13.8 kg; medication use other than metformin had decreased from 57% to 30%; and 94% of subjects had reduced or eliminated insulin therapy (Figure 3).

*Editors Note: As noted on CrossFit.com on May 14, 2019, the trial to which Prof. Noakes refers was funded and run by Virta Health, a private company that sells the app used in the trial to privately insured employers; as such, the trial involves a conflict of interest similar to a pharma-funded drug trial. Additionally, the 262 subjects all chose to opt into the Virta program and were neither randomized nor blinded. Despite these issues, the significance of this trial can hardly be overstated. This trial represents the first clear, long-term evidence in a large population that a ketogenic diet, when followed properly, can lead to significant improvements in health among Type 2 diabetics, and in many cases (in this trial, the majority) even resolves diabetes completely.

Figure 3: Top Panel: Percent changes in HbA1c, fasting blood glucose and insulin concentrations, Homeostatic Model Assessment Insulin Resistance (HOMA-IR), and diabetic medication use in persons with T2DM on the Virta Health intervention (blue) compared to patients receiving standard care (gray). Bottom left panel: Absolute changes in average HbA1c levels over the first 12 months of the Virta Health intervention. Bottom right panel: Percent weight loss in T2DM patients receiving the Virta Health intervention. Reproduced from the Virta Health website.

A separate paper compared changes in cardiovascular disease risk factors in the same populations (64). With one exception (circled in Figure 4), all changes in the Virta Health group were greater and considered to be more healthy than those in the usual care group.

Figure 4: Percent changes in multiple cardiovascular risk factors measured in persons with T2DM receiving either the Virta Health intervention or usual care. All changes favor the Virta Health group, with perhaps one exception (circled) persons in the usual care group show a reduction in blood LDL-cholesterol concentrations, whereas these concentrations rose in persons on the Virta Health intervention. However, as in the studies from the Volek research group (49, 53), this change was due to an increase in the size of the LDL-cholesterol particles. This is not considered an adverse health consequence. Redrawn from reference 64.

The sole exception was the increase in blood LDL-cholesterol concentrations in the Virta Health group. However, the long-term health consequences of this change are uncertain. For example, the Framingham study, which was designed specifically to determine which biological markers might predict future health risk, established that a falling blood cholesterol concentration with age is an indicator of failing, not improving health. In that study (65), falling blood cholesterol concentrations over the studys first 14 years were found to predict an increased mortality rate over the next 18 years. The study found a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (p. 2176). Thus, there was an 11% overall and 14% CVD death rate increase for each 1 mg/dL per year drop in blood cholesterol concentrations. In contrast, there was a lack of an association of total serum cholesterol measured after age 50 years with overall mortality (p. 2179).

Additionally, the increase in LDL-cholesterol concentrations in persons eating a low-carbohydrate diet was due to an increase in the number of large LDL-cholesterol particles (54, 55) and was not considered harmful.

In June 2019, the two-year results of the Virta Health study were reported (66). All the benefits already apparent at one year were sustained, and 54% of participants receiving the Virta Health intervention had reversed their T2DM; another 18% were in remission. No patient in usual care showed this response. Overall medication use fell from 55% to 25% in the Virta Health group so that daily insulin use fell from an average of 89 to 19 units/day.

Another recent study found evidence of significant improvements in non-invasive markers of liver fat and fibrosis (non-alcoholic fatty liver disease) in persons receiving the Virta Health intervention and no change in the usual care group (67).

Atkins is the single strongest thread binding all those on the North American continent who have promoted the low-carbohydrate diet over the past century.

He is the link from Icelandic Arctic explorer Vilhjalmur Stefansson to the work of the Virta Health company, guided by Finnish entrepreneur and ultradistance athletic explorer Sami Inkinen.

Most importantly, the definitive studies of Westman, Phinney, and Volek, together with those performed by the Virta Health company, prove that Atkins was correct.

So when the 100-millionth patient with T2DM is reversed by the Virta Health intervention sometime before 2025, Atkinss legacy will become one of the most significant in the history of modern medicine.

But what of Reaven? What will be his monumental contribution? How will he be remembered?

We take up that story next.

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Science is never settled, Part 3: Prof Noakes on Dr Atkins and Dr Westman - BizNews

No one wants to see their child sick, even if its just temporary. For example, the occasional upset stomach or diarrhea is expected if your child is home with stomach flu or eats something that doesnt agree with them. And often, the solution is simple eliminate troublesome foods or recover from the stomach flu.

But sometimes, you might suspect that theres something more going on. So, how do you determine that theres a more serious bowel or digestive problem with your child, and how do you work toward a long-term solution?

Lets look at some of the most common bowel problems that are found in children and their symptoms. Well also discuss treatment options and when you should contact a doctor or healthcare provider.

Digestive and bowel discomfort is quite a large health category, with many temporary or underlying causes that might be contributing to your childs tummy woes. But ultimately, you know your child better than anyone. So, if you see the following persistent symptoms, it might mean your child has a more serious digestive or bowel issue.

To receive a diagnosis of constipation, your child must be 4 years old or older and exhibit at least two or more of the below symptoms and experience them once a week for at least 2 months. Common symptoms include:

While uncomfortable, irritable bowel syndrome (IBS) isnt life threatening for your child, nor does it cause them additional health problems or digestive tract damage.

Symptoms of IBS include:

Inflammatory bowel disease (IBD) is another type of intestinal disorder that can cause inflammation in your childs digestive tract. Common forms of IBD include Crohns disease and ulcerative colitis.

Common symptoms include:

Unlike IBS, if left untreated IBD can create further complications such as bowel obstruction, malnutrition, and fistulas, and in more severe cases, it can contribute to colorectal cancer.

Hirschsprungs disease is a condition that impacts the large intestines. While its always present at birth, it can sometimes take a while for symptoms to appear. Children with Hirschsprungs disease may have trouble emptying their bowels. Symptoms can vary depending on your childs age.

Symptoms in newborns:

Symptoms in toddlers and older children:

While some formal diagnoses, such as constipation, wont be applied until certain timelines have been met, that doesnt mean that you cant see a pediatrician, or a doctor for infants and children, before then. For example, with constipation, if your childs symptoms and inability to pass stool have persisted for more than 2 weeks, youre encouraged to see a doctor.

And especially if your childs symptoms begin to get worse such as developing a fever, losing weight, or refusing to eat dont delay scheduling your child an appointment with a physician to start the diagnostic process and work toward a treatment plan.

The diagnostic process used to determine if your child has a bowel problem is going to depend on what disease or condition is suspected.

For example, childhood IBS and IBD both rely on a physical exam and a review of medical history (including family history). Depending on the results of initial reviews, a pediatrician may order a blood test, stool test, ultrasound, or even an endoscopy or colonoscopy.

Meanwhile, a suspicion of constipation will include a medical history and physical exam. It may sometimes also require other tests, such as a barium enema X-ray, abdominal X-ray, and even a motility test, if other conditions need to be ruled out, but often a doctor will be able to diagnose constipation without further tests.

A barium enema is also a primary tool for diagnosing Hirschsprungs disease, but a biopsy may also be necessary for this condition.

If youre concerned that the diagnostic process may be stressful for your child, make sure to talk with a doctor or pediatric team so you can know exactly what their testing process will be like.

Similar to diagnosing bowel problems, treatment methods can vary depending on your childs condition and the severity of it.

While constipation in children is very common, its also often undiagnosed and untreated. For many children, constipation can be treated at home by boosting fiber in their diet, increasing water intake, and encouraging more physical activity. With a doctors supervision, stool softeners or laxatives may be occasionally used.

IBD requires a comprehensive approach to treatment that incorporates both medication and dietary changes. The overall goal is to relieve symptoms and prevent future flare-ups to heal the intestines.

If an infection is suspected, your child might be prescribed antibiotics. But other treatments can include:

To treat IBS, nutritional changes are frequently encouraged, along with possibly being prescribed probiotics to help balance your childs gut. A doctor may also prescribe a range of different medications depending on their symptoms.

Depending on the type of IBS, your child may be prescribed medications to treat associated conditions such as constipation or even antidepressants depending on how severely the condition is impacting your childs quality of life.

Due to the seriousness of Hirschsprungs disease, surgery is the most effective method for treating the condition. Depending on the severity of their condition, children may either undergo one or two surgeries to remove the unhealthy part of their colon and treat the disease.

Although some bowel conditions arent life threatening, they can impact your childs quality of life. For example, conditions such as IBS which usually dont cause more concerning medical conditions can cause children to miss out on social events, or to even find it difficult to be present in school. This can negatively impact your childs mental health.

Meanwhile, if left untreated, other conditions can act as precursors to more serious health complications. Even constipation, which is incredibly common in children, can manifest into bladder control issues, fecal impaction, hemorrhoids, rectal prolapse, and even anal fissures.

Untreated IBD can lead to painful ulcers and damaging bowel inflammation. Additionally, it has been known to also cause rashes, arthritis, eye and liver problems, and slow growth and delayed puberty.

Because Hirschsprungs disease already prevents children from properly passing stools, leaving it untreated can be life threatening and lead to toxic enterocolitis.

Regardless of the source of your childs gastrointestinal distress, its important to get a treatment plan established with a doctor as soon as you can.

Sometimes an upset stomach or a case of diarrhea is temporary, and at other times it might be more serious. These bowel problems in children can be caused by a variety of conditions, some of which can lead to more health problems if not dealt with.

If you suspect that your childs tummy issues might be something more, be proactive and reach out to a pediatrician. When caught early, treatment can prevent further long-term problems that would impact your childs quality of life.

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Bowel Problems in Children: When It's More Than an Upset Tummy - Healthline

It is generally believed that intestinal bacteria are closely related to our diet, but research has found that high intestinal bacteria diversity and having a large number of beneficial bacteria are also related to exercise. According to gut bacteria experts, doing aerobic exercise correctly can improve the gut microbiome.

When you get out of the house and go jogging in the park, your gut bacteria may have started to change for the better, even if you dont take extra probiotics.

Research by Jeffrey Woods, a professor of kinesiology and community health at the University of Illinois, found that regular exercise habits, independent of diet or other factors, result in more diverse intestinal flora.

The researchers had a group of usually sedentary people do 30 to 60 minutes of aerobic exercise three times a week for six weeks. The exercise intensity ranged from moderate to high. Then, they were allowed to return to their original sedentary lifestyle, also for six weeks.

As it turned out, after six weeks of regular exercise, there were changes in the composition and function of the participants intestinal microbiome. Many participants gut microbiome helped produce more short-chain fatty acids.

These fatty acids supply nutrients to intestinal cells, regulate the function of some immune cells, and have anti-inflammatory, anti-tumor, and antibacterial properties. They also play an important physiological role in many organs, including the brain.

However, when participants returned to a sedentary lifestyle, their active gut microbiota returned to its pre-exercise state.

Why does exercise affect intestinal bacteria?

Dr. Ting Chief Tsai, chair professor at National Yang Ming Chiao Tung University, explained that the epithelial cells on the surface of the intestines are closely related to the endocrine and immune systems, and that these two systems secrete different substances.

Underneath the epithelial cells is the circulatory system. When people perform exercises that promote blood circulation, the blood flow is accelerated, and the oxygen supply is sufficient, which will activate the endocrine and immune systems in the intestines, as well as the secretions of these systems.

Dr. Tsai pointed out that the intestinal bacteria are sensitive to changes in the intestinal environment. The intestinal bacteria can also sense the aforementioned series of changes, and they would then change accordingly.

However, as to how these environmental changes specifically affect the intestinal bacteria, the scientific community is still unclear.

Regarding the effects of exercise on gut bacteria, a 2021 review published in Frontiers in Nutrition showed that moderate aerobic exercise reduces inflammation and positively affects gut microbial diversity and metabolism.

An Italian study conducted in 2017 found several health benefits of exercise on intestinal bacteria.

Exercise increases the Bacteroidetes-Firmicutes ratio, which may help with weight loss, and improve obesity-related diseases and gastrointestinal disorders.

Bacteroides can break down plant starches and fibers into short-chain fatty acids, while Firmicutes prefer a diet high in oil and sugar and are also known as the obesity bacteria.

At the same time, exercise can stimulate the proliferation of intestinal bacteria that can regulate mucosal immunity and improve barrier function, thus reducing the incidence of obesity and metabolic diseases.

Exercise can also stimulate intestinal bacteria to secrete substances (such as short-chain fatty acids) that prevent gastrointestinal diseases and colorectal cancer.

However, not all exercises can bring about positive changes in intestinal bacteria.

Common exercises include aerobic exercise to strengthen the heart and lungs, and resistance exercise to train muscle strength. Studies have found that aerobic exercise is more effective in improving intestinal bacteria.

Northern Arizona University conducted a study, in which subjects performed aerobic and resistance training exercises for eight weeks, and the researchers observed the effects of these exercises on their intestinal bacteria.

As it turned out, the subjects who underwent resistance training did not experience changes in their intestinal bacteria. However, in the subjects who did aerobic exercise, intestinal microbiota showed significant changes in the second week of exercise compared to the first week.

Dr. Tsai pointed out that resistance training has little effect on blood circulation and little systemic effect on the entire body. This means there is no shortness of breath and no lack of oxygen, he added.

However, if the resistance training is long-term, which increases the muscle mass and raises the basal metabolic rate, then it will have positive effects on the intestinal bacteria.

In contrast, even if you only run or jump rope for 5 to 10 minutes, a short period of aerobic exercise will promote blood circulation throughout the body and increase the supply of oxygen in the body.

To improve intestinal health, we have two more tips:

Take note of the fact that high-intensity exercises actually have a negative impact on the intestinal bacteria. An example of a high-intensity exercise is a triathlon, which includes swimming, bicycling, and long-distance running.

Although swimming, bicycling, and long-distance running are all aerobic exercises, Dr. Tsai said that prolonged high-intensity exercises would result in reduced blood flow to the intestines, causing systemic inflammation and thus harming the intestinal bacteria. He pointed out that moderate aerobic exercise can make the intestinal bacteria quickly adjust and start improving in the right direction.

We did a study and found that triathlon athletes are very stressed before a competition, so their immune system will be in decline, and their entire intestinal microbiota will deteriorate, said Dr. Tsai.

He emphasized that mental and stress factors have a great impact on the intestinal bacteria, because they are the most sensitive sensors in the body. He said, If you drink a glass of beer, they will change; and if you even say a negative sentence, they will also change.

Therefore, it is necessary to exercise in a happy mood, and proper exercise can also help relieve stress. Its only when a person becomes relaxed and has stress relieved that the balance of intestinal bacteria can be improved.

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Beyond Diet: 10 Minutes of This Helps Heal the Gut - The Epoch Times

Concerns about personal health and climate change are key drivers for consumers to choose plant-based food and beverage options, according to Datassential's 2022 Plant-Forward Opportunity report.

By Tricia Contreras Published: June 27, 2022

Concerns about personal health and climate change are key drivers for consumers to choose plant-based foods and beverages, according to the 2022 Plant-Forward Opportunity report. Datassential, which created the report in collaboration with The Culinary Institute of America, Food for Climate League and the Menus of Change University Research Collaborative, unveiled the third iteration of the yearly consumer survey at the 10th annual Menus of Change conference at The Culinary Institute of America in Hyde Park, N.Y., earlier this month.

More than 1 in 5 (21%) of the 1,500 US consumers surveyed said they are looking to reduce their meat consumption up from 15% who said the same last year, according to the report. Fifty-seven percent of consumers want to increase their fruit and vegetable intake, and about a third of those surveyed want to increase their consumption of meat or egg substitutes or other plant-based proteins.

One of the key drivers of the plant-based movement is health and nutrition, and Datassential polled consumers on what health benefits they hope to get by eating a more plant-based diet.

The main health benefit consumers seek from plant-based foods and beverages is digestive health, with 39% of respondents saying they seek out plant-based options for this reason. Protection from long term disease is a key value for 32% of consumers, while 29% look to plant-based foods for weight loss.

I think that suggests that consumers are looking to plant-based foods with a longer runway in mind, Datassential researcher Marie Molde said while addressing the audience at Menus of Change on June 14.

So its not that Im choosing a plant-based or plant-forward choice to avoid getting a cold tomorrow there is some of that but more so its this notion of I want to choose plant-based because I want this longterm runway of health in my life, Molde said.

Another factor driving consumers to limit meat intake and eat more plant-based foods is the effect food production has on the environment. More than half (55%) of consumers overall view the issue of climate change as extremely or very important, while those who limit their meat consumption were more likely to list climate change as a major concern. Seventy-one percent of vegan, vegetarian, pescatarian and flexitarian consumers said climate change is an important issue to them.

Unsurprisingly, consumers who are concerned about climate change are more likely to believe that the food choices they make have an impact on the environment. Three-quarters of respondents who are concerned about climate change said they think the choices they make about what to eat have an impact on the environment, while only 57% of total respondents said the same. Furthermore, two-thirds of climate-concerned respondents said plant-based foods are generally better for the environment than animal-based foods, compared to half of overall respondents who said the same.

While consumers express a growing interest in plant-based eating for health and environmental reasons, there are still several factors that can keep them from choosing plant-based options on the menu or the store shelf.

The factor that most often keeps consumers from choosing plant-based foods is taste. More than half of those surveyed (53%) said taste concerns hold them back from eating plant-based foods at all or more often, while 39% said the same about affordability concerns. Rounding out the top five reasons were texture concerns (32%), uncertainty about nutritional value (21%) and uncertainty about how to cook or prepare plant-based foods (19%).

The survey also delved into how consumers view traditional plant-based foods such as beans, lentils and tofu compared to the wave of new plant-based protein products that are meant to emulate meat such as the burgers and chicken nuggets from brands like Impossible Foods.

With so many headlines and menu items dedicated to this new breed of plant-based foods, it may come as a surprise that plant-based whole foods edged out plant-based protein products that are meant to be meat analogues. Twenty-three percent of consumers said they are more interested in plant-based or plant-forward choices that emphasize whole, less processed foods, compared to 18% who said they would prefer to be able to order plant-based substitutes that taste just like their favorite burgers and sausages.

Plant-based whole foods also came out slightly ahead when it came to consumer perceptions of their health and environmental benefits. Among consumers who said they are concerned about the environment, slightly less than two-thirds (64%) said we would have less of a negative impact on the environment by reducing our consumption of meat and eating more plant-based foods that are meant to replicate meat, while 69% said the same about eating more whole food plant-based foods that are not meant to replicate meat. Only 33% of consumers think new meat analogues are healthier than traditional plant-based options like beans and soy products such as tofu, and just 21% believe these newer meat analogues are actually a better substitute for animal proteins.

To ensure that consumers continue to make choices that benefit personal and environmental health, it is essential that restaurants, retailers and food and beverage manufacturers offer options that appeal to consumers values and taste buds.

The survey suggests that consumers are already looking to brands and restaurants to lead the way. Nearly 6 in 10 consumers (58%) are already choosing environmentally-conscious brands at least occasionally when shopping retail, and 33% said they are open to doing so in the future. Forty-six percent said they often or occasionally choose to visit restaurants that care about the environment, and almost as many (44%) said they would be open to dining at climate-conscious restaurants in the future.

In addition to the food they offer, Molde said restaurants and manufacturers should also consider how they deliver it to consumers.

Something that really continued to pop was packagingand how that is coming into the consideration set of consumers when theyre making sustainable food choices, she said, noting that 77% of those surveyed said they believe the type of material used to package food has an impact on the environment.

Although, of course, most of us in the room are focused on food and beverage and flavor and things like that, we have to think about packaging too because our consumers are thinking about that.

Paying attention to the full package from the food to the packaging that contains it will help brands and restaurants move the needle toward a more sustainable future by making it easier for consumers to make virtuous choices.

As Datassential writes in the report, [c]hefs and restaurant industry leaders who care about planetary health have an enormous opportunity to raise the visibility of their efforts and better engage an increasingly sustainability-minded dining public.

_____________________________________

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Personal, planetary health drive appetite for plant-based foods - Smartbrief

Patients

Data were collected from the Iranian National Obesity Surgery Database (INOSD)12 and all surgical procedures were performed at a tertiary, academic and accredited IFSO-EC bariatric surgery center.

All the patients who had undergone OAGB from September 2014 to January 2017 were evaluated. During this time, 1356 patients had undergone OAGB, including 73 cases as conversion surgery. A total of 29 patients had undergone conversional OAGB following SG due to weight regain or incomplete weight loss. We only included the 23 patients who had completed their 5-year follow up (Fig.1).

Flow chart of the patients participated in the study.

Prior to the conversional OAGB, all the patients were evaluated by a Multidisciplinary Team (MDT) and an esophagogastroduodenoscopy (EGD) was performed on them.

SG failure was taken as weight loss failure or weight regain and was defined as an unsatisfying weight loss (EWL<50% in 1year)13, a BMI greater than 35kg/m2 after reaching the appropriate weight, or 25% EWL increase from the nadir weight14.

The data registered at the time of SG and OAGB included age, gender, weight, height, nadir weight, BMI, percent excess weight loss (%EWL): %EWL=[(Initial Weight)(Post-Op Weight)]/[(Initial Weight)(Ideal Weight)]14 and conversion indication.

Obesity associated medical problems included type-2 Diabetes Mellitus (DM), arterial Hypertension (HTN), dyslipidemia, Obstructive Sleep Apnea (OSA) and GERD, weight indicators and obesity associated medical problems outcomes were evaluated 1, 2, 3 and 5years after the conversion to OAGB. The changes in obesity associated medical problems were classified in five categories: no change, remission, improvement, new onset and recurrence, which were assessed according to standardized outcomes reporting in metabolic and bariatric surgery14.

DM remission was defined as HbA1c<6%, FBG<100mg/dl) in the absence of anti-diabetic medications. HTN remission was taken as being normotensive (BP<120/80) without antihypertensive medications. Dyslipidemia remission was confined to normal lipid profile (LDL, HDL, Cholesterol, TG) without medication usage. GERD remission was defined as the absence of symptoms with no medications14 and the GERD score was assessed using the GERD-Q questionnaire15 in these patients. The patients with GERD score more than eight points were evaluated by EGD. DM improvement was defined as statistically significant reduction inHbA1c and FBG or decrease in antidiabetic medications requirements. HTN improvement was taken as a decrease in dosage or number of antihypertensive medications or decrease in systolic or diastolic blood pressure (BP) on the same medication. Dyslipidemia improvement was confined to decrease in number or dose of lipid-lowering agents with equivalent control of dyslipidemia or improved control of lipids on equivalent medication14.

All of the surgeries were carried out by two senior surgeons of one bariatric surgery team. For these surgeries, the surgeon stands in between the patients legs in the French position. OAGB was performed with five trocars laparoscopic technique. The patient was administered general anesthesia. First, the His angle was released and adhesiolysis was performed. Then, the gastric pouch was constructed along the lesser curvature beginning from the distal part of the crows foot to the angle of His and if the sleeve tube was dilated, the pouch was trimmed on a 36 Fr calibration tube and the remnant was excised. Then, gastrojejunostomy was carried out with a 3040mm anastomosis length in the posterior wall of the pouch side to side with the jejunum with a biliopancreatic limb (BPL) of 180cm for BMIs under 50 and 200cm for BMIs of 50 and over by a linear stapler. The enterotomies were closed with one-layer absorbable suture (PDS 2-0). Finally, after obtaining a negative air leak test, a drain was placed for the patient. The average of operation time was 70min.

On the first postoperative day, after the methylene blue leak test and clear liquid tolerance, the drain was removed and according to Enhanced Recovery after Bariatric Surgery (ERAS) protocol the patient was discharged16.

The research followed the tenets of the Declaration of Helsinki. The Ethics Committee of Iran University of Medical Sciences approved this study (IR.IUMS.REC.1399.801). Accordingly, written informed consent was taken from all participants before any intervention.

The mean, standard deviation (SD), percentage and 95% confidence interval (CI) were reported for the description of the data. Repeated measurements were used to assess the trend of changes in weight, BMI, %TWL and %EWL after conversion surgery. Friedmans test was used for changes in the pattern of obesity associated medical problems during the time. The level of statistical significance was taken as P-value<0.05. All the analyses were carried out in SPSS version 25.0 (Chicago, Illinois, USA).

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Five-year outcomes of one anastomosis gastric bypass as conversional surgery following sleeve gastrectomy for weight loss failure | Scientific Reports...

2. Atkins diet - 67.9 percent positive feedback

One review compared seven popular diets and found that Atkins was most likely to result in significant weight loss after six to 12 months.

Plus, 75 percent of the studies indicated that Atkins may be effective for long-term weight loss.

The Atkins diet is low-carb, with the theory that as a person reduce carbs, their body will be prompted to use fat for fuel, resulting in weight loss from this fat-burning metabolism.

Researchers say people should expect to see significant results within 14 days of starting the diet.

A person on the meal plan will eat fruits, vegetables, whole grain, low-fat dairy foods, poultry, fish, nuts, and beans, but they will limit their intake of red meat, fat, sugar, and salt.

Foods should be low in sodium, saturated and trans fats, rich in fibre, protein, magnesium, calcium, and potassium.

Despite the positive weight loss feedback, experts have explained the Atkins diet is "not a good all-purpose diet" for long-term weight loss.

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Which diet is for you? The most successful plans for weight loss - 'You can stick to them' - Express

A juice cleanse is a diet where you consume nothing but juices containing vegetables, fruit and other healthy items such as cashew nuts. Its about flooding your system with an abundance of incredible nutrients, claims Kara Rosen, founder of a juice brand called Plenish. On a cleanse, youre abstaining from eating solid foods, but its also about the other thing that youre not putting into your body (coffee, sugar, alcohol, and stimulants) and getting lots of hydration, she added. The benefits of the diet are said to be numerous. Jenny Hardwick, a nutritionist at Plenish, claims the diet can aid energy levels, help with weight loss and bloating. But other nutritionists are sceptical.

Talking with Express.co.uk, some nutritionists have contested the idea that juice cleanses detox the body at all, and believe it can even end up damaging our health.

Rachel Clarkson, a reviewed dietician and nutritionist and founder of The DNA Dietician, said: The human body has a complex detoxification system in the liver, kidneys, lungs and even skin that are constantly cleansing the body, ridding it of toxins and detoxifying it of any unwanted materials 24 hours a day.

No amount of drinking juice will aid with this process. Sadly, juice cleanses have zero scientific evidence to back up their use and are just pseudo-science wellness and marketing claims.

According to some nutritionists, aside from having little evidence to show they flush toxins from the body, juice cleanses are likely to be detrimental to weight loss in the long term. Studies have even linked juice cleanses to a higher risk of diabetes.

READ MORE: Hair loss: Three hair-care habits found to be responsible for permanent hair loss

Ironically, if we consistently take a large number of herbal supplements and/or fast it can actually end up damaging our health, said Tamra Willner, nutritionist for NHS partnered health brand Second Nature.

She adds: As detox diets mainly consist of juices, fruits and vegetables, the lack of protein will cause your muscle to waste away.

So, while youve lost overall weight (which appears good on the surface), youve also lost muscle mass (which is bad). This will reduce your longer-term metabolism, meaning that you will burn fewer calories at rest.

The goal of weight loss is to reduce body fat while maintaining muscle levels.

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One study published in August 2013 in the British Medical journal found that drinking fruit juice was associated with a higher risk of type 2 diabetes. Eating whole fruits, like blueberries, apples, and grapes, on the other hand was linked with a reduced risk.

Juice cleanses also contain no protein or fibre, which can result in loss of muscle mass and huge spikes in blood sugar if the juice is predominantly fruit, explained Clarkson from The DNA Dietician.

This spike in blood sugar is quickly followed by a crash in blood sugar levels, making you crave sugar, which increases feelings of irritability and hunger and decreases energy and focus.

Willner offers her advice to people who want to lose weight safely: The fastest way to lose weight and keep it off in the long term is to reduce the number of ultra-processed foods (cakes, crisps, biscuits) and refined carbohydrates were eating (white bread, white pasta, white rice).

Instead, consider building your meals from protein (chicken, tofu, fish, eggs), healthy fats (olive oil, avocado, nuts) and non-starchy vegetables (broccoli, peppers, spinach etc).

If you are truly set on doing a detox diet, consider juices or foods that are vegetable-based, rather than fruit-based, to reduce the potential spikes in blood sugar levels, and avoid particularly strenuous exercise whilst your energy levels are low.

Continued here:
Juice cleanse may be damaging to health - how it could increase risk of diabetes - Express

If you are trying to manage your weight in a healthy way, you may think that means doing without the craveable taste of frozen sweet treats. And while it is true that eating frozen snacks that are loaded with added sugars, fat, or empty calories won't do you any favors in the weight management department, there are some better-for-you choices available in the frozen novelty aisle that can support your wellness efforts without compromising on taste.

From frozen treats made with sugar alternatives instead of table sugar to sweet chilly treats that lean on the natural flavor of fruit instead of empty calorie ingredients, the better-for-you options are abundant (and thank goodness for that).

If you want to do without frozen desserts that are ultra-sugary and empty calorie-laden, here are four frozen dessert choices that fit the billallowing you to have your cake (or pop) and eat it too. Read on, and for more on how to eat healthy, don't miss Eating Habits to Lose Abdominal Fat As You Age, Say Dietitians.

Sorbet is the ultimate sweet treat that hits the spot on a warm summer day. But for those people who want to enjoy a fruity sorbet treat while supporting their health and wellness goals, Halo Top Mango Sorbet fits the bill. This sorbet contains only 100 calories per serving and a whopping 55% less sugar per serving than leading frozen fruit sorbet options, making it a treat that you can feel good about eating.

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Wyman's Just Fruit & Banana Bites are dairy-free and made with wild blueberries and strawberries for the perfect grab-and-go snack and refreshing treat. At just 40 calories per serving and perfectly portioned, this frozen treat is as fun to eat as it is good for you. Bonus? Wild blueberries have twice the antioxidants than ordinary blueberries.6254a4d1642c605c54bf1cab17d50f1e

A fudge bar that comes with a boost of probiotics and only contains 80 calories per serving is a dream come true for frozen treat lovers who have some serious health goals.

Data shows that the inclusion of probiotics in a diet is linked to weight loss and a reduction in BMI. And the fact that this pop contains 6 grams of protein per serving adds a satiety factor to eating this treat too, which may ultimately help people eat less over the long term and support their weight loss goals.

If you are a lover of the old-school fudge bars, making the swap to Yasso Chocolate Fudge Bars will provide you with the same satisfying taste but with an extra boost of weight management-supporting yogurt live cultures, protein, and micronutrients like calcium and potassium.

Sweetened with monk fruit juice and allulose instead of added sugars, this no-sugar-added frozen treat from Chloe's contains only 50 calories per pop. These treats are a great alternative to classic fruit pops that are jam-packed with added sugars and artificial colors for those who want to manage their weight in a delicious way.

Lauren Manaker MS, RDN, LD, CLEC

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4 Best Frozen Desserts for Weight Loss, Says Dietitian Eat This Not That - Eat This, Not That

Get it, girl! Winter Everett has gone on a public weight loss journey since she first appeared as part of sister Chantel Jimeno (ne Everett)s story line on season 4 of TLCs 90 Day Fianc. The Everett and Jimeno families continued to share their journey on their own spinoff,The Family Chantel. During season 4 of the show, Winter took a major step for her health and underwent weight loss surgery.

During season 2 of The Family Chantel, Winter took cameras along to a consultation appointment for bariatric surgery. She was 313 pounds at the time, and the show was filmed sometime in 2020.

In July of that year, Winter took to Instagram to reveal she had lost 50 pounds.

The picture on the left was taken a few years ago. Back then I was around 330 pounds, Winter captioned a before-and-after photo of herself. That was the heaviest I had ever weighed. So many unfortunate situations surrounded me and my focus was directed outwards. During that time, my health was definitely not a priority.

The Georgia native said her body was screaming out for help, but she didnt know how to start her weight loss journey. She ended up setting a fitness goal and changed her perspective on weight loss and before she knew it, the extra pounds came right off.

In 2020, I completely changed my focal point. Instead of focusing on what I want, I tried to focus more on WHO I AM, she added. It was not an easy road, but I made it. Its only down from here!

Following her split from her long-term boyfriend Jah King, Winter decided to focus on herself and thats when she decided to undergo weight loss surgery.

After the breakup, I was sitting in my room scrolling through TikTok and I saw the Weight Loss Barbie, Winter said on the season 4 premiere of The Family Chantel. She was telling her story about how she has the bariatric surgery in Mexico. So I decided to do some research and look into her doctors and I decided that this would be a great opportunity for me.

Winter decided she would travel to Mexico to have her bariatric surgery done by the same surgeons as the Weight Loss Barbie. The gastric sleeve procedure, which is also called sleeve gastrectomy, is a type of bariatric surgery that shrinks the stomach for the purpose of long-term weight loss.

However daunting, Winter did not have to face the operation alone. Her mom, Karen Everett, and sister Chantel were there alongside her to offer support.

While comforting her sister before the surgery, Chantel assured Winter that its going to be OK, adding that it is the start of a new beginning for her.

After reassuring Winter, Chantel goes on to explain that the surgeon will be removing 75 percent of her siblings stomach.

Keep scrolling below to see before and after photos of Winters weight loss journey!

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The Family Chantel Star Winter Everetts Weight Loss Surgery Journey: Before and After Photos - inTouch Weekly

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