Tag Archive for: obesity

Does Exercise Intensity Affect Obesity?

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As I wrote on Thursday, exercise intensity did not seem to impact mortality, or death rate, in a large group of older women. Of course, living longer is important to many people. Could exercise intensity provide benefits as it relates to reducing the staggering 40% rate of obesity in the U.S.? Maybe. Let’s look at a recent study from Taiwan.

The Taiwan Biobank Study is a longitudinal study that recruits Han Chinese subjects 30 to 70 years old. Much like the All of Us study, researchers take anthropometric data such as height and weight as well as blood samples for multiple DNA analyses. They also collected data on physical activity; their objective for this part of the study was to see if exercise and the intensity of exercise impacted genetic manifestations of obesity.

Genes and Obesity 

What manifestations? Body mass index, percent body fat, and waist circumference among others. Researchers asked the subjects what type of exercise they did, how long they exercised, and how many times per month they exercised. Then they calculated a BMI Genetic Risk Score (BMIGRS) based on the genetic markers for five obesity-related gene combinations. This was complicated; you know I like to see raw data, but with over 16,000 subjects and all of the compounding variables, that’s not realistic.

When they divided the subjects into quartiles based on BMIGRS, they found that the exercise with the greatest impact on the obesity-related genes was jogging. That was followed closely by mountain climbing, walking, exercise walking, international standard dancing (the kind of ballroom dance you learn at a studio or see on Dancing With the Stars), and a longer practice of yoga. Those activities had an impact on the expression of the genes related to obesity. It means that it down-regulated those genes, which means that if you jog, your BMI is lower, you have a lower percent body fat, and your waist circumference will be smaller.

Do you have to jog? No. All the listed exercises had an impact on the obesity genes so if you can’t jog, that’s fine. Extended yoga and dance were also on that list, and they don’t have the impact on joints that jogging or even mountain walking would have.

There were also some other interesting findings. Joggers exercised less time, about 30 minutes, and fewer days per month, about every other day. Walkers walked nearly an hour at a time and walked two out of three days.

The Bottom Line      

One thing was clear: every type of exercise was better than no exercise. I’ve said many times before that exercise by itself is not a great way to lose weight because you have to invest so much time in it to have an impact, and no matter what exercise you choose, you still have to eat less. But if you want an advantage that will impact any obesity genes you have, higher intensity exercise is better. You have to adjust for orthopedic and any other issues, but the more intense the exercise, the better the results. If you’re going to walk 10,000 steps per day, walk them like you mean it.

What are you prepared to do today?

        Dr. Chet

 PLOS Genetics | https://doi.org/10.1371/journal.pgen.1008277.

Nutrition Education: The Best Solution

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The scientific paper about nutrition education programs from South America was an opinion piece derived from a student’s dissertation defense. It addressed nutrition labels in Brazil: the labels were too focused on the caloric content instead of the ingredient information.

The paper gives an example of two foods that have 97 calories but are vastly different in nutritional value. Chewy fruit-flavored candy had 21 grams of carbs, no protein, 1.5 grams of saturated fat, and no fiber; 14 almonds had 3.6 grams of carbohydrate, 3.5 grams of protein, 8.4 grams of healthy fat, and 2.1 grams of fiber. The almonds also had several vitamins and minerals while the chewy fruit candy had none.

The question is whether labels alone can change the nutritional health of a nation. Hard to say. Brazil came up with a simple public health approach using three recommendations:

  1. Choose whole, minimally processed foods
  2. Cook those foods yourself
  3. Eat those foods with other people

I think that’s an excellent approach. It means that people may have to shop a little more often and spend more time preparing food. But when you consider travel to get take-out or fast food, or the expense of food delivery, we can get better and fresher quality foods with fewer preservatives and more nutrition for around the same price.

Eating those foods with other people, at a minimum, means that families eat at least one meal together daily, possibly two if we include breakfast. The other possibility is to invite neighbors, friends, or other family members. We don’t have to fix feasts; just fresh, healthier foods that are simple to cook and share.

The Bottom Line

I think the Brazilian approach could work in the U.S. If we were to use the public health nutrition education program from WWII with an emphasis on the benefits of the foods for our health along with videos people could use to prepare the foods simply, and even scale that down to individual communities where small groups could learn how to shop and cook, we can change the health of the nation.

I also think it begins with parents: they’ll have to lead the way if they expect children to eat better. When we visited Paula’s cousin, who has three children under two (a toddler girl and identical twin baby boys), we remarked at the variety of food their daughter was willing to eat. Her dad said that she may be the only kid in preschool asking, “Excuse me, where is the hummus?” It may mean that parents will have to learn more about healthier foods and how to prepare them. I think it’s a small price to pay to improve their kids’ potential for better health.

What are you prepared to do today?

        Dr. Chet

Reference: Adv. Nutr. 2019;10:549–556.

Improving Nutrition in South America

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One of the problems today with public nutrition education programs is that there’s an important element that would prefer it not be done. In fact, food manufacturers are doing all they can to avoid any approach that may impact sales of high-fat, high-sodium, high-sugar, and highly processed food. I get it—they want to sell as much as they can. But to suggest that ketchup is a vegetable in the school lunch program doesn’t make any sense. I’m not going to comment further because that could take a month of Memos.

Instead let’s look at what some countries in South America have done to address nutrition as their obesity and related disease rates rise. One of the most controversial steps was taken by Mexico: the government put a 10% tax on high-sugar drinks, snacks, and sugary cereals that have limited nutritional benefit compared to total calories. It was not easy because the people of Mexico, much like the U.S., are against paying any more in taxes. But as of 2019, consumption of sugary sodas has dropped 12% in the poorest segment of the population and 5% in more affluent segments.

One of the most innovative approaches is used in Chile: foods high in added sugar, saturated fats, sodium, and high in calories have to place black stop signs on the front of package labels, and those foods can’t be sold or promoted in schools or promoted on television. Children have been educated about the meaning of the label changes and are steering their parents away from foods with black stop signs on the labels.

These radical approaches had to fight the food industry all the way, but the good of the people outweighed the profits of the industry. There may be a better way yet, and that’s what I’ll talk about Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.washingtonpost.com/business/2019/07/16/latin-americas-war-obesity-could-be-model-us/

How Can We Improve Nutrition and Public Health?

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I recently read a couple of articles, one from a newspaper and another from a journal, that talked about South American countries and how their governments should deal with the obesity epidemic and how some are approaching this issue. There may be lessons we can use here for us in the U.S. and other parts of the world.

Some historical perspective: the last public health initiative that actually worked well in the U.S. was during WWII. To direct more meat to the people fighting the war, the government enlisted any and all means to convince the public that organ meats were actually delicacies. Instead of a simple call to support the war movement, the pitch was to help consumers understand how organ meats such as brains, intestines, liver, and kidneys were nutritious. Along with that, they provided recipes for how to prepare these special parts of cows and pigs. It worked and those cuts were really considered delicacies. After the war ended, the special nature of these parts gradually drifted away.

In my opinion, that was the most successful public health education program ever done. When you consider all that’s been done related to educating the public about cholesterol, fat, trans fat, and sugar, nothing has ever gotten people to change their habits; the nutrition facts label is often more confusing that helpful. It’s obvious we need help, but what and how? We’ll take a look at what these countries in South America have tried on Thursday.

What are you prepared to do today?

        Dr. Chet

Sugar vs. Sweetener Research: Meaningless in the Real World

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I’m in a slight disadvantage in evaluating this study; I was able to read only the convention-session abstract and the press release. There were no recordings of the presentation that I could find, so there are details I don’t know. I have questions about the process, not the results, so here are my thoughts.

The In-Vitro Study

If you’re not familiar with the lingo, time to learn. In vitro is Latin, meaning literally “in glass.” An in-vitro study is conducted in a Petri dish, a test tube, or some location outside of an entire animal or human.

In this study, researchers exposed endothelial cells from the rats’ arteries to sugars and artificial sweeteners. We know there were changes in proteins; what we didn’t know is whether the change in protein genes that were activated in response to the artificial sweeteners mimicked a pattern we might see in a rat that’s diabetic. That’s an important question.

It would have been more meaningful if they examined a pattern of protein responses that occurred in the endothelial cells of rodents that already had diabetes. Just because something is activated in response to a stimulus, in this case sugars or artificial sweeteners, that doesn’t necessarily mean it’s a bad thing. It just means it happened.

The In-Vivo Study

In vivo is also Latin and means within a live animal or human. I have several issues with the rodent part of the study. First they gave high levels of sugar to the rats as well as high levels of artificial sweeteners. It would seem to me that it would be beneficial to get an estimate of what humans actually consume on a daily basis, dose it down to the appropriate amount for a rat, and start with that. Then you can compare your test results to a “normal” level. Next you can begin increasing the amount to see when the negative effects begin.

Second they used the DR/BB rat; DR stands for diabetes resistant and BB stands for biobreeding. This type of rodent is often used for research on type 1 diabetes because although it’s diabetes resistant, it has an underdeveloped immune system. It will respond to environmental insults differently than normal rats. Excess levels of sugar and artificial sweeteners may create an insult to the immune system to cause type 1 diabetes in this breed of rat.

The reason for doing the study was to see if artificial sweeteners may be contributing to the obesity and diabetes epidemic—type 2 diabetes, not type 1. Using this breed of rat seems like it would muddy the results. The changes they found in the blood of these rats fed excessive amounts sugar and artificial sweeteners would have been expected. The question is whether this is related directly to the research hypothesis or not. In my opinion, no.

To make this study pertinent to humans, we would need a similar pattern found in humans. Perhaps people under excessive stress and whose immune systems were compromised might show some relationship. But we’re not talking about susceptibility to type 1 diabetes. We’re talking about type 2 diabetes, and although they share a name, they’re vastly different diseases.

What we have is a study in test tubes on protein genes that are activated in response to artificial sweeteners and a second study on rodents with some dysfunction in over 200 different protein genes in response to sugar and artificial sweeteners. We may have people who use excessive amounts of artificial sweeteners everyday. We may have specific but as yet unknown gene patterns that may make people more susceptible to type 2 diabetes, but we haven’t identified what those genetic patterns are at this point or even if they exist at all.

The Bottom Line

So what does this study mean? This basic research shows that there may be a pattern to protein synthesis that’s different in high-sugar versus artificial-sweetener intake. But that does not resemble in any way what the authors of the study suggested in the press release. This study is relatively meaningless in the real world. Maybe we’ll know more about how all this impacts humans in another 5–10 maybe even 20 years. But as of today, it’s just provocative headlines. And we get far too many of those already.

Use artificial sweeteners or do not; that’s your choice. But don’t change based on this study. Use the old adage: everything in moderation including moderation.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

What They Got Right in the Sugar and Artificial Sweetener Research

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Whether it’s a new form of treatment, a new medication, or even examining a phytonutrient for potential benefits, it all starts with basic research. That’s what the study I began talking about Tuesday is all about: basic research. I like it because this is the way all research has to begin. This is where test-tube studies are appropriate.

In this case they used epithelial cells from the vascular system of the rodents, exposed them to high amounts of sugars and artificial sweeteners, and then looked at specific changes in proteins that are involved in various types of cell action. In other words, they were looking for dysfunction in the way the genes for the proteins responded after exposure to the sugars and artificial sweeteners.

Were there differences? Yes. The important thing that they discovered was that the proteins inside these epithelial cells responded differently when exposed to sugar than when exposed to artificial sweeteners.

The question is this: was any of this meaningful in the real world? I’ll let you know what I think on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

Artificial Sweeteners, Obesity, and Diabetes

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Last week, you may have seen headlines that said something like “Artificial Sweeteners May Cause Obesity and Type 2 Diabetes!” Just about every news organization picked up a press release from the Experimental Biology meeting. In the press release, researchers gave some of the results of a paper that was presented at a scientific session, including comments by the lead author, Dr. Brian R. Hoffman.

The purpose for doing the study, he said, was because of the epidemic of obesity and diabetes in the U.S. While there’s little question that excessive sugar intake, combined with excess calories over years, does contribute to obesity and type 2 diabetes, no one has really examined the role artificial sweeteners may play.

In these studies, he and his research team examined the effect of high levels of sugars, aspartame, and acesulfame potassium on epithelial cells taken from rodents in a test-tube study. Then using another group of rodents, they overfed them sugars and the same artificial sweeteners for three weeks. The objective was to see what changes occurred in proteins and metabolites that were produced in cardiovascular epithelial cells in the test-tube study and the blood of the rodents.

They found that there were modifications in proteins under both conditions, which may have led to changes in the products they produced. But is this meaningful research or not? I’ll tell you what I liked about the study in Thursday’s memo.

What are you prepared to do today?

Dr. Chet

 

Reference: EB 2018. The Influence of Sugar and Artificial Sweeteners on Vascular Health during the Onset and Progression of Diabetes Board # / Pub #: A322 603.20.

 

Does a Little Extra Weight Keep You Alive?

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The Rotterdam Study was begun in 1991 to investigate the risk factors of cardiovascular, neurological, ophthalmological, and endocrine diseases in people 55 and older (1). The study is still ongoing, but periodically subsets of subjects are examined to find out which characteristics are associated with these diseases. In a study published in 2001, researchers reported on a group of subjects who were diagnosed with heart failure at the beginning of the study and followed for an average of six years—181 out of over 5,000 subjects. By the end of five years, 85 subjects had died. One of the observations that researchers noted was that a higher BMI was associated with reduced mortality; in plain terms, the heavier people were more likely to stay alive.

It didn’t stop there. In 2013, a study was published that directly examined the relationship between BMI and mortality (2). This meta-analysis included 97 studies and examined more than 2.88 million participants and more than 270,000 deaths. They reported that while grades 2 and 3 obesity (grade 2: BMI of 35-39.9; grade 3: BMI more than 40) were associated with increased mortality, grade 1 (BMI of 30-34.9) was not, and the overweight category (BMI of 25-29.9) actually showed a reduced risk of dying. (How do you rate? Check your BMI here.)

Is this true? Is body weight not associated with an increased risk of death? Have we been trying to lose weight for no reason? I’ll finish this on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. European Heart Journal (2001) 22, 1318–1327.
2. JAMA. 2013 January 2; 309(1): 71–82.

 

What Is the Obesity Paradox?

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Did you ever hear something that didn’t seem to make sense? That seemed to go against everything you thought to be true? One example of this is something called “The Obesity Paradox.” I’ve seen a few headlines this week that have talked about it, so it’s time to address it in the Memo.

One of the variables that we would think is related to the development of cardiovascular disease would be body weight. It seems logical: as weight increases, so does the strain on pumping the blood through the additional blood vessels required to feed the extra fat and muscle. People who are overweight may eat the wrong foods, consume too much food, and move too little.

But since the early 2000s, several studies have been published seeming to show that body weight wasn’t necessarily a risk factor for CVD or an early death. They showed that those who were overweight, a BMI between 25.0 and 29.9, had lower mortality rates than those who were normal weight. Some showed that stage-one obesity, a BMI between 30.0 and 34.9, was also not related to mortality. Thus the term “The Obesity Paradox” was coined. But is it true? We’ll take a look at the research the rest of the week.

What are you prepared to do today?

Dr. Chet

 

A New Commitment

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The numbers are in and the U.S. is fatter than ever: 39.6% of all adults over 20 years old are obese based on the Body Mass Index. That’s a rise of close to 2% since 2015, the last time the statistics were released. This isn’t affecting only adults; children 2–19 are also fatter than ever with 18.5% now considered obese. If we throw in those who are overweight, more than 70% of the population is fatter than ever.

I could review the causes, from refined carbohydrates to chemicals with estrogenic properties. I could talk about all the diets that could help. I could talk about supplements that may help to give people an edge. I’ve done that all before. There’s no single diet nor exercise program nor supplement that works for everyone. We all just have to find our own way. Instead, I’m going to tell you a story and issue you a challenge.

One of my best friends for the past 30 years, Dick Heller, died last week; he’d fought off cancer several times, but it finally got him just before his 80th birthday.

Dick and I were professors together in Buffalo. He was an excellent swimming coach and a competitive swimmer throughout his life. He was also a great teacher, especially when it came to helping people change their habits; he would help people identify what they wanted to achieve in the health and fitness classes he taught, have them write it down, develop a plan, and track the progress. Their grade was not based on how they compared to others; it was based on the goals they set.

To honor Dick, Paula and I are going to use that approach as we continue to improve our diet. Getting enough vegetables is a particular problem so we’re going to add at least one serving per day, every day, until it becomes a new habit.

Here’s my challenge to you. Pick one small health habit you want to improve, write it down, and start doing it every day until it becomes a new habit. Whatever small habit, if done repeatedly, that will help you achieve your goal. It may be related to your weight because, like I said, 70% of us are overweight or obese. It may be a different health goal. If people you know have died because of a health challenge, do it to honor them.

Identify. Write it down. Plan. Execute. Evaluate. I can’t think of a better tribute to Dick than that.

What are you prepared to do today?

Dr. Chet

 

Reference: https://www.cdc.gov/nchs/products/databriefs/db288.htm.