Pat Hartman | Childhood Obesity News

Many-Sided Problem, Potent Solution

Pat Hartman December 5, 2024 No Comments

Today it is fashionable to assume that Artificial Intelligence will swoop in like a flying superhero and solve all the world’s puzzles. That hypothesis is far from proven. Another common belief is that the presumptive saviors, the new weight loss drugs, can and will be the answer for everybody with every type of counterproductive eating pattern.

Not so fast, starry-eyed optimists! Some cautious professionals are still, and quite appropriately, hung up on other basic questions, like who should decide which individuals really and truly need the GLP-1 RA drugs? Are children part of that population? For the young, shouldn’t other approaches be tried first? Especially an approach that involves neither surgery nor medication, because neither of those has proven to be totally harmless over the long term.

How much of what we categorize as dangerous obesity might actually be not-so-bad? Critics maintain that to categorize someone as in need of weight loss is often a matter of opinion. In this whole area of human experience, the wide variety of experiences is a minefield of possible error. Even adults who have logged plenty of miles and years are rarely able to control their eating habits, so how can we expect better from children? Even grownups need to be wary of solutions that seem too good to be true.

A cautious approach

An over-eater may coast along for many a year without feeling a serious need to address their issue, but could this be true for a professional actor vying for international prizes? A recent interview with Kathy Bates revealed interesting details of her experience, although not saying much about her weight status as a child. In fact, to search for evidence that obesity was a factor in her early years could occupy a solid chunk of time. It has, however, been documented that the mother-daughter relationship was far from ideal.

The photo on this page is from 2015 and the important thing is, even carrying a lot of extra pounds, Bates created a stellar acting career.

As time passed, some things happened, like major surgery, and type 2 diabetes. Eventually, and much to her credit, the artist did a self-appraisal and got serious. Over an approximately six-year period she lost 80 pounds, and then used Ozempic just long enough to shed another 20, landing at 145, which was 100 pounds less than her heaviest weight.

One drawback of Ozempic is that anyone who uses it (or similar drugs) and then quits will regain the weight. But maybe this is not an ironclad rule. In the course of vanquishing those 80 pounds, Bates had changed both the “what” and the “how” of her eating habits thoroughly enough to overcome that probability. It all paid off with a great new career opportunity, about which she says,

I wouldn’t have been able to withstand the long hours and the discipline of learning lines that a series requires. I can tuck in my shirts and close my jackets on set. I can stand all day and move in ways that were previously restricted by my weight.

I know it’s hackneyed, but for the first time in my life, I feel free of the sorrow and the burden […] of dealing with being a woman who can’t move and breathe.

After that segue to the “drawbacks” side of the equation, it is only fair to note that currently, what with one thing and another, many patients tend to have a miserable time with the GLP-1 RA drugs:

Perhaps these individuals could be better served by spending that money on psychological counseling, or any kind of therapy, rather than ingesting substances that may not offer permanent health, and indeed might cause actual harm.

Possible solution: May we suggest?

A recent article by Steve O’Keefe examines the concept of a universal addiction recovery program, giving BrainWeighve as an example, and asking and answering some questions:

Can it be fun? Can you turn recovery into a game? A challenging game? One with contests and conquests, rewards and disappointments, teams and fans? Can you make it a game where persons or teams are compensated with points, merchandise and prizes when they contribute solutions or assistance that other persons or teams find valuable?

It sounds like the universal addiction recovery program involves flipping the tables and using the mechanics of addiction to beat addiction. If you can make recovery self-directed, social and fun, the patient becomes addicted to recovery. And that’s a much healthier, happier affliction to deal with.

To dig into the question of whether BrainWeighve can be the answer for obese children and youth, here is a partial collection of our previous descriptions of various aspects of that program:

Your responses and feedback are welcome!

Source: “Kathy Bates at 76: What I Know Now,” AARP.org, 09/27/24
Source: “Toward a Universal Treatment for Addiction,” AddictionNews, 09/23/24
Image by Gage Skidmore/Attribution-ShareAlike 2.0 Generic

Weight-Loss Drugs and Human Subjects

Pat Hartman December 3, 2024 No Comments

In regard to GLP-1 RA drugs, a previous post asked a lot of questions about which questions most urgently need to be asked. That was only a few months ago, and maybe nothing major has happened, but the briefest web search assures us that plenty of people are working on it, and coming up with some startling possibilities.

The type of long-term research needed to settle all the questions must, obviously and unfortunately, be carried out over the long term — and by looking at the case files of many thousands of patients. Depending on variables, it must in some instances be extremely difficult for researchers to keep track of so many facts about so many people, over a span of years.

It may happen that some of the people under scrutiny develop conditions that take them outside the predetermined research parameters. They get pregnant, or move halfway around the world. Communication becomes difficult, or they just get tired of being totally conscious of and recording every detail of their existence.

Subjects may develop a reluctance to overshare, which morphs into an intense craving for privacy, especially if they are children entering adolescence, or teenagers turning into adults. Any individual might fall into a delusional wish to make the scientists happy; or feel the need, for whatever reason, to be less than honest with them.

You lookin’ at me?

When a subject is recruited, the research concerns literally every cell of their body. Tracking what they put into it and what comes out of it, is only the start. To live under a microscope can be taxing in ways that the subjects did not anticipate. Under those circumstances, some folks get antsy. They can fall into, or away from, religious or political convictions, or be caught up in an unhealthy emotional relationship, or be influenced by an individual who exerts control. They might be drafted into military service. In the worst case, some subjects die.

Over the long months that such observations should be expected to take, even the experience of mental or emotional growth could shake a person loose and make them unable to tolerate their participation for one more day. Just as some citizens will go to great lengths to avoid jury duty, a person who is really fed up with being part of an experiment will find a way out.

Ideally, a significant long-term study encompasses a very large number of participants. They might need to give up many informational tidbits, starting with simple ones like, “How much did your mother weigh when you were conceived?” and, “Now, 30 or 50 years later, how much do you weigh?” But gathering basic data is only the beginning.

Academia = intellectual rigor in lab coats

It all becomes fiendishly complicated, with linear miles of charts and suchlike. Another layer of complexity includes underlying philosophical assumptions and aspirations. According to what standards and rules must medical research be performed? What is seen as important, and what should be treated as even more important?

One thing we discover from research is how to do better research. Does the thinking on these matters advance, or has it solidified? When researchers write up their results, can they weasel without actually telling a lie? Why would anyone do that?

For a scientific researcher or anyone else, questions should never cease. Once a large number of 20-year studies of semaglutide, for instance, have been compiled, someone will come along and say, “Not good enough. This can’t be definitively judged until more evidence comes in — like for instance, a pile of 30-year studies.”

And quite rightly. Mistakes have been made. Science does not always progress in an immaculate, untarnished linear fashion. There have been errors and oversights, and that is unlikely to change.

Your responses and feedback are welcome!

Image by Beckie/Attribution 2.0 Generic

Of Mice and Men and Women

Pat Hartman November 29, 2024 No Comments

Anyone in any of the health professions will necessarily be aware of, and often intensely involved with, the results of scientific studies. Systemic investigations in the hard sciences include research development, testing, and evaluation that hopefully will contribute to the general pool of knowledge for the benefit of everyone.

How often do we think about what is really behind the numerous studies that must be completed in order for a drug or other treatment to eventually become acceptable to and accessible by the general public? Observing a caged rodent is a whole different proposition from keeping tabs on a human being. What behavior of the human subject will be observed? Will they be following their natural, normal course and recording it? Or dealing with something different being done to the natural course, like taking a different medication?

Any objections?

To track the trajectory of a planet is one thing. To convince a person to, for instance, meticulously record every particle of matter that goes into them and comes out of them is a whole different situation. Even with the most cooperative subject, in the most meticulously conducted experiment, there will be times when the person just wants out.

On other occasions, it might be that the professionals doing the research will decide to end a subject’s participation. In either case, there are plenty of guidelines and multiple strict rules, declared by different agencies, concerning any possible circumstance.

For the benefit of scientists connected with the Marshfield Clinic, MarshfieldResearch.org turned its attention to research itself in a document by Lori A. Scheller titled “Withdrawal of Subjects from Research.” In some instances, the participation of a human subject consists of interaction and/or intervention with the research team.

Or, it might be that their identifiable personal information is used, whether that information consists of data only, or specimens obtained from them. A whole set of rules defines what is considered individually identifying information. This is one of the circumstances that can lead to the involvement of lawyers.

A person might discontinue participation in a research study through voluntary withdrawal, and the federal government requires that human subjects retain the right to withdraw their informed consent at any time. In other cases, the Principal Investigator (PI) might end someone’s participation, for the good of the project. Of course, in any case where the PI withdraws a subject, it is strongly urged that the reasons be explained to that individual.

To prevent trouble, regulations demand that any prospective research participant (or parent of a participating minor) must be fully informed of their rights before they sign anything. The information about withdrawal, voluntary or otherwise, includes…

[…] statements that participation in the research is voluntary, that participation may be discontinued at any time without penalty or loss of benefits to which the subject is otherwise entitled, a description of any circumstances whereby an investigator may terminate a subject’s participation, consequences of withdrawal, and procedures for orderly withdrawal.

Then, there will be another whole set of rules about what happens to the data already generated by their previous involvement. For instance,

According to the guidance, a biological specimen collected but not analyzed prior to a subject’s withdrawal may not be analyzed following a subject’s complete withdrawal from a study…

The guidance states that an institution may choose to honor a subject’s request that his or her data be destroyed or excluded from further analysis at withdrawal, but only with agreement from the funding agency, and only if the research is not FDA-regulated.

Where the Food and Drug Administration is involved, however, there is a requirement for “all data collected on withdrawing subjects to remain as part of the study database or records after withdrawal.” This “ensures clinical study validity and prevents unreasonable risks to enrolled subjects, future subjects, and eventual users of marketed products”:

The FDA describes its concern that subjects who withdraw from research are more likely to have experienced adverse events or a failure of efficacy, and allowing exclusion of their data would increase the probability of introducing bias, and would negatively impact the scientific validity of the research.

What happens when a PI has to cope with a lot of the subjects quitting, or with the necessity to “withdraw” them through executive action? In that case, it might be time to fall back and regroup:

He or she should re-evaluate the protocol and determine whether changes are necessary to facilitate subject retention without weakening the scientific integrity of the research.

Your responses and feedback are welcome!

Source: “Withdrawal of Subjects from Research,” MarshieldResearch.org, 09/11/15
Image by Steve Jurvetson/Attribution 2.0 Generic

Weight-Loss Drugs on the Horizon

Pat Hartman November 26, 2024 No Comments

There are medications that a child needs in order to preserve life, improve an aspect of health, or prevent a damaging condition from occurring. With some pharmaceutical products, like for instance GLP-1 weight-loss drugs, the case is not so clear-cut, and the use of such products on children can initiate a vigorous discussion among adults.

At any rate, no one wants to see minors sticking hypodermic needles into themselves. Even adults who need to treat their type 2 diabetes would prefer not to carry out the self-injection process day after day, but they don’t have a choice.

A healthcare marketing research and business consulting firm called DelveInsight is one of several similar companies that issue annual reports on the state of the pharmaceutical arts. The typical report covers the “present clinical development scenario and growth prospects” in the specialized market of weight loss and weight management. It describes “pipeline products from the pre-clinical developmental phase to the marketed phase.” According to DelveInsight,

In the report, a detailed description of the drug is proffered including mechanism of action of the drug, clinical studies, NDA approvals (if any), and product development activities comprising the technology, Weight Loss/Weight Management (Obesity) collaborations, licensing, mergers and acquisition, funding, designations, and other product-related details.

Such a report includes all the companies in the field, along with descriptions of their various products in early-, mid-, and late-stage development. It includes information on the drug’s target receptor within the human organism, along with the route of administration, mechanism of action, molecular type, and whether it is suitable for monotherapy or combination therapy. The list of “key questions” covered by the report comprises 14 areas of inquiry. This year’s report covers more than 80 companies and 100 pipeline drugs. So there is a lot going on.

Weird and unanticipated

The human body has a vested interest in keeping unknown and potentially dangerous chemicals out of itself. Where medicine is concerned, in many cases the body can adapt, even though that might take time and entail discomfort. Science persists in trying to find ways to make ingestion work because needles are expensive, a lot of trouble to use properly and dispose of, and just generally icky.

Now let’s segue to tomorrow, and a fascinating article by Anil Oza about an amazing innovation the future might bring to the realm of drugs that require needles because the destructive nature of stomach acid precludes oral delivery. Very recently, STATNews.com reported on a device that is under development after drawing its inspiration from sea creatures. Hopefully, this item will introduce into the body drugs that formerly had to be injected either quickly by syringe or slowly via intravenous drip.

Described as blueberry-sized, it is meant to be swallowed. Also,

It then uses jets, modeled after the organs cephalopods use to propel themselves through the water and to release ink, to eject drugs into the tissue lining the digestive tract. The researchers report […] a series of experiments that serve as a proof of concept, showing that the device was more efficient at delivering drugs than other methods of delivering drugs orally.

The innovation has been tested on a pig, with GLP-1 drugs, and the outlook is promising although of course a long and complicated program of testing and more testing lies ahead. But the implications are exciting, especially if the results will make useful drugs available to children without the necessity for needles.

Your responses and feedback are welcome!

Source: “Obesity Pipeline Insight, 2024,” DelveInsight.com, undated
Source: “A new device for delivering drugs without needles draws inspiration from the elegant squid,” STATNews.com, 11/20/24
Image by Dawn Pedersen/Attribution 2.0 Generic

GLP-1 Drugs — Are Alternatives Feasible? (Continued)

Pat Hartman November 21, 2024 No Comments

This post is a continuation of a recent post.

A probiotic supplement may also contain golden turmeric extract (anti-inflammatory), black pepper extract (for bioavailability), sunflower lecithin, and other natural ingredients which are said to provide additional benefits. A fiber, glucomannan, helps a person to feel full, and various ingredients promote thermogenesis, or actual heat inside the body, which literally burns calories (or possibly not.)

A typical brand of natural stuff combines several ingredients and does come with the possibility of side effects which however are said to be rare. They are bloating, headache, and gut imbalance (dysbiosis), a particularly disconcerting outcome because one never knows whether to expect constipation or diarrhea, and they are pretty much the opposite phenomena.

But even if that internal chaos occurs, it is said to improve within weeks. One is tempted to ask, how many weeks? Four weeks? That would be a month, or one-12th of a year, at least. Many people prefer to remain overweight and enjoy life, instead.

A USNews.com article names seven high-satiety foods (high in fiber, healthy fats, and protein) and assures that a diet rich in them will aid in reaching weight loss goals. They are oats, barley, legumes, eggs, Greek yogurt, avocado, and fish. It goes on to say,

Foods high in protein, fiber and healthy fats can trigger the release of GLP-1 hormones and other satiety-enhancing effects… Eating more of these foods is less expensive than weight loss medications and have none of the unwanted side effects.

Even better, a piece by Joe Cannon, who for three decades has advised people about how to stoke up their own innards to manufacture their own GLP-1, names a total of 31 such foods. There are major groups, like fermented foods (yogurt, kefir and kimchi) and high-fiber foods (beans, oats, and barley), as well as resistant starch, whey protein, phytonutrients, Spinach Thylakoid Extracts, certain nuts and seeds, extra virgin olive oil, and other esoteric ingredients.

Along with the substances already mentioned, he recommends Resveratrol, glutamine, Valine, glycine, arginine, tryptophan, and more. Cannon also also warns of what to stay away from, and adds,

While going the natural route may not produce as impressive weight loss as drugs like Ozempic (semaglutide), it’s also true that it will cost less, and the risk of side effects may be lower, too.

…[T]he fact that natural therapies work is valuable knowledge to those who cannot afford these medications and who are averse to taking drugs for weight loss purposes.

A WebMD.com article by Jessica Migala adds some important information, namely that GLP-1 production is aided by exercise because it also facilitates the production of insulin, giving the body’s cells energy — and although research is not definitive, this appears to also be true for patients with type 2 diabetes. “Exactly what’s going on needs further study,” the report says.

Migala warns that natural supplements cannot achieve the same results as the drugs will. Although berberine might do something, the trials that opinion is based on have all used different doses and durations, so the overall picture is not clear. Also, it can cause the same nausea, bloating, and constipation that GLP-1 drugs are known for. She writes,

[I]t’s clear what the prescription medications are supposed to do, and at specific doses. But supplements may rely on preliminary or incomplete data, so it’s less clear what effect they will have on you.

The author warns patients to keep their physicians aware of anything they are taking, because some herbs and other remedies might interfere with or accentuate the effects of some medications. If the supplement route is chosen, it is important to try just one at a time, in order to be able to get clear answers about exactly what is working, and where the cause of any side effects can be found.

Your responses and feedback are welcome!

Source: “Provitalize Side Effects: What are the Side Effects of Provitalize Probiotics?,” TheBBCoo.com, undated
Source: “7 Foods that Mimic the Effects of Ozempic and Other GLP-1 Drugs,” USNews.com, 07/17/24
Source: “31 Best Foods and Supplements That Raise GLP-1 Levels,” SupplementClarity.com, 05/11/24
Source: “Can You Boost GLP-1 Naturally?,” WebMD.com, 07/26/24
Image by Michał Parzuchowski on Unsplash

GLP-1 Drugs — Are Alternatives Feasible?

Pat Hartman November 19, 2024 No Comments

In recent times, numerous illnesses have caused conventional medicine, and particularly the pharmaceutical industry, to be challenged by those who believe that natural substances and actions can achieve a cure. When it comes to the GLP-1 RA drugs (leaving type 2 diabetes aside, and considering only the weight-loss aspect) the case for nature has been proven in enough instances to make the idea worth considering.

A previous post asked,

What if, instead of making semaglutide universally comfortable to use, the emphasis could be on making it obsolete?

Well, first of all, many large corporations would commence to bleed from the pockets. But, leaving that aside, could dietary supplements be the answer? Would natural products work as well, only slower? Could people be convinced to try other substances instead?

Possibly they could, because apparently, GLP-1 drugs have some bad effects, and current science does not reveal how to eliminate the bad ones while keeping the good ones. Some practitioners believe that, rather than supply a GLP-1 receptor agonist, medicine’s goal should be to encourage the body to make its own GLP-1, which the expensive pharmaceutical product definitely does not. So, the market also features probiotics, which do not cause as much harm as the GLP-1 RA drugs.

What problems with Ozempic (and other semaglutide brands) have natural alternatives been found to avoid? Not surprisingly, it seems that one of the earliest to be noted was unwanted facial remodeling. As Zsa Zsa Gabor reputedly said long ago, “As a woman, you have to choose between your fanny or your face. I chose my face.”

Apparently, when weight is lost too fast, especially if it is from muscle, the metabolism may slow down and the whole hormonal system can be thrown out of sync. The immune system could be impaired, bones could become brittle, and hair could be shed. For women, any menopause-related symptoms might intensify.

Okay, so what else is there?

One suggestion is berberine:

When taken as a pill or powder, berberine enters the bloodstream and interacts with cells, influencing various biological processes. Instead of targeting a single pathway, berberine acts on multiple fronts, impacting several conditions simultaneously.

Proponents of the natural approach say that three bacterial strains (Lactobacillus gasseri, Bifidobacterium breve, and Bifidobacterium lactis) trigger the gut to release GLP-1 on its own. They also in some way make the body more responsive to the chemical, and incidentally, help prevent the leaky gut syndrome.

Endorsements from the public say that the probiotic combo helps to eliminate the craving for junk food. One enthusiast quoted in the advertising claims to have lost three inches from her stomach; another claims to have dropped three jean sizes. It is also asserted that these natural probiotics do not lead to what is called “rebound” weight, in other words gaining it all back again if the drug is discontinued.

A probiotic supplement can reportedly prevent that negative outcome, while still providing the benefits sought by Ozempic users. As always, a doctor should be consulted, especially about potential conflict with other substances, prescribed or otherwise, and it should be firmly understood that patient compliance, in the matters of dosage and timing, is paramount.

(To be continued…)

Your responses and feedback are welcome!

Image by South Australian History/Public Domain

What’s Wrong With Ozempic and Its Kin?

Pat Hartman November 14, 2024 No Comments

A recent post mentioned some of the complications of using Ozempic or other brands of semaglutide, which are GLP-1 receptor agonists used to facilitate weight loss. It’s necessary to look closely at this trend for the sake of patients, who are being prescribed these drugs at ever-younger ages. We don’t want them to suffer (or hate us) 20 or 40 years from now, if their future bodies are messed up in some way that present-day science does not even suspect.

And of course, as has been widely publicized, a lot of their bodies are already messed up while using the stuff now. One big problem is that even the injectable form can cause misery in the patient’s digestive system, in addition to other difficulties. Yet, users and potential users clamor to have this medication in oral form, delivered directly to their stomach and gastrointestinal tract. (And how about the suspense of using a substance so versatile, it can bring on both constipation and diarrhea?)

In addition to possibly causing pain, nausea, and vomiting, the pills have to be swallowed on a strict daily schedule: upon awakening, with an empty stomach, and half an hour before eating a bite of food. They come with quite a few cautions and contraindications, including a list of almost 40 side effects.

The person taking oral semaglutide may have to give up alcohol and/or tobacco because of negative interactions, according to the Mayo Clinic, which also adds:

Appropriate studies have not been performed on the relationship of age to the effects of semaglutide in children. Safety and efficacy have not been established.

One foundational and undeniable fact here is that on the whole, people would rather not give themselves injections, no matter how streamlined the process. Also, there is an ecological angle. The users do not refill a single apparatus with the substance they need. The tool is not a reusable syringe. The medication arrives in individual, single-dose devices. Eons from now, there will still be millions of them in landfills, and in the oceans.

Additionally, these gadgets are costly to manufacture, forcing people to spend lavish amounts on objects destined to be thrown away. Viewed from a certain perspective, this just looks insane.

Speaking of mental health…

Everyone has heard of semaglutide’s desirable effects: decreased appetite and a feeling of fullness that lasts longer because the stomach empties slowly. But we aren’t done mentioning the undesirable effects yet. Semaglutide has some serious drawbacks that are classified as uncommon, which means it affects one person in 100; and rare, which translates to one in 1,000. These include hypoglycemia, allergic reactions, pancreatitis, stomach paralysis, and liver abnormalities.

Because of the factor called titration, which means getting just enough of the drug at just the right time, the patient has to check in with the doctor quite frequently. Most people don’t have enough money or time to spend either resource so extravagantly.

And of course, there is the expense of the substance itself. And the fact that a user’s facial appearance may change in unexpected and unwelcome ways. And it has begun to look pretty certain that they have to stay on the medication forever, or else gain the weight back.

Previous posts have mentioned how some weight-loss drugs cause depression and suicidal ideation, which is ironic, considering that many patients have been programmed to equate weight loss with ecstatic happiness, or at least with the potential to solve many life problems. Their disappointment and discouragement must in some cases be profound.

Here is a question: What if, instead of making semaglutide universally comfortable to use, the emphasis could be on making it obsolete?

Your responses and feedback are welcome!

Source: “Semaglutide (oral route),” MayoClinic.org, undated
Source: “How Ozempic Works: The Science Behind the Medication,” JoinLevity.com, 06/19/24
Image by Richard Riley/Attribution 2.0 Generic

Natural Rivals to Ozempic?

Pat Hartman November 12, 2024 No Comments

First off, the title is misleading, because the subject matter also applies to the other GLP-1 RA drugs, not just to the grand-daddy of the genre. Ozempic was originally okayed to treat type 2 diabetes, and went on to demonstrate its unsuspected usefulness as weight-loss medicine. To avoid a lot of unnecessary verbiage, this brand name will stand in for similar brands because in the mass mind, it already does.

Only the body makes GLP-1 peptide hormone, which triggers insulin production. But sometimes another substance can fill the same function as a natural chemical, in which case it is called a Receptor Agonist. It has that ability to hit a receptor the same way and fill the same function as the natural chemical, which in this case is to trigger insulin production. Semaglutide does that and is called a GLP-1 RA drug for short. When Ozempic or another brand is administered, it plugs into receptors in the stomach, brain, and pancreas.

Some caveats

Before this whole weight loss shot fad got started, quite a lot about semaglutide was already known because of its successful use in diabetes, and much more has been learned recently. An important factor for patients is that a lot of folks don’t like to give themselves injections; and when it comes to children and teens, some adults are nervous about encouraging minors to become so comfortable around needles.

Patient compliance is never an exact science, and it is not such a great idea for even grownups to become casual or smug about self-treatment. Some people doubtless expend more intellectual energy figuring out how to safely take a self-indulgent holiday break from their Ozempic than they did in acquiring a college education.

Even if injections can eventually be escaped, massive costs and potential side effects — both in the present and in the future — must be dealt with. Nobody knows what kind of shape these patients will be in 20 years from now. The rapidity with which lean muscle mass can dissolve from the body is only one troubling aspect. It is all too easy to envision a scenario in which the experts of 2050 look back, shake their heads and mutter “How did they miss this?”

Speaking of costs, in the present-day market for Ozempic and its peers, a lot of counterfeiting goes on. People are shelling out enormous sums for bogus products that could contain — well, anything. They also willingly pay for “companions for weight-loss drugs” which are said to counteract the unwanted effects of the GLP-1 agonists.

These supplements are meant to prevent, among other things, the loss of lean muscle mass by providing or facilitating the body’s ability to absorb the minerals and other nutrients it must have in order to keep the patient healthy. It was discovered that, sadly, a person might also need another kind of supplement, something for the old mental health, because Ozempic seemed to have unbalanced it in certain people.

But then, the wind changed, and…

Interestingly, it was widely reported last January that health agencies in the U.S. and Europe have conducted thorough reviews and found no evidence linking thoughts of suicide or self-harm to semaglutide.

On the other hand, the public has been warned off by such luminaries as Sharon Osbourne, who told an interviewer, “There is no quick weight loss recipe for what is basically a mental problem.”

Your responses and feedback are welcome!

Image by Madras 91/Attribution 2.0 Generic

Binge Eating Is a Tough One, But They All Are

Pat Hartman November 7, 2024 No Comments

As previously mentioned, the cause of malnutrition may rest in either the voluntary or the involuntary realm. A person might not have money to buy food, or might be held in a POW camp. Various physical ailments can cause malnutrition. In any case, it is caused by the restriction of calories, and in some very problematic cases that restriction is self-imposed.

Notable instances of self-imposed malnutrition are anorexia, bulimia nervosa, and binge eating disorder (BED). People with anorexia avoid eating, which is an upfront restriction. People with bulimia eat and purge, which is ex post facto, or retroactive restriction. People with BED periodically eat an enormous amount and then maybe vomit or take laxatives or diuretics, or “go on a diet,” or half-heartedly start an exercise program to compensate; or just vow that it will not happen again — until it does.

An emotional beating

Apparently it is common for a person with BED to spend a lot of time sunk in guilt, figuratively beating themselves up because it happened again, and they don’t even like any of the stuff they so rashly consumed. One veteran of the syndrome advises others to put that mental energy to better use by exploring alternatives, which admittedly will be difficult because “ED thrives on rigidity.” This person recommends an attitude of flexibility, curiosity, and experimentation. For instance, by experimenting with food they personally have noticed that eating smoked salmon and acorn squash will make them feel “fed” enough to avoid a binge.

People who have been dealing with the condition for a while recommend protein, because it has worked for them, and at the same time acknowledge and warn others that everyone’s struggle is different. Some people are very conflicted. One forum participant writes, “I wake up thinking about what to binge on… I hate feeling full, I hate having food in me.”

Trying to rid oneself of binge eating disorder can become very complicated. According to the Cleveland Clinic,

Some people find that a structured, nutritionally balanced meal plan can simply reduce some of the decision-making stress related to eating. It can satisfy your physical needs while leaving less room to act impulsively or emotionally. Although weight loss isn’t the main goal of treatment, it can be a side effect, and this can help relieve stress for some people. However, diet may be triggering for others with BED.

Paradoxically, a binge eater might suffer from malnutrition. Most likely they take in plenty of macronutrients — sugar and fat — but they are probably not getting anywhere near enough micronutrients (vitamins and minerals). Deficiencies can cause cravings, which is the body’s way of saying it doesn’t get enough of some specific nutrients. The ED (eating disorder) mind translates this into “I’m not getting enough FOOD,” which then pushes the person into binge eating whatever happens to be nearby — which may be something they don’t even like! — or whatever high-calorie treat is easiest to lay hands on at the moment.

Apparently the one thing that all people who suffer from eating disorders have in common is their ED mind, which speaks with its distinctive and annoying, yet somehow captivating, ED voice. One person writes,

When it comes to eating disorders, logic does not apply to its mechanisms. It’s more like a compulsion, or an obsession — your little rituals that you have to do or your world will fall apart — take over the voice of reason that knows they’re unnecessary. That voice is still there but it feels like it’s constantly arguing against your ED voice.

Another person says,

I’m terrified to gain *too* much weight because my ED says my life will fall apart if I do.

One symptom of a falling-apart life is to constantly run up against obstacles that seems to have momentous importance and imply dire consequences. Here is one example:

So today I put new batteries in my scales and I weighed in at 199lbs, which was a difference of +3.4lbs from before I changed the batteries. This means I’ve been weighing wrong for weeks, which is making me panic now — I have all my numbers and calories based on what I weigh and it was wrong.

Another person talks about a wedding invitation he will refuse because…

I’ll have to wear a suit and look fatter than ever. I also don’t want to be around that many people at once — I’ll end up having a panic attack and then binging, and I really can’t afford that.

Another respondent offers a shred of hope:

I feel like over time the ED voice gets louder and louder until [it’s] screaming at you 24/7 while the other voice is barely a whimper. But if you ever want to get out of this, you have to let that little voice speak.

Your responses and feedback are welcome!

Source: “ED Support Forum,” EDSupportForum.com, undated
Source: “Stop Binging for Once,” EDSupportForum.com, 01/15/24
Source: “Binge Eating Disorder,” ClevelandClinic.org, undated
Source: “ED Support Forum,” EDSupportForum.com, undated
Image by Chic Bee/Attribution 2.0 Generic

Refeeding Syndrome — Cure Worse Than Condition

Pat Hartman November 5, 2024 No Comments

The commonality amongst all kinds of starvation, whether unavoidably imposed or intentional, is that a person cannot simply start eating normally again. This is due to the condition called refeeding syndrome, which is characterized, if the word can even be used for such a general purpose, by “a wide range of symptoms and a lack of clear diagnostic criteria.”

Consequently, although various recommendations have been made for the management of refeeding syndrome, they “remain controversial due to a lack of objective data and quantification standards.”

Who gets refeeding syndrome? Anyone who receives increased nutrition after a prolonged experience of starvation, and this includes a lot of people because there are plenty of “populations at high risk for malnutrition.” Whatever the cause of their malnutrition, they can’t just start randomly and heedlessly eating again. Immediately following World War II, this problem was dramatically apparent among certain populations…

[…] when individuals living during the famine unexpectedly became ill following nutritional reconstitution. In 1951, Schnitker et al reported that one-fifth of Japanese prisoners starved in prison camps died suddenly after nutritional and vitamin replenishment.

The lack of food in a concentration camp or POW camp is not the only possible cause of malnutrition. Even in peacetime, ordinary citizens may be in this kind of trouble for a number of reasons. In some cases, they may experience malnutrition because of inflammatory bowel disease and other conditions that impede the absorption of nutrients.

Poorly controlled diabetes is another possible cause, as well as cancer-related conditions; inadequate post-operative recovery; undergoing dialysis because of renal failure; chronic alcoholism; extreme weight loss from a starting point of morbid obesity; or suffering from an eating disorder.

Kids with problems

That last cause is where the topic intersects with childhood obesity, because teenagers trying to be thin can kill themselves by developing refeeding syndrome with its consequent “electrolyte and metabolic disturbances that manifest in cardiopulmonary, hematologic, and neurological dysfunction.” This is just a rough outline of what can happen when nutrition is replenished carelessly: Glucose levels, rise, followed by insulin levels…

[…] which then drive phosphorus and potassium intracellularly, causing a decrease in the amount of available extracellular potassium or hypokalemia… This increase in insulin and the effects on electrolyte migration (intracellular vs. extracellular) are compounded by nutritional electrolyte deficiencies.

The many and varied effects on the body of being fed after starvation include potentially fatal conditions with exotic names like torsades de pointes and Wernicke-Korsakoff encephalopathy. Because there is so much going on, treatment requires not just a doctor or a hospital bed, but an entire interprofessional team.

A WebMD article by multiple authors also asserts that “malnutrition has serious health consequences” and provides a list of ten of them, including paralysis and cardiac arrest, and also affirms that the cure for it, “refeeding syndrome is a life-threatening complication… without swift treatment, refeeding syndrome can result in death.” According to the article,

You will need to be admitted to the hospital, and doctors will prescribe a special formula of artificial nutrients to replenish your body. This process is called refeeding. You’ll get the artificial nutrients by mouth or through a tube.‌..

During refeeding, your metabolism can start to overproduce insulin, which triggers your body to synthesize protein and produce fat. The process can monopolize the electrolytes in your body. You don’t get sufficient electrolytes to your organs and this results in organ system problems.

A Cleveland Clinic website goes into more detail, naming phosphate deficiency (hypophosphatemia) which can manifest in a number of harmful ways. Or the person might experience a magnesium deficiency, which brings its own list of problems. Or a shortage of potassium or thiamine, adding such possibilities as delirium and amnesia.

Then, there are dehydration and blood sugar maladjustments. Ominously, one risk factor that could lead to refeeding syndrome is “recent loss of more than 10% of your body weight.” This fact might need special attention in light of the recent popularity of miracle weight-loss drugs.

The Cleveland Clinic notes,

Refeeding syndrome is a complication of treatment for malnourishment. This is already a stressful condition for your body to endure. It may seem counterintuitive, but too much cure too quickly can be harmful. Refeeding is a delicate and complex process. Ideally, it should be medically supervised. During medical refeeding, your healthcare team will monitor you closely. They’ll work to prevent refeeding syndrome and will be prepared to manage it if needed.

In other words, with refeeding syndrome, the cure can literally be worse than the condition. It can be so bad that medical personnel would much prefer to avoid and prevent it, and not have to reach the point of needing to treat it.

Your responses and feedback are welcome!

Source: “Refeeding Syndrome,” NIH.gov, 11/07/22
Source: “Refeeding Syndrome,” WebMD.com, 07/19/23
Source: “Refeeding Syndrome,” ClevelandClinic.org, undated
Image by Emilio Labrador/Attribution 2.0 Generic

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