- Liraglutide is a glucagon-like 1 peptide that has been available for diabetes management for a few years and now has an added FDA approval for weight loss management!!
- To date, Phentermine/topiramate ER (Qsymia) is the most effective drug available. Locaserin (Belviq) is another approved drug for weight loss, but it is less effective. However, it is better tolerated. Other options such as Xenical are helpful, but it prevents absorption of food and can cause excessive bloating and gas in some patients. Contrave (Wellbutrin and Naltrexone) is also effective but has neuropsychiatric effects.
- Liraglutide is used to treat type 2 diabetes at a dose of 1.8 mg a day. It is injectable. The weight loss form of the drug is a dose of up to 3.0 mg a day injected. The amount of weight loss varies as the dose approaches the upper limit of 3 mg a day.
- Liraglutide decreases appetite and therefore energy intake, which is how it causes weight loss. It also delays gastric emptying. Used as an adjunct to physical exercise and dieting, it has resulted in up to an 8 kg body weight loss over the 56 week course of treatment [ −8.0±6.7% (−8.4±7.3 kg)].
- Liraglutide treatment was associated with reductions in cardiometabolic risk factors, including waist circumference, blood pressure, and inflammatory markers. Fasting lipid profiles were also improved as well. The combination of weight loss and improved glycemic control probably contributed to the observed reductions in the prevalence of prediabetes and the delayed onset of type 2 diabetes.
- Side effects include an increased incidence of gallstones, which commonly increase with weight loss. Nausea and constipation (or diarrhea) has been reported. Rarely, pancreatitis and kidney failure has occurred. The FDA has required a boxed warning about the risk of thyroid C-cell tumors in the package insert, and in patient’s with a family history of Multiple Endocrine Neoplasia Type 2 or medullary thyroid carcinoma, this treatment is to be avoided.
- Treatment is started at 0.6 mg injected a day and increased weekly by another 0.6 mg until a total of 3 mg a day is injected. At 16 weeks, if a 4% body weight loss is not achieved, therapy should be stopped. Total cost per month is about $1000.00!
- For patients who have a BMI>30 (Body mass index) and are not diabetic, or have a BMI>27 with a risk factor, such as hyperlipidemia or diabetes, Saxenda is a consideration for weight loss.
Successful aging requires continued effort for the best outcome. Do you want to live to one hundred and be bed-bound or live to one hundred and be active? Successfully aging people need to consider healthful behaviors to maintain their independence and health. Conditions that affect people over sixty can be modified and lessened by nutritional strategies:
- Cardiovascular disease: High blood pressure, cholesterol/triglycerides, and obesity are modifiable by diet and medication. Weight control allows for better mobility, less pain, and fewer heart attacks. Obesity is associated with sleep apnea, as well, which reduces quality of life because it makes you fatigued in the day time and generally weak.
- Cerebrovascular Disease: Such as strokes and dementia are impacted by high blood pressure and diet. First off, quit smoking to decrease your risk of dementia and stroke. Decrease your sodium intake to decrease your blood pressure (1500 mg of sodium a day is about right for an average diet.) Use herbs and spices to flavor your foods. Foods such as cold cuts, cheeses, breads, pizza, pasta dishes, snack foods, and soups have higher levels of sodium, so beware. Consider following the DASH diet: http://www.nhlbi.nih.gov/health/health-topics/topics/dash and http://health.gov/dietaryguidelines/2015-scientific-report/
- Diabetes Control: Diabetes affects everything from your eyes to your kidneys. There is a four-fold increased risk of death from heart disease or stroke if you are diabetic. Take your medicines, track your hemoglobin A1C (sugar control measure) and eat food with a low glycemic index. Eat food with less fat and avoid high-sugar content items, but include more vegetables and whole grains to maintain glucose control. It takes a lot of effort if you are diabetic, so don’t let diabetes take your life one leg at a time!
- Cancer: Get your recommended screening examinations. Also, maintain a healthy weight since obese people have higher risks of cancer!
- Chronic Kidney Disease: Another disease modifiable by diet control – CKD risk is increased if you have hypertension, diabetes, obesity, or cardiovascular disease. A healthy diet and physical activity will maintain your weight and blood pressure, minimizing aging’s impact on your kidneys!
- Eat bright colored vegetables (carrots, brocolli) and deep colored fruits (berries) for phytochemical, healthy support.
- Chose whole, enriched, fortified grains and cereals, i.e. whole wheat bread.
- Chose low and non-fat dairy products: Yogurt and low-lactose milk
- Use herbs and spices to add flavors to meals
- Lots of fluids: no sodas
Eating right affects many body systems and can be beneficial at ALL ages of life. Graceful aging comes best when you follow your body’s owners manual and eat healthy and maintain physical activity.
- Cardiovascular disease: Cholesterol levels, triglycerides, hypertension, and obesity all impact cardiovascular health. Eat right and remain physically active to decrease high blood pressure and obesity. Remember that overweight people have more pain and more joint problems. That will impact your quality of life in later years when you have chronic knee and hip pain. Also, weight loss that comes with good diet also decreases the incidence of sleep apnea, which can cause high blood pressure and general exhaustion.
- Cerebrovascular disease: This includes stroke and dementia. These result from smoking, no activity, and poor diet. It is important to control your blood pressure by decreasing sodium intake to <1500 mg a day. Foods with high sodium include pizza, bread and rolls, cold cuts, processed chicken, pasta, snack foods, soups, sandwiches, and mixed meats. Follow the DASH diet to help control hypertension and salt intake. This alone can decrease blood pressure by 12/6 points (systolic/diastolic). This is a link to a dash diet plan and information: http://www.nhlbi.nih.gov/health/health-topics/topics/dash
- Diabetes: Diabetes will increase your risk of stroke, cardiovascular disease, and cerebrovascular disease by 2-4 times. Be certain to eat low glycemic index foods, eat less fats and avoid high sugar foods. Include more fruit and vegetables in your diet, as well as whole grains. Maintain a normal weight and exercise. Here is the glycemic index link: http://www.glycemicindex.com/
- Cancer: Cancer risk increases with obesity. Maintain a normal weight and increase your physical activity. Moderate your alcohol intake, quit smoking, and include fruits and vegetables with whole grains in your diet.
- Chronic Kidney disease: High blood pressure, diabetes, and high cholesterol all increase the chances of kidney disease. Maintain a healthy weight through diet.
The key for the healthiest lifestyle includes:
- Limit high-trans fats and saturated fat in your diet
- Decrease salt intake
- Decrease added sugar intake.
- Increase whole grains in the diet.
- Add bright colored vegetables to your diet.
- Add deep colored fruits such as bananas and peaches.
- Use whole enriched fortified grains such as whole wheat bread.
- Use liquid vegetable oils
- replace salt with spices.
- Stay physically active.
Spices add flavorings to the foods on which they are added, without the additional sugar, fat, or salt content of other flavorings.
- Tumeric comes from Curcuma longa, a plant that is related to ginger. Tumeric is used in Indian cooking quite frequently and imparts the curry flavor. There are several phytochemicals in tumeric, among which curcumin is very active. It has been linked to being protective oagainst cognitive decline, heart disease, and cancer, and is associated with improved cholesterol and sugar metabolism. Arthritis seems to be positively affected by curcumin as well. In India, the decreased risk of colorectal cancer may be attributable to this spice. Suggested daily dose is 1500 mg a day. It has been found that black pepper, which contains piperine, may enhance curcumin’s absorption, so consider adding some black pepper to your tumeric-containing recipes.
- Mint: including peppermint and spearmint
Peppermint has been used as a digestive aid, causing smooth muscle relaxation in the gut. It has rosmarinic acid in it, which is an anti-inflammatory agent and seems to be effective in decreasing asthma as well.
- Pepper, including paprika, cayenne pepper, chili peppers, and others have capsaicin in them, which provides cancer protection and anti-inflammatory effects. Capsaicin used topically is helpful in arthritis pain.
- Basil (Ocimum basilicum) has eugenol in it, an oil with anti-inflammatory effects similar to motrin-type effects. It also has an antibacterial effect in the gut as well.
Cinnamon is derived from the bark of a cinnamon tree (Cinnamomum verum) and has antioxidant, antimicrobial, as well as anti-inflammatory effects.Studies have shown that a gram of cinnamon a day can lower blood sugar and the hemoglobin A1C ( a measure of long-term blood sugar control) by ~.8 percent, which is excellent!
- http://www.januvia.com/sitagliptin/januvia/consumer/living-with-diabetes/healthy-eating/index.jsp < diabetic cooking
- It is apparent and true that increasing the quantity of whole fruits and vegetables in your diet decreases your mortality risk. This occurs by decreasing obesity, hypertension, and cardiovascular disease risk.
- Soluble fiber in fruits decreases the postprandial glucose leves and decreases inflammatory damage. The carotenoids, vitamin C, vitamin E, and flavonoids in fruit decrease the diabetes risk by decreasing oxidative stress which interferes with the uptake of glucose by cells.
- Studies have shown that increasing your intake of fresh fruit does not increase your risk of developing type 2 diabetes, except with excessive intake of cantaloupe( at an amount of three times a week).
- The best choice of fruit to decrease diabetes risk is blueberries, especially when eaten five times a week.
- Glycemic index has no association between a fruit type and its diabetes risk. Glycemic index is the measure of incremental glucose response per gram of carbohydrate taken in, whereas the glycemic load is the amount of carbohydrate and the glycemic index multiplied. these measures are not helpful in determining the healthfulness of fruit intake.
- Consuming grapes, apples, bananas, and grapefruits have been shown to be associated with decreased risk of type 2 diabetes.
- The World Health Organization recommends that a minimum of 400 gm or 5 portions of fruits and vegetables be taken per day to prevent type 2 diabetes.
- It is more important to have a great variety of fruit in the diet and not quantity to be healthful. Decrease your fruit juice intake.
- Best choices for organic fruits and vegetables include: apples, celery, cherry tomato, cucumbers, grapes, hot peppers, potatoes, peaches, spinach, strawberries, and sweet bell peppers.
- Best choices of non-organic fruits and vegetables are: asparagus, avocado, cantaloupe, corn, cabbage, eggplant, mango, kiwi, onion, papya, pineapple, sweet pea, and sweet potatoes.
Testing for Diabetes:
If you have a BMI of more than 25 kg/Meter squared and one of the following risks then you need testing now:
- Physical inactivity
- First degree relative with diabetes (mother or brother, i.e.)
- High-risk racial prevalence: African-American, Asian, Pacific Islander, native American.
- Women who have had a baby that was over 9 pounds at birth or had gestational diabetes.
- Hemoglobin A1C more than 5.7 % and impaired glucose tolerance.
- History of heart disease.
If you don’t have any of the above risks, then you should be tested at age 45 and have repeat testing every three years.
http://www.ewg.org/?gclid=CLuGmovz9sECFU8R7AodgngA6Q < Environmental working group and food safety information.
‘The most difficult part of a diet isn’t watching what you eat. It’s watching what other people eat!’
- Artificial sweeteners may cause the very problem that dieters are trying to avoid – obesity and diabetes. A study in Nature (September 17) showed that a diet high in saccharin resulted in impaired glucose metabolism in human volunteers and mice.
- Saccharin is found in Sweet’N Low, jam, salad dressing, and many low-calorie foods. The effect of saccharin on humans and mice was consistent. Feeding a diet high in saccharin, whether the subject was obese or skinny resulted in higher blood glucose levels. Those who were fed glucose based diets had normal metabolism.
- What was discovered was that the microbes of the gut were altered by saccharin and that seems to enable bacteria that feed on saccharin to thrive. These bacteria somehow cause glucose intolerance (pre-diabetes). Antibiotics that are given to these individuals to kill the gut bacteria can reverse these changes in sugar metabolism, suggesting that the bacteria were the clear cause of the problem.
- Thus it seems that saccharine and even other artificial sweeteners (aspartame and sucralose for example) induce changes in our natural gut bacteria. These changes predispose us to glucose intolerance and even diabetes!It is possible that heavy antibiotic use in our society results in some people being more sensitive to the effects of saccharin. Obesity and diabetes may, in part, be linked to the bacteria in our gut!
- Bottom line: using artificial sweeteners is clearly not as healthful as we think!!