James G Beckerman, M.D.  
Portland, OR

Specialties: Cardiology

Interests: Weight Loss, lifestyle changes, healthy diet
Author of The Flex Diet (January 2011)
Providence Heart and Vascular Institute
(503) 216-0900
Portland, OR
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Would you take an obesity drug if it were safe, effective, and...available?

Nov 08, 2010 - 31 comments



obesity drugs

Another drug bites the dust. In the past few weeks, we have seen sibutramine (Meridia) pulled from the shelves due to an increased risk of heart attacks, and now lorcaserin (Lorqess) has failed to pass muster with the FDA because of concerns about cancer. Many years and millions of research dollars later, our only remaining pharmaceutical arm in the fight against obesity is orlistat (Xenical), with the convenient side effects of bloating, stomach upset, and the need to have a public restroom app on your iPhone in case of emergencies.  So what’s a health care system to do?

On one hand, you might argue that Big Pharma has failed us in the obesity space.  So should they throw in the towel? The drugs work poorly, have gross side effects, and increase our health risks in other ways. Some say, why don’t we save the millions of dollars spent on drug research and instead invest them in education, legislation, and regulations that will help us eat better and exercise more? Put the money towards the health costs of the uninsured. Or, use it to fund research in diabetes, heart disease, or any of the other countless complications of obesity.

But is it too early to admit defeat?  If we had done the same for cholesterol medications or diabetes medications, or even smoking patches and pills, we’d be paying for it in countless ways.  So is there something unique about developing medications for obesity?  Obesity is considered by many to be purely a “lifestyle” disease, and some are biased against the obese as a result.  Given that we already have proven treatments (eat less and exercise more), some argue that we are wasting our time by investing heavily in a pharmaceutical solution.

As a physician who believes strongly in the power of personal choice to influence one’s health outcomes, I tend to favor an investment in healthy lifestyles.  But in all fairness to the other side of the debate, one can also argue that prevention hasn’t worked out so well either.  Despite the fact that we have effective treatments, we are not very effective in their prescription or compliance.  For example, aggressive lifestyle modification can lower heart disease risk as effectively as cholesterol medication for many people — but the fact of the matter is, some people would rather take a pill.  Obesity has skyrocketed despite our efforts at communication.  So, it looks like the health care system has failed as well.  Could our failure as health care providers actually position obesity drug research and development as the most important pharmaceutical goal of the decade?

Where do you think we should put our resources?  Do you accept the recent obesity drug hurdles in stride and want the pharmaceutical companies to take on the challenge to develop more anti-obesity medications?  Or do you think we should concentrate our efforts on non-pharmaceutical interventions?  Would you take an obesity drug if it were safe, effective, and available? I’d love to hear what you think!

Yes You Can - But Will You?

Oct 01, 2010 - 6 comments






   I was talking yesterday with one of the medical assistants in my cardiology office - he is an amazing athlete and plans to compete in an Ironman Triathlon next year.  As more of a weekend warrior myself, I told him how impressed I am that he is able to maintain such a strenuous level of physical activity for so many hours at a time.  He thought about it for a second, and then commented, “There are a lot of things you can train your body to do, but in the end it’s really more of a question of what you are willing to do.”

   He is absolutely right.  The human body is incredibly resilient, and can be pushed to do things that often surprise us.  And we forget sometimes that our minds are similarly capable.  Think about the all-nighters that you might have pulled in college, or the discipline you required to sit at that piano and practice day after day.  You can do so many things - but it’s time to really start thinking about the "will."

   Every day we make many decisions that impact our families, our careers, and our sense of purpose.  Some of these require sacrifice, others require more of an investment of time and thought.  But an increasingly larger number of choices - particularly as we grow older - involve our actual desire to have things go a particular way.  Health-related decisions seem to fall into that category.  You make a decision every single time you light a cigarette, take your pills on time, go to the gym, have a drink, or eat a bag of chips.  You can put the cigarette down.  You can go for a walk.  You can leave the saltshaker off the table.  But will you?

   When many of us are confronted by the choices we make - whether by a doctor, family member, or even the mirror - we tend to explain away those decisions by saying that we just couldn’t do it.  

   “I can’t help myself sometimes.”

   “I couldn’t pass it up.”

   “I can’t stop.”

   But I’m trying to encourage my patients (and remind myself) to approach these decisions differently.  Because if you decide that you can’t do something, you have ended the discussion.  There is no more debate.  There is no possibility for a solution.  But try to recognize that you are capable of doing much more than you realize.  Refocus the question towards what you want.  Because if you decide that you want to do something, or want to make a change in your life, it puts you in charge - not the problem or the decision in question.  And once you realize that you want to do something - that you have the will to face a particular challenge - you now need to think about how you can do it.  And the reassuring part is that there are a lot of people who want to help you figure out that part.

   Thanks for joining the conversation!

HGH - weight loss solution?

Aug 27, 2009 - 32 comments





hgh weight loss


Weight Loss

I’ve been getting a lot of posts recently about using Human Growth Hormone (HGH) for weight loss, and decided it was about time I explained my position.  Basically, I don’t recommend it.  Why not?  For those of you less familiar, let’s break it down.  

1) What is HGH?  Human Growth Hormone is a hormone normally produced by the brain’s pituitary gland.  Its purpose is to stimulate growth and cell reproduction.  For this reason, levels are higher in adolescence, and peak during your twenties.  By the time you hit your forties, levels are in a decline.

2) How is HGH administered?  Because it is a large molecule, it has to be injected, either subcutaneously (like insulin) or directly into the muscle.  It is usually given once a week.

3) Who gets HGH?   Generally, people deficient in HGH (usually kids, sometimes adults), people with short stature, and people who may be undergoing organ transplantation or who have muscle wasting conditions like advanced HIV.

So why are people requesting HGH for weight loss?  While there is a lot of controversy around it, there are some small studies that indicate that HGH administration can be associated with changes in body composition (i.e. less fat, more muscle).  But these changes aren’t terribly significant – just a few pounds in either direction.  Interestingly, these studies suggest that there’s not a significant improvement in fitness or muscle strength, leading some people to believe that HGH just results in more water being stored in muscles.  But this hasn’t stopped some athletes from using it, despite the absence of good data to suggest that it significantly improves performance.

So why don’t I recommend it?  First of all, it’s poorly regulated.  HGH straddles the line between “supplement” and “medication,” and many people will search for it online, without having confidence that what they are receiving is sterile, pure, or uncontaminated.  Second, medications like this really do need to be given under a reasonable doctor’s care.   I stress the word “reasonable.”  Remember, just because a doctor is prescribing something doesn’t mean that it’s medically appropriate or the doctor has enough experience to prescribe it safely.  Recent news about potent anesthetics being prescribed to Michael Jackson brings this point to light.  And finally?  Side effects.  Because HGH has not been well studied in the longer term in healthy individuals without deficiency or other medical indications, we just don’t know what will happen if you take it.  There are reports of increased risk of diabetes, carpal tunnel syndrome, joint problems, and possibly heart disease.

In the end, HGH – like many supplements – is being used by people as a substitute for making lifestyle changes.  You can argue that doctors do this all the time. We place people on blood pressure medications and cholesterol medicine when the combination of diet and exercise just doesn’t cut it.  But we also have data that shows that reducing blood pressure and cholesterol with drugs actually reduces the risk of heart attacks and strokes and makes people live longer.  HGH?  Not so much.  Until further studies are done, I recommend that you get your HGH the old-fashioned way – it turns out that exercise and sleep stimulate higher levels…and are also associated with weight loss.  

Zen and the Heart of Medical Maintenance

Jul 24, 2009 - 13 comments

Between college and medical school, I spent a year living in Spain.  It was one of those “discovery” years you now only dream of, a delicate balance of academics and culture, with an appropriate complement of red wine.  It was Spain, you know.  In the midst of it all, I found myself with a lot of time on my hands, and spent much of it reading – reading about other people’s journeys and the paths they took during their own formative years.  There were the classics like On the Road, Siddhartha, and even Catcher in the Rye – but what impacted me the most were Zen and the Art of Motorcycle Maintenance and its sequel Lila, both by Robert Pirsig.

Part novel, part philosophy text, and partly meandering, Zen and Lila take the reader on an intellectual journey through morality, purpose, and of course, motorcycles.  One concept that has stuck with me after fifteen years is an idea stated in the conclusion of Lila: “Good is a verb.”

The first time you read that sentence, something doesn’t feel right.  We typically think of “good” as an adjective to describe our core values.  It may define who we are or who we’re not.  It’s a group we want to belong to, and sometimes exclude our enemies from.  But using “good” as a passive descriptor takes something out of the equation - choice.  By thinking about goodness as a verb, as an action, our choices can change who we are and where we belong.  Good is a process.  Good is a journey.

So after spending a year trying to find myself, I ultimately found myself in medical school and specialty training, spending a lot of time with people who are often categorized by a different system – wellness and disease.  Doctors, patients, and insurers judge themselves and others by this simple metric all too frequently.  And we all know that illness places us in a less desirable grouping, populated by symptoms, hospital stays, and medications.  Having an illness shifts us away from the happy-go-lucky and pushes us toward the somber.  Nobody wants to be ill.  And nobody wants to be part of the group of people who experience illness.

But I’ve learned that this way of thinking about health and disease, or wellness and illness, is an oversimplification – because it implies that our health status defines who we are, and takes away the element of choice.  Obviously, no one chooses to be sick.  Genetics and environment conspire to create illness even in those with the best of intentions.  But we can’t ignore the impact of the lifestyle choices we make every day on our health, whether positive or negative.  Sure, there’s genetics and bad luck, but there’s also the saltshaker on the table.  There’s the extra slice of chocolate cake on the plate.  There’s the cigarette in your hand.

The choices my patients make and the ways in which they approach their own health have shown me that an eighty-year-old recovering from heart surgery can sometimes be my healthiest patient, whereas a twenty-four-old on no medications can be my sickest.  Wellness is partially about choice.  Wellness is sometimes about change.  

Wellness is...a verb.  So do well, and share your challenges and successes with us!

For more observations join me at www.twitter.com/jamesbeckerman - thanks!  This blog entry also appears on the website www.healthin30.com - a great blog maintained by Barbara Ficarra, RN, BSN, MPA, the host and executive producer of the Health in 30® Radio Show.  Enjoy!