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Weight Loss Should Improve OSA in Obese Patients With Type 2 Diabetes

Weight loss should result in significant and clinically relevant improvements in obstructive sleep apnea (OSA) among obese patients with type 2 diabetes, according to the results of a multicenter randomized study published in the September 28 issue of the Archives of Internal Medicine.

"The belief that weight loss improves...OSA has limited empirical support," write Gary D. Foster, PhD, from the Center for Obesity Research and Education, Temple University in Philadelphia, Pennsylvania, and colleagues from the Sleep AHEAD Research Group of the Look AHEAD Research Group. "The purpose of this 4-center study was to assess the effects of weight loss on OSA over a 1-year period."

The study sample consisted of 264 participants with type 2 diabetes who were randomly assigned to either an intensive lifestyle intervention (behavioral weight loss program developed specifically for obese patients with type 2 diabetes) or to a diabetes support and education group (3 group sessions discussing effective diabetes management). Mean age was 61.2 ± 6.5 years, mean weight was 102.4 ± 18.3 kg, mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 36.7 ± 5.7 kg/m², and mean apnea-hypopnea index (AHI) was 23.2 ± 16.5 events per hour.

Compared with participants in the support and education group, participants in the intensive lifestyle group lost more weight at 1 year (10.8 kg vs 0.6 kg; P < .001) and had a relative adjusted decrease in AHI of 9.7 ± 2.0 events per hour (P < .001). Total remission of OSA at 1 year occurred in more than 3 times as many participants in the intensive lifestyle group vs the support and education group, and the prevalence of severe OSA in the intensive lifestyle group was half that in the support and education group. The factors most predictive of changes in AHI at 1 year were initial AHI and weight loss (P < .01), with the greatest reductions in AHI occurring in participants with weight loss of at least 10 kg.

"Physicians and their patients can expect that weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes," the study authors write. "The greatest benefit was observed in men, in participants with more severe OSA at baseline, and in participants who lost the most weight."

Limitations of this study include lack of generalizability to younger patients, to patients without type 2 diabetes, or to patients with milder degrees of OSA. In addition, future research should address the mechanical, metabolic, and hormonal mechanisms underlying these improvements in OSA.

"The significant increase in AHI over 1 year in participants who were weight stable suggests that OSA is a rapidly progressing syndrome that will worsen without treatment in middle-aged obese adults with type 2 diabetes," the study authors conclude.

The National Institutes of Health (NIH) National Heart, Lung, and Blood Institute supported Sleep AHEAD. The NIH National Institute of Diabetes and Digestive and Kidney Diseases supported Look AHEAD. One of the study authors (Dr. Sanders) has disclosed various financial relationships with Philips-Respironics, Cephalon, and Sanofi-Aventis. Read More!

Everything You Need to Know About Vitamins

Following all the latest news on vitamins could be a full-time job. Actually, what the average consumer needs to know about vitamins is surprisingly straightforward.

New studies and claims about vitamins are published daily, and many seem to contradict each other. What does an average consumer really need to know about vitamins?

“The fairly simple answer is, not much,” says Paul Thomas, EdD, RD, scientific consultant with the National Institutes of Health Office of Dietary Supplements. Almost everyone can benefit from taking a supplement with calcium because most people don’t get as much as they need through their diets — 1,000 mg a day for adults, increasing to 1,200 mg after age 50. Thomas notes that some vitamins become especially important at certain times in a person’s life. Pregnant women or women who may become pregnant should be certain to get enough folate, or folic acid, a B-complex vitamin — 600 units a day, rather than 400. And as you age, you should probably take a daily supplement to get additional B12, he suggests.

“You don’t have to become an expert or learn all the intricacies of all the vitamins — because you can't,” adds Dr. Thomas. There’s simply too much information to try to remember.

What you need to do is eat a healthy diet, selecting recommended foods based on the USDA guidelines. Because few of us consistently eat a well-balanced diet, Thomas says taking an over-the-counter multivitamin, even a store brand, is a good idea. “It’s sort of like an insurance policy that covers all your bases,” he explains.

Vitamins and Healthy Living: Not as Easy as A, B, C, and D

Maintaining a balance of the vitamins we need is important yet tricky. While vitamins work together in the body to ensure our health — the most obvious being the way vitamin D aids in absorbing calcium — the interaction between vitamin supplements and prescribed medications can cause health problems. For example, calcium can interact with some pharmaceuticals, limiting the body’s ability to absorb the prescribed medication. So whenever your doctor gives you a new prescription or changes one, it’s important to discuss all of the vitamin and mineral supplements you’re taking to avoid any potential problems.

Vitamins and Healthy Living: Is Taking More Better?

For people who have a healthy diet, taking a multivitamin according to package directions won’t trigger a vitamin overdose. But Thomas warns, “You run into trouble if you take vitamins and supplements where the dose is very large.”

Some people take large amounts of supplements — hundreds or thousands of times more than the recommended amount — to treat or prevent illnesses or diseases, in effect treating vitamin supplements like drugs. “That’s different from taking them to get the recommended amount,” Thomas cautions.

Using supplements as therapy should be done only with a doctor’s guidance, as side effects and complications can and do occur. As an example, Thomas points to niacin, or B3, which in very high doses can harm the liver. However, in many cases niacin is a good drug for reducing statin levels, he adds.

Even some very familiar advice isn’t yet proven medical theory, Thomas notes: “When you look at the use of large doses of vitamin C (to combat colds), the evidence to date is kind of murky.”

To evaluate any supplement as a medical treatment, consider the body of evidence supporting any health claims and seek information from a pharmacist, dietitian, or your family doctor. “The folks who sell supplements probably aren’t the best sources of information,” Thomas says.

Know the limitations of weight loss drugs

Have you ever used prescription drugs for weight loss or considered asking your primary care provider to write you a prescription for medication to help you lose weight?

If you have, you're not alone. Between 1996 and 1998 it is estimated that 4.5 million U.S. adults were prescribed a weight loss drug to promote weight loss.

For those of you who have joined the ranks of the millions of fellow Americans using prescription meds for weight loss, and more importantly for the group who are considering taking pills to reduce your waist line, I ask you to consider the following information.

First, it is important to know who should be using drugs for weight loss; there are some basic criteria that need to be met before you are considered to receive a prescription. Your Body Mass Index (BMI) should be at or above 30. This number drops to 27 if you have a co-morbidity such as type 2 diabetes, hypertension, heart disease or sleep apnea.

An example would involve a person who is 5-foot, 5-inches tall: a BMI of 30 means this person would need to weigh 180 pounds, or if they have any of the above health problems a BMI of 27 represents 162 pounds. For people who do not meet these criteria, the risks of taking a drug for weight loss often outweigh the benefits.

Second, there has yet to be found a magic bullet that works for everyone. Keeping that in mind, it is important to know that anything used to achieve weight loss is simply a tool. Pills, diets and sports equipment only work if you understand what you're doing and use them properly. And once you stop using them, unless you have learned to change your behavior toward food, they stop working. This is the primary reason people regain weight after they finish their diet regimen.

Third, consider the benefits verses the risks of taking a drug for weight loss. While some weight loss drugs simply suppress the appetite, others interfere with nutrient absorption and brain chemicals to aid in weight loss. Take the time to research all aspects of a drug before you consider taking it. Asking about the long-term effects, common side-effects and knowing how long the drug can be safely taken will help you make an informed decision.

Finally, don't just rely on a weight loss drug to produce long-term weight loss all by itself. Incorporating a lifetime goal of healthy eating and exercise is the only way to ensure weight loss success.

Remember, if it sounds too good to be true, it probably is! Read More!

6 Tips to Boost Mood and Metabolism

What you eat can have an effect on your mood and metabolism. Learn what food you should eat to boost your energy and spirits.

By making a few simple adjustments to your diet, you can elevate your mood and boost your metabolism. The benefits are huge: Maintaining a good mood will help you stick to a healthy diet, be more productive, and increase your self-esteem. Metabolism is the process your body uses to break down food. “Ensuring your metabolism is working most effectively will help you feel your best and energized to get the most out of life,” explains Nicole Berkowitz, RD, a nutrition consultant in Toronto, Canada.

Here are six simple tips to help you optimize your diet to boost mood and metabolism.

1. Resist Skipping Meals

Skipping or missing a meal can cause a dip in your blood sugar, leading to crankiness and lethargy. Maintain your blood sugar levels, and your energy, by eating small amounts of food throughout the day. You might even prefer eating six smaller meals rather than three large ones.

2. Stay Hydrated

Dehydration can also make you feel sluggish and lethargic. Be sure to drink throughout the day, and don’t rely on thirst alone to remind you to have another glass of water. The average person needs about eight glasses of water, and that may be hard to drink without reminders.

3. Think Moderation, Especially for Low-Nutrient Foods

Avoid a lot of caffeine, refined carbohydrates (sugar), alcohol, salt, and other food additives. Any of these, especially in large amounts, can decrease your metabolic efficiency. “Eating large quantities of carbohydrates tend to cause an energy rush and then a big crash; this can lead to crankiness and fatigue," says Heidi McIndoo, MS, RD, a nutrition consultant in Roslindale, Mass. Excess salt can disrupt your fluid balance, changing your daily water needs, not to mention increasing health risks like high blood pressure.

4. Strive for Balance in the Food You Eat

Properly combine protei, carbohydrates, and fat to achieve a balanced energy intake. In general, a healthy diet includes a mix of whole grains, fruits and vegetables, and some protein, but each person has individual needs based on age, sex, physical activity level, body size, and stress factors. To find out the best foods for you, consult a nutritionist who can help you determine the right balance.

5. Get a Boost From “Good Mood” Food

While research about the mood- and metabolism-boosting qualities of certain foods is mixed, foods high in the amino acid tryptophan can increase serotonin levels in the brain, contributing to feelings of optimism and calm. Add some bananas, avocados, dried apricots, walnuts, sunflower seeds, or pumpkin seeds for some extra tryptophan. Polyunsaturated omega-3 fats help elevate mood and reduce anxiety and depression. Look for omega-3-rich fish, like salmon and mackerel; walnuts and pumpkin seeds are also sources of these healthy fatty acids.

6. Keep a Food Diary

Some foods can have the opposite effect of tryptophan and instead trigger negative changes in mood and cause irritability or headaches. If you think a particular food might be affecting your mood, start a food diary. Record all the foods you eat each day and how you feel before and after every meal. After two weeks, review your entries to see if any foods line up with specific moods, either good or bad.

In addition to following a healthy diet, regular exercise will keep your body working most effectively and will augment both your mood and metabolism. The key message here is balance. A variety of healthy foods with a dose of exercise will help you maintain your energy, speed up your metabolism, and boost your mood.

Ruby Gettinger

She made the brave decision to document her weight-loss efforts on reality TV. Find out how Ruby lost 300 pounds and counting.

Ever since she was 13, Ruby Gettinger has struggled with her weight. She has topped the scales at more than 700 pounds and has suffered the indignities and cruelties that come with being obese. But it was a doctor’s grim warning that finally shocked Gettinger, 34, into making the changes necessary to lose weight and improve her health.
When she got down to 400 pounds and found herself at a loss for how to successfully lose the rest of the weight, Gettinger convinced friends to create an amateur documentary of her relationship with food and her weight loss journey. “I wanted to find out if this is mental, physical, spiritual or emotional,” she says. “I wanted to know the truth behind my obesity.”
The truth, Gettinger found, was that she was addicted to food. An emotional eater, she used food for comfort. She did not eat meals; rather, she snacked on sweets and chips all day long. Breaking this habit would require more than just sheer willpower. She needed a support team.
So when the Style Network offered to turn her weight-loss documentary into a reality program, Gettinger readily agreed. She now works with a personal trainer, a therapist, and a nutritionist. Now in its second season (the first season is available on DVD), “Ruby” shows Gettinger successfully breaking the 350-pound mark and learning how to deal with life’s tragedies without turning to food for comfort. Gettinger also wrote a recently released memoir, "Ruby's Diary: Reflections on All I've Lost and Gained", that chronicles her personal journey.
Gettinger spoke with Weight Loss True Story about her food addiction and the health problems that shocked her into taking control of her weight.
Weight Loss True Story (WLTS): Eating became an addiction for you. What convinced you that you needed to break this addiction?
Ruby Gettinger: I went to the doctor, and he said: “Ruby, you’re going to die. I’m telling you right now you are a walking time bomb about to explode.” I had diabetes and an enlarged heart. I’d have to start taking insulin. I said, “I will never take insulin.” I mean I was adamant about never doing that. I felt like if I gave in to the insulin that I’m giving in to my addiction.
I left the doctor’s office, and I felt myself dying. But it took me three weeks to finally say, “Okay, I’m going to do something.” But there was a part of me that thought: “Maybe it’s meant for me to die. I can’t beat this; I’m never going to beat this. Maybe I’ve finally done my purpose.”

WLTS: That just shows how strong the addiction was in you.

Ruby Gettinger: Exactly. I didn't realize until now that that was the food addiction talking.

WLTS: So what does it mean to be addicted to food?

Ruby Gettinger: Food is everywhere. It's in church, at the movies, and at every social event you go to. I don't care if they have celery and carrots out, you know there's cheese right there, too, and chips and stuff like that. And that's what I liked to eat. When I first started the diet, I was furious because I literally had headaches for the first two weeks. I was shaking. I went from snack eating — candy and chips — to eating meals. It took me almost three months for everything to kick in.
Now I crave things like fish. This is the girl that would never put real fish in her mouth at all. I never ate vegetables. Now I eat things like broccoli and asparagus. Everything you could think of that's good for you, I'm eating it.

WLTS: You really had to change your palate.

Ruby Gettinger: Well, that's what happened. I didn't go to rehab, but in a way, I kind of did. The times when I've had setbacks, I realize now that was the addiction taking hold of me. The biggest thing I've found out doing this show is that I am addicted to food. But now I need to find out the root of my addiction. I need to find out how this could have become so powerful that it got me to 716 pounds at one point.

WLTS: You have lost so much weight. Do you feel better physically?

Ruby Gettinger: Oh my gosh, yes. One of the biggest lessons I've learned is that eating right and exercising will change your health. It really, really will. I had diabetes, but my doctor said I don't need any medication now. My heart is now coming down to a normal-sized heart. Is that not amazing?

WLTS: Do you feel more energetic?

Ruby Gettinger: Oh my gosh, I've never ever moved around as much as I move around now. I love it. I'm on the recumbent bike, and I'm doing it 30 minutes straight, and I say, "This is not challenging me enough." [Before] I couldn't have even walked five minutes — I mean, I couldn't even breathe. I've become an outdoorsy girl. I also love boxing. If you find what you love, you're going to do it, and you're not going to stop doing it.

WLTS: You also had sleep apnea. Any improvement with that?

Ruby Gettinger: I don't wake up anymore feeling like I'm going to die, so that's amazing. But you want to know the most amazing thing? I can get in the bathroom of an airplane now. I was on a flight from New York to L.A. I opened the bathroom door and was like, "There's no way." But I walked right in. I could not believe it! I closed the door. Before I lost weight, I could not even fit through the width of the door. Honey, you would have thought I just won the lottery. I was the happiest girl ever.

WLTS: I think that's a great example of the way they say that when you've lost weight, your mind doesn't see it right away. You still see that fat girl in the mirror.

Ruby Gettinger: You're just so right about that. Two months ago, I'm sitting there brushing my teeth, looking in the mirror, and all of a sudden I went, "Oh my gosh." I mean literally I was thinking, "Look how tiny your face is." I saw my jawline. I was turning my head left and right. It was as if I finally saw my face for the first time.

WLTS: To that obese person out there who hasn't started to lose weight but wants to, what are your words of wisdom?

Ruby Gettinger: The first thing I tell people is you have to go to a doctor. If my mother did not make me go to the doctor, I would have been dead because you don't know what's going on with you physically. Once that's done, just start with the baby steps. Do one thing each day to start getting healthier. Make one change. Walk two times in your living room back and forth. Then walk to your mailbox and then to the stop sign on your street. Then the next week, instead of snacking on Oreo cookies, snack on an orange. You know, just take it one step at a time. I also tell people to write down everything they eat and the calorie counts. That really helps.

WLTS: How does it feel to know that you've inspired so many people to change their lives?

Ruby Gettinger: People come up to me, and they tell me that they've lost 40 pounds, they've lost 80 pounds, and they say: "Because of you, I'm walking now; I'm riding a bike." And I'm sitting there looking at them, and I'm thinking, "They're inspiring me to keep going on." People ask me, "Where do you find the strength to do this?" I started realizing we all have the strength to do it. When people tell me, "Because of you I've lost…" I say, "No, you're doing this. You may be watching me, and I may have given you the push, but you are the one doing this. I'm not with you every single day. You've got the strength — you start giving yourself credit, because you're doing this." Read More!

'Natural' Products are Not Always Safe

Many herbs have a long history of use and of claimed health benefits. An herb, or botanical, is a plant or part of a plant that is used for its scent, flavor, and/or therapeutic properties. Although they are so-called ‘natural’, herbal products are not necessarily safe or without harmful effects. They may come from plants, but many plants are considered harmful and poisonous.

Unlike prescription medicines, herbal products are not tested to certify their safety and efficacy before their marketing. Active ingredients in many herbal medicines and supplements are still unknown. Some have been found contaminated with metals, unlabeled prescription drugs, microorganisms or other substances.

Since herbal products are not tested, they may cause certain health problems/complications. It may not be wise to take herbal products if you have any of these medical problems/conditions:

• High blood pressure
• Thyroid problems
• Parkinson’s disease
• Blood-clotting problems
• Diabetes
• Heart disease
• Epilepsy
• Depression or psychiatric problems
• Liver problems
• Enlarged prostrate gland
• Glaucoma
• History of stroke or organ transplant

Women who are pregnant or nursing should be especially cautious about using herbal products, as well as with people who are about to have surgery. Always check with your health care provider.

It is likewise important to consult with your doctor before using herbal products if you are taking any medications (whether prescription or over-the-counter). Some herbal products are known to interact with medications in ways that may pose risks to your health. Read More!