Bariatric surgery may slow cognitive decline for people with obesity.

Cognition scores remained stable, while secondary executive function tests showed improvement
Cognition scores remained stable, while secondary executive function tests showed improvement

Within the next 10 years, it’s projected that up to 50% of United States adults will be affected by obesity, which is associated with cognitive impairment and dementia. 

Investigators at Michigan Medicine found that people with obesity who underwent bariatric surgery had stable cognition two years later

Researchers say it suggests that bariatric surgery may mitigate the natural history of cognitive decline expected in people with obesity.

The results are published in the Journal of Nutrition, Health & Aging.

“Since individuals with obesity experience more rapid cognitive decline than those without, stable cognition two years after bariatric surgery may be considered a success against historical trends, yet future controlled trials are needed to test this,” said first author Evan Reynolds, Ph.D., lead statistician for the NeuroNetwork for Emerging Therapies at Michigan Medicine.

Using a collection of memory and language tests developed by the National Institutes of Health, as well as the Rey Auditory Verbal Learning Test, the research team assessed over 85 bariatric surgery patients at two-year follow up.

They found that NIH Cognitive Battery test scores remained stable, with secondary executive function tests showing improvement. 

One of the memory assessments, however, declined following surgery.

While this current study is the largest to assess changes two years after bariatric surgery, researchers say, the results conflict with previous studies which found improved memory and executive functioning among similar patients.

“That study was primarily made up of patients who received gastric bypass, while our study was made up primarily of individuals that completed a sleeve gastrectomy,” Reynolds said. 

“To provide the best evidence on the effectiveness of bariatric surgery on cognition and potential differences between surgery types, we must conduct larger observational studies or randomized, controlled trials.”

After bariatric surgery, improvements in diabetes complications, such as peripheral neuropathy, chronic kidney disease and retinopathy, were not associated with improved cognition.

“Metabolic factors, including diabetes and obesity, are associated with cognitive decline, but we still need to better understand how best to treat these factors to improve patients’ cognitive outcomes,” said senior author Brian Callaghan, M.D.

Practicing mindfulness can help people make heart-healthy eating choices

Practicing mindfulness focused on healthy eating can be good for the heart, a new study shows, because it improves self-awareness and helps people stick to a heart-healthy diet.

When people who had elevated blood pressure participated in an eight-week mindfulness-based blood pressure reduction program for the study, they significantly improved their scores on measures of self-awareness and adherence to a heart-healthy diet compared to a control group. The results were published in JAMA Network Open.

“Participants in the program showed significant improvement in adherence to a heart-healthy diet, which is one of the biggest drivers of blood pressure, as well as significant improvements in self-awareness, which appears to influence healthy eating habits,” said lead study author Eric B. Loucks, an associate professor of epidemiology, behavioral and social sciences, and director of the Mindfulness Center at Brown University.

Loucks said the study helps explain the mechanism by which a customized mindfulness training program adapted toward improving diet can affect blood pressure.

“Improvements in our self-awareness, of how different foods make us feel, of how our body feels in general, as well as our thoughts, emotions and physical sensations around eating healthy as well as unhealthy food, can influence people’s dietary choices,” he said.

High blood pressure, a major cause of cardiovascular disease, is the single most important risk factor for early death worldwide, according to a recent report by the World Health Organization, leading to an estimated 10.8 million avoidable deaths every year. The important thing to note about those avoidable deaths, Loucks said, is that there is ample research supporting effective strategies to control and prevent hypertension.

“Almost everyone has the power to control blood pressure through changes in diet and physical activity, adherence to antihypertensive medications, minimizing alcohol intake and monitoring stress reactivity,” he said.

A heart-focused mindfulness program

The mindfulness-based blood pressure reduction program used in the study, which Loucks developed in 2014, trains participants in skills such as meditation, yoga, self-awareness, attention control and emotion regulation. What makes the program unique, he said, is that participants learn how to direct those skills toward behaviors known to lower blood pressure.

The MB-BP plan consisted of a group orientation session, eight 2.5-hour weekly group sessions and one day-long retreat, as well as recommended home practice for 45 minutes, six days a week. The program was led by trained instructors with expertise in cardiovascular disease etiology, treatment and prevention. Classes were held in Providence, R.I., at Brown University and at a health center in a lower-income, urban neighborhood.

The study compared two groups, totaling 201 participants. The 101 people in the test group were a part of the 8-week MB-BP program, which included personalized feedback and education about hypertension risk factors; mindfulness training of participants in relationship to hypertension risk factors (including mindful eating); and behavior change supportThe “usual care” control group received educational brochures on controlling high blood pressure. Both groups received a home blood-pressure monitoring device with usage training, and options for referral to primary care physicians.

The researchers focused on participant adherence to the DASH (Dietary Approaches to Stop Hypertension) program, a balanced eating plan rich in fruits, vegetables, whole grains and low-fat dairy, intended to create a heart-healthy eating style for life. Despite its effectiveness, adherence to the DASH diet is typically low.

After six months, the mindfulness group showed a 0.34-point improvement in the DASH diet score. Loucks explained that this effect can be interpreted as equivalent for a participant shifting from a vegetable intake approaching recommended levels (2-3 servings) to recommended levels (at least 4 servings), or making similar shifts across another component of the DASH score. The control group showed a -0.04-point change in DASH diet score.

The mindfulness group also showed a 0.71-point improvement in the average interoceptive awareness (which is the process of sensing and interpreting signals from one’s own body) score compared to six months prior, which outperformed the control group by a significant 0.54 points.

The authors said the trial results offer evidence that an adapted mindfulness training program for participants with high blood pressure that targets diet and self-awareness significantly improves both.

“The program gives participants the tools to make heart-healthy diet changes that can lower their blood pressure and decrease their risk of cardiovascular disease,” Loucks said.

The researchers are studying different “doses” of the program (for example, shorter program lengths, fewer sessions), as well as factors influencing the implementation of the MB-BP plan in a real-world setting — including eligibility for health insurance coverage, accessibility for different patient groups and flexibility for physicians.

Danish experiment reveals: You can satisfy your appetite just by looking at pictures of food on your phone.

The results may lead to a new form of treatment for overeating.
The results may lead to a new form of treatment for overeating.

The internet is overflowing with pictures of food: On news sites, social media and the banner ads that pop up everywhere.

Many of the food images are uploaded to sell specific foods. The idea is that the images on Facebook or Instagram will make us yearn for a McDonalds burger, for example. In other words, the image awakens our hunger.

New research from Aarhus University now shows that the images can actually have the opposite effect. At least if we see pictures of the same product repeatedly. 

A number of experiments reveal that we can get a sense of satiety if we see the same image more 30 times. Tjark Andersen, who recently defended his PhD at Department of Food Science at Aarhus University, explains more.

“In our experiments, we showed that when the participants saw the same food picture 30 times, they felt more satiated than before they had seen the picture. The participants who were shown the picture many times also chose a smaller portion than those who had only seen the picture three times, when we subsequently asked about the size of portion they wanted,” he says.

Tricking your brain into feeling full
It may sound strange that the participants felt full without actually eating anything. But this is really quite natural, explains Tjark Andersen. How we think about food has a large influence on our appetite. 

“Your appetite is more closely linked with your cognitive perception than most of us think. How we think about our food is very important,” he says, and continues:

“Studies have shown that if you make people aware of different colours of Jelly Beans, even if they have eaten all they can in red Jelly Beans, will still want the yellow ones. Even if both colours taste completely the same.”

Within brain research, these findings are explained with so-called grounded cognition theory.  For example, if you imagine putting your teeth in a juicy apple, the same areas of the brain are stimulated as if you actually take a bite of an apple.

“You will receive a physiological response to something you have only thought about. That’s why we can feel fully satisfied without eating anything,” he says.

A large online experiment
Tjark Andersen and his colleagues are not the first to discover that we can get feel full by looking at pictures of food. Other research groups have previously shown this. 

The new research from Aarhus University is that they examined the number of repetitions needed – and whether variation in the images removes the sense of satiety.

“We know from previous studies that images of different types of food don’t have the same effect on satiety. That’s why you can really feel full after the main course but still have room for dessert. Sweet things are a completely different type of food,” he says.

To investigate whether variation in food completely removes the sense of satiety, Tjark Andersen and his colleagues designed a number of online experiments. They ended up getting more than 1,000 people through their digital experiments.

First they showed a picture of just orange M&Ms. Some participants were shown the picture three times, others 30 times. The group that saw most pictures the M&M felt most satiated afterwards, explains Tjark Andersen.

“They had to answer how many M&Ms between 1 and 10 they wanted. The group which had seen 30 images of orange chocolate buttons, chose a smaller amount than the other two groups.”

Afterwards, they repeated the experiment. This time with M&Ms in different colours. The colours did not change the result.

Finally, they replaced the M&Ms with Skittles. Unlike M&Ss, Skittles taste different depending on the colour.

“If colour didn’t play a role, it must be the imagined taste. But we found no major effect here either. This suggests that more parameters than just colour and flavour have to change before we can make a effect on satiety,” he explains.

Could be used as a weight loss strategy
Since 1975, the number of overweight people worldwide has tripled. According to the WHO, obesity is one of the biggest health challenges facing humans. And the reason why we become too fat is that we eat too much food and too much unhealthy food and we do not take enough exercise.

This is where Tjark Andersen’s results come into the play. Perhaps they can be applied as a method to control appetite, he says. 

“Think if you developed an app based on a Google search. Let’s say you wanted pizza. You open the app. Choose pizza – and it shows a lot of photos of pizza while you imagine eating it. In this way, you could get a sense of satiety and maybe just stop wanting pizza.”

Perhaps his results can best be used to ensure that you don’t start a meal. The participants in the study only chose slightly fewer Skittles or M&Ms, corresponding to less than 50 calories.

“You won’t save many calories unless you completely refrain from starting a meal. But perhaps the method can be used for this as well. It’d be interesting to investigate,” he says.

Social media are overflowing with food
Tjark Andersen and a number of other researchers are studying how food advertisements on social media affect us, because we are constantly being confronted with delicious food. 

A few years ago, an American research group tried to find out how many advertisements with food we encounter on average when we are on social media. The researchers monitored a number of young people and mapped out the content they met.

On average, the young people saw 6.1 of food-related posts in 12 hours. The vast majority of the posts were pictures of food – and more than a third were about desserts or other sweet food.

The internet and, in particular, social media can be a contributory factor in our becoming increasingly overweight. But it may also be the solution.

Only the future will tell.

The naturally occurring peptide may tackle obesity-related conditions’ ‘root cause’.

Naturally occurring peptide may tackle the ‘root cause’ of obesity-related conditions
Naturally occurring peptide may tackle the ‘root cause’ of obesity-related conditions

Research shows that a peptide (small protein) called PEPITEM could provide a revolutionary approach to reducing the risk of type 2 diabetes and other obesity-related diseases such as hepatic steatosis (fatty liver). 

The researchers used an animal model of obesity to investigate whether PEPITEM, delivered by a slow-release pump, could prevent or reverse the effects that a high fat diet has on the pancreas.  Excitingly, the results showed that administration of PEPITEM significantly reduced the enlargement of insulin-producing cells in the pancreas and also significantly reduced immune cell migration into various tissues. 

The research team was led by Dr Helen MCGettrick and Dr Asif Iqbal from the University of Birmingham’s Institute of Inflammation and Ageing and Institute of Cardiovascular Sciences.  Dr McGettrick said: “We have found a new therapeutic approach that could provide new drugs to tackle the root cause of obesity-related conditions by preventing the damage caused by systemic inflammation.

PEPITEM was first identified in 2015 by Birmingham researchers who described its role in the adiponectin-PEPITEM pathway, which is involved in controlling the onset and severity of auto-immune and chronic inflammatory diseases. 

Obesity causes complex and dramatic changes in metabolism in adipose (fat) tissue, damage to the pancreas, reduced insulin sensitivity and eventually the hyperglycaemia that underpins type 2 diabetes.  It also causes a low-level inflammatory response across the boyd, encouraging white blood cells to enter into many tissues including the visceral adipose tissue (fat stored deep inside the body wrapped around the organs, including the liver and gut) and peritoneal cavity (a thin membrane that encompasses the gut). 

The latest research, published in Clinical and Experimental Immunology, shows that the adiponectin-PEPITEM pathway also connects obesity, the low-level inflammatory response that is driven by it, and changes in the pancreas that precede diabetes. 

The results showed that dosing with PEPITEM while the mice were on a high fat diet significantly reduced the enlargement of insulin-producing beta cells in the pancreas and the number of white blood cells in the visceral adipose tissue and peritoneal cavity, compared to controls. 

The researchers also looked at the potential of PEPITEM to reverse the changes brought on by obesity, by feeding the animals a high fat diet prior to treating with PEPITEM.  Excitingly, they saw similar results.  Dr Asif Iqbal commented: “Until now we have understood very little about how the inflammation that accompanies obesity drives pathology.  These results show us that PEPITEM can both prevent and reverse the impact that obesity has on metabolism.  The next stage is to translate these exciting results into therapeutics that can be used in humans.”

Professor Ed Rainger from Birmingham’s Institute of Cardiovascular Sciences led the team that first identified PEPITEM.  He commented: “We are all very excited about these latest results.  PEPITEM is a naturally occurring peptide.  We have already shown it has effects on several organs and now for the first time, we have shown that PEPITEM is effective

A ‘Keto-like’ diet may be linked to a higher risk of heart disease and cardiac events.

Popular weight-loss diet also associated with higher levels of LDL cholesterol
Popular weight-loss diet also associated with higher levels of LDL cholesterol


The ketogenic or “keto” diet, which involves consuming very low amounts of carbohydrates and high amounts of fats, has been gaining popularity. However, a new study presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology suggests that a “keto-like” diet may be associated with higher blood levels of “bad” cholesterol and a twofold heightened risk of cardiovascular events such as chest pain (angina), blocked arteries requiring stenting, heart attacks and strokes.

“Our study found that regular consumption of a self-reported diet low in carbohydrates and high in fat was associated with increased levels of LDL cholesterol— or “bad” cholesterol—and a higher risk of heart disease,” said Iulia Iatan, MD, PhD, attending physician-scientist at the Healthy Heart Program Prevention Clinic, St. Paul’s Hospital and University of British Columbia’s Centre for Heart Lung Innovation in Vancouver, Canada, and lead author of the study. “To our knowledge, our study is one of the first to examine the association between this type of dietary pattern and cardiovascular outcomes.”

Carbohydrates are the body’s first “go-to” source for fuel to provide energy for daily life. Low-carbohydrate, high-fat (LCHF) diets, like a keto diet, restrict consumption of carbohydrates (e.g., bread, pasta, rice and other grains, baked goods, potato products such as fries and chips, and high-carbohydrate fruits and vegetables). By depriving the body of carbohydrates, it is forced to start breaking down fat for energy instead. The breakdown of fat in the liver produces ketones, chemicals that the body uses as energy in the absence of carbohydrates—hence the name ketogenic, or “ketone producing.” Proponents of a ketogenic diet generally suggest limiting carbohydrates to 10% of total daily calories, protein to 20% to 30% and obtaining 60% to 80% of daily calories from fat.

Some previous studies have shown that an LCHF diet can lead to elevated levels of LDL cholesterol in some people. While elevated LDL cholesterol is a known risk factor for heart disease (caused by atherosclerosis, a buildup of cholesterol in the coronary arteries), the effects of an LCHF diet on risk for heart disease and stroke have not been well studied, Iatan said.  

For this study, Iatan and her colleagues defined an LCHF diet as consisting of no more than 25% of total daily energy or calories from carbohydrates and more than 45% of total daily calories from fat. They dubbed this an LCHF diet and “keto-like” because it is somewhat higher in carbohydrates and lower in fat than a strict ketogenic diet. They defined a “standard diet” as individuals not meeting these criteria and having more balanced eating habits.

The research team analyzed data from the UK Biobank, a large-scale prospective database with health information from over half a million people living in the United Kingdom who were followed for at least 10 years. Upon enrollment in the biobank, 70,684 participants completed a one-time self-reported 24-hour diet questionnaire and, at the same time, had blood drawn to check their levels of cholesterol. The researchers identified 305 participants whose questionnaire responses indicated that their diet during the 24-hour reporting period met the study’s definition of an LCHF. These participants were matched by age and sex with 1,220 individuals who reported eating a standard diet. This resulted in 73% of the participants in each group being women and the group’s average age was 54 years. Those on an LCHF diet had an average body mass index (BMI) of 27.7; those on a standard diet, 26.7. A BMI of 25 to 30 falls within the overweight range.

Compared with participants on a standard diet, those on an LCHF diet had significantly higher levels of both LDL cholesterol and apolipoprotein B (apoB), the protein component that sits on LDL and other atherogenic lipoprotein particles. Previous studies have shown that elevated apoB may be a better predictor than elevated LDL cholesterol for risk of cardiovascular disease, Iatan said. After an average of 11.8 years of follow-up—and after adjustment for other risk factors for heart disease, such as diabetes, high blood pressure, obesity and smoking—people on an LCHF diet had more than two-times higher risk of having several major cardiovascular events, such as blockages in the arteries that needed to be opened with stenting procedures, heart attack, stroke and peripheral arterial disease. In all, 9.8% of participants on an LCHF diet experienced a new cardiac event, compared with 4.3% of those on a standard diet, a doubling of risk for those on an LCHF diet.

“Among the participants on an LCHF diet, we found that those with the highest levels of LDL cholesterol were at the highest risk for a cardiovascular event,” Iatan said. “Our findings suggest that people who are considering going on an LCHF diet should be aware that doing so could lead to an increase in their levels of LDL cholesterol. Before starting this dietary pattern, they should consult a health care provider. While on the diet, it is recommended they have their cholesterol levels monitored and should try to address other risk factors for heart disease or stroke, such as diabetes, high blood pressure, physical inactivity and smoking.”

The study’s findings also suggest that not everyone responds to an LCHF diet in the same way.

“On average, cholesterol levels tend to rise on this diet, but some people’s cholesterol concentrations can stay the same or go down, depending on several underlying factors,” Iatan said. “There are inter-individual differences in how people respond to this dietary pattern that we don’t fully understand yet. One of our next steps will be to try to identify specific characteristics or genetic markers that can predict how someone will respond to this type of diet.”   

A limitation of the study is that participants provided dietary information at only one point in time, which should be considered when interpreting the study findings, Iatan said. Moreover, self-reports of food consumption can be inaccurate, though Iatan said this questionnaire has been extensively validated.    

Because the study was observational, it can only show an association between the diet and an increased risk for major cardiac events, not a causal relationship. However, Iatan said the findings merit further research in prospectively designed studies, especially when approximately 1 in 5 Americans report being on a low-carb, keto-like or full keto diet.