Do I need a new diet? Is mine safe?

The European Union (EU) are constantly assessing the formulations of very low calorie diets (VLCDs) such as the Lipotrim pharmacy weight management programme.

There has been no recommendation to alter the formulation of VLCDs that has been passed as law in the EU. The EU laws cover all EU members including the UK and Ireland.

The discussions within the political powers has over the years revolved around whether:

• VLCDs should include MORE Linoleic Acid and Linolenic Acid (Omega-6 and omega-3 essential fatty acids)
• VLCDs should include MORE protein
• VLCDs should contain more calories

Our blog post on the Lipotrim Ireland website discusses these issues in detail.

The list above is just that: a list of possible talking points. VLCDs in their current form have a much valued position in the prevention and treatment of obesity, with an excellent safety record spanning decades.

The scare stories will unfortunately most likely carry on, but rest assured the Lipotrim programme, delivered by healthcare professionals throughout the UK and Ireland, is still delivering safe and significant clinical outcomes every day.

https://ireland.lipotrim.com/?p=611&preview=true

Pharmacy sector tackles budget cuts every day

Is Healthcare so expensive because the NHS are using the wrong treatments?

Northern Ireland is facing another round of budget cuts, sparking further protests. This time the Chartered Society of Physiotherapy joined other trade unions outside Stormont, sharing their anger towards the never-ending decrease in healthcare funding. Read article

A proposed £70 million of cuts to patient healthcare services has encountered the usual hostility, but we've picked up on one very interesting point raised.

"Simply cutting services, they say, is a false economy.  If patients do not get the care they need, when they need it, their conditions will worsen and require further support at a greater cost to the NHS."

 Excess weight is often the major cause, or at least seriously contributes to the severity, of a significant percentage of diseases and conditions requiring costly medical treatment.
It is understandable that budget cuts are often the catalyst for anger and frustration, especially when it relates to potential job losses and the likely consequence of a reduction in the level of patient care. Instead of pouring vast sums of limited money into treatments that have questionable efficacy, why not treat the excess weight properly.  It will likely preserve many jobs and can really improve patient care outcomes.

Weight management underpins almost every aspect of a person’s health and the NHS as a whole. Carrying excess weight is the catalyst for many of the main diseases that cause the NHS to haemorrhage money. Type 2 diabetes, cancer and high blood pressure are just three such diseases.

The false economy is not the budget cuts, which could hurt the already poor NHS, but the lack of foresight when it comes to the tremendous benefits coherent weight management options could offer.

"If patients do not get the care they need, when they need it their conditions will worsen" 

Care is defined as the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

Weight loss NOW, not in the distant future, is the care that is required. 

For those individuals, where excess weight and obesity is one of the main contributing factors to their ill health, care through weight management is critical.

The person with type 2 diabetes, or high blood pressure, has high risk factors for heart disease. There is also a high risk of a need for amputation, a high risk of cancers, fertility problems, muscle and joint problems, depressive illness and overall, a poor quality of life. The usual medication given to alleviate the symptoms of diseases and conditions such as these is important, but why not treat the real problem as well?

Weight management could be the care of choice for treating the ailing NHS, potentially saving it a fortune.

Pharmacist Fin McCaul & Prof. David Haslam discuss the benefits to healthcare & NHS.

Type 2 diabetes is reversible.  An obese type 2 diabetic requires the obesity to be removed possibly at least as much as taking a diabetic medication. Removing excess weight is enough to force many type 2 diabetics into remission. Weight loss is well documented in its ability to reduce high blood pressure and it now seems to have importance in cancer prevention, possibly even treatment.

The Lipotrim pharmacy weight loss programme is run throughout the UK and Ireland using nutrient complete formula foods that produce fast, reliable and healthy weight loss.
The care, offered by healthcare professionals, means Lipotrim may just be the best thing since sliced bread.

A type 2 diabetic can indeed be forced into remission by the weight loss. In fact the weight loss results using Lipotrim are such that the remission occurs within the first few days of the weight loss phase, resulting in the need for the cessation of most diabetic medication on day 1 of the diet (with GP cooperation).

Read more on treating type 2 diabetes with weight loss, and Lipotrim here....

In essence we should be protesting about why the health services are not geared more towards preventing the issues from worsening rather than treating the symptoms.

The correct care package is not being routinely delivered by the NHS but it doesn’t need to be.

NHS budget cuts may be essential but the simple recognition, and recommendation, of the Lipotrim Pharmacy weight management programme may just be the care the NHS requires. 

Lipotrim helpline

UK  0800 413 735
ROI 0152 55636

Stop the amputations - Type 2 diabetes cured by diet alone but is this revolutionary?

Tackling obesity head on can REVERSE type 2 diabetes and help Stop the amputations.

Obesity and type 2 diabetes are in the news again.
This time it is another "revelation" that type 2 diabetes can be
reversed through weight loss, as described in the BMJ:

Beating type 2 diabetes into remission BMJ 2017; 358 doi (Published 13 September 2017)

Professor Roy Taylor's research has been published and the evidence shows type 2 diabetes can be reversed and maintained through weight loss and weight maintenance. The fanfare that has accompanied the Counterpoint study (published 2011) and the Counterbalance study (published 2016) is surely justified.

News on the obesity epidemic currently fueling record levels of amputations adds to the urgency for an effective method of treating obesity related type 2 diabetes (Telegraph  29/09/17):

 "Britain’s obesity epidemic is fuelling devastating numbers of amputations - almost all of which could have been prevented, experts have warned. Official figures show the number of cases have reached an all-time-high, with  more than 8,500 procedures carried out last year as a result of diabetes.  Nine in ten cases of the condition are type 2, which is linked to obesity and inactivity.  Official figures from Public Health England show 23 amputations are carried out every day, with a 16 per cent rise in interventions between 2013 and 2016, compared with the previous three years…..
People with diabetes have an increased risk of foot ulcers, which can deteriorate
quickly."

What have these new studies found?

The Counterpoint study was the first of these studies into the effect of weight loss on type 2 diabetes. Phase 1 of the Counterpoint study found that in the 40% of individuals who responded to their Very Low Calorie Diet formula (VLCD),  the type 2 diabetes was forced into remission lasting for at least 6 months. The resulting improvement in insulin secretion was seen without the presence of any diabetic medication. Insulin sensitivity was also seen to be improved.
Phase 2 of the study involved a controlled weight maintenance programme which was shown to be successful in preventing weight gain after the phase 1 weight loss using a VLCD.

The Counterbalance study demonstrated the long term remission of type 2 diabetes, of up to 10 years, so long as the weight lost through a VLCD was maintained.

It should be noted that in these studies, the use of VLCD formula foods allowed for sustained, comfortable weight loss, with the authors stating any similar VLCD formula food would give similar results:

 Although Optifast was used in the study, this is not readily available in the UK. An alternative liquid food supplement of similar calorific content is equally suitable.

There is no excuse for continuing the appalling number of amputations. The Lipotrim VLCD is available in over 2000 pharmacies and medical practices and has been for more than 30 years. Effectively treating type 2 diabetes in the UK must become standard now.

The Newcastle work is valuable research into the positive effect very low calorie diets (VLCDs) have on weight loss and especially type 2 diabetes and will add to the ever increasing Lipotrim data we have been producing.

The research into type 2 diabetes and weight loss using VLCDs at Newcastle is now continuing through a very large donation made to Diabetes UK. The study is called DiRECT (DIabetes REmission Clinical Trial) and is questioning whether type 2 diabetes can be routinely reversed in Primary Care and whether these interventions are better than conventional treatment.

We all eagerly await the DiRECT study results.

These "new" revelations could, and should, turn the medical world upside down. Type 2 diabetes could virtually be confined to the history books.

Why is this news neither new nor revolutionary?

The effect of weight loss on type 2 diabetes is already in the history books!
We should not wait for it any longer. 150 years is enough!

The issue is that this is not new news and no-one in the 21st century has just "discovered" that weight loss can reverse type 2 diabetes.

"The skim-milk treatment of Diabetes and Bright's disease" by Arthur Scott Donkin, first published way back in 1871, appears to be visionary. This excellent publication details much of the "new" concepts included in the Counterpoint and Counterbalance studies.

When explaining the results taken from his diabetic subjects in the 1800s, using the Skim-milk treatment, Donkin found that he had:

"in several very successful instances considered it unnecessary to prescribe any medicines whatever"

This treatment was a crude form of the modern day VLCDs such as that used in the two modern day studies into diabetes and weight loss, and it too was forcing diabetic remission. The book goes on to talk about phase 2, as in the Counterpoint study, where food is reintroduced carefully to help maintain weight long term. It says:

"After complete recovery from diabetes, a strict regimen, excluding vegetable substances containing starch and sugar, must be adhered to for a lengthened period, the exact limit of which is impossible to determine, in consequence of the strong tendency which these substances have to excite a return of the disease........With such persons, therefore, a cure is purely conditional"

Professor Donkin had already demonstrated in 1871 that diabetes was able to be forced into remission by controlled weight loss methods, similar to modern day VLCDs such as Lipotrim, and those patients being then able to remain in remission so long as the weight loss is maintained.

What do we need to take away from these new vs old revelations?

This is a story with a happy ending, or so we at Lipotrim hope. It is fair to say that we should all hope that these studies into the remission of type 2 diabetes, old and new, end up as a fully recognised treatment option within every healthcare system across the world. Our ever increasing world population is suffering from type 2 diabetes  and yet here is a small sample of some of the research, prior to the Newcastle work, that is currently being ignored.

There are more, but the list below should make part of the point.  The Newcastle studies just add to a long list, but they have one very important advantage over everything that has come before. Newcastle researchers are using a product that is currently owned by Nestle.  Nestle knows how to make people, press and authorities aware of their products and has the resources required to counter the clout of the drug companies who have worked hard to keep the use of drug in the forefront of medical approaches.  This despite the fact that no drug puts diabetes type 2 into remission.

The other important point is that Lipotrim, which recognises the exciting work of Professor Donkin in 1871, is based upon enriched skimmed milk, and has been in widespread UK use for more than 30 years under the exclusive monitoring of healthcare professionals.  Several accounts of its value in diabetes have been published independently of Lipotrim by hospital diabetic specialists over the years.
Perhaps the Nestle clout can finally, after 146 years, help the NHS save over a million pounds an hour “treating” a disease that can be effectively put into remission in a matter of days.  Weight loss using Lipotrim works rapidly. Let the world know.

Amatruda JM, Richeson JF, Well SL, Brodows RG & Lockwood DH. The safety and efficacy of a controlled low energy (very low calorie) diet in the treatment of non-insulin dependent diabetes and obesity. Arch Int Med, 148: 873-877, 1988. 

Brown SA, Upchurch S et al Promoting weight loss in type II diabetes, (A meta-analysis) Diabetes Care,19:30-36,1994. 

Freidenberg GR, Reichan D Olefsky JM & Henry RR. Reversibility of defective adiposyte insulin receptor kinase activity in no insulin dependent diabetes mellitus: effect of weight loss. J Clin Invest. 83:1393-1406,1988 

Galli G, Giannini S, Messeri G, Diani F, Vannini R et al. Short cycles of very low calorie diet in the therapy of obese type II diabetes mellitus. J Endocrin Invest, 17: 171-179, 1994. 

Genuth S. Supplemented fasting in the treatment of obesity and diabetes. Amer J Clin Nutrit, 32: 2579-2586, 1979. 

Gumbiner B, Wendel JA & McDermott MP. Effects of diet composition and ketosis on glycemia during very low energy diet therapy in obese patients with non insulin dependent diabetes mellitus. Amer J Clin Nutr, 63: 110-115, 1996. 

Hanefeld M & Weck M. Very low calorie diet therapy in obese non-insulin dependent diabetes patients. Internat J Obes, 13: suppl 2, 33-37, 1989. 

Henry RR & Gumbiner B. Benefits and limitations of very low calorie diet therapy in obese NIDDM. Diabetes Care, 14: 802-823, 1991. 

Henry RR, Wiest-Kent TA, Scheaffer L, Kolterman OG, & Olefsky JM. Metabolic consequences of very low calorie diet therapy in obese non-insulin-dependent and non-diabetic subjects. Diabetes, 35: 155-164, 1986. 

Hughes TA, Gwynne JT, Switzer BR et al. Effects of caloric restriction and weight loss on glycaemic control, insulin resistance and atherosclerotic risk in obese patients with type II diabetes mellitus. Amer J Med, 77: 7-17, 1984. 

Kanders BS, Blackburn GL, Lavin PT, Norton D, Peterson FJ & Istfan N. Long term health effects of obesity treatment with a multidisciplinary very low calorie diet program: Change in diabetes and hypertension. Manuscript submitted for publication, 1993. 

Messeri G, Plani F, Vnnini R et al. Short cycles of very low calorie diet in the therapy of obese type II diabetes mellitus. J Endocrinol Invest. 17: (3), 171-179, 1994. 

Miles P, Cavan D & Kerre D. Desirable weight loss and diabetes – miracles can happen! Diabetic Medicine. 17 (Suppl 1):86,2000     (used Lipotrim)  

Paisey RB, Harvey P, Rice S et al. An intensive weight loss programme in established type 2 diabetes ans controls: effects on weight and atherosclerosis risk factors at 1 year. Diabetic Med 15: 73-79, 1998. (used Lipotrim) 

Uusitupa M, Alaakso M et al. Effects of a very-low-calorie-diet on metabolic control and cardiovascular risk factors in the treatment of obese non-insulin-dependent diabetes. Amer J Clin Nutr. 51:768-773,1990. 

Weck M, Hanefeld M & Schollberg K. Effects of VLCD in obese NIDDM (non-insulin dependent diabetes) on glucose, insulin and C peptide dynamics. Internat J Obes, 13: suppl 2, 159-160, 1989.

Lipotrim helpline

UK    0800 413 735
ROI   015255636      

Pharmacy funding cuts - is homeopathy the answer?

Pharmacy funding cuts are starting to dig deep, and many pharmacies face closure if new, profitable revenue streams, are not found quickly.

2017 and beyond will be testing times for the community pharmacy sector, so every opportunity to keep these foundations of the local high-street alive must be sought.

IS EVERY OPPORTUNITY A WISE CHOICE FOR THE REPUTATION OF PHARMACY?

The NHS is choosing to stop paying for homeopathic medications.  A long overdue action.  Leave homeopathy to the health food industry.  Pharmacy is not into faith healing.

In The Chemist & Druggist, a renowned pharmacy publication, a recent article has sparked many comments from the pharmacy profession as to whether "Homeopathy could be pharmacy's saviour from funding cuts". 

Comments made by pharmacists and those closely connected to the pharmacy sector were not very complimentary to the idea of capitalizing on the sale of homeopathic remedies:

·         Great. Let's do a proper return to the 17th century and bring back purging and bloodletting as well.

·         David, why are you suggesting this rubbish. The future of the profession, if it has one, is not in quack remedies with no scientific basis.

These are strong replies so what is the issue with homeopathy?

What is homeopathy?

The British Homeopathic Association describes homeopathy in this definition:

“Homeopathy is a natural form of medicine used by over 200 million people worldwide to treat both acute and chronic conditions. It is based on the principle of ‘like cures like’. In other words, a substance taken in small amounts will cure the same symptoms it causes if taken in large amounts.”

For those involved in the homeopathic industry, worth over £46 million according to a Mintel report on Complimentary medicines 2007, homeopathy works. The belief and faith in homeopathy can be very strong in those wishing to use it, but for pharmacy medicine is not a religion.

Pharmacy works with facts and strong evidence. The Healthy Living Pharmacy status pharmacies are working towards within the new pharmacy contract, will strengthen this notion.

Conventional medicine, using evidence based science rather than anecdotal claims, views homeopathy as nothing more than a placebo, yet surprisingly  has been available through the NHS for many years. The time has now come, with the NHS running out of money, to cut back on many peripheral and worthless services, with homeopathy being one such cut for many Clinical Commissioning Groups (CCGs). If homeopathy is no longer prescribed on the NHS, the over the counter market for such "treatments" will be opened further. Could this be pharmacy's best opportunity to plug the pharmacy funding cuts?  Should it be?

Plugging the pharmacy funding cuts - the right way.

It is not surprising for pharmacists to refuse to accept this opportunity with homeopathy.  A complimentary therapy, with little clinical evidence, is not a treatment option. Real medical problems must be treated by real medicines.   

Pharmacists are very highly trained experts in medicines and to fall en-mass into recommending non-evidence based therapies, purely for financial gain, violates the pharmacy code of ethics. Luckily for the pharmacy profession most pharmacists will refuse this option as seen in the loud responses to the article. Fraudulent medical therapies could put pharmacists at serious risk, when proper treatment options are not provided and lead to more serious medical conditions.

One answer has been staring pharmacy in the face for over 15 years....

Flu vaccines? Recently the pharmacy sector has turned towards flu-jabs as a means to stay profitable with a recent article in "The Pharmacist" magazine titled "Fantastic flu vaccine effort by community pharmacy" waxing lyrical about the 817,000 flu vaccinations achieved by pharmacies in 2016/17 season. 

This, however, equates to a paltry £30 profit per pharmacy per month on average.

Pharmacy needs to look further than just turnover and service uptake. 

Profits now matter a great deal too. Flu-jabs are not the saviour of pharmacy after all.

So who could be a saviour of pharmacy?

Lipotrim

Lipotrim is an evidence based weight management programme offered exclusively  by healthcare professionals, including nearly 2000 pharmacies, across the UK and Ireland. The wealth of evidential  data,  produced from audits, has demonstrated the value of Lipotrim, not only to the patients treated successfully, with significant weight losses and reduced medication needs, but also for the pharmacies with highly profitable remuneration.

This white paper, "Treating obesity and excess weight using a holistic, Pharmacy based approach to weight management", from Waistaway shows what a single pharmacist has achieved. With weight losses in this one study averaging above 11%, even for type 2 diabetics.

Lipotrim is replicating this achievement in pharmacy across the UK and Ireland. 

Weight management is hot topic with the National Diabetes Prevention Programme being rolled out in the UK and a similar programme in Ireland. It is time for more pharmacies to realise they are in the perfect location, and that it is a perfect time to really utilise their expertise in medicine and general health, tackling the obesity and diabetes crisis head-on.

Contact Lipotrim now to request information on how to join Lipotrim as a patient or a pharmacy

on 0800 413 735 (UK)

on 00353 (0) 1525 5636 (ROI)

or email lipotrim@lipotrim.co.uk

Lifestyle change - cut your type 2 diabetes risk with Lipotrim

The official dogma is that lifestyle change is required if we are to reduce the risk of type 2 diabetes in the UK population. A sedentary lifestyle leading to excess weight, increases the risk of many of the long term health conditions that type 2 diabetes brings.

Quoting the Meerkats “Simples”

If Only!

Type 2 diabetes is a terrible illness and should be taken very seriously indeed. The effect of living with type 2 diabetes is profound. This debilitating "lifestyle disease" causes many health issues, ranging from problems with your eyes and feet, erectile dysfunction and thrush, to heart problems and possible lower limb amputation. At the time of diagnosing type 2 diabetes, the individual may have already placed their body under pressure for many years.   Less well known, however is that type 2 diabetes is usually preventable and often reversible.

Once diagnosed with type 2 diabetes, the individual will likely be prescribed increasing amounts of medication, over time, to help the struggling body regulate the blood glucose levels. Eventual reliance on injecting insulin or using newer, more powerful drugs persists until the body finally gives up.

Type 2 diabetes levels in the UK are increasing and show no sign of slowing. With around 3 million type 2 diabetics in the UK, and over half a million people thought to be type 2 diabetic yet undiagnosed, controlling excess weight should therefore be top of everyone's list.

 

Type 2 diabetes - what is being done?

This article on the BBC News channel describes type 2 diabetes, the effects it has on the body, and what a Doctor recommended for one patient. The NHS is currently rolling out the National Diabetes Prevention Programme and so it is important to look at what the lifestyle changes proposed by health professionals could do:

The lifestyle changes that can cut type 2 diabetes risk

By Dr Rangan Chatterjee

Doctor in the House

The recommendations made to this patient were based around 4 lifestyle changes: food, movement, stress and sleep.

Food

It is very good to see food at the top of the list. Consumption of food and drink is the first, and most important, lifestyle change to be made if you are trying to prevent or treat type 2 diabetes.

Food, or really the contribution excess food makes to an individual's weight, causes the emergence of insulin resistance. It is insulin resistance, and the body's subsequent lack of ability to adequately regulate blood glucose levels, that inevitably leads to a diagnosis of type 2 diabetes and the inevitable downward health spiral.

Tackling excess weight is the lifestyle change that truly matters to type 2 diabetics.

Lowering weight from obese levels away from a BMI >35 and ideally into a healthy range (BMI 20 to <25) has a massive impact on the treatment and reduction of type 2 diabetes. Susceptibility to type 2 diabetes is increased at much lower rates, but becomes more and more probable as BMI increases.  Some populations, such as south Asians become susceptible even at weights considered normal for white Europeans.

The food advice given to type 2 diabetics is often as is described by the Doctor:

I advised her to eliminate refined carbohydrates in her diet such as sugary breakfast cereals, white rice and bread.I encouraged her to increase her intake of healthy, natural fats such as avocados, nuts, and olives as well as healthy protein sources such as salmon and anchovies.

The food lifestyle changes described are important for nutritional health and will likely have a small benefit to her circulating glucose levels. It is highly important that any excess weight is lost to truly gain blood glucose control and so this advice must also promote a reduced intake of calories below that required each day. It is quite possible these lifestyle changes may even lead to a worsening of blood glucose control and diabetes, if body weight increases as a result of an increased, albeit "healthier calorie" intake.

Movement

It is evident that for an individual to be type 2 diabetic, they are highly likely to be carrying excess weight (as discussed above). Eating less and moving more is the mantra for losing weight and making a positive lifestyle change.

What if the diabetic is confined to a wheelchair? What if the excess weight is such that exercise is painful, even dangerous?

The Doctor advised his patient to stop her intense gym sessions and replace them with yoga and the result was that:

At the end of her yoga session, La-Vern not only felt as though she had worked out but also felt rejuvenated and energised. Plus, it was the only "switch off" time she had all week.

Some Questions

This raises an important question. What is the role of exercise? Is it adequate to just "feel" like you are exercising or should we all be following the exercise guidelines of approximately 30 mins moderate exercise 5 days a week? For extremely overweight people, 30 minutes moderate exercise could mean just getting dressed each morning. Is this an acceptable method of exercise?

The effect exercise alone has on diabetes is likely to be small since excess weight itself can lead to difficulty for meaningful activity. For an overweight individual to gain the most from exercise, we must initially tackle the excess weight. Effective and significant weight loss opens the door to more meaningful and potentially less painful, increased activity levels.

Stress and Sleep

The blue light emitted from smart phones and their use late at night can have an effect on sleep pattern. The knock-on effect can be increased susceptibility for putting on excess weight and stress. 

It is important to reduce the amount of "screen-time" before bed and to keep to good sleep routine, with reduced caffeine and alcohol levels especially in the evenings.

We must not ignore the effect sleep apnoea has on sleep deprivation and stress levels. Weight loss can often be the most effective treatment method to reduce Obstructive Sleep Apnoea symptoms and is possibly even curative.

Lipotrim has an answer.

The prevention or treatment of type 2 diabetes often revolves around making small lifestyle changes that need to be maintained for a long period of time. By looking at these recommendations we have seen that these small changes may have an effect, but it is the necessity to reduce the excess body weight that in turn reduces the insulin resistance that will have the strongest effect. The diabetes needs to be stopped quickly. The longer it takes the more difficult it may be to stop.

Losing weight is not easy. It is easy to say, but decades of history prove that despite the massive attempts at weight control, the battle is being lost. Calorie restriction and increased exercise takes too much time, produces scant results and so will have little effect on weight. Type 2 diabetes will not be effectively contained.

Lipotrim however uses nutrient complete formula foods for weight loss.  Taking care of the advice given above to make healthier food and lifestyle changes will assist with weight maintenance after the loss. The very low calorie nature of Lipotrim leads to rapid weight loss at the maximum safe rate. 

A significant reduction in weight often allows for increased exercise levels, reduced sleep disturbance and stress levels and, if you are already type 2 diabetic, reversal or prevention of type 2 diabetes if you are at risk.

If you would like to learn more about taking a major step towards a better and healthier life change contact Lipotrim today:

Lipotrim UK      0800 413 735            
Lipotrim ROI     00353 (0) 1525 5636

To find your nearest Lipotrim pharmacy click on either UK or ROI

Counting Calories? Pharmacy has the answer.

Fitness trackers and food labels, have they stepped out of line?

Whether people are trying to lose excess weight or maintain their weight, they need to know the number of calories they are eating and the number of calories being used through exercise. Only then can they truly calculate their expected weight gain, weight loss or weight maintenance.

How can you count the calories you are eating and work out how many calories you are using? 

Food composition tables, used in food labelling, is the mainstream method of calculating calorie intake, and fitness tracking devices for calories used. They both use simple maths, but will almost certainly give a very wrong result. Research demonstrates that both methods, relied on by the public and healthcare professionals, could be almost worthless.

Food Composition tables

The composition of almost any food item can be looked up in official books or searched online. These charts will detail what calories, vitamins, minerals and macronutrients the food consists of.

But how about the specific food sample you are planning to eat? Not just whether it is a beef burger but this particular beef burger on your plate. 

All foods, previously living plants or animals, vary in their composition in the same way that people differ in their composition. For example we do not all have exactly the same level of muscle mass even though we share the same general physiology.

For food composition tables to exist, hundreds of samples of the same food, from avocados to beef burgers, have to be analysed and the results averaged. If you eat 100 beef burgers, you might get close to the amount of calories listed per 100 consumed, but a single beef burger is likely to have a different value to that listed in the food composition table or on the food label. 

A wonderful study by Professor Jackie Stordy at Surrey University requested dieticians to plan a 1000 Calorie diet menu. Her graduate students purchased the foods and analysed them under laboratory conditions. They found an enormous variation between the samples, ranging from 1050 Calories up to 1600 Calories. Remember the menu was meant to be 1000 Calories, and so the poor soul attempting a 1000 Calorie a day programme, actually eating 1600 Calories per day would be very disappointed indeed.

It is essential that next time you study food labels, look at food composition tables, or rely on literature produced from commercial diets and books, you understand that you cannot be sure the calories stated is accurate. Use the food labels as a guide rather than as gospel.

Fitness trackers

Recent research from Stanford University in California has shown fitness trackers, such as the FitBit Surge and the Apple Watch, to be so inaccurate they are potentially worthless. 

The fitness tracker devices studied by Stanford University included 45 wrist-worn devices such as:
Apple Watch, Fitbit Surge, Basic Peak, Alpha 2
Microsoft Band, PulseOnMio, and the Samsung Gear S2.

The researchers measured the heart rate (HR) and energy expenditure (EE) in a diverse group of 60 people. The group was subjected to a range of activities including walking, sitting and cycling. The effect on their heart rate and energy expenditure, the number of calories burnt, were then measured using various fitness devices and compared to that measured using detailed laboratory tests, including continuous telemetry and indirect calorimetry.

Why measure heart rate (HR) and energy expenditure (EE)?

Physical health is the topic of our time. The NHS is making lifestyle advice and obesity intervention centre stage through the roll out of the new National Diabetes Prevention programme (DPP). We are being constantly reminded on how the NHS is running out of money through our inability to be healthy; our smoking and drinking habits, and most notably our increasing waistlines.
Fitness trackers, in the form of wrist-worn devices, are currently perched at the top of many people's wish list, and worn for all to see. The fitness market is currently worth £4.7 billion  and technology is playing a big part in our attempts to improve our health.

Heart rate

Measuring heart rate gives a quick measure of the amount of work the heart is under. A person can have a "normal" resting heart rate within quite a range, generally between 60 and 100 beats per minute. If the heart rate is outside of these values for any prolonged time medical advice should be sought. A trained athlete may well have a heart rate of below 60 and someone with tachycardia will likely have a regular resting heart rate above 100.

On taking exercise the heart rate gives a measure of fitness level and also a measure of training intensity.
Heart rate is therefore a useful basic measure of health and fitness.

Energy expenditure

Measuring energy expenditure, the number of calories lost over time, is widely used to estimate the effectiveness of a persons weight management regime. Combining the HR and EE, using a fitness device, theoretically should allow for a tighter and more accurate assessment of any health improvement progress. Counting calories consumed or used up through exercise, is essential in all weight loss programmes.
The majority of weight loss programmes, designed for you or self imposed, will include a method of counting calories consumed (Food composition tables and food labels discussed above). Measuring the calories burnt is even more difficult and therefore many people are turning to fitness trackers that claim to provide this data.

What did the research on fitness trackers find?

Firstly the good news. The fitness trackers measured heart rate generally within the 5% leeway the researchers felt acceptable (walking showed the highest error in HR at just 5.5%). 

The comparison of the results for HR between the fitness tracker and laboratory measurements means that, if you do use one of the wrist-worn devices you can be quite sure the readings are accurate whether you are an athlete or just managing your health or weight.

The bad news is that the measurements of energy expenditure, made by fitness trackers, overall was poor. None of the devices measured the energy expenditure within the target range of less than 5% error. Shockingly the error rates for measuring energy expenditure ranged from an error margin of 27.4% up to an embarrassing 92.6%.

It is also important to note that the results from the research into fitness trackers was under laboratory conditions. Real life use would predictably produce much worse results through changeable conditions and potential for the user of the device to not follow the manufacturers instructions fully.

What can we take away from this study on fitness trackers?

The results demonstrate the need for users, and more importantly healthcare providers, to proceed with caution when relying on, or recommending the use of, these wrist-worn devices for weight management purposes.

These devices should not be trusted as an accurate guide on the amount of calories burnt over a period of time. Using these devices for measuring heart rate however could be recommendable.

Exercising to lose weight

Travelling a mile, either by running or walking (remember work done = force x distance) uses about 100 extra Calories (without consuming a sports drink). The number of calories to use up a single pound of body fat is 3500 Calories. It is important to remember that the calories taken from stored fat are only those necessary to make up the difference from the calories actually eaten. So if you are eating 1000 Calories and burning 2000 Calories a day, only 1000 Calories will be taken from storage. To lose a pound of fat weight, at that rate, will take 3.5 days.

It takes approximately 35 miles of exercise (3500 Calories divided by 100 Calories per mile moved) to burn off 1 pound of body fat. Wearing a dysfunctional fitness tracker may not help your assessment of your calorie burn, or in real terms, towards losing weight or maintaining your weight after weight loss.

Increased exercise levels in the UK are being encouraged as part of an overall strategy to prevent and treat the rising levels of excess weight. The NHS Diabetes Prevention Programme is one such measure with exercise being employed to tackle obesity and type 2 diabetes in the UK. Hopefully it will be recognised that overweight people with disabilities, elderly people, or even seriously overweight and obese people, will not usually be able to do sufficient exercise to even make a dent in their excess weight.

Lipotrim has the solution

Lipotrim uses a bespoke computer programme to help pharmacies accurately measure the calories expended under real life conditions by a dieter. This method could be also be used to validate the performance and accuracy of fitness trackers. It is one of the outstanding features of dieting with Lipotrim. In addition to rapid, reliable and safe weight loss, sufficient to put type 2 diabetes into remission, it is possible to learn the actual daily calorie usage over a prolonged period of time. The Lipotrim results, predicting calorie usage, comes at no extra cost to the patient, and the whole programme at zero cost to the NHS.  

This is a typical weight loss pattern of a compliant Lipotrim dieter. It is a plot of weight change over time, showing the drop in weight is continuous over each period of time. An accurate reading of kg weight loss per day can be read from the graph, and easily converted to Calories used up per day (conversion is 7700 Calories per kg).

The Lipotrim formula foods contain a fixed calorie intake per day. Any deviation from the diet and the resulting weight loss would no longer follow the straight line, as seen in this model example. If the person were to do more exercise, above that taken on an average day, the slope of the weight loss line will become steeper since more calories are used up. 

Since the calories lost per day can be easily and accurately taken from the graph, by adding this output value to the calories consumed, which is fixed in the case of the Lipotrim dieter, the total maintenance calorie value can be calculated. The total maintenance calorie value is the number of calories that, if you strictly consumed just that amount per unit of time (no more, no less), body weight would be maintained. Eat more and weight will be gained, eat less and weight will be lost.

Pharmacies offering the Lipotrim weight management programme have a powerful tool that saves the NHS enormous amounts of money, and offers reliable and substantial weight loss, sufficient to prevent and treat most cases of type 2 diabetes. We have also demonstrated Lipotrim could also provide evidence of the impact of exercise on the utilisation of calories.

Hopefully the DPP will take note of the impact pharmacies are already having on this critical aspect of healthy living, despite the NHS having to deploy billions of pounds each year to achieve much poorer results. 

There are times when pharmacies should not be invisible to the health authorities.

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NHS diabetes prevention programme expanded but what about pharmacists!

NHS National Diabetes Prevention Programme expanded in Lancashire and South Cumbria 

Type 2 diabetes remains as one of the major serious diseases, resulting in many long term medical issues such as blindness and amputation. Type 2 diabetes causes extreme suffering to its victims and is an ever increasing burden on the NHS, even though it is largely a preventable disease. The most effective prevention and treatment of this "lifestyle disease" is weight loss. Pharmacy is in an ideal position to deliver significant weight losses, resulting in the reduction of type 2 diabetes prevalence and severity, all with no expense to the NHS. Pharmacy is undervalued.

Using QOF figures with estimates from the Diabetes Prevalence Model 2016 (Public Health England) and 2012 APHO Diabetes Prevalence Model, there are an estimated 4.5 million people with diabetes in the UK. This includes 1 million people not aware they have type 2 diabetes and are yet to be diagnosed.

Five million people in England are at high risk of developing Type 2 diabetes. More than 90% of people with type 2 diabetes are obese. Forecasts predict that there will be a large increase in the prevalence of diabetes with one in three people likely to be obese by 2034. Since one in ten people are likely to develop type 2 diabetes in this time period, the NHS must find a better preventative method than currently employed.

The current programme is designed to aid people take control of their health by giving them the tools, information and support needed to make significant lifestyle changes. Ultimately the work done through the NHS Diabetes Prevention Programme aims to reduce the risk of diabetes and the burden of diabetes on the NHS.

This Lancashire Telegraph article looks into the expansion of the national NHS Diabetes Programme

Lancashire Telegraph Article - National Diabetes Programme

In this news article Russ McClean, 56, Chair for patients across East Lancashire said:

"As a diabetic, I am really pleased that the commissioners have decided to roll out the programme and give people the tools to look after themselves." 

"We all know the NHS is falling down, it will take prevention to save money when it comes to diabetes."

The Telegraph's health expert Dr Tom Smith said:

"If something doesn't change, diabetes is going to be the biggest health issue for our country in the future, not alzheimers, not cancer, Type 2 diabetes".

Lipotrim welcomes any move to address the rising levels of type 2 diabetes in the population but feel there is an important opportunity being missed by both the NHS and type 2 diabetic patients.

Firstly what is Type 2  diabetes?

Type 2 diabetes is one of a group of metabolic diseases in which the person suffers from prolonged high blood glucose levels (blood sugar). The  most common cause of high blood sugar is due to insulin resistance where the body's cells do not respond properly to insulin. To compensate for the reduced effectiveness, excess insulin is carried in the blood. Ultimately the system is overwhelmed by prolonged elevated sugars with serious long term health consequences.

The primary risk factor for type 2 diabetes appears to be related to carrying excess weight. Having a family history of diabetes may also increase the person's diabetic risk.

What is the NHS Diabetes Prevention Programme missing?

The NHS Diabetes Programme, although commendable in its attempt to reign in the levels of type 2 diabetes, misses the two key issues surrounding diabetes that it is aiming to solve:

1    Decreasing the risk of diabetes

Significant weight loss for a majority of existing type 2 diabetics will usually send the diabetes into remission (it is important to note that current medication cannot cure diabetes). For those patients at high risk of developing type 2 diabetes, namely those overweight but not yet obese, a reversal of their excess weight to a more healthy level (ideally BMI <25) will greatly reduce the likelihood of developing type 2 diabetes. In some ethnic populations, notably those from South Asia, the increased risk from weight starts at an even lower BMI.

So the NHS programme should work? 

Yes and no. The issue surrounding losing significant weight is time. The patients that are most likely to require such lifestyle interventions will often need to lose a greater  amount of weight and at a faster rate than is traditionally lost on lifestyle intervention programmes. A patient losing weight through lifestyle intervention will be lucky to sustain  weight losses of 1lb a week.

Many diets fail to produce significant weight loss because it takes too long, and daily life events can often negatively intervene. When there is an element of food addiction the problem is magnified. If the patient cannot exercise, the problem is enhanced.

The diabetes prevention programme entails the patient being actively recruited by the NHS healthcare provider. If the patient accepts their place on the programme they will be attending monthly sessions for around 12 weeks each lasting in the region of 1 to 2 hours:

7.1   Individuals with a Body Mass Index (BMI) > 25 are eligible for Tier 2 WMS.iiTier 2 WMS are commissioned by local authorities, they tend to be deliveredin person through group sessions in the community, should be multicomponentlifestyle services (including physical activity, behaviour changeand nutrition elements) and typically last for 12 weeks. 

Data used to construct the programme, taken from randomised trials in countries such as USA and Japan, has claimed a 30% to 60% reduction in type 2 diabetes. Real world studies however have suggested this type of programme might reduce type 2 diabetes incidence by 26%, with a measly 1.57% reduction of weight at 12 to 18 months compared with "usual care".

A patient with a starting BMI of 35 would finish with a BMI of 34.5 with this predicted reduction in weight, way short of even reaching a non-obese BMI at <30. A 26% reduction in type 2 diabetes is an unlikely result.

2    Decreasing the burden on the NHS by diabetes

The cost to the NHS in delivering the diabetes prevention programme is not insignificant, especially since the desired uptake number is 100,000 interventions in the first year alone. The expected costs are:

• £2.70 to invite and recruit each patient
• £270 per patient on average per year to deliver the interventions
• initial implementation payments per area of between £30,000 and £60,000

The NHS is therefore going to be spending a vast amount of money and resources to simply educate and motivate people to be healthier.

Is Bariatric surgery the face behind the programme?

The diabetes prevention programme Tier 3 and Tier 4 involves the recommendation and use of bariatric surgery. Weight loss surgery is a serious proposition for both the patient and NHS because bariatric surgery;

• is not always a single operation for the patient. Follow-up operations may be required and results are not guaranteed. In a study of 209 type 2 diabetics who underwent surgery, only 34.4% had complete diabetic remission. The conclusion of the study was that "Focusing on improved glycaemic control rather than remission may better reflect the benefit of this type of surgery". 
• can cost around £10,000 per operation. Does the NHS have this money going spare to not achieve high remission rates?
• requires surgeons, and plenty of them, if the lifestyle interventions fail to deliver the significant weight loss as we expect. We do not have the numbers of qualified surgeons available nor the extra money in the NHS. 

The detail behind the recommendation for surgery is also interesting:

7.4Surgical intervention is only an option if all appropriate non-surgical measuresto achieve or maintain an adequate, clinically beneficial weight loss s havebeen tried and the person has been receiving or will receive intensivemanagement in a Tier 3 WMS.iii

There is no mention of using a Very Low Calorie Diet (VLCD), in the NHS diabetes prevention programme Tier guidance, such as Lipotrim.

VLCDs have a pivotal role to play in the prevention and treatment of type 2 diabetes, especially in the modern climate of rising prevalence of the disease and prolonged austerity. A private, patient funded weight management programme would have a zero running cost for the NHS. Lipotrim would therefore deliver cost savings this prevention programme is aiming to achieve without the implementation and running costs the NHS is having to fund.

What about pharmacists?

It is scandalous to see the undervalued network of pharmacies, with their highly trained pharmacists, have not been used to deliver this programme. The extended opening hours of pharmacies and the expertise of their pharmacists could have been utilised to enhance the availability and effectiveness of any national weight management programme. The recruiting and educating of new DPP trainers, coupled with the need for premises is unnecessary and frivolous. 



Pharmacy is already contributing to the tackling of type 2 diabetes through their every-day, opportunistic lifestyle interventions. The network of Lipotrim pharmacies are adding their own success stories with significant weight losses contributing to medication cessation.

Current successful evidence based pharmacy weight management programmes, such as Lipotrim, save the NHS money now and in the future, and should be harnessed, not ignored.

Contact Lipotrim today
UK        0800 413 735
lipotrim@lipotrim.co.uk  

The NHS National Diabetes Prevention Programme