Monday 23 December 2013

Dr. Oz and Green Coffee Beans – More Weight Loss Pseudoscience

I can’t keep up with Dr. Oz. Just when I thought the latest weight loss miracle was raspberry ketone, along comes another weight loss panacea. This time, it’s green coffee beans.
Eveyone knows Dr. Oz, now. Formerly a guest on Oprah, he’s got his own show which he’s built into what’s probably the biggest platform for health pseudoscience and medical quackery on daytime television. In addition to promoting homeopathy, he’s hosted supplement marketer Joe Mercola several times to promote unproven supplements. He has been called out before for  promoting ridiculous diet plans, and giving bad advice to diabetics. And don’t forget his failed attempt to actually demonstrate some science on his show, when he tested apple juice for arsenic which prompted a letter from the FDAabout his methodology.  His extensive track record of terrible health advice is your caution not to accept anything he suggests at face value. So when the sign in front of my local pharmacy started advertising “Green coffee beans – as seen on Dr. Oz”, I tracked down the clip in question. The last time I saw Dr. Oz in action when when he had SBM’s own Steven Novellaas a guest, where there was actually a exchange (albeit brief) about the scientific evidence for alternative medicine. Replace Dr. Novella with a naturopath, and you get this:
Yes, Oz did use the terms “magic”, “staggering”, “unprecedented”, “cure” and “miracle pill”. And clearly the naturopath, Lindsay Duncan, is enamored with this product. But Dr. Oz is a health professional – he’s the Vice-Chair of the Department of Surgery at Columbia University. He’d be a bit skeptical, right? This exchange at the end, made me shake my head – Dr. Oz really has crossed the woobicon:
Now I always pride myself at having the smartest TV audience out there. So I’m hoping that some of you are skeptical about this. I was certainly skeptical about it. Am I speaking for a couple of you, anyway?  It does seem a little too good to be true.
So what did Dr. Oz do – issue cautions about obesity panaceas? No. He created some anecdotes:
So I gave the supplements to two viewers 5 days ago. I gave all the information I could find on this product to our medical unit, they did diligent work, but we still wanted to see what would happen in real life.
One viewer dropped 2 pounds in 5 days. The other viewer lost 6 pounds in 5 days. Convincing weight loss?  It was persuasive to Dr. Oz.
So now I’m going to do what Dr. Oz, the producers of the show, and the naturopath Lindsay Duncan didn’t do — actually review the evidence.

The Evidence Check

There is some suggestion, but no convincing evidence, that coffee consumption or caffeine consumption may have a modest, effect on weight. This study examined unroasted or “green” coffee beans, and was published in the online journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. The journal says it’s a peer-reviewed publication, but with an average of 12 days from submission to editorial decision, which apparently includes peer review, it’s obvious the review is cursory at best. The study is entitled Randomized, double-blind, placebo-controlled, linear dose, crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects. The lead author, Joe A Vinson, is a chemist at the University of Scranton, Pennsylvania. None of the three authors appear to be clinicians or medical professionals, and none appear to have published obesity-related research before, according to PubMed. The study was funded by a supplement manufacturer, Applied Food Sciences.
To start — this is a very tiny trial — just 16 patients (8 males, 8 females) with an average age of 33 years. The research location was a hospital in Bangalore, India. How these patients were recruited was not disclosed. Normally a trial would list detailed inclusion and exclusion criteria, and then describe how many patients were considered and the reasons for exclusion. This paper just reports the final number, and there is no information provided on why 16 was felt to be the desireable number. The average weight was 76.6kg (168 lbs) and the average body mass index (BMI) was 28.22. While the BMI on an individual basis may not be informative, when looking at a population, a score between 25 and 30 is usually accepted to mean overweight, but not obese. The details on how these measurements were taken were not well described — which is surprising, given this is a this is a pretty important part of the study.
One of the tricks that researchers (both pharma and supplement) can play when conducting clinical trials is to change parameters of the trial, after the trial is started. Because of the risk of conflicts of interest, there has been a growing commitment to publish the trial parameters in advance of the trial at the website clinicaltrials.gov. Many medical journals will now refuse to publish a trial if it was not initially entered into a public registry. Not only does a registry ensure that negative results don’t disappear, it gives valuable information about the study, including its design, entry criteria, and who gave formal ethics approval for the study. This study was never registered at clinicaltrials.gov. And there’s no evidence provided that a research ethics board ever reviewed the protocol. I find it hard to believe that any investigator would undertake a clinical trial of an unproven supplement without obtaining prior ethics approval – but that seems to be the case.
Green coffee extract (the brand “GCA”) was used in the study. The authors note that GCA has a standardized content of 45.9% chlorogenic acid, which is purported to be the active ingredient. Now contrary to what was said on the Dr. Oz show, chlorogenic acid is also in roasted coffee in significant amounts, so you don’t need to take green coffee extractto get a good dose. Patients were “randomly” divided (method was not disclosed) into three groups: high dose, low dose, and placebo (which was described only as an “inactive substance”). No clear justification for how the dose was determined was provided. Each group stayed in one group for six weeks, had a washout of two weeks, then moved to the next group. Here’s where we run into more problems.

Double-blind in name only

Groups served as their own controls, and rotated betwen a “high dose”, a “low dose” and the placebo.
  • Group 1 (6 patients): High dose (x 6 weeks) — washout (x 2 weeks) — low dose  (x 6 weeks)- washout (x 2 weeks) — placebo (x 6 weeks)
  • Group 2 (4 patients): Low dose — washout — placebo — washout — high dose
  • Group 3 (6 patients): Placebo — washout — high dose — washout — low dose
This doesn’t look that unreasonable. But the investigators noted the following:
The high-dose condition was 350 mg of GCA taken orally three times daily. The low-dose condition was 350 mg of GCA taken orally twice daily. The placebo condition consisted of a 350 mg inert capsule of an inactive substance taken orally three times daily.
Wait, what? The low dose arm was twice daily, while the placebo and the high dose arm were three times per day? That means that participants and investigators could determine which period was the “low dose” treatment. Knowing this, the other two treatment periods can be determined.  So much for blinding and placebo control – we can’t credibly consider this to a blinded trial.
Based on the protocol, participants were evaluated at weeks 0, 6, 8, 14, 16, and 22. Diet was assessed by interviews and recall — a notoriously unreliable means of measuring actual calorie consumption. Weight, height, body fat, and blood pressure were calculated each visit.  So here are the results for the three groups:
The table above is where Dr. Oz got his statistics of “17 lbs” of weight loss and 10% weight loss over 22 weeks. Oz also points out that there is no reported difference in dietary intake at the beginning and end of the trial – which is correct, but this is based only on patient recall. So is the weight loss due to the intervention? The group-by-group results are baffling.
Spot anything odd? Check out the HD/LD/PL group. This group  lost about 4kg during the 6-week treatment period, but then lost an additional 4kg during the washout. There was relatively no change thereafter on the low dose. The PL/HD/LD group is even odder. In the first eight weeks of no active treatment (placebo & washout), the group lost about 8kg, but then didn’t budge on the high dose, and lost about 1kg on the low dose. Finally the LD/PL/HD group lost about 3kg on the low dose, was flat on the placebo, and then lost a smaller amount of weight on the high dose, which continued during the washout.
The results don’t add up. If the green coffee is having an actual effect, it should be occuring when the dose is given, not during the washout, or when a placebo is taken. Bias? Random noise? In a tiny, poorly-controlled trial, it’s not possible to say. The breakdown of the results by arm are interesting:
Here it’s a bit more revealing. The changes in each period are modest. Given the small sample size, the repeated measurements, and lack of proper blinding, the risk of bias is high.

Safe and Effective?

Both Oz and the authors state that the supplement was safe and free of side effects. But the trial doesn’t report any side effect information at all, other than stating “no side effects of using GCA”. Given no information seems to have been systematically collected, it’s not clear we can accept this statement. At a minimum, the authors should have reported side effects between the three treatment periods. Surprisingly, there was a non-significant increase in systolic and diastolic blood pressure, which the authors note appeared restricted to the placebo treatment component.
Did the weight loss last? The authors claim that 14 of 16 participants maintained their lowered weight after completing the study – this is doubtful, as no supplement or medication for obesity continues to work after you stop taking it.

The Red Flag Bogus Weight Loss Test

Diet products that promise rapid weigh loss with no exercise or calorie restriction are nothing new. The Federal Trade Commission routinely takes on on diet supplement scams, and has a list of claims it calls “red flags” in advertisements for worthless products. Let’s put green coffee beans to that test:
  • Cause weight loss of two pounds or more a week for a month or more without dieting or exercise? Weight loss claim is just under 1lb/week with no dieting or exercise.
  • Cause substantial weight loss no matter what or how much the consumer eats?Investigators claim there was no difference in calorie type or intake, yet weight loss occurred.
  • Cause permanent weight loss (even when the consumer stops using product)?Investigators claimed weight loss sustained after trial ended.
  • Block the absorption of fat or calories to enable consumers to lose substantial weight? Actual mechanism (if any) is not clear. On the show it’s called a “fat blocker”.
  • Safely enable consumers to lose more than three pounds per week for more than four weeks? Claims 10% over 22 weeks.
  • Cause substantial weight loss for all users? Study claims all participants lost weight, lost fat, and reduced their BMI.
  • Cause substantial weight loss by wearing it on the body or rubbing it into the skin? — not applicable
The Dr. Oz segment raises several of the FTC’s red flags – if it was a paid commercial message, you could report it to the FTC.

Conclusion

Green coffee bean supplements have the characteristics of a bogus weight loss product. The supplement lacks plausibility, the only published clinical trial is tiny, and it appears to have have some serious methodological problems. Ignoring all of this, Dr. Oz has instead embraced it as the newest panacea for weight loss. Obesity is a real health issue, yet Dr. Oz seems quite content touting unproven products instead of providing credible, science-based information. In the real world, permanent weight loss is difficult, and there are no quick fixes. But not in the Land of Oz.

Reference

ResearchBlogging.org
Vinson, Joe A, Burnham, Bryan R, & Nagendran, Mysore V (2012). Randomized, double-blind, placebo-controlled, linear dose, crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy (5), 21-27 DOI: 10.2147/DMSO.S27665

Source : http://www.sciencebasedmedicine.org/dr-oz-and-green-coffee-beans-more-weight-loss-pseudoscience/

Saturday 21 December 2013

Raspberry Ketone: Fat-Burner in a Bottle

Research has shown that raspberry ketone can help in your weight-loss efforts, especially when paired with regular exercise and a well-balanced diet of healthy and whole foods.

Raspberry ketone is the primary aroma compound of red raspberries. This compound regulates adiponectin, a protein used by the body to regulate metabolism. Raspberry ketone causes the fat within your cells to get broken up more effectively, helping your body burn fat faster. The recommended dose is 100mg per day. To get the same benefit from the whole fruit, you'd have to consume 90 pounds of raspberries. 

Thursday 19 December 2013

Meal Plans for a High-protein Diet

Among different weight loss diets, the high-protein and low-fat diet is a very popular diet plan. People opt for a high-protein diet for weight loss as well as for muscle building. An interesting fact about proteins is that they can help you lose extra pounds, and at the same time and also gain muscle mass. Proteins are a fundamental component of all living cells. Proteins are considered the building blocks of the body. They are needed for the production, maintenance and repair of skin, hair, bones, and other organs of our body. Proteins also play a significant role in the production of enzymes and hormones. For these reasons, proteins form an integral part of a healthy and balanced diet. A balanced intake of proteins in our diet can effectively help to lose weight.

High-protein Meal Plans

** Each meal plan must include 2 liters of liquids; and one is suggested to have the following in various combinations:
Water
Tea (chamomile, peppermint, dandelion leaf)
Juice (apple, kale, celery, carrot)
Fresh lime juice (with honey)
Plan #1
Breakfast
2 eggs (scrambled or boiled with low-fat margarine)
2 pieces of sliced toast
1 sausage link
½ sliced grapefruit or orange, or 3 slices of tomatoes
½ cup low-fat milkLunch
2 slices of whole wheat bread
3 oz. chicken salad (3 oz. chicken with ½ tsp light mayonnaise and 4 grape halves)
1 cup sliced vegetables
8 oz. water, unsweetened tea or coffee
Evening Snacks
½ cup cottage cheese with peaches or pineapples
2 tsp peanut butter with celery
1 oz. peanuts or mixed nutsDinner
1 cup of green beans, carrots or broccoli
4 oz. lean chicken, beef, pork or fish (cooked or pan fried)

Plan #2
Breakfast
2 slices of bread
50 g ricotta
1 glass of low-fat milk with honey and cinnamonLunch
100 grams grilled chicken
Salad greens with tahini
Evening Snacks
1 apple
GrapesDinner
1 whole meal pita with 150 grams chopped, grilled chicken and spinach
Cucumber and yogurt salad

Plan #3
Breakfast
2 hard-boiled eggs
2 slices of whole wheat bread with cheese spread
1 glass of low-fat milkLunch
Brown rice
Grilled chicken with scallion-ginger sauce
Steamed broccoli
A glass of water or fresh juice without any added sugar
Evening Snacks
Sprout salad or salmon sandwich made with whole grain breadDinner
Steamed chicken with hummus (made from chickpeas, hummus is an excellent high-protein dip)
2 whole grain flour tortillas
A glass of juice (apple or kale)

Plan #4
Breakfast
1 cup yogurt with 10 grams flax seeds
1 cup muesli with 1/2 cup berries
1 passion fruitLunch
1 cup brown rice
Lentil soup (boiled lentils mixed with 1 clove garlic, 1 medium chopped onion, 1 chopped carrot, 1 small, diced tomato, shredded spinach and 500 ml water)
Evening Snacks
1 banana
7-8 cashewsDinner
1 cup steamed squash, eggplant, and mushrooms
½ cup cooked brown rice

Plan #5
Breakfast
Steak and egg, either boiled or scrambled
One cup of tea or coffee without milkLunch
Pita pocket loaded with tuna salad
Almonds (small serving size)
Evening Snacks
Peanut butter smoothieDinner
A mixture of cauliflower and broccoli with broiled salmon

Healthy Meal Plans for a High-protein Diet

Proteins can be obtained through various dietary sources. The daily protein requirement for kids is approximately 0.5 grams per pound of their body weight. Adults need about 60 grams of proteins everyday. Major sources of proteins are meat, fish, and seafood, dairy products, eggs, seeds and nuts, soy products, legumes, beans, and cereals such as wheat, rice and oats, etc. Most animal foods like poultry, eggs, fish, meat, and milk are rich in complete proteins and contain all essential amino acids. Most plant foods such as vegetables, seeds, nuts, grains, and legumes contain incomplete proteins, which have small quantities of one or more essential amino acids. Seafood is one of the best sources of proteins with low amounts of fats.

A high-protein diet is helpful in healthy weight loss as it keeps your hunger satisfied and makes you feel full for a longer time. When you have more proteins and fewer carbohydrates in your diet, you feel less hungry throughout the day, leading to a lower calorie intake. Such a diet stabilizes blood sugar levels. Some of these diet plans focus on bodybuilding. Such diet plans include protein bars, protein powders, and protein drinks. Some of the popular weight loss diets that include abundant amounts of proteins are the Atkins Diet, Zone Diet, and Sugar Busters.

Meal plans for a high-protein diet are one of the most effective ways to lose weight fast and improve your overall health. High-protein foods that can be, and should be, included in your daily diet without changing your meal plans are cheese, eggs, soybean, and products sourced from soy (such as tofu, soy milk, etc.), milk, lean meat, legumes, etc. Even while snacking, you can switch to healthier, high-protein options such as a tuna sandwich made with whole wheat bread or a sprout salad.

Read more at Buzzle: http://www.buzzle.com/articles/meal-plans-for-a-high-protein-diet.html

Thursday 12 December 2013

Vegetarian diet: five tips to get started

 Want to go veggie? These tips will make following a vegetarian diet plan much easier.

Research suggest vegetarians live up to eight years longer than the rest of the general population. Here’s five expert tips to get you started on your veggie journey.

Pre-planning Load your larder and fridge with veg and fruit. Plan menus ahead so you don’t waste food and are less likely to grab unhealthy options. James Ramsden, who runs a London supper club, recommends stocking up on seeds and nuts to add crunch to dishes, and using seasonings such as citrus and chillies.

Snack attack Prepare vegetables in advance to nibble on or make into meals on the fly. If you have guests coming round, assemble a colourful crudité platter of celery, carrots and peppers. For pudding, an exotic, ripe fruit salad, or Moroccan sliced oranges with cinnamon can work well.

The big freeze Making batches of your favourite grains and beans, and freezing them in pots, saves time in the long run when added to soups, stews and stir-fries. Other freezer friends include home-made curry paste, Kaffir lime leaves and lemongrass, for an impromptu veggie Thai curry that’s bursting with flavour.

Spice things up Eat out of your comfort zone. Resolve to try at least one new plant food a month and experiment with making veg exciting. Don’t just boil – roast, grill, sauté and braise. Add spices such as anardana (sun-dried pomegranate seeds) to salads or dip crusty bread in Middle-Eastern blend za’atar and olive oil.

Small beginnings To slowly introduce yourself to vegetarian eating, nutritionist Fiona Hunter suggests viewing meat as an ingredient, not the centrepiece of the meal. For example, if you’re making a bolognese, chilli or lasagne, add peppery Puy lentils to the sauce. It still will taste just as good but contain less meat per portion.

For more healthy eating tips subscribe to Health & Fitness magazine. We'll give you 3 issues for £1! 

Read More : http://www.womensfitness.co.uk/healthy-eating/914/vegetarian-diet-five-tips-follow-one