Shortly after recommending approval of Qnexa (Phentermine / Topiramate), the FDA advisory panel this week also voted to approve Arena Pharmaceuticals weight loss drug, Lorgess (Lorcacerin). This medication has been in clinical trials over the past several years and works through the 5HT2c sub-type Seratonin receptor in the brain.
Why is this important? What is 5HT2c? Well, Lorgess is a seratonin agonist – that means it triggers the release of seratonin. Sound familiar? The big hit weight loss drug of the 90′s, Fenfluramine worked as a seratonin agonist as well. That was when it was discovered that we had seratonin receptors in lots of places, not just our brains. In fact, we have a seratonin receptor in heart valves. That’s why Fenfluramine caused heart valve damage.
Fast forward to 2012. We now have the technology to target specific seratonin receptors. By targeting the 5HT2c receptor, Arena Pharmaceuticals has been able to develop a medication that targets only the brain, with little to no activity in the heart. They have done careful safety studies, and have proven that their new obesity drug is both safe and effective.
The FDA panel is scheduled to vote on Qnexa on July 17th, and on Lorgess on June 27th, but they are under no obligations to follow their advisory panel’s advice.
So, will 2012 be the first year in 13 years that we get a new obesity treatment? Stay tuned…
Another hot topic at this year’s American Society of Bariatric Physicians meetings here in Denver, CO this year was the Mediterranean Diet. Dr. Scott Rigden gave a very interesting review.
Interest in this style of diet was really sparked in 1999 by the Lyon Diet Heart Study. In this study, participants were asked to either follow a Mediterranean Diet, or to follow an American Heart Association (AHA) style diet. After 5 years, the study was stopped early due to excess mortality in one group.
Which group? The AHA diet group. In fact, comparing the 2 groups, those following the Mediterranean Diet experienced a drop in Total Mortality (death rate) by an astounding 72%, and a drop in death rates from Cardiovascular events of 47%.
We’ve now had 13 years to ponder these results. Even though there was no significant change in blood cholesterol, blood pressure or weight between the 2 groups, the answer seems to be inflammation. Because the Mediterranean style of eating incorporates a much higher intake of nutrients known to decrease inflammation (like Omega 3, Gamma Tocopherol, Flavenoids, Coumarins and Anthrocyanins) and excludes many nutrients known to increase inflammation (Omega-6, linoleate and arachidonate, iron, trans fats, and alpha tocopherol), it results in marked decrease in inflammatory mediators in the body (c-reactive protein, interleukin 6, and white blood cell count).
It appears to have benefits for a variety of conditions including:
- Obesity
- Diabetes
- High Blood Pressure
- Metabolic Syndrome (Insulin Resistance)
- Cardiovascular Disease
- Inflammation
- Alzheimers Dementia / Parkinsons
- Depression
- Certain Cancers
- Sexual Function
So, what is the Mediterranean Diet? There are actually several styles of Mediterranean Diet and several good books on the topic, but in short:
- Eat Large Quantities of minimally processed plant based foods including fruits, vegetables, whole grains, legumes, seeds and nuts.
- Olive oil is the principal source of dietary fat.
- Low consumption of red meat and dairy products (some authors suggest moderate intake of low-fat dairy).
- Wine in low to moderate amounts with meals.
- Eat fish and healthy fats.
- Engage in regular physical activity.
If you are interested to learn more, be sure to talk to your Clinical Nutrition Center Dietitian to learn how to incorporate these principals in to your eating plan.
