EACH ISSUE OF THE WELL NEWSLETTER will feature one or more articles from health care professionals. Our contributing writers will be medical doctors, PhDs (or PhD students) and fitness trainers who will tackle issues that are important to your health and wellness.
An APPEAL to end exercise-only obesity interventions!
THE STUDY IS ENTITLED, "A Program Promoting Exercise and Active Lifestyle". In it, 196 overweight (average BMI nearly 30) carefully selected for motivation and affinity to start exercising individuals were asked to exercise at moderate to vigorous intensity for 60 minutes a day, 6 days a week, for a year! To ensure objectivity, subjects were provided with logbooks and heart rate monitors and adherence was excellent. Men in the study averaged 370 weekly minutes of exercise, and women 295.
Subjects were not instructed to make dietary changes.
So if weight loss were about exercise, certainly you would expect that after a year of an hour a day, 6 days of week of exercise, that weight would be lost in a dramatic manner.
The results?
Over the course of the year, men lost an average of 3.5lbs and women 2.6lbs.
Readers of my blog will know that I'm all for exercise - reason being is that it's one of the single most important determinants of health and that doing it psychologically bolsters patients who've lost weight and helps them keep their focus on their weight loss behaviours (including dietary changes).
Clearly what it won't do is by itself lead to dramatic weight loss.
Therefore I would argue that studies and public health interventions for obesity that focus exclusively on exercise or increasing day to day activity can no longer be considered ethical as we know that the outcomes will be dismal. My other concern of course is that since we know these interventions are doomed to failure, by throwing public health care dollars at interventions whose success will be measured on the basis of weight, we're going to drain the pot of public health dollars for obesity treatment and potentially make it less likely to receive funding in the future from once burned, twice shy stretched federal, provincial and municipal governments.
SO YOU'RE FINDING YOURSELF THIRSTY all the time — a lot more than usual. Or you've been really, really tired lately. Can't seem to get enough sleep.
Maybe you've dropped a bunch of weight — without even trying. Funny, but these days, it seems you always have to go pee, even when you've just gone.
You dismiss it all as just something you're going through. Something that will pass.
Well, it could be that you've developed something that's going to stick around for the rest of your life.
You could be one of the almost 250 million people around the world who has diabetes. A third of those people aren't even aware they have the condition. Forty-six per cent of them are between 40 and 59 years old.
Two million of them are Canadian.
Diabetes — or complications from the disease — now kills 3.8 million people a year or about the same number as HIV/AIDS.
The International Diabetes Federation calls the disease the epidemic of the 21st century. It notes that only 20 years ago, the best information suggested that 30 million people around the world had the disease. The federation expects that by 2025, the number of people living with diabetes will hit 380 million — if nothing is done.
In 1991, the federation and the World Health Organization proposed a World Diabetes Day as a way to bring attention to the escalating incidence of diabetes around the world. It took 15 years for the United Nations to pass a resolution declaring Nov. 14, 2007, the first World Diabetes Day.
The date of what is to be an annual event was chosen to mark the birthday of Frederick Banting. Along with Charles Best, Banting is credited with discovering insulin.
In 1999, the federal government pledged $115 million over five years to develop a Canadian Diabetes Strategy. Its goals included developing a health-promotion, disease-prevention strategy for the entire population and improving access to information about diabetes and the effects it can have.
Still, the number of new cases continues to grow. In March 2007, a Canadian study suggested that the disease was outpacing expectations and growing rapidly. Lorraine Lipscombe of the Institute for Clinical Evaluative Sciences in Toronto found that the percentage of people with diabetes in Ontario, and probably the rest of Canada, has jumped noticeably, affecting about one in every 11 adults, or 8.8 per cent of the population. By comparison, the disease affected just 5.2 per cent, or one in every 19, in 1995.
The study, published in the Lancet, suggests that rising obesity levels across Canada are contributing to the onset of the disease.
These figures exceed original projections made by the World Health Organization, which suggested that diabetes would affect 8.4 per cent of people in developed countries.
What is diabetes?
Diabetes interferes with the body's ability to produce or properly use insulin, a hormone that is essential for the proper use of the energy contained in the food we eat. You need insulin to process glucose, a sugar that your body requires for fuel. If your body is not producing or properly using insulin, you will have too much — or too little — glucose in your system.
There is no cure for the condition, but diabetes can be controlled through diet or medication. Over time, diabetes can lead to life-threatening and debilitating complications.
There are three main types of diabetes.
Type 1 diabetes occurs when your body makes little or no insulin. There is no known cause for it. You normally find out that you have it while you are a child or an adolescent. For that reason, it used to be called juvenile or insulin-dependent diabetes.
Type 1 diabetes is normally treated through insulin therapy. You take insulin injections to compensate for a pancreas that isn't working properly. The pancreas is the organ that produces insulin in the body.
In January 1922, a 14-year-old Toronto boy, Leonard Thompson, became the first diabetic in the world to receive an insulin injection. The treatment was deemed a success and earned Frederick Banting and J.J.R. MacLeod the Nobel Prize for Medicine the next year.
Type 2 diabetes occurs when the pancreas either does not make enough insulin or makes it but cannot use it properly. Nine out of 10 Canadians with diabetes have type 2 — and 60,000 new cases are diagnosed each year.
Many people don't know they have type 2 diabetes until they go to the doctor, usually for an unrelated problem.
The condition is usually controlled through diet.
Gestational diabetes affects pregnant women. Up to 18 per cent of aboriginal women in Canada and 3.5 per cent of non-aboriginal women will develop the condition during pregnancy.
The condition usually disappears after childbirth, but a woman who has had gestational diabetes faces a higher risk of developing type 2 diabetes later in life. The condition can also pose a danger to the unborn child and the mother. The child may be born severely obese, putting him or her at a higher risk of having a dangerously low blood glucose level. There is also a risk of severe breathing problems.
Like type 2 diabetes, gestational diabetes is usually controlled through diet.
What are the symptoms?
The classic symptoms of type 1 diabetes include:
Feeling tired.
Unusual thirst.
Frequent urination.
Being hungry.
Mood swings.
Weight loss.
Blurry vision.
Frequent infections.
Symptoms of type 2 diabetes and gestational diabetes are similar. They include:
Recurring skin, gum or bladder infections.
Cuts and bruises that are slow to heal.
Itchy skin.
Frequent vaginal yeast infections.
Fatigue, drowsiness or blurred vision.
Increased thirst.
Frequent need to urinate.
Tingling in the hands or feet.
Sometimes there are no symptoms.
What are the risk factors?
Risk factors for type 1 diabetes have not been identified as it's still not clear what causes the disease. But there are many risk factors for type 2. They include:
Age. Most cases of type 2 diabetes occur in people 40 and older.
Obesity, especially if you have an "apple-shaped" body that carries extra weight around the middle.
A sedentary lifestyle.
High cholesterol, high blood pressure and a high fat diet.
Having a family member who has diabetes.
Gestational diabetes, which leaves you with a 40 per cent risk of developing type 2 diabetes.
If you gave birth to a baby that weighed more than four kilograms (about nine pounds), your risk is higher.
Aboriginal people have a three to five times higher risk than other Canadians.
People of Hispanic, Asian, South Asian or African descent are also more at risk.
What can I do to avoid developing diabetes?
A healthy diet and keeping fit will go a long way towards minimizing your risk of developing diabetes. Limit the amount of fat and sugar in your diet and don't smoke.
It also helps to keep your cholesterol levels within healthy ranges and to maintain a normal blood pressure.
In other words, do all those things you're supposed to do to maintain good health. And hope that genetics is working in your favour.
The International Diabetes Federation says it's critical for parents to ensure their children are eating a healthy diet and exercising. The number of children being diagnosed with type 2 diabetes is skyrocketing.
"There is no doubt that this is linked to the epidemics of overweight and obesity, and there is no doubt that this increase in overweight and obesity is linked to the profound way in which the life of those children and adolescents has changed over the past 10 to 20 years," Pierre Lefebvre, the group's outgoing president, told the World Diabetes Congress in South Africa.
The congress was told that as long as developing countries continue to embrace the bad health habits associated with affluence, the diabetes epidemic will continue to grow.
What are the major complications associated with diabetes?
Diabetes is a lifelong condition. If left untreated, high blood glucose levels over a long period of time can cause:
Blindness.
Heart disease.
Reduced blood supply to the limbs, leading to amputation.
Nerve damage.
Erectile dysfunction.
Stroke.
Diabetes has also been linked to depression. It's estimated that 25 per cent of people who live with diabetes also have symptoms of depression.
The Canadian Diabetes Association says you can greatly reduce your risk of developing the complications associated with diabetes if you "keep your blood sugars as close to normal as possible, maintain your weight at an acceptable level, and live a healthy lifestyle."
RIGHT NOW IT'S ONLY AIRING across the pond (in the UK) but thanks to the magic of the internet, with a bit of effort, you can watch it in North America.
Go to a city of 250,000 people in Northern England, a city with one of the highest obesity rates in the nation. Once there harness the power of social networking to try to teach the city to cook.
Teach 8 cooks 10 recipes in return for a promise that they each teach two people and each of them two people and so on and in less than 6 months, all of Rotherham ought to be able to cook.
The show provides a fascinating snapshot into the lives of some working class folks out in Rotherham and the pressures surrounding making home cooked meals (do you spend your welfare check on the bus tickets it takes to travel with your two under 6 year old kids to purchase fresh produce or do you save yourself the time and energy and go to a "take-away"?) and it's also a fascinating social experiment.
So far I'm completely captivated by the first two episodes and can't wait to see more.
Find it, watch it, you won't regret it and until then, head over to his website and you 'll find that already his social experiment has sprouted wings as there are 612 bloggers currently blogging about their newest cooking escapades and literally thousands of posts in the forums.
Letter to the Editor by David Wehrenberg, Certified Athletic Trainer
PRESIDENT-ELECT BARRACK OBAMA has definitely changed the face of America. Not only will Obama be the first African-American President of the United States, he will also be considered one of the fittest presidents.
President-Elect Barrack Obama was also considered fit enough to grace the cover of Men's Health. He was featured in an article depicting him as a "Hero of Health and Fitness." In the Men's Health November 2008 feature article Obama stated, "Most of my workouts have to come before my day starts. There's always a tradeoff between sleep and working out. The main reason I do it is just to clear my head and relieve me of stress."
:: from June/July 2008 issue: Men's Fitness: 25 Fittest Guys in America #5 Barack Obama, 46 – The Candidate
It takes a certain stamina to endure months of 16-hour days in pursuit of the land's highest office. Obama is not the first politician dedicated to fitness, but the Illinois senator starts every day with a morning workout, whether it's machines at the hotel gym or a brisk 45-minute run. He's also quit smoking. Obama can be excused for enjoying the occasional state-fair corn dog because he mostly stays away from fatty foods. He's also, as we've seen, a bit of a baller. Nicknamed "Barry O'Bomber" for his jump shot, the former high school hoopster now releases stress during pickup games-including one on every primary day. "He's wiry-looking but actually pretty strong," former Duke player and Obama staffer Reggie Love has said. "And he hates losing. He plays hard." Now that we know.
Regardless of your political or personal affiliation, you have to admire Barrack Obama's dedication to his personal health. Hours before it was determined that he would be the next President of the United States, what did he do? He exercised. He spent time playing basketball, working up a sweat, strengthening his cardiovascular and muscular systems.
President Elect Barrack Obama is implementing the correct exercise mix of muscle building strength training to increase his metabolism, thereby burning more calories at a higher rate throughout the day and cardiovascular exercise to give him stamina while campaigning.
In his Men's Health interview with Peter Moore, Obama described his fitness regimen. "Usually I get in about 45 minutes, 6 days a week. I'll lift one day and do cardio the next," said Obama.
Imagine that, a United States President Elect lifting weights three days a week and doing aerobic exercise three days a week. Obama has kept this program up while being a senator and running a full-time presidential campaign. It makes the rest of us wonder why we fail to maintain a consistent program of health and fitness. Our meager excuses fall short in comparison.
During my many years as a personal trainer and fitness professional, I have often sat across the table from someone, obviously in need of my services, who will debate with me why they do not have the time to take care of themselves — even when I offer them fitness programs that take 30% less time than Obama's personal routine.
Perhaps all Americans can truly look to our leadership as a role model. Together, with President Obama at the helm, we can fight some of the problems which plague our country such as obesity, diabetes, and high cost of health care. And when asked, 'Can we change the health of our nation?' We will resound, "Yes, we can."
RECENTLY I WAS ASKED HOW I, personally, stayed fit. Do I have "inside info" as a doctor that benefits me as well as my patients? And if I have the courage to write it down, what would be 10 salient points?
I do recommend lifestyle modifications as initial treatment for patients with health issues such as obesity, hypertension, diabetes, hyperlipidemia, depression and addictions. I present a three-prong approach: exercise, diet, and relaxation.
EXERCISE
Get a routine! I meet 4 mornings a week with friends for runs or walks. This works for me because I feel obliged not to let the other person down. I have company — two women always talk so it's stress reduction, therapy time and friendship consolidation.
I go to an exercise class 3 times a week, not aerobic, but stretch and strength. My husband goes too and now we have a social network of like-minded couples that meet at our local community centre.
Yoga — one or two classes a week, two blocks from home — a class in the evening is very relaxing and meditative.
EATING
I used to exercise and not worry about what I ate. Now I am in my 5th decade and I DO have to eat less. I've always had an interest in preventive medicine. I subscribe to Nutrition Action, the only journal I've consistently renewed my subscription to and read for 25 years. I highly recommend it for it's sensible, easy to understand format and suggestions.
Gradually I have changed my diet. First, I eliminated deli meats, then I started reading labels trying to avoid trans fats and salt, then I cut back on dairy fats and now I use 'no fat' milk products nearly all the time.
Next I started consciously adding more vegetables to my diet, serving them up before the main course.
Handling sweets is a personal challenge. I just try to not have them around or substitute them with fruits.
RELAXATION
This aspect of the three-prong approach has always been difficult for me. So what have I done to improve myself in this area?
That classic 'be in the moment' line, to me is much harder to maintain than exercising or eating properly. I am bad for multitasking and so now, I try more to just do what I am doing.
I've started riding my bike to work or taking the bus. Both these activities are much more peaceful than driving a car.
I have a meditation space and a meditation time, as for me, routine seems important to getting stuff like this into my life. The yoga helps too.
Finally, to get more esoteric about lifestyle, I have the luxury and privilege to be self-employed and to set my own hours. This, of course, results in 80-hour weeks for many of my colleagues and I've done that too. But now I choose to work less and, of course, earn less. That means I'll be working longer (no freedom 55 here). Actually, I think it is good for my health to keep doing a job I enjoy and have a lot of experience in, to give back and contribute. This is important, to have work you love, or at least like, and not just be holding out for another 'X' years for retirement and the pension.
So there it is. 10 points I try to practice, but not fanatically.
Anne M. Thompson M.D. CCFP
Dr. Anne Thompson is a family doctor in Vancouver. She is a full service doctor who counsels her patients to modify their lifestyles
to incorporate preventive medicine, and tries to practice what she preaches.
by Peter Janiszewski, PhD (Cand.), MSc from his blog.
SINCE WE HAVE DEVIATED SLIGHTLY from our original blog purpose of examining various obesity cures, [today I will] evaluate a weight-loss supplement that I keep coming across. Posts which assess the claims of weight-loss supplements, exercise equipment or techniques, and other gadgets (such as the Slender Shaper which I blogged about a while back) will be a regular feature on this blog.
This week’s anti-obesity elixir is called Accelis. You can purchase this product at your local drug stores or directly from this website.
Here is a brief summary of the product as provided by the manufacturer:
“Accelis® is a revolutionary stimulant-free weight-loss product that can help you lose 10.65 pounds fast. Accelis® contains a patent-pending weight-loss ingredient in an absorption-enhanced softgel delivery system. It's so simple to use: You just take one serving each night and follow a balanced, active lifestyle.”
And now, let’s begin…
I guess I should just get used to the abuse of words such as ‘revolutionary’, ‘simple’, ‘fast’, ‘effective’, etc. in such exaggerated claims, so for the sake of time I will skip the semantics.
The claim is that you can lose 10.65 lbs (the extra decimal places really carry some authority, don’t you think?) over the course of 8 weeks with the use of this product. Notwithstanding the fact that a reference to the “one 8-week double-blind, placebo-controlled study, conducted at a major research center in Miami” on which this whole concoction is basing efficacy is nowhere to be found, the manufacturers do give us something to discuss.
First, this one study (which I could not find after serious PubMed and Google Scholar searching) did not actually assess efficacy of Accelis, per se, but the efficacy of “the active ingredient” in Accelis (discussed below).
Additionally, what is only unearthed by reading much fine print, is that the placebo group in this ‘study’ lost 5.87 lbs, so we are actually talking about a less than 5 lb weight loss accomplished during 8 weeks which may be attributed to the effects of Accelis’ “active ingredient’. As a simple comparison, a randomized-controlled trial from our lab published back in 2000 showed that men who went on a caloric-restriction diet (700kcal/day) lost over 16 lbs (in comparison to a control group) during 12 weeks. And remember there was no magic potions administered in this study – people simply ate less. Thus, the weekly loss in weight in our study of 1.4lbs is more than double that reported for the active ingredient in Accelis (0.6 lbs). If the weight-loss achieved through Accelis administration is indeed “fast”, then simple caloric restriction produces “warp-speed” weight-loss!
On this topic, if you want a really good laugh, click here to read the frequently asked questions (FAQ) section of the Accelis website. My favourite FAQ is: “Is there a study on the key ingredient in Accelis?” Yes, this would be my first question as a consumer evaluating this product. And, nevermind the reference, or any real details, I am convinced of efficacy when a website pedalling some elixir simply answers “Yes there is” to this FAQ. That’s evidence-based medicine for you.
The purportedly medicinal ingredients in Accelis can be separated into 3 main categories:
Non-stimulating stimulants
Caffeine-free green tea extract
Caffeine-free oolong tea extract
Caffeine-free white tea extract
Sedatives
Chamomile extract
Passionflower extract
Active Ingredient
Lagerstroemia speciosa
The inclusion of caffeine and other stimulants, as we shall see in future posts, is a staple of the weight-loss supplement. Indeed, caffeine is an established ergogenic (performance-enhancing) aid, which improves performance in physical as well as mental tasks. In addition to elevating metabolic rate, caffeine also influences substrate metabolism by promoting greater reliance on free-fatty acid (fat) oxidation while sparing muscle glycogen (carbohydrate) – a good thing if you want to lose more fat while exercising. Lastly, caffeine also acts to suppress appetite. Thus, the inclusion of caffeine in weight-loss supplements makes some sense – albeit, this practice comes with some health risks (i.e. elevated blood pressure, anxiety, etc.). On the other hand, including caffeine-free stimulants in Accelis is like buying a car without an engine – likely not very useful.
Given that Accelis is to be taken before bed, the inclusion of sedatives is appropriate – if you are looking for a sleep-aid, that is. Camomile tea is a common remedy for insomnia and restlessness, and is often ‘prescribed’ to me by my mother (Dr. Mom) with varying degrees of treatment success. Sedatives are generally included in weight-loss supplements to help offset some of the hyper-activity induced by the effects of the commonly-included stimulants (i.e. caffeine) – again, none of which are included in this product. This is much like purchasing a new ABS brake system for that engine-less, and thus immobile car I alluded to above.
Lastly, the “active ingredient” is Lagerstroemia speciosa, or more specifically, corosolic acid, which is found mainly in the banaba plant grown in the Philippines, and nearby areas. While I have been able to find some (limited but consistent) literature addressing the ability of corosolic acid to improve glucose tolerance (possibly via enhanced GLUT-4 translocation), there is very little evidence if any, reporting that this compound may induce significant weight loss.
In all, I personally doubt that taking this product will lead to any loss in body weight, although the effects of one of its ingredients on glucose metabolism are intriguing, and warrant further investigation. Until that time, save your money and stick with what works – diet and exercise.
In agreement with my lacklustre assessment of Accelis, a survey on a diet blog reports that only 4 out of 34 individuals who rated this product gave it a favourable (thumbs up) rating, while the large majority reported dissatisfaction with the product’s effect.
So there you have it – Accelis, like many of its relatives, largely fails as the panacea for obesity. It may, however, be a panacea for all that excess cash you are carrying around ($53.59 for a 40 day supply).
Readers of my blog will know that I'm all for exercise - reason being is that it's one of the single most important determinants of health and that doing it psychologically bolsters patients who've lost weight and helps them keep their focus on their weight loss behaviours (including dietary changes).
Two million of them are Canadian.
