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.”

How to Navigate Safely Through the Fat, Lipid, Omega World

 Confused yet?

Confused yet?

Doctors, scientists, and technical people take morbid delight in using terminology which the general public does not always understand fully. However, they get away with it, because people are loath to question them, not wanting to appear ill-informed. Thus, the media throws around terms like fats, lipids, oils, omega-3 fats, and the like, with abandon. And nobody takes them to task.

Speak clearly, please

Fat, lipid, and oil: These are commonly used terms, and their meaning needs to be crystal clear.

Our diet has three major constituents: protein, fats, and carbohydrates. We need fats to ensure our bodily structure and metabolism.



This is chemically an ester, which is a compound formed by the combination of an acid with an alcohol. In the case of a fat, the acid is a fatty acid, and the alcohol is glycerol.

So a fat is basically a glyceride. If we have three fatty acid chains combining with glycerol, we have a triglyceride, which is another term which nobody explains, but which you see all the time on your report if you have a “cholesterol blood test.”

What, then, is a lipid?

A lipid is an organic compound having certain characteristics. Before we go further, let us refresh our understanding of organic and inorganic compounds.

Organic, inorganic, what’s the difference!

Chemistry consists mainly of organic and inorganic compounds.

Compounds associated with living beings are organic. They always have carbon atoms as part of their structure, while most inorganic molecules don’t.

Almost all of the organic compounds contain bonds between carbon and hydrogen (C—H). Some, however, do not, like urea.

Some examples of organic compounds are fats, lipids, sugars, proteins, nucleic acids, enzymes, etc.

Examples of inorganic compounds are metals, salts, and other molecules not containing carbon-hydrogen bonds.

Back to lipids

So lipids are organic compounds. They have carbon to hydrogen bonds, and they also have oxygen. The number of hydrogen atoms in a lipid molecule is always more than double the number of oxygen atoms.

The carbon to hydrogen bond in a lipid is a special one, called a nonpolar covalent bond. This means that the carbon and hydrogen atoms share a pair of electrons equally. The importance of this is that the molecule of a lipid is made fat soluble. It will not dissolve in water, though.

Types of lipids

Biologically, we have four important lipids. They are fats, steroids, phospholipids, and waxes.

So fat is a type of lipid.

All fats are lipids, but not all lipids are fats.

Then what is an oil?

Fats are usually solid at room temperature.



A fat which is liquid at room temperature is called an oil.

Oils can have saturated, monounsaturated, and polyunsaturated fatty acids. Being liquid at room temperature, they tend to have more unsaturated fats than saturated ones.

Essential fat?

Yes, fat can be essential, in that the body would not function without a healthy dose of fat.

Alpha linolenic acid

Alpha linolenic acid

However, biochemically, the term “essential fatty acid” is applied to those fats which cannot be made by the body. Therefore, we have to eat them as part of our diets. There are two of them: alfpha-linolenic acid (an omega-3 fat) and linolenic acid (an omega-6 fat).

Other fats needed by us can be made by our bodies using these essential fats and other substances.

Are we saturated yet?

Saturated fat is bad, unsaturated is good: You have heard this refrain most of your life. It is not necessarily true.

But what is a saturated fat anyway?


Atoms join with other atoms to make molecules. And molecules are what make up matter.

There are laws which govern this union. If a carbon atom is able to join with all the hydrogen atoms it possibly can, it is called saturated. It is happy. In that case, it combines with other carbon atoms with what is called a single bond, chemically shown as C—C. However, if it cannot combine with all the hydrogen atoms it is capable of, it ends up joining with other carbon atoms using a “double bond.” This is shown as C=C. This makes it unsaturated. The same is true of “triple bonds.”

How do you bond with others?

In a fatty acid molecule, if a carbon atom joins with another carbon atom using a double bond (or triple bond), that fat is called “unsaturated.” Otherwise (with carbon-to-carbon single bonds only) it is “saturated.”

Avocado with monounsaturated fat

Avocado with monounsaturated fat

If in one fatty acid molecule, there is only one double bond between two carbon atoms, that is called a “mono-unsaturated fat.”

The presence of more than one double bond makes the fat a “poly-unsaturated fat.”

What is this omega business?

If you are an adult, you must have heard of omega-3 and omega-6 fatty acids. One is supposed to be good, the other one not so good.

But what are they?

It is all about the ending

The fatty acids chains have two ends: the beginning and the tail. The beginning is the so-called acid end, and the tail is the methyl end. Since we are all in love with the Greeks, we call the beginning the “alpha end” (since alpha is the first letter in the Greek alphabet), and the tail is the “omega end.” Omega, of course, is the last letter of the Greek alphabet. This end is also called the n-end.


This is a polyunsaturated fat. Which means that the fatty acid chain has more than one double bond (C=C).

The omega part means that you start looking at the tail end (omega end) of the chain. Then look at the third carbon atom from that end. If the first double bond occurs at this location, you are dealing with an omega-3 fatty acid.

Why is this important? Read on.


Apply the same process as above. If the first double bond is at the 6th carbon atom from the tail end, you have an omega-6 fatty acid. Again, this is a polyunsaturated fat.

What’s the big deal?

Mono-unsaturated fatty acids are felt to be better for your health than poly-unsaturated fats. Among the poly-unsaturated fats, the omega-3s are again supposed to be better than the omega-6s.

In fact, many experts feel that in the ancient era, humans had much more omega-3s in their diets than omega-6s, and that nowadays this ratio has been reversed, leading to several ill-effects on our health.

And what about trans fats?

About this, not much debate exists. These fats are universally condemned as the worst types of fats for our heart health. Many localities in the US have legislated to ban them, or severely cut down on their presence in our food supply.

What’s so “trans” about the fat?

It is basically a chemical arrangement.

There are two types of arrangements of hydrogen atoms in unsaturated fatty acids (which have at least one double bond).

The “cis” type occurs when the two hydrogen atoms are on the same side of the double bond in the chain. “Cis” in Latin means “on this side.”

The “trans” type occurs when the hydrogen atoms are on opposite sides of the double bond (“trans” means “across” in Latin).

Again, what’s the big deal?

The trans configuration in unsaturated fatty acids creates problems. So why was it created? For convenience.

Of course, there are some naturally occurring trans fats also. These are produced in the guts of some animals. Meat and milk from these animals can have small amounts of trans fats.

Then we have artificial trans fats, which are created by the hydrogenation of vegetable oils.

Adding hydrogen to a liquid vegetable oil makes the product more solid, and increases its shelf life.

In some instances, trans fatty acids can alter the taste and texture of food in a manner which consumers like.

Oils containing trans fats are often used by fast-food chains and restaurants around the world, because such oils can be reused several times in commercial fryers to deep-fry food.

Trans fat = Bad fat

The hydrogenation of vegetable oil leads to a product which has serious implications for heart disease.

The trans fats produced in this manner can reduce the amount of “good cholesterol,” or HDL cholesterol, and increase the amount of “bad cholesterol, or LDL, in your blood stream.


  • The terms fats, oils, lipids, trans fats, omega-3, and omega-6 are frequently seen by the public, but not always fully understood. It is important to be clear about what they mean.
  • Fats can be saturated or unsaturated, and their ratio in our diet is important.
  • The ratio of omega-3 and omega-6 fats in our diets is also important.
  • Trans fats are the worst kinds of fats, and should be avoided as far as possible.

Food sources of different fats

We will discuss details of this, and their health implications, in subsequent posts.

Stay tuned!

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.















Worried That More Fat in Dairy Will Make You Fat?

We have made fat a four-letter word. Full-fat is even worse, not fit to be uttered in polite company.

Doctors have been warning us for decades about the ills which fat can visit upon us. Heart disease obviously has been the main issue. The population lives in fear of keeling over dead if it so much as puts another fat calorie into its mouth.

Are we there yet?

The implicit promise seems to be that if we only behave ourselves, if we only avoid this dreadful fat monster, we would get slimmer, we would be free of heart attacks, and we would live happily ever after.

So what happened?

Full Fat?

Full Fat?

Americans, in particular, have been shunning fat in droves. If you look in large grocery stores, everything is fat-free, or low-fat, or reduced fat. Folks like me, who enjoy full-fat milk, cheese, and yogurt, have almost become pariahs. We have to search far and wide, and at times go to multiple stores, before we can find dairy products to meet our tastes. And then we have to hide them at the check-out counter, so nobody can see what we are guilty of.

So have we gotten any slimmer as a nation after cutting out the fat? Have we eliminated the scourge of heart disease?



Fat consumption is going down, at least in the US, but we are getting fatter. BMI is going up. Kids are approaching the weight adults used to have decades ago. And diabetes is on the rise.

So what gives?

Were we, as physicians, wrong? Horror of horrors!

Is all fat bad? Or, as Paleo-diet proponents might suggest, is fat good?

Are there good fats and bad fats?

Is saturated fat good, bad, or ugly?

What do studies show?

For decades, the fat, or saturated fat-heart disease link was considered settled fact. And then, heretics started to question that. More heretics followed, till they were no longer heretics.

Now, a growing body of literature is calling into question the link between full-fat, saturated fat, and heart disease, obesity, and diabetes.

Types of fat

All fats are not created equal. There is saturated fat and unsaturated fat. Among the unsaturated variety, you can find mono-unsaturated fat, and poly-unsaturated fat. Then, of course, there is trans-fat, omega-3 fat, and omega-6 fat.

 Omega-3, anybody?

Omega-3, anybody?

I could give you a detailed chemical account of all this, but that would make you stop reading any further. So we will leave that for a later date.

Sources of fat

You do not go to a grocery store and buy five pounds of fat, ten pounds of protein, six pounds of carbohydrates, and a whole lot of sugar.

You buy foodstuff.

Saturated fat


This contributes about 10% of the total calories in a typical North American diet. Major sources are animal products: butter, milk, meat, salmon, and egg yolks. Some plant products, such as chocolate, coconut oil, palm kernel oil, and cocoa butter, also contain saturated fats.

Of late, a few studies and meta-analysis of studies have suggested that there may not be a significant link between saturated fat intake and coronary heart disease. A study published in the American Journal of Clinical Nutrition in January 2010 reported on pooled data from 21 studies on saturated fatty acid intake and risk of coronary heart disease, stroke, or cardiovascular disease in general. Over 340,000 individuals were studied.

The researchers found no significant association between high intake of saturated fatty acids and an increased risk of coronary heart disease, stroke, or cardiovascular disease.

But what about becoming fat? Or diabetic?

Let us return to our obsession with low-fat and no-fat products. Before long, we might even be looking for fat-free water. And that might be all right, if it made us slimmer. But it has not. Do not take my word for it. Just look around you.

Thank you, Tufts University

A recent study in Circulation (March 2016) conducted by researchers at Tufts University investigated the link between the intake of dairy fat and the development of diabetes. The scientists checked the blood of more than 3000 people for byproducts of full-fat dairy.

They found that people who had higher level of these byproducts in their blood (thus identifying those who consumed full-fat dairy) had, on an average, a 46% lower risk of developing diabetes during the period of follow-up.

Obesity and dairy fat


There has been a fear in the general population, perhaps abetted by the medical profession in the past, that if you drink full-fat milk or eat full-fat yogurt, you will become fat. This is simply not true.

A study published in The American Journal of Clinical Nutrition in April 2016 evaluated more than 18,000 women who were 45 years or older and whose weight was normal at baseline. These were participants in the Women’s Health Study, and were followed for over 11 years.

The researchers found that a greater consumption of high-fat dairy products was associated with less weight gain during follow up.

They also found that women whose intake of high-fat dairy was in the top 20% in the group had a lower risk of becoming overweight or obese.

Shouldn’t fat make you fat?

That was the logic behind recommending low-fat products to the general public.

However, it now appears that when people cut out the fat in their diets, they start increasing their intake of carbohydrates. The body then turns these carbohydrates into sugar, and then into fat, which is stored.


  • It appears that the strategy of focusing on individual nutrients, such as fat, or saturated fat in particular, may not be the healthiest way to proceed.
  • diet
  • It is better to deal with food as a whole, and make healthy choices, incorporating a whole range of nutrients, including plenty of fruits and vegetables.
  • The phobia about full-fat dairy appears to be misplaced, and recommending low-fat products may not lead to weight loss or protection from diabetes.
  • Multiple mechanisms involving insulin and glucose regulation are probably involved in the link between full-fat dairy consumption and protection from diabetes.
  • However, common sense should be used, and people should not go out and start consuming vast amounts of high-fat foodstuffs. Calories do add up.
  • Some types of fat are still best avoided, the prime example being trans-fats, which have been regulated or banned in several US cities.
  • Processed foods, sugary drinks, and desserts should be consumed sparingly, if at all.

How to Recognize Sugar Right Away – And Avoid It!

You think you can recognize sugar? Think again!

But first things first.

Those of you who reach for that five-pound bag of grocery store sugar and shovel teaspoon after teaspoon into your mouths, pay attention! The US government has a message for you: STOP!


Millions of Americans have been waiting with bated breath for five years for their government to tell them what to eat. Well, in case you missed it, perhaps because you were busy with the business of life, the feds have finally delivered.

The Agriculture and Health and Human Services Departments have ended the suspense, and released their 2015-2020 edition of the Dietary Guidelines for Americans.


The feds have taken aim at multiple targets, and made lots of recommendations, most of which have attracted a lot of criticism. No matter. These people live in ivory towers, and your brickbats and mine don’t reach that high. Not unless you have well-heeled and well-organized lobbies.

Eat less sugar!

Eat less sugar!

Anyway, these worthies advise you and me to eat less sugar.

And then they get really specific: Limit sugar to no more than 10% of daily calories.

How we eat

This is wonderful news. It fits in seamlessly with my eating habits. Each time I put an olive or piece of toast into my mouth, I whip out a smartphone app and calculator. I quickly calculate each calorie going into my mouth, the amount of sugar in each bite, and what percentage of total calories that adds up to. As soon as I reach my targets, I stop, mid-morsel if need be. Isn’t that how you eat? Mom, Dad, and two kids eating at the dinner table, smartphones out? Well, the part about phones might actually be true!

So what advice do we need?

Let us get real.

Let us acknowledge how people eat. As the guidelines themselves state, people do not eat nutrients. They eat food.

Let us talk about food

When my wife gives me a grocery list, she does not say, “Get five pounds of fat, ten pounds of carbs, and fifteen pounds of protein. And throw in about 10% of the calories you buy as sugar. Plus some sodium, but not too much!”

This is not how we shop, and this is not how we eat!

So what is sugar?

Glad you asked.

Sugar is a carbohydrate (popularly known as carbs), a member of a much-maligned and frequently misunderstood group.

Not all carbs are bad.

Essentially, you need to know about simple carbohydrates (bad), and complex carbohydrates (good).

Simple carbs (bad)

Simply Sugar!

Simply Sugar!

These are nutrients which are digested and absorbed quickly once you eat them, and rapidly enter the bloodstream, where they raise your blood sugar levels fairly quickly. This is not good, for a variety of reasons.

Sugar (or, more accurately, what we commonly call sugar) is a simple carb.

Complex carbs (good)

These nutrients are more difficult for the body to digest and absorb. Thus they enter the bloodstream very slowly, and they have a slow and mild effect on blood sugar levels. These carbs are rich in fiber.

Classic examples are lentils, beans, chick peas, whole grains, and many fruits and vegetables, such as carrots, spinach, broccoli, apples, pears, etc.

Eating these will make you feel full faster, and this feeling will last longer.

So what was sugar, again?



“Sugar” can be traced back to the Arabic “sukkar,” which itself arose from the Sanskrit “sharkara.”

Sugars are technically called saccharides. A monosaccharide is the simplest unit, with examples being glucose, fructose, and galactose.

What we call sugar is technically sucrose. Each sucrose molecule has 12 atoms of carbon, 22 atoms of hydrogen, and 11 atoms of oxygen.

Sucrose is really the union of two even more simple sugars: fructose and glucose. As such, it is a disaccharide, which is two monosaccharides bound together. Fructose is the sugar commonly found in fruits and honey.

Lactose (in milk) is another disaccharide, a combination of glucose and galactose.

Plants make sugar through photosynthesis, using sunlight, and use it as a store of energy.

Natural versus added sugar

As the name implies, natural sugar is not introduced by man (or woman). Examples include sugar found in fruits and milk.

Added sugar is what we add to our food, or what is added during processing and preparation, in the form of syrup or sugar.


1 g sugar = 4 calories

1 teaspoon = 4 g sugar

1 teaspoon of sugar = 16 calories

How much added sugar do we need?

The daily requirement of added sugar for an average human being, male or female is … EXACTLY  ZERO!

How much do we eat?

In 1822, the average American’s intake of sugar was 45 g every 5 days. This is the amount of sugar found in one 12 oz can of soda. By the way, when did you last see anybody drink a 12 oz can of soda?

In 2012, this went up to 765 g every 5 days (equal to 17 such cans of soda).

This adds up to about 130 lbs of sugar every year.

Sources of added sugar

The average adult consumes 22 teaspoons of sugar a day. The average child? 32 teaspoons daily.

Liquid Calories

Liquid Calories

Regular soft drinks are responsible for 33% of this. Sugars and candy contribute 16.1%, cakes, cookies and pies 12.9%, fruit drinks 9.7%, dairy desserts and milk 8.6%, and other grains 5.8%. Breakfast cereal is an often overlooked source of added sugar.

Many so-called “low-fat” foods have more added sugar than their regular versions.

A 12 oz can of soda contains 8-10 teaspoons of sugar. This is more sugar than 2 frosted pop tarts and a Twinkie combined.

An average American drinks 53 gallons of soft drinks a year. You do the math.

Cost of daily soda

Weight Gain

Weight Gain

Drinking one can of sugary soft drink daily will lead to a 10-15 lb weight gain in a year– unless you cut back on calories elsewhere.

People who drink 1-2 cans or more of sugary drinks daily have a 26% higher risk of developing type 2 diabetes.

A study in Circulation 2012 (125: 1735-41) revealed that men who averaged one can of sugary drink a day had a 20% higher risk of having a heart attack or dying from a heart attack compared with men who rarely consumed sugary drinks. Similar findings have been noted in women, too.

Sugar is often hidden

Industry is fond of using different names for added sugar. There are all kinds of sweeteners, which effectively are added sugar. Some of these include: agave nectar, high-fructose corn syrup, fruit juice concentrates, malt syrup, maple syrup, molasses, evaporated cane juice, etc. Most of the stuff they include ending in –ose is basically added sugar.

Brown sugar? Honey?

Do not get confused. Your body does not. You cannot fool it: It metabolizes all added sugars in the same manner!

So how much added sugar do you need, again?


The Healthy Eating Pyramid says sugary drinks and sweets should be used sparingly, if at all.

The Healthy Eating Plate, created by nutrition experts at Harvard, does not include foods with added sugars.


The American Heart Association suggests an added sugar limit of no more than 100 calories per day (about 6 teaspoons) for most women, and no more than 150 calories per day (about 9 teaspoons) for most men.


There is no minimal daily requirement for added sugar. There is no nutritional benefit you get from eating added sugar.


There is a school of thought that believes that the major reason for the obesity epidemic is too much sugar and not enough fiber in the diet.

So, what now?

  • For the most part, you do not need any added sugar in your diet. Minimize it, if you cannot cut it out entirely.
  • Read labels. Sugar hides in many forms.
  • The best liquid to drink is water.
  • If you visit an orchard, you will notice that orange juice does not grow on trees; oranges do. Consider this a message.
  • Pay special attention to the kids: You are responsible for their lifelong food habits!
  • Breakfast = cereal = lots of sugar, in many cases. Break this cycle!



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!


How to Feed Your Lower Gut: Microbiome Part II

In our previous post, we had outlined how your skin, mouth, and gut are hosts to trillions of mostly helpful micro-organisms:  bacteria, viruses, and fungi, which are vital to your health. For details, visit

Research into these organisms is still in an early state. But we are getting a lot of useful insights.

Antibiotics hurt the good bugs, too

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In the first two years of life, an average American child receives almost three antibiotic courses. The next eight years bring eight more.

In 2010, almost every US citizen received an antibiotic course: doctors wrote prescriptions for 258 million antibiotic courses. It is quite clear that all of these were not prescribed for bacterial infections. Many infections suspected to be bacterial are due to viruses. Giving an antibiotic in this setting promotes resistance to antibiotics.

Such unnecessary antibiotic treatment also hurts the good bacteria in our intestines. Even necessary antibiotics end up killing both bad and good bacteria.

Antibiotics and chronic disease?

There is a school of thought which believes that antibiotic use and abuse in children, by disrupting their protective gut microbial environment, leads to an increase in chronic diseases like obesity, asthma, celiac disease, and type 1 diabetes. And these diseases are becoming more prevalent. Of course, more research is needed to prove conclusive linkage, but the signs are worrisome.

Gut bacteria, antibiotics and obesity


Research on mice has led to the suspicion that antibiotics potentiate the effects of a high-fat diet in promoting obesity (? by eliminating useful gut bacteria). Mice placed on a high-fat diet become fat. However, mice given antibiotics early in life also tended to become obese, in a previous study. Finally, another group of mice which received antibiotics and a high-fat diet developed morbid obesity.

Again, more research is necessary, but it is clear that we need to be cautious and use antibiotics wisely.

Antibiotics to animals


Farmers seem to have been aware of the link between antibiotics and body weight. Farm animals have been getting antibiotics for several decades, apparently to cut down the risk of infection, or to treat infections. However, in many cases, the dose of antibiotics used is lower than what is known to be effective for treatment of infections. It is possible that this lower-than-necessary dose of antibiotics may be directed towards making the animals more bulky. Animals tend to bulk up more rapidly if they are given antibiotics with food.

More research in this field will be needed to come to firm conclusions, but can we afford to ignore the warning signs?

Caesarian section and gut bacteria


The baby prior to birth is surrounded by membranes which rupture during passage through the birth canal. At this point, the baby is exposed to the “good” bacteria in the mother’s body. These bacteria are swallowed, and also go to reside on the skin. This exposure starts the baby on a pathway to health through co-existence with healthy microbes.

Caesarian section obviously deprives the baby of this beneficial exposure. In addition, antibiotics used during this surgery also affect the baby’s bacterial environment.

Thus the gut microbes of babies born naturally and those born by Caesarian section are quite different. Does this have implications for their health? Many studies have looked at weight problems and the mode of birth. Pooling together multiple studies shows that being overweight as adults is 26% more likely to happen to babies born by Caesarian section versus those delivered normally. And obesity as adults is 22% more likely in Caesarian section babies.

Mother’s milk & complex carbs

Mother’s milk has nutrients for both the baby and its bacteria. Oligosaccharides (a type of complex carbohydrate) in this milk are not meant for the baby, which cannot even digest them. However, an organism called bifidobacterium infantis, present in the baby’s gut, can digest this nutrient, and uses it to proliferate in the gut. This is done at the expense of more harmful bacteria, which are crowded out.

There is an additional benefit: This microbe keeps the lining of the baby’s intestine healthy!

Stress and mood?

Let us look at mice again. If you take anxious and timid mice, and transplant into their guts the microbes from adventurous mice, the timid ones become adventurous! Obviously, we are not mice, but…

H. pylori, ulcers & obesity?

Many years ago, the bacterium Helicobacter pylori was shown to be responsible for stomach ulcers. Since then, doctors have been trying to eliminate it from Western stomachs, though people from other parts of the world still have it.

There is some suggestion, though, that H. pylori can calm the immune system, possibly leading to allergy and asthma being less common in communities which still have H. pylori.

Another possible effect: an empty stomach produces the appetite hormone, ghrelin, and you eat. When you are full, the stomach stops producing ghrelin, a signal is sent to the brain that you are full, and you stop eating. Data suggest that H. pylori regulates the amount of ghrelin produced by the stomach, and thus may have a role in causing or preventing obesity.

All of this is based on preliminary observations, and more research needs to be done. But eliminating or changing gut bacteria can have unintended consequences.

Gut bacteria, fermentation, and inflammation

The large intestine is vital for our health. The processed or ready-made food we eat nowadays is often digested and absorbed by the upper gut, leaving the large bowel with little to do.

The lining of the large gut is kept healthy by our gut bacteria.  If we eat a wide variety of plant fiber, this is fermented by the bacteria in the colon. As a result, short chain fatty acids are produced, which protect the health of the lining of the gut.

In the absence of this nutrient, the gut lining becomes leaky, and allows dangerous substances to be absorbed and enter the blood stream. The body mounts a response, and the result may be a low-grade inflammation. Some authorities feel this is the foundation for many chronic diseases common today.

Processed food


Some processed foods have emulsifiers and other products which are suspected of damaging the lining of our guts, again causing leakage and inflammation.

So what to do?

There is not enough information available at present to prove cause and effect. More research is essential. But taking some common-sense measures might not be a bad idea.

  • Let us feed the lower gut with fermented foods, such as yogurt, kimchi, and sauerkraut.zaziki-368163_1280
  • Eat lots of plant foods with different kinds of fiber. Insoluble fiber in whole grains, resistant starch in oats, beans, and bananas, and soluble fiber in nuts and root vegetables like onions, will encourage fermentation by large gut bacteria, with resulting health benefits.
  • Raw or lightly cooked vegetables are better for the gut flora.
  • Exercise regularly: preliminary data suggest that this creates a more hospitable gut environment for “good” bacteria.
  • Use antibiotics wisely.
  • Don’t overuse hand sanitizers. You might eliminate “good” bacteria, too.
  • Work with soil! Digging around in your vegetable patch will expose you to a variety of useful organisms.
  • Try to avoid processed foods.
  • Prebiotics, probiotics, and all that jazz: this is a vast industry, promising you the moon. Regulation of this industry does not appear to be very strict. Products available contain huge quantities of microbes, of which lactobacillus and bifidobacterium seem to be useful for our immunity. However, at least one study has cast doubt on whether you always get the microbes which the labels mention.

Too much info?

Possibly. Not too much proof is available yet. However, we often have to make decisions and judgments in real life, based on incomplete evidence.

So use common sense, while trying to get ahead of the curve!



100 Trillion Residents Live in Your Body!


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?


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


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


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.


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.


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.


  • 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?


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


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


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?


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.

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.


  • 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.