Archive for September, 2010

Should you go on the HCG diet?

Tuesday, September 28th, 2010

A friend told me how much weight she had lost on the HCG diet and I have to admit I was impressed. She mentioned others people I know who also had been trying the program.

So I tried to find out more about the diet, which more appropriately should be called the hCG diet. Human chorionic gonadotropin was first discovered in urine samples of pregnant women in 1927 and it plays a number of roles as a hormone in pregnancy. One is making sure the fetus gets the calories needed for growth and development.

The peak level of hCG in the serum of a pregnant woman is found relatively early in the gestational period, usually at nine to twelve weeks after the last menstrual period. Many women are unaware they are pregnant at this point and may not be "eating for two" (I put this in quotes because I'm certainly not an Ob-Gyn physician and I'm unaware of what current dietary recommendations are for pregnancy).  Fat is released from storage areas (hips, buttocks, thighs and abdomen) when hCG is present and, if the Mom-to-be isn't eating enough for normal fetal growth, the fat calories and other nutrients can sustain fetal development.

From there it was only a step to the research of Dr. A.T.W. Simeons showing that daily injections of hCG might result in weight loss when accompanied by a severely calorie-restricted diet (500 calories per day). I'll paste in the original diet from Dr. Simeons.

Breakfast:Tea or coffee in any quantity without sugar. Only one tablespoonful of milk allowed in 24 hours. Saccharin or Stevia may be used.

Lunch: 1.    100 grams of veal, beef, chicken breast, fresh white fish, lobster, crab, or shrimp. All visible fat must be carefully removed before cooking, and the meat must be weighed raw. It must be boiled or grilled without additional fat. Salmon, eel, tuna, herring, dried or pickled fish are not allowed. The chicken breast must be removed from the bird. 2.    One type of vegetable only to be chosen from the following: spinach, chard, chicory, beet-greens, green salad, tomatoes, celery, fennel, onions, red radishes, cucumbers, asparagus, cabbage. 3.    One breadstick (grissino) or one Melba toast. 4.    An apple, orange, or a handful of strawberries or one-half grapefruit.

Dinner : The same four choices as lunch.

Simeons  published a 1954 article in the British medical journal the Lancet reporting on a group of patients who followed his program for forty days and lost twenty to thirty pounds. He stated 70% had maintained their weight loss after finishing his diet.

Now things get convoluted with many controlled studies over the next forty years denying Simeons' findings and position papers from major medical organizations against the hCG diet.

But in 2007 a popular book was published that rejuvenated interest in the program and ever since then it has received enormous amounts of public attention and hCG clinics have become widespread. There are both injectable and, now, oral forms of hCG advertised on the Web.  Programs with the injectable form run from 26 to 43 days, with daily injections on all but three of those days.

Incidentally the author of that book has served jail time for fraud, was sued by a number of states for running a pyramid scheme (he and his company settled the suit with the states for $185,000)  and, in 2004, agreed to a lifetime ban on informercials, excluding his books. I've just watched "20/20" interview with him and would not buy a used car from him.

So that's the background I've been able to find on the hCG diet. More to come, I'm sure. My real question is what happens after the program is finished? I want to see if the weight loss can be maintained. At the moment I'm a skeptic.

Bill Clinton meets The China Study

Friday, September 24th, 2010

Back in July I wrote about The China Study, a book written by a PhD named T. Colin Campbell who advocates our switching to a plant-based diet. Both Dr. Dean Ornish and Dr. Caldwell Esselstyn have extended Campbell's work into the clinical arena. Their diet and lifestyle programs are being followed by many who've wished to reverse deleterious effects of the typical Western diet they'd followed for years.

Yesterday I got an email from a friend asking if I'd write a blog post on the subject and mentioning that former President Bill Clinton was now on the plan. This afternoon I Googled "Bill Clinton's Diet" and found articles and a video interview of Mr. Clinton with Wolf Blitzer. Clinton had coronary artery surgery and his stent had begun to clog up with new deposits of lipid-rich material. He wants to live to see grandchildren, so he's adopted the plant-based diet fully.

Mr. Clinton is eating veggies and fruit, drinking almond milk instead of anything dairy. He occasionally eats fish, but no other meat; he does add a protein powder to a fruit shake daily. Thus far he's lost twenty-four pounds and his image on the video I watched was clearly that of a much slimmer man than before.

I have to admit I'm impressed. Mr. Clinton stated that 82% of those who've followed a similar diet have "begun to heal." Those figures go as far back as 1986.

I think if I had coronary artery disease I'd be tempted to change my eating habits completely, as has the former President. At the moment I'm about 80 to 90% of the way there. I drink soy milk (in my  case because of lactose intolerance) and eat a lot more veggies and fruit and much less meat than I did up to May of 2009 when I went back on the diet and lifestyle plan I came up with in 1996. I did so primarily to lose more weight and I'm roughly 25 pounds lighter today.

But, in the absence of any clinical atherosclerotic artery disease, I haven't gone the next step. I still occasionally eat red meat, though much smaller portions than in past years (a quarter the size of the steaks I used to love). I had some Swiss cheese at lunchtime (about 2 ounces) and I do eat chicken and fish.

As more evidence turns up I may further alter my dietary pattern. For now, since I'm lean with a Body Mass Index (BMI )of 20.5 and haven't been pushed by chest pain or any other signs of blood vessels being clogged, I'll settle for my part-way-there status.

I do think all of us in the US and much of Europe, plus some in other parts of the world, need to move away from the Western Diet and need to get our BMIs down below 25. Now two-thirds of us in America are above this figure which marks the boundary of being overweight (anyone with a BMI over 30 is obese).

Thanks, Mr. President, for setting an example for us to follow.

I'd be bugged too, or would I?

Tuesday, September 21st, 2010

I picked up the Wall Street Journal this morning and saw an article, "Virus linked to Obesity." The virus in question is called adenovirus 36, or Ad-36 for short and, when I started combing medical articles, was first found in 1978 in the feces of a girl with a bowel disease. Its kin cause respiratory, eye and bowel infections, but Ad-36 is the only known virus that can attack fat cells directly.

There are a host of articles on Ad-36 and similar viruses; many of them associating it with obesity in other species, chickens and mice among them. Several studies have found antibodies to Ad-36 in humans, more freqently in those who are obese.

An article that was just published online in the journal Pediatrics is causing quite a stir. That came from a pediatric subspecialist in San Diego and studied Ad-36 antibodies in obese and non-obese children aged 8 to 18. Of the 124 kids in the study group, over half were obese and of that group 22% had antibodies to Ad-36. This is in contrast to 7% of the non-obese group, so 78% of the kids who were Ad-36 positive were obese

Now there are articles out there that don't support the same linkage. Another San Diego group, this one a US Navy research unit studied 300 military subjects, half of whom were lean and half obese, and found antibodies to Ad-36 in 34% of the obese group vs. 39% of the lean group. That article was published last November in the Journal of Obesity.

The animal research seems to imply that Ad-36 infection can lead to obesity and maybe that's true in people also. The question in humans remains as to which came first, the obesity or the infection.

And we shouldn't forget that only 30% or thereabouts of obese people in these research papers had the antibodies. If Ad-36 does lead to weight gain in humans, what about the other 70%?

This is a fascinating new subject and isn't confined to the us.  Antibodies to Ad-36 have been found in Australia and England as well. I'm sure we'll be hearing hear more about viral infections and their link to our obesity epidemic.

Even the experts don't agree

Friday, September 17th, 2010

Reading the September issue of the scholarly journal, Annals of Internal Medicine, a monthly publication of the American College of Physicians, I came across a marvelously detailed article on low-carb diets. It was a joint effort by the Harvard School of Public Health and the National University of Singapore and examined the results of two huge, long-term projects. It was followed by an editorial review as major articles frequently are in the Annals; the groups reviewing the article were from Duke and the Durham VA Medical Center (staffed by Duke professors in my day there).

The Nurses Health Study prospectively followed 85,168 women, aged from mid-30s to just under 60 initially, for twenty-six years. The Health Porfessional's Follow-up Study did the same for a group of 44,548 men (podiatrists, optometrists, pharmacists, dentists and veterinarians, but not physicians), aged 40 to 75 years initially, for twenty years.

The researchers conclusions were that eating a low carb diet from animal sources led to a higher mortality risk whereas the opposite was true for eating a low carb diet based on vegetable sources.

So far, things seemed reasonable to me, but then the reviewers analyzed the article and tore it apart in many respects. It was the best of times; it was the worst of times, or to paraphrase, it wasn't the best of studies; it wasn't the worst of studies.

The first problem was this wasn't a controlled clinical trial, but just an enormous observational study. Then there were caveats about extra risk factors: sure the men who ate the most animal-based fat were at greater risk for heart-disease deaths, but they also smoked more and exercised less. And low-carb wasn't exactly really low carb; the group eating the least carbs per day really ate a fair amount (nearly 40% of their calories as carbs). And the participants in these studies aren't exactly representative of the broader (no pun intended) US population and weren't put on specific diets at all.

So what did I end up with? Just what I've been saying all along. Eating more veggies and less red meat, exercising more, not smoking...all those make sense. Moderate carb, low carb, this diet, that diet...none of those ideas has been convincingly proven. Actually low-fat hasn't been shown to reduce health outcomes either.

So eat sensibly, try cutting back on red meats and processed meats and be sure to eat your veggies (and fruits). Didn't Mom always say that?

Freeze or puncture your fat cells?

Wednesday, September 15th, 2010

I read a fascinating article in the Wall Street Journal a few days ago, but ended up with several caveats.  The FDA has recently approved two new gadgets that physicians can now use in office-based procedures to get rid of fat.

I had to read that several times before I fully understood what was and what was not going on. Let's talk about the devices themselves first. One freezes fat cells, leading them to shut down over a few months. The other is laser-based and basically punctures fat cells; they then empty out mch of their fat, but don't die.

Wow, that sounds wonderful, but is it? These new therapeutic tools can be used without anesthesia or any major pain, on outpatients and remove fat deposits. The problems are you don't actually lose any weight, the treatments are relatively expensive ($1,500 to $3,000) and they release fat into the blood stream, so it ends up elsewhere.

So let's go back to why someone would want to have such devices used on them in the first place. Fat deposits in our bodies may end up in subcutaneous areas, one such area, fondly named "love handles" by many, would be an example.  They are unsightly and lots of us would like to get rid of them.

Pinch an inch...or more?

Pinch an inch...or more?

On the other hand, fat can be deposited in visceral areas, for instance in and around your heart and liver, and that's much more of a problem.

The "subQ" fat cells can actually be helpful in some senses. They take in fat that's in the bloodstream, package it nicely in large globs and act as storage tanks, releasing the fat when your body needs energy. These are "healthy" fat cells, as opposed to the potentially deadly ones affecting your vital organs.

We've still got a lot to learn about fat cells, but there have been some relatively new discoveries concerning their natural history. Lean folk have perhaps a third the number of fat cells as do the very obese; fat cells die and we get new ones on a regular basis; the distribution of our fat cells changes as we age (less subQ, more visceral). And they produce a number of chemical agents, including estrogen and leptin (the latter influences your appetite).

The issue many experts have with the new tools is serious and would make me want to think twice about having these procedures. One real problem is the what happens to the fat that's released after either device is used; another is what happens to your leptin levels (if they go down, you may want to increase your calorie intake.

All in all I'm not real impressed by either of these brand new modalities. Remember they can remove localized fat deposits, but they don't cause people to lose weight. But I'll bet they get used a lot. Let's look back at this issue in a few years.

Drinking your calories

Friday, September 10th, 2010

We have a close friend who always says, "No dessert for me; I'd rather drink my calories." Now she's fairly slender and doesn't drink to excess, but today I heard a story from another writer about a visiting relative and her drinking and eating patterns that made me look up data on calories in alcoholic beverages.

I do drink, almost always wine and very rarely more than two to three standard-sized glasses a week. I've had reaction to Cabernet in the past and don't like dry white wines, so these days I usually prefer sweet Riesling or, if I'm elsewhere and the only white wine offered is Chardonnay, I'll have a glass of Merlot or Shiraz.

There are some medical data I've read in the past few years that talk of health benefits from wine, especially red wine. The term "in moderation" is always attached; there are obviously lots of medical concerns with excess alcohol consumption.

The story I heard today is of a woman who typically has at least two or three drinks, gets a little tipsy and then starts munching on snacks. She's not going to be driving, so that at least is something positive, but I wondered about her calorie intake.

Let's start with wine. Five ounces of Chablis is 120 calories, according to several references I found. A dessert wine, sweeter by a considerable measure, may weigh in at 165 calories. Twelve ounces of a light beer gives you 100 calories; a regular beer 150 calories.

Then there are rum, vodka, tequila and gin, all offering at 80 proof (40% alcohol), 100 calories per ounce and a half shot. Mixed drinks up the ante. A frozen margarita is 246 calories and a Daiquiri 314 calories.

In one of my posts I talked about cutting your calorie intake by 50 calories per day. That adds up, over the course of a year, to losing five pounds. If you add 50 calories of exercise (and don't eat extra) you can lose ten pounds in a year. Those numbers are approximates, as 3,500 calories is the equivalent of a pound. So 100/day x 365 days equals 36,500 calories or somewhat over ten pounds.

Now go the other direction. If you eat the same amount as usual, but add a glass of wine a day, you can gain ten pounds or more in a year. If  you typically have a mixed drink or two, we're talking weight gains of twenty pounds or more. And that's before the snacks. No wonder some people who think they eat a fairly healthy diet and complain they can't lose weight, turn out to be "drinking their calories" and still eating dessert as well.

A guest blogger warns us about MSG

Tuesday, September 7th, 2010
Liana Werner-Gray

Liana Werner-Gray

I want to start this post by introducing a young friend who recently moved to New York from Australia. Her blog often features topics similar to mine. Our belief sets sometimes differ markedly, but overlap much more often than I would have initially thought. Let me know what you think about her comments on MSG.

Liana Werner-GrayWerner-Gray was born in Perth, Western Australia in 1987, but grew up mostly in Alice Springs in Australia's Northern Territory. She attended Charles Darwin University in Alice Springs before relocating to New York City where she currently resides. She is the creator of  "The Earth Diet", a diet plan she designed following her Miss Earth Australia 2009 People's Choice win. With the environment in mind and health of the world population, she pursued the idea of eating only foods that nature intended for 365 days. Werner-Gray started a daily online blog to share her journey with the world. She began the diet on Saturday, October 24, 2009.  She also developed "I Love Earth", a program designed to help children reduce their carbon footprint.Here's a link to Liana's blog and then I'll paste in her recent post on MSG.Thoughts: How is MSG manufactured?

This blog is thanks to Truth In Labeling. Processed free glutamic acid (MSG) is created when protein is either partially or fully broken apart into its constituent amino acids, or glutamic acid is secreted from selected bacteria. A protein can be broken into its constituent amino acids in a number of ways (autolysis, hydrolysis, enzymolysis, and/or fermentation). In general, these processes are referred to as "hydrolyzation" of protein. When a protein is hydrolyzed, the amino acid chains in the protein are broken, and individual amino acids are freed. Acids, enzymes, and/or fermentation processes are used to hydrolyze protein. These processes are discussed in some detail in food encyclopedias -- wherein articles on glutamic acid and "monosodium glutamate" are generally written by persons who work for Ajinomoto, Co., Inc., the world's largest producer of the food ingredient "monosodium glutamate."

Today, the glutamic acid component of the food additive "monosodium glutamate" is generally made by bacterial or microbial fermentation wherein bacteria used are often, if not always, genetically engineered. In this method, bacteria are grown aerobically in a liquid nutrient medium. The bacteria have the ability to excrete glutamic acid they synthesize outside of their cell membrane into the liquid nutrient medium in which they are grown. The glutamic acid is then separated from the fermentation broth by filtration, concentration, acidification, and crystallization, and, through the addition of sodium, converted to its monosodium salt.

According to The Encyclopedia of Common Natural Ingredients:

"Monosodium glutamate can generally be produced by three methods: (1) hydrolysis of proteins such as gluten or proteins present in sugar beet wastes, (2) synthesis, and (3) microbial fermentation. In the hydrolysis method, the protein is hydrolyzed with a strong mineral acid to free amino acids, and the glutamic acid is then separated from the mixture, purified, and converted to its monosodium salt, [monosodium glutamate]. This used to be the major method of [monosodium glutamate] manufacture. Currently most of the world production of [monosodium glutamate] is by bacterial fermentation. In this method bacteria (especially strains of Micrococcus glutamicus) are grown aerobically in a liquid nutrient medium containing a carbon source (e.g., dextrose or citrate), a nitrogen source such as ammonium ions or urea, and mineral ions and growth factors. The bacteria selected for this process have the ability to excrete glutamic acid they synthesize outside of their cell membrane into the medium and accumulate there. The glutamic acid is separated from the fermentation broth by filtration, concentration, acidification, and crystallization, followed by conversion to its monosodium salt [monosodium glutamate]." (Leung, A. and Foster, S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs , and Cosmetics. New York: Wiley, 1996. pp 373-375.)

Creating processed free glutamic acid (MSG) by bacterial fermentation is not openly discussed by the glutamate industry, and it is not generally discussed in detail in food encyclopedias. It seems strange to us that when Ajinomoto discusses the way in which "monosodium glutamate" is manufactured, they talk about it being made from beets, corn, or some other crop, instead of describing their use of bacteria (which may be genetically engineered) and their process of bacterial fermentation.

It used to be that when any ingredient contained 78%-79% processed free glutamic acid (MSG), and the balance was made up of salt, moisture, and up to 1 per cent impurities, the product had to be called "monosodium glutamate" and had to be labeled as such. The FDA required that other MSG-containing ingredients be identified by names other than "monosodium glutamate." Never has the FDA required mention of the fact that an ingredient contains processed free glutamic acid (MSG). Presently, the FDA refers to the 6th edition of the Food Chemical Codex for their definition of "monosodium glutamate."

While the glutamic acid in "monosodium glutamate" is generally produced through bacterial fermentation, the glutamic acid in the other MSG-containing ingredients is made through use of chemicals (hydrolysis or autolysis), enzymes (enzymolysis), fermentation, or a complex cooking process wherein reaction flavors are produced from a combination of specific amino acids, reducing sugars, animal or vegetable fats or oils, and optional ingredients including hydrolyzed vegetable protein.

In acid hydrolysis, crude gluten or other proteinaceous starting materials are generally hydrolyzed by heating with hydrochloric acid. The chemical hydrolysis with hydrochloric acid is said to be efficient, but almost any organic substance in the raw material is hydrolyzed, resulting in desired reactions such as hydrolysis of proteins, carbohydrates, fats (triglycerides), and the unwanted formation of mono and dichloro propanols, which are carcinogenic. The FDA has admitted, and even pretended to address the fact, that processed free glutamic acid created by acid hydrolysis contains carcinogenic mono and dichloro propanol ( Food Chemical News, December 2, 1996. Pp.24-25).

The FDA has also admitted that processed free glutamic acid found in reaction flavors which are produced from a combination of specific amino acids, reducing sugars, and animal or vegetable fats or oils, and optional ingredients including hydrolyzed vegetable protein is also carcinogenic (Lin, L.J. Regulatory status of Maillard reaction flavors. Division of Food and Color Additives, Center for Food Safety and Applied Nutrition, FDA. August 24, 1992; Food Chemical News. May 31, 1993, p 16).

Processed free glutamic acid (MSG) carries with it material not found with unprocessed glutamic acid. Unprocessed glutamic acid in higher organisms is L-glutamic acid, only. Processed free glutamic acid (MSG) is both L-glutamic acid and D-glutamic acid, and is accompanied by pyroglutamic acid and other impurities. The impurities differ according to the materials and methods used to produce the glutamic acid. Under certain circumstances, processed free glutamic acid is accompanied by mono and dichloro propanols (which are carcinogenic) or heterocyclic amines (which are also carcinogenic).

By FDA definition, processed free glutamic acid (MSG) is "naturally occurring," because the basic ingredient is found in nature. "Naturally occurring" does not mean that a food additive is being used in its natural state. "Naturally occurring" only means that the food additive began with something found in nature. By FDA definition, the ingredient "monosodium glutamate" is natural. So is hydrochloric acid. So is arsenic. "Natural" doesn't mean "safe."

There are a number of straightforward bold faced lies used by the glutamate industry in defending its contention that exposure to free glutamic acid found in processed food does not cause adverse reactions including hives, asthma, seizures, and migraine headache; could not possibly cause brain damage, learning disorders, or endocrine disturbances; and could not possibly be relevant to diverse diseases of the central nervous system such as addiction, stroke, epilepsy, schizophrenia, anxiety, depression, and degenerative disorders such as ALS, Parkinson's disease, and Alzheimer's disease. Central to their argument is the lie that the processed free glutamic acid used in processed food is identical to the glutamic acid found in unprocessed, unadulterated food and in the human body.

Source: Truth In Labeling