Oats fibre as effective as Ozempic

From Science Alert

 

Research on the gut microbiome has triggered a 'revolution' in nutritional science, and in the last few years, dietary fiber has become the "new protein" – added to foods in abundance to feed our gut and boost our health.

A recent study on mice, however, suggests not all fiber supplements are equally beneficial.

A form that is readily found in oats and barley, called beta-glucan, can control blood sugar and assist in weight loss among mice fed a high-fat diet.

Researchers at the University of Arizona (UA) and the University of Vienna say it is the only type of fiber supplement they tested that decreased a mouse's fat content and body weight within 18 weeks.

The other fibers considered, including wheat dextrin, pectin, resistant starch, and cellulose, had no such effect, despite shifting the makeup of the mouse microbiome significantly compared to mice fed no fiber supplements.

"We know that fiber is important and beneficial; the problem is that there are so many different types of fiber," explained biomedical scientist Frank Duca from UA in July.

"We wanted to know what kind of fiber would be most beneficial for weight loss and improvements in glucose homeostasis so that we can inform the community, the consumer, and then also inform the agricultural industry."

Dietary fibers are the main source of energy for bacteria living in our guts, and yet less than 5 percent of people in the US consume the recommended 25–30 grams (0.9–1 ounce) of fiber a day.

To make up for this, fiber supplements and 'invisible fiber'-infused foods are growing in popularity. But fibers are extremely diverse, so which do we choose?

Some fibers, like oat beta-glucans and wheat dextrin, are water-soluble, meaning they are easily fermented by gut bacteria.

Others, like cellulose and resistant starch, are less soluble or insoluble, meaning they stick to other materials to form stool.

Until now, writes biomedical scientist Elizabeth Howard from UA and her colleagues, "there is no study that has investigated the role of various fibers in one cohort."

To make up for this, the current study tested several forms of fiber in one cohort of mice. Only beta-glucan was found to increase the number of Ileibacterium found in the mouse intestine. Other studies on mice have linked this bacterium to weight loss.

Sure enough, long before the 10-week marker, mice fed beta-glucan showed reduced body weight and body fat content compared to mice fed other forms of fiber.

The findings align with another recent study by Duca, which fed barley flour, rich in beta-glucan, to rodents. Even though the rats continued eating just as much of their high-fat diet as before, their energy expenditure increased and they lost weight anyway.

A similar outcome was observed in mice fed beta-glucan in the new study. These animals also showed increased concentrations of butyrate in their guts, which is a metabolite made when microbes break down fiber.

Butyrate induces the release of glucagon-like peptide-1 (GLP-1), which is the natural protein that synthetic drugs like Ozempic mimic to stimulate insulin release.

"Part of the benefits of consuming dietary fiber is through the release of GLP-1 and other gut peptides that regulate appetite and body weight," said Duca.

"However, we don't think that's all of the effect. We think that there are other beneficial things that butyrate could be doing that are not gut peptide related, such as improving gut barrier health and targeting peripheral organs like the liver."

Far more research is needed before these results can be extended to humans, but the findings suggest that some fibers may be better suited to weight loss and insulin control than others.

The study was published in the Journal of Nutrition.

Unless you have gluten intolerance, eating oats for breakfast seems like a good idea.  Fibre is good for you and helps reduce the risk for bowel cancer.  It seems plausible that it might also reduce weight. 

Wegovy dramatically cuts cancer risk

From The Guardian

Weight-loss drugs offer a new weapon in the global fight against cancer, with “enormous potential” to [both] prevent new cases and shrink tumours, doctors said as research showed the jabs can cut the risk of developing the disease by a fifth.

Blockbuster injections such as Wegovy [Ozempic] have revolutionised the treatment of obesity, and recently been approved for use in other areas of medicine, including reducing the risk of heart attacks, strokes and cardiovascular-related deaths.

Now experts say they increasingly believe weight-loss drugs could play a big role in preventing and treating cancer, the second leading cause of deaths globally.

A study presented at the world’s largest cancer conference found patients taking the drugs were 19% less likely to develop 13 obesity-related cancers, including ovarian, liver, colorectal, pancreatic, bowel and breast cancer.

The research involving 34,000 people, led by the Case Western Reserve University in Ohio, also found patients were half as likely to die over 15 years compared with patients not taking the jabs, also known as GLP-1 receptor agonists (RA).

The study co-authors, Dr Cindy Lin and Dr Benjamin Liu, said: “Our findings are significant in that they could change the paradigm of obesity management by suggesting early intervention with GLP-1 RAs could delay or prevent obesity-related cancer development.” There could be “multiple” ways in which the drugs cut the risk of cancer – not just by helping people to lose weight, they added.

A second study published at the American Society of Clinical Oncology (ASCO) annual meeting suggested weight-loss drugs could reduce the risk of cancer coming back in breast cancer patients – and boost their prospects of long-term survival. Researchers from Memorial Sloan Kettering Cancer Centre in New York said the jabs could cut the risk of cancer recurrence and be a “new tool” against the disease.

A third paper released at ASCO and led by Yale University, also looking at breast cancer patients, suggested taking weight-loss drugs reduced the chances of the disease returning.

Speaking in Chicago at ASCO, Dr Mitchell Lazar, the director of the institute for diabetes, obesity and metabolism at the University of Pennsylvania School of Medicine, said: “GLP-1 based therapies are highly effective at producing weight loss, and thus one of the fundamental mechanisms by which they improve cancer outcomes is via the impressive weight loss that they produce.

“Obesity is a risk factor for nearly all cancers, in both men and women. Thus the revolution in the medical treatment of obesity has enormous potential to prevent new cancers, reduce the severity and growth rate of existing tumours, and synergise with new cancer-specific therapies.”

Dr Jennifer Ligibel, a senior physician at Dana-Farber Cancer Institute who was not involved with the studies, said: “These are exciting, preliminary findings of a link between use of GLP-1 RAs and cancer risk.” They added to previous work suggesting the drugs could reduce cancer risk, she added.

A study published last December showed they were associated with a 50% reduced risk of bowel cancer in people with type 2 diabetes. “Individuals with diabetes who were prescribed a GLP-1 RA had a lower risk of colorectal cancer as compared with individuals who were not prescribed one of these drugs,” Ligibel said.

Dr Julie Gralow, the chief medical officer of ASCO, said the evidence was not clear yet as to whether the potential benefits of weight-loss drugs in reducing cancer risk were just as a result of weight loss – or whether there were other, unknown factors at play.

Gralow, a world-renowned cancer expert who was named woman oncologist of the year in 2023, said she was absolutely certain the jabs would become a much greater focus of cancer prevention research in the future. “The more we can do to reduce the risk factors and prevent cancer, the better,” she added.

“I do think that there are so many potential and already proven health benefits to these drugs, that it would be icing on the cake if we saw that they were also reducing cancers.

“I am very hopeful about overall improvements in health from this class of drugs.”

Cancer Research UK’s chief clinician, Prof Charles Swanton, cautioned it was still “early days”. There have been suggestions the drugs could even raise the risk of certain cancers, although recent research on thyroid cancer and pancreatic cancer has cast doubt on those concerns.

“Well-designed prospective trials with randomised data will provide more clarity on the potential and safety of weight-loss drugs to lower people’s risk of cancer,” said Swanton.

One wonders what the antiscience and antivaxxers think about this.  Will the far right take us back to the middle ages, more than just socially?

Ozempic reduces heart attack risk by 20%

I've tried all my life to control my weight.  I've tried umpteen diets, exercised, starved myself, and still my weight has barely fallen.  Because I'm vegetarian (actually, mostly vegan), I have normal cholesterol, normal blood sugar, and OK blood pressure despite my age and my fatness.  But my weight exacerbates the pain in my knees and back.  If I could lose weight, I might be able to walk again, and get fitter. 

Now, we have really, really effective drugs which will help us slim, eliminate diabetes, and also reduce heart attack risk.  It's like something out of science fiction!   I haven't asked my doctor to prescribe Ozempic for me, because there is still a shortage and people with diabetes should get it first.  All the same, one day I might be slim enough to walk for pleasure, like I used to, to climb stairs easily, and to be free of pain.  Here's to science and medical research!

From The Guardian

A weight loss injection could reduce the risk of heart attacks and benefit the cardiovascular health of millions of adults across the UK, in what could be the largest medical breakthrough since statins, according to a study.

It found that participants taking the medication semaglutide, the active ingredient in brands including Wegovy and Ozempic, had a 20% lower risk of heart attack, stroke, or death due to cardiovascular disease.

The study, presented at the European Congress of Obesity (ECO) and led by researchers at University College London, also found that semaglutide brought about cardiovascular benefits for its participants, regardless of their starting weight or the amount of weight that they had lost. It suggests that those with mild obesity or who have lost only a small amount of weight could have an improved cardiovascular outcome.

Prof John Deanfield, the director of the National Institute for Cardiovascular Outcomes Research and the lead author of the study, said the findings showed that the medication should be routinely prescribed to treat cardiovascular illnesses, and that millions of people across the UK could be taking the medication in the next few years.

“This fantastic drug really is a gamechanger. This [study] suggests that here are potentially alternative mechanisms for that improved cardiovascular outcome with semaglutide beyond weight loss … Quite clearly, something else is going on that benefits the cardiovascular system,” Deanfield said.

The study involved 17,604 adults aged 45 and over with a body mass index of over 27 from across 41 countries. The participants, who had also previously experienced a cardiovascular event such as a heart attack, were prescribed either a 2.5mg weekly dose of semaglutide or a placebo for an average period of 40 months.

Of the 8,803 patients in the semaglutide group, 569 (6.5%) experienced a primary cardiovascular end-point event, such as a heart attack, compared with 701 (8%) of the 8,801 patients in the placebo group.

Semaglutide under the brand name Wegovy has been prescribed for weight loss on the NHS since 2023.

Deanfield said that in the 1990s, statins – drugs that lower cholesterol – were considered a medical breakthrough and revolutionary in treating cardiology practice, and he said semaglutide could be seen as similarly groundbreaking in regarding to improving cardiovascular health. “We now have a class of drugs that could equally transform many chronic diseases of ageing,” he said.

Prof Jason Halford, president of the European Association for the Study of Obesity, said that as the medication could be seen to improve cardiovascular health, it could be economically beneficial for it to be prescribed widely.

“I think in the next 10 years we’ll see a radical change in the approach to healthcare,” he said. “Once the costs come down then the cost savings to the NHS will be significant. There are already people in the Treasury thinking about the savings to the economy because of the opportunity to boost productivity. You need to get your workforce as fit as possible.”

About 7.6 million people in the UK are living with heart or circulatory disease, according to the British Heart Foundation.

Another study based on the same clinical trial found that participants who were prescribed semaglutide lost an average of 10.2% of their body weight and 7.7cm from their waist over a four-year period, while the placebo group lost 1.5% of body weight and 1.3cm from the waist.

A separate study looking at a new slimming jab has found that it could be much more effective than those already on the market. Retatrutide, a weekly injection, works by suppressing appetite and also by helping the body burn more fat, according to its phase 2 clinical trial.

The trial of 338 participants living with obesity showed that participants lost 24% of their body weight over a 48-week period. Researchers say it is more effective for weight loss than Ozempic or Wegovy, which only work by suppressing appetite.

Prof Naveed Sattar, of the University of Glasgow, who has worked on trials of other weight loss treatments, said: “Five or 10 years ago, we could never have imagined drugs that would cause this kind of weight loss. The trial suggests retatrutide still hadn’t plateaued, so it’s probably going to see more weight loss. If we give this drug even longer, I think it could reach nearly 30% of someone’s body weight.”

A remarkable new weight-loss drug

From Melbourne's The Age newspaper

Scientists and advocates say new anti-obesity drugs generating remarkable levels of weight loss in clinical trials will once and for all dispel the myth that obesity is simply the result of making unhealthy choices, rather than a genuine disease.

The emergence of the new drug, marketed locally as Wegovy, promises to revolutionise weight-loss treatments. In one major clinical trial patients using the drug lost 11 per cent more body weight than those undergoing an intensive diet and exercise program.

Scientists and campaigners have long rejected the popular narrative that obesity is solely the result of unhealthy choices. Wegovy’s dramatic results might provide the sort of black-and-white proof that convinces society at large, they hope, that it is a disease and needs to be treated as such.

“I think it will reframe the argument. As these drugs become more effective and available, it will be harder for people to ignore them,” said Professor Brian Oldfield, a leading obesity researcher at Monash University and editor of the field’s top academic journal.

Tiffany Petre, director of the Obesity Collective, said she “hopes this drug changes conversations about obesity in society”.

“People with obesity haven’t been able to get appropriate healthcare. Now there is something on the market.”

Governments around the world have poured hundreds millions of dollars into public health campaigns that aim to tackle obesity by encouraging healthy eating and exercise.

Then-prime minister John Howard in 2004, for example, rolled out a $116 million program to pay for after-school sports and healthy-eating education for families – while also rejecting plans to ban fast-food advertising in children’s TV programs.

While healthy eating and physical activity are vital for good health, decades of evidence suggest they simply do not lead to large amounts of weight loss, said Oldfield. “They are not enough by themselves. They typically give a 3 to 5 per cent reduction in body weight.”

This problem shows up in a large trial of Wegovy published in JAMA early last year. Some 611 volunteers were given ‘Intensive Behavioral Therapy’: eight weeks on a supervised very-low-calorie diet, followed by more than a year of a low-calorie diet.

They were also asked to do 100 minutes of exercise a week, eventually increasing to 200 minutes, and received 30 visits from a dietitian. “That’s extreme and unsustainable,” said Oldfield.

After this enormous effort they lost, on average, 5.7 per cent of their body weight. A subgroup who did all this and took Wegovy lost 16 per cent of their body weight – an average of 16.8 kilograms.

Wegovy, which was approved by Australia’s medicines regulator for weight loss last year, mimics a natural hormone that slows down how fast the stomach works, making people feel fuller for longer. It also seems to affect how the brain regulates appetite.

The drug does come with side effects – particularly nausea – and in clinical trials about 6 per cent of volunteers are forced to drop out. Experts caution it is not a silver bullet and must be used alongside diet and exercise.

Several years ago, Professor Stephen Simpson, director of the Charles Perkins Centre at the University of Sydney, and his team ran a series of focus groups looking at how to change people’s opinions about the cause of obesity.

“People have this deep-seated view it is their fault, particularly those with living experience. It’s deeply held and pervasive,” he said. (Oldfield has received fees from the drug’s sponsor Novo Nordisk, as has Obesity Australia; Simpson sits on that organisation’s board).

This stigma has even shown up in the response to recent Wegovy shortages, said Simpson, with some seeking to blame people with obesity for seeking medical treatment for their condition.

The most-effective tool, he found in his focus groups, was to “smash the frame” – to disrupt people’s idea that obesity was caused by predominantly by bad choices.

“One of the most powerful ways of pushing back against that, we found out very quickly, is to say it is biological. There is a powerful biology that underpins obesity.” The success of Wegovy, he said, “is clearly indicating there is a profound biological underpinning”.