So You Think Dietary Fat Causes Heart Disease?

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If you believe in unicorns, myth and mythology, you can continue to believe that fat in the diet causes heart blockages and heart attacks. If, on the other hand, you believe in science and evidence, you might want to question those beliefs. Because the evidence is in, and most people are wrong.

Bad science

So what was the problem to begin with? Americans made huge changes to their diets, the food industry changed its grocery store offerings, and lots of patients received rather severe tongue lashings from their doctors. All for no good reason. How could so many people be so wrong for so long?

Well, the answer is bad science.

Correlation is not causation

Scientists, including doctors, conduct trials to see if a particular theory or hypothesis is correct. Now, there are trials, and there are trials.

We have epidemiological studies, where segments of the population are followed for a number of years, and their health outcomes are noted. Observations are then made to see if those outcomes are correlated with certain habits or risk factors.

So what is the problem?

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Correlation is not causation. If two things are correlated, one does not necessarily cause the other. A rooster’s cry and the rising of the sun are correlated, but the rooster does not cause the sun to rise.

A murky beginning

The whole saga appeared to start in the 1970s. The Seven Countries Study by Ancel Keys revealed a strong correlation between the average amount of saturated fat in the diet, the average blood cholesterol levels, and the 10 year death rates from coronary heart disease (blockages in the heart arteries). Again, the key word is correlation. No cause and effect was proved.

However, what followed was an avalanche of government advice, and change in the food industry offerings. There were other epidemiological studies, but there was a lack of well-designed trials to support this undertaking.

What is a good trial?

Well, the gold standard is the so-called randomized controlled trial, often shortened to RCT. The details of such trials are beyond the scope of this article, but RCTs are better suited to look for a cause and effect relationship.

What were we told?

For over fifty years, we have been sold a bill of goods which was defective. And all of this based on epidemiological studies, of doubtful quality.

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Governments, and scientists, and doctors, told us that saturated fat was bad for us, that fat was bad for us. That consuming too much fat would cause blockages in the heart, leading to heart attacks, and premature death.

We were advised to cut down on fat, so that no more than 30% of our daily calories came from dietary fat. We were also told to limit saturated fat intake to no more than 10% of daily calories.

So what happened next?

Well, our calories come from carbohydrates, protein, and fat. If you eat less fat, you will tend to eat more of the other stuff. And that is what people did when they were asked to cut down on fat. They loaded up on carbohydrates. Not protein. Carbohydrates. In fact, in the late 20th century, the US government advised the public to start eating more carbohydrates, including 6-11 servings of grain products daily.

What next?

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Americans have dutifully heeded their government’s warnings about fat. Fat used to provide 40% of daily calories in the past. This has dropped to 30% in the last 30 years. But people have become heavier. Obesity rates have tripled in the last few decades. You don’t need data to know this. Just go to any mall or sports stadium and look around. Alarmingly, the incidence of type 2 diabetes has gone up many-fold.

So what is the problem?

It is clearly not dietary fat.

A meta analysis of prospective studies evaluating the association between saturated fat consumption and cardiovascular disease was published in the American Journal of Clinical Nutrition in January 2010. It analyzed 21 studies, which followed nearly 350,000 people over 5-23 years. It revealed that there was no significant evidence for concluding that saturated fat in the diet is associated with an increased risk of coronary heart disease or stroke.

Fat out, sugar in

Sugar

Sugar

The law of unintended consequences can be seen at work in this entire saga. Governments want less fat in the diet, so industry is urged to offer more low-fat products. But fat makes food taste good. Taking fat out worsens the taste. Thus, industry has been replacing fat with sugar, with results that we are seeing all around us: fatter people, with more diabetes. Also, we are witnessing a plateau in cardiovascular disease, which had been showing a decline for decades. And we may well see an uptick in this disease if things continue the way they are.

So is a calorie a calorie?

Not necessarily.

Food has metabolic consequences. A low-fat diet can lead to biological adaptations, such as increased feelings of hunger, a lower metabolic rate, and other components of a starvation response which tend to oppose weight loss.

Sugary drinks and sweets, as well as simple carbohydrates and starches, tend to increase blood levels of insulin, which is related to many chronic diseases, including diabetes and obesity.

Low-carbohydrate diets and low-glycemic index diets (with foods containing complex carbohydrates) tend to lower the levels of insulin in the blood, thus helping people maintain the weight loss they have achieved. Such diets might be protective against chronic diseases such as diabetes.

More recent studies

The Women’s Health Initiative Dietary Modification Trial revealed that over a mean of 8.1 years, a low-total fat diet did not significantly reduce the risk of heart disease or stroke in postmenopausal women.

The PREDIMED trial was a study of the Mediterranean diet in high risk people who were free from known coronary disease at the beginning of the trial. This study showed a 30% lower risk of having a major cardiovascular event in the higher- fat dietary groups compared with the low- fat control. This risk reduction is similar to that shown in the statin (cholesterol lowering drugs) studies, but at no cost to the health system!

Higher death rates?

A study by DD Wang and associates, published in JAMA Internal Medicine in August 2016, noted that men and women following low-fat/high-carbohydrate diets had higher rates of premature death, not lower.

Lesson learned?

Hardly!

The US government, through its Dietary Guidelines for Americans, 2015-2020, still recommends cutting down on saturated fat. These guidelines also state that a healthy eating pattern includes fat-free or low-fat dairy.

MILK

School lunch programs in the US provide only low-fat milk. No whole milk is provided at all, although they do allow chocolate skim milk with its added sugars. And this is in spite of the Dietary Guidelines calling for a restriction on added sugar.

And the general public, of course, keeps buying low-fat everything. In fact, at most grocery stores, it is hard to find full-fat dairy.

And this is in spite of a study published in the reputable journal Circulation early in 2016 which found that people consuming full-fat dairy had a 50% lower risk of diabetes, compared to those consuming the low-fat variety.

So what to do?

  • Don’t obsess about fat. The link between fat, especially saturated fat, and heart disease is tenuous at best.
  • Trans-fat is still bad for you. This is found in cakes, pies, cookies, biscuits, crackers, and many fried or processed foods.
  • Try to eat whole or minimally processed foods.
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  • Include lots of fruits and vegetables in your diet.
  • Cut down on sweets and sugary drinks, as well as simple carbohydrates.
  • Include whole grains in your diet.
  • Eating an ounce of nuts daily is good for you.
  • Low-fat dairy has no benefits over the full-fat variety, and may well be worse, according to recent data.

And finally

Focus more on the overall dietary pattern.

As Dr. Mozaffarian, a leading researcher, says, “If something has a food label, it’s probably not the best choice. We need to move away from the idea that we can manufacture an artificially healthy diet.”

The Truth About Cholesterol: Good, Bad, and Ugly!

Do you really want to get rid of cholesterol? If somebody promised to remove all trace of it from your body, would you agree, thinking that that would eliminate the threat of heart disease? If you say yes, that would be a mistake. Because you would then find it difficult to survive.

What is cholesterol?

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It is all over the news, both TV and print, and tons of medical articles are devoted to this rogue. Except that it is not always a rogue.

“Chole” in Greek means bile, while “stereos” means solid. The “ol” signifies that it is an alcohol.

So cholesterol is a sterol, which is a modified steroid.

It is also a lipid molecule, which basically means that it is a type of fat.

Do we need cholesterol?

You better believe it!

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Why? Because it is an essential part of the cell membrane of all animal cells. Bacterial and plant cells have cell walls, which are fairly rigid. However, because of the cell membrane, animals, including us, can avoid having a cell wall. Thus animal cells can change shape and move around.

Anything beyond membranes?

Yes!

If you are Mycoplasma, you need cholesterol for growth. But if you are reading this, it is unlikely that you are Mycoplasma.

Assuming that you are a human being, you would need cholesterol for intracellular transport, cell signaling, and nerve conduction.

Vitamins and hormones

Unless you want to pop Vitamin pills and depend on hormone shots, you had better thank God for cholesterol.

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The synthesis of Vitamin D and all steroid hormones requires cholesterol. This includes sex hormones and adrenal gland hormones.

So should we eat a lot of cholesterol?

Hold on for a while.

If you are a man weighing 150 pounds (are there any of those around anymore?), your body makes about 1000 mg of cholesterol daily. Yes, makes. Since cholesterol is vital for the structure and functioning of the body, your body does not want to depend on your diet to give it enough of a supply.

Remember, the time of excess is relatively recent. For hundreds of thousands of years, human beings struggled to get enough food to survive and flourish.

So your body makes a lot of cholesterol. As we speak, your body (if you are the above-mentioned hypothetical male) contains 35 g of cholesterol. And most of it is not in the heart or arteries. It is mostly within the cell membranes, performing a vital function.

So how much should we eat?

Good question.

Let us turn to the Dietary Guidelines for Americans (DGA) which has been telling us what to eat and how much since 1980.

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In 2010, American men were consuming 350 mg of cholesterol daily, while women limited themselves to 240 mg. The DGA recommended that year that we should keep our intake below 300 mg/day. The rationale, of course, was that if we ate less cholesterol, our blood cholesterol levels would fall, and we would not develop blockages leading to heart attacks.

DGA 2015-2020 advice

The latest DGA report is revolutionary in one regard. It makes no recommendation to limit cholesterol intake.

The report states that “adequate evidence is not available for a quantitative limit for dietary cholesterol specific to the Dietary Guidelines.”

Say what?

Dietary cholesterol does not play a major role in blood cholesterol levels.

Yes, you heard that right.

The amount of cholesterol in your blood stream is not affected significantly by how much cholesterol you eat in your food.

Why?

Most of the cholesterol we eat is in the form of esters, and as such is poorly absorbed.

In addition, if we eat too much cholesterol, and a lot of it is absorbed, the body compensates by making less cholesterol on its own.

There are many factors which have a more pronounced effect on blood cholesterol than dietary intake of cholesterol.

Body weight, age, sex, physical activity, heredity, and consumption of saturated fats and trans-fats, all have significant effects on our blood cholesterol levels.

But what about heart disease?

That, of course, is the million dollar question.

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Links between high cholesterol levels and the development of coronary artery disease (blockages in the heart) leading to heart attacks are quite clear.

So what should we do to lower blood cholesterol?

And will that lead to prevention of heart attacks?

And what about the different types of cholesterol?

Conclusions

  • Cholesterol is not always bad.
  • Without cholesterol, we would not have cell membranes, some vitamins, and important hormones.
  • High cholesterol levels are associated with an increased risk of heart disease and heart attacks.
  • Cholesterol is of several types.
  • The level of cholesterol in your blood is not primarily dependent on how much cholesterol you consume in your diet.

Future direction

  • How best can you lower cholesterol?
  • Will that affect heart disease?

Stay tuned!

We will address these issues in subsequent posts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Want to Protect Your Heart? Control High Blood Pressure!

If every third American adult came down with malaria, we would be outraged. The public would demand immediate action to start proper treatment, and monitor the results. Then we would also demand steps to prevent any such a calamity from happening again.

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Then why is it that high blood pressure (high BP, or hypertension), which is as serious a public health threat, is treated so casually: by patients, doctors, the government, and the public alike?

I feel well, I must be well!

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This is one of the most common reactions of the average person. If your head hurts like crazy, you will call your doctor’s office and scream at the receptionist till you receive an early appointment. Or you would race to the nearest emergency room.

If your stomach felt ready to explode, you wouldn’t tell your spouse, “Honey, I’ll go see the doc next month, promise!”

But with high blood pressure, most people never have any symptoms. Even if the blood pressure is dangerously high. So the patient is lulled into a false sense of security.

The data should scare you!

Every third American adult 20 years or older has high BP. That is close to 80 million adults!

It is worldwide!

Do not feel that you are fine if you are not an American. WHO data from 2012 reveal similar percentages of prevalence of hypertension all over the world. In fact, two-thirds of all the people with high BP live in the developing world.

It kills!

Sufferers may feel fine, but hypertension is deadly.

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Around half of all deaths from heart disease and stroke worldwide are caused by high blood pressure.

If you are 50 years old, your life expectancy is likely to be approximately 5 years lower if you have high blood pressure compared to your peers of the same age with normal blood pressure.

You can prevent it

Complications of uncontrolled blood pressure are fairly easy to prevent.

Even a small improvement in blood pressure for a short time can improve cardiovascular outcome substantially.

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A 10 mm Hg (millimeters of mercury) lower systolic BP (the top number) is linked to a 50-60% drop in the risk of dying from a stroke. It is also associated with a 40-50% lower risk of dying as a complication of blockages in the heart (coronary artery disease).

Controlling blood pressure adequately also slows the progression of heart failure and kidney failure.

So how are we doing?

The National Health and Nutrition Examination Survey (NHANES) data from 2003-2010 reveal that almost 36 million (35.8) Americans did not have their blood pressure under control.

Of these, 14.1 million did not even know that they had high BP.

However, 5.7 million of these people knew they had hypertension, but were not on medications.

Amazingly, 16 million Americans knew they had high BP, and were on medications, but still did not have their BP under control.

Thirty-six million people!

That is a lot of people!

Treating high blood pressure is not rocket science. Leaving thirty-six million people uncontrolled should not be acceptable.

Are they poor and uninsured?

No.

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Nearly 90% of American adults with poorly controlled blood pressure have a usual source of healthcare.

Nearly 90% have health insurance.

Nearly 90% received health care in the previous year.

So clearly we are missing opportunities to improve the outcomes of these people.

What is the root problem?

Everybody blames somebody else. And there may well be enough blame to go around.

There are clearly issues with non-standardization of the way BP is measured in clinics and hospitals.  There are also questions about the utility of office versus patient home versus ambulatory measurement of BP, and the prognostic value of each of these.

Patients do not always follow instructions. Physicians do not always follow treatment guidelines. And then there are confusing and often contradictory guidelines issued by different “expert panels.”

How to get better?

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We need to rethink our entire approach to treating people with high blood pressure.

Among other measures, innovative health-care delivery models are being looked at. These include team-based care, patient-centered medical homes, and efforts to improve medication adherence.

System-wide strategies

Kaiser Permanente implemented a program in Northern California to improve blood pressure control among its patients by creating a hypertension registry to keep track of patients with high blood pressure and the care they were receiving. They instituted several system-wide protocols to monitor and improve the quality of care of these patients.

The result: In 2001, 44% of their patients had their blood pressure under control, while in 2010, this improved to 87%.

During roughly the same period, death rates from stroke in this group went down by 42%, heart attacks went down by 24%, and the most serious types of heart attacks went down by 62%.

Conclusion

  • Controlling blood pressure leads to tremendous benefits.
  • The healthcare system is currently doing a very poor job of blood pressure control.
  • We will need innovative thinking and reforms to improve this state of affairs.
  • It is time to get serious!

Want to read more?

My book “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control” deals with these issues in more detail, and is available here:

http://goo.gl/t3h2zs.

Is Your Blood Pressure Really High?

There are close to a billion people in the world with high blood pressure, and almost half of them do not have it under control.

Full pay, half the job

Imagine hiring a painter who paints only half your house, but charges you the full amount. This is what the healthcare system is doing to patients with high blood pressure (also called hypertension).

Not acceptable!

It would be bad enough if only money were involved. Here, however, we are talking about disastrous consequences of poor blood pressure control.

Heart disease, including heart attacks, strokes, kidney failure, vascular disease … the list goes on. Uncontrolled hypertension takes a very heavy toll.

Deaths rise

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In the last ten years, according to the CDC, the number of people dying from illnesses related to high blood pressure has increased by 66% in the US (compared to a 3.5% increase in the number of deaths from all other causes combined in the same time frame).

And with all the high-tech and fancy gadgetry available to us, we cannot control high blood pressure.

Where to start?

First things first.

Are we really measuring BP correctly?

Just do it?

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It should be pretty simple, right, to measure someone’s blood pressure?

Every adult who goes to see a doctor, or enters a hospital, has his or her BP checked. They slap a cuff on you, and boom! It is done!

Not so fast!

Incorrect technique leads to inaccurate and unreliable results.

It sounds obvious, but needs to be restated.

Correct methods of checking blood pressure need to be revisited and re-emphasized.

One high reading= hypertension?

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Before we go any further, it is important to emphasize that the diagnosis of high blood pressure, or hypertension, should only be applied after obtaining at least 3 readings of the person’s blood pressure over the course of at least 2 visits to the doctor’s office.

ACC advice

This is how the American College of Cardiology recommends obtaining a blood pressure reading, whenever possible:

  1. The patient should be settled and comfortable for at least 5 minutes before checking the blood pressure.
  2. The patient should be sitting down with the back supported, with his or her feet well supported on the floor.
  3. The arm should be supported in the horizontal position, with the blood pressure cuff at the level of the heart.
  4. At least 2 measurements should be obtained.
  5. The blood pressure should also be measured with the patient standing up for 1-3 minutes, because posture can affect the blood pressure.
  6. An appropriate sized blood pressure cuff should be used. The bladder of the cuff should go around at least 80% of the circumference of the upper arm.
  7. When evaluating a new patient, blood pressure should be checked in both arms, and the arm with the higher reading should be used for BP checks at subsequent visits.

AMA advice

The American Medical Association has some additional pointers:

  1. The patient should empty his or her bladder before getting a blood pressure check. A full bladder can raise the systolic BP (top number) by 10-15 millimeters of mercury (mm Hg).
  2. The legs should be uncrossed. Crossing the legs can raise the systolic BP by 2-8 mm Hg.
  3. The BP cuff should be placed over the bare arm; putting it over clothing can artificially raise the systolic BP by 10-40 mm Hg.
  4. No talking! A patient having a conversation with the person checking his or her blood pressure can experience a rise in systolic BP of 10-15 mm Hg.

What else?

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The patient should preferably avoid tobacco, alcohol and caffeine use for at least 30 minutes before having a BP measurement.

It is also important to have the doctor’s office temperature in a comfortable range.  The blood pressure is likely to rise if the patient is feeling cold.

Proper calibration

Blood pressure measuring instruments should be regularly calibrated in accordance with the instructions of the manufacturer. Machines can malfunction!

SPRINT trial

It is interesting to note how blood pressure was measured by the investigators in this recent scientific study, which was stopped a year early by the National Heart, Lung and Blood Institute because of potentially life-saving information which had already been gathered. Although a detailed report of the study has not yet been released, they did announce significant benefits from lowering blood pressure beyond current recommendations.

However, one should not jump to conclusions till we receive more information about the risks and benefits of treatment, and which groups of patients were included and excluded from the study.

SPRINT BP details

  • BP was measured in an office setting.
  • An automated machine was used (an Omron machine). This is not an endorsement by me of a specific company, but just a statement of fact.
  • The machine waited for 5 minutes, and then took 3 BP measurements, and averaged them.
  • The BP was measured while the staff were out of the room.

According to Dr William C. Cushman, a network principal investigator in the SPRINT study, “With the way it’s (BP check) done in office practices today, even if it’s done with a good machine and by somebody who knows how to take blood pressure, it is often 5 or 10 mm Hg higher than that.

CONCLUSIONS

  • Checking blood pressure sounds simple, and can be simple.
  • However, several important precautions need to be taken.
  • Ignoring these steps can lead to inaccuracy and inconsistency when serial blood pressure readings are followed, and the patient can at times receive an inaccurate diagnosis.

Want to read more?

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For a more detailed analysis of BP control, and reasons for lack of control, you can refer to my eBook: “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control,” available at http://goo.gl/t3h2zs.

 

Want to be Happy Right Now? Try Gratitude

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Who does not want to be happy?

However, most of us are confused about what that means. We often choose the wrong ways of trying to achieve happiness, spending a lot of money chasing transient pleasures. And we are reluctant to do some simple, and often free, things which can bring about lasting satisfaction.

Gratitude brings happiness

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Most people tend to overlook the established fact that gratitude is a crucial component of happiness.  Regular inclusion of grateful thinking into your life can change the way you look at the world. This has been shown to boost happiness levels significantly.

Gifts

No matter how little you have, if you think carefully, you will find gifts that others have given you over time. Life is one of them. Whether your life is ideal, or less than that, it still is a wonderful thing to be alive, at least for the vast majority of us. Except for some people with serious mental health issues, and some with other tragic circumstances, most human beings would choose life over death.

How did you get here?

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The human infant is quite helpless. Turning him or her into a functioning adult requires significant effort from numerous people: parents, teachers, friends, community members, relatives. It is naïve to think that you became successful just because of your own hard work.

Acknowledging that, and expressing gratitude for it, is nothing more than accepting reality. This is the first step to developing a healthy attitude to life.

A spark from another

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“At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.”

-Albert Schweitzer

The sense of awe

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Look around you. The sky is amazing, as are the stars. The sun rises every day, and shines upon rich and poor alike. If you have ever enjoyed a sunset at the beach, or looked at majestic mountains, or just walked in the moonlight, you are bound to feel a sense of awe. If you believe in God, thank Him for the miracles of nature. If you do not believe in God, you can still feel grateful for an opportunity to enjoy nature, often free of charge.

Everyday epiphanies

“Gratitude bestows reverence, allowing us to encounter everyday epiphanies, those transcendent moments of awe that change forever how we experience life and the world.”

-John Milton

Good in the world

There is good in this world. There are good people, who perform good deeds. There are good things, many of which are free, such as the air we breathe. A self-centered view of the world can lead people to believe that they are the center of the universe. However, gratitude helps us to acknowledge that there are forces of good in this world outside of ourselves, and that these people, these forces, and these things can make a huge difference.

Of course, evil exists, too. And it is talked up all the time. Not too many people think and talk about the good that exists. Turning our attention to that can cause a paradigm shift.

Shift in focus

It is normal for human beings to think of themselves first and foremost. This is an attitude which promotes survival. But taken to an extreme, it becomes a damaging selfishness, which can color our attitude toward everything.

Gratitude allows us to shift our focus from ourselves to others, and encourages us to become more appreciative citizens of a global community. This is not just mumbo-jumbo. A grateful attitude has important, well-documented benefits.

More happy, less depressed

Research studies by Robert A. Emmons, PhD, suggest that gratitude leads to an increase in happiness and a reduction in depression.

Emmons is a leading researcher in the field of gratitude.

Gratitude journal

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Keeping a journal in which people regularly jot down things and people they are grateful for has been shown to improve the health and happiness of users.

Interestingly, it appears that writing down your feelings of appreciation and thankfulness even once a week in a journal has beneficial effects.

Sleep better

A study published in 2011 in Applied Psychology: Health and Well-Being revealed the positive effects of gratitude on sleep. People who keep a gratitude journal, and spend even 15 minutes a night writing down grateful sentiments tend to sleep longer and better.

Stress, optimism, immunity

The research of Dr Emmons suggests that feelings of thankfulness enable people to deal better with stress and other day-to-day problems.

There is also a link between gratitude and feelings of optimism. And there is some suggestion that optimism is linked to better immune function.

Better health

People who regularly express gratitude tend to exercise more often, and report fewer physical symptoms. In general, they admit to feeling more healthy compared to other people.

Teenagers

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A 2010 study in the Journal of Happiness Studies showed that high school students who are grateful have higher GPAs. They also have fewer signs of depression or envy.

Other studies reveal that grateful teenagers are better behaved in school and more hopeful.

Relationships

Gratitude and friendship go hand in hand. Grateful people recognize the positive contributions others make in their lives. As such, they tend to connect better with other people and have stronger personal relationships.

Athletic burn out

The journal Social Indicators Research published a study in 2008 showing that athletes who were grateful had higher life satisfaction and team satisfaction, and were less likely to suffer from burn out.

Conclusion

  • A world-view that begins and ends with oneself is unlikely to lead to lasting happiness.
  • Acquisition of material goods is unlikely to cause permanent joy.
  • Long-term satisfaction with life often requires a shift in the way we perceive ourselves and the world.
  • Developing and practicing a sense of gratitude has been shown to promote happiness and a feeling of well-being.
  • Even if you have very little, you can find something or someone to be grateful for.
  • Research into gratefulness has documented several physical and mental health benefits.

Call to action

  • Think of people who have helped you get where you are in life.
  • Appreciate what you have.
  • Keep a gratitude journal and write in it at least once a week.

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Diabetes: A Double Whammy for Women!

It is tough enough being a woman: ask any woman! If you don’t believe them, ask any man if he would like to turn into a woman. With rare exceptions, the answer will be a resounding NO!

Similarly, it is tough enough having diabetes. It is a disease which can affect almost any organ in the body, and often does, causing untold misery all over the world.

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But combine being a woman with having diabetes, and you have a double whammy which is as unfair as it is real. Because diabetes places a unique burden on women.

Some data

There are about 246 million people with diabetes in the world. More than half are women. At least a third of people with diabetes do not know they have the disease.

Mother and child

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Unlike men, women with diabetes have a unique problem: Diabetes can affect them, as well as their unborn children.

Diabetes can cause a miscarriage. It can also lead to babies born with birth defects.

Gestational diabetes

Women who have never had diabetes before can still develop it during pregnancy: a condition called gestational diabetes.

This happens in 2-5% of all pregnancies.

Women who develop gestational diabetes have a 20-50% risk of developing type 2 diabetes 5-10 years after delivering their baby.

Women who give birth to a baby weighing 9 pounds or more are at a greater risk of developing type 2 diabetes later.

Control & complications

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Several complications of diabetes are more severe in women than in men. Although proof is lacking, it is felt by many experts that this could be due to the quality of control of diabetes.

Starting in their mid-teens and persisting for the rest of their lives, women show signs of poorer control of their diabetes than men. The exact reasons for this are unclear, but it is possible that it could partly be due to the dual responsibility of many women to cope with both their diabetes and the care of their families.

Death

It does not get any more serious than this. Women with diabetes have a higher all-cause mortality rate than men with diabetes.

Heart disease

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Diabetes is a more common cause of coronary artery disease in women than in men. Before menopause, estrogen levels in women are thought to protect women against heart disease. Experts believe that diabetes may change those protective effects of estrogens.

In women between the ages of 45-64 years, there is a 3-7 times higher risk of coronary disease in the presence of diabetes.

Heart attack

Compared to women without diabetes, diabetic women are more likely to have a heart attack, and that too at a younger age.

A greater burden

Diabetes places a larger burden on women of risk factors leading to heart disease, as compared to men.

Obesity, high blood pressure and cholesterol problems are more prevalent in diabetic women than men.

47% of diabetic women are obese, with a body mass index (BMI) of 30 or more, compared to 25% of all women.

Lipid/cholesterol problems

Diabetic women have a greater burden of lipid disturbances which increase the risk of heart disease. Their “good” cholesterol (HDL) is more likely to be low, their Apo A1 protein is low, their Apo B protein is high, their triglyceride levels are usually high, and they have more small, dense, LDL (bad) cholesterol particles. Bingo, more coronary disease!

Outcomes

Not only do women diabetics have a higher risk of developing heart disease, but once these ladies do get heart disease, their prognosis is worse than that of diabetic men with heart disease.

The eyes have it

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Diabetes increases the risk of developing eye problems, ranging from mild to severe, at times proceeding on to blindness.

The risk of developing severe eye complications of diabetes is higher in girls and women than in boys and men.

Let’s not fall

Women with diabetes have an increased risk of hip fracture.

Type 1 diabetes increases the risk of hip fracture 6.4 times, and type 2 diabetes by a factor of 2.2. If you have ever used insulin, or if you have had type 2 diabetes for 12 years or longer, your hip fracture risk is higher.

An ounce of prevention

News flash from the Nurses’ Health Study: Type 2 Diabetes is preventable!

Listen up:  90% of type 2 diabetes in women is due to 5 risk factors:

  • Excess weight
  • Lack of exercise
  • Less than healthy diet
  • Smoking
  • Abstaining from alcohol

What to do?

  • Control your weight. If you are overweight, your risk of developing type 2 diabetes increases seven-fold. If you are obese, your risk of developing diabetes is 20-40 times higher than that of your friends who have a normal weight.
  • Losing 7-10% of your current weight will cut your risk of developing diabetes in half.woman-163746_1280 (1)
  • Turn off your TV and start walking around! Walk briskly for half an hour daily, and your diabetes risk will drop by 30%.
  • On the other hand, if you choose not to be active, and opt for watching TV for 2 hours instead, your diabetes risk will climb by 20%.
  • Make 4 changes to your diet.
  • Eat whole grains, rather than highly processed carbohydrates. The Nurses’ Health Study revealed that women eating 2-3 servings of whole grains daily had a 30% lower risk of developing type 2 diabetes.
  • Two to three servings of brown rice weekly can cut your diabetes risk by 11%.soda-211686_1920
  • Choose water, tea, or coffee instead of sugary drinks. In the Nurses’ Health Study II, women who drank one or more sugar-sweetened drink daily had an 80% higher risk of type 2 diabetes than women who drank these beverages only once a month.
  • In the Black Women’s Health Study, women consuming 2 or more fruit drinks daily had a 31% increase in the risk of developing type 2 diabetes compared with those who did so less than once a month.
  • Choose polyunsaturated or monounsaturated fats over the other kinds.
  • Reduce your consumption of red meat and processed meat. A meta-analysis of several studies suggests that eating a 3 ounce daily serving of red meat (a piece of steak the size of a deck of cards) can raise your risk of developing type 2 diabetes by 20%. The good news from this same analysis is that if you swap the red meat or processed meat in your diet for nuts, low-fat dairy, poultry, fish, or whole grains, you can reduce your diabetes risk by up to 35%.
  • If you smoke, please stop! Smokers have a 50% higher risk of type 2 diabetes. Heavy smokers have an even greater risk.
  • Moderate amounts of alcohol can help. One drink a day in women, and up to 2 in men, can increase the efficiency of the action of the body’s insulin in getting sugar out of your blood stream and into the cells.
  • However, if you do not drink alcohol, do not start!

 

So watch your weight & move around.

You CAN beat this disease!

 

100 Trillion Residents Live in Your Body!

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Most of us are scared to death of bacteria and other “bugs.” They create a lot of misery and illness, we are told. So we wash our hands ad infinitum, and disinfect everything in sight. We need to kill all the bugs, don’t we?

No, we don’t.

Even if we wanted to, we could not come close to killing all of them. Because our bodies harbor about 100 trillion of them, on average. They are bacteria, viruses, and fungi. They live on our skin, in our mouths, and in our intestines. They outnumber the cells of our body by 10:1.

What are they?

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These are tiny microbes which have been evolving for tens of thousands of years. And they are a diverse lot.

My gut microbes are different from yours. Their composition depends on multiple factors, including personal hygiene, genetics, diet, and antibiotic therapy, among others.

Do they have names?

Many of the gut microbes have no names or descriptions at present. Research into this field is still at an early stage.

What do they do?

These micro-organisms create byproducts, which enter our bloodstreams. It is suspected that they can be of significant benefit to us, but can also carry a potential for harm.

Some of these byproducts have anti-inflammatory effects. Some are anti-oxidants. They affect the health of the lining of our intestine. They are also felt to play a role in metabolic disorders, and influence immunity.

These bugs are also a manufacturing powerhouse.

Exercise and gut bacteria

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Preliminary data suggest that athletes who exercise vigorously have a greater variety of microbes living in their guts. Greater diversity in gut microbes is generally believed to be beneficial.

Athletes have also been shown to have low levels of inflammation markers in their blood. Some rugby players have demonstrated large numbers of bacteria (Akkermansiaceae) shown to be associated with a low risk of obesity in previous trials.

On the other hand, researchers looking at non-athletic healthy men doing light exercise, and also overweight or obese sedentary men, found high blood levels of markers of inflammation and relatively low numbers of Akkermansiaceae bacteria.

So exercise appears to have a positive effect on gut bacteria. And this is beneficial for general health.

Obesity and the gut microbiome

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We have all seen people who appear to eat a lot and never put on weight. How can that be possible?

The obese mouse

Believe it or not, if you take the microbes from the gut of an obese mouse, and give them to a slim mouse, that mouse also becomes obese. And vice versa.

So clearly, there is some connection between gut bacteria and weight issues. At least in mice.

Of mice and…men?

The pan-European HIT consortium organized a study on nearly 300 volunteers from Denmark. These volunteers included both lean and obese people.

The diversity of their gut flora was then analyzed and correlated with signs of metabolic problems.

People with low diversity in gut flora had more insulin resistance (which can lead to type 2 diabetes), higher levels of inflammation markers, and other warning signs of metabolic disorders.

Obese volunteers who also had low diversity in gut flora put on significantly more weight over 9 years of follow-up compared to other participants.

Bugs work with your diet?

A French study organized by the ANR MicroOrbes group evaluated the effects of a low-calorie diet on obese and overweight people.

The people who had low diversity in their gut bacteria at the beginning of the study improved significantly with the diet. The signs of metabolic disorders improved, and their bacterial diversity also got better.

The improvement with diet was not as significant in people whose gut bacterial diversity levels were already high to begin with.

Timing of bacterial colonization

A baby in the uterus has a sterile gut. Shortly after birth, bacteria, viruses and fungi begin to move in.

As solid food is started, and the baby is weaned from breast milk, there is a change in the composition of the microbial guests. By the age of 3 years, the baby’s gut microbes are fairly similar to the parents’. Incidentally, couples living in the same house tend to have similar flora in their intestines.

Manufacturing via bugs

The gut microbes are involved in the production by the body of several important substances, such as amino acids (building blocks of proteins), short -chain fatty acids, Vitamin K and B series, and chemicals needed for signal transmission in the brain, like serotonin.

Appetite

It also appears that the gut bacteria produce chemicals which act as signals affecting our digestion, appetite, and sensations of “fullness,” or satiety.

Milk and bugs

The nature of your gut bacterial colony depends heavily on your diet.

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There is a difference between the gut flora of bottle-fed babies and breast-fed babies. Mother’s milk is a prebiotic, or a food for the gut microbes, which are helpful for the babies. It is also a probiotic, containing colonies of helpful microbes being put into the baby’s body.

Bottle-fed babies have intestines which have suboptimal colonization by helpful microbes. It is possible that these babies have inadequate protection against some diseases.

Diet and bugs

Whole grains, fiber, and the presence or absence of meat and processed foods in our diet affects the composition of our guts’ tiny resident guests.

The Western gut is less diverse than the Eastern one, and the rural gut also looks different.

Does this affect the incidence of chronic diseases and metabolic diseases so much more common in the West? It is too early to tell.

Conclusions

  • It is time to stop thinking of “me,” and start thinking of “my bugs & I.”
  • A diverse group of gut bacteria are essential for our health.
  • Diet, genetics, and lifestyle play a vital role in our intestinal composition.
  • Many diseases, especially chronic diseases common in the West, might be linked to poor protection from a less diverse gut microbial flora.
  • More research is necessary, and is ongoing, to clarify the association of gut bacteria and serious diseases.
  • Obesity and gut bacteria may well be linked.

Stay tuned!

In a subsequent post, we will discuss:

  • Antibiotics and gut bacteria
  • Cesarian section births and gut bacteria
  • Artificial sweeteners and gut bacteria
  • How to look after your gut bacteria and
  • Other relevant issues.

 

 

 

 

 

 

M and M for Alzheimer’s?

Want to do your brain a favor? Adopt the two Ms. Move & Mediterranean. No, you don’t really need to relocate to Greece (unless you really want to. I have nothing against Greece).

M & M

The first M is for Motion, as in exercise. The second M is for Mediterranean, as in diet. There is some evidence that both of these approaches can protect you from Alzheimer’s disease.

What is Alzheimer’s?

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Almost everybody has heard of it. A lot of people are taking care of loved ones who are struggling with it. Most of us kind-of, sort-of know what it is. But let us make sure we know what we are talking about. Alzheimer’s is a form of dementia.

Cognition, dementia

Cognition is the group of processes which helps us to acquire knowledge and comprehension. Thinking, knowing, judging, solving problems, and remembering things fall under this umbrella. These are high level brain functions. Language, perception, planning, and imagination are all involved in this interplay between us and our environment.

Dementia is a condition characterized by a decline in mental ability. In general, this decline must be severe enough to interfere with daily life.

Types of dementia

Many medical conditions can cause a decline in brain function. 60-80% of the cases of dementia are caused by Alzheimer’s disease, with a stroke leading to vascular dementia being the next most common cause.

Thyroid disease and some vitamin deficiencies have also been linked to dementia, but are uncommon causes.

So what, then, is Alzheimer’s?

It is the commonest type of dementia. The earliest symptom is often a loss of memory, affecting information learned recently. It usually starts around age 65, but up to 5% of patients are in their 40s or 50s when symptoms start.

This disease is not a normal phenomenon associated with aging. The symptoms usually get worse with time, affecting multiple cognitive abilities.

Risk factors for Alzheimer’s

Increasing age and a positive family history increase the risk of developing this disease.

Genetics also plays a role. A variant of the gene Apolipoprotein E-e4 (APOE4) has the greatest genetic impact in elevating the risk for Alzheimer’s. Amyloid precursor protein (APP), Presenilin-1 (PS-1) and Presenilin-2 (PS-2) are other gene mutations which increase the risk of Alzheimer’s.

Serious head injury, especially repeated injuries, and Alzheimer’s also appear to be linked.

Diagnosing Alzheimer’s

This is usually done with a thorough history and physical examination, often complemented by blood tests and scans of the brain. There is no unique single test to establish the diagnosis.

Brain changes in Alzheimer’s

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Nerve cells start to die all over the brain, leading to significant shrinkage of the brain over time. The hippocampus, a region which allows us to form new memories, shrinks markedly.

Under the microscope, one can see abnormal clusters of protein fragments, called plaques. These form when sticky protein pieces called beta-amyloid clump together. These clumps likely block the signals sent from one brain cell to another at their junction (called a synapse). The clumps lead to the activation of the body’s immune system, which sends out cells causing inflammation. The disabled brain cells are “eaten up” by these immune cells.

Twisted strands of another protein, called tau, are found in dead and dying nerve cells. These twisted strands are called tangles. Tau protein is important to keep nutrient transport channels in brain cells straight and orderly. When tau protein collapses into twisted strands (tangles) in patients with Alzheimer’s, the nutrient tracks fall apart. This leads to a disruption of the transport of nutrients along brain cells, which eventually die.

M is for diet

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Yes, M for diet: the Mediterranean type, or something similar.

The April 2006 online issue of the Annals of Neurology reported the results of a study involving 2258 people without dementia who were placed on the Mediterranean diet. The people who had the highest level of adherence to the diet had a 39-40% drop in their risk of developing Alzheimer’s, compared to the people who had the lowest adherence to the diet.

What is the Mediterranean diet?

This diet is rich in vegetables, legumes, fruits and cereals. It encourages a moderately high intake of fish, and a high consumption of unsaturated fatty acids, consisting mainly of olive oil. It advises a low intake of saturated fatty acids, meat and poultry, and a low to moderate consumption of dairy products, such as cheese and yogurt. It recommends moderate, daily alcohol consumption, mostly wine with meals.

DASH diet

This is the short form for the Dietary Approaches to Stop Hypertension. A study conducted by researchers at Utah State University followed more than 3800 people over 11 years and analyzed their adherence to the DASH diet, and evaluated their mental skills over time. Their data presented in 2009 showed that the people with the best adherence to this diet maintained their mental skills better than other participants. This does not prove that this diet prevents Alzheimer’s disease, but any measure which helps preserve mental function has to be of value.

What is in the DASH diet?

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This diet recommends that you eat 8-10 servings of fruits and vegetables daily. It also encourages eating low fat dairy, nuts, legumes, and whole grains. It advises limiting the consumption of red meat, sugar, and sodium.

The second M: Motion

Several studies have shown that regular exercise can help preserve mental skills. But recent studies have also shown the effects of exercise on the structure of the brain, which can be affected by Alzheimer’s.

A study published in May, 2014 in Frontiers in Aging Neuroscience showed that people at high risk of Alzheimer’s (with an e4 gene) who exercised regularly for 18 months had changes in their brain structure. Compared to their counterparts who did not exercise, they were able to avoid shrinkage of the hippocampus region of their brains. Shrinkage of the hippocampus occurs commonly in Alzheimer’s disease.

Another study from the University of Wisconsin published in 2014 found positive brain structure changes in people who exercised at least five days a week. They had less reduction of glucose use by the brain, less hippocampus shrinkage, less collection of beta-amyloid plaque, and fewer neurofibrillary tangles in their brains. All of these problems are commonly noted in Alzheimer’s disease. The people who exercised also had better scores on cognitive tasks than their less active counterparts.

Lifestyle intervention

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So why not combine diet and exercise? Swedish researchers did just that and presented their data at the Alzheimer’s Association International Conference in July 2014. Over 1200 older people at risk for dementia were assigned to lifestyle intervention or routine health care. After 2 years the group combining diet and exercise had improvements in mental function and cognitive skills.

What are you waiting for?

Alzheimer’s disease is a devastating illness, with no known cure, and a scarcity of simple, effective medications.

A sensible diet and regular exercise appear quite effective in the fight against this dreaded disease. If diet and exercise were pills, we would all be lining up at our doctors’ offices to get our supply.

Can Sitting Around Cause… Cancer?

Yes, researchers have found a significant link between inactivity and some scary diseases, including cancer. So stand up, and head for the road to health and fitness.beautiful-15728_1280

Say you have done your one hour of exercise for the day. You feel great! Time to hit the computer, answer all the pending emails, surf the web, peek in at social media, just hang out at your desk. You have earned it, right? Wrong!

Exercise cannot make up for sitting

You heard that right. Exercise is good. Sitting around is bad. So bad, that it can overwhelm everything else. Even exercise.

So whether you exercise regularly or not, too much sitting puts you at a higher risk of developing multiple diseases, and even of dying, according to a recent study from Canada.

We are less active these days

Many studies have shown that over the last 100 years or so, we have been spending less energy while at work. And with the advent of technology, household chores have also become less physically demanding. Can you remember the last time you chopped wood for your Chicago apartment?

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Analysis of the US Bureau of Labor Statistics data from the 1960s to 2008 shows that men on an average are burning 142 fewer calories at the workplace these days, while women are burning 124 fewer calories. No wonder our health and fitness has suffered.

The jobs requiring significant physical labor are slowly being phased out, and there is an ongoing, significant increase in the number of mostly sedentary office and desk jobs.

Work is more sedentary

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The average person spends more than half of his or her day in sedentary activities now, such as sitting, working at a computer, driving, or watching TV. A study published in 2012 evaluated office workers, call center workers, and customer service employees in Australia. More than three-fourths of their time (77%) was spent in sedentary activities. For half of this duration, the periods of inactivity lasted 20 minutes or longer continuously. And this trend does not appear to be limited to Australia alone.

So what is the problem?

When you are standing upright, you burn almost twice as many calories as when you are sitting down. The upright posture brings multiple muscles into play, and helps make your muscles and bones stronger. Prolonged sitting creates problems.

The ‘sitting disease’

A study published in the New England Journal of Medicine in 1993 evaluated Harvard alumni and looked at their activity levels. Compared with active men, sedentary men had a 36% higher risk of dying from coronary heart disease.

Watching TV

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This is usually a sedentary activity, and is often used as a surrogate for sitting time in studies.

An Australian study evaluating the TV watching habits of 8800 men and women was published in the journal Circulation  in January 2010. The researchers found that compared to the people who watched TV for fewer than 2 hours a day, the people who watched TV for more than 4 hours a day had an 80% higher risk of dying from heart disease.

One could say that perhaps the heavy TV watchers were snacking on unhealthy food, but their higher risk held up even when the researchers made adjustments for diet, calorie intake, high blood pressure, high cholesterol, and smoking.

To put matters in perspective, the average American watches TV for more than 3 hours a day.

Women and physical activity

Women have a greater risk reduction from exercise than men.

Another Australian study published in May 2014 in the British Journal of Sports Medicine evaluated risk factors for heart disease in women at various ages. They found that after the age of 30 years, physical inactivity increased the risk of heart disease in women much more than high blood pressure, cigarette smoking or obesity.

In particular, they noted that physically inactive middle-aged women had a 33% higher risk of heart disease.

WHO data

The World Health Organization states that 3.2 million people die every year as a consequence of physical inactivity.

This makes physical inactivity the 4th leading risk factor for death worldwide.

Recent data

January 2015 saw another study reviewing the ill effects of sitting around. This study was published in the Annals of Internal Medicine. Canadian researchers performed a meta-analysis of 41 previous trials linking inactivity with disease. They concluded that sitting for long periods of time on a daily basis led to a 15-20% higher risk of dying prematurely from any cause. It was also associated with a 15-20% increase in the risk of developing heart disease, or dying of heart disease, as well as developing or dying from cancer.

In their analysis, prolonged sedentary behavior was associated with a 90% increase in the risk of developing type 2 diabetes.

They also noted a significant link between inactivity and breast, colon, uterine, and ovarian cancer.

All of these ill effects persisted after adjusting for the effects of regular exercise.

So exercise cannot really override the harmful effects of prolonged sitting.

What to do?

Do something, anything. Anything is better than doing nothing, or sitting around. Standing is better than sitting. Walking is better than standing.

There is a term called Non-Exercise Physical Activity (NEPA),” which is the term used for any activity more intense than sitting around, but less intense than “traditional” exercise. A Swedish study published in October 2013 revealed that NEPA lowers the death rate from all causes.

Practical tips

  • If you are watching TV, get up and move around as soon as a commercial comes on.
  • If you are working on your computer, or working at a desk, set an alarm. Every half an hour, get up and walk around for a minute or more.communication-231627_1280
  • If you get a phone call, stand up and walk around while talking.
  • In an office setting, if your colleague is nearby, walk over to talk instead of sending an email.
  • If possible, try to get a “standing desk.”executive-511702_1280
  • Follow the guideline from the Public Health Agency of Canada. Sitting down, or activities involving a lot of sitting, like driving, computer work, or watching TV, should not make up more than 4-5 hours of a person’s day.

Save your own life

  • The “sitting disease” is a risk factor for early death, on par with smoking.
  • If more people spent fewer than 3 hours a day sitting, it would add 2 years to the average life expectancy in the USA.

What about you?

How many hours a day do you spend mostly sitting down? What strategies can you adopt to reduce this? I would love to hear from you!

The Updated Battle of the Bulge, Circa 2014

Losing weight, as millions of people have discovered, is seldom easy. Maintaining the weight loss is even more difficult. However, data exist to prove that it can be done. And the reality is that it must be done, since obesity is increasing rapidly, and spreading misery in its wake.

What is obesity?

The standard definition uses the Body Mass Index (BMI) to classify weight problems.

The BMI is calculated by multiplying your weight in pounds by 703. The resulting number is then divided by the square of your height in inches.

A BMI of 18.5-24.9 is considered normal.

A BMI of 25-29.9 is considered overweight.

A BMI of 30 and higher is called obese.

Is BMI perfect?

There are several problems with the BMI. In athletes, and other people who are muscle-bound, the BMI might be in the obese range, but their body fat, which is what we are truly interested in, may well be normal. Similarly, elderly people, or those who have lost muscle mass, may have a normal BMI, but higher than normal body fat.

However, in spite of its limitations, the BMI has been found to be of practical help, and is widely accepted world-wide. Most scientific studies of obesity also use the BMI.

What other measures exist?

People also use waist circumference as an estimate of body fat.

A WHO Expert Consultation on Obesity states that a waist circumference of more than 94 cm (37 inches) in men and 80 cm (31.5 inches) in women is associated with an increased risk of metabolic complications of obesity in Caucasians. These include type 2 diabetes, cardiovascular disease, and the risk factors for cardiovascular disease.

A waist circumference of 40 inches (102 cm) in men and 35 inches (88 cm) in women is associated with a substantial increase in the risk of these metabolic complications.

These cut-off numbers are different for people of different races, such as Asians.

Body fat measurement

Several methods are described to measure body fat content. The simpler and cheaper ones are less accurate, while the more accurate ones are either cumbersome, or expensive, or both.

Skin fold thickness measurement using calipers is a simple and inexpensive, but approximate, estimate of body fat content.

The acceptable range for body fat percentage is 18-25% for men and 25-31% for women.

Burden of obesity

More than 2.1 billion people in the world are obese or overweight. This represents almost 30% of the population of the world.

According to a recent McKinsey Global Institute report, the global economic impact of obesity is approximately $ 2 trillion a year. This is close to the global costs of smoking, armed violence, war, and terrorism.

More than two-thirds of all adults and one-third of school age children in the USA are overweight or obese.

Many diseases are associated with obesity, including high blood pressure, type 2 diabetes, heart disease, lipid problems, and some cancers.

The US spent $147 billion in 2008 on diseases related to obesity. And the number of obese and overweight people keeps rising.

Clearly, we need to do more.

What does work?

Comprehensive lifestyle intervention programs which include caloric reduction, increased activity, and behavioral intervention by trained professionals have been clearly documented to be of value for weight loss.

The key component is creation of an energy deficit (calories consumed and calories burned) of about 500-750 calories a day.

The type of diet (low fat, low carbohydrate, high protein, etc.) is much less important than consuming fewer calories.

The behavioral component is also important, focusing on self-monitoring of diet (with a food diary), weight and activity levels, preferably daily. In addition, information and feedback is provided by trained interventionists, either face-to-face, or by remote means (telephone or internet).

Usual pattern

With the programs described above, weight loss of at least 5% is often seen, with the maximum weight loss usually seen by 6 months. Some people can lose even 10% of their initial weight.

This degree of weight loss (5-10% of the initial weight) has been shown to be clinically significant, and has a positive effect on several diseases associated with obesity.

Other adjuncts

Weight loss medicines, and surgery in some cases, can be employed in higher risk patients, who need to be selected and monitored carefully.

What happens next?

This is the major problem.

Weight starts to creep back up within 6 months to 1 year (in non-surgical patients). A number of people, in the absence of further intervention, may regain all of the weight they had lost. Why is that?

“The empire strikes back”

The body starts to fight.

Energy balance is crucial for the survival of animals and humans. Our bodies have developed a finely-tuned system of regulatory mechanisms which kicks in as we lose weight.

Appetite and satiety, or fullness, are controlled by signals sent by multiple hormones and peptides. These signals are received by the hypothalamus in the brain, which then controls the response by the body to weight loss.

Leptin and ghrelin

These are only two of dozens of hormones affecting energy balance and appetite.

Leptin is a hormone released by fat cells. Its site of action is the hypothalamus. It reduces appetite and leads to reduced food intake. Ghrelin is produced by the stomach and increases appetite.

Response to weight loss

Weight loss leads to significant reductions in levels of leptin, cholecystokinin, and peptide YY. There is also an increase in ghrelin levels. All of this favors appetite stimulation, and increased food intake. Interestingly, these changes can persist for 12 months. No surprise, then, that the body tries to regain the weight it had lost.

Conclusion

  • Weight loss requires a negative energy balance, and most diets which reduce calories are helpful.
  • There is a need for an increase in physical activity as well.
  • Comprehensive behavioral intervention works best, with an emphasis on self-monitoring of diet, weight and exercise.
  • Some carefully selected patients require medications and/or surgery.
  • Regulatory mechanisms with hormonal changes lead to a tendency to regain the lost weight, starting at 6-12 months.
  • There are methods to fight this regain of weight, as well. All is not doom and gloom. Stay tuned for a whole new discussion of weight maintenance.