Nonsense slimming diets

Part 6: The end of diets?

As women have realised that constant yo-yo dieting is only making their situation worse, they have fallen prey to other organisations which, at first sight appear to be good for the overweight. A prime example is the anti-slimming club, Diet Breakers. Mary Evans Young, Diet Breakers' founder, told me in 1994 that the club's aim was to teach women that yo-yo dieting was harmful and that it was better to accept themselves the way they were rather than be continually dieting. She certainly had a valid point: weight fluctuation is harmful. Yet in 1996 she teamed up with Canadian dietician, Linda Omichinski, to produce the book, You Count, Calories Don't (As recommended by Diet Breakers) . This, the blurb says, is not a diet book, it is a 'non-diet lifestyle' but it turns out to be a carbohydrate based, low-fat, non-diet lifestyle, just like almost every other diet book! The introduction states: "All of these programmes emphasise eating more high-fibre foods (carbohydrates) for immediate energy, some protein for sustained energy and gradually decreasing fat intake." You Count, Calories Don't , however, has a significant twist in that its authors recommend reducing protein intake as well. On page 15 they say: "Gradually increase the carbohydrate content of your meals and gradually decrease your protein content so that you have energy and feel satisfied for a longer period of time." And six pages later: "The entire focus [is] to increase the quantity of carbohydrates that you may be consuming."

It is obvious also that they expect already overweight women to put on even more weight with their non-diet lifestyle: on page 111 they say "Any weight gain that may occur may be due to . . . rehydration of water stores with reintroduction of carbohydrates because carbohydrates are stored with water. This is 'water weight', not 'fat weight'". And on page 115: "it takes three to four pounds of water to store one pound of glycogen". No doubt the women who follow this 'lifestyle' will be happy in the knowledge that their increase in weight is only due to water, not fat!

Quality of life

Even if being fat permanently is healthier than constantly weight changing, it's not so easy to accept being overweight if your excess weight is ruining your quality of life. Apart from possible health risk, people who are very overweight are more limited in what everyday activities they can perform.

One of the first signs that you are under stress from excess fat around your middle is shortness of breath. As fat accumulates, it crowds the space occupied by your organs. This may mean that you can't sit comfortably. While sitting your lungs have less space to expand, so your breathing is more difficult. But standing may also be a problem. Even if you are only moderately overweight, you are constantly putting an extra burden on your backs and legs. Eventually, this can result in osteoarthritis. Too much fat around your middle means that surgery is more difficult; wounds don't heal as well or as quickly and infection is more common.

Even simple everyday activities become more difficult: lifting or carrying groceries, climbing stairs, bending, kneeling, bathing, and dressing. You are more likely to suffer from depression, nervousness, self-consciousness, and lack of self-esteem. It's all very well being told to accept your weight - but it's much more comfortable to be slimmer.

Pop a pill

In December 1996 came word of the dangers of diet pills in America called Phen-fen, a combination of two appetite suppressant drugs that have been in use since 1973. In 1996, dexfenfluramine, marketed as Redux in the United States was the first anti-obesity drug to be approved by USA's Food and Drugs Administration for nearly 25 years. (It has been on sale in Britain since 1990 as Adifax.) Less than one year later, 85,000 prescriptions for Redux were being written each week. Dexfenfluramine depresses appetite by affecting the brain's production of seratonin. But scientists are already warning of serious adverse side effects, primarily of primary pulmonary hypertension and neurotoxicity. Other effects noticed in America include drowsiness, dry mouth and diarrhoea. Women taking dexfenfluramine in Britain have also complained of heart and lung problems pounding heart and chest pains. One woman speaking on the BBC's Watchdog programme in 1997 was so badly damaged by the drug that she will never be able to live a normal life again. These pills are available over the counter in the USA without a prescription.

Another product, a liquid that is currently used as artificial blood, is being trialled by a Dr. Alvin Shemesh. This inert liquid is said to coat the lining of the small intestine stopping the absorption of nutrients. Food passes straight through. We have yet to see what harm this will do, but it is pretty certain that harm will be done. Let's face it, if the body can't absorb nutrients, it can't stay alive.

Olestra

In 1994 an American advisory panel decided that Olestra, a controversial calorie-free fat substitute made by Proctor & Gamble was safe to eat. Just over a year later, the American Food and Drugs Administration passed it for general sale. Olestra is a mixture of sugar and vegetable oil. It is the first fat substitute that doesn't break down when cooked, so it can be used in place of cooking oil. And while it may appear as a fat, the sugar/fat molecule is too large to be absorbed by the intestine, its makeup prevents the digestive enzymes from getting at the sugar or the fats, so it passes undigested right through the digestive tract leaving behind no fat or calories.

But there are many who are worried. Professors Walter Willett and Meir Stampfer of Harvard School of Public Health, are concerned for the loss of vital nutrients from those eating Olestra leading to long-term health problems. As Olestra passes along the digestive tract, the fat-soluble vitamins A, D, E, and K and carotenoids attach to the Olestra molecule and are swept along with it. When it leaves the body, they go with it and are lost. There have been studies that link Olestra with increased risk of macular degeneration, prostate and breast cancer and heart disease. In a letter to David Kessler, the US Food and Drugs Administration's commissioner, Willett and Stampfer include a bibliography of twenty-six references. Proctor & Gamble say they will get round this by saturating Olestra in vitamins so that those from other foods do not attach to it. What a waste!

There were also adverse effects such as stomach cramps that subjects suffered when Olestra was tested. Proctor & Gamble say that there were similar effects when bran was fed, but opponents point out that the body gets used to bran but not to Olestra.

If all that weren't bad enough, 'passive oil loss' is a problem. This is a euphemism for anal leakage of the undigested Olestra. The advisory panel didn't think this was a problem. But you might disagree: eat Olestra and you could have to wear incontinence pants.

The American Food and Drugs Administration, which authorised Olestra for sale, says that Proctor & Gamble must carry out studies into its long-term health effects.

Wouldn't it have been better if they have been carried out before its widespread use was authorised?

Olestra currently found in some potato crisps, corn chips, and fat free crackers.

Xenical

In September 1998, another pill was licensed for prescription throughout the European Community. This was orlistat, marketed as Xenical, made by the drug company, Roche Pharmaceuticals. Xenical has a similar effect to Olestra in that about a third of fat eaten is not digested but ends up unchanged in the lavatory or in your pants, as Xenical too causes anal leakage. Many patients taking Xenical experienced fatty stools, diarrhoea, and oily spotting. Xenical works in a different way from Olestra: it reduces the body's ability to absorb fats. This will have two important consequences: by reducing fat intake still further, it will exacerbate the problem of obesity; and as Xenical costs £3.00 per day, it will add enormously to the National Health Service drugs bill. It is estimated that prescriptions for Xenical could cost £750 million per year. That means diverting £750 million from more worthy causes. And for what?

Journalists (but not the manufacturers) have suggested that this new drug will enable fat people to eat what they like and still lose weight. Professor John Garrow suggests that this is highly misleading. Anyone taking Xenical who eats a high fat diet, he says, will receive a powerful incentive to reduce fat intake. Its side effects tend to encourage the patient to stay on a low fat diet while she is taking Xenical so what possible use is Xenical?

There may also be another good reason to think carefully about taking drugs like Xenical. In March 1998 a news report in The Lancet told of a five to five split in the FDA vote on whether to approve Xenical because there were 3.6 times as many cases of breast cancer in the group testing it compared to the control group who were not. Panel chairman, Henry Bone of the Michigan Bone and Mineral Clinic, said: "The fact that studies don't reveal a direct carcinogenic effect doesn't really address whether an indirect mechanism might be at work." Nevertheless, Xenical was approved a few months later.

Leptin

Many people have declared that their obesity must be due to a 'slow metabolism' or be a genetic disorder they can do nothing about. This, they say, is the same as any other birth defect and should be treated as such.

In 1994 scientists came across a mouse that was much fatter than its fellows. They looked at its DNA and discovered the difference. This mouse was missing a gene that produced a hormone that they called leptin from the Greek leptos , meaning thin. Leptin is produced by the body's fat cells: the more fat cells normal mice had, the more leptin they produced.

In the base of the brain there is a small region called the hypothalamus. It contains several important centres that control many body functions: body temperature, sexual function, water balance, hunger and thirst. It is also closely connected with emotional activity and sleep. The scientists found that leptin from body fat signalled the hypothalamus so that if more fat were laid down, appetite was suppressed and if body fat were used up, that stimulated the mouse to eat more. In other words, body fat, via leptin, regulated feelings of hunger and, thus, the amount of body fat. This close feedback loop tended to keep body fat within certain well-defined limits.

Scientists found that the fat of the mouse that received defective genes from both its parents, the obese 'ob/ob mouse', produced no leptin at all. There was no internal control of eating and, no matter how much the mouse ate, it always felt hungry. When ob/ob mice were given leptin they slept and lost weight.

The discovery of the ob gene and its associated hormone in the mouse seemed to justify the notion that fat people might also have a gene defect and produce little or no leptin. If this turned out to be the case, simply giving them leptin could help obese people.

Unfortunately, what was true for the obese mouse turned out not to be the case for obese humans. When tested, no obese patient was found to be low on leptin. Indeed the reverse was found: the fatter people were, the more leptin they had. Obviously something else must be the cause.

Research results suggested that as people got fatter their production of leptin increased. However, there appeared to be a resistance to the action of leptin, so that the increase in fatty tissue mass was maintained. The problem in the obese people, therefore, was not a fault in leptin production but decreased sensitivity by the hypothalamus to the leptin.

To complicate the issue, Dr Considine and colleagues found that in both humans and animals, reducing energy intakes reduced leptin concentrations in body fat, and feeding increased these levels. In other words, low-calorie dieting increased hunger which is the last thing you want if you are trying to lose weight on a low-calorie diet and are hungry already.

The problem with drugs of this type is the incredible intricacy and complexity of our bodies' system that maintains a fixed level of energy storage. The mechanisms that measure food intake and energy expenditure and maintain constant energy storage whether you are slim or overweight is determined by the metabolism of liver, pancreas, gut, muscle and body fat. Regulation also involves adrenal and sex steroids. There is thus a complex set of chemical signals that automatically regulate energy expenditure and food intake. This system is designed so that relatively constant body fat storage is assured for use in response to times of food scarcity or hard physical exercise.

Another problem confronting scientists looking for the elusive magic bullet is that this system is still not completely understood. Firing a magic bullet at it blindly could have all sorts of unforeseen side effects. There is currently no magic bullet that can strike the central control mechanism and make permanent changes in fat storage without an unacceptably high level of adverse effects. Neither is there one on the horizon.

The dramatic increase in obesity in the West now that food is plentiful and we are enticed into eating ever more of it suggests that the genetic factors that control us react to influences during our early growth. This belief is strengthened by our relatively long infancy and childhood compared with other animals. There may one day be a magic bullet that we can take with impunity, while we stuff ourselves with unhealthy foods. I can't help feeling, however, that it would be better to prevent the occurrence of obesity in the first place.

Seaweed soap

But why risk the danger of drugs' side effects when you can wash your fat away?

I was 'surfing' the Internet recently and came across an advertisement for 'Seaweed Defat Soap'. It gave a brief history of Chinese women using seaweed in baths for weight control dating back to the sixteenth century and told of recent medical studies in Zhong Shan Medical University and the Life Science Research Institute of Bei Jing University, China, which proved, it said, that seaweed helps to lower blood fat and cholesterol, as well as reduce fat and prevent its accumulation. The soap's 'defatting agents', it continued, "penetrate the subcutaneous layer to assist in the elimination of fat layers". It then went on to give the results of what looked like a clinical medical trial conducted by Professor Masami Asayama of Chukyo University, Nagoya City, Japan. Here are the results:

Here's what the soap contains:
Dried soap base 83%, Sea weed powder 3%, Perfume 1%, Aloe gel 5%, Purified water 12.5%.

Potential purchasers are assured that these "rare elements of seaweed . . .will easily permeate the skin when it contacts with the skin. It can clean the dirt out of capillary holes. Moreover, its ingredients help your body bind insulin to burn fat, stabilize blood sugar to reduce cravings and prevent dietary fats from being stored as body fat." "You can achieve good results by using 3 to 5 bars. If you need to defat on [sic] certain area of your body, concentrate on rubbing that area 2 to 3 minutes each time you bathe."

And if you believe that, you will believe anything. Scrutiny of the trial results shows that the participants lost an average of only 0.2 kg (7 ozs) over three months. It is hardly a significant amount and well within the range of chance.