Liposuction Might Have 'Boomerang' Effect

But exercise kept post-surgical increase in fat around organs at bay, study found June 14, 2012 By Alan Mozes HealthDay Reporter THURSDAY, June 14 (HealthDay News) -- Women who have the popular plastic surgery procedure known as liposuction may be trading one form of fat for another, as a new study reveals that the sudden removal of abdominal fat seems to trigger a buildup of fat around the internal organs. At issue, the Brazilian researchers said, is an apparent trade-off between two kinds of fat, with the removal of "subcutaneous fat" spurring the growth of "visceral fat." Subcutaneous fat, located directly under the skin, is the primary target of liposuction. Visceral fat wraps itself around internal organs, and its accumulation has been strongly linked to a higher risk for diabetes and heart disease. Here's the good news: The same research team found that liposuction patients who adopted an exercise program shortly after surgery both enjoyed the benefits of abdominal fat removal while largely preventing the post-surgical growth of visceral fat. "Importantly, a four-month, supervised exercise program prevented this compensatory visceral fat increase, increased fat-free mass and improved physical capacity and insulin sensitivity," the team, led by Fabiana Benatti from the University of Sao Paulo, reported. Benatti and her colleagues detail the findings in the July issue of the Journal of Clinical Endocrinology and Metabolism. The authors focused on the experience of 36 healthy Brazilian women between the ages of 20 and 35, all of whom underwent abdominal liposuction between 2010 and 2011 in Sao Paulo. None of the women had a body-mass index (BMI) over 30 prior to the procedure, meaning that while they were overweight none was obese. All of the surgeries were also described as being "small-volume" in nature. Two months post-surgery, the women were divided into two groups: the first embarked on a four-month (three times per week) exercise regimen, while the second essentially maintained a sedentary lifestyle. Both groups were deemed to have experienced similar drops in body weight and overall fat mass as a result of their surgery, and both followed comparable diets post-procedure. Those in the exercise group engaged in aerobic and anaerobic (weight training) training through the four-month period. The result: Six months after their operation, neither group had regained fat in the abdominal region that was the target area of the liposuction surgery, leading the team to describe the procedure as "cosmetically efficient." However, patients in the sedentary group experienced a roughly 10 percent increase in visceral fat, equating to what the authors described as a "significant regain of total fat mass." In contrast, those in the exercise group did not. Benatti's team said that it is not yet clear exactly how liposuction raises the risk for visceral fat growth. What is clear, however, is that exercise seems to mitigate that risk. Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern at Dallas, expressed little surprise with the findings. "You oftentime have this snapback of the fats," she said. "Sure, you can get rid of some of it with surgery. But if you don't change your lifestyle, it doesn't stay away forever. And certainly if you've spent all this money and incurred the risk of undergoing liposuction -- and it's not a risk-free option, by any means -- why wouldn't you want to do what you can to preserve the gain?" "So, no, I don't think it's surprising that exercise helps after surgery," Sandon added. "And in that respect, cardiovascular exercise, in particular, is one of the best ways to go. That means jogging, swimming, biking, roller blading, getting your heart rate up for an extended period of time and burning calories. Even walking helps to decrease visceral fat, even in people who have not had liposuction. And so I would expect it would work the same for people who have had liposuction." Connie Diekman, director of nutrition at Washington University in St. Louis, seconded the notion. "This is a small study," she cautioned. "And it raises the question of how this might play out among women who were significantly more overweight than those included in this study." "But I think there is a very important message here," Diekman added, "in that this study is an example of how you can make a positive change with exercise. It may not ultimately prevent the return of body fat, but clearly it can change its distribution or delay its return. And that is very good news."

Not All Calories Are the Same, New Research Finds

From Heartwire Lisa Nainggolan June 26, 2012 (Boston, Massachusetts) — A small mechanistic study comparing three different eating patterns--a low-fat diet, a low-glycemic-index diet, and a low-carbohydrate diet--has found that participants used up the most energy with the last, but there were metabolic disadvantages to this approach [1]. The findings reinforce the message that a low-glycemic-index diet is best for weight loss and cardiovascular disease prevention and illustrate a novel concept--that not all calories are alike from a metabolic perspective, say Dr Cara B Ebbeling (New Balance Foundation, Obesity Prevention Center, Children's Hospital, Boston, MA) and colleagues in their paper published in the June 27, 2012 issue of the Journal of the Medical Association. Extreme restriction of fat or carbs can have bad effects. Senior author Dr David S Ludwig (New Balance Foundation, Obesity Prevention Center) told heartwire : "Extreme restriction of fat or carbs can have bad effects. The best long-term approach will be to avoid restriction of any major nutrient--either fat or carbohydrate--and instead focus on the quality of nutrients. This is not to say that the number of calories isn't important, but it's now saying we should also pay attention to the quality of those calories. So the argument that the food industry likes to make--that all foods can be part of a healthful diet as long as you watch calories--is really misleading at best. "Relatively unprocessed, low-glycemic-index foods are best, things that our grandmother would recognize. Choose relatively unprocessed foods whenever you can and cut back on white bread, white rice, potato products, prepared breakfast cereals, and, of course, concentrated sugars." The argument that the food industry likes to make--that all foods can be part of a healthful diet as long as you watch calories--is really misleading at best. Dr Arne Astrup (Department of Human Nutrition, University of Copenhagen), who was not involved with the study, said it adds to previous research and demonstrates that "a slight reduction in carbs (and increase in protein) with a focus on low [glycemic-index]/whole-grain carbs and 20% to 30% of calories from protein from shellfish, fish, poultry, dairy, nuts, lentils, and beans is the optimal diet today for weight control and reduction of cardiovascular risks." To this end, Ludwig believes it's time to change recommendations. "Most of the professional nutritional associations continue to feature, expressively or implicitly, targets on fat reduction. Our work--and really many other studies--now suggest that there is absolutely no benefit by selectively targeting fat for reduction." Low-Fat and Low-Carb Diets Both Have Important Downsides The researchers conducted a three-way crossover design feeding study between June 2006 and June 2010 involving 21 overweight and obese young adults in Boston who were recruited by newspaper advertisements and postings. After losing 10% to 15% of body weight during a run-in phase, participants were allocated to a low-fat diet (20% fat, 60% carbohydrate, 20% protein), a low-glycemic-index diet, and a very low-carbohydrate diet (10% carbohydrate, 60% fat, 30% protein) in random order, each for four weeks. The primary outcome was resting energy expenditure with secondary outcomes of total energy expenditure, hormone levels, and metabolic syndrome components. Ludwig notes these type of studies are "difficult to perform," because for each participant there were seven months of feeding, "and that's about the limit you can put a human subject through, so we could only examine each diet for a month at a time." The reduction in resting energy expenditure was greatest with the low-fat diet, intermediate with the low-glycemic-index one, and least with the low-carb diet. The decrease in TEE showed a similar pattern. Those on the low-carb diet burned 350 calories per day more than those on the low-fat one, even though they consumed the same amount of calories on all these diets. "Those on the low-carb diet burned 350 calories per day more than those on the low-fat one, even though they consumed the same amount of calories on all these diets. That's equivalent to one hour of moderate-intensity physical exercise," Ludwig said. And those on the low-glycemic-index diet lost about 150 calories per day more than those on the low-fat one, "equal to about an hour of light physical activity," he added. (Neither total physical activity nor time spent in moderate- to vigorous-intensity physical activity differed among the diets.) But he explained that, as well as energy expenditure, "we also looked at heart disease risk factors, and the two restrictive diets both had important downsides." Strongest Support for Concept That Not All Calories Are the Same With the low-carb diet, the researchers observed increases in CRP, a measure of chronic inflammation, and 24-hour cortisol, the key stress hormone, "suggesting that any initial advantages were eroded over time by these biological stressors," Ludwig notes. And the low-fat diet--as well as resulting in the least energy expenditure--"exacerbated many of the components of the metabolic syndrome, so insulin resistance, triglycerides, and HDL cholesterol were all worse on this diet," he explained. Hence the study, despite its limitations, "provides the strongest support for a novel concept, that all calories are not alike from a metabolic perspective. This has been postulated before, but never shown in this context," Ludwig says. "We are emphasizing mechanisms that underlie how diets affect body weight and saying that this knowledge should be used to design more effective and least-restrictive approaches to weight loss and heart disease prevention. We want to line up biology and behavior. Losing weight is hard enough for anybody. We need every advantage we can get. We've wasted a lot of energy pursuing ineffective approaches like a low-fat diet."

Eating placenta, an age-old practice in China

From www.straitstimes.com SHANGHAI (AFP) - After Ms Wang Lan delivered, she brought home a baby girl and her placenta, which she plans to eat in a soup - adopting an age-old practice in Chinese traditional medicine. The health-giving qualities of placenta are currently creating a buzz in Western countries, where some believe it can help ward off postnatal depression, improve breast milk supply and boost energy levels. But placentophagy - the practice of eating one's placenta after birth - is relatively common in China, where it is thought to have anti-ageing properties, and dates back more than 2,000 years. 'It is in the refrigerator now and I am waiting for my mother to come and cook it to eat. After cleaning, it can be stewed for soup, without that fishy smell,' Ms Wang said, adding she believed it would help her recover from delivery. My comment: Oral placenta pills are now freely available & registered with the Ministry of Health in Malaysia so the prices are quite reasonable (depending on concentration of the active ingredient, prices vary between RM300-600 per month's supply.) & you don't have to put up with the fishy gooey original raw product.

Can we educate physicians to be more human?

By Brooke Holmes, Special to CNN Editor’s note: Brooke Holmes teaches the history of medicine and Greek literature at Princeton University. She writes with The Op-Ed Project . http://schoolsofthought.blogs.cnn.com/2012/05/14/my-view-can-we-educate-future-physicians-to-be-more-human/?hpt=hp_bn5 "For all the strides we’ve made through technological innovation, medicine is failing at the very human art of treating patients. Doctors are ill-equipped to deal with factors like diet and poverty, which are now responsible for over half the cases of premature disease and death in the United States. Armed with state-of-the art drugs and machines, they don’t always consider whether using these resources will cause more harm than good. In many cases, it no longer makes much sense to call what physicians and patients have a “relationship” at all." "Let’s back up and ask an even more fundamental question: What do we want from our doctors? In a word: communication." "Right now we inhabit a paradox. We tell pre-med students they need to focus on the sciences and then we complain that the doctors they become don’t treat us like people. If we want to improve the quality of health care, we need to be educating future physicians to think qualitatively and quantitatively, humanistically and scientifically."

Yet another overpriced MLM "miracle" product

Just got approached yesterday to buy waaaaay overpriced Cordyceps & ginseng pills (Nuskin's new product) - RM4500 per month's supply. Buy 10, get 2 free to boot - a RM45K investment - I could use this as a down payment for a car or piece of property (OK, outside Klang Valley)! I'm very open-minded & a supporter of traditional Chinese medicine, where it's due, but it's a fact that these MLM companies always overprice their products & the downliners always misrepresent their products. The Taiwanese (the upline of my gullible friend who can ill-afford such products but looking for a business opportunity) used the classic MLM tricks to pull wool over my eyes: 1. 1st thing was misrepresenting the product as being developed by & endorsed by Stanford University. The fine print of their website says "No". They only plan to approach Stanford U to conduct clinical trials on their product. 2. She used a listing of the product in Physician's Desk Reference as a rubber stamp approval by FDA to treat a long list of diseases. Fact #1 - their product is a food supplement & does not require FDA approval to market it Fact #2 - a listing in PDR in no way implies a drug or substance is FDA-approved. It only means it is available for sale in USA. Fact #3 - food supplements are not permitted to make medical claims of treating anything & of course, the Nuskin upline went on & on about miracle cures of impotence, look 15 years younger in 1 month, blah, blah, blah. I think the only thing she didn't cover was cancer & maybe because she knew she was talking to a doctor. 3. Thousands of rich people including movie stars are using the product & giving it "free endorsement" so why should they when they are already so rich? Well, that's why they are so rich - they are top of the heap of the MLM scheme & even M'sian downliners are subservient to S'pore upliners in Nuskin! 4. When she sensed she was losing me, she went on to say she is promoting this product only because she wants to spread the good word about the positive benefits & "Look at me, I'm 50 & look so good" - yeah, with the thickest layer of makeup. I responded & told her to look at me, I'm 44, no makeup on & I don't spend RM4500 every month on health supplements. The meeting ended pretty soon after that. Take home message: If you're already a Nuskin member, think about whether it makes sense to buy overpriced Chinese herbs from an MLM company when you can buy them from your local trustworthy Chinese medicine shop. If you aren't already a Nuskin member, think about whether it makes sense to buy overpriced Chinese herbs so you can make money off your friends for the business opportunity. So many MLM schemes in the past - Bioyoung, Lampberger (their therapeutic "medicinal" fragrance oils from France were eventually found to be sourced from China), Herbalife (Yes, I got sucked in by a relative - the only benefit I got from my experience with this MLM scheme was learning to eat less & more healthily which kickstarted my journey to healthy weight loss)...- have come & gone. They're here to stay, despite what I say (kinda like corruption in Malaysia) but that's my 2 cents worth...

FDA Announces Safety Label Changes to Finasteride

April 12, 2012 — The product labels for finasteride 1 mg (Propecia) and finasteride 5 mg (Proscar) from Merck & Co are being revised to note that some sexual adverse effects may continue after the drugs are discontinued, the US Food and Drug Administration (FDA) announced April 11.

The new label changes include:

* a revision to the Propecia label to include libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug,
* a revision to the Proscar label to include decreased libido that continued after discontinuation of the drug, and
* a revision to both the Propecia and Proscar labels to include a description of reports of male infertility and/or poor semen quality that normalized or improved after drug discontinuation.

In 2011, both Proscar and Propecia's labels were revised to include erectile dysfunction that continued after drug discontinuation.

The FDA approved finasteride 5 mg in 1992 to treat benign prostatic hyperplasia and finasteride 1 mg in 1997 to treat androgenic alopecia in men. Finasteride 1 mg is also used off-label to treat unwanted facial hair in women. It has also been studied for chemoprevention of prostate cancer and is used off-label for this, but this use has not been approved by the FDA.

Adverse Event Reports Prompt Action

The FDA notes that sexual adverse effects were reported by patients during clinical trials of finasteride, a 5-alpha reductase inhibitor, and that this information was included in the drug's labels at the time of approval. In clinical trials, these adverse effects resolved in patients who stopped taking finasteride, as well as in most patients who continued therapy.
Finasteride (Propecia, Proscar)

For finasteride 1 mg, the FDA reviewed 421 postmarketing reports of sexual dysfunction submitted to the agency's Adverse Events Reporting System database between 1998 and 2011. Of these, 59 cases reported sexual dysfunction that lasted for at least 3 months after discontinuation of the drug, and included erectile dysfunction, decreased libido, problems with ejaculation, and orgasm disorders.

For finasteride 5 mg, the FDA reviewed 131 cases of erectile dysfunction and 68 cases of decreased libido associated with the drug that were submitted to the drug sponsor's global safety database between 1992 and 2010. Where information was available, these reported events of erectile dysfunction and decreased libido lasted for at least several weeks after drug discontinuation, the FDA says.

"Despite the fact that clear causal links between finasteride (Propecia and Proscar) and sexual adverse events have NOT been established, the cases suggest a broader range of adverse effects than previously reported in patients taking these drugs," the FDA notes in a statement. "Information about these adverse events may be important to individual patients. Therefore, prescribers and patients need to be aware of them, as part of a discussion of risk and benefits of finasteride when determining the best treatment options," the statement continued.

The agency notes that in controlled clinical trials of finasteride 1 mg, 36 (3.8%) of 945 men reported 1 or more adverse sexual experiences compared with 20 (2.1%) of 934 men who received placebo.

Sexual adverse events associated with finasteride 5 mg surfaced in 2 clinical trials. In 1 trial, these events were reported more frequently during the first year of treatment compared with in men who received placebo. In years 2, 3, and 4 of the trial, there was no significant difference between treatment groups in the incidences of impotence, decreased libido, and ejaculation disorder, the FDA says.

Botulinum to Relax Frown Lines Relieves Major Depression

From Medscape Medical News
Daniel M. Keller, PhD

March 13, 2012 (Prague, Czech Republic) — For patients with chronic major depression that does not sufficiently respond to other treatments, a single injection of botulinum neurotoxin into the glabellar muscle of the forehead to relieve frown lines appears to lead to strong and sustained improvement of the depression.

Tillmann Kruger, MD, Associate Professor in the Department of Psychiatry, Social Psychiatry and Psychotherapy at Hannover Medical School in Hannover, Germany, reported here at the 20th European Congress of Psychiatry that these findings support the concept that facial musculature not only expresses mood states but also affects mood.

He explained that frowning expresses negative emotions such as anger, fear, or sadness. A facial feedback hypothesis says that the frown itself reinforces negative emotions, with the implication that suppressing frowning will help to relieve the negative emotions.

"The theory is pretty old, and it says that many or most of the emotions we have develop somewhere in the brain, and some of them are expressed in your face, for example...and this is again received and sent back to the central nervous system by this proprioceptive feedback," he told Medscape Medical News. He said that in some cases of depression, there are signs of increased glabellar muscle activity.

Facial Feedback Theory

"Not all glabellar frown lines have to disappear to guarantee a good psychological effect," Dr. Kruger said, and full remissions have been observed in patients with residual frown lines.

"We think, regarding possible mechanisms, that the reduced proprioceptive feedback — the facial feedback theory — is the most important one. I think this is something that works 24 hours per day," he added.

There may also be some effect of social feedback in that friends and family may tell patients that they do not look so angry.

Dr. Kruger said that botulinum is able to travel in a retrograde direction via nerve fibers to the central nervous system, but given the small amount of drug used, he thought this mechanism would not explain the effects seen.

However, when asked whether a more appropriate control than placebo injections would be botulinum injections into a cranial muscle that did not affect frowning, he agreed that such a procedure would be a good control for a possible effect of botulinum not related to the relief of frown lines. Therefore, it is still possible that botulinum acted through a mechanism other than relief of frown lines.

Dr. Kruger said the study also showed that botulinum injections had excellent safety and tolerability. "It may be even economic because it's only a single injection [session], and it works for more than 16 weeks, as we have seen," he said, but the study needs to be validated in larger trials.

At present, botulinum is not indicated for treatment of depression. "But Botox has an indication to treat glabellar frown lines...and if someone has frown lines and has a depression and says, 'I want to have them away, these frown lines,' you can, of course, use it," Dr. Kruger noted.