Abdominal Fat Strongest Indication of Health Risks

Researchers writing in the medical journal Obesity, say that waist measurement is one of the most useful indicators of health risk.

Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist Circumference Correlates with Metabolic Syndrome Indicators Better Than Percentage Fat.

From the article abstract
OBJECTIVE: Percent fat is often considered the reference for establishing the magnitude of adipose tissue accumulation and the risk of excess adiposity. However, the increasing recognition of a strong link between central adiposity and metabolic disturbances led us to test whether waist circumference (WC) is more highly correlated with metabolic syndrome components than percent fat and other related anthropometric measures such as BMI. (Body Mass Index)

Waist circumference had the strongest associations with health risk indicators, followed by BMI. Although percent fat is a useful measure of overall adiposity, health risks are best represented by the simply measured WC.

Obesity and Decreased Hormone Production

Researchers writing in the medical journal Clinical Endocrinology say that “Obesity may predict greater decline in testosterone and SHBG levels with age.”

Derby CA, Zilber S, Brambilla D, Morales KH, McKinlay JB. Body mass index, waist circumference and waist to hip ratio and change in sex steroid hormones: the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf). 2006 Jul 1;65(1):125-31.

From the study abstract:
Objective Cross-sectional data suggest that obesity, particularly central obesity, may be associated with decreased production of sex steroid hormones in men. However, longitudinal hormone data on men in relation to obesity status are limited. Previous studies have not consistently demonstrated whether sex steroids are associated specifically to body mass index or to measures of central obesity.

Our objective was to examine the relation of obesity and of central obesity to longitudinal change in sex steroid hormones in men.

Measurements Free and total testosterone (FT and TT), dehydroepiandrosterone sulphate (DHEAS), and sex hormone-binding globulin (SHBG) were assessed using standardized methods. Health behaviours and medical history were obtained by structured interview.

Repeated measures regression was used to describe trends in steroid hormones and SHBG in relation to obesity status, adjusting for age, smoking, alcohol, comorbidities, and physical activity.

Results: Obesity was associated with decreased levels of total and free testosterone, and of SHBG at follow-up relative to baseline. For any given baseline concentration of TT, FT or SHBG, follow-up levels were lowest among men who remained obese or who became obese during follow-up.

This was true for all three indices of obesity. Central adiposity was associated with lower DHEAS levels at follow-up, while elevated body mass index was not.

Conclusions: Obesity may predict greater decline in testosterone and SHBG levels with age. Central adiposity may be a more important predictor of decline in DHEAS than is body mass index.

Low Gylcemic Index Foods for Weight Loss and Diabetes

Researchers writing in The Diabetes Educator say that incorporating more low-glycemic foods helped individuals with weight control and diabetes.

From the abstract:
“PURPOSE: This retrospective study evaluated the incorporation of low-glycemic index (GI) carbohydrates into daily meal planning as an effective behavioral lifestyle change to improve glycemic control and weight management in patients with type 1 and 2 diabetes.

CONCLUSIONS: Daily incorporation of low-GI carbohydrates in meal planning can be an effective diabetes self-management strategy for glycemic control and weight management. The documented responses to the subjects’ conceptual and practical knowledge of the GI confirm their acceptance of this approach as a permanent behavioral lifestyle change and not a “diet.” The positive results of this study attest to what worked for these subjects, inviting diabetes educators to consider offering low-GI dietary advice to their diabetes patients.”

Read the abstract
Burani J, Longo PJ. Low–Glycemic Index Carbohydrates. An Effective Behavioral Change for Glycemic Control and Weight Management in Patients With Type 1 and 2 Diabetes. The Diabetes Educator, Vol. 32, No. 1, 78-88 (2006)

Waist Size and Health Risks in 50-95 Year Olds

Researchers writing in the medical journal Diabetes Care say that while overall body fat and fitness levels are important in predicting health risks, it is your waist size or the measurement of abdominal obesity that is the still the measurement to assess health risk among older adults.

Racette SB, Evans EM, Weiss EP, Hagberg JM, Holloszy JO. Abdominal Adiposity Is a Stronger Predictor of Insulin Resistance Than Fitness Among 50–95 Year Olds. Diabetes Care 29:673-678, 2006

Excerpts From the study abstract
OBJECTIVE—Physical inactivity and increased adiposity contribute to insulin resistance; less is known, however, about the relative contributions of these factors in older adults. The aim of this study was to determine whether cardiovascular fitness, whole-body adiposity, or abdominal adiposity is the strongest predictor of insulin resistance into old age.

CONCLUSIONS—Adiposity and fitness continue to be significant predictors of insulin sensitivity into old age, with abdominal obesity being the most important single factor. These findings support the measurement of waist circumference to assess health risk among older adults.

Exercise Induced and Calorie Reduction Weight Loss

Researchers writing in the Journal of Applied Physiology say that caloric restriction (dieting) can lower extremity muscle size and strength. While weight loss due to exercise does not.

Weiss EP, Racette SB, Villareal DT, Fontana L, Steger-May K, Schechtman KB, Klein S, Ehsani AA, Holloszy JO; Lower extremity muscle size and strength and aerobic capacity decrease with caloric restriction but not with exercise-induced weight loss. J Appl Physiol. 2007 Feb;102(2):634-40. Epub 2006 Nov 9

Weight Loss Blog

Weight Gain and Thyroid
Estimates say that by age 50, 10% of women will be hypothyroid (not producing enough thyroid hormone) and by age 60 that number can nearly double.

You won’t need a scientific study to know that once over the age of 50, maintaining proper body weight becomes more difficult. When a person become hypothyroid staying trim and fit becomes nearly impossible.

The Evil Cycle of Weight Gain and Hypothyroidism
The Thyroid is a master gland participating and controlling the function of all the major body organs. When thyroid hormone is not produced in sufficient quantities to regulate our energy levels (hypothyroidism), our metabolism slows down to a crawl. This has the following weight gain effect.

1. Even on reduced calorie diets, your metabolism will not burn enough calories and you will retain weight.

2. A slow down in metabolism means a drop in energy and the inability to exercise or lead a sufficiently active life to stay trim.

3. Another consequence of hypothyroidism is constipation, accumulated fecal matter accounts for significant pounds.

4. Let’s add water retention for that bloated feeling.

Diagnosis of hypothyroidism
Hypothyroidism is not easily diagnosed by physicians because the symptoms are that which are routinely attributed to old age, that is the loss of energy, weight gain, etc. A “Thyroid Panel,” measuring TSH, T3, and T4 levels should be part of a basic blood chemistry panel in everyone over 30 so this “old age issue,” may be treated.

Beyond the blood test
Sometimes a suspected Thyroid problem can show “normal blood tests” it is important for the women and the doctor who suspect that thyroid is a problem to look for the following besides those symptoms, weight gain, depression, thinning or losing hair mentioned above.

Especially significant are
* memory and mood disorders
* cold sensitivity
* and menstrual problems

Even after you are put on thyroid supplementation, it is important to monitor these symptoms and your general overall health so that you can guide your physician and together your thyroid the type and amount of thyroid supplementation can be altered to help you be the best you can.

Caloric Restriction
Although the term calorie-restriction may cause some of us to recoil in fear, or scoff that the idea is even possible, the practice could make a big dent in our our rising disease states.

For many, calorie restriction brings to mind a state of starvation, yet, new research, published in the Journal of the American Medical Association, shows that even cutting back a little, has big rewards for many longevity markers. The study demonstrated that fasting insulin levels, body temperature, DNA damage, and metabolism (a free radical generator) were lowered in all the groups on calorie restriction. This was the first study to illustrate lessened DNA damage with calorie restriction.

Below are the different calorie restrictions, the last bullet point being the most extreme case.
-Comparison group: No changes in daily calories
-Calorie restriction group: Calories cut by 25%
-Calorie restriction plus exercise group: Calories cut by 12.5%, calories burned in exercise raised by 12.5%
-Very low calorie group: Calories cut to 890 daily calories until 15% of body weight was lost, followed by a weight-maintenance diet.

The study showed that any calorie restrictive diet, stressing foods densely packed with vitamins and antioxidants, could ultimately lead to better longevity predictors and weight loss. Although, all four groups lost weight, the groups on a type of calorie restrictive program had the most success. Below is each group’s average percentage of weight lost during the six-month study:
-Comparison group: 1%
-Calorie restriction group: 10%
-Calorie restriction plus exercise group: 10%
-Very low calorie group: 14%

A twenty-five percent calorie restriction daily, or 12.5 calorie restriction with 12.5 calories burned through exercise, is not a big sacrifice when the rewards of longevity and weight loss are possible.

Menopause and Obesity
After menopause, many women notice that their muscle-to-fat ratio tilts in favor of the latter and the battle of the bulge is increasingly difficult. All the hormones, especially estradiol and testosterone, can help tip the scale back in the right direction.

Estradiol, increases fat breakdown from body fat stores so that it can be used as fuel and increases basal metabolic rate, while testosterone has been shown to maintain muscle tone, volume, and strength, increase metabolism, and decrease body fat. In a 2000 study, featured in Menopause, estrogen supplementation had effects on body fat distribution in postmenopausal women that was associated with improved lipid parameters.

The Journal of Clinical Endocrinology and Metabolism reported that obese women given low doses of testosterone lost more body fat and subcutaneous abdominal fat, and gained more muscle mass than women who were placed on a placebo.

In a 2006 study, researchers writing in the medical journal Diabetes, Obesity & Metabolism found “HRT reduces abdominal obesity, insulin resistance, new-onset diabetes, lipids, blood pressure, adhesion molecules and procoagulant factors in women without diabetes and reduced insulin resistance and fasting glucose in women with diabetes.”

Women are not alone in the hormonal decline department. Men also experience a falling off of hormone levels. In my practice, I have found that most men over forty suffer from low levels of testosterone, a condition called andropause, or male menopause. Testosterone decline may be linked to many age-related symptoms like muscle weakness, bone loss, memory complications, weight gain and heart disease. As far as quality of life is concerned, in the absence of normal-to-high levels of testosterone, men suffer from mood swings, fatigue, and libido dysfunction

Not everyone will benefit from hormone supplementation. The goals, realities, and risks of hormone supplementation should be discussed, at length, with your physician prior to onset of treatment.

Why Can’t I Lose Weight?
As we get older, a lot of us don’t watch our diets, our sugar burning metabolism doesn’t work as well, and we don’t exercise. So there is weight gain.

You need to exercise to lose weight
When we exercise we raise the adrenal in the body, which lowers the insulin in our body. When insulin levels are up, insulin as a “storage hormone” prevents us from burning fat. Since we don’t exercise as much, we don’t build muscle, we don’t burn fat, and we do the wrong things nutritionally to get rid of the fat.

Drop the insulin levels
Good nutrition is getting the insulin down. I do a simple diet; protein, vegetables and water, nuts, and avocados. Fatty vegetables will help you lose weight. Stay away from grain it’s inflammatory, stay away from dairy products we don’t digest them.

Stay away from fruit
When someone is trying to lose a lot of weight or manage their diabetes we tell them to stay away from fruit. Fruit makes insulin levels rise.

Insulin also makes you age
Our bodies release insulin into our blood stream so that we can process glucose from food to make energy, especially in our muscles. Glucose belongs in our cells and not in our blood. When it remains in our blood we produce more insulin. Increased insulin, according to many researchers, is the number one factor for accelerated aging.

Watch what your meat is eating
Free range meats
We have to be careful about the term “Free Range” because the term may simply mean that they are free ranging BUT eat a lot of grain, and we want these animals to stay away from grain because it is so inflammatory, these animals also eat a lot of corn which is also bad.

Your Hormones and Your Poor Diet
Poor eating habits precipitate more than just an enlarging waistline. They affect every aspect of your health, and although you may not notice it right away, your hormone levels suffer dramatically from sugary, fatty, and nutritionally deficient foods. Many of your beneficial hormones will nose-dive, while the other more dangerous hormones, like insulin, skyrocket.

Insulin Resistance Syndrome
Our bodies DO need sugar (glucose) as a fuel for our cells to perform their daily cellular functions. When we eat sugar or foods that are broken down into glucose such as high-glycemic carbohydrates, our body’s digestive process puts that glucose into the blood stream for the cells to collect and utilize. The cells rely on the pancreas to monitor the blood levels and to alert them when glucose is abundant. The pancreas does this by secreting insulin which circulates through our bodies delivering the message to the cells of glucose’s presence.

In perfect balance, when we eat carbohydrates and produce glucose, the cells use it up as energy and there is little left over.

When our cells ignore insulin and become resistant
Over the course of years as we get older, become more sedentary, and our diets become “sugar loaded,” we process more glucose than our cells can use and the excess floats around in our blood, or is turned into fat in the cells.

Insulin Resistance also increases the symptoms and/or risk factors associated with metabolic syndrome, contributing to:

1. Accumulation of body fat
2. Obesity
3. Elevated triglycerides
4. High blood pressure.
5. Acceleration of the aging process.

Diet
It is commonly accepted that eating large amounts of simple carbohydrates (pastas, breads, and sugar filled foods) could lead to Insulin Resistance, elevated cholesterol, elevated triglycerides, and obesity. For this reason, as part of our program, we recommend that our patients change to a low-glycemic index diet.

The Glycemic Index is the rate that carbohydrates break down into sugar in the blood. The best source of low-glycemic carbohydrates are vegetables. Vegetables are slow burning carbohydrates and help keep insulin levels steady.

A diet rich in vegetables, proteins, good fats in the form of omega-3, and water is optimal for a long health span.

It is important to point out that a single diet will not work for everyone. To optimize your nutritional needs you should visit with an experienced health care professional well versed in the issues of metabolic syndrome and nutrition.

Obesity as a result of stress despite low caloric intake
In our practice we see many patients with complains of fatigue, flu-like symptoms, body aches and pain, headaches, and just not feeling well. To compound this, in some, are complaints of reduced appetite, but increased abdominal fat.

Many of these patients have been to other doctors and leave with a constellation of prescriptions ranging from painkillers to anti-depressants, yet with no real answers to the source of their dilemma other than their chronic health problems are “stress-related,” and a contributing, if not primary cause, of their obesity.

Nature gave our bodies the ability to employ stress beneficially and instinctively as a weapon during the famed flight-fight syndrome. We produce hormones such as adrenaline to give ourselves sometimes “superhuman” abilities, for instance the ability to run extra fast or the ability to lift extra heavy objects.

We also produce Cortisol, the primary stress hormone, which pumps large sugar stores into the blood stream. The sugar is used as “high-octane” fuel during fight/flight. Cortisol also controls energy distribution through the use of “rolling black outs.” Temporarily shutting down the immune system and other systems it sees as non essential for “immediate survival” (This is why people who are chronically stressed seemingly always have colds)

Stress and Weight Gain
When stress, fear, or anxiety becomes chronic our bodies stay in a state of alarm, negatively impacting our physical well-being including our ability to stay well and lose weight. Cortisol, in addition to pumping sugar into the blood, has also been shown to increase fat production and storage.

Losing Weight
When we see a patient with stress and abdominal obesity, depending on the severity of each individual case, we begin the patient on a low glycemic diet. Patients have heard us refer to this as the Paleolithic Diet or the Cave Man Diet. This is a diet consisting mainly of proteins and vegetables in the beginning and slowly introducing back fruits and nuts in moderation later. This type of diet helps maintain consistent and even sugar levels in the blood, a main component of stress reduction and reduced fat production.

We do ask that patients absolutely refrain from processed sugar for obvious reasons and that they avoid dairy products, grains (breads and pasta products) as they are converted quickly into sugars in the body.

We also teach people how to meditate. Of course these are general recommendations; if you would like more information, please call our office.

Does Being Optimistic Really Lower Risk From Cardiovascular Disease in Elderly Men?

Researchers writing in the medical journal the Archives of Internal Medicine say that having an optimistic outlook, DOES lower mortality risk associated with cardiovascular disease.

Here are excerpts from the study abstract:
Background-Dispositional optimism, defined in terms of life engagement and generalized positive outcome expectancies for one’s future, may be related to lower cardiovascular mortality. We aimed to determine whether dispositional optimism is a stable trait over time and whether it is independently related to lower cardiovascular mortality in elderly men.

METHODS-In a cohort study with a follow-up of 15 years, we included 545 (61.4%) of 887 men, aged 64 to 84 years, who were free of preexisting cardiovascular disease and cancer and who had complete data on cardiovascular risk factors and sociodemographic characteristics.

RESULTS-Optimism scores significantly decreased over 15 years, but showed temporal stability.

Conclusion-Dispositional optimism is a relatively stable trait over 15 years and shows a graded and inverse association with the risk of cardiovascular death.

Giltay EJ, Kamphuis MH, Kalmijn S, Zitman FG, Kromhout D. Dispositional Optimism and the Risk of Cardiovascular Death. The Zutphen Elderly Study. Arch Intern Med. 2006;166:431-436.
Read the full abstract

Nutrition in Brain Development and Aging: Role of Essential Fatty Acids

Researchers writing in the the medical journal Nutrition Reviews say that essential fatty acids (EFAs) are increasingly seen to be of value in limiting the cognitive decline during aging.

Uauy R, Dangour AD. Nutrition in brain development and aging: role of essential fatty acids. Nutr Rev. 2006 May;64(5 Pt 2):S24-33; discussion S72-91.

From the abstract: The essential fatty acids (EFAs), particularly the n-3 long-chain polyunsaturated fatty acids (LCPs), are important for brain development during both the fetal and postnatal period.

They are also increasingly seen to be of value in limiting the cognitive decline during aging.

EFA deficiency was first shown over 75 years ago, but the more subtle effects of the n-3 fatty acids in terms of skin changes, a poor response to linoleic acid supplementation, abnormal visual function, and peripheral neuropathy were only discovered later. Both n-3 and n-6 LCPs play important roles in neuronal growth, development of synaptic processing of neural cell interaction, and expression of genes regulating cell differentiation and growth.

Aging is also associated with decreased brain levels of DHA: fish consumption is associated with decreased risk of dementia and Alzheimer’s disease, and the reported daily use of fish-oil supplements has been linked to improved cognitive function scores, but confirmation of these effects is needed.

MORE ON THIS SUBJECT
Eating Fish Slows Aging of the Brain
Study Published in the October 10, 2005 issue of the Archives of Neurology.

In brief, researchers looked at people 65 years of age and over to see if intakes of fish and omega-3 fatty acids protected against “age-related cognitive decline.”

What did they find? Quoted from the article in the Archives of Neurology:
“Dietary intake of fish was inversely associated with cognitive decline over 6 years in this older, biracial community study.

The rate of decline was reduced by 10% to 13% per year among persons who consumed 1 or more fish meals per week compared with those with less than weekly consumption.

The rate reduction is the equivalent of being 3 to 4 years younger in age.

There were no consistent associations with the omega-3 fatty acids, although the effect estimates were in the direction of slower decline.”

Green Tea and Cognitive Function

Kuriyama S, Hozawa A, Ohmori K, Shimazu T, Matsui T, Ebihara S, Awata S, Nagatomi R, Arai H, Tsuji I. Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project. American Journal of Clinical Nutrition, Vol. 83, No. 2, 355-361, February 2006

Researchers writing in the American Journal of Clinical Nutrition say that green tea consumption can improve cognitive function. The researchers measured the effects of drinking 3 cups a week, 4 to 6 cups a week, and two cups a day.

From the study abstract:
Background: “Although considerable experimental and animal evidence shows that green tea may possess potent activities of neuroprotection, neurorescue, and amyloid precursor protein processing that may lead to cognitive enhancement, no human data are available.”

Objective: “The objective was to examine the association between green tea consumption and cognitive function in humans.”

Results: “Higher consumption of green tea was associated with a lower prevalence of cognitive impairment.”

Conclusion: “A higher consumption of green tea is associated with a lower prevalence of cognitive impairment in humans.”

Eating Fish Slows Aging of the Brain

Study Published in the October 10, 2005 issue of the Archives of Neurology.
You can read the entire article here

In brief, researchers looked at people 65 years of age and over to see if intakes of fish and omega-3 fatty acids protected against “age-related cognitive decline.”

What did they find? Quoted from the article in the Archives of Neurology:
“Dietary intake of fish was inversely associated with cognitive decline over 6 years in this older, biracial community study.

The rate of decline was reduced by 10% to 13% per year among persons who consumed 1 or more fish meals per week compared with those with less than weekly consumption.

The rate reduction is the equivalent of being 3 to 4 years younger in age.

There were no consistent associations with the omega-3 fatty acids, although the effect estimates were in the direction of slower decline.”

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