Oprah Through the Years, Part 1

The entire world is familiar with Oprah Gail Winfrey’s early biography. Born in the deep South; constantly shuttled from one relative to another; abused, molested, and impregnated as a child; a bereaved mother herself at age 14…

This all seems like the standard first chapter in a sordid tale of ruin. But no. Somehow, this extraordinary woman became a media professional before age 20, won awards for both her beauty and her brains, and went on to earn for herself a long list of descriptors that included the word “first” or the word “only.”

In 1986, she was nominated for both an Oscar and a Golden Globe for her performance in the role of Sofia in The Color Purple. The press mentioned her hefty figure as often as her multiple talents. In the mid-eighties, her weight often topped 200 pounds, and TV fans adored her.

The Oprah Winfrey Show, which had begun as a tabloid-type production, evolved into a venue for more serious topics. Some criticized the host for giving a platform to medical professionals with less-than-stellar credentials, while others admired her taste in literature. In any case, she became a trendsetter of unrivaled influence.

The big oops

In 1988, after existing for four months on a liquid protein diet and losing 67 pounds, Oprah acquired the equivalent number of pounds of animal fat and loaded it on a little red wagon. Wearing size 10 designer jeans and a form-fitting top, she pulled the wagon out onto the stage to graphically illustrate just how much of her former self no longer existed. The jeans were legit — her own pair that had actually been worn back in her Baltimore show-biz days.

It was an audacious stunt, but one that she later came to regret. In a 2005 interview, the star admitted, “Two hours after that show, I started eating to celebrate. Of course, within two days those jeans no longer fit!”

The episode was incredibly popular with audiences everywhere, but a few months later, Oprah had to admit that she had regained almost 20 of those pounds, and as time passed, the situation became much worse.

Years later, in a 2005 interview, she acknowledged what an embarrassing gaffe the stunt had been — “my biggest, fattest mistake.” Fat had become her trademark, a combination of a curse and a blessing. On the plus side, she was doing what she has always done best — looking after other people. She recalled the red wagon fiasco, using the ineradicable memory to grab attention for her current charity fundraising:

Winfrey has released a six-disc DVD collection of her biggest moments and interviews during the past 20 years of her show, with net profits going to Oprah’s Angel Network, a charitable foundation dedicated to helping educate and advance women and children around the world.

The more things change, the more they stay the same

Weight remained both a personal and a public issue. Many fans unburdened themselves by writing to Oprah, including a trio of young girls who appeared on the show along with their mothers, these live appearances presented along with candid films of moments in their daily lives.

According to the written description of the episode,

The children and their mothers address the emotional roadblocks that contribute to childhood obesity. By providing solutions, rather than showcasing problems, the show hopes to use the power of broadcasting in a positive manner.

Overall, a useful service was being performed. Audiences were being enlightened and delighted. Thanks to Oprah Winfrey, millions of Americans were learning things about which they might never have become aware, including the fact that a woman can be intelligent, talented, philanthropic, beautiful, successful, and overweight — all at the same time. Meanwhile, fate had something wonderful in store for the star.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Stars of The Color Purple, Past and Present,” OprahDaily.com, 12/15/23
Source: “Oprah’s ‘Fattest’ Mistake,” CBSNews.com, 11/16/05
Source: “Oprah’s Top 20 Moments,” Oprah.com, October 2005
Source: “Oprah Winfrey laments her ‘biggest mistake,’” TODAY.com, 11/15/05
Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Image by get everwise/Attribution-ShareAlike 2.0 Generic

A Probiotic, and a GLP-1 Non-Substitute

For months, we have been hearing claims concerning the importance of GLP-1 and the expensive process of injecting a substance that acts like it into the body. Meanwhile, some researchers work on ways to induce the body to make more of its own hormone, right inside the gut microbiome, where it does the most good. The concept is to get in there where food cravings originate and stop them in their tracks.

According to an illustrated explanation, here is what happens. In the distal colon, beneficial bacteria go to work on fiber and metabolize it into butyrate, acetate, and propionate, meanwhile secreting P9 and other essential proteins, and stimulating mucin rejuvenation. All this activity in turn stimulates the production of GLP-1, which tells the pancreas to make insulin, which then alerts the brain to deactivate the mouth from eating, and instructs the stomach to hold onto its contents and not empty so fast. Et voilà! Food cravings are vanquished!

Now, this is based on preclinical studies, a phrase which often translates as, “Come back in a year, when we have solid results.” But the makers of this “powerful, multi-strain probiotic” sound very sure of themselves. The whole secret to their product or, to be fair, any similar products that might come along, is to encourage the thriving of the very best, most helpful and efficient strains of gut bacteria — in this case, a strain called Akkermansia and another known as Clostridium butyricum.

Here is the paragraph that catches the reader’s attention and encourages the eternal springing of hope:

Gut bacteria can significantly impact weight, independent of genes. Transplanting the microbiome from an obese twin drives obesity. Conversely, transplanting the microbiome from a healthy twin drives weight loss.

Moving on… A previous post took a deep dive into berberine, which turns out to not be everything that some folks say it is. The longer the subject is pursued, the more it seems that debunking berberine has become a minor industry. Yes, the substance appears to lower fasting blood sugar levels, and even to reduce BMI in some cases. And it does seem to encourage beneficial gut bacteria while suppressing the harmful kind.

On the other hand, it also produces unpleasant side effects like nausea, constipation, and diarrhea, just like the expensive injectables. Also, the list of people who should avoid it altogether includes “children and adolescents, pregnant and breastfeeding women, diabetic individuals and individuals with liver or heart disorders…” — so there’s that. On the third hand, unlike the GLP-1 RA drugs, berberine has not been observed to cause mental health issues, which would be a definite plus, if only it actually did a useful job.

In France, the agency that looks into food, environmental and occupational health, and safety, is called ANSES, and it…

[…] draws the attention of healthcare professionals to berberine’s ability to interact with numerous drugs, which could compromise the efficacy of certain treatments… [C]onsuming berberine-containing food supplements in combination with a drug treatment can inhibit its effects or lead to adverse effects… [T]he safety of use of these food supplements cannot currently be guaranteed.

Via a website in the business of selling a brand of semaglutide that costs only a fraction of what Ozempic does, Dr. Melissa VanSickle says this of berberine:

A significant challenge is its poor bioavailability; only a small portion is absorbed into the bloodstream when taken orally… Human clinical trials are few and often lack robustness. Some studies indicate that Berberine can lower blood sugar and improve cholesterol in type 2 diabetes patients, but these results are not definitive enough to recommend it as a standalone treatment.

A McGill University article comes right out and uses the H-word in the title: “Berberine. Don’t swallow the hype. Or the pill.“:

Berberine may indeed be “natural,” not that this has any relevance… Berberine has nothing to do with GLP-1.

The piece scoffs at the barely relevant studies found in “low-impact journals” with wildly varying dosages or the inclusion of other substances; or which have not tested the substance in subjects whose only problem was extra weight. Via another source, Dr. Lisa Kroon, who holds a very high academic position, confirmed:

It’s absolutely not nature’s Ozempic and does not work like Ozempic… It is a completely different mechanism… I think people are just grasping here and manufacturers of these supplements are just kind of creating a hype to try to be appealing for people looking for a magic potion to help them lose weight.

So. Definitely not a substitute for the GLP-1 drugs.

Your responses and feedback are welcome!

Source: “The Science Behind GLP-1 Probiotic,” PendulumLife.com, undated
Source: “Use of berberine-containing plants in food supplements,” Anses.fr, 11/25/19
Source: “Berberine vs Ozempic®: Understanding the differences,” BMIDoctors.com, 01/12/24
Source: “Berberine. Don’t swallow the hype. Or the pill.,” McGill.ca, 06/22/23
Source: “Berberine Isn’t ‘Nature’s Ozempic.’ But It May Help Manage These Conditions,” VeryWellHealth.com, 06/08/23
Image by NIH Image Gallery/Attribution 2.0 Generic

The Inevitable Growth of Companion Products

Way back in 2017, for DiabetesJournals.org, Deborah Hinnen noted that in a non-diabetes situation, expectations concerning weight loss should be realistic. This, she defined as looking to lose maybe 6 to 8 pounds altogether. Such a modest hope is quite different from the extravagant losses that have, since the advent of GLP-1 RA drugs, been reported in subsequent studies.

But the writer also noted that greater weight loss can be achieved, especially if the patient experiences the “feeling full” effect, and consequently eats less. And — here is the condition that, for the most part, is easier said than done — if the patient exercises conscientiously.

In those days, the potential of this genre of weight-loss drugs was not fully envisioned, and certainly not realized. But even back then, we can safely bet that the idea of “companion” products was a gleam in somebody’s eye.

A lot is going on today in the multifaceted world of seemingly magical weight-loss drugs that include semaglutides or GLP-1 RA drugs, such as Ozempic and Wegovy, as well as tirzepatides like Mounjaro and Zepbound. Will the questions ever end?

One very relevant query is, how many friends will the GLP-1 drugs eventually succeed in bringing to the party? We have discussed the companion candies that are meant to get some valid nourishment into the patient, in order to lessen the expected loss of lean muscle mass. This is only one of the ever-growing variety of supplementary foods created to make sure that enough of the right stuff gets into the diet of folks on the new drugs.

All is not well

By January of this year, it had been determined that a whopping 68% of patients were giving up on the GLP-1 meds before even 12 months had gone by. Even worse, by the 24-month (two-year) mark, six out of seven patients had flat-out discontinued the use of their GLP-1 medication.

But that is not all. Even though they had lost both fat and muscle mass, (and in some cases, muscle would constitute as much as 40% of the loss) the weight had a tendency to come back as pure fat, leaving them, for all practical purposes, worse off than before.

Even the CEO of digital health company Noomy warned that the drug alone is not enough. A regimen is needed too, a strong program incorporating a lot of changed behavior including a high-protein diet and some muscle-building exercise, or else…

[…] they risk losing a significant amount of muscle mass, strength, and bone density, which can result in lowered resting metabolic rate and worsening insulin resistance. All together this may lead to a complication called sarcopenic obesity, which is associated with worse prognoses from chronic disease and higher all-cause mortality.

In fact, Noom, the “highly-adaptable behavior change platform,” offers so many potentially helpful bells and whistles, to stay fit while shedding pounds could easily become a full-time job.

In February, Herbalife introduced its Nutrition Companion Classic, a product line that includes a shake mix, a protein drink mix, and a fiber drink available in a variety of flavors and designed to address the problems of malnutrition and decreased muscle density. These offerings are described as “low-glycemic, suitable for diabetics and vegetarians, presenting an opportunity for the development of diverse and accessible nutrition options for individuals on weight-loss regimens.”

Then in May, Nestlé, which had already quite definitively entered the companion product market, introduced a line called Vital Pursuit. It appears to consist of supplemental foods in the familiar guise of sandwich melts, pizzas, and bowls; described as high in protein, fiber, and nutrients, served up in budget-conscious portions “aligned to a weight-loss medication user’s appetite,” meaning, quite small.

In the following month, for Reuters, Jessica DiNapoli explained thoroughly how Nestlé avoids legal entanglements by not naming on the packaging the drugs to which its Vital Pursuit items are meant to be companions. Nestlé executive Tom Moe communicated that rather than mention the drug connection on wrappers, the company would do its marketing via social media. Other brands are more forthcoming, and will tell customers that their companion product might alleviate the nausea that many people experience from “the shot.”

(To be continued…)

Your responses and feedback are welcome!

Source: “Glucagon-Like Peptide 1 Receptor Agonists for Type 2 Diabetes,” DiabetesJournals.org, 2017
Source: “Noom GLP-1 Companion to Add “Muscle Defense” to Promote Safer GLP-1 Use,” BusinessWire.com, 01/19/24
Source: “Herbalife Debuts GLP-1 Nutrition Companion Classic,” TrendHunter.com, 02/15/24
Source: “Nestlé launches frozen food brand aimed at weight-loss drug users,” Axios.com, 05/21/24
Source: “Food companies wade carefully into weight-loss waters,” Reuters.com, 06/20/24
Image by David Shankbone/Attribution 2.0 Generic

Weight-Loss Drugs and Human Subjects

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