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Cycling Wed: Shame at the Tour, Diet Pills and The Greatist

It’s going to have to be brief tonight.

The data from today: 7 bottles, 4 water stops, 110 degrees and 2200+ calories. (Strava proof.) Needless to say, as I type, my legs are on the brink of locking up. My brain feels as if it’s shrunk down in my head. Even this Retina screen looks blurry. Alas, I might be inflamed.

Three things:

Cycling and Cheating:

There was disappointment from the Tour de France. Another champion cyclist, Frank Schleck, who rides on the US-based RadioShack/Nissan/Trek team, failed a drug test. Mr. Schleck’s urine tested positive for a potent diuretic. Why would a Tour de France cyclist take a pill that promotes dehydration? It sure wasn’t for puffy ankles. Diuretics are taken to mask performance-enhancing drugs. Mr. Schleck has already started his defense: he was poisoned.

Gosh, this cheating, and then denying, gets so old. Can you just feel his inflammation swelling with the denials?

Speaking of inflammation, imagine the angst spared if a certain former Tour de France champion ended the grand charade. A friend’s suggestion: He could call up his old colleagues, Mr. Ulrich, Mr. Zulle, Mr. Hamilton and Mr. Landis, among many others, and suggest that they band together, tell the truth and say they were starting a foundation to clean up cycling. The truth worked beautifully for British cyclist, David Millar; it could work for them too. I hate to see an American icon suffer so much inflammation.

Obesity Pills:

I’m highly conflicted about the FDA’s approval of obesity drugs. Last month, locraserin, an activator of serotonin (a hormone important in mood) receptors in the brain, got the nod. This week, a combination of a stimulant and seizure drug, phentermine and topiramate, was approved. Both drugs failed on their first attempt at the FDA.

The reflex response from a health and fitness blogger is obvious: dismay and disdain. How could the FDA approve potent drugs, which affect brain chemistry and speed metabolism, to treat a problem best treated by very simple lifestyle choices? It seems so obvious, even to sportswriters, that Americans are over-medicated.

That’s the easy response. But obesity is such a baddie. Fatness is literally killing us. As I said yesterday, fat cells manufacture and proliferate inflammation. Inflammation leads to heart disease, stroke, dementia, diabetes and joint disease. Look around, you don’t need Harvard-level statistics, or cardiologists, to tell you there’s no end in sight. We are losing the battle. That’s why the FDA approved the free-lunch pills. It is true: the science reveals that obese patients who took these pills lost modestly more weight than patients who took placebo. This is important because in very obese patients, even modest weight loss might mean better outcomes. The thinking goes: from a public health standpoint, considering the millions of obese patients, the means justify the ends. Get the weight down, and there will be fewer cases of diabetes and heart attacks.

I understand this thesis. I need to ponder this one some more. Are stimulants and chemicals that mess with our brains good long-term solutions? Will mass-media promotion of the drugs directly to the consumer lead to even more over-medication of the populace? Will these drugs really be used to help obese people ‘over the hump’ and onto healthy living behaviors? When the drugs are unleashed to the masses, will adverse effects counter the benefits? Lots of doubt.

The Greatist—on Boosting Endurance:

Finally, It’s Cycling Wednesday; reviewing the topic of building endurance is always timely. I was pleased to participate—as an ‘expert’ (gasp)–on this nicely done review of ways to improve endurance. Greatist writer Laura Schwecherl does a nice job laying out both basic and nuanced principles for reaching personal bests. Who knew beet juice could make you faster? The smart and young people over at the Greatist continue to publish…well…really great stuff. Seriously folks, for useful health information, written in a refreshingly fun tone, I’d highly recommend following the Greatist. They are on to something.


8 replies on “Cycling Wed: Shame at the Tour, Diet Pills and The Greatist”

Cycling IS a great sport – but as you say, “it gets so old” – and I have clearly reached the point of not caring to follow the Tour de France any more because it seems that whoever does well may in the end be disqualified (SORRY for my pessimism …. ).

Interesting combination of subjects you chose for this post …. but Gotta admit that I totally agree re your skepticism about the wisdom of more drugs for weight loss. I preached in primary care for many years the true benefits of markedly overweight patients losing as little as 5-10% of body weight – but doing so by medications with potential adverse effects seems not to be the way – especially since such medication-induced-weight-loss is most often temporary. Hard not to use meds when desperate patients come asking for them – but would be far better all the way around if those patients could realize that their ultimate wellbeing depends on them buying in to lifestyle change (other approaches generally being without longlasting beneficial effect …).

Thanks Doc. The obesity pills are indeed a highly bloggable topic. I’m going to do some more research and thinking about them.

“The data from today: 7 bottles, 4 water stops, 110 degrees and 2200+ calories. (Strava proof.) Needless to say, as I type, my legs are on the brink of locking up. My brain feels as if it’s shrunk down in my head. Even this Retina screen looks blurry. Alas, I might be inflamed.”

Sorry, haven’t been following the thread – is this you Dr. John? Are you riding the TDF
Course? If so and you’re blogging it this is the input I’m dying for.

Any bets on when the other shoe will drop on these new “diet pills”? This area of pharmacology has a pretty dismal history.

Abbott voluntarily withdrew weight-loss drug Meridia (sibutramine) from the U.S. market in 2010 due to concern about it causing heart attacks and strokes.

In 2008, the European Medicines Agency withdrew prescription-writing for the weight-loss drug rimonabant, citing concern about psychiatric side effects.

Between 1997 and 2007, five weight-loss drugs were removed from various markets around the world due to safety or effectiveness considerations: phenylpropanolamine HCl, dexfenfluramine HCl (e.g., Redux), fenfluramine HCl (Pondimin), diethylpropion HCl (Tenuate), and phentermine HCl (e.g., Ionamin).

Phentermine, remember, is one of the components of Qsymia.

It’s unknown whether weight-loss drug therapy reduces the morbidity and mortality of obesity over the long run.

I’ll wait at least two or three years before giving these new drugs to my patients—I’ve seen too many drugs withdrawn from the market because of adverse effects showing up years after drug approval.


GREAT points Steve! I remember one-by-one as these medications were removed …

Typical Scenario: Patient walks into physicians office saying, “I want to lose weight”. Physician prescribes weight-losing medication. Even if transiently effective for brief limited weight loss – longterm weight loss is rare. Patient is discouraged and stops trying …

Comment: Longterm weight loss is unlikely to be successful unless a total understanding and commitment is made toward lifelong lifestyle change. That doesn’t happen overnight – and usually doesn’t happen in a 5-minute office visit in which the primary intervention is prescription of weight-losing medication …

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