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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

What Doctors Say About Prescribing GLP-1 Receptor Agonists to Kids

Tatyana Meshcheryakova November 20, 2024 No Comments

Yesterday, MedPage Today published another part of its series called “Ozempic: Weighing the Risks and Benefits.” In the piece, Enterprise & Investigative Writer Sophie Putka examines how often doctors prescribe new weight loss drugs to kids and interviews a few professionals about their thinking process, reservations, and concerns.

As enthusiasm for GLP-1 receptor agonists as a weight-loss solution has grown, their use in children has also increased. Currently, liraglutide and semaglutide are the only GLP-1 drugs approved by the FDA for treating obesity in children aged 12 and older.

Between October 2022 and September 2024, prescriptions for these two medications by pediatric and adolescent medicine specialists surged from 3,448 to 24,435 — a sevenfold increase in just two years, according to a MedPage Today analysis of Symphony Health data. During this time, total prescriptions for all GLP-1 drugs written by these specialists more than doubled, rising from 59,868 to 125,538. These figures include prescriptions for 11 GLP-1 brands, many of which are approved for type 2 diabetes, but exclude those written by primary care or family medicine physicians and compounding pharmacies.

Many specialists feel cautiously comfortable prescribing GLP-1 medications to children when other options have been exhausted, provided that families are engaged in lifestyle interventions. However, concerns remain about long-term effects, particularly on bone density, and some experts remain uneasy about the rapid adoption of these drugs in pediatric care.

The jury is still deliberating

According to a recent article in Scientific American, written by Lauren J. Young, an associate editor for health and medicine, experts express concerns about potential impacts on bone health, growth, puberty, and restrictive eating habits, emphasizing the need for long-term studies like this JAMA study. These medications, considered lifelong treatments, pose unique challenges for teenagers compared to adults. Here at Childhood Obesity News, we also covered all kinds of questions and concerns regarding the potential risks of pediatric, adolescent, and adult use of GLP-1 drugs.

Still,

Clinical trials in younger age groups have shown significant weight and BMI reductions compared to lifestyle changes like diet and exercise, leading to FDA approvals of liraglutide (Saxenda) in 2020 and semaglutide (Wegovy) in 2022 for children 12 and older. A recent study reported a nearly 600% increase in GLP-1 prescriptions for adolescents and young adults between 2020 and 2023, largely driven by Wegovy’s approval for weight management in late 2022.

Proceeding with care

Last year, the American Academy of Pediatrics (AAP) issued an updated Clinical Practice Guideline for recommending the use of pharmacotherapy for adolescents 12 and up, including GLP-1 agonists.

Sarah Hampl, M.D., of the University of Missouri-Kansas City School of Medicine and lead author of the AAP guidelines, emphasized the role of other interventions that accompany medication. She said:

It was recommended, not in isolation or not as a monotherapy, but as adjunct or addition to intensive health behavior and lifestyle treatment… [AAP] needed to comment on [pharmacotherapy], because it can be a very effective form of treatment — again, as an adjunct and these kids, especially with severe obesity, they have some really serious and real comorbidities right here and now, in their childhood.

On the other hand, Dr. Fatima Cody Stanford, a pediatric obesity specialist at the Massachusetts General Hospital in Boston, avoids prescribing GLP-1 drugs to children under 12.

She said:

I would still probably use my other drugs where we do have some data, like a topiramate or metformin, or if they have very severe obesity, I would wonder if they had something else,” such as proopiomelanocortin (POMC) deficiency or leptin receptor deficiency.

Dr. Stanford ensures her adolescent patients receive comprehensive care, including dietitian support and psychological counseling, while closely monitoring bone health given the lack of long-term data on GLP-1 use.

It looks like family medicine doctors tend to use weight-loss drugs as a last resort. Dr. Tochi Iroku-Malize, former board chair of the American Academy of Family Physicians, noted that while medications might be necessary for some children with severe obesity, their long-term effects on developing bodies remain unclear.

She said:

When we’re starting with children, they have a longer way to go than adults when it comes to using these medications… [W]e don’t yet know what the long-term effects of taking the weight-loss medications are, and whether the young patients would have to continue taking them indefinitely to maintain their weight.

Despite these challenges, experts agree on the importance of combining medication with healthy lifestyle habits, stressing that the long-term success of any treatment relies on addressing the broader environmental and behavioral factors contributing to childhood obesity.

Your responses and feedback are welcome!

Source: “How Often Do Doctors Use New Weight-Loss Drugs in Kids?,” MedPage Today, 11/18/24
Source: “Teenagers Are Taking New Weight-Loss Drugs, but the Science Is Far from Settled,” Scientific American, 10/25/24
Image by Ben Wicks 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

Gene Therapy for Childhood Obesity

Tatyana Meshcheryakova November 13, 2024 No Comments

Childhood Obesity News has been looking at various types of treatment for childhood obesity, including GLP-1 agonists, digital technology, and behavioral interventions. Now, let’s take a quick look at yet another promising treatment — gene therapy.

For the past four years, researchers at Shriners Children’s St. Louis have been exploring new methods to combat the impacts of childhood obesity. Led by Farshid Guilak, Ph.D., and Ruhang Tang, Ph.D., the research team has developed a promising approach using gene therapy. Their studies in mice have shown that this therapy can convert harmful fatty acids into beneficial ones, which may help children with obesity lower their risk of associated health problems, particularly arthritis.

The study, published in the Proceedings of the National Academy of Sciences, details a gene therapy technique called “fat-1 gene therapy,” which prevents metabolic dysfunction, cellular aging, and arthritis linked to obesity.

According to Dr. Guilak, excess weight is the top preventable risk factor for arthritis in children. The team’s findings highlight that it’s not only obesity itself but also the diet that contributes to arthritis risks. Specifically, the type of fatty acids children consume significantly affects their weight and health.

Dr. Tang explained that gene therapy involves using an adeno-associated virus (AAV) to introduce a gene coding for an enzyme into cells. This enzyme automatically transforms pro-inflammatory Omega-6 fatty acids into Omega-3 fatty acids, which are healthier for metabolism. Omega-3s — found in foods like fish and certain nuts — enhance metabolic health by improving insulin sensitivity, promoting fat breakdown, and reducing inflammation, potentially lowering the risk of diseases related to obesity. Natalia Harasymowicz, Ph.D., another study leader, noted that the therapy also reduces the number of inflammatory cells involved in obesity and arthritis.

The study specifically examined post-traumatic arthritis, a form common among children due to injuries such as knee meniscus tears. A single gene therapy injection was shown to significantly reduce the negative effects of a high-fat, Omega-6-heavy diet on both metabolic health and knee arthritis. The therapy also appeared to prevent early “aging” in the mice caused by diet-induced obesity.

Dr. Guilak said:

What we are observing is that obesity results in old knees in young patients… The modern diet, especially in the United States, tends to be high in Omega-6s and low in Omega-3s, which can lead to an imbalance, especially for kids… Arthritis can be a very painful and debilitating condition for children so we’re hopeful that this research will help reduce the risk of it developing and make treatments more effective. The implications for how this research might be used in the future are vast but we’re excited about the potential for it to help kids lead healthier lives.

The research team, led by Dr. Guilak, is now collaborating with the FDA, aiming to start clinical trials within the next three to five years.

Your responses and feedback are welcome!

Source: “Gene Therapy Method Converts Omega Fatty Acids to Combat Childhood Obesity,” Genetic Engineering & Biotechnology News, 10/14/24
Source: “Gene therapy for fat-1 prevents obesity-induced metabolic dysfunction, cellular senescence, and osteoarthritis,” PNAS.com, 10/14/24
Image by National Cancer Institute on Unsplash

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

Digital Technology Can Help Reduce Obesity

Tatyana Meshcheryakova November 8, 2024 No Comments

We continue looking at the role of digital technology in improving pediatric care. Two recent studies, both published in JAMA, found that adding a digital component to health counseling — even something as simple as a text message — may help reduce childhood obesity.

One study, funded by the Patient-Centered Outcomes Research Institute, used REDCap data tools hosted by Vanderbilt University Medical Center, with support from the National Institutes of Health. It was co-led by Dr. Eliana Perrin, a Bloomberg Distinguished Professor of Primary Care at Johns Hopkins University.

Text messages as a tool against obesity in infants

Dr. Perrin and her team developed the Greenlight Program, an initiative designed to educate parents about promoting healthy growth in infants. With most parents owning smartphones, this digital program is easily accessible.

The researchers recruited nearly 900 parent-infant pairs from hospitals and pediatric clinics at six different medical institutions. All participating infants were 21 days old or younger, born after 34 weeks of pregnancy, at a healthy weight, and without chronic conditions affecting weight gain.

Participants were divided into two groups. Both groups received Greenlight Program materials, which included counseling on nutrition and healthy habits, as well as age-appropriate booklets with goal-setting advice. However, only half of the group received interactive, personalized text messages from an automated system. These texts offered immediate feedback, tips for addressing challenges, and words of encouragement as they made progress.

The impact of text messages

The study tracked the outcomes of the text messages on childhood obesity until the children reached two years old. Researchers measured various health metrics, including weight and growth, to evaluate the program’s success. Through regular followups and digital monitoring, they could capture a comprehensive view of each child’s development.

Results showed a marked improvement in maintaining healthy growth patterns in children whose parents received the personalized texts. Between the two groups, children of parents who received digital support had healthier growth trajectories over their first two years compared to those who received only counseling.

The digital program led to a 45% relative reduction in obesity. Researchers found that the benefits of the digital intervention began as early as four months and continued over the two-year period, marking this study as one of the first large-scale efforts to prevent early childhood obesity.

Dr. Perrin said:

If we can prevent obesity in these children at the highest risk, we can also work toward greater health equity.

Implications for broader applications

The success of this study suggests that similar text-based interventions could be adapted to address other age groups or health issues. Digital technology offers a scalable way to deliver health education tailored to individual needs and support in real-time. The duration and size of this groundbreaking study adds confidence that the outcomes are not a coincidence.

Another study focuses on diversity

A recent study published in JAMA focused on infants coming from diverse racial and ethnic backgrounds. Called Greenlight Plus, the trial randomized 449 parent-child pairs to the digital intervention group and 451 to the counseling-only group. The study included 45% Hispanic children, 20.6% non-Hispanic White, 15.9% non-Hispanic Black, and 18.3% identifying as other or mixed races. Among parents, 65.2% preferred English and 34.8% preferred Spanish; 15.6% reported food insecurity, and 55.6% had limited health literacy.

Results showed a lower mean weight-for-length in the digital intervention group compared to the counseling-only group. Although the proportion of children classified as overweight was similar between groups, the digital intervention group had a significantly lower obesity rate (7.4% vs. 12.7%).

The authors noted that some population groups were not well represented in the study and that only English and Spanish speakers were included. Nonetheless, they highlighted the potential for a meaningful population-level impact if the intervention is scaled up, suggesting further studies on broader implementation.

Finally, a quick reminder about Dr. Pretlow’s app and an upcoming study geared at teens. The ability to rechannel displacement into less harmless activities rather than succumbing to urges is behind the behavior modification app, BrainWeighve, currently ramping up for a trial through the University of California Los Angeles (UCLA). The trial focuses on weight loss for obese teens using a self-directed, physician-supervised program withdrawing from one problem food at a time.

Your responses and feedback are welcome!

Source: “Digital Intervention Reduces Early Childhood Obesity Risk in Diverse Populations,” American Journal of Managed Care, 11/4/24
Source: “Simple text messages could help tackle childhood obesity,” Earth.com, 11/4/24
Image by Eyestetix Studio on Unsplash

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

Almost Half a Ton, Continued

Pat Hartman October 31, 2024 No Comments

Katie Peterson realized she needed help, but was trapped in the old catch-22 known as needing help too much. She had to lose 200 pounds before any medical institution would even consider her case; and was turned away by several facilities, which did not even want to make an appointment to talk it over until those 200 pounds were gone.

The general guidelines to qualify for bariatric surgery would frustrate a saint. As journalist Kati Blocker explained in a meticulously detailed piece for UCHealth.org,

You must have a BMI of 40 or more; or a BMI of 35 or more, plus a serious obesity-related health problem, such as type 2 diabetes, high blood pressure, or sleep apnea.

But at the same time, with all that going on, the patient must be deemed healthy enough to undergo surgery. Also, the doctors require the patient not to be a smoker — which Peterson was. The hopeful patient must have tried other weight-loss methods, like diet and exercise. There is a mandatory psychological exam.

Blocker writes,

Most importantly, you have to be committed to the long-term process of weight loss. By following the post-surgery recommendations, you give yourself the best possible chance to begin successfully.

In 2016, the family encountered both interpersonal and financial difficulties. Katie’s son got in some trouble serious enough to be arrested for. At this point, her lifelong habit of stress eating extended to consuming a bottle of pills all at once. She was hospitalized until a judge had pretty much no choice other than to let her go home, because no mental health facility would take her. She was still too big. Despite periodic talks with a therapist, she reverted to type:

I again stress ate. I was eating this whole time. From when I woke up to when I went to bed, I was eating something.

Although outside pressures eased a bit, Katie was up to 700 pounds and facing even more determined rejection from medical institutions. The math was simple. No 200-pound loss equals no surgery. Her depression did not lift, and the non-stop stress eating continued. But when her son graduated from high school, she felt inspired to look for help again and found an intriguing article online. After filling out a form, she was invited to meet with Dr. Robert Quaid of UCHealth.

The three-hour trip to Colorado involved being loaded into a minivan by half a dozen firefighters, and at Poudre Valley Hospital she weighed in at 890 pounds. This was the occasion of the quotation borrowed for our title:

I was flabbergasted. I couldn’t believe I’d let my life go that far where I was almost half a ton.

Dr. Quaid, the bariatric surgeon, made a treatment plan that would include attempted removal of the lap band, then a sleeve gastrectomy, to be followed around 18 months later by a single anastomosis duodenal switch, and then at some future point the removal of around 100 pounds of “excess tissue and skin.”

To help her attain mental and physical readiness, Peterson was paired up with nurse navigator Michelle Carpenter for ten months of preparatory life changes. In May of 2022, it finally happened. After the very complicated first surgery, she spend five days in the hospital before returning to Wyoming where therapy continued, along with virtual support group attendance and communication with Carpenter. The three-month follow-up visit was good, and by the six-month check-up Peterson had lost 242 pounds since surgery. She was down to 648.

Almost exactly one year ago, journalist Kati Blocker published another follow-up story about Katie Peterson, who had already lost 330 pounds at that point, a considerable improvement from her days of weighing “almost half a ton.” In the meantime, she had been cheered by messages from many strangers who reached out to encourage her and also to express how much she had encouraged them. These include a young man (almost 700 pounds) about whom Kati Blocker also wrote a very recent article.

Your responses and feedback are welcome!

Source: “900 pounds and hopeless:” Katie’s weight-loss story, UCHealth.org, 01/17/23
Source: “From 900 pounds to independence,” UCHealth.org, 11/07/23
Source: “Once nearly 700 pounds, this young man is on the road to better health,” UCHealth.org, 09/19/24
Image by Ian Britton/Attribution-NonCommercial 2.0 Generic

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

What Doctors Say About Prescribing GLP-1 Receptor Agonists to Kids

The jury is still deliberating

Proceeding with care

GLP-1 Drugs — Are Alternatives Feasible?

Okay, so what else is there?

What’s Wrong With Ozempic and Its Kin?

Speaking of mental health…

Gene Therapy for Childhood Obesity

Natural Rivals to Ozempic?

Some caveats

Digital Technology Can Help Reduce Obesity

Text messages as a tool against obesity in infants

The impact of text messages

Implications for broader applications

Another study focuses on diversity

Binge Eating Is a Tough One, But They All Are

An emotional beating

Refeeding Syndrome — Cure Worse Than Condition

Kids with problems

Almost Half a Ton, Continued

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

Presentations