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Newswise LOS ANGELES (Nov. 13, 2019) Maria Robles Garcia was sure her uncomfortable abdominal symptoms weren't caused by irritable bowel syndrome or from being overweight, no matter that her local doctors repeatedly told her that was the case. Eight months of escalating abdominal and back pain, bloating, vomiting, hair loss and fatigue added up to something worse-of that she was certain.

"My doctor told me I was getting fatter, and that was the problem, even though I could feel something hard in my belly," Garcia, 53, recalled of the months of frustrating physician visits at which she believed her symptoms were dismissed because she's overweight and a woman. "I've been overweight for a long time. That was not the problem. I was actually losing weight because I was so sick."

Garcia credits her Cedars-Sinai Emergency Department physicians and surgeon with saving her life, after they detected and removed a 25-pound, cancerous ovarian tumor.

"They listened to me," Garcia said. "If not, I could have died."

Physician dismissals of women's physical symptoms as "all in your head" or "irritable bowel syndrome" are nothing new to Bobbie J. Rimel, MD, assistant professor of Obstetrics and Gynecology at Cedars-Sinai and Garcia's gynecologic oncologist.

"I have treated many patients who were told they felt ill because they're fat or have gluten intolerance when, in fact, they had cancer," Rimel said.

Lack of financial resources and access to proper health screenings, plus physician bias based on physical appearance, ethnicity and gender are among the health inequities that often delay cancer diagnoses and treatment, Rimel said. "These disparities in healthcare break my heart."

In the case of ovarian cancer, women face the additional burden of vague and mild-sounding symptoms that often fail to prompt a pelvic exam, delaying diagnosis.

"Indigestion, fatigue and changes in bowel movements don't usually prompt doctors to palpate women's abdomens," Rimel said. "Nor do they do so when women complain of constipation. If Maria's doctors had, they would have felt the large tumor."Garcia's torturous road to a life-saving diagnosis began two years ago with multiple visits to an Antelope Valley primary care physician and a gastroenterologist. She repeatedly complained of vomiting and frequent diarrhea and she felt a hard mass in her abdomen.

Garcia said she "begged" her gastroenterologist for a CT scan to get an accurate look inside her abdomen and pelvis, but he rejected her request. She did undergo an ultrasound, but the ovarian tumor apparently was not identified, Rimel said. The physician told Garcia she was fat and had a liver condition, the cure for which, he said, was weight loss.

As the Lancaster residents condition worsened, she sought help again from her primary care physician, who told her to go immediately to the Cedars-Sinai Emergency Department. Once there, abdominal and pelvic imaging quickly confirmed the huge mass in her ovary. About 48 hours later, Garcia was in surgery, where Rimel removed the 18-inch, 25-pound tumor.

"She was incredibly lucky that the cancer had not spread," Rimel said. Unlike most cancerous tumors, which grow on the surface of the ovary and then spread into the abdomen, Garcias cancer apparently lived inside her ovary and grew there.

"Women need to know that it's not normal to suffer," Rimel said. "Do not delay a doctor visit. If you are in pain, dont give up until you feel better." She encourages women with ongoing abdominal pain to see a gynecologist who, she said, "is more in tune with the cancer risks women face. They are more likely to pursue diagnostic tests."

Garcia underwent chemotherapy for six months following surgery because tests revealed some cancer cells in her abdominal fluid. Genetic testing also revealed that Garcia has one of the BRCA gene mutations, which increases her risk for breastand other cancers. Follow-up CT imaging and regular blood tests that monitor the presence of cancer during and after treatment have revealed no cancer recurrence, Rimel said.

To maintain her physical and emotional well-being, Garcia participates in the Cedars-Sinai Wellness, Resilience and Survivorship Programs. Shes completed the six-week "Emerging from the Haze" program, which helps cancer survivors deal with cognitive concerns, strong emotions or other quality of life issues following cancer treatments. She also has partaken of the "Nutrition in the Kitchen" program and art therapy classes. She currently is enrolled in the "Community for Resilience with Exercise" program.

Garcia says she is on a mission to help other women who need guidance as they deal with the effects of a cancer diagnosis and treatment. She says the hard work is worth it.

"Im the luckiest woman out there," Garcia said. "I want other women to listen to their bodies and not doubt what theyre hearing. There is beauty in this world, and I want them to be around to enjoy it."

More here:
Cedars-Sinai Team Saves Life of Patient with 25-Pound Ovarian Tumor - Newswise

Penn State head coach James Franklin appeared on the Move the Sticks Podcast with Daniel Jeremiah and Bucky Brooks to discuss refocusing the his team after a loss.

...the way we do it here we have a light practice on Sunday, make corrections, Franklin said when asked how the Nittany Lions will get back on track after the loss at Minnesota. Basically do a walk and talk for our scouting report for our next opponent on the field, and then were off on Mondays and then practice Tuesdays. I thought our locker room, it was the correct response. A lot of raw emotion. Guys were hurting. Our guys are on our own Monday when we come in and game plan...From my conversations with the guys, were in a good place. Well use this -- you have a choice. In my mind, everything is used for fuel. When you win a game, thats used for fuel from a confidence perspective. When you lose a game, you can use that as fuel to make sure to do everything in your power to make sure you never feel that again.

Brooks asked Franklin how he keeps Penn State on a level plane over a 12 or 13 game season.

For us, thats really where we try to do the 1-0 mantra, Franklin said. We dont just talk it, we try to live it in everything we do. Ive worked around a lot of coaches where they say were going to do the 1-0 deal, but then they get up in front of the team and you can tell that this game is more important than another game. That may be going to class, that may be going to the weight room. Its winning the moment, its being present, and those types of things. I think weve done a pretty good job of that. Since I got here, you look at where the program was right before I got the job to where it is now. Obviously, weve made signiificant strides...Hard to have this conversation after having our first loss of the season, but Ive been impressed with it. We try to live it, we try to be consistent with it, we try to be consistent with our behavior, our habits, and our approach. So far, weve done a pretty good job of that.

Penn State hosts Indiana on Saturday, who is ranked for the first time since 1994 at No. 24 in the AP Top 25. The Nittany Lions will hope to put the Minnesota loss behind them and get the job done heading into a showdown with Ohio State next week.

"I think Coach Franklin said it best right after the game we can't let Minnesota beat us twice," sophomore defensive tackle PJ Mustipher said. "So when you're coming off a game like that, you've got to be able to quickly move on."

A Nittany Lions victory would set the stage for Penn State to make its biggest statement yet Nov. 23 in Columbus, where an unbeaten Ohio State squad will await (unless the Buckeyes suffer the upset of all upsets Saturday at 2-7 Rutgers). The winner would be destined for a Big Ten championship game appearance Dec. 7 in Indianapolis, and Minnesota is in the driver's seat to serve as their opponent.

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James Franklin talks about where Penn State is coming off a loss - 247Sports

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Diabetes doesnt have to be a life sentence. Although the disease isnt considered curable because it can return after several years, it can go into remission with appropriate medication and a change of diet and lifestyle.

More than one million adults in the UAE or about 17 per cent of the population have type 2 diabetes, according to the International Diabetes Federation.

Contributing factors in the UAE include a sedentary lifestyle, stress and an unhealthy diet, explains Dr Naveed Rauf, Specialist Cardiologist at Emirates Hospital Day Surgery and Medical Centre in Dubai Motor City.

Diabetes mellitus is a set of metabolic disorders characterised by high blood glucose levels. By far the most common is type 2 diabetes, a lifestyle disease triggered by factors such as obesity and age, as well as by ethnicity and family background. It accounts for 90 per cent of all cases and occurs when the body cant produce enough insulin, or when insulin doesnt regulate blood glucose levels properly.

Type 2 diabetes has been proved to go into remission for some period of time, says Dr Kishore Kumar Katam, Specialist Endocrinology at Thumbay University Hospital, Ajman. He points to the DiRECT open-label study that tracked 280 participants in the UK over 24 months to assess whether lifestyle changes can trigger remission. Two years later, more than a third of participants remained in remission. Younger people with new onset diabetes in whom insulin is started as initial therapy sometimes see diabetes go into remission, says Dr Katam. But [overall], weight loss due to a well-planned diet and exercise or bariatric surgery can cause remission of diabetes.

The UAE has already clocked a reduction in overall levels of type 2 diabetes. In March, the Ministry of Health and Prevention announced that diabetes among adults dropped by over a third between 2010 and 2019, while adult obesity decreased by about a quarter.

GN Focus asks doctors across the nation to illustrate how type 2 diabetes goes into remission with case studies from their practice. For privacy reasons, the patients names have been left out.

Take a combined approach

Dr Katam cites the case of an overweight South Asian man aged 35 years, who visited the clinic with new onset diabetes and HbA1C levels above 10 per cent in February 2018. HbA1C is a blood pigment bound to glucose, tests for which indicate how well diabetes is being controlled. Normal levels are under 6 per cent. Hed had symptoms of increased urination and thirst for over two months. He was frightened because hed developed diabetes at a younger age, says Dr Katam. We counselled him to follow a low-calorie and high-fibre diet, with regular exercise. He was advised to take insulin as the sugars were very high, above 250 mg/dL. He was started on premix insulin; two weeks later, his sugars were well controlled. Insulin was slowly brought down to the lowest possible dose, before being stopped entirely.

Several follow-ups later, through to July, the patient has been able to maintain blood sugar levels without insulin in the target range, but by keeping a careful watch on his diet and exercise.

The period of remission depends on diet, exercise and genetic background.

Drugs combined with lifestyle changes delivered quick results for an Arab patient too.

On February 2, a 34-year-old male who was obese at 115kg with high fasting glucose, elevated blood pressure and high cholesterol levels was counselled about his condition and offered a treatment of lifestyle modification and metformin for three months, explains Dr Rauf.

He came back seven months later after losing 14kg. We repeated the blood tests and all was within normal limits. Hed taken metformin for three months only and did the rest with lifestyle modification. This included diet control, calorie reduction and reduced carbohydrate intake, as well as exercise of least half an hour five times per week and giving up smoking.

Theres so much we still dont know about how long remission lasts or complications in the future, but lowering your blood sugar, blood pressure and cholesterol definitely reduces the risk of complications.

Involve the family

Dr Sarla Kumari, Specialist Physician Diabetologist, Canadian Specialist Hospital, tells of a 35-year-old Egyptian man who weighed 140kg and had a BMI of over 40. He came to me in May 2018, feeling weak and tired. He complained of repeated throat infections, had a family history of diabetes and his HbA1c levels were 9 per cent.

We then involved his wife to help change his diet and prescribed one hours brisk walk aimed at weight reduction and started him on oral hypoglycaemic medication Janumet two times a day. We explained diabetes can be reversed with weight loss, gave him diet charts and referred him to a dietician. The patient stopped eating rice and bread, opting instead for soups, salads, grilled fish and chicken, vegetables and fruit.

Over a year, he has lost 40kg and now weighs 100kg. The good news is that his last HbA1c was 5.4 per cent, well within normal limits this June, and he remains committed to losing 10kg more. I credit his success to his willpower and strong determination to reverse his diabetes along with his wifes support, and his commitment to regular check-ups so as to monitor his blood sugar levels.

Add a surgical intervention

Dr Shaimaa Mashal, Specialist Internal Medicine at Bareen International Hospital, MBZ City, Abu Dhabi, describes the case of a 38-year-old obese Arab woman: She had type 2 diabetes for four years on (uncontrolled) oral hypoglycaemic medication and presented with hyperglycaemia (400-500mg/dL) and all the basic symptoms of diabetes. Her HbA1C was 12.5 per cent.

We changed all diabetic treatment to a diabetic diet, basal insulin combined with glycogens such as a peptide agent, short-acting insulin and combined metformin with sodium glucose transporter inhibitor.

The patient responded quickly and within two months, her HbA1C levels dropped to 8 per cent. Nevertheless, Dr Mashal felt bariatric surgery would help her further. Two weeks after surgery, her HbA1C was down to 7 per cent. On self-monitoring, her blood glucose is 100-120 mg/dL, so we reduced the insulin to a third of the total dose. There was an improvement in protein and lipid profiles as well. Overall, she has now a better quality of life and is on her way to remission.

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The sweet success of diabetes remission | Health - Gulf News

Insects are disappearing en masse.

A new report from the Somerset Wildlife Trust in the UK found that 41% of the worlds 1 million known insect species are threatened with extinction.

The decline of butterflies, bees, and other bugs might seem low on a list of environmental concerns that includes rising seas and melting glaciers.

Yet the loss of these species could be devastating.

Insects are food sources for countless bird, fish, and mammal species. They recycle nutrients in the soil, and break down dead carcasses and animal waste. Pollinators like bees and hoverflies also perform a crucial role in fruit, vegetable, and nut production.

But insects are quickly losing their habitats to farmland and urbanization, and are threatened by farmers use of pesticides as well.

We cant be sure, but in terms of numbers, we may have lost 50% or more of our insects since 1970 it could be much more, ecologist Dave Goulson, the author of the new report, wrote. We just dont know, which is scary Perhaps more frightening, most of us have not noticed that anything has changed.

According to Goulsons report, it is hard to avoid the conclusion that there has been a major decline in insect biomass.

Goulson, a professor of biology at the University of Sussex, found that in the UK specifically, 23 bee and wasp species have gone extinct in the last century. Butterfly species have declined by as much as 77% since the mid-1970s, and populations of local insect-eating birds, like the spotted flycatcher, have similarly shrunk.

His work relied heavily on a February 2019 study in which scientists Francisco Snchez-Bayo and Kris Wyckhuys looked at 73 historical reports on insect declines around the world. Their results showed that the total mass of all insects on the planet is decreasing by 2.5% per year.

Beyond the 41% of the worlds known insect species that are already in decline, Snchez-Bayo and Wyckhuys noted that 31% are threatened (according to criteria set by the International Union for Conservation of Nature), and 10% are going locally extinct.

The February study also suggested that moths and butterflies are disappearing; between 2000 and 2009, the UK lost 58% of butterfly species on farmed land.

Dragonflies, mayflies, and beetles appear to be dying off as well.

If this trend continues unabated, Snchez-Bayo and Wyckhuys warned, the Earth may not have any insects at all by 2119.

Already, insects extinction rate is eight times faster than that of mammals, birds, and reptiles. That biodiversity crisis could trigger a catastrophic collapse of Earths ecosystems, the authors said.

Gary Mantle, chief executive of the Wiltshire Wildlife Trust (another environmental group in the UK), told The Guardian that this unnoticed apocalypse should set alarms ringing.

One of the most concerning trends in this insect apocalypse is the decline of honey bees.

In the US, the number of honey-bee colonies dropped from 6 million in 1947 to just 2.5 million in 2014.

Between October 2018 and April 2019, about 40% of US honey bee colonies died, according to research from the University of Maryland. Thats the highest winter bee loss in 13 years.

Researchers have observed a similar problem in the UK: one-third of 353 wild bee and hoverfly species there experienced declines between 1980 and 2013, according to a March study.

Honey bees pollinate $15 billion worth of US food crops, according to the Associated Press. One-third of everything Americans eat comes from pollinators like honey bees, per US Department of Agriculture estimates.

Worldwide, approximately three-quarters of all crops are pollinated by insects, Goulson said. So insect extinctions could have a major impact on our food production and supply.

Experts think honey bees are dying due to a combination of decreasing crop diversity, poor beekeeping practices, and loss of habitat. Pesticides like neonicotinoids can also kill bees in droves, causing colony collapses.

Goulson reported that 75% of honey samples from around the world contained neonicotinoids.

He added that in the UK, the number of pesticide applications has doubled over the last 25 years, and thats primarily to blame for widespread insect declines there.

To make the problem worse, insect habitats are disappearing as more land area gets used for farmland and urban development around the world.

Studying changes in insect populations over time is challenging, and many analyses rely heavily on reports about bugs in Europe and North America, even though most insects live in the tropics. Because of this, some scientists have pushed back against the idea that all insects could disappear within a century.

I understand the desire to put numbers to these things to facilitate the conversation, but I would say all of those are built on mountains of unknown facts, Michelle Trautwein, an entomologist from the California Academy of Sciences, told The Atlantics Ed Yong in February.

But the data trends we do have are troubling.

A 2017 study concluded that populations of flying insects in Germany had decreased by more than 75% percent in the last three decades. Another study conducted in Puerto Rico found that 98% of the islands ground insects had vanished since the 1970s.

The overwhelming weight of evidence that exists suggests the rapid decline is a real phenomenon, Goulson told The Guardian.

Although he agrees that there is a shortage of data on insect population trends, he added: It really worries me to hear people say we need more long-term studies to be sure. That would be great, but we cant wait another 25 years before we do anything because it will be too late.

Trautwein agreed that its better to approach the risk of insect extinctions with caution, rather than disregard.

I dont see real danger in overstating the possible severity of insect decline, but there is real danger in underestimating how bad things really are, she told the Atlantic.

Read more:
More than 50% of insects have disappeared since 1970, an ecologist warns even more evidence of an insect apocalypse - Business Insider

My father died on October 8. It was Yom Kippur. They say that God takes only the saintliest and most beautiful of souls on that holy day. I didnt know this until a rabbi told me after hearing that I had lost my father. But it is one of the truest things I now know.

I know a lot of things, especially when it comes to death and loss and suffering and memory. Ive made a career out of it. If anyone should have been prepared to face loss with grace and dignity and understanding, it should be me. And yet, in the weeks since he disappeared, I have heard myself say so many times to myself and others, I didnt know. I didnt know it would feel like this. Each time I say it, it is with a sense of wonder. Not the kind of bright, childlike wonder, but the kind one feels only when its too late to go back perhaps the kind of wonder experienced by the poor souls of Dantes Inferno as they descend into the circles of hell: My God, it exists, it really exists and its happening to me.

I thought I knew myself but I had a blind spot, and all I can think about is what I didnt know until now. Usually I write about things I know and that I think others should know. But this time, I want to write about all the things I didnt know: all the things they never tell you.

No one ever tells you that while youll forget a lot of things in the weeks after the death of your father like why you walked into the kitchen, who you were about to call, what day your son has basketball and swimming, what your car looks like your memory, in other ways, will kick into overdrive and you wont be able to stop images of your father and your childhood from rising to the surface. You wont be able to stop the memory of your last conversation with your father, your last glimpse of his face, from running through your mind. You wont be able to stop hearing your mothers voice when she called you: Your father. Hes not breathing. I think hes dead. You wont be able to unhear her sobs as she pleads with his body: I love you, please come back to me, please dont leave me. Those words, and the sensation of hearing them, will be inscribed on your skin. Theyll leave traces in the breath that goes in and out of your body. You and those words will become inseparable. Its written on your face.

No one ever tells you about how there isnt just one layer of grief.

No one ever tells you that when youre in the grocery store checkout line trying to look normal and buy a bottle of wine and the cashier asks for your ID, that your hands will shake. Hard. And no one tells you that when you cant find the ID in your wallet, that you will start sobbing uncontrollably, that you will yell, loud enough for everyone in line to hear, that youre 42 years old and your dad just died.

No one ever tells you that things dont get easier. No one tells you that they get harder. No one tells you that even though you think you will wake up the day after the funeral and feel 1% better, youll actually wake up with a new, profound and permanent sense of pain and grief, and that youll come alive with the realization that this is the new weight youll have to learn to carry.

I didnt know. I didnt know it would feel like this. Each time I say it, it is with a sense of wonder. Not the kind of bright, childlike wonder, but the kind one feels only when its too late to go back.

No one ever tells you about how there isnt just one layer of grief. No one tells you that in addition to contending with your personal sense of loss, youll break down under the weight of seeing your younger siblings in pain. No one tells you that your chest will rip open when you see your youngest sibling, your 29-year-old baby brother, crushed and crying his eyes out, and that in that moment youll remember holding him when he was 3 years old to comfort him, and wish you could do it again. No one tells you that in the days after your fathers death youll visit your mother in the house they used to share, and that you will want to die because it hurts so bad to leave her alone in that big empty house she and your father built together. And no one tells you that when you think youve scraped the bottom of griefs pit, your 6-year-old son will start to break down under the burden of sadness that is too much for his little body and soul, and that during the funeral, when his tears finally come and he starts to wail with his whole heart, youll realize that there is no bottom to grief that it is an endless maze where you bump around and try to feel your way out of something that has neither form nor end.

No one ever tells you that such grief is like waking up and realizing you have a stone inside the now hollowed-out place that you call your chest, and that you will carry that stone for the rest of your life. Common sense tells me that the stone must get lighter, that Ill forget its even there after a time. But my friend Audrey tells me that this is the Great Lie that people tell that it gets easier. It doesnt, she says. And in my heart I know she is right, that I will have to carry this stone with me everywhere I go, and that some days it might feel light, but on others it will be too much to bear no matter how much time has passed. The weight of grief I want to forget that its there. And yet, I cant. The guilt I feel from simply desiring that reprieve is the sharpest of rebukes.

Losing a parent especially when you have spent your whole life chasing a deeper understanding of that parent is a loss like no other.

No one tells you that in the weeks after your fathers death, you wont stop eating. No one tells you that instead youll want to fill your body with all the things that he loved to eat, the things you told him to stop eating, the things you said were killing him. No one tells you that youll find yourself eating those mini grocery store powdered sugar doughnuts, making that rice with two sticks of butter baked into it, and drinking Squirt soda. No one tells you that youll think constantly about baked potatoes, that youll both crave them and be sickened by the thought of them. Why? Because thats what his last meal was. A sad little baked potato pushed to the side of his plate, just before his final moments. But then youll remember that it was one of his favorite things to eat, and that your mother had made it for him with love. So much love wrapped up in a baked potato: the last supper.

Love and loss are always wound together, arent they? Its strange that we work to unravel them when they seem to coexist so exquisitely.

No one ever tells you that a month after your father dies, youll still catch yourself whispering, to yourself, my dad died over and over because you dont believe it. You cant believe it. And thats the thing: No one tells you that seeing his body, the life gone out, and touching his hand, growing colder with each second, wont make you believe its real. No one tells you of the horror that is the body absent of life, that it grows cold so quickly, that it becomes colder than the temperature of the room in which it lays. It doesnt seem possible. And yet.

No one tells you that it death is the one thing we cant really talk about in an honest way.

Perhaps most importantly, no one tells you that while some of your friends will lean into your grief and show up in ways you never imagined, others will shrink away and remain silent. They wont call or email. They wont send flowers or soup. They wont even text you. And when they see you at a party, they will avoid you because they dont know what to say, how to act. But somehow, you wont resent them for it because youll realize that what has happened to you is terrifying and uncomfortable for them that they dont know what it feels like and so they dont know what to say. But it will still hurt. Youll still get angry that they werent there for you even though you understand.

And so it happens that you will learn so much from all the things that no one ever told you. Youll realize that you carry not only the weight of profound loss but also the weight of responsibility, because now you understand at least to a certain degree what others are going through when they lose a loved one. And with knowledge comes responsibility.

I never knew that one of the most powerful revelations that can come from loss is the understanding that I have fallen short, that when friends lost loved ones, I didnt do enough, didnt say enough, didnt listen closely enough. I have always prided myself on being a good friend. Im that friend who will help you bury a body if it ever comes to that. But extreme declarations of loyalty are useless if I dont show up in the right ways for people who I call my friends when someone they love has disappeared from their life.

And heres the thing: Ive made an intellectual career out of studying and writing not only about trauma and loss, but more precisely about all that we cannot know when it comes to the suffering of the other. And yet here I am, marveling at all the things I didnt know, as if I expected otherwise.

Losing a parent especially when you have spent your whole life chasing a deeper understanding of that parent is a loss like no other, and it is impossible to comprehend, even as it is being experienced. But its also true that we will all face this kind of loss at some point. It is deeply and devastatingly universal, and yet so much of what happens in the wake of such loss is unspoken.

Maybe some things need to remain unspoken until we find ourselves inside of them. Maybe it would be too much to bear otherwise the anticipation of an unavoidable loss that changes the world as we know it. But there are other things that need to be spoken, things to which we must always bear witness. That things get easier in the wake of a loss might be the Great Lie, but there is also an expanse of truth that becomes clear alongside the loss. Theres no silver lining to death. Everything does not happen for a reason. The death, pain and suffering of others is always incomprehensible. But when these things happen, when we see others in our lives experiencing these dark parts of what it means to live in a broken world, we can show up for them in all the ways that matter.

That truth, and the understanding that I have more love and empathy to give when others experience loss, might bring a little light to the eternal darkness I felt on Yom Kippur.

Monica Osborne is a scholar of Jewish literature and culture. She is the author of The Midrashic Impulse and the Contemporary Literary Response to Trauma.

Read more:
The Great Lie Of Grieving: It Gets Easier - Jewish Journal

CARLSBAD Nov 14, 2019 (Thomson StreetEvents) -- Edited Transcript of Obalon Therapeutics Inc earnings conference call or presentation Friday, November 8, 2019 at 2:00:00pm GMT

Obalon Therapeutics, Inc. - CFO

Obalon Therapeutics, Inc. - Chief Retail Officer

Obalon Therapeutics, Inc. - President, CEO, Secretary & Director

Good day, ladies and gentlemen, and welcome to the Obalon Therapeutics Third Quarter 2019 Financial Results Conference Call. (Operator Instructions) As a reminder, this conference call is being recorded.

I would now like to turn the conference over to Bill Plovanic, Chief Executive Officer for Obalon. Mr. Plovanic, you may begin.

William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [2]

Thank you, operator. Good morning, and welcome to Obalon Therapeutics Third Quarter Financial Results Conference Call. With me on today's call are Bob Macdonald, Chief Retail Officer; and Nooshin Hussainy, Chief Financial Officer. This morning, the company issued a press release detailing our financial results for the 3 months ended September 30, 2019. This release can be accessed through the Investor Relations section of the Obalon website at obalon.com. You can also access the webcast of this call from there.

Before we get started, I'd like to remind everyone that any statements made on today's conference call that express a belief, expectation, projection, forecast, anticipation or intent regarding future events and the company's future performance may be considered forward-looking statements as defined by the Private Securities Litigation Reform Act.

Forward-looking statements in this release include Obalon's expectations regarding the near and the long-term growth potential of its business, including the company-owned retail treatment centers. These forward-looking statements are based on information available to Obalon management as of today and involve risks and uncertainties, which include, but are not limited to, the risk factors disclosed in the periodic and current reports filed by the company filed with the SEC from time to time, including the Form 10-Q for the quarter, September 30, 2019.

Such forward-looking statements are not guarantees of future performance. Actual results may differ materially from those projected in the forward-looking statements. Listeners are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. Obalon specifically disclaims any intent or obligation to update these forward-looking statements, except as required by law.

The archived webcast will be available for 1 year on the company's website, obalon.com. For the benefit of those who may be listening to the archived webcast, this call was held and recorded on November 8, 2019. Since then, Obalon may have made announcements related to the topics discussed, so please reference the company's most recent press releases and SEC filings.

And with that, I'll now provide an update on our business and review highlights from the recently reported quarter. The third quarter of 2019 was a transitional quarter for the company. We successfully financed the company, paid off our debt, which provides a runway to begin executing on the revised commercial strategy. We further streamlined operations and have significantly reduced our quarterly operating expenses, especially as compared to the first quarter of 2019.

Our new commercial model allows us to eliminate the expensive direct field force and the costs associated with supporting them. We still maintain all of our other capabilities, such as manufacturing, marketing, research and development, clinical, regulatory and quality assurance. Although our primary commercial focus is on establishing the Obalon Center for Weight Loss retail treatment center strategy, we have continued to provide product to key high-volume private practices. We have done so with the centralized support model, no field sales personnel. We believe this keeps the door open to expand back into that channel in the future if we believe it to be complementary to our Obalon-branded store strategy. Importantly, we opened the first Obalon Center for Weight Loss in San Diego, California and successfully treated the first patients. We have also laid the groundwork to allow us to rapidly open additional Obalon Centers for Weight Loss once we believe we have a repeatable store model.

At this time, I'd like to describe in more detail the Obalon Center for Weight Loss. The Obalon Center for Weight Loss is the first Obalon-branded center where a patient is able to receive a comprehensive weight loss treatment experience, including 6 months of the Obalon Balloon System and 12 months nutritional counseling in a high-end medical spa-like setting. The first center is located in the relatively affluent San Diego suburb with easy access to and from major roads and thoroughfares. The center itself is in a high-end medical building with other practices such as plastic surgery, cosmetic dentistry and orthodontics. It looks more like a high-end medical spa than a bariatric surgery office.

The first Obalon Center for Weight Loss, or OCWL, is staffed to provide everything required for a patient's weight loss journey. This includes a physician who's experienced in weight loss, supported by a medical assistant to manage the medical aspects of treating a patient with the Obalon Balloon System, a professional experienced salesperson with an aesthetic medical background that handles initial patient interest and financially qualifies the patient and a registered dietitian to provide nutritional counseling to drive the lifestyle changes that can help create and sustain meaningful weight loss for patients.

We are leveraging our prior experience with a centralized interest creation and conversion model to drive the patient funnel more efficiently. We believe this model can be expanded to support future Obalon centers. The model includes: one, a tactical marketing team to drive patient interest in the form of leads to our in-house call center. This is primarily accomplished through digital and social media and may also include radio and print, which capitalizes on our prior experience of creating strong top line patient interest. And two, a central call center, which had previously been utilized to support a private practice physicians. The goal of the call center is to properly respond to patient interest or leads and convert that interest in a consultation with our sales professional at the center.

As a reminder, there are approximately 69 million adults in the U.S. that are in our FDA-approved indication, which has a body mass index range of 30 to 40, are those people that need to lose between 30 to 100 pounds. We believe that Obalon-owned treatment center model will make the Obalon Balloon System more accessible to many individuals with obesity.

I'd now like to turn the call over to Bob Macdonald, our Chief Retail Officer, who is responsible for driving the Obalon Center for Weight Loss strategy. As a reminder, Bob previously functioned in a similar role with Sono Bello, the largest aesthetic surgery chain in the United States and was instrumental in expanding Sono Bello's footprint from 16 sites to over 40 sites in a little over 2 years.

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Robert Macdonald, Obalon Therapeutics, Inc. - Chief Retail Officer [3]

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Thank you, Bill. Overall, I am pleased with our initial results in the few weeks that our first center has been open. I'm very impressed with how quickly the team was able to open the first Obalon Center for Weight Loss. And I believe that we have established an initial model that can allow us to expand to other markets quickly. Currently, we're focused on making the first center successful and maximizing our operational efficiency with the goal to create a portable and replicable store model.

We've analyzed and identified our next potential markets for expansion and believe that we're positioned to move quickly once we're confident that we've established the correct Obalon Center model. We've also established a set of strict metrics to measure our performance, and we review these on a daily basis, especially those metrics related to the efficiency and effectiveness of the patient funnel, from creating initial patient interest, converting that interest to a consultation and ultimately, a patient receiving treatment.

We're encouraged by the initial results and the current trends. However, because we've only been operational a few weeks, we're not sharing those key metrics at this time, but expect to provide them in the future.

But with that, I'll turn the call back to Bill.

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William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [4]

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Thanks, Bob. I'd now like to have Nooshin Hussainy, our Chief Financial Officer, provide a brief financial recap for the quarter.

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Nooshin Hussainy, Obalon Therapeutics, Inc. - CFO [5]

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Thanks, Bill. Today, I'll share details on our financial results for the third quarter ended September 30, 2019. I will compare third quarter 2019 to second quarter 2019 as I believe sequential growth is what a majority of investors are most interested, given the recent pivot in our business model.

This quarter revenue was reported at $0.3 million compared with $0.4 million in the second quarter of 2019. Revenues in the third quarter of 2019 included a mix of both navigation consoles and balloon reorder kits as compared to only balloon reorder kits in the second quarter of 2019. In the third quarter of 2019, we shipped 6 navigation consoles to current physicians -- physician customers who wanted to offer the most current generation of the Obalon Balloon System to their patients. We did not recognize any revenue from the Obalon Center for Weight Loss in the third quarter as the site became operational at the very end of the quarter.

Cost of revenue was $0.4 million in the third quarter as compared to $0.7 million in the second quarter of 2019. Gross deficit for the third quarter of 2019 was $0.1 million, which was an improvement from a gross deficit of $0.3 million in the second quarter of 2019. Onetime charges associated with the changes in the business in the second quarter of 2019 contributed to the sequential improvement.

R&D expenses for the third quarter of 2019 totaled $1.2 million compared to $1.8 million in the second quarter of 2019. We have continued to make investments to support improvements of our recently approved Obalon Navigation System and Obalon Touch Dispenser, as well as continued development of our new product pipeline. Sales, marketing and G&A expenses for the third quarter totaled $2.5 million, down from $4.3 million in the second quarter of 2019.

As a reminder, the beginning of the second quarter of 2019, we changed our commercial strategy, which include an elimination of our field sales force and a significant deduction in overall corporate headcount. In the third quarter, we continued to streamline operations and expenses to support the new company-owned retail treatment center strategy.

The operating loss for the third quarter was $3.7 million, which is down significantly from an operating loss of $6.4 million in the second quarter of 2019. We believe operating expenses of $3.7 million in the third quarter of 2019 is representative of a baseline level upon which we will grow as the business expands. Net loss for the third quarter of 2019 was $3.7 million or $0.61 per share based on 6.1 million weighted diluted average common shares outstanding as compared to a net loss of $6.8 million or $2.52 per share based on 2.7 million weighted diluted average common shares outstanding in the second quarter of 2019.

We ended September 30, 2019, with $19.4 million in cash, cash equivalent and short-term investments and no debt. As of October 31, 2019, we had 7.7 million total shares of common stock outstanding.

We will not be providing guidance at this time, given that the first Obalon Center for Weight Loss has been operational for only a few weeks. We would expect to provide more detail regarding our expectations, including performance metrics, in the future.

And with that, I will turn the call back over to Bill for final comments.

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William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [6]

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The third quarter of 2019 was a transitional quarter for Obalon. We began to lay the foundation for our new commercial strategy of developing company-owned retail treatment centers. In a very short time, we created the required corporate structure, engaged a professional medical corporation to oversee medical care, hired the necessary staff to run day-to-day operations and entered into a lease and built out the physical space, all of which culminated in the opening of the first Obalon-owned retail treatment center and initial patient treatments. We believe this groundwork will allow us to rapidly open additional Obalon Centers for Weight Loss at the appropriate time.

As a reminder, we will be participating in 2 upcoming conferences: the Stifel 2019 Healthcare Conference in New York City on Wednesday, November 20; and the Canaccord Genuity, MedTech and Diagnostics Forum in New York City on Thursday, November 21. With that, our prepared comments are complete. Operator, will you please now open the line for questions.

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Questions and Answers

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Operator [1]

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(Operator Instructions) Your first question comes from the line of Ben Haynor with Alliance Global.

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Benjamin Charles Haynor, Alliance Global Partners, Research Division - Analyst [2]

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First off for me, congrats on opening the first center and I know there are some things that you have to do prior to opening the first center, writing out procedures, doing things of that nature. But can you talk about what the opening expenses look like, and whether there's kind of good metric that we can think about in terms of build-out costs? Is it $1,000 a square foot? What's a good way for us to think about that?

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Robert Macdonald, Obalon Therapeutics, Inc. - Chief Retail Officer [3]

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Yes. Ben, thanks for the question. So we obviously modeled this out going in. And based on my prior experience in a similar type business, we were able to, I think, have a pretty good handle on what the expectations were. And proportionately, in terms of the square footage, these are a little smaller facilities than what I had done before. But proportionally, the expenses came in line. And as we continue to refine it and look at future stores, we think we'll get some more efficiencies there. But we're quite pleased with where we are at today.

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Benjamin Charles Haynor, Alliance Global Partners, Research Division - Analyst [4]

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Okay, great. And then just thinking about the training that goes into the personnel that you hire? I mean is that something that you can do over the course of a handful of days? Or is it weeks? Or does it depend on when they come on and giving them all the work together? Or any thoughts there that you can share?

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Robert Macdonald, Obalon Therapeutics, Inc. - Chief Retail Officer [5]

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Yes. I mean we kind of designed the operating model before we opened and established what those procedures are. There's obviously some learnings as you get into it. And as patient flow increases, you get better at it, and we've kind of continually refined and updated some of those protocols and procedures over the first few weeks. But we expect that, that will settle in and we'll capture those learnings and then replicate those.

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William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [6]

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Yes, Ben, and this is Bill Plovanic. Just remember, from a physician and a medical training standpoint, we've been working with the physician customers for almost 3 years now. So in terms of the policies and procedures for training the medical staff on the administration of balloons and -- that's well scripted, and we've been doing it for a long time, 3 years, as I said. So that was in place prior to even opening the center.

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Benjamin Charles Haynor, Alliance Global Partners, Research Division - Analyst [7]

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Okay. That's definitely helpful. And then you mentioned that you continue to streamline some of the operating expenses in Q3. And I know you said you're not providing guidance. I don't know if whether to take that as revenue guidance or guidance period, but I thought I'd ask on the operating expense line items. What should we kind of expect through the end of the year? I mean, should it -- we look at it as similar to Q3 with some of the expenses with the center being live? Or is there anything that you can share that might be helpful for us.

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William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [8]

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Yes. I think if you look at the financial results for the third quarter, Ben, operating expenses were approximately $3.7 million for the third quarter of 2019. And we think that's representative of a baseline level as we springboard off of as we start expanding and building the company.

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Benjamin Charles Haynor, Alliance Global Partners, Research Division - Analyst [9]

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Okay. That helps. And then lastly, from -- sorry, go ahead.

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William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [10]

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Obviously, Ben, as we -- as we add additional sites, each additional site would be incremental with the objective, obviously, of driving those to profitability, those individual sites to profitability. But -- so you have your baseline in terms of the operating expenses today, and then you'd have whatever you add incrementally with each additional treatment center.

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Benjamin Charles Haynor, Alliance Global Partners, Research Division - Analyst [11]

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Okay. That makes sense. And then, I guess, one last one for me, probably directed at Bob here. I know it's early days, but looking at the funnel conversion rate that you've seen with the Obalon Centers, can you maybe compare and contrast or maybe tell us if that conversion rate is relatively similar to what you saw at your prior firm?

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Robert Macdonald, Obalon Therapeutics, Inc. - Chief Retail Officer [12]

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Well, the businesses are a little bit different, and the marketing strategies are different with respect to some things. But our marketing focus right now is largely driven by digital and social media. So we have the ability to measure conversion at each step of that funnel on a fairly granular basis. And we are looking at that every day. And we're testing. We're doing some AB tests and otherwise optimizing it. But again, keeping a sharp eye on that on a daily basis.

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William John Plovanic, Obalon Therapeutics, Inc. - President, CEO, Secretary & Director [13]

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Link:
Edited Transcript of OBLN earnings conference call or presentation 8-Nov-19 2:00pm GMT - Yahoo Finance

Please Note: This article is presented for informational purposes only and is not meant to diagnose or treat any illness. If you have any health concern, see a licensed healthcare professional in person.

Selective Androgen Receptor Modulators (SARMs) can imitate testosterone reactions in the bodys muscle and bone tissues.

When they bind with selective receptors, they can avoid many of the negative side effects caused by steroids. Since SARMs are a better alternative to more severe drugs on the market, the Food and Drug Administration is currently going through some trials to approve the use of SARMs.

After the World Anti-Doping Agency banned this chemical in 2008, only scientists could buy them for research purposes. However, they have proven to be highly beneficial for treating muscle loss in the eldery and people suffering from muscle-related illnesses.

The problem is that these drugs are believed to pose serious health risks, leading to heart attacks, liver toxicity, and strokes. Lets find out more.

When it binds with androgen receptors, the testosterone hormone helps the body to grow facial hair, gain muscle, lose body fat, deepen your voice, etc. The androgen receptors then transform into Dihydrotestosterone (DHT), which converts into estrogen, and binds with the receptors in the cell.

This process continues naturally until old age when the body stops producing as much testosterone. SARMs stimulate the cells to produce androgens so that the muscles can continue to grow.

The drugs worked miracles for elderly people and cancer patients who were dealing with chronic fatigue, osteoporosis, and anemia. Scientists claim that SARMs can help treat obesity, boost appetite, improve bone health, and prevent muscle wastage.

There are several benefits of SARMs which are:

SARMs can help you work out for longer periods without getting tired. Strength training requires stamina, power, and the ability to keep improving over time. Many people may not possess this ability naturally, which is where SARMs come in.

Although adequate nutrition is also essential before and after working out, health supplements, like SARMs, can prevent muscle wasting. Motivation and strength are two important factors when working out and SARMs act as boosters for this.

Losing weight takes determination and hard work. Some fats are stubborn, and they stick to vital organs and muscles. SARMs are good at getting rid of these stubborn fats.

However, despite two people following the same workout routine and diet, one may look better than the other due to his or her reliance to SARMs.

Obese people can greatly benefit from using SARMs. But remember, its not advisable to rely only on this supplement without working out and following a healthy diet.

Aesthetics is not only about losing weight, its also about shaping your body adequately by building muscle. Your muscle mass is determined by your nutrition, genetics, history of training, and lifestyle.

Steroids can bulk you up, building both fat and muscle. On the other hand, SARMs only build lean muscles. In this case, SARMs are considered to be healthier and more effective than steroids for gaining muscle mass, because steroids interfere with the liver, kidney, lungs, heart, and other organs.

There is little evidence to confirm that SARMs can cure tumors. However, the supplements have been proven to heal diseases related to the bodys skeletal system.

Some people have weak bones, brittle bones, poor bone density, fractured bones, or osteoporosis. SARMs supplements can heal and strengthen bones, increase bone density, reduce inflammation, and cure osteoporosis.

SARMs can prevent and undo muscle wasting for good. People who suffer from muscle atrophy can gain lean muscles by taking SARMs.

Muscle wasting may be a hereditary condition or developed over time due to age. The condition can worsen if you dont treat it properly. Whats more, some people may display noticeable symptoms of this disease, while others may not.

All supplements have side effects, and so do SARMs. Lets take a look at the disadvantages of using this muscle-building supplement.

Despite its popularity, SARMs have not been approved by the Food and Drug Administration and the World Anti-Doping Agency as suitable for human consumption. If they dont think its fit, should you be buying them?

Although theyre not as harmful as steroids, SARMs can affect other organs of the body, such as the liver, kidney, heart, etc. The risk of experiencing a stroke increases when you take SARMs.

Since it hasnt been approved by the FDA or WADA, naturally, there is a shortage of SARMs on the market. The supplement is available online, but users may have trouble continuing to use one brand long term.

This section will talk about the different types of SARMs.

The most popular SARM is Ostarine. It helps to preserve the muscle you have gained at the gym. It can do this even when youre on a caloric deficit. On average, you should take 10 to 25 mg of this drug for six to ten weeks.

Ostarine reduces the production of testosterone when used for a long period of time, so you also have to consume SERM PCT. The supplement is known to cause Gynecomastia in some people; hence, having an Aromatase Inhibitors (AI), such as Exemestane is important.

RAD 140 has an anabolic to androgenic ratio of 90:1, which means that users can gain muscle, lose weight, heal skeletal problems, feel stronger, and reduce muscle waste without any side effects.

This supplement needs to be taken twice a day, with doses ranging between 4 to 12 mg for four to six weeks. It also minimizes the effect of testosterone on the prostate, so you must take a Post Cycle Therapy (PCT) at the end of the cycle.

GW 501516 is more like a PPAR Delta Modulator that regulates the metabolism and development of cells. It creates more muscle tissue by using more glucose.

The dosage should be as low as 7 mg, and no higher than 20 mg. This is a non-hormonal supplement, so it wont affect your testosterone levels.

It also makes you more energetic, improves muscle mass, and increases endurance. Some people believe that GW 501516 improves the lipid profile and blood pressure.

MK 677 is a non-peptide and a secretion-boosting receptor. It promotes IGF-1 levels and the growth hormone by copying the functions of ghrelin. Luckily, it wont affect your cortisol level.

This supplement has shown that IGF-1 levels can be increased by 60% in just six months, whereas IGF-1 levels can be increased by 72% in 12 months. You should use it for about six months, increasing the dosage every month.

Its non-hormonal, so you wont be needing a PCT at the end of the cycle. Tingly hands and feeling numb are the common side effects of MK 677, so be aware.

LGD 4033 is like Ostarine, but more powerful. It suppresses the Hypothalamus-Pituitary-Testes-Axis system; hence, you need to undergo Selective Estrogen Receptor Modulator (SERM) therapy after the completion of the cycle.

Andarine S4 can build muscles very quickly. The dosage is lower than those used in previous SARMs.

However, its known to alter vision in users who have been consuming it at 50 mg. Therefore, sticking to a minimum dosage of 10 mg is recommended. At the end of the cycle, you will need PCT.

SARMs have not been approved by the FDA and selling this drug for human consumption is illegal in the United States. However, they are sold on the market as research chemicals for scientists.

Taking SARMs will lower your testosterone levels, while Ostarine can lower them only when you take a higher dose.

Testolone will certainly lower your testosterone levels, so taking PCT is recommended. Generally speaking, you dont always have to take PCT after taking any SARMs it depends on the dose, the duration of the cycle, and the type of SARMs youre taking.

Getting your blood tested after the first cycle can give you an idea of how the supplement is affecting your testosterone levels. Then, only take PCT if you feel the symptoms of lower testosterone levels in your body.

By running health tests every month, youll be able to keep track of your wellbeing. If you see any changes due to SARMs supplements, talk to your doctor. If in doubt, stop taking the supplement immediately.

SARMs are not necessarily harmful. It all depends on your body type, the dosage youre taking, and the duration of the cycle.

If you want to be strong, work out longer at the gym, follow a healthy diet, and use SARMs as an added boost. But remember, since SARMs are not regulated for human consumption, you should only buy them from reputable brands.

Dont forget: get regular health check-ups with your doctor to determine the right dosage and cycle before you start taking SARMs. Good luck!

Photo: Shutterstock

See the rest here:
SARMs: Is It Safe or Not? - The Good Men Project

SAO PAULO Renan Barao is happy.

Thats what he says, anyway, on the Wednesday prior to Saturdays UFC on ESPN+ 22 meeting with Douglas Silva de Andrade. Of course, its not like fighters tend to say that theyre miserable ahead of upcoming fights, but theres something about Baraos disposition that makes it believable. Perhaps its a perspective thing; after years of talking to bantamweight Barao, the featherweight version is noticeably different.

For someone just looking at the numbers, the idea that Barao would be happy might sound a little strange. He has, after all, lost six of his past seven bouts. Hes gone from being a champion on a 33-fight unbeaten streak, the unstoppable force from Joe Rogans once omnipresent Renan Barao is a monster! proclamation, to being someone who may very well not even be a UFC fighter next week.

Its a good thing, then, that Barao doesnt seem all that preoccupied with what people...

Read the original post:
Slump be damned, a well-fed Renan Barao is a happy Renan Barao - The Athletic

Intermittent fasting (IF) has tons of benefits, including weight loss, preventing diabetes, and reducing your risk of cancer. Many people who follow IF say that it's helped them savor their meals more and understand the difference between hunger and cravings. It has also helped them break through weight loss plateaus.

"IF makes you feel good because you're getting rid of the inflammation," says, Wendy Scinta, M.D., president of the Obesity Medicine Association and a member of Prevention's Medical Review Board. "I follow the 16:8 diet and find that when I prescribe IF to patients who want to lose 100 pounds and can't seem to lose the last 15 pounds, IF helps them get there."

But IF isn't for everyone (Dr. Scinta doesn't recommend it for people who have a history of disordered eating or pregnant women), and it's important to understand the side effects that come with it.

No matter what type of intermittent fasting method you're interested in following, here are side effects you should know.

At first, you may experience hypoglycemia, a condition caused by very low blood sugar levels. This can lead to headaches, increased heart rate, dizziness, and nausea, according to Dr. Scinta. Oh, and bad moodsno one's happy when they're restricting food. "When you don't eat, your body will first burn the glycogen (stored glucose) in your liver and muscles (hence feeling irritated at first), then it will begin to burn fat for fuel," says Frances Largeman-Roth, R.D.N., nutrition and wellness expert, author of Eating in Color and creator of the FLR VIP program, says. But as your body becomes more keto adaptive and learns to run on fat instead of glucose, Dr. Scinta says hypoglycemia becomes less of a concern.

However, if you continue to feel dizzy or lightheaded over time, Largeman-Roth says to eat somethingeven if it's a small snack. "Losing weight is never a good enough reason to pass out," she says.

And make sure to fuel up on healthy, satisfying foods during meals. Lean protein, fruits and vegetables, whole grains, and healthy fats, such as avocados, nuts, and extra-virgin olive oil will keep your blood sugar levels balanced during your fast and provide the nutrients your body needs to function properly.

Dr. Scinta says she often finds that people on IF struggle to get enough protein, so remember to eat regularly, including snacks, when you're not fasting. "You should aim to get at least one gram of protein per kilogram of weight daily," she says.

Dr. Scinta says that many people who follow IF have a better time at keeping their blood sugar levels balanced. Because IF forces you to stop eating at a certain time, you'll fuel up on more satisfying foods, like lean protein and fiber, to stay full during your fast. "What I've found with IF is that it's helped me watch my carb intake," Dr. Scinta says. "You're not only eating as much, but you're not eating as much of the bad stuff."

IF also promotes satiety through the production of appetite-reducing hormones. A 2019 study from Obesity suggests that IF can help decrease ghrelin levelsthe hormone that stimulates hungerin overweight adults and improve people's ability to switch between burning carbs for energy and burning fat for energy.

"There are folks who eat at night due to boredom or stress, not because they're actually hungry. Putting guardrails on the times they can eat may help them avoid eating when they don't need to be," Largeman-Roth says.

Dr. Scinta and Largeman-Roth also advise people to stay hydrated while fasting because people tend to confuse thirst for hunger.

"When people fast in the morning, they drink a lot of coffee, which is a diuretic, and forget to drink water," Dr. Scinta says. "Every function in the body requires water, so staying hydrated is incredibly important," Largeman-Roth says. "We get about 20% of our water intake from the food we eat, so when we fast, we're losing a significant source of hydration," she says.

A 2018 study in Cell Metabolism found that men with prediabetes who followed IF improved their insulin sensitivity, even though they didn't lose weight. How does it work, exactly? Whenever you eat, your body releases the hormone insulin to move sugar from your bloodstream into your cells for energy. But people with prediabetes don't respond well to insulin so their blood sugar levels stay elevated. Increasing the time between meals can help because your body releases less insulin.

However, Dr. Scinta says that people who are on insulin-dependent medications should consult with their doctor before following IF because it can affect the effectiveness of their treatment. "People with type 1 or 2 diabetes are on these medications to lower their glucose, so they need to have consistent meals to prevent spikes in their blood sugar," Dr. Scinta says.

Following IF and working out is totally safe, but you'll need to make some adjustments to your schedule so that you're not running on empty. Say you're following the 5:2 diet: Doing low-impact workouts instead of more intense ones, like weight lifting, running, and HIIT, on days when you're limiting calories can help your body adjust to the new demands. As your body gets used to burning fat for fuel, the intensity of your workouts won't be as much of a concern.

That said, the last thing you want to do is pass out during your HIIT class, so Dr. Scinta recommends timing your workouts at the beginning or end of your fast. This way, you can enjoy a pre- or post-workout snack. Foods that are easy to digest, like a smoothie, low-fat yogurt, and peanut butter with toast work better pre-workout, while foods with a higher carb-to-protein ratio, such as a bowl of oatmeal, are ideal for post-workout.

For this reason, health experts advise following the 16:8 diet over 5:2 and other intermittent fasting methods if you're very active.

Like what you just read? Youll love our magazine! Go here to subscribe. Dont miss a thing by downloading Apple News here and following Prevention. Oh, and were on Instagram too.

The rest is here:
4 Common Intermittent Fasting Side Effects and Health Risks - Prevention.com

THE feeling of dread filled Natalie Mellor's stomach as she imagined walking down the aisle in a size 20 wedding dress.

The customer service advisor, 29, had ballooned to a staggering 15 stone after gorging on full bags of cheese for dinner every night.

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And the prospect of hundreds of wedding guests seeing how big she'd become on her special day made her feel sick to the stomach.

Determined to do something about her weight, Natalie, from Brough, East Yorkshire, ditched the cheese and overhauled her diet and has since lost an incredible six stone.

She managed to tie the knot to her partner Gavin, 34, in a size eight wedding gown - and feels more confident than ever, weighing just nine stone.

Natalie said: "I am more confident in myself and have a positive outlook. I feel like a new person and have left the old me behind."

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Natalie had always been larger than her friends when she was younger, but as the years went by she gradually became even bigger.

In particular, Natalie piled on the pounds during her first pregnancy with her now husband Gavin in 2015.

"Ive always struggled with my weight from a young age, but I seemed to gradually get bigger and bigger compared to my friends," said Natalie.

"It was when I fell pregnant with my first child, Henry, that it was made apparent that I was morbidly obese and was putting us both at risk."

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During the pregnancy, Gavin got down on one knee and asked Natalie to marry him.

But, as thrilled as she was about her future nuptials, it quickly dawned on Natalie that she didnt want to be a bride in a size 20 dress.

However, she continued to gorge on fatty foods including sausage sandwiches, chocolate and bags of crisps - even after little Henry, now 4, was born.

Natalie added: "My husband asked me to marry him, which of course I was happy about, but it also filled me with dread because of the size I was.

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"I am an emotional eater; I surpass every emotion with food, like a celebratory takeaway or a condolence tub of ice cream.

"Breakfast was a sausage or bacon sandwich on the go.

"For lunch Id usually have an unhealthy fast food thing that was a grab and dash.

"Dinner was a pasta bake with a full bag of grated cheese, so it was extra gooey, with garlic bread and a sticky toffee pudding to finish.

"Snacks were crisps, biscuits and chocolate. I also never factored in my alcohol intake, so Id drink a lot of wine."

I am an emotional eater; I surpass every emotion with food, like a celebratory takeaway or a condolence tub of ice cream

As Natalie's waistline continued to expand, her mood plummeted - and she felt more and more miserable about her appearance.

And before she knew it she had reached 15st 7lb, and she felt ashamed of her large frame.

"I was embarrassed, ashamed and humiliated that I had let myself get so overweight," Natalie said.

"It held me back from many things, such as wearing clothes that I wanted to wear, going for promotions at work, and being sociable in more high-end establishments.

"Being pregnant made me look back and reflect on when Id spent time with my nephew and wasnt able to squeeze myself into childrens play areas or be in a water park.

"It made me not want to feel that uncomfortable with my own children."

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After a holiday to Turkey in September 2014, Natalie deleted all of the images of herself because she was deeply unhappy with how she looked, blaming the angles that the photos were taken from.

Natalie said: "I no longer wanted to feel down and ashamed of myself.

"I went on holiday with my fianc at the time, and on the flight home I realised I had deleted every image of myself because I didnt like the angles.

"But then I had a pause and realised it might not be the angles."

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In 2016, Natalie joined Slimming World to lose weight and there was no better target than her wedding in June 2017.

She cut down her calorie intake and swapped bags of cheese for steamed vegetables and new potatoes.

She said: "I started attending Slimming World and educating myself on healthier food choices and calorie intake.

"My wedding was a target, but also wanting to be a healthy mum for my child. I also wanted to do it for my own mental health.

"I cook my meals most nights now, adding a lot of the right things.

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"I eat more fish and cut back on red meat, with the occasional vegetarian meal. I can still have treats, but now its in moderation and I consistently keep on plan during the week.

"For breakfast I have Greek yoghurt with honey or Weetabix and fruit.

"Lunch is a freshly prepared salad, then dinner is salmon with steamed vegetables and new potatoes usually.

"I try not to snack throughout the day, but if I do, I have fruit and I only have wine on a weekend.

"I can go in any shop now and I dont hesitate about wearing a bikini in crowded places."

Natalie's diet before and after

BEFORE

Breakfast: Sausage or bacon sandwich

Lunch: Grab and dash fast food

Dinner: Pasta bake with a full bag of grated cheese, garlic bread, sticky toffee pudding and wine

Snacks:Crisps, biscuits and chocolate

AFTER

Breakfast: Greek yoghurt with honey or Weetabix and fruit

Lunch: Freshly prepared salad

Dinner: Salmon with steamed vegetables and new potatoes

Snacks: Fruit

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Through her incredible diet overhaul, Natalie managed to shed six stone in just 11 months.

And she feltincredible as she walked down the aisle in her size eight wedding gown, weighing just 9st 7lb.

Natalie said: "I have only happy memories of feeling like a princess in my wedding dress with all eyes on me for the right reasons, for a change.

"I didnt delete any pictures, I kept them as happy memories.

"People think its fantastic and amazing, they have nothing but praise.

"When I went back to work after losing all my weight during maternity leave, people said I was unrecognisable."

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Natalie is now encouraging others to follow in her footsteps and says the key thing is to remember it's all about "balance".

She said: "Everyone always asks how I have done it and for advice on what they can do.

"What I say is to make a food diary because when you write things down its easier to put into perspective and see what changes you need to make.

"Drink more water, move more and educate yourself on the right foods.

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"Its all about balance and if you eat right and stick to your plan, it will happen.

"Take measurements, sometimes youll lose inches but not pounds."

You can follow Natalie's weight loss journey here.

Read more:
Weight loss: Mum sheds 6st to fit into size 8 wedding dress after gorging on bag of cheese every night - The Sun