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Tuesday, February 27, 2024

NIH-supported study shows long-term benefits of surgery compared to medication and lifestyle change.

People with type 2 diabetes who underwent bariatric surgery achieved better long-term blood glucose control compared to people who received medical management plus lifestyle interventions, according to a new study supported by the National Institutes of Health. The participants who underwent bariatric surgery, also called metabolic or weight-loss surgery, were also more likely to stop needing diabetes medications and had higher rates of diabetes remission up to 12 years post-surgery. Results of the study were published in JAMA and funded by the National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK), part of NIH.

While there are many factors involved, and not all of them are completely understood, bariatric surgery typically results in greater weight loss that affects a persons metabolic hormones, which improves the bodys response to insulin and ability to maintain healthy blood glucose levels, said Dr. Jean Lawrence, NIDDK project scientist. These results show that people with overweight or obesity and type 2 diabetes can make long-termimprovements in their health and change the trajectory of their diabetes through surgery.

The current study is a follow-up that combined data from four independent single-center randomized trials conducted at clinical sites in the United States. The original trials, which were conducted between May 2007 and August 2013, evaluated the effectiveness of bariatric surgery compared to intensive lifestyle and medication therapy involving oral and injectable diabetes medications including insulin, for adults with type 2 diabetes and overweight or obesity. While some participants in the study were prescribed GLP-1 agonists as part of their medical management of diabetes, these drugs were not specifically examined in the study. The investigators from the four individual studies pooled their data to provide a larger and more geographically diverse data set to evaluate efficacy, durability, and safety of bariatric surgery to treat type 2 diabetes. Follow-up data were collected through July 2022.

In total, 262 participants from the four original studies enrolled in the current study. Of these, 166 were randomized to surgery and had undergone one of three bariatric surgery procedures. The remaining 96 participants were randomized to the medical/lifestyle management group. The medical/lifestyle interventions have previously been shown effective for weight loss. All participants were between the ages 18 and 65 and had overweight or obesity as measured by body mass index, or BMI. Primary endpoint results were measured at seven years, with continued follow-up through 12 years.

At seven years, participants in the surgery group experienced an average 20% weight loss compared to 8% in the medical/lifestyle group. The surgery group had greater improvements in blood glucose control, measured by HbA1c, with 54% of participants in the surgery group achieving an HbA1c less than 7% compared to only 27% of participants in the medical/lifestyle group. More participants with surgery achieved diabetes remission compared to participants in the medication/lifestyle group, and the percent of participants using medications to treat diabetes in the surgery group decreased from 98% to 61%, yet remained largely unchanged in the medication/lifestyle group.

The results and differences between groups remained significant at 12 years.

Additional exploratory analyses in this study showed that bariatric surgery had important, beneficial effects on HbA1c and weight loss among participants with a BMI between 27 and 34 (within overweight and lower obesity ranges). These findings lend important information about the benefit of surgery in people with type 2 diabetes who fall short of the traditional, higher BMI threshold of 35 for bariatric surgery, said Dr. Anita P. Courcoulas, chief of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center and lead author of the study.

No differences in major adverse events occurred between the two groups, but there was a higher number of fractures, anemia, low iron, and gastrointestinal events in the surgery group. Nutritional deficiencies may explain fractures and anemia, underscoring the importance of continued monitoring of people who have bariatric surgery.

Obesity and type 2 diabetes are complex conditions with many common risk factors and long-term complications, said NIDDK Director Dr. Griffin P. Rodgers. This study exemplifies how public investments in obesity and diabetes research can lead to real clinical advances and long-term health benefits for millions of Americans experiencing these conditions.

The study, known as the Alliance of Randomized Trials of Medicine vs. Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is supported by cooperative agreement U01DK114156 from NIDDK.

The NIDDK, part of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see https://www.niddk.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIHTurning Discovery Into Health

Courcoulas AP, Patti ME, Hu B, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes. JAMA. 2024; doi:10.1001/jama.2024.0318.

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Bariatric surgery provides long-term blood glucose control, type 2 diabetes remission - National Institutes of Health (NIH) (.gov)

Does anyone really need to lose weight?

Project HEAL, an organization focused on equitable access to treatment for eating disorders, believes intentional weight loss is not healthy for anyone.

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Project HEAL promotes body acceptance, or accepting ones body exactly as it is, regardless of weight, size, or shape.

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Body acceptance can improve body image (the thoughts and feelings someone has about their body) and reduce a person's risk of developing an eating disorder, says Stephanie Albers, PhD, a clinical assessment program manager at Project HEAL. A positive body image can also help people realize they do not need to participate in disordered eating behaviors for their body to be good, Dr. Albers explains.

Everyday Health sat down with Albers to talk about body acceptance, why Project HEAL does not promote intentional weight loss for health, and how to make treatment for eating disorders more accessible.

Everyday Health: Why does Project HEAL believe no one really needs to lose weight?

Stephanie Albers: Project HEAL does not support intentional weight loss because efforts aimed at weight loss far too rarely produce the desired result and far too often lead to eating disorders. If the goal is health, not only is weight a poor indicator, but we have to include mental health in that equation. When it comes to dieting as the kids say, the math simply doesnt math.

EH: What research backs this up linking attempted weight loss to poorer mental health, including eating disorders?

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RELATED: Why Arent We Paying More Attention to Eating Disorders in People With Larger Bodies?

EH: Are there other potential health consequences of intentional weight loss?

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The demonstrated physical and psychological risks of intentional weight loss, including the likelihood of developing eating disorders, are too concerning to ignore.

EH: Given that people at higher weights tend to have an increased risk of complications like heart disease, how can doctors help people in bigger bodies address their health while still looking out for potential issues?

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No matter what an individuals weight is, they should receive a comprehensive physical exam, be asked to provide a complete medical history, and undergo necessary tests to determine risk for any medical condition or receive an official diagnosis.

It is simply not okay to assume a patient in a larger body is at risk for certain medical conditions based on weight alone. Discussing all known risk factors not exclusively weight provides a more inclusive approach to health issues that have been solely attributed to weight in the past.

EH: Why is body acceptance (as a means of achieving health) so important to Project HEALs mission?

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EH: There are many misconceptions about eating disorders, including that someone has to be thin to have one. Whats the solution to helping more people realize that myth is not true and help people in larger bodies recognize when they do have disordered eating behaviors?

SA: Body acceptance helps us understand that it's detrimental to have a disordered relationship with food, no matter our size. This helps us recognize harmful and eating disordered behavior because we know that it can occur in anyone. Rather than believing that dieting, weight cycling, and eating disorders are acceptable due to society's unrealistic ideals, we can identify how others in our community are struggling and support them.

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EH: What are some other barriers to better prevention and treatment of eating disorders for people in bodies of all sizes?

SA: Depending on their diagnosis and whether they meet certain weight criteria (like having a higher BMI), some people may not be eligible for their insurance to pay for the cost of inpatient care. We are working toward getting equitable access to care for all no matter what type of body you are in.

Project HEAL does this through a couple of different avenues. We have our treatment placement program, which we have made up of ourHEALers circle (treatment providers and centers who donate pro bono care to certain Project HEAL beneficiaries each year), which is used to help place folks with treatment if their insurance does not afford it.

We offer a virtual meal support program for folks over 16 at the outpatient level of care to drop in and attend as well. We haveinsurance navigation, meaning we offer services to help if you're trying to navigate insurance difficulties, or even signing up for insurance that can help cover some of your care.

Within my role, I work on theclinical assessment, which is providing a diagnosis and level-of-care recommendation for someone with an eating disorder, regardless of their background.

EH: How can talking about body acceptance help buffer some of the harms of diet culture, especially when it comes to conversations with young people?

SA: Talking about body acceptance, particularly for people with kids and teens around them, is important because it helps rewrite the narrative about what bodies are considered valuable in our society. It is important to discuss body diversity when these questions come up. For instance, you can emphasize that, "Bodies aren't all meant to look alike. That is the beauty in having a body.

The book Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole-Smith has a lot of great information on talking to your children about bodies and weight. Its also important to be a role model to others in the ways that you talk about your body, movement, and food.

EH: What are some body acceptance-friendly phrases people can use in their own lives?

SA: Some examples are:

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Q&A: Why Project HEAL Believes No One Really Needs to Lose Weight - Everyday Health

In a recent study published in the journal Nature Metabolism, a team of scientists investigated whether modulation of the gut microbiome using dietary fiber supplementation in the form of resistant starch could help with insulin resistance and weight loss and offer a potential treatment avenue for metabolic disorders.

Study: Resistant starch intake facilitates weight loss in humans by reshaping the gut microbiota. Image Credit:Sokor Space/ Shutterstock

Obesity has been classified as a global epidemic, with substantial research being conducted on strategies to reduce weight and prevent obesity. It contributes significantly to the global mortality rates by increasing the risk of metabolic diseases such as diabetes, as well as cardiovascular disease risk. Weight management and effective weight loss can lower the risk of these diseases.

Increasing evidence indicates that the gut microbiome plays a pivotal role in the regulation of human physiology and development of various diseases. Gut microbiome composition and diversity are intricately linked to the metabolism of glucose and fat and inflammation.

Furthermore, while fecal microbiome transplantation has been used to establish healthy gut microbiome communities, the procedure has not yielded effective or long-term results. However, diet can be used to modulate the gut microbiome, and dietary interventions, either alone or in conjunction with fecal microbiome transplantation, could potentially improve the clinical outcomes.

In the present study, the team conducted a randomized, crossover clinical trial involving overweight individuals to determine whether dietary supplementation with resistant starch positively impacted obesity and metabolic phenotypes. They also conducted metagenomic and metabolomic analyses to understand how the resistant starch affected the composition of the gut microbiome and its function.

Furthermore, they studied antibiotic-treated mice that had received gut microbiomes from human donors that had already been modified through resistant starch supplementation to understand how gut microbiomes modified through supplementation with resistant starch influence glucose metabolism and adiposity. The metabolomic advantages offered by the gut microbiome modified through resistant starch supplements were also explored.

Resistant starch cannot be broken down by the amylase enzymes produced in humans, functioning as a dietary fiber. During digestion, resistant starch does not get broken down in the stomach or small intestine but moves into the large intestine or colon, where the gut microbiome ferments this dietary fiber. Rodent model studies have shown a decrease in body fat and better metabolic outcomes when the carbohydrate portion of their diet consists mainly of resistant starch.

The present clinical trial included participants with excess body weight who did not have any chronic disorders, were not using any probiotics or antibiotics, and were not undergoing any treatments that would impact their glucose metabolism. The participants were randomly assigned to the treatment or control group, with the treatment group receiving resistant starch in the form of high-amylose maize and the control group receiving amylopectin with no resistant starch.

The starch was provided in sachets in powdered form, and all the participants in the treatment and control groups consumed one packet of the appropriate starch twice a day before a balanced, isoenergetic meal that was provided thrice a day. Since this was a crossover clinical trial, all the participants underwent two eight-week-long interventions, one for the resistant starch treatment and the other for the control treatment.

The results showed that supplementation with resistant starch helped achieve a mean weight loss of about 2.8 kg and improved insulin resistance in overweight participants. The study also found that the beneficial effects of resistant starch supplementation were associated largely with gut microbiome composition changes.

The bacterium Bifidobacterium adolescentis was found to be associated with resistant starch supplementation in humans, and the monocolonization of mice with this bacterium protected them from diet-induced obesity. Resistance starch impacted lipid and fat metabolism by reducing inflammation, restoring the intestinal barrier, and altering the bile acid profile.

The gut microbiota impacts the host physiology through signaling metabolites, of which bile acids play a significant role. Secondary bile acids, such as glycodesoxycholic acid, deoxycholic acid, glycocholic acid, and taurodeoxycholic acid, are important in improving insulin sensitivity and ameliorating hepatic steatosis. The enzyme bile salt hydrolase carries out the deconjugation of secondary bile acids.

The study found that resistant starch supplementation decreased the production of bile salt hydrolase and increased the levels of secondary bile acids. The results were reciprocated in the mice after they were monocolonized with B. adolescentis from humans who underwent resistant starch supplementation.

Resistant starch (RS, 40g d-1) accompanied with isoenergetic and balanced diets led to an obvious reduction in body weight and improvement of insulin sensitivity, as well as alteration in metagenomics and metabolomics. Faecal microbiota transplantation (FMT) showed benefits of RS were associated with the reshaped gut microbiota composition. Monocolonization of mice withB. adolescentis, which was closely correlated with the benefits of RS in human protected mice from diet-induced obesity. Mechanistically, the RS-induced changes in the gut microbiota influenced metabolites of gut microbiome, reduced chronic low-grade inflammation by improving intestinal integrity, inhibited lipid absorption by modulating angiopoietin-like 4 (ANGPTL4), and improved the sensitivity of fibroblast growth factor 21 (FGF21) in adipose tissue. SPF, specific-pathogen-free; LPS, lipopolysaccharide; BCAAs, branched-chain amino acids; Erk1/2, extracellular signal-regulated kinase 1/2; FGFR1, fibroblast growth factor receptor 1. Created with BioRender.com.

To summarize, the study found that supplementation with resistant starch can facilitate weight loss by increasing the abundance of B. adolescentis in the gut microbiome. It can also help improve insulin sensitivity through gut microbiome-induced changes in the levels of secondary bile acids and lowering of inflammation.

Journal reference:

Originally posted here:
Resistant starch diet proves a game changer for weight loss and diabetes control - News-Medical.Net

Dallas, TX, Feb. 28, 2024 (GLOBE NEWSWIRE) -- Physical activity and weight loss top the list of ways employees improve their heart health, according to new survey results from Wondr Health. The proven leader in metabolic, emotional, and physical health transformation, Wondr Health conducted the survey in February 2024. When asked how they prioritize heart health, nearly 700 respondents indicated physical activity, stress management, and weight loss as the top three strategies:

The benefits of physical activity have been well documented when it comes to heart health in addition to overall mental and physical health, said Tim Church, MD, MPH, PHD, Chief Medical Officer, Wondr Health. Physical activity even plays an important role in weight-loss medication use.

A recent report from leading obesity experts found that in addition to the heart health benefits, physical activity may reduce the loss of lean muscle from weight-loss medications and improve the quality and function of muscles.

While weight-loss medications are highly effective at addressing obesity and related chronic conditions like heart disease, they can lead to lean muscle loss, said Tim Church, MD, MPH, PhD, study author and Chief Medical Officer, Wondr Health. Lifestyle factors, such as physical activity, need to complement the weight loss pointing to the importance of using a proven behavior-change program with weight-loss medications.

With obesity and heart disease on the rise, and a surge in demand for weight-loss medications, an advanced obesity-management solution will help employers and payers transform the long-term health of their population and contain costs. Wondr Advanced is the only clinical obesity-management solution that combines personalized medicine with a world-class behavior-change program for long-term weight loss, improved movement, reduced stress and anxiety, healthy eating habits, and better sleep all factors that support heart health.

For more information, visit http://www.wondrhealth.com.

ABOUT WONDR HEALTH Wondr Health is the proven leader in preventive and chronic care for metabolic, emotional, and physical health transformation. Leveraging over 15 years of behavior change experience and partnership with health plans and employers, Wondr Health delivers interrelated, personalized, skill-building programs for weight management, obesity, nutrition, stress relief, anxiety, and movement that improve the health of participants. Powered by data-driven engagement expertise and personalized programming, and supported by expert content and coaching, the companys flexible and scalable digital solutions engage populations, improve quality of life and health outcomes, and prevent and reduce the cost of chronic health conditions.

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One in Two Employees Rank Physical Activity and Weight Loss as Top Strategies for Heart Health - GlobeNewswire

Social media is obsessed with the type 2 diabetes drug Ozempic. But Ozempics ability to control blood sugar isnt the reason its so popular online. Instead, the drug is trending because it has been shown in clinical trials to cause weight loss in diabetic patients taking it.

This has led to an uptick in the number of people trying to get their hands on Ozempic in the hopes of losing weight even though the Ozempic is not recommended for weight loss. The drugs soaring popularity online has not only contributed to shortages and bootleg versions of the drug, its also led to an influx of harmful diet trends.

One of these diet trends circulating on social media is what some have dubbed Budget Ozempic. Budget Ozempic is in fact not at all related to Ozempic, nor does it contain semaglutide the drug component which is the active ingredient in Ozempic. In most cases, what people online are calling budget Ozempic, actually refers to laxatives and stool softeners.

There are many reasons why you should avoid using budget Ozempic if youre trying to lose weight least of which is because they only have a small, short-term effect on weight loss. Laxatives and stool softeners are not designed to be used long-term, nor are they indicated for weight loss. Using them improperly can be harmful for many reasons.

Some types of laxatives work by bringing water from elsewhere in the body into the intestines in order to soften the stool and make it easier to pass. But abuse of laxatives and stool softeners can lead to water loss and dehydration. This may lead to short-term symptoms such as feeling more tired or thirsty than usual, as well as dizziness and lightheadedness.

Water loss can also trigger the bodys renin-angiotensen response. The key function of this response is to keep fluids and blood pressure balanced. If too much water is lost in a short period of time, it will eventually cause fluid retention. This temporary fluid retention happens due to your body overcompensating for the dehydration. Chronic dehydration may lead to hypertension and other cardiovascular problems.

But while laxative use causes water loss, it does not lead to fat loss. This means that any weight a person loses from using laxatives is only temporary and any water lost will be regained.

Using laxatives irresponsibly may also cause you to lose electrolytes.

Electrolytes (such as sodium, potassium and chloride) are essential for the body to function. They help to balance your fluid levels and keep your muscles and nervous system working. But when our body loses water or we become dehydrated, our bodys electrolyte balance is thrown out of whack.

In the short-term, electrolyte imbalance can cause muscle cramps and spasm, nausea, fatigue, headaches and even numbness in the limbs. But chronic, long-term electrolyte imbalance can be more dangerous increasing risk of heart problems.

Our body requires many nutrients in order to function properly including vitamins, minerals, carbohydrates and protein. These nutrients come from the foods we consume, and are mainly absorbed in the small intestine.

Using laxatives and purging (as is sometimes seen in cases of bulimia nervosa) can lead to poor quality nutrient intake. One study even found that the use of laxatives led to 12% less absorption of essential nutrients.

Laxative use affects the gastrointestinal system. If you use them for a long period of time, it can cause diarrhoea.

The reason this causes diarrhoea is because laxatives work to move waste quickly through the intestine and secrete water into the bowel. This can also, in turn, lead to an imbalance in mineral and salt levels in your body.

Although use of laxatives and stool softeners could temporarily lead to weight loss, this is only due to a loss of water weight, the detrimental effects of laxative misuse far outweigh any temporary weight loss you may achieve. Misuse of laxatives could also increase risk of eating disorders, such as bulimia nervosa.

Anyone who wants to lose weight should try to follow a structured weight loss programme that includes a healthy, balanced diet paired with exercise. Laxatives should only be used to treat constipation if other methods havent worked and after speaking with your GP.

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'Budget Ozempic': five ways this dangerous TikTok trend will harm your health - The Conversation Indonesia

Drugs that induce rapid weight loss, like Ozempic and Wegovy, are some of the most talked about medications on the market today. Yet despite recently exploding in popularity, some researchers are skeptical of their long-term benefits.

Studies suggest that once a person stops the weekly appetite-suppressing injections they typically regain about two-thirds of lost weight within a year.

That doesn't have to be the reality. A randomized controlled trial, led by experts at the University of Copenhagen in Denmark, has found a solution.

When patients combine liraglutide injections with a supervised exercise program they maintain their weight loss much better a year after the drugs and supervised exercise are stopped, researchers say.

Liraglutide is different to the drug behind Ozempic and Wegovy, which is called semaglutide. Both medications, however, belong to a branch of pharmaceuticals known as glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs work by mimicking a natural hormone in the body that controls blood sugar, and they were initially designed to treat diabetes.

Today, researchers are still figuring out how to best use the appetite-suppressing nature of these drugs for controlled weight loss.

"Even though medical treatment for obesity is effective, people who stop taking the drugs have difficulties maintaining the beneficial effects," explains biomedical scientist Simon Birk Kjr Jensen from the University of Copenhagen.

"However, our study shows that people who exercise during treatment do not have the same propensity to put on weight post treatment."

The clinical trial in Denmark is the first to directly compare body weight changes after physical exercise, as opposed to pharmaceutical interventions, or both treatments combined.

The trial involved 109 adults with obesity, who were randomly split into four groups. One group undertook a year-long weight loss plan that included liraglutide injections only. Another group was assigned liraglutide and moderate-to-vigorous exercise that was supervised for two hours a week. A third group underwent only supervised exercise. And the last group underwent no specific weight loss plan.

A year after the end of the trial, researchers checked up on all of the participants to see how they were managing their weight on their own. Those who had taken liraglutide had regained about two-thirds of their initial weight loss. Those prescribed only exercise fared better in the long run.

The findings reveal that while liraglutide can result in weight losses comparable to exercise on its own, the drug is not as effective at maintaining weight loss as exercise on its own, the researchers conclude.

In fact, a year post-treatment, those who started and stopped liraglutide regained roughly 6 kilograms (13 pounds) more than patients who underwent a supervised exercise regime for a year.

The only participants to show better outcomes than those in the exercise-only group were those who underwent combined treatments. A substantial number of patients who combined liraglutide with supervised exercise were able to sustain a weight loss of at least 10 percent of their initial weight a year after stopping treatment.

On average, they weighed about 5 kilograms less than those in the liraglutide-only group a year post-treatment.

This difference was due not only to greater weight loss during active treatment, but also to reduced weight gain once treatment had ceased.

The sustained outcomes are probably due to participants picking up healthy exercise habits and maintaining those habits even without supervision, researchers say.

While GLP-1 receptor drugs can trigger an initial loss of weight, they don't change a participant's lifestyle, and they can come with a bunch of unfortunate side effects that could actually make exercise less appealing.

"From our data, it is clear that those who followed an exercise regime with or without treatment with obesity drugs felt less tired and more energetic. They also experienced better mental health. It simply led to improved quality of life," says biomedical researcher Signe Srensen Torekov.

"The same did not apply to those who only received medical treatment. In fact, they felt more tired and less energetic."

"The study almost makes me want to advise against medical treatment without increased physical exercise, especially if you do not want to be taking the drugs for the rest of your life," adds Srensen Torekov.

More research needs to be done on larger cohorts to really explore how weight-loss drugs like liraglutide can be used most effectively for long-term maintenance of body weight.

Despite all the hype surrounding these appetite suppressing drugs, exercise is a prescription that isn't likely to be replaced anytime soon.

The study was published in LANCET eClinicalMedicine.

Read more here:
Study Reveals How to Keep Weight Off After You Quit Ozempic - ScienceAlert

Bulletin: ...WIND ADVISORY REMAINS IN EFFECT UNTIL 7 AM EST THURSDAY... * WHAT...West winds 20 to 30 mph with gusts up to 55 mph expected. * WHERE...Portions of central Pennsylvania. * WHEN...Until 7 AM EST Thursday. * IMPACTS...Gusty winds could blow around unsecured objects. Tree limbs could be blown down and a few power outages may result. PRECAUTIONARY/PREPAREDNESS ACTIONS... Use extra caution when driving, especially if operating a high profile vehicle. Secure outdoor objects. For high wind safety information, visit weather.gov/safety/wind. The latest forecast information can be found on the NWS State College Facebook page and Twitter @NWSStateCollege, or on the web at weather.gov/ctp. &&

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Type: Wind Advisory

start_time_local: 2024-02-28T15:00:00-05:00

end_time_local: 2024-02-29T07:00:00-05:00

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state: PA

headline: Wind Advisory from WED 3:00 PM EST until THU 7:00 AM EST

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certainty: Likely

geographicname: Schuylkill County

state_name: Pennsylvania

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RAW: STUDY: WEIGHT LOSS SURGERY BENEFITS DIABETICS LONG TERM - 69News WFMZ-TV

Working hard has always been important for Ashley Gertley, who opened her own hair salon at 19 years old, but her dedication and work ethic came at a cost. For years, Gertley sacrificed her own wellbeing for the sake of her career, and she watched as the scales continued to go up and clothes continued to get tighter.

Gertley, now 23, would hardly eat anything while she was rushing around at work, only to binge on fast food as soon as she arrived home at the end of her shift. With all the chaos each day, there was also zero chance to squeeze in a workout, as she told Newsweek that she was "putting business above [her] personal health."

But in January 2023, Gertley, from Toronto, Canada, knew she could no longer continue with this unhealthy lifestyle, as her weight reached 270lbs and she was wearing US size 16 clothes. She'd tried a few fad diets in the past and nothing worked, but in 2023 she challenged herself to get back into shape and make it last.

"After opening my salon and putting that first to ensure its success, I finally decided it was time to put the same effort I was putting into my business into myself. I worked hard to create a balance between my personal and work life by making time for meal prep, socializing, family time, and working out," Gertley, the owner of Ashleeybeauty, told Newsweek.

"To lose the weight I shifted to have a complete lifestyle change. It was a more maintainable approach that didn't make me lose the weight quickly, but it was a gradual transformation with healthier habits."

Her previous routine involved hours without eating before gorging on fast food and quick meals at the end of the day, but Gertley has swapped that for a high-protein diet with plenty of vegetables and minimal sugar.

She still has some carbohydrates, but not as many as she used to, which is why she refers to it as a "dirty keto lifestyle." The website WebMD says that a keto diet involves eating less than 50 grams of carbs a day, which can work for short-term weight loss as it has rapid results in the first three to six months, but it won't have any long-term health benefits.

Hannah Sutter, a keto expert and founder of Natural Ketosis, told Newsweek that "when you reduce your intake of carbohydrate to below 50g a day, your body will automatically use fat for energy."

For that reason, she said that a low-carbohydrate diet (in other words, a keto diet), "can ensure you burn excess body fat for energy while feeling full and eating delicious natural food."

The keto diet can certainly be a challenge to sustain, which is why Gertley has gone for a more laid-back approach which still allows her to enjoy other foods "in moderation."

"I stick to high-protein food with lots of vegetables and low carbs, and I have minimal fruit to reduce my sugar intake. I've never stuck to a certain number of calories per day or cut out any foods completely," she said.

Monitoring her food has made Gertley more aware of what she put into her body, without being completely restrictive, which is why nutritionist Sarah Herrington believes her weight loss has been so successful.

Herrington told Newsweek that following a dirty keto diet, as Gertley has done, can cut back on the unhealthy elements while still providing "food satisfaction" with an enjoyable diet.

"Dirty keto includes a multitude of highly palatable foods, like bacon, steak, and cheese, which allow for the inclusion of fun foods when trying to lose weight," Herrington said. "Keto diets focus heavily on fats and proteins, which are far more satiating than carbohydrates; meaning they make you feel fuller for less calories.

"When we completely deprive ourselves of certain foods for extended periods of time, then we run into issues, as Gertley did by restricting food all day and subsequently binge eating. Combining a high-protein intake, the inherent muscle-preserving properties of a keto diet, and healthy exercise can assist weight loss."

The dirty keto diet worked for Gertley, but Herrington, who provides a holistic and sustainable approach to nutritional counseling at Brio-Medical, notes that it won't work for everyone.

"It is most important to find a dietary pattern that works for you, your lifestyle, and your preferences, and not just what others have been successful with," she said.

Indeed, health considerations should be made before starting any diet, and a number of nutritionists have warned against keto in particular. Newsweek previously spoke to Ashley Kitchens, a registered dietician based in North Carolina, who explained that carbohydrates are often demonized in diet culture, but they "are not the enemy" and shouldn't be cut out.

She continued: "I do not recommend low-carb diets. They are not sustainable, suitable, or safe, especially long-term. Low-carb diets are enticing in the beginning because people tend to drop weight quickly from water loss and they may even feel better. However, low-carb diets are not a long-term solution to weight loss."

It's not just her diet that's been overhauled, though, because Gertley also started a new exercise regime in January 2023 to help shed even more pounds.

"I do Pilates three times a week, and then cardio or a HIIT (high intensity interval training) session three times a week too," Gertley said.

"I started to notice the difference within the first four weeks. I was losing around 4-5lbs a week, and then after the first few months I was losing 2-3lbs a week. Now, I am losing closer to a pound or less a week as I'm closer to my goal weight."

People looking to lose weight might hope for quick results, but doing it steadily is considered the best way to ensure it stays off. According to the Centers for Disease Control and Prevention, those who shed around 1 or 2 pounds a week are more likely to maintain their weight loss, rather than those who lose it faster.

After managing to lose 90lbs in a year and transforming her lifestyle, Gertley began sharing her success story on TikTok (@ashleey.gertley) to encourage others to put their own wellbeing first. A post she shared in December, showing how her weight changed with every passing month, went viral with more than 6.8 million views and over 696,900 likes on TikTok.

Gertley said: "I documented my entire journey with small snippets of how I was looking and feeling, but I didn't expect the video to get this popular. I've had a lot of people reach out and ask how I was able to do this."

Now, at 180lbs, Gertley is turning her attention to reducing her body fat percentage and gaining muscle, which could see her weight drop to around 160lbs. But it's not just the physical transformation that's reinvigorated the 23-year-old, as she's also learned so much about her mental strength.

"I've learned that self-discipline is self-love," she said. "It's not a matter of whether I can do something anymore, but it's whether I have the strength to be disciplined enough to carry it out. You have to be disciplined to fuel your body with better nutrition, which isn't easy to do but you must remind yourself of why you're doing it."

Since sharing the post about making herself "a priority" on TikTok, Gertley was inundated with more than 3,300 comments of support and praise. One comment reads: "The difference between Jan and march alone is insane!"

Another person responded: "You should be so proud of yourself."

"You are an inspiration and a reminder these transformations don't happen overnight," another TikTok user commented.

Is there a health issue that's worrying you? Let us know via health@newsweek.com. We can ask experts for advice, and your story could be featured on Newsweek.

Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

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Woman Claims 'Dirty Keto Lifestyle' Helped Her Shed 90lbs In A Year - Newsweek

If you've ever tried to lose excess weight, you've probably gotten this advice: drink more water. Or perhaps it was more specific: drink a full glass of water before each meal.

The second suggestion seems like a reasonable idea, right? If you fill your stomach with water before eating, you'll feel fuller and stop eating sooner. But did that work for you? Would drinking more water throughout the day work? Why do people say drinking water can help with weight loss and what does the evidence show?

Three top theories are:

Feel full, eat less. As noted, filling up on water before meals has intuitive appeal. Your stomach has nerves that sense stretch and send signals to the brain that it's time to stop eating. Presumably, drinking before a meal could send similar signals.

Burning off calories. The water we drink must be heated up to body temperature, a process requiring the body to expend energy. The energy spent on this called thermogenesis could offset calories from meals.

You're not hungry, you're thirsty. This explanation suggests that sometimes we head to the kitchen for something to eat when we're actually thirsty rather than hungry. If that's the case, drinking calorie-free water can save us from consuming unnecessary calories and that could promote weight loss.

Being well-hydrated improves exercise capacity and thus weight loss. Muscle fatigue, cramping, and heat exhaustion can all be brought on by dehydration. That's why extra hydration before exercise may be recommended, especially for elite athletes exercising in warm environments.

Swapping out high calorie drinks with water. Yes, if you usually drink high-calorie beverages (such as sweetened sodas, fruit juice, or alcohol), consistently replacing them with water can aid weight loss over time.

Burning fat requires water. Dehydration impairs the body's ability to break down fat for fuel. So, perhaps drinking more water will encourage fat breakdown and, eventually, weight loss.

So, should you bump up hydration by drinking water before or during meals, or even at other times during the day?

Some evidence does suggest this might aid weight loss, at least for some people. But those studies are mostly small or short-term, or based on animal data. Even positive studies only found modest benefits.

That said, if you think it's working for you, there's little downside to drinking a bit more water, other than the challenge of trying to drink if you aren't particularly thirsty. My take? Though plenty of people recommend this approach, it seems based on a theory that doesn't hold water.

See original here:
Does drinking water before meals really help you lose weight? - Harvard Health

Key Takeaways:

In order to reduce potential obesity-induced consequences to the brain, long-term weight loss solutions are important. Bariatric surgery (BS) is a method that can contribute to rapid, sustainable weight loss as well as a reduction in comorbidities; however, results are often contradictory due to underlying mechanismswhich remain relatively unknownand the uncertainty of whether or not outcomes are long-lasting. Authors of a study published in JAMA Network Open aimed to strengthen the understanding of the impact of BS to further contribute to the development of treatment strategies for dementia and obesity.

The cohort study included participants from the Bariatric Surgery Rijnstate and Radboudumc Neuroimaging and Cognition in Obesity (BARICO) study. Patients aged 35 to 55 years with severe obesity (body mass index [BMI] of >40 or >35 with comorbidities) who underwent BS to induce weight loss were included in the study. Individuals were excluded from enrollment if they had neurological or severe psychiatric illnesses, were pregnant, received treatment with antibiotics, probiotics, or prebiotics.

In addition, magnetic resonance imaging (MRI) scans were obtained at baseline and 24 months following BS. MRI imaging was used to examine brain volume (total cerebral gray matter [GM] and white matter [WM] volumes which are normalized by intracranial volume), cortical thickness (global measures and overall mean cortical thickness), and subcortical volumes (hippocampus, amygdala, caudate nucleus, putamen, and nucleus accumbens); output WMH volume as well as global WM mean diffusivity; and arterial spin labeling, which included cerebral blood flow (CBF), and spatial coefficient of variation (sCOV) within the overall GM and different regions of interests (ROIs).

Each participants cognition was assessed prior to BS (baseline) and again with the use of neuropsychological tests at both 6 and 24 months following BS, in which overall cognitive performance, episodic memory, flexibility, and verbal fluency were assessed. Patients filled out standardized online questionnaires that assessed their depressive symptoms over the past 2 weeks (range: 0-63) with higher scores indicating greater depressive symptoms, and physical activity and the amount of time spent on different activities (range: 3-15) with higher scores indicated greater physical activity.

Image credit: Siam | stock.adobe.com

A total of 133 participants were included in the study. According to the authors, mean body weight, BMI, WC, and blood pressure were significantly lower at 6 and 24 months after BS; however, from 6 to 24 months, percentage total body weight loss was noticeably higher.

Additionally, several cognitive domains had improved at 6 and 24 months after BS. At baseline, the cohort had a median cognitive score of 27 (range: 26.0-29.0). Notably, participants demonstrated improvements in working memory (n = 15; 11.3%), episodic memory (n = 42; 31.6%), verbal fluency (n = 32; 24.1%), the ability to shift attention (n = 51; 40.2%), and global cognition (n = 52; 42.9%). Further, the BDI score at baseline indicates that 71 participants (54.6%) had experienced minimal depressive symptoms, 55 (42.3%) had mild symptoms, and 4 (3.1%) had moderate symptoms; however, at 24 months after BS, 12 participants (9.4%) had mild depressive symptoms and 2 (1.6%) had moderate symptoms. In addition, the Baecke score was noticeably higher 6 months after surgery and remained stable up to 24 months (mean [SD] Baecke score: baseline, 7.64 [1.29]; 6 months, 8.36 [1.23]; 24 months, 8.19 [1.35];P<.001).

The study authors noted that brain changes were observed after BS, with GM volume, GM cortical thickness, and GM CBF all significantly lower after 24 months. Other ROIsamygdala, caudate nucleus, putamen, insula, cingulate gyrus, as well as occipital, parietal, and temporal cortexhad exhibited much lower volumes following BS. There were no observed volumetric changes in hippocampus, nucleus accumbens, frontal cortex, or WM. In addition, cortical thickness for all ROIs was significantly lower following BS; however, the temporal cortex was shown to be much larger (mean [SD] thickness: 2.724 [0.101] mm vs 2.761 [0.007] mm;P=.007). Further, after BS, CBF was lower in multiple cortical and subcortical regionscaudate nucleus, putamen, insula, as well as frontal and occipital cortexbut CBF in temporal cortex, parietal cortex, and nucleus accumbens did not change post-BS.

After 6 months, high-sensitivity C-reactive protein, serum amyloid A, tumor necrosis factor, interleukin-1 (IL-1), IL-6, and plasminogen activator inhibitor-1 were noticeably lower, whereas adiponectin and neurofilament light chain (NFL) were significantly higher compared with baseline levels.

Limitations of the study include the lack of control group and the exclusion of cortical surface and curvature when analyzing the MRI scans. The study authors note that there was an unequal sex distribution among participants (less than 20% of participants were male); however, the investigators note that the sex distribution in the study represents the general BS population.

Although the results indicate a cognitive improvement after 24 months among participants who received BS, according to the study author. They suggest that future research that includes control groups as well as other mechanisms to better clarify cognition and brain changes post-BS should be conducted.

Reference

Custers E,Vreeken D,Kleemann R, et al. Long-Term Brain Structure and Cognition Following Bariatric Surgery.JAMA Netw Open.2024;7(2):e2355380. doi:10.1001/jamanetworkopen.2023.55380

Excerpt from:
Study Shows 40% of Participants Sustain Cognitive Improvement After Surgery-Induced Weight Loss - Pharmacy Times

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