Conference pasta::flex

    I got into a bit of a controversy last night in one of my fitness
    classes, so I'm looking for some information from you folks. For teh
    read-onlies, could you send me e-mail? I'd like to get as much
    anecdotal stuff as possible.
    The controversy is this - fruit.  One woman who is very much overweight
    but is making remarkable progress in terms of stamina in my class went
    to a nutritionist. This nutritionist told her to eat 6 servings of
    fruit a day. 
    In my opinion, fruit is simply a sweet-tooth fix. It's sugar, water,
    fiber and a vitamin or two.  The argument I got was that it's FRUIT
    sugar, as if FRUIT sugar is a magic bullet.  Again, in my opinion based
    on everything I've ever read, sugar is sugar to our bodies and is
    handled identically, whether it's a spoonful of table sugar, a
    sppoonfull of honey, or a spoonful of dextrose syrup. Sucrose,
    fructose, dextrose all equal glucose.
    Now, if I could have gotten a word in edgewise (these people were HOT
    with me!), I would have explained it this way :
    Your average size apple (and by the way, a meduim apple in any calorie
    counter book is very small - not that nice big red delicious type) is
    about 90 calories.  For that amount of calories you could have had 3
    ounces of fish and gotten more nutrient value per calorie ingested.
    So, for 5 apples, you could have had almost a pound of fish, 4 oz. of
    tofu, 1 cup of carrots, 1 chicken leg, 2 slices of multi-grain light
    bread, etc.  You see where I"m going with this?  I'm wondering if I'm
    way off base here, because people were SO upset that I dissed fruit as
    a good diet choice.
    I guess if the option is a MilkyWay bar or an apple, obviously the
    apple wins.
    But in general practice, how much fruit do you eat?  Do you feel it's a
    good value calorie-wise?  Do you feel you need that vitamin C and
    fiber, because you don't get it anyplace else?  Do you eat it as a
    treat only?
    Sarah 

    Well, first off, your body definitely handles different sugars
    differently.  Issues over which sugar is best have come up most often
    in recent years as the debate over sports drinks (glucose) vs. juice
    (fructose) to enhance glycogen replenishment after a long (2hr+)
    workout.  
    
    Interestingly enough, fructose, which is the sugar that occurs
    naturally in many fruits and vegetables, has gotten a very bad
    reputation in many ways.  Several studies point to fructose as the
    component that contributes most heavily to heart disease, where sugar
    intake is a causitive factor.  Fructose seems to contribute to high
    cholesterol.
    
    However, researchers are quick to point out that its the quantity of
    fructose that causes the problems.  The fructose content of most fruits
    percentage-wise is significantly lower than table sugar or foods like
    candy bars.  Consequently, although fructose, especially high fructose
    corn syrup (HFCS), its most common form in our diet, may not be overly
    good, fruit is still preferable to many other sources, since the
    nutrient ratio is very high (relatively speaking), and overall sugar
    content is relatively low.
    
    From an article on the web:  
    
    "Fructose accounts for only 5 to 7.7 percent of the wet weight of
    cherries,pears, bananas, grapes, and apples. That's about 5.5 to 8
    teaspoons perpound of fresh fruit. There's even less fructose- 2 to 3
    percent, or roughly 2 to 3 teaspoons per pound-in strawberries,
    blackberries, blueberries, oranges,and grapefruit. Honey, refined by
    bees, contains 40 percent fructose, butits extreme sweetness deters
    most people from consuming it in large amounts".
    
    As far as sports drinks are concerned, glucose is called a
    "right-handed D-starch", and can be used very quickly, almost anywhere
    in the body.  You are right that all sugar becomes glucose
    *eventually*.  Table sugar (sucrose) in the body becomes 50% glucose
    and 50% fructose. 
    
    However, fructose is a left-handed starch, and can only be processed in
    the liver, requireing ATP for the conversion.  Fructose therefore
    actually depletes energy stores temporarily.  The conversion process is
    what increases blood triglycerides and cholesterol.  Glucose is ready
    for use as ingested.  Also, since fructose doesn't easily pass through
    the intestine walls, it generates an imbalance that causes water to
    flood the intestines, sometimes causing diarhea or gastric distress
    (when used by atheletes as a replenishment drink).
    
    I think the argument regarding weight loss is that sugar intake must be
    reduced (which creates a *big* dent in fat consumption as well,
    usually).  Fruits have a low sugar content.  By substituting fruit for,
    say candy or other high sugar sources, sugar content is decreased, and
    nutrient content is increased (somewhat).  A non-vegetarian might find
    it difficult to go from a Snickers bar to a carrot, so fruit is a move
    in the right direction, and you can eat a lot more of it than the more
    sugar concentrated snacks.  That is, you'll run out of room eating
    fruit before you've come close to the sugar you would get in a sweet
    snack.
    
    I can't really say much about fruit from the nutrient point of view. 
    However, vitamin C, an anti-oxident is believed by some to help prevent
    cancer.  There are even claims that vitamin C from fresh fruit is more
    useful than from supplements.
    
    I suppose that overall, high vitamin content, low sugar content, fibre
    and "filler" make fruit sound like an ideal snack for someone trying to
    avoid hunger during a diet.  If you can live without it, great.  But, I
    think anyone but a pure vegetarian would have a difficult time
    balancing their diet.  For example, a vegetarian might enjoy a
    cheesecake, which though high in fat, would probably fit well into the
    overall diet.  A non-vegetarian probably couldn't afford the fat, and
    would find themselves wanting for a sweet treat.  Perhaps doing without
    sweets is best (since I don't think glucose occurs naturally many
    places), but they are the first resort when you need sweets.
    
    Glucose is the choice for atheletes, but anyone at risk for diabetes
    should consult a physician before modifying their diet to increase
    glucose consumption.
    
    Look up fructose on the web.  Here are some starting points:
    
    	http://www.hammernutrition.com/fructose.html
    	http://ificinfo.health.org/insight/fructose.htm
    	http://www.jrthorns.com/Challem/fructose_dangers.html
    
    BTW, if you think that you are avoiding fructose by avoiding sweets,
    you should check your labels.  HFCS use has skyrocketed, and on
    average, consumption has gone from approximately 6 pounds per year in
    the 1800s to over 150 pounds per year today.
    
    jeb
    

    
    I think the fruit also may be more of a behavior modification than an
    actual diet food.  While 5 apples may be equivant to so many ounces of
    fish, or slices of wheat bread, most overweight people are not able to
    think through the full nutritional benifits of certain foods.  The
    fruit is simple solution that keeps them from snacking on less healthy
    foods such as candy bars and chips.  Those unhealthy foods most likely
    were mainstays of their diets, and by removing them, and the enourmous
    amount of fat they contain, you do a great deal of good.
    
    Almost certainly they would benifit even more by planning all they eat
    to make sure they get the right nutrition, but that's a lifestyle
    change they haven't yet been able to make.  By at least eating fruit
    instead of high fat junk food they are making a positive modification
    to their diet.  They will eventually have to make more modifications,
    but they have started.
    
    -Nat
    

yeah<-- what jeb and nat said!  i have irritable bowel syndrome and _should_ 
watch what i eat more closely, but i love so many foods i just deal with it.

for my system, if i eat more than 1 piece a fruit a day, i pay; too much juice, 
also. oranges and grapefruit [as much as i love them] i limit in my intake. 
vegetables have a slower digestable fiber, thus i eat more of them than fruit.

the nutritionist i went to a few years ago suggested 4-6 servings a day of vegs 
and 1-3 serving a day of fruit and to concentrate more on legumes and high grain
fiber foods then protein; obviously, not all nutritionist feel the same way 
about food groups, but for those severely over weight: behavior modification is 
the way to go and asking them to eat more fruti throughout the course of the 
day and getting off the candy bars, etc is more helpful than not. however, it 
should not a be a diet fix and the quant a fruit consumed should be tapered off
to something more desireable.

eating large doses of fruit is training the brain [and tasetbuds] to get sugar 
from other sources, but the diet should always be in a state of modification.

reg.

    Sarah
    
    I am not sure what your asking feedback for.  If the nutrionalist
    instructed the person to eat 5-6 servings of fruit in place of a bunch
    of fat foods, ie, icecream, cookies  etc then the nutrion program is
    sound.  I believe many folks on diet would do better eating fruit when
    they crave something sweet for two reasons, 1. it is sweet and will
    help asuage the sweet tooth craving 2. Most fruits have a satisfying
    crunch which to me helps if you eat when stressed.  There could be a
    bunch of reasons why someone would recommend eating a ton of fruit,
    what did the person who started the controversy state as a reason?
    
    Brian

    The controversy ensued when I was told that because it was FRUIT sugar,
    it was OK to eat. That's when I probably gave this incredulous look.
    I agree, if she would normally grab a Snickers bar, then by all means
    grab that apple instead.  In terms of behaviour modification to silence
    that sweet craving, fruit is a good source. But in terms of basic sound
    nutrition principles, there are better choices for the same caloric
    value than fruit.  For an elite marathoner, perhaps there is a
    difference in -ose (glucose, fructose, dextrose, sucrose, etc.). For
    someone who is overweight, sugar is sugar, and in my opinion there
    should be an attempt to educate the person on better nutritional
    choices and try to stem that sweet craving, than feed the craving with
    just another form of sugar.  I don't think anyone who substitutes a
    sweet for a sweet is really learning anything about hunger, nutrition,
    and making good choices. 
    I think there is also a tendancy to overeat the fruit, too. How many
    people really know what 1 serving is?  When I buy apples at the
    supermarket, I buy those nice, big, shiny Delicious apples. They are
    usually 2 apples per pound. That's 8 oz. per apple = 2 servings.
    I didn't get into this detail with her, because I couldn't get past the
    'fruit sugar is better than regular sugar' argument.  
    I don't disagree that fruit is a valuable component of a good diet. I
    just think some nutritionists could do a better job at EDUCATING their
    clients on the finer points of nutrition.  Encouraging sugar intake
    is, in my opinion, a bad idea.  Just my opinion : )
    Sarah

    Sarah
    
    I agree with your points, but if a person has very poor dietary habits,
    eats a lot of garbage and I mean a lot, then telling them to stop
    eating fat foods, cut calories etc etc won't work.  I will make a gross
    generalization and I hope not to offend anyone, but if your fat and not
    so because of a physical problem you tend to be lazy.  Eating properly,
    meaning creating healthy menus that count calories and limits fat,
    carbo and protien to acceptable limits is too much work.  So if you
    force this person into looking at massive, hard changes to the way they
    think and eat, is going to loose that person before you begin.  It
    would not be wrong to start changing that persons diet by going after
    the easy stuff first, showing some success that would have and then
    gradually introduce more difficult changes.  You do this to help that
    person make life changes in increments that are positive and can be
    assimilated without shaking up their entire lifestyle.  I know from
    exerience if you painstakingly show people what a good diet is, unless
    they are absolutely committed you loose them immediately, the first day
    they try it and see how much work it is.
    
    
    Brian

    Brian,
    We are in violent argeement on the behavior modification aspect. 
    Do you agree that the vast majority of people, fat or otherwise, eat
    too much sugar in their diets as a whole, and that nutritionists should
    seek to limit sources of sugar when they map out diet plans?  Not
    eliminate, but limit?
    Sarah
    
    

    Sarah 
    
    We are in agreement on everything.
    
    I would comment though, that often times people hear only what they
    want to.  The nutritionalist may have said something like if you feel
    like eating a milky way have an apple instead its better for you.  I
    have found that many people would then hear something like they can 
    eat as much fruit as they like, because they eat 4 or 5 candy bars a day.

    Think of this, that woman who argued with you, did not hear one teensy
    bit of what you said, thats why your so energized about this issue
    right?  So if she refuses to listen to you, what makes you think she
    really listened to her nutrionalist.
    
    Brian

Sarah's easy to not listen to and/or argue with !  8^)

reg.

    Brian,
    So you are telling me that the pain will stop when I stop banging my
    head against the wall?  Good advice ; ) 
    
    reg, treading on thin ice there, eh pal??? : ) 
    Maybe people don't listen to me, but it's nearly IMPOSSIBLE not to HEAR
    me!  Argue? No, that's called 'debating' ; )
    
    Sarah

    
    There is another reason entirely for prescribing a fruit-oriented diet, 
    and that is that fruit is an excellent detoxifier of the body.  Many 
    people who are overweight need to detox their system, and fruit is 
    perfect for that.  (For example, the lymph system responds well to 
    oranges, apples and grapes.  The liver responds well to green
    vegetables such as sprouts, lettuce, dandelion greens, and spirulina.) 
    
    Simply reducing sugar and fat does not always address the core problem 
    of overweight people.  Often, it is because there are so many toxins
    stored in the body (particularly in the liver) that it becomes
    difficult for the body to process, absorb, and eliminate properly, 
    and additional help is needed.  Vegetables and fruits are excellent 
    cleansers, and should especially be eaten in the spring and summer 
    respectively.  For people with poor digestion, it is better to cook 
    the more hearty vegetables (broccoli, cauliflour, carrots, beets, etc.) 
    first.
    
    Also, oil is critical to the body, especially in the wintertime.  Many
    diets would have you cut out fats and oils altogether in the name of
    calorie counting, however this is a big mistake because the body dries
    out and this affects the elimination function, along with making the
    skin and membranes dry and suseptible to allergy attacks.  Of course,
    it is important to get the right kinds of oils.  A very good oil to 
    take every day is flaxseed oil.  Cold-pressed sesame oil is also good, 
    and so is ghee (clarified butter).  Olive oil is good too, especially 
    for its antifungal properties.  With sesame oil, you can apply that 
    directly to dry skin (has lots of vitamin E in it, and even put drops 
    in your nasel passages to moisten them (use either a q-tip or a spray 
    bottle).  John Douillard talks about these sorts of things in "Body, 
    Mind, and Sport".  
    
    Cindy  

    >everything I've ever read, sugar is sugar to our bodies and is
    >handled identically, whether it's a spoonful of table sugar, a
    >sppoonfull of honey, or a spoonful of dextrose syrup. Sucrose,
    >fructose, dextrose all equal glucose.
    
    Sarah, 
    
    The following is a passage from the book "Enzyme Nutrition, The Food
    Enzyme Concept" by Dr. Edward Howell, probably the foremost authority
    in the field of enzymology.  
    
    Some Perils of Sugar Consumption
    
      "Bearing on the matter about the efficiency of food technologists in
    promoting their products is a report from England in the 1969 issue of
    'Nature', a journal carrying a variety of scientific information from
    around the world.  Two English chemists, M. Brook and P. Noel (1969)
    while evidently promoting a product, developed some information which
    should be passed on to candy and cake eaters.  They went to the trouble
    of feeding 5 baboons for 26 weeks on 2 kinds of diets.  One diet had
    sucrose as the carbohydrate ingredient and the other featured dextrose. 
    At the end of the experimental period the abdominal fat was examined,
    and it was found that the sucrose produced 3 times as much fat as did
    dextrose -- it was 3 times as fattening.  The experimenters suggested
    that food processors take note of this matter and use dextrose in place
    of sucrose in supermarket foods.  But from the standpoint of long-range
    human health, I have to conclude that such a substitution is on par
    with exchanging a rattlesnake for a cobra as a bed partner."  (He uses
    some humour in his book :-)
    
    Based on the above passage, it is pretty easy to conclude that the
    sugars dextrose & sucrose are not handled the same within the body.  I
    imagine the possibility that others react similiarly different is real 
    as well.
    
    Another aspect of this topic, though not specific to sugars, is that of 
    raw vs. cooked calories.  Studies have shown that "cooked calories" 
    contribute more to obesity than "raw calories".  In another passage, 
    Dr. Howell writes:
    
      "Some intriguing experiments were performed on normal people and
    diabetics by Drs. S.M. Rosenthal and E.E. Ziegler at George Washington
    University Hospital in 1929.  The subjects ate almost two ounces of raw
    starch and then had blood tests for sugar.  Eating cooked starch, it is
    well known, causes the blood sugar of diabetics to skyrocket, unless
    they use insulin.  The diabetics in this study used no insulin and yet
    after raw starch ingestion, the blood sugar rose only 6 milligrams the
    first half hour.  Then it decreased 9 milligrams after 1 hour, and 14
    milligrams 2 1/2 hours after ingestion of the raw starch.  In some
    diabetic individuals, the decrease in blood sugar was a much as 35
    milligrams.  In the normal persons there was a slight increase followed
    by a slight decrease in blood sugar in 1 hour.  This is convincing
    evidence that there is a difference between raw and cooked calories."
    
    ...
    
      "Avocados are blessed with a lot of nice calories.  Ever hear of
    anyone getting fat on them?  Or on bananas, which also have plenty of
    raw calories?  It would be an exceptional person who could eat enough
    bananas to get fat.  All of these high-calorie raw foods might fill out
    a thin individual to a slight degree, but they know just where to put
    the ounces, and when to stop. They will not drape the weight about in
    ugly disarray over the exterior, or clog up delicate heart arteries. 
    The doctor who invented the banana diet for reducing, George Harrop,
    put his overweight patients on a milk and banana diet and wrote up his
    results in the 'Journal of the American Medical Association'in 1934. 
    His results should dispose of the idea that bananas are fattening
    because their calories count up to so-and-so.  To judge a banana, an
    avocado, an apple, or an orange by its calories is just as misleading
    and false as evaluating the moral stature of a pretty woman by her
    exterior embellishments.  There is a difference between raw and cooked
    calories."
    
    Just my 2-cents worth.
    
    -Andy

    Cindy,
    Just what toxins are we talking about, exactly?  And what is it about
    fruit, specifically, that cleans these toxins out?   What is the
    metabolic action that causes fruit to detoxify any internal organ?
    
    Andy,
    Thanks for the info. I wish it were a little more current, but it is
    interesting nonetheless.  Food for thought, as it were ; )
    Sarah

i believe one of the cleansing ingredients would be niacin? if i'm not mistaken,
niacin is abundant in certain/most fruits and vegetables.

sucrose vs dextrose: most of the carbo drink suppliment manfs are making their 
drinks with dextrose, prolly because the fat thing is true; also, isn't dextrose
less sweet tasting than most other oses? [plus, i think you'll find dextrose is 
added into a lot of (or naturally found in) the health food choices available.

reg.

    
    Sarah,
    
    *All* toxins - from medicines to air and water pollutants. The liver,
    especially, is the main detoxifying organ in the body.  This also 
    includes things like refined sugar and bleached flour and even coffee
    (very bad for the liver).  Btw, the produce should be organically 
    grown, to avoid pesticide toxins.
    
    I do not have the information about the metabolic actions available
    here at work...will see if my books specify.  This information comes
    from texts on herbal, Oriental, alternative, and Ayurvedic medicine.  
    They all recommend the same regarding fruits and vegetables and 
    detoxification of these organs.  There are also specific herbs 
    involved that one can take to detoxify as well.
    
    One reason that is obvious, is that fruit has fiber, which helps in 
    the elimination function.  When constipation is present, the toxins 
    that are eliminated by the colon are instead reabsorbed through the
    intestinal wall and back into the body along the way due to the slow 
    elimination function, and this continues the make the toxification 
    problem worse.  
    
    Cindy

Toxin in general refers to a poison; for example, the venom of various snakes,
insects and spiders is considered to be a toxin to other organisms (like
humans).  A toxin in high enough concentration can inhibit and even stop
cellular functioning - for example, people that get spider bites sometimes go
into anaphylactic shock.  Toxins are proteins which the body cannot tolerate or
does not need for functioning.  As you know, one of the functions of the liver
is to filter these poisons/toxins from the blood stream.

Toxins include items such as insectisides, drugs, food additives and various
industrial chemicals.  Ammonia, which is a common compound found in the body as
a result of changing various amino acids to other compounds is also a toxin, and
is converted by the liver into urea.

--Scott

    OK, so long as you don't start extolling the virtues of colonics ; )
    
    Can one assume, then, that proper hydration (clean water) and proper
    amounts of undigestible fiber along with proper nutrition and exercise
    is the best recipe for detoxification?  Would there really be any need
    for herbal detoxifiers?  I assume these detoxifiers remove same and
    eliminate it through natural bodily functions? Have these toxins ever
    been measured from waste products in a double-blind study? Anybody got
    the results, or a source where I can research this? 
    
    I'm certainly not knocking homeopathic or naturopathic ideals. I'm a
    firm believer in nature-based remedies to soothe a lot of our ills.
    Just curious, is all.  Can't learn without asking questions! : )
    
    Thanks for further info. and discussion.
    Sarah

just red a diity about sucrose vs fructose and the GLYCEMIC INDEX; did we all
forget about this little wonder table?  I'm now guessing that Sarah's 'friend' 
was prescribed ample amount of fruit [and hopefully the right ones] based on the
GI table as fruit [fructose] is much lower in it's potential to be readily 
absorbed with excess converted to fat stores [bananas fall in the 60% range].

The GI was created on studying a food's potential to be utilized for energy 
[converted to glucose], the rate at which it converts, the time the boost lasts,
and the potential for anything extra to be converted to fat.

an apple may be sweet, but it's high fibre content helps to assimilate it's use 
and/or storage potential.

reg.

    One other thought that occurred to me while I was on vacation last
    week...
    
    If you *live* for body building, and you are carefully monitoring your
    diet to maximize your body building, then you may take a look at two
    foods, like three oz. of fish and three oz. of fruit, and think, gee,
    the fruit will not help me attain my goals as well as the fish will.
    
    However, most people don't give two hoots about their diet, and the
    ones that do are more often than not interested in what will help them
    lose weight, rather than increase it (in the form of increased muscle
    mass).  Since overeating (the wrong things) is a typical cause of
    obesity, then finding low-fat, low-carb substitutes are important.  And
    the dietary niche you are usually trying to fill is typically the area
    of sweets rather than main courses.
    
    So, I guess its just a different way of saying the same old thing.  But
    the thing that made this pop into my head was the song "Bread and
    Roses" sung by Judy Collins.  If your "roses" are bulging biceps, then
    substituting 3 oz. of fish for a Snickers bar will make sense to you.
    But if your "roses" are eating sweets while losing weight, then
    strawberries might be just what the nutritionist ordered.
    
    Remember, just as you shouldn't try to self-medicate yourself using
    someone else's prescription, you should't try to follow someone else's
    diet either.  I'm sure the nutritionist would have come up with
    something totally different for you.
    
    Also, I am *not* prepared to give up my sweets for a better looking
    body.  Fortunately, I define "better looking" *pretty* loosely, so I
    doubt I'll have to - much.
    
    jeb
    

    Yesterday on my way to a meeting I was listening to a discussion on NPR
    over fen/Phen and dieting in general.  The one intersting point this
    one doctor stated was studies have shown that 90% of diets taken in a
    formal diet workshop, ie weight watchers, jenny craig, diet workshop
    fail. That 90 % of diets that require drugs fail.  The principle reason
    for the failures are that diet alone does not work, you need to add
    excercise and most importantly, make a life change that makes excersize
    and diet conscsiouness a part of your every day life.  What too often
    happens is people set some artificial goal, do short term things to get
    there, reach the goal then quit and 3 months later are back to where
    they were.
    
    Brian

    Often even worse Brian.  Many people tend gain even more weight when
    they quit the dieting.  They may have once weighed 230lbs but after
    quitting end up putting on another 10 or 20 lbs.
    
    But I agree, diet and excercise go hand in hand.  One's useless with
    out the other.  (for losing weight that is)
    
    	Jay

    
    What kind of weight to people lose on fen/phen, anyway? Is it fat,
    muscle, both? 

    Watch tonights news. There is a controversy (sp) on it. Someone died
    over it.:( They die over ciggi butts, auto accidents, booze and guns.:(
    
    

I think there's been more than just one death blamed on this stuff; last time I
heard I thought the number was closer to 20 people.  So, based on that you could
say that people lose both fat and muscle, sometimes all they have.

    
    Here are some articles on this drug that may be of interest.
    
    Re.82 - Sarah, I'd prepared a response in Notes, but lost it and
    haven't had the time to recreate it. 
    
    Cindy
    
    
    AP 29 Sep 95 0:30 EDT V0962
 
    Copyright 1995 The Associated Press. All rights reserved.
 
    FDA Rejects Obesity Drug Sale

    ROCKVILLE, Md. (AP) -- A new drug effectively fools obese patients into
    feeling full so that they will lose weight, scientists told the Food
    and Drug Administration. 

    But a bitterly divided FDA panel couldn't put aside worries about a
    theoretical risk that it could cause brain damage, so the government
    advisers voted 5-3 Thursday to reject the drug's sale in this country. 

    The issue remains open, however, after a panelist won a revote. 

    "I cannot live with my conscience tonight," proponent Dr. Nemat Borhani
    of the University of California, Davis, said after he was outvoted. 

    His impassioned plea for the first new obesity drug in 22 years
    prompted the panel to revote -- but after three opponents had gone
    home. The three supporters again voted yes, two opponents voted no, and
    the ballot remained open Friday for the three missing panelists to
    finally decide the issue. 

    Interneuron Pharmaceuticals Inc. said its dexfenfluramine helped 40
    percent of patients studied lose up to 10 percent of their body weight,
    twice that lost with diet alone. The majority lost 5 percent to 10
    percent. 

    But when dexfenfluramine is given in ultra-high doses to animals it can
    permanently alter their brain chemicals. There is no proof that this
    happens in people and dexfenfluramine would only be given to Americans
    in one-tenth of the dose found to be risky. Still, the finding worried
    the FDA panel. 

    Two doctors raised the fear that Redux -- the drug's brand name --
    could hurt patients. Redux given at high doses cripple animals' ability
    to produce serotonin naturally after the drug is stopped, studies show. 

    These drugs "should be used with the greatest caution if at all," said
    Lewis Seiden of the University of Chicago. 

    Some FDA panelists questioned whether Seiden's concern was relevant
    because the animals were given doses 20 to 30 times higher than any
    person would take. The company said it has seen no sign of brain damage
    in the 10 million people who have taken Redux in the 65 countries where
    it is sold. 

    The panel said Interneuron should answer the concerns with a
    well-designed two-year trial of Redux in Americans. 

    The panel also was more concerned with indications that Redux could
    cause a fatal lung disease in certain patients. This disease, primary
    pulmonary hypertension, affects one or two of every million people, but
    obliterates the lungs' ability to get oxygen to the heart. 

    But most of the panelists agreed that Redux's risk was very small --
    and acceptable -- for this disease. One study shows that at worst Redux
    could cause 10 deaths in five years from this disease, compared with
    the hundreds of obesity-related deaths the drug could prevent in the
    same time, said Gerald Faich of the University of Pennsylvania. 

    Not everyone responds to the pill, however, and the company suggested
    that doctors discontinue therapy for any patient who does not lose four
    pounds within the first month of taking Redux. 

    Obesity, defined as being more than 20 percent over ideal weight,
    causes 20 million new illnesses in the United States yearly and kills
    300,000. 

    Doctors typically urge patients to diet and exercise to drop the
    pounds, but almost all the few who succeed regain the weight within
    five years. The FDA has not approved any drug that can be used by these
    patients for more than several months because of concerns about risks.
    The majority of approved obesity drugs are amphetamines, which can be
    addictive. 

    The only nonamphetamine treatment is called fenfluramine, and
    Interneuron is seeking to sell a chemical relative of that drug for
    patients to use for years at a time. Dexfenfluramine is safer and
    possibly more effective than its older cousin, the company said. 



	From the Worcester Telegram & Gazette, Tuesday April 30th, 1996
	(Copied without permission)

	WASHINGTON - 	The Food and Drug Administration approved the first
	new anti-obesity drug in 22 years yesterday, a controversial medicine 
    	that essentially fools patients into feeling full so they lose 
	weight.

	Dexfenfluramine won FDA approval over the objection of consumer
	advocates and some doctors, who fear it could cause brain damage
	or a rare but dangerous lung disorder.

	But the FDA said brain damage so far has been found in only animals,
	and the lung ailment is rare.  Consequently, obese Americans can use 
	Dexfenfluramine longer than is allowed for any other appetite 
	suppressant, the agency ruled.

	Dexfenfluramine, created by Interneuron Pharmaceuticals, will be sold
	by Wyeth-Ayerst Labratories under the name Redux.  It will hit the
	pharmacy shelves this Summer and cost consumers approximately $2. per
	day the company said.
    


From:   Worst Pills/Best Pills News, July 1996, p.1
        Public Citizen's Health Research Group
Editor: Dr. Sidney M. Wolfe

Dexfenfluramine (Redux): A Diet Drug Without Proven Value and Possible
Serious Adverse Effects

In a reckless and irresponsible move, the Food and Drug Administration 
(FDA) had disregarded the advice of neuroscientists (specialists in 
brain chemistry and physiology) and approved the diet drug 
dexfenfluramine (Redux) for long term use.  At issue is 
dexfenfluramine's potential to cause serious neurotoxicity (changes in 
structure and function of the brain.)

Public Citizen's Health Research Group wrote FDA Commissioner David 
Kessler on April 29, 1996 in support of the opinion of 22 
neuroscientists who asked that approval be deferred until the safety 
question could be answered.  The scientists were worried because 
neurotoxicity has consistently been found in a variety of laboratory 
animals given dexfenfluramine.  Some of the scientists contacted the FDA 
in 1993 and again in 1995 asking that the effects of dexfenfluramine on 
human brains be studied carefully before the drug was released for 
general public use.  The FDA did not take this advice and recently 
cleared dexfenfluramine for use for periods up to one year.

The proposed studies in humans would have been possible because 
dexfenfluramine is not a new drug.  Pondamin (fenfluramine), another 
diet drug, has been on the U.S. market for 20 years and is 50 percent 
dexfenfluramine.  Dexfenfluramine as a single drug has been available in 
Europe since the early 1990s.  Scientists have developed methods, using 
modern brain imaging devices, to test for possible neurotoxicity in 
people who have taken dexfenfluramine.

The request to delay dexfenfluramine is logical, sound, and in the best 
interest of public health.  If the answer to a potentially serious 
safety problem can be obtained before a drug is approved it is only 
sound public health policy to get it.  Waiting to look for neurotoxicity 
until after dexfenfluramine is released just makes guinea pigs of the 
American people in a very large experiment.  Wyeth-Ayerst, maker of 
dexfenfluramine, says it will do post-marketing surveillance to check 
for possible neurotoxicity.

Dexfenfluramine is not a "break-through drug" - one of those rare 
medications that offer a significant, proven benefit that other drugs 
lack.  The scientific evidence shows dexfenfluramine results in weight 
loss so meager that it is of unknown value in reducing the health risks 
of obesity.  Not only that, but the drug is associated with a rare but 
serious adverse reaction, primary pulmonary hypertension.

These are the facts about dexfenfluramine:

- On average, studies show that persons taking dexfenfluramine over a
  period of one year may lose up to 7.5 pounds more weight than others
  who take a dummy dose (placebo).

- Those who use dexfenfluramine for longer than three months are nine 
  times more likely to develop primary pulmonary hypertension than those
  who have never used the drug.  Primary pulmonary hypertension is not 
  a simple rise in blood pressure that can be treated with ordinary
  antihypertensives (drugs to lower blood pressure); rather, it is a
  potentially fatal adverse drug reaction.  Drugs used to lower blood
  pressure often do not work to treat primary pulmonary hypertension 
  and when they do not, in extreme cases the patient may require a 
  heart-lung transplant.

- Drug regulatory authorities in France and the United Kingdom have
  restricted the use of dexfenfluramine to three months because of its
  association with primary pulmonary hypertension.

- Neuroscientists are worried about dexfenfluramine's neurotoxic
  potential in humans.

There are no "magic bullets" for losing weight and keeping it off.  
Changing eating habits and exercise are the only known ways to reduce 
the long term health risks of obesity.

------------------------------------------------------------------------
The Health Research Group was co-founded in 1971 by Ralph Nadar and 
Sidney Wolfe in Washington, D.C., to fight for the public's health, and
to give consumers more control over decisions that affect their health.

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