ScienceDaily (Feb. 3, 2009)
— Researchers at UT Southwestern Medical Center have uncovered crucial clues about a paradoxical disease in which patients with no body fat develop many of the health complications usually found in obese people.
The findings in mice, appearing online Feb 3 in Cell Metabolism, have led to the initiation of a National Institutes of Health-funded clinical trial to determine whether eating an extremely low-fat diet could prevent many of the metabolic complications brought on by lipodystrophy.
Lipodystrophies are metabolic disorders characterized by the selective loss of fat tissues and complications of insulin resistance. Scientists speculate that the condition could be caused by the failure of stem cells to become fat cells.
“These patients don’t have fatty tissue, even inside their abdomen,” said Dr. Abhimanyu Garg, professor of internal medicine at UT Southwestern and senior author of the study. “They basically lack all the fat we see in a typical person, but their livers are loaded with fat. That’s a big problem because too much fat in the liver leads to liver damage.
“We cannot do anything to reverse fat loss, but our findings might lead to the development of new therapies for the metabolic complications of lipodystrophy, such as diabetes, fatty liver and high triglycerides,” said Dr. Garg, an investigator in the Center for Human Nutrition.
Dr. Garg has been studying patients with lipodystrophies for more than 20 years. He and colleagues at UT Southwestern have led the way in identifying gene mutations responsible for several forms of lipodystrophy and in identifying novel therapeutic approaches for these patients.
In this study, researchers genetically engineered mice to lack a specific enzyme called AGPAT2, which is also lacking in humans with generalized lipodystrophy. Under normal conditions, AGPAT2 is involved in the production of fat in body fat cells. In 2002 Dr. Garg’s lab found that the AGPAT2 gene is mutated in patients with congenital generalized lipodystrophy.
“We generated this mouse model to learn why humans with this type of lipodystrophy develop metabolic complications,” Dr. Garg said.
The researchers found that mice without the AGPAT2 enzyme used a novel, previously uncharacterized pathway to synthesize fat in their liver. Dietary fat also contributed to fat accumulation in the liver. Typically, particles called chylomicrons carry dietary fat throughout the body and release it in peripheral tissues so that it can either be stored in adipose tissue for later use or immediately burned as energy by muscles. Normally, adipose tissue provides fatty acids for fat synthesis in the liver. In these lipodystrophic mice, however, the adipose tissue did not release the excess fatty acids and the dietary fat accumulated in the liver.
What is surprising about this, Dr. Garg said, is that the amount of fat stored in the liver dropped substantially when researchers put the lipodystrophic mice on a fat-free diet. “Just eliminating the dietary fat reduced liver triglycerides by approximately 50 percent,” he said.
In addition to establishing a clinical trial, Dr. Garg said the next step is to study the stem cells from the mice with lipodystrophy in order to determine why their stem cells become bone and muscle but not fat.
Other UT Southwestern researchers involved in the research were Dr. Victor Cortés, lead author of the study and postdoctoral researcher in molecular genetics; Dr. David Curtis, surgery resident; Dr. Xinli Shao, research scientist in immunology; Dr. Vinay Parameswara, instructor of internal medicine; Dr. Jimin Ren, instructor in radiology at the Advanced Imaging Research Center; Dr. Victoria Esser, associate professor of internal medicine; Dr. Robert Hammer, professor of biochemistry; Dr. Anil Agarwal, associate professor of internal medicine; and Dr. Jay Horton, professor of internal medicine.
The research was funded by the NIH, Southwestern Medical Foundation and the Perot Foundation. Dr. Cortés is supported by a postdoctoral fellowship from Pontificia Universidad Católica de Chile and a presidential fellowship from the Chilean government.

You may have read reports of a study that showed a vegan diet can be helpful for people with rheumatoid arthritis. But is it true? There are lots of problems with the way the study was carried out, and the results are far from clear.
What do we know already?
Rheumatoid arthritis is a painful condition that causes stiffness and swelling in your joints. It happens because of a problem with your immune system. Your immune system fights infections in your body, but if you have rheumatoid arthritis, it also attacks healthy tissue in your joints. People with rheumatoid arthritis have a higher risk of heart attacks and strokes.
There are lots of treatments for rheumatoid arthritis. Many people take ibuprofen or a similar drug to help with pain and swelling. Other drugs can be used to slow down the damage to your joints.
There has been a lot of interest in whether eating particular types of food can help with the symptoms of arthritis. One small study suggests a Mediterranean diet, which includes lots of fruit, vegetables and fish and little meat, might help reduce the joint pain people get from rheumatoid arthritis. Researchers have also studied fish oil and vegetarian diets.
Researchers have now done a study looking at whether a vegan, gluten-free diet could help people with rheumatoid arthritis. A vegan diet involves no animal products of any kind. Gluten is found in wheat and some other cereals. Avoiding gluten means cutting out most types of bread, pasta, pizza, pastry and cakes. In the study, one group followed this strict diet, while another group followed a healthy, balanced diet that wasn’t vegan.
All the people in the study carried on taking their usual medicines for rheumatoid arthritis.
What does the new study say?
People in the study who ate the vegan, gluten-free diet lost some weight. But as they were normal weight to begin with, we don’t know if that’s a good thing. They also saw very small drops in their cholesterol levels, compared to the start of the study.
They had a slightly higher amount of a natural antibody that helps fight the damage caused by rheumatoid arthritis. But we don’t know what, if any, effect this had on the disease.
The researchers didn’t look at whether the people on the diet had less pain or joint damage from rheumatoid arthritis. So we don’t know if it had any effect on the main problems from the disease.
It’s also obvious from the study that a vegan, gluten-free diet is very hard to stick to. Out of 38 people who tried the diet, eight gave up within three months. Another eight dropped out before the end of the study, which lasted a year. And this was despite having a week of training about how to prepare vegan food, and continuing support from doctors, nurses and dietitians. No-one dropped out of the study from the group who were asked to eat a balanced, non-vegan diet.
Where does the study come from?
The study was done by researchers from the Rheumatology Unit at Karolinska University Hospital in Stockholm, Sweden. It appeared in the journal Arthritis Research and Therapy, published by a company called BioMed Central.
How reliable are the findings?
This study has a number of problems that make it hard to rely on the findings. It was a small study, and only looked at 66 people to start with. Of these, 16 people who were supposed to eat a vegan diet dropped out before the end of the study.
The researchers only looked at the results of the people who didn’t drop out. This means that they ignored results for all the people who found the diet hard to stick to, or perhaps had to stop the diet for health reasons.
The researchers compared the weights and cholesterol levels of the two groups against their figures at the start of the study, not against the other group. This makes it hard to draw conclusions about whether one diet worked better than the other.
What does this mean for me?
Rheumatoid arthritis is a painful condition, and it’s only natural to consider anything that might help. But this study is a long way from proving that a gluten-free or vegan diet can help with rheumatoid arthritis. The most the researchers could say was that there’s a “potential” benefit.
What should I do now?
There’s no need to make drastic changes to your diet as a result of this study. It doesn’t show that a vegan diet helps people with rheumatoid arthritis.
And strict diets, like a vegan diet, can make it hard to get all the nutrients your body needs. It’s a good idea to talk to a doctor or dietitian before making big changes to what you eat, especially if you plan to completely cut out particular foods.
The Food Standards Agency (FSA), which advises on food safety in the UK, says vegans need to take special care that they get enough:
Protein (found in beans, lentils and soya products)
Selenium (from nuts, especially brazils)
Vitamin B12 (from yeast extract, bread or fortified breakfast cereals).
It’s important to remember that the people in the study were taking medicines for arthritis as well as eating a vegan diet. The research doesn’t suggest that a diet can be used instead of drugs. Not getting the right medicines for rheumatoid arthritis can mean you’re in pain, and also mean more damage to your joints.
If you have rheumatoid arthritis and your treatment isn’t helping, make an appointment to see your doctor. Changing the drug or drugs you’re taking may help to reduce your symptoms.
Elkan A, Sjoberg B, Kolsrud B, et al. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study. Arthritis Research and Therapy. 2008; 10: R34.
To read more, see our information on rheumatoid arthritis.

So you started the new year on a diet, right? Giving up carbs and starches, watching the sugars, heavy on the fish and chicken and light on the beef and pork.
Forget it, says Francie Berg, founder of Healthy Weight Network. She’s a licensed nutritionist and adjunct professor at the University of North Dakota School of Medicine.
“Resolve to follow a healthy, diet-free lifestyle through 2009,” Berg says. “You can get your life back on track, improve your health and move on with what’s really important to you.”
Q: There are always diets, maybe always have been diets.
We’ve had diets for about 50 years. If any one of them worked, we wouldn’t have so many obese people. The truth is some people are thin and some are larger.
The real problem with people 50 and older is a deficiency in nutrients. There’s a lot of emphasis on not eating meat, and these people need the protein they get from meat.
Q: So the answer is …
Eat all the food groups. Eat moderately. Eat at regular times, three meals and one or two snacks a day.
Q: You actually have a file on the Web site you edit, healthyweightnetwork.com, on “normal eating.”
Normal eating. An interesting concept. It’s pretty easy. Right now, it’s politically correct to be a vegetarian. I don’t want to talk against that. And for some people, it works. But most of us need animal products to get the full nutrition from the food we eat.
Q: Your Web site always lists the worst diet promotions of the year. What’s there for 2009?
For the most outrageous claim, we cited the Kevin Trudeau infomercials. He was fined more than $7 million for deceptive infomercials on his weight-loss book, and he was banned from making infomercials for three years. The worst gimmick is the skineez jeans ($139) that supposedly release “medication” through friction and that reduces cellulite.
The worst claim is AbGONE, with drug-like claims that it increases “fat metabolism and calorie burn.”
And our panel decided the worst product was Kimkins diet by Heidi “Kimmer” Diaz that charged users to view her Internet diet site, claiming they could lose 5 percent of their body weight in 10 days safely and permanently. It is essentially a starvation diet. Eleven people are suing her.
Q: So you encourage people to make good food choices and eat enough to keep themselves satisfied?
And also to feel good about yourself and others, accept your own body. I hope we will accept and respect other people – people who are naturally larger. These people are harassed in our country.