Hey, don't say we haven't warned you that you can be playing with fire when you buy into some of the Internet hype on weight-loss supplements. And if you won't take our word for it, you could listen to a rash of recent safety warnings from the FDA.

But here's a twist we didn't see coming: The inclusion in some dietary supplements marketed for weight loss of a form of chromium that, in large doses, can lead to stomach ulcers, convulsions, kidney and liver damage and even death. The state of California considers it a carcinogen and wants to monitor the safety of the chemical -- called hexavalent chromium -- in California water supplies. Hexavalent chromium is an industrial byproduct used in the chemical and welding industries: It's the stuff that made Erin Brockovich famous.

Chromium is an essential trace mineral that is important for insulin function -- specifically, for the metabolism of fats and carbohydrates. While the evidence for its effectiveness as a weight loss agent is mixed, it's a popular ingredient in dietary supplements promising to help you shed pounds. Even the safe form of chromium (called trivalent, and often taken as a supplement by diabetics) can be toxic at levels as low as 200 micrograms a day. But for its evil twin, hexavalent chromium, California has considered a safe daily "public health goal" of 0.12 mcg in its drinking-water standards (the federal and California legal limits are, however, not so stringent).

The online tester of consumer products, ConsumerLab, has found that three chromium products marketed for weight loss contain quantities of hexavalent chromium way beyond that proposed limit: Mega-T Green Tea, Natural Factors Chromium GTF, and Dexatrim Max. A daily dose of Mega-T Green Tea Max had 220 times the maximum daily dose thought to be safe by California's proposed standard. Those three represented half of the six chromium products ConsumerLab tested, and one of a wide range of dietary supplements that ConsumerLab has tested for purity and adherence to their labeled ingredients.

Wholly aside from whether the products work as promised, ConsumerLab hasn't found many that are either free of contaminants or deliver what their labels advertise. 

ConsumerLab also echoes a recent package of articles in The L.A. Times about extremely high levels of caffeine in some of these products, and the dangers of mixing some dietary weight loss supplements with some prescription medicines.

--Melissa Healy

New blood sugar measurements used to determine gestational diabetes could mean that lower levels may pose risks for mother and baby.

The findings, released Friday and published in the March issue of Diabetes Care, were based on a study that included more than 23,000 women in nine countries. Researchers discovered that a fasting blood sugar level of 92 or higher, a one-hour level of 180 or higher on a glucose tolerance test or a two-hour level of 153 or higher on a glucose tolerance test may present grave risks to both mother and child. Before, these numbers were believed to be in the normal range.

If healthcare providers go by these levels, far more pregnant women could be diagnosed with gestational diabetes.

"This study says these risks to pregnancy are like many things we deal with in medicine," said the study's lead author, Dr. Boyd Metzger of Northwestern Memorial Hospital in Chicago. "The risk of having a stroke doesn’t begin when your blood pressure is 140 over 80. That's when we say you have hypertension, but that's not where the risk begins to affect your health. That starts sooner. A similar situation is how your cholesterol level relates to the risk of having heart disease. It doesn't begin at 200. That's where it reaches the threshold where common treatments can reduce the risks."

Researchers are finding more about what may trigger gestational diabetes. A study published this week in the journal Obstetrics & Gynecology found that women who gain weight in the first trimester of pregnancy were at a higher risk for gestational diabetes than women who did not, and obese women who gained weight during that period were especially at risk.

-- Jeannine Stein

Photo credit: Lori Shepler / Los Angeles Times

A newly developed computer program merges the operations of continuously implanted glucose sensors and insulin pumps in diabetics, bringing researchers closer to an artificial pancreas that could provide much better control of insulin levels, minimizing complications of the disease. The new results, published Friday in the medical journal Lancet, show that the computer can safely monitor glucose levels at night, a period when patients are at greatest risk of falling into potentially dangerous hypoglycemic episodes without realizing it. "This is an important step in diabetes control because it shows that, with this system, people can sleep safely with minimized risk of hypoglycemia," Dr. Eric Renard of Montpellier University Hospital in France wrote in an editorial accompanying the report.

Technology has been advancing in diabetes control in the last few years, and the biggest developments have been the adoption of continuous glucose monitors and insulin pumps. The monitors, embedded beneath the skin, provide regular updates on blood glucose levels, sounding an alert when they fall too low or climb too high. The pumps infuse a continuous low background level of insulin into the bloodstream, allowing the user to increase the amount after a meal or when otherwise necessary. An estimated 10% to 15% of the 3 million Americans with Type 1 diabetes now use one of the two devices or both. But researchers have been slow to successfully merge the two types of device because of problems ensuring that blood sugar levels do not get too high or too low.

With its cartoon book cover and high-concept premise, "The Big Breakfast Diet" looks and sounds like a gimmick. Eat a breakfast of up to 3,000 calories -- loading up on protein, sweets and starches -- and watch the pounds disappear? Uh, right.

But first impressions might be deceiving. Dr. Daniela Jakubowicz, a specialist in endocrinology and metabolic disease, developed the eating plan while treating patients with thyroid disorders, Type 2 diabetes and other health conditions associated with weight gain.



To test her theories, she and a team of researchers conducted an eight-month study with 94 overweight women, comparing weight loss in one group on her big-breakfast diet with a second group on a low-carbohydrate diet. Women on her diet lost an average of nearly 40 pounds, she says, while women on the low-carb diet ended down about 9 pounds on average after losing more and gaining some back.



Jakubowicz’s premise is that it’s not what you eat but when you eat it that matters. She says overweight people often eat out of sync with what their bodies need -- which is more food early in the day and less at night.



The main component at breakfast should be protein, she says, and lots of it. Her diet calls for 2 cups of milk or soy milk and yogurt at breakfast, as well as additional protein. She suggests options such as an egg white scramble, a lean steak or a chicken breakfast burrito. Protein eaten in the morning builds muscle mass, provides energy, increases alertness and maintains the body’s glucose levels for hours, she says.

Also mandatory is a moderate amount of carbs and fat, including a breakfast sweet. She says that a morning sweet, such as a chocolate doughnut or a piece of apple pie, satisfies cravings and keeps the body’s levels of serotonin at an even keel throughout the day.
 And eating starches in the morning increases energy rather than fat reserves because of how the body processes insulin, she says.

All this food, she says, should be consumed before 9 a.m. (10 a.m. in fall and winter).  Lunch should be eaten by 2 or 3 p.m., even if you’re not yet hungry, and be limited to vegetables, protein and fruit. Dinner is minimal – ideally nothing, or just vegetables, a small amount of lean protein and maybe some fruit.



Follow this plan, she says, and the excess weight will melt away and stay off. And you will be spared the afternoon and evening cravings for sweets and starches that plague many a dieter.

Jakubowicz says you can eat even 3,000 calories a day and lose weight, as long as you eat in sync. For the fastest weight loss, however, she recommends a fairly spartan 1,100 to 1,450 calories daily: 600 to 850 or so consumed at breakfast, 350 to 400 calories at lunch and 150 to 200 calories at dinner. 


Of course, most overweight people would lose weight on 1,100 calories a day. But on her diet, she says, they won't get hungry or crave carbs at night and be tempted to abandon the plan. She says the large amount of protein consumed early in the day keeps dieters satisfied through the evening. 

The main drawback to the big-breakfast diet would seem to be the fact that people eat not just to satisfy hunger or cravings, but as a social activity. And dinner is when they typically gather to break bread. Sure you can order up a vegetable platter or salad while others are noshing on pesto pasta and pizza, but it takes commitment.


Jakubowicz claims, however, that the results you get on the diet will be enough to make you stick with it.

She offers a recipe for a vegetable-packed stew to eat at dinner, and for those who need more flexible options, recipes for dishes such as goat cheese and baby spinach salad, spicy Thai beef and sauteed shrimp and peppery red cabbage.



Photo: "The Big Breakfast Diet: Eat Big Before 9 a.m. and Lose Big for Life," Daniela Jakubowicz, Workman Publishing, $11.95.

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You've just finished a serious workout and your stomach is rumbling. Figuring you should replace the carbohydrates you just burned, you reach for something carb-heavy. But is that the best thing to have?

Researchers from the University of Michigan discovered that what you eat following a workout may trigger different metabolic responses. In a small study published last December in the Journal of Applied Physiology, nine healthy men went through four different sessions: In one they were sedentary and ate meals with a calorie equivalent of what they burned that day (this served as the control), and three in which they exercised for about 90 minutes at moderate intensity and then ate a meal.

After one of those three sessions they ate a carb-, fat- and protein-balanced meal that had the calorie equivalent of what they burned; after another they ate a low-carb meal with the calorie equivalent of what they burned; and after the third they ate a meal with a higher carb content to replace the carbs they burned during exercise, but the calorie content was below what they burned by about one-third.

The bouts of exercise all improved insulin sensitivity, but it was especially enhanced when the session included the low-carb meal. Having good insulin sensitivity means that the body can more easily take sugar from the bloodstream, allowing muscles to use it for fuel.

Among the sessions that included the low-calorie meal or the calorie-equivalent meals there were no discernible differences in improving insulin sensitivity. Researchers believe that although weight loss may be the goal of many who exercise, there still could be health benefits without cutting back on food.

-- Jeannine Stein

Photo credit: Kirsten Luce / MCT

Having a big butt, wide hips and full thighs is generally thought to come with a lower risk of heart disease, diabetes and other health problems, while having a high proportion of belly fat increases that risk. We know this, right?

Still, the findings keep coming. A study published today in the International Journal of Obesity isn’t objectionable – fat deposited on the butt and thighs is a good thing – but still it makes me cringe.

“[I]n day-to-day metabolism,” the study observed, “[gluteofemoral fat] appears to be more passive than the abdominal depot and it exerts its protective properties by long-term fatty acid storage.”

I don’t mind the explanation about the benefits of the pear shape over the apple shape. And I generally don’t argue with the Department of Health and Human Services, which says that women with waists measuring more than 35 inches are at greater risk of “weight-related health problems.”

I do, however, take issue with the disproportionate focus on women’s bodies in this debate. Too much commentary involves posting a photo of some well-endowed starlet’s rear end.

Such obsessing about female body shapes doesn’t seem necessary -- or necessarily healthy for women. Especially since the really bad belly fat is not the love handles that inevitably mushroom over a pair of jeans, but visceral fat -- fat on the inside of the body, close to the organs, invisible to the naked eye. 

-- Amina Khan

Photo credit: Tim Sloan / AFP/Getty Images

In the same week that would-be quitters got the depressing news that they're at higher risk of developing diabetes for roughly a decade after stopping smoking, a study published Thursday in the Journal of the National Cancer Institute has made a remarkable discovery:

Positive messages are a better way to help you quit!

It turns out that phone counselors staffing Quitlines, which are an increasingly popular and effective way to support smokers in kicking the habit, might be more effective if they reframed their comments to be positive, a study conducted by Yale University researchers found.

So instead of telling a smoker in the grips of nicotine withdrawal, "you gotta resist the urge to light up, or else you'll be more likely to die an early and painful death," the counselor might say, "if you resist the urge to light up, you're very likely to live a longer life!"

Whodathunkit?

Actually, the effectiveness of scary versus positive messages in discouraging people from smoking is very much an active subject of research right now. With its new regulatory powers over tobacco, the Food and Drug Administration is empowered to dictate that cigarette packaging has prominent warnings about the dangers of smoking or the importance of quitting. Amid growing evidence that scary, graphic images of blackened lungs and death actually backfire, the agency is deliberating just what kinds of messages will sway consumers best from buying cigarettes. 

The Yale study found that the consistent delivery of such "gain-framed" exhortations to quit made smokers using the quit-lines more likely to attempt a program of smoking cessation and more likely to have continued abstaining from cigarettes when they were contacted two weeks later. At the three-month mark, alas, the difference between the two disappeared--a testament, perhaps, more to the addictive powers of nicotine than to the weakness of positive thinking.

Even more remarkable, perhaps, is that these were would-be quitters who were taking antidepressants to aid in their effort. That may have made them more amenable to hopeful, positive messages encouraging them to stay the abstinence course.

Nevertheless, the authors of the study argued that positive messages of encouragement--which are neither more expensive nor more intrusive to deliver than messages that are scary or more neutral--are worth trying for states and institutions running quit lines. And their study showed that it's possible to get operators to deliver "gain-framed" messages consistently, with just a little training.

So, let's go back to that diabetes/quitting study published Monday in the Annals of Internal Medicine, and think how to "gain-frame" that message.

Old: "Hey, while you're jones-ing for that cigarette, you want to be careful not gain too much weight, because for the next three years, you're at much higher risk of developing Type 2 diabetes."

New: "You know, if you can just quit smoking now, you're going to lower your risk of developing diabetes to that of someone who never smoked in about 12 years!"

See? It's that easy! 

Is giving up cigarettes your New Year's resolution, or have you done so in recent years? Here's the National Cancer Institute's guide to all things quitting, and here's the American Cancer Society's guide, also available in Spanish. And here's a guide to all the research that says you should do so. And if you think that packing on the pounds is an inevitable effect of quitting, check out this authoritative website.

-- Melissa Healy

Six days before Thanksgiving, a 21-year-old Air Force enlistee, Tre Francesco Porfirio, was pulling duty in Afghanistan when three high-velocity bullets tore through his pancreas — the fist-size organ that produces insulin and enzymes we need to extract fuel from the food we eat.

With an injury like that, Porfirio's prognosis was very difficult: If he could survive long enough to get to a specialized transplant center, he could perhaps get a transplant of islet cells from a deceased donor and take anti-rejection drugs for the rest of his life. Or doctors could remove his pancreas, leaving him completely dependent on insulin. Either way, an early death from complications of Type 1 diabetes was highly likely.

But doctors who improvised a way to help the serviceman quickly made Porfirio a pioneer in the technique of islet-cell transplantation instead.

On Tuesday, Dr. Camillo Ricordi, director of the University of Miami's Diabetes Research Institute, told the story of a long-distance islet cell transplant — a still-experimental procedure considered to be the best hope for treating those, such as Type 1 diabetes patients, with a non-functioning pancreas. The transplant involved flying Porfirio's shattered pancreas — now removed — from an operating room at Walter Reed Army Medical Hospital in Washington to Ricordi's specialized laboratory, more than 1,000 miles away, at the University of Miami's Miller School of Medicine. There, on the night before Thanksgiving, the delicate islet cells of Porfirio's own pancreas were extracted and purified — a specialized operation performed at only a handful of transplant centers across the country.

Until now, if you were a patient who couldn't make it in time to one of 15 cities with medical centers equipped to prepare islet cells for transplant, you were out of luck. But physicians willing to try anything to help Porforio have shown that may no longer be true. 

The stew of islet cells prepared at the University of Miami was sent back to Walter Reed. There — under the supervision of Ricordi's team in Coral Gables, Fla., watching remotely — physicians carefully fed the purified cells through a tube into the airman's liver. Within days of the procedure, performed on Thanksgiving, Porfirio's islet cells did what all physicians hope they will do in such cases: They began to produce insulin, effectively doing the work of the excised pancreas.

Porfirio is unusual also in that his islet cells came from his own pancreas, which, while in shreds, was not dead yet. Most patients must rely on a deceased donor's pancreas and must take anti-rejection drugs to ensure their immune system doesn't attack the foreign cells. The ability to use Porfirio's own islet cells for the transplant, while "very rare," according to Ricordi, means he will not face rejection issues that make such transplants a lifelong challenge for recipients.

That remote transplant, said Ricordi in an interview, is a first: it could mean patients whose pancreas is destroyed by diabetes or trauma can be treated, potentially, anywhere in the country. Having shown that islet cells can be prepared for transplantation remotely and returned in time to a waiting patient — and then, that physicians with minimal training in such transplants can be supervised in doing them — Ricordi's team says that many more patients may gain access to the procedure. Patients with chronic pancreatitis, an inflammation of the insulin-producing organ, may, with some fancy logistics, be able to get the treatment they need close to home. And patients whose pancreas is compromised or destroyed by trauma can be treated where they are.

— Melissa Healy

Did you make a stop at your favorite coffee place today for some java or a cup of tea? If not, you may want to schedule one for tomorrow. Because a new study shows that coffee and tea consumption--even decaf versions--could help lower the risk of Type 2 diabetes.

The study, which appears today in Archives of Internal Medicine, is a meta-analysis of 457,922 people in 18 studies published between 1966 and 2009 that looked at the link between drinking coffee and diabetes risk. After analyzing the research, the study authors concluded that every extra cup of coffee consumed in one day was correlated with a 7% decrease in the excess risk of diabetes. Even better results were found for bigger coffee and tea consumers--drinking three to four cups a day was associated with about a 25% reduced diabetes risk compared with those who drank between none and two cups day.

Researchers also saw positive results with decaf coffee and tea (some tea varieties do have caffeine, but typically far less than the average cup of coffee). People who drank more than three to four cups of decaf a day had about a one-third lower risk than those who didn't drink any. And tea drinkers who consumed more than three to four cups a day had about a one-fifth lower diabetes risk than non-tea drinkers.

Because the decreased risk was seen among those who didn't consume caffeine, researchers concluded that that substance couldn't be the only key ingredient. Attention has been focused on other chemicals found in the beverages: magnesium (shown in studies to reduce diabetes risk), lignans (plant-derived chemical compounds that have antioxidant properties), and chlorogenic acids (also plant-derived antioxidants that slow down glucose release after eating).

In the study, researchers speculated that identifying the components of coffee and tea active in reducing Type 2 diabetes risk could potentially pave the way for new therapies to treat the disease. Health experts could also recommend drinking coffee and tea to at-risk patients, in addition to counseling them to exercise more and lose weight.

-- Jeannine Stein

Photo credit: Alex Garcia / Chicago Tribune

About one in every ten American women of Chinese and Korean heritage develop gestational diabetes during pregnancy, a rate that is 2.5 times higher than that of Caucasian women and three times higher than that of African Americans. Gestational diabetes, marked by high blood-sugar levels typical of Type 2 diabetes, can if untreated lead to early delivery and a need for cesarean sections and increases the child's risk of developing obesity later in life. Women who develop it are also 2.5 times as likely to develop metabolic syndrome after their pregnancy. Metabolic syndrome, characterized by high cholesterol levels, high blood pressure and obesity, among other things, is a significant risk factor for diabetes and cardiovascular disease.

Researchers have known that Asian women, in general, have a higher than normal risk of developing gestational diabetes, but it has not been clear what the magnitude of the risk is or which nationalities are most at risk. To answer those questions, a team from the Kaiser Permanente Center for Health Research in Portland studied all singleton births, more than 16,000, at Kaiser Permanente Hawaii from 1995 to 2003. That location was chosen because of its ethnic diversity.

They reported today in the journal Ethnicity and Disease that the average risk for the entire group was 6.7%. The individual risk ranged from a high of 10.1% for Korean Americans and 9.8% for Chinese Americans to 3.3% for African Americans. Women of Filipino ancestry also have high risk, but those with Japanese and Vietnamese heritage had average risk. Native Americans and women of Hispanic heritage had below-average risk.

"Many previous studies have lumped all Asians and Pacific Islanders together," study co-author Teresa Hillier said in a statement. "We now know that the risk for developing [gestational diabetes] varies greatly depending on your specific ethnic background. Future studies should also look at whether women in these higher risk groups also have more complications."

The study was funded by the American Diabetes Assn.

-- Thomas H. Maugh II