Understanding of the various ways vitamin D effects the body is growing rapidly. Originally this vitamin was thought to only effect calcium in the blood and bone but recent research shows it possesses important influences on the immune system and cancer development. A study just published in Journal of Endocrinology and Metabolism June 2012 now shows that this same vitamin can possibly influence metabolism. A common disorder of metabolism known as Syndrome X or the Metabolic Syndrome is characterized by high triglycerides and low good cholesterol (HDL), abdominal obesity, along with elevated blood pressure and blood sugar. The researchers discovered those with vitamin D levels between 16 and 20 were 75% more likely to develop the Metabolic Syndrome within 5 years than those with vitamin D levels above 34 (levels below 30 are considered low).
Whether low vitamin D is the cause of the Metabolic Syndrome is unclear. Vitamin D prevents fat cells from reproducing, helps the natural process of triglyceride breakdown and helps regulate blood sugar by making insulin work more efficiently. Without enough vitamin D the fat cells could multiply faster, triglyceride levels accumulate and blood sugar rise as is seen in Metabolic Syndrome.
As I have explained in previous posts at metabolism.com, vitamin D is also related to development of hardening of the arteries (atherosclerosis) and obesity in Type 2 Diabetes which could be considered a more advanced form of Metabolic Syndrome.
Doctors’ efforts to monitor vitamin D levels are being hindered by new regulations by Medicare and private insurance carriers to deny payment for vitamin D screening. Lately, a number of my patients’ vitamin D tests were denied by insurance carriers with patients being charged over $200 per test because it was not “indicatedâ€.
Recommendations for vitamin D supplementation are debated. When skin is exposed to sunlight it manufactures vitamin D so there is thought that people who get sun exposure should not need vitamin D supplement but that is not borne out in reality. Previously the recommended daily allowance (RDA) was 400 units per day an amount which has been increased slightly for the elderly. Some experts recommend 1000 unit daily or more. In my practice I generally recommend starting at 1000 units and then rechecking 25 hydroxy vitamin D levels a few months later. Some individuals require 4000 unit or more daily to achieve vitamin D levels over 30. When purchasing vitamin D the D3 form appears to be converted in the body more rapidly than the D2 variety. High priced brands of vitamin D, in my opinion, are a waste of money.
Much as has been said recently about the health benefits of coconut milk and coconut oil. Coconut milk is a white liquid mixture of water and the white “flesh†of the coconut and is considered a more diluted form of coconut oil a thick clear liquid. Coconut extracts have been used in commercial food products, non-dairy creamers and cooking for many years but lately there has been a burst of publicity for coconut oil and milk as a new form of health-food with beneficial properties including increasing energy, preventing cancer and speeding weight loss. I have seen it being added to ice cream and even bottled water. I want to sound a note of warning here.
Most physicians and nutritionists will advise against having too much fat in the diet for a number of reasons. First, and most obvious, fats have lots of calories. In addition dietary fat can increase the bad cholesterol (LDL) content of the blood leading to increased risk of heart attack and stroke. Among the different kinds of fat that raise LDL the worst are the saturated fats. One tablespoon of coconut oil contains about 120 calories with about 90% of the coconut oil being saturated fat. In fact the saturated fat, palmitic acid, takes its name from the plant that produces coconuts, the palm tree. Compare this to the fat in dark chocolate which is 30% oleic acid, the healthy monounsaturated fat found in olive oil.
Oils which are far more beneficial for preparing foods are unsaturated fats including the monounsaturated and polyunsaturated fats. I like canola, safflower and olive oil due to their high content of these healthier fats.
Coconut oil has many other applications which are useful outside the body. It can be used as a diesel fuel, deodorant, insect repellent, to make soap, and as a moisturizer for hair and skin. My advice is to think twice however, before supplementing your diet with it.
The old saying, “The way to a man’s heart is through his stomach†implies there is a deep connection between emotions and eating. My guess is  no one is really surprised by this idea. Both men and woman can identify ways in which their mood and appetite are intertwined and it is no mere quirk of man’s personality that this is true.
Evolution tells us that we were born to eat. The earliest creatures in the world’s history were simple eating machines. Their bodies consisted of an entrance for food, a digestive tract and an exit for refuse. In order to become more efficient at getting food creatures developed a system to locate food and to move toward it. This system is known as a nervous system. The first creature to have this ability is the worm. Eventually the nervous system controlling the digestive system (enteric nervous system) began to sprout nodes which were early brains. As time went on and the brain became better developed it split off from the nervous system that controlled the digestive tract. Everything that followed in evolution, has served the purpose of developing  increasingly efficient brains (central nervous system) for acquiring the fuel of life.
Another example of how deeply connected the gut and brain are, is to look at the development of the fetus. When a human fetus is still just a lump of jelly, the digestive and nervous systems are one structure. Soon this organ splits into two, one to become our gastrointestinal tract and the other the brain and spinal cord (central nervous system). Even though they become physically separated the chemical signals used by the gut and nervous system remain virtually identical. These chemicals comprise the groups known as neurotransmitters and hormones.
The same chemicals in the digestive tract that cause the intestines to twist and convulse (peristalsis), in the brain stimulate the emotion of anxiety. This explains why people get “butterflies” in the stomach or diarrhea when they are nervous. The brain chemicals involved in depression can cause constipation.  The syndrome of irritable bowel disease (IBS) with its cycles of diarrhea and constipation is thought to be a reflection of an emotional rollercoaster.  The chemical relationship between mood and appetite is even more complex but no less real. One of the most common side effect of mood altering drugs is increased appetite and weight gain. Just ask anyone who has been on an anti-depressant drug such as Prozac, Zoloft or Abilify.  The chemical in marihuana that gets people high is famous for triggering the eating binge called “the munchies”.
Appetite suppressant drugs often have effects on mood and can be the source of major side effects. One new generation of appetite suppressants being developed, Acomplia, failed to be approved by the FDA because it caused severe depression and suicidal thinking.
In the next part of this series we will look at ways we can influence the brain to control our appetite.
Many members at metabolism.com have expressed concern that their cortisol level is either too high or too low. I thought it would be helpful to highlight the latest exchange I had on the subject.
Mohammed writes:
Hello: My overall dhea and cortisol levels are ok but cortisol is a little high what can i take to stabilise the level of cortisol, i know reducing stress and exercise e.t.c but i mean in terms of products is there anything that can balance cortisol, because i am suffering from low t3 and i know without good adrenal fnx thyroid supplemts wont be as effective
My reply:
As you know the adrenal gland produces a hormone that is vital to survival known as cortisol, cortisone, or glucocorticoid. You are correct that during stress the adrenal will produce more cortisol which helps prepare the body for aggressive activity or injury. When the stress is relieved cortisol levels return to normal. Excess of cortisol causes a disorder known as Cushing’s Syndrome and a deficiency is called Addison’s Disease or adrenal insufficiency. Both of these disorders can cause illnesses serious enough to result in death. Fortunately cortisol excess or insufficiency is very rare and when diagnosed in time can be controlled. Several years ago there was an unethical company marketing a product called Cortislim which they claimed reduced cortisol levels to induce healthy weight loss. This product was removed from the market. As far as I’m concerned there is no legitimate product that will safely reduce cortisol levels, nor should there be. The body regulates production of cortisol very carefully because it is such a potent hormone with potential to help and harm in major ways. I believe you would be safer letting your body decide what your cortisol level should be rather than trying to do it yourself. You can check out another of my blogs on the subject of adrenal function. My book Metabolism.com includes a section where I review the controversy about adrenal fatigue as well.
One aspect of lifestyle that is often overlooked is time spent sleeping. Getting adequate sleep is often sacrificed due to the demands of job and family. In the Sleep Heart Health Study over 1400 men and women were surveyed about their sleep habits and its relationship to diabetes and prediabetes. It was found that sleeping less than 6 hours per night was associated with increased risk of having diabetes. Interestingly, in those sleeping more than 9 hours per night there was an increased risk of diabetes and prediabetes.The authors of the study recommend trying to get between 7 and 8 hours of sleep per night to minimize the chances of developing blood sugar problems. To learn more about ways of preventing diabetes see pages 90 to 98 in my ebook “Metabolism.com”
Maintaining ideal body weight with diet and exercise is also crucial for avoiding diabetes and prediabetes.In overweight adults for each2.2 pounds(1 kilogram) gained per year the risk of developing diabetes increases about 50% over the next ten years. By losing 2.2 pounds per year the risk of developing diabetes is reduced about33% for the next 10 years (J Epidemiol Community Health. 2000; 54(8):596-602).
Speak to your healthcare professional to find out if you are at risk for developing diabetes and to learn ways you can avoid it.
Gary Pepper M.D.
Editor-in-Chief, Metabolism.com
The terms of service for metabolism.com apply to this and all posts; https://www.metabolism.com/2008/09/06/terms-conditions-service-agreement/
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing†in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
by Gary M. Pepper, M.D. and Sam Jeans, MSc The global anti-obesity drug market, in 2021was valued at over $2 billion. Within one year this figure had skyrocketed to $8 billion and is expected to climb to nearly $ 20 billion by 2027. This astounding growth is a reflection of soaring obesity rates, and the arrival of a new class of weight loss medication fueling a craze both in the USA and across the world.
The FDA and global health regulators, until very recently, had maintained a very tight ship when it comes to treating obesity with medication, placing the emphasis on diet and exercise rather than weight loss drugs. Since the 80s, anti-obesity drugs continued to be controversial, and a more stringent FDA implemented ongoing safety trials along with other precautions. There is some speculation that a shift in attitude toward approval of weight loss medication by the FDA , is underway
Weight loss drug controversies are far from over and, in fact, may soon rival the amphetamine crisis of the 70’s. For that reason, metabolism.com has felt it important to provide our guide to weight loss drug issues, past and present.
Anti-Obesity Drugs Timeline
Prescription drugs for lifestyle diseases such as obesity were marketed heavily throughout the 1950s to the 1970s. Amphetamines entered the public domain after the Second World War where they were used extensively in the military.
In the 50s, walk-in clinics prescribed diet pills with other medications almost at random, with or without genuine concern for one’s weight. These brightly colored pills became known as “rainbow pills”.
In the 1960s and 1970s, the so-called “rainbow pill diet” of pills was finally coming to an end as the FDA began to systematically ban many of the drugs involved. A high-profile expose by investigative journalist Susanna Mcbee, published in Life magazine, brought attention to this new modern public health crisis.
The rainbow pill diet combined amphetamines, laxatives, thyroid hormones, and even diuretics to produce extreme weight loss, combined with benzodiazepines, barbiturates, and steroids to reduce side effects, and antidepressants to suppress medication-induced insomnia and anxiety.
In 1968, rainbow pills were linked to over 60 deaths, with numerous accounts of their devastating impact surfacing in the news and media. Within just two months, 48 million pills were seized and destroyed. Nevertheless, amphetamine-based diet pills remained extremely popular throughout the 1970s. In 1978, some 3.3 million prescriptions for amphetamines were written each year, with some 50 million pills a year ending up in the black market.
In 1979, the FDA banned amphetamines as a weight loss aid, but that is hardly the end of the USA’s love affair with obesity medication.
Here’s a brief timeline of recent anti-obesity drugs:
