Fad diets can work, but experts find no magic slimming bullet

January 13, 2014

Resolutions to lose weight are often made in January yet almost as frequently abandoned as heavy hopefuls find diets that demand fasting, virtually no carbs or liquid food shakes notoriously hard to stick to. But even "fad" diets can lead to a slimmer, lighter New Year for those whose resolve remains robust, according to doctors and nutritionists analysing them.

Gathering for a London conference to review evidence behind popular weight loss diets - at just the time of year when slimming ideas are in peak demand - specialists concluded that food fads such as the hunter-gatherer "Paleo" plan or the 5:2 diet can deliver. But it's hard work. "If it was easy, our species would have died out years ago. As humans we have a default to eat," said Gary Frost, a professor and chair of nutrition and dietetics at Imperial College London. The results of that default are looming large in a global "wave of obesity", he said. According to the World Health Organisation, worldwide obesity - defined as having a body mass index of more than 30 - has nearly doubled since 1980. The latest global figure is that in 2008, more than 1.4 billion adults were overweight.

WAVE OF OBESITY

According to the US Centers for Disease Control and Prevention, almost 36% of American adults are obese and almost 70% are either obese or overweight. In Britain, a government health study predicts 60% of men, 50% of women and 25% of children will be obese by 2050. Against this background, experts say the search for effective diets must always take account of how easy it is for people to understand and follow, and how likely they are to abide by its restrictions.

Michelle Harvie, a research dietician from the Genesis Prevention Centre at Britain's University Hospital of South Manchester, said that on this front, fasting diets - sometimes called intermittent diets - can be successful. "Energy restriction is difficult to maintain over the long term and people tend to find it easier to follow a diet with intermittent energy restriction," she said. She said that while a regular weight loss plan might require the dieter to take in 25% fewer calories, intermittent diets may suggest two days of a 75% calorie cut interspersed with five days of normal healthy eating. But the key to these diets - such as the 5:2 diet in which followers eat as little as 400 calories on two "fasting" days per week - is that dieters won't succeed if they "pig out" and eat whatever they want on non-fasting days.

Harvie's research shows those who succeed in losing weigh on these diets find the fasting days lead them to also have a lower food intake on normal days - leading to lower calorie intake overall.

HUNTING FOR FOOD

Mark Berry, head of plant biology and biochemistry at the consumer company Unilever's research and development unit, says there are also positive signs in data from studies of "Palaeolithic" or stone-age diets - plans designed to mimic the diet of pre-agricultural hunter-gatherers of that era. A sign of its current popularity is that "Paleo diet" was one of the most "Googled" terms of 2013.

The idea is based around foods that can be hunted, fished or foraged for - meat, seafood, eggs, nuts, seeds, fruits and vegetables. Berry said his research showed little impact on glucose response in the body in people eating a Palaeolithic diet, but did find a significant impact on hormones that signal satiety and tell the brain the eater is full. Alexandra Johnstone of the Rowett Institute of Nutrition and Health, who has been looking into high protein and low carbohydrate diets such as the Atkins diet, said these also had a significant impact on fullness feelings - giving them the potential to help dieters control appetite and lose weight. "The high satiety effects of increased protein in the diet seems to be a contributing factor to the success of high-protein, low-carbohydrate diets," she said.

Johnstone cited data showing the amount of weight lost on high-protein diets is around double that lost on a comparable low-fat diet at the six-month mark. But there is little difference in weight loss after one year, as dieters often lose momentum and their resolve to slim down fades. "There's no magic bullet," she said. Judy Buttriss, head of the British Nutrition Foundation, said the evidence for popular diets was clearly nuanced. While there are several that can be used as tools for effective weight loss and maintenance, she said "there's currently no evidence that one is any better than another in the long term".

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Agencies
March 3,2020

Taking multiple courses of antibiotics within a short span of time may do people more harm than good, suggests new research which discovered an association between the number of prescriptions for antibiotics and a higher risk of hospital admissions.

Patients who have had 9 or more antibiotic prescriptions for common infections in the previous three years are 2.26 times more likely to go to hospital with another infection in three or more months, said the researchers.

Patients who had two antibiotic prescriptions were 1.23 times more likely, patients who had three to four prescriptions 1.33 times more likely and patients who had five to eight 1.77 times more likely to go to hospital with another infection.

"We don't know why this is, but overuse of antibiotics might kill the good bacteria in the gut (microbiota) and make us more susceptible to infections, for example," said Professor Tjeerd van Staa from the University of Manchester in Britain.

The study, published in the journal BMC Medicine, is based on the data of two million patients in England and Wales.

The patient records, from 2000 to 2016, covered common infections such as upper respiratory tract, urinary tract, ear and chest infections and excluded long term conditions such as cystic fibrosis and chronic lung disease.

The risks of going to hospital with another infection were related to the number of the antibiotic prescriptions in the previous three years.

A course is defined by the team as being given over a period of one or two weeks.

"GPs (general physicians) care about their patients, and over recent years have worked hard to reduce the prescribing of antibiotics,""Staa said.

"But it is clear GPs do not have the tools to prescribe antibiotics effectively for common infections, especially when patients already have previously used antibiotics.

"They may prescribe numerous courses of antibiotics over several years, which according to our study increases the risk of a more serious infection. That in turn, we show, is linked to hospital admissions," Staa added.

It not clear why hospital admissions are linked to higher prescriptions and research is needed to show what or if any biological factors exist, said the research team.

"Our hope is that, however, a tool we are working for GPs, based on patient history, will be able to calculate the risks associated with taking multiple courses of antibiotics," said Francine Jury from the University of Manchester.

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Dr G K Sudhakar Reddy
August 4,2020

Being overweight or obese is now recognised as a serious cause of ill health and disability. There is a significant positive association between orthopaedic disorders and the level of obesity causing pain, deformity and difficulty in walking.

Excess body weight accumulation increases pressure on joints, particularly the hips, knees and ankles.

Here are a few type of  arthritis:

Osteoarthritis

It is a condition of damage/ wear and tear of the joint lining or cartilage. Obesity triggers this by loading excessive weight on the weight bearing joints like the knee and the hip. 

Knee Osteoarthritis

This is the most common arthritis especially in the Indian subcontinent.

While walking, an individual exerts 3 to 6 times pressure that of the body weight on the weight-bearing knee joint, which means in an obese with excess body weight, larger forces are exerted, which lead to higher risk of deterioration of cartilage.

In addition, there are excessive fat tissues that produce hormones and other factors that affect the joint cartilage metabolism and cause inflammation of the joints giving rise to joint pathology.  Leptin is one of the hormones causing knee osteoarthritis. 

Hip osteoarthritis

The force exerted across the hip is 3 times that of body weight. Hip osteoarthritis is caused by factors such as joint injury, increasing age and being overweight.    

Hand osteoarthritis

The observation that obese individual has a higher risk in having hand osteoarthritis has led to a hypothesis that the metabolic effect produced by fat tissue is the underlying factor. 

Osteoporosis

It is a progressive bone condition of decrease in bone mass and density (Bone Mineral Density or BMD) which can lead to an increased risk of fracture. Recent research suggests that obesity may accelerate bone loss. It is the amount of muscle mass which is seen in an active person, which accounts for bone strengthening effects and not due to the fat seen in a heavy person.

Low back pain

Low back pain from degenerative disc disease of the lumbar spine is one of the most disabling conditions in the community and overweight and obesity have the strongest association with seeking care for low back pain.

Managing Hip and Knee Osteoarthritis

Life style changes

If one is overweight, try to lose weight by doing more physical activity and eating a healthier diet. Regular exercise keeps you active and mobile and builds up muscle, thereby strengthening the joints and can improve symptoms. 

Pain Killers

Painkillers help with pain and stiffness for short term. They don’t affect the arthritis itself and won’t repair the damage to your joint. Creams and gels can be applied directly onto painful joints.

Nutritional Supplements

Glucosamine and chondroitin are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage. However, there is insufficient evidence to support the use of glucosamine in humans and one can expect only a mild-to-moderate reduction in pain

Joint injections

If pain from osteoarthritis is severe joint steroid injections are injected into the joints that can reduces swelling and pain. The injections can start working within a day or so and may improve pain for several weeks or months. 

Hyaluronic acid injections, which help to lubricate your knee joint also give short term relief. In early stages. Stem cell treatment or cartilage regeneration procedures are being tried in young people with small defects, however it is still experimental and lacks long term evidence.

Surgery

May be recommended if you have severe pain or mobility problems.

Arthroscopy

If one has frequent painful locking/stiffening episodes especially in the knee joint, an operation to wash out loose fragments of bone and other tissue as joint can be performed by a minimally invasive key hole procedure called Arthroscopy.

Arthrodesis

If hip or knee replacement is not suitable, especially in young people who do heavy manual work, one can consider an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

In young, active people in whom a knee joint replacement would fail due to excessive use one can consider an operation called an osteotomy. This involves adding or removing a small section of bone either above or below your knee joint.  This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually as you grow old

Joint replacement surgery

Joint replacement therapy is most commonly carried out to replace hip and knee joints. It involves replacing a damaged, worn or diseased joint with an artificial joint made of special plastics and metal.

For most people, a replacement hip or knee will last for at least 20 years, especially if it is cared for properly and not put under too much strain.

Dr G K Sudhakar Reddy is a Sr Consultant Orthopaedic Surgeon at Citizens Speciality Hospitals, Hyderabad

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Agencies
July 4,2020

The Union health ministry on Friday revised the dosage of anti-viral drug remdesivir to be administered to coronavirus patients in the moderate stage of illness from the earlier six days to five days as it issued an updated 'Clinical Management Protocols for COVID-19'.

The drug, administered in the form of injection, should be given at a dose of 200 mg on day one followed by 100 mg daily for four days (total five days), the new treatment protocols stated.

The Health Ministry on June 13 had allowed the use of remdesivir for restricted emergency use in moderate cases under "investigational therapies".

"Under emergency use authorisation, remdesivir may be considered for patients in moderate stage requiring oxygen support," the document stated.

It is not recommended for those with severe renal impairment and high level of liver enzymes, pregnant and lactating women, and those below 12 years, it said.

The ministry also okayed off-label application of tocilizumab, a drug that modifies the immune system or its functioning, and convalescent plasma for treating COVID-19 patients in the moderate stage of illness as "investigational therapies".

It also recommended hydroxychloroquine for patients during the early course of the disease and not for critically-ill patients.

On June 27, the ministry had included an inexpensive, widely used steroid dexamethasone in treatment protocols for COVID-19 patients in the moderate to severe stages of their illness among other therapeutic measures.

The ministry advised use of dexamethasone, which is already used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects, as an alternative choice to methylprednisolone for managing moderate to severe cases of coronavirus infection.

India's COVID-19 cases soared by over 20,000 in a day for the first time taking the country's total tally to 6,25,544 on Friday while the death toll climbed to 18,213 with 379 new fatalities, according to the Union Health Ministry data updated at 8 am.

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