Posts Tagged ‘Endocrine’

Debra’s Gone Defunct (not entirely — I’m not dead)

In Weight-Loss Maintenance on October 3, 2011 at 10:10 am

Welcome, newcomers and old friends, to Debra’s Just Maintaining!  For roughly a year, starting September 29, 2010, this blog set about exploring the cultural mythology and science surrounding weight-loss maintenance, especially after “radical” loss (more than 10% of highest body weight).  As blog owner, I found myself moderating a discussion involving mostly weight-loss maintainers and size acceptance proponents, two seemingly disparate groups who ended up having more in common than any of us might have expected.   It turns out we are all betrayed by the myth that radical weight loss is some hard-won victory, to be followed (of course!) by maintenance, a less challenging, zippy “lifestyle” composed of tips and tricks.  It’s much more complicated than that. 

This blog is not a “big” blog, but big enough, and certainly has much heart.  Over the year it received just over 60,000 “views” of its various posts.  Many were repeat visits from people I came to regard as friends, dear friends.  We shared a sort of cathartic grief process as we stripped apart the mythology, and discussed from a lay vantage point some of the science surrounding weight-loss maintenance.   In addition to the maintainers and size acceptance advocates, we also entertained a scientist visitor from time to time, and a couple of trolls.

The blog is now mostly defunct because I have gone on to other time-consuming pursuits, and I also need time to be a good Mom, and to continue my weight-loss maintenance, an endeavor that I regard as a third- to half-time unpaid job.  To be competent at these things, something had to give. 

Since the blog is mostly defunct, it’s likely that you arrived here because someone sent you here or you conducted a search for “Weight-Loss Maintenance” or some topic discussed here.  A lot of people find this blog with searches to the effect: “Is obesity killing our children?”  If that is you, you are looking for this post.  Other people are apparently interested in a maintainer’s take on intuitive eating.  That would be here and here.  And a lot of people want to know what I think about journalist and anti-carb pundit Gary Taubes.  Those posts are here and here

If someone sent you here, it may be because you just lost a lot of weight and said something silly like, “If I can do it anyone can!”  Then that person wants you to start with the post subtitled Skiing as Useful Metaphor.

Other reasons someone may have sent you here: 

  •  You said something insensitive or rude about fat people being “in denial.”
  • You said something insensitive or dismissive of someone who works hard to maintain a particular weight – along the lines of “but certainly the rewards outweigh any effort you expend.” 
  • You said something definitively naïve, such as, “science has proven people are fat because of modern breakfast cereals.”  
  • You announced that you are embarking on a weight-loss process/diet (what number?), and a friend wants you to have a realistic idea of what lies ahead, more so than what some women’s magazine or morning news show may be touting today as a “breakthrough.”
  • You are struggling with weight-loss maintenance.  Perhaps your weight is sliding.  You need affirmation from a kindred spirit who knows how challenging this is, and doesn’t sugar coat it or pop off with “inspirational” platitudes. Read the rest of this entry »

What Katarina Borer Found: Good News for Maintainers?

In Weight-Loss Maintenance on July 8, 2011 at 12:52 pm

Before I say another word, my conscience tells me to add a BIG trigger caution here.  If you are a size acceptance proponent and are feeling the least bit susceptible to the call of the weight-loss diet fairy, skip today’s post.  If you’re feeling brave, however, I’d love your response as well as that of my maintainer friends.

In my last post I explained Katarina Borer’s methodology for comparing the effects of food intake and exercise on appetite and on certain endocrine secretions.  Dr. Barry Braun describes it as “a multicondition crossover design to cleverly disentangle the relationships between energy imbalance, exercise, energy intake, putatative energy-regulating hormones and perceived appetite.”  Yup.   That’s what it was.  Now, let’s see whether I can explain in plain English what happened and what was correlated and what was not.

In her first study, Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track changes in energy Availability, Dr. Borer found:  

  1. Human appetite is influenced by the passage of food through the mouth and gastrointestinal tract.  When food went through the mouth, it triggered GIP, a gut peptide that is activated and serves as a marker for GI activity but seemingly has no affecting qualities of its own.  This peptide rose and fell in concert with participants’ reported appetites. 
  2. Participants’ appetites responded to the size of meals that came in through the mouth, but were insensitive to calorie replacements (or saline placebos) that came through an IV.  Moreover, exercise did not increase appetite, but marginally suppressed it.  This led her to state that “between-meal increases in circulating nutrient load and exercise energy expenditure are not under homeostatic feedback control.”
  3. Ghrelin, leptin and insulin respond in slightly different ways to changes in energy availability, but had no influence on participants’ appetites.  Whoa.  Interesting, yes?  Dr. Borer thought so too.

The graph array that interested me most, as a maintainer, however, was Figure 2 (in the second study it was reposted as Figure 4).  I was surprised, in fact, that it was not included as a “finding” in the Discussion section.

It looks fuzzy in my preview, but I was able to click on it to get a blown-up view that was very clear.  Column 4 describes the trial day Read the rest of this entry »

Katarina Borer: My First Impressions of her Recent Work

In Weight-Loss Maintenance on June 30, 2011 at 3:04 pm

It’s taking time, but I am working my way through a study, an article and a commentary surrounding some recent work by Dr. Katarina Borer and colleagues on endocrine, appetite and exercise.  

I believe I mentioned that Dr. Borer contacted me in response to my Open Letter to Weight Management Scientists.  I may have also mentioned that she said my postings were, ahem, interesting and remarkably well informed for a person who is not actively engaged in research. I am digging deep to find my inner objective scientist who would not be moved by such flattery.

I am working my way through these pieces simultaneously because they are based on the same trials, but they present two sets of conclusions.  The first set may be found in the study itself, entitled Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track Changes in Energy Availability and was published in July 2009 in The Journal of Clinical Endocrinology and Metabolism.  To give credit where due, her co-scientists are Elizabeth Wuorinen, Kimberly Ku and Charles Burant, not that those names are meaningful to me.  Actually, very few of the names in this line of research are meaningful to me . . . yet. 

The way I read a study or article is to turn first to the footnotes to get an idea of the bricks that form the foundation for the work or thought at hand.  I screen through the lens of my own evaluation system to determine what biases are present.  Mostly, in the past, I have read studies that are solely obesity focused, and, whether they admit to it or not, most scientists in this area come with one or more biases.  Some feel that obesity is a medical and social ill that must be reversed or cured, and their research is colored by that view – it may prevent them from seeing certain options.  Some of these scientists have accepted support from commercial interests – diet companies, foundations associated with pharmaceutical companies, and the like, and that makes their work horribly suspect.  Others who publish in this realm are testing the “Health at Every Size” paradigm, or, more accurately, are Hell bent on proving the efficacy of that model, and that limits their view.  In any event, I often can see a study or article’s self-imposed limitations in its footnotes.  Certain names pop up together over and over, and they indicate a point of view.

I don’t have a grasp of such biases and limitations in the world of endocrine and exercise.  In this world, obesity and weight loss are sometimes the focus, but often just confounding factors. With the exception of Cummings et. al., who produced a Ghrelin study that I happened upon by accident, I recognized no one.  I am, therefore, trusting that these are all sterling people, and none is a “scientist for sale.”  Feel free to correct me if I’m wrong. Read the rest of this entry »

More Thoughts on Endocrine

In Weight-Loss Maintenance on June 20, 2011 at 9:53 am

It’s useless to try to persuade me to be uninterested in endocrine.  If your interests lie elsewhere, I forgive you for skipping my entries on the topic.

First the news:  I heard from Katarina Borer, author of Exercise Endocrinology

As a lay person, it’s hard to know what qualifies as a respected source on a particular topic.  What I know is that in terms of textbooks, it’s the first that pops up when you do searches on Google, Yahoo or Bing using the terms “exercise endocrine.”  It gets Google’s top honors, in that it appears in the number one position, above articles from clearly “popular” sources, such as  Moreover, two other articles from Katarina Borer appear in top ten slots.  That’s my confession.   I have accepted this woman’s qualifications on the basis of her Google Quotient.  She, of course, rose even higher in my esteem when she contacted me by email, and attached three articles for my review (two in which she was lead author, one a commentary on one of the other pieces).  She attained nearly saint status by paying me a compliment, “I found your postings interesting and remarkably well-informed for a person who is not actively engaged in research.”

There.  Confessions dispensed.  I will, sometime soon, review those articles, but they will require time to digest.  I have read each one’s first two paragraphs, and it is apparent to me that I will need to read these articles when my intellectual cylinders are all firing properly and I am under the influence of a precise dose of caffeine.  (Too little and I don’t make important, rapid mental connections; too much and I start cleaning my house instead.)

Several things emerged in the comments on my last post that gave me “Eureka” twinges:  

  1. That other people experience “eat impulses” and at least one commenter feels relieved to have language to describe them.   Our vocabulary, clearly, is constrained by having only two words to describe the sensations that precede eating:  hunger and appetite.  With dozens of hormones, peptides, proteins and the like, reacting in hundreds or thousands of combinations with our individual gene profiles and contributing to our metabolic processes, it seems a bit silly to me that we reduce the entire process to two, singular tense, words.  Moreover, the limits imposed by these two words have created a perfect Petri dish for fomenting the social discord we size acceptance proponents know as weight bias and the oppressors are happy to use in a “war on obesity.”  To wit:  “If you don’t eat when you’re hungry, obviously you’re simply responding to appetite, you out-of-control schmuck, and we, society, will judge you harshly for that if it results in a larger body than we find pleasing.  Hmmmmph!  (We’ll leave you alone or even venerate you if you can eat sans hunger and remain trim.)” Read the rest of this entry »

An Open Letter to Weight-Management Scientists

In Weight-Loss Maintenance on June 15, 2011 at 1:22 pm

Dear Scientist Friends:

Consider this a personal invitation to test a theory, especially if your area of expertise is endocrine and/or you have a personal interest in exercise physiology and weight management.  (Er, and if you’re just one of my regular blog readers, please eaves drop on this letter.)

For several years, I have been synthesizing scientific information and personal experience as a radical weight-loss maintainer, and I would appreciate an experiment designed to better test the relationship between exercise and endocrine, especially those dicey signals that I believe cause most people to regain lost weight – the imbalance of leptin and ghrelin, PYY3-36 and aghouti related protein.  If you know of an experiment that has already explored this relationship, then please provide me a link.  (Disclaimer, as a lay person, my knowledge is embarrassingly limited.  I have not yet read Katarina Borer’s book on Exercise Endocrinology, or any other scholarly text, so maybe I’m naive, but if we do know all that we could know on this topic, it sure hasn’t made it into the mainstream marketplace of ideas.) 

It has occurred to me that there are different kinds of “hunger.”  Those of us who maintain radical weight losses have pretty much mastered how to quell insulin-triggered hunger and vacuous (empty stomach) hunger using macronutrient management.  In short, we use carbs (such as bananas or dark chocolate) to quell immediate, sharp (vacuous) hunger, and we use proteins and fats to keep sneaky insulin-triggered hunger at bay.  But this is not the full story.  If it were, more than 3% of people would be successful at maintaining radical weight loss for five years, the depressing figure that empirical research suggests.

According to the National Weight Control Registry (which could also be called the 3% Club), where I am listed as a participant, 90% of us exercise on average one hour per day.  This finding is one of the most dramatic commonalities among us, more so than eating breakfast (78%), regular weighing (75%) or limiting our TV viewing (62%).  In fact, the only two characteristics that are more common than the hour of exercise are that we have restricted our food (98%) and increased our exercise from our fat days (94%).  (It should hardly come as a surprise that one hour daily represents an increase for most people!) 

Learned people debate the value of exercise compared to food restriction in losing or maintaining weight, assuming that  exercise is a function of energy balance – calories expended v. calories consumed.  Energy balance, however, is not a simple equation, and I think exercise serves an additional, more important, function beyond expending energy.  I think we need to know more about its effect on endocrine.  Read the rest of this entry »

Word Play: Addiction v. Compulsion

In Weight-Loss Maintenance on April 8, 2011 at 12:45 pm

I thought my most recent post would be a “quickie.”  Here’s something interesting in Science Daily on food addiction linking ghrelin to excessive sugar consumption.  I expected a few responses.  “That’s nice, and resonates with me because blah blah.”  Or, “Fine, but that’s not my issue.” 

We all go home. 

What I learned instead is that the word “addiction” is not even recognized in certain professional circles (those who treat substance abuse, e.g.) and that many find the word “compulsion” less judgmental and more useful in treating people who engage in excessive behaviors. 

For some reason, in our discussion, we were compelled to raise the topic of “sex addiction,” and I, for grins, visited this site analyzing the Tiger Woods debacle:  Sex Addiction:  What Tiger Woods’ Story Forces us to Confront.  

Here are the first two paragraphs:

From Tiger Woods to Lifetime movies, there has been no small amount of conjecture about the slippery concept known as ‘sex addiction.”  But does such a condition really exist?  Finding out requires sweeping aside the presumption, dismissiveness, and shame that clouds the subject.

The phenomenon didn’t have a name until 1983 when psychologist Patrick Carnes published the influential book, Out of the Shadows: Understanding Sexual Addiction. Prior to that, the behavior was described as “hyper-sexual arousal.” In short, the term “sex addiction” is used to describe a pattern of frequent, progressive, and often secret sexual behavior, even when the behavior jeopardizes a person’s time, employment, financial stability, relationships, and reputation. While often conflated with adultery, sex addiction does not necessarily mean cheating—or even intercourse. Rather, it can manifest as a dependency on pornography, masturbation, phone or Internet sex, and other related behavior.

Now, that opening reads sensibly enough to these eyes, trained by our “developed” culture to accept certain logical leaps.  However, it was easy to see that we, indeed, may have a problem (practical and/or semantic) when we “translate” it to a comparable analysis of the less understood/accepted concept of “food addiction.” Read the rest of this entry »

Bingeing. Mini-bingeing. Is it Addiction?

In Weight-Loss Maintenance on April 6, 2011 at 11:55 am

I appreciate science that debunks the notion that we eat and gain weight because we are emotionally out of control and we just need to buck up and make better decisions:  Push away from the table.  Drop the fork.  Hit the gym.  Ignore the fridge.  Science tells us it’s not that simple; food may be a complicated “addiction.”

Many of my blog world friends are talking about food addiction:  Here’s the most recent post on that topic from Beth, the Weight Maven, who has many well thought-out posts on the concept.  Barbara at RTR, is also using the “A” word.   

I struggle with the notion of calling eating that leads to fatness “addiction.”  It is likely inaccurate for many people.  Moreover, it doesn’t prevent fatphobic lay people from pigeon-holing and demonizing fat people.  (Do NOT go to My Fat Spouse and run a search on “food addiction”; just trust that you will be disappointed.)  On the other hand, the word seems to help doctors get beyond the notion that their patients merely need to “get serious” and be “compliant.”

In Science Daily, there’s a nice summary of a study out of Sweden, that links a gene variant, that affects the signalling system for the neuropeptide ghrelin, to cravings for sugar and alcohol (and, by leap, then, to binge eating and alcohol addiction).  Here’s the actual study.      

In simpler words, the study links ghrelin to sugar-seeking (and alcohol-seeking) behaviors, by way of a genetic variant.  Sugar seeking, sadly, is not my issue, darn it (and this blog is about me, after all).  I have said before that I am painfully aware that my internal chemistry has changed since my radical weight loss, which makes maintenance of that loss a hell of a lot harder than popular celebrities like Jillian Michaels would have us believe.   And, given past research that links voluntary radical weight-loss to a 24% average increase in Ghrelin throughout the day, I have blamed Ghrelin.  I may be wrong.    Read the rest of this entry »

Dueling Research

In Weight-Loss Maintenance on March 29, 2011 at 11:59 am

Last night on ABC news, former director of the CDC and current ABC pontificator, Dr. Richard Besser reported that gastric bypass surgery reverses Type 2 Diabetes forever

This morning on Good Morning America, the story replayed and then in commentary, to Robin Roberts and George Stephanopoulos, Dr. Besser bemoaned how health care insurance won’t pay for bariatric surgery.  It is, after all, clearly a cure for Type 2 Diabetes.  

He doesn’t credit his source for this revelation.  His story begins, “Doctors have discovered something incredible. . .”   Ah, those ambiguous “doctors.”  And they all agree, eh?  Mmm.  As a hedge he slips in the modifier “may”:   “Gastric bypass surgery may actually reverse type 2 diabetes almost instantly.”  (What does that “may” modify — “almost instantly” or that surgery reverses diabetes?)   He goes on to interview Dr. Phil Schauer, the Director of the Bariatric and Metabolic Institute for the Cleveland Clinic (no vested interest there) who tells us that the cure is not only instant, but permanent.  “Before they leave the hospital, they will NEVER use insulin again.”  Hmmmm.  This is a miracle, indeed. 

Dr. Besser goes on to explain that “how the procedure normalizes blood sugar remains unclear.”  Then he speculates vaguely with Dr. Schauer about “incretins” and then “humanizes” the report (as journalists are supposed to do) with the story of Katy Wiley, and actual patient who once was a fat, diabetic train wreck and now claims to be “healthy, healthy, healthy!”

Diane Sawyer doesn’t tell us what Dr. Besser’s report is based on.  She introduces it as important medical news springing from “something making headlines today.”   I would guess that Dr. Besser is probably hanging his story on the statement issued by the International Diabetes Federation (IDF) yesterday at the Second World Conference on Interventional Therapies for Type 2 Diabetes in NYC.  Here’s a two-page executive summary.   The recommendation for surgery as treatment begins at subpoint 1.5: Read the rest of this entry »

“Experts”: Phooey

In Weight-Loss Maintenance on March 22, 2011 at 2:18 pm

Well, my colonoscopy has been postponed.  Yeesh.  And it wasn’t me; I didn’t chicken out.  The nurse called and the doctor is taking a day off on Friday.  I got all wound up, and now I’ll wind down until April 18th – prep day, followed by the no-big-deal procedure on the 19th.  Thank you for all your well wishes.  When it FINALLY happens, I’ll let you know how it goes with more subtlety and decorum (but less humor) than Dave Barry.  Thank you, alert reader, Mulberry for the link.

I am especially pleased to learn that many maintainer friends did not experience a weight shake-up from their colonoscopies.  Had I not heard from you, I wouldn’t have taken it for granted.  I don’t trust the words of doctors and other “experts.”  With regard to weight management and weight rebound, simply, they’re out of their depth.  What’s more aggravating, they don’t acknowledge how out-of-their-depth they are.

Regular reader, Ali, just recently ran into an “expert” (chiropractor) who dismissed her dietary choices (which were working pretty well for her) in a conversation that lasted less than ten minutes.  With the pseudo-scientific authority granted by the likes of journalist and weight-loss opportunist Gary Taubes, she stated simply, “you must go low carb.”  Well, Gee, lady.: thanks but no thanks.  Low carb works for some people, and I’m happy for them, but if it worked for everyone we’d all be trim.  Anyone over the age of 20 in this country saw the rise and crash of the New Atkins Revolution (which nearly killed our grain markets and bankrupted our grain farmers at the beginning of this century). Had the Revolution worked for everyone, I’d have jumped on board too.  Instead, most of us witnessed sad stories of radical weight loss and rebound among earnest, disciplined people.  The few who succeeded then must now work at least as hard as I do to maintain their losses in a carbolific society (who pushes them to portion control, while pushing Ali and me to drop our bananas).

One sure sign that you’ve found a person who knows something is that they are secure enough to acknowledge that they don’t know everything.  That’s why Arya and Yoni have charmed me.  And I especially love this post from Barbara Berkeley, The Perfect Diet:  Does it Exist?   The one word answer is “nope.”  People who have earned their bona fides do not pretend to have the one and only answer.  Read the rest of this entry »

Overreactions: The Price of being a Maintainer?

In Weight-Loss Maintenance on March 15, 2011 at 10:02 am

I’m saying this up front:  This is triggering.  I’m asking that my Size Acceptance friends don’t try to intervene or convert me.  Just acknowledge or don’t read.  Please.

In less than two weeks I go in for my first colonoscopy.  Yuck.  I’m feeling horribly anxious, but not because of the procedure.  It’s the prep.  And not the awful laxative.  That would be okay, by itself. 

I fear the fasting.   Not the discomfort, but how I will respond and rebound afterwards.

For the day before the procedure, I can have clear, golden or brown liquids and I can suck on hard candy, but nothing red or purple.  Selections include water, jello and popsicles (orange and lemon-lime flavored), apple juice, tea and coffee (sweetened, okay, but no milk).   That’s mostly carbs.  Except that I can also drink clear broth.

I will be hungry.  Anxious.  I know that I’ll be drugged for the procedure, but when I’m out of the fog, I’ll eat, and I don’t trust that my body will respond as I’ve been promised by all the people who have undergone this procedure before me – “Oh, it’s no big deal.  You lose a bunch of weight from the fast and the laxative, but it’s only temporary.  Once you’re eating again, you just jump right back to where you were.”

Oh, yeah?

Many people laugh about how they tried to hold on to their losses, but just couldn’t.  Ha ha.  They write it off as personal weakness.  We who are maintainers or who have given up on the weight-loss pursuit all together know it’s not weakness.  The body puts up an enormous fight to regain homeostasis at a particular weight.  And for those of us maintaining big losses, the body seems to look for opportunities to reclaim a pound or two, or five.  A yo-yo jolt like this may be just the ticket.

When I awake from the fog, I’m sure I’ll respond to the hunger, but will I then be hounded by those dreaded “eat now” impulses?  If so, for how long?  A couple of days?  A week?  Until I give my body back a pound?  Two?  How many?  I am edgy beyond what is “normal” for this procedure, and it’s because I’m a maintainer, I want to remain one, and I don’t take maintenance for granted. Read the rest of this entry »