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Mark Hyman, MD

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Pharmageddon: Can a New Weight Loss Drug Really Save Us?

Posted: 02/27/2012 9:20 am

This week, in an act of desperation to turn back the tide of the obesity epidemic that now affects almost seven out of every 10 Americans and more than 80 percent of some populations (African-American women), the advisory committee to the Food and Drug Administration (FDA) voted 20 to 2 to recommend approval of Qnexa, a "new" obesity drug that is simply the combination of two older medications, phentermine (the "phen" of phen-fen") and topiramate (Topamax).

It is a misguided effort at best, and a dangerous one at worst. Mounting evidence proves that the solution to lifestyle and diet-driven obesity-related illnesses including heart disease, diabetes, dementia, and even cancer won't be found at the bottom of a prescription bottle.

By 2020, more than 50 percent of the U.S. adult population will have Type 2 diabetes or prediabetes, with annual costs approaching $500 billion. By 2030, total annual economic costs of cardiovascular disease in the U.S. are predicted to exceed $1 trillion. By 2030, globally we will spend $47 trillion, yes trillion, to address the effects of chronic lifestyle-driven disease.

Prescription medication for lifestyle disease has failed to bend the obesity and disease curve. Statins have been recently found to increase the risk of diabetes in women by 48 percent. And large data reviews by independent international scientists from the Cochrane Collaborative found that statins only work to prevent second heart attacks, not first heart attacks, which means they are not helpful and most likely harmful for 75 percent of those who take them.

Avandia, the No. 1 blockbuster drug for Type 2 diabetes, has caused nearly 200,000 deaths from heart attacks since it was introduced in 1999. The drug was designed to prevent complications of diabetes, yet heart attacks are the very disease that kills most Type 2 diabetics. In 2011, the FDA issued stricter prescribing guidelines for Avandia, but the drug is still on the market.

The large ACCORD trial found in more than 10,000 diabetics that intensive blood-sugar lowering with medication and insulin actually led to more heart attacks and deaths.

Something is deeply wrong with our medical approach.

The problem of chronic disease, including obesity, diabetes, and heart disease, is not a medication deficiency, but a problem with what we put at the end of our fork.

The emperor truly has no clothes. Why would good men and women of science vote to approve a medication for a condition that is a social disease and requires a social cure? The social, environmental, economic, and political conditions of America and increasingly the global community have created an obesogenic environment.

Clearly we need to do something. But it is not better medication or surgery or more angioplasties and stents, which have no proven benefit in more than 90 percent of those who receive them. The data show they work for acute coronary events, but not stable angina or blockages.

We continue to pay for expensive treatments for chronic disease, despite the fact that they don't work, while insurance does not pay for nutrition counseling unless the patient has kidney failure or diabetes.

Chronic disease is a food-borne illness. We ate our way into this mess and we must eat our way out.

Every year the average American consumes 24 pounds of French fries, 23 pounds of pizza, 24 pounds of ice cream, 53 gallons of soda (or a gallon each week), 24 pounds of artificial sweeteners, 2.7 pounds of salt, 90,700 mg of caffeine, and about 2,700 calories a day. And that's just the average.

Do we really think that we can medicate our way of this problem with a repackaged old diet drug (phentermine), combined with an older anti-seizure medication (Topamax)? Both these drugs have concerning side effects, including increased heart rate, heart attacks, and birth defects such as cleft lip.

I recently saw a patient on 26 medications and 450 units of insulin. This is Pharmageddon. His physicians were treating the downstream symptoms, not the causes. They were mopping up the floor while the sink was overflowing.

Large studies published over many decades show that 90 percent of coronary heart disease cases, 90 percent of Type 2 diabetes cases, and one-third of cancers can be avoided by maintaining a healthier diet, increasing physical activity, and stopping smoking. We must treat the cause, not the symptoms.

Mounting evidence points to the power of food to reverse heart disease, diabetes, and cancer, and even to lengthen our telomeres, slowing the aging process. In a recent study, intensive dietary change reversed advanced Type 2 diabetes in only 12 weeks. There is no medication that can achieve those results.

The science of epigenetics and nutrigenomics documents how food regulates gene expression and can upgrade our biologic software, reversing obesity, Type 2 diabetes and chronic disease.

There is a solution to our obesity epidemic. But it is not at the bottom of a pill bottle. It is at the end of our forks. It is simply more effective than any medication and works better, faster, and cheaper, not just as prevention, but also as treatment for what ails us in the 21st century. We can change our obesogenic environment through individual small choices we make every day, and by making changes in our homes, our families, our schools, our workplaces, our faith-based communities. We have the power to take back our health. Let's start today.

My new book The Blood Sugar Solution is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society. Obesity and diabetes is a social disease and we need a social cure.

My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our diabesity epidemic.

To learn more and to get a free sneak preview of the book go to www.drhyman.com.

For more by Mark Hyman, M.D., click here.

For more on diet and nutrition, click here.

For more on personal health, click here.

For more on weight loss, click here.

 
 
 

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10:44 PM on 02/28/2012
I wish the author hadn't used his post to promote his book. It might be a great book, but it makes me suspicious of his true motivations (and the integrity of his article).
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Chad Wheeler
04:56 PM on 02/29/2012
What is wrong with doing good work and expecting to be paid for it? Do you suspect your doctor of ulterior motives because he or she expects to get paid, or your attorney?
10:41 PM on 02/28/2012
I think that obesity is just going to get worse. The food industry creates food that is addictive as well as bad for you. You can try and exercise will power but you only have to drive down any street and see hundreds of fast food restaurants. TV is littered with commercials for food that tempts us. You can drive into a gas station and fill up on snacks. Food is available 24 hours a day, every day. All these "signals" overpower people despite their/our best intentions.

And of course it leads to our health care crisis. I laugh (and scoff) at any politician of any party who says he or she has a health plan that constrains health care costs. They're all meaningless without a wholesale change in the way we eat, what we eat, and how much we eat. Do I think that's possible? Well, we have put a dent in sickness and deaths caused by smoking. We could look learn from how we effected dramatically less smoking. But I think food is different (we all have to eat something), and I think the food and drug industries with their lobbyists and big bucks advertising dwarf, by far, that of the cigarette industry.

I think its hopeless.
01:33 PM on 02/28/2012
topamax is a horrible drug, I was on it for migraines, I barely took it twice, it is highly sedative and literally makes you dumb. Your thought process slows down and it makes it hard to concentrate.
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tygrrrress
Logic crashes on dangerous left turns.
03:39 PM on 02/28/2012
It can also raise your blood sugar. I was given it for headaches after a stroke and being a diabetic that just didn't make sense at all. I told my doctor I was done with it. Another side affect is upsetting your gut. For the 'just eat right' answers: I eat no sugar, add no salt, eat low-fat and limit my daily calories to 1800 per day. No family history of strokes or diabetes. Sometimes the body just malfunctions.
12:21 PM on 02/28/2012
As soon as I saw the part about the book, I too felt that this article was just self-serving advertising. However, it does bring up many points that will never be solved here. One thing I did notice though was that part about how taking meds for one condition caused another. That may be true but what are you supposed to do? Exercise and diet are very important, but not everything physically wrong with us can be solved by eating more fish and veggies and going for a walk. In some cases, you basically have to roll the dice and decide which condition you want to die from. You might get lucky and take the meds to control a disease and not have the side effects. Really, I don't find this to have been much of an "article" but more of a commentary by one doctor trying to sell a new book. Sad, HuffPost. Pretty sad. Yes, we ALL need to do better but there are a lot of reasons why we can't or don't. It isn't always a matter of willpower or just "doing it". I agree that some of it is just laziness. If you can, you should drop the fork and go for a walk but this article seems to take a complex issue down to one simple answer. I'm sorry to all of you hard liners out there, but there isn't one solution to this problem. If there was, we wouldn't be in this mess.
11:03 AM on 02/28/2012
No criticism from me. I'd just like to add what others here are saying (Finally!): the problem isn't fat, greasy foods, eggs, or even regular sugar. It's all of the complex carbohydrates which is from grains like wheat and rice that are the basis of our diets. Insulin is produced by the body to handle what are really these complex sugars. They are then stored as fat to be burned (or not) later. Using our own fat for energy is a complex process and much of that fat is really not available for the body to use. Artificial sweeteners have been shown to prime the body for a sugar that never arrives causing it to produce insulin that is not used adding to its increasing ineffectiveness, 'insulin resistance'.
10:53 AM on 02/28/2012
I WAS 56 WHEN I HAD MY MASSIVE HEART ATTACK..ALMOST LEFT HER...I WAS LUCKY..I SERVIVED..I NOW GET UP AT 5AM & WALK 4 MILES IN LESS THAN AN HOUR... I ALSO LOST 35 LBS. ...I WALK WITH 2 OTHERS ..ONE IS 82 & THE OTHER IS 74...THEY ARE MILITERY RETIRED.....THEY HAVE BEEN DOING THIS ALL THEIR LIVES & ARE INGREAT SHAPE... I TURNED 68 TODAY & FEEL GREAT ...NO PILL CAN DO THIS....I DONT EVEN TAKE BLOOD PREASUR MED...GET OFF YOUR BUTT & LIVE........
10:52 AM on 02/28/2012
I was with the writer of the article up until he mentioned "his book". Then this article was nothing but an advertisement. He is just out for money.

Truth be told, nothing, ABSOLUTELY NOTHING is going to change America's eating problems. Corporate America will not let it happen. Here's what needs to happen-

-Ban advertising of unhealthy foods
-Ban unhealthy foods
-Ban Alchohol
-Regulate sugar
-abandon dwarf wheat, return to natural, non-genetic wheat.

But we all know this will not happen. Also, notice I did not mention "people acting responsibly". Because we all know this just will not happen. As a society we are doomed and we should just accept it and move on.

Sad.
02:09 PM on 02/28/2012
We've already tried the "ban alcohol" thing (and didn't THAT work well!). The others will just create a market for bootleg Twinkies and Pizza Hut.
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Chad Wheeler
04:58 PM on 02/29/2012
Why is "his book" in quotation marks?
HUFFPOST SUPER USER
Dancenownzen
10:46 AM on 02/28/2012
All these pills abd diets are just making that industry BILLIONS of dollars.

Change your eating habits and STOP eating crap
Get out and move your body

we have known these two fact for decades - just DO IT
01:57 PM on 02/28/2012
Amen to that one!
10:43 AM on 02/28/2012
Look at all the stuff that's put into food these days. While the food is being "preserved," what's happening to us? Yet, the FDA allows all of these unnatural things to go into our food. They allow our foods to be chemically treated, hormose induced, salted to death. Even when there were no sugar substitutes, people were slimmer. The fact is that we don't know what we're putting into our bodies any longer. Our Congress isn't doing anything about it either. No, they're more concerned about sending billions of dollars to nations that hate us.
Huffedit
Your micro-bio is empty
10:38 AM on 02/28/2012
My opinion is if a food addict needs help of the various drugs out on the market, it's no different then patches, well butrin and other various aids used to break addictions.
11:08 AM on 02/28/2012
I was right about to say something about that...while Wellbutrin is prescribed for depression, it has an alter known as Zyban that helps people stop smoking. The addiction fighting side of this drug is pretty powerful and can indeed help people with food addiction. I even think it's being tested as a weight loss drug?
Huffedit
Your micro-bio is empty
10:36 AM on 02/28/2012
Imagine a foot-high pile of broccoli, or a giant bowl of apple slices. Do you know anyone who would binge broccoli or apples? On other hand, imagine a mountain of potato chips or a whole bag of cookies, or a pint of ice cream. Those are easy to imagining vanishing in an unconscious, reptilian brain eating frenzy. Broccoli is not addictive, but cookies, chips, or soda absolutely can become addictive drugs.

The "just say no" approach to drug addiction hasn't fared to well, and it won't work for our industrial food addiction, either. Tell a cocaine or heroin addict or an alcoholic to "just say no" after that first snort, shot, or drink. It's not that simple. There are specific biological mechanisms that drive addictive behavior. Nobody chooses to be a heroin addict, cokehead, or drunk. Nobody chooses to be fat, either. The behaviors arise out of primitive neurochemical reward centers in the brain that override normal willpower and overwhelm our ordinary biological signals that control hunger. Consider:

* Why do cigarette smokers continue to smoke even though they know smoking will give them cancer and heart disease?

* Why do less than 20 percent of alcoholics successfully quit drinking?

* Why do most addicts continue to use cocaine and heroin despite their lives being destroyed?

* Why does quitting caffeine lead to irritability and headaches?

http://www.huffingtonpost.com/dr-mark-hyman/food-addiction-could-it-e_b_764863.html
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HUFFPOST SUPER USER
dsws
No owning ideas. Limit only commercial use.
10:32 AM on 02/28/2012
Qnexa doesn't sound as promising as orlistat, but I'm glad you passed along the news about it.
Huffedit
Your micro-bio is empty
10:29 AM on 02/28/2012
Just think people, if all the dieting and exercise worked so well, we wouldn't have the problems we do now. What has changed? Yes we do get less exercise but the majority of the change has come from the food we eat.

http://www.huffingtonpost.com/dr-mark-hyman/food-addiction-could-it-e_b_764863.html
Huffedit
Your micro-bio is empty
10:18 AM on 02/28/2012
Seeing over weight people that work a farm or horse farm all day, that do physical labor all day and they are still over weight, I do not believe all are just lazy or eat too much. As we have eaten healthier(low fat) we are in worse shape than ever. Fat does not make you fat. Starches/carbs are what is making people fat. Processed foods are what is making people fat. Until we move back to natural whole/raw foods we will have a problem. Processed foods need to be outlawed.
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daniel o
09:28 AM on 02/28/2012
Wonder how much Big Pharma gives to Sarah Palin, who attacks any suggestions about improved diet and exercise as an attack on our freedom.

They're after our freedom. Our freedom!
11:09 AM on 02/28/2012
I really don't think Sarah Palin has anything to do with this.