Tag Archives: risk

Dael Challenges the Conventional Wisdom about Smoking and Weight Control


Dael is taking a lonely path as a confirmed smoker. So far the benefits seem to out weigh the risks, but we all know what the end of this road will look like. I am posting Dael’s comments to see if the community at metabolism.com can make a positive impact on Dael’s rebellious attitude.

Dael writes:

hey guys and gals just to let you know,

am down to 130lbs and feeling fit as a fiddle. have the 6 pack and abs i dreamed of and am fitter than i have ever been.. it really is odd cos i hate smoking but here i am having lost 42 lbs and loving every second of it apart from the smoking. what can i say – maybe rather die skinny and liking myself, than a fatty with some self righteous notion of how wonderful i am for not smoking… i hated myself with the extra weight, sorry but true…. i really can’t give a f***k for what anyone thinks on here but at least i can bear to look at myself in a mirror and like what i see, not loathe what i look like and try to bullshit myself into believing that i am sooooo happy cos i gave up the cigs….. but next is the NRT – lets see what happens there, and b4 anyone says it, yes i lost two of my best friends to cancer, of the spine and brain, but all i can say is like james dean , i’d rather live fast and furious, that be fat and dumb til 101, you can all choose, but in the end what do you all want?
i do not advocate smoking !!!

I know who i am

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Don’t Expect New Weight Loss Meds for 10 Years or More


As a culture we don’t plan for a sudden halt in scientific advancements. Our tendency is to expect progress to be rapid and continuous. My prediction is that in certain areas of medical science we are likely to see not only a halt in progress but a slipping backward. In particular, the realm of medical weight management is in complete disarray at this time. Two new drugs designed to induce weight loss have been shot down by the FDA in the last few months. The first is Qnexa, developed by Vivus Inc. Interestingly, Qnexa combines two drugs already approved for use in the U.S. One of the drugs is phentermine which is a medication used for decades as an appetite suppressant. The other is a common drug used to treat seizures with the brand name Topamax (topiramate) which also induces weight loss. The drug performed admirably in clinical trials with most participants losing over 10% of body mass. The FDA cited excessive risks of the drug in its statement of rejection. One wonders why the drugs are still being marketed separately if they are so dangerous.

The latest drug to be rejected by the FDA is Lorgess (lorcaserin), developed by Arena Pharmaceuticals. This drug, not as effective as Qnexa, produced 5% body mass loss in about half of participants in clinical trials. Lab animals showed a tendency to develop breast tumors when exposed to the medication, adding to the FDA’s decision to reject the drug application based on safety concerns.

I am a strong advocate of drug safety and regulation. On the other hand we know obesity, and with it Type 2 diabetes, is epidemic in the U.S. I regard weight loss as the “holy grail” when treating type 2 diabetes and yet it is the most difficult goal to achieve. Any drug which could assist in weight loss is highly desirable in the treatment of Type 2 diabetes. Not only does blood sugar improve with weight loss but also blood pressure and cholesterol readings show declines. All three of these parameters are known to be prime contributors to the main cause of death in diabetics, cardiovascular disease.

It has already been 10 years since the last drug was approved specifically for a weight loss indication. The failure of these two latest medications to achieve approval is certain to cause the pharmaceutical industry to severely curtail if not abandon further investment in this type of drug development.

Why is the FDA so reluctant to approve a weight loss pill? This is a complex issue but requires an answer. A new weight loss inducing medication is certain to be highly anticipated and widely prescribed. Therefore, from the very first day of approval the FDA must take responsibility for the well being of millions of people who are likely to take the medication. We are a society which demands our medications deliver miraculous cures with no side-effects. If someone perceives they have been injured by a medication our legal system is primed to unleash brutal retribution on everyone remotely involved in the approval process. Abuse and injury with a medication designed to cause weight loss is almost a certainty. This is a no-win situation for the administration of the FDA.
I predict it will be at least another 10 years before a medication for weight loss is approved by the FDA. Unless there is a change in the climate of litigation in this country it will take longer than that. In the meantime the only new developments in weight loss drugs will be the result of exploiting appetite suppressant effects which are the “side-effect” of medications approved for other purposes.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

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Chubby Neck Becomes the New Normal


After reading the latest research on the metabolic hazards associated with chubby necks I am more sensitive to the size of people’s necks then ever. Of course I look at the size of my patient’s neck but people who I pass in the street or supermarket may find me staring. Watching TV a few days ago I was startled by a series of people in one commercial for Quicken Loans who definitely qualify for the metabolic high risk category based on neck chubbiness. One after another the characters in this commercial walk on, outdoing each other in this physical trait. Has the chubby neck become the new normal? If so, the incidence of diabetes and heart disease is sure to continue to rise.

Let me know if you agree with my impression, or am I biased by being an endocrinologist?

Gary Pepper, M.D.
Editor-in-chief, Metabolism.com

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Large Neck Size Equals Big Metabolic Problems


Large Neck Size Equals Big Metabolic Problems:

A bulging stomach is widely accepted as a sign of poor metabolic health. A recent study published in the August Clinical Endocrinology and Metabolism (95:3701, 2010), finds a chubby neck is likely to hold even a worse prognosis for metabolic health.

The research team evaluated the relationship between waist circumference and neck circumference with levels of blood sugar, good cholesterol (HDL), bad cholesterol (LDL), triglycerides, and insulin resistance, as well as blood pressure. What was found was that neck circumference was a better predictor than waist circumference of elevated blood pressure, LDL, triglycerides and insulin resistance, with lower levels of HDL. All this amounts to a greater risk of cardiovascular disease as neck size increases. As an example, an increase in neck circumference of about one inch is expected to result in a 2.5 point rise in blood pressure.

The authors point out that the neck circumference was a more accurate predictor of cardiovascular risk in women than men. The average neck size for men in this study was about 16 inches (40.5 cm) and about 13.7 inches for women (34 cm).

Alfred Hitchcock, the famous director of suspense movies, made a trademark of his corpulent silhouette with bulging chin and abdomen. Thanks to this research we know his silhouette can signify more than a movie that will thrill you but also a metabolism that will kill you.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

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5 Steps to a Healthy Being by Beth Ellen DiLuglio M.S., R.D., C.N.S.D., C.C.N., LD/N,


5 steps, 5 simple steps can help us reduce dis-ease and induce ease.

1)  EAT WHAT GROWS OUT OF THE GROUND.  A pretty simple concept, yet the best way to have a healthy diet high in fiber, antioxidants, phytonutrients, good fats and good carbs.  Eating 5 or more servings of fruits and vegetables combined can reduce your risk of cancer, heart disease,  high blood pressure and even osteoporosis.  Ideally eat 9 or more servings per day for optimal health.  Add whole grains, legumes,  nuts, seeds, herbs and spices and you are on your way to a truly health promoting diet.  Of course it is important to minimize exposure to pesticides and toxins that can end up in our produce and we’ll cover that in a future post.

2)  HYDRATE.  Drinking adequate amounts of fluids is extremely important to our metabolism.  Our bodies are at least 60% water and even mild dehydration can lead to headaches, fatigue and impaired athletic performance.  Preferably our fluid intake will mostly come from purified water (I recommend Reverse Osmosis for several reasons we will cover in a future post).  You can use RO water to make tea, coffee, lemonade and fruit seltzers.  Most of us need at least 1 ounce per kilogram of body weight to start.  We need to take in additional fluid in case of hot weather, losses during exertion, fever and other specific conditions.

3)  BE ACTIVE.  We all know that a sedentary lifestyle can increase our risk of heart disease and even cancer!  Moderate activity that lasts at least 60 minutes should be done daily , or at least 5 days per week.  To improve our fitness level, aerobic activity can be added a minimum of 3 times per week along with some weight training to build and maintain lean body mass.

4)  RELAX.  Stress can be as detrimental as a poor diet.  The “fight or flight” response is great if you have to wrestle a foe or escape from one.  A chronic “fight or flight” response is not great as the hormones coursing through our bloodstream can actually wreak havoc on our systems over time.  A constant barrage of cortisol can even negatively affect parts of the brain.  Deep breathing can reverse the stress response and begin to restore balance and harmony.  Plan play time and get adequate sleep in order to keep that balance.

5)  SMILE!  Just the thought of a smile can make us feel really good.  Imagine what the real thing can do!

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When Should I Be Tested for Diabetes?


When Should I be tested for Diabetes?

1) Screening for diabetes usually involves obtaining a blood sugar reading before breakfast, also known as a fasting blood sugar. A blood sugar value over 126 mg% indicates type 2 diabetes. Ideal fasting blood sugar is less than 100 mg%.

2) Opinions are divided regarding whether to test all normal adults for diabetes. More agreement about routine diabetes screening exists for people considered to be at higher risk for diabetes. The U.S. Preventive Services Task Force recommends that adults with blood pressure of 135/80 (high blood pressure) and those with dyslipidemia (high cholesterol) be screened for type 2 diabetes. The American Diabetes Association recommends that all adults over the age of 45 years be screened for diabetes.

3) Diabetes which occurs only during pregnancy is known as gestational diabetes. In the U.S. it is common practice to screen for the development of gestational diabetes. This testing is generally conducted between 24 and 28 weeks of gestation, by administering a glucose solution by mouth and checking the blood sugar one hour later. If this is abnormal a formal 3 hour glucose tolerance test is performed. 

Gary Pepper, M.D.

Editor-in-Chief

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