Tag Archive for: fat

Metabolically Healthy and Obese

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The researchers in Germany continued to determine which factors associated with being obese were the most predictive of mortality from any cause and from cardiovascular disease. While not explicitly stated, it seems to me that they attempted to use variables that were simple to assess. With that in mind, here are the variables which demonstrated whether someone was metabolically healthy or not, regardless if they were normal weight, overweight, or obese.

Criteria for Metabolic Health

  • Systolic blood pressure less than 130 and no use of blood pressure lowering medication
  • Waist-hip ratio less than 0.95 for women and less than 1.03 for men
  • No prevalent diabetes

These criteria are simple enough for most people to determine for themselves, no doctors necessary. People usually know whether they’re diabetic, and they also know whether they’re taking medication to lower their blood pressure. Most people have a home BP cuff to assess systolic blood pressure or have access to one in a store.

The waist should be measured at its widest point and hip should be measured at the bony process of the femur. Divide the second number into the first, and that gives you the waist hip ratio.

The Results

The subjects who were considered metabolically healthy and obese had no greater risk of mortality from all causes or from cardiovascular disease then did normal weight, metabolically healthy subjects. This study examined only the death rate, not the rate of disease. Still, I think that if someone is working towards becoming a healthier version of themselves, intermediate goals can be very motivating.

I like this study for two reasons. First, it confirms what I thought for many years: people who are overweight or obese can be metabolically healthy. Second, it means that instead of trying to lose all the weight a person needs to lose, there can be intermediate steps on the way to becoming the best version of yourself; in fact, you don’t even need to be trying to lose weight to start being healthier.

The study also found that some people who were metabolically unhealthy and normal weight or slightly overweight were at higher risk for cardiovascular disease and total mortality. Could it be that the reason for the reduced risk was exercise? It was not considered, but it would be interesting to see further analysis on the data to determine if fitness was a contributing factor in metabolic health.

The Bottom Line

This study provides a basis for assessing risk of mortality on more than just BMI. What it shows is that even though you may be carrying too much weight, that doesn’t mean that you’re automatically at risk for death due to cardiovascular disease or other causes. I believe regular exercise is critical to achieve metabolic health and thus reduce your mortality risk, so that’s your first step to becoming and staying metabolically healthy.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Net Open. doi:10.1001/jamanetworkopen.2021.8505

Can You Be Obese and Healthy?

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The research question that was most interesting to me as a graduate student was this: could you be overweight, even obese, and still be healthy? That question still interests me today, and for good reason: 70% of the U.S. population is overweight or obese, and we’ve just passed 40% of the entire population falling into the obese category. And it’s not just the U.S.; we’ve exported our poor fitness and diet habits around the world.

Research done decades ago from by Cooper Institute, most often under the direction of Steven Blair, demonstrated that you could be fat and fit. Their research showed that people who were obese, meaning they had a BMI greater than or equal to 30.0, were no more at risk for death from cardiovascular disease or all-cause mortality if they were in the high fitness category.

That’s not the same question as this: could you be metabolically healthy and at no more risk for death from cardiovascular disease or all-cause mortality than someone with a normal BMI (18.5-24.9 kg/m2)? Researchers from Germany decided to examine that question. They used data collected from the National Health and Nutrition Education Survey III, which included over 12,000 subjects, and the U.K. Biobank, which contained over 374,000 subjects. Then they examined the statistical relationship between many different variables such as triglycerides, total cholesterol, hemoglobin A1C, C-reactive protein, systolic blood pressure, and on and on. Once they had a series of statistical relationships between obesity and mortality, then they sought to derive as simple an algorithm as they could to develop a profile of someone who would be metabolically healthy and obese. I’ll tell you more about that in Saturday’s memo.

Meanwhile, have you examined that map that was part of the CDC atrial fibrillation primer? Here’s what I saw: I’ll call it the I-75 Corridor of A-fib. Starting in Flint, MI, if you follow the pattern of the deepest red, it follows I-75 through Detroit to Toledo, OH, then Cincinnati, OH, and all the way down through Georgia to Florida. That’s the I-75 Corridor of A-Fib. What does it mean? Nothing, as far as I know; it doesn’t correspond to race or income or temperature. It’s an observation, nothing more, but maybe some epidemiologist or statistician somewhere will look into in more deeply.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Net Open. doi:10.1001/jamanetworkopen.2021.8505

Review: That Sugar Film

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Summer gives us a chance catch to up on reading or binge watch a television series, so I thought I’d watch some of the nutrition documentaries that I’ve been asked about. I’ve done some in the past such as Forks Over Knives. It gives me a chance to check the facts on what’s said and how true or relevant it is. That’s the case with the film titled That Sugar Film. It was written, directed, and starred in by an Australian filmmaker Damon Gambeau. Hugh Jackson even performed the opening scene.

The premise of the movie is that all sugar is bad. There was at least one anti-sugar and ketogenic diet proponent in Gary Taubes author of Good Calories, Bad Calories. The filmmaker also assembled a team of experts who were going to provide information and medical supervision during an experiment he wanted to conduct on himself. The experiment was to see how a high-sugar diet, one typical of the average Australian, would impact him. Based on what he claimed to eat, he was somewhere between the paleo diet and the ketogenic diet before that.

There was the requisite discussion of the cholesterol hypothesis and how fat was chosen as the demon to avoid instead of sugar as they relate to heart disease. The sugar industry conspiracy was also talked about in the same vein as the tobacco industry. But it’s what he did to himself that was by far the most interesting: switching to a diet that contained 40 teaspoons of sugar a day for 60 days. What happened to him? That’s coming on Thursday.

What are you prepared to do today?

        Dr. Chet

The Bottom Line on Human Fat as Medicine

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The final question in our look at human fat is whether there are actual benefits to the use of human fat for human health. Human fat is primarily long-chain saturated fatty acids; we’re animals and that’s the type of fat animals make. There are some hormones present in fat tissue and probably other factors related to blood vessel growth, but there were no proven benefits for the use of human fat for anything related to human health 400 or 500 years ago.

Why not? Science had not yet begun to use research techniques to assess the benefits. I sometimes criticize randomized clinical trials and the way they’re conducted, but even with its faults, research is necessary to assess whether benefits exist for any chemical. At its core, that’s what human fat is: simply a chemical.

Could there be unknown benefits? We’ll most likely never know for two reasons. First, no Human Subjects Committee would approve the research for the use of human fat for research. The legal and scientific quandaries of using fat from some humans on other humans are mind-bending.

Second, even if some benefits could be proven, there’s the issue of collection. We do not dispose or treat corpses in the same way we did 500 years ago. Where would the human fat come from? Just the thought would be disturbing to many people.

The Bottom Line

The historical look at human fat as medicine illustrates why the scientific process is important and irreplaceable, flawed though it may be. It’s a slow process and can be frustrating, especially as it relates to nutrition. In today’s “get a product to market first” climate, we end up with too many nutritional products in a marketplace with little to no science behind them. That will be our topic for next week’s Memos.

What are you prepared to do today?

        Dr. Chet

Reference: Christopher Forth PhD. 2019. Fat: A Cultural History of the Stuff of Life.

The Benefits of Human Fat

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Imagine that you woke up this morning with lower back pain; that’s not unusual for many people. You make it to your bathroom, pull out your nicely painted apothecary jar of human fat, and rub some into the painful areas. Or you have arthritis and you rub the human fat into your knees. No way, you say? Not if you lived in Europe in the 1600s. Human fat was thought to be able to heal and repair the body.

Not only that, it was thought it was able to heal wounds and promote the growth of connective tissue. How did they come to the idea that fat could help these conditions? There was supposed to be a spiritual quality to human fat that enabled these medicinal qualities, something that wasn’t present in fat from other animals or plants. Yes, they thought some of the dead person’s “vital force” was still there in the harvested fat.

Could there really be any medicinal benefit of human fat? We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Christopher Forth PhD. 2019. Fat: A Cultural History of the Stuff of Life.

How Are You Fixed for Axungia Hominis?

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When the title of any article is written in Latin, you might think that what follows is probably complicated. How about if you knew that Axungia hominis simply means “human fat”? What follows isn’t complicated but it sure is surprising—at least it was to me. I read an excerpt from a forthcoming book I’m adding to my reading list; it’s titled Fat: A Cultural History of the Stuff of Life by Christopher Forth PhD. It explores human fatness over the ages.

For the Memos this week, I’m going to focus on human fat from a different perspective: medicinal qualities. Medicinal qualities? Yes. That was the belief from the 16th century through the middle of the 19th century according to Forth.

The first question has to be: how did they collect human fat to use as medicine? From corpses, of course. An entire industry was developed to collect human fat, and getting it from the recently deceased was a logical source. Battlefields also provided many recently deceased corpses from which to collect fat. What surprised me was the entrepreneurial spirit of the executioners during those times; they were compensated for the hangings or beheadings and then sold the fat that was harvested from the bodies.

That’s enough gross stuff for today. What exactly made the fat so valuable? What was it supposed to be able to do? I’ll cover that on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Christopher Forth PhD. 2019. Fat: A Cultural History of the Stuff of Life.

Will Bitter Orange Help You Burn More Fat?

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When it comes to weight loss and exercise, we’re always looking for an edge such as burning more fat at rest or during exercise. Bitter orange is an herb that contains p-synephrine, a reputed booster of fat metabolism while you’re at rest. A small study tested p-synephrine, caffeine, and both together to see the effects during exercise when compared with a placebo; the researchers wanted to find which was more effective in increasing fat metabolism during exercise.

The researchers used 13 young, healthy volunteers for the experiment. They tested each of the subjects on four separate days with three to five days between tests. In random order, subjects were tested taking a placebo, three mg/kg body weight caffeine, three mg/kg body weight p-synephrine, and three mg/kg body weight of a combination caffeine and p-synephrine.

They found that caffeine raised systolic BP by eight mm Hg and diastolic mm Hg at rest; statistically different but nothing extraordinary. During the exercise phase, subjects began at 40% of max capacity and increased effort by 10% every three minutes until they reached 90% of capacity Caffeine raised fat use during exercise more than p-synephrine or the combination of caffeine and p-synephrine. Overall energy use and carbohydrate metabolism did not change.

What does that mean for us? It could mean that a strong cup of coffee or an energy drink would help us burn more fat during exercise better than some exotic plant. Why waste money buying an herbal product with long-standing safety concerns?

What we don’t know is whether that effect would remain after the body adapted to the caffeine intake. Here’s what does work: training your body to use fat as a fuel at rest and during exercise. That’s what the Optimal Performance program is all about. Check it out.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE 2018. 50(9):1899-1906.

The Bottom Line on Veggies and Carbs

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Go ahead and finish your oatmeal and drink your protein-kale smoothie—you do need those veggies. Meanwhile I’ll put the PURE study in perspective.

This is a large study that looks at the economics of food as well as the health benefits. In a separate publication, the analysis of the data focused on the cost of fruit and vegetable intake as a percentage of monthly income. They specifically collected data from low-, middle-, and high-income communities from 18 different countries. Researchers actually went to grocery markets in those countries to collect the cost data. As you might expect, the lower the income, the higher the percentage of monthly revenue spent on vegetables and fruits.

I think that explains part of the reason the second study on vegetable intake and mortality said there was no additional benefit beyond three or four servings per day: if people can’t afford more, it’s wrong to teach them that more is better if it might not be. But that doesn’t justify the headlines because the message that Americans hear is “I don’t have to eat those darn vegetables!”

Yes, you do. Here are the issues with each of the studies.

 

Do Carbs Kill?

In the first study on carbohydrate intake and mortality, researchers used a simple percentage of caloric intake in their analysis. Basically we have a math problem: if someone in a poor country eats 80% of their diet as carbohydrates from root vegetables but they only get 1,000 calories per day that’s a completely different situation from a person who eats 3,000 calories per day but 50% of their calories are from refined carbohydrates and sugars.

As I’ve said many times, while we should eat fewer refined carbohydrates, carbohydrates are not inherently bad; it is the overconsumption that’s the problem. If researchers didn’t analyze the total caloric intake from carbohydrates, protein, and fats, we don’t have the complete answer. The PURE study used a food frequency questionnaire. I’ll leave it at that because I rant too much about the FFQs.

Finally, the researchers simply jumped the gun by recommending that health education should now focus on increasing fat intake while reducing carbohydrates. All types of vegetables and fruits are carbohydrates. Because researchers did not parse out different sources of carbohydrates in their analysis, their recommendations are meaningless.

 

Don’t Bother with More Veggies?

PURE is an observational study; it cannot determine cause and effect. Also it can tell you a lot about a large group of people but nothing about an individual.

The lead researcher actually provided the perspective on vegetables and fruit during an interview: if the research shows that the benefit of eating more plant-based food is a 20% reduction in mortality, and the mortality rate of the population is just 1%, that means the reduction goes from 10 out of 1,000 to 8 out of 1,000. It’s virtually meaningless to an individual.

The researchers hesitated to tell people with very low incomes to spend more on additional servings of plant-based food if there was not a meaningful benefit. But for most of you, the cost of fruit and vegetables is not a hardship, so buy ’em and eat ’em.

 

The Bottom Line

These will not be the last headlines we hear from the PURE study because the data continues to be analyzed. One issue for me is that there’s no data from the U.S. included so the ability to generalize to the U.S. population is very limited. We lead the world in obesity and overweight and our food consumption patterns are different even from other Westernized countries.

One thing remains clear to me: we should all eat more vegetables and fruit and reduce refined carbohydrates. The recommendation never changes: eat less, eat better, move more.

What are you prepared to do today?

Dr. Chet

Reminder to Insiders: The next Insider Conference Call will be Tuesday at 9 p.m. Not an Insider? Join now to participate in this call and get your questions answered.

 

References:
1. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32252-3.
2. DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8.

 

PURE Headline 2: Don’t Bother with More Veggies?

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Using the same data base of subjects in the PURE Study, researchers examined the vegetable, fruit, and legume intake on total mortality, mortality, and major cardiac events such as heart attacks.

The most important finding was that higher vegetable, fruit, and legume intake was associated with a reduced risk of mortality and morbidity. Simply put, the more plant-based the diet, the better off you are from an overall health perspective.

But that’s not what the headline messages said. They focused on the part of the study that said there appeared to be no additional benefits if subjects ate more than a few servings of vegetables, fruits, and legumes. That seems to fly in the face of the “more is better” results that previous research has shown.

Have all the prior studies been wrong? Have you been eating kale for no good reason? No, and I’ll explain why the headlines are wrong on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: DOI: http://dx.doi.org/10.1016/S0140-6736(17)32253-5.

 

PURE Headline 1: Do Carbs Kill?

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Never a dull moment when it comes to health news: now they’re asking if you should choose fat rather than carbs.

The research study was called PURE: Prospective Urban Rural Epidemiology, and you’ll be hearing more about it. Over 150,000 people from five continents, 18 countries, and 613 different communities were included in the study. Researchers collected data on demographics, smoking habits, and health questionnaires including a semi-quantitative food frequency questionnaire (FFQ).

In the first paper, researchers examined the relationship between macronutrient intake, specifically fats and carbohydrates, and total mortality including cardiovascular events. Higher fat intake was associated with a decreased risk of total mortality while high carbohydrate intake was associated with a higher risk of mortality. There was no specific relationship between either macronutrient and heart disease.

Should you put down that rice? How about the bread? What about that cabbage and broccoli? Before you decide, let’s check out the second headline grabber on Thursday.

What are you prepared to do today?

Dr. Chet

Insider Update: The next Conference Call will be next Tuesday September 25 at 9 p.m. If you’re not an Insider yet, join now to participate in this information-packed call and get your questions answered.

 

Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8