This is an interesting story. We are probably years away from understanding which patients will benefit from this knowledge. Hormone breakthrough in obesity

The treatment is based on injections of leptin, a hormone that appears to play a central role in suppressing appetite by informing the brain when the stomach is full.

Doctors believe its use could form the basis of a new and highly effective way to treat severe obesity.

…

Dr Ian Campbell, chairman of the UK National Obesity Forum, told BBC News Online that the treatment sounded promising.

But he warned that only a small proportion of severely obese people were deficient in leptin.

“This shows that replacing leptin can have a profound effect in achieving weight loss, but what remains to be seen is the effect leptin would have on people who are not deficient in the hormone in the first place.”

We still have a lot to learn about obesity. This does not obviate the benefits of diet and exercise for the great majority of patients. Nonetheless, I find such research very interesting.

What are the problems with the Atkins diet?

The Atkins diet sure get a lot of attention – Researchers chew the fat on merits of the Atkins diet

Some of the nation’s leading obesity researchers and nutritionists are outraged by the diet, arguing that it runs contrary to the advice of most major health organizations, which advocate a diet relatively low in saturated (animal) fat and high in complex carbohydrates (grains, vegetables). Those recommendations are based on scientific evidence that a diet rich in fruits and veggies and low in saturated fat reduces the risk of heart disease, some types of cancer and other health problems.

Still, many dieters swear by the Atkins diet. And until recently, there haven’t been many studies investigating its safety and effectiveness.

As a skeptical physician, I am always happy to question the “advice of most major health organization’. I worship at the altar of data. We need to see the data – ’show me the money’.

In one new study, conducted at Duke University Medical Center and funded by a grant from the Robert C. Atkins Foundation, participants ate a very low carbohydrate diet of 25 grams a day for six months. They could eat an unlimited amount of meat and eggs, two cups of salad and one cup of low-carbohydrate vegetables such as broccoli and cauliflower a day. Of the 50 patients enrolled, 80% adhered to the diet for the entire study, losing an average of 10% of their original body weight. The average weight lost was approximately 20 pounds, says Eric Westman, associate professor of medicine at Duke University Medical Center.

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In another pilot study, obesity researchers at three universities recruited 63 people who were 30 or more pounds overweight and assigned them to one of two programs. One group was given a copy of Dr. Atkins’ New Diet Revolution. The other group was put on a conventional diet with about 30% of calories from fat, 55% from carbohydrates and 15% from protein.

At the end of six months, those following the Atkins diet lost about 10% of their starting weight and those on the conventional diet lost about 5%. Atkins dieters also were more likely to stick with the plan than conventional dieters.

…

Foster and fellow researchers are going to continue to investigate the Atkins diet with a longer-term study sponsored by the National Institutes of Health. They will look at several different aspects, including whether the diet may be more useful for some people than others and how much people are able to exercise while eating a low-carb diet. They also want to investigate why some dieters seem more likely to stick with the Atkins program than a more conventional diet.

The data speak. At least in the short run Atkins works for dramatic weight loss. I am glad the the NIH is studying the diet in a longer-term study. That seems a good use of federal funds.

Drug company rebuked

I hate typing this. FDA Rebukes Maker Of Diet Drug Meridia

The Food and Drug Administration has told the maker of the diet drug Meridia that it violated federal regulations by failing to properly report the deaths of patients taking the drug.

In a letter to Abbott Laboratories made public yesterday, the FDA said that information about seven deaths associated with Meridia was not reported properly to the agency, that one death was not reported at all, and that reports on three other deaths were incompletely reported.

Why are they not thinking? What are they trying to hide? This makes me very unhappy.

Osteoarthritis – a patient primer

Jane Brody (one of my favorites) wrote this week on osteoarthritis. First Step in Treating Arthritis: Keep Moving. While we know from good studies that physical therapy helps osteoarthritic patients, I am dismayed by how few of our patients will devote themselves to a program. They assume that we have a magic pill that will fix them. The article discusses the wide variety of therapies. She discusses the increasingly popular supplements:

So-called dietary supplements offer another option that may be taken alone or along with other arthritis drugs. Most popular among them are glucosamine and chondroitin sulfate, often sold in combination tablets or capsules with instructions to take three a day.

Other than a possibility of somewhat loose stools in the first few weeks of therapy, they have no known side effects. Several clinical studies, not always pristinely conducted, have indicated that glucosamine alone or the two in combination can relieve arthritic discomfort and may delay or halt its progression.

The National Institutes of Health is conducting a proper study of their effectiveness.

Some evidence also supports another dietary supplement, SAM-e, for arthritis pain, as well as mild depression. For arthritis, 200 to 400 milligrams of SAM-e are taken three times a day. With all supplements, do not expect noticeable pain relief for three or four weeks.

Dietary supplements can be quite costly and are not covered by medical insurance. Neither are their quality and potency regulated by the Food and Drug Administration. So bargain hunting may be a bad idea. It is best to choose products made by reputable companies like Nutramax and Schiff.

This is a good reference for the web searching patient. The information is sound, well balanced and obviously researched.