Intermittent Fasting – A New Dietery Modification For Weight Loss
I want you to think about the first calorie you consumed yesterday. Mine was probably the sugar in my coffee around 6 AM.
Now think about the last calorie you consumed yesterday. Mine would have been some sugar in my tea around 9:30 PM.
Most adults in the United States are like me, consuming calories over an approximately 15-hour period.
But if you haven’t been living under a pizza lately, you will have heard of intermittent fasting, a dietary plan that extols the virtue of prolonged fasts to reset the metabolism. The details on any individual plan vary, but the central idea revolves around time-restricted eating—limiting caloric consumption to specific hours on the clock. And now, thanks to this paper appearing in Cell Metabolism, we have some evidence that a relatively modest time-restricted eating plan can significantly improve blood parameters among individuals with the metabolic syndrome.
This is a small but nicely done study. Nineteen individuals with metabolic syndrome who had a daily eating interval of about 15 hours were followed for 3 months, during which they were asked to restrict their eating to a 10-hour window—think 8 AM to 6 PM.
Other than that, there were no particular requirements. Participants could eat whatever they wanted and however much they wanted, provided it was in that timeframe.
By and large, this was a compliant bunch, reducing their eating window to just over 10 hours. Detailed dietary profiling found that they weren’t skipping meals but compressing them—eating breakfast a bit later and dinner a bit earlier.
And in that process, they ended up taking in fewer calories, about 200 fewer calories a day than during the baseline period. That reduction in caloric intake led to a fair amount of weight loss: around 7 pounds over the 3-month study.
Several metabolic parameters improved. Body fat and systolic blood pressure decreased, LDL cholesterol went down, and the average participant lost about 4 cm of waist circumference.
But not everything changed so dramatically. Fasting blood sugar and hemoglobin A1c got a bit lower, but not to the point of statistical significance, for example.
There were a lot of measurements done in this study; 32 are reported in the outcome table, so we need to be a bit worried about false positives. But that’s not really the main limitation here.
The main limitation is that these patients were enrolled in a study. See, without a control group, we don’t know if the beneficial changes seen were due to the effects of intermittent fasting or just because the patients knew they were being “watched.” They had to log in to an app, go to study visits, and so on. That alone may be enough to change behaviors in a beneficial direction.
In other words, we don’t have great support here for particularly large, unique effects of intermittent fasting compared with other diets that lead to calorie restriction.
And this leads to one of my central theories of diet studies: Any diet that makes it harder to eat, whether you are limiting certain types of foods or certain times of day, will probably [lead to weight loss]. One of the central drivers of the obesity epidemic is our ad libitum access to food. We often see promising results like this when we simply limit that free access.
What I like about time-restricted eating is that it’s pretty easy to explain: Eat inside these hours, don’t eat outside of these hours. That’s a bit easier than explaining how, for example, ketosis works. But in the end, the key to any diet plan is adherence. Researchers contacted these participants 3 months after the study ended. At that point, only five were still adherent to the calorie window.
Future studies examining novel dietary interventions would do well to prove that participants not only understand the diet but can stick with it.
Source : Medscape
Uterine Transplantation : Both Success & Failure ….
Until recently, adoption and surrogacy were the only means for women with absolute uterine factor infertility (AUFI) to have a family. The concept of uterine transplantation is not new , but the first such surgery resulting in a live birth was reported only 5 years ago from Sweden. Since then, uterine transplant programs have been established in multiple countries. A recent report summarizes the first 45 cases of uterine transplantation with known outcomes.
AUFI is rare, and the uterine problems that cause it can be congenital or acquired. The most common congenital anomaly is Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Acquired uterine infertility can be caused by conditions that interfere with implantation (eg, Asherman syndrome, fibroids, adenomyosis, damage due to ischemia/radiation).
MRKH was the cause of AUFI in 89% of the 45 uterine transplant recipients, whose mean age was 27.8 years. Live donors were used in 36 (80%) of the transplants, whereas the organs came from deceased donors in the remaining nine cases. About half of the donors were relatives of the uterine recipients.
Eleven percent of the live donors suffered severe complications (eg, ureteric injury, fistula formation, vaginal cuff dehiscence), and 28% were affected by minor complications (eg, infection, hypotonic bladder, constipation, leg pain, anemia).
Graft failure following transplantation occurred in 13 women (28.8%), leading to emergency hysterectomies for thrombosis, ischemia, or infection. In another seven cases (15.5%), planned hysterectomy was performed after successful delivery. The remaining 25 women (55.5%) still have functioning grafts.
So far, 18 live births have been reported (17 from live donors and one from a deceased donor). All were born by cesarean section. The mean gestational age of the infants at delivery was 34+6 weeks and the mean birth weight was 2500 g. All neonates did well and no congenital anomalies were seen. One third of the women developed preeclampsia and 22% developed cholestasis.
In summary, uterine transplant offers an alternative method to establish a family in women with AUFI. The procedure is associated with significant risks, however, as almost half of the patients experienced minor or more severe complications.
Viewpoint
Uterine transplantation offers women with AUFI another option for starting a family. The procedure is complex, however, and not without risk. Before transplantation, a recipient must undergo in vitro fertilization to cryopreserve embryos for later transfer. Therefore, the ideal candidate would be a young woman with good ovarian reserve, who is either in a stable relationship or open to using donated sperm. Many transplant programs have age restrictions and require the availability of a certain number of embryos before considering a uterine transplant.
The use of a live donor, preferably a close relative, is ideal. This would allow advanced planning and coordination of the hysterectomy and transplant procedures to minimize the risk for ischemic damage of the organ. Donation by a relative allows the use of lower-dose immunosuppression. Live donors are usually older women who have reached their own desired family size. The older uterus may be less elastic and the blood vessels are more likely to be sclerotic, potentially increasing the risk for graft rejection and compromising perinatal outcomes. On the other hand, the use of a brain-dead donor precludes advanced planning, so the risk for ischemic injury is higher.
Most children in this series were born after live-donor uterine transplantation. Prenatal medical complications and the risk for preterm delivery and low birth weight are increased after uterine transplant, possibly as a result of underlying maternal medical problems, suboptimal function of the transplanted uterus, or the need for immunosuppressant therapy. All newborns in this series did well and no congenital anomalies were detected.
Finally, one has to consider the ethical issues surrounding uterus transplantation because the uterus is not a vital organ, and two or three people are exposed to risks (donor, recipient, and newborn) as a result of the procedure. Some of these concerns may be addressed in the future if bioengineered uteri become available. Until then, the surgical technique and the preparation of the recipient should be improved further.
Source : Medscape
Clarify Your Doubts Regarding Fastag
PPI’s Linked To Viral Gastroenteritis
Continuous use of proton pump inhibitors (PPIs) may cause acute viral gastroenteritis, researchers say.
For every 153 patients who receive PPI therapy during winter months, one could be expected to fall ill from an enteric virus, report Ana-Maria Vilcu, MSc, from Sorbonne Université in Paris, and colleagues in an article published online November 27 in JAMA Network Open.
The finding adds to existing evidence that physicians should deprescribe PPIs when possible to reduce potential adverse events, according to an invited commentary in the same issue of the journal.
PPIs, which are widely prescribed, reduce acid in the stomach by blocking an enzyme that produces it. But decreasing the secretion of hydrochloric acid make may the stomach more hospitable to gastrointestinal pathogens and weaken the immune system.
Although PPIs are generally considered safe, multiple studies have shown associations between the long-term use of PPIs and adverse effects, such as osteoporosis-related fractures, vitamin B12 deficiency, kidney disease, and infections, including enteric infections from Clostridium difficile.
To test whether PPIs increase the risk for acute enteric infection, Vilcu and colleagues analyzed a large database of drug-dispensing data from community pharmacies during winter months, when the infections are most common.
The Longitudinal Treatment Dyamics Database contains data from 7000 community pharmacies in continental France and includes approximately 30% of the French population.
For each patient who took PPIs continuously during the winter of 2015 to 2016, the researchers found three patients who were not using the drugs and who were matched by sex and year of birth.
The researchers defined “continuous” on the basis of the frequency of PPI prescriptions and the amount dispensed. They defined “acute gastroenteritis episodes” on the basis of results of the use of a previously validated algorithm that took into account patient characteristics, the types of drugs prescribed, the delay between the time at which the drug was prescribed and the time that the drug was dispensed, and the number and quantity of drugs dispensed.
They identified 233,596 continuous PPI users and 626,887 non-PPI users. The median (interquartile range) age was 70 years for the non-PPI users and 72 years for the continuous-PPI users.
The researchers found that at least one case of acute gastroenteritis occurred for every 3131 PPI users, compared with 4327 non-PPI users. After controlling for age, sex, and treatments for the most common chronic conditions (diabetes, cardiovascular diseases, obstructive airway diseases, and conditions requiring a psychotropic medication), they found a significant association between PPI use and acute gastroenteritis (relative risk, 1.81).
They also found a significant association between age and use of histamine 2 receptor antagonists (adjusted relative risk, 2.08). They also found a significant association between PPI use and age, with older patients (aged 45 – 64 years) at highest risk and younger patients (aged 0 – 14 years and 15 – 44 years) at no significant increased risk.
The researchers note some limitations in their study. They used prescribing information instead of actual diagnoses to identify gastroenteritis. They didn’t have the PPI doses, and some patients may have drawn prescriptions from pharmacies outside the database. The researchers didn’t have information on potential cofounders, such as socioeconomic factors or food consumption.
Still, they conclude that “continuous PPI use may be associated with an increased risk of enteric viral infections.”
The commentary writers, Kaleen Hayes, PharmD, from the University of Waterloo in Canada, and colleagues, agree.
They recommend looking for opportunities to deprescribe PPIs, particularly in cases in which there is no identifiable indication for their use. They advise limiting long-term prescriptions in ambulatory patients for “prevention of nonsteroidal anti-inflammatory drug–induced ulcers, severe esophagitis, Barrett esophagus, idiopathic chronic ulcer, refractory gastroesophageal reflux disease, pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome), and certain patients with a history of gastrointestinal ulcer with bleeding….
“The study by Vilcu et al flags yet another potential risk of therapy with what was previously thought to be a generally safe drug class,” they conclude.
Source : Medscape
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