Antibiotics, Gut Bacteria, and Childhood Obesity

Bailey LC, Forrest CB, Zhang P, Richards TM, Livshits A, DeRusso PA. Association of Antibiotics in Infancy With Early Childhood Obesity. JAMA Pediatr. Published online September 29, 2014. doi:10.1001/jamapediatrics.2014.1539.

******This is for the abstract. I did a free trial with JAMA for full access.****

A coworker recently brought this research to my attention. This is an article that demonstrates how complex the obesity issue is and how there are factors involved that are still being discovered and studied.

The study examined the use of antibiotics in infancy and the relationship to childhood obesity. This was a cohort study comprised of 64580 children. Data was collected using health records from the Children’s Hospital of Philadelphia from 2001-2013.
The study population included children with 1 visit to the PCP from 0-11 months of age, then again from 12-23 months of age, and at least one additional visit between 24 and 59 months for BMI. Excluded from the study were premature or low birth weight infants. The researchers then reviewed exposure to antibiotics during the first 23 months of life.

Results:

-69% of the study population was exposed to antibiotics between 0-23 months of age.

-an increased risk of obesity was found for those with antibiotic exposure but it was significant for those with 4 or more exposures in the 23 month time frame.

-Additionally, the increase in obesity risk was only seen with broad spectrum drugs and not with narrow spectrum drugs.

-The earlier the exposure to broad spectrum drugs, the higher the risk for obesity.

The authors speculate repeated antibiotic exposure has an impact on the health of intestinal flora which in turn effects long term energy homeostasis. The researchers do point out that this is only one factor in the obesity epidemic.

I’ve seen several other articles discussing gut health and the link to obesity. It will be interesting to see what is discovered with future research on this topic.

Cognitive Distortion: 17 Day Diet

 

The public is always looking for ways to increase one’s metabolism. The 17 day diet, created by Dr. Michael Moreno, capitalizes on the idea of altering our metabolism to rev up our calorie burning power. This diet is divided into four 17 day cycles which claim to alter metabolism and fat burning by varying energy intake during each cycle, preventing the body from becoming accustomed to one calorie range.

The initial cycle is the most restrictive and reduces calories per day to 1200. In this first phase carbohydrates are limited, and as is often the case with low carbohydrate diets, the majority of weight loss is likely due to fluid. During the second cycle, Dr. Moreno introduces the concept of calorie cycling. The theory is that this will confuse the metabolism to prevent any slowdown in metabolic rate. In the third cycle, participants continue calorie cycling while increasing the types of foods allowed. The final phase, focuses on maintenance and a lifelong continuation of the first three phases.

One type of cognitive distortion, failure to consider alternative explanations, plays a role in persuading the public into believing this program can have powerful effects on metabolism which lead to fast weight loss. There is very limited research on calorie cycling and what is available does not provide adequate data to support this idea. The small studies that have been conducted show no changes in metabolic rate or increase in weight loss when varying energy intake as opposed to following a calorie restricted diet at one set calorie range.

The alternative explanation and actual mechanisms behind the weight loss success with this diet are energy intake reduction and increasing energy expenditure. Calorie intake is controlled during all phases and once participants get past the initial 17 days the diet becomes a generally healthy diet focused on whole grains, fruits and veggies, lean proteins, with the addition of exercise. Although this diet is packaged as a metabolism booster and fat burning secret, the resulting weight loss comes to the basics of cutting calories and moving more.

 

Weight Loss Supplements

        Dr. Oz and many other popular “nutritionists” tout the efficacy of weight loss supplements such as Garcinia Cambogia and Raspberry Ketones. However, many weight loss supplements, especially those sold over the counter, may not be scientifically proven to be effective and can even cause dangerous side effects. In fact, there are only a few supplements that have been FDA approved for weight loss. FDA stands for the U.S. Food and Drug Administration, this body can investigate supplements once safety issues have been reported and then they may provide warnings, approve the drug or remove the drug from the market if warranted. This means that weight loss supplements seen on store shelves do not need FDA approval to be there, it is the manufacturers responsibility to ensure that their products are safe and claims are truthful.

        Supplements that have been approved by the FDA include Orlistat Belviq, Qsymia and Contrave. The only supplement that can be found over the counter is Alli, which is half the strength (60mg Orlistat) of the prescription drug Xenical (120mg Orlistat). These supplements are recommended for use in those with a body mass index (BMI) ≥30, or BMI ≥27 with a weight related comorbidity (ex. hypertension, type 2 diabetes).

        There is a common misconception that weight loss supplements are magical pills that will simply melt fat away without any lifestyle changes. Over the counter supplements will often advertise their medications in this manner. However, the FDA certainly does not claim that approved drugs are “magic pills” and they encourage that medications be used with a reduced calorie diet and exercise for maximum benefit.

        The mechanisms of each of these approved drugs varies. Orlistat reduces the absorption of ingested fat by binding to gastric and pancreatic lipases. This helps contribute to a caloric deficit, which aids in weight loss. Qsymia is a combination of two FDA approved drugs. It is composed of an appetite suppressant (phentermine) and an anti-epileptic drug (topiramate). It is unclear how exactly topiramate, meant to reduce seizures, is helpful for weight loss, but it is thought to reduce appetite and increase feelings of satiety. Belviq (locaserin hydrochloride) is thought to activate serotonin receptors in the hypothalamus to stimulate a hormone (alpha-melanocortin), which suppresses appetite. Lastly, Contrave is another combination of two FDA approved drugs, Naltrexone hydrochloride and Bupropion hydrochloride. Naltrexone treats alcohol and opioid dependence, while bupropion treats depression and helps aid in smoking cessation. It is unknown how this drug combination causes weight loss, but they are thought to have appetite-suppressing effects. 

        Studies conducted by the FDA, demonstrate that these medications result in significant weight loss. Trials have shown a 5% average weight loss after about a year of using the approved supplements when in conjunction with lifestyle modifications. By no means are these medications a quick or easy weight loss fix, but their efficacy has been shown in obese and overweight patients.

Paleo and Raw Foods

I've noticed recently that many of my friends and extended family members have been into finding a "natural" or a "wholesome" diet plan. Maybe it is living in Colorado that to go on a diet not only do you have to find a diet, but it has to emphasize "green living", "organic foods" or "gluten-free". Mostly, they each talk about one of two diets: Paleo and raw foods diet.

Paleo

It seems many are drawn into the Paleo craze. What is it? And why does it appeal to so many people?

The Claims

The Paleo diet states it is based on the human genes. It promises to decrease the risk of heart disease and type 2 diabetes. The authors claim it will improve athletics, decrease acne, increase energy, and improve your sleep. As most diets, it also promises weight loss if the principles in the diet are followed.

The "Diet"

The Paleo diet focuses on what the author considers to be our natural eating pattern. They suggest increasing protein in our days- stating this is how our hunter-gatherer forefathers ate. The diet also states you should avoid grains, legumes, dairy, and processed foods.

Raw Foods

Another diet that has many followers is the raw food diet. It sounds self-explanatory. Yet what are the specifics?

The Claims

This diet claims it is a way to reach whatever outcome you are searching for. The diet asks you to choose what your end goal is: weight loss, healthy living or detoxification from the toxic food we eat.

The "Diet"

Each version of this "diet" are slightly different. However the basics are you only eat foods that are raw and unprocessed. It focuses on alkaline foods to decrease stress on the body. It also states you should only eat organic foods. It is very focused on keeping food in as natural of a state as you can.

How they "Sell" the "diet"

These two diets each have ways of selling the diet. Both diets use polarization: they give lists of "good" foods and "bad" foods. The Paleo diet even claims that some foods cause everything from headaches to auto-immune disorders. 

The raw foods diet uses filtering as a basis. The raw food diet states that heating or processing food destroys nutrients and enzymes in foods. It states altering the food makes it toxic. It is true that some of nutrients can be lost in cooking. But many are not, and some nutrients are more available for the body to use after cooking. Some foods (such as raw meat and eggs) are made safer for the body when they are cooked. The paleo diet 

The Paleo diet uses expert opinion to help justify the diet. It states scientific research "proves" this diet is the best. This is also an overgeneralization to help those who may not fall for other diets by saying this isn't some "fad diet" and it is scientifically backed. While there are good parts of the diet, this overgeneralization makes it sound like the perfect diet, which it is not. 

The Pitfalls of "natural"

Each of these two diets are based on natural eating. Interestingly, both have many followers that publish recipes for cupcakes and brownies, making sure they still follow the "rules." They try to play by the letter of the law, not the essence of what the diet is trying to teach. 

Both diets also rely on the idea of eating only "alkaline" foods. This is leaving out a large number of foods that are beneficial to the body. The diets state that eating too many acidic foods puts a strain on the kidneys and can lead to osteoporosis. However, the body has mechanisms to maintain acid-base balance. Diet does not need to be controlled to protect this mechanism. 

The Bottom Line

Each of these diets have good qualities. They both emphasize fruit and vegetable consumption, which is often lacking in society. However, each has potential problems and deficiencies. Any diet that tells you to avoid whole food groups should not be strictly followed. The Paleo diet steers clear of grains which are on of the food groups that provide many important nutrients (including folate, thiamin, and niacin) as well as being a good source of carbohydrates, the fuel for our bodies. The raw foods diet avoids many meats and animal products, which could lead to deficiencies in calcium and vitamin B12. While these have sound advice, the main key to a healthy diet is moderation in all things.

Cognitive Distortion: The Blood Type Diet

Cognitive Distortion Discussion: The Blood Type Diet

 http://www.dadamo.com/

http://www.pinterest.com/explore/blood-type-diet/.

The blood type diet was developed by naturopath Peter J. D’Adamo, N.D. who believes that blood type is the key that unlocked the door to the mysteries of health, disease, longevity, physical vitality and emotional strength. He also believes that blood type is the evolutionary market that determines which foods are best and harmful for your body.

This theory is focused around the action of sugar-containing proteins called lectins. Lectins are found on the surface of certain foods and can cause disruptions throughout the body depending on blood type. These lectins determine which foods and exercise is recommended for each blood type.

There is no scientific evidence and research to support the blood type diet. The diet guidelines are also very restrictive and eliminate whole food groups in certain diet plans. Eliminating major food groups can lead to the lack of essential vitamins, minerals and nutrients needed for a healthy body.

There is a lot of cognitive distortion surrounding the blood type diet. First, A’damo’s book, Eat Right for your Type was a New York Times best seller and the Huffington Post readers voted it one of the 50 Life-Changing books. Remembering there is no scientific research to back this diet up; readers and dieters look past this and believe it is a creditable diet because it was on the best seller list.

D’Adamo dedicates an entire section on his website to In the News. He posts links to articles that support his diet. For example, he has an article from Dr. Oz stating that eating for his blood type gives him more vital energy. We all know how powerful Dr. Oz is in the health and nutrition world and if he is following this diet, everyone should be following it too….ughh! He also has articles from Gwyneth Paltrow and Larry Fitzgerald supporting the diet. Going back to our forum post about celebrities and fad diets, the blood type diet has a lot of celebrity support and advocates.

Another interesting form of cognitive distortion I found was a pinterest page supporting the blood type diet. The page had articles, celebrities’ articles, articles written by A’damo, testimonials, before and after photos and more. Social media has a huge influence on what we do, what we think, etc. and pinterest is a huge craze right now. Having an entire page dedicated to the blood type diet sparks interest in those who never heard of it and persuades those you have to try it.

Lastly, I had someone at work ask me about the blood type diet the other day. It was perfect timing because I had already started my research on the diet for the presentation. The lady said she had been doing “research” and has heard a lot of great things about it. Her friend tried it and said she’s never felt better. Word of mouth is also a huge form of cognitive distortion. People trust and believe others who have tried something and liked it.

I’ve always been aware of cognitive distortion but this paper and presentation have made me more aware and conscious about it. Just about every health and wellness product has some form of cognitive distortion which has created this halo effect in the health and nutrition world.

Low Fat Diet or Low Carb Diet?

http://www.nytimes.com/2014/09/02/health/low-carb-vs-low-fat-diet.html

This is a great controversial article I found on the New York Times website! There is currently a lot of attention surrounding whether a low fat diet or a low carbohydrate diet is better for weight loss and overall health. As we all have seen with the multitude of diets that have come and gone in the media, there is a forever changing idea of "what we should eat". In class, specifically NTR 201, we learn what the body actually needs to function properly while maintaining homeostasis. This article presents the facts observed in a scientific study, comparing a group of individuals who followed a low fat diet and a group who followed a low carbohydrate diet. Upon first reading it, it seems the skies have opened and we now have the answer to all of our weight loss questions. But looking further, and using our education in nutrition, we can see the flaws in the content of this article. First off, fats and lipid digestion is a much slower and more complex process than that of carbohydrates, causing a person to feel satiated for longer after a high fat meal. This could be the cause of the loss of weight between the two groups, as one was eating less. Also, the body looks for glucose to burn as fuel first- it is the preferred source for brain and neuro function, and drives physical movement. When your diet consists of more carbs, there is never a need to tap into stored glucose as it is always readily available for use. When your diet consists mostly of fats and proteins, your body will search for this glucose in stored areas (such as muscles and liver) and when that is tapped, your body will go into ketosis; breaking down fats incompletely to obtain the energy needed for life processes. This causes fat to be burned up, hence why that group lost weight, however it leaves ketone bodies circulating in the blood stream (something you don't want!) The national guidelines for healthy consumption do promote unsaturated fats. They are not the heart disease causers- they are omega 3's, 6's, and many others that your body needs and wants- this article mentions very briefly that they were instructed to have unsaturated fats, no wonder their LDL's didn't skyrocket. Lastly, the loss in lean muscle mass is because they were not consuming enough protein to keep their muscles functioning how they were. Muscle is built by protein, more protein does in fact contribute to more muscle and lack of protein will in fact decrease lean muscle mass. These were just a few issues I noticed with this article! I would think if we looked at the actual study itself we might find more!

Lindsey Green

Obesity runs in families…but exactly how remains a mystery!

Of all inherited traits, obesity is one of the strongest.  However, despite enormous advances in genetics research over the past two decades, very little progress has been made in untangling exactly how genetic factors work to determine body weight.   The magnitude of genetic influence on the current obesity epidemic also remains to be determined.

A recent article in the Nature Outlook Supplement underscores the complexity of the issue and outlines where we currently are in our understanding.    

The author, Cassandra Willyard, explains: “Many scientists had first assumed that the heritability of obesity would be explained by common genetic variants.  But that hasn’t held true.”  The genome-wide association studies (GWAS), from which we’ve obtained most of our information about obesity genetics, have revealed many common variants, but all together these explain less than 5% of the variability that is attributed to genetics.   One scientist quoted in the article refers to this as the “dark matter of quantitative genetics”.  There is agreement among scientists that up to 70% of body weight variability is due to genetic factors even though no one can yet explain how this works.   Three possible answers are provided in the article: 

One possibility is that some genetic variants related to obesity have yet to be discovered.   Since GWAS can only identify variants common in greater than 5% of the population, less common variants may yet emerge and may demonstrate a more pronounced impact on obesity than the common variants.

Another interesting possibility is that our genes must interact with our environment to be expressed.  The GWAS study methods simply can’t account for this complexity yet.  One featured study showed that individuals with one common genetic variant were predisposed to eat greater quantities of food and weighed, on average, 6.6 pounds more than those without the variant.  Men in this variant group were also shown to have higher levels of the appetite-stimulating hormone ghrelin.  The best evidence we have so far though is from a large meta-analysis study which showed that people who carry a common “susceptibility gene” have a higher risk of obesity, but that this risk is much lower in people who are physically active.   In this case, a single environmental influence in essence protects individuals from their genetics.   What’s suggested is that our current obesigenic environment may exert much more influence on some individuals than others purely based on their individual biology.

Also intriguing is the evidence that gene expression is strongly influenced by the intrauterine environment.  The concept of “fetal programming”, as the author puts it “raises the possibility that a mother’s experiences during pregnancy –such as malnutrition – can influence the next generation.”   Put another way, lifestyle factors during pregnancy can influence an offspring’s  gene expression without altering the genetic code – and may also alter gene expression in the offspring’s offspring.   “When a pregnant woman experiences malnutrition or some other environmental stress, three are directly exposed – the mother, the child in her womb and also her grandchildren."  This presents one more way obesity can be “passed down” among generations.  A father’s exposure and lifestyle habits appear to have some influence as well, though the effect appears not to be as strong or persistent. 

 Overall, an interesting dynamic in the nature vs. nurture discussion is emerging.  We know that as obesity rates have risen in the past 30 years, our environment has changed dramatically, while our genetic code has not.  We also know that up to 70% of variation in body weight is attributed to genetics.  It seems gene-environment interactions – particularly in utero - may prove to be the missing link.  So, while our genetic code has not changed, our genetic expression has and these changes are now being passed down through successive generations.