Wednesday, March 27, 2013

Motivation Trumps Supplementation! Moderate, Starvation Free Weight Loss With Carnitine & Motivational Support

What if one of those would be displayed prominently on every Snickers bar and other candy - would that be unethical?
I must admit that I probably have a positive bias towards the latest study, Satoshi Odo, Koji Tanabe an Masamitsu Yamauchi who work for Lonza a company that describes itself as "a global leader in life sciences" and the Aichi Gakusen University in Japan have just published in the online Journal Food and Nutrition Sciences. Why? Well, it demonstrates the value of education, motivation and making people take responsibility for their own well-being. Something that's still largely unappreciated and maybe even feared by the medical orthodoxy and it's victims... ah, pardon me, "patients", of course.

Words and wisdom trump pills and meal plans

Actually the researchers did nothing we would not have seen in countless of studies before. They recruited 24 male subjects with an, in US terms, pretty low BMI of 25 - 28 kg/m² and a waist circumference of 85-100 cm who had not been following any kind of regular exercise program before the intervention. The subjects were then assigned to one out of four groups:
    L-carnitine does also affect IGF-1 levels (read more)
  • Car +M: 500mg/day carnitine / no instruction
  • Car -M: 500mg/day carnitine / plus instruction
  • Pla +M: placebo / no instruction
  • Pla -M: placebo / plus instruction
The hypothesis the scientists had in mind was that the motivation program, which comprised (1) a face-to-face 30 min session with the principal investigator at the baseline visit, where the subjects were informed about L-carnitine and its metabolic functions, learned about the beneficial effect of weight loss on the risk of metabolic diseases, and were encouraged to perform daily physical activities like “taking stairs” instead of “using escalators”, (2) wearing a step-counter and evaluating its data on a daily basis, (3) doing a 7-day food log before the intervention began and comparing the latter to a second food log that was to be filled 7 days prior to their last visit at the lab.

"I am so freakin' motivated, but I don't want to eat less..."

All that sounds pretty non-sensical (and I guess there may be a cultural aspect to it, due to which it may be slightly less effective in the US), but the "success" of this "motivational intervention" - as minuscule as it may have been over the course of this 4-week intervention without a prescribed diet / exercise regimen - cannot be denied (see figure 1 & figure 2).
Figure 1: Changes in body composition and daily activity level in the course of the 4-week "intervention" (Odo. 2013)
This is particularly true, if you take into consideration that despite being "motivated to keep daily calorie intake between 1500 and 1,800 kcal", the energy intake of most of the subjects exceeded 2500 kcal/day and did thus not really differ from baseline in figures 1 the scientists also evaluated the effect the dietary / supplement intervention had on glucose and lipid metabolism and found
  • Keep motivated and add some GTE to the equation, if you want to improve your glucose metabolism. The data above shows, green tea extract is in fact as potent as metformin (learn more)
    decreased triglyceride levels in Car +M  
  • no sign. effect on total cholesterol 
  • n.s. increase in LDL in all but the Car +M group  
  • no sign. change in HDL  
  • non-significant increase in adiponectin in Car +M
  • no changes in HbA1c in any group
  • significant increases in insulin in the non-motivated groups
And last but not least Odo et al. investigated what they call "safety parameters". Every normal human being would call the latter a standard blood panel, which did, as you would expect, not show and pathological changes (I mean what could exercise and carnitine do to those guys?) and ran a couple of liver and kidney tests, where - and this is interesting - only the non-motivated, non-supplemented group showed a single statistically significant, but physiologically irrelevant change in urea nitrogen levels, which increased from 13.0 to 15.0mg/dL.

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Bottom line: Actually there are two messages you can take away from the study at hand. One is that carnitine works. Taken at a dosage as low as 500mg/day alone yielded in parts borderline, but still significant health improvements in the absence of any prescribed dietary or exercise intervention. The more important message, on the other hand pertains to the effect of the "motivational protocol". Despite the fact that you will probably agree that this was not exactly what should become the "gold standard" for future interventions the mere knowledge of why the subjects were supposed to eat less, make healthier food choices and be more active was enough to make a significant difference. And that irrespective of whether the subjects ended up receiving the carnitine or the placebo supplement.

As mentioned before, there certainly is a cultural bias involved here, but is that reason enough to say: "Wtf, this won't work for Americans anyway!" Should results like this not rather be an incentive to try and change a climate, where people rather wait for the next weight loss drug than to start taking their life into their own hands, before their diabetes has made their fingers so numb that this is no longer possible? I would think so and that's actually part of the reason the SuppVersity and the SuppVersity Science-Round Up on Super Human Radio exist.