Physician Weight Loss Tips!

Two recent FDA-funded reports in the Journal of the American Medical Association and the New England Journal of Medicine found no evidence that stimulant medication widely utilized to treat Attention Deficit Hyperactivity Disorder (ADHD) increased the risk of serious cardiac complications. Ritalin and Adderall were the primary drugs reviewed. One study reviewed records of 150,000 patients using ADHD medication and compared their incidence of heart attack, sudden cardiac death and stroke to 300,000 nonusers. No increase in cardiovascular complications in the users was detected. The other study focused on 1.2 million children and young adults between the ages of 2-24 and similar results were found. This report, covering the years 1986-2009, represents encouraging news to physicians and patients since it appears to lay to rest concerns raised by other limited studies that ADHD medications might precipitate heart or vascular problems. Use of ADHD drugs continues to increase significantly. The Prescription Perspective: Appetite suppressant medications (phentermine, diethylproprion, phendimetrazine) used in weight loss programs are in a class of drugs called phenylethylamines. All phenylethylamines suppress appetite but these medications vary widely in the degree of cardiovascular stimulation produced. The two phenylethylamine drugs in Adderall are much more potent cardiovascular stimulants than the appetite suppressants. The same is true for Ritalin, a drug structurally similar to amphetamine. There is a widespread belief within the general medical community, based on no concrete information, that appetite suppressant medications may be dangerous because of an increased risk of cardiovascular problems. As a result even patients who are quite overweight are often discouraged from participating in well supervised medical weight loss programs which utilize appetite suppressants. Although these studies did not specifically evaluate the phenylethylamine appetite suppressants, their conclusions are important for bariatric physicians and patients since phenylethylamines in the much more potent ADHD category exhibited no increased risk of cardiovascular complications. Therefore it is reasonable to infer that the risk of cardiovascular problems induced by less potent appetite suppressant medication is minimal or nonexistent. Furthermore, the very large sample size in these studies should certainly have detected any increased risk, however small. Nevertheless, it is always wise to carefully consider risks versus benefits in patients with obesity and known cardiac disease before making a decision to prescribe appetite suppressants. Close monitoring is also mandatory.

Caffeine a Healthy Choice??? A report from Harvard University on long term followup of 50,739 female Registered Nurses in the Nurse?s Health Study suggests that caffeine,particularly caffeinated coffee, reduces the risk of developing chronic depression by 15% over a ten year follow up. This effect was seen in women who drank 2-3 cups of coffee daily. Drinking four or more cups a day reduced the risk of depression by 20%! Other sources of caffeine (tea, sodas, chocolate, caffeinated drinks)were also evaluated but coffee was by far the most common source of consumed caffeine. When decaffeinated coffee was analyzed, the data showed no protective effect on the development of depression, suggesting that caffeine was the active ingredient. The Prescription Perspective: This is yet another report emphasizing the benefits of moderate coffee and caffeine consumption. Caffeine is a mild central nervous system stimulant which increases alertness. Benefits of caffeine, and caffeinated coffee in particular, include a lower incidence of Type 2 diabetes, Parkinson?s disease and dementia along with a lower incidence of certain types of cancer, particularly colon cancer, cardiac conditions and stroke, reduced frequency and intensity of asthma attacks and fewer gallstones. Although there are clearly other chemicals in coffee, many of which are not yet known to science, it now appears that caffeine is most likely the primary ingredient responsible for these beneficial effects. Coffee is rapidly moving from the list of foods to be limited to a ?healthy? dietary item!

Several companies have recently started to market inhalers, scent jars and crystals to be sprinkled on food, each of which creates a variety of different scents that are ?sniffed? by the diner before consuming the food item. Supposedly these scents stimulate the ?satiety center? in the brain which reduces the desire to eat. Significant weight loss claims are made for these products, but none have been objectively tested in a controlled clinical trial. The Prescription Perspective: These reports come as a huge surprise to many who were under the impression that smelling good food actually increases the desire to eat! The ?appetite? and ?satiety? centers of the brain are actually located in close proximity in the hypothalamus; however, they tend to respond quite differently to various biochemical and hormonal stimuli. Unsubstantiated claims about the efficacy of a diet related product should never be accepted without firm objective evidence from controlled scientific studies that support those claims. Nevertheless, empiric evidence seems to support both points of view. Certainly we have all had the experience of smelling delicious food and immediately wanting to have a taste. Conversely, there are occasions when the mere scent of food can turn us off and we don?t even want to think about eating. This is a subject that is still poorly understood and clearly in need of further research. Until the question is clarified, however, we advise avoiding any fad-type dietary add--ons which promise quick and easy weight loss without having to rely on diet and exercise.

The International Diabetes Federation has recommended that bariatric surgery be considered as an early option for the treatment of obese patients with Type II diabetes. A panel of 20 medical and surgical specialists, concerned that obesity and diabetes is now a global public health issue, released a position statement recommending bariatric surgery as an acceptable treatment option for patients with Type II diabetes and a BMI >35kg/m2, and even in patient with a BMI > 30kg/m2 if there are cardiovascular co-morbidities or if diabetes is difficult to control medically. Since Asian patients have an increased risk for diabetes and heart disease, the panel recommended that a BMI >27.5kg/m2 should be the minimum criteria for patients of Asian origin. This consensus statement is based on previously reported studies demonstrating an improvement in blood sugar control in overweight adult and pediatric patients undergoing obesity surgery. Dr. Bill's comment's (The Prescription Perspective) The strong association between excess body fat and Type II Diabetes Mellitus has been very well documented. Hundreds of diabetics in the Prescription program have been able to reduce and/or discontinue their diabetes medication after significant weight loss. Excess body fat increases insulin resistance making the pancreas work progressively harder to control blood sugar. Eventually the insulin- producing pancreatic beta cells "burn out." Type II diabetes is the result. Type II diabetes is also one component of the Metabolic Syndrome, a constellation of factors which increase overall cardiovascular risk. Metformin is a first line therapeutic drug since it improves insulin sensitivity. Bariatric surgery in any form represents a drastic metabolic alteration for the patient. Even those who advocate bariatric surgery recognize that it has many long term complications including osteoporosis, nutritional deficiencies and other mechanical complications of the procedures. Nevertheless it can be a lifesaving "last resort" for the severely obese. We do not advocate bariatric surgery as a first line therapy for overweight patients, however. Improvement in diabetes following medical weight loss has been documented numerous times, achieving results similar to those seen with more drastic surgical approaches. It is not at all uncommon for patients with a BMI in the 30-35% range to achieve excellent results in a medical weight loss program rather than resorting to direct gastric intervention. Failures of bariatric surgery are almost always treated medically anyway. This consensus report recognizes, however, that an active intervention is required to "cure" diabetes in the obese. It is not enough to tell patients to change their lifestyle and eat less. Whether a surgical or medical approach is utilized, it is clear that good results can only be achieved with a well organized program featuring long term followup. If the study had used body fat percentage as a criterion for patient selection rather than BMI, it is quite likely that the results would have been even more dramatic. Excess carbohydrate intake is the real culprit, however. A diet high in refined carbohydrates and simple sugars commonly seen in Western societies leads directly to fat accumulation and diabetes. Many diabetologists are now treating diabetes with low carbohydrate diets, eschewing medical therapy completely in many cases. The message is clear: Weight loss = less diabetes and improved cardiovascular health.

Bariatric Surgery and Weight Loss Improves Cardiovascular Health. Swedish and American surgeons presented two studies in March at the Second World Congress on Interventional Therapies for Type II Diabetes which demonstrated a marked reduction in the incidences of heart attacks, strokes, high blood pressure, rapid pulse rate and a lowered serum lipids following bariatric procedures. Cardiac function was also demonstrated to have improved. The Swedish study included 4047 patients studied over a 20 year time period and the American study had 1156 participants followed over 2 years. A decrease in LDL (bad cholesterol) and triglycerides was noted as well as an improvement in insulin resistance. Each of these studies was compared with "conventional medication therapy and/or lifestyle modification." The lead surgeons commented that these results supported the use of bariatric surgery to prevent cardiovascular complications in obese type II diabetics. Benefits were felt to outweigh the risk of long term complications from the bariatric procedures. Since according the American Heart Association at least 65% of diabetics die of heart disease or stroke, improvement in diabetes resulting from weight loss should markedly increase long term survival. This study is yet another which demonstrates that significant weight loss can significantly lower a wide range of cardiovascular risk factors. Diabetes is improved and high blood pressure often disappears. Unfortunately the study only compared bariatric surgery, which has significant long term complications and represents a drastic alteration in gastrointestinal metabolism, with "conventional medication therapy and/or lifestyle modification." A much more interesting study would have also included a large number of patients on an intensive medical weight loss program with long term weight management similar to the Prescription Weight Loss Clinic® program. In our experience losing weight is what is important, not the method utilized. Massive weight reductions on the order of those obtainable through bariatric surgery can be achieved with a good medical weight loss program in patients who are willing to participate. All too often patients use bariatric surgery as the "easy way out" -- just have an operation and then all of your problems are solved. Unfortunately that is often not the case. Failure of bariatric surgery due to patient overeating remains a real problem. Many of these patients end up in medical weight loss programs where they learn the techniques useful for long term weight management. The message is clear, however, Lose Weight and Your Health Improves.

HCG, or human chorionic gonadotropin, is used in some states by certain practitioners who promote it for weight loss. Mobilization of fat, increased metabolism of fat tissue and increased metabolic rate are among some of the claims made by those who distribute this medication. The American Society of Bariatric Physicians (ASBP) has issued a position statement which concludes that in numerous clinical trials HCG has shown no demonstrable weight loss effect and the Society also recommends that HCG not be used for treatment of obesity. This report is available on the ASBP website. In addition, the FDA requires that all products containing HCG be labeled and advertised with the following wording: HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from calorie restriction, that it causes a more attractive or ?normal? distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets. Many states have also specifically prohibited the use of HCG for weight loss. Dr. Blackshear?s comment: As these prestigious organizations note, no scientific studies have ever demonstrated any benefit of HCG in the treatment of obesity. Nevertheless, HCG has been promoted by many weight loss centers as a ?magic bullet? in the treatment of obesity. Close inspection of the labeling on packaging of HCG products and/or the advertising often discloses in the fine print that HCG should be used ?in conjunction with diet and exercise.? Of course it is diet and exercise which actually produce the weight loss seen in their studies. In summary, patients who are seeking to lose significant amounts of weight should not rely on any medical or ?physiologic? treatment method which has not been demonstrated scientifically to have proven value.

Dr. Bill has recently been recognized as a Diplomate of the American Board of Bariatric Medicine. This award recognizes a high level of professional competence in the knowledge and practice of bariatric medicine. Diplomates must pass a rigorous written examination covering all aspects of (weight loss) bariatric practice and an on site inspection of office policies, procedures and records by a member of the Board. Less than forty physicians in the state of Florida have achieved this prestigious distinction. Dr. Blackshear adds: "This award represents another step in providing the best in bariatric care for our patients."

Prescription Weight Loss Clinic® HOLIDAY TIPS AND TECHNIQUES Staying on track with your weight loss program is always a challenge during the holidays! Good food and drink are an integral part of most holiday gatherings. Family, friends, trips and office parties all conspire to sabotage your good work of the past weeks or months. This means that it?s easy to lose ground over the holidays, which means, in turn, that you?ll spend part of January getting back into the ketosis/diet/exercise routine that was responsible for your earlier success. No one likes to spend time re-losing pounds that they had already lost before, but with just a few simple techniques and continued focus on your long term weight management goals, you can make it through the holidays or other special occasions successfully and stay on track with your First Step to Success! 1. Carbs and Calories are your enemy! At holiday parties or family dinners stay away from bread/mashed potatoes/stuffing/desserts and fatty or high carb foods. 2. Remove the bread/crackers from finger foods and just eat the contents. 3. Eat more of protein foods instead of desserts, but if you must deal with desserts, just take a couple of nibbles. Avoid the crust on pies and the icing on cakes. 4. At dinners, take a small portion of those dishes you are going to sample and focus on protein foods. Treat big holiday meals like a tasting menu, not a feast! 5. Remember, holiday cheeses are sky high in fat content which means heavy calorie loads! 6. Drinking lots of a zero calorie drink will curb your appetite. 7. Make sure you take your appetite suppressant medication to suppress hunger at holiday events. You may need to adjust your medication schedule to insure that you are ?covered? during the special event. 8. Cranberry sauce tastes great, but it?s a HIGH CALORIE, HIGH CARB! Better to skip it and pass it on to the next person. 9. Select a small plate for your food. You?ll tend to eat less that way. 10. It?s best not to snack, but, if you must, consume a non-caloric snack. Diet colas or anything sugar-free work well here. 11. Eat slowly and chew longer! You?ll eat less. 12. If you are bringing a dish to a holiday party or gathering, take a protein dish that you can eat. Shrimp cocktail or grilled chicken strips are good choices. 13. Stick to your ?Acceptable Seasonings? list (Chapter 10). 14. At larger gatherings mingle with people who are not standing close by the food tables. 15. Keep both hands full. You?ll eat less with both hands occupied. 16. Alcohol is low in carbs but high in calories. It?s best to skip it altogether, but if you choose to imbibe, follow these basic rules: a. Take sips rather than swallows. b. Avoid mixers with cocktails. They add lots of calories. c. Set a limit at the start of the evening/event and stick to it! d. Take one glass of wine/cocktail/beer and then switch to a nonalcoholic drink, preferably a zero calorie, zero carb drink, such as diet cola, sparkling water or club soda. e. If you are going to have more than one alcoholic beverage, drink two glasses of water after each alcoholic drink. f. Ask if nonalcoholic wine/beer is available (BUT, check the carb/calorie content on the bottle). 17. Don?t forget to exercise daily! A brisk walk around the neighborhood can work wonders in keeping pounds off.

For many years an increasing body of scientific evidence has accumulated which indicates that Vitamin D has a number of additional health benefits in addition to its well known ability to maintain strong bones. A just-released report from the Institute of Medicine triples the recommended daily intake of vitamin D for Americans from 200 International Units (IU) to 600 IU?s. Considering the high level of vitamin D deficiency in North Americans, related no doubt to a significant reduction in sun exposure, many authorities feel that this increase falls far short of an optimum Vitamin D intake. Although direct links are difficult to prove, low levels of vitamin D have been associated with numerous chronic diseases such as cardiovascular disorders, diabetes, prostate, colon and breast cancers, stroke, depression and mood disorders, Alzheimer?s disease, various severe infections and autoimmune disorders. Vitamin D deficiency is well known to be associated with osteoporosis. Dr. Blackshear/s comment: Vitamin D is the subject of intense research in a number of areas of medicine. In particular, a high percentage of obese patients have significantly low concentrations of vitamin D in the blood. Supplementation seems wise in these individuals since obesity is well recognized to be associated with many of the chronic disorders that vitamin D deficiency also exacerbates. It is quite likely that in the future the recommended daily intake of vitamin will rise significantly. Boston University School of Medicine professor Dr. Michael Holic recommends 2000-3000 IU/s daily for adults and further notes that in some of his research studies he had administered 50,000 IU/s twice a month for many years and seen no harmful effects.

If you love losing weight but miss your pasta, Asian Shirataki noodles (sometimes called Miracle Noodles) may be just the linguini the doctor ordered. Shirataki noodles are made from a plant root and sold in precooked wet packages. They have zero protein, zero fats and zero net carbs. In the stomach they tend to expand somewhat which increases satiety so they are a perfect compliment to the protein dishes in Step 1 and an excellent choice to substitute for high carb noodles for Step 2 and 3 patients. Wash the noodles after removing from the package and put them together with whatever you are cooking. Some consumers have noted the texture to be a bit rubbery but a brief period of boiling tends to eliminate this slight disadvantage. Dr. Blackshear/s comment: I haven?t tried these noodles as yet but they sound like an excellent option for pasta fans. Any food containing zero calories is a perfect choice for patients in each Step of the Prescription Weight Loss Clinic® program. Shirataki noodles are not all that easy to find in grocery stores yet but purchasing over the internet is simple. This is another way to add additional variety to your diet without also adding calories and carbs, which stimulate insulin release.

A large multinational study involving almost 250,000 patients reported that 18 new gene sites related to obesity have been identified along with 13 additional sites associated with how fat is distributed in the body. The researchers speculated that various combinations of these gene sites may be an important factor in determining body habitus. Women were much more likely than men to have gene combinations predisposing them to deposition of fat in the hips and thighs whereas men were more likely to have combinations favoring abdominal fat deposition. Dr Blackshear?s comment: This study is yet another demonstrating that an individuals genetic makeup plays an important role in determining how they acquire, process and store calories. Genetic makeup may well explain while some patients remain lean when consuming calories far in excess of others who seem to gain weight on a much lower caloric intake. It has been know for years that men have a higher incidence of metabolic syndrome and earlier onset type II diabetes and coronary artery disease. These metabolic abnormalities are strongly associated with abdominal fat deposition and this new study suggests that abdominal fat is under genetic control. It also raises the possibility that genetic therapy may eventually become an important tool in future treatment of obesity.

The Latest Skinny! Fat Stored Differently in the Abdomen and Lower Body. To determine the effect of overeating on fat distribution 28 healthy adults were fed for eight weeks with a very high calorie diet, including all- you- can- eat ice cream shakes and king sized candy bars (don?t even think about it!). Participants gained an average of ten pounds of fat, distributed equally between the upper and lower body. Fat wasn?t stored in the same way, however. Abdominal fat cells expanded their fat storage capacity by storing 40% more fat in each cell. The cells didn?t increase in number. Thigh fat cells did not increase in size but their number expanded by 23%. The researchers concluded that abdominal fat reacts differently to a calorie load than fat in other parts of the body. Dr. Blackshear?s comment: This study is interesting in that it demonstrates what may be an inborn protective mechanism. We know that abdominal fat cells are particularly toxic to the body, producing a large number of hormone-like substances which affect an enormous variety of bodily functions, usually in an adverse way. Storing new fat by expanding the fat cells? capacity, and not their number, may represent the body?s attempt to dampen the adverse metabolic impact of more abdominal fat cells. Since thigh cells aren?t as active metabolically, growing in number doesn?t carry such serious consequences. WMB

A retrospective review of over 1000 injured patients admitted to a level I trauma center presented at the recent Surgical Forum of the American College of Surgeons demonstrated that an elevated body mass index (BMI) was associated with a significant increase in the risk of hospital acquired infections. This risk increased steadily as BMI increased. The authors from the University of Toledo and Oakwood Medical Center in Michigan speculated that the chronic inflammatory state found in obese patients was behind the marked increase in risk of infections. -- 4.7X in obese patients and 6X morbidly obese patients. Dr. Blackshear?s comments: This study is yet another which confirms that obesity is a significant risk factor for complications of all sort in hospitalized patients. 30% of the patients in this study were obese as defined by BMI. Our own experience indicates that body fat percentage (BF %) is an even more accurate indicator of obesity. Re-analyzing the data using BF% might produce an even more striking risk.

An eight year Italian study of over 48,000 adults published in the Archives of Internal Medicine demonstrated that women who ate the most high glycemic index (GI) foods increased their risk of developing heart disease by 2.25 times compared to women who consumed the lowest number of high (GI)carbohydrates. Surprisingly, these differences were not as evident in men in the study. Dr. Blackshear's comment: This study adds yet another report to the many which illustrate that consumption of refined (high GI) sugars are much more of a health problem in our diet than fats consumed in moderate quantities.

Pre-pregnancy weight loss reduces risk of blood pressure disorders and diabetes during pregnancy. A recent retrospective study of 500 American women revealed that those who had lost a significant amount of weight during the four year period prior to delivery had only a 10% chance of pre-eclampsia (hypertension and kidney dysfunction) compared to a 31% incidence in obese women who did not lose weight before the delivery. Obese mothers also had twice the incidence of gestational diabetes (often a precursor of type II diabetes later in life) compared to with the mothers who lost significant weight before delivery.

Body fat percentage accurately predicts post operative surgical site infections. A study from Brigham and Women's hospital in Boston in the April issue of The Journal of the American College of Surgeons demonstrated that body fat percentage (BF %) as measured by bioelectrical impedance, markedly outperformed body mass index (BMI) as a predictor of postoperative surgical site infections. Obesity measured by BF% was associated with five times the risk of surgical site infections postoperatively compared to non-obese patients. BMI measurements of obesity were unable to accurately predict an increased risk of postoperative infections. BF% also identified almost twice as many patients as obese, therefore at greater risk, compared to BMI measurements.

Dr. Blackshear's comment: This study demonstrates once again that BF% is a much more sensitive clinical tool for identifying patients who are at increased risk from obesity. It has long been recognized that BMI can be elevated for reasons other than obesity. For example, individuals with significant muscularity may be identified as obese by BMI when in fact their body fat percentage is low. We have long relied upon BF%, as measured by bioelectrical impedance, to identify patients who will benefit from significant weight loss.

Genetic makeup may play an important role in successful dieting and/or weight maintenance. A recent Stanford University study of 133 overweight women surprisingly showed that genes which help regulate fat and carbohydrate metabolism radically influence the amount of weight lost on low fat or low carbohydrate regimens. Patients with a "low carb" genotype did much better on low carbohydrate diets. Conversely those with a "low fat" genotype were much more successful restricting fats. A currently available genetic test can be used as an outpatient to determine a patients "carb vs. fat" genotype. Preliminary data indicates that 45% of white females have a low carb genotype and 39% have a low fat genotype. Researchers, speculated that genotype testing, if it is confirmed in subsequent studies with larger groups including men and other racial groups, might be an important new consideration in weight control. Dr. Blackshear points out that these studies were not done in a medically supervised intensive weight loss program but only an outpatient, patient-controlled diet. Nevertheless the findings are interesting and may have significant long term implications for weight maintenance if the results prove valid in subsequent studies.

Fructose, a naturally occurring sugar present in fruits and in high concentrations in corn and corn syrups, was recently reported to influence the metabolic processes which lead to early onset diabetes and heart disease. In a ten week study of volunteers on a high fructose diet, University of California researchers demonstrated a significant increase in fat accumulation in the heart and other visceral organs--the type of fat accumulation which can often lead to metabolic disease. Abnormalities linked to diabetes and heart disease were also noted. A matched group of volunteers eating an identical diet but with glucose as a sugar instead of fructose did not demonstrate these same changes. Fructose is a common sweetener used in processed foods including cakes, cereals, salad dressing, yogurt and fruit drinks. The researchers speculated that high concentrations of fructose consumed at an early age might be a factor in the increasing incidence of childhood diabetes. "The message that we should take away from this report is to limit sugar consumption in any form," said Dr. Blackshear.

The Federal Trade Commission (FTC) doled out fines totaling $29.5 million to four manufacturers of the over-the-counter weight loss medications Cortislim, Xenadrine EFX, TrimSpa and One-A-Day WeightSmart for making false claims about their products. The FTC found that these products were primarily a combination of caffeine, herbs and vitamins and did little or nothing to induce weight loss, particularly of the magnitude claimed in advertising for the products. A study by the manufacturer of Xenadrine found that participants taking placebo lost more weight than those on Xenadrine, but this finding went unreported in their advertising. People who purchased these medications may qualify for reimbursement through the FTC web site.

The Centers for Disease Control & Prevention reports that new diabetes cases in America have doubled over the last ten years. An estimated 23 million Americans now suffer from diabetes and the incidence continues to rise.

Chicago researcher Adam Reppert at Swedish Covenant Hospital reported that in a study of 5,000 Illinois adults 30 minutes of daily exercise reduced the incidence of metabolic syndrome (central obesity, hypertension, diabetes, atherosclerosis, hyperlipidemia) by 85%. Furthermore, regular consumption of calcium rich foods lowered this risk by 61%.

Researchers in Boston and Louisiana reported on a two year study of overweight patients in the New England Journal of Medicine that trying to maintain weight loss by manipulating fat, carbohydrate and protein intake with various prescribed diets was not beneficial. Patients who ate foods of their choice and simply focused on calorie management were much more successful at weight maintenance. Epidemiologist Catherine Loria says that dieting is "much simpler" than we believed because "all you have to do is count your calories." Calorie management eating foods according to patient choice has been the basis of Dr. Blackshear's Prescription Weight Loss Clinic Weight Management Program.

In a thorough review of the medical literature published in the winter quarter of The Bariatrician , Michael Anchors, MD, PhD, found no credible evidence of any dangerous side effects of phentermine use as an appetite suppressant. Dr. Anchors' review was unable to document any instance of addition, significant hypertension, heart valve damage or serotonin syndrome in patients on prescribed doses of phentermine, although these problems are often cited by medical professionals as reasons not to take phentermine for appetite suppression. In addition, Dr. Anchors found no evidence that prolonged use of phentermine produced any ill effects.

Gnagnarella, et al., reported on a meta-analysis of 39 studies in the American Journal of Clinical Nutrition that subjects regularly consuming a diet ranked in the top 25% in glycemic index (GI) and glycemic load (GL) were 26% more likely to develop colorectal cancer when compared to subjects on the opposite end of the GI/GL scale.

Vitamin D is generating renewed interest as ongoing research demonstrates its crucial role in preventing a wide range of medical disorders, including coronary artery disease, many cancer, stroke, osteoporosis, insulin resistance, macular degeneration, depression, hypertension, diabetes, MS, rheumatoid arthritis, chronic back pain and impaired immune responses. Obesity increases the risk of clinical deficiency since vitamin D is deposited in body fat stores. Those with large amounts of body fat trap vitamin D in these stores of fat, making it less available for beneficial uses. Recommended daily requirements of vitamin D are increasing. Since it is difficult to ingest or synthesize (exposing skin to sunlight) sufficient D to meet these new standards, daily consumption of up to 10,000 International Units of vitamin D3 has been recommended.