Metabolic Weight Loss

One of the most important accomplishments at Condon Medical has been the discovery and publication of the differences in caloric metabolism in diabetes and prediabetes vs. people not at risk for these disorders. This has resulted in the strong support for early treatment of prediabetes and other related disorders like Dysmetabolic Syndrome, Syndrome X, and Poly Cystic Ovarian Syndrome. This early treatment often results in large successful weight loss.

Early in Dr. Condon’s career, he became frustrated with the common teaching then, and now, that diabetecs and pre-diabetics could control their disorder by diet and exercise. Clearly diet and exercise are very important and rare patients (less than 2%) are able to be successful, but many patients experience the reality that even if they did diet and exercise they did not lose weight.

These are the patients to whom we used to say unenlighened comments, like “You must be secretly eating and not know it,” “You must be eating at night,” "You must not count your food properly,” and “You must not be eating enough to lose weight.”

Most diet programs then and now used a formula to advise diet to the patient. The formula states that if you multiply the weight of the patient by 15 you will know the number of calories the patient is eating to maintain their weight. For example: if you weight 200 pounds x 15 = 3000 calories. Most diets were and are based on this formula.

If you weigh 200 pounds and you want to lose a pound a week you would be placed on a 2500 calorie diet I.E. 500 calories a day less than you were eating which over the seven days of the week would lead to a loss of 3500 calories ( which is equal to one pound.)

The problem is that many patients come back and say they were following the diet and not losing weight. Early in his career, like many others Dr. Condon thought the patient was not counting their calories correctly, or sleep eating, or not recognizing the need for their diet.

In considering an answer for this, Dr. Condon looked to the most extreme form of dieting. There are several interesting facts about human starvation. First, no person can go more than 3 or 4 days without water or they will die. Second, people without food will die but they die in two very different groups. Some people will die without food for one month, but others can and have survived for up to four months.

This is a very important difference result between humans, and obviously the people who can last four months have starvation survival genes and lose weight differently. This would be beneficial during times of starvation but in a food rich society it may be detrimental and lead to pr diabetes and diabetes.

It is obvious that if people die from lack of food at such a widely different times, then when they diet (a milder starvation) they will lose weight at a very different slower rate. Roughly, 50% of people lose weight four times slower than the other 50%. We should then expect very different rate of weight loss between people on the same diet.

In fact, following the exact same diet, some people lose 1 pound a week and others 1 pound a month. At the end of one year, one person will be down 52 pounds and the other 12. The patient losing the pound a month (and being blamed for it!) usually ends up leaving the program and quitting the diet.

Dr. Condon decided to directly measure how many calories each patient was eating and compare the results with the calculated amount.

The abstract published follows:

Metabolic testing for weight management: Dr. Condon has published data in the abstracts of the American College of Endocrinology, which indicates that diabetics and prediabetics burn calories more slowly than people without diabetic genetics. This test is used to adjust your diet and medication to help you with your diet and exercise. This was published and discussed at the 2011 American Association of Clinical Endocrinology annual meetings by Dr. Condon: abstract #289

Caloric utilization predicts hyperinsulinemia and impaired glucose tolerance.

Edward Michael Condon, MD, ECNU,

Gary Comparetto BA, Gregory Comparetto, MS

ABSTRACTS – Diabetes Mellitus

Objective:

Observe that caloric utilization is less in patients with impaired glucose tolerance and related to hyperinsulinemia.

Methods:

170 overweight patients were examined for resting energy expenditure by indirect calorimetry (Korr Reevue). Expected caloric requirements were calculated by a modified Harris Benedict method and compared to the measured calorimetric results. All patients were studied using a 75 gram glucose tolerance test measuring c-peptide on the second hour. 148 patients were observed to require 500 calories less than calculated to maintain weight. Twenty-two patients were observed to require the calculated calories to maintain weight.

Results:

85 percent of the low calorie utilizers had abnormal glucose tolerance tests by ADA criteria and had impaired glucose tolerance or diabetes, and all had elevated c-peptides. Twenty two patients with expected caloric intake matching actual had normal glucose tolerance tests and normal c-peptides.

Discussion/Conclusion:

Caloric utilization may be restricted or conserved in hyper insulin states. Caloric utilization may predict impaired glucose tolerance and diabetes. Study may reveal that correction of hyperinsulinemia will correct caloric utilization and promote weight loss. Measurement of caloric utilization may predict diabetes.

This is a very important finding which helps us to identify who will lose weight and who will not.  Additionally it prompts an important investigation to identify pre diabetes.  Pre diabetes is amenable to treatment and we are proceeding with our research and treatment for patients with this problem.

We are presently preparing for publication the results of treating these patients for insulin resistance early as an adjunct to diet and exercise.

Edward M. Condon MD FACE ECNU