Caffeine Before Exercise Helps You Burn Fat

Researchers at the University of Granada have published a research article in the Journal of the International Society of Sports Nutrition showing that drinking a caffeinated beverage 30-minutes before exercising in the afternoon is the best way to burn fat. Morning exercise with caffeine, or without, was less productive at burning fat than afternoon exercise. Fifteen men, with an average age 32, each completed an aerobic exercise test four times with seven days in between testing. On the days tested, they were given either a caffeine dose equivalent to a strong cup of coffee or a placebo. They then rested for 30-minutes and then completed the aerobic exercise. Their meals were standardized on test days. Researchers measured the participants for fat oxidation, maximum oxygen uptake and exercise intensity.

Caffeine increased fat oxidation by 10.7 % in the morning and 29% in the afternoon. Caffeine increased exercise intensity by 11% in the morning and 13% in the afternoon. Maximum oxygen uptake was higher in the afternoon.

Recent literature has shown the benefit of tea in lowering systolic blood pressure. I think I might try a stiff cup of tea 30-minutes before my after-work exercise regimens. Come to think of it, Ii will try some coffee prior to my weekend morning workouts as well.

Obstructive Sleep Apnea Surgery vs. CPAP? Daytime Anti-Snoring Device?

Obstructive sleep apnea is now epidemic in a population where it runs hand-in-hand with obesity, which is also an epidemic. The consequences of untreated sleep apnea include daytime somnolence, cardiovascular, neurological and endocrine complications.   One of the hallmark signs of obstructive sleep apnea (OSA) is snoring. 

The US Food and Drug Administration (FDA) recently approved an oral device to be worn during the daytime to reduce and/or eliminate snoring. The device is called eXciteOSA made by Signifier Medical Technologies.  The device is a prescription item which will be used by sleep specialists, dentists and ENT physicians.  It has four electrodes that deliver a series of electrical stimuli to the tongue with rest periods in between. The stimulation over time improves tongue function preventing the tongue from collapsing backward into the airway and obstructing it during sleep.  The device is used for 20-minutes once a day, while awake, for six weeks and then once a week thereafter. It is designed to be used in adults 18 years of age or older with snoring and mild OSA. Think of it as physical therapy for the tongue.

The device was tested on 115 patients, 48 of whom had mild obstructive sleep apnea plus snoring. The others were all snorers. The snoring was reduced in volume by more than 20% in 87 of the 115 patients. In the group of patients with the diagnosis of OSA and snoring, the apnea-hypopnea index score was reduced by 48%

It is recommended that a thorough dental exam be performed prior to trying this device. The major side effects noted from its use were excessive saliva production, tongue discomfort or tingling, metallic taste, jaw tightening, tooth filling sensitivity.  No mention of the cost was included in the printed review.

The online journal Practice Update reviewed a JAMA Otolaryngology publication on the use of surgery to treat Obstructive Sleep Apnea versus using a CPAP machine. There are many patients who just can not wear the CPAP mask which is the first-line “gold standard” for treating OSA.  Most patients who spend 90-days adjusting to the mask sleep far better and look forward to using the device to obtain a restful night’s sleep. The study looked at patients who were at high risk for not being able to adhere to a CPAP use regimen. Soft tissue surgery to the uvula was found to reduce the rates of cardiovascular, neurological and endocrine systemic complications compared with prescriptions for CPAP in patients less likely to adhere to or use the CPAP mask. 

The takeaway message is clear. When a patient is unlikely to adhere to CPAP mask use offering soft tissue oral surgery should be offered early while treating the disease.

Will I Be Able to Choose My COVID-19 Vaccine?

There are currently four vaccines to prevent COVID-19 in the pipeline. I have been asked numerous times when am I going to have the vaccine in my office and which vaccine should individuals take? This question was addressed by MedPage Today, an online health care periodical on 11/27/2020. The same question was asked of National Institute of Health “chief” Francis Collins, MD, PhD last week at a press briefing. Dr Collins responded there will not be enough vaccine available in December for the whole country and “people who get offered one should feel quite happy about that.” Leana Wen, MD, of George Washington University responded to the same question saying, “Initially there won’t be nearly enough vaccines for hundreds of millions of Americans. We will probably take whatever we are able to get access to.”

If you are a healthcare worker, or in the more vulnerable groups, you are most likely to be offered one of the nRNA vaccines from Pfizer/BioNtech or Moderna because they are further along in completing the FDA required trials and application process for approval. Younger healthier individuals having less priority may get to choose.

Larry Corey, MD, a viral expert at Fred Hutchinson Cancer Institute in Seattle and a leader of the COVID-19 Prevention Network Vaccine Program broke down the numbers at a November 18, 2020 meeting of the American Public Health Association and National Academy of Medicine:

  1. The US Government has contracts for 100 million doses of the Pfizer/BioNTech and Moderna vaccines with production producing the 200 million doses by the spring of 2021. That should cover the highest risk groups including healthcare personnel, nursing home residents, essential workers and the medically vulnerable per the CDC Advisory Committee on Immunization Practices (ACIP) guidelines. The vaccine will be shipped to 50 states, the District of Columbia, 8 territories and five large urban health departments including NYC and Chicago. Who receives it first, and where they receive, it will be decided by the local jurisdictions. This process should take until the end of March 2021 leaving some 200 million Americans waiting for a vaccine. Dr. Corey was clear that “We need other vaccines for the rest of the population.”
  2. In addition to the Moderna and Pfizer/BioNTech mRNA vaccines, there are products from Oxford/AstraZeneca, Janssen/Johnson &Johnson, Merck, Sanofli/Glaxo SmithKline and Novavax. Jay Butler, MD, deputy director for infectious disease at the CDC expects there to be mass vaccinations run by public health agencies and possibly some vaccination programs at community pharmacies. No mention was made of supplying physician offices or clinics.
  3. If there are no major delays, seven different vaccines should be available by the spring of 2021. Naor Bar-Zeev, PhD, of the International Vaccine Access Center at Johns Hopkins University in Baltimore said it is too soon to compare the products because there are no studies comparing them head-to-head. He reminded us that different vaccines might be better suited for different patient populations with pediatric patients, the elderly, the immunocompromised likely to do better with some and not others.

Despite the lack of detail to date, Moncef Slaoui, MD, head of the federal Operation Warp Speed, told CNN that he expects 70% of the US population to be vaccinated by May 2021.

New Drug Shows Weight Loss Promise – Just in Time for the Holidays

Thomas Walden, PhD of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania presented data on weight loss at a Bariatric Medicine meeting held remotely called ObesityWeek. It was reported this week on Medscape Medical News.

Using the diabetic drug semaglutide (Ozempic), they demonstrated that 75% of the 611 participants lost 10 % or more of their baseline body weight. When they used the higher diabetic dosage, 55% of the participants lost more than 15% of their initial body weight and 36% lost greater than 20%.

Diabetic drugs have been used off-label for years for weight loss. Byetta and Trulicity work to reduce weight as well. The real problem with these medications is cost – with a month of Ozempic costing $800 – $900 while the other two (Trulicity and Byetta) are more expensive than that.

We know weight loss helps diabetics and hypertensives improve their control and health but there are a limited number of drugs you can safely give a 55 year-old with these types of medical conditions. I was surprised and perplexed when a local bariatric specialist started my 64 year-old patient on an amphetamine for three weeks with their heart rate accelerating and blood pressure elevating characteristics.

In patients, 55 or older, I believe in nutritional counseling first. We have experienced dietitians locally both at our hospitals and private practice who will teach you how to eat correctly and work you to develop a personal weight loss plan.

The retail diets like Weight Watchers, Jenny Craig and NutriSystem work and are safe. However, not all retail diets provide behavioral coaching which is a crucial component for losing weight safely and maintaining the weight loss (not yo-yo dieting).

I have twice now experienced great success with OPTAVIA.  The program incorporates Healthy Habits which is an innovative and proven lifestyle approach which gets your mind and body working together.  A health coach provides you with personalized guidance for maximum effectiveness.

Their plan uses five of their “fueling meals” plus one “lean and green meal” you prepare per day.  Following their plan, I have lost more than 35 pounds, in just three months.

I have recently signed up to be an OPTAVIA coach for those patients interested in this program and requiring help and encouragement along the way. Losing the weight is always easier than keeping it off for a “foodaholic” like me but with their maintenance program, and hopefully some discipline, I will keep it off this time.

Happy Holidays to all my patients, colleagues and friends. If you would like to shed those extra pounds, and live healthier, just give me a call. We will discuss the program and how you would benefit from it.

Brown Fat Injections Reverse Weight Gain in Obese Mice

There is hope for those of us battling weight gain and obesity. An article appeared this week in the journal Endocrinology discussing the research of Wanzhu Jin, PhD, of the Chinese Academy of Sciences involving weight loss and reversal of Type I diabetes. Researchers are well aware of the different types of lipid or fat in all mammals. Brown fat or brown adipose tissue has been felt to have protective effects against weight gain, lipid abnormalities and glucose metabolism problems.

Dr Jin, used mice that were genetically engineered to be overweight or fat. He injected them with a quantity of Brown Adipose Tissue (BAT) and these mice lost weight and improved their glucose metabolism into the non-diabetic range. The success in weight loss and sugar control was felt to be due to the BAT increasing the energy expenditure of the genetically altered mice. The sugar control occurred through similar mechanisms and was unrelated to the production of insulin or insulin metabolism. Dr Jin’s team of researchers felt that the transplanted brown adipose tissue activated and enhanced the BAT already present in these obese mice allowing it to produce the weight loss and improvement in glucose and lipid metabolism. Their research seemed to hint that brown adipose tissue actually acted as an endocrine gland like the pancreas or adrenal gland or thyroid gland, secreting substances that improved metabolism of obese mice.

Dr Jin’s work will provide an incentive for human researchers to look at brown adipose tissue and its modulation and enhancement as a way to control human obesity and diabetic epidemic in the future.

Weight Loss May Prevent Recurrent Atrial Fibrillation

Heart - CopyAtrial fibrillation is a chaotic heart rhythm seen generally in patients with an enlarged left atrium chamber of the heart and or disease of the heart valves. The heart beats irregularly in many cases decreasing the effective pumping ability of the heart muscle. Patients with atrial fibrillation tend to form blood clots in the left heart chambers which are at risk to break off and travel downstream especially to the brain causing embolic strokes. Newly diagnosed patients are placed on anticoagulant medications such as warfarin, dabigatrin, rivaroxaban, or apixaban to prevent these clots from forming in addition to medicines to slow down the heart rate and hopefully shift you back to your normal heart sinus rhythm in time. Other patients are forced to undergo electrical shock cardioversion to re-establish their normal sinus rhythm while others require ablation therapy to do the same. Once these procedures and chemical maneuvers have been successful, and many times they are not, patients are placed on medications to maintain the correct rhythm.

At a meeting of the American College of Cardiology, Rajeev K. Pathak, MBBS, of Australia’s Royal Adelaide Hospital, presented data showing patients who went on a diet and lost 10% of their body weight were six times more likely to be free from the arrhythmia without having to use antiarrythmic medication at five years (rate 46% versus 13% with less than a 3% weight loss.) The results were presented at the ACC meeting and published in the Journal of the American College of Cardiology.

The study looked at 355 patients who had atrial fibrillation and a body mass index of 27kg/m2 or greater. They were offered a low fat, low carbohydrate weight loss program plus an exercise program at a weight loss clinic. They determined freedom from recurrent atrial fibrillation by using a seven day Holter monitor recording. The evaluations showed that those patients who kept the weight off with less than a 2% fluctuation in weight were 85% more likely to not have recurrent atrial fibrillation or require medication use to control their rhythm.

Lifestyle modification in the form of weight loss is always preferable to the use of medication and procedures. Bernard Gersh, J. MBChB, DPhil, of the Mayo Clinic in Rochester, Minnesota was adamant in saying, “Bottom line is this is a very simple strategy for people with atrial fibrillation. They must lose weight.” He went on to say that weight loss should be considered and tried before a patient is sent for an ablation procedure.

It is important to note that this study is an observational study and did not actually prove that losing weight caused atrial fibrillation to disappear. A further study is underway to prove this point. The article additionally did not specify if the researchers discontinued anticoagulants in the weight loss group no longer exhibiting atrial fibrillation.

Brown Fat Injections Reverse Weight Gain in Obese Mice

Overweight, Belly, ManThere is hope for those of us battling weight gain and obesity. An article appeared this week in the journal Endocrinology discussing the research of Wanzhu Jin, PhD, of the Chinese Academy of Sciences involving weight loss and reversal of Type I diabetes. Researchers are well aware of the different types of lipid or fat in all mammals. Brown fat or brown adipose tissue has been felt to have protective effects against weight gain, lipid abnormalities and glucose metabolism problems.

Dr Jin, used mice that were genetically engineered to be overweight or fat. He injected them with a quantity of Brown Adipose Tissue (BAT) and these mice lost weight and improved their glucose metabolism into the non-diabetic range. The success in weight loss and sugar control was felt to be due to the BAT increasing the energy expenditure of the genetically altered mice. The sugar control occurred through similar mechanisms and was unrelated to the production of insulin or insulin metabolism. Dr Jin’s team of researchers felt that the transplanted brown adipose tissue activated and enhanced the BAT already present in these obese mice allowing it to produce the weight loss and improvement in glucose and lipid metabolism. Their research seemed to hint that brown adipose tissue actually acted as an endocrine gland like the pancreas or adrenal gland or thyroid gland, secreting substances that improved metabolism of obese mice.

Dr Jin’s work will provide an incentive for human researchers to look at brown adipose tissue and its modulation and enhancement as a way to control human obesity and diabetic epidemic in the future.

New Hope to Keep the Weight Off

Diet DrugsAs we head into the New Year, with our “new” resolutions, those of us inclined to gain weight are always looking for something new to help us along the way. Announcements regarding new weight loss products or services offer us hope which, in turn, encourages discipline and determination. Along those lines, Gary Frost PhD, of Imperial College London, and associates reported in GUT magazine that their newly developed short chain fatty acid propionate powder helps satiety and prevents weight gain.

Propionate is normally produced when dietary fiber is digested in the gut. Frost and his researchers produced inulin-propionate ester (IPE) to deliver larger quantities of propionate to the colon than can be obtained by diet alone. They noted that propionate stimulates the release of the appetite suppressing hormone PYY and GLP-1 from colon cells in the test tube. They then randomized 20 participants to a pre-meal dose of their propionate compound or just inulin. They then allowed these participants to eat at a buffet. Those given propionate ate 14 % less than those given inulin alone. They then measured the appetite suppressing hormones in both groups and found them higher in the propionate recipients.

This initial study was followed by a study in which 60 overweight patients were given propionate powder (IPE) to put in their food or inulin powder for 24 weeks. Over that time the propionate group had no patient with more than a 5% body weight gain compared to 17% in the inulin group. They then measured abdominal and liver fat and found that the propionate group had far less.

These are initial works with the authors seeing the potential of adding propionate powder to fattening foods. More research is needed but hope springs eternal.

Skipping Breakfast May Be Fine For Weight Loss

Scale and foodEmily Dhurandhar, Ph.D, of the University of Alabama at Birmingham is a nutritionist who does not believe in following myths and dogma unless there is sufficient research and evidence to back it up. She recently led a team of researchers who looked at the question of whether skipping breakfast was a hindrance to weight loss. Her group conducted the first controlled randomized study on the topic looking at 309 overweight and obese patients over a 16 week period. Patients were assigned to one of three groups:

1.            An intervention group told to eat breakfast

2.            An intervention group told to skip breakfast

3.            A control group not specifically instructed to do eat or skip breakfast

They were all placed on a caloric restricted diet. The results of the study showed that the only thing that mattered in weight loss was whether your intake of calories was less than calories used during the day. The time of day we first eat had no effect on weight loss in this study.

Dr. Dhurandhar reasoned that none of us actually skip breakfast since our first meal of the day after a prolonged overnight fast is still breakfast. The study only looked at weight loss related to skipping or eating breakfast. It did not answer the other age old dietary question of whether eating a large calorie amount late at night and then retiring affects your weight. For those of you who enjoy sleeping in, this is excellent news.

New Diet Drugs Not Being Used

Diet DrugsA joint survey was conducted by the online medical news service MedPage Today, Everyday Health and The Daily Meal to evaluate physicians’ methods of treating obesity. They surveyed almost 1000 providers and found that the newer drugs such as Qsymia (phentermine/topiramate) are only being used by about 6% and Belviq (lorcaserin) in only 3.3%. Several of the survey respondents cited the high cost of the medications as barriers to use. One provider noted that “middle class (patients) and below cannot afford “these medications so he prescribes generic phentermine 37.5 mg one half tablet each morning with generic topiramate 25 mg twice a day with similar effectiveness.

Fat absorption blockers such as orlistat in it’s over the counter form “Alli” or its prescription form xenical were popular with over 20 % of respondents using those products. Generic phentermine was used alone by 16%. Other medications frequently mentioned included metformin the diabetic drug, and victoza another diabetic drug not yet approved for weight loss therapy.

The majority of the respondents prescribe diet and exercise to begin with. Weight Watchers is their favorite commercial diet with over 75% of those surveyed noting that it works steadily and safely. The South Beach Diet was the clear runner up. When the Atkins Diet was mentioned there was concern and controversy.

In our local clinical practice we are asked frequently about medication to lose weight. The survey did not look at the average age of the patients the respondents treated and their associated medical issues. Locally we have many elderly individuals using multiple medications for heart disease, elevated lipids, diabetes, heart rhythm control and other complex problems. It is much more difficult to find any oral medications for weight loss that do not adversely react with their prescribed medicines or that are not contraindicated due to their underlying medical problems.