FISH and PLANT BASED NUTRIENTS FOR WEIGHT LOSS AND HEALTH

For years, eating according to scientists, PLANTS are healthier than meats, but since the 25 year China Study published in 2002, and the September NEJM latest Nurses Health Study, there has been no doubt about it. MEATS (bovine, sheep, pork, goat) SHOULD BE EATEN IN MODERATION OR NOT AT ALL depending on one's genetics particularly the APO-E. Poultry and principally fish are indeed good sources of protein. When eating the bulk of this plan, which is the vegetables, it should be the leaves, flower, and stems rather than the roots and fruits that should be consumed. Nutrient Density is an important concept in recommending dietary advice. Not merely vitamins and minerals, but adequate consumption of phytochemicals is essential for proper functioning of the immune system and to enable our body’s detoxification and cellular repair mechanisms that protect us from gaining fat and the consequences of chronic disease. To guide people toward the most nutrient dense foods, a scoring system called ANDI (Aggregate Nutrient Density Index), or HANDY ANDI, which ranks foods based on their ratio of nutrients to calories, was developed by Dr Joel Fuhman. The following index and pyramid is taken directly from his Website www.drfuhrman.com/library/article17.aspx.

HANDY ANDI FOOD PYRIMID

Nutritional science has demonstrated that colorful plant foods contain a huge assortment of protective compounds, mostly of which still remain unnamed. Only by eating an assortment of nutrient-rich natural foods can we access these protective
compounds and prevent disease and obesity that afflict our current civilization. We need the whole orchestra, not just the woodwinds to make Beethoven’s 3rd Symphony sound wonderful. That is why multi-supplement pills do not work.
FISH contain Omega 3s which increases insulin sensitivity in the muscle, and preserves the production in the pancreas. The Omega 3s should come from farmed Salmon which has 6,000 mg per 6 0z severing compared to the wild with 4,500. If these came from Chile, Scandinavia, British Columbia, or Australia, they are without pollution compared to Asian farmed salmon. Wild fish are not richer in omega-3 fish oils than farm-raised varieties. Farm-raised fish such as salmon and trout won't grow without omega-3 fatty acids in their diet, so fish farmers add it to the fish- meal. Farmed catfish and tilapia, however, do not need omega-3 fatty acids, so these farm-raised fish have little or no omega-3s. In the wild, fish get their omega-3s from algae, plankton and other fish that they may eat.
Escolar (Ivory Tuna) has even more omega 3s. This essential fat should be consumed as the working DHA and/or EPA rather than ALA, a precursor of the active form that many of us cannot convert to EPA and DHA. If eating salmon, daily is too much, obtain it as a liquid. One tablespoon has 6000mg needed. I put it in my smoothie. Research has shown that omega-3 fatty acids decrease risk of arrhythmias (abnormal heartbeats), which can lead to sudden death. Omega-3 fatty acids also decrease triglyceride levels, raise the super good cholesterol (HDL-2), slow growth rate of atherosclerotic plaque, and lower blood pressure. Fish is also a good source of protein and unlike fatty meat products it’s not high in saturated fat. Although having a bad reputation in the past are the tropical oils (palm kernel, palm, and coconut) which are saturated fats, but are metabolized to Medium chain triglycerides that produce healthy nutritional ketosis. These protect our blood vessels, do not go into our fat cells and are used by our body to enhance the functioning of our heart and skeletal muscle as well as our neurons.

Some types of fish may contain high levels of mercury, PCBs, dioxins and other environmental contaminants. Levels of these substances are generally highest in older, larger predatory fish. Avoid eating those fish with the potential for the highest level of mercury contamination (e.g., shark, swordfish, king mackerel or tilefish). Eat a variety of fish and shellfish that are lower in mercury i.e.: Escolar, Salmon, canned light Tuna, Pollock (in artificial shell fish like crab), and catfish. Albacore ("white") tuna has more mercury than canned. Check local advisories about the safety of fish caught by us as well as family and friends from local lakes, rivers and coastal areas. Perchlorate, an ingredient in rocket fuel, has infiltrated 80% of our inland farm streams and ponds. It is a thyroid receptor inhibiter causing low thyroid in millions of folks who docs are telling them there is nothing wrong with them. This (Type II) Hypothyroid does not show up on any of the blood studies we do but does on the old fashion BMR (Basic Metabolism Rate) which are done by only a handful of physicians in our modern highly technical medical society.
In summary a non red meat, fish and high nutrient dense vegetable-based diet offers a diet healthy protein, high Omega 3s as well as low refined carbohydrates. This program emphasizes a liberal intake of vegetables, some beans, a few tree nuts, but low in high glycemic fruits and minimal grains and almost no bad carbs (sugar and starch). Weight loss is sustained in patients who followed this and even more substantial in those who have good adherence to these recommendations. Favorable changes in the lipid profile and blood pressure are noted. In fact in our successful patients who were hypertensive, diabetic, and had bad lipids, we were able to “cure” them of their disease and stop all their medications! This diet then has the potential to provide sustainable, and significant, long-term weight loss, and provides substantial lowering of cardiac risk and potential disabilities in patients who are so motivated.

PRESCRIPTION DRUGS

At times medications are needed in our obesogenic society. There are at least 43 different neurotransmittors (serotonin. nor-epinephrine, ghrelin, leptin, neuropeptide-y etc) involved with our gaining and maintaing excess weight in the form of fat. Research conducted at the University of Texas at Austin provides evidence of a vicious cycle created when individuals overeat to compensate for reduced pleasure from food. It appears that obese individuals have fewer pleasure receptors and overeating further down regulates these pleasure receptors. For example food intake is associated with dopamine release. The degree of pleasure derived from eating correlates with the amount of dopamine released. Obese individuals have fewer dopamine (D2) receptors in the brain compared with lean individuals thereby the obese individual may overeat to compensate for this reward deficit.

This year alone the Food and Drug Administration (FDA) has been reviewing three new anti obesity drugs for government approval. Although drugs that seem promising early on sometimes prove ineffective and/or dangerous after they are released into the market.

Amphetamines in the 1960s and 1970s were touted as the answer until they proved to be habit forming. In the mid-1990s the disaster with fen-phen (fenfluramine and phentermine) leading to heart valve disease. Then just a few years ago the FDA denied approval for several new weight-loss drugs because of the potential for suicidal behavior.

Only two drugs to date have been FDA-approved for long-term treatment of obesity yet they are not without concern. Earlier this year the European Union banned one of the compounds, sibutramine (Meridia) after reports of heart attack and stroke and recently the FDA is posturing to take them off our market. The other drug, Orlistat, now sold over the counter in half strength size as Alli, causes gastrointestinal distress and has been associated with liver damage in some patients.

Obesity has a neuropsychiatric component, which creates difficulty in finding the “magic bullet”. Yet there are three new drugs that will target the brain, each in a different manner, facing FDA review. Contrave takes aim at the brain's reward pathway yet bupropion, an ingredient in contrave, has been linked to anxiety and neurological effects. Lorcaserin affects serotonin, which involves many brain processes such as emotion and cardiovascular regulation. In July, an FDA advisory panel narrowly voted against the third drug, Qnexa, due to side effects such as memory problems and other unwanted neurological effects.

Our appetite is controlled by the central nervous system present in the hypothalamus. When food enters our stomach, an enzyme called Cholecystokinin-Pancreozymin (CCK-PZ) is secreted from the pancreas. Presence of food is sensed and a number of complex signals are sent to this control center. The neurons there acknowledge it, then send another signal back to tell the body that our stomach is full. These signals are carried by some of the neurotransmitters mentioned above.

There are medications that work by increasing serotonin or catecholamines, two neurotransmitters (chemicals) in the brain that affect both mood and appetite. This class of medications, used most often for weight loss, is commonly referred to as “appetite suppressants.” The FDA approved them in 1959 and has been the most popular prescription weight loss medications sold in the United States. These medications promote weight loss by helping to suppress appetite, and by increasing the subjective feeling of fullness
The prescription medications prescribed in this class are Generic name Phentermine (trade name: Adipex-P, Fastin, Ionamin), Generic name Phendimetrazine (trade name: Bontril, Plegine) and Generic name Diethylpropion (trade name: Tenuate, Tenuate Dospan). Since many of the medical weight loss clinics use them, they will be discussed in more detail later.

The goal of prescribing weight loss medication is to help the medically at risk obese patient “jump start” their weight loss effort and lose at least 10% or more of their starting body weight. Usually anywhere from 5-22 pounds on average will be expected. When this can be accomplished, it usually leads to a reduction in risk for obesity related illnesses, such as diabetes, high blood pressure and heart disease.

Potential Benefits of Appetite Suppressant Treatment:
Short-term use has been shown to modestly reduce health risks in obese individuals. These medications have shown to lower blood pressure, blood cholesterol, blood fats (triglycerides), and decrease insulin resistance (the body’s ability to utilized blood sugar). There have been recent studies mentioned in the American Society of Bariatric Physician community that long term use of these medications resulted in lasting reductions in health risks and should be looked into further.

Potential Risks of Appetite Suppressant Treatment:
All prescription medications used to treat obesity, with the exception of orlistat, are controlled substances. This means that doctors need to follow rigid guidelines when prescribing them. Although abuse and dependence are not common with non-amphetamine appetite suppressants, caution is still advised, especially for those with a history of drug abuse or addiction.

Side Effects:
Appetite suppressants such as phentermine, phendimetrazine and diethylpropion are chemically similar to amphetamines. Thereby these medications can likewise cause insomnia, restlessness, constipation, excessive thirst, sweating, light-headedness, drowsiness, headache, stuffy nose, nervousness and rapid heart rate. Most of these side effects will decrease within the first week to two weeks.

Development of Tolerance:
Studies of appetite suppressant medications indicate that an individual’s weight tends to level off after four to six months of treatment. Is this due to drug tolerance, or reduced effectiveness of the medication over time? Studies are not clear. Yet experience shows that things can be adjusted to extend that timeframe and give the patient a few extra months, at minimum, to accomplish further weight loss.

When considering taking any anti-obesity drugs there are different ways to get them. For many years now there have been websites offering anti-obesity drugs online by simply filling out a form, giving your credit card and having them mailed to your home. Some of these drugs come from countries that do not stand up to the quality assurance that the United States requires for the safety of the recipient. These are not over-the-counter (OTC) medications and need to be strictly monitored. It is best to entrust your overall health and safety to a licensed physician. It is partially due to the quality assurance that these medications should be obtained from a reliable source who has done their home-work rather than a undependable one.

Fringe Benefits
These drugs in addition to weight loss help with ADD, ADHD, Depression, PMS, and Migraines.

SUPPLEMENTS HELP WEIGHT LOSS

Some supplements are a must for weight loss diets, and others are helpful, but not necessary. Since diets are deficient in some necessary micronutrients, it is mandatory to take at least a high quality Multi-Vitamin, Mineral Supplement. Inferior to some, but price worthy is taking daily two generic CentrumR tablets/capsules daily. The following is a partial list of OTC (Over-The-Counter) supplements one could take to enhance fat loss in addition to the real foundation of a successful diet which is as low a carb intake as one can do and muscle building exercise. Prescriptive medicines (Phenteramine etc.) will be discussed at some other time.

Fiber, particularly Propolmannan swells in the stomach after ingestion with water to help reduce calorie consumption. These bind to bile acids in the small intestine and helps transport them out of the body. These bile acids otherwise facilitate the digestion and assimilation of dietary fat into the bloodstream. It also slows the rapid emptying of ingested food into the small intestine, thereby reducing the surge of glucose entering the bloodstream. LuraLean® from Life Extension works better than other fibers in that its own enzymes have been removed, thus sparing it from degradation in the digestive tract. This enables LuraLean to form a stable viscous barrier to help impede calorie absorption and maintain its sponge-like activity throughout the digestive tract. In placebo-controlled studies, additional fiber (supplemental plus food fiber) to equal 50 gms/day induces moderate weight loss along with significant reductions in fasting lipid and post-meal glucose and insulin levels. Guar Gum, or sugar free Metamucil, Ground Flax Seed, can be substituted for similar results. Flax seed is 28% fiber about half soluble and half insoluble. Most Americans consume less than 10 gms/day, but a healthy diet is 30 to prevent cancer and heart disease. Our ancient ancestors ingested at least 60! Eating plants for food is healthier than meats according to many authorities, but it should be the leaves, flower, and stems rather than the roots and fruits that should be consumed. There are much carbs in the former and lots of fiber in the later. Some berries and cherries are OK. No grapes though because of their high sugar content.

Whey influences food intake through its effects on cholecystokinin and other mechanisms. Cholecystokinin is a regulator of appetite. During the digestion of food, the gastrointestinal tract secretes cholecystokinin, a small peptide with multiple functions in both the central and peripheral nervous systems. Cholecystokinin is largely responsible for the feeling of fullness or satiety experienced after a meal, and that controls appetite, at least in the short term. Also whey is almost all protein which naturally reduces body fat by increasing insulin sensitivity. Whey protein is rich in branch chain amino acids (valine, leucine, and isoleucine) that are used as fuel for working muscles and stimulate protein synthesis for muscle repair. There is a large amount of information on the various types and preparations of whey which I will not go into. Good quality whey has no gluten or lactose. It is usually available as a powder and may have a flavor and a sweetener added. I add 2-3 oz to my smoothie.

Xylitol and D-ribose are not only a good sugar substitutes but makes us healthier. Xylitol is a prebiotic, feeding our intestinal friendly bacteria and killing our bad ones such as staph, strep and fungus. Not only does it give strong bones and teeth, but fortifies our immune system. It cost $8/ pound has 60% less calories than sucrose, but can do anything that it does. Xylitol dissolves in water, is sticky, caramelizes, bakes, and can be used topically for superficial infections. D-ribose on the other hand is expensive but very, very healthful. Costing $35/ lb, it cannot be obtained from any food, but is made naturally in our body as is Xylitol. It is the backbone our DNA and RNA (Ribo Nucleic Acid) and figures into our immune and energy production. It is the metabolic forerunner of our ATP, the fuel that powers our cells particularly the cardiac and skeletal muscles. It is these cells that have the most mitochondria, the engines of our body that use the most ATP for energy. Many scientific studies indicate it strengthens and builds these. Used by body builders for years, doctors have recently prescribe this for Fibromyagia, Chronic Fatigue, Weakness, and Heart Failure with excellent results. It is available in 1000mg (1 gram) capsules, with the dose of 5 grams three times a day. Better is to buy it as a powder using 1 teaspoon as a sweetener 3 times a day. As noted above, Xylitol is a prebiotic that is the food for our probiotic.

Probiotics are the 6 pounds of “friendly” bacteria that coexist in our intestines. There are those that make us fat, and those that help us loose it. The fat bugs digest the insoluble fiber that is naturally in our food to simple sugars that are easily absorbed. Additionally, they elaborate an absorbable “hormone” that stimulates insulin to immediately take them into our fat cells to make them fatter. The thin bacteria oppose these and are bad in times of famine but good in our over abundant food society to help us loose weight. Probiotics can be bought as capsules at all health food stores. I recommend one that has at least 6 different ones such as PB-8 that has 8 strains.

Green tea epigallocatrchin gallate or EGCG for short boosts resting metabolic rate by stimulating our brown fat and increasing insulin sensitivity. Also the tea extract impedes lipase which causes some decrease of fat absorption. To get this effect 5 cups a day are needed. The caffeine in it also contributes to weight loss by increasing the burn even more.

White kidney bean (Phaseolus vulgaris) extract inhibits amylase, the digestive enzyme that breaks down starchy carbohydrates that are then absorbed into the bloodstream as glucose,

Irvingia gabonensis – Like white kidney beans, Irvingia has amylase-inhibiting properties. Moreover, it also favorably regulates: leptin to decrease appetite and facilitate triglyceride removal from adipocytes.

This promotes the hormone, adiponectin, to facilitate insulin sensitivity and glycerol-3-phosphate dehydrogenase to inhibit glucose from converting to triglyceride fat in adipocytes.

Curcumin prevents dietary-induced fatty liver, prevents activation of the liver inflammatory cells that produce the condition, and can also ameliorate fatty liver, common in our obese and diabetic population. In 2009, it was shown that curcumin achieves these effects by suppressing destructive lipid-handling genes, simultaneously stimulating PPAR-gamma activity to improve liver cells’ energy utilization.

Carnitine is an amino acid-derived molecule used by cells to shuttle fats into mitochondria, where they are burned for energy. Both aging and obesity reduce carnitine levels, contributing to mitochondrial aging and loss of metabolic control. That makes carnitine a very appealing supplement for its ability to promote mitochondrial health and fat/sugar utilization. L-Carnitine tartrate seems to work better than other salts. At least 3 grams daily are needed.

Omega 3s increase insulin sensitivity in the muscle, and preserves the production in the pancreas. The Omega 3s should come from farmed Salmon which has 6,000 mg per 6 0z severing compared to the wild with 4,500. If these came from Chile, Scandinavia, British Columbia, or Australia, they are without pollution compared to Asian farmed salmon. This essential fat should be consumed as the working DHA and/or EPA rather than ALA, a precursor of the active form that many of us can not convert to EPA and DHA. If eating salmon daily is too much, obtain it as a liquid. One tablespoon has 6000mg needed. I put it in my smoothie.

Gamma Linoleic Acid (GLA) stimulates our brown fat, increasing thermogenisis-the burn. And decreasing fat accumulations obtained from seed oils in evening primrose, blackcurrant, borage (the most concentrated), and hemp. GLA is also found in considerable quantities in edible hemp seeds and from spirulina. This has also lots of good minerals and amino acids. It is best to take daily the natural pure 1000mg GLA oil, rather than the caloric seed oils.

5 Hydro TryptoPhan (5 HTP) promotes weight loss by causing satiety-the feeling of satisfaction. This leads to consuming fewer calories at meals. To obtain the early satiety it may take several weeks Take initially 50mg twenty minutes before a meal. In a week it can be increased to 100. It will still work some if you forget and take it with that meal. 5 HTP is an amino acid that is directly metabolized to serotonin, our happy hormone that decreases carb cravings.

Bitter Orange extract (and bitter orange peel) is a dietary supplement and an aid to fat loss and appetite suppression, although in traditional Chinese medicine it is always prescribed in concert with other support herbs, not in isolation. Bitter orange contains the amphetamine metabolites N-methyltyramine, octopamine and synephrine, substances similar to ephedrine, or the now illegal ephedra which acts on the adrenergic receptor to constrict blood vessels and increase blood pressure and heart rate. However it does not only increase the burn, but gives more energy to have additional hours of caloric utilization. I prefer to use the better quality controlled prescription when I recommend this type of drug.

Glutamine is used for muscle growth. Evidence indicates that glutamine when orally loaded may increase plasma HGH levels by stimulating the anterior pitutitary gland. Glutamine is a non-essential amino acid, meaning it can be produced by the body and is involved in a variety of metabolic processes. Glutamine has recently been re-classified as a conditionally essential amino acid. This means that while the body can make glutamine, under extreme physical stress the demand for glutamine exceeds the body's ability to synthesize it. During times of stress glutamine reserves are depleted and need to be replenished through supplementation. It is the most abundant amino acid in the body and is involved in more metabolic processes than any other amino acid. It is converted to glucose when more glucose is required by the body as an energy source. Glutamine also plays a part in maintaining proper blood glucose levels and the right pH range. It serves as a source of fuel for cells lining the intestines. Without it, these cells waste away. It is also used by white blood cells and is important for immune function. It is the basis of the building blocks for the synthesis of RNA and DNA. Supplementation is effective at eliminating junk food cravings. Taking approximately 30 grams (6 teaspoons)of glutamine powder per day in two divided doses, it takes a week to realize the effects.

Conjugated linoleic acids (CLA) are found especially in the meat and dairy products derived from ruminants consuming natural grass. It is also found in eggs of free range chickens and in specially farmed raised fish. CLA has been shown to reduce body fat by increasing lean muscle mass. CLA is a naturally occurring derivative of the Omega-6 essential fatty acid, linoleic acid. The adult dose for weight loss is 3,400mg of pure CLA daily (the amount found in 6 soft gels).

Nicotine is almost like a weight-loss wonder drug. It naturally suppresses appetite, causing you eat less. It also increases your heart rate, which burns more calories, and acts as a diuretic to remove fluid from your body. When this drug is removed from your system, your body reverts back to normal, and you begin to put back the pounds. 
People who don't smoke and want to take nicotine as a weight-loss treatment should be cautioned that it is an addictive drug, and you may become dependent on the nicotine in the same way that smokers are dependent on cigarettes. Beware, if you are not a smoker and take too much, nausea, light headedness and rapid heart action can occur. Its natural properties do help weight loss, and if used with proper diet and exercise, I recommend this drug. Nicotine spearment drops are available from Economy Pharmacy in Tulsa as a prescription. Each drop contains 0.25 mg of nicotine. Take 2-3 drops 20 minutes before a meal, it decreases the amount one eats during that meal. It also can be used as a “snack”.

Other supplements that are of value that may be considered are Chromium, choline, methionine, inositol, Coenzyme Q10, Biotin, Magnesium, Cinnamon , Ginseng, Alpha Lipoic Acid, Hoodia, Gymnema Sylvester and Banaba Leaf.