So You Think Dietary Fat Causes Heart Disease?


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?


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.


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?


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



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?


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.


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.
  • appetite-1239167_1920
  • 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?


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!

cell membrane

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?


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.


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.


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.


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.


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?


  • 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.


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!


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.


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.


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?



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?


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%.


  • 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:

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


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?

bp machine

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?


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?


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.


  • 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?


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


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.


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


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


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.


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!


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


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!


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?


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


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!

What Color is Your Fat?

Brown is better than white. Let me hasten to add that I am not talking about skin color. My concern is what lies under the skin.

All fats are not equal

You are probably sick and tired of hearing about different types of fats. Omega-3, omega-6, poly-this, mono-that. Enough already.

But there are two types of fat you absolutely have to know about: brown fat and white fat.

White fat

Most of the fat stored by adults is the so-called white fat. The major function of this is to act as an energy storage system. One gram of fat has approximately 9 calories. So when your body needs energy, you can mobilize fat and get energy easily. Incidentally, proteins and carbohydrates each have 4 calories per gram.

White fat can pose dangers to your health. However, how dangerous white fat is depends on its location.

Fat thighs and buttocks?

These tend more to be cosmetic issues. The fat stored in these areas is usually not significantly harmful to the body as a whole.

These, of course, are the areas where a lot of women have deposits of fatty tissue, especially before menopause.

This fat has been shown to be genetically different from the fat stored in the belly. The genes active in the thigh fat are different from those active in belly fat. Hip and thigh fat does not appear to increase the risks of heart disease or diabetes.

Belly fat

This is a different kettle of fish altogether.

A study published in 2012 in the Journal of Clinical Endocrinology & Metabolism looked at some of the differences between fat located in the belly and that located on thighs and buttocks. The researchers studied stem cells from these two locations, and found differences in gene activity. Some of these genes help decide during development which part of the body goes where. And some of the genes determine how these fat cells respond to certain hormones, such as estrogen.

It appears that the location of fat: belly versus thighs, is preprogrammed.

And belly fat is a marker that the individual is at a higher risk of diabetes and heart disease. So if your belly is flat, but your hips and thighs are not, umm…be glad.

Subcutaneous fat

This is fat located just under the skin. It can be found in the thighs, buttocks, or even in the ‘abdomen,’ or the belly region. But this is not what we traditionally call ‘belly fat.’ People worry a lot about this kind of fat, because it is clearly visible, and it looks unsightly. It jiggles when we move, and we don’t like it. But it does not cause any significant health problems.

Visceral fat

This is where the problem lies. This is the ‘deep fat’ that we cannot see, also called ‘belly fat.’

It is called visceral fat because it surrounds the viscera, or the deep-situated organs of the body, especially in the belly.

Men tend to have more visceral fat than women, but after menopause, women start storing more of their fat in this location, thus raising their risk of major illnesses.

Secretory organ

Fatty tissue, especially white fat surrounding deep organs, is not just a store of energy. It secretes a lot of chemicals/hormones, which affect numerous body functions, such as sugar and fat metabolism, and even complex systems of immunity and reproduction.

Some of these hormones include leptin, cytokines, adipsin, angiotensinogen, etc. Fatty tissue also secretes steroid hormones.

It is felt that these secretions of the white fat contribute to illnesses such as type 2 diabetes, heart disease, high blood pressure, and perhaps even certain kinds of cancer.

What is brown fat?

This is a type of fat which is quite different from what we normally think of as fat. The main function of white fat has always been to store energy, which it does in the form of large droplets of fat. Of course, we now know that it also secretes some rather harmful hormones.

Brown fat, however, is designed to burn its fat stores and release energy in the form of heat. It contains much smaller fat droplets than white fat. Its color is the result of stores of iron present in the mitochondria, which are present in abundance in brown fat.

Where is the brown fat?

It turns out that this type of fat is present mostly in human infants in the shoulders and upper spine. This store is about 5% of the total weight of the infant, and is mainly there to keep the baby warm. Scientists used to think that adults did not have any brown fat. However, it is now felt that even adults have a little bit of brown fat in the neck and shoulders.

So what is the advantage?

Mice who have larger than usual stores of brown fat are more lean and healthy than regular mice. Interestingly, when these mice take in more calories, this brown fat burns more calories, thus avoiding obesity.

There is also some data in human beings that people with more brown fat have a lower body weight.

Turn white to brown

There is a transcription factor called Ppar γ which is involved in the specialization of both white and brown fat cells. Ppar is short for peroxisome proliferator-activated receptor. This is a type of protein which binds to a particular region in the DNA of a gene, and affects the development and metabolism of cells.  However, there is a protein called Ebf2, or early B cell factor-2, which regulates the functioning of Ppar γ. This Ebf2 takes Ppar γ and directs it to binding sites on cells in such a way that a cell which is destined to become a fat cell is now ordered to become a brown fat cell.

Recruit brown fat

A Harvard research team has found that brown fat can be recruited in mice. Mice are apparently born with a present-from-birth, or ‘constitutive’ brown fat, and a so-called ‘recruitable’ brown fat. This kind of fat is found in the muscles, and also in areas of white fat.

There are some triggers which the brain responds to, and on receiving these signals, the brain can proceed with converting this ‘recruitable’ brown fat to actual brown fat, with significant health benefits.

Beige fat?

There is some suggestion that human beings exposed to cold can change some of their white fat to a type of fat which has some features of brown fat, the so-called ‘beige fat.’ There is considerable research interest in these newer developments, as they could impact the prevention and treatment of obesity and its complications.


  • There is more to fat than meets the eye. In fact, the fat which does not meet the eye, the so-called belly fat or visceral fat, is more dangerous.
  • An indicator that you have more belly fat than you need is a waist circumference of 35 inches or more in a woman and 40 inches or more in a man.
  • Waist circumference needs to be measured just above the hip bone (pelvis).
  • Also, brown fat is a specialized type of fat which may benefit us. Research is being conducted to see if we can convert white fat to brown or beige fat.

5 Special Ways Exercise Helps Women

Message to Venus: start exercising. They say women are from Venus, and I understand it is too hot to exercise there. But now they are on earth, and it is time to get moving.

Women live longer than men do, and can extend their lives further. In addition, they can make those extra years more independent, comfortable and productive.

Both men and women benefit from exercise. However, women have health issues which affect them in different ways, and exercise offers women unique benefits.

  1. Women, Exercise and Heart Disease

Estrogens protect women before menopause. As such, women tend to have their first heart attack at an older age than men. However, then they start to catch up.

Historically, women have been more worried about breast cancer than heart disease for multiple reasons. However, one in four American women die of heart disease, compared with one in thirty who die of breast cancer.

Heart disease is the number one killer of American women.

More than 6.5 million American women have heart disease of some kind. Only half of all women know that heart disease is the leading cause of death in women, as per an interview conducted by the American Heart Association.

The online British Journal of Sports Medicine reported on an Australian study on May 8, 2014. University of Queensland researchers analyzed data on more 32,000 Australian women of different ages. They found that at every age, from the 30s to the 80s, physically inactive women were at a higher risk of heart disease compared with women with any other risk factor. Inactivity conferred a greater risk of heart disease to these women of all ages than obesity, smoking, or high blood pressure.

Middle-aged inactive women had an increase of 33% in their risk of heart disease, while older women noticed a jump of 24%, just from physical inactivity.

There is no reason to believe that American women would be affected differently, according to experts.

So ladies, let us start moving!

  1. Women, Exercise and Breast Cancer

Obviously, women are worried about breast cancer. It not only affects their health, but also threatens their self-image and sexuality.

Numerous risk factors which affect a woman’s risk of this deadly cancer have been evaluated. Some of them, such as genetics, cannot be modified. But some can, particularly exercise, or lack thereof.

French researchers presented data about the link between exercise and breast cancer in women at the European Breast Cancer Conference in Glasgow in March 2014.

Data published in 2011 had suggested a reduction of 25% in breast cancer risk among physically active women. This effect appeared to be stronger in post-menopausal women, and women who performed moderate to vigorous intensity exercise regularly.

The French conclusions are different, and probably more accurate because of sheer numbers. Researchers looked at data from more than 4 million women from all around the world. There was a 12% reduction in breast cancer risk among the women who did the most exercise: more than 1 hour of vigorous, daily exercise.

What was more interesting, though, was the fact that it was not all or nothing. All physically active women had a lower breast cancer risk. The benefits were higher with increasing activity levels, but even a little bit of exercise was helpful. Even activities of daily living were protective. So you don’t have to jump on a treadmill and start racing away.

The benefits occurred irrespective of age or menopausal status. Thin women were helped, as were the ones who were overweight.

  1. Women, Thin Bones and Fractures

Estrogens keep women’s bones strong. As estrogen levels drop after menopause, female bones become thinner. But the problem starts earlier. The bone density of women is lower than that of men to begin with, and keeps declining with age faster than that of men. The peak bone density of women is at age 18 years.

After the age of 50, half of all women will sustain a fracture at some point, secondary to their thinning bones. In men, that rate is 25%.

Hip fractures are a problem

  • 75% of all hip fractures occur in women, according to the Centers for Disease Control (CDC).
  • Osteoporosis, or bone thinning, raises the risk of a hip fracture.
  • 258,000 people over 65 were hospitalized in 2010 with hip fractures.
  • Most hip fractures are due to falls.
  • One patient out of five dies within a year of a hip fracture.
  • After a hip fracture, 1 out of 3 patients living independently before have to spend a year or more in a nursing home.

Exercise to prevent fractures

Regular exercise can prevent falls by increasing bone strength and improving balance, thus reducing the risk of a fall. Weight-bearing exercises are better at improving bone density. Running and jumping, which cause intermittent impact with the earth, are particularly useful. Dancing and squats are also of benefit, as are “odd impacts,” such as walking sideways or backwards, which is to say, in any direction except straight ahead. And the earlier the age when ladies start exercising, the better off will their bones be.

But one does not have to get fancy. The Nurses’ Health Study followed thousands of post-menopausal women. Those who walked for 4 hours a week were 40% less likely to fracture a hip compared to their less active counterparts.

  1. Women, Exercise and Diabetes

A recent study in the journal PLOS Medicine reported data from the Nurses’ Health Study and the Nurses’ Health Study II about the link between exercise and diabetes risk in women.

  • One hour of strength training weekly reduced diabetes risk in women by 14%.
  • Two and a half hours of such training weekly cut diabetes risk by 40%.
  • One hour of strength training and 150 minutes of aerobic exercise (cardio) weekly reduced diabetes risk by two-thirds.
  1. Women, Exercise and Stroke Risk

The California Teachers Study of 133, 479 women who were followed from 1996 to 2010 analyzed data from women who engaged in moderate to strenuous physical activity for 3 years before entering this study. The researchers found a 20% lower stroke risk in these women compared to less active women.


Exercise is good for both men and women. However, women, because of their unique anatomy, biology and physiology, can obtain special benefits from exercise and lower their risks of heart disease, breast cancer, bone fractures, diabetes, and strokes.

So ladies, start your engines!