Category: weight loss

There are side effects of weight loss injections than need to be considered

kaitiscotland2 Comments
Photo by SHVETS production on Pexels.com

Adapted from BMJ 9 August 2025

Glucagon like peptide-1 receptor antagonists such as Mounjaro, Wegovy, Trulicity and Ozempic, have truly changed the outlook for people who live with obesity or type two diabetes.

There are now one billion people who have obesity and 800 million with diabetes in the world. Many of them could benefit from these drugs there are side effects to the drugs, not all of which are publicised.

Up to 40% of people on these drugs will get gastro-intestinal side effects such as nausea, vomiting, constipation, and diarrhea. More than one in ten patients will stop treatment due to these side effects.

Some people will also lose their sense of taste. Many will also lose their desire for alcohol which is a good thing.

Acute pancreatitis is less common but is a much more serious side effect.

Non arterial anterior ischaemic optic neuropathy (NAION) is emerging as a possible side effect of these drugs. It is the second most frequent cause of optical neuropathy and is a cause of blindness in adults. It is estimated that the risk could be four times as common in those using GLP-1 receptor antagonists.

The large weight losses associated with these drugs is due to both fat loss and skeletal muscle loss. Studies indicate that up to 39% of the weight loss is due to muscle loss. To put this into context, it is like losing 20 years of muscularity compared to normal aging muscle loss. As these drugs are new, we don’t know what the longer term consequences will be but those who already have sarcopenia, falls, are frail or who are older, are more at risk of serious problems.

If people have decided to go on these drugs, supervision from a clinician will help them understand and modify treatment to deal with side effects. Resistance exercise could counteract the muscle loss.

50% of people are known to regain weight after stopping the drugs, so education on lifestyle and the adoption of exercise routines while on the drug may help.

More research on rare side effects such as NAION and ways to identify vulnerable people are needed.

Alternate day fasting may help weight loss on the short term

kaitiscotlandLeave a comment
Photo by Towfiqu barbhuiya on Pexels.com

Adapted from BMJ 28 June 2025 Intermittent fasting as a nutritional tool by Semnani-Azad et al.

A study aimed to find out what effect intermittent fasting diets had on cardiometabolic factors compared to unrestricted diets or continuous energy restriction.

99 RCTs involving over six thousand people were examined. Compared to no restriction in food intake (no dieting), both continuous energy restriction and intermitting fasting led to reduced body weight.

The only type of intermittent fasting diet that produced more weight loss than continuous food restriction ( eg traditional calorie counting) was the alternate day fasting method. Otherwise, whatever method was adopted, the cardiometabolic improvements were similar for the other dietary types.

Some people find it easier and more simple to stop eating certain meals entirely rather than count calories or undertake other forms of food limitation. For caloric restriction, a deficit of 30% was usually able to be maintained in the first three months, when motivation was high, but fell below 10% after 12 months.

This study looked at differences between no dietary restriction, overall calorie restriction, fasting on alternate days, time restricted eating, and whole day fasting. Although alternate day fasting produced the most weight loss after 24 weeks, the amount was only 1.29kg more per participant. Fat lost from the viscera is particularly helpful for people who have fatty liver disease. People with type one and two diabetes, overweight, obesity, metabolic syndrome and metabolic dysfunction such as fatty liver, were included in this study.

This study does not establish any particular dietary strategy as being superior, but does suggest that alternate day fasting be considered as a worthwhile option. The best diet for an individual is one that they can stick to and so widening the options may be helpful.

Time restricted eating no better than not bothering for weight loss if calorie intake is equal

kaitiscotland1 Comment
Photo by Stas Knop on Pexels.com

Adapted from BMJ 27 April 2024

Time restricted eating has been hailed as having a wide range of benefits including weight loss and weight maintenance.

Popular methods include intermittent fasting, only eating in 8 or 12 hour windows of time, and avoiding food within three hours of bedtime. This is meant to reduce the insulin response to food.

A 12 week study followed 41 women whose average age was 59 years. The mean body mass index was 36. All had obesity and either pre-diabetes or diet controlled diabetes. The idea was to find out if they would lose more weight with time restricted eating (TRE).

The groups were told to either stick to an eating window of ten hours with 8% of calories eaten before 1pm or to eat in a usual eating pattern of 16 hours or more a day with at least half of the daily calories eaten after 5pm.

There was no difference in weight loss -2.3kg v 2.6kg and no change in glycaemic measures.

My comment: It would seem that if TRE makes it easier to stick to your chosen dietary regime then fair enough, but if you prefer to eat at intervals through the day then you won’t be missing out. Total calorie intake seems to make the difference.

One in 20 type two diabetics get into remission

kaitiscotlandLeave a comment
Photo by Charlotte May on Pexels.com

Adapted from BMJ Dec 4 2021

A Scottish study showed that one in 20 people diagnosed with type two diabetes gained remission long term. This was defined as having a HbA1c of below 48 mmol/mol.

In comparison with those who did not gain remission, they tended to be older, to have a lower HbA1c at diagnosis, not to have taken glucose lowering medications, and to have lost weight since diagnosis. They were also more likely to have had bariatric surgery.

A review of weight loss diets in diabetics reported in Diabetolgia, reported gloomy results for all of the diets that they reviewed. Meaningful weight loss did not occur often.

These included low carbohydrate diets, high protein, Mediterranean and vegetarian. The best results were for low calorie liquid shakes when these replaced normal food. But even then the weight loss was only a few kilograms.

Most people with type two diabetes need to lose weight to improve their cardiovascular risk, especially if they don’t want to rely on lifelong medication.

Dr David Ludwig: Childhood obesity the the crossroads of science and social justice

kaitiscotland1 Comment
Photo by Loren Castillo on Pexels.com

Adapted from paper by Dr David S Ludwig and Dr Jens J Holst published in JAMA May 1 2023

Treatment that focuses on the root cause of a disease has guided research and clinical practice for centuries. The American Academy of Pediatrics (AAP) published a clinical practice guideline for the evaluation and treatment of children with obesity earlier this year. This guideline emphasises the use of weight loss drugs and bariatic surgery. Diet received little attention apart from advising the USDA’s MyPlate recommendations and the limitation of sugar sweetened beverages.

The researchers are of course constrained by available evidence and the results on weight loss for drugs and surgery do seem superior to the changes achieved by diet. Yet, the physiological changes that occur on a carbohydrate restricted diet have many similarities to what occurs in the body with drugs such as GLP-1 receptor antagonists.

GLP-1 RAs improve beta cell sensitivity to glucose so that the same amount of insulin will be released at a lower glucose concentration. It also slows the rate that the stomach empties after eating food. Thus people feel fuller up after eating for longer, and the lower blood sugars released from the stomach over time result in lowering the total amount of insulin from the pancreas. The lower the rate that the stomach empties, the more weight is lost.

Slower digesting carbohydrate, for instance, must travel farther down the gut before being fully absorbed. This causes lower post meal blood sugars and insulin secretion. Protein and fat also digest more slowly and stimulate less insulin secretion than an equivalent amount of rapidly absorbed carbohydrate. Additional similarities between low glycaemic load diets and GLP-1 RAs include lower leptin levels, suggesting lower leptin resistance, lower ghrelin levels and higher adiponectin levels. This dietary strategy shares mechanisms with gastric bypass surgery which shifts nutrient absorption from a more proximal to a more distal location in the intestines. Of special relevance is that natural GLP-1 secretion is increased with a low glycaemic load diet, which slows gastric emptying thus improving satiety, and bariatric surgery.

Although in theory a low carb diet should be able to replicate the results of GLP-1 RAs (15% weight loss) results are usually disappointing, except where a ketogenic diet with intensive behavioural support (12% weight loss) is provided. In other words, the results can be almost replicated but the person must stick to the diet.

GLP-1 RAs cost $1,400 per adolescent per month. Treatment of all adults with obesity would cost $1 trillion and all adolescents $100 billion per year. Instead of spending this sort of money to solve the obesity crisis, it would be more worthwhile to enhance dietary quality and create environments that would encourage physical activities and outdoor play as an alternative to screen time and electronic gadgets. This would improve mental as well as physical health.

Unfortunately, once GLP-1 RAs are stopped, the weight is usually rapidly regained. Therefore we are really looking at potentially lifelong drug treatment for the obese population. We do not know the effects of prolonged drug treatment on other health factors. A low quality diet could still produce a raised lifetime risk of cardiovascular disease, cancer and other chronic conditions, independent of weight.

Perhaps low glycaemic load diets when given in conjunction with GLP-1 RAs would improve the therapeutic effect and thus allow drug use at lower dosages. This could reduce adverse effects.

To advance science and social justice we must fund research into new dietary treatments and overcome obstacles to the provision of intensive behavioural interventions. Especially for children, diet and lifestyle must remain at the forefront of obesity prevention and treatment.

Worsening obesity in children can be reversed with a ketogenic diet

kaitiscotland5 Comments
Photo by Alexander Dummer on Pexels.com

Adapted from Independent Diabetes Trust Newsletter March 2023

The National Child Measurement Programme 16 March 2022

In the western world obesity rates continue to climb in children. In the UK when children start primary school at the age of 4-5 14.4% are obese and a further 13.3% are overweight. In Primary 6, at the age of 10-11 25.5% are obese and 15.4% are overweight.

My comment: from my own schooldays, there was only one overweight child in my primary class and she was on steroids and had a heart complaint that stopped her from participating in any exercise. In primary 7, there was one girl who was overweight and she had started puberty earlier than the rest of us.

In the USA in 2019 more than 30% of children were overweight or obese, similar to the UK figures. Physicians are reporting that since the Covid epidemic children are usually between 5 and 10 pounds heavier than they were at any given age, so these figures are likely to worsen even more.

Since 2006 Duke University has treated more than 15,000 children with a restricted carbohydrate diet which encourages the eating of vegetables, fatty fish, nuts and other features of the Mediterranean diet.

Meghan Pauley and colleagues from the Marshall University School of Medicine in Huntington West Virginia have cut the carbohydrate intake for children further to 30g or less a day and have been effective in short term weight loss in severely obese children and teenagers.

The ages of the subjects ranged from 5 years to 18 years. The study lasted 3-4 months. The children were otherwise told to eat as much fat and protein as desired with no limit on calories.

Two groups of analyses were done of different intakes into the programme in 2017 and 2018.

 In Group A, 310 participants began the diet, 130 (42%) returned after 3-4 months. Group B had 14 enrollees who began the diet, and 8 followed up at 3-4 months (57%).

Girls compared with boys were more likely to complete the diet. Participants less than 12 years age were almost twice as likely to complete the diet compared with those 12-18 years, however, the older group subjects who completed the diet had the same percentage of weight loss compared with those under 12 years. Group A had reductions in weight of 5.1 kg , body mass index (BMI) 2.5 kg/m2 , and percentage weight loss 6.9% .

Group B had reductions in weight 9.6 kg , BMI 4 kg/m2 , and percentage weight loss 9% . In addition, participants had significant reductions of fasting serum insulin and triglycerides.

This study demonstrated that a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.

No chips with mine thanks!

kaitiscotland4 Comments
Photo by Glady Francis on Pexels.com

After considerable number crunching a low carb colleague has come to the very reasonable conclusion that the worst food in the world for weight gain is the fried potato in its several incarnations.

In the USA French Fries are what we in the UK call Chips. In the USA Chips are what we in the UK call Crisps.

These are ubiquitous and difficult to avoid particularly if you eat in fast food restaurants. Even if you order a sandwich you may be given a side order of chips or crisps.

Tucker explains that the vegetable and seed oils that these items are fried in play havoc with the appetite control centres of your brain. This article serves as a reminder, since we are all still at least trying to keep to our New Year’s Resolutions, why it would be better to avoid having them on your plate or hand in the first place. And just the one or two….who are you kidding?

https://yelling-stop.blogspot.com/2021/10/whats-most-fattening-food.html

Low carb diets are beneficial for weight normalisation after childbirth

kaitiscotland2 Comments
Photo by Creation Hill on Pexels.com

Everyone knows how hard it is to shift body fat after having a baby. A recent study suggests that adopting a low carb diet featuring plentiful meat/poultry/fish and animal fats was more successful than having a low carb diet based mainly around plant foods.

Readers who are keen to shed their post holiday season weight gain may also find this information useful.

Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown.

The present study involved 426 women from a prospective mother-infant cohort study.

Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys.

PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23–0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19–0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05).

A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.

https://pubs.rsc.org/en/content/articlelanding/2021/fo/d1fo00935d

Wondering if fasting is worth the pain?

kaitiscotland2 Comments

Carbohydrate restriction regulates the adaptive response to fasting
S. Klein and R. R. Wolfe 
Department of Internal Medicine, University of Texas Medical Branch, Galveston.
The importance of either carbohydrate or energy restriction in initiating the metabolic response to fasting was studied in five normal volunteers.

The subjects participated in two study protocols in a randomized crossover fashion. In one study the subjects fasted for 84 h (control study), and in the other a lipid emulsion was infused daily to meet resting energy requirements during the 84-h oral fast (lipid study).

Glycerol and palmitic acid rates of appearance in plasma were determined by infusing [2H5]glycerol and [1-13C]palmitic acid, respectively, after 12 and 84 h of oral fasting.

Changes in plasma glucose, free fatty acids, ketone bodies, insulin, and epinephrine concentrations during fasting were the same in both the control and lipid studies.

Glycerol and palmitic acid rates of appearance increased by 1.63 +/- 0.42 and 1.41 +/- 0.46 mumol.kg-1.min-1, respectively, during fasting in the control study and by 1.35 +/- 0.41 and 1.43 +/- 0.44 mumol.kg-1.min-1, respectively, in the lipid study.

These results demonstrate that restriction of dietary carbohydrate, not the general absence of energy intake itself, is responsible for initiating the metabolic response to short-term fasting.

Dr Michael Eades: Omega 6 fats make you fat way beyond their caloric value

kaitiscotland2 Comments

There is a hypothesis gaining ground which is that the omega 6 fats in vegetable oil disrupt metabolism and promote fat gain way beyond their simple caloric value.

Dr Michael Eades explains the epidemiology which suggests that this is the case and then the biochemistry which provides a plausible explanation.

This video is 45 minutes long and is quite technical in parts.

 

Abstract and video here:

https://denversdietdoctor.com/dr-michael-eades-a-new-hypothesis-of-obesity/