Weight Loss and Will Power

Weight Loss and Will Power

 

aka “Losing Weight has (almost) nothing to do with Will but (almost) everything to do with Hormones”

The main article should take approximately 5.5 mins to read.

I am reusing some of the material I’ve posted earlier under “Calories IN = Calories OUT. Is it?”.

 

Lot of people out there have tried various diets over a long periods and failed to lose Weight consistently or they tend to lose in the short term and put it back on later. Friends and doctors think these folks do not have the will to control what they eat and do not have the will to exercise. The dieters themselves start to feel guilty and slowly lose confidence in themselves thinking that perhaps they lack the Will and the mental strength to do so.

If you are one of those (either struggling to lose weight or those that think people who do not lose weight lack the Will) – please read on as I intend to show that losing Weight is much more to do with hormones than your will power.

My argument in this post will be:

  1. Eating less will not make you lose Weight in the long run
  2. Increasing the amount of Exercise will not make you lose Weight (for most people)
  3. Losing Weight (and Fat) is mostly related to Hormones. Hormones are very dependent on WHAT you EAT and not much to do with Will Power. So eating right will make you lose Weight (and fat).

Eating Less – Does it really work?

 

Key Message

If you eat the typical diet (High Carbohydrates, Low Fat, Low to Moderate Protein) but cut down the calories quite a bit, you are unlikely to lose significant weight in the long run. If your calorie intake is much less than is needed for a normal human being, all that happens is

  1. You will feel hungry
  2. You will feel irritable and cold (most or all the time)
  3. You will stop being active because you don’t feel like it (not much exercise)
  4. You will perhaps lose muscle mass and not FAT
Why is this the case?

Sensing the lower Energy intake, the Body adjusts (lowers) the base metabolic rate if the total energy intake is less than what is needed. This is done through the effect of various Hormones in the body.

In 2007, Jeffrey Flier, dean of Harvard Medical published (along with his wife) an article in Scientific American called “What Fuels Fat”. In it they quote

“An animal whose food is suddenly restricted tends to reduce its energy expenditure both by being less active and by slowing energy in cells, thereby limiting weight loss. It also experiences increased hunger so that once the restriction ends, it will eat more than its prior norm until the earlier weight is attained.”

Summary

Drastically reducing calorie intake is not going to solve any Weight problems. You are likely to feel miserable, perhaps will lose muscle, will move a lot less and also may not be able to focus on your job or domestic life.

 

Exercise More

 

Key Message:

You cannot achieve Weight Loss over the medium to long term through regular exercise ALONE.

 

Why is this the case?

 

  1. Exercise makes you hungry(ier) so you tend to overeat
  2. Exercise gives a lot of people a sense of entitlement to eat more or indulge
  3. Together the above negate any real weight loss benefits of Exercise

There have been many studies and trials undertaken to look at the impact of Exercise on weight. In most instances, the effects of exercise on Weight loss were small or marginal in the long term (2 years or more).

You may read the following article for more information.

http://well.blogs.nytimes.com/2012/08/01/dieting-vs-exercise-for-weight-loss/

 

Summary

If your intention is solely weight loss and if you undertake regular aerobic exercise for 30 mins a day or even up to an hour, it is unlikely to help you lose Weight in the long run.

So, how can I lose Weight?

Key Message:

Losing Weight (or Putting on Weight) is almost entirely related to Hormones and not related to Will Power. Hormones respond to food we eat. So by eating Right we can lose Weight.

 

So, what makes NORMAL human beings put on Weight

  1. Insulin is the only Storage Hormone in the body (pretty much)
  2. The more Insulin you have in the body the more FAT you put on
  3. Insulin responds to Blood sugar levels. Insulin levels go higher if the Blood sugar levels are higher in the body (body tries to keep Blood Sugar level within a range to the extent possible – this mechanism fails in diabetics due to a) Insulin not being able to do its job well (called Insulin Resistance) and b) Not Enough is being produced by the Pancreas)
  4. Your Blood sugar levels go higher if you eat a) Carbs (processed Carbs are much worse) and b) Sugary Foods (Sugar itself, Sweets, Cookies, Chocolates, Fruit juices etc.)
  5. The more easily digestible the Carbs are (Bread, Sweets, Rice etc.) and the more you eat of these, the quicker the blood sugar levels rise and more Insulin gets produced

As long as you eat processed Carbs and Sugars your blood sugar levels are high and your Insulin levels go higher and as long as Insulin levels are high there is hardly anything you can do but to put on Fat. Eating less and Exercising More won’t make much difference. Your Will has very little Role to Play since you associate Will to Eating Less and Exercising More. 

Summary:

So your aim should be to reduce the Blood sugar levels thereby reducing Insulin levels by Eating RIGHT and Eating WELL.

Appendix

Please find below more evidence on effect of hormones on growth and body fat. The key argument here is that people overeat to grow or become fat and not the other way round.

1. Growing Children

It is well known that Children start eating quite a bit during their peak growth period. Levels of the Growth Hormone grow rapidly. This makes them Grow which will make them hungry and eat more. Assuming their diet is balanced, children will grow in height, will have longer/stronger bones and also put on muscle. All that eating is to support the growth (which is kicked into gear by the growth hormones) – Vertical growth (height) and not horizontal growth.

If someone says that Children overeat and that is why they grow that is not right. Children Grow – that is why they overeat.

As soon as the growth period is over, the additional eating stops generally. This also supports our assumption.

2. Hibernating Animals

A number of animals go into Hibernation during seasons (typically winter). Hibernation is mainly controlled by the endocrine system. Glands in the body alter the amounts of hormones being released and can control just about every physiological aspect of hibernation (Thyroid, Melatonin, Insulin etc.)

All these Hormones make the animals put on a lot of Fat which makes them overeat. They do not put on Fat because they overeat, they Over Eat because they are putting on Fat.

Once the season starts they go into hibernation during which the metabolic rate plummets, temperature drops significantly, blood pressure and heart rate become slow (all of this essentially to reduce the consumption of energy thereby saving energy).

 

3. Pregnant Women

We all know that Pregnant Women eat quite a bit and also put on both Fat and Weight. Going by conventional logic, we could say that pregnant women are getting Fat because they are Overeating.

We know better. They are Overeating because they are getting Fat. Again this is mostly due to hormones and for a very good reason. The fat is to provide nourishment to the mother and the child and also perhaps to cushion the baby’s weight and provide protection.

Once the child is born the Overeating stops and the mother generally returns to her previous size (assuming a balanced meal) over a period of time.

So in essence the hormones create the condition for Overeating by pumping a lot of energy into fat for the sake of the mother and child. Not the other way around.

 

4. Zucker Rats

Perhaps the best examples to state that the Weight / Fat problem is related to Hormones and not Overeating or Laziness (or being sedentary) are a set of wonderful experiments done with a special category of rats bred for research in Obesity and Hypertension by a researcher called George Wade (et al) in University of Massachusetts in the 1970s. (Just to note that not all experiments that have been successful on rats have not had the same result in humans).

Part 1

Wade and team removed ovaries from rats and then monitored their subsequent weight and behaviour.

  • The rats began to eat voraciously and quickly became Obese (the rats have been given as much food as they wanted to eat – called “Ad Libitum” in medical terms)

Part 2

Wade then did a second experiment. He removed the ovaries but then restricted the amount of food the rats can eat.

  • But the rats got just as fat as quickly. But these rats are now completely lazy. They moved only when necessary.

Removing the Ovaries stopped the production of Estrogen (Oestrogen) in Rats (in both experiments) and Estrogen (a hormone) has a role to play in fat storage (Estrogen works to sensitise Insulin more – less Estrogen means more fat at least in Rats – it’s much more complicated but this is the simple explanation)

Part 3

Estrogen was infused into the rats.

  • The rats did not become fat or did not overeat and moved normally even if unlimited food was made available to them.

This Zucker Rat experiments should make it very clear that Hormones are playing a part in Obesity and Fat Metabolism not Overeating and Laziness.

What’s the deal with Statins?

What’s the deal with Statins?

This blog post will cover the controversies related to the use of Statins to lower cholesterol and thereby lower heart disease risk. It will contain arguments from the camps supporting Statin therapy and the camp that expresses serious reservations about the benefits of Statins and concerns around their side effects.

I am going to include some clinical trial data to illustrate the point. Furthermore, I will explain some terminology that is key to making any personal decisions around Statin usage.

What are Statins?

They are a class of drugs that reduce Total Cholesterol and so called Bad Cholesterol (also called Low Density Lipoprotein – LDL). (More on cholesterol in an earlier post here.)

What are Statins used for?

They are used to prevent the occurrence of heart disease and death due to heart disease. It is generally assumed that this benefit is achieved through their cholesterol lowering effect (more about this later).

How many people use Statins?

It is difficult to say but in the US approx. 25 to 30 million take statins and in the UK approx. 5 to 7million take statins (approx. 8 to 10% of total UK population). If this is extrapolated to the wider population of the world (with usage numbers less for the developing world), then it is likely that approx. 250 to 400 million people take Statins daily.

What are the typical Statin drugs?

There are currently six statins on the US market: lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. The brand names are Lipitor, Zocor etc.

How much benefit do Statins provide?

Let’s get into terminology here – RRR (Relative Risk Reduction), ARR (Absolute Risk Reduction) and NNT (Number Needed to Treat). Let’s use an example to explain this.

Supposing we start a clinical trial with 200 people. Let’s randomise them into 2 groups of 100 each (the randomisation process to take away any biases). Let’s call them Groups A and B.

Let’s give Group A (100 people) a Statin and let’s give Group B (100 people) a placebo (a pill with no active ingredient – a sugar pill basically). Let’s also ensure the pills look exactly the same so that patients in Groups A and B can’t figure out who has been given the drug and who has been given the sugar pill.

At the end of 5 years, the trial ends and we look at the results – In Group B (placebo) 4 people got heart attacks whereas in Group A (statin) only 2 people got heart disease. Therefore,

Absolute Risk Reduction is 4 -2 / 100 = 2 %

ARR tells you how many lives actually get saved on a percentage basis.

Relative Risk Reduction is 4-2/4 = 2 / 4 = 50%

RRR is generally used by pharma companies to glorify the benefits of drugs (like most marketing messages do – pharma or no pharma) because 50% sounds much better than 2%.

Number Needed to Treat is 50

This is defined as the number of people that needed to be treated to save 1 life. Since treating 100 people has saved 2 lives (supposedly), then we can say the NNT is 50. If only one life was saved then NNT will be 100. So in essence, in this example 50 people need to take the drug for 5 years to save 1 life.

Statin Clinical Trials

To get a more balanced (or contrarian) picture, let us look at the results of some Statin Trials (reusing work published in some papers)

JUPITER

The first one is the JUPITER trial, in which Rosuvastatin (Crestor) or a placebo was administered to 17,802 healthy people. It was investigating incidences of cardiovascular disease (such as non-fatal and fatal heart attacks, stroke or angina). The trial ended after 1.9 years.

The benefit of Statins was calculated to be between 0.5% and 1%. Slightly fewer people had heart attacks ( < 1%) with the drug but more people died in the group given the drug when they actually had a heart attack. Anywhere between 83 to 244 people need to take the drug for 5 years continuously to reduce their heart attack risk by between 0.5 to 1% over 5 years.

What Else Happened in the Trial?

In the Rosuvastatin group there were 270 new cases of diabetes, but only 216 in the control group (3% vs 2.4%). There was an absolute Risk of 0.6% and a relative risk of 20%.

The following description has been given by a contrarian for the above Trial:

Your chance to avoid a nonfatal heart attack during the next 2 years is about 97% without treatment, but you can increase it to about 98% by taking a Crestor every day. However, you will not prolong your life and there is a risk you may develop diabetes, not to mention other serious adverse effects.

Let’s look at one more Trial before we move on.

PROSPER

PROSPER was a large trial involving 5804 men and women aged 70–82 years with a history of, or risk factors for, vascular disease (diseases of the blood vessels). Half of them were given pravastatin, the other half a placebo. After 3.2 years later, they wrote in the abstract that mortality from heart disease had fallen by 24%. However, according to one of the tables, 4.2% had died from a heart attack in the control group and 3.3% in the treatment group, thus with an ARR of only 0.9 percentage points.

The small cardiovascular benefit was neutralised by a substantial number of patients who had died from cancer. There were 28 fewer deaths from heart disease in the pravastatin group, but 24 more deaths from cancer. If we include nonfatal cancer in the calculation, the cancer difference was statistically significant – 199 in the control group and 245 in the pravastatin group.

Conclusion  – On the whole, a 0.9% ARR was achieved with the taking of Statins, however this came with a raised risk of cancer.

Do Statins have any other Benefits?

There is some evidence to suggest that the small absolute benefit is not because of cholesterol lowering at all but due to something else.

How do we know this – The current Statin drugs can be called v2.0 of cholesterol lowering drugs. The v1.0 drugs lowered cholesterol but had such considerable side effects that some of them had to be withdrawn from the market (more deaths and unintended side effects).

There is a theory that heart disease and other chronic diseases are caused by Inflammation (a topic for future discussion) and that Statins reduce the inflammation slightly (this is a different effect of Statins unrelated to Cholesterol lowering) and thereby provide some benefit – some of the markers for Inflammation like CRP (C Reactive Protein) or hs-CRP (high sensitive C Reactive Protein) are lowered slightly by Statins.

What about Stroke?

Stroke is when poor blood flow to the brain results in cell death (wiki). (For the layman, heart attack is related to the heart and stroke is related to the head). Similar arguments are extended for use of Statins to reduce the risk of Stroke.

Some studies have shown a small absolute benefit but this could be due to non-cholesterol lowering effects of Statins such as a reduction in inflammation. Furthermore, high cholesterol has a weak association with incidences of stroke, which confirms the suspicion that Statins effects could be due to other aspects.

An area to watch, though we also know that there could be an impact on brain functioning.

Interim Summary – What do we know so far?

It appears that Statins reduce the risk of heart attacks by an absolute 1% if you take them for 5 years but with a raised risk of diabetes and cancer. If you do get a heart attack while on the drug you are more likely to die than not taking the drug (from the trial).

What are the side effects of Statins?

The following are the most documented side effects of Statins (in descending order of risk)

  1. Muscle and Joint aches and pains – Anywhere between 10% to 50% of the people report this problem. Officially it is supposedly far less but in practice it seems to occur more. Some people avoid this by switching to a different Statin. Also most people report that the pains go away when they stopped taking Statins.

This side effect has a bigger impact on people if they stop exercising due to this as we all know that proper life style (good diet and plenty of exercise) can make you more healthy and reduce the risk of so many diseases

  1. Diabetes Risk – It appears that there is a higher risk (ARR) of 3 to 4% of diabetes for people on Statin Drugs
  2. Temporal Memory Loss and Mood disorders – Some people have reported episodes of memory loss for short periods of time. Several studies have shown that low cholesterol is associated with lower cognition and Alzheimer’s disease and that high cholesterol is protective. In a study of 143 patients with memory loss or other cognitive problems associated with statin therapy, they reported that 90% of them improved, sometimes within days, after statin discontinuation.
  3. Liver Function – For some people, their liver function seems to have been affected after they start taking Statins

What other Downsides do Statins have?

Everyone (people who promote Statins and people who suggest that Statins are being taken by many people unnecessarily and that their benefits are exaggerated) agree that a proper life Style (a good diet, regular exercise that covers aerobic, strength and weigh training, stress reduction, good sleep, not smoking and limiting alcohol intake) provides good health.

I personally believe that Statins take away some of the incentive for someone with an elevated heart disease risk to make the necessary life style changes. Popping a Statin is an easy way out for people to continue their existing (and perhaps improper lifestyle).

People can benefit from a good life style in many different ways other than just reducing heart disease risk. You’ll get an overall improved health, feel much better, you can be sharper and more focused, can move around lot more, enjoy things more, brains function better etc.

Conclusions

Benefits of Statin

They seem to have a marginal absolute risk reduction of heart Disease (approx. 1% when taken over 5 years) but with a slightly higher overall risk of death  from other causes (Personally it makes no difference whether  I die of Cancer or Heart Disease – whether I die or not is what matters)

Should I take a Statin?

Warning: Do not stop taking any drugs without consulting your doctor. He or She may not agree with below views and it is ultimately a personal decision for you.

The devil is in the detail but based on reading a large number of papers, the general conclusions are as follows:

If you are a woman :

  1. If you already had a heart attack, then it is worth a discussion with your physician (this is called secondary prevention) though there is not much evidence to suggest it is of any net benefit
  2. With no previous heart attack disease, it is very unlikely that Statin is of any NET benefit to you given all the downsides
  3. If you are a woman above the age of 65 or 70, it is very unlikely that Statin is of any NET benefit to you no matter whether you had a heart attack or not

If you are a man

  1. If you already had a heart attack, then you should perhaps consider a Statin (this is called secondary prevention)
  2. With no previous heart attack disease, it is very unlikely that Statin is of any net benefit to you given all the downsides
  3. Above the age of 65 or 70, it is very unlikely that Statin is of any net benefit to you no matter whether you had a heart attack or not

An After-thought

We talked a lot about Heart Disease Risk. How can we quantify the risk? There are a number of Calculators out there but they are very generic and also not as applicable to Asians compared to others.

One of the better ones is the Mayo Clinic calculator. (Your physicians may have their own version)

http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-risk/itt-20084942

Give it a go!

If you also have blood test results in hand, then check the following out

Assuming your vitamins and minerals are at the right levels, the following Cholesterol levels indicate excellent health according to some experts

HDL (level) >1.2 mmol/L > 60 md/dL
Triglycerides (TG) / HDL Ratio < 1 < 1

 

If you eat a lot of processed carbs, sweets etc. then your Triglycerides are likely to be higher and you’ll struggle to hit the above ratio.

Also check to make sure your Liver Function is solid and that your blood sugar levels are relatively low (HbA1C < 5.5)

Please post any comments on the Blog. Would appreciate it.

Are you eating well (or Is your Diet working?)

If this is your first visit please go to Introduction.

Are you eating well (or Is your Diet working?)

Is your Diet working? The main purpose of this post is to outline some signs, measures and tests that can give you a clue as to whether your Diet is working (or not working as the case may be) and whether you are eating well.

Please note that the context here is more about Weight management, Obesity, Heart health, insulin resistance and diabetes. This post will not cover this from other perspectives (muscle building, mental health, sports, other diseases etc.)

For those of you who have not already seen, an evaluation of various diets and a suggested diet was discussed in the last post. Please click here.

The post cover three categories:

  1. First, we will cover some signs (physical and mental) that you can observe yourselves (and perhaps your family and friends). No measurements are required and no Blood tests are required for this category. No costs need to be incurred.
  2. Then we will cover some basic measurements that you can undertake within your home environments with a tape or a scale. Again there is no need for third parties or blood tests. No costs need to be incurred.
  3. Finally we will look at Blood tests – This would involve you providing a sample of your blood to a lab (most likely on a fasting basis).

1. Physical and Mental Signs

If your NOT eating well (or if your Diet is NOT correct), then you are very likely to encounter the following SIGNS

1.1 Cravings

If you have strong cravings for a chocolate or snack or a something sweet within 3 or 4 hours of a meal, then it is highly likely that your meal was not very balanced (I see this in my office environment – people raiding the vending machine regularly between 3:30 and 5 pm every day)

This is what is likely to have happened – You have eaten a meal rich in easily digestible or processed/refined Carbohydrates (white bread, rice, pizza, pasta etc.) or Sugars. This would have raised your blood sugar levels to a high level which would have precipitated a high release of insulin. The sugars in the blood would have been removed and pumped as fat and the blood sugar levels would fall below normal thereby resulting in a craving.

1.2 Hunger and Irritability

You may also feel hungry and irritable if your blood sugar falls low as discussed above in point 1.

The situation would also happen if you have eaten a highly energy restricted meal (as part of a particular dieting scheme etc.) and this would also result again in a low blood sugar level precipitating hunger

1.3 Fatigued and Tired

Around 3-5 hours after a Carb/Sugar rich meal (or a very calorie restricted meal) and with blood sugars low, you could also be fatigued and tired unless you top up with a chocolate bar or a snack or a fruit.

I am told that Diabetics who take insulin do feel tired more often than normal healthy adults (again because the insulin removes the blood sugar very quickly thereby leaving you with low blood sugar levels).

This is also stated as one reason why people do not want to exercise because they are physically and mentally tired and don’t feel like exerting themselves – lethargy sets in.

1.4 Sleep

One more general indication (more about stress levels and less related to Diet directly etc.) is whether you are able to have a good night’s sleep. Insomnia is meant to be a serious problem in western countries these days.

1.5 Other IMPORTANT Signs

The following are general signs that a number of authors and some doctors mention in relation to Insulin Resistance and Pre-Diabetes. Though not all of them are scientifically proven (perhaps because people have not paid sufficient attention yet) , I STRONGLY believe the following are very early signs of Insulin Resistance leading to Diabetes at a later stage.

1.5.1 Rapidly receding hair line or hair loss – particularly in men

1.5.2 Receding gums and dental caries

1.5.3 Small skin tags and skin folds on the body

1.5.4 Signs of Cataract (eye) relatively earlier in life

1.5.5 Kidney stones

1.5.6 Mild to moderate hypertension

1.5.7 Gout

2. Body Measurements (also called “Anthropometric measures”)

These range from very crude to above average measures

2.1 Trouser or Dress size (very crude):

This is the simplest measurement. If your trousers and dresses (which were ok in the past) are getting loose (or tight) then you know very well which way your waist is heading. If you need punch more holes on your belt to the left then you are doing well (and not doing so well if you need do this on the right hand side) – I am not considering those people whose waist is becoming bigger because of additional muscle or kids here.

2.2 Weight (Crude)

Absolute Weight is a rather crude measure because this is dependent on your height, how well built you are (Frame), gender, how muscular/bony you are etc.

People place much more emphasis on Weight than is warranted and there is a large range of acceptable weight for a particular person.

A slightly better measurement is “Change in Weight”. But again this can be misleading – because research indicates that a lot of initial weight loss is due to loss of water.

If you are working out a lot (and eating a lot of protein) you can technically be heavier than earlier but also much healthier due to increased muscle.

A simple rule to follow while taking a weight measurement is: Always measure your weight early in the morning after you finish your ablutions. There can be a variation of up to 2 kgs in a person’s weight in a given day – during the day.

2.3 BMI (Body Mass Index) (Crude)

BMI takes into account the height of a person and the weight and is calculated as follows:

BMI = Weight (in kgs) divided by (Height in metres squared)

So if a person’s weight is 85 kgs and height is 1.75 m (approx. 5 feet 9 inches) then

BMI = 85 / (1.75*1.75) = 85 / 3.0625 = 27.75

The official BMI guidelines are as follows

BMI
CATEGORY
Below 18.5 Underweight
18.5 – 24.9 Normal
25.0 – 29.9 Overweight
30.0 and Above Obese

Though BMI is slightly better than just weight, it still does not account for the fact that some people are of bigger build and are muscular than other people of same height. In fact, most body builders and other muscular people will invariably fall in the over weight (and obese) range.

BMI is used as one of the measures to assess metabolic syndrome or insulin resistance.

There is some latest research that suggests that being slightly overweight is better than being under weight. I am not sure how applicable this is for Asians and some of the other ethnic communities. But less than 18.5 is definitely under weight.

Perhaps a range of 23-25 is good target for Asians and between 25-28 for Caucasians and African Americans. But remember that BMI is “crude”.

2.4 Waist, Hip and Waist/Hip Ratio (Above average)

Another set of measurements that are used by dieticians and researchers are absolute measurements of Waist, Hip and the ratio of Waist/Hip.

The reason these are used as risk factors for diabetes and heart disease/stroke is due to the fact that visceral fat is supposed to be risky and visceral fat mostly accumulates around waist for men and around hip for women.

These measures have been adjusted for ethnicity. The official guidelines are Waist are

Increased
Risk

Substantially
increased risk

Men

>=94 cm

>=102 cm

Women

>=80 cm

>=88 cm

Waist/Hip is supposed to be one of the better measures of the risk and the official guidelines are as follows:

If you’re a man and your ratio is more than 1.0, or a woman and your waist-hip ratio is more than 0.8, it means you’re an apple shape and at greater risk of health problems.

2.5 ABSI (A Body Shape Index) (Good)

This is a relatively new and unknown index and develops on BMI and Waist/Hip circumferences. The idea is to mathematically calculate the shape and assess the risk (if the shape is like an apple rather than a pear then the risk is higher)

Numerous studies indicate that carrying excess belly fat, or being apple shaped, is more risky for your health, than being bottom heavy, or pear shaped.

The formula is slightly complex (and hence I am not providing it here) and there is an useful calculator at the below link which will show your results in comparison to the population average.

http://www.absi-calculator.com/

3. Blood Tests

There are various blood tests that can be undertaken to assess the general health or health of various organs but the focus of this post is to assess potential diabetes risk and general cardio-vascular health.

This would involve tests related to measuring sugar in the blood and cholesterol in the blood mostly but I have added 4 more measurements that I think are very useful. I believe the official ranges are perhaps not as good as they ought to be so I have included both the Official range and an Ideal range. The Ideal range is based on my study of the literature and research.

Also please note that the units are different from Country to Country and hence I have included the two main measurement units (US/India and European).

Please click on the image to make it larger.

Blood test ranges v1

Please drop me a comment if you have any questions.

 

 

 

All you need to know about Dieting and Weight Loss

If this is your first visit please go to Introduction.

All you need to know about Dieting and Weight Loss

This post will cover various aspects related to Diets, Dieting and Weight Loss. I have been reading a lot about various diets over the past few years (and have dabbled in some in the past).

Research into Diets consistently shows the following:

  1. For most people Diets work in the Short term (6-12 months) but rarely work in the long term (24 months+)
  2. Most people lose very little weight or none at all (on average) in the long term (some actually gain). Some are extremely successful with their Diets but these are exceptions rather than the rule (you will only read the exceptions in the media but not about the thousands that have not been successful). Average weight loss in the long term is +/- 2 kgs.
  3. Dropout ratios for Diets are extremely high- between 60% and 90%

Caution: Before we proceed further, a note of caution. In general Diets are not advisable for Children, Pregnant or Lactating women. Also if you have a serious disease (cancer, kidney problems etc.) you should seek medical advice before you jump on a diet as Dieting can harm than help you (for example Atkins Diet is not advisable for people who have kidney problems)

Why Do Diets Not work?

For a number of reasons – partly down to the individual and partly down to the Diet itself.

My own take on this is as follows:

  1. People jump into Diets without doing the necessary homework or upfront thinking and realise over a period of time that it doesn’t work for them (e.g. If you are vegan you will struggle to undertake Atkins Diet)
  2. Some of the Diets impose such restrictions that people will feel they are not practical for a busy day to day life or they make you hungry and tired etc.
  3. More importantly, Dieting is not about just Food and Drink. It is much more about behavioural change and Will – in essence about the Mind. This is often underestimated (or not considered at all) and perhaps that is why Diets fail. Human mind is a creature of habit and will resist change and Will is like a muscle and will get tired if you use too much. If you don’t grapple with these two aspects of the mind, then success is harder

Whether Diets fail because people give up or people give up because the Diets are not successful (resulting in weight loss) is a chicken and egg situation.

Why do people Diet anyway?

For a number of reasons

  1. For weight loss
  2. For better health (to avoid or manage diabetes, gout, heart disease etc.)
  3. As part of some treatments (some doctors prohibit specific foods or encourage some for certain diseases)
  4. For religious or cultural reasons (Lent, Ramadan Fast, Hindu vegetarian Diet etc.)

So how should I choose a Diet?

The best way to approach this problem is on an analytical basis by means of having a framework or a template (I know, I know – this is corporate speak – what I mean is that we need a set of criteria to evaluate any Dietary initiative to be undertaken). You assign points to any Dietary initiative using this criteria and then choose one with a relatively high total score. Given that some of the criteria are more important than the others, some of them have a maximum of 10 points and some 5 points.

By definition, this is subjective and judgemental.

The criteria I propose are as follows:

  1. Practicality – Any Diet has to be practical. If the Diet expects you to calculate points or calories all the time or tells you not eat some stuff on a Monday and something else on a Wednesday it will score low on this
  2. Nutrition – Any Diet has to provide all the nutrients required for a healthy life and if a Diet is deficient in certain nutrients and expects you to undertake supplements and vitamins lifelong, it will score low
  3. Cost – If you need to subscribe to websites or clubs or buy food or books then the Diet will score low on this
  4. Portion control – If a Diet imposes constraints on portion sizes or calories then it will score low on this
  5. Restrictions – If a Diet imposes too many restrictions on what not to eat and when to eat or now then it will have a low score on this
  6. Availability – The food items proposed by the Diet should be easily available to get a high score on this
  7. Evidence – Diets that are backed by scientific evidence score high on this. If the evidence is lacking or is not strong enough it will score low
  8. Side Effects – Some of the Diets can have side effects and they will score low on this

So how do the major Diets compare?

The following table shows the ratings for Major Diets based on my subjective evaluationComparison of Diets RatingsAs can be seen above, the top Diets are

  1. Mediterranean
  2. Low Carb (High Fat)
  3. South Beach

in that order.

(The Med Diet is slightly higher in Carbs to my liking and the Low Carb has slightly higher saturated fats (though there does not appear to be any problem with it) to my liking so I prefer a combination of 1 and 2 – less amounts of Carbs than a Med Diet and less amount of Saturated Fat than a Low Carb (High Fat) Diet. It is just a personal preference given that I am Ovo-Lacto-Vegetarian (a vegetarian who eats milk products and eggs) (with occasional meat).

What does research tell us about success of various Major Diets?

There have been many trials held to assess the efficacy of various Diets and typically these trials include two or more of the following Diets

  1. Low-Fat / High-Carb – Energy / Calorie restricted Diet (typically 1500-1700 for women and 1800-1900 for men)
  2. Mediterranean Diet – sometimes energy / Calorie restricted Diet (typically 1600-1800 for women and 1800-1900 for men)
  3. Low-Carb / High Protein Diet – normally unrestricted – eat as much as you can
  4. Low-Carb / High-Fat Diet – normally unrestricted – eat as much as you can

Time and again, the trials prove that Low-Carb and Mediterranean are the best for weight loss (in that order) and Mediterranean and Low-Carb are best for lowering Tri-glycerides, increasing HDL and reducing inflammation (in that order). This is despite the fact that Low-Carb Diets generally do not restrict Calorie intake. Also the drop-outs tend to be lower on Low Carb Diets.

So how many Calories should I eat?

There is no need count Calories if you eat right. Counting calories is an unnecessary drag on your mind. The calories will (should) take care of themselves. Also as explained in the previous paragraph, some of the Diets do not restrict calories and people have struggled to eat more than 2000-2200 calories even when allowed to eat as much as they can on these Diets.

But if you still need numbers – here you go.

The daily recommended intake in the UK is 2500 cals for men and 2000 cals for women. I suspect for most people who are not undertaking physical work or working out a lot, 2000-2200 for men and 1600-1800 for women should suffice (again please bear in mind that these are not valid if you are a child or are pregnant/lactating).

So what would you recommend?

As mentioned earlier, anything that imposes too many restrictions or expect you to remember what to eat on any given day of the week has a lesser chance of success.

Before we get into lists the following broad principles should be considered

  1. Eat when you are hungry
  2. Eat enough to relieve your hunger. Don’t starve yourselves. If you severely under eat or starve yourselves, you are likely to end up tired, hungry and irritable and also unlikely to lose weight in the long run
  3. Aim for variety / rotation (different colours on your plate will look better. Won’t they?)
  4. Eat food that is grown/available locally and that grows in season (this is likely to provide immunity towards colds, flus etc.)
  5. Drink plenty of water
  6. If you can, fast every now and then (perhaps one or two meals a week or whenever it is convenient)

Here is the list then (with Traffic Light System – Red, Amber, Green (RAG) if it helps)

Eat the following in GENEROUS or UNRESTRICTED amounts (GREEN)

  1. Oily Fish
  2. All Vegetables (except starchy vegetables like potato, turnip etc.)
  3. All leafy vegetables
  4. Eggs
  5. Meat (avoid red meat if you are doubtful but there is no need to)
  6. All types of fruits (not fruit juices) (go easy on bananas, dried fruits etc.)
  7. Sprouted or Germinated seeds
  8. Fermented foods – Yoghurt, Miso, Tempeh etc.

That’s plenty to eat. Isn’t it?

Eat the following in MODERATE amounts (AMBER)

  1. Dairy products (Cheese, Butter, Ghee (clarified butter), Cream etc.)
  2. All types of Seeds and Nuts
  3. Legumes, Beans and Lentils
  4. Whole grain products (brown rice, wild rice, stonemilled whole meal flour)
  5. Basmatic Rice
  6. Extra virgin olive oil (not cooking olive oil) or Virgin Coconut Oil

SEVERELY RESTRICT the following (RED)

I am afraid there will have to be some restrictions:

  1. All foods made with sugar – anything that is man made and tastes sweet
  2. White rice particularly long grain polished white rice
  3. Foods made with white flour – white bread, croissants, bagels etc.
  4. Processed (unfermented) Soy products
  5. Vegetable cooking oil
  6. Deep fried foods / snacks
  7. Completely avoid foods made with Trans Fat or Hydrogenated Fat/Oils – this includes margarine, spreads etc.

A lot of diets completely eliminate Alcohol, Caffeinated products etc. but I am not sure there is a need for this. As long as the quantities are low and reasonable it should be fine.

So how much fat or protein should I eat?

Official guidelines suggest that you should eat 50-60% Carbs, less than 20% Fat and approximately 25-30% protein.

To keep it simple, eat a third each i.e. 33% of Fat, Protein and Carb (whole grains). That should be fine.

So is that it?

I am afraid not.

Any Diet has to go hand in hand with other aspects and has to be a part of an overall balanced lifestyle.

  1. No Smoking
  2. Consumption of low to moderate amount of alcohol (preferably Red Wine)
  3. Sleeping well (this is a major issue in developed countries)
  4. Exercise – HIIT, strength and resistance exercises etc.
  5. Managing stress (meditate, exercise, take long walks, pick up a hobby – learn a musical instrument, watch movies, read books, start playing a sport / game you enjoy (if you don’t enjoy the sport then perhaps it will not last long) (also a team game perhaps) – spend time with friends and family, work for a charity or best of all write a Blog around a theme you enjoy !!!! etc.)

So how do I know the Diet is working?

You need to look at a number of things apart from weight. That will be the subject of the next post..

I will add some details about each of the Major Diets in the next few days in pages 2/3 of this Blog. But please write an email or comment if you need any particular detail.

Enjoy!!

 

Cholesterol is Bad. Isn’t it ?

Cholesterol is Bad. Isn’t it?

If this is your first visit to the Blog, please go to Introduction or Index of All Posts.

In this post, we will talk about the controversial subject of “Cholesterol“. Almost 90% of the friends and family I speak to, think that Cholesterol is “Bad”. There are a few who think that there is such a thing as a “Good” Cholesterol along with a “Bad” Cholesterol in the body.

Aspects related to Cholesterol can be quite technical but keeping in mind the audience and philosophy of this Blog, I will try to keep it as non-technical as possible but to drive the message home there will be an element of technicality. Also there will be tables and pictures and the format will be a Q & A format. Entire books have been written on this subject and trying to do justice in a 3-4 page post is a significant ask.

Separately, not everything related to Cholesterol has been figured out despite what people have been led to believe. People are still doing significant amount of research and putting together all the pieces of the jigsaw. Hence, any statements made around this topic need to be taken with a pinch of salt.

I have used the following guidelines where I am quoting numbers and showing pictures

  1. I have not used data from people based outside the medical community or public health authorities (like WHO etc.)
  2. I have tried to use data and research undertaken by people within the medical community (doctors, researchers, professors etc.) but with a slightly contrarian and challenging views

There has been a publicity in the media and and also via public health literature (which is the reason why most people think Cholesterol is “Bad”) around Cholesterol. Almost universally the advice is that higher Cholesterol levels are bad. Some of them do recognise that there are Good and Bad Cholesterols.

So, as far as Cholesterol is concerned there are two camps:

  1. Cholesterol Proponents (I’ll call them CPs): This group thinks that higher Cholesterol levels are bad and cause heart disease or stroke. Most of this group also thinks that higher Cholesterol levels are caused by consumption of saturated fat. Again, 98%-99% of the establishment belong to this group (doctors, medical researchers, drugs companies, media, public health officials)
  2. Cholesterol Sceptics (I’ll call the CSs): This group thinks that a) higher Cholesterol levels do not necessarily cause heart disease and also that consumption of saturated fats to not cause heart disease. They think that something that is causing Heart Disease is also perhaps causing the Cholesterol levels to up (but not all the time and in all the people). In their words there is perhaps an association to some extent in some people between high Cholesterol and Heart Disease. To this group, high Cholesterol levels in normal population are a “Bio-marker” – a sign that something is wrong perhaps in the body and that Cholesterol does not itself cause Heart Disease. Whatever is making Cholesterol levels High is also causing the other problems in the body. Less than 1%-2% belong to this camp.

Across the entire post, the following abbreviations have been used:

      • TC – Total Cholesterol
      • HDL – High Density Lipoprotein
      • LDL – Low Density Lipoprotein
      • VLDL – Very Low Density Lipoprotein
      • IDL – Intermediate Density Lipoprotein
      • TG – Tri-glyceride

But both CPs and CSs agree on a few things mentioned below (and disagree on a lot more):

1. Cholesterol is absolutely essential to the body

Without Cholesterol we cannot survive. Cholesterol has a number of important functions in the human body

    • Cell membranes – all cells in our body need Cholesterol to build their membranes
    • Brain synapses – made predominantly out of Cholesterol
    • Synthesis of Vitamins like Vitamin D
    • Bile – Cholesterol is a key component of Bile etc.

As a slight anecdote, I would like to also mention a couple of things:

a) Mother’s milk is very rich in Cholesterol

b) A hen’s egg contains a good amount of Cholesterol

The one thing I can reasonably confidently say is that mothers never do or produce anything that harms their offspring intentionally. The reason why there is good amount of Cholesterol in an egg and mother’s milk is because it is very useful and essential for the babies.

2. You cannot have a Cholesterol level in your Blood

Again, this is indisputable. Cholesterol cannot dissolve in water and hence it cannot dissolve in blood. So it needs to be carried by something else (like a cargo in a ship or a sub-marine). The ships are called “Lipoproteins” (some of you may recall – HDL and LDL in your Lipid Profile blood test results – HDL stands for High Density Lipoprotein and LDL stands for Low Density Lipoprotein.). Blood tests measure or estimate the cargo – the actual cholesterol but technically you cannot have a Cholesterol in the blood directly.

3. Cholesterol you eat (Dietary Cholesterol) has no bearing on your Blood Cholesterol levels

Cholesterol is so essential to our survival that Liver and most cells can manufacture Cholesterol from raw ingredients. Approximately 75% of the Cholesterol is produced within the body with around 25% coming from food sources. Just to give you some perspective, the entire amount of Cholesterol in our body is approx 30-40 gms and the daily need is around 800-1200 mg (milli-grams). If you eat 600 mg, your body will produce 600 mg and if you eat 1200 mg body will produce none. So the human body will produce whatever Cholesterol is necessary whether you eat it or not. Compare this to the amount of fat (Tri-glycerides) in a typical person (weighing 75 kgs and approx 20% body fat) – 15,000 gms (15 kilos)

 What is Cholesterol anyway?

Cholesterol is an organic molecule which is a steroid alcohol (but does not behave like a normal alcohol). It belongs to the Lipid class (like other fats). It does not dissolve in water entirely.

That’s enough I think.

How many types of Cholesterol are there?

As discussed earlier, Cholesterol is carried by protein molecules called Lipoprotein. Lipoproteins also carry fat (Tri-glycerides – TG), Phospholipids etc. We will concern mainly with Cholesterol and TG.

There are only two types of Cholesterol – Free or Unesterified Cholesterol (UC) and Esterified Cholesterol (called CE). (there are other categorisations around Cholesterol in animals and Cholesterol in plants but we needn’t concern ourselves with that).

But why I do hear about LDL, HDL, VLDL etc.?

These are different types of Lipoproteins that carry the Cholesterol. Last time I read, there are five major types and many sub-types of Lipoproteins. Altogether I counted 16 different types of Lipoproteins as per the picture below (courtesy Dr.Peter Attia). It is highly confusing to say the least and apparently even a lot of doctors don’t know about this..

Lipoprotein Types - Courtesy Dr. Peter Attia

The main types of Cholesterol are Chylomicron, VLDL (Very Low Density Lipoprotein), IDL (Intermediate Density Lp), LDL (Low Density Lipoprotein) and HDL (High Density Lipoprotein) in ascending order of density. There is something called Lp(a) which is a type of LDL but again we needn’t worry.

The following picture shows the density and typical cargo for a given Lipoprotein type (or class).

LP Density Wiki

A couple of Observations: LDL has more Cholesterol in general compared to HDL and VLDL and Chylomicron has the highest amount of Fat (Tri-glyceride). In general, as the density keeps increasing, there is less Fat carried by the Lipoprotein and more protein carried by the Lipoprotein (from wiki)

How does a Lipoprotein look like?

The below picture shows a typical Lipoprotein in case you are interested.

lipoprotein2

How is Cholesterol measured or How do I read my Lipid Profile or Cholesterol test results?

As mentioned earlier, Cholesterol is measured by breaking open the Lipoproteins and measuring the underlying Cholesterol. Despite the number of tests performed and the amount of medication prescribed based on the tests, the most used Lipid Profile test uses a degree of estimation and approximation in identifying Cholesterol levels associated with various Lipoproteins. Not all Cholesterol is measured. Only some components are measured.

So, normally

TC = HDL + LDL + IDL + VLDL + Chylomicron + a couple of other Cholesterol types

Assumption 1: IDL and Chylomicron are negligible. So they are set to 0.

TC  = HDL + LDL + VLDL

Assumption 2: Cholesterol in VLDL is approximately 20% (or 1/5th) of Total Triglycerides (TG)

TC = HDL + LDL + (TG/5)

In the test TC and TG are measured and based on the results LDL is calculated.

LDL = TC – HDL – (TG/5)

That’s how your Cholesterol levels are calculated.

An example,

TC = 220  HDL = 50 and TG = 180

LDL = 220 – 50 – 36 (180/5)

LDL = 134

Actually, Cholesterol is measured in 2 different units – milli-mole / litre (mmol/l) in UK / Europe etc. and milligram / deci-litre (mg/dl) in US, India etc. The above equation is for calculations based on mg/dl.

The equivalent calculation for mmol/l is TC = HDL + LDL + (TG/2.17)

The normal Lipid test is simple, practical and relatively in-expensive. The only thing needed is a 12-hr fast and works well in most cases.

But it has been proven to be incorrect in individuals who are highly “Insulin Resistant” and have extremely high or extremely low TGs.

Pls go to Part 2

 

Cholesterol is Bad. Isn’t it ? – Part 2

Please go to Part 1 of the post if you have not already read it.

How does Cholesterol cause Heart Disease or Stroke?

There is a lot of history as to how the official line came to be the above mentioned, but it is way too much digression for us. Based on a few different pieces of research the following has been hypothesised.

The so-called “Diet Heart Hypothesis  or “The Cholesterol Hypothesis” is (as well articulated by Malcolm Kendrick):

“If you eat too much food containing cholesterol and/or saturated fat, the level of cholesterol in your blood will rise. The excess cholesterol will be deposited in artery walls, causing them to thicken and narrow. In time this will block blood supply to the heart (and other organs) causing a heart attack, or stroke.”

For the purposes of this Blog, we will use the term CVD (Cardio-Vascular Disease) to refer to heart attack and stroke.

So, if we split this into two parts

  1. Does an increased consumption of Saturated Fat result in increased heart disease?
  2. Does an increased level of Cholesterol create a greater CVD risk?

Saturated Fat and Heart Disease

The original premise that increased saturated fat causes heart disease was based on a famous study known as the “Seven Countries Study”  (initially 6) by Ancel Keys. The following picture shows the logic from Ancel Keys.

ancel keys 6 countries study

But it appears that Mr. Keys has been selective and a bit dis-ingenuous. He only selected countries that seem to fit his pre-conceived conclusions. If the study was extended to all the countries it will look like this:

22-country-graph

The data is all over the place.

Malcolm kendrick looked at some more countries in detail and this is what he has put together and the following conclusions can be drawn

Countries with the highest saturated consumption has the lowest mortality rate and vice-versa.

kendrick - highsatfatcountries kendrick - lowsatfatcountries

There is still a raging argument around this between CPs and CSs but the tide seems to be turning towards CSs.

There are many more examples but the point has been made, I think.

Does eating more fat reduce the risk of heart disease. I don’t think so. If you have not changed other aspects of Diet and Lifestyle much then perhaps not – at least not significantly.

There are perhaps good reasons why the above graphs look the way they are and this may have nothing to do with saturated fat. It could be due to lower consumption of processed foods and sugars or something else like stress etc.

continued in part 3

 

 

Cholesterol is Bad. Isn’t it ? – Part 3

Please go to Part 1 of the post if you have not already read it.

So what is the relationship between Cholesterol and Cardio-Vascular Diseases (CVD)?

Part 2 of the Diet-Heart Hypothesis is that increased Cholesterol levels CAUSE heart disease.

The following picture is from a huge medical study and shows the relationship between Cholesterol on one side and a) deaths from all causes and b) deaths from CVD on another side.

MRFIT Total Chol vs All Cause Mortality

Per the above picture, the relationship is not as linear as it is made to be. It is more an “U” shaped relationship with the ideal (if there such a thing) Cholesterol level to be approx 210 mg/dl or 5.5 mmol/l. If you have too much Cholesterol or too little Cholesterol then the risk is higher.

Most of you will agree that what matters is whether you live or die and not bothered about what underlying causes your death.

The above picture though shows Stats for Men in one trial.

Another study (a Norwegian one  published in 2012 and based on 52,000 people) has the following Stats:

hunt study smoking vs cholesterol

I have highlighted some of the data in the above picture.

For people in this study who are not smokers and who do not have High Blood pressure the risk of death is greater if your Cholesterol levels are lower than 5.5 compared to levels greater than 5.5. Smoking and High Blood pressure increase the risk of death generally and we will talk about them later. In men of age less than 59 there is a small increase in risk if your Cholesterol levels are greater than 5.5 (green areas highlighted).

The following are actual quotations from the Norwegian study (emphasis is mine):

Our study provides an updated epidemiological indication of possible errors
in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

In this validation study of current guidelines for CVD prevention, which is based on new epidemiological data from a large and representative Norwegian population, we found total cholesterol to be an overestimated risk factor.

Our results contradict the guidelines’ well-established demarcation line (5 mmol L-1) between ‘good’ and ‘too high’ levels of cholesterol. They also contradict the popularized idea of a positive, linear relationship between cholesterol and fatal disease. Guideline-based advice regarding CVD prevention may thus be outdated and misleading, particularly regarding many women who have cholesterol levels in the range of 5–7 mmol L-1 and are currently encouraged to take better care of their health.

At least in some settings, cholesterol may represent a risk marker and/or a weak risk factor rather than an important one.

Many individuals who could otherwise call themselves healthy struggle conscientiously to push their cholesterol under the presumed ‘danger’ limit (i.e. the recommended cut-off point of 5 mmol L-1), coached by health personnel, personal trainers and caring family members. Massive commercial interests are linked to drugs and other remedies marketed for this purpose. It is therefore of immediate and wide interest to find out whether our results are generalizable to other populations

WHO Data

Another piece of Data – this time WHO data showing the relationship between Cholesterol and mortality for males and females

who all male and chol

255121_WHOdatafemales

The correlation coefficient is poor and in general you can say with a reduced confidence that Cholesterol levels are inversely proportional to CVD death.

While interpreting these graphs you need to know the profile of the underlying subjects – age, gender, smoking habits, medication, blood sugar levels, previous cardiac disease occurrence,  inflammation indicators etc, otherwise we can easily draw incorrect conclusions.

UK has relatively the lowest level of TC (on average) in Europe but one of the highest rates of Heart Disease in Europe.

So if Total Cholesterol (TC) levels do not tell us anything, what about LDL and HDL?

A little background here. A number of you would have read that LDL Cholesterol is BAD and HDL Cholesterol is GOOD.

This was based on the following assumptions:

  1. LDL (Bad Cholesterol) carries Cholesterol from Liver etc. to the tissues and if there is more LDL in the blood, it is more likely to get deposited in the arteries (and thereby causing Plaque) and hence more likely to cause Heart Disease. So LDL transports Cholesterol (called CT for Cholesterol Transport) from Liver
  2. HDL (Good Cholesterol ) carries Cholesterol from tissues to Liver – thereby removing Cholesterol from the Blood and hence is beneficial leading to lower Heart Disease risk. HDL transports Cholesterol in the reverse manner (called RCT –  Reverse Cholesterol Transport)

This model is now thought to be out-dated and the latest research indicates that LDL also undertakes significant Reverse Cholesterol Transport.

But let us examine the above two assertions. If higher levels of LDL were to cause Heart Disease then we should expect higher LDL levels in Heart Disease patients on average. The target LDL level being advocated now is an LDL of less than 100 mg/dl (or approx < 2.5 mmol/l) and this is tough target. Some still use approx 130 mg/dl as the target.

The following picture contains analysis of actual hospital admissions and the Cholesterol levels (courtesy Dr. Peter Attia). Please read the accompanying text and this has been shown in a number of other studies.

HALF THE PATIENTS HAD LDL levels less than TARGET and HALF ABOVE (with a target of 100 mg/dl) and if we use a Target of 130 mg/dl, then almost 75% had less than this level. So if a lower level of LDL is protective then half the patients should not be in the hospital.

LDL-C-in-CAD-hospitalizations-645x312

What about HDL (Good Cholesterol) then?

The same study shown above also documented the HDL levels. A good HDL level is supposed to be 60 mg/dl (approx 1.5 mmol/l).

HDL Levels Hospitalisation CAD

Almost 90% had less than the Target level of 60 mg/dl. So perhaps HDL can better predict the CVD risk.

Now that we have discussed LDL and HDL let us also consider the following example (and the fallacy of using Total Cholesterol levels and Heart Disease risk)

Day 1: A gentleman has the following Lipid Profile

TC = 190 LDL = 110 HDL = 30 TG = 250 ( TC = LDL + HDL + TG/5)

The above are considered “Very Good” according to official standards.

Let us say that the gentleman works very hard and increases his Good Cholesterol (because his Doctor said so) to 80 for example and everything else remains the same.

His TC is now  110 + 80 + 50 (250/5) = 240.

He will be considered at High Risk given the TC level but the only thing he has done is increase Good Cholesterol !! He may even be prescribed statins if TC is used as the measure.

What is the latest on Cholesterol Research?

There is some recent research that shows that the AMOUNT of LDL cholesterol does not matter but the LDL PARTICLE Number and SIZE matter much more.

LDL Particle Number is abbreviated as LDL-P and LDL Cholesterol amount is known as LDL-C.This is based on the thinking that small, dense LDL particles are much more harmful (atherogenic) compared to big, fluffy LDL particles of lesser density because the smaller size and the larger number causes more of them to be deposited in the artery wall leading to Plaque, Rupture,  Clot and Heart Attack.

    1. It is very much possible in some instances that even if your LDL Cholesterol amount (LDL-C) decreases you are at a greater risk because your LDL particle Number (LDL-P) has gone up.
    2. Conversely, it is very much possible that your LDL Cholesterol amount increases but you are at a lesser  risk because your LDL particle Number (LDL-P) has gone down.

The following diagram (courtesy Dr. Peter Attia) shows relative risks associated with LDL-P given a particular amount of LDL-C. The X Axis shows the particle size.

This shows 2 graphs in one – 1) for people NOT suffering from Metabolic syndrome and 2) for people suffering from Metabolic syndrome.

It is very evident from the picture below that for a given LDL amount, the risks are very much higher for people with metabolic syndrome because the LDL particle size is much greater on average.

Microsoft PowerPoint - ADA Otvos LDL size talk_modified.ppt [Com

The next picture shows the cumulative incidence or occurrence of CVD events in 3 different groups.

MESA-LDL-P-vs-LDL-C-3-groups-645x481

The above picture shows that the highest incidence is in people with the largest LDL-P (particle number and also the smallest size) and the LOWEST LDL amount and the lowest incidence is in people with the smallest or lowest LDL-P but the highest LDL-C (amount).

This is also perhaps a reason why the LDL-C goes up a little when you eat a lot of Saturated Fat but LDL-P goes down. To this extent, if the LDL-C increase is around 10%-15% but with LDL-P decreasing (and TGs decreasing and HDL increasing) then there may not be a lot to worry about – this could happen due to dietary changes.

We will talk more about the metabolic syndrome in the near future but it is generally characterised by high glucose (and insulin levels), high TGs, large waist size, high Blood Pressure, Insulin Resistance etc.

So what are better predictors of CVD risk?

I personally think (based on the current available information) the following will predict the risk better than LDL or TC:

  1. Tri-glycerides (TG)
  2. HDL
  3. LDL Particle Number and Size

Of the data I have seen there seems to be an inverse relationship, in general, between the above two i.e. people who have very high TGs seem to have a low HDL.

The following are good (and tough) targets:

HDL ( > 60 mg/dl or > 1.5 mmol/l)

TGs ( < 90 mg/dl or < 1 mmol/l)

Low LDL Particle number and size

Unfortunately, estimating LDL-P reliably is an expensive process and not available to all. The most reliable method currently available involves nuclear magnetic resonance spectroscopy, or NMR for short.

I have also seen that the level of TGs increase (and HDLs decrease) a lot in people who have

  1. High Blood glucose levels
  2. High Insulin levels
  3. Insulin Resistance

It is also quite likely that these people have a lot of fat around their waist/hip/thighs and also eat a Carb rich (particularly sugary, processed and refined food based) Diet.

If you can achieve the above targets then the TC and LDL do not matter much, I think.

So if I have a High Cholesterol level it does not matter, is it?

Not entirely.

  1. If you are woman with no history of Heart Disease then it is quite likely that your TCs does not matter – certainly if you are above 50-55 years of age. Also if your blood sugars, insulin levels and TGs are low and HDL is high, then you perhaps have little to worry about TC.
  2. If you are a man and above 50  and with no history of Heart Disease again it appears that TCs do not matter as much. Also if your blood sugars, insulin levels and TGs are low and HDL is high, then you perhaps have little to worry about TC.
  3. But if you are a man and less than 50 years of age and your TCs are high, it does indicate that there is some underlying problem and you better be cautious. Whatever is causing the Cx levels to go high might also be causing some other damage elsewhere. Aim to get your HDL high (> 60 mg/dl) and TGs low (< 90 mg/dl). You may also consider medication while sorting out your Diet and Lifestyle.
  4. If you have already had a Heart Attack, you need to watch your Cholesterol levels not so much because they cause a problem but they are sort of saying something wrong is going in the body

 

continued in part 4

 

Cholesterol is Bad. Isn’t it ? – Part 4

Please go to Part 1 of the post if you have not already read it.

Managing Cholesterol Levels

How can I increase my HDL then?

Drugs companies have been trying for a number of years to manufacture drugs that elevate or increase HDL levels. They have been able to manufacture drugs that can achieve this but in most of the clinical trials more people taking these drugs died compared to ones not taking the drugs. In fact, the HDL levels have increased significantly but without much benefit.

So it appears that artificially increasing HDL levels cannot do the trick. I guess these drugs have not been able to mimic what naturally happens in the body.

The best way to increase HDL is through a healthy Diet and Lifestyle.

My doctor prescribed Statins for me because I have a high Cholesterol. What are Statins?

Statins are a class of drugs which inhibit the production of an enzyme used in the production of Cholesterol. By inhibiting the process the TC and LDL levels are reduced in a complicated way. I think that’s about as much as we need to know.

There is not much controversy around the Cholesterol reducing effect of Statins.

So Statins save lives by reducing Cholesterol. Is that correct?

Not exactly. Apart from reducing Cholesterol levels, Statins also reduce what is known as Inflammation (this has been proven by measuring the level of inflammation marker(s) before and after taking Statins). It is thought that some of the beneficial effects of Statins are due to the reduction in inflammation rather than their ability to lower Cholesterol.

Should I take Statins?

Statins are one of the biggest selling drugs of all time with close to a 100 million people taking Statins across the world. Statins have made the Pharma companies close to 300 billion dollars in total, according to some research.

As soon as your Cholesterol levels are above 200 or LDL above 100-130, your GP may be ready to prescribe a Statin for you. I urge you to discuss the need for taking Statins and advise caution particularly if you have not already had a Heart Attack.

Statins are known to have a number of side effects most notably – muscle damage, polyneuropathy, liver damage, cancers etc. and you need to weigh the risks and benefits before you go onto Statins.

However, there is one group that is definitely likely to benefit from Statins – people who have already had Heart Disease.

For other people who have higher Cholesterol levels(but no prior history of Heart Disease), some people believe that Statins are over-prescribed though the Pharma companies and doctors would always encourage you to take Statins. The risks might outweigh the benefits. Also remember that if your Cholesterol levels go too low your risk of death could go higher.

This is what Wiki has to say (an extract):

“Research has found that statins are most effective for treating cardiovascular disease (secondary prevention), with questionable benefit in those without previous CVD but with elevated cholesterol levels.Statins have rare but severe adverse effects, particularly muscle damage, and some doctors believe they are over prescribed”.

A popular media article in the Daily Mail below

Benefits of statins are exaggerated and not always the best way to prevent heart disease, study claims

 You can also read the following BBC articles

‘Unintended’ statin side-effect risks uncovered

 Q&A: The debate over statins

So, if not Cholesterol hat causes Heart Disease and Stroke (CVD)?

There are several theories and I don’t think there is the last word on this yet. But a number of aspects seem to be converging to say that “Inflammation” is perhaps key to CVD.(remember that Statins lower inflammation apart from lowering Cholesterol levels)

A slight digression: Most of the Statins are going to go out of patent soon. This will result in a huge drop in revenues for the Big Pharma since Generic versions are coming along. Given that the Cholesterol bandwagon has had its day (and made enough money and will no longer make money for Big Pharma), I can see that the messages will start moving away from Cholesterol onto other things like Inflammation. This will enable the Big Pharma to tinker with the existing drugs a little and apply for a new patent or introduce a new drug soon and make a few more billions.

So what causes Inflammation?

This will be the subject of a future post but a brief overview below:

  1. Smoking
  2. Excessive alcohol consumption
  3. Sugars and Fructose
  4. High-Glycemic Foods (Processed, Refined Carbs etc.)
  5. Highly Refined Vegetable Oils
  6. Trans Fats or Hydrogenated products
  7. Stress Levels

Hope you enjoyed the post..

 

Why we get FAT?

Why we get Fat?

If this is your first visit to the blog, please go to Introduction or Index of All Posts.

In this post, we will discuss the following topics related to “Why we get Fat” actually?

  1. Role of Fat
  2. Types of Fat
  3. Measuring Body Fat
  4. Factors that affect Fat metabolism (e.g. Gender, Age etc.)
  5. Metabolism of Fat (or what happens when we eat/drink)
  6. Role of Stress in Fat metabolism
  7. What can be done to reduce fat deposition

For the purposes of this blog – a Fat is the same as a “Fatty Acid” (remember Omega-3 fatty acids and fish oil !!)

1. Role of Fat

  1. A certain amount of Body Fat is essential. Typically an average male contains approx 15-20% of Fat and an average female contains between 20-25% of Fat. Assuming a body weight of 80 kgs that is approximately 15 kgs of Fat. The essential fat for men is approx. 5% and for women is approx. 10%. So, to be sure, you cannot have zero fat without harming yourselves
  2. Fat is stored energy and is a more efficient (and condensed) form of energy storage compared to Glucose (or Glycogen). 1 gm of Fat has approx 9 calories and 1 gm of Glucose yields closer to 4 calories
  3. Fat also helps to provide insulation as well as padding (to prevent shock and injury)

2. Types of Fat

There are many types of Fat depending on the context we use. Let us look at a few..

2.1 In the Human Body

In the Human body, there are two types of fat – 1) Sub-cutaneous and 2) Visceral

Sub-cutaneous (beneath the skin : This is considered to be harmless generally. Mostly for insulation purposes.

Visceral – Packed between organs mostly in the abdomen. Too much of this is considered to be harmful. The focus of the blog will be on Visceral fat.

Note: Most of the human Fat is white. There is something known as “Brown Fat” which is present in mammals – mostly newborns and hibernating animals. We will ignore this for now.

2.2 In Nature

In general fats in nature occur in 3 forms – Saturated (supposed to the bad one), Poly-unsaturated and Mono-unsaturated (supposed to be the good ones). (For the record I don’t agree with this good and bad categorisation).

In Saturated Fats the carbons are fully “saturated” with Hydrogen atoms. There is no room for any more Hydrogen atoms generally and has the maximum number of Hydrogen atoms bonded. Most of animal fats and milk products belong to this category as well as tropical oils like Coconut oil, palm oil etc. They are also mostly made up of Tri-glycerides (we will come to this soon)

In Unsaturated fats, there are some double bonds which means there is room for some more Hydrogen atoms than that are already present. Foods containing unsaturated fats include Olive oil, Avocado, Nuts etc. Some part of meat is also made up of unsaturated fats.

2.3 Trans Fats and Hydrogenated Fats

Fats that are available in nature generally (not always) have the bonds on the same side (called “cis”). Trans Fats on the other hand have bonds that are on the opposite side. Typically these are created by taking oils and blasting Hydrogen at extremely high speed. This process solidifies the oils which increases their trans-portability and storage. It also makes it easy to apply on bread (an olive spread is definitely more convenient compared to applying olive oil in liquid form on a slice of bread !!!). So this is done mostly for commercial reasons.

Examples of Trans Fats (and partially hydrogenated oils) are margarine, most of the spreads, Vanaspati (Dalda) etc.

Avoid Trans Fats and Hydrogenated oils like the plague. They are very harmful !!

3. How do we measure Fat in the body

There are many ways of measuring body fat. In descending order of their accuracy they are as follows:

  • DEXA scan: Based on x-ray absorptiometry. Very accurate. Expensive and not for common use.
  • Weighing in Water: Very accurate measurement that is based on submerging the person in a customised water tank. Expensive, Impractical and not for normal or regular use
  • Calipers: Measuring skin folds at multiple points on the body. Slightly awkward and somewhat accurate
  • Special weighing scales or bathroom scales with fat measurement capability: These are based on the electrical resistance. Unreliable and are dependent on hydration levels etc.
  •  Lastly the “Anthropometric” method based on a few tape measurements and standard parameters. Very crude and approximate. But the easiest of the lot.

Pls visit this link which has a Body Fat calculator used by US Navy

http://www.scientificpsychic.com/fitness/diet.html

There is a helpful table at the bottom showing the categories and the levels.

Most of all, the easiest way is to just be conscious of your trousers and belts. If you need an extra hole in the belt (on the wrong side) then perhaps things are not going too well. Also if you need to buy the next higher size trousers it does not bode too well either. But if you are dropping trouser sizes and moving into the inner holes on the belt then you perhaps are doing well.

Bottom line: If you are a man try to stay around 12 – 17% or so and if you are a woman try staying around 25% if you want to be healthy and fit.

4. Factors that affect Fat Metabolism

The following factors seem to be affect the fat metabolism in general.

  • Gender
  • Age
  • Food and Drink consumed
  • Stress Levels
  • Sepcialised Exercise (not regular aerobic exercise for 30 mins a day)

4.1 Gender

In general women tend to have more fat (as a proportion – not absolute weight) than men – on average. 25% of fat in women is not uncommon or unhealthy whereas the same level could potentially be deemed unhealthy in men.

I am not sure why this is the case but there are suggestions that this could be evolutionary (for the sake of the babies etc.). But that does not seem correct since there is a tendency to put on more fat in women after menopause.

Also Fat is stored mostly around the waist and hip for men but mostly around the thighs and buttocks in women.

4.2 Age

Again there is a general tendency to be fatty as one ages – both across men and women. Several explanations are out there but the most likely one could be related to Insulin Resistance.

4.3 Food and Drink consumed

Part 3 of the post will deal with this.

4.4 Stress Levels

There are some suggestions that increased stress levels resulting in increased Cortisol and Adrenaline hormone production interfere with the general metabolism and fat metabolism (by impacting insulin levels). Certainly there is some evidence that increased stress levels cause Cardio-vascular diseases.

4.5 Exercise

As discussed in the previous post, regular aerobic exercise for 30 mins a day is unlikely to make a huge impact on either weight or fat levels. But specialised exercise regimes loosely called “High Intensity Interval Training” (HIIT) are supposed to increase insulin sensitivity thereby impacting fat metabolism. I intend to write a detailed post later but for now you can look at the following links if you are interested.

http://greatist.com/fitness/interval-training-complete-guide/ 

http://en.wikipedia.org/wiki/High-intensity_interval_training

Continued in Why we get Fat – Part 2

 

Why we get FAT? – Part 2

If you have not read Part 1, please go there first.

This part will provide a general overview of what happens before and after we consume food or drink. The format of this post is more Q&A style covering a number of common questions and myths.

The digestion and assimilation of food in humans is a wide ranging and complex topic and I am no expert in this area. I will focus on the aspects that are relevant for our discussion and keep it at a high level.

Some basics first

  1. Various tissues and organs in the human body need energy on a continuous basis to  execute their functions (heart, lungs, brain etc.). The common denominator or currency for energy is ATP
  2. The most abundant form of energy supply in the body is in the form of Glucose which is supplied by the Blood to the tissues and organs (also commonly called Blood Sugar)
  3. In general, humans consume three categories of food items (called “macro-nutrients”) – Carbohydrates, Fat and Protein. (Vitamins and minerals are “micro-nutrients”)
  4. Glucose is a form of Carbohydrate and when we eat food containing easily digestible  Carbohydrates (sugars, white flour etc.) this gets converted into Glucose in the blood relatively quickly
  5. Body can convert Fat and Protein into energy as well but some organs like brain have a strong preference for Glucose

How is energy stored in the body?

There can only be limited amount of energy available in the blood circulation as the body tends to maintain the glucose levels in the blood in a reasonably narrow range. Too much sugar in the blood has a lot of side effects and hence glucose levels are maintained tightly in the blood and this is ensured by Insulin. As soon as there is glucose in the blood (after food intake), Insulin (a hormone) gets secreted at a higher level.

Insulin is secreted in the Pancreas in very small quantities but it is extremely potent and can potentially overpower many other hormones. Insulin has many functions but its primary role is energy storage. It is a storage hormone.

There are two forms of (energy) storage in the body just like in a PC – a limited but quick form (like a RAM in a PC) called Glycogen and a larger, more permanent form (like a hard disk in a PC) called Fat (also called Adipose Tissue).

Once the blood sugar levels go beyond a range, Insulin will start to provide the Glucose to the liver and the muscle to store it in the form of Glycogen (think of Glycogen as an aggregated form (technically it is a polysaccharide (many sugar molecules clubbed together) of Glucose and water). There can only a limited amount of Glycogen in the body (approx 100 to 200 ml or so in Liver and perhaps 200-300 ml in other parts – mostly muscle).

If there is still lot of Glucose in the blood even after providing Glycogen, then Insulin will start pumping this into Fat cells and it is stored as Fat (these two processes may happen simultaneously and not necessarily sequentially). The level of Insulin (which is determined by the level of Blood glucose in a healthy adult) determines how much fat is stored.

More Blood glucose means more Insulin means more Fat. This is a fundamental point to be remembered.

Because the Glucose is a) getting used by the body b) being stored as Glycogen and c) getting stored as fat, naturally the Blood glucose level falls to the normal range a few hours after a meal, by which time the Insulin level falls down (in a healthy adult) (because there is nothing much for the Insulin to do any longer).

How does the body run when the Blood Glucose levels continue to fall down?

As we have seen earlier, body would like to maintain a constant supply of energy (within a range). When the blood glucose levels fall down a certain level (due to consumption of energy by the tissues which will reduce the amount of glucose in the blood), Liver will provide energy from the Glycogen reserves and fats from Fat tissue will start to be broken down into free fatty acids which go into the cells and are then broken down to provide energy.

Crucially, it appears that supply of energy from Glycogen (the temporary, quick storage) and Fats (the more permanent storage) can only occur if the Insulin levels are very low. So to break down the Fat in the body, we need to keep Insulin levels low which implies keeping blood sugars low (there is a role for protein and we will discuss that later in this post).

When and why do I feel hungry?

When blood sugar come down to a lower level and Glycogen stores starts to get depleted, hunger signals are generated in the body and some special hormones (particularly one called “Ghrelin”) gets produced. The job of Ghrelin is to make you hungry so that you can go around looking for food.

The processes related to energy supply and hunger seem to work differently at day than at night and that is why we don’t go looking for food in the middle of the night even though our last meal was more than 5-6 hours ago. We seem to do that during the day. The hormonal cycle may behave differently at night. It it also the case that energy consumption is low at night but this does not fully explain being without food for 12 hours or so.

When do I stop consuming food?

Another hormone called “Leptin” gets produced in the body when we start eating food and the level of Leptin slowly rises. Leptin receptors in the brain start monitoring the level of Leptin and once it reaches a certain level, a signal of Satiety (fullness) is apparently sent which makes you stop eating. (It is speculated that Leptin signals are sent quickly if you consume a food rich in fats and proteins as compared to Carbs meaning fullness is reached quicker with fatty foods or meats/dairy products etc.)

As a slight anecdote, people have run medical trials where the participants have been asked to only eat Fat and Protein but can eat as much as they like. Apparently many of them struggled to eat more than 2,500 to 3,000 calories because they felt full relatively easily.

So, the body ensures that there are strong checks and balances and controls so that the processes work in a reasonably tight range and most of the time they do work properly.

Can you please run the sequence of events past me again?

  1. Your blood glucose levels are running low
  2. Body produces Ghrelin (and perhaps others) which makes you hungry
  3. You go looking for food and start eating (let’s say it is mostly Carbs)
  4. Insulin secretion starts
  5. While there is Insulin in the blood, liver will stop providing Glycogen and break-down of Fats for energy stops (this happens for a good reason – the logic goes like this – why break down energy reserves in the body when we are getting additional supply of energy by means of food)
  6. When there is sufficient food, Leptin signals that you had enough. You stop eating.
  7. Carbs are digested and enter the circulation as glucose.
  8. Blood sugar levels increase
  9. More insulin is secreted
  10. Glycogen stores are topped up
  11. Blood glucose and Fats in the Diet are pumped into the Fat Cells by Insulin
  12. The levels of Fat increase
  13. Over a period of time, the blood sugar levels go down and Insulin levels go down
  14. Body will then starts releasing Glycogen and Fat for energy
  15. Once Glycogen stores go low and blood sugars go low you will feel hungry
  16. The cycle starts again

The picture below (courtesy: stargazey) shows how energy is supplied to the body after a meal (or glucose in this instance) (Gluconeogenesis below refers to body’s way of generating glucose from various sources)

Gluconeogenesis--Time Course

If the Carb levels are high, the blood sugar levels are high which means Insulin is high which means fat storage is very high.

This all sounds normal, so what is the problem?

If the blood sugar levels are high only temporarily or once in a while that’s correct. Also if you are young you may be able to cope.

If your blood sugar levels continue to be chronically high (over a long period), then Pancreas will try to respond by secreting more and more Insulin. Initially the tissues and liver respond fine, but over a period of time higher Insulin levels no longer produce the desired effect and blood sugar levels continue to stay high. The response would be more Insulin from Pancreas. There reaches a point when the additional Insulin is not able to reduce the Glucose levels in blood sufficiently. This is called “Insulin Resistance”. This is the first stage for what is known as Metabolic Syndrome or Syndrome X – in layman’s terms this is pre-diabetes.

What is wrong with having high blood sugar levels?

The pre-diabetic condition with high blood sugar levels start harming the body in a number of ways and is meant to precipitate High Blood pressure, Stroke, Heart Disease, Cancer as well diseases related to Kidneys, Eyes, Diabetic Neuropathy (leading to amuptations) etc. Diabetes is known as a Silent killer. It will start damaging a number of organs of the body.

Also high blood sugar levels are meant to promote Inflammation (we will discuss this later in another post) which is responsible for the blockages of arteries etc. It is also well known that cancerous tissues need a lot of sugar to grow (and cancer is out of control or abnormal growth of cells) and there is one theory that higher blood sugar levels make things worse for caner (whether some cancers are caused by the high sugars in the blood is a topic of controversy).

Higher blood sugar levels generate a lot of products in the body which are harmful – examples like AGE (Advanced Glycation End products etc.)

Sometimes I don’t stop eating when I should. Why?

As discussed earlier, the signal to stop eating comes from Leptin (amongst other things). It appears that when we eat a meal containing sugars and Carbs, body produces fatty components called Tri-glycerides (we will discuss more about this in the next post about Cholesterol but Tri-glycerides are the form of fat in our body – mostly). If the Tri-glycerides are produced in the normal range then it seems to be ok, but if the Tri-glyceride levels are very high they seem to interfere with the Leptin signalling and the brain does not respond in  time for us to stop eating. This inability of Leptin to generate the “Stop Eating” signal is known as “Leptin Resistance”. Apparently “Leptin Resistance” is also common when you consume a lot of fruit juices, sugary drinks (like Coke – even if it is Diet Coke etc.) i.e. too much Fructose or Sugar.

So, once again – try to stay away from anything that tastes SWEET as much as possible no matter it is Diet or low-cal or Fruit based.

Will only Carbohydrates and Sugars raise Insulin levels?

Not really. Insulin also helps break down protein and to that extent Insulin is secreted when you eat Protein. The only macro-nutrient that does not generate a decent Insulin response is Dietary Fat (Fat in the meats, Dairy products like cheese, Eggs, Fish, Oils, Butter etc.)

So in a sense the worst combination of food (after a food containing only Carbs/Sugars) for someone who is Insulin Resistant would be a diet containing Carbs and Protein only with no Fat (e.g. Lamb Biryani or Chicken Fried Rice)

It appears that Dietary Fat moderates the Insulin response.

But I was told that you have to eat Carbs for energy. Is that not correct?

As discussed earlier in the post, human body is smart enough to convert any of the macro-nutrients (Carbs, Fat or Protein) into energy. Theoretically, you do not have to eat Carbs to live and you certainly do not have to eat a single gram of sugar in your entire life to live normally.

On a practical level, some Carbs (for taste, variety, practicality, availability etc.) are perhaps needed. But the average consumption of Carbs is at the high end for most people these days.

I feel hungry or crave for sugars (chocs etc.) 3 or 4 hours after a normal meal. Why?

I guess it depends on the word “normal”. If by normal you mean 200-300 gms of Carbs/Sugars and some Protein and Fat, then that is not “normal” according to my definition.

If you eat a lot of rice or a significant amount of bread (as sandwiches etc.) then your blood sugars go high. Body responds by producing a large amount of Insulin and most of the Glucose is pumped into fat and sufficient amount of Glycogen is not produced. So after 3 or 4 hours your body is starving for energy. In the normal course, the fat is released as fatty acids and all is fine but if the Insulin levels are high (because you may be Insulin Resistant) then fat does not get released. So you will be in this ironic state when your muscles and tissues do not get enough energy (water, water everywhere but not much to drink) and you will feel tired and fatigued.

So I regularly see people in my office raiding the vending machine between 3 and 4 pm.

You can easily try this out. Do this on 2 separate days and make a note (mentally or on paper).

Day 1 – Have your lunch with just Carbs and Sugars (cakes, juices, chocolates etc.). Make a note of how you feel 3 to 5 hours after a meal (I guarantee you will feel hungry despite the amount of food and energy intake)

Day 2 – Eat mostly Fatty foods and protein with very little Carbs (less than 20 gms). See how you feel 3 to 5 hours (I bet that you would still feel heavy in your stomach and not hungry).

If you want to know some technical detail, there is something known as “Reactive Hypoglycemia” (Hypo is low). This means “low blood sugar”.  Pls see the picture below

GTT

 

This shows the Glucose levels for different types of conditions. The normal level is between 4.5 and 5.5. You can see that under two of the conditions (Prediabetic and Hypoglycemic) the blood sugar rises rapidly (but not as much as in a diabetic) and then undershoots and goes below the normal level. This is why you feel cravings and tiredness.

What about Alchohol?

Alcohol works slightly differently. It is mostly metabolised by the liver and to that extent any excessive alcohol intake has the potential to do harm to the liver. Also each gram of Alcohol has approximately 4 calories. Together with a heavy load of Fructose (either via sugars or sugary drinks or too much fruit) the load on the liver could be considerable. Please pay attention to what you are eating/drinking while taking alcohol.

I read that – once I put on Fat, the Fat cells do not grow smaller?

Previous research indicated that a given person is born with a certain number of fat cells and the only thing that changes is the size of each cell. Current research seem to cast doubt on it, but it does seem likely that some message is passed on down to the babies when they are in the mother’s womb. There are a lot of studies out there that indicate that babies born of Fat mothers and Insulin Resistant mothers tend to be fatter in the long run. This is supposed to be caused by the high blood sugar levels in the mother during pregnancy.

Also, contrary to popular belief, Fat is not something which just goes and sits in the Fat cells. It is not inert. Fat tissue is metabolically active. Fat keeps moving IN and OUT of the Fat tissue continuously.

continued in part 3

Why do we get FAT? – Part 3

If you have not read Part 1, please go there first

So what should I do to keep my Fat levels low?

Reduce the intake of foods (and drinks) that raise the blood glucose levels quickly and to a high level.

How do I do that?

Thankfully, research has been done around this and people have a way of measuring the ability of a given food item to raise the blood sugar levels quickly. This is called “Glycemic Index”.

Glycemic Index – Definition

“The Glycemic Index is a numerical Index that ranks carbohydrates based on their rate of glycemic response (i.e. their conversion to glucose within the human body). Glycemic Index uses a scale of 0 to 100, with higher values given to foods that cause the most rapid rise in blood sugar. Pure glucose serves as a reference point, and is given a Glycemic Index (GI) of 100.”

The picture below shows the response to High GI and Low GI foods

gi_graph

The following picture shows a sample of foods and their GI value.

Common_GI

 So eat foods that have a low GI (less than 30-40) whenever possible.

Health warning: Though GI is a step in the right direction, unfortunately it does not consider the effect of Fructose. It only considers Glucose. So GI will understate its value for foods that contain Sugar or artificial sweeteners like High Fructose Corn Syrup. So use GI only for things that do not taste SWEET. (In any case, apart from a small amount of fresh fruit, I don’t advice you to eat anything that tastes SWEET!).

FYI – Table sugar contains one-half Glucose and one-half Fructose. Most of the sweetness in fruits is due to Fructose.

Also GI does not consider normal portion sizes fully into account. So another measure called “Glycemic Load” is available. This takes both the GI and the portion size.

You can read more about this at the links below:

http://www.mendosa.com/gilists.htm

 

http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm

Ideally the Glycemic Load (GL) should be less than 10.

What specific Dietary advice should I follow?

I was originally meaning to provide the dietary advice and goals towards the end of the Blog. But quite a few folks have already asked me to tell them “what to do”. My belief was that Diets tend to fail in the medium to long term if you do not understand the context and the reasons why various things happen.

Anyway, here you go. I provide a high-level Dietary advice (will follow-up with a detailed post later) below.

Health-warning: If you are already on diabetic (or other) medication, severe changes to your dietary regime may have considerable impact on the dosage of medication you take. Please consult your medical adviser before implementing any drastic changes to your diet.

There is always a tendency to see results quickly and hence try to overdo the Diet or the Exercise regime.

My advice would be to slot the changes slowly (as the body needs to adjust to your new regime).

  1. Cut down most or all sugars (excepting some fresh fruit) – no juices, cokes (diets or otherwise), cakes, sweets, chocolates etc. – essentially anything that tastes SWEET should be OUT.

Over a period of time, eliminate SWEET foods and Sugar in your drinks. There is really no need to SUGAR to live a healthy life. In fact, if you have too much of it in your blood you have a serious problem.

Also, if you are already Insulin Resistant or Diabetic – cut down on Dried fruits, Bananas, Melons etc.

Goals

Short term: Cut down your sugar from all your food items to less than 1 kilo / month

Medium term: Cut down your sugar from all your food items to less than 0.5 kilo / month

Long term: Eliminate all forms of sugar but enjoy the occasional dessert.

2. Cut down consumption of rice, pasta, pizza and any WHITE flour based stuff by 60-80%.

Perhaps a small helping of brown or wild rice if you feel like eating rice and 1 or  2 chappatis. Unless you already do so – eat much more sides and curries (essentially eat low Glycemic Load (GL) / Glycemic Index (GI) foods – but beware that GI does not account for Fructose).

Most cereals or useless (very few cereals are decent – perhaps “All Bran” flakes).

Goals

Short term: Cut down your non-sugar Carb intake to less than 300 gms a day

Medium term: Cut down your non-sugar Carb intake to less than 200 gms a day

Long term: Maintain your non-sugar Carb intake at 100-200 gms a day

Where possible, eat Whole-meal, Wild rice, brown bread etc. (by the way, a lot of whole meal and whole grain stuff is not really great – perhaps slightly better than White).

3. Eat as much of fish, eggs, meat, milk products as you like

Increase the quantity if you don’t eat enough. Some people have a slight issue with milk products in which case eat them in moderate amounts. Try eating Oily Fish every week if you can.

4. Eat a good amount of Nuts and Seeds (assuming you have no NUT allergy)

There is a world of Nuts out there ! – Pecan, Hazel, Walnut, Brazil, Peanut even Pista and Cashews.

Some people have problem digesting Nuts in which case you can do two things – reduce the quantity or slightly roast them in an oven or a pan.

5. Eat as much Vegetables and greens (and sprouted seeds) as possible

Either as salads or in the soups or steamed or sauteed etc. Again there is plenty of choice out there. But try to limit consumption of starchy vegetables like potatoes, parsnips etc. Sprouted seeds is a fantastic choice of food. You can actually sprout peanuts, almonds apart from beans and lentils.

6. Plenty of water

7. Moderate amount of Alcohol (red wine?) but if you do not drink at all that is even better

8. Try to undertake some Stress reduction activities

– Play a game you enjoy, walk, perhaps pick-up a hobby

– Do meditation or practice slow and deep breathing techniques

9. Exercise specifically designed to reduce Insulin Resistance (like HIIT etc.)

Before I finish, there is one more aspect of Diet I would like to Opine on. I am thin ground here and what I state here is my personal preference.

10. There is a theory in some circles that Inflammation (which causes heart disease, many of the arthritic conditions etc.) is caused by high levels of Omega-6 Fatty acids (w-6). Omega-6 is beneficial in low quantities but is harmful in high quantities. It is thought that the ideal Omega-6 to Omega-3 ratio is between 1:1 to 3:1. Most modern diets contain Omega-6 and Omega-3 in the ratio of between 10:1 and 15:1. There is a lot of Omega-6 in refined vegetable oils (cooking oils) like Sunflower oil, Corn oil, Soya oil.

There is also another suggestion that things become worse if you raise the temperature of the oils to a very high level (to or beyond the so called smoking point).

Like white flour and sugar, processed vegetable oils have been stripped of most of their nutritional value. Natural oils contain vitamins, minerals and other nutritional factors that help the body process the fat. The process of extracting the oils destroys this nutritive value. Processed oils are usually extracted using heat, then degummed (a process which removes phospholipids like lecithin and minerals like iron, copper, calcium and magnesium). They are usually partially hydrogenated, a process which involves adding hydrogen to the oil in the presence of nickel. They are deodorised etc. In essence, so many things are done to the REFINED oils that hardly any of the good stuff is left.

So my preference is to reduce the consumption of refined cooking oils (and certainly deep frying) as much as possible. This means that a lot of snacks (crisps, batter fried snacks, flour based Indian snacks) are out.

You can steam the vegetables, use water as the base or Grill or Sautee the meat or vegetables or even better – use ghee or butter as the base. Trust me on this one. A small amount of ghee or butter is better than refined cooking oils. Where you need to use oils, use only a small amount and where possible buy UNREFINED, COLD PRESSED oils and cook on low temperatures. They may look and dark murky but they are better (not everything that looks nice is necessarily always good in life !).

You should target reducing the consumption of oil to less than 0.5 kg per person per month or even lower.

If I have to replace Carbs, should I eat more Fat or Protein?

In general, the Protein and Fat intake should be higher for most of us given the current levels and Carb levels much lower. But if the choice comes down either eating a much higher amount of Protein or Fat, my personal preference is to lean towards more Fat than more Protein. As we have seen earlier, Protein also produces Insulin and some researchers believe that consistently high amount of protein over a long period has some unwanted side effects. If you are not doing a lot of muscle building exercise (or running marathons etc.) and eat a lot of protein there is perhaps a case to say that in the long run it may have unwanted side effects. (I have to point out that this has not been proven in short term studies).

Summary

Remember, Dietary Fat does NOT make you Fat if you can keep Insulin levels low. It’s the Carbs and Sugar that make you Fat by keeping your blood Glucose levels high which will keep your Insulin levels high thereby depositing more Fat (made out of Glucose mostly).

The next post is Cholesterol is Bad. Isn’t it?.

 

Calories IN = Calories OUT. Is it? – Part 3

Please read Part 1 of the post first before starting here.

I quote a few examples in real life and lab studies to provide additional reading and evidence related to the observations and statements in Parts 1 and 2.

1. Growing Children

It is well known that Children start eating quite a bit during their peak growth period. Assuming their diet is balanced, Children will grow in height, will have longer/stronger bones and also put on muscle. All that eating is to support the growth (which is kicked into gear by the growth hormones) – Vertical growth (height) and not horizontal growth.

If someone says that Children overeat and that is why they grow that does not sound right. Children grow that is why they Overeat.

As soon as the growth period is over, the additional eating stops generally. This also supports our assumption.

2. Hibernating Animals

A number of animals go into Hibernation during seasons (typically winter). Prior to the start of the season, animals overeat and they also put on a lot of fat.

Once the season starts they go into hibernation during which the metabolic rate plummets, temperature drops significantly, blood pressure and heart rate become slow (all of this essentially to reduce the consumption of energy thereby saving energy).

All these indicators are consistent with our observations earlier (if you under-eat significantly – in effect you will create a mini-hibernating condition – your body thinks food is scarce and starts shutting down or reducing the function of parts of the body).

(On a slightly different note – not all animals put on fat under the skin – it depends on where they live. A polar bear puts on fat under the skin – insulation – this protects it from the cold weather as well as providing energy. But a Camel lives in hot deserts and if it puts fat under the skin it will have a problem with heat – hence the fat in a camel is in the hump. There are some animals which do so in their tails – fat-tailed animals. It is all wonderfully sorted out by Evolution!!)

3. Pregnant Women

We all know that Pregnant Women eat quite a bit and also put on both Fat and Weight. Going by conventional logic, we could say that pregnant women are getting Fat because they are Overeating.

We know better. They are Overeating because they are getting Fat. Again this is mostly due to hormones and for a very good reason. The fat is to provide nourishment to the mother and the child and also to cushion the baby’s weight (that is why the fat is mostly around the thighs and buttocks I was told).

Once the child is born the Overeating stops and the mother generally returns to her previous size (assuming a balanced meal) over a period of time.

So in essence the hormones create the condition for Overeating by pumping a lot of energy into fat for the sake of the mother and child. Not the other way around.

(A slight digression: It is very well known to the medical researchers that women are less prone to heart disease prior to their menopause (leading to a gradual decrease in Oestrogen production) – so women are cardio-protected. The researchers (well intentioned) thought this was due to hormones and have actually prescribed HRT (Hormone Replacement Therapy) to a number of women in the past and this has had disastrous results. HRT is now strongly recommended against for protection from Heart Disease for women).

Summary

In essence, the regulation of fat metabolism in humans is complex, has evolved over millions of years and tries to do the right thing at the right time in the right amounts. It is only when it gets chronically challenged does it go out of balance.

4. Zucker Rats

Perhaps the best examples to state that the Weight / Fat problem is related to Hormones and Not Overeating or Laziness (or being sedentary) are a set of wonderful experiments done with a special category of rats bred for research in Obesity and Hypertension by a researcher called George Wade et al in University of Massachussets in the 1970s. (Just to note that not all experiments that have been successful on rats have not had the same result in humans).

Part 1

Wade and team have removed Ovaries from rats and then monitored their subsequent weight and behaviour.

  • The rats began to eat voraciously and quickly became Obese (the rats have been given as much food as they wanted to eat – called “Ad Libitum” in medical terms)

Part 2

Wade then did a second experiment. He removed the Ovaries but then restricted the amount of food the rats can eat.

  • But the rats got just as fat as quickly. But these rats are now completely lazy. They moved only when necessary.

Removing the Ovaries stopped the production of Estrogen in these rats (in both experiments) and estrogen (a hormone) has a role to play in fat storage (more about this later but for now understand that less estrogen means more fat).

Part 3

Estrogen was infused into the rats.

  • The rats did not become fat or did not overeat and moved normally even if unlimited food was made available to them.

This Zucker Rat experiments should make it very clear that it is most likely the Hormones that are playing a part in Obesity and Fat Metabolism not Overeating and Laziness.

Remember,

“You Overeat because you are putting on Fat not getting Fat because you are Overeating”

There are many important hormones but we will be talking about four hormones in particular in the next post – Insulin, Leptin, Ghrelin and Lipoprotein Lipase (LPL) and also about the science of Fat metabolism.

The next post will be “Why do we actually get Fat?”

 

Calories IN = Calories OUT. Is it? – Part 2

If this is your first visit to the Blog please go to Introduction.

Go to Part 1 of this post if you have not already read it.

1. Energy Consumed (or Intake of Food / Drink)

One of the ways proposed to lose weight is to reduce the total calories consumed (let us assume the composition of Diet does not change) – so essentially eat less food/drink.

If you eat the typical diet (High Carbohydrates, Low Fat, Low to Moderate Protein) but cut down the calories quite a bit, you are unlikely to lose significant weight in the long run. This has been proven in a number of studies. (I myself have given up breakfast for a good 18 months in order to cut down my calories and it made practically no difference to my weight).

There are many studies to prove this. Some of the studies used calorie intake as low as 600 or 1000 Cals. There is an initial weight loss which is regained in an year or two. Also this level of intake was not sustainable for a long term and once the medical trial is over study subjects (or participants) ate much more than they used to eat prior to the study and regained the weight. They sort made up for the lack of food in during the trial.

Body adjusts (lowers) the base metabolic rate and also there is less energy available for  exercise / work if the intake is less than what is needed. In some studies, the body also cannibalised the muscle and tissue if the calorie intake is drastically reduced. So EM (Energy for Metabolism) and EE (Energy available for Exercise) will get reduced if EC (Energy Consumed) is too low. This is the dependency that kicks in and so EE and EC are not as independent as we think and this not considered by people quoting Calories IN => Calories OUT or the laws of thermodynamics.

(As quoted by Gary Taubes) In 2007, Jeffrey Flier, dean of Harvard Medical published (along with his wife) an article in Scientific American called “What Fuels Fat”. In it they quote

“An animal whose food is suddenly restricted tends to reduce its energy expenditure both by being less active and by slowing energy in cells, thereby limiting weight loss. It also experiences increased hunger so that once the restriction ends, it will eat more than its prior norm until the earlier weight is attained.”

If your calorie intake is much less than is needed for a normal human being, all that happens is

  1. You will feel hungry
  2. You will feel irritable and cold (most or all the time)
  3. You will stop being active (not much exercise or exertion)
  4. You will perhaps lose muscle mass

I am sure many of you have experienced this personally 1,2 and 3 if not 4 above.

(Note: There is a particular form of a diet called “Calorie Restriction” which is in vogue. People who have adopted this swear by it and many have lost weight and maintained it. Their blood pressure reduced significantly. But their diet composition also has changed significantly and they also apparently feel cold and perhaps are less active than they were in the past. I will discuss in a future post about diets and comparison of diets.).

In summary, drastically reducing calorie intake is not going to solve the weight problem. You are likely to feel miserable and also may not be able to focus on your job or domestic life.

2. Exercise

What about Exercise? Everyone universally seem to believe that the more Exercise one does the more Weight one loses. The official guidelines are 5 days a week 30 mins a day of aerobic exercise aka treadmill or cross trainer or brisk walking.

Let us look at this in some detail:

A normal aerobic workout of 30 mins for a typical person will burn approximately 250 calories or so. That is the same amount of calories in one single Mars bar or 2 slices of large white bread. If you work out and feel tired or thought you are entitled to an additional helping of pasta or bread or rice or have a pudding or chocolate bar you pretty much have negated all the work done as part of the exercise. It is known that Exercise works your appetite and makes you hungry to some extent.

There have been many studies and trials undertaken to look at the impact of Exercise on weight. In most instances, the effects of exercise on Weight loss were small or marginal in the long term (2 years or more).

Read the following articles..

New York Times

http://well.blogs.nytimes.com/2012/08/01/dieting-vs-exercise-for-weight-loss/

An extract from the article

” And in a just world, frequent physical activity should make us slim. But repeated studies have shown that many people who begin an exercise program lose little or no weight. Some gain”

Another analysis

Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis.

http://www.ncbi.nlm.nih.gov/pubmed/22681398

Latest article posted in Wall Street Journal (27/Nov/2012)

“New Studies on Older Endurance Athletes Suggest the Fittest Reap Few Health Benefits”

http://online.wsj.com/article/SB10001424127887323330604578145462264024472.html?mod=ITP_pageone_7

An extract from the article:

” A fast-emerging body of scientific evidence points to a conclusion that’s unsettling, to say the least, for a lot of older athletes: Running can take a toll on the heart that essentially eliminates the benefits of exercise.

“Running too fast, too far and for too many years may speed one’s progress toward the finish line of life,” concludes an editorial to be published next month in the British journal Heart.

What the new research suggests is that the benefits of running may come to a hard stop later in life. In a study involving 52,600 people followed for three decades, the runners in the group had a 19% lower death rate than nonrunners, according to the Heart editorial. But among the running cohort, those who ran a lot—more than 20 to 25 miles a week—lost that mortality advantage.”

Don’t get me wrong. There are a host of benefits of exercise and I exercise regularly (makes you feel better, has cognitive benefits, improves insulin sensitivity, reduces triglycerides , helps recover from injury quicker, increases flexibility, stamina and strength etc.). And I strongly encourage you to exercise regularly (but do the right type of exercise and for the right amount of time) but if your intention is solely weight loss and if you undertake regular aerobic exercise for 30 mins a day, it is unlikely to help significantly in the long run.

Note: There are some special forms of exercise (called HIIT  – High Intensity Interval Training) which are now being advocated for decreasing insulin resistance etc. which in turn should help reduce waistline, triglycerides etc. They will be covered in a future post.

 3. Base Metabolic Rate

Another oft quoted reason is that exercise will build muscle which will increase the base metabolic rate.

Pls see the following article in NY Times about increasing the metabolism

http://www.nytimes.com/ref/health/healthguide/esn-exercise-ess.html

Quote from the article

“Jack Wilmore, an exercise physiologist at Texas A & M University, calculated that the average amount of muscle that men gained after a serious 12-week weight-lifting program was 2 kilograms, or 4.4 pounds. That added muscle would increase the metabolic rate by only 24 calories a day”

To be sure, 24 calories translate to less than 3 gms of Fat reduction a day, if at all.

The amount of muscle that will be built for normal aerobic exercise is much less and hence the amount of energy burnt due to the normal exercise either due to a) increase muscle or b) general increase in metabolism is almost insignificant.

Summary

  1. If you eat too few Calories, you will feel hungry and cold and perhaps will lose muscle
  2. Doing regular 30-min exercise solely for the purpose of weight loss is unlikely to work
  3. The increase in metabolism rate due to normal aerobic exercise or otherwise is too small to make a difference to your weight
  4. How much you eat is also dependent on how much you are converting to fat

So, what’s going on then:

The current thinking is that Obesity is perhaps most likely related to improper regulation of Fat metabolism which is mostly due to a problem with hormones. And the problems with hormones mostly are related to diet (and perhaps inter-related to genetic factors to some extent, stress, sleep etc.) but more fundamentally because of issues with our diet.

If our Diet is fine, then the hormones work in balance, the fat metabolism is regulated properly and we will tend not to put on too much weight.

So remember

You do not get Fact because you Overeat. You Overeat because you are getting fat.

For those of you not convinced by the Post read on. I will try to give some examples in real life as well as some lab studies that have been undertaken. These are interesting examples and I urge you to read on..

Go to Part 3

 

 

Calories IN => Calories OUT. Is it?

Calories IN => Calories OUT

If this is your first visit to the Blog, please go to Introduction or visit the Index of All Posts .

We have seen in the previous post that Obesity is sky-rocketing but at the same time a lot of the people seem to be (on average in the US)

  1. Eating more fruit and veg
  2. Doing more exercise
  3. Eating less saturated fat
  4. Eating less red meat and more lean meat
  5. Eating less butter but more cooking and salad oils

Given that some (if not all the people) are following the official guidelines or doctor’s advice, it is surprising that the prescription does not seem to be working.

This post will examine the common notion that you need to spend all the calories you take in and that Obesity is generally caused because of Overeating and lack of Physical Activity. The aim of this post is to challenge existing notions and beliefs around this thinking..

Quite a few folks invoke the laws of thermodynamics to diet, exercise and weight loss. It is true but not in the sense that is normally understood. Human body is too complex  to apply the laws of thermodynamics on a simplistic basis.

I have used Gary Taubes’s notes here. Credit to Gary for helping me change my thinking around dieting and weight loss.

So to repeat once again, we have been told all along (and I bet most of us will believe this very strongly) that in general normal people put on weight because

  1. You Overeat
  2. You do NOT Exercise Enough

Stronger words have been used to describe Fat or Obese or Overweight people but we will not get into that business and you will see why. A lot of the people instinctively think of the above two reasons/factors whenever they bump into Fat or Obese or Overweight people.

Also, it is routinely assumed that if you are not spending all the Calories of Energy (taken in as Food/Drink) then you are definitely going to put on Weight to the tune of any Energy not used up.

You will see in this post that this assumption or belief or dogma is not correct and I will attempt to explain why, with some examples.

It is also highly likely that this assumption is perhaps one of the two main reasons (the other being that high fat diets are harmful (because they increase Cholesterol) and high Carb – low Fat diets are healthier) for the existing prevalence of Obesity.

Please take a look at the following slides which I have put together to provide a simple demonstration of the conventional thinking a little bit (but not too much) mathematically.

Let us look at a few examples

(I noticed a small typo in Example 2 above – it should read “2500-900-1600” = 0 and not “2500-600-1600” (will fix the original soon))

Human body is highly complex with multiple inter-dependencies between various systems and lot of this is driven primarily by various hormones – the levels of which are intricately linked. To the extent possible, the body will try to regulate the levels of hormone and the various processes in the body within a range (sometimes very tight and sometime not so tight) and it does succeed remarkably in doing so on a short term basis. The above one-way dependency is way too simplistic (that you need spend all the calories you take in and the calories you take in are independent of anything).

But if the various inputs into the system are either too high or too low (diet, exercise, stress levels, sleeping patterns, external temperature etc.) over a lengthy period of time, the hormonal regulation system can get out of whack and harm can occur to the body. This is where the Chronic aspect comes into picture.

Calories IN => Calories OUT

Regarding the above, the truth is perhaps closer to the following:

  1. Energy intake, base metabolism, energy spent on exercise and fat storage/release (the four variables used above) are dependent on one another. The level of one or more can affect the levels of the others
  2. Your base metabolism depends on how much you eat. The lower the calorie intake, the lower the metabolism (and this is proven in many studies)
  3. Regular aerobic exercise (like the 30 mins on treadmill or cross trainer) is unlikely to help lose weight in the long term (but it does seem to help in the short term)
  4. The calories you spend in working out is dependent on how much has already been stored as FAT – NOT THE OTHER WAY ROUND. This is important because most of the fat storage happens within 2-3 hours of eating food and a lot of energy gets stored as fat if you eat  a high amount of easily digestible Carbs (which will increase your blood sugar levels and insulin levels). So the energy left over after the conversion into fat would be available for exercise and if there is only little left, then you do not feel like exercising or moving about (more about this later).

If you have been Overweight or Obese I am sure you have tried to reduce your intake of food/drink, tried to exercise and still struggled to lose (and maintain the loss) in the long run. Most people are conscious of their Weight these days and it is only an exception if someone has not tried to eat less or exercise. I bet most of us can relate to this.

So, to quote Richard Wade (as explained to Gary Taubes)

“You do not become FAT because you Overeat. You Overeat because you are becoming FAT”. This makes our diet related assumptions Upside Down.

But you may not be convinced by this yet.

So, let us peel the “Calories IN => Calories OUT” onion layer by layer in Part 2 of the post.

 

 

Trends in Dietary and Social Habits – Part 2

If you have not read Part 1, pls go there first or alternatively to the Index of All Posts.

In this part 2 of the post we will discuss a few more dietary and social habits that people mention in relation to Obesity, Weight Loss and Chronic Diseases.

1. Smoking

We have already discussed this in detail in the first post.

Suggestions: Please Quit !

2. Alcohol Consumption

Again, we have discussed this in detail in the first post. The official recommendations are 3 units/day for men and 2 units/day for women and none for pregnant women.

There is some evidence to suggest that low to moderate alcohol consumption is beneficial to health but excessive consumption is harmful.

Suggestions: My personal take is that – the odd beer or spirit is fine. You should perhaps limit your intake to no more than 7-10 units a week maximum ideally – a glass of Red Wine with a meal (and not on empty stomach).

If you are drinking outside a meal, drink at-least a glass or 2 glasses of water for every unit of spirit/wine. I have recently read that alcohol gives a headache due to dehydration and loss of ions and drinking half a litre of Coconut water (rich in potassium) is meant to cure any hang-over headaches. Am trying this out..

3. Coffee

Coffee is rich in caffeine. Evidence is highly contradictory regarding the effects of coffee consumption. Whilst some studies indicate beneficial effects some others have indicated harmful effects.

In general, Coffee is well tolerated in limited doses (between 100-200 mg caffeine) by most people. Quantities of caffeine in a given cup of coffee is highly variable from shop to shop as well as perhaps the specific coffee bean and the brewing method. A recent study by Glasgow University indicated that a Starbucks coffee contained 60 mg of Caffeine, a Costa coffee approx 155 mg and some independent shops over 200 mg.

There is some evidence to suggest coffee is habit forming and can produce withdrawal symptoms.

Suggestions: Stick to 1 or 2 cups a day (totaling approx 200 mg of caffeine) if you have to drink coffee. Try to drink at different times of the day to ensure a habit is not formed. If you suffer from anxiety or sleep disorders – avoid coffee entirely.

4. Tea

There is some evidence that consumption of black tea is beneficial to health but slightly stronger evidence for Green Tea. Green tea is supposed to contain a lot of anti-oxidants and flavinoids which are protective against cancer.

Some green tea extracts (sold as supplements) contain very high levels of tea which could be toxic to liver.

Suggestions: Like coffee, 1 or 2 cups of black tea and perhaps up to 3 cups of green tea are fine. There is unlikely to be any benefit drinking green tea from tea bags. You should preferably drink green tea made out of dried tea leaves.  If you suffer from anxiety or sleep disorders – avoid black tea entirely.

 5. Stress Levels

A lot more people are talking about stress these days (more so after the start of the financial crisis). There is a general consensus that stress levels are increasing – though not proven. Stress in humans is notoriously difficult to measure and in fact there isn’t a general agreed test to the best of my knowledge.

So we are on thin ground here. This is what the “American Psychological Association (APA)” says about stress levels and its symptoms in humans (APA Survey 2004)

  • Two thirds of Americans say they are likely to seek help for stress
  • Fifty-four percent of Americans are concerned about the level of stress in their everyday lives
  • 62% of Americans say work has a significant impact on stress levels
  • A majority of workers (52%) are more stressed because of work than home
  • 54% of workers are concerned about health problems caused by stress
  • Executives and managers tend to have the most stressful jobs, while self-employed workers are the least stressed
  • 1 in four workers has taken a mental health day off from work to cope with stress
  • 73% of Americans name money as the number one factor that affects their stress leves
So, how does stress affect people? This is what the APA says
  • Adults reported that their physical and emotional symptoms due to stress increased 47% over the past year
  • 53% reported fatigue in 2008 compared to 51% in 2007
  • 60% reported feelings of irritability or anger compared to 50% in 2007
  • 52% reported lying awake at night or insomnia as a result of stress compared to 48% in 2007
  • 48% reported overeating or eating unhealthy foods to manage stress, while one in four skipped a meal in the last month because of stress.  Poor eating habits have resulted in higher rates of obesity
  • 1/5 of Americans reported drinking alcohol to manage their stress and 16% reported smoking

Suggestions: There may be a lot of medication and psychiatric counselling help out there.  Meditation and related techniques and Breathing techniques often perceived as helping reduce stress levels. There is also some evidence to support this. The types of techniques most often mentioned are – a) Mindfulness meditation b) Transcendental meditation and c) Tai Chi and the breathing technique most often mentioned is a Yoga breathing technique called “Pranayama”.

More about these in a later post…

All good things to people who wait!! 

6. Herbs and Supplements

The nutritional supplements industry in the US is worth approximately USD 28 billion in 2010. In the UK it is approximately USD 1 billion.

The most popular supplements are :

  1. Vitamin D
  2. Omega 3 Fish oil
  3. Multi-vitamins
  4. Single Vitamin supplements
  5. Glucosamine and Chondroitin and surprisingly
  6. CoQ 10 (Co Enzyme Q10)
The Supplements and Complementary and Alternative medicine industry swear by the benefits of supplements and the Mainstream health and pharmaceutical industry keeps coming out with research that disproves the benefits of supplements.

The latest research disproves the claimed benefits of Omega 3 Fish oil and Glucosamine/Chondroitin supplements.

Laboratory research proving the efficacy of supplements is rarely replicated in real life commercial products (efficacy gets lost because of preparation methods, packaging and storing). Also most natural ingredients when extracted and provided in a pill form are unlikely to provide the same amount of benefit.

Observations and Suggestions:

  1. Assuming you are taking a balanced diet (by definition this will involve eating animal products – because purely vegetarian diets cannot provide all the nutritional elements) it is unlikely you need supplements
  2. If you are a vegetarian, you are likely to need B vitamin supplements – particularly B12
  3. If you are born closer to the equator but live in the higher latitudes currently, you are likely to need a Vitamin D supplement – at least in Winter
  4. A multi-vitamin supplement every so often might be ok but the risks involved in using them long term are not known (at least I don’t know)
  5. As for as other supplements are concerned, it is entirely up to you

Note: A lot of supplements (particularly herbs) interact (some severely) with normal medication and other supplements/herbs. So please keep your doctor informed of any herbs/supplements you are taking and read the literature online to assess the risks.

7. Miscellaneous

A number of other factors are mentioned in relation to Obesity and NCDs as follows:

  1. Divorce rates and Single parent families
  2. Use of Mobile devices
  3. Mass network media
  4. Pollution – Air, Food etc.

Keeping in mind the spirit of the Blog, I will not deal with the above in this Blog.

The next post will deal with the famous quote “Calories IN = Calories OUT”. Watch out for some surprises ..

Next Post – Calories IN = Calories OUT. Is It?

 

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