Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Fructose sweetener, appetite and obesity

Use of fructose as artificial sweetener has been subject of media reports recently. Some have advised against using fructose because of potential for increased appetite and weight gain. However, multiple studies using fructose in humans have failed to support effect of fructose and the association may be weak at best.

Fructose and glycemic index: Dr. Bantle in a recent review article, “Is fructose the optimal low glycemic index sweetener?” suggests that , there is not yet any convincing evidence that dietary fructose does increase energy intake.

Fructose and food intake and satiety: Soenen and colleagues from Netherlands found no differences in satiety or energy intake after high-fructose corn syrup, sucrose, or milk preloads.

Glucose fructose ratio and food intake, satiety: Similarly, Akhavan and Anderson from Canada studied the effects of glucose-to-fructose ratios in solutions on subjective satiety, food intake, and satiety hormones in young men. They found that sucrose, high fructose corn syrup, and G50:F50 (50:50 solution of glucose and fructose) solutions do not differ significantly in their short-term effects on subjective and physiologic measures of satiety, uric acid and food intake at a subsequent meal.

Bottomline about fructose: As always, moderation is the key. Just because there is paucity of evidence to support deleterious effects of fructose, does not mean that you should load up on fructose in your diet. Naturally occurring fructose in your daily consumption of fruits and vegetables should not be a problem.

Do you use sugar or artificial sweeteners? Do you have any prefered kind? Please share your thoughts about fructose and artificial sweeteners.

Do bacteria cause obesity?

Let us start the year 2007 on a cheerful note. There is an old saying, all sickness begins in gut. Obesity is no exception. And it is not just related to imbalance between ingestion of excess food and calorie expenditure. And of course obesity cuts down your life span also.

Now that you may have packed some extra-pounds during the holidays, you may be feeling guilty since taking them off is usually not that easy. Worry not! If you can't take them off, it may not be entirely your fault. Even viral infections have been implicated. According to two articles reported in the prestigious journal Nature (October 2006), the gut bacteria may be playing an important role.

Obesity alters the ecology of the trillions of bacteria present in the gut. Dr. Turnbaugh and colleagues from Washington University in St. Louis, Missouri studied the intestinal bacteria of lean and obese mice as well as humans.

There is an alteration in relative dominance of two types of bacteria (Bacteroidetes and the Firmicutes) in the gut of obese persons. For example, the relative proportion of Bacteroidetes is decreased in obese people as compared to their lean counterparts. This relative proportion increases with weight loss on low-calorie diet.

This altered bacterial flora results in the alteration of bacterial metabolism. For example, bacterial flora in obese facilitates extraction of greater amount of energy from the diet. Data also showed that it might not be a static phenomenon. For example, the transfer of the "obese" bacterial flora to the lean animals results in induction of obesity in the lean ones!

Above findings in no way diminish the fact that obesity is directly related to the net balance between in amount of calories ingested and the calories consumed by the body as energy expenditure. It just means that the pathogenesis of obesity has a bacterial component.

Do you have a weight problem? Do you have difficulty taking off excess body weight? Have you been on yo-yo diet? Your thoughts are welcome.

Drink water to lose weight

We have always been told that water, the liquid that sustains life, is good for overall health and well being. No matter what kind of health-advice book you read including obesity, "plenty of water" is always one of the important suggestions given for improving your health. However, there has been a paucity of data to back up such very plausible and intuitive claims.

It is indeed gratifying when such a study on "plenty of water" comes along proving that such traditional claims are not empty. And the current study tackles no small issue, but the huge problem of obesity affecting the world, no pun intended.

NAASO, The Obesity Society, is the largest conference in North America focuses on the cutting edge issues related to obesity research and treatment. A study presented at the annual Scientific in Boston (October 2006) showed how drinking water instead of beverages with sugar could help people lose weight.

Researchers studied 240 overweight women who were on one of the several diet plans restricting carbohydrate consumption.

They found that dieters who replaced completely abstained from sugar-laden drinks and consumed water instead lost 5 pounds per year more than the subjects who did not do the switch.

In addition, the subjects who drank more than four cups of water per day lost an additional 2 pounds as compared to those who did not.

One simple explanation is that those drinking water were consuming fewer calories. Intestinal bacteria have been linked to obesity. Perhaps plenty of water gets rid of obesity-related bacteria. However, it is also possible that increased water may alter some hitherto unknown aspects of energy metabolism and improve health.

Do you have an overweight problem? What do you think about this study? Do you drink water more than beverages or vice-versa? Feel free to share your thoughts.

Fermented soy prevents obesity

As the health care costs keep rising on account of the epidemic of obesity, scientists are looking at more and more unconventional strategies to combat the curse of extra weight.

Dr. Manzoni and colleagues from Brazil studied the effect of a soy product fermented by two probiotics (Enterococcus faecium and Lactobacillus jugurti) in rats. The rats were fed a chow diet or Soy diet as above. The results were published in the journal Nutrition (October 2005)

They found that the soy had beneficial effect on fat pads in the body. This was likely due to the fact that the fat cell size was significantly smaller in the rats fed fermented soy diet. In addition, the data showed that the fermentation of probiotic was responsible for enhancing the anti-fat effects of the soy diet on the fat cells.

The authors concluded that this fermeted soy diet might be another option to pursue for obesity prevention.

While this study was done in rats, the results look very promising. The soy products and probiotics have many beneficial effects on health and it would be a coup if these results can be duplicated in humans.

What are your thoughts on soy or probiotics? Do you take soy or any probiotics for any reason? Feel free to share your thoughts.

Early dementia: another reason to lose extra weight

Obesity is associated with memory problems in older people. Is the true for younger people also indicating risk for early dementia? This was answered by Dr. Gunstad and colleagues from Brown Medical School in Providence, RI. They published their findings recently in the journal Eat Weight Disorders (March 2006).

These investigators studied 486 healthy persons. They were divided into normal weight, overweight, and obese groups. All the subjects were subjected them to a verbal list-learning task. 

These authors found that obese subjects performed poorly on memory as compared to their age-matched leaner counterparts. The analysis demonstrated that there is an independent relationship between obesity and memory and that the relationship between BMI and memory does not vary with age.

These findings suggest that extra-weight during middle age may result in a higher risk of dementia later in life.

Even a little extra weight will shorten life

Obesity is known to contribute to many diseases and premature death. However, the impact of just being overweight but not "obese" has been hotly debated.

Two recent studies (New England Journal of Medicine August 2006) confirm what many of us had long suspected, i.e. even a little extra weight is harmful and shortens life.

In one of these studies, Dr. Adams and colleagues from National Institutes of Health, Bethesda, MD, studied the impact of overweight, obesity, and mortality in subjects 50 to 71 years old.

They studied body mass index (BMI) and its relation to the risk of death in over five hundred thousand subjects. Results were adjusted for age, race or ethnicity, education, smoking , physical activity, alcohol intake and preexisting diseases.

Examination of BMI in nonsmoking subjects above the age of 50 years revealed that the risk of death increases by 20 to 40 percent among overweight persons and by two to three fold among obese persons.

The other study concluded that underweight, overweight, and obese men and women had higher rates of death than men and women of normal weight.

Bottomline: Maintaining a healthy weight and preventing weight gain especially in middle age is critical for a longer and healthy life.

Green tea for weight control

Numerous strategies have been suggested in order to conquer the growing epidemic of obesity. Among the commonly used tools are caffeine, ephedrine, capsaicin and green tea since they are likely to increase the body metabolism and energy use thus contributing to weight loss.

Dr. Diepyens and colleagues from the Maastricht University in Netherlands recently published a review on this topic in the American Journal of Physiology (July 2006).

They conclude that while a combination of caffeine and ephedrine is effective for weight loss, the adverse effects of ephedrine preclude its use.

Capsaicin is effective but compliance has been a big problem.

Green tea is effective for weight loss and works via multiple mechanisms including its role in regulation of body fat metabolism.

Do you or csomeone you know has ad difficulty losing excess weight? Have you been on yo yo diets or any fad diets? What tools worked or did not work for you?

Exercise and waist versus hip fat

Obese individuals may be characterized as "apple-shaped" and "pear-shaped". Waist fat is not just important for many of us to fit into a smaller dress size but note that it is the waist fat that contributes more to increased risk of obesity-related illnesses. Diet alone won't help much here. The current study demonstrates clearly that exercise is needed and explains why.

Dr. You and colleagues from the Center on Aging at Wake Forest University sought to examine the impact of low calorie diet with or without low impact or high intensity exercise on abdominal (waist) and hip fat and the size of fat cells in these body regions. They published their findings in the International Journal of Obesity (August 2006).

They studied 45 middle aged obese women with an average BMI of 33. Biopsies were done before and after intervention.

Not surprisingly, all three groups had similar decline in body weight, fat mass, percent fat and waist as well as hip size to similar degree.

Surprisingly, the adipocyte (fat cell) size in the waist region was markedly less in the exercise groups versus diet alone. On the other hand, there were no differences in the fat cells in the hip region.

Thus exercise program when added to dieting reduces abdominal fat cell size in the waist of obese women. Thus even without weight loss, exercise can cause a positive impact on distribution of body fat. This fat distribution has profound health implications on the management of health problems like diabetes and heart disease associated with waist fat obesity.

Do you restrict your caloric intake? Do you have a regular exercise program that you follow? If you practice both, do you follow both equally, or one more than other?

Watch your weight daily to keep extra pounds off

As anyone who has been on a weight loss program knows, losing excess weight is often easier than keeping it off.

Dr. Wing and colleagues from Brown Medical School  studied 314 subjects who had lost weight in the preceding 2 years as part of weight loss program. They divided them into three groups for further study. One group received face to face intervention while others were based on quarterly newsletters or Internet. The intervention involved emphasis on daily self-weighing and self-regulation.

They concluded that face to face intervention involving self-regulation program based on daily weighing is superior to receiving quarterly newsletters.

While it is intuitive that a regular self-monitoring of body would be important for long-term weight maintenance, this study emphasizes that only those active face to face teaching about eating or exercise habits is likely to keep most of the extra pounds off.

Bottom line: Self-regulation is important and that includes weighing everyday for maintaining a successful weight loss program.

Why you been involved in a diet or weight loss program? Which diet plan did you use and how effective was it and for how long? What are your thoughts on commercial weight loss diet plans?

Optimal body fitness crucial before bariatric Surgery

If you are overweight and contemplating bariatric surgery, do not defer your exercise plan until after you have had bariatric surgery. Do not forget that this surgery like any other can have significant complications including death. An otherwise fit obese person is much more likely to have successful surgical outcome with fewer complications than someone that is not.

Dr McCullough, and colleagues from William Beaumont Hospital, in Michigan studied 109 patients who underwent bariatric surgery. Peak oxygen consumption during exercise testing was used as a measure of cardiorespiratory fitness. Their findings were published in the August 2006 issue of the journal Chest.

These investigators found that significant complications occurred in 16.6% patients with low peak oxygen consumption as compared to 2.8% patients with higher peak oxygen consumption. Similarly, poorly fit patients required longer hospital stays and had to be readmitted to the hospital more frequently.

Bottom line, if you are overweight and contemplating bariatric surgery, do not put off exercising till after your surgery. Optimize your cardiorespiratory fitness to get the optimal surgical results.

Do you exercise frequently? Do you have a formal exercise plan and/or work with a trainer? No matter what your bodyweight is, exercise is needed!