Obesity Pill

Arena Pharmaceutical's experimental obesity drug, Lorcaserin, cleared another hurdle en route to FDA approval but the results were less than hoped for. With the relatively disappointing results, share prices fell this week.

It's no secret that Americans are fat. Two thirds of us are overweight and about 100 million Americans are obese. In a nation of fast food, caloric excess, massive sugar consumption, weird breakfast cereals, soda machines in schools, 600 empty calorie 'afternoon snacks', and a general culture that promotes excess (as we're seeing with the economy these days, it hasn't just been caloric excess we've been guilty of the past few decades), it's no wonder that we're looking for a quick fix and hang our hopes on Arena Pharmaceutical Inc.

Let me tell you something we already know- there is no quick fix. I admit that obesity and overweight is a complicated issue. In the old days, we would simply say, "eat less and exercise more." But most clinicians understand that we've let the obesity beast get out of control and for many people, that simple mantra (still repeated in many health clubs across the U.S.) just doesn't hold true any more. Don't get me wrong- you absolutely must exercise. But we understand that there is much more to the picture of weight loss.

In April, we'll spend time taking a different look at weight loss. I'll explain some of the vicious cycles that can promote further weight gain and what you can do about them.

Drugged Fish

Our fish are on drugs! Another disheartening report was released by Environmental Protection Agency and Baylor University today. It appears that our incredibly over-medicated society is resulting in our medicating the waters and the fish that swim in them. Antidepressants, cholesterol-lowering medications, anti-hypertensives and others have been detected in waterways near 5 major U.S. cities; Chicago, Dallas, Philadelphia, Phoenix and Orlando.

The implications are obvious.

You are what you eat. If we eat drug contaminated fish, we consume those same contaminants. In other words, even if you are not on prescribed antidepressants, you will be ingesting them as a part of your food supply.

In fairness, Dr. Brian Brooks, one of the coauthors of the study, says that you would "have to eat hundreds of thousands of fish dinners to get even a single therapeutic dose."

Frankly, I don't know how many of these contaminants we can run away from. There is 'stuff' in the air, in the food and in the water we drink. Your best best is to enhance your body's ability to detoxify and eliminate these chemicals. The best detox plan? Eat good food and don't eat junk. Your liver and kidneys have a way of taking care of the rest. There may be a need for some of us to do a more formal 'detox plan.' I'll post more on a good detox plan another time.

I wish I had a solution to the problem of drugs in your water. I don't have one. My point is that our drug dependence has environmental impacts, which then have health impacts that lead to a a vicious cycle that degrades our health and our planet.

For all of you who recycle, compost, turn out the lights, vote for leaders who advocate alternative fuel sources and are generally environmentally conscious (as I hope most of you are), then don't overlook your own health and the potential impact your health choices have on the environment.

Spring Training

As warmer weather looms, many of us are ready to get back in the swing of things with a regular exercise program. Here are a few tips to ease into spring and shake off the winter chills.

1. Go slow. Listen to your body and if you feel discomfort, stop. No- don't slow down... just stop. That twinge in your knee or hitch in your shoulder is not likely to go away if you just "work it out." Stop, rest and go at it another day. When your body fatigues, biomechanics tend to fail in subtle ways. Continuing your workout may shed some pounds but at the cost of pain, altered mechanics and potential long-term dysfunction.

2. Work on the core. Adequate core strength will help the mechanics of your arms and legs. On the other hand, adequate arm and leg strength will not necessarily help our core. Get the help of a good fitness trainer, chiropractor or yoga instructor to help familiarize you with your core.

3. Set realistic goals. If you intend on running a marathon this summer, playing pickup basketball or heading to the golf links, do you really need to bench press 225 pounds? Make your exercises functional. They should be things that enhance stability, strength and balance for you to perform your routine activities. If you exercise for vanity, then OK, pile on the weights. But for actual health, performance and well being, rethink your exercises.

4. Stretch. Really- you have to stretch and cool down. Most gym rats spend an hour with the weights and about 60 seconds stretching out. Muscles tend to tighten in patterns and spending all your time shortening them (lifting weights) and no time loosening them is a recipe for disaster. Spend at least 10 minutes on a cool down and on careful, safe stretching.

5. Pick an event. Working out aimlessly for days and weeks on end can be disheartening to some. Pick a fun event that you and your friends can enjoy together. Maybe a 5K walk, half marathon or mini triathlon. A local basketball or flag football tournament may be the motivation you need to help you exercise.

Enjoy the warmer weather!

Is Celiac Disease Common?

One of the comments I frequently hear is that celiac disease is rare. If you go on the website of the Celiac Disease Foundation, you’ll find that 1 in 133 people are afflicted. That turns out to be about 0.7% of the population or about 2.2 million Americans.

If your doctor isn't quite as informed on this issue as she is on other issues, then she may cite this "official number"(also cited by the National Institutes of Health). But I want to tell you that this number is very, very wrong. It's a very old number based on old criteria and an old understanding of celiac disease. (OK- actually not that old. The data was published in a 2003 article in the Archives of Internal Medicine. Nonetheless... a lot has been learned in that past 6 years so here's an update on the numbers).

“Thanks to greater awareness of the disease and the availability of improved diagnostic tools… the prevalence of celiac disease in Western countries has been increasing steadily, and it is now recognized as a common disorder, even in adults. International Journal of Immunopathology and Pharmacology 2009-Jan-Mar;22(1):1-7

A 2008 study out of the University of Chicago showed 4 types of celiac disease.
1. Typical: with gastrointestinal (GI) signs and symptoms
2. Atypical (extraintestinal): with little or no GI symptoms
3. Silent: with destruction to the small intestine but absolutely no symptoms
4. Latent: where people have genes that set you up for celiac and even antibody production. But in this case, you may or may not have any symptoms but your small intestine is just fine! Molecular Diagnosis & Therapy:Volume 12(5)2008pp 289-298

The original number (1 in 133), really describes the 'typical' version of celiac described above. Over the past few years, we're starting to understand that the 'atypical' or 'silent' versions can take on many faces, some of which we wouldn't expect. Here's what it could look like.

1. "Osteoporosis... can be a sign of silent celiac disease ." Minerva Medica 2006 April; 97(2): 191-203

2. Type 1 diabetes and autoimmune thyroid disease. Advances in Pediatrics 2008; 55:349-65.

3. Infertility. "Each woman with unexplained infertility should be screened for celiac disease."
Minerva Medica 2007 Jun; 98(3):217-9

4. Irritable bowel syndrome and anemia. Gastroenterology 2005 Apr; 128 (4 suppl 1):S74-8

5. Skin problems. "Atopic dermatitis was about 3 times more frequent in patients with celiac disease..." The Journal of Allergy and Clinical Immunology 2004 Jun;113(6):1199-203.


... and these are just a handful of presentations you can find in the scientific literature. Admittedly, some of these findings are disputed in other papers but the important thing to note here is this:

40 million Americans have irritable bowel syndrome
30 million+ Americans have atopic dermatitis
28 million Americans have osteoporosis.
12 million Americans may have autoimmune thyroid conditions.
6 million American couples struggle with infertility.
2 million Americans have type 1 diabetes.

Even if only 10% (I pulled this number out of the air) of each disease group suffered from celiac disease, then the 1 in 133 number already gets blown out of the water. That alone is already 12 million people or 1 in 25.

Now- I'm not saying that the incidence of celiac disease is 1 in 25. I'm saying we need to rethink the numbers and that it is a lot more common than we think.