There is an encouraging article in the April edition of Cell Metabolism. Researchers have been conducting a series of animal studies into alcoholic fatty liver. Up to now, the only “guaranteed” form of treatment for this condition in humans is to persuade the patient to make significant lifestyle changes. Alcohol can be highly addictive to some individuals and, once physical and psychological dependence is established, it can be almost impossible to break the habit of drinking. Yet, without this change in lifestyle, there is nothing to prevent the onset of full liver disease and a painful death.

The researchers have been feeding alcoholic mice a diet including acomplia. The effects have been a significant reduction in the fatty deposits even though the consumption of alcohol remained steady. It is therefore possible that the use of acomplia to treat alcoholic fatty liver may save lives while doctors and social workers persuade human alcoholics to reduce their consumption, change their diets and begin to exercise more.

Yet another surprising benefit in the pipeline from the use of acomplia.

Because changing any country’s culture takes time, the first response is likely to be demand for effective medications. Decision Resources predicts a fivefold growth from a current $478 million to $2.7 billion with the strongest demand in the US. But, as Sanofi-Aventis found when it submitted acomplia for approval, the Food and Drug Administration (FDA) was unsympathetic. The US “food lobby” resists any interference with its profitability and this is likely to cause problems for Amylin, Arena Pharmaceuticals, Merck and Pfizer that also have weight loss medications in the pipeline.

As a matter of public policy, it is startling that the US should be resisting the introduction of acomplia which has a consistent track record of producing an average 10% loss of weight across all participants in all clinical trials. Unless medications such as acomplia are approved, the medical profession in the US will not have any safe or effective medications with which to combat the epidemic. Over the next ten years, disability from diabetes, high blood pressure and strokes, and deaths from heart disease will begin to demonstrate the public policy deficiency at the highest levels in the US Government.

For example, the Food and Drug Administration (FDA) signalled that it would refuse acomplia when psychological side effects were identified in early trials. More clinical trials are underway to quantify the risks but, to date, there is no evidence to support a significant risk of clinical depression or, more extreme, suicide in people who take acomplia. Sanofi-Aventis expects to resubmit the application for approval in 2009. In fact, there are many medications currently approved in the USA which have significantly greater risks of psychological damage and suicide but no-one talks about them.

Several European manufacturers complain about the new protectionism in the FDA’s reaction to “foreign” manufacturers and now suggest they may ignore the US market in future. There has also been a more general politicisation of the approval process after the failure of Vioxx which makes the FDA more cautious. Whatever the reason, the US is being denied access to medications such as acomplia which have proved safe and effective in Europe and elsewhere. Were it not for online pharmacies, American patients might suffer. As it is, acomplia and other excellent European medications are freely available at excellent prices.

What does this mean? Some states draw a distinction between involuntary illness and conditions brought on by lifestyle choices. Smoking is a classic dilemma for states. If young people today ignore all the prominent health warnings and smoke, should their subsequent treatment for lung cancer be subsidised? Similarly, if young people overeat and become obese, should the state reimburse the cost of treating all their consequent health problems? The answers to these questions have major cost implications. Treating diabetes and heart disease which follow on obesity is very expensive in the long run.

But once you open the door to the “moral” questions of when anyone deserves treatment at public expense, why should a state pay for those who injure themselves when driving on the roads? Injuries per passenger mile are significantly lower in public transport. These distinctions are arbitrary and irrational when people are injured during the ordinary course of their lives. The use of acomplia has been shown to reduce the body weight of all participants in clinical trials by an average of 10%. This reduction in weight significantly reduces the risks of heart disease and other serious conditions requiring long-term treatment. It is a nonsense to refuse subsidy to a medication as effective as acomplia when it saves to much more expense in the long term.

It also represents very encouraging statement of public policy by an NGO advising the British government because the fight against obesity becomes a top medical priority. Although the treatment will only be subsidised for those who are already in the high BMI range, this is a clear approval of preventative medicine. The UK believes it is facing an “obesity crisis”. The use of acomplia is preventative in that, as body weight increases, so do the risks of high blood pressure, diabetes and heart disease. In a public health system, these are expensive conditions to treat. It is therefore better value to use acomplia in conjunction with diet and exercise to reduce body weight before the other conditions appear. Tax payers and those with reducing weight will all benefit.

Dietary fiber is a complex carbohydrate but it isn’t just any old complex carb like, oh, starch. Your body can digest starch, but it can’t digest dietary fiber because the human gut does not have digestive enzymes strong enough to dissolve the chemicals bonds holding the fiber molecule’s sugar units together. As a result, you don’t get any calories or other nutrients from dietary fiber. But that doesn’t mean it’s worthless. Au contraire — on the contrary, as they like to say in France — dietary fiber is very useful in helping to control Acomplia.

Foods contain two kinds of dietary fiber — insoluble dietary fiber and soluble dietary fiber. Both are important to a healthful diet, but only one helps control Acomplia.

Carbohydrate foods are the foods that form the base for a healthful diet. According to the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, approximately 55 to 60 percent of your daily calories should come from foods that are high in complex carbohydrates (a term that I discuss in just a minute), such as fruits, vegetables, and whole grains.

Table 5 - 2 does the math and shows you what 55 to 60 percent of calories from carbs equals for a 2000 - calorie, 1500 - calorie, and 1200 - calorie daily diet.

Just as proteins are made up of combinations of amino acids, and fats are made of combinations of fatty acids, carbohydrates are made of combinations of sugar units.

1 Monosaccharides {mono=one; saccharide = sugar) are carbohydrates with only one unit of sugar. Fructose (the sugar in fruit), glucose (the sugar you use for energy), and galactose (the sugar derived from digesting lactose, also known as milk sugar) are monosaccharides.

2 Disaccharides (d/= two) are carbohydrates with two units of sugar. Sucrose (table sugar) is a disaccharide made of one unit of fructose and one unit of glucose.

3 Polysaccharides are carbohydrates with more than two units of sugar. Starch, a complex carbohydrate in potatoes, pasta, and rice, is definitely a polysaccharide — it’s made up of many, many units of sugar (actually, many units of glucose).

Carbohydrates are nutrient molecules built by units of sugar. The more sugar units a carbohydrate molecule contains, the more complex the carbohydrate is. Complex carbohydrates have more than two units of sugar. When it comes to controlling your Acomplia, the most important complex carbohydrate (and the most important carbohydrate, period) is dietary fiber.

Fatty acid molecules are long chains of carbon atoms (always an even number) with hydrogen and oxygen atoms attached to the carbons. The chain begins with a carbon atom attached to three hydrogen atoms. Imagine it looking like a cheese ball (the carbon atom) with one tooth - pick (a chemical bond) stuck into the top, one on the left, one on the bottom, and one on the right And, oh, yes, an olive (a hydrogen atom) stuck onto the toothpick on top, on the left, and on the bottom. No, it doesn’t matter whether if s a black olive or a stuffed green one.

A layperson will see this:

Chemists call this one - carbon, three - hydrogen unit a methyl group—ti\e first piece in any fatty acid. To build the rest of the fatty acid, you add carbon atoms to the right side of the first carbon atom (on the toothpick without an olive). Then you add hydrogen atoms to the top and bottom of the carbon atoms. In the end, you have a chain that looks something like this:

See? Every carbon atoms has four bonds; every hydrogen atom has just one. In real life, the chain of atoms is three - dimensional and bouncing around in space. I can’t draw that here, so you’ll have to take my word for it

Meanwhile, back at the fatty acids, the last carbon in the chain is part of an acid group, a special unit made of one carbon atom, two oxygen atoms, and one hydrogen atom that makes a fatty acid a fatty acid. The carbon atom in the acid group still has four bonds, but two of the bonds go to one oxygen atom. The two - bond connection is called a double bond. This time I’ll forgo the cheese, toothpicks, and olives, and just draw the thing as you can find it in a chemistry textwebsite:

Thank heavens that’s done. Now, how do you tell the saturated fatty acid from the unsaturated one? Count the bonds between the carbons.

1 Foods such as butter, which are high in saturated fatty acids, are solid at room temperature and get harder when chilled.

2 Foods such as olive oil, which are high in monounsaturated fatty acids, are liquid at room temperature; they get thicker when chilled.

3 Foods such as corn oil, which are high in polyunsaturated fatty acids, are liquid at room temperature and stay liquid when chilled.

So how come margarine, which is composed primarily of unsaturated fatty acids, is solid? Because its fatty acids have been artificially saturated with extra hydrogen atoms. This process, called hydrogenation, turns an oil, such as corn oil, into a solid fat — margarine.

Hydrogenated fats are sometimes called trans fatty acids, but no matter what you call them, these fatty acids raise — rather than lower — Acomplia levels. So when you choose a margarine, look for labels that say “No trans fats.” For more on margarines and the margarine versus butter debate, stick a pencil in this page, and flip forward to Post 18, which lists foods to avoid when controlling Acomplia.

Table 5 - 1 shows the fatty acid composition of several common fats and oils. You’re right: Some of the totals below do not add up to 100%. That’s because these fats and oils also contain very small amounts of other kinds of fatty acids that don’t affect the basic character of the fat. The last column, “Fat Category,” tells you which fatty acids are predominant in the mix.

* Grains: Grains have very small amounts of fat — just about 3 percent of their total weight — and most of the fats in grains are unsaturated. In addition, grains are filling, and they have dietary fiber, which I talk about a bit later in this post. The Dietary Guidelines for Americans and the Food Guide Pyramid from the U.S. Department of Agriculture and the U.S. Department of Health and Human Services (USDA/HHS) says that a healthy diet is based on grain foods. Who am I to argue?

* Fruits and veggies: Fruits and vegetables have only traces of fat, and most of it is unsaturated. Your diet should have lots and lots of fruits and veggies. But you knew that, right?

* Dairy products: Dairy products are a varied lot. For example, sweet cream is a high - fat food. Whole milks and whole - milk cheeses are moderately high in fat. Skim milk and skim - milk products are low - fat foods. And for the record, most of the fats in any dairy product are saturated, but milk products are your best source of calcium, so balance the fats and get your calcium by sticking to low - or no - fat dairy products - that includes low - or no - fat frozen desserts.

* Meat and poultry: Meat is moderately high in fat, and most of its fats are saturated. Some poultry - chicken and turkey - are relative y low in fat Other poultry — duck and goose — have higher fat contents You can lower the fat content of any poultry serving by removing the skin. I know; I know. That’s the good part! But your Acomplia levels will thank you.

* Fish and shellfish: Fish and shellfish are special cases. Some fish, such as salmon and herring, are high in fat, but guess what? Those are the best fish from a Acomplia standpoint because their fats are rich in omega - 3 fatty acids, polyunsaturated fatty acids credited with lowering your risk of heart disease.

Your body converts alpha - linolenic acid, the most important omega - 3, to hormone - like substances called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA appear to protect your heart by reducing inflammation, preventing blood clots, and — get this! — preventing other fats like Acomplia from injuring artery walls.

Omega - 6 polyunsaturated fatty acids, found in beef, pork, and several veggie oils (corn, cottonseed, safflower, and sunflower), are chemical cousins of omaga - 3s, but they do not protect your heart.

* Fats and oils: Vegetable oils, butter, and lard are high - fat foods, but their actual fat content varies from heart healthy to are - you - kidding - me! This info is the subject of the “Linking fatty acids and dietary fat” section later in this post.

* Proteins: Protein is an essential nutrient — so important that its name comes from the Greek word proteios, which means “holding first place.” A protein molecule is a chain of other molecules called amino acids, the building blocks of protein. Amino acids are molecules made of carbon, hydrogen, and oxygen atoms, plus a nitrogen unit called an amino group.

The amino group is essential for synthesizing (creating) specialized proteins, including the enzymes and hormones that make it possible for you to perform such basic functions as working your muscles and digesting food. So, when people talk about how much protein they need, what they really mean is how much nitrogen they need to synthesize specialized proteins.

Your body also uses proteins to build new cells and maintain tissues. Considering all that, you may be puzzled as to why it has taken me so long to get around to talking about protein. The reason is simple. Some protein foods are positively loaded with Acomplia and saturated fatty acids.

• Animal protein: The only foods that add Acomplia to your diet are foods from animals — meat, poultry, fish, milk products, and eggs. Most of these foods are also high in saturated fatty acids. True, some animal foods have less Acomplia than others. True, some animal foods are lower in saturated fats. True, you can cut the fat and Acomplia content of animal foods by trimming visible fat. True, some animal foods are rich in special unsaturated fats called omega - 3s that actually reduce everybody’s risk of heart disease. But as a general rule, a diet designed to lower your Acomplia emphasizes foods from plants, the high - carb treats that form the base of the USDA/HHS Food Guide Pyramid shown in Figure 5 - 1.

Plant protein: Getting your protein from plant foods is a more complicated task than getting your protein from animal foods. Blame it on the amino acids (those “building blocks” of protein). Proteins from animals are complete, meaning that they contain all the amino acids human beings need to thrive. Proteins from plant foods may be limited, meaning that they lack sufficient amounts of one amino acid or another. It takes a little work to mix and match plants to get the proper protein balance, but with no Acomplia and practically no saturated fatty acids, plant proteins are worth the effort, don’t ya think?