Monthly Archives: March 2007

Dr. Atkins Diet Wins by a Nose

Diet by Dr. Atkins Wins by a Nose

A nose that weighs about 4 or 5 pounds, that is.

A recent Stanford University study compared the benefits of four different weight loss programs: Atkins, Zone, Ornish and Learn diets. What they found was that after 12 months the average weight loss with the Atkins diet in overweight and obese but otherwise healthy women was about 10 lbs. which was more than with any of the other diets. The next best diet was the Learn diet with an average weight loss of about 5.5 lbs. The Ornish and Zone diets produced about a 3 or 4 pound weight loss after one year.

Of particular interest was that the amounts of fats in the blood (triglycerides in this case) were lower in the Atkins group by the end of the study than in the other diet groups. Since the Atkins diet is a high fat diet and very low carbohydrate, while the others are low in fat and relatively higher in carbohydrate, the finding of better triglyceride levels with Atkins was unexpected.

I applaud the hard work and effort made by these researchers to uncover these findings. Unfortunately I don’t think they have provided us with enough information to make an informed decision about whether the Atkins diet is truly the best of these four dietary approaches to weight loss. It has been my experience that many who start the Atkins diet fail to adhere to it for very long. Many people tell me they find that the high fat of content of Atkins makes them want to vomit. Making matters worse the development of ketones in the body that are thought to be crucial for success of the Atkins diet also induce nausea. Perhaps it is the effect of a high fat diet to make you sick to your stomach that causes some of the weight loss. In the Stanford University experiment each participant was carefully selected and nurtured through the study. Even with this level of care, of all the subjects starting a diet about 1 in 5 couldn’t finish a year. Without the intense personal support from study coordinators that goes with this type of clinical research I predict many fewer people would last a year on the Atkins. In the real world my concern is more for those who couldn’t finish the diet than for those who did. What if a person consumes all those fat calories and can’t lose weight? What happens to their blood fat levels, blood pressure, body mass etc?

A researcher reading these comments may go “Piss-posh…who ever studies the drop-outs from a study? These people simply disappear.” I assume the drop-outs themselves and their doctors are concerned about the drop-outs. If someone is placed on a diet by their doctor and doesn’t succeed on it, the patient and the doctor still have to deal with the aftermath. It would not surprise me at all if a lot of bad things happen in the body of those non-losers on Atkins.

So I say, let’s attend to the drop-outs and non-losers as well as those who succeed with their diet. Let’s study high fat diets in a real world environment without a million dollar budget for support staff and other luxuries. I need to tell my patient what happens if they are unsuccessful on Atkins as well as if they succeed. Will their triglyceride, blood pressure, and sense of well-being deteriorate? If that is the risk they must take for losing 5 pounds more then with the Ornish, Zone, or Learn diet I would think twice about suggesting the Atkins diet. When the “non-loser study” is available I’ll feel much better informed about which diet to recommend then I do now.

Only you and your own doctor can decide what is the best treatment for you. The comments made here by the staff at are purely for educational purposes and are not meant to guide you in the treatment of any condition or illness.

Gary Pepper, M.D. FACP
Editor-in- Chief,

Boston Men Show Decline in Testosterone (Male Hormone) Levels

A published study confirms what has been suspected for some time, which is that men in the Boston area over the past two decades are showing declining levels of testosterone (male hormone), in their blood. Over twenty years the average testosterone level in these men dropped from 501 to 391. Many experts regard a testosterone lower than 300 to be abnormally low and possibly needing testosterone replacement treatment. One of the scientists on the study, Dr. Thomas Travison states that when comparing testosterone levels in Boston men from 1987 to 2005 a decline in the testosterone level in every adult age group was found over this time. The researcher stated that the speed with which the levels of male hormone declined over the twenty years and the uniformity of the decline in all age groups was cause for concern.

It is known that testosterone levels decline slowly as men age. Declining male hormone levels were found even in the 45 to 71 year age range, however. Other known causes of declining testosterone levels, the growing incidence of obesity and sedentary life style in Boston men, did not explain the findings, say the researchers.

Could other factors be at work here? Alcohol has a powerful effect on male hormone levels for many reasons. Some alcohol products like bourbon and beer may have estrogen (female hormone) like plant products in them. Liver disease from excess alcohol consumption can also reduce the level of male hormone. Other drugs may have a negative effect on male hormone production such as cannabis (marijuana, Mary Jane, pot, herb, weed, splif, ganja, the bomb, the shit etc.). Although not nearly as wide spread in its use are the opiate type drugs, heroine, methadone, opium, codeine, hydrocodone etc. which can severely depress male hormone levels.

Environmental pollutants are known to cause adverse hormonal effects in men. Pollutants such as PCB’s and DDT act like female hormone and could reduce a man’s testicular function (the testicle is the site of testosterone and sperm production in men). Even herbal products can have anti-male hormone effect such as soy, black cohosh, and white clover. Perhaps the Boston men are being exposed to these influences more now then in the past and the result is sinking male hormone levels.

Before concluding that Boston men are simply pot smoking, beer drinking, soy eating effeminate couch potatoes, the authors of the study call for additional research into the possible origins of this serious loss of virility hormone in the Boston area.

Gary Pepper M.D.

Ramonabant (Acomplia) for Weight Loss; Sinner or Saint?

If you went to college in the 60’s and 70’s you may remember the “munchies” or voracious appetite which sometimes accompanied marijuana smoking. Little did the pot heads of that day realize that medications in the future which block the munchies would help them shed the pounds that they would gain over the next 30 or so years.

This new medication, ramonabant (affectionately known at as Ramona), brand name Acomplia, is presently available in Europe and may soon be available in the United States. The company which produces this medication, Sanofi-Aventis, has been in lengthy negotiations with the FDA regarding gaining the critical approval required to bring Acomplia to market in the U.S. There has been much speculation about the reasons for the lengthy delay in gaining approval from the FDA. One possible reason is that although extensive clinical trials suggest that the new drug is safe and effective for weight loss, many experts are concerned about potential side-effects of this weight loss drug.

Studies show that about 30-40% of obese people taking ramonabant lost more than 5% of their body weight and 10-20% of subjects lost over 10% of their body weight above what they lost on diet alone. Because this diet pill acts on the liver as well it had beneficial effects on triglycerides and other fats in the blood. Blood pressure reduction has also been observed with Ramona treatment.

Ramona works by blocking an important chemical pathway in the brain known as the endocannabinoid system. Scientists speculate that our body naturally manufactures substances resembling cannabis (marijuana, pot, reefer erc.), which interact with the endocannabinoid system. The endocannabinoid system not only participates in the control of appetite but is active in many areas of the body including the gastrointestinal tract, mood regulation, bone development, muscle control, blood pressure, adaptation to stress and the reproductive system. Several experts such as University of Colorado at Colorado Springs biology professor Dr. Robert Melamede have warned that the long term use of Ramona for weight loss could result in unwanted side-effects involving these other body systems. In fact, depression is listed as one of the side-effects that may limit drug’s tolerability occurring in about 3% of obese subjects in a weight loss study. Nausea was another important limiting side-effect.

Industry experts speculate that Acomplia may be available for U.S. consumers by this summer but no one knows for sure. Insurance companies in the U.S. will not pay for medications for weight loss. Only a drug that treats a medical illness or condition will be “covered” by an insurance company. For that reason it is thought that Sanofi-Aventis will approach the FDA for an approval to use the weight loss drug in the treatment of diabetes. This is because many diabetics will see an improvement in their blood sugar as they lose weight and because Ramona may have a direct beneficial effect on glucose and cholesterol regulation, as well. It will then be up to the FDA to finish their analysis of the safety and efficacy of the drug for this purpose. How long this will take is anyone’s guess.

In the meantime we wait and wait and wait for Ramona. At we have been thinking that it might help if our members wrote a song about their feelings on the matter.

We took a stab and came up with this little ditty.

(in a Calypso beat)
Lyrics by GPepper, Director

Oh Ramona, Oh Ramona
Why you left me so blue?
Xenical not nearly so sweet as you.

Oh Ramon, My Ramona
Me want to shed these ugly pound
Me getting to look so soft and round

Oh Ramona, Oh Ramona
Why you left me so blue?
I’m all alone wit’a powerful taste for some yellow cheese fondu.

Oh Ramona, Oh Ramona
I don’t know if you sinner or saint
You make my liver happy but the rest of me body complaint.

Please add your comments and your own song to the blog at It may help you feel better.

Only you and your doctor can decide on what medical treatments are best for you. The articles on such as this one are meant for educational purposes only and should not be used to guide you in your medical care. Speak to your health professional before undertaking to change or initiate medical treatment plans.

Gary Pepper M.D.