Theratechnologies Inc T.TH

NASH and fructose

[jfm1330]

I listened to a recent presentation by Dr Robert Lustig. The title is about cancer, but most of it is about the toxicity of chronic excess consumption of refined fructose or sucrose (sucrose is fructose+glucose) on the liver, including NAFLD and NASH. The case against refined fructose and sucrose is very strong. You listen to him and you say, yes, the lipolytic effect of tesamorelin can help to mitigate the effect of fructose on the liver, but as long as a patient will continue to eat excess refined fructose and sucrose, drugs against NASH will only help to slow down the process. Also, listening to all that, I was thinking about the critical role maintaining the same diet will have in giving valid results in a NASH clinical trial. The positive effect of reducing the consumption of refined sugars can have on NASH is likely so strong that it can easily messed up the results if patients would change their diet because they are in a clinical trial. Maybe the reported problems in the placebo group of some studies on NASH could be related to that. Maybe some patients, because they are in a trial, change the way they eat. This is clearly a wild card in any NASH trial. The protocol should specify to the patients not to change the way they eat.

https://www.youtube.com/watch?v=jpNU72dny2s

[palinc2000]

Great idea! The protocol should also specify not to modify their alcohol consumption nor the level of exercise...We cant tolerate any wild card in the trial..I hope they contact FDA and EMA first thing next week to discuss this change in the protocol..    

[scarlet1967]

After practicing over two decades I can tell you to change people's eating, drinking or smoking habits is not as easy as one could imagine. The NASH patients know diet and exercise etc would help but the prevalence is still growing. They could put whatever requirements for placebo group but I doubt it will have any meaningful effect on their habits so if they do or don't exercise, eat

[scarlet1967]

In conclusion, physical exercise improves non-alcoholic fat liver disease (NAFLD), however an optimum approach is still unclear. Regardless, a regular and long-term systematic practice of exercise leads to a better general health, body weight control, and life quality improvement. Interestingly, findings of the reviewed authors are quite varied and of the low significance level. However, 90% of

[jfm1330]

Hey! I was not off the marks in my thinking. Here is a link to a recent full article on the subject of the necessity of standardisation of diet and exercise in the context of NASH trials. They say it is a major point in achieving misleading results and hard to compare results with other NASH trials. https://www.journal-of-hepatology.eu/article/S0168-8278(20)30274-9/pdf I remember my father was

[jfm1330]

Obviously lack of standardisation and compliance by patients to it will give wrong results about the pure effect of the tested drug.

[scarlet1967]

Obviously you are motivated and not compromised mentally so you managed to make changes in your life style which is great. There is a mental aspect to people's habits. A very close person to me is a recovering alcoholic, naively my only advice to her was well stop drinking but that didn't happen so we tried physiotherapists, medication,multiple rehabs for years with no luck until she

[jfm1330]

Addiction like alcoholism is something else. But again, read the article I referenced. Standardisation of eating and exercise is key to the success of a NASH trial. It is a real challenge. It will not occur for every patients, but some, knowing that they will be closely followed, could change their habits to a certain extent, even more considering that they are motivated enough to enter in a trial

[Wino115]

You are completely right that this has been ascribed to some of the large placebo effects we have seen. I don't recall which trial report it was that I read but they had a slew of baseline measurements around north just weight, but muscle density, waist circumfrance,etc to try to explain it.    But what I read in the notes of that trial was that everyone enrolled in the trial was

[jfm1330]

One thing is sure, the cure to NASH would be an enzyme taken before a meal that would be able to convert fructose to glucose in the small intestine before absorbtion. Robert Lustig wrote a scientific paper in 2013 with the title: "Fructose it's alcohol without the buzz". All the fructose that we eat end up in the liver, and the metabolism byproduct it generates is very similar to

[scarlet1967]

I have no doubt improving eating habits and exercise routines can help the trial in fact that's mostly the only remedy for NASH at the moment but addiction regardless if it's to food,alcohol or drugs etc is a serious disease! Most medical professionals including  physicians, psychologists, psychiatrists to this date are struggling with this vicious disease so I don't agree with

[scarlet1967]

Binge eating disorder (BED) is a type of feeding and eating disorder that’s now recognized as an official diagnosis. It affects almost 2% of people worldwide and can cause additional health issues linked to diet, such as high cholesterol levels and diabetes. The causes of BED are not fully known. As with other eating disorders, a variety of genetic, environmental, social, and psychological risks

[jfm1330]

Again. This is not my point. If binge eating led you to NASH and you enter the trial, then continue binge eating for 18 months. We want to see the effect of the drug, not the effect of stopping binge eating. If you think you can change your bad eating habits, don't enter the trial and go on with better eating habits and more exercize, cut refined sugars.

[scarlet1967]

This is the whole point people with eating disorders are not capable of "standardisation", their eating habits are unpredictable and depends on their mental health at the time. Bing eaters don't have any control of when or how much they eat. On a good day they try to fight it on a bad day it's a total chaos same applies to alcoholics, drug dependants,  gamblers etc. They are

[scarlet1967]

The reality is standardisation/being stable is a rare commodity not many are capable of.

[scarlet1967]

You seem to think people are robots you can program to do or not to do certain things for a period of time which is not the case at all although I wish it was that simple.

[jfm1330]

OK. I am done with you. I provided the reference to a recent comprehensive article on the subject in Journal of Hepatology. You obviously did not read it and you compulsively post ridiculous stuff to argue against it. Pointless to argue with you. Again I am done. Bye.

[scarlet1967]

These "ridiculous stuff" have devastated many real people's life, you want to have a perfect trial based on some theories published on some journals good luck this trial is going to have same obstacles like previous trials because the subjects are humans with all the same imperfections as previous subjects which happens to be also HUMANS. I can sense a lot of anger which is again a

[Bucknelly21]

He's just another persons who can't think out of the science box 

[palinc2000]

Its has nothing to do with science .His problem is   For dialogue to be successful, there must be an understanding that no one has a monopoly on the truth. quote=Bucknelly21]He's just another persons who can't think out of the science box [/quote]

[jfm1330]

I think you don't get my point. I don't care what patients in the trial will eat. The key is for them to continue eating the same stuff that lead them whith NASH in the same way. Same for exercicise.  If some patients, not all of them, either in the drug group or placebo group start changing their way of eating and execising, for the worst or the better, it will mess up the results

[qwerty22]

What you're suggesting is basically unethical and is not what any NASH trial has done in practise. You can't withhold Standard of Care from a patient on a trial. In the case of NASH Standard of Care is advise on diet and exercise (D&E). Every NASH trial has a D&E component. Companies rarely talk about it, probably because it complicates the story as you say. KOLs

[scarlet1967]

Not a heavy smoker but I do smoke cigarettes and I know what they do to my body, I used to be asked how come although I advise my patients to stop smoking I smoke myself and my  sarcastic response was well dentistry is a profession  not a religion(I want to readdress my previous comment although I don't believe in religions I would like to think I do believe in god just don't

[palinc2000]

Al I know is that at this stage of the pre  Phase 3 trial after mny many many months of prep work  the company has probably finalized the protocol subject to Fda approval and to think they will introduce at the last minute JMF suggestions is ludicrous, In all due respect I  dont think that anyone  on this board can infer or pretend that they are better equipped than the company

[FredTheVoice]

I Follow Palinc on this one, Levesque is just waiting for the best moment, but everything is almost ready to be announced, My call: its done and great PR within MAX two weeks.... (Yes all that stuff around Frustose will be behind us....). FTV.

[SPCEO1]

Everyone believes in religion, even you. On the contniuum of religious belief, you go from no belief to full belief and everything in between. So, to say you do not believe in religion is, itself, a religious belief. Unfortunately, there is no getting around religious belief - we all have our religious beliefs, it is just a matter of what those beliefs actually are. And don't let your

[ANALIAS00]

Please please please ....can we stick to stocks and medecines please ? There are enought fanatic sites for those who believes in religions and any other weird stuff. I hope my prayer will be heard. Hooo my !!

[SPCEO1]

Well, I think I know where to place you on the religious continuum Analias00! I hope you don't stay there. At least I did not lecture him to quit smoking! 

[scarlet1967]

It's off topic but since it's mentioned here my wife is devoted Christian and her belief in the religion served her well,  in fact many in AA identify  the higher power as god through a religious belief having said our marriage survived many obstacles based on understanding and flexibility. Maybe one day I join her between now and then I strongly believe in the good and all

[SPCEO1]

You are a blessed man to have the wife you do and how you see things is not much different than what Jesus taught. Thanks for sharing that.

[qwerty22]

Testify sister! (u are female right?)

[ANALIAS00]

Nop... When I ceated my account...they asked me for AN ALIAS. So I entered Analias. :o)

[Lee430]

I am grateful for all of the research that is shared here, it just amazes me how insatiable some of your appetites are for knowledge, thanks to all as this message board has been good for my health, wealth & spirituality, what more could one ask for. Some of your recent post’s on liver health has my wife and I rethinking our diets (we are already Vegetarians due to health issues) SOOO my wife