Think Muscle Newsletter #13 August 15, 2001 - Number 13 http://www.thinkmuscle.com/ ISSN: 1532-0561 12,618 opt-in subscribers
The Think Muscle Newsletter publishes the latest news and research on exercise physiology,dietary supplements, performance enhancement, lifestyle management, health & nutrition, andbodybuilding & fitness. The newsletter is dedicated to providing accurate and unbiasedscientifically based information. Editor-Email: PDF Version: HTML Version: http://www.thinkmuscle.com/beta/newsletter/013.htm IMPORTANT NOTICE: If you haven't been getting the newsletter and you are a subscriber, rtently removed from the list. Please send a blank email to [email protected] to add your email address back to the Think Muscle Newsletter list.
• aining: Fatigue Management Strategies for
• ogy Part I: The Absurdity of the New Diet Drugs
Message from the Editor-in-Chief
Hello everyone. Let me be the first to apologize for the lateness of this issue of the Think Musclenewsletter. Let me also be the first to say "Thank You" so much for all the kind emails. ThinkMuscle readers from all over the world seem to be the most gracious, appreciative, andintelligent readers I have ever witnessed in a magazine of this type. I get a lot of mail fromreaders and seldom, if ever, is it negative. We at Think Muscle can’t thank you enough for allyour support, but we can, and do, commit to continue to bring you the best information availableanywhere about exercise, nutrition, supplements, hormones, or anything else important enoughto investigate and write about.
I have a pressing issue that I must offer up for your consideration and feedback. As most of youknow, I love supplements. I have probably spent enough money on supplements over the years topay off my school loans. I have used them for over 20 years (I’ve calculated that over the years Ihave consumed at least 1,000 lbs of protein powders alone). I write about supplements for printmagazines and websites. I even work as a consultant for the supplement industry. But after allthe writing and consulting, what has given me the most satisfaction and sense of purpose, hasbeen (and continues to be) the mail I get from readers.
Unfortunately, from the mail that I get from Think Muscle readers from all corners of the globe,it is clear that there is a tremendous amount of confusion about which supplements work andwhich don’t. This is no surprise considering the type of marketing practiced by the current cropof supplement companies.
Supplement companies today are certainly aggressive, and many times deceitful, in theirmarketing tactics. This is what bothers me most. Let me explain to you why many supplementcompanies feel compelled to lie to you to get you to buy their products.
Supplement companies today are afraid NOT to lie to you in their adds. This fear stems fromtheir lack of faith. Faith in what? Faith in the quality and effectiveness of their own products. Why can’t they have faith in the quality and effectiveness of their own products? Because theylack the education, knowledge, and experience required to formulate high quality and effectivesupplements. How do I know this? Well, for one thing they call me to ask me questions that asupplement company would not ask if they knew what they were doing. Not only that, butanyone can see the pitiful lack of competence in the industry by picking up a bottle, looking atthe ingredients and comparing it with the claims they are making.
Now before I offend any of my friends that work for, or own, supplement companies, let me saythat not all people working in the industry are incompetent. There are a few (I can count them onone hand) that are extremely intelligent, creative, and very good at what they do. Unfortunately,unless they own the company, they are not usually involved beyond formulation of a single
product for any one company. Seldom do they have anything directly to do with marketingeither.
I have always said that if I had a chance to make my own supplements, I would do it differently. First of all, I would only make supplements that did something measurable or that had ademonstrable effect in research, regardless of what was "flying off the shelves." No one has atruly justifiable reason to sell anything that doesn’t work. Secondly, I would not make any claimsabout the product except what could be backed up by research. Lastly, I would not overly "hype"my own line of products. If the line really does deserve some hype, let the people who have usedit with good results hype it themselves by word of mouth. Not only that, but I would continue toreport on and support any ingredient or supplement that was effective, whether I made it or not. Now this has been met with plenty of skepticism by those who feel it impossible to compete withthe persuasive yet false advertising of the current crop of companies. I know it seems that way,but when I read your (Think Muscle readers) emails I am confident that if you had a source oftrusted "unbiased" information (which we are committed to remain as), and a source for a fewkey supplements, fairly priced, that you could equally trust, it would work out well foreverybody.
Let me know what you think. If you think that supplements can still be sold solely on the basis ofwhat they do, instead of what greedy, faithless companies want you to think they do, tell me so(see survey at bottom of newsletter). Now, please take time to do this, even if you never respondto surveys, please take a moment to fill out the survey below. The reason I’m so interested inyour opinion is because if Think Muscle readers say they want their own line of supplements,composed ONLY of those few products that actually do something, we are going to pool ourresources together to create a Think Muscle line of supplements, formulated by us (usingavailable research) and built to our standards. If these initial products meet with your approval,we will then be able to develop some never before seen supplements that have only seen the lightof day in research journals and the Think Muscle collective conscious. More on that later.
Thanks again to everyone who lends an ear every month…or so.
P.S. Don’t forget to voice your opinion! Whether you like the idea of Think Muscle creatingsupplements or even if you just want to vent about being taken advantage of one too many timesby false claims. Speak up now!
Bryan Haycock MS
Editor in Chief - ThinkMusclehttp://www.thinkmuscle.com
About Bryan Haycock Bryan Haycock M.Sc. is an exercise physiologist and NPC judge. Bryan has been bodybuildingfor over 20 years and holds certifications with the NSCA, ACE, and is a member of the Americanditor in Chief of ThinkMuscle.com and is thefounder and CEO of LifeStyleMgmt.com. Bryan is a highly sought after authority on thephysiology of muscle growth and fat loss. Bryan also specializes in the management of type-IIdiabetes through diet and exercise.Research Update: Cycling Creatine, Steroids and the Heart, Meal Replacement Drinks by Bryan Haycock MS [email protected]
As we approach the new millennium we find the science of building muscle progressing fasterthan ever before. Long gone are the days of simple trial and error when it comes to buildingmuscle. The modern bodybuilder demands more than just "hear say" if they are to adopt a newtraining routine or nutritional supplement. This column was created to keep today’s bodybuilderon the cutting edge of scientific research that might benefit them in their quest for bodyperfection. Are you cycling your creatine? Find out why you may want to.
Creatine supplementation in health and disease. Effects of chronic creatine ingestion in vivo:down-regulation of the expression of creatine transporter isoforms in skeletal muscle. Researchers:
Guerrero-Ontiveros ML, Wallimann T. Institute for Cell Biology, Swiss Federal Institute of Technology, ETH-Honggerberg, Zurich.
Mol Cell Biochem 1998 Jul;184(1-2):427-37
Summary:
These researchers studied the in vivo effect of dietary creatine as well as 3-GPA (a creatineanalog that is a competitive inhibitor of creatine entry) on the expression of the creatinetransporter (creatine T). Long term feeding of rats with 3-GPA has been previously shown todecrease creatine levels in skeletal muscles without effecting creatine T expression. In this study,
the expression of the creatine T was examined in rats chronically fed either 4% creatine or 2.5%GPA. Dietary creatine administered for 3-6 months, significantly lowered the expression ofcreatine T polypeptides. The rats fed the creatine analog GPA showed virtually no change(perhaps even a slight increase) in creatine T polypeptide expression. Discussion:
The wide spread use of creatine among athletes and bodybuilders has raised concerns aboutpossible negative side effects. Of course most of the nay sayers are looking to control itsavailability with little real concern for the well being of those who use it. This study hasanswered a question that has rested on the minds of many, which is, "Is there any reason to cyclecreatine?" From the study above we see that the abundance and activity of the creatinetransporter is negatively effected by long term creatine ingestion. The creatine transporter isdown regulated with continued exposure to extracellular creatine.
Human skeletal muscle has an upper limit of creatine that can, or will, be contained within thecell. This limit is around 150-160 mmol/kg of dry muscle. As the intracellular concentration ofcreatine approaches this level, the synthesis of creatine transporters declines and even stopsdepending on the amount of creatine ingested over time. In the study above, it was shown thatthe creatine transporter is regulated by the content of creatine in the cell rather than by theinteraction of creatine, or it’s analog 3-GPA, with the transporter.
All the arguments about creatine absorption being a limiting factor in creatine content within thecell are bogus. Creatine does not need to be "micronized" or "effervesent" to lead to an increasein creatine content within your muscles. The activity of the creatine transporter is the limitingfactor. Any trick increase in creatine absorption will only hasten creatine transporter downregulation. It only requires about 5 grams per day for 30 days to increase the content of creatinewithin muscle tissue to the same extent as 30 grams per day for 6 days. The sooner you reach theupper limit the sooner your muscles become unable to take up creatine. It is better to maintainsufficient levels of creatine transporters in order not to cause a rapid decline in creatine contentonce creatine supplementation is discontinued. Clearly there appears to be good reason to cyclecreatine supplementation.
The authors of this study recommend not using creatine for over 3 months at a time. To trulycycle creatine you will have to take at least 4 weeks off. Creatine levels take at least one monthto return to pre-supplement levels. It may be important to take the entire month off because onespeculated mechanism of creatine transporter downregulation is that when the intracellular levels(levels inside the muscle cell) are increased the creatine transporters are taken down and notreplaced as long as creatine levels remain elevated. Thus it might take as long as a month forcreatine transporters to return to normal after chronic creatine supplementation. Keep in mindthat no one has actually shown that long-term supplementation with creatine is a bad thing. Researchers too quick to blame steroids for changes in heart muscle.
Left ventricular wall thickening does occur in elite power athletes with or without anabolicsteroid Use. Researchers:
Dickerman RD, Schaller F, McConathy WJDepartment of Biomedical Sciences, University of North Texas Health Science Center, FortWorth, Tex., USA. Summary:
Researchers examined 4 elite resistance-trained athletes by two-dimensional echocardiography. In addition, they retrospectively examined the individual left ventricular dimensions of 13bodybuilders from our previous echocardiographic studies. All 4 elite resistance-trained athleteshad left ventricular wall thicknesses beyond 13 mm. One of the elite bodybuilders has the largestleft ventricular wall thickness (16 mm) ever reported in a power athlete. Retrospectively, 43% ofthe drug-free bodybuilders and 100% of the steroid users had left ventricular wall thicknessbeyond the normal range of 11 mm. In addition, 1 drug-free subject and 3 steroid users werebeyond the critical mark of 13 mm. No subjects demonstrated diastolic dysfunction. In contrastto previous reports, we have demonstrated that left ventricular wall thicknesses >/=13 mm can befound routinely in elite resistance-trained athletes who do not use anabolic steroids. Discussion:
Left ventricular hypertrophy is characterized by thickening of the left ventricular wall secondaryto cardiac fiber enlargement. Left ventricular hypertrophy is normally caused by a chronicincrease in systemic blood pressure. It may also be seen with sudden or rapid weight gain. Thethickening of the ventricular wall due to increased afterload from elevated vascular resistancecan be viewed as adaptive protection up to a point. Beyond minor wall thickening, leftventricular hypertrophy is a strong predictor of serious cardiovascular risk.
During heavy lifting, systemic blood pressure is increase from what is called the valsalvamaneuver. It is simply the act of forceful expiration with the mouth and nose closed producing a"bearing down" on the abdomen. Pressure also increases due to blood vessels being occluded bycontracting muscles. It should be noted that the LVH seen in bodybuilders and power lifters iscalled "concentric left ventricular hypertrophy", meaning that it is the result of contractingagainst acute increased systemic pressure, and was not considered pathological. "Eccentric" LVHis caused by constant increases of blood pressure not as a result of the valsalva maneuver butinstead clinical hypertension that forces the ventrical to expand against resistance. It waspreviously believed that the intermittent increase in blood pressure that is caused by heavy lifting
was not sufficient to elicit left concentric ventricular hypertrophy (CLVH). Any evidence ofCLVH in strength athletes or bodybuilders was seen as a sign of anabolic steroid use.
In the study above researchers identified LVH at or beyond 13mm in not only bodybuildersusing anabolic steroids but also in "drug free" athletes as well. Although it was shown that thoseusing anabolics showed significantly more ventricular thickening, at least one drug free athletewas beyond the 13mm limit. Are meal replacement drinks really that important after your workout? Read on and decide for yourself.
Hormonal responses to consecutive days of heavy-resistance exercise with or without nutritionalsupplementation. Researchers:
Kraemer WJ, Volek JS, Bush JA, Putukian M, Sebastianelli aWJThe Human Performance Laboratory, Ball State University, Muncie, Indiana 47306, USA. Summary:
Nine resistance-trained men consumed either a protein-carbohydrate supplement (Twin Lab’sMassFuel) or placebo for 1 wk in a crossover design separated by 7 days. The last 3 days of eachtreatment, subjects performed resistance exercise. The supplement was consumed (half serving)2 h before and immediately after (half serving) the workout, and blood was obtained before andafter exercise (0, 15, 30, 45, and 60 min postexercise). Lactate, growth hormone, andtestosterone were significantly (P </= 0.05) elevated immediately postexercise in both placeboand supplemented groups. The lactate response was significantly lower during supplementationon days 2 and 3. Growth hormone and prolactin responses on day 1 were significantly higherduring supplementation. After exercise, testosterone declined below resting values duringsupplementation. Cortisol decreased immediately postexercise on day 1; the response wasdiminished on days 2 and 3. Glucose and insulin were significantly elevated by 30 min duringsupplementation and remained stable during placebo. Insulin-like growth factor-I was higherduring supplementatiom on days 2 and 3. These data indicate that protein-carbohydratesupplementation before and after training can alter the metabolic and hormonal responses toconsecutive days of heavy-resistance exercise. Discussion:
The reason for performing this study was to see what would happen after consecutive days oftraining and supplementation with a carb/protein drink. Most all previous studies looking at theeffect of macronutrient supplementation are done acutely after a single bout of exercise.
The results of this study are not surprising. There was a significant increase in post-exerciseglucose and insulin due to the carbs and BCAAs in the supplement drink. As with previousstudies, there was also an increase in post exercise growth hormone however, it was only greaterthan placebo after the first workout. After the second and third workouts the differences werevery small. There was a significant increase in resting IGF-1 levels in the supplemented groupwith no difference in post exercise levels when compared to placebo. This is not unusual ine supplement added between 1575 - 2475 kcals per day in thisstudy.
There was a trend for reduced cortisol levels for both placebo and the supplement groups. Surprisingly, cortisol levels were not greatly different after post exercise supplementation. Performance appeared to be unaffected by supplementation. This is not unusual after such a shorttraining protocol (3 days). There was one significant difference that should be noted, namelyserum testosterone was significantly lower in the MassFuel group. The authors explained thisobservation from a macro nutrient ratio perspective. You see, while supplementing withMassFuel the percentage of calories from fat drops to 14% compared to 24% for the placeboperiod. It is well known that the highest resting testosterone levels are achieved when fatprovides ~30% calories. It can be optimistically speculated that free testosterone levels remainedthe same from data measuring the ratio of total serum test and SHBG.
What is the take home message from all this? First, there was virtually no difference in the waythe body responded to three consecutive days of training the same body parts. It is notunreasonable to consider training a body part for two or three days in a row and then giving it acouple days off. And finally, by using a carb/protein supplement in liquid form after training youcan ensure that protein synthesis will begin as soon as possible after exercise. Creative Applications of Circuit Training: Fatigue Management Strategies for Bodybuilders: Part I by Charles Staley [email protected]
When I teach acute training parameters in seminars across the USA, a very common questionregards which exercise to do first, second, third, etc., in any given workout. Traditional wisdomsays to do whatever exercise is most important first, since fatigue accumulates over the course ofthe workout. While I agree, there is a much more refined way to address the problem ofaccumulating fatigue, and it’s called circuit training.
Of course, whenever one uses the term "circuit training," serious lifters often conjure up images
of PACE classes which are used in Gold’s Gym’s across the World. PACE is in fact a form ofcircuit training, but it’s simply one variant out of hundreds, and it unfortunately leads serioustrainees to assume that circuit training is more appropriate for the "chrome & fern crowd" than itis for dedicated, experienced weight trainers.
I’m here to tell you that circuit training is a tool that will improve your workouts regardless ofyour experience level, and I’ll show you exactly how. I don’t care if it’s your first day in thegym, or if you are a dedicated athlete finally closing in on a 500 pound squat, circuit training willget you toward your goals faster than any other alternative. What Exactly is Circuit Training?
To most fitness enthusiasts, circuit training (I’ll abbreviate it to "CT" from here on out) isthought of as a method of integrating resistance and aerobic exercise by performing several (9 to12) exercises in "vertical" progression (meaning you perform one set of each exercise on theworkout "menu" until all have been completed, as opposed to finishing all sets of the firstexercise before progressing to the second exercise, and so on) with little or no rest betweenexercises. The supposed benefit of this type of exercise is you'll improve aerobic and anaerobicfunctioning at the same time.
Unfortunately, this narrow definition has done a disservice to CT and to those who havedismissed this method as an ineffective fringe variant used by only the profoundly unfit as a wayof regaining some semblance of fitness. In truth, CT has much to offer, for weight trainers at alllevels, if you'll allow for a slightly broader definition of the term and a bit of creative application.
First, CT is NOT defined by the number of reps per set, the length of rests between sets, thenumber of exercises performed, or even the exercises chosen. It is defined by the fact that youprogress from one exercise "station" to another in sequence, until the entire circuit of stations hasbeen completed. You then continue until you have completed the prescribed number of circuits.
(Incidentally, "non-circuit training" is any exercise format where you complete all prescribed setsof a particular exercise before moving on to the next exercise.)
If you were to conduct a poll of weight trainers, you’d find that between 90 and 98 percent use"non-circuit" training. This is unfortunate, when you consider the enormous benefits of CT,which I’ll describe in detail. Macro and Micro Circuits
Within the context of CT, there are actually two distinct ways that you can organize any trainingsession: macro or micro circuits.
The macro circuit is what most people mean when they think of CT: you simply perform one setof each planned exercise in the circuit, and then repeat for the desired number of circuits.
The is another way to perform CT, however. It’s called micro circuits: here, you break up the
circuit into several small circuits of 2-3 exercises each, and then repeat for the desired number ofcircuits. For example, if you have planned to perform 4 exercises, do the first 2 circuit style untilall planned sets are completed, then finish off the second two in the same manner. Benefits of CT
No exercise method is perfect of course (if there was such a thing, I would have discovered it bymy 13th birthday!), but CT is about as close as you can get. Compared to the alternatives, CT ismore efficient, more motivational, and far more versatile. Here’s a quick run-down of CT’sassets:
CT allows for more work to be done in the same time frame. For example, let’s imagine thatyou’re performing dumbbell incline presses and close grip lat pulldowns. Let’s further assumethat each set takes 30 seconds to complete, and that you’re resting 2.5 minutes between sets.
If you perform this workout "non-circuit" style as most people do, you’re getting 2.5 minutes restbetween sets of whichever exercise you’re doing.
But if you perform this session CT style, you’d perform one set of incline presses, rest, then do aset of pulldowns, rest, and so on. Here, you’re obtaining 5.5 minutes of rest between two sets ofthe same exercise! This is more than double the rest, yet your total exercise duration does notincrease. Now it is true that you’re still doing a set every 2.5 minutes, but fatigue from differentexercises, particularly if they are for different muscle groups, tends to be specific. This meansthat even though you may still be too fatigued to accomplish another set of the same exercise,you will still be able to complete a set for another exercise. For this reason, CT is clearly a betterway of managing fatigue through the workout.
If you arrange your exercises stations in antagonistic fashion (i.e., a hamstring exercise isfollowed by a quadriceps exercise), you’ll further enhance the efficiency of CT through aprinciple known as reciprocal inhibition: since muscles work in antagonistic pairs, when youperform a set for the agonist (in this case, the hamstring), the antagonist (quadriceps) achieves abetter contraction because the hamstrings are too fatigued to oppose it.
For many people, "sampling" from each item on the menu is more satisfying than simplyfinishing off your swordfish, then your rice pilaf, then your veggies, and so on. Similarly, in awork environment, it’s more productive to alternate between tasks than it is to spend a hugeblock of time on a single task.
Training is no different. Somehow, it’s intrinsically more satisfying to move from exercise toexercise as opposed to "slugging it out" on a single exercise until it’s finished.
CT can be integrated with your favorite training techniques, such as rest-pause training, dropsets, eccentric training, you name it. You can also use any exercise you wish, including freeweights, machines, plyometrics, Olympic lifts, whatever is appropriate given your particularcircumstances. CT accomm
CT also works well in non-gym environments, such as the high school track (where you cancreate circuits consisting of sprints, jumps, and throws) or a community park (where your circuitmight contain pull-ups, sit-ups, push-ups, lunges, short sprints, and so forth). Drawbacks
For all the benefits of CT, there are a few drawbacks as well, but most can be solved with a bit ofcreativity and imagination.
For technical exercises such as the Olympic lifts, which demand a very refined sense of timingand coordination, CT should not be used, at least during competition preparation cycles. This isbecause the enormous effort and specific coordination involved in executing say, a snatch, wouldhave a negative transfer to something like a clean & jerk when both lifts are performed in CTstyle. Nevertheless, CT remains an effective training option for Olympic lifters in the earlypreparatory phase of their training.
Another possible problem: in crowded gyms, you may find someone has "stolen" your nextstation while you performing the last exercise. Although this can usually be solved by simplywaiting until the station is available, you can get around this by doing "micro circuits" whereyou're only going back and forth between two machines. Or, simply make a quick substitution"on the fly," such as substituting a machine bench press for a dumbbell bench press. In Part II of "Creative Applications of Circuit Training: Fatigue Management Strategies forBodybuilders" you will learn how to adapt circuit training methods for your specific goals. We’llhave detailed circuit training workouts to help you build strength, power, size and evenperformance.Anorectic Pharmacology Part I: The Absurdity of the New Diet Drugs by Karlis Ullis, MD with Josh Shackman, MA
I have greatly enjoyed reading Bill Roberts’ Anabolic Pharmacology Column and I applaud himfor his help in bringing much needed common sense to the area of anabolic hormone research. Only recently with the HIV/AIDS epidemic and the AIDS wasting syndromes has research onthe therapeutic use of anabolic steroids become respectable again. However, as clueless as themedical establishment has been on drugs that make you bigger, it is often even more misguidedon the use of drugs that make you smaller. Unlike the minimal amount of research devoted to
anabolic steroids which, millions and millions of dollars and hundreds and hundreds of studieshave been done to develop and test the efficacy of diet drugs. The rapidly increasing plague ofobesity in America has been well established, but nothing significant has been done to stop itdespite the copious volumes of new research data and new diet drugs. This series is meant toexpose the scandalous use of expensive and ineffective drugs, and show how cheaper and moreeffective drugs have been largely overlooked. The Quest for the New "Phen-Fen"
For a brief moment, obesity had the appearance of being cured. Doctors were getting rich dolingout a combination of Phentermine and Fenfluramine dubbed Phen-Fen. While these drugs wereonly indicated for seriously obese individuals, almost anyone looking to lose a few pounds hadno trouble getting a prescription. Of course, both of these drugs had been around for years. Thepositive results of the long-term Weintraub obesity studies (1) with this combination drove theAmerican obesity industry into a frenzy. The combination was more effective then either drugalone. As an added plus, the mildly sedating and satiating properties of Fenfluramine seemed topartially negate the stimulating effects of Phentermine. Thus the combination apparently hadfewer side effects than either alone as well (or so we thought). However, phentermine is still onthe market and new combinations are being concocted with it.
We all know now that Phen-Fen proved to be a fiasco. Needless to say, this "cure" for obesityand the millions doctors were making could not go on forever. The revelation that Fenfluraminecan cause pulmonary disease and heart problems has lead the medical establishment to start overagain in its quest to find a new "cure", a new "Phen-Fen" that proves as effective (and profitable)as the original. Attempt #1: Meridia (Sibutramine)
Meridia is an attempt to combine the properties of Fenfluramine and Phentermine in one pill. Phentermine is a stimulant, scientifically referred to as an adrenergic or catecholaminergic drug. A catecholanminergic drug increases brain levels of andrenaline and/or noradrenaline, yourbody's most stimulating neurotransmitters. Phentermine makes you stimulated and energized,thus reducing appetite, delaying time for food intake and increasing your metabolic rate . Fenfluramine, on the other hand, stimulates serotonin release. Serotonin is one of your brain'smost sedating, satiating and relaxing neurotransmitters. Fenfluramine, by increasing serotoninlevels, makes you feel less anxious, decreases carbohydrate cravings , and produces a feeling ofrapid satiety - thus reducing food intake.
Meridia is a drug with both catecholaminergic and serotonergic properties. It works by blockingyour brain’s reuptake of both serotonin and noradrenaline, thus prolonging and increasing theactivity of these neurotransmitters (2). Theoretically at least, Meridia should be highly effectiveas it should help suppress appetite through two different pathways. So Meridia theoreticallyshould be the next Phen-Fen.
Early clinical trials do in fact did look impressive. Two separate year-long studies showed
Meridia at recommended doses to produce much larger losses in weight than a placebo. At 10mg per day, the Meridia group lost 4.8 kg over a year while the placebo group lost 1.8 kg. At 15mg per day, the Meridia group lost even more weight - 6.1 kg while the placebo lost only 1.8 kg. (3)
However, Meridia is not exactly flying off the shelves like Phen-Fen. Very few of my patientshave requested a prescription for Meridia, and many have told me that they have tried it and itdidn't do anything for them. None of my medical colleagues have reported much success withMeridia either. So why is Meridia so effective in studies (funded by the pharmaceutical companythat makes it), and yet apparently ineffective in the real world? I believe the studies mentionedabove are somewhat misleading since the drop out rates were exceptionally high - around 50% inboth studies. A common reason people drop out of diet drug studies is because they feel the drugis ineffective. Obviously, the people losing the most weight are most motivated to stay in thestudy. Thus the results are likely biased.
A survey by the newsletter Obesity Meds and Research News showed that of 248 people whohad used Meridia for longer than four weeks, 45% were deemed "non-responders" - i.e. failed tolose more than one pound per week (4). While this survey was not scientific, it does parallel withmy own observations that Meridia is not especially effective.
Meridia's apparent lack of efficacy may be due to its mode of action. Unlike Fenfluramine whichstimulates the release of serotonin, Meridia is a serotonin reuptake inhibitor. Like Prozac andother anti-depressants, Meridia "recycles" your brain's serotonin instead of increasing serotoninproduction. Meridia and Prozac are safer than Fenfluramine, as the excess serotonin fromFenfluramine is what led to heart problems in Phen-Fen users. However, serotonin reuptakeinhibitors are simply not as effective as Fenfluramine. Prozac might have some use for short-term weight loss, but in trials lasting longer than six months it is a failure. Patients might evengain more weight than a placebo when using Prozac (3). Since Meridia has similar properties asProzac, its lack of success as a new Phen-Fen does not surprise me. Attempt #2: Xenical (Orlistat)
This is an especially silly drug. Yes, clinical trials do show that patients on Xenical lose moreweight than a placebo, and even keeps weight off longer than Meridia does when the drugs wereterminated. Perhaps it was simply Pavlovian conditioning with the fear that when you eat fat youmay leak stool and get stinky.
In the real world, I predict Xenical will be even more of a flop than Meridia. Unlike studies onMeridia, the Xenical studies controlled for diet. Both the Xenical and the placebo groups wereput on restricted calorie diets. Strictly speaking, Xenical is not a classic anorectic drug likeMeridia, phentermine, or fenfluramine. Xenical does not effect appetite much but prevents yourbody from processing dietary fat by blocking the digestive enzyme lipase. As a result up to onethird of your dietary fat is excreted in your feces when you are on Xenical. So if you have twogroup of people each with consuming the same amount of calories, and the same dietarycomposition the group taking Xenical will lose more weight since they will be absorbing less
But let's look at real world conditions. Your average overweight person with a prescription forXenical will not have his food intake monitored closely by a scientist. However, this patient willknow that up to one-third of his fat calories will magically be gone. So do you think he willcontinue to eat as he was before, or might he be tempted to increase his fat intake by one-third?I'll let you be the judge, but I'm quite sure what the outcome will be. Since Xenical does notsuppress appetite or increase metabolism, I really doubt it will have any long term effects onweight loss. Xenical requires strict adherence to a low fat diet to have any effect, but its use willlikely encourage people to eat more high-sugar, high fat junk food instead of less. Xenical willalso cause a few unfortunate "bathroom-related" side effects. Anything that causes you to excretemore fat--leaky stool will inevitably make going to the bathroom a less pleasant experience, andcompound the social problems that the obese all ready have. Side effects of Xenical includeecal incontinence. The last side effect can beespecially embarrassing – fecal incontinence is just a polite, scientific way of saying that Xenicalcan make you "crap in your pants". Another problem is that the fat soluble vitamins--vitamin D,and the carotenes have been shown to be lowered in the Xenical studies. Researchers recommenddaily multi-vitamin supplementation for those taking Xenical . Probably all fat soluble vitaminlevels are ultimately affected—vitamin E, K etc.
I also don't like Xenical because it promotes the fallacy that fat is evil and responsible forobesity. As I'm sure most Mesomorphosis readers know, no macronutrient is "evil". There arefats that can make you slimmer such as Omega-3 fatty acids, and those that can be fattening suchas saturated fats and partially-hydrogenated fats. The key is to eat a diet balanced in proteins,fats, and carbohydrates with a good portion of the fat coming from Omega-3's. Someone who iseating a good, balanced diet should not take Xenical as it would mean less absorption ofbeneficial fatty acids for optimum human health. I really believe that the only people who canbenefit from Xenical are those with simply atrocious eating habits who simply cannot stay awayfrom potato chips, ice cream, and other such high fat, high starch foods. However, these are thelast people who I would prescribe diet drugs to. In the next installment of Anorectic Pharmacology Dr. Ullis will discuss the appropriateness ofthese drugs for athletes, bodybuilders or fitness enthusiasts. He will also cover issues such ascost effectiveness and give perspectives on future alternatives.References
1. Weintraub M, et al. "Long-term weight control study, I-VII". Clin Pharmacol Ther. 1992 May;51(5):586-94
2. Mcneely, Wendy, and Goa, Karen L. "Sibutramine: A Review of its Contribution to the Management of
Obesity", Drugs 1998 Dec 56(6) 1093-1124
3. Scheen, AJ, and Lefebvre, PJ. "Pharmacological Treatment of Obesity: Present Status", Int J Obes Relat
4. "OMR Meridia Survey Results" Obesity Meds and Research News, Volume 3, Issue 1 January/February
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Reader Survey Tell Us What You Think? 1. Its about time Think Muscle readers had their own no-nonsense line of affordable "research based" supplements!
[ ] I agree[ ] I’m not sure. [ ] I’m not interested. 2. If I had my choice, and I knew I could trust the manufacturing, I would want a high quality: (check all that apply)
[ ] Protein powder (not just another whey protein. I can get whey anywhere) [ ] Meal Replacement (the right protein with the right amount of carbs, essential fatty acids and Vit/Minerals) [ ] Thermogenic (based on ephedra, caffeine or other sympathomimetic(s) from research of its proper usage, safety, and efficacy) [ ] Essential fatty acid supplement (Omega-3s, CLA, Flax, or other body composition altering fatty acid) [ ] Anabolic/androgenic (prohormone based product known to produce androgen induced
muscle growth) [ ] Creatine (nothing fancy, just pure and free of industrial chemicals) [ ] Otyour wants and needs) 3. Research Update: Cycling Creatine, Steroids and the Heart, Meal Replacement Drinks
[ ] It was good. [ ] It was okay. [ ] I didn't like it. [ ] I'm not interested. 4. Creative Applications of Circuit Training: Fatigue Management Strategies for Bodybuilders: Part I by Charles Staley
[ ] It was good. [ ] It was okay. [ ] I didn't like it. [ ] I'm not interested. 5. Anorectic Pharmacology Part I: The Absurdity of the New Diet Drugs by Karlis Ullis, MD with Josh Shackman, MA
[ ] It was good. [ ] It was okay. [ ] I didn't like it. [ ] I'm not interested. 6. What type of articles would you like to see in the future? (Check all that apply.)
[ ] Anabolic Steroids and Pharmaceuticals[ ] Anti-aging medicine[ ] Body Transformation[ ] Children's Health and Nutrition[ ] Competitive Bodybuilding[ ] Diet and Nutrition Reviews[ ] Dietary Supplements[ ] Exercise Physiology[ ] Fitness Competitions[ ] Fitness Psychology[ ] General Health Topics[ ] Lifestyle Management[ ] Men's Health[ ] Powerlifting[ ] Seniors Health Topics[ ] Sports Specific Training[ ] Women's Health and Nutrition
We hope you have enjoyed the latest issue of the Think Muscle Newsletter. Suggestions?Comments? Questions? We'd love to hear them!
The Think Muscle Editorial Staff URL: http://www.thinkmuscle.com/
The information contained in this newsletter is for educational and entertainment purposes only and should not beinterpreted as a recommendation for a specific treatment plan, product, or course of action. This information is notintended to be a substitute for professional medical advice. You should not use this information to diagnose or treata health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcareprovider with any questions or concerns you may have regarding your condition.
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mostrar agradecimiento por una condecoración, formular una petición, ocasiones permanecía en Viena. En septiembre de 1898 Isabel fue próxima sala. Allí se encuentra también un cuadro de María Teresa o realizar una presentación al conseguir un puesto oficial. Francisco apuñalada en Ginebra por el anarquista italiano Luigi Lucheni con una como reina húngara, obra del pintor de cámara
REFERENCES .plosjournals.org/archive/1549-1676/5/3/supinfo/10.1371_journal.pmed.0050067.sd001.pdf. 1. Food and Drug Administration. Developing guidance on conducting scientifi- 9. Joffe HV, Parks M, Meyer R, Jenkins J, Temple R. Rosiglitazone and the FDA. cally sound pharmacoepidemiologic safety studies using large electronic health- N Engl J Med . 2007;357(17):1775-1776. care data set
Think Muscle Newsletter #13